Probabilistic Forecasts Using Expert Judgment: The Road to Recovery From COVID-19.

The COVID-19 pandemic has had a devastating effect on many industries around the world including tourism and policy makers are interested in mapping out what the recovery path will look like. We propose a novel statistical methodology for generating scenario-based probabilistic forecasts based on a large survey of 443 tourism experts and stakeholders. The scenarios map out pessimistic, most-likely and optimistic paths to recovery. Taking advantage of the natural aggregation structure of tourism data due to geographic locations and purposes of travel, we propose combining forecast reconciliation and forecast combinations implemented to historical data to generate robust COVID-free counterfactual forecasts, to contrast against. Our empirical application focuses on Australia, analyzing international arrivals and domestic flows. Both sectors have been severely affected by travel restrictions in the form of international and interstate border closures and regional lockdowns. The two sets of forecasts, allow policy makers to map out the road to recovery and also estimate the expected effect of the pandemic.

Prompt recovery after surgical treatment of pulmonary and aortic valve endocarditis in a patient with acute heart failure.

Infective endocarditis remains a medical challenge among urgent cases of cardiac disease. Multi-valvular endocarditis is uncommon and simultaneous right and left-sided valvular involvement, particularly affecting the pulmonary valve, is scarcely reported. A rare case of a patient with subacute myelodysplastic syndrome, who presented with endocarditis involving both aortic and pulmonary valves, complicated with new-onset heart failure, is described. The patient presented prompt recovery of both right and left ventricular function after combined aortic and pulmonary valve replacement.

Atrial fibrillation in hypertrophic cardiomyopathy - A contemporary mini-review.

Hypertrophic cardiomyopathy (HCM) represents the most common genetically inherited cardiovascular disorder and a leading cause of heart failure and sudden cardiac death. Atrial fibrillation (AF) is the most common arrhythmia encountered in HCM patients, primarily due to the process of left atrium dilatation and remodeling. Its presence typically leads to progressive functional decline, increased frequency of heart failure hospitalizations, and increased thromboembolic risk. In this mini-review, we summarize the contemporary data on AF pathophysiology, risk factors, and management in HCM patients suffering from AF.

Correction: Harmonic organisation conveys both universal and culture-specific cues for emotional expression in music.

[This corrects the article DOI: 10.1371/journal.pone.0244964.].

Longer-term impacts of trading restrictions on alcohol-related violence: insights from New South Wales, Australia.

BACKGROUND AND AIMS: In February 2014, the government of New South Wales (NSW), Australia, introduced new restrictions (known as the 'lockout laws') on the sale of alcohol in licensed premises in two of Sydney's most prominent entertainment districts, Kings Cross (KX) and the central business district (CBD). This study aimed to determine: (i) whether the introduction of the lockout laws was the point at which the time pattern of the assault series in the KX and CBD entertainment precincts changed; (ii) whether the apparent reduction in assault in these precincts persists when we control for common variations in assault across the entire state of NSW; (iii) whether the reduction in assault in the KX and CBD entertainment precincts resulted in a displacement of the assault problem into other areas; and (iv) whether there is a net reduction in assault after taking any spill-over or displacement effects into account. DESIGN: Structural break analysis was used to determine the date at which the time pattern of assaults changed. Interrupted time series analysis with a rest-of-NSW comparator was used to assess the change in assault. SETTING, CASES AND MEASUREMENTS: The monthly totals of incidents of non-domestic assaults reported to the NSW Police between January 2009 and March 2019 (n = 123). FINDINGS: The structural break in assaults occurred in January 2014 rather than in February 2014, when the lockout laws were introduced. The reduction in assault persists even when we control for common influences across NSW as a whole. In particular, from January 2014 onwards, assaults fell immediately by 22% (a downward step) in KX (90% confidence interval [CI] = 15-28) and by 33% in the CBD (90% CI = 19-47). Assaults continued declining in KX (trend-break coefficient = -0.094, 90% CI = -0.192 to 0.005). The reduction in assault in the KX and CBD precincts is associated with a rise in assault in areas surrounding these precincts. The net effect, nonetheless, remains a lower level of assault. In particular, we estimate that the net reduction over the three areas combined was 1670 assaults (i.e. 27 per month). CONCLUSION: Some of the initial reduction in assault in KX and the CBD of Sydney, Australia, previously attributed to the February 2014 introduction of lockout laws may have been a response to publicity surrounding recent deaths connected with alcohol-related violence.

Updated knowledge and practical implementations of stress echocardiography in ischemic and non-ischemic cardiac diseases: An expert consensus of the Working Group of Echocardiography of the Hellenic Society of Cardiology.

