bluuebunny/crossref_metadata_2025 huggingface dataset:
Profile of retired employees of civil service attending pension management office in Nepal
Authors: Hamal Achyut Bikram , Shah Mausam , Hamal Arjun B , Shah Jharana
Published: August 2020

The retirement decision can significantly affect an individual's well‐being for many years. There are many reasons and issues for retirement decision for a government official. Financial and health concerns are a major part of the retirement decision but there are other issues that bring about the retirement decision that are unrelated to an individual's financial and health status. In Nepal, majority of government workers have compulsory retirement due to age concern. To study the profile of the retired employees and their perception toward retirement. A descriptive cross‐sectional research methodology was used in this study. About 85% (out of 105) of the retired employees attending Pension Management Office were male, which was due to the absence of female inclusiveness in employment before 2006. There were several reasons for retirement. The most common reason for being retired was the compulsory retirement, which was followed by the reasons of poor health and family problems, each counting about 14.2%. Most of the retired employees, that is, 48.5% (51) rated the retirement program as fair and about 42% (44) rated it as poor. Preserving the skilled and productive manpower in civil service is equally important as the nation has greater effort in building them up in terms of career and capacity.
Integrated genetic and epigenetic analysis of cancer‐related genes in non‐ampullary duodenal adenomas and intramucosal adenocarcinomas
Authors: Ota Ryosuke , Sawada Takeshi , Tsuyama Sho , Sasaki Yasushi , Suzuki Hiromu , Kaizaki Yasuharu , Hasatani Kenkei , Yamamoto Eiichiro , Nakanishi Hiroyoshi , Inagaki Satoko , Tsuji Shigetsugu , Yoshida Naohiro , Doyama Hisashi , Minato Hiroshi , Nakamura Keishi , Kasashima Satomi , Kubota Eiji , Kataoka Hiromi , Tokino Takashi , Yao Takashi , Minamoto Toshinari
Published: August 2020

The molecular and clinical characteristics of non‐ampullary duodenal adenomas and intramucosal adenocarcinomas are not fully understood because they are rare. To clarify these characteristics, we performed genetic and epigenetic analysis of cancer‐related genes in these lesions. One hundred and seven non‐ampullary duodenal adenomas and intramucosal adenocarcinomas, including 100 small intestinal‐type tumors (90 adenomas and 10 intramucosal adenocarcinomas) and 7 gastric‐type tumors (2 pyloric gland adenomas and 5 intramucosal adenocarcinomas), were investigated. Using bisulfite pyrosequencing, we assessed the methylation status of CpG island methylator phenotype (CIMP) markers and MLH1. Then using next‐generation sequencing, we performed targeted exome sequence analysis within 75 cancer‐related genes in 102 lesions. There were significant differences in the clinicopathological and molecular variables between small intestinal‐ and gastric‐type tumors, which suggests the presence of at least two separate carcinogenic pathways in non‐ampullary duodenal adenocarcinomas. The prevalence of CIMP‐positive lesions was higher in intramucosal adenocarcinomas than in adenomas. Thus, concurrent hypermethylation of multiple CpG islands is likely associated with development of non‐ampullary duodenal intramucosal adenocarcinomas. Mutation analysis showed that APC was the most frequently mutated gene in these lesions (56/102; 55%), followed by KRAS (13/102; 13%), LRP1B (10/102; 10%), GNAS (8/102; 8%), ERBB3 (7/102; 7%), and RNF43 (6/102; 6%). Additionally, the high prevalence of diffuse or focal nuclear β‐catenin accumulation (87/102; 85%) as well as mutations of WNT pathway components (60/102; 59%) indicates the importance of WNT signaling to the initiation of duodenal adenomas. The higher than previously reported frequency of APC gene mutations in small bowel adenocarcinomas as well as the difference in the APC mutation distributions between small intestinal‐type adenomas and intramucosal adenocarcinomas may indicate that the adenoma–carcinoma sequence has only limited involvement in duodenal carcinogenesis. © 2020 The Authors. The Journal of Pathology published by John Wiley & Sons, Ltd. on behalf of The Pathological Society of Great Britain and Ireland.
CAR T‐cell therapy‐related neurotoxicity in paediatric acute lymphocytic leukaemia
Authors: Tan Ai Peng
Published: August 2020

Background

The advent of chimeric antigen receptor (CAR) T‐cell therapy has created a paradigm shift in the management of patients with refractory B‐cell acute lymphocytic leukaemia (ALL). The aim of this study is to correlate imaging findings of CAR T‐cell therapy related neurotoxicity with clinical course and eventual clinical outcome, with the hope that it will bring us a step closer to the identification of potential imaging biomarkers that may allow more accurate prognostication and risk stratification of patients.

Procedure

Our imaging database was queried from January 2018 to April 2020 to identify paediatric patients who fulfil the following criteria: (a) diagnosed with ALL, (b) underwent CAR T‐cell therapy, and (c) had magnetic resonance imaging (MRI) brain studies performed before and after CAR T‐cell therapy. A total of seven patients were included and all MRI studies were analysed by a paediatric neuroradiologist for the presence of acute neuroimaging findings post CAR T‐cell infusion. Acute neuroimaging findings are defined as new imaging findings detected within 28 days of CAR T‐cell infusion.

