bluuebunny/crossref_metadata_2025 huggingface dataset:
Boosting pseudocapacitive charge storage in in situ functionalized carbons with a high surface area for high-energy asymmetric supercapacitors
Authors: Zhang Hao , Lu Mingjie , Wang Huanlei , Lyu Yan , Li Dong , Sun Shijiao , Shi Jing , Liu Wei
Published: August 2018

The porosity and heteroatom doping level can be tuned for jellyfish-derived carbons to adjust capacitive and pseudocapacitive contributions.
On outage secrecy minimisation in an energy harvesting relay assisted cognitive radio networks
Authors: Banerjee Avik , Maity Santi P. , Roy Subhabrata
Published: August 2018

This work considers an energy harvesting (EH) based two‐hop relay assisted cognitive radio system that consists of a secondary transmitter, a relay node and a cooperative jammer operated in an underlay mode with a primary transmitter–receiver pair. An optimisation problem is formulated to minimise the secrecy outage probability under the constraints of simultaneously meeting the energy causality of the secondary transmit nodes, interference to the primary receiver and secondary outage probability. An analytical expression of the secrecy outage probability is developed followed by deriving the closed‐form expressions to determine the optimal transmit power of the source, the relay node and the fraction of the time slot for EH. Simulation results show that the minimum value of the secrecy outage probability is and less over the existing works.
Warm CO in evolved stars from the THROES catalogue
Authors: Ramos-Medina J. , Sánchez Contreras C. , García-Lario P. , da Silva Santos J. M.
Published: August 2018

In this work (Paper I), we analyse Herschel-PACS spectroscopy for a subsample of 23 O-rich and 3 S-type evolved stars, in different evolutionary stages from the asymptotic giant branch (AGB) to the planetary nebula (PN) phase, from the THROES catalogue. (C-rich targets are separately studied in Paper II). The broad spectral range covered by PACS (∼55–210 μm) includes a large number of high-J CO lines, from J = 14 − 13 to J = 45 − 44 (v = 0), that allow us to study the warm inner layers of the circumstellar envelopes (CSEs) of these objects, at typical distances from the star of ≈1014–1015 cm and ≈1016 cm for AGBs and post-AGB-PNe, respectively. We have generated CO rotational diagrams for each object to derive the rotational temperature, total mass within the CO-emitting region and average mass-loss rate during the ejection of these layers. We present first order estimations of these basic physical parameters using a large number of high-J CO rotational lines, with upper-level energies from Eup ∼ 580 to 5000 K, for a relatively big set of evolved low-to-intermediate mass stars in different AGB-to-PN evolutionary stages. We derive rotational temperatures ranging from Trot ∼ 200 to 700 K, with typical values around 500 K for AGBs and systematically lower, ∼200 K, for objects in more advanced evolutionary stages (post-AGBs and PNe). Our values of Trot are one order or magnitude higher than the temperatures of the outer CSE layers derived from low-J CO line studies. The total mass of the inner CSE regions where the PACS CO lines arise is found to range from MH2 ∼ 10−6 to ≈10−2 M⊙, which is expected to represent a small fraction of the total CSE mass. The mass-loss rates estimated are in the range Ṁ ∼ 10−7 − 10−4 M⊙yr−1, in agreement (within uncertainties) with values found in the literature. We find a clear anticorrelation between MH2 and Ṁ vs. Trot that probably results from a combination of most efficient line cooling and higher line opacities in high mass-loss rate objects. For some strong CO emitters in our sample, a double temperature (hot and warm) component is inferred. The temperatures of the warm and hot components are ∼400–500 K and ∼600–900 K, respectively. The mass of the warm component (∼10−5–8 × 10−2 M⊙) is always larger than that of the hot component, by a factor of between two and ten. The warm-to-hot MH2 and Trot ratios in our sample are correlated and are consistent with an average temperature radial profile of ∝ r−0.5 ± 0.1, that is, slightly shallower than in the outer envelope layers, in agreement with recent studies.
Biodiversity Indexes: Value and Evaluation Purposes
Authors: Supriatna Jatna
Published: August 2018

Biodiversity is a word recently introduced by experts in the field of biology. This word became more meaningful after Edward O. Wilson of Harvard University introduced it in a book entitled Biodiversity, an extension of biological diversity, in 1989 [11]. In subsequent developments, it became very popular and used not only by environmental biologists but also by researchers, environmentalists, funders, educators, social experts, economists, policy makers, and many others, although many do not know what that means. Biodiversity includes variations within the biological community, where living species, and ecosystems, where communities are located, as well as interaction between them (Pri. The science of biodiversity has emerged rapidly since then included monitoring and evaluation systems which is measuring the value of biodiversity components, such as the number of species present, the population of species, a habitat or the sum of all such components within a given area or site. Such monitoring and evaluation may be carried out for a variety of reasons, included identification of a given area for biodiversity richness, evenness or healthy ecosystems. The richness is the number of species per sample, the more species present in a sample, the richer the sample. Evenness is a measure of the relative abundance of the different species making up the richness of an area. Two commonly used to measure biodiversity Simpson index Ds and Shannon’s index H’. Simpson’s index DS is similarity index (the higher the value the lower in diversity). While Shannon index is combining evenness and richness and less weighted on dominant species. Both indexes are more reflective in nature and can predict the environment health. Therefore, it may be good to have one of those biodiversity indexes to be used for UI GreenMetric to understand the environment healthiness in the campus.
Design and operation experience of zero-carbon campus
Authors: Xu Pan , Jin Zebang , Zhao Yuzhu , Wang Xiaobo , Sun Haiquan
Published: August 2018

