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This paper explores the impact of emerging artists serving as opening acts on larger tours, and how this exposure affects streaming metrics and audience growth. As the live music industry rebounded in 2023 and 2024, many smaller artists sought to benefit from this increased demand by opening for established acts. The study utilizes data from Pollstar, Songkick, and Chartmetric to analyze monthly listenership patterns before and after tours, tracking streaming metrics for 57 opening artists. Consumer and artist surveys offer further insights into the perceived value of these opportunities. Results suggest that while opening for major acts can lead to an immediate increase in streaming numbers, this often does not translate into long-term audience retention. Developing artists saw significant spikes in streams during tours, followed by a sharp decline post-tour, while more established acts showed more stable engagement. Consumer surveys reveal that while audiences may not buy tickets specifically to see openers, they often discover new music during these performances, with many continuing to follow opening artists after the tour. These findings highlight the complex dynamics of touring as a growth strategy for emerging artists in a competitive live music market. [ABSTRACT FROM AUTHOR]

To establish reference standards for ocular ultrasound and biometry, 24 cinereous vultures (Aegypius monachus) (45 eyes) underwent B-mode and A-mode ultrasonographic examination using a 12.5-MHz probe. The vultures were manually restrained without sedation, and the eyes were topically anesthetized. Biometry was performed in the sagittal plane for axial length of the globe (AGL), anterior chamber depth (ACD), lens thickness (LT), and vitreous chamber depth (VCD). Biometry of the pecten oculi (LP) was measured on images of transversal scan at 9 hours. Biometric findings were as follows: AGL=27.74 6 0.77 mm, ACD=3.73 6 0.62 mm, LT=5.41 6 0.18 mm, VCD=18.60 6 0.58 mm, and LP=10.21 6 1.19 mm. No correlation was found between body weight and AGL. Right and left globe sizes were not significantly different, but AGL and VCD were significantly longer (P, .05) in male than in female vultures. Including diagnostic protocols such as ocular ultrasound may improve the ophthalmologic care of endangered raptors injured by blunt trauma, when opacities of the ocular media prevent examination of the internal ocular structures. [ABSTRACT FROM AUTHOR]

Since the end of 2016 experiments were performed on FTU with a tin limiter, for testing liquid metals under reactor relevant thermal load up to 17 MW/m2 in nearly stationary conditions. FTU is the first tokamak in the world operating with a liquid tin limiter and one of the pioneers in liquid metal application. The preliminary analysis of the experimental data has been focused in detecting the presence of tin in the discharge: suitable monitors are the spectroscopic diagnostics in the visible and UV ranges. The experimental observation of the tin spectral lines represents a new goal for extending the database of atomic nuclear data in the plasma tokamak research. In particular, 607.8 and 645.3 nm spectral lines of SnII have been observed. In addition, all the expected spectral lines in VUV range have been detected, 20.4 nm of SnXXI and 21.9 nm and 27.6 nm of SnXXII. [ABSTRACT FROM AUTHOR]

Since 2006, experiments using a liquid lithium limiter (LLL) were successfully performed on FTU, pointing out the problem of the quantity of lithium in the plasma, especially in conditions of strong evaporation due to the high temperature of limiter surface. In order to avoid the strong evaporation it is necessary to control the temperature by removing the heat from the limiter during the plasma exposure. To explore this issue a new actively cooled lithium limiter (CLL) has been installed and tested in FTU. Suitable monitors to detect the presence of lithium in the plasma are the spectroscopic diagnostics in the visible range that permit to measure the flux of lithium, coming from the limiter surface, through the brightness of the LiI spectral lines. For this aim an Optical Multichannel Analyser (OMA) spectrometer and a single wavelength impurities monitor have been used. The analysis of the Li influx signals has permitted to monitor the effects of interaction between the plasma and the limiter connected to the thermal load. Particular attention has been paid on the possible occurrence of sudden rise of the signals, which is an index of a strong interaction that could lead to a disruption. On the other hand, the appearance of significant signals gives useful indication if the interaction with the plasma has taken place. [ABSTRACT FROM AUTHOR]

Adversarial samples mostly aim at fooling machine learning (ML) models. They often involve minor pixel-based perturbations that are imperceptible to human observers. In this work, adversarial samples should fool both humans and ML models, which is important in two-stage decision processes. We perform changes on a higher abstraction level so that a target sample exhibits properties of a desired sample. Technically, we contribute by deriving a regularization scheme for autoencoders incorporating a classifier loss for smoothly interpolating between wildly different samples. The realism and effectiveness of generated samples are confirmed with a user study and other evaluations. Our experiments consider neural networks of four architectures, assessed on MNIST, FashionMNIST, QuickDraw and CIFAR-10. Results show that our scheme leads to superior performance compared to existing interpolation techniques: on average, other methods have an 11% higher failure rate when producing a sample that is of any of two interpolated classes. Furthermore, our attacks work in both white- and black-box settings. [ABSTRACT FROM AUTHOR]

Thanks to the inherent redundancy to generate the different output voltage levels, the multilevel active-clamped (MAC) topology presents an important fault-tolerance ability which makes it interesting for several applications. This paper presents an analysis of the fault-tolerance capacity of the MAC converter. Both open-circuit and short-circuit faults are considered, and the analysis is carried out under single-device and two simultaneous device faults. Switching strategies and different hardware modifications to overcome the limitations caused by faults are proposed. Experimental tests with a four-level MAC prototype are presented to validate the analysis. [ABSTRACT FROM PUBLISHER]

FTU plasma discharges with an extremely high amount of Li injection have been performed using a poloidal liquid lithium limiter acting as the principal Li source in the shadow of the main TZN toroidal limiter. Very peculiar of these discharges is the formation of a 'virtual' toroidal lithium limiter that redistributes the energy flux to the tokamak vessel first wall by radiative processes and therefore decreases the heat load onto the Mo limiter. These experiments contribute to the investigation of a more complex scenario that will possibly be faced by a project of a liquid lithium divertor in a tokamak with high additional power (or high power load on to the targets). [ABSTRACT FROM AUTHOR]

