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PURPOSE: Upper airway (UA) surgery is commonly employed in the treatment of patients with obstructive sleep apnea (OSA). The intricate pathophysiology of OSA, variability in sites and patterns of UA collapse, and the interaction between anatomical and non-anatomical factors in individual patients may contribute to possible surgical failures. This clinical consensus statement aims to identify areas of agreement among a development group comprising international experts in OSA surgery, regarding the appropriate definition, predictive factors in patients, and management of surgical failure in OSA treatment. METHODS: A clinical consensus statement (CCS) was developed using the Delphi method by a panel of 35 contributors from various countries. A systematic literature review adhering to PRISMA guidelines was conducted. A survey consisting of 60 statements was then formulated and presented to the experts. RESULTS: Following two rounds of the Delphi process, consensus or strong consensus was achieved on 36 items, while 24 items remained without consensus. Specifically, 5 out of 10 statements reached consensus regarding on the Definition of Surgical Success/Failure after OSA Surgery. Regarding the Predictive Factors of Surgical Failure in OSA Surgery, consensus was reached on 10 out of 13 statements. In the context of the Diagnostic Workup in OSA Surgery, consensus was achieved on 9 out of 13 statements. Lastly, in Treatment in Surgical Failure Cases, consensus was reached on 12 out of 24 statements. CONCLUSION: The management of OSA after surgical failure presents a significant clinical challenge for sleep specialists. This CCS provides valuable guidance for defining, preventing, and addressing surgical failures in the treatment of OSA syndrome.

BACKGROUND: SARS-CoV-2 binding to ACE2 is potentially associated with severe pneumonia due to COVID-19. The aim of the study was to test whether Mas-receptor activation by 20-hydroxyecdysone (BIO101) could restore the Renin-Angiotensin System equilibrium and limit the frequency of respiratory failure and mortality in adults hospitalized with severe COVID-19. METHODS: Double-blind, randomized, placebo-controlled phase 2/3 trial. Randomization: 1:1 oral BIO101 (350 mg BID) or placebo, up to 28 days or until an endpoint was reached. Primary endpoint: mortality or respiratory failure requiring high-flow oxygen, mechanical ventilation, or extra-corporeal membrane oxygenation. Key secondary endpoint: hospital discharge following recovery (ClinicalTrials.gov Number, NCT04472728). FINDINGS: Due to low recruitment the planned sample size of 310 was not reached and 238 patients were randomized between August 26, 2020 and March 8, 2022. In the modified ITT population (233 patients; 126 BIO101 and 107 placebo), respiratory failure or early death by day 28 was 11.4% lower in the BIO101 (13.5%) than in the placebo (24.3%) group, (p = 0.0426). At day 28, proportions of patients discharged following recovery were 80.1%, and 70.9% in the BIO101 and placebo group respectively, (adjusted difference 11.0%, 95% CI [-0.4%, 22.4%], p = 0.0586). Hazard Ratio for time to death over 90 days: 0.554 (95% CI [0.285, 1.077]), a 44.6% mortality reduction in the BIO101 group (not statistically significant). Treatment emergent adverse events of respiratory failure were more frequent in the placebo group. INTERPRETATION: BIO101 significantly reduced the risk of death or respiratory failure supporting its use in adults hospitalized with severe respiratory symptoms due to COVID-19. FUNDING: Biophytis.

Experimental studies show that the tendency to derive Scalar Implicatures (SIs) varies considerably between individuals: some individuals accept sentences that are literally true but carry a false SI, while others systematically reject them. The question of what factors drive these differences is crucial to understanding the mechanisms involved in SIs and currently at the center of numerous discussions. To date, there is no agreement on how to quantify individual differences in SI rates. In this article, we show how a hierarchical Bayesian modelling approach can be used to quantify subjects' preferences observed in the results of a truth value judgement task that investigated intra-individual and inter-individual variability in the rates of upper-bounding and lower-bounding SIs associated with the -scale. The results provide further evidence that the robustness of an SI is modulated within individuals by certain linguistic features, such as the presence of negation.

