bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the Impact of Military Service on Patient Health Literacy in an Otolaryngology Clinic
Authors: Morrison Danielle A , Riley Charles A , Tolisano Anthony M
Published: June 2021

Objective

To examine the impact of military service on health literacy.

Study Design

Prospective, cross-sectional study.

Subjects and Methods

The validated Brief Health Literacy Screen (BHLS) with military supplement was administered to sequential adult patients (military and civilian) treated at two outpatient academic military otolaryngology clinics between November and December 2019. Inadequate health literacy, defined by a BHLS score ≤9, was the primary outcome measure. Secondary outcome measures included comparisons of inadequate BHLS scores with patient demographics and history of military service.

Results

Three hundred and eighty-two patients were evaluated during the study period. The median age was 48-57 years, with a majority being male (230, 60.2%), White (264, 69.1%), married (268, 70.2%), and active duty military (303, 79.3%). A minority reported history of PTSD (39, 13%) or traumatic brain injury (29, 9.6%). Overall, very few subjects (10, 2.6%) demonstrated inadequate health literacy. Patients with prior (1.6% vs 6.3%, P < .05) or current (0% vs 5.0%, P < .05) military service had lower rates of inadequate health literary as compared to civilians. Gender, race, marital status, history of PTSD, and history of traumatic brain injury did not significantly impact health literacy. In a multivariate regression model exploring history of military service, age was not predictive of inadequate health literacy.

Conclusions

Both history of and current military service predict higher health literacy rates for patients treated at military otolaryngology clinics. Widely accessible health care and mandatory health evaluations for service members to maintain deployment readiness may contribute to this finding but warrant additional study.
Towards a Genealogy of Forward-Looking Responsibility
Authors: Alfano Mark
Published: June 2021

I propose an account of how our forward-looking moral and epistemic responsibility practices arose, how they related to backward-looking responsibility practices, and what makes them stable. This account differs in several ways from prominent theories already in the literature. Traditionally, forward-looking accounts of responsibility are framed third-personally in terms of social control and neglect the perspective and agency of the responsible person. The account I develop allows that there are third-personal, control-based aspects of our responsibility practices, but it also makes room for the first-personal perspective of the responsible agent and emphasizes the role of partner choice and cooperative planning and action. Whereas existing research focuses on forward-looking accounts of the practice of holding others responsible, I offer an account of forward-looking practices of taking responsibility and assigning responsibility. I hope thereby to provide a richer and more plausible framework in which to think about responsibility and our practices related to it.
GGGCTA repeats can fold into hairpins poorly unfolded by replication protein A: a possible origin of the length-dependent instability of GGGCTA variant repeats in human telomeres
Authors: Chatain Jean , Blond Alain , Phan Anh Tuân , Saintomé Carole , Alberti Patrizia
Published: June 2021

Human telomeres are composed of GGGTTA repeats and interspersed with variant repeats. The GGGCTA variant motif was identified in the proximal regions of human telomeres about 10 years ago and was shown to display a length-dependent instability. In parallel, a structural study showed that four GGGCTA repeats folded into a non-canonical G-quadruplex (G4) comprising a Watson–Crick GCGC tetrad. It was proposed that this non-canonical G4 might be an additional obstacle for telomere replication. In the present study, we demonstrate that longer GGGCTA arrays fold into G4 and into hairpins. We also demonstrate that replication protein A (RPA) efficiently binds to GGGCTA repeats structured into G4 but poorly binds to GGGCTA repeats structured into hairpins. Our results (along with results obtained with a more stable variant motif) suggest that GGGCTA hairpins are at the origin of GGGCTA length-dependent instability. They also suggest, as working hypothesis, that failure of efficient binding of RPA to GGGCTA structured into hairpins might be involved in the mechanism of GGGCTA array instability. On the basis of our present and past studies about telomeric G4 and their interaction with RPA, we propose an original point of view about telomeric G4 and the evolution of telomeric motifs.
Does Variceal Drainage Affect Arteriovenous Malformation Obliteration and Hemorrhage Rates After Stereotactic Radiosurgery? A Case-Matched Analysis
Authors: Faramand Andrew , Alan Nima , Kano Hideuyki , Niranjan Ajay , Agarwal Nitin , Ozpinar Alp , Flickinger John , Lunsford L Dade
Published: June 2021

BACKGROUND

Stereotactic radiosurgery (SRS) is widely accepted as a minimally invasive alternative to surgery in the management of arteriovenous malformations (AVMs). Dilated AVM outflow veins or varices may be caused by high-flow or partial outflow obstruction, which may increase the risk of a hemorrhage before or after SRS.

OBJECTIVE

To compare the obliteration and hemorrhage risks in patients with and without AVM varices (AVMv).

METHODS

From our prospective database of 1012 AVM patients who underwent Gamma Knife® (Elekta) SRS, we identified 103 patients with AVMv, and 847 patients without varices. The median follow-up was 52 mo. Balancing variable score matching was performed to compare obliteration and hemorrhage rates between the 2 groups.

RESULTS

Obliteration rates in the AVMv group were 38% at 3 yr, 65% at 4 yr, and 70% at 5 yr. Patients with an AVMv had no difference in the final obliteration rate compared to patients who did not have variceal drainage (P = .35). Actuarial hemorrhage after SRS in the matched patients with AVMv was 4.9%, 13%, and 13.7%, at 1, 3, and 5 yr, respectively. The rate of hemorrhage in the group with no varix was 2.9%, 5.4%, and 9.1% at 1, 3, and 5 yr, respectively (P = .14).