This paper presents a novel multilevel active-clamped converter topology, which is an extension to m levels of the three-level active neutral-point-clamped topology. The operating principle is established through the definition of a proper set of switching states and a transition strategy between adjacent switching states. The benefits of the proposed converter topology and control in comparison to alternative multilevel converter topologies are discussed. The simulation and experimental results of a simple four-level dc–dc converter configuration are presented to illustrate the converter performance features. The experimental results of a four-level three-phase dc–ac converter are also presented to further validate the proposed topology and operating principle. [ABSTRACT FROM AUTHOR]

Abstract: A three-dimensional continuum damage mechanics-based material model was implemented in an implicit Finite Element code to simulate the progressive intralaminar degradation of fibre reinforced laminates based on ply failure mechanisms. This paper presents some structural applications of the progressive failure model implemented. The focus is on the non-linear response of the shear failure mode and its interaction with other failure modes. Structural applications of the damage model show that the proposed model is able to reproduce failure loads and patterns observed experimentally. [Copyright &y& Elsevier]

Abstract: This paper presents a three-dimensional continuum damage mechanics-based material model which was implemented in an implicit finite element code to simulate the progressive intralaminar degradation of fibre reinforced laminates. The damage model is based on ply failure mechanisms and uses seven damage variables assigned to tensile, compressive and shear damage at a ply level. Non-linear behaviour and irreversibility were taken into account and modelled. Some issues on the numerical implementation of the damage model are discussed and solutions proposed. Applications of the methodology are presented in Part II . [Copyright &y& Elsevier]

The residence time distribution in an intermeshing, co-rotating twin-screw extruder was measured in-line and off-line by stimulus–response technique. FD&C Red 40 was used as the tracer for the study. The die concentration was monitored in-line using a fiber-optic- equipped vis-near Infrared spectrometer while the color concentration in the off-line samples was measured using a charge coupled device (CCD) spectrometer. The in-line results correlated well with the off-line method. The effect of feed rate, water content and temperature on the residence time distribution were precisely determined and fit by the tanks in series (TIS) model. [Copyright &y& Elsevier]

l-Cystine is the natural least soluble of the naturally occurring amino acids. Its solubility is a function of the hydrogen ion concentration depending on its protonation. This paper presents an investigation on properties of l-cystine in a constant ionic medium of NaCl at different concentrations (3.00, 2.00, 1.00, 0.500, 0.150 mol dm−3) and at 25 °C. In such experimental conditions, solubility and its changes as a function of hydrogen ion concentration were determined. Protonation of cystine was studied in acid and basic solution, by measuring the electromotive force of galvanic cell involving a glass electrode. Four protonation constants for l-cystine were determined in all the selected concentrations of ionic medium. The different values obtained for the constants in ionic medium of different concentration could be explained both with the variation of activity coefficients or with the complex formation between l-cystine and sodium ions. Variations of solubility for different concentration of NaCl were observed as well. [Copyright &y& Elsevier]

Axillary nerve injuries are some of the most common peripheral nerve injuries in athletes who participate in contact sports. Resulting deltoid muscle paralysis is secondary to nerve trauma which occurs following shoulder dislocation or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in quadrilateral space syndrome as the axillary nerve exits this anatomic compartment. The axillary nerve is also extremely vulnerable during any operative procedure involving the inferior aspect of the shoulder, and iatrogenic injury to the axillary nerve remains a serious complication of shoulder surgery. Accurate diagnosis of axillary nerve injury is based on a careful history and physical examination as well as an understanding of the anatomy of the shoulder and the axillary nerve in particular. Inspection, palpation and neurological testing provide the bases for diagnosis. A clinically suspected axillary nerve injury should be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. During the acute phase of injury, the athlete should be rested and any ligamentous or bony injury should be treated as indicated. Patients should undergo an extensive rehabilitation programme emphasising active and passive range of motion as well as strengthening of the rotator cuff, deltoid and periscapular musculature. Shoulder joint contracture should be avoided at all costs as a loss of shoulder mobility may ultimately affect functional outcome despite a return of axillary nerve function. If no axillary nerve recovery is observed by 3 to 4 months following injury, surgical exploration is indicated. Athletes who sustain injury to the axillary nerve have a variable prognosis for nerve recovery, although the return of function of the involved shoulder is typically good to excellent. We recommend that athletes who sustain axillary nerve injury may return to contact sport participation when they achieve full active range of motion of the shoulder and when shoulder strength is documented to be good to excellent by isometric or manual muscle testing. [ABSTRACT FROM AUTHOR]

Background: Transesophageal echocardiographic imaging plays an important role in assessing coronary sinus anatomy prior to placement of a retrograde cardioplegia cannula. The coronary sinus can be imaged in the long axis by advancing the TEE probe from the mid-esophageal 4-chamber view or using a modified mid-esophageal bicaval view, while a short axis view can be obtained in the mid-esophageal 2-chamber view. While use of a transgastric view is only briefly mentioned in the literature as an alternative to mid-esophageal views, the authors commonly include it in our comprehensive transesophageal echocardiographic exam of the coronary sinus. This study examines the various imaging strategies. We hypothesize that the transgastric view offers comparable coronary sinus imaging to the mid-esophageal views. Methods: After approval by our institutional review board, the intraoperative transesophageal echocardiographic exams for 50 consecutive elective cardiac surgical patients with a comprehensive echocardiographic assessment of the coronary sinus were retrospectively reviewed and analyzed to evaluate imaging of the coronary sinus in the various views. For each view, we noted and recorded if the coronary sinus and coronary sinus cannula were visualized. Statistical analysis required pairwise comparisons between each of the 4 views. P values were calculated using McNemar's Exact test. Results: Both the coronary sinus and coronary sinus cannula were visualized a majority of the time for each view. There was no statistically significant difference between each view in its ability to visualize the coronary sinus, nor was there a statistically significant difference between each view in its ability to visualize the coronary sinus cannula. Conclusions: Use of a transgastric window provides the echocardiographer with an effective alternate modality for imaging the coronary sinus when mid-esophageal views are limited. [ABSTRACT FROM AUTHOR]