Shandong Normal University - Lishan College is a zero-carbon campus, using the technical scheme “multiple sources of energy complementing each other, 100% utilization of renewable energy, combining concentrated demonstration with popular extension”. It has built 5 distributed energy stations, including roof PV power station, solar heating water system, biomass vacuum hot water unit, natural gas (straw pyrolysis gas, biomethane) CCHP demonstration project etc. Renewable energy can provide power, heating, air conditioning and hot water for 10,000 teachers and students. The zero-carbon campus save 3,650 tce/a, and the CO2 emission reduction is 9,490 t/a. It offers great experience and is a model for the regional clean and low carbon energy usage and the realization of sustainable development.
Evaluation of electricity consumption and carbon footprint of UI GreenMetric participating universities using regression analysis
Authors: Presekal Alfan , Herdiansyah Herdis , Harwahyu Ruki , Suwartha Nyoman , Fitri Sari Riri
Published: August 2018

UI GreenMetric as sustainability-based university rankings has received a worldwide acceptance since its initiation in 2010. One of the criteria for this ranking is the annual electricity consumption of participating Universities. There are some challenges in evaluating the overall data, i.e. some electricity consumption information is missing or may not accurately represent the real condition. There is various information that can be used to calculate the university rank associated with electricity consumption. On the other hand, some external data sources from World Bank on the annual electricity consumption per capita for every country is highly correlated with the electricity consumption in every University. This paper aims to show our evaluation and prediction of the annual electricity consumption from participating university using regression analysis based on the available data of UI GreenMetric and relevant external information. This is conducted using regression analysis on the data submitted in 2017 and the predicted KWH based on the number of full-time student and staff in the university. The result shows that some universities are consuming more electricity than the average KWH used per-capita in their country. The result also shows that the prediction cannot be used accurately, especially for the carbon footprint. This evaluation may help universities to improve their policy in reducing the electricity consumption and the greenhouse gas emission reduction policy, and mainly helps UI GreenMetric to speed up the verification process when necessary
Sustainability in motion at UAO: integrated waste management
Authors: Pérez Luis H. , Gandini Mario A.
Published: August 2018

The Universidad Autónoma de Occidente (UAO), located in Cali (Colombia), launched the Sustainable Campus Program in 2015, in order to implement sustainability actions and strategies within the University campus with the purpose of contributing both to a better environmental performance of the campus operations and to generate knowledge and experience than can be used in the context of cities and regions in their search for reaching sustainable conditions. Integrated waste management is one of the components of the UAO Sustainable Campus Program. Based on the categories and indicators presented in the GreenMetric 2017, the integrated waste management includes the program to reduce the use of paper and plastic in campus, recycling program for university waste, toxic waste handled, organic waste treatment and inorganic waste treatment.
Water conservation and management: case study in Siam University
Authors: Mongkhonvanit Pornchai , Rukspollmuang Chanita , Silalai Nattiga , Phitthayanon Chanida
Published: August 2018

Siam University (SU) is one of the leading Thai comprehensive private universities of which “Sustainability” is one of the main missions. The mission is guided by the concept of “Sustainable Development (SD)” and the principle of “Sufficiency Economy Philosophy (SEP)” bestowed by the late King Rama IX. SU has endorsed many sustainability policies and projects including those concerned with ecosystem and water management system. Our target groups include SU staff and students as well as members in Phasi Charoen district. SU has encouraged water conservation and management policies and practices including reduction of water usage program for quite some time. Although piped water is still mainly used, we have installed automated hand washing taps counting to more than 75% of total water appliances. Water from the campus natural pond is used and reused for gardening and washing. After this initial stage, we have planned to do more programs concerning water recycling, reuse, and treatment system under the principle of SEP. Considering that our pond and surrounding canals are connected to Phasi Charoen communities, we hope that our water conservation and management system will not only lead to a more sustainable campus but also a more sustainable district.
How universities can work together with local communities to create a green, sustainable future
Authors: Oliver Su Yuhlong , Chen Ku-Fan , Tsai Yung-Pin , Su Hui-I
Published: August 2018

