bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinically Significant Hepatopathology Detected At Cholecystectomy Dramatically Increases Billing
Authors: Rane A , Li-cheng Wu M
Published: October 2020

Introduction/Objective

Incidental hepatic tissue obtained via cholecystectomy is generally minute and inconsequential. For these reasons, the hepatic tissue is bundled with the gallbladder and cannot invoke additional billing. However, hepatic tissue that is very large or that harbors significant hepatopathology has clinical utility and could justify additional billing. We hypothesized that such incidental hepatic tissue would dramatically increase billing because the liver is billed at a higher level of complexity than the gallbladder and requires cytochemistry for evaluation.

Methods

We retrospectively reviewed pathology reports, slides, and codes from 9 specimens from cholecystectomy that contained hepatic tissue that was grossly evident or that demonstrated significant hepatopathology. Our billing department with decades of experience but without medical training codified the reports using the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and Current Procedural Terminology (CPT), blinded to our study.

Results

The patients included 5 women and 4 men, ages 18 to 72 years. Five specimens contained very large pieces of liver 0.8 cm to 2.2 cm long and 0.3 cm to 1.8 cm thick. Diagnoses included nonalcoholic fatty liver disease or steatohepatitis (6 specimens), de novo alpha-1 antitrypsin deficiency (2 specimens), de novo sinusoidal amyloidosis (1 specimen), hemosiderosis (1 specimen), and obstruction (1 specimen). Some specimens demonstrated multiple diagnoses. Only ICD-10 codes K76.0 (6 specimens) and K75.81 (2 specimens) were generated, corresponding to nonalcoholic fatty liver disease and steatohepatitis, respectively. ICD-10 codes were omitted for 1 specimen. Although all specimens generated CPT codes 88312 (20 charges) and 88313 (14 charges), corresponding to cytochemistry, none generated CPT code 88307, corresponding to the liver.

Conclusion

Incidental hepatic tissue obtained via cholecystectomy dramatically increases billing, but significant hepatic findings and exceptions to coding principles must be clearly conveyed to billing departments to ensure proper coding.
Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management
Authors: Tsang H C , Mathias P , Hoffman N , Pagano M B
Published: October 2020

Introduction/Objective

To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties.

Methods

Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed.

Results

During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage.

Conclusion

Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.
Prevalence Of Urinary Tract Infections (Utis) Among Pregnant Women Attending Antenatal Clinic At Ile –Ife, Southwestern Nigeria
Authors: Oladipo A , Onifade J A
Published: October 2020

Introduction/Objective

This is a prospective study that reports the prevalence of Urinary Tract Infections (UTIs) and the bacteriological causative agents among pregnant women attending antenatal clinics at a Secondary Care Hospital in Ile Ife, South western Nigeria. 335 mid-stream clean catch urine samples were collected from pregnant women between April -July 2017.

Methods

These were cultured for the presence of bacterial pathogens. All the isolates were subjected to antibiotic sensitivity testing on Mueller Hinton agar by modified Kirby-Bauer disk diffusion technique using CLSI, guidelines. Data were analysed using SPSS for Windows version 16 and WHONET 5.

Results

A total of 190 showed significant bacterial growth while 145 showed no significant bacterial growth. Bacterial agents isolated included Klebsiella spp. showing the highest occurrence of [60(31.5%) followed by Escherichia coli and Staphylococcus aureus with prevalences of [49(25.7%) and [32(16.8%) respectively. Other organisms implicated are Proteus mirabilis [20(10.5%), Coagulase Negative Staphylococci [24(12.3%) and Pseudomonas aeruginosa with the least prevalence of [5(2.6%). Resistant to antibiotics such as amoxycilin 64%, gentamicin 52.6%, erythromycin 62.5%, ceftazidime 69%, cefotaxime 74%, ceftriaxone 79.6% while a high sensitivity to tetracycline (88.5%), nitrofurantoin (96.3%), imipenem (100%) respectively.

Conclusion

This study indicated a high prevalence of UTIs (56.7%) in pregnant women though most of them showed no clinical manifestation.
Antibiotic Resistance Crisis in Urinary Tract Infections Utis in Egypt
Authors: Abdelmonem M , Wasim H , Shedid M , Hassan D M , Boraik A , Elshamsy M , Al-Shalchi N
Published: October 2020

Introduction/Objective

Bacterial adaptation to antibiotics has been very successful. Over the past decade, the increase in antibiotic resistance has generated considerable medical problems. UTIs are one of the most common community-onset infections. The emergence of resistance to all classes of antibiotics in previously susceptible bacterial pathogens is a major challenge to infectious disease medicine. Thus, it is important that we forcefully implement strategies to reduce the rate of appearance and spread of resistant bacteria to allow new drug discovery to catch up with bacterial resistance development. Objectives:

