bluuebunny/crossref_metadata_2025 huggingface dataset:
From telementorship to automation
Authors: Anvari Mehran , Manoharan Baanu , Barlow Karen
Published: July 2021

The effective integration of robotic technology and surgical tools has played a vital role in advancing surgical care by enabling telepresence in surgery to provide mentorship and surgical care across long distances in the absence of surgeons. This article describes our experiences with advancing surgical education and innovation through telementoring community surgeons, establishing the world's first telerobotic surgical service, and the integration of Artificial Intelligence and robotics to provide remote surgical care and training.
Pretherapeutic Predictive Factors for Histological High‐Grade Parotid Gland Carcinoma
Authors: Mikoshiba Takuya , Ozawa Hiroyuki , Watanabe Yoshihiro , Kawaida Miho , Sekimizu Mariko , Saito Shin , Yoshihama Keisuke , Nakamura Shintaro , Nagai Ryoto , Imanishi Yorihisa , Kameyama Kaori , Ogawa Kaoru
Published: July 2021

Objective

The histological grade of parotid gland carcinoma (PGC) is an important prognostic factor; however, the diagnosis prior to treatment has been challenging to make. This study aimed to investigate whether the pretreatment clinical findings, including hematological inflammatory, nutritional, and immune markers, could predict the histological grade of PGC.

Study Design

Retrospective study.

Methods

We retrospectively enrolled 111 patients with PGC and evaluated the correlation between histological grade and pretreatment clinical findings such as age, sex, tumor staging, facial nerve paralysis, pain or tenderness, adhesion to the surrounding tissues or tumor immobility, and hematological markers.

Results

Sixty patients (54%) were diagnosed with histological high‐grade PGC. Univariate analysis revealed that age, T classification, N classification, TNM stage, facial nerve paralysis, adhesion/immobility, C‐reactive protein (CRP), and CRP‐to‐albumin ratio (CAR) were significant predictors of PGC histological grade. On multivariate analysis, high T classification (T3, 4), high N classification (≥1), and elevated CRP (≥0.22 mg/dL) were independent predictors of high‐grade PGC.

Conclusions

Pretreatment T classification, N classification, and CRP are significant predictors of the histological grading of PGC. Our results are useful for treatment planning and obtaining appropriate informed consent from the patients before treatment.

Level of Evidence

4 Laryngoscope, 132:96–102, 2022
Research Progress on On‐Chip Fourier Transform Spectrometer
Authors: Zhang Lichao , Chen Jiamin , Ma Chaowei , Li Wangzhe , Qi Zhimei , Xue Ning
Published: July 2021

A Fourier transform spectrometer (FTS) is recognized as a highly precise analytical instrument for analyzing the constituent elements of matter in the fields of physics, chemistry, aerospace, and so on. With the emergence and development of miniaturized and portable devices in numerous scientific and technological fields, there has been an urgent need for on‐chip FTSs due to their benefits of small size, portability, low energy consumption, and robustness. However, the small size of on‐chip FTSs hinders the acquisition of a large optical path difference, resulting in a low resolution of the spectrometer. In addition, the sampler spacing is not sufficiently small to satisfy Nyquist's sampling theorem, directly influencing the bandwidth of the spectrometer. Therefore, studies have been performed to investigate the trade‐off between the reduced size and performance of spectrometers. This paper aims to systematically review the progress in on‐chip FTSs, especially in on‐chip static FTSs, including spatially modulated, temporally modulated, and space‐time comodulated FTSs, from the aspects of theories, implementations, and performance indicators. Finally, the paper ends with a discussion of the challenges and a view of the prospective development of this exciting field.
Effect of n‐Alkyl Side Chain Length on the Thermal and Rheological Properties of PolyN‐(3‐(alkylamino)‐N‐(3‐(isopropylamino)‐3‐oxopropyl)acrylamide) Homopolymers
Authors: Kumari Archana , Vishwakarma Sambhav , Mitra Kheyanath , Chen Chuangbi , Cui Shuming , Maiti Biswajit , Mondal Sourov , Biswas Chandra Sekhar , Maiti Pralay , Stadler Florian J. , Ray Biswajit
Published: July 2021

Four new N‐isopropylacrylamide‐ and N‐n‐alkyl amine‐based acrylamide monomers, N‐(3‐(alkylamino)‐N‐(3‐(isopropylamino)‐3‐oxopropyl) acrylamide (Mn) (n = 4, 8, 10, 12) are successfully synthesized and polymerized via reversible addition‐fragmentation chain‐transfer polymerization (polyMn, n = 4, 8, 10, and 12), which are characterized by gel permeation chromatography, 1H NMR, Fourier transform infra red spectroscopy, thermo‐gravimetry‐differential thermal analysis, differential scanning calorimetry (DSC), and rheology. All polymers are thermally stable and undergo a two‐step degradation process at ≈280 and ≈375 °C. Glass transition temperature (Tg)s of these polymers decrease gradually from 99.6 to 52.5 °C with increasing n‐alkyl side chain length. The rheology of these polymers in melt state agrees to a typical Rouse‐melt behavior and allows for confirming the Tg determined from DSC. Benzyl alcohol solution rheology proves a weak structural build‐up, in particular for polyM12. Comparison of the quantum chemical calculations of polyMns with n = 4–8 reveals increase in backbone helicity with increasing n‐alkyl side chain length.
Deacetylated Cellulose Acetate/Polyurethane Composite Nanofiber Membranes with Highly Efficient Oil/Water Separation and Excellent Mechanical Properties
Authors: Wang Weiwen , Ma XiRui , Si Junhui , Cui Zhixiang , Wang Qianting , Liu Xianhu
Published: July 2021