Over the past few years, National Chi Nan University (NCNU) has made significant achievements in its development as a “green university.” Besides continuing to implement sustainable development of its campus, NCNU has also been implementing the “Citizenship Cultivation Plan,” “University without Boundary Project” and “University Social Responsibility (USR) Plan,” using the local community as a test-bed, and working actively to integrate NCNU’s curriculum with the community, so as to enhance awareness of local environmental issues among students, faculty members and local residents, and build consensus of sustainable environmental development. NCNU has implemented a range of action plans and practical courses of environmental education to work together with local residents for environmental issues, such as water resources, air quality, waste, etc. Through these activities, NCNU’s students and faculty members and local residents are able to develop a better understanding of the environment, and how they can make a bigger contribution towards environmental protection. Regarding the international voluntary service activities, NCNU has endeavored to fulfil its social responsibility as a university. Under the dynamic leadership of President Dr. Yuh-Long Su, College of Science and Technology and College of Management have joined forces with “Chunghwa International Sunshine Charitable Association” established by Taiwanese businesspeople in Southeast Asia, using NCNU’s knowhow and technology to build the water purification systems in Cambodia, providing clean and safe drinking water for people in remote and disadvantaged areas. NCNU has strongly rooted in the local community with the content of the United Nations’ Sustainable Development Goals (SDGs) to build capabilities in four key areas - educational development, local action, industry-academia collaboration, and global integration - and to expand the scope of its activities from the local to the international. In the future, NCNU will continue devoting itself to sustainability and environmental issues, working wholeheartedly to meet its social responsibility goals as a university.
NPUST’s practice on achieving sustainable development goals
Authors: Tai C.-H. , Chang C.-L. , Leong J.C.
Published: August 2018

The National Pingtung University of Science and Technology was established as an agricultural institution in 1924. Since then, this educational institution has been one of the key role players in developing the agricultural advancement in Taiwan. For years, the university has seriously planned and carried out projects that strengthen her identity, “being green”. Under the scope of university’s uniqueness and responsibility, measures taken in the university directly involves administrative affairs, such as teaching, research, university development, student welfare, etc. As a matter of fact, initiating new policies, measures, and projects is only the beginning of everything. Without proper planning, enforcement, and funding, any one of these policies, measures, and projects may end up going nowhere. In other words, sustainability is absolutely the most critical element that dictates the success of the policies, measures, and projects. This sustainability covers financial allocation, manpower, negotiation, evaluation, and adjustments. The university has invested a lot of funding and effort to achieve the aforementioned goals through various means in the aspects of administration, education, research and development.
Augmented bio-based lipids for cosmetics
Authors: Duprat-de-Paule Sébastien , Guilbot Jérôme , Roso Alicia , Cambos Sophie , Pierre Aurélie
Published: August 2018

Practical examples showcase the key role of plant-based lipids in the design of innovative sustainable specialty ingredients. Great diversity in plant origins and chemical transformations leads to great molecular diversity and explains why bio-based lipids are involved in broad ingredient categories such as biodegradable emollients, environmentally friendly surfactants, rheology modifiers and active ingredients. Choosing lipid structure, with varying fatty chain length, saturation level and branching, determines ingredient functionality and usage, as these vary, for instance in the case of surfactants, solubilizing, wetting, foaming and emulsifying properties (oil-in-water or water-in-oil). The lipid structure also impacts the ingredients’ final solid or liquid appearance. Now ready-to-use ingredients can be created and we can innovate with cold processable new cosmetic formulation concepts. Perhaps most importantly, optimal selection of lipid structure and composition can also drive consumer benefits in cosmetic ingredients, especially, the final sensory experience (for excipients) and biological efficacy (for active ingredients). Bio-based lipids lead to new ingredients with augmented performance and sensoriality.
Langzeit-Augmentationstherapie von Patienten mit Alpha-1-Antitrypsin-Mangel in der häuslichen Pflege
Authors: Wilke A. , Semper H. , Gross C. , Grohé C.
Published: August 2018

Hintergrund Die Augmentation mit humanem Alpha-1-Proteinase-Inhibitor ist die einzige spezifische Behandlung des Alpha-1-Antitrypsin-Mangels (AATD), einer seltenen genetischen Erkrankung mit Symptomen einer fortschreitenden COPD.

Objektives Eine prospektive Langzeituntersuchung objektiver Messwerte und subjektiver klinischer Daten während des Augmentationsprogramms „Alpha-1-Mobile“ für die häusliche i. v.-Applikation von Alpha-1-Proteinase-Inhibitor bei einem Patientenkollektiv im fortgeschrittenen Erkrankungsstadium.

Methoden Sieben Patienten erhielten wöchentlich eine i. v.-Augmentation in der häuslichen Umgebung, begleitend zur stadiengerechten COPD-Therapie. Symptome, Lungenfunktion, Gesundheitszustand, Lebensqualität und Sicherheit wurden kontinuierlich über einen Zeitraum von 6 Jahren dokumentiert. Die Ergebnisse wurden auf einer inter- und intraindividuellen Basis ausgewertet. FEV1-Verläufe wurden mit Vorprogrammdaten verglichen.

Ergebnisse Die betreuten Patienten hatten ein Durchschnittsalter von 56,7 (40 – 68) Jahren und für 8,8 (1 – 19) Jahre eine Augmentationstherapie erhalten. Verglichen mit der dreijährigen Vorprogrammperiode, verringerte sich der funktionelle Abfall von FEV1 (ΔFEV1: 0,47 l gegenüber 0,17 l) unter der Therapie. Die mittleren Lebensqualitätsdaten (QoL-Werte) zeigten in den ersten drei Beobachtungsjahren saisonale Schwankungen und stabilisierten sich dann. Die bestimmten Serumspiegel überschritten die protektive Schwelle von 50 mg/dl mit einer Augmentationsdosis von 60 mg/kg/Woche. Weniger als ein exazerbationsbedingter Krankenhausaufenthalt trat pro Patientenjahr auf. Es wurden keine auf die Therapie zurückzuführenden unerwünschten Ereignisse beobachtet.