CONCLUSION

The presence of AVM variceal venous drainage did not affect the obliteration rate and did not confer a higher risk of a subsequent hemorrhage both before and after SRS.
Hospital-Acquired Bloodstream Infections in Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 Infection (Coronavirus Disease 2019): Association With Immunosuppressive Therapies
Authors: Khatri Akshay , Malhotra Prashant , Izard Stephanie , Kim Angela , Oppenheim Michael , Gautam-Goyal Pranisha , Chen Thomas , Doan Thien-ly , Berlinrut Ilan , Niknam Negin , Flannery Sarah , Hirschwerk David , Epstein Marcia , Farber Bruce
Published: June 2021

Background

Immunosuppressive therapies proposed for Coronavirus disease 2019 (COVID-19) management may predispose to secondary infections. We evaluated the association of immunosuppressive therapies with bloodstream-infections (BSIs) in hospitalized COVID-19 patients.

Methods

This was an institutional review board-approved retrospective, multicenter, cohort study of adults hospitalized with COVID-19 over a 5-month period. We obtained clinical, microbiologic and laboratory data from electronic medical records. Propensity-score-matching helped create balanced exposure groups. Demographic characteristics were compared across outcome groups (BSI/no BSI) using two-sample t-test and Chi-Square test for continuous and categorical variables respectively, while immunosuppressive therapy use was compared using McNemar’s test. Conditional logistic regression helped assess the association between immunosuppressive therapies and BSIs.

Results

13,007 patients were originally included, with propensity-score-matching producing a sample of 6,520 patients. 3.74% and 3.97% were diagnosed with clinically significant BSIs in the original and propensity-score-matched populations respectively. COVID-19 patients with BSIs had significantly longer hospitalizations, higher intensive care unit admission and mortality rates compared to those without BSIs. On univariable analysis, combinations of corticosteroids/anakinra [odds-ratio (OR) 2.00, 95% confidence intervals (C.I.) 1.05-3.80, P value.0342] and corticosteroids/tocilizumab [OR 2.13, 95% C.I. 1.16–3.94, P value .0155] were significantly associated with BSIs. On multivariable analysis (adjusting for confounders), combination corticosteroids/tocilizumab were significantly associated with any BSI [OR 1.97, 95% C.I. 1.04–3.73, P value.0386] and with bacterial BSIs [OR 2.13, 95% C.I. 1.12–4.05, p-value 0.0217].

Conclusions

Combination immunosuppressive therapies were significantly associated with BSI occurrence in COVID-19 patients; their use warrants increased BSI surveillance. Further studies are needed to establish their causative role.
Quantifying the Impact of Lifting Community Nonpharmaceutical Interventions for COVID-19 During Vaccination Rollout in the United States
Authors: Matrajt Laura , Janes Holly , Schiffer Joshua T , Dimitrov Dobromir
Published: June 2021

Using a mathematical model, we estimated the potential impact on mortality and total infections of completely lifting community nonpharmaceutical interventions when only a small proportion of the population has been fully vaccinated in 2 states in the United States. Lifting all community nonpharmaceutical interventions immediately is predicted to result in twice as many deaths over the next 6 months as a more moderate reopening allowing 70% of prepandemic contacts.
On the nature of the anomalous event in 2021 in the dwarf nova SS Cygni and its multi-wavelength transition
Authors: Kimura Mariko , Yamada Shinya , Nakaniwa Nozomi , Makita Yoshihiro , Negoro Hitoshi , Shidatsu Megumi , Kato Taichi , Enoto Teruaki , Isogai Keisuke , Mihara Tatehiro , Akazawa Hidehiko , Gendreau Keith C , Hambsch Franz-Josef , Dubovsky Pavol A , Kudzej Igor , Kasai Kiyoshi , Tordai Tamás , Pavlenko Elena , Sosnovskij Aleksei A , Babina Julia V , Antonyuk Oksana I , Itoh Hiroshi , Maehara Hiroyuki
Published: June 2021

SS Cyg has long been recognized as the prototype of a group of dwarf novae that show only outbursts. However, this object has entered a quite anomalous event in 2021, which at first appeared to be standstill, i.e., an almost constant luminosity state observed in Z Cam-type dwarf novae. This unexpected event gives us a great opportunity to reconsider the nature of standstill in cataclysmic variables. We have observed this anomalous event and its forerunner, a gradual and simultaneous increase in the optical and X-ray flux during quiescence, through many optical telescopes and the X-ray telescopes NICER and NuSTAR. We have not found any amplification of the orbital hump during quiescence before the anomalous event, which suggests that the mass transfer rate did not significantly fluctuate on average. The estimated X-ray flux was not enough to explain the increment of the optical flux during quiescence via X-ray irradiation of the disk and the secondary star. It would be natural to consider that viscosity in the quiescent disk was enhanced before the anomalous event, which increased mass accretion rates in the disk and raised not only the optical flux but also the X-ray flux. We suggest that enhanced viscosity also triggered the standstill-like phenomenon in SS Cyg, which is considered to be a series of small outbursts. The inner part of the disk would always stay in the outburst state and only its outer part would be unstable against the thermal–viscous instability during this phenomenon, which is consistent with the observed optical color variations. This scenario is in line with our X-ray spectral analyses which imply that the X-ray-emitting inner accretion flow became hotter than usual and vertically expanded, and that it became denser and was cooled down after the onset of the standstill-like state.
Biocompatible and antibacterial soy protein isolate/quaternized chitosan composite sponges for acute upper gastrointestinal hemostasis
Authors: Wang Zijian , Ke MeiFang , He Liu , Dong Qi , Liang Xiao , Rao Jun , Ai Junjie , Tian Chuan , Han Xinwei , Zhao Yanan
Published: June 2021