Stress echocardiography (SE) is a well established and valid technique, widely used for the diagnostic evaluation of patients with ischemic and nonischemic cardiac diseases. This statement of the Echocardiography Working Group of the Hellenic Society of Cardiology summarizes the consensus of the writing group regarding the applications of SE, based on the expertise of their members and on a critical review of present medical literature. The main objectives of the consensus document include a comprehensive review of SE methodology and training-which focus on the preparation, the protocols used, the analysis of the SE images, and updated, evidence-based knowledge about SE applications on ischemic and nonischemic heart diseases, such as in cardiomyopathies, heart failure, and valvular heart disease.

Impact of COVID-19 lockdowns on hospital presentations and admissions in the context of low community transmission: evidence from time series analysis in Melbourne, Australia.

BACKGROUND: Melbourne, Australia, successfully halted exponential transmission of COVID-19 via two strict lockdowns during 2020. The impact of such restrictions on healthcare-seeking behaviour is not comprehensively understood, but is of global importance. We explore the impact of the COVID-19 pandemic on acute, subacute and emergency department (ED) presentations/admissions within a tertiary, metropolitan health service in Melbourne, Australia, over two waves of community transmission (1 March to 20 September 2020). METHODS: We used 4 years of historical data and novel forecasting methods to predict counterfactual hospital activity for 2020, assuming absence of COVID-19. Observed activity was compared with forecasts overall, by age, triage category and for myocardial infarction and stroke. Data were analysed for all patients residing in the health service catchment area presenting between 4 January 2016 and 20 September 2020. RESULTS: ED presentations (n=401 805), acute admissions (n=371 723) and subacute admissions (n=15 676) were analysed. Substantial departures from forecasted presentation levels were observed during both waves in the ED and acute settings, and during the second wave in subacute. Reductions were most marked among those aged >80 and <18 years. Presentations persisted at expected levels for urgent conditions, and ED triage categories 1 and 5, with clear reductions in categories 2-4. CONCLUSIONS: Our analyses suggest citizens were willing and able to present with life-threatening conditions during Melbourne's lockdowns, and that switching to telemedicine did not cause widespread spill-over from primary care into ED. During a pandemic, lockdowns may not inhibit appropriate hospital attendance where rates of infectious disease are low.

Sweetness is in the ear of the beholder: chord preference across United Kingdom and Pakistani listeners.

The majority of research in the field of music perception has been conducted with Western participants, and it has remained unclear which aspects of music perception are culture dependent, and which are universal. The current study compared how participants unfamiliar with Western music (people from the Khowar and Kalash tribes native to Northwest Pakistan with minimal exposure to Western music) perceive affect (positive versus negative) in musical chords compared with United Kingdom (UK) listeners, as well as the overall preference for these chords. The stimuli consisted of four distinct chord types (major, minor, augmented, and chromatic) and were played as both vertical blocks (pitches presented concurrently) and arpeggios (pitches presented successively). The results suggest that the Western listener major-positive minor-negative affective distinction is opposite for Northwest Pakistani listeners, arguably because of the reversed prevalence of these chords in the two music cultures. The aversion to the harsh dissonance of the chromatic cluster is present cross-culturally, but the preference for the consonance of the major triad varies between UK and Northwest Pakistani listeners, depending on cultural familiarity. Our findings imply not only notable cultural variation but also commonalities in chord perception across Western and non-Western listeners.

Harmonic organisation conveys both universal and culture-specific cues for emotional expression in music.

Previous research conducted on the cross-cultural perception of music and its emotional content has established that emotions can be communicated across cultures at least on a rudimentary level. Here, we report a cross-cultural study with participants originating from two tribes in northwest Pakistan (Khow and Kalash) and the United Kingdom, with both groups being naïve to the music of the other respective culture. We explored how participants assessed emotional connotations of various Western and non-Western harmonisation styles, and whether cultural familiarity with a harmonic idiom such as major and minor mode would consistently relate to emotion communication. The results indicate that Western concepts of harmony are not relevant for participants unexposed to Western music when other emotional cues (tempo, pitch height, articulation, timbre) are kept relatively constant. At the same time, harmonic style alone has the ability to colour the emotional expression in music if it taps the appropriate cultural connotations. The preference for one harmonisation style over another, including the major-happy/minor-sad distinction, is influenced by culture. Finally, our findings suggest that although differences emerge across different harmonisation styles, acoustic roughness influences the expression of emotion in similar ways across cultures; preference for consonance however seems to be dependent on cultural familiarity.