Methods

The aim of this study is to predict the percentage of urine cultures antibiotic resistance in patients with UTIs in Egypt. Subjects and methods: A total of 200 subjects were enrolled in this study from The Delta region in Egypt; 38% males and 62% females with a median age of 39 years and 35 years respectively. Identification of the isolated organisms was identified by the cultural characters (Morphological characters of the purified bacterial isolates were carried out according to the colony characters, Gram stain reaction and biochemical tests for each organism using a standard semi-automated technique

Results

98 cultures (49%) were observed to have resistance to 3- 5 classes of antibiotics including, 98% Cephalosporins, 85% β-lactam inhibitors and 71% fluoroquinolones; 66 females (57 gram -ve stain and 9 gram +ve stain) and 33 males (27gm -ve stain, 6gm +ve stain). 82 cultures (41%) were not resistant to any classes.; 32 males (28 gram -ve stain and 3 gram +ve stain) and 50 females (45 gram -ve stain and 5 gram +ve stain). 19 cultures (9.5%) were observed to be resistant to all antibiotics.; 12 males (11 gram -ve stain and 1 gram +ve stain) and 7 females (2 gram -ve stain and 5 gram +ve stain).

Conclusion

This study highlights the highest antibiotic resistance associated with urinary tract infection in Egypt as well as the classification of the organisms. The high resistance percentage is due to the overuse of antibiotics by public and inappropriate antibiotic prescribing. Antibiotics are unregulated and available over the counter without a prescription in Egypt which makes it easily accessible. We recommend regulating the use of antibiotics and lunch antimicrobial stewardship programs in Egypt.
Frequent Mutations in p53, CDKN2A, PTEN Genes in Lung Squamous Cell Carcinoma: A Next Generation Sequencing Study
Authors: Xu H , Wei E
Published: October 2020

Introduction/Objective

Targeted therapies have been successfully used for the treatment of lung adenocarcinoma but have not been implemented in the treatment of lung squamous cell carcinoma (SqCC). In order to better understand the underlying biology of SqCC, we present comprehensive Next Generation Sequencing (NGS) data via Cancerplex from SqCC. We have observed frequent mutations in p53, CDKN2A, PTEN, CDKN2B, and TGFBR2 genes together with few new rare gene mutations.

Methods

Twenty-one patients with diagnosis of Lung SqCC have been selected for Cancerplex assay (Kew, Inc., Waltham, MA). Formalin-fixed tissues from these patients were used for the assay. Neoplastic tissues with tumor content higher than 20% were micro-dissected from the blocks and NGS was performed with at least 50 ng DNA content and with a limit of detection of 10% mutant alleles. The depth of coverage was 500, and the size of the targeted region was 2.8 Mb. Results were compared with published databases.

Results

We have observed p53 mutations in 100% cases. p53 gene mutations included single point mutations with various coding protein mutations as well as splice variants. Mutations in CDKN2A is found in 47.6% of cases; PTEN mutations in 33.3% of cases; CDKN2B mutations in 28.6% of cases, and TGFBR2 in 28.6% of cases, which has been reported as actionable variants and actionable copy number variants.

Conclusion

Previous literatures have provided evidence that SqCC arising in different anatomical sites share common genomic mutation patterns. Our data partially supports this finding. We demonstrated p53, CDKN2A and PTEN are among the most commonly mutated genes in lung SqCC, while a few other genes mutations does not fit in this pattern. Apparently more studies need to be done to provide a more clear genetic landscape of SqCC, which would facilitate the development of targeted therapies.
The Wild West of Emergency Use Authorizations for SARS-CoV-2 Testing: What Could Be the True Sensitivity?
Authors: Dalal S , Patel S , Petersen J M , Jhala D
Published: October 2020

Introduction/Objective

SARS-CoV-2 is a pandemic that has required mobilization to meet urgent needs. In this mobilization, emergency use authorizations (EUA) have been issued by the FDA to expedite the deployment of these tests. This has led to a situation whereby sensitivity has not been rigorously studied for any of the assays with EUAs. Estimates can be extrapolated from the limited samples documented by the company in their instructions for use (IFU). Although the nationwide shortage of testing reagents prevent parallel testing of multiple platforms on all specimens, observations of repeat specimens at the Veteran Affairs Medical Center (VAMC) provides the first study in the literature of more complete data for SARS-CoV-2 nucleic acid (RT-PCR) assay on sensitivity on the Abbott (Abbott Park Ill) and Cepheid (Sunnyvale CA) assays.

Methods

A retrospective search was performed for all test results for SARS-CoV-2 by RT-PCR from 3/1/2020 to 4/14/2020 at Corporal Michael J. Crescenz Medical Center, in order to evaluate the sensitivity on Abbott m2000 and Cepheid platforms. Results across multiple reference laboratories and in-house testing platforms were collated in a table with all patients clinically requiring repeat testing recorded.