Schlussfolgerungen Die häusliche Betreuung inklusive Applikation der i. v.-Therapie durch medizinisches Fachpersonal sorgte aufgrund kontinuierlicher Behandlung und engmaschiger Überwachung des Gesundheitszustandes für eine optimale Versorgung der von uns untersuchten Patienten. Dies zeigt sich unter anderem in einer weitgehenden Vermeidung exazerbationsbedingter Krankenhauseinweisungen während der beobachteten Zeit. Die häusliche Applikation der Therapie im Rahmen des „Alpha-1-Mobile“ wurde gut angenommen, war praktisch und sicher.
Design and Synthesis of Aromatics through [2+2+2] Cyclotrimerization
Authors: Kotha Sambasivarao , Lahiri Kakali , Sreevani Gaddamedi
Published: August 2018

The [2+2+2] cycloaddition reaction is a useful tool to realize unusual chemical transformations which are not achievable by traditional methods. Here, we report our work during the past two decades that involve utilization of transition-metal complexes in a [2+2+2] cyclotrimerization reaction. Several key “building blocks” were assembled by a [2+2+2] cycloaddition approach and they have been further expanded by other synthetic transformations to design unusual amino acids and peptides, diphenylalkanes, bis- and trisaryl benzene derivatives, annulated benzocycloalkanes, spirocycles, and spirooxindole derivatives. Furthermore, we have also discussed about alkyne surrogates, environmentally friendly, and stereoselective [2+2+2] cycloaddition reactions. Application of the [2+2+2] cycloaddition reaction in total synthesis is also covered. In this review we also included others work to give a balanced view of the recent developments in the area of [2+2+2] cycloaddition.

1 Introduction

2 Unusual Amino Acids and Peptides

3 Heteroanalogues of Indane

4 Diphenylalkane Derivatives

5 Multi-Armed Aryl Benzene Derivatives

6 Annulated Benzocycloalkanes

7 Spirocycles

8 Selectivity in [2+2+2] Cycloaddition of Alkynes

9 [2+2+2] Cycloaddition Reactions under Environmentally Friendly Conditions

10 Alkyne Surrogates

11 Domino Reactions involving a [2+2+2] Cycloaddition

12 Biologically Important Targets/Total Synthesis

13 Conclusions
Going Mobile: Resident Physicians' Assessment of the Impact of Tablet Computers on Clinical Tasks, Job Satisfaction, and Quality of Care
Authors: Sweeney Megan , Paruchuri Kaavya , Weingart Saul
Published: August 2018

Background There are few published studies of the use of portable or handheld computers in health care, but these devices have the potential to transform multiple aspects of clinical teaching and practice.

Objective This article assesses resident physicians' perceptions and experiences with tablet computers before and after the introduction of these devices.

Methods We surveyed 49 resident physicians from 8 neurology, surgery, and internal medicine clinical services before and after the introduction of tablet computers at a 415-bed Boston teaching hospital. The surveys queried respondents about their assessment of tablet computers, including the perceived impact of tablets on clinical tasks, job satisfaction, time spent at work, and quality of patient care.

Results Respondents reported that it was easier (73%) and faster (70%) to use a tablet computer than to search for an available desktop. Tablets were useful for reviewing data, writing notes, and entering orders. Respondents indicated that tablet computers increased their job satisfaction (84%), reduced the amount of time spent in the hospital (51%), and improved the quality of care (65%).

Conclusion The introduction of tablet computers enhanced resident physicians' perceptions of efficiency, effectiveness, and job satisfaction. Investments in this technology are warranted.
The Hartman effect in Weyl semimetals
Authors: Xu Zhonghui , Siu Zhuobin , Jalil Mansoor B. A. , Yesilyurt Can , Lv Weishuai , Huang Jinsong , Zhong Yangwan , Chen Yuguang
Published: August 2018

The group delay and dwell time are theoretically investigated in Weyl semimetals in the presence and absence of a magnetic field. The Hartman effect, which denotes the independence of group delay time on barrier length, is observed in Weyl semimetals when the incident angle and electron energy exceed certain critical values. We discuss the influence of the incident azimuthal angle, incident electron energy, and barrier length on the group delay time. Additionally, we found that the Hartman effect is also influenced by the magnetic field due to the direction dependence of the dwell time. This suggests some possible means to control the group delay time in applications involving Weyl semimetal-based devices.
Experimental validation of the hybrid scattering model of installed jet noise
Authors: Lyu Benshuai , Dowling Ann P.
Published: August 2018