This paper reports the first simultaneous measurement of the horizontal and vertical components of the polarization vector in a storage ring under the influence of a radio frequency (rf) solenoid. The experiments were performed at the Cooler Synchrotron COSY in Jülich using a vector polarized, bunched 0.97 GeV/c deuteron beam. Using the new spin feedback system, we set the initial phase difference between the solenoid field and the precession of the polarization vector to a predefined value. The feedback system was then switched off, allowing the phase difference to change over time, and the solenoid was switched on to rotate the polarization vector. We observed an oscillation of the vertical polarization component and the phase difference. The oscillations can be described using an analytical model. The results of this experiment also apply to other rf devices with horizontal magnetic fields, such as Wien filters. The precise manipulation of particle spins in storage rings is a prerequisite for measuring the electric dipole moment (EDM) of charged particles.

In this paper, we demonstrate the connection between a magnetic storage ring with additional sextupole fields set so that the x and y chromaticities vanish and the maximizing of the lifetime of in-plane polarization (IPP) for a 0.97-GeV/c deuteron beam. The IPP magnitude was measured by continuously monitoring the down-up scattering asymmetry (sensitive to sideways polarization) in an in-beam, carbon-target polarimeter and unfolding the precession of the IPP due to the magnetic anomaly of the deuteron. The optimum operating conditions for a long IPP lifetime were made by scanning the field of the storage ring sextupole magnet families while observing the rate of IPP loss during storage of the beam. The beam was bunched and electron cooled. The IPP losses appear to arise from the change of the orbit circumference, and consequently the particle speed and spin tune, due to the transverse betatron oscillations of individual particles in the beam. The effects of these changes are canceled by an appropriate sextupole field setting.

The Interface Transparency Thesis (ITT) proposes that people tend to use a canonical interpretation of linguistic expressions, even when this interpretation is sub-optimal for the task at hand. The current paper sought to investigate this claim further by adding a time-pressure manipulation to a quantified sentence verification task and analyzing the results through a computational model of decision-making. The results indicate that time pressure -while effectively changing behavioral responses- does not alter cognitive processes associated with quantifier verification, thus supporting the ITT.

Precision experiments, such as the search for electric dipole moments of charged particles using storage rings, demand for an understanding of the spin dynamics with unprecedented accuracy. The ultimate aim is to measure the electric dipole moments with a sensitivity up to 15 orders in magnitude better than the magnetic dipole moment of the stored particles. This formidable task requires an understanding of the background to the signal of the electric dipole from rotations of the spins in the spurious magnetic fields of a storage ring. One of the observables, especially sensitive to the imperfection magnetic fields in the ring is the angular orientation of stable spin axis. Up to now, the stable spin axis has never been determined experimentally, and in addition, the JEDI collaboration for the first time succeeded to quantify the background signals that stem from false rotations of the magnetic dipole moments in the horizontal and longitudinal imperfection magnetic fields of the storage ring. To this end, we developed a new method based on the spin tune response of a machine to artificially applied longitudinal magnetic fields. This novel technique, called spin tune mapping, emerges as a very powerful tool to probe the spin dynamics in storage rings. The technique was experimentally tested in 2014 using polarized deuterons stored in the cooler synchrotron COSY, and for the first time, the angular orientation of the stable spin axis at two different locations in the ring has been determined to an unprecedented accuracy of better than 2.8 μ rad.

According to logical theories of meaning, a meaning of an expression can be formalized and encoded in truth conditions. Vagueness of the language and individual differences between people are a challenge to incorporate into the meaning representations. In this paper, we propose a new approach to study truth-conditional representations of vague concepts. For a case study, we selected two natural language quantifiers "most" and "more than half." We conducted two online experiments, each with 90 native English speakers. In the first experiment, we tested between-subjects variability in meaning representations. In the second experiment, we tested the stability of meaning representations over time by testing the same group of participants in two experimental sessions. In both experiments, participants performed the verification task. They verified a sentence with a quantifier (e.g., "'Most' of the gleerbs are feezda.") based on the numerical information provided in the second sentence, (e.g., "60% of the gleerbs are feezda"). To investigate between-subject and within-subject differences in meaning representations, we proposed an extended version of the Diffusion Decision Model with two parameters capturing truth conditions and vagueness. We fit the model to responses and reaction times data. In the first experiment, we found substantial between-subject differences in representations of "most" as reflected by the variability in the truth conditions. Moreover, we found that the verification of "most" is proportion-dependent as reflected in the reaction time effect and model parameter. In the second experiment, we showed that quantifier representations are stable over time as reflected in stable model parameters across two experimental sessions. These findings challenge semantic theories that assume the truth-conditional equivalence of "most" and "more than half" and contribute to the representational theory of vague concepts. The current study presents a promising approach to study semantic representations, which can have a wide application in experimental linguistics.