Results

114/863 patients had repeat testing. The tests were performed initially by outside reference laboratories (25 patients), on the Abbott m2000 (63 patients), and Cepheid Infinity (26 patients). 15/114 (13%) had discordant results on repeat testing. This included 1 test initially done by a reference laboratory. 8 days after the initial result from the reference lab, a positive for the same patient was identified on the Abbott platform. 11 initial Abbott results were discordant on further repeat testing on two platforms - Abbott (6 patients) and Cepheid (5 patients) 1-6 days later. In addition, 3 initial Cepheid were discordant on further repeat testing by the same Cepheid platform (1-16 days later).

Conclusion

While the instructions for use for both platforms suggest 100% sensitivity and specificity (due to the 100% positive and negative percent agreement in limited specimens), the true sensitivity is less than 100%, particularly early in the course of the infection. In our study, the positive percent agreement (surrogate for sensitivity) was 83% for initial Abbott tests, 88% for initial Cepheid tests, and 95% by Reference laboratory platform.
Prognostic and Theragnostic Applications of Circulating Tumor DNA (CtDNA) in Metastatic Castrate- resistant Prostatic Carcinoma in Veterans: A Novel Promise in Precision Oncology
Authors: Dalal S , Jhala D
Published: October 2020

Introduction/Objective

Utility of CtDNA in peripheral blood through liquid biopsies serves as a robust biomarker for precision oncology. Prostate cancer is most common cancer diagnosed in veterans, more commonly presenting at advanced stage with increased incidence of metastatic castrate-resistant prostatic carcinoma (MCRPC). Minimally invasive liquid biopsy is not limited by tumor site, type, tumor heterogeneity, and most importantly enables real time disease monitoring for best therapy decisions in MCRPC. The literature is sparse depicting the role of CtDNA in MCRPC in veteran patient population with distinct demographics/frequency of Tp53 mutations. We herein aim to study role of CtDNA in liquid biopsies for prognosis, treatment decisions and outcome in veterans with MCRPC.

Methods

QA documents from Foundation One (Cambridge MA, NGS) on liquid biopsies performed for the Corporal Michael J. Crescenz Veteran Affairs Medical Center (CMCVAMC) from May 2019 to April 15, 2020 were reviewed. All liquid biopsies were performed on MCRPC with evidence of tumor progression. Statistical data for adequacy, type of mutations either altering therapy, disease course or outcome was noted.

Results

A total of 23 liquid biopsies were performed. 21/23 (91.3%) biopsies were adequate, 19/21 (90.4%) showed signature mutations for resistance to therapy, predicting prognosis, or suggesting poor outcome with decreased overall survival. 4/21 (19%) showed androgen receptor amplification (ARV7 mutation) that helped in making treatment decisions. Increased frequency of Tp53 mutations were noted (12/21 (57.1%) compared to general population (30- 40%)) indicating worse prognosis/aggressive disease course with decreased survival.

Conclusion

Combined exposure of herbicide agent orange and smoking may be a fertile soil for observed differences in type and frequency of genomic alterations in veteran patient population with MCRPC. Comprehensive genomic profiling on CtDNA through minimally invasive liquid biopsy is feasible and can be successfully implemented in veterans with multiple co-morbidities. Although ARV7 mutation is much more common in general population, veterans with advanced hormone resistant prostatic carcinoma may benefit from aggressive approach in developing targeted therapy focused on DNA repair genes, especially Tp53.
Loss-Of-Function Mutation Of ARID1A Tumor Suppressor Gene In A Glycogen-Rich Clear Cell Mammary Carcinoma
Authors: De la Sancha Verduzco C A , Popnikolov N , Ruiz-Cordero R
Published: October 2020

Introduction/Objective

Glycogen-rich clear cell carcinoma (GRCC-CA) is a rare subtype of breast carcinoma accounting for 0.9 - 3% of all breast malignancies. It is characterized by more than 90% of the neoplastic cells containing glycogen-abundant clear cytoplasm. Due to the rarity of this tumor, the information about the specific genetic alterations, their prognostic significance and potential therapeutic implications are quite limited. Here we report the molecular alterations of a GRCC-CA diagnosed in a 69-year-old woman.

Methods

Tumor-only sequencing using a hybrid-capture next-generation sequencing (HC-NGS) assay was performed using formalin-fixed paraffin-embedded tissue. The HC-NGS panel included the coding regions of 479 cancer-related genes, select introns of 47 genes and the TERT promoter.

Results

The HC-NGS showed the following alterations: 1) large inversion in chromosome 1 between exon 20 of gene ARID1A (1p36.12) and intron 2 of KDM5B (1q32.1) leading to loss-of-function of ARID1A tumor suppressor gene, 2) MAP2K4 p.E376 truncating mutation with a variant allelic frequency of 87% suggestive of loss-of-heterozygosity, 3) c- MYC gene amplification (5x), 4) variant of uncertain significance in gene PTPRB (p.D1848N) and 5) deep deletions of NCKAP5, CCNT2, MAP3K19, LRP1B, and KMT2A genes.