Retroperitoneal Abscess Formation Extending to the Lumbar Area After Extracorporeal Shock Wave Lithotripsy.

Background: Renal rupture and retroperitoneal abscess formation after extracorporeal shock wave lithotripsy (SWL) is a rare and potentially life-threatening complication if left untreated with a high morbidity rate. In this study, we present a rare case of renal rupture after SWL, with formation of an extensive retroperitoneal abscess extending to the left abdominal and lumbar area. Case Presentation: A 48-year-old Caucasian woman presented to the outpatient department with left abdominal and lumbar redness and swelling caused by renal rupture and massive perinephric abscess formation, 10 days after SWL treatment of her left renal pelvic stones. She was treated first with drainage of the retroperitoneal abscess and simultaneous Double-J stent placement in her left kidney. A left open nephrectomy was subsequently performed because of persistence of kidney infection. Conclusion: Retroperitoneal abscess formation after SWL is a serious and highly morbid complication, which should be early diagnosed and timely treated.

The use of Amplatz renal dilators in the minimally invasive management of complex urethral strictures.

INTRODUCTION: To present the outcomes of using Amplatz renal dilators in the management of complex urethral strictures. MATERIAL AND METHODS: From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post-void residual volume measurement. Under spinal anesthesia, sequential dilatations were performed with Amplatz renal dilators measuring from 8 Fr up to 24 Fr. Urethrotomy was sequentially performed. RESULTS: The mean stricture length was 2.6 (1.5-3.5) cm. Preoperative mean Qmax was 4.4( 3.2-9.6) ml/sec. From September 2011 to August 2015, 34 patients with complex urethral strictures were treated with Amplatz renal dilators assisted with internal urethrotomy. Evaluation included uroflowmetry, IPSS and post- void residual volume measurement. Under spinal anesthesia, sequential dilatations with Amplatz renal dilators over an 8 Fr stylet were performed up to 24 Fr. Urethrotomy was sequentially performed. PVR was 155 (75-380) ml. Postoperative mean Qmax at 1 month was 18.4 (14.6-21.8) ml/sec, p <0.001, at 6 months was 16.6 (9.8-18.2) ml/sec, p <0.003 and at 12 months was 12.7 (7.4-17.3) ml/sec, p <0.005. Accordingly, mean PVR was significantly improved postoperatively, at 32 (12-88) ml in 1 month, p <0.001, while at 6 months was 34 (28-101) ml, p <0.005 and at 12 months was 62 (38-115) ml, p <0.005. Only 8 patients (23.5%) had a stricture recurrence in the first nine months and were treated with Amplatz dilatations alone. CONCLUSIONS: The use of Amplatz renal dilators in combination with internal urethrotomy is a safe and effective technique for the endoscopic treatment of complex urethral strictures in patients unfit for reconstructive surgery.

Cardiac transplantation: towards a new noninvasive approach of cardiac allograft rejection.

INTRODUCTION: Cardiac allograft rejection (CAR) may occur after transplantation and remains silent, until hemodynamic deterioration takes place. Endomyocardial biopsy (EMB) is applied to early detect CAR. Although, flexible bioptoms have decreased the incidence of lethal complications, EMB remains an invasive procedure carrying risk of tamponade and permanent heart block. Therefore, a new non-invasive approach is needed. Areas covered: AlloMap molecular expression testing and graft-derived cell-free DNA (GcfDNA) test can be used as blood indices of acute and chronic CAR, respectively. Among diagnostic techniques, only echocardiography and cardiovascular magnetic resonance (CMR) have shown a strong correlation with EMB. Echocardiography is bedside, cost and time saving. However, the currently used indices are insensitive markers of CAR. Global longitudinal strain (GLS) can diagnose the subclinical CAR and be used together with EMB to monitor acute CAR. CMR can improve our diagnostic accuracy using T2STIR, T1, T2 mapping, early/late gadolinium enhancement and functional assessment. Expert commentary: A new non-invasive approach in asymptomatic transplanted patients should be based on a serial assessment of AlloMap, GcfDNA testing, echocardiographic and CMR indices that will guide the indication for EMB. In symptomatic patients immediate EMB is the approach of choice, since they have high likelihood for CAR.

Large-scale direct shear testing of municipal solid waste.