Adversarial attacks represent a critical issue that prevents the reliable integration of machine learning methods into cyber defense systems. Past work has shown that even proficient detectors are highly affected just by small perturbations to malicious samples, and that existing countermeasures are immature. We address this problem by presenting AppCon, an original approach to harden intrusion detectors against adversarial evasion attacks. Our proposal leverages the integration of ensemble learning to realistic network environments, by combining layers of detectors devoted to monitor the behavior of the applications employed by the organization. Our proposal is validated through extensive experiments performed in heterogeneous network settings simulating botnet detection scenarios, and consider detectors based on distinct machine- and deep-learning algorithms. The results demonstrate the effectiveness of AppCon in mitigating the dangerous threat of adversarial attacks in over 75% of the considered evasion attempts, while not being affected by the limitations of existing countermeasures, such as performance degradation in non-adversarial settings. For these reasons, our proposal represents a valuable contribution to the development of more secure cyber defense platforms. [ABSTRACT FROM AUTHOR]

This paper proposes a closed-loop control implementation fully-embedded into an FPGA for a permanent-magnet synchronous motor (PMSM) drive based on a four-level active-clamped converter. The proposed FPGA controller comprises a field-oriented control to drive the PMSM, a DC-link voltage balancing closed-loop control (VBC), and a virtual-vector-based modulator for a four-level active-clamped converter. The VBC and the modulator operate in consonance to preserve the DC-link capacitor voltages balanced. The FPGA design methodology is carefully described and the main aspects to achieve an optimal FPGA implementation using low resources are discussed. Experimental results under different operating conditions are presented to demonstrate the good performance and the feasibility of the proposed controller for motor-drive applications. [ABSTRACT FROM AUTHOR]

Objective: Recent studies have uncovered diverse cell types and states in the rheumatoid arthritis (RA) synovium; however, limited data exist correlating these findings with patient‐level clinical information. Using the largest cohort to date with clinical and multicell data, we determined associations between RA clinical factors with cell types and states in the RA synovium. Methods: The Accelerated Medicines Partnership Rheumatoid Arthritis study recruited patients with active RA who were not receiving disease‐modifying antirheumatic drugs (DMARDs) or who had an inadequate response to methotrexate (MTX) or tumor necrosis factor inhibitors. RA clinical factors were systematically collected. Biopsies were performed on an inflamed joint, and tissue were disaggregated and processed with a cellular indexing of transcriptomes and epitopes sequencing pipeline from which the following cell type percentages and cell type abundance phenotypes (CTAPs) were derived: endothelial, fibroblast, and myeloid (EFM); fibroblasts; myeloid; T and B cells; T cells and fibroblasts (TF); and T and myeloid cells. Correlations were measured between RA clinical factors, cell type percentage, and CTAPs. Results: We studied 72 patients (mean age 57 years, 75% women, 83% seropositive, mean RA duration 6.6 years, mean Disease Activity Score‐28 C‐reactive Protein 3 [DAS28‐CRP3] score 4.8). Higher DAS28‐CRP3 correlated with a higher T cell percentage (P < 0.01). Those receiving MTX and not a biologic DMARD (bDMARD) had a higher percentage of B cells versus those receiving no DMARDs (P < 0.01). Most of those receiving bDMARDs were categorized as EFM (57%), whereas none were TF. No significant difference was observed across CTAPs for age, sex, RA disease duration, or DAS28‐CRP3. Conclusion: In this comprehensive screen of clinical factors, we observed differential associations between DMARDs and cell phenotypes, suggesting that RA therapies, more than other clinical factors, may impact cell type/state in the synovium and ultimately influence response to subsequent therapies. [ABSTRACT FROM AUTHOR]

Bolometric diagnostics on fusion devices usually suffer from inadequate performances: moderate S/N ratio, limited time and space resolution, radiation and neutron induced damage (particularly important for the next generation of fusion devices). A new bolometric system in which a blackened foil exposed to the plasma is monitored on its back side by an IR camera is described. It is first demonstrated that the foil preserves, within a given time and space resolution, a linear relation between the incoming plasma radiation and the IR emission. Then the S/N ratio is derived as a function of the various system parameters. Representative values of resolution and S/N are computed for a realistic set of operational conditions. [ABSTRACT FROM AUTHOR]