Innovative biomedical applications have high requirements for biomedical materials. Herein, a series of biocompatible, antibacterial and hemostatic sponges were successfully fabricated for the treatment of acute upper gastrointestinal bleeding (AUGB). Quaternized chitosan (QC) and soy protein isolate (SPI) were chemically cross-linked to obtain porous SPI/QC sponges (named SQS-n, with n = 30, 40, 50 or 60 corresponding to the weight percentage of the QC content). The chemical composition, physical properties and biological activity of SQS-n were investigated. SQS-n could support the adhesion and proliferation of L929 cells while triggering no obvious blood toxicity. Meanwhile, SQS-n exhibited good broad-spectrum antibacterial activity against both gram-positive bacteria (Staphylococcus aureus) and gram-negative bacteria (Escherichia coli). The in vivo hemostatic effect of SQS-n was evaluated using three different bleeding models. The results revealed that SQS-50 performed best in reducing blood loss and hemostatic time. The overall hemostatic effect of SQS-50 was comparable to that of a commercial gelatin sponge. The enhanced antibacterial and hemostatic activities of SQS-n were mainly attributed to the QC component. In conclusion, this work developed a QC-functionalized hemostatic sponge that is highly desirable for innovative biomedical applications, such as AUGB.
Recognition of foreign family foundations in Switzerland
Authors: Peter Natalie
Published: June 2021

Swiss Family Foundations are not commonly used for asset protection or estate planning purposes due to a de facto prohibition of family maintenance foundation. Since families are often spread over different countries and continents and assets are located in various jurisdictions, contributions of assets to a foundation may very well be an optimal solution, also because these assets no longer fall within the scope of the estate. For this purpose, foundations are set up in jurisdictions like Liechtenstein.
Caffeine consumption attenuates ethanol-induced inflammation through the regulation of adenosinergic receptors in the UChB rats cerebellum
Authors: Rossetto Isabela Maria Urra , Cagnon Valéria Helena Alves , Kido Larissa Akemi , Lizarte Neto Fermino Sanches , Tirapelli Luís Fernando , Tirapelli Daniela Pretti da Cunha , de Almeida Chuffa Luiz Gustavo , Martinez Francisco Eduardo , Martinez Marcelo
Published: June 2021

Caffeine consumption is able to interfere in cellular processes related to inflammatory mechanisms by acting through the adenosinergic system. This study aimed to recognize alterations related to adenosinergic system and inflammatory process in the cerebellum of University of Chile Bibulous (UChB) rats after the consumption of ethanol and caffeine. UChB and Wistar rats, males at 5 months old, were divided into the groups (n = 15/group): (i) Control (Wistar rats receiving water); (ii) Ethanol group (UChB rats receiving ethanol solution at 10%) and (iii) Ethanol+caffeine group (UChB rats receiving ethanol solution at 10% added of 3 g/L of caffeine). The cerebellar tissue was collected and processed for immunohistochemistry, Reverse transcription polymerase chain reaction (RT-PCR) and western blotting techniques for the adenosinergic receptors A1 and A2a and inflammatory markers, including Nuclear factor kappa B (NFkB), TLR4, TLR2, MyD88, TNF-α, COX-2, iNOS and microglial marker Iba-1. Results showed ethanol and caffeine consumption differentially altering the immunolocalization of adenosinergic receptors and inflammatory markers in the cerebellar tissue. The A2a receptor was overexpressed in the Ethanol group and was evident in the glial cells. The Ethanol group had increased protein levels for NFκB and TLR4, expressively in Bergmann glia and Purkinje cells. Caffeine reduced the expression of these markers to levels similar to those found in the Control group. The A1 gene was upregulated the Ethanol group, but not its protein levels, suggesting post-transcriptional interference. In conclusion, caffeine seems to attenuate ethanol-induced inflammation in the cerebellum of UChB rats through the A1 and A2a modulation, playing a neuroprotective role in the chronic context of ethanol consumption.
EdTech in Developing Countries: A Review of the Evidence
Authors: Rodriguez-Segura Daniel
Published: June 2021