Jet installation causes jet noise to be amplified significantly at low frequencies, and its physical mechanism must be understood to develop effective aircraft noise reduction strategies. A hybrid semi-empirical prediction model has recently been developed based on the instability-wave-scattering mechanism. However, its validity and accuracy remain to be tested. To do so, in this paper we carry out a systematic installed jet-noise experiment in the laboratory using a flat plate instead of an aircraft wing. We show that reducing H (the separation distance between the flat plate and jet centerline) causes stronger low-frequency noise enhancement while resulting in little change to the noise shielding and enhancement at high frequencies. Decreasing L (the axial distance between the jet exit plane and the trailing edge of the plate) results in reduced noise amplification at low frequencies and also weakens both the shielding and enhancement at high frequencies. Increasing the jet Mach number abates the installation effects. It is shown that the hybrid model developed in the earlier work agrees with experimental measurements and can capture the effects of varying H, L, and jet Mach number extremely well. It is concluded that the model captures the correct physics and can serve as an accurate and robust prediction tool. This new physical understanding provides insights into innovative strategies for suppressing installed jet noise.
A critical assessment of the line tension determined by the modified Young’s equation
Authors: Zhang Jun , Wang Pengfei , Borg Matthew K. , Reese Jason M. , Wen Dongsheng
Published: August 2018

Although the modified Young’s equation is frequently applied to evaluate the line tension of droplets, debate concerning the value and even the sign of the line tension is ongoing. The reason for this is that the line tension defined in the modified Young’s equation is not a pure line tension but an apparent line tension, which includes the effects of the Tolman length and the stiffness coefficients. In this paper, we employ molecular dynamics (MD) to simulate three-dimensional water nanodroplets on platinum surfaces and determine their apparent line tensions by applying a linear fit to the relation of the cosine of the contact angle to the curvature of the contact line. The effects of the Tolman length and the position of the solid-liquid dividing interface on the measured line tension are investigated. On the one hand, our results elucidate the reason why MD results for line tensions are so scattered and also lend numerical support to Schimmele et al.’s theoretical predictions [“Conceptual aspects of line tensions,” J. Chem. Phys. 127, 164715 (2007)]. On the other hand, our MD simulation results demonstrate that the modified Young’s equation is a useful tool to predict the macroscopic contact angle based on a linear fit of the measured contact angles at the nanoscale. The apparent line tension is, however, sensitive to the chosen position of the solid-liquid dividing interface.
Moving regional health services planning and management to a population-based approach: implementation of the Regional Operating Model (ROM) in Victoria, Australia
Authors: Levesque Jean-Frederic , O'Dowd John J. M. , Ní Shé Éidín M. , Weenink Jan-Willem , Gunn Jane
Published: August 2018

Various jurisdictions are moving towards population-based approaches to plan and manage healthcare services. The evidence on the implementation of these models remains limited. The aim of this study is to evaluate the effect of a regional operating model (ROM) on internal functioning and stakeholder engagement of a regional office. Semi-structured interviews and focus groups with staff members and stakeholders of the North West Metropolitan Regional office in Victoria, Australia, were conducted. Overall, the ROM was perceived as relevant to staff and stakeholders. However, creating shared objectives and priorities across a range of organisations remained a challenge. Area-based planning and management is seen as simplifying management of contracts; however, reservations were expressed about moving from specialist to more generalist approaches. A clearer articulation of the knowledge, skills and competencies required by staff would further support the implementation of the model. The ROM provides a platform for public services and stakeholders to discuss, negotiate and deliver on shared outcomes at the regional level. It provides an integrated managerial platform to improve service delivery and avoid narrow programmatic approaches.
Effect of the level of effort during resistance training on intraocular pressure
Authors: Vera Jesús , Jiménez Raimundo , Redondo Beatríz , Torrejón Alejandro , De Moraes Carlos Gustavo , García‐Ramos Amador
Published: August 2018

Background: We aimed to evaluate the influence of the level of effort during four basic resistance exercises leading to muscular failure on intraocular pressure (IOP) and ocular perfusion (OPP), as well as the role of exercise type and sex. Methods: Twenty‐five young adults (12 women) performed 10 repetitions against their 10‐RM (repetition maximum) load in the squat, military press, biceps curl and calf raise exercises. IOP was measured before, during and after exercise, whereas OPP was indirectly assessed before and after each exercise. Results: There was a progressive IOP rise during exercise (p < 0.001, η² = 0.531), which was dependent on exercise type (p = 0.020, η² = 0.125). The squat exercise induced higher IOP increments in comparison to the other exercises (corrected p‐values < 0.001), and higher IOP values were found for the military press and biceps curl than for the calf raise exercise (corrected p‐values = 0.012 and 0.002). OPP exhibited a significant reduction when leading to muscular failure (p = 0.001, η² = 0.364), being statistically significant for the squat and military press exercises (corrected p‐values = 0.037 and 0.047). No effect of sex was found for IOP and OPP (p > 0.05). Conclusions: A single set of resistance training leading to muscular failure causes an instantaneous and progressive IOP rise in healthy young individuals. These IOP rises depend on exercise type (squat > military press = biceps curl > calf raise), but not on participant´s sex. OPP diminished as a consequence of performing resistance training exercise, being statistically significant for the squat and military press exercises. Future studies should include glaucoma patients aiming to corroborate the generalizability of our findings.
Domain-Specific Diaschisis: Lesions to Parietal Action Areas Modulate Neural Responses to Tools in the Ventral Stream
Authors: Garcea Frank E , Almeida Jorge , Sims Maxwell H , Nunno Andrew , Meyers Steven P , Li Yan Michael , Walter Kevin , Pilcher Webster H , Mahon Bradford Z
Published: August 2018