Conclusion

We report for the first time a loss-of-function mutation of ARID1A gene in mammary GRCC-CA. Loss of function of ARID1A gene, as shown by molecular studies or loss of protein expression, is often seen in clear cell carcinomas with high glycogen contents from other sites (ovary and kidney), indicating similarities in the molecular mechanisms of development. In our patient, the loss of ARID1A probably enhanced the effect of the c-MYC amplification, since ARID1A is involved in the repression of c-MYC and other proliferation associated genes during differentiation. Larger molecular studies are needed to elucidate further the genetic mechanisms of mammary GRCC- CA.
Effects of Blackboard Resources Utilization on Students’ Performance in Molecular Biology Course
Authors: Kandel B P , Hackfeld M , Zhang J , Guo F
Published: October 2020

Introduction/Objective

Molecular diagnostics utilizes structural and functional fundamentals of molecular biology and finds its scope in clinical education for disease diagnosis and monitoring, and evaluation of non-disease status. Time and financial constraints make molecular biology education challenging for both teachers and students. Advances in information technologies have helped teachers to provide a rich resource to students which if properly utilized is expected to generate better teaching-learning outcomes. However, the pattern of utilization of digital resources by students and its impact on their performance is still unknown. The aim of this study was to assess students’ behavior to Blackboard resource utilization and its impact on their performance in molecular biology course.

Methods

We conducted a retrospective cross-sectional study including all the 46 students (9 graduate and 37 undergraduate students; 14 distant and 32 regular students) enrolled for molecular biology course in the year 2017 and assessed the associations between blackboard resource visits and students’ final weighted total grades.

Blackboard resource visit variables included “Tegrity” viewing duration, viewing times, and contents viewed (“My Grades”, “Announcement”, “Discussion”, “Contacts”, “Content Item”).

Results

Among all students, the most and least visited contents were “Content Item” (261 average hits) and “Contacts” (1.28 average hits), respectively with similar patterns of the visit among all student sub-categories. The longest average Tegrity viewing duration (25 hours) and the highest average Tegrity viewing times (56 hits) were noted among undergraduate distance students. The average grade was higher among graduate students than undergraduate students. The overall blackboard resource visit and the individual category visit among graduate and undergraduate students had no association with students’ final weighted scores.

Conclusion

Our findings have important implications for the utility of blackboard resources among graduate and undergraduate clinical laboratory science students. Similar assessments including students from many different years are recommended to generate more accurate evidence.
Mucinous Adenocarcinoma With Intrapulmonary Metastasis HarboringKRASandGNASMutations Arising in Congenital Pulmonary Airway Malformation
Authors: de Cordova Ximena Fernandez , Wang Huiying , Mehrad Mitra , Eisenberg Rosana , Johnson Joyce , Wei Qiang , Borinstein Scott , Danko Melissa E , Liang Jiancong
Published: October 2020

Objectives

Mucinous adenocarcinoma arising in unresected congenital pulmonary airway malformation (CPAM) is rare. Underlying driver mutations in addition to KRAS gain-of-function mutations in this setting and the long-term outcomes of these patients are unknown.

Methods

We report a case of metastatic mucinous adenocarcinoma harboring both KRAS and GNAS mutations arising in a type 1 CPAM of a 14-year-old male. A literature review was performed.

Results

Next-generation sequencing revealed identical KRAS (G12V) mutations in both the CPAM and metastatic adenocarcinoma and a missense mutation in the GNAS (R201C) gene in the metastatic adenocarcinoma only. Median survival was 23 and 4 years for patients with localized (no or limited spread within the same lobe of CPAM) and distant involvement (spread to any different lobe of CPAM) of mucinous cells, respectively (95% confidence interval, 23-23 and 1.5-22 years, respectively; P = .017).

Conclusions

Mucinous cell proliferation associated with type 1 CPAM has exceptionally good long-term outcomes if confined within the same lobe of CPAM. A second oncogenic mutation in the GNAS gene may be necessary for progression to malignancy and distant spread.
Dealing With Treatment-Confounder Feedback and Sparse Follow-up in Longitudinal Studies: Application of a Marginal Structural Model in a Multiple Sclerosis Cohort
Authors: Karim Mohammad Ehsanul , Tremlett Helen , Zhu Feng , Petkau John , Kingwell Elaine
Published: October 2020