The emergence of educational technology (“EdTech”) in developing countries has been received as a promising avenue to address some of the most challenging policy questions within educational systems. In this paper, I review and synthesize all existing studies with credible causal identification frameworks of EdTech interventions in developing countries. While other studies review the evidence for EdTech interventions in developed countries, there is currently no equivalent study for developing contexts, in spite of the rising number of studies being produced. I classify studies into four thematic categories based on the type of EdTech intervention analyzed: Access to technology; technology-enabled behavioral interventions; improvements to instruction; and self-led learning. I find that EdTech interventions centered around self-led learning and improvements to instruction are the most effective forms of EdTech at raising learning outcomes. Similarly, technology-enabled behavioral interventions are less promising for generating large effects but highly cost-effective given their typically low marginal costs. Although expanding access to technology alone is not sufficient to improve learning, it is a necessary first step for some other types of interventions. More broadly, the overall success of interventions rests on the thoughtful customization of the EdTech solution to the policy constraints at hand. Finally, EdTech interventions across all thematic areas can and should act as complements by leveraging their respective comparative advantages to address deficiencies within educational systems in developing countries.
An Empirical Investigation Into Milestones Factor Structure Using National Data Derived From Clinical Competency Committees
Authors: Yamazaki Kenji , Holmboe Eric S. , Hamstra Stanley J.
Published: June 2021

Purpose

To investigate whether milestone data obtained from clinical competency committee (CCC) ratings in a single specialty reflected the 6 general competency domains framework.

Method

The authors examined milestone ratings from all 275 U.S. Accreditation Council for Graduate Medical Education–accredited categorical obstetrics and gynecology (OBGYN) programs from July 1, 2018, to June 30, 2019. The sample size ranged from 1,371 to 1,438 residents from 275 programs across 4 postgraduate years (PGYs), each with 2 assessment periods. The OBGYN milestones reporting form consisted of 28 subcompetencies under the 6 general competency domains. Milestone ratings were determined by each program’s CCC. Intraclass correlations (ICCs) and design effects were calculated for each subcompetency by PGY and assessment period. A multilevel confirmatory factor analysis (CFA) perspective was used, and the pooled within-program covariance matrix was obtained to compare the fit of the 6-domain factor model against 3 other plausible models.

Results

Milestone ratings from 5,618 OBGYN residents were examined. Moderate to high ICCs and design effects greater than 2.0 were prevalent among all subcompetencies for both assessment periods, warranting the use of the multilevel approach in applying CFA to the milestone data. The theory-aided split-patient care (PC) factor model, which used the 6 general competency domains but also included 3 factors within the PC domain (obstetric technical skills, gynecology technical skills, and ambulatory care), was consistently shown as the best-fitting model across all PGYs by assessment period conditions, except for one.

Conclusions

The findings indicate that in addition to using the 6 general competency domains framework in their rating process, CCCs may have further distinguished the PC competency domain into 3 meaningful factors. This study provides internal structure validity evidence for the milestones within a single specialty and may shed light on CCCs’ understanding of the distinctive content embedded within the milestones.
Cost Effectiveness of Cochlear Implantation in Single-Sided Deafness
Authors: Dreyfuss Michael , Giat Yahel , Veraguth Dorothe , Röösli Christof , Huber Alexander M. , Laske Roman D.
Published: June 2021

Objective:

To analyze the cost effectiveness of cochlear implantation (CI) for the treatment of single-sided deafness (SSD).

Study Design:

Cost-utility analysis in an adapted Markov model.

Setting:

Adults with single-sided deafness in a high-income country.

Intervention:

Unilateral CI was compared with no intervention.

Main Outcome Measure:

Incremental cost-effectiveness ratios were compared with different cost-effectiveness thresholds ($10,000 to $150,000) for different age, sex, and cost combinations. The calculations were based on the quality-adjusted life year (QALY), national life expectancy tables, and different cost settings. The health utility values for the QALY were either directly collected from published data, or, derived from published data using a regression model of multiple utility indices (regression estimate).

Results:

The regression estimate showed an increase of the health utility value from 0.62 to 0.74 for SSD patients who underwent CI. CI for SSD was cost effective for women up to 64 years ($50,000 per-QALY threshold), 80 years ($100,000 per-QALY threshold), and 86 years ($150,000 per-QALY threshold). For men, these values were 58, 77, and 84, respectively. Changing the discount rate by up to 5% further increased the cutoff ages up to 5 years. A detailed cost and age sensitivity analysis is presented and allows testing for cost effectiveness in local settings worldwide.

Conclusions:

CI is a cost-effective option to treat patients with SSD.
A Clinical Evaluation of Minimally Invasive Ponto Surgery With a Modified Drill System for Inserting Bone-Anchored Hearing Implants
Authors: Caspers Coosje Jacoba Isabella , Kruyt Ivo Joachim , Mylanus Emmanuel Antonius Maria , Hol Myrthe Karianne Sophie
Published: June 2021

Objective:

To compare 6-months outcomes of the modified minimally invasive Ponto surgery (m-MIPS) to both the linear incision technique with soft tissue preservation (LIT-TP), and original MIPS (o-MIPS) for inserting bone-anchored hearing implants (BAHIs).

Study design:

Exploratory pilot study with one test group and two historical control groups.

Setting:

Tertiary referral center.

Patients:

In the test group, 24 patients (25 implants) were prospectively included. Each control group comprised 25 patients (25 implants) who participated in previously conducted clinical trials.

Interventions:

The test group received a BAHI using m-MIPS. The two control groups underwent surgery using the LIT-TP and o-MIPS, respectively.

Main outcome measures:

Implant survival, implant stability, and surgery-related variables were compared between the test and control groups. Soft tissue status, skin sensibility, and subjective numbness were compared between m-MIPS and LIT-TP only.