Large direct shear testing (300 mm x 300 mm box) of municipal solid waste (MSW) collected from a landfill located in the San Francisco Bay area was performed to gain insight on the shear response of MSW. The study investigated the effects of waste composition, confining stress, unit weight, and loading rate on the stress-displacement response and shear strength of MSW. The amount and orientation of the fibrous waste materials in the MSW were found to play a critical role. The fibrous material had little effect on the MSW's strength when it was oriented parallel to the shear surface, as is typically the case when waste material is compressed vertically and then tested in a direct shear apparatus. Tests in which the fibrous material was oriented perpendicular to the horizontal shear surface produced significantly stronger MSW specimens. The test results indicate that confining stress and loading rate are also important factors. Based on 109 large-scale direct shear tests, the shear strength of MSW at low moisture contents is best characterized by cohesion=15 kPa, friction angle=36 degrees at a normal stress of 1 atmosphere, and a decrease in the friction angle of 5 degrees for every log-cycle increase in normal stress.

Prognostic significance of renal function in patients undergoing dobutamine stress echocardiography.

BACKGROUND: Dobutamine stress echocardiography (DSE) is used for risk stratification of patients with suspected coronary artery disease (CAD). However, the prognostic value of DSE among the entire strata of renal function has yet to be determined. We assessed the prognostic value of renal function relative to DSE findings. METHODS: We studied 2292 patients, divided into 729 (32%) patients with normal renal function [creatinine clearance (CrCl) >90 ml/min] and 1563 (68%) with renal dysfunction, classified as mild (CrCl: 60-90 ml/min) in 933, moderate (CrCl: 30-60 ml/min) in 502 and severe (CrCl < 30 ml/min) in 128 patients. All patients underwent DSE for the evaluation of known or suspected CAD and were followed for a mean of 8 years. RESULTS: New wall motion abnormalities during DSE and mildly, moderately and severely abnormal CrCl were powerful independent predictors for all-cause mortality, cardiac death and hard cardiac events (cardiac death and non-fatal myocardial infarction). Kaplan-Meier curves demonstrated that patients with normal DSE and renal dysfunction have greater probability for cardiac death and hard cardiac events compared to those with normal renal function. The warranty of a normal DSE in the presence of moderate renal dysfunction was 15 and 36 months for 10 and 20% risk for cardiac death and hard cardiac events, respectively. CONCLUSIONS: The presence and severity of renal dysfunction has additional independent prognostic value over DSE findings. The low-risk warranty period after a normal DSE is determined by the severity of renal dysfunction.

A 6-month follow-up of intermittent levosimendan administration effect on systolic function, specific activity questionnaire, and arrhythmia in advanced heart failure.

BACKGROUND: Levosimendan (LS) improves cardiac contractility without increasing myocardial oxygen demand. We administrated LS on a monthly intermittent 24-hour protocol and evaluated the clinical effect after 6 months in a randomized, open, prospective study. METHODS AND RESULTS: Fifty patients (age 45-65 years) with LV systolic dysfunction and New York Heart Association (NYHA) III or IV were randomized in 2 groups. LS group (n = 25) was compared with a control group (n = 25) matched for sex, age, and NYHA class. LS was given monthly on a 24-hour intravenous protocol for 6 months. Patients were evaluated by specific activity questionnaire (SAQ) and echocardiography (ECHO) before and 3 to 5 days after last drug administration, whereas 24-hour Holter recording was performed before and during last drug administration. Patients in LS and control group had same baseline SAQ, ECHO, and Holter parameters. At the end of the study, a larger proportion of patients in the levosimendan group reported improvement in symptoms (dyspnea and fatigue) (65% versus 20% in controls, P < .01). After 6 months, the LS group had a significant increase in LV ejection fraction versus controls (28 +/- 7 versus 21 +/- 4 %, P = .003), LV shortening fraction (15 +/- 3 versus 11 +/- 3 %, P = .006) and a decrease in mitral regurgitation (1.5 +/- 0.8 versus 2.7 +/- 0.6, P = .0001). There was no increase in supraventricular or ventricular beats or supraventricular tachycardia and VT episodes in LS group, compared with controls. Two patients from the LS group died in the 6-month follow-up period, compared with 8 patients in the control group (8% versus 32%, P < .05). CONCLUSIONS: A 6-month intermittent LS treatment in patients with decompensated advanced heart failure improved symptoms and LV systolic function.

A spontaneously ruptured primitive neuroectodermal tumor/extraosseous Ewing's sarcoma of the kidney with renal vein tumor thrombus.