Neural responses to small manipulable objects (“tools”) in high-level visual areas in ventral temporal cortex (VTC) provide an opportunity to test how anatomically remote regions modulate ventral stream processing in a domain-specific manner. Prior patient studies indicate that grasp-relevant information can be computed about objects by dorsal stream structures independently of processing in VTC. Prior functional neuroimaging studies indicate privileged functional connectivity between regions of VTC exhibiting tool preferences and regions of parietal cortex supporting object-directed action. Here we test whether lesions to parietal cortex modulate tool preferences within ventral and lateral temporal cortex. We found that lesions to the left anterior intraparietal sulcus, a region that supports hand-shaping during object grasping and manipulation, modulate tool preferences in left VTC and in the left posterior middle temporal gyrus. Control analyses demonstrated that neural responses to “place” stimuli in left VTC were unaffected by lesions to parietal cortex, indicating domain-specific consequences for ventral stream neural responses in the setting of parietal lesions. These findings provide causal evidence that neural specificity for “tools” in ventral and lateral temporal lobe areas may arise, in part, from online inputs to VTC from parietal areas that receive inputs via the dorsal visual pathway.
Large-Scale Organization of the Hand Action Observation Network in Individuals Born Without Hands
Authors: Vannuscorps Gilles , F Wurm Moritz , Striem-Amit Ella , Caramazza Alfonso
Published: August 2018

The human high-level visual cortex comprises regions specialized for the processing of distinct types of stimuli, such as objects, animals, and human actions. How does this specialization emerge? Here, we investigated the role of effector-specific visuomotor coupling experience in shaping the organization of the action observation network (AON) as a window on this question. Observed body movements are frequently coupled with corresponding motor codes, e.g., during monitoring one’s own movements and imitation, resulting in bidirectionally connected circuits between areas involved in body movements observation (e.g., of the hand) and the motor codes involved in their execution. If the organization of the AON is shaped by this effector-specific visuomotor coupling, then, it should not form for body movements that do not belong to individuals’ motor repertoire. To test this prediction, we used fMRI to investigate the spatial arrangement and functional properties of the hand and foot action observation circuits in individuals born without upper limbs. Multivoxel pattern decoding, pattern similarity, and univariate analyses revealed an intact hand AON in the individuals born without upper limbs. This suggests that the organization of the AON does not require effector-specific visuomotor coupling.
Anticholinergic Amnesia is Mediated by Alterations in Human Network Connectivity Architecture
Authors: Chhatwal Jasmeer P , Schultz Aaron P , Hedden Trey , Boot Brendon P , Wigman Sarah , Rentz Dorene , Johnson Keith A , Sperling Reisa A
Published: August 2018

Disrupted cholinergic neurotransmission plays a central role in Alzheimer’s disease, medication-induced memory impairment, and delirium. At the systems level, this suggests anticholinergic drugs may alter the activity and interplay of anatomically distributed neural networks critical for memory function. Using a network-sensitive imaging technique (functional connectivity MRI) and a double-blind, crossover design, we examined the consequences of anticholinergic drug administration on episodic memory and functional network architecture in a group of clinically normal elderly. We observed that low-dose scopolamine (0.2 mg IV) decreased episodic memory performance and selectively decreased connectivity strength in 3 of 7 cortical networks. Both memory and connectivity effects were independent of β-amyloid burden. Drug-induced connectivity changes within the Default and Salience networks, as well as reductions in the strength of anticorrelation between these 2 networks, were sufficient to fully statistically mediate the effects of scopolamine on memory performance. These results provide experimental support for the importance of the Default and Salience networks to memory performance and suggest scopolamine-induced amnesia is underpinned by disrupted connectivity within and between these 2 networks. More broadly, these results support the potential utility of fcMRI as tool examine the systems-level pharmacology of psychoactive drugs.
Childhood socioeconomic circumstances and disability trajectories in older men and women: a European cohort study
Authors: Landös Aljoscha , von Arx Martina , Cheval Boris , Sieber Stefan , Kliegel Matthias , Gabriel Rainer , Orsholits Dan , van der Linden Bernadette W A , Blane David , Boisgontier Matthieu P , Courvoisier Delphine S , Guessous Idris , Burton-Jeangros Claudine , Cullati Stéphane
Published: August 2018

Background

We observed a lack of population-based longitudinal research examining the association of disadvantaged childhood socioeconomic circumstances (CSC) and disability [activities of daily living (ADL) and instrumental activities of daily living (IADL)] in older age, and whether socioeconomic attainments in adulthood can compensate for a poor socioeconomic start in life.

Methods

Data on 24 440 persons aged 50–96 in 14 European countries (Survey of Health, Ageing and Retirement in Europe) were used to measure the associations between CSC and limitations with ADL and with IADL, using mixed-effects logistic regression models. Models stratified by gender were adjusted for education during young adulthood, main occupation during middle age, ability to make ends meet during old age and potential confounding and control variables.

Results

Risks of ADL and IADL limitations increased with age and were different between women and men. For women, a gradient across CSC strata was observed, showing that the more disadvantaged the CSC, the higher the risk of ADL and IADL limitations in old age, even after adjustment for adult socioeconomic indicators. For men, the association between CSC and disability was mediated by the main occupation in middle age and the ability to make ends meet at older age.