Nowadays, oil pollution has become more serious, which causes great threats both to the ecological environment and human life. In this study, a novel type of multifunctional deacetylated cellulose acetate/polyurethane (d‐MCA:MTPU) composite nanofiber membranes for oil/water separation are successfully fabricated by electrospinning, which show super‐amphiphilicity in air, super‐hydrophilicity in oil, and oleophobicity in water. All the d‐MCA:MTPU composite nanofiber membranes with different mass ratios can be used as water‐removing, oil‐removing, and emulsion separation substance only by gravity driving force. The highest separation flux for water and oil reaches up to 37 000 and 74 000 L m−2 h−1, respectively, and all the separation efficiencies are more than 99%. They have outstanding comprehensive mechanics performance, which can be controlled by simply adjusting the mass ratios. They show excellent antifouling and self‐cleaning ability, endowing powerful cyclic stability and reusability. Those results show that d‐MCA:MTPU composite nanofiber membranes have great application prospects in oil/water separation.
Microstructure Engineering of Stretchable Resistive Strain Sensors with Discrimination Capabilities in Transverse and Longitudinal Directions
Authors: Shen Gengzhe , Zhang Chi , Liang Tianlong , Xin Yue , Liang Jionghong , Zhong Yu , He Jie , He Xiang , He Xin
Published: July 2021

Featuring simple device structure, high sensitivity, and excellent reliability, stretchable resistive sensors have developed rapidly due to the high demand for flexible and wearable electronics. Nevertheless, it remains critically challenging to evaluate external stimuli using one simple device for diverse application scenarios. Here, a microstructure is engineered for a stretchable sensor by a facile replication/transferring and a prestretching/releasing process, enabling the device to have discrimination capabilities in the transverse direction (X‐axis) and longitudinal direction (Y‐axis). Consisting of silver nanowires (Ag NWs)/transition metal carbides (MXene)/poly(3,4‐ethylenedioxythiophene):poly (styrene‐sulfonate) (PEDOT:PSS) conducting layer and polydimethylsiloxane (PDMS)/Ecoflex elastomer, the microstructured sensor has a broad strain range of 120% along the X‐axis and a large gauge factor (GF) of 37.44 along the Y‐axis, and shows good stability during 1000 stretching/releasing cycles along two directions, indicating the excellent interfacial connection between the sensing layer and elastomer. As a result, taking advantages of distinct performance along two directions, the proposed stretchable sensor is demonstrated to monitor a variety of human movements and physical stimuli as a wearable and flexible device, revealing its promising potential in diverse application scenarios.
University's first Ph.D. program would boost workforce development
Authors: Enos Gary
Published: July 2021

A Florida state university that historically has responded to the mental health needs of its surrounding community is seeking to establish a doctorate program to enhance mental health workforce development and research. The doctorate program in counselor education and supervision would be the very first Ph.D. program at Florida Gulf Coast University (FGCU).
Deformation driven Seq2Seq longitudinal tumor and organs‐at‐risk prediction for radiotherapy
Authors: Lee Donghoon , Alam Sadegh R. , Jiang Jue , Zhang Pengpeng , Nadeem Saad , Hu Yu‐chi
Published: July 2021

Purpose

Radiotherapy presents unique challenges and clinical requirements for longitudinal tumor and organ‐at‐risk (OAR) prediction during treatment. The challenges include tumor inflammation/edema and radiation‐induced changes in organ geometry, whereas the clinical requirements demand flexibility in input/output sequence timepoints to update the predictions on rolling basis and the grounding of all predictions in relationship to the pre‐treatment imaging information for response and toxicity assessment in adaptive radiotherapy.

Methods

To deal with the aforementioned challenges and to comply with the clinical requirements, we present a novel 3D sequence‐to‐sequence model based on Convolution Long Short‐Term Memory (ConvLSTM) that makes use of series of deformation vector fields (DVFs) between individual timepoints and reference pre‐treatment/planning CTs to predict future anatomical deformations and changes in gross tumor volume as well as critical OARs. High‐quality DVF training data are created by employing hyper‐parameter optimization on the subset of the training data with DICE coefficient and mutual information metric. We validated our model on two radiotherapy datasets: a publicly available head‐and‐neck dataset (28 patients with manually contoured pre‐, mid‐, and post‐treatment CTs), and an internal non‐small cell lung cancer dataset (63 patients with manually contoured planning CT and 6 weekly CBCTs).

Results

The use of DVF representation and skip connections overcomes the blurring issue of ConvLSTM prediction with the traditional image representation. The mean and standard deviation of DICE for predictions of lung GTV at weeks 4, 5, and 6 were 0.83 ± 0.09, 0.82 ± 0.08, and 0.81 ± 0.10, respectively, and for post‐treatment ipsilateral and contralateral parotids, were 0.81 ± 0.06 and 0.85 ± 0.02.