Results:

Implant survival was comparable between m-MIPS and LIT-TP, whereas implant stability measurements were slightly lower for m-MIPS. M-MIPS resulted in comparable adverse skin reactions and skin sensibility, significantly reduced surgical time and slightly improved subjective numbness, compared with LIT-TP. Between m-MIPS and o-MIPS, no statistically significant differences in implant survival, implant stability and surgical time were observed.

Conclusions:

A trend toward lower implant loss rates after m-MIPS was observed, when compared with o-MIPS. M-MIPS seems to be a good alternative to LIT-TP for inserting BAHIs, since most clinical outcomes were either comparable or slightly better for m-MIPS. Upon deciding on which technique to use, larger studies on implant survival should be performed. Furthermore, other aspects such as costs, training aspects and surgical experience should be evaluated.
Contralesional High-Acceleration Vestibulo-Ocular Reflex Function in Vestibular Schwannoma
Authors: Lee Jennifer Wing Yee , Hassannia Fatemeh , Rutka John Alexander
Published: June 2021

Impairment of ipsilesional vestibulo-ocular reflex (VOR) function is well described in vestibular schwannoma (VS) and a correlation between gain of the VOR and tumor size has been suggested. Bilateral VOR impairment may also occur in VS patients, but its mechanisms are poorly understood. We sought to explore the effect of unilateral VS on ipsilesional and contralesional high-acceleration VOR function using video head impulse testing, and evaluate potential factors responsible for contralesional VOR impairment.

Materials and Methods:

Chart review in tertiary referral center of patients with unilateral VS, who completed neurotological examination and vestibular function testing.

Results:

One hundred one patients (mean age 57.4 yrs) were included. Maximal tumor diameter ranged from 0.3 to 5.0 cm. Forty one patients had evidence of brainstem compression from VS on magnetic resonance imaging (MRI). Ipsilesional and contralesional VOR impairment was present in 81 (80%) and 44 (43%) patients, respectively. Bilateral VOR impairment was seen in 42 (42%) patients. Bilateral VOR impairment correlated with tumor size. Presence of brainstem compression was associated with reduced ipsilesional VOR gain, but not contralesional VOR gain.
The outcomes of pregnant and postpartum patients with cerebral venous sinus thrombosis after anticoagulant therapy
Authors: Meng Shi-Hui , Li Jing-Hua , Zuo Li-Jun , Feng Li-Min
Published: June 2021

Background:

To describe the outcome of the patients with cerebral venous sinus thrombosis (CVST) during pregnancy and postpartum treated with anticoagulant therapy.

Methods:

This is a retrospective cohort study and patients with CVST were collected from October 2009 to March 2018. Patients were divided into pregnancy-related (occurred during pregnancy and postpartum) group and non-pregnancy-related. Recovery rate at 12 months after anticoagulant therapy, adverse events, characteristics of patients with poor outcomes were statistically analyzed.

Results:

Fifty-eight pregnancy-related CVST patients (17 pregnancy and 41 postpartum) as study group and 76 non-pregnancy-related CVST women as control group were enrolled. Study group was statistically different to control group in several baseline variables. More pregnancy-related patients had modified rankin scale (mRS) = 5 (15.5% vs 11.8%, P = 8.1×10−3) before anticoagulant therapy. At 12 months heparinization, difference in recovery rate was not statistically significant (80% vs 87.5%, P = .29) between 2 groups. No differences were found of adverse events between 2 groups. Patients with poor outcomes had less sigmoid sinus thrombosis (16.7% vs 61.5%, P = .14), more coma (41.2% vs 17.2%, P = 5.2×10−7), more mRS = 4 (33.3% vs 19.2%, P = 1.63 × 10−4), more mRS = 5 (66.7% vs 9.6%, P = 1.63 × 10−4) before treatment.

Conclusion:

Pregnancy-related CVST patients had severer condition before treatment, but can achieve comparable recovery rate at 12 months after anticoagulant therapy with non-pregnancy-related women. Pregnancy-related patients with poor prognosis had less sinus sigmoid occlusion, more coma, high mRS at admission.
The correlation with tumor radiological characteristics and prognosis of patients with early-stage hepatocellular carcinoma receiving transcatheter arterial chemoembolization
Authors: Lee Shou-Wu , Lee Teng-Yu , Cheng Yu-Chi , Yen Chieh-Ling , Yang Sheng Shun
Published: June 2021

Transcatheter arterial chemoembolization (TACE) is a standard treatment modality for intermediate stage hepatocellular carcinoma (HCC). The aim of this study was to determine the tumor radiological characteristics associated with prognosis of patients with early-staged HCC receiving TACE.

Patients with BCLC stage A HCC were enrolled at Taichung Veterans General Hospital from January 2005 to December 2009. According to mRECIST criteria, patients with or without complete response (CR) were assigned to either the CR group or the non-CR group. Clinical and radiological characteristics were compared between the two groups.

In 40 enrolled patients, 24 (60%) were in the CR group, and 16 (40%) in the non-CR group. Clinical parameters were similar between the 2 groups. Radiological characteristics including complete lipidol retention and the absence of residual tumor blush were significantly correlated with achievement of CR in the patients with small-sized HCC. Patients with CR after TACE had a significantly longer overall survival than those without (31.29 vs 22.63 months, P = .021).