Data commons is an often-used but also ambiguous notion, and aspires to connect the complex notion of ‘data’ with that of the ‘commons’ — a concept with an equally variable and contested meaning. This entry collects and connects several recent contributions to discussions on data commons as a means to foreground several important community-related themes. We take this discursive move to be important because the adjective ‘data’ has the tendency to transform social, communal, and political problems into technological ones that result in confusions between means and ends that endanger the viability of the commons. We discuss four themes that help to re-prioritise community-related interests and problems over their technological solutions. We discuss a data commons relationship to itself (1), its relationship to other commons (2), to capitalism (3), and sustainability (4). We structure the literature on data commons to contextualise, historicise, and politicise data commons, and ultimately understand them as ways of living together (with data) rather than as instruments to manage data.

Abstract Changes in upstream land-use have significantly transformed downstream coastal ecosystems around the globe. Restoration of coastal ecosystems often focuses on local-scale processes, thereby overlooking landscape-scale interactions that can ultimately determine restoration outcomes. Here we use an idealized bio-morphodynamic model, based on estuaries in New Zealand, to investigate the effects of both increased sediment inputs caused by upstream deforestation following European settlement and mangrove removal on estuarine morphology. Our results show that coastal mangrove removal initiatives, guided by knowledge on local-scale bio-morphodynamic feedbacks, cannot mitigate estuarine mud-infilling and restore antecedent sandy ecosystems. Unexpectedly, removal of mangroves enhances estuary-scale sediment trapping due to altered sedimentation patterns. Only reductions in upstream sediment supply can limit estuarine muddification. Our study demonstrates that bio-morphodynamic feedbacks can have contrasting effects at local and estuary scales. Consequently, human interventions like vegetation removal can lead to counterintuitive responses in estuarine landscape behavior that impede restoration efforts, highlighting that more holistic management approaches are needed.

Abstract Climate change adaptation is paramount, but increasing evidence suggests that adaptation action is subject to a range of constraints. For a realistic assessment of future adaptation prospects, it is crucial to understand the timescales needed to overcome these constraints. Here, we combine data on documented adaptation from the Global Adaptation Mapping Initiative with national macro indicators and assess future changes in adaptation constraints alongside the Shared Socioeconomic Pathways, spanning a wide range of future socio-economic development scenarios. We find that even in the most optimistic scenario, it will take until well after 2050 to overcome key constraints, which will limit adaptation for decades to come particularly in vulnerable countries. The persistence of adaptation constraints calls for stringent mitigation, improved adaptation along with dedicated finance and increasing efforts to address loss and damage. Our approach allows to ground truth indicators that can be further used in climate modelling efforts, improving the representation of adaptation and its risk reduction potential.

A recent sampling-based model of causal cognition, the Mutation Sampler, can explain the average responses of participants on a wide variety of tasks (Davis & Rehder, 2020). Careful analysis, however, shows that the predicted response distributions do not match empirical data. As an explanation for the observed response distributions, we propose that people engage in mutation sampling when confronted with a causal query and subsequently integrate this information with a prior. Several theoretical arguments can be made for the notion that people use priors in causal judgements; it is rational and matches the phenomenology of making such judgements. We have modelled this process with a new model called the Bayesian Mutation Sampler (BMS). We fit the BMS to experimental data and find that, in addition to average responses, the BMS explains multiple ‘distributional phenomena’, such as the moderate conservatism of the bulk of responses and the lack of extreme responses.