Results

Three out of four patients with acute neuroimaging findings had sustained complete remission for more than 6 months, while all three patients without acute neuroimaging findings had positive minimal residual disease (MRD) within 1 month. Both patients with acute diffuse leptomeningeal enhancement showed clinical improvement within 1‐2 days.

Conclusions

Acute neuroimaging findings may be a potential imaging biomarker for peak neurotoxicity and treatment response, and it is not necessarily associated with poor outcome, as previously reported.
Tuberculosis drug safety and pharmacovigilance in health system of Kosova: A cross‐sectional analysis
Authors: Krasniqi Shaip , Neziri Burim , Jakupi Arianit , Shurdhaj Ismajl , Daci Armond , Jupolli‐Krasniqi Nora , Pira Mimoza
Published: August 2020

Background

Tuberculosis (TB) remains a significant worldwide social and life‐threatening epidemiological problem. Because this disease requires multiple drug treatment and prolonged therapy for several months, followed by a high probability of adverse effects (AEs), we assessed AE monitoring for anti‐TB drugs in the Health Care System of Kosova.

Methods

This survey was a cross‐sectional analysis performed at the primary, secondary and tertiary health care levels in Kosova. We included 930 registered tuberculosis patients within three levels of this health system in our study. Furthermore, we interviewed 62 physicians and 71 nurses at TB health facilities. Data were collected from official TB registers and personal contact with patients for 12 months.

Results

The representative age group was 19 to 29 years (30.49%), followed by a group of patients aged >60 years (23.23%). Among 930 patients treated with TB drugs, the total incidence of adverse AEs was 29.03%. Female TB patients had a higher rate of AEs than did male patients (33.56% vs 28.84%, respectively). The highest incidence of registered AEs was recorded in the gastrointestinal system (270, 80.83%), followed by the central nervous system (CNS, 7.50%) and was lower in other organ systems. The reporting of anti‐TB drug effects by medical staff (TB medical doctor and TB medical nurse) at different levels of TB medical settings occurred among 62.90% of medical doctors and 81.69% of nurses. Only 53.23% of medical doctors and 46.48% of nurses completed pharmacovigilance training.

Conclusion

The pharmacovigilance approach in Health System of Kosova is not comprehensible and not systematic. The relatively low incidence of AEs among TB patients is due under reporting of these by medical staff. The knowledge, attitudes, and adherence of medical staff reveal low awareness for pharmacovigilance activities, and this concern should be addressed to reinforce this important issue for the safe treatment of TB patients.
Effect of ammonium polyphosphate and acrylic acid onNaCltreated electrospunPLAmicrofiber mat
Authors: Yoon Chang Ki , Ko Se Jun , Jeon Ji Ho , Lee Woo Il
Published: August 2020

In this study, insulation material was developed using polylactic acid (PLA), which is one of the most widely‐used biodegradable polymers. The PLA was fabricated into a fiber mat shape using the electrospinning method, and NaCl salt was added to achieve thinner fiber diameter. This fiber‐based mat showed lower thermal conductivity than PLA blocks but had poor tensile strength and heat stability. To improve these mechanical and thermal properties, ammonium polyphosphate (APP) and acrylic acid (AA) were added; AA was used to better bond the APP with the polymer matrix. The APP/AA mixed PLA fiber mat showed improved performance overall; with the addition of these materials, the thermal conductivity was about 35 mW/mK, which was slightly lower than before, the tensile stress improved about two times. Thermal stability was also augmented as the increase in the weight percentage of the sample residue after the thermogravimetric analysis indicated.
Towards a tiered test strategy for plant protection products to address mixture toxicity by alternative approaches in human health assessment
Authors: Bloch Denise , Marx‐Stoelting Philip , Martin Sabine
Published: August 2020

Plant protection products (PPPs) consist of pesticide active substances and co‐formulants. Generally, active substance effects are assumed to dominate in PPP toxicity. Nevertheless, co‐formulants may well affect the toxicity of PPPs via toxicodynamic and toxicokinetic interaction. To account for potential mixture effects and improve PPP data requirements for application in risk assessment, a tiered test strategy is proposed. The strategy is based on a comparison of PPP and active substance toxicity, which enables the prioritisation of PPPs for further testing, adaptation of the toxicological threshold value or removal of toxic co‐formulants from the PPP. Moreover, it focuses on the integrative assessment of existing information and newly generated data using alternative test methods. The proposed strategy will improve PPP toxicological assessment by accounting for mixture toxicity, providing a set of regulatory options for risk assessment and the necessary data for hazard assessment. The predictivity of alternative methods for PPPs will improve by evaluation of their reliability and uncertainty. © 2020 The Authors. Pest Management Science published by JohnWiley & Sons Ltd on behalf of Society of Chemical Industry.
Photovoltaic Response and Charge Redistribution Processes in GaAs/AlGaAs Multiple‐Quantum Wells Structure
Authors: Haldar Subhomoy , Kumar Shailendra , Roychowdhury Rijul , Dixit Vijay Kumar
Published: August 2020