Conclusion

Women who grew up in socioeconomically disadvantaged households were at higher risk of disability in older age and this disadvantage was not attenuated by favourable adult socioeconomic conditions. Men were more likely to make up for a disadvantaged start in adulthood.
Health promotion and prevention among the unemployed: a systematic review
Authors: Hollederer Alfons
Published: August 2018

The interactions between unemployment and health create a need for specific interventions for health promotion and prevention. This overview provides information on how health promotion for the unemployed has been approached with an analysis of controlled intervention studies between 1996 and 2016. The literature search consulted 11 international databases in medicine, social sciences and psychology. A total of 30 health interventions for the unemployed were identified, with 43 articles that included the effects of intervention. A controlled-study design was used in 14 studies. The health promotion measures were generally based on individual counselling, case management, training or group services. The overview demonstrates the breadth of variation in target groups and types of measures. Their result indicators for health and integration into the labor market vary substantially, as do the employment promotion effects. There is evidence of improved health and labor market integration for established approaches like the JOBS Program and JobFit. Effects are rather moderate or low in magnitude and the effect mechanisms often remain unclear. Effects weaken over time. While success is more common in the areas of health, physical activity, nutrition and stress relief, there was no impact on smoking behavior. A significant evolution can be observed in the quality and quantity of health promotion for the unemployed over time. There is a need for further research on the effectiveness and sustainability of interventions. Intervention strategies should be developed that take account of the diversity of the unemployed and their different needs.
San Juan Bautista School of Medicine’s Experience in the Aftermath of Hurricane Maria
Authors: Brugal Yocasta , Pérez Jorge
Published: August 2018

The San Juan Bautista School of Medicine (SJBSM) is located in Caguas, Puerto Rico. On September 20, 2017, Hurricane Maria hit the island, making landfall as a Category 4 storm. The extreme wind force and rainfall caused extensive power outages and other damage. In this Invited Commentary, the authors discuss SJBSM’s actions and lessons learned in the aftermath of Hurricane Maria.

By September 25, SJBSM had contacted students to ensure their safety and identify their immediate needs. The medical school’s primary goal was to restore services as expeditiously as possible. By October 9, SJBSM had reopened and adjusted its offerings and practices to accommodate students’ needs. The medical school worked to support students’ emotional and physical well-being as well as meet their academic needs. First- and second-year students who could not be present received recorded lectures, study guides, assessments, and other materials electronically or via hard copy. Third- and fourth-year students were authorized to complete a single clerkship rotation at another medical school in the United States. During this time, SJBSM consulted with the Association of American Medical Colleges, the Liaison Committee on Medical Education, and other academic agencies. These groups offered advice on how to proceed given the hardships the medical school faced.

Since then, SJBSM has applied lessons learned from Hurricane Maria and taken measures to ensure that it can meet the needs of faculty, staff, and students in the immediate aftermath of future disasters.
The More Things Change: Buprenorphine/naloxone Diversion Continues While Treatment Remains Inaccessible
Authors: Carroll Jennifer J. , Rich Josiah D. , Green Traci C.
Published: August 2018

Objectives:

Buprenorphine/naloxone, an evidence-based treatment for opioid use disorder, is sometimes diverted for non-medical use. In Rhode Island, the prevalence of opioid use and, more recently, of fentanyl in the illicit drug supply is driving overdose fatalities, which increases the need for treatment and raises questions about the changing role of diverted medication in shaping overdose risk.

Methods:

This study considered data from 2 Rhode Island based studies (conducted in 2009 and 2016, respectively) of people who use illicit or diverted prescription opioids and their patterns of buprenorphine/naloxone diversion. Using targeted sampling, individuals who use opioids completed a brief questionnaire about their drug use. For the 2016 study, logistic regression was used to identify associations with recent and lifetime use of diverted medication.

Results:

A total of 128 individuals who use opioids non-medically participated in the 2016 study. Of these, 38% (n = 13) reported diverted buprenorphine/naloxone use in the past 2 months, similar to the pattern observed in 2009 (41%, n = 41). Common motivations for using diverted medication included the management of withdrawal symptoms (40%, n = 35) and self-treatment of opioid use disorder (39%, n = 34). Few reported using to “get high” (12%, n = 4). Seeking buprenorphine/naloxone treatment in the previous 12 months was positively associated with using diverted medication in the past 2 months (odds ratio = 5.14, 95% confidence interval = 1.0–26.5, P = 0.05). Participants of both studies reported the same barriers to care in 2009 and 2016.

Conclusion:

The use of diverted/buprenorphine remains common among people who use opioids non-medically and indicates a severe shortage in treatment capacity and inaccessibility of existing services.
Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain
Authors: Azad Tej D. , Vail Daniel , Bentley Jason , Han Summer S. , Suarez Paola , Varshneya Kunal , Mittal Vaishali , Veeravagu Anand , Desai Manisha , Bhattacharya Jay , Ratliff John K.
Published: August 2018

Study Design.

Retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.

Objective.

To determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis.

Summary of Background Data.

Patients with low back pain present to a variety of providers and receive a spectrum of treatments, including opiate medications. The impact of initial provider type on opiate use in this population is uncertain.