Assessing global progress on human adaptation to climate change is an urgent priority. Although the literature on adaptation to climate change is rapidly expanding, little is known about the actual extent of implementation. We systematically screened >48,000 articles using machine learning methods and a global network of 126 researchers. Our synthesis of the resulting 1,682 articles presents a systematic and comprehensive global stocktake of implemented human adaptation to climate change. Documented adaptations were largely fragmented, local and incremental, with limited evidence of transformational adaptation and negligible evidence of risk reduction outcomes. We identify eight priorities for global adaptation research: assess the effectiveness of adaptation responses, enhance the understanding of limits to adaptation, enable individuals and civil society to adapt, include missing places, scholars and scholarship, understand private sector responses, improve methods for synthesizing different forms of evidence, assess the adaptation at different temperature thresholds, and improve the inclusion of timescale and the dynamics of responses.

Abstract Tamoxifen may lead to bothersome side effects contributing to non-compliance and decreased quality of life. Patients searching for relief are increasingly turning to cannabinoids such as CBD-oil. However, CBD-oil might affect tamoxifen pharmacokinetics (PK) through CYP2D6 inhibition. The aims of this open-label, single-arm study were (1) to determine the PK profile of tamoxifen when using CBD-oil, and (2) to subsequently investigate whether CBD-oil has a beneficial influence on side effects. Study patients had to have steady-state endoxifen concentrations ≥16 nM (conservative threshold). PK sampling and side effect assessment was done at initiation of CBD-oil and 28 days thereafter. Bio-equivalence could be concluded if the 90% confidence interval (CI) for the difference in endoxifen AUC fell within the [−20%; +25%] interval. The effect of CBD-oil on side effects was evaluated using the FACT-ES questionnaire. Endoxifen AUC decreased after CBD-oil by 12.6% (n = 15, 90% CI −18.7%, −6.1%) but remained within bio-equivalence boundaries. The endocrine sub-scale of the FACT-ES improved clinically relevant with 6.7 points (n = 26, p

While causal reasoning is a core facet of our cognitive abilities, its time-course has not received proper attention. As the duration of reasoning might prove crucial in understanding the underlying cognitive processes, we asked participants in two experiments to make probabilistic causal inferences while manipulating time pressure. We found that participants are less accurate under time pressure, a speed-accuracy-tradeoff, and that they respond more conservatively. Surprisingly, two other persistent reasoning errors-Markov violations and failures to explain away-appeared insensitive to time pressure. These observations seem related to confidence: Conservative inferences were associated with low confidence, whereas Markov violations and failures to explain were not. These findings challenge existing theories that predict an association between time pressure and all causal reasoning errors including conservatism. Our findings suggest that these errors should not be attributed to a single cognitive mechanism and emphasize that causal judgements are the result of multiple processes.

Despite wide variation among natural languages, there are linguistic properties thought to be universal to all or almost all natural languages. Here, we consider universals at the semantic level, in the domain of quantifiers, which are given by the properties of monotonicity, quantity, and conservativity. We investigate whether these universals might be explained by differences in complexity. We generate a large collection of quantifiers, based on a simple yet expressive grammar, and compute both their complexities and whether they adhere to these universal properties. We find that quantifiers satisfying semantic universals are less complex: they have a shorter minimal description length.

While research indicates that people are skilled causal reasoners, systematic deviations from the normative causal Bayesian network model have been observed. These include Markov violations, failures to ‘explain away’, and conservative responding. Different processes have been posited to account for these violations: sampling, associative reasoning, and heuristics. These processes entail effects of response time. To test the relationships between these theories, normative violations, and reasoning time we conducted a causal reasoning study employing time pressure manipulations and response time measurements. Our results show that time pressure decreases overall accuracy. Crucially, we find that time pressure does not affect the magnitude Markov independence violations. This is not what many existing explanations would predict. We find evidence that participants’ responses result from two separate cognitive processes and that time pressure modulates their relative contribution to responses. Hence we provide an explanation of non-normative reasoning patterns based on a mixture of cognitive processes.