The impact of radiative and non‐radiative processes on the photovoltaic response of GaAs/AlGaAs multiple‐quantum wells is investigated by temperature, excitation power, and chopping‐frequency‐dependent surface photovoltage (SPV) measurements. It is shown that a systematic study of SPV amplitude along with phase spectra can provide important information on thermal escape, carrier localization, and spatial redistribution of charge carriers. Characteristic features in SPV‐phase spectra related to quantum well (QW) transitions and their variation under an external perturbation are explained by the electron–electron interaction. It is found that a many‐body interaction inside the QW is responsible for the capture of charges at the heterointerfaces, which builds up an interface electric field and hinders the drift/diffusion of charges. Such an effect becomes dominant under higher excitation powers, causing a sub‐linear enhancement of photovoltage amplitude and an increase in phase delay as a function of photon flux. From the chopping‐frequency‐dependent SPV measurements, it is concluded that carriers during the drift in barrier layers are repeatedly captured by point defects and other QWs, which enhances the effective time response of the photovoltage signal. Results obtained in this study are beneficial in the engineering of quantum structures for high‐efficiency photovoltaics and non‐invasive characterization of electro‐optical processes.
Structural and energetic properties of RMX3‐NH3 complexes
Authors: Phillips James A. , Ley Anna R. , Treacy Patrick W. , Wahl Benjamin M. , Zehner Brittany C. , Donald Kelling J. , Gillespie Samuel
Published: August 2020

We have explored the structural and energetic properties of a series of RMX3‐NH3 (M=Si, Ge; X=F, Cl; R=CH3, C6H5) complexes using density functional theory and low‐temperature infrared spectroscopy. In the minimum‐energy structures, the NH3 binds axially to the metal, opposite a halogen, while the organic group resides in an equatorial site. Remarkably, the primary mode of interaction in several of these systems seems to be hydrogen bonding (C‐H‐‐N) rather than a tetrel (N→M) interaction. This is particularly clear for the RMCl3‐NH3 complexes, and analyses of the charge distributions of the acid fragment corroborate this assessment. We also identified a set of metastable geometries in which the ammonia binds opposite the organic substituent in an axial orientation. Acid fragment charge analyses also provide a clear rationale as to why these configurations are less stable than the minimum‐energy structures. Matrix‐isolation infrared spectra provide clear evidence for the occurrence of the minimum‐energy form of CH3SiCl3–NH3, but analogous results for CH3GeCl3–NH3 are less conclusive. Computational scans of the M‐N distance potentials for CH3SiCl3–NH3 and CH3GeCl3–NH3, both in the gas phase and bulk dielectric media, reveal a great deal of anharmonicity and a propensity for condensed‐phase structural change.
Fractionation of stable oxygen and clumped isotopes during acid digestion of calcite in the presence of an external direct current electric field
Authors: Banerjee Sanchita , Ghosh Prosenjit , Pramanik Chirantan , Reddy B Subba
Published: August 2020

Rationale

Phosphoric acid digestion of carbonate generates CO2 for stable oxygen and clumped isotope analysis using a gas source isotope ratio mass spectrometer. The initial step of the digestion reaction is protonation of calcite while the product CO2 equilibrates with the system allowing further exchange of isotopes to various extents depending on the nature of the acid digestion methods. An external electric field is introduced in the break seal method to demonstrate the role of the protonation reaction and the post‐digestion isotopic exchanges in the final isotopic composition of product CO2.

Methods

An acid digestion experiment following the break seal method was conducted at a constant temperature of 25 ± 0.5°C in the presence of a uniform external electric field of 0.5 kV/cm within a specially fabricated corona chamber. Replicate samples of a calcite powder of a reference standard (MAR J1) were reacted for 24 h in the presence and absence of an external electric field for varying exposure times (6 to 24 h) and the evolved CO2 was analyzed using a dual‐inlet MAT 253 isotope ratio mass spectrometer.

Results

The CO2 yield from the phosphoric acid digestion of MAR J1 calcite was 20% lower during the reaction in presence of an electric field for an exposure time of 24 h, while the corresponding δ18O value and Δ47 composition were 0.3‰ and 0.1‰ less, respectively, than without any electric field.

Conclusions

We documented the systematic control of oxygen and clumped isotope ratios in CO2 evolved from the carbonate acid digestion reaction with varying exposure time to the external electric field. We provide a new method involving use of an external electric field to manipulate the isotopic fractionation during the acid digestion reaction of calcite. The experimental observation enabled theoretical understanding of the reaction mechanism of carbonate with phosphoric acid which will be useful for stable and clumped isotope studies.
Charting a path between firm‐specific incentives and human capital‐based competitive advantage
Authors: Kryscynski David , Coff Russ , Campbell Benjamin
Published: August 2020

Research Summary

Scholars have long recognized the theoretical and practical implications of firm‐specific human capital. However, we highlight that firm‐specific incentives (i.e., worker incentives that provide more utility to workers in the focal firm than similar incentives available at other employers) provide an important pathway to competitive advantages that has not been comprehensively examined in the extant organizational research. We address this gap by (a) defining firm‐specific incentives and showing why they are different from incentive conceptualizations and typologies in the extant literature, (b) articulating potential origins of firm‐specific incentives, and (c) formally proposing the conditions under which firm‐specific incentives facilitate human capital‐based competitive advantages. In so doing, we develop a cohesive theoretical framework of incentive‐based competitive advantage that integrates across multiple literatures.