Background: To address the postoperative outcomes between outpatient and inpatient neck surgery involving thyroidectomy procedures. Methods: A cohort analysis of surgical patients undergoing primary, elective, total thyroidectomy from multiple United States medical institutions who were registered with the American College of Surgeons National Surgical Quality Improvement Program from 2015 to 2018. The primary outcome was a composite score that included any 30-day postoperative adverse event. Results: A total of 55,381 patients who underwent a total thyroidectomy were identified comprising of 14,055 inpatient and 41,326 outpatient procedures. A cohort of 13,496 patients who underwent outpatient surgery were propensity matched for covariates with corresponding number of patients who underwent inpatient thyroidectomies. In the propensity matched cohort, the occurrence of any 30-day after surgery complications were greater in the inpatient group, 424 out of 13,496 (3.1%) compared to the outpatient group, 150 out of 13,496 (1.1%), P < 0.001. Moreover, death rates were greater in the inpatient group, 22 out 13,496 (0.16%) compared to the outpatient group, 2 out of 13,496 (0.01%), P < 0.001. Similarly, hospital readmissions occurred with greater frequency in the inpatient group, 438 out of 13,496 (3.2%) compared to the outpatient group, 310 out of 13,496 (2.3%), P < 0.001. Conclusion: Thyroidectomy procedures performed in the outpatient setting had less rates of adverse events, including serious postoperative complications (e.g., surgical site infection, pneumonia, progressive renal insufficiency). In addition, patients who had thyroidectomy in the outpatient setting had less 30-day readmissions and mortality. Surgeons should recognize the benefits of outpatient thyroidectomy when selecting disposition of patients undergoing neck surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: The wildcats (Felis silvestris) and Iberian lynx (Lynx pardinus) are species of special relevance in the Spanish fauna and are protected, as their populations are small and the lynx is classified as endangered. Both feline species can become infected by Toxoplasma gondii, a parasite that can cause morbidity and mortality in transplacentally infected or immunocompromised mammals. The data on the prevalence of this parasite in Spanish wild populations of wildcats and lynx were last reported 10 years ago, so the objective of this study is to update this information and assess the importance of these felines in the parasite's epidemiology and the potential impact of the parasite on the conservation of these species. Wild populations show a high prevalence, necessitating the establishment of monitoring programs to assess the health status of these animals. The wildcat (Felis silvestris) and the Iberian lynx (Lynx pardinus) are important species in Spain, considered as near-threatened and endangered, respectively. Both can be infected by Toxoplasma gondii, a parasite that can cause morbidity and mortality in transplacentally-infected or immunocompromised mammals. The data on the prevalence of this parasite in wild populations of these species in Spain are outdated. The objective of this study was to update information and evaluate the role of these felines in parasite epidemiology and the potential impact of the parasite on their conservation. Blood and fecal samples were collected from captured animals, as well as the tongue, diaphragm, and spleen, from animals killed in road accidents in central Spain. An indirect fluorescent antibody test (IFAT) was used to detect parasite antibodies in serum, microscopy and molecular analysis were used to detect oocysts in feces, and molecular analysis was used to determine the existence of tissue cysts. Seroprevalence was 85% in wildcats and 45% in lynx, and parasite DNA was detected in the feces of one wildcat and in tissue samples from 10 wildcats and 11 Iberian lynxes. These results highlight the epidemiological importance and high risk of T. gondii infection in animals and humans in the studied areas. Considering feline susceptibility to infection, monitoring programs are needed to assess the health status of wild felines. [ABSTRACT FROM AUTHOR]

Several pulsewidth modulation (PWM) strategies have been proposed for three-phase multilevel converters. Typically, these PWM methods can be either space-vector or carrier-based implemented, where the carrier-based implementation usually presents a lower computation complexity. In this paper, a novel approach for the carrier-based implementation of different existing PWM methods is proposed for three- (3L) and four-level (4L) dc–ac converters, which can be easily extended to any number of levels. The main features of the proposed approach are its reduced computation complexity and computation time. On the other hand, the proposed approach suggests the derivation of novel PWM strategies which can potentially present improved performance features. As an example, two new discontinuous PWM (DPWM) strategies are proposed for the 4L converter. One of these DPWM strategies presents lower weighted total harmonic distortion than other previously proposed strategies. Simulation and experimental results verify the effectiveness of the proposed approach and novel DPWM strategies. [ABSTRACT FROM AUTHOR]

This paper studies the coupling between the capacitor voltage control loops of diode-clamped (or functionally equivalent) multilevel multileg (multiphase) dc–ac converters. From a complete model of the plant revealing the coupling, a simple approach consisting in multiplying the vector of control commands by a constant matrix is proposed to decouple the control problem and achieve a better controller performance. Simulation and experimental results are presented to prove the superior performance of the proposed decoupled control. [ABSTRACT FROM PUBLISHER]

Aiming to improve the performance features of conventional two-level dual-active-bridge (DAB) converters, this paper presents a three-level neutral-point-clamped (NPC) DAB dc–dc converter. A general modulation pattern is initially defined, the dc-link capacitor voltage balancing is analyzed in detail, and a proper balancing control is designed. Then, a set of decoupled optimization problems is formulated as a function of the available modulation degrees of freedom to minimize the predominant converter losses. Finally, a simple and practical specific modulation strategy is provided, resembling the optimum solutions. The good performance of the proposed three-level NPC DAB converter operated with the proposed modulation strategy and voltage balancing control is verified through simulation and experiments. The capacitor voltage balancing can be guaranteed for all operating conditions. In addition, it is concluded that the multilevel topology provides benefits compared with the conventional two-level DAB converter. [ABSTRACT FROM PUBLISHER]

In order to prevent the overheating of the liquid Li surface and the consequent Li evaporation for T > 500 °C, an advanced version of the liquid lithium limiter has been realized and installed on FTU. This new system, named Cooled Lithium Limiter (CLL), has been optimized to demonstrate the lithium limiter capability to sustain thermal loads as high as 10 MW/m 2 with up to 5 s of plasma pulse duration. The CLL operates with an actively cooled system with water circulation at the temperature of about 200 °C, for heating lithium up to the melting point and for the heat removal during the plasma discharges. To characterize CLL during discharges, a fast infrared camera and the spectroscopic signals from Li and D atom emission have been used. The experiments analyzed so far and simulated by ANSYS code, point out that heat loads as high as 2 MW/m 2 for 1.5 s have been withstood without problems. [ABSTRACT FROM AUTHOR]