Complete lipidol retention and the absence of residual tumor blush were correlated with the radiological complete tumor response of these patients with small-sized early-stage HCC receiving TACE.
The Home Healthcare Nurse
Authors: Riekert Susan A.
Published: June 2021

The home healthcare nurse is a concept that has grown rapidly in the past two centuries, however, the role and meaning remain ambiguous. Continuous changes in the healthcare system have sparked confusion with patients and healthcare providers as to the essence of the home healthcare nurse. With the popularity and demand for home healthcare-based care on the rise, it is necessary to differentiate the concept of the home healthcare nurse from other related terms through a concept analysis. Using Walker and Avant's methodology, a literature search using Cumulative Index to Nursing and Allied Health Literature (CINAHL) along with dictionaries, encyclopedias, and professional organizations was performed to identify all the uses, attributes, and characteristics of the concept. Five defining attributes emerged during the analysis: autonomy, adaptability, person-centered holistic care, care coordination, and self-efficacy. Antecedents, consequences and empirical referents were identified. As a first step, this concept analysis brings clarity to the meaning and role of the home healthcare nurse from which arose an operational definition and proposed conceptual model. With the number of patients admitted to home healthcare accelerating, healthcare organizations and clinicians must distinctly understand the concept of the home healthcare nurse. Future research should include testing theoretical relationships between the home healthcare nurse and patient outcome variables to enhance nursing science and promote population health.
Fabry Disease Frequency Among Young Cryptogenic Stroke Patients in the City of Edirne, Turkey
Authors: Güler Sibel
Published: June 2021

Background:

We sought to determine the incidence of Fabry disease (FD) in young cryptogenic stroke patients who lived in the City of Edirne, Turkey, and to define the clinical features helping to recognize patients with FD.

Methods:

Acute ischemic stroke patients aged 18 to 55 years who were admitted to our hospital between January 2017 and September 2019 were evaluated for inclusion. The screening was performed for α-galactosidase A activity on dried blood spot, and DNA was sequenced for GLA mutation in patients with low-plasma α-galactosidase A activity.

Results:

Two proband cases were detected. The first proband patient was identified as having a 427G>A (rs 104894845) (p.A143T) hemizygous mutation along with his family; 3 patients were identified as having the same hemizygous mutation; and 6 patients were identified as having the same heterozygous mutations. The second proband patient was identified as having a c.352C>T (rs 148158093) (p.R118C) heterozygote mutation along with her family; 5 patients were identified as having the same heterozygote mutation; and 1 patient was identified as having the same hemizygous mutation. Our study identified the FD incidence as 3.27%.

Conclusions:

This research is just one of a few studies conducted on FD screening studies in Turkish stroke patients. Our results underlined the importance of considering FD during the etiologic evaluation of young cryptogenic stroke patients, as it is a rare but potentially treatable entity.
John Lander Harper. 27 May 1925—22 March 2009
Authors: Townsend Colin R. , Watkinson Andrew R.
Published: June 2021

Born into a farming family, John Harper identified a number of influential figures in his formal education, including his inspirational school master Wilfred Kings, and the plant ecologists Roy Clapham (FRS 1959) and Jack Harley (FRS 1964) and animal ecologists Charles Elton (FRS 1953) and George Varley during his university education at Magdalen College, Oxford. His first academic appointments were in the University of Oxford School of Rural Economy and the Department of Agriculture, where he carried out pioneering research on seed and seedling mortality and the ecology and control of weeds. In 1960 John was appointed to head the Department of Agricultural Botany at the University College of North Wales, Bangor. The departments of Botany and Agricultural Botany merged in 1967 with John as head of the new School of Plant Biology. From this base, he established a research centre that attracted students and visitors from around the world. As one of the most influential of thinkers, John Harper generated a new discipline: plant population biology. In addition, by integrating advances in animal population biology and evolution into his own work, John helped to create a complete master discipline of ecology, as reflected in a textbookEcology: individuals, populations and communities(Oxford, UK: Blackwell) for which he received (with co-authors Mike Begon and Colin Townsend) an exceptional lifetime achievement award from the British Ecological Society.
Mathematical modelling of the use of insecticide-treated nets for elimination of visceral leishmaniasis in Bihar, India
Authors: Fortunato Anna K. , Glasser Casey P. , Watson Joy A. , Lu Yongjin , Rychtář Jan , Taylor Dewey
Published: June 2021

Visceral leishmaniasis (VL) is a deadly neglected tropical disease caused by a parasite
Leishmania donovani
and spread by female sand flies
Phlebotomus argentipes
. There is conflicting evidence regarding the role of insecticide-treated nets (ITNs) on the prevention of VL. Numerous studies demonstrated the effectiveness of ITNs. However, KalaNet, a large trial in Nepal and India did not support those findings. The purpose of this paper is to gain insight into the situation by mathematical modelling. We expand a mathematical model of VL transmission based on the KalaNet trial and incorporate the use of ITNs explicitly into the model. One of the major contributions of this work is that we calibrate the model based on the available epidemiological data, generally independent of the KalaNet trial. We validate the model on data collected during the KalaNet trial. We conclude that in order to eliminate VL, the ITN usage would have to stay above 96%. This is higher than the 91% ITNs use at the end of the trial which may explain why the trial did not show a positive effect from ITNs. At the same time, our model indicates that asymptomatic individuals play a crucial role in VL transmission.
Preparation and characterization of cornstalk microspheric hydrochar and adsorption mechanism of mesotrione
Authors: Zhang Zhongqing , Zhou Mengmeng , Liu Jinhua , Li Jiahao , Yang Jingmin , Chang Haibo
Published: June 2021