Primitive neuroectodermal tumor/extraosseous Ewing's sarcoma (PNET/EES) is a childhood disease rarely seen in adults. It is a soft tissue tumor, which is often observed in the paraspinal region and lower extremity. We report the case of a 32-year-old man who presented with sudden abdominal pain on the right upper quadrant that was radiated to the right flank. During the operation, a spontaneously ruptured right kidney mass was found. The histopathologic and immunohistochemical characteristics of the excised mass were consistent with PNET/EES. This is the first known reported case of spontaneously ruptured PNET/EES of the kidney with renal vein tumor thrombus. The clinical details and the management of this case are described.

Successful moxifloxacin prophylaxis against experimental streptococcal aortic valve endocarditis.

OBJECTIVES: Studies related to the prophylactic efficacy of fluoroquinolones against infective endocarditis are scarce. The aim of this study was to evaluate the efficacy of moxifloxacin, a quinolone active in vitro against Gram-positive cocci, in preventing streptococcal aortic valve endocarditis. METHODS: Non-bacterial thrombotic endocarditis of the aortic valve was induced by the insertion of a polyethylene catheter. Twenty-four hours later, rabbits were randomly assigned to a control group, and groups receiving either two doses of ampicillin (40 mg/kg, intravenously), 2 h apart, or a single dose of moxifloxacin (15 mg/kg, intravenously). Ampicillin and moxifloxacin were administered 0.5 and 1 h, respectively, prior to the intravenous inoculation of 10(7) cfu of Streptococcus oralis. RESULTS: Eighty-nine percent of the control animals developed infected vegetations. In rabbits challenged with this very high inoculum, moxifloxacin and ampicillin prevented endocarditis in 80% (P < 0.001 versus controls) and in 50% (P = 0.022 versus controls) of animals, respectively. The difference between ampicillin and moxifloxacin was not statistically significant (P = 0.128). CONCLUSIONS: Moxifloxacin was at least as effective as ampicillin in preventing streptococcal endocarditis.

Cardiac and sternocleidomastoid muscle involvement in Duchenne muscular dystrophy: an MRI study.

OBJECTIVE: To examine the extent of cardiac muscle and sternocleidomastoid muscle (SCM) involvement detected by MRI measurement of T2 relaxation time in patients with Duchenne muscular dystrophy (DMD) and no cardiorespiratory symptoms. DESIGN: Prospective controlled study. SETTING: Teaching referral hospital and university hospital. SUBJECTS: Seventeen patients with DMD (age range, 7 to 25 years) and 17 age-matched control subjects. All patients were free of cardiac or respiratory complaints and had normal ECG, echocardiograph, and Holter monitor examination findings. METHODS: We assessed respiratory function by means of standard pulmonary function testing. MRI measurements included the T2 relaxation time of the myocardium and the SCM in patients and control subjects. RESULTS: The FVC and FEV1 values were lower in patients with DMD than in age-matched control subjects, whereas the FEV1/FVC ratio was normal in all subjects. Patients with DMD had lower T2 relaxation time of the heart (37.8 +/- 6.1 ms vs 58.1 +/- 7.1 ms, p < 0.001) and lower T2 relaxation time of the right SCM (24.5 +/- 2.6 ms vs 42.2 +/- 1.3 ms, p < 0.001) and left SCM (23.2 +/- 3.2 ms vs 42.2 +/- 1.6 ms, p < 0.001), compared to control subjects (+/- SD). In children (< 12 years of age), the T2 of the SCM was lower than that of the control subjects, but T2 of the heart did not differ between the two groups. In the patient group, T2 relaxation time of the heart decreased with age (r = - 0.80, p < 0.001). In patients with FVC < 80% of predicted, the T2 values of the heart were lower than the T2 values of patients with FVC > or = 80% of predicted (35.6 +/- 5.8 ms vs 41.8 +/- 4.6 ms, p < 0.05). CONCLUSIONS: MRI measurements of the T2 relaxation time in the myocardium and SCM of patients with DMD and no cardiorespiratory symptoms are abnormal, indicating altered tissue composition. These measurements may prove a clinically useful test for monitoring cardiac and respiratory muscle involvement in these patients.

Silent Pulmonary Embolism of a Large Right Atrial Thrombus.

We report the case of a patient who was admitted to the hospital with acute pulmonary embolism 2 weeks after a complicated pelvis fracture. Echocardiography revealed a large, long, and mobile thrombus in the right atrium. The patient was scheduled to undergo urgent surgical thrombectomy. Preoperative echocardiography did not detect any thrombi in the right heart and pulmonary artery. The obvious embolism of this large thrombus in the pulmonary circulation was silent as the patient remained asymptomatic and hemodynamically stable. We discuss the contribution of echocardiography to the appropriate therapeutic management of right atrial thrombi and particularly to the cancellation of urgent operative thrombectomy.