Managerial Summary

Just as companies differentiate their products by creating unique value for customers, they also create unique value for their employees. Some companies do this by offering employee incentives, perks, and benefits that are highly unique to the company and difficult for other companies to imitate. These unique incentives, perks, and benefits can help these companies to attract, motivate, and retain top talent at a financial discount and, accordingly, can help these companies realize competitive advantages over their rivals.
Effect of Hot‐Deformation Processes on Phase Transformation of Low‐Alloyed, Multiphase, High‐Strength Steel
Authors: Li Dazhao , Yan Zhijie , Wang Rui , Kang Yan , Shen Liyuan
Published: August 2020

Low‐alloyed, multiphase, high‐strength steels are strong and tough with good weldabilities and high cost‐to‐performance ratios. They have long‐term research value and broad application prospects. However, there are many types of phase transformations and complicated transformation processes that occur in these steels, which must be studied in detail. Understanding the phase transformations and their relationships to the mechanical properties of steels can theoretically facilitate material property enhancement and support the application and production of such steels. Herein, a Gleeble‐3800 thermosimulation test system is used to simulate the rolling process with different hot‐rolling process parameters. The effects of various parameters, such as the deformation, temperature, and velocity, on the phase‐transformation process and microstructural characteristics of low‐alloyed, multiphase, high‐strength steel are studied under hot deformation and subsequent cooling. The results show that low‐alloyed, multiphase, high‐strength steels generally undergo multiple types of phase transformations in a fixed order. The conditions during hot deformation have a critical influence on the phase transformation, i.e., they change the order of the phase transformations by promoting or suppressing certain phase‐transformation types. This causes different phase‐transformation types to predominate and results in different steel microstructures.
Mechanical Performance‐Based Optimum Design of High Carbon Pearlitic Steel by Particle Swarm Optimization
Authors: Qiao Ling , Wang Zibo , Wang Yuan , Zhu Jingchuan
Published: August 2020

Herein, particle swarm optimization is used to quickly acquire the optimal composition range for pearlitic steel. Four groups within the obtained composition range are selected to prepare the steel. Microstructural and mechanical analyses of pearlitic steel are performed, and the results emphasize the significant impacts of elemental Si. The refinement of pearlite interlamellar spacing with degenerated morphology is found to be more prominent for samples with higher Si concentration. The benefit of micro‐alloying on increasing microhardness can be achieved by additive elemental Si, which correspondingly brings about the improving tensile strength and yield strength. Then, a correlation between the evolving microstructure and the resulting mechanical properties is made that satisfies the Hall–Petch relationship. For a full pearlite microstructure, the failure mechanisms are also identified, where the fracture morphology is characterized by a mixed mechanism of brittle and quasi‐cleavage features. However, a thermodynamic analysis is performed to reveal the characteristics of phase transformation induced by elemental Si. Simulation and experimental results show that this approach can effectively generate promising performance features.
Angler Experience and Seasonal Effects on the Response of the Lake Sturgeon to Catch‐and‐Release Angling
Authors: Mullen Eric J. , Schoen Alexandra N. , Hauger McKenzie D. , Murray Lee , Anderson W. Gary
Published: August 2020

Lake Sturgeon Acipenser fulvescens, once widespread throughout North America, are now considered endangered in much of their natural range. However, recreational catch‐and‐release (C&R) fisheries targeting the Lake Sturgeon have developed in areas with strong populations. Here, we evaluated physiological and behavioral impairment of Lake Sturgeon after C&R angling. Fish were angled from the Winnipeg River and transferred to a holding pen to recover and facilitate serial sampling after angling. Measured physiological traits included blood osmolality, pH, glucose, and cortisol concentration. Behavioral impairment was measured as a binary score using reflex action mortality predictors in addition to ventilation rate. The effects of season and angler experience on these measured variables were assessed. Catch‐and‐release angling resulted in an immediate physiological stress response and behavioral impairment in all Lake Sturgeon regardless of treatment. Generally, we observed a recovery in acid–base balance, ion balance, and reflex impairment by 24 h; however, cortisol and glucose were elevated throughout the recovery period, possibly indicating interactive stressors of holding and repeat sampling. Angling in the summer period caused increased ventilation rate and decreased osmolality at all timepoints compared to angling in the spring. In comparison with experienced anglers, novice anglers caused higher reflex impairment in Lake Sturgeon immediately after capture. This is the first study to examine the response of wild Lake Sturgeon to C&R angling. Data show an apparent resilience of Lake Sturgeon to C&R and can be used to assess the validity of C&R as a management strategy in the conservation of Lake Sturgeon.
Integrated optimal wind‐resistant design of super‐tall structures with toggle‐brace damper systems
Authors: Zhao Xin , Guo Junchen , Ma Haojia , Ding Kun
Published: August 2020

With the increasing heights of super‐tall buildings, the natural frequency of these structures approaches the predominant frequency of winds, causing the structures to be more sensitive to wind load. For the safety and economy of these structures, the formulation of a reasonable wind‐resistant design is crucial. In this paper, an optimal design of toggle‐brace damper systems for super‐tall buildings using a damping ratio limit method is presented to obtain the optimal placement, number, and damping coefficient of toggle‐brace dampers under different constraints. The constraints include the additional damping ratio under a 50‐year return period wind, the maximum power of the damper under a 50‐year return period wind, and the maximum output force of a moderate earthquake. The toggle‐brace damper systems improve the structural performance. Hence, the structural components produce design redundancy, which can be optimized using the sequential quadratic programming (SQP) algorithm and a multi‐grade constrained optimal design method to further improve the economic benefits of the structure. Based on the combination of the optimal design method of toggle‐brace damper systems, SQP algorithm, and multi‐grade constrained optimal design method, an integrated optimal wind‐resistant design for toggle‐brace damper systems is proposed. To demonstrate the effectiveness and applicability of this design, a 245‐m super‐tall building is employed as an engineering case.
Genome‐wide mapping and prediction of plant architecture in a sorghum nested association mapping population
Authors: Olatoye Marcus O. , Hu Zhenbin , Morris Geoffrey P.
Published: August 2020