Conclusion

We presented a novel DVF‐based Seq2Seq model for medical images, leveraging the complete 3D imaging information of a relatively large longitudinal clinical dataset, to carry out longitudinal GTV/OAR predictions for anatomical changes in HN and lung radiotherapy patients, which has potential to improve RT outcomes.
The attitudes towards, and beliefs about, physical activity in people with osteoarthritis and comorbidity: A qualitative investigation
Authors: McKevitt Sarah , Jinks Clare , Healey Emma L. , Quicke Jonathan G.
Published: July 2021

Objective

To investigate the attitudes towards, and beliefs about, physical activity (PA) in older adults with osteoarthritis (OA) and comorbidity to understand experiences and seek ways to improve PA participation.

Methods

Semi‐structured interviews with adults aged ≥45, with self‐reported OA and comorbidity (N = 17). Face‐to‐face interviews explored participant perspectives regarding; (1) attitudes and beliefs about PA in the context of OA and comorbidity and (2) how people with OA and comorbidity could be encouraged to improve and maintain PA levels. Data were transcribed verbatim and inductive thematic analysis was undertaken using a framework approach.

Results

Participants did not conceptualise multiple long‐term conditions (LTCs) together and instead self‐prioritised OA over other LTCs. Barriers to PA included uncertainty about both the general management of individual LTCs and the effectiveness of PA for their LTCs; and, negative perceptions about their health, ageing and PA. Participants experienced dynamic and co‐existing barriers to PA, and problematized this as a multi‐level process, identifying a barrier, then a solution, followed by a new barrier. Facilitators of PA included social support and support from knowledgeable healthcare professionals (HCPs), together with PA adapted for OA and comorbidity and daily life. PA levels could be increased through targeted interventions to increase self‐efficacy for managing OA alongside other LTCs and self‐efficacy for PA.

Conclusion

People with OA and comorbidity experience complicated PA barriers. To increase PA levels, tailored PA interventions could include HCP and social support to anticipate and overcome multi‐level PA barriers and target increased self‐efficacy for LTC management and PA.
SARC‐CalF tool has no significant prognostic value in hospitalized patients: A prospective cohort study
Authors: Rodrigues Fernanda W. , Burgel Camila Ferri , Brito Júlia Epping , Baumgardt Eduardo , de Araújo Bruna Espíndola , Silva Flávia Moraes
Published: July 2021

Background

Screening of sarcopenia is proposed to identify patients who require the diagnosis of this condition. One of the proposed screening tools is Strength, Assistance with walking, Rise from a chair, Climb stairs, Fall and Calf Circumference (SARC‐CalF). However, evidence for its applicability, especially in a hospital setting, is scarce. Therefore, this study aimed to evaluate the association between “suggestive signs of sarcopenia using SARC‐CalF” and clinical outcomes.

Methods

Prospective cohort study with hospitalized patients aged ≥60 years was conducted, and they were evaluated within 48 h of admission using the SARC‐CalF tool. Calf circumference and handgrip strength were measured, and the “timed get up and go” test was performed in all patients. The outcomes for testing the predictive validity of SARC‐CalF were prolonged length of hospital stay, in‐hospital death, hospital readmission, and mortality in 6 months.

Results

Of the 554 patients (55.22 ± 14.91 years old, 52.9% males) evaluated, 17.3% were classified as having “suggestive signs of sarcopenia using SARC‐CalF.” In univariate analysis, “suggestive signs of sarcopenia using SARC‐CalF” was associated with in‐hospital death (P = .002) and mortality in 6 months (P = .004). However, in the multivariate analysis, these associations were not significant.

Conclusion

SARC‐CalF was not an independent predictor of clinical outcomes during the hospitalization neither in the following 6 months of discharge.
Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant
Authors: Evans James , Gardiner Breeana , Green Dan , Gibson Faith , O'Connor Graeme , Lanigan Julie
Published: July 2021

Background

Nutrition support is essential in children with cancer, including those undergoing bone marrow transplant (BMT), to reduce the risk of malnutrition and associated deleterious outcomes. Enteral nutrition is more commonly provided via nasogastric than gastrostomy tubes because of safety concerns with the latter in immunocompromised children. This systematic review investigated the incidence and type of complications and outcomes in pediatric cancer patients fed by gastrostomy.

Methods

Databases were searched for randomized and observational studies investigating the use of any gastrostomy device in children aged <18 years with any cancer diagnosis, including those undergoing BMT. Five cohort and 11 case series studies were included. Owing to clinical heterogeneity, meta‐analyses were not performed.

Results

Quality of evidence varied, with five studies judged at serious risk of bias and poor quality; however, the remaining 11 were considered to range from moderate to good quality. Across studies, 54.6% of children developed one or more complications, of which 76.6% were classified as minor, 23.4% major. The most frequent complications included inflammation (52% of episodes), infection (42.1%), leakage (22.3%), and granuloma (21%). Evidence regarding infection rates in cancer/BMT patients compared with other disease states was inconclusive. Gastrostomy feeding was associated with improvement or stabilization of nutrition status in 77%–92.7% of children.