People’s causal judgments exhibit substantial variability, but the processes that lead to this variability are not currently understood. In this paper, we use a repeated-measures design to study the within-participant variability of conditional probability judgments in common-cause networks. We establish that these judgments indeed exhibit substantial within-participant variability. This variability differs by inference type and is related to the extent to which participants commit Markov violations. The consistency and systematicity of this variability suggest that it may be an important source of evidence for the cognitive processes that lead to causal judgments. The systematic study of both within- and between-person variability broadens the scope of behavior that can be studied in causal cognition and promotes the evaluation of formal models of the underlying process. The data and methods provided in this paper provide tools to enable the further study of within-participant variability in causal judgment.

Estimating parameters of cognitive models is crucial to be able to accurately describe cognitive processing of individuals, under varying circumstances. To ensure that individual parameter estimates represent individual cognitive processes, it is important to consider model identification and specific influence. Model identification refers to whether a unique set of parameter estimates is associated with a particular pattern in the data; Specific influence means that certain experimental manipulations affect only specific cognitive processes, reflected in changes in only those parameters that represent those processes, and not others. These two general concepts also apply to cognitive models of more applied tasks and settings, such as driving. In the current work, we specifically test whether these two requirements hold in a commonly used cognitive model of visual control of steering behavior. For this model, we test the identifiability, and then estimate parameters of two experiments to understand how cognitive load and driving speed specifically influence parameter estimates of the model. The results indicate that the two-point visual control of steering model is identified, and that cognitive load and driving speed are related to different parameters.

In skill acquisition, instructing individuals the stimulus-response mappings indicating how to perform and act, yields better performance. Additionally, performance is helped by repeated practice. Whether providing instructions and repeated practice interact to achieve optimal performance remains debated. This paper addresses that question by analyzing the learning curves of individuals learning stimulus-response mappings of varying complexity. We particularly focus on the question whether instructions lead to improved performance in the longer run. Via evidence accumulation modeling, we find no evidence for this assertion. Instructions seem to provide individuals with a head start, leading to better initial performance in the early stages of learning, without long-lasting effects on behavior. We discuss the results in light of related studies that do report long-lasting effects of instructions, and propose that the complexity of a skill determines whether long-lasting benefits of initial instructions exist.

Psycholinguistic studies have repeatedly demonstrated thatdownward entailing (DE) quantifiers are more difficult to pro-cess than upward entailing (UE) ones. We contribute to thecurrent debate on cognitive processes causing the monotonic-ity effect by testing predictions about the underlying processesderived from two competing theoretical proposals: two-stepand pragmatic processing models. We model reaction timesand accuracy from two verification experiments (a sentence-picture and a purely linguistic verification task), using the dif-fusion decision model (DDM). In both experiments, verifica-tion of UE quantifier more than half was compared to verifica-tion of DE quantifier fewer than half. Our analyses revealedthe same pattern of results across tasks: Both non-decisiontimes and drift rates, two of the free model parameters of theDDM, were affected by the monotonicity manipulation. Thus,our modeling results support both two-step (prediction: non-decision time is affected) and pragmatic processing models(prediction: drift rate is affected).

Background Diagnostic delay in patients with pulmonary embolism (PE) is typical, yet the proportion of patients with PE that experienced delay and for how many days is less well described, nor are determinants for such delay.Objectives This study aimed to assess the prevalence and extent of delay in diagnosing PE.Methods A systematic literature search was performed to identify articles reporting delays in diagnosing PE. The primary outcome was mean delay (in days) or a percentage of patients with diagnostic delay (defined as PE diagnosis more than seven days after symptom onset). The secondary outcome was determinants of delay. Random-effect meta-analyses were applied to calculate a pooled estimate for mean delay and to explore heterogeneity in subgroups.Results The literature search yielded 10,933 studies, of which 24 were included in the final analysis. The pooled estimate of the mean diagnostic delay based on 12 studies was 6.3 days (95% prediction interval 2.5 to 15.8). The percentage of patients having more than seven days of delay varied between 18% and 38%. All studies assessing the determinants of coughing (n = 3), chronic lung disease (n = 6) and heart failure (n = 8) found a positive association with diagnostic delay. Similarly, all studies assessing recent surgery (n = 7) and hypotension (n = 6), as well as most studies assessing chest pain (n = 8), found a negative association with diagnostic delay of PE.Conclusion Patients may have symptoms for almost one week before PE is diagnosed and in about a quarter of patients, the diagnostic delay is even longer.