This paper presents a capacitor voltage balancing control applicable to any multilevel dc–ac converter formed by a single set of series-connected capacitors implementing the dc link and semiconductor devices, such as the diode-clamped topology. The control is defined for any number of dc-link voltage levels and converter legs (for single-phase and multiphase systems), guaranteeing the capacitor voltage control for any modulation index value and load (from idle mode to full power). The associated control loop small-signal transfer function is presented, from which optimum compensator design guidelines are derived. The improvement in control performance is verified through simulation and experiments comparing with a previous balancing control strategy in a four-level three-phase dc–ac conversion system. The satisfactory control performance is also verified through simulation in a four-level five-phase dc–ac conversion system. [ABSTRACT FROM PUBLISHER]

Objective Delayed detection of LN associates with worse outcomes. There are conflicting recommendations regarding a threshold level of proteinuria at which biopsy will likely yield actionable management. This study addressed the association of urine protein:creatinine ratios (UPCR) with clinical characteristics and investigated the incidence of proliferative and membranous histology in patients with a UPCR between 0.5 and 1. Methods A total of 275 SLE patients (113 first biopsy, 162 repeat) were enrolled in the multicentre multi-ethnic/racial Accelerating Medicines Partnership across 15 US sites at the time of a clinically indicated renal biopsy. Patients were followed for 1 year. Results At biopsy, 54 patients had UPCR <1 and 221 had UPCR ≥1. Independent of UPCR or biopsy number, a majority (92%) of patients had class III, IV, V or mixed histology. Moreover, patients with UPCR <1 and class III, IV, V, or mixed had a median activity index of 4.5 and chronicity index of 3, yet 39% of these patients had an inactive sediment. Neither anti-dsDNA nor low complement distinguished class I or II from III, IV, V or mixed in patients with UPCR <1. Of 29 patients with baseline UPCR <1 and class III, IV, V or mixed, 23 (79%) had a UPCR <0.5 at 1 year. Conclusion In this prospective study, three-quarters of patients with UPCR <1 had histology showing class III, IV, V or mixed with accompanying activity and chronicity despite an inactive sediment or normal serologies. These data support renal biopsy at thresholds lower than a UPCR of 1. [ABSTRACT FROM AUTHOR]

Objective: Current lupus nephritis (LN) treatments are effective in only 30% of patients, emphasizing the need for novel therapeutic strategies. We undertook this study to develop mechanistic hypotheses and explore novel biomarkers by analyzing the longitudinal urinary proteomic profiles in LN patients undergoing treatment. Methods: We quantified 1,000 urinary proteins in 30 patients with LN at the time of the diagnostic renal biopsy and after 3, 6, and 12 months. The proteins and molecular pathways detected in the urine proteome were then analyzed with respect to baseline clinical features and longitudinal trajectories. The intrarenal expression of candidate biomarkers was evaluated using single‐cell transcriptomics of renal biopsy sections from LN patients. Results: Our analysis revealed multiple biologic pathways, including chemotaxis, neutrophil activation, platelet degranulation, and extracellular matrix organization, which could be noninvasively quantified and monitored in the urine. We identified 237 urinary biomarkers associated with LN, as compared to controls without systemic lupus erythematosus. Interleukin‐16 (IL‐16), CD163, and transforming growth factor β mirrored intrarenal nephritis activity. Response to treatment was paralleled by a reduction in urinary IL‐16, a CD4 ligand with proinflammatory and chemotactic properties. Single‐cell RNA sequencing independently demonstrated that IL16 is the second most expressed cytokine by most infiltrating immune cells in LN kidneys. IL‐16–producing cells were found at key sites of kidney injury. Conclusion: Urine proteomics may profoundly change the diagnosis and management of LN by noninvasively monitoring active intrarenal biologic pathways. These findings implicate IL‐16 in LN pathogenesis, designating it as a potentially treatable target and biomarker. [ABSTRACT FROM AUTHOR]

Study Objective: To assess the utility of preoperative testing in ASA physical status 1 and 2 patients undergoing outpatient surgery across several surgical specialties.Design: Retrospective cohort study.Patients: The American College of Surgeons National Surgical Quality Improvement Program database from 2017 to 2018 was queried to extract patients defined as ASA 1 and 2 who underwent outpatient surgeries. A total of 352,775 adult patients underwent outpatient surgery with 186,954 patients had at least one lab drawn within 30 days prior to the surgery.Interventions: ASA physical status 1 and 2 patients who underwent outpatient surgeries.Measurements: The primary independent variable was the utilization of preoperative laboratory testing. The primary outcomes were the occurrence of any medical or surgical complication adverse events within 30 days of discharge. In addition, we also examined hospital readmissions. A P value of 0.025 was used to avoid type I error for each primary outcome.Main Results: In the overall cohort, 186,954 out of 352,775 (53%) of patients had at least one lab test. Hematology was the most common lab test ordered, 172,903 out of 352,755 patients (49%), followed by chemistry (43%), liver function (23%), and coagulation tests (11%). After adjusting for confounding factors, the use preoperative testing was not associated with overall medical complications, OR (95%CI) of 1.09 (1.00 to 1.18), P = 0.05 and overall surgical complications, 1.00 (0.92 to 1.08), P = 0.96 [Bonferroni corrected: medical complications OR (97.5% CI) of 1.09 (0.989 to 1.202), P = 0.0950 and overall surgical complications, 1.00 (0.918 to 1.093), P = 1.00.Conclusion: We detected a low utility of preoperative tests for ASA 1 and 2 patients undergoing a large variety of outpatient procedures. Our results support the elimination of preoperative laboratory test for ASA 1 and 2 undergoing ambulatory surgery. [ABSTRACT FROM AUTHOR]