Conclusion

Gastrostomy feeding in this population is relatively safe and effective in stabilizing or improving nutrition status throughout treatment. Complications are frequent but mostly minor. Placement requires careful consideration of the complications, benefits, nutrition risk and status at diagnosis, and quality of life.
Catch‐down growth in infants born large for gestational age
Authors: Dunn Rachel K. , Uhing Michael , Goday Praveen S.
Published: July 2021

Infants born large for gestational age (LGA) not exhibiting catch‐down growth (a decline of weight z‐score by 1) have a higher likelihood of future obesity. We aimed to identify the term LGA infants in our neonatal intensive care unit (NICU) and document nutrition interventions that may influence growth. Our 10‐year retrospective review identified 47 term LGA infants who had a NICU length of stay (LOS) ≥7 days. We obtained demographic data, nutrition interventions in the NICU, and data regarding growth patterns. Of the 47 infants, 31 (66%), demonstrated catch‐down growth at discharge at ≥7 days. Overall, 39 of 47 patients (83%) received interventions during their NICU stay, including 32 (69%) who had nasogastric tubes placed, and 24 (51%) had formula fortification to augment weight gain. Among patients with LOS ≥14 days, 23 of 23 patients without catch‐down growth and four of five patients with catch‐down growth had nutrition interventions performed. Of the overall population, only 38% of those who did not demonstrate catch‐down growth had an LOS of ≥14 days vs 77% of all infants that did exhibit catch‐down growth (P = .01). Our data suggest that nutrition interventions in LGA infants are common in the NICU. Our study highlights the need for further clinical studies to help direct care in this population of infants.
Medical nutrition therapy for patients with malnutrition post–intensive care unit discharge: A case report of recovery from coronavirus disease 2019 (COVID‐19)
Authors: Burslem Ryan , Parker Anna
Published: July 2021

Patients discharged from an intensive care unit (ICU) are frequently malnourished and experience ongoing inadequate nutrition intake because of a variety of barriers, which may lead to further declines in nutrition status. The coronavirus disease 2019 (COVID‐19) pandemic has drawn increased awareness to this vulnerable patient population and the importance of nutrition rehabilitation to promote optimal recovery from acute illness. Despite this, there are no formal guidelines addressing medical nutrition therapy during the post‐ICU recovery phase. This review provides an overview of the nutrition management of patients during the post‐ICU recovery phase with a specific focus on COVID‐19. A case study will demonstrate how medical nutrition therapy improved the nutrition status and quality of life for a patient who became severely malnourished after a prolonged hospitalization for COVID‐19.
Postpyloric feeding tube placement at the bedside: Complication rate and impact on length of stay
Authors: Gillis Holly Catherine , Lin Ada , Jackson Kenneth , Stewart Claire
Published: July 2021

Background

Postpyloric feeding tube (PPFT) placement is essential for the ongoing nutrition care of critically ill children requiring noninvasive and invasive ventilation. PPFTs are placed by a variety of providers, including advanced practice nurses (APNs), surgeons, gastroenterologists, and radiologists. Complication rates, time to enteral nutrition (EN) following placement, and association with length of stay (LOS) have not been well documented.

Methods

A query of the electronic medical record identified patients in the pediatric intensive care unit (PICU) in whom PPFTs were placed. A retrospective chart review was performed to identify patient demographics; PPFT placement provider, indication, and duration; PICU LOS; hospital LOS; and patient pediatric risk of mortality (PRISM) scores.

Results

A total of 452 PPFTs were placed in 346 patients , with 318 placed by APNs. There was only one complication in 452 placed PPFTs. PRISM scores between patient groups for APN‐placed PPFTs and non‐APN–placed PPFTs were not significantly different. Mean time from hospital admission to PPFT placement was 1.5 days (APN) to 2.0 days (non‐APN) (P < .02). Spearman correlation coefficients demonstrated shorter hospital and PICU LOS were associated with shorter duration to insertion.

Conclusion

Overall complication rates of PPFT insertion is very low and do not significantly differ between provider type , even in patients with higher PRISM scores. Additionally, early time to insertion of PPFT is associated with decreased hospital and PICU LOS. Further research is needed to determine if the earlier time to insertion of PPFTs is associated with the achievement of goal feeds.
Twelve‐week peptide‐based formula therapy may be effective in inducing remission of active Crohn disease among women who are pregnant or preparing for pregnancy
Authors: Yang Qingfan , Tang Jian , Ding Ni , Chao Kang , Li Miao , Huang Zicheng , Guo Huili , Chen Junrong , Zhi Min , Hu Pinjin , Gao Xiang
Published: July 2021

Background

Conventional treatment for Crohn disease (CD) in pregnancy includes mesalamine, thiopurine, and anti–tumor necrosis factor (TNF)‐α agents. However, women may abstain because of complications, nonresponse, or potential adverse outcomes. Peptide‐based formula therapy, through oral or nasogastric feeding without other food intake, is an effective and safe therapy for active CD. Herein, We confirmed the effectiveness and safety of peptide‐based formula therapy for active CD in pregnant women or those preparing for pregnancy.

Method

Outcomes of peptide‐based formula therapy to induce CD remission during pregnancy preparation and the conception period were evaluated retrospectively among 14 women. Efficacy was evaluated as the change in serum indices and inflammatory markers after 12‐week treatment. Pregnancy outcomes were compared between 14 women treated with nutrition therapy and eight women using conventional CD drugs.