The beta-interferons are widely prescribed platform therapies for patients with multiple sclerosis (MS). We accessed a cohort of patients with relapsing-onset MS from British Columbia, Canada (1995–2013), to examine the potential survival advantage associated with beta-interferon exposure using a marginal structural model. Accounting for potential treatment-confounder feedback between comorbidity, MS disease progression, and beta-interferon exposure, we found an association between beta-interferon exposure of at least 6 contiguous months and improved survival (hazard ratio (HR) = 0.63, 95% confidence interval 0.47, 0.86). We also assessed potential effect modifications by sex, baseline age, or baseline disease duration, and found these factors to be important effect modifiers. Sparse follow-up due to variability in patient contact with the health system is one of the biggest challenges in longitudinal analyses. We considered several single-level and multilevel multiple imputation approaches to deal with sparse follow-up and disease progression information; both types of approach produced similar estimates. Compared to ad hoc imputation approaches, such as linear interpolation (HR = 0.63), and last observation carried forward (HR = 0.65), all multiple imputation approaches produced a smaller hazard ratio (HR = 0.53), although the direction of effect and conclusions drawn concerning the survival advantage remained the same.
Chapter FiveDidymus and the Greek historians
Authors: Montana Fausto
Published: October 2020

We lack positive evidence that Didymus composed scholarly works specifically devoted to Greek historians. Even more, the very origins and characteristics of the Alexandrian interest in the historiographic genre, not to say in literary prose, represent open issues for the historian of Hellenistic scholarship. In this chapter, the rare and sparse pieces of information are gathered, in order to obtain a possibly systematic and organic overview on the very defective puzzle of the Didymean approach in this field. In the first part, clues from testimonies and fragments directly concerning historians (Herodotus, Thucydides) and antiquarian subjects (Solon’s axones) are taken into special consideration. The second part deals with the use and abuse of history and historical sources detectable in fragments from Didymean works which were devoted to fields and genres other than historiography. As a result, the testimony of the Pindar scholia and of the writing On Demosthenes attested to by P.Berol. inv. 9780 recto (second century ad) proves to be especially decisive for a reassessment of Didymus’ approach to historiography and history.
Parenting in fear: Child welfare micro strategies of Nigerian parents in Britain
Authors: Okpokiri Cynthia
Published: October 2020

Parental engagement with British child-rearing normative practices and policies has been a source of conflict between Black African parents and professionals involved in child-safeguarding in Britain. These professionals include teachers, police, healthcare practitioners such as health visitors, nurses and doctors, and most importantly, social workers, because Children Act 1989, section 47 legally tasks social workers to investigate child-safeguarding concerns. Child-rearing norms and practices across all four UK countries are largely similar, although substantive legislative differences necessitate the application of only child welfare laws/policies of England and Wales in this study. This article focuses on Nigerian parents’ experiences of British child welfare system, tensions ensuing from those interactions and how parents mitigate them. Insights are drawn from 25 in-depth semi-structured interviews and two focus group discussions with Nigerian parents living in Greater London. Honneth’s recognition theory and Fraser’s participatory parity undergird the conceptual framework. The findings reveal an interplay of the structural forces of race, power and cultural differentials on participants’ thinking processes and actions. Thus, suggesting that social workers perpetuate the British public’s misrecognition of Nigerian parents through uncritical social work practices, which are implicated in further disempowerment of Black African parents, to the detriment of the families’ well-being.
Context Matters: Situational Stress Impedes Functional Reorganization of Intrinsic Brain Connectivity during Problem-Solving
Authors: Liu Mengting , Backer Robert A , Amey Rachel C , Splan Eric E , Magerman Adam , Forbes Chad E
Published: October 2020

Extensive research has established a relationship between individual differences in brain activity in a resting state and individual differences in behavior. Conversely, when individuals are engaged in various tasks, certain task-evoked reorganization occurs in brain functional connectivity, which can consequently influence individuals’ performance as well. Here, we show that resting state and task-dependent state brain patterns interact as a function of contexts engendering stress. Findings revealed that when the resting state connectome was examined during performance, the relationship between connectome strength and performance only remained for participants under stress (who also performed worse than all other groups on the math task), suggesting that stress preserved brain patterns indicative of underperformance whereas non-stressed individuals spontaneously transitioned out of these patterns. Results imply that stress may impede the reorganization of a functional network in task-evoked brain states. This hypothesis was subsequently verified using graph theory measurements on a functional network, independent of behavior. For participants under stress, the functional network showed less topological alterations compared to non-stressed individuals during the transition from resting state to task-evoked state. Implications are discussed for network dynamics as a function of context.
Model-Driven Simulation of Elastic OCCI Cloud Resources
Authors: Ahmed-Nacer Mehdi , Kallel Slim , Zalila Faiez , Merle Philippe , Gaaloul Walid
Published: October 2020