This article presents detailed Markov models for the reliability assessment of multilevel neutral-point-clamped (NPC) converter leg topologies, incorporating their inherent fault-tolerance under open-circuit switch faults. The Markov models are generated and discussed in detail for the three-level and four-level active NPC (ANPC) cases, while the presented methodology can be applied to easily generate the models for a higher number of levels and other topology variants. In addition, this article also proposes an extremely fast calculation method to obtain the precise value of the system's mean time to failure from any given formulated system Markov model. This method is then applied to quantitatively compare the reliability of two-level, three-level, and four-level ANPC legs under switch open-circuit-guaranteed faults and varying degrees of device paralleling. The comparison reveals that multilevel ANPC leg topologies inherently present a potential for higher reliability than the conventional two-level leg, questioning the suitability of the traditional search for topologies with the minimum number of devices in order to improve reliability. Experimental results are presented to validate the fault-tolerance assumptions upon which the presented reliability models for the three-level and four-level ANPC legs are based. This article is accompanied by supplementary MATLAB scripts. [ABSTRACT FROM AUTHOR]

Background and Objective: Studies with nonsignificant results are less likely to be published or published in lower impact factor journals. To determine whether a similar phenomenon occurs in pain literature, we explored impact factor bias in peer‐reviewed pain journals. Methods: A PubMed search involving randomized controlled trials in pain journals during 2012 through 2018 was performed. The primary outcome was the publication impact factor. Exclusion criteria included commentaries, editorials, meta‐analyses, reviews, and animal studies. The average impact factor for each journal was determined. The primary independent variable was a study with a positive outcome. Results: Of the 9 journals evaluated, 1108 articles met our inclusion criteria and were included in our analysis. The quartiles for the impact factor for the journals included were 2.5, 2.9, and 3.6. A multivariate analysis identified sample size greater than 100, description of a sample size calculation, presence of a stated hypothesis, and presence of sponsorship funding as independent predictors of publication in a journal with greater impact factor. In contrast, positive results were not associated with publication in a greater impact factor journal, even when forced into the model, P = 0.49. Conclusions: After adjusting for study factors associated with publication, there is no evidence of impact factor bias within the pain literature. The lack of impact factor bias in the pain literature is a positive finding for the field and should benefit scientific development and the clinical care of patients. [ABSTRACT FROM AUTHOR]

Background: A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods: The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results: A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions: The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population. [ABSTRACT FROM AUTHOR]

We report on the results achieved by installing two Chemical Vapor Deposition (CVD) single crystal diamond detectors in one of the equatorial ports of the Frascati Tokamak Upgrade (FTU) tokamak, during the last six months of operation of the machine. The devices were fabricated at the University of Rome "Tor Vergata" in a metal/instrinsic/p-type diamond layered structure, allowing them to be used as Schottky photodiodes for VUV and Soft-X ray detection. Both detectors were placed inside the machine and operated in current mode under high vacuum conditions. The fast response capabilities of diamond detectors allowed to observe several plasma events, like the so-called Anomalous Doppler instabilities, the pellet injection and ablation, and Multifaceted Asymmetric Radiation From the Edge (MARFE). Diamond detectors often but not always followed the Magnetohydrodynamics (MHD) activity, depending on their localization relative to the emitting region. Core temperature oscillations following Electron Cyclotron Heating system (ECH) modulation were also observed. In addition, the diamond signals were compared to selected channels of the FTU bolometry system with similar line-of-sight: the encouraging results have launched an R&D program for the development of diamond-based bolometers. [ABSTRACT FROM AUTHOR]

This paper studies a multilevel multiphase dc–ac conversion system configured by a neutral-point-clamped converter fed by multiple battery packs connected in series. A virtual-vector modulation is selected and a state-of-charge (SoC) balancing control is designed to be able to employ the full battery bank capacity, even under different battery initial SoC values or different battery nominal capacities. The SoC balancing among battery packs is accomplished through the multilevel converter operation in a lossless manner, by simply distributing the dc-to-ac power flow among the batteries according to their SoC. A simple average system model is also presented, which allows performing very fast system simulations over long periods of time and serves as a convenient tool to tune the compensator parameters. The satisfactory performance of the proposed system configuration and control, which can be applied with any number of levels and phases, has been verified through simulations and experiments in a four-level three-phase dc–ac converter fed by three lithium-ion battery packs. The results prove the feasibility and advantages of the proposed system configuration, which can be used to implement conversion systems with different specifications combining several instances of a standard battery pack and a standard power semiconductor device. [ABSTRACT FROM AUTHOR]

In this contribution, new data concerning the distribution of vascular flora alien to Italy are presented. It includes new records, confirmations, exclusions, and status changes for Italy or for Italian administrative regions. Furthermore, three new combinations are proposed. Nomenclatural and distribution updates published elsewhere are provided as Suppl. material 1. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: There is controversy about the outcome of patients with acute myocarditis (AM), and data are lacking on how patients admitted with suspected AM are managed. We report characteristics, in-hospital management, and long-term outcome of patients with AM based on a retrospective multicenter registry from 19 Italian hospitals. Methods: A total of 684 patients with suspected AM and recent onset of symptoms (<30 days) were screened between May 2001 and February 2017. Patients >70 years of age and those >50 years of age without coronary angiography were excluded. The final study population comprised 443 patients (median age, 34 years; 19.4% female) with AM diagnosed by either endomyocardial biopsy or increased troponin plus edema and late gadolinium enhancement at cardiac magnetic resonance. Results: At presentation, 118 patients (26.6%) had left ventricular ejection fraction <50%, sustained ventricular arrhythmias, or a low cardiac output syndrome, whereas 325 (73.4%) had no such complications. Endomyocardial biopsy was performed in 56 of 443 (12.6%), and a baseline cardiac magnetic resonance was performed in 415 of 443 (93.7%). Cardiac mortality plus heart transplantation rates at 1 and 5 years were 3.0% and 4.1%. Cardiac mortality plus heart transplantation rates were 11.3% and 14.7% in patients with complicated presentation and 0% in uncomplicated cases (log-rank P <0.0001). Major AM-related cardiac events after the acute phase (postdischarge death and heart transplantation, sustained ventricular arrhythmias treated with electric shock or ablation, symptomatic heart failure needing device implantation) occurred in 2.8% at the 5-year follow-up, with a higher incidence in patients with complicated forms (10.8% versus 0% in uncomplicated AM; log-rank P <0.0001). β-Adrenoceptor blockers were the most frequently used medications both in complicated (61.9%) and in uncomplicated forms (53.8%; P =0.18). After a median time of 196 days, 200 patients had follow-up cardiac magnetic resonance, and 8 of 55 (14.5%) with complications at presentation had left ventricular ejection fraction <50% compared with 1 of 145 (0.7%) of those with uncomplicated presentation. Conclusions: In this contemporary study, overall serious adverse events after AM were lower than previously reported. However, patients with left ventricular ejection fraction <50%, ventricular arrhythmias, or low cardiac output syndrome at presentation were at higher risk compared with uncomplicated cases that had a benign prognosis and low risk of subsequent left ventricular systolic dysfunction. [ABSTRACT FROM AUTHOR]