Results

After 12 weeks, 85.7% (12 of 14) of patients treated with peptide‐based formula achieved remission with a significant decrease in the CD activity index (P < .001) and high‐sensitivity C‐reactive protein level (P = .004). There were no effects of peptide‐based formula therapy on pregnancy outcomes compared with conventional CD treatment (P > .05). Among the 12 patients who achieved CD remission with exclusive peptide‐based formula therapy, 10 selected to continue total or partial peptide‐based formula treatment to maintain CD remission throughout pregnancy.

Conclusion

Peptide‐based formula therapy, without other food intake, may provide a safe and effective alternative to conventional CD drugs to induce disease remission among women during conception and pregnancy.
Use of telehealth in home nutrition support: Challenges and advantages
Authors: Mundi Manpreet S. , Mohamed Elfadil Osman , Bonnes Sara L. , Salonen Bradley R. , Hurt Ryan T.
Published: July 2021

Coronavirus disease 2019 (COVID‐19), after initially being detected in Wuhan, China in late 2019, quickly spread to most regions of the world, meeting World Health Organization criteria for a pandemic. Social distancing along with other measures implemented to control spread had a drastic impact on the provision of healthcare including deferred elective procedures and surgeries as well as delayed care and evaluation for emergent diagnoses such as heart attacks and strokes. In the home nutrition practice, patients began to delay routine laboratory tests and were canceling or deferring annual visits. Our group soon began to rapidly deploy telehealth to meet the needs of the home nutrition patients. Telehealth is not a new concept with descriptions of healthcare being provided at a distance with the use of telephone in the 1870s. However, widespread adoption has been limited because of regulation (licensure, prescriptions, credentialing, and privileges), lack of reimbursement, as well as adoption and availability of technology needed to carry out telehealth visits. As regulations and limits on reimbursements were waived during COVID‐19 pandemic, our home nutrition practice began to evaluate core components of the care we provide for our patients and assess which could be successfully transitioned to telehealth. In addition to the history and regulation of telehealth, the current manuscript provides details regarding successful implementation of telehealth visits such as change management, selection of telehealth platform, scheduling and logistics, as well as carrying out the virtual visit including history and physical exam.
The use of nutrition support near the end of life for hospitalized patients with advanced cancer at a reference center: Two realities
Authors: Wiegert Emanuelly Varea Maria , da Costa Rosa Karla Santos , dos Santos Rhayara Thacilla Ferreira , dos Santos Daiane Almeida , de Freitas Renata , de Oliveira Livia Costa
Published: July 2021

Objective

To assess the frequency and factors associated of the provision of nutrition support (NS) in the last 30 days of life in patients with advanced cancer in the palliative or non‐palliative setting.

Methods

Retrospective cohort study in palliative and non‐palliative care units at a specialized cancer center for oncology in Brazil. The use of oral nutrition supplements (ONS) and enteral (EN) and parenteral (PN) nutrition in the 30 days before death were assessed.

Results

The 239 patients included were predominantly older (>60 years; 63.2%) and female (61.1%). The use of ONS was lower in palliative than non‐palliative care during the last 30 (52% vs. 6%), 7 (42% vs. 4%), and 3 (23% vs. 2%) days before death (all P < .001). The use of EN and PN was lower in palliative care, decreasing with the approach of death. The independent factors associated with ONS in non‐palliative care were (odds ratio): breast tumor (3.03), hypoalbuminemia (1.10), and nutrition risk (16.98); in palliative care, only the Karnofsky Performance Status (KPS) ≥40% (1.24) was associated to the use of ONS. The use of EN and PN was associated with head‐neck (HN) tumor in both settings (5.41) in non‐palliative and (8.74) in palliative. Others independent factors were: hypoalbuminemia (3.12) in non‐palliative care and KPS (1.31) in palliative care.

Conclusions

The use of NS near the end of life was high in the non‐palliative and less frequent in palliative care setting. The factors associated with NS differed according to the clinical oncology setting, with one of the factors in palliative care being a better prognosis.
X‐IGALME: Isogeometric analysis extended with local maximum entropy for fracture analysis
Authors: Fathi Farshid , Chen Lin , de Borst René
Published: July 2021

An extended approach is developed by blending isogeometric analysis and the first‐order local maximum entropy for the standard and the enhanced fields, respectively. Isogeometric analysis facilitates the accurate parametrization of the geometry in general, particularly the exact geometric parametrization of the conic curves and quadratic surfaces using NURBS. On the other hand, the local maximum entropy leads to an improved estimate for the enhanced part due to its infinite continuity. Moreover, local maximum entropy paves the way to a nonelementwise crack propagation owing to its meshfree characteristic. To enforce compatibility, the shifting technique is amended for the meshfree enhanced part to localize the effect of the Heaviside function to a narrow region around the crack. Next, a blending technique is exploited to remove the effect of the discontinuity in front of the crack tip. The viability of the approach is illustrated at the hand of several examples comprising straight and curved crack propagation.
Impact of central nervous system‐directed treatment on competence and adjustment among children in early cancer survivorship
Authors: Winning Adrien M. , Moscato Emily L. , Lehmann Vicky , Keim Madelaine C. , Rausch Joseph R. , Lipak Keagan G. , Himelhoch Alexandra C. , Murphy Lexa K. , Prussien Kemar V. , Olshefski Randal S. , Vannatta Kathryn , Compas Bruce E. , Gerhardt Cynthia A.
Published: July 2021

Background

Central nervous system (CNS)‐directed treatments can cause long‐term academic, social, and emotional difficulties for children with cancer. However, limited research has examined the emergence of problems longitudinally and has often stratified risk by diagnosis alone. Therefore, this study compared competence and adjustment in children, who did and did not receive CNS‐directed treatment, over the first 3 years following a cancer diagnosis.