Deploying a cloud configuration in a real cloud platform is mostly cost- and time- consuming, as large number of cloud resources have to be rented for the time needed to run the configuration. Thereafter, cloud simulation tools are used as a cheap alternative to test cloud configuration. However, most of the existing cloud simulation tools require extensive technical skills and do not support simulation of any kind of cloud resources. In this context, using a model-driven approach can be helpful as it allows developers to efficiently describe their needs at a high level of abstraction. To do, we propose, in this article, a model-driven engineering approach based on the Open Cloud Computing Interface(OCCI) standard metamodel and CloudSim toolkit. We firstly extend OCCI metamodel for the supporting simulation of any kind of cloud resources. Afterward, to illustrate the extensibility of our approach, we enrich the proposed metamodel by new simulation capabilities. As proof of concept, we study the elasticity and pricing strategies of Amazon Web Services (AWS). This article benefits from OCCIware Studio to design an OCCI simulation extension and to provide a simulation designer for designing cloud configurations to be simulated. We detail the approach process from defining an OCCI simulation extension until the generation and the simulation of the OCCI cloud configurations. Finally, we validate the proposed approach by providing a realistic experimentation to study its usability, the resources coverage rate and the cost. The results are compared with the ones computed from AWS.
Proposed Artificial Bee Colony Algorithm as Feature Selector to Predict the Leadership Perception of Site Managers
Authors: Kaya Keles Mumine , Kilic Umit , Keles Abdullah Emre
Published: October 2020

Datasets have relevant and irrelevant features whose evaluations are fundamental for classification or clustering processes. The effects of these relevant features make classification accuracy more accurate and stable. At this point, optimization methods are used for feature selection process. This process is a feature reduction process finding the most relevant feature subset without decrement of the accuracy rate obtained by original feature sets. Varied nature inspiration-based optimization algorithms have been proposed as feature selector. The density of data in construction projects and the inability of extracting these data cause various losses in field studies. In this respect, the behaviors of leaders are important in the selection and efficient use of these data. The objective of this study is implementing Artificial Bee Colony (ABC) algorithm as a feature selection method to predict the leadership perception of the construction employees. When Random Forest, Sequential Minimal Optimization and K-Nearest Neighborhood (KNN) are used as classifier, 84.1584% as highest accuracy result and 0.805 as highest F-Measure result were obtained by using KNN and Random Forest classifier with proposed ABC Algorithm as feature selector. The results show that a nature inspiration-based optimization algorithm like ABC algorithm as feature selector is satisfactory in prediction of the Construction Employee’s Leadership Perception.
The effect of intrinsic physiological traits on diapause survival and their underlying mechanisms in an annual bee speciesBombus impatiens
Authors: Treanore Erin , Amsalem Etya
Published: October 2020

In the face of insect declines, identifying phases of the life cycle when insects are particularly vulnerable to mortality is critical to conservation efforts. For numerous annual insect groups, diapause is both a key adaptation that allows survival of inhospitable conditions and a physiologically demanding life stage that can result in high rates of mortality. As bees continue to garner attention as a group experiencing high rates of decline, improving our understanding of how annual bees prepare for diapause and identifying factors that reduce survival is imperative. Here, we studied factors affecting diapause survival length and their underlying mechanisms using an economically and ecologically important annual bee species, Bombus impatiens. We examined how age and mass upon diapause onset correlate with diapause survival length, and the mechanistic role of nutrient acquisition and oxidative stress post pupal eclosion in mediating these effects. Our findings show that both age and mass were strong predictors of diapause survival length. Heavier queens or queens in the age range of ~6–17 days survived longer in diapause. Mass gain was attributed to increases in lipid, protein and glycerol amounts following pupal eclosion, and the ability to deal with oxidative stress was significantly compromised in older pre-diapause queens. Our results demonstrate that age-related shifts in bee physiology and timing of nutrient acquisition may both be critical factors driving diapause survival.
In patients undergoing coronary artery bypass grafting, is endoscopic harvesting superior to open radial artery harvesting?
Authors: Lei Jonathan Jin Hei , Ravendren Andrew , Snosi Mostafa , Harky Amer
Published: October 2020

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘In patients undergoing coronary artery bypass grafting, is endoscopic radial artery harvesting (ERAH) superior to open radial artery harvesting in terms of postoperative complications, mortality, graft quality and patency rates?’. Altogether 130 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. Two studies were meta-analyses and 3 were randomized trials. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In terms of graft quality, 2 randomized studies showed preserved endothelial integrity and vasoreactivity with ERAH, whereas 1 randomized study found superior endothelial function with open radial artery harvesting. Importantly, 3 studies showed graft patency was not compromised with ERAH. One meta-analysis reported no differences in graft patency between groups at 1 year [odds ratio (OR) 1.24] and up to 3–5-years follow-up (OR 1.81), as well as similar perioperative myocardial infarction rates (OR 0.80). Two meta-analyses found similar mortality in the perioperative period (OR 0.62–0.78) and up to 5 years (OR 0.64–0.67); ERAH reduced the incidence of perioperative wound complications (P-values 0.001–0.03); however, harvest times were increased with ERAH (P < 0.0005). We conclude that ERAH is non-inferior to open radial artery harvesting in terms of mortality, graft quality and patency rates, but superior in terms of reducing perioperative wound complications, with good cosmetic effect. However, these benefits come at the cost of increased harvesting time.
Double Grothendieck Polynomials and Colored Lattice Models
Authors: Buciumas Valentin , Scrimshaw Travis
Published: October 2020