Modifying plant architecture is often necessary for yield improvement and climate adaptation, but we lack understanding of the genotype‐phenotype map for plant morphology in sorghum. Here, we use a nested association mapping (NAM) population that captures global allelic diversity of sorghum to characterize the genetics of leaf erectness, leaf width (at two stages), and stem diameter. Recombinant inbred lines (n = 2200) were phenotyped in multiple environments (35,200 observations) and joint linkage mapping was performed with ∼93,000 markers. Fifty‐four QTL of small to large effect were identified for trait BLUPs (9–16 per trait) each explaining 0.4–4% of variation across the NAM population. While some of these QTL colocalize with sorghum homologs of grass genes (e.g., those involved in transcriptional regulation of hormone synthesis [rice SPINDLY] and transcriptional regulation of development [rice Ideal plant architecture1]), most QTL did not colocalize with an a priori candidate gene (92%). Genomic prediction accuracy was generally high in five‐fold cross‐validation (0.65–0.83), and varied from low to high in leave‐one‐family‐out cross‐validation (0.04–0.61). The findings provide a foundation to identify the molecular basis of architecture variation in sorghum and establish genomic‐enabled breeding for improved plant architecture.
Exploiting molecular probes to perform near‐infrared fluorescence‐guided surgery
Authors: Wu Yifan , Zhang Fan
Published: August 2020

Near‐infrared (NIR) fluorescence imaging can provide real‐time navigation for surgeons to discriminate boundaries between lesions and healthy tissue, which serves as a promising tool to enhance precise diagnosis and accurate excision during surgery. Molecular probes with NIR fluorescence can visualize diseased tissue in deep penetration with improved signal‐to‐noise ratio, which considerably encourages the active participation of NIR fluorescence‐guided surgery in the operating room. Although a great quantity of fluorescent probes has been employed in clinical trials, the U.S. Food and Drug Administration only approves an extremely narrow number of contrast agents for clinical use so far. Currently, there remain two significant problems to be addressed in surgical resection: accurate identification of diseased tissue and the preservation of adjacent vital structures. Here, molecular probes with NIR fluorescence are systematically reviewed to offer possible solutions to these two problems. Targeting strategies of fluorescent probes are introduced, where the strengths and weaknesses of each strategy are presented. Advances in fluorescent probes for the imaging of vital structures, such as nerve and ureter, are also summarized in this review. It is convinced that NIR fluorescence‐guided surgery has the potential to improve current surgical resection and ameliorate the postoperative outcomes of diverse diseases.
Thermoplastic polyurethane (TPU) modifier to develop bimodal cell structure in polypropylene/TPUmicrocellular foam in presence of supercriticalCO2
Authors: Wang Jie , Li Jun , Li Hui , Zhou Hongfu
Published: August 2020

Currently, the fabrication of microcell and bimodal cell structures (BCS) in polymer foams by using supercritical fluids has become a hot as well as a challenging research area worldwide. In this work, an environmentally friendly, effective, facile, and CO2‐based foaming technique was presented to fabricate microcellular polypropylene (PP) foams with BCS via blending with thermoplastic polyurethane (TPU). The toughness, thermal properties, rheological properties, and foamability of PP were systematically investigated with gradual incorporation of TPU. Representative sea‐island structure was observed in the scanning electron microscopy (SEM) images for the fracture surface of various PP/TPU samples. Rheological measurement results demonstrated that the viscoelasticity of various PP/TPU samples was improved remarkably compared with that of pure PP and pure TPU. The impact strength of various PP/TPU samples possessed the highest value as 12.4 kJ/m2with the TPU content of 15 wt%. After the addition of TPU, an ameliorative cellular morphology was observed in the SEM micrographs of various PP/TPU samples and their volume expansion ratio was enhanced significantly thanks to their improved melt elasticity. Moreover, it is worth noting that BCS appeared in various PP/TPU foams when the TPU content exceeded 5 wt%.
The clinical and educational outcomes of an inter-professional student-led medication review team, a pilot study
Authors: Reumerman Michael O. , Richir Milan C. , Domela Nieuwenhuis Philippe M. , Sultan Rowan , Daelmans Hester E. M. , Springer Hans , Muller Majon , van Agtmael Michiel A. , Tichelaar Jelle
Published: August 2020

Aims

The involvement of an inter-professional healthcare student team in the review of medications used by geriatric patients could not only provide patients with optimized therapy but also provide students with a valuable inter-professional learning experience. We describe and evaluate the clinical and learning outcomes of an inter-professional student-run mediation review program (ISP).

Subject and method

A variable team consisting of students in medicine, pharmacy, master advanced nursing practice, and master physician assistant reviewed the medication lists of patients attending a specialized geriatric outpatient clinic.