Procedure

Mothers, fathers, and children (ages 5–18 years at diagnosis) from 217 families reported on the child's competence (academic, social) and adjustment (anxious/depressed, withdrawn/depressed) near a new cancer diagnosis or relapse and 3 years later. Children were categorized into CNS‐directed treatment (n = 112; including cranial radiation, intrathecal chemotherapy, and/or neurosurgery) and non‐CNS‐directed treatment (n = 105) groups.

Results

At enrollment, there were few differences in competence and emotional adjustment among children based on treatment or diagnostic group. At 3 years, mothers and fathers reported poorer social competence for the CNS‐directed treatment group, and fathers reported poorer school competence for the CNS‐directed treatment group. Over time, father ratings of social competence increased for the non‐CNS‐directed treatment group, but not the CNS‐directed treatment group. While father ratings of academic competence declined for the CNS‐directed treatment group, mother ratings declined the most for children diagnosed with a brain tumor. All children demonstrated higher anxious/depressed scores over time.

Conclusions

CNS‐directed treatment may be a valuable indicator to identify childhood cancer survivors at risk for poor competence during early survivorship. Follow‐up screening and supportive services are recommended, as well as additional longitudinal research.
A prospective survey study of lower urinary tract dysfunction in childhood cancer survivors after vincristine and/or doxorubicin chemotherapy
Authors: Hecht Sarah L. , Quach Alan , Gao Dexiang , Brazell Andrew , Beltran Gemma , Holbrook Sheryl , Gore Lia , Iguchi Nao , Malykhina Anna , Wilcox Duncan , Cost Nicholas G.
Published: July 2021

Background

Two chemotherapeutic agents used widely in pediatric oncology are vincristine (VCR) and doxorubicin (DOX), which may cause neuropathy and myopathy, respectively. The study hypothesis is that neurotoxic effects of VCR and/or myotoxic effects of DOX affect bladder physiology and manifest clinically as lower urinary tract dysfunction (LUTD).

Procedure

Based on a priori power analysis, 161 children divided evenly by gender were recruited. Children aged 5–10 years completed the dysfunctional voiding scoring system (DVSS) survey. The study cohort comprised cancer survivors treated with VCR and/or DOX. Healthy controls were recruited from well‐child clinic visits. Exclusion criteria included pelvic‐based malignancy, pelvic irradiation, pre‐existing LUTD, neurologic abnormalities, and treatment with cyclophosphamide/ifosfamide. DVSS scores and presence of LUTD, defined as DVSS scores above gender‐specific thresholds (males ≥9, females ≥6), were compared across cohorts.

Results

Median DVSS scores were higher in the study cohort (6 vs. 4, p = .003). Moreover, children in the study cohort were more likely to exceed threshold scores for LUTD (38.8% vs. 21%, p = .014; OR 1.8). Subanalysis by gender revealed female cancer survivors are more likely to report LUTD than controls (57.5% vs. 30%, p = .013, OR 1.9). This did not hold true for males (20% vs. 12.2%, p = .339).

Conclusions

Childhood cancer survivors who received VCR and/or DOX reported higher rates of LUTD than controls. Female cancer survivors appear more likely to suffer from LUTD than males. Further study with a positive control cohort of cancer survivors who received non‐VCR, non‐DOX chemotherapy is underway to elucidate the contribution of a cancer diagnosis to LUTD.
Adolescent and young adult childhood cancer survivors’ preferences for screening and education of sexual function
Authors: Sopfe Jenna , Marsh Rebekah , Frederick Natasha N. , Klosky James L. , Chow Eric J. , Dorsey Holliman Brooke , Peterson Pamela N.
Published: July 2021

Background

Sexual dysfunction (SD) is a common yet underrecognized concern among childhood cancer survivors (CCS). CCS who are now adolescent and young adult (AYA‐CCS) identify SD as an unmet need. This study sought to explore AYA‐CCS preferences on how, when, where, and by whom SD‐focused communication should occur.

Procedure

This qualitative study utilized semi‐structured interviews to explore AYA‐CCS (now aged 15–24 years) experiences with, and preferences for, SD conversations. Thematic analysis methodology guided interpretation; themes were clustered into categories of who, how, when, and where SD conversations should occur.

Results

AYA‐CCS highlighted the importance of patient–provider rapport to facilitate SD conversations, but did not have consistent preferences regarding provider type or specialty. Providers should reduce discomfort by normalizing ongoing, personalized conversations. Some AYA‐CCS mentioned that notification that such a conversation is going to occur would be appreciated, and most were in favor of a screening tool to facilitate conversations. Preferences for when and where SD conversations should occur were centered on maximizing privacy.