Importance: Dual antiplatelet therapy after percutaneous coronary intervention (PCI) reduces ischemia but increases bleeding.Objective: To develop a clinical decision tool to identify patients expected to derive benefit vs harm from continuing thienopyridine beyond 1 year after PCI.Design, Setting, and Participants: Among 11,648 randomized DAPT Study patients from 11 countries (August 2009-May 2014), a prediction rule was derived stratifying patients into groups to distinguish ischemic and bleeding risk 12 to 30 months after PCI. Validation was internal via bootstrap resampling and external among 8136 patients from 36 countries randomized in the PROTECT trial (June 2007-July 2014).Exposures: Twelve months of open-label thienopyridine plus aspirin, then randomized to 18 months of continued thienopyridine plus aspirin vs placebo plus aspirin.Main Outcomes and Measures: Ischemia (myocardial infarction or stent thrombosis) and bleeding (moderate or severe) 12 to 30 months after PCI.Results: Among DAPT Study patients (derivation cohort; mean age, 61.3 years; women, 25.1%), ischemia occurred in 348 patients (3.0%) and bleeding in 215 (1.8%). Derivation cohort models predicting ischemia and bleeding had c statistics of 0.70 and 0.68, respectively. The prediction rule assigned 1 point each for myocardial infarction at presentation, prior myocardial infarction or PCI, diabetes, stent diameter less than 3 mm, smoking, and paclitaxel-eluting stent; 2 points each for history of congestive heart failure/low ejection fraction and vein graft intervention; -1 point for age 65 to younger than 75 years; and -2 points for age 75 years or older. Among the high score group (score ≥2, n = 5917), continued thienopyridine vs placebo was associated with reduced ischemic events (2.7% vs 5.7%; risk difference [RD], -3.0% [95% CI, -4.1% to -2.0%], P < .001) compared with the low score group (score <2, n = 5731; 1.7% vs 2.3%; RD, -0.7% [95% CI, -1.4% to 0.09%], P = .07; interaction P < .001). Conversely, continued thienopyridine was associated with smaller increases in bleeding among the high score group (1.8% vs 1.4%; RD, 0.4% [95% CI, -0.3% to 1.0%], P = .26) compared with the low score group (3.0% vs 1.4%; RD, 1.5% [95% CI, 0.8% to 2.3%], P < .001; interaction P = .02). Among PROTECT patients (validation cohort; mean age, 62 years; women, 23.7%), ischemia occurred in 79 patients (1.0%) and bleeding in 37 (0.5%), with a c statistic of 0.64 for ischemia and 0.64 for bleeding. In this cohort, the high-score patients (n = 2848) had increased ischemic events compared with the low-score patients and no significant difference in bleeding.Conclusion and Relevance: Among patients not sustaining major bleeding or ischemic events 1 year after PCI, a prediction rule assessing late ischemic and bleeding risks to inform dual antiplatelet therapy duration showed modest accuracy in derivation and validation cohorts. This rule requires further prospective evaluation to assess potential effects on patient care, as well as validation in other cohorts.Trial Registration: clinicaltrials.gov Identifier: NCT00977938. [ABSTRACT FROM AUTHOR]

Study Objective: A high prevalence of burnout, depression and suicidal ideation has been reported among anesthesiology trainees. Over the last decade, there has been a significant emphasis on the development of wellness programs in academic departments to mitigate the prevalence and effects of burnout during anesthesiology training. Therefore, we aimed to reevaluate the prevalence of burnout and depression in anesthesiology trainees in the United States.Design: Cross-sectional survey.Setting: Anesthesiology Department.Patients: A nationally representative sample of 1000 anesthesiology trainees in the United States.Measurements: A 33-item questionnaire consisting of 1) burnout, 2) depression, 3) job satisfaction, 4) family support, 5) work characteristics, 6) demographic factors, 7) self-reported errors, and 8) impact of COVID-19 pandemic.Results: We received 384 responses. Twenty-four percent (91/384) of the respondents met the criteria for high burnout risk and 58/384 (15%) of the respondents screened positive for depression. Multivariable analysis revealed that: (1) hours per week > 70, (odds ratio [OR; 95% confidence interval {CI}] = 3.1 [1.4-6.8], P=0.005 and (2) overnight calls per month > 7 (OR [95% CI] = 2.5 [1.0- 6.0], P=0.03 were independent factors for increased odds of burnout whereas the presence of (3) married/domestic partnership (OR [95% CI} = 0.52 [0.32-0.85], P=0.01 was associated with lower odds of burnout and/or depression. Ten percent (4/40) of high burnout/depression residents reported that they often times fall short in the quality of care provided to patients compared to 0.36% (1/275) residents with low burnout/depression scores, P < 0.001. Similarly, 22% (9/40) of high burnout/depression residents reported that they often times did not have enough attention to their patients compared to 4% (11/275) residents with low burnout/depression scores, P < 0.001.Conclusions: We report a still concerning but significantly lower rate of burnout and depression in anesthesiology trainees than previously reported a decade ago. This suggests that efforts on wellness implemented by academic programs have positively impacted the work experience of anesthesia trainees. [ABSTRACT FROM AUTHOR]