We construct an integrable colored six-vertex model whose partition function is a double Grothendieck polynomial. This gives an integrable systems interpretation of bumpless pipe dreams and recent results of Weigandt relating double Grothendieck polynomias with bumpless pipe dreams. For vexillary permutations, we then construct a new model that we call the semidual version model. We use our semidual model and the five-vertex model of Motegi and Sakai to give a new proof that double Grothendieck polynomials for vexillary permutations are equal to flagged factorial Grothendieck polynomials. Taking the stable limit of double Grothendieck polynomials, we obtain a new proof that the stable limit is a factorial Grothendieck polynomial as defined by McNamara. The states of our semidual model naturally correspond to families of nonintersecting lattice paths, where we can then use the Lindström–Gessel–Viennot lemma to give a determinant formula for double Schubert polynomials corresponding to vexillary permutations.
Swab-Free Transport as an Optimized Preanalytical Workflow for SARS-CoV-2 Amplification
Authors: Greene Dina N , Matthys Tawna , Lockwood Christina M
Published: October 2020

Introduction

Efficient detection of SARS-CoV-2 will continue to be an invaluable tool for pandemic control. Current instructions specify that the collection swab should be transported within its collection media to the laboratory. Developing a process whereby this swab is removed before transport to the lab would allow for improved automation and decreased manual manipulation of samples.

Methods

A proof of principle approach was taken by eluting viral particles from flocked swabs into collection buffer with and without a mucus background. Paired swab-free and swab-containing samples were transported to the laboratory and evaluated for SARS-CoV-2 (n = 28) or RNaseP (n = 6). SARS-CoV-2 amplification was performed using the Hologic Panther Fusion Aptima and RT-PCR assays.

Results

SARS-CoV-2 was detected in all proof of principle samples with Ct values indicative of dilution. The rare exception was for a few samples where the dilution pushed the viral load below the LOD. Paired samples were 100% concordant for SARS-CoV-2 and RNaseP detection.

Conclusion

Discarding the swab after inoculating the transport buffer is an appropriate preanalytical modification. Adopting this approach can save up to 1 minute per sample. For labs processing more than 500 samples per day this equates to 1 full time equivalent shift per day.
Optimizing clinical decision support alerts in electronic medical records: a systematic review of reported strategies adopted by hospitals
Authors: Van Dort Bethany A , Zheng Wu Yi , Sundar Vivek , Baysari Melissa T
Published: October 2020

Objective

To identify and summarize the current internal governance processes adopted by hospitals, as reported in the literature, for selecting, optimizing, and evaluating clinical decision support (CDS) alerts in order to identify effective approaches.

Materials and methods

Databases (Medline, Embase, CINAHL, Scopus, Web of Science, IEEE Xplore Digital Library, CADTH, and WorldCat) were searched to identify relevant papers published from January 2010 to April 2020. All paper types published in English that reported governance processes for selecting and/or optimizing CDS alerts in hospitals were included.

Results

Eight papers were included in the review. Seven papers focused specifically on medication-related CDS alerts. All papers described the use of a multidisciplinary committee to optimize alerts. Other strategies included the use of clinician feedback, alert data, literature and drug references, and a visual dashboard. Six of the 8 papers reported evaluations of their CDS alert modifications following the adoption of optimization strategies, and of these, 5 reported a reduction in alert rate.

Conclusions

A multidisciplinary committee, often in combination with other approaches, was the most frequent strategy reported by hospitals to optimize their CDS alerts. Due to the limited number of published processes, variation in system changes, and evaluation results, we were unable to compare the effectiveness of different strategies, although employing multiple strategies appears to be an effective approach for reducing CDS alert numbers. We recommend hospitals report on descriptions and evaluations of governance processes to enable identification of effective strategies for optimization of CDS alerts in hospitals.
Multi-Frequency Ultrasonic Extraction of Anthocyanins from Blueberry Pomace and Evaluation of Its Antioxidant Activity
Authors: Hu Ai-Jun , Hao Shu-Ting , Zheng Jie , Chen Lin , Sun Peng-Peng
Published: October 2020

Background

A large amount of blueberry pomace is discarded and wasted.

Objective

To make full use of blueberry pomace and extract anthocyanins.

Method

Multi-frequency ultrasound was used to extract anthocyanins from blueberry pomace. The effects of different extraction conditions on the anthocyanin yields were studied. The antioxidant activity of anthocyanins was evaluated, and the main anthocyanin components were identified by HPLC-electrospray ionization (ESI)-MS/MS.