Conclusions

SD is an inadequately addressed concern in AYA‐CCS, and providers must familiarize themselves with AYA‐CCS preferences for discussing SD to reduce communication barriers and address this unmet need. In addition to corroborating prior studies’ findings such as normalizing ongoing SD conversations, this study demonstrated novel ideas for reducing barriers, including use of a notification to prepare them prior to SD conversations, favoring the use of a screening tool, and the importance of establishing rapport prior to the SD conversations.
Early death and treatment‐related mortality: A report from SUCCOUR ‐ Supportive Care for Children with Cancer in Africa
Authors: Israels Trijn , Afungchwi Glenn Mbah , Chagaluka George , Hesseling Peter , Kouya Francine , Paintsil Vivian , Landman Lisa , Chitsike Inam , Njuguna Festus , Sung Lillian , Molyneux Elizabeth
Published: July 2021

Background

Deaths during paediatric cancer treatment are common in Africa. It is often difficult to distinguish between treatment‐related and disease‐related causes. To prevent these deaths, it is important to study them and identify the cause. The Supportive Care for Children with Cancer in Africa (SUCCOUR) programme enabled a study with the objective to identify the reasons for early death during treatment.

Methods

We conducted a multicentre prospective, observational cohort study in sub‐Saharan Africa. Children younger than 16 years with newly diagnosed cancer treated with curative intent were included from 1 September 2019 until 30 March 2020. Data were abstracted in real time by trained personnel using standardised case report forms. The treating clinician's assessment of the cause of death and signs, symptoms and laboratory values of patients who died during the first 3 months of treatment (early death) were documented.

Results

We included 252 patients (median age 6.0, range 0.2–15.0 years, 54% male). The most common cancer was Burkitt lymphoma (63/252, 25%). Fifteen percent of patients (37/252) died during the first 3 months of treatment. Of these 37 patients, 33 (89%) died of a treatment‐related cause. Treatment‐related mortality of all patients in the first 3 months of treatment was 13% (33/252).

Conclusion

Fifteen percent of patients had an early death during treatment and 13% had a treatment‐related death. This suggests the need to improve supportive care. Implementation of supportive care pathways adapted to local circumstances may be helpful.
Utilization of drugs with reports on potential efficacy or harm on COVID‐19 before, during, and after the first pandemic wave
Authors: Enners Salka , Gradl Gabriele , Kieble Marita , Böhm Michael , Laufs Ulrich , Schulz Martin
Published: July 2021

Purpose

Conflicting information on potential benefits of drugs as well as reports on hypothetical harm of commonly used drugs in COVID‐19 treatment have challenged clinicians and healthcare systems. We analyzed the change in ambulatory drug utilization before, during, and after the first wave of the pandemic in 2020.

Methods

We explored dispensing data of nearly 19 000 pharmacies at the expense of the statutory health insurance funds covering 88% of Germany's population. We analyzed utilization of publicly discussed drugs with conflicting information. Drug utilization as number of packages dispensed per week from January to June 2020, reflecting 314 million claims, was compared with 2019.

Results

Utilization of hydroxychloroquine increased +110% during March 2020 and then slightly decreased until week April 13–19. Renin–angiotensin–aldosterone system inhibitors and simvastatin/atorvastatin increased, +78% and +74%, respectively, and subsequently decreased below 2019 levels. Utilization of azithromycin and all systemic antibiotics decreased continuously from March 2–8 until June to levels considerably lower compared to 2019 (June 22–28: azithromycin: −55%, all systemic antibiotics: −27%). Pneumococcal vaccines utilization initially increased +373%, followed by supply shortages. Paracetamol utilization showed an initial increase of +111%, mainly caused by an increase of over‐the‐counter dispensings.

Conclusions

Apart from the pandemic itself, the data suggest that dissemination of misinformation and unsound speculations as well as supply shortages influenced drug prescribing, utilization, and purchasing behavior. The findings can inform post‐pandemic policy to prevent unfounded over‐ and underprescribing and off‐label use as well as drug shortages during a public health crisis.
Uncommon side effects of common drugs in patients with familial dysautonomia
Authors: Perl Liat , Hakimian David , Maayan Channa , Rekhtman David , Fried Elchanan , Salmon‐Divon Mali , Sapozhnikov Daniel Mark , Cheishvili David
Published: July 2021

Purpose

Patients with the autosomal recessive disorder of familial dysautonomia typically exhibit exacerbated adverse side effects to many common drugs. We aimed to catalog these adverse effects – with a focus on common drugs that are frequently administered to FD patients and compare their incidences to those within the general population.

Methods

We used data of 595 FD patients from an international database with information on drugs received and adverse effects. To investigate the molecular causes of reported differences in drug responses in FD patients, we used expression microarrays to compare the mRNA expression profiles in peripheral blood leukocytes of FD patients (n = 12) and healthy individuals (n = 10).

Results

Several drug classes, including cholinergics, anti‐cholinergics, anti‐convulsants, methylxanthines, SSRIs, and antibiotics caused either unreported symptoms or elevated rates of adverse events in FD patients. FD patients experienced different or more frequent adverse side effects than the general population in 31/123 drugs. These side effects included blood cell dyscrasias, amenorrhea, gastrointestinal bleeding, and bronchospasm. New findings include enhanced reaction of FD patients to H2 antagonist agents and to serotonin receptor agonists. We also detected eight genes differentially expressed between FD patients and healthy individuals that may underlie the differential drug responses of FD patients.