In order to assess the risk of SARS-CoV-2 infection, transmission and reservoir development in swine, we combined results of an experimental and two observational studies. First, intranasal and intratracheal challenge of eight pigs did not result in infection, based on clinical signs and PCR on swab and lung tissue samples. Two serum samples returned a low positive result in virus neutralization, in line with findings in other infection experiments in pigs. Next, a retrospective observational study was performed in the Netherlands in the spring of 2020. Serum samples (N =417) obtained at slaughter from 17 farms located in a region with a high human case incidence in the first wave of the pandemic. Samples were tested with protein micro array, plaque reduction neutralization test and receptor-binding-domain ELISA. None of the serum samples was positive in all three assays, although six samples from one farm returned a low positive result in PRNT (titers 40–80). Therefore we conclude that serological evidence for large scale transmission was not observed. Finally, an outbreak of respiratory disease in pigs on one farm, coinciding with recent exposure to SARS-CoV-2 infected animal caretakers, was investigated. Tonsil swabs and paired serum samples were tested. No evidence for infection with SARS-CoV-2 was found. In conclusion, Although in both the experimental and the observational study few samples returned low antibody titer results in PRNT infection with SARS-CoV-2 was not confirmed. It was concluded that sporadic infections in the field cannot be excluded, but large-scale SARS-CoV-2 transmission among pigs is unlikely.

IntroductionAbscessation of equine head lymph nodes can be caused by various bacteria, but Streptococcus equi subsp. equi is mainly involved. At our laboratory, samples of three unrelated horses with submandibular abscesses were found negative for S. equi, and further testing proved the presence of another genus. This raised the question for the exact identity of this pathogen and whether these isolates were epidemiologically related and it warranted further characterization with regards of virulence and resistance factors.MethodsCulture followed by identification using MALDI-TOF MS, MIC testing and whole genome sequencing (WGS) was performed to characterize the bacteria.ResultsBacterial culture and subsequent identification with MALDI-TOF MS resulted in the reliable identification of A. denticolens in two of the three cases. Final confirmation of A. denticolens for all three isolates was achieved by analysis of the WGS data, supported by multilocus sequence typing (MLST). The three isolates showed 95% nucleotide sequence identity. The number of single nucleotide polymorphisms (10,170 to 36,058) indicated that the isolates were not clonal, suggesting that these cases were epidemiologically unrelated. Only four known virulence related genes were detected. The absence of known antibiotic resistance genes was in line with the high susceptibility, as indicated by the susceptibility patterns obtained for two of the three isolates.ConclusionWe conclude that A. denticolens should be included in the differential diagnosis of (submandibular) lymph node abscessation in horses, especially if strangles cannot be confirmed with laboratory diagnostics. Furthermore, we report the first draft genome of A. denticolens isolated from horses.

In countries endemic for foot-and-mouth disease (FMD), routine or emergency vaccinations are strategic tools to control the infection. According to the WOAH/FAO guidelines, a prior estimation of vaccine effectiveness is recommendable to optimize control programs. This study reports the results of a small-scale immunogenicity study performed in Transcaucasian Countries. Polyvalent vaccines, including FMDV serotypes O, A (two topotypes) and Asia1 from two different manufacturers, were evaluated in Georgia, Azerbaijan and Armenia. Naïve large and small ruminants were vaccinated once and a subgroup received a second booster dose. The titers of neutralizing antibodies in sera collected sequentially up to 180 DPV were determined through the Virus Neutralization Test versus homologous strains. This study led to the estimate that both the vaccines evaluated will not induce a protective and long-lasting population immunity, even after a second vaccination, stressing that consecutive administrations of both vaccines every three months are mandatory if one aspires to achieve protective herd immunity.