In this study, cornstalk was pyrolysed to obtain hydrochar (HC), which was used to remove mesotrione from aqueous solutions. HC characterization and batch experiments were conducted to investigate mesotrione adsorption and the underlying mechanism. The characterization revealed microspheres on the HC surface. FT-IR spectra showed that the HC contained a large number of –OH groups, C=C bonds of aromatic rings, C–H groups in aromatic rings and phenolic C–O bonds. The adsorption results showed that the mesotrione adsorption ability gradually increased as the HC preparation temperature increased. The quasi-second-order kinetic equation (

R
2

≥ 0.9860,
p
< 0.05) agreed well with the mesotrione adsorption process. The maximum monolayer adsorption capacity, which was obtained at pH 7 and 45°C with HC prepared at 240°C, was 3181.7 mg kg
−1
with the Langmuir isotherm model (

R
2

≥ 0.9491,
p
< 0.05). Van der Waals and dipole forces and hydrogen bonds were inferred as the main adsorption mechanisms. HC has potential as an effective and energy-saving adsorbent for mesotrione to reduce environmental pollution.
Towards locust-inspired gliding wing prototypes for micro aerial vehicle applications
Authors: Isakhani Hamid , Xiong Caihua , Chen Wenbin , Yue Shigang
Published: June 2021

In aviation, gliding is the most economical mode of flight explicitly appreciated by natural fliers. They achieve it by high-performance wing structures evolved over millions of years in nature. Among other prehistoric beings, locust is a perfect example of such natural glider capable of endured transatlantic flights that could inspire a practical solution to achieve similar capabilities on micro aerial vehicles. An investigation in this study demonstrates the effects of haemolymph on the flexibility of several flying insect wings proving that many species exist with further simplistic yet well-designed wing structures. However, biomimicry of such aerodynamic and structural properties is hindered by the limitations of modern as well as conventional fabrication technologies in terms of availability and precision, respectively. Therefore, here we adopt finite-element analysis to investigate the manufacturing-worthiness of a three-dimensional digitally reconstructed locust wing, and propose novel combinations of economical and readily available manufacturing methods to develop the model into prototypes that are structurally similar to their counterparts in nature while maintaining the optimum gliding ratio previously obtained in the aerodynamic simulations. The former is assessed here via an experimental analysis of the flexural stiffness and maximum deformation rate as EI

s

= 1.34 × 10
−4
Nm
2
, EI

c

= 5.67 × 10
−6
Nm
2
and greater than 148.2%, respectively. Ultimately, a comparative study of the mechanical properties reveals the feasibility of each prototype for gliding micro aerial vehicle applications.
Sex pheromone signal and stability covary with fitness
Authors: Blankers Thomas , Lievers Rik , Plata Camila , van Wijk Michiel , van Veldhuizen Dennis , Groot Astrid T.
Published: June 2021

If sexual signals are costly, covariance between signal expression and fitness is expected. Signal–fitness covariance is important, because it can contribute to the maintenance of genetic variation in signals that are under natural or sexual selection. Chemical signals, such as female sex pheromones in moths, have traditionally been assumed to be species-recognition signals, but their relationship with fitness is unclear. Here, we test whether chemical, conspecific mate finding signals covary with fitness in the mothHeliothis subflexa. Additionally, as moth signals are synthesized de novo every night, the maintenance of the signal can be costly. Therefore, we also hypothesized that fitness covaries with signal stability (i.e. lack of temporal intra-individual variation). We measured among- and within-individual variation in pheromone characteristics as well as fecundity, fertility and lifespan in two independent groups that differed in the time in between two pheromone samples. In both groups, we found fitness to be correlated with pheromone amount, composition and stability, supporting both our hypotheses. This study is, to our knowledge, the first to report a correlation between fitness and sex pheromone composition in moths, supporting evidence of condition-dependence and highlighting how signal–fitness covariance may contribute to heritable variation in chemical signals both among and within individuals.
Walruses produce intense impulse sounds by clap-induced cavitation during breeding displays
Authors: Larsen Ole Næsbye , Reichmuth Colleen
Published: June 2021

Male walruses produce some of the longest continuous reproductive displays known among mammals to convey their physical fitness to potential rivals and possibly to potential mates. Here, we document the ability of a captive walrus to produce intense, rhythmic sounds through a non-vocal pathway involving deliberate, regular collision of the fore flippers. High-speed videography linked to an acoustic onset marker revealed sound production through cavitation, with the acoustic impulse generated by each forceful clap exceeding a peak-to-peak sound level of 200 dB re. 1 µPa. This clapping display is in some ways quite similar to the knocking display more commonly associated with walruses in rut but is produced through a very different mechanism and with much higher amplitudes. While this clapping behaviour has not yet been documented in wild individuals, it has been observed among other mature male walruses living in human care. Production of intense sounds through cavitation has previously been documented only in crustaceans but may also be an effective means of sound production for some aquatic mammals.
Confirmed archaeological evidence of water deer in Vietnam: relics of the Pleistocene or a shifting baseline?
Authors: Stimpson C. M. , O'Donnell S. , Huong N. T. M. , Holmes R. , Utting B. , Kahlert T. , Rabett R. J.
Published: June 2021