Methods.

We performed a retrospective analysis of opiate-naïve adult patients in the United States with newly diagnosed low back or lower extremity pain. We estimated the risk of early opiate prescription (≤14 d from diagnosis) and long-term opiate use (≥six prescriptions in 12 mo) based on the provider type at initial diagnosis using multivariable logistic regression, adjusting for patient demographics and comorbidities.

Results.

We identified 478,981 newly diagnosed opiate-naïve patients. Of these, 40.4% received an opiate prescription within 1 year and 4.0% met criteria for long-term use. The most common initial provider type was family practice, associated with a 24.4% risk of early opiate prescription (95% CI, 24.1–24.6) and a 2.0% risk of long-term opiate use (95% CI, 2.0–2.1). Risk of receiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine (43.1%; 95% CI, 41.6–44.5) or at an urgent care facility (40.8%; 95% CI, 39.4–42.3). Risk of long-term opiate use was highest for patients initially diagnosed by pain management/anesthesia (6.7%; 95% CI, 6.0–7.3) or physical medicine and rehabilitation (3.4%; 95% CI, 3.1–3.8) providers.

Conclusion.

Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.

Level of Evidence: 3
Shoulder Impairment Following Critical Illness: A Prospective Cohort Study
Authors: Gustafson Owen D. , Rowland Matthew J. , Watkinson Peter J. , McKechnie Stuart , Igo Simon
Published: August 2018

Objectives:

Identify the prevalence of shoulder impairment in ICU survivors within 6 months of discharge from ICU. Evaluate the impact of shoulder impairment on upper limb functional status in patients treated on an ICU. Identify risk factors for the development of shoulder impairment.

Design:

Prospective cohort study.

Setting:

A tertiary care medical-surgical-trauma ICU at a U.K. hospital over 18 months, with a further 6-month follow-up after hospital discharge.

Subjects:

Adult patients with an ICU length of stay of greater than 72 hours with no preexisting or new neurologic or traumatic upper limb injury.

Interventions:

None.

Measurements and Main Results:

Patients underwent targeted shoulder assessments (pain, range of movement, Constant-Murley Score, shortened version of the disabilities of the arm, shoulder, and hand [DASH] score [QuickDASH] score) at hospital discharge, 3 and 6 months after hospital discharge. Assessments were undertaken on 96 patients, with 62 patients attending follow-up at 3 months and 61 patients at 6 months. Multivariate regression analysis was used to investigate risk factors for shoulder impairment. ICU-related shoulder impairment was present in 67% of patients at 6 months following discharge from hospital. Upper limb dysfunction occurred in 46%, with 16% having severe dysfunction (equivalent to shoulder dislocation). We were unable to identify specific risk factors for shoulder impairment.

Conclusions:

Shoulder impairment is a highly prevalent potential source of disability in ICU survivors. This persists at 6 months after discharge with a significant impact on upper limb function. More research is needed into potential mechanisms underlying shoulder impairment and potential targeted interventions to reduce the prevalence.
The Association of Nutrition Status Expressed as Body Mass Index z Score With Outcomes in Children With Severe Sepsis: A Secondary Analysis From the Sepsis Prevalence, Outcomes, and Therapies (SPROUT) Study*
Authors: Irving Sharon Y. , Daly Bridget , Verger Judy , Typpo Katri V. , Brown Ann-Marie , Hanlon Alexandra , Weiss Scott L. , Fitzgerald Julie C. , Nadkarni Vinay M. , Thomas Neal J. , Srinivasan Vijay
Published: August 2018

Objectives:

The impact of nutrition status on outcomes in pediatric severe sepsis is unclear. We studied the association of nutrition status (expressed as body mass index z score) with outcomes in pediatric severe sepsis.

Design:

Secondary analysis of the Sepsis Prevalence, Outcomes, and Therapies study. Patient characteristics, ICU interventions, and outcomes were compared across nutrition status categories (expressed as age- and sex-adjusted body mass index z scores using World Health Organization standards). Multivariable regression models were developed to determine adjusted differences in all-cause ICU mortality and ICU length of stay by nutrition status.

Setting:

One-hundred twenty-eight PICUs across 26 countries.

Patients:

Children less than 18 years with severe sepsis enrolled in the Sepsis Prevalence, Outcomes, and Therapies study (n = 567).

Interventions:

None.

Measurements and Main Results:

Nutrition status data were available for 417 patients. Severe undernutrition was seen in Europe (25%), Asia (20%), South Africa (17%), and South America (10%), with severe overnutrition seen in Australia/New Zealand (17%) and North America (14%). Severe undernutrition was independently associated with all-cause ICU mortality (adjusted odds ratio, 3.0; 95% CI, 1.2–7.7; p = 0.02), whereas severe overnutrition in survivors was independently associated with longer ICU length of stay (1.6 d; p = 0.01).

Conclusions:

There is considerable variation in nutrition status for children with severe sepsis treated across this selected network of PICUs from different geographic regions. Severe undernutrition was independently associated with higher all-cause ICU mortality in children with severe sepsis. Severe overnutrition was independently associated with greater ICU length of stay in childhood survivors of severe sepsis.