Results

During 32 outpatient visits, 188 medications were reviewed. The students identified 14 medication-related problems, of which 4 were not recognized by healthcare professionals. The ISP team advised 95 medication changes, of which 68 (71.6%) were directly implemented. Students evaluated this pilot program positively and considered it educational (median score 4 out of 5) and thought it would contribute to their future inter-professional relationships.

Conclusion

An inter-professional team of healthcare students is an innovative healthcare improvement for (academic) hospitals to increase medication safety. Most formulated advices were directly incorporated in daily practice and could prevent future medication-related harm. The ISP also offers students a first opportunity to work in an inter-professional manner and get insight into the perspectives and qualities of their future colleagues.
Decreased hemoglobin as a quantifiable indicator of renal arterial embolization in post-percutaneous nephrolithotomy hemorrhage
Authors: Ran Ruitu , Zhang Ruiyuan , Xie Ye , Yin Zhikang
Published: August 2020

To determine quantifiable indicators for post-percutaneous nephrolithotomy (PCNL) renal arterial embolization. A total of 2043 patients who underwent PCNL from September 2012 to March 2018 were reviewed retrospectively. Post-operative hemorrhage patients were extracted and divided into two groups according to treatment methods (conservative methods or super-selective renal arterial embolization [SRAE]). Demographic characteristics and hemorrhage outcomes were compared between the two groups by univariable analysis. Multivariable logistic regression was used to reveal the association between hemorrhage outcome factors and SRAE. A receiver operating characteristic (ROC) curve was drawn to determine the optimized cut-off value for SRAE. We identified 71 patients who had post-PCNL hemorrhage. Seventeen and 54 patients comprised the SRAE and conservative groups, respectively. No significant differences in demographic characteristics were found between the two groups. Univariate analysis showed that the differences in decreased hemoglobin (Hb), hemorrhage types, and transfusion were significant between the two groups (p < 0.001). Multivariable analysis showed that the decreased Hb was closely associated with the risk of SRAE. The ROC curve showed that an adjusted Hb decrease of 3.45 g/dL was an optimum indicator (AUC = 0.925). Decreased Hb is an indicator for SRAE after PCNL. When the adjusted decrease in Hb is ≥ 3.45 g/dL, SRAE should be performed regardless of the manifestations of hemorrhage.
National diabetes registries: do they make a difference?
Authors: Bak Jessica C. G. , Serné Erik H. , Kramer Mark H. H. , Nieuwdorp Max , Verheugt Carianne L.
Published: August 2020

Aims

The global epidemic of diabetes mellitus continues to expand, including its large impact on national health care. Measuring diabetes outcomes and their causes of variation highlights areas for improvement in care and efficiency gains; large registries carry this potential. By means of a systematic review, we aimed to give an overview of national registries worldwide by quantifying their data and assessing their influence on diabetes care.

Methods

The literature on MEDLINE up to March 31, 2020, was searched, using keywords diabetes mellitus, national, registry, registration, and/or database. National disease-specific registries from corresponding articles were included. Database characteristics and clinical variables were obtained. All registries were compared to the ICHOM standard set of outcomes.

Results

We identified 12 national clinical diabetes registries, comprising a total of 7,181,356 diabetic patients worldwide. Nearly all registries recorded weight, HbA1c, lipid profile, and insulin treatment; the recording of other variables varied to a great extent. Overall, registries corresponded fairly well with the ICHOM set. Most registries proved to monitor and improve the quality of diabetes care using guidelines as a benchmark. The effects on national healthcare policy were more variable and often less clear.

Conclusions

National diabetes registries confer clear insights into diagnostics, complications, and treatment. The extent to which registries influenced national healthcare policy was less clear. A globally implemented standard outcome set has the potential to improve concordance between national registries, enhance the comparison and exchange of diabetes outcomes, and allocate resources and interventions where most needed.
Prognostic impact of the preoperative hemoglobin A1c levels in patients with gastric cancer surgery depends on postoperative complications
Authors: Shibamoto Jun , Shoda Katsutoshi , Kubota Takeshi , Kosuga Toshiyuki , Kubo Hidemasa , Ohashi Takuma , Shimizu Hiroki , Arita Tomohiro , Yamamoto Yusuke , Konishi Hirotaka , Morimura Ryo , Shiozaki Atsushi , Kuriu Yoshiaki , Ikoma Hisashi , Fujiwara Hitoshi , Okamoto Kazuma , Otsuji Eigo
Published: August 2020

Purpose

The long-term prognostic impact of the hemoglobin A1c levels has not yet been evaluated in patients with gastric cancer. The present study investigated the clinical significance of the hemoglobin A1c levels in patients with gastric cancer.

Methods

We enrolled 294 patients with stage II, III, or IV gastric cancer who underwent gastrectomy. The patients were divided into high preoperative hemoglobin A1c (> 6.0%) and low preoperative hemoglobin A1c (≤ 6.0%) groups.

Results

In patients with stage III gastric cancer with severe postoperative complications, the high preoperative hemoglobin A1c group had a significantly worse prognosis than the low preoperative hemoglobin A1c group (p = 0.0409). In patients without severe postoperative complications, the high preoperative hemoglobin A1c group had a significantly favorable prognosis compared with the low preoperative hemoglobin A1c group (p = 0.0348).