Results

The optimal anthocyanin extraction conditions were as follows: dual-frequency ultrasound of 40 + 80 kHz, ultrasonic power of 350 W, extraction temperature of 50°C, and extraction time of 40 min. Compared with single frequency (25 kHz) and tri-frequency ultrasound (25 + 40 + 80 kHz), the anthocyanin yield with dual-frequency ultrasound increased by 15.26% and 5.45% respectively. Furthermore, the antioxidant activities (DPPH, hydroxyl radical scavenging ability, and reducing power) of anthocyanins extracted with dual-frequency ultrasound were all higher than those without ultrasound. Seven kinds of anthocyanins were identified by HPLC-ESI-MS/MS.

Conclusions

Dual-frequency ultrasound had a higher extraction yield than single frequency ultrasound, tri-frequency ultrasound, and no ultrasound.

Highlights

Dual-frequency ultrasonic technology provides an effective approach for improving the extraction yield of anthocyanins from blueberry pomace.
Screening of Synthetic Cathinones and Metabolites in Dried Blood Spots by UPLC–MS-MS
Authors: Wang Yang , Shi Yan , Yu Yingjia , Chen Lizhu , Jiang Jiebing , Long Jiakun , Xiang Ping , Duan Gengli
Published: October 2020

After its use for decades in clinical screening, dried blood spots (DBS) have recently received considerable attention for their application in various novel psychoactive substances. The goal of this study was to develop and apply a DBS-based assay for 37 synthetic cathinones and their metabolites. Thirty microliters of whole blood sample after administration was spotted onto Whatman FTA classical cards, dried and extracted, and then analyzed by ultra-performance liquid chromatography–tandem mass spectrometry (UPLC–MS-MS). The samples were chromatographed on a Waters Acquity UPLC®HSS T3 column (1.8 μm, 2.1 × 100 mm) and then identically packed defender guard cartridges of a Waters Acquity UPLC®HSS T3 column (1.8 μm, 2.1 × 5 mm, 3/pk). The separation was achieved via solvents of 20 mM ammonium acetate/formic acid 0.1% (A) and acetonitrile (B) at a flow rate of 0.25 mL/min. A tandem MS equipped with positive electrospray ionization mode source was used as the detector. Multiple reaction monitoring with the precursor/product ion combinations was used to quantify each analyte. The linear range of synthetic cathinones in the DBS was 2.0–200 ng/mL, and the lowest limit of quantification was 2.0 ng/mL for some synthetic cathinones and 10 ng/mL for others. The precision and accuracy of the results for the validation samples of the synthetic cathinones were within acceptable criteria. DBS sampling offers the advantages of reduced sample volume and convenient sample storage and shipment. This method can be successfully applied to the quantification of synthetic cathinones.
To Be (a State) or Not to Be?
Authors: Heinsch Robert , Pinzauti Giulia
Published: October 2020

One of the traditional criteria for statehood under the Montevideo Convention is that an entity possesses an ‘effective government’. Against this backdrop, this article discusses the impact of belligerent occupation on Palestine’s ability to possess an effective government, and thus fulfil the criteria for statehood. It argues that, as a matter of law, the requirement of effective government should not be interpreted strictly. Statehood does not require an immutable threshold of effectiveness; rather, the criterion has been flexibly interpreted and applied in practice. Belligerent occupation is a factual circumstance calling for such a flexible interpretation. While occupation impairs an occupied entity’s ability to exercise the functions of government, it does not affect statehood. Within the framework of the Rome Statute, the fact that the Court has jurisdiction over situations of belligerent occupation confirms this interpretation. Moreover, when assessing whether an occupied entity meets the criteria for statehood, deficiencies in effectiveness should be weighed against the principle of self-determination and international recognition. Applying those considerations to Palestine’s situation, the conclusion seems warranted that it meets the criteria for statehood under general international law and can thus validly trigger the Court’s jurisdiction to investigate and prosecute alleged crimes committed on its territory.
German Politics and Government
Authors: Davidson-Schmich Louise K.
Published: October 2020

Due to Germany’s prior history of foreign aggression, its important role in the contemporary global economy, and its unique social market economy, the post–World War II German political system has been widely studied by both German- and English-speaking scholars. This article begins by outlining some general overviews of German politics and history as well as textbooks and academic journals covering the subject. It also includes links to leading German-language news sources. It then turns its attention to German political institutions and depicts treatments of the executive, legislative, and judicial branches of government followed by studies of multilevel governance at the European, state, and local levels. The subsequent section delves into the important role played by political parties in Germany; this section also explores treatments of individual parties. Then the bibliography covers the German electoral system, voting behavior, and specific national elections. It then covers scholarly treatments of the political elites. The discussion then turns away from formal political institutions and leaders toward the societal influences on them. This portion of the article begins by examining literature on political culture, immigration, and social movements in Germany. The final portion of the bibliography focuses on interest groups and policy making in a number of areas, including economic and foreign policy.