Studies of archaeological and palaeontological bone assemblages increasingly show that the historical distributions of many mammal species are unrepresentative of their longer-term geographical ranges in the Quaternary. Consequently, the geographical and ecological scope of potential conservation efforts may be inappropriately narrow. Here, we consider a case-in-point, the water deerHydropotes inermis, which has historical native distributions in eastern China and the Korean peninsula. We present morphological and metric criteria for the taxonomic diagnosis of mandibles and maxillary canine fragments from Hang Thung Binh 1 cave in Tràng An World Heritage Site, which confirm the prehistoric presence of water deer in Vietnam. Dated to between 13 000 and 16 000 years before the present, the specimens are further evidence of a wider Quaternary distribution for these Vulnerable cervids, are valuable additions to a sparse Pleistocene fossil record and confirm water deer as a component of the Upper Pleistocene fauna of northern Vietnam. Palaeoenvironmental proxies suggest that the Tràng An water deer occupied cooler, but not necessarily drier, conditions than today. We consider if the specimens represent extirpated Pleistocene populations or indicate a previously unrecognized, longer-standing southerly distribution with possible implications for the conservation of the species in the future.
Convex hull estimation of mammalian body segment parameters
Authors: Coatham Samuel J. , Sellers William I. , Püschel Thomas A.
Published: June 2021

Obtaining accurate values for body segment parameters (BSPs) is fundamental in many biomechanical studies, particularly for gait analysis. Convex hulling, where the smallest-possible convex object that surrounds a set of points is calculated, has been suggested as an effective and time-efficient method to estimate these parameters in extinct animals, where soft tissues are rarely preserved. We investigated the effectiveness of convex hull BSP estimation in a range of extant mammals, to inform the potential future usage of this technique with extinct taxa. Computed tomography scans of both the skeleton and skin of every species investigated were virtually segmented. BSPs (the mass, position of the centre of mass and inertial tensors of each segment) were calculated from the resultant soft tissue segments, while the bone segments were used as the basis for convex hull reconstructions. We performed phylogenetic generalized least squares and ordinary least squares regressions to compare the BSPs calculated from soft tissue segments with those estimated using convex hulls, finding consistent predictive relationships for each body segment. The resultant regression equations can, therefore, be used with confidence in future volumetric reconstruction and biomechanical analyses of mammals, in both extinct and extant species where such data may not be available.
Noise matters: elephants show risk-avoidance behaviour in response to human-generated seismic cues
Authors: Mortimer Beth , Walker James A. , Lolchuragi David S. , Reinwald Michael , Daballen David
Published: June 2021

African elephants (Loxodonta africana) use many sensory modes to gather information about their environment, including the detection of seismic, or ground-based, vibrations. Seismic information is known to include elephant-generated signals, but also potentially encompasses biotic cues that are commonly referred to as ‘noise’. To investigate seismic information transfer in elephants beyond communication, here we tested the hypothesis that wild elephants detect and discriminate between seismic vibrations that differ in their noise types, whether elephant- or human-generated. We played three types of seismic vibrations to elephants: seismic recordings of elephants (elephant-generated), white noise (human-generated) and a combined track (elephant- and human-generated). We found evidence of both detection of seismic noise and discrimination between the two treatments containing human-generated noise. In particular, we found evidence of retreat behaviour, where seismic tracks with human-generated noise caused elephants to move further away from the trial location. We conclude that seismic noise are cues that contain biologically relevant information for elephants that they can associate with risk. This expands our understanding of how elephants use seismic information, with implications for elephant sensory ecology and conservation management.
Win-Stay-Lose-Shift as a self-confirming equilibrium in the iterated Prisoner’s Dilemma
Authors: Kim Minjae , Choi Jung-Kyoo , Baek Seung Ki
Published: June 2021

Evolutionary game theory assumes that players replicate a highly scored player’s strategy through genetic inheritance. However, when learning occurs culturally, it is often difficult to recognize someone’s strategy just by observing the behaviour. In this work, we consider players with memory-one stochastic strategies in the iterated Prisoner’s Dilemma, with an assumption that they cannot directly access each other’s strategy but only observe the actual moves for a certain number of rounds. Based on the observation, the observer has to infer the resident strategy in a Bayesian way and chooses his or her own strategy accordingly. By examining the best-response relations, we argue that players can escape from full defection into a cooperative equilibrium supported by Win-Stay-Lose-Shift in a self-confirming manner, provided that the cost of cooperation is low and the observational learning supplies sufficiently large uncertainty.
Public discussion on a proposed revision of the International Code of Nomenclature of Prokaryotes
Authors: Oren Aharon , Arahal David R. , Rosselló-Móra Ramon , Sutcliffe Iain C. , Moore Edward R. B.
Published: June 2021

The Editorial Board for the International Code of Nomenclature of Prokaryotes (ICNP) has compiled proposed revisions of the ICNP. As outlined previously (Orenet al.,Int J Syst Evol Microbiol2021;71:004598;https://doi.org/10.1099/ijsem.0.004598) and to comply with Articles 13(b)(4) and 4(d) of the statutes of the International Committee on Systematics of Prokaryotes, a public discussion of the document will start on 1 July 2021, to last for 6 months. Here, we present the procedure for this discussion.