Conclusion

The prognosis of patients with stage III gastric cancer having high preoperative hemoglobin A1c levels greatly depended on the presence or absence of postoperative complications. To avoid postoperative complications, optimal perioperative management and personalized treatments are critical, particularly for these patients.
Guidelines versus evidence: what we can learn from the Australian guideline for low-level laser therapy in knee osteoarthritis? A narrative review
Authors: Chow Roberta , Liebert Ann , Tilley Sharon , Bennett Gregory , Gabel C. Philip , Laakso Liisa
Published: August 2020

This narrative review analyses the Australian Guideline (2018) for the treatment of knee osteoarthritis (KOA) developed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The Guideline recommended against the use low-level laser therapy (LLLT). Why this conclusion was reached is discussed in this review in the context of evidence provided in other systematic reviews, the latest of which was published in 2019 and which provided strong support for LLLT for knee OA. We evaluated the reference list cited for the recommendation “against” LLLT and compared this with reference lists of systematic reviews and studies published before and after the publication date of the Guideline. Eight randomised controlled trials (RCTs) of LLLT were cited in the Guideline the latest of which was published in 2012. There were seventeen additional RCTs, five of which together with one systematic review were located in the year of publication, 2018. The most recent systematic review in 2019 included 22 RCTs in its analysis. Discordance with the levels of evidence and recommendations was identified. Although GRADE methodology is said to be robust for systematically evaluating evidence and developing recommendations, many studies were not identified in the Guideline. In contrast, the latest systematic review and meta-analysis provides robust evidence for supporting the use of LLLT in knee OA. The conflict between guidelines based on opinion and evidence based on meta-analysis is highlighted. Given the totality of the evidence, we recommend that the Australian Guideline should be updated immediately to reflect a “for” recommendation.
Passive bilateral leg cycling with concomitant regional circulatory occlusion for testing mechanoreflex–metaboreflex interactions in humans
Authors: Lis Adrian , Łopusiewicz Wojciech , Piepoli Massimo F. , Ponikowska Beata , Paleczny Bartłomiej
Published: August 2020

Purpose

The exercise pressor reflex (EPR) plays a fundamental role in physiological reactions to exercise in humans and in the pathophysiology of cardiovascular disorders. There is no “gold standard” method for EPR assessment; therefore, we propose a new protocol for testing interactions between the muscle mechanoreflex and metaboreflex (major components of EPR).

Methods

Thirty-four healthy subjects (mean age [± standard deviation] 24 ± 4 years, 22 men) were enrolled in the study. During the study, the hemodynamic and ventilatory parameters of these subjects were continuously monitored using our proposed assessment method. This assessment method consists of an initial 5-min rest period (baseline) followed by 5 min of passive cycling (PC) on an automated cycle ergometer (mechanoreceptor stimulation), after which tourniquet cuffs located bilaterally on the upper thighs are inflated for 3 min to evoke venous and arterial regional circulatory occlusion (CO) during PC (metaboreceptor stimulation). Deflation of the tourniquet cuffs is followed by a second 5 min of PC and finally by a 5-min recovery time. The control test comprises a 5-min rest period, followed by 3 min of CO only and a final 5-min recovery.

Results

Mean arterial pressure (MAP) and minute ventilation (MV) increased significantly during PC (MAP: from 90 ± 9.3 to 95 ± 9.7 mmHg; MV: from 11.5 ± 2.5 to 13.5 ± 2.9 L/min; both p < 0.05) and again when CO was applied (MAP: from 95 ± 9.7 to 101 ± 11.0 mmHg; MV: from 13.5 ± 2.9 to 14.8 ± 3.8 L/min; both p < 0.05). In the control test there was a slight increase in MAP during CO (from 92 ± 10.5 to 94 ± 10.0 mmHg; p < 0.05) and no changes in the ventilatory parameters.

Conclusion

Bilateral leg passive cycling with concomitant circulatory occlusion is a new, simple and effective method for testing interactions between the mechanoreflex and metaboreflex in humans.
Direct Numerical Simulations of the Evaporation of Dilute Sprays in Turbulent Swirling Jets
Authors: Ciottoli P. P. , Battista F. , Malpica Galassi R. , Dalla Barba F. , Picano F.
Published: August 2020

The effects of swirled inflows on the evaporation of dilute acetone droplets dispersed in turbulent jets are investigated by means of direct numerical simulation. The numerical framework is based on a hybrid Eulerian–Lagrangian approach and the point-droplet approximation. Phenomenological and statistical analyses of both phases are presented. An enhancement of the droplet vaporization rate with increasing swirl velocities is observed and discussed. The key physical drivers of this augmented evaporation, namely dry air entrainment and swirl-induced centrifugal forces acting on the droplets, are isolated with the aid of additional simulations in which the inertial properties of the droplets are neglected. The correlation between swirl and dry air entrainment rate is found to be responsible for the increase of the global evaporation rate and the spray penetration length reduction, while swirl-induced centrifugal forces are found to be effective only in the jet shear layer, close to the injection orifice, for the analyzed cases.
Is a colorectal neoplasm diagnosis a trigger to change dietary and other lifestyle habits for persons with Lynch syndrome? A prospective cohort study
Authors: Brouwer Jesca G. M. , Snellen Merel , Bisseling Tanya M. , Koornstra Jan Jacob , Vasen Hans F. A. , Kampman Ellen , van Duijnhoven Fränzel J. B.
Published: August 2020