Background: In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study), treatment of mitral regurgitation (MR) with a novel percutaneous device showed superior safety compared with surgery, but less effective reduction in MR at 1 year.Objectives: This study sought to evaluate the final 5-year clinical outcomes and durability of percutaneous mitral valve (MV) repair with the MitraClip device compared with conventional MV surgery.Methods: Patients with grade 3+ or 4+ MR were randomly assigned to percutaneous repair with the device or conventional MV surgery in a 2:1 ratio (178:80). Patients prospectively consented to 5 years of follow-up.Results: At 5 years, the rate of the composite endpoint of freedom from death, surgery, or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the percutaneous repair and surgical groups, respectively (p = 0.01). The difference was driven by increased rates of 3+ to 4+ MR (12.3% vs. 1.8%; p = 0.02) and surgery (27.9% vs. 8.9%; p = 0.003) with percutaneous repair. After percutaneous repair, 78% of surgeries occurred within the first 6 months. Beyond 6 months, rates of surgery and moderate-to-severe MR were comparable between groups. Five-year mortality rates were 20.8% and 26.8% (p = 0.4) for percutaneous repair and surgery, respectively. In multivariable analysis, treatment strategy was not associated with survival.Conclusions: Patients treated with percutaneous repair more commonly required surgery for residual MR during the first year after treatment, but between 1- and 5-year follow-up, comparably low rates of surgery for MV dysfunction with either percutaneous or surgical therapy endorse the durability of MR reduction with both repair techniques. (EVEREST II Pivotal Study High Risk Registry; NCT00209274). [ABSTRACT FROM AUTHOR]

Introduction. The purpose of this study was to analyze the influence of metabolic phenotypes during the construction of ROC curves for waist circumference (WC) cutpoint selection. Materials and Methods. A total of 1,902 subjects of both genders were selected from the Maracaibo City Metabolic Syndrome Prevalence Study database. Two-Step Cluster Analysis (TSCA) was applied to select metabolically healthy and sick men and women. ROC curves were constructed to determine WC cutoff points by gender. Results. Through TSCA, metabolic phenotype predictive variables were selected: HOMA2-IR and HOMA2-βcell for women and HOMA2-IR, HOMA2-βcell, and TAG for men. Subjects were classified as healthy normal weight, metabolically obese normal weight, healthy and metabolically disturbed overweight, and healthy and metabolically disturbed obese. Final WC cutpoints were 91.50 cm for women (93.4% sensitivity, 93.7% specificity) and 98.15 cm for men (96% sensitivity, 99.5% specificity). Conclusions. TSCA in the selection of the groups used in ROC curves construction proved to be an important tool, aiding in the detection of MOWN and MHO which cannot be identified with WC alone. The resulting WC cutpoints were <91.00 cm for women and <98.00 cm for men. Furthermore, anthropometry is insufficient to determine healthiness, and, biochemical analysis is needed to properly filter subjects during classification. [ABSTRACT FROM AUTHOR]

Background. Mathematical models such as Homeostasis Model Assessment have gained popularity in the evaluation of insulin resistance (IR). The purpose of this study was to estimate the optimal cut-off point for Homeostasis Model Assessment-2 Insulin Resistance (HOMA2-IR) in an adult population of Maracaibo, Venezuela. Methods. Descriptive, cross-sectional study with randomized, multistaged sampling included 2,026 adult individuals. IR was evaluated through HOMA2-IR calculation in 602 metabolically healthy individuals. For cut-off point estimation, two approaches were applied: HOMA2-IR percentile distribution and construction of ROC curves using sensitivity and specificity for selection. Results. HOMA2-IR arithmetic mean for the general population was 2.21 ± 1.42, with 2.18 ± 1.37 for women and 2.23 ± 1.47 for men (P = 0.466). When calculating HOMA2-IR for the healthy reference population, the resulting p75 was 2.00. Using ROC curves, the selected cut-off point was 1.95, with an area under the curve of 0.801, sensibility of 75.3%, and specificity of 72.8%. Conclusions. We propose an optimal cut-off point of 2.00 for HOMA2-IR, offering high sensitivity and specificity, sufficient for proper assessment of IR in the adult population of our city, Maracaibo. The determination of population-specific cut-off points is needed to evaluate risk for public health problems, such as obesity and metabolic syndrome. [ABSTRACT FROM AUTHOR]

An important etiopathogenic component of cardiovascular disease is atherosclerosis, with inflammation being an essential event in the pathophysiology of all clinical pictures it comprises. In recent years, several molecules implicated in this process have been studied in order to assess cardiovascular risk in both primary and secondary prevention. C-reactive protein is a plasmatic protein of the pentraxin family and an acute phase reactant, very useful as a general inflammation marker. Currently, it is one of the most profoundly researched molecules in the cardiovascular field, yet its clinical applicability regarding cardiovascular risk remains an object of discussion, considered by some as a simple marker and by others as a true risk factor. In this sense, numerous studies propose its utilization as a predictor of cardiovascular risk through the use of high-sensitivity quantification methods for the detection of values <1 mg/L, following strict international guidelines. Increasing interest in these clinical findings has led to the creation of modified score systems including C-reactive protein concentrations, in order to enhance risk scores commonly used in clinical practice and offer improved care to patients with cardiovascular disease, which remains the first cause of mortality at the worldwide, national, and regional scenarios. [ABSTRACT FROM AUTHOR]