A cancer diagnosis is suggested to be associated with changes in dietary and lifestyle habits. Whether this applies to persons with familial cancer, such as Lynch syndrome (LS) is unknown. We investigated whether a colorectal neoplasm (CRN) diagnosis in persons with LS is associated with changes in dietary and lifestyle habits over time. We used data of confirmed LS mutation carriers from the GEOLynch study, a prospective cohort study. Information on dietary intake and lifestyle habits was collected with a validated semi-quantitative food frequency questionnaire and a general questionnaire administered at baseline (2006–2008) and follow-up (2012–2017). Participants’ medical records were used to identify CRN diagnoses. Changes in dietary and lifestyle habits in the CRN and the no-CRN group were compared using multivariable linear regression models for continuous variables and cross-tables with percentage change at follow-up compared with baseline for categorical variables. Of the 324 included participants, 146 developed a CRN (CRN group) between baseline and follow-up, while 178 did not (no-CRN group). Smoking cessation was more often reported in the CRN than in the no-CRN group (41.4% vs. 35.0%). There were no differences in changes of energy intake, alcohol, red meat, processed meat, dairy, fruit, vegetables and dietary fiber consumption, BMI, physical activity and NSAID use. Apart from a potentially higher likelihood of smoking cessation, we found little evidence that a CRN diagnosis is associated with changes in lifestyle habits in persons with LS.
An analytic framework for conceptualisations of disease: nine structuring questions and how some conceptualisations of Alzheimer’s disease can lead to ‘diseasisation’
Authors: Zeiler Kristin
Published: August 2020

According to the US National Institute on Aging and the Alzheimer’s Association (NIA-AA), Alzheimer’s disease (AD) should be understood as a biological construct. It can be diagnosed based on AD-characteristic biomarkers only, even if AD biomarkers can be present many years before a person experiences any symptoms of AD. The NIA-AA’s conceptualisation of AD radically challenges past AD conceptualisations. This article offers ananalytic framework for the clarification and analysis of meanings and effects of conceptualisations of diseases such as that of AD. This framework consists of nine questions that allows us to determine how the conceptualisations of diseases, such as that of AD, link or decouple the following terms to/from each other: screening, diagnosis, pathology, disease (along the lines of what have been labelled as “biological-physiological” or “normative” conceptions of disease in philosophy of medicine), symptoms, and illness. It also includes questions regarding how specific decouplings open up for new categories through which people can understand themselves in new ways, and what spaces of possibilities specific conceptualisations (and their decouplings and linkages) open to. The article shows how specific decouplings/linkages can open up not only for the phenomena of pathologisation but also for a distinct, but related phenomenon here termed as diseasisation.
Sense of coherence and psychological well-being among coronary heart disease patients: a moderated mediation model of affect and meaning in life
Authors: Krok Dariusz
Published: August 2020

There are credible data that the indirect relationship of sense of coherence with well-being can involve potential mediation and moderation mechanisms related to emotional and meaning-oriented factors. The self-concordance model provides a theoretical framework through which these associations can be examined. The current research explored whether the relationship between sense of coherence and well-being in people with coronary heart disease can be mediated by affect and simultaneously moderated by meaning in life. A total of 176 patients with coronary heart disease completed four questionnaires. Positive and negative affect turned out to mediate, though differently, the relationship between feelings of coherence and well-being. Furthermore, meaning in life moderated the indirect effect of sense of coherence to well-being only through positive affect. This confirmed the validity of a moderated mediation model of affect and meaning in life in associations between sense of coherence and well-being in people with coronary heart disease problems.
Pellets from Biogas Digestates: A Substantial Source of N2O Emissions
Authors: Petrova Ioana Petrova , Ruser Reiner , Guzman-Bustamante Ivan
Published: August 2020

The field application of pellets from biogas residues resulted in high N2O emissions which could not yet be parametrized through soil drivers. Therefore, the aim of this study was to determine potential N2O production from pellets themselves. N2O and CO2 release from the pure pellet body (in form of intact, crushed or finely ground pellets produced from biogas digestates) were measured during the first seven days after pellet wetting under constant laboratory conditions. Three pellet water contents were examined: 47, 62 and 72% water of the total fresh pellet weight. Additional replicates of similarly wetted intact pellets were used to determine NH4+, NO3− and DOC contents on days 0, 1 and 4 of incubation. Two further treatments of wet intact pellets (62% moisture) were sterilized prior or after moistening to investigate the emissions’ origin. N2O release was found to increase with decreasing pellet size fraction. A maximum of N2O fluxes within all three fractions was determined at 62% moisture, whereas lowest fluxes were measured at 72% moisture. The cumulative N2O emissions over seven days ranged between 1 µg N2O–N g−1 pellet (intact pellets at 72% moisture) and 166 µg N2O–N g−1 pellet (finely ground pellets at 62% moisture). In general, our findings indicate that denitrification was the main factor for N2O emissions, driven by indigenous microbial communities already present in the pellets. The results show that the N2O emissions released by the pellets themselves can explain a major portion of the N2O fluxes measured in situ.

Graphic Abstract