Conclusion

We provide evidence that suggests the use of several common drugs should be discontinued or reduced in FD patients.
Airway obstruction and inflammation on combined bronchoscopy in children with Down syndrome
Authors: Vielkind Monica , Wolter‐Warmerdam Kristine , Jackson Arwen , Maybee Jennifer , Brown Mark , Friedlander Joel , Friedman Norman , Hickey Francis , Prager Jeremy , Wine Todd , DeBoer Emily
Published: July 2021

Objective

To characterize the upper and lower airway findings in children with Down syndrome and chronic respiratory symptoms, based on evaluation by flexible bronchoscopy (FB) with bronchoalveolar lavage and microlaryngoscopy with bronchoscopy (MLB).

Study design

A retrospective review was conducted of children with Down syndrome aged 1 month to 17 years, who underwent both FB and MLB within a 1‐year timeframe between 2010 and 2019 at Children's Hospital Colorado. Anatomic airway findings are reported as frequencies within the cohort. Bronchoalveolar lavage fluid (BALF) culture results, cell differential, and cytopathology are reported as frequencies or mean ± standard deviation. BALF results were compared between children with and without dysphagia documented on a recent swallow evaluation.

Results

Overall, 168 children with Down syndrome were included, with median age of 2.1 years (interquartile range: 0.9–5.1 years). At least one abnormal airway finding was recorded in 96% of patients and 46% had at least three abnormal findings. The most common findings included tracheomalacia (39% FB; 37% MLB), subglottic stenosis (35% MLB), pharyngomalacia (32% FB), and laryngomalacia (16% FB; 30% MLB). Comparison of BALF based on dysphagia status showed that children with dysphagia had more frequent cultures positive for mixed upper respiratory flora (76% vs. 47%, p = 0.004) and a higher percentage of neutrophils (20% vs. 7%, p = 0.006).

Conclusion

Abnormal findings for FB and MLB are common in children with Down syndrome and chronic respiratory symptoms, and performing the procedures together may increase the diagnostic yield.
Estimating and ranking the impact of human error roots on power grid maintenance group based on a combination of mathematical expectation, Shannon entropy, and TOPSIS
Authors: Tavakoli Mehdi , Nafar Mehdi
Published: July 2021

Due to the importance of electrical grid reliability, analysis and evaluation of human error in the maintenance of electrical networks should be also considered seriously. The root causes of these errors must be identified and prioritized to plan for human error reduction. One of the objectives of the present study is to identify and predict these roots for power transmission maintenance groups from organizational, job position, communication, individual, and supervision aspects along with the relationships between these factors. In particular, this paper demonstrates that supervisor behavior as an external factor has a significant effect on maintenance personnel error. For this reason, special attention has been paid to identifying and controlling human factors from a supervisory point of view in this study. This paper also provides a method for detecting the extent of the expected influence of these roots on each personnel, since human error has a random nature. This is done based on the law of mathematical expectation. Finally, a method is suggested to rank roots based on greater effectiveness and evaluate personnel with higher error expectations. The proposed method is a combination of intermediate methods, Shannon entropy, and technique for order of preference by similarity to ideal solution (TOPSIS). The origins of the four human errors between 2014 and 2018 related to the two experts of Fars Electricity Maintenance Contractor Company are compared by the proposed method.
Fundamental Models in the Light–Matter Interaction: Quantum Phase Transitions and the Polaron Picture
Authors: Liu Junpeng , Liu Maoxin , Ying Zu‐Jian , Luo Hong‐Gang
Published: July 2021

The light–matter interaction not only is ubiquitous in nature but also can be simulated in various artificial systems. Besides the tunability of artificial quantum systems, the experimental access to the ultra‐strong and even deep‐strong couplings has brought a regime with novel phenomenology. Theoretically the finding of the integrability for the quantum Rabi model (QRM) has attracted tremendous attention to the study of the QRM and its extensions which are fundamental models of the light–matter interaction. With the continuing enhancements of coupling strengths, a most fascinating phenomenon of these light–matter models is that they can exhibit few‐body quantum phase transitions (QPTs), while a full understanding of these QPTs is a challenge. The polaron picture is a method capable of analyzing these fundamental models in the entire coupling regime and extracting the essential physics behind the QPTs. A review of its extensive applications on the fundamental light–matter models is presented, with discussions on the phase diagrams and QPT‐related features. The universality of critical exponent of the anisotropic QRM as well as the possibility of QPTs in A2 terms are also addressed.
Robust repetitive control for a class of uncertain nonlinear systems
Authors: Zhou Lan , Jiang Fuxi , She Jinhua , Zhang Xian‐Ming
Published: July 2021

This paper presents an output‐feedback repetitive control method for a class of systems with nonlinearities, unknown state‐dependent uncertainties, and external disturbances. An additive‐state‐decomposition approach is used to decompose the system under study into a primary linear periodic system in charge of repetitive‐control tracking task and a secondary linearized system in charge of robustly stabilization task. Such a treatment not only significantly simplifies system analysis and controller design, but also provides an effective method to cope with the intrinsic constraints between tracking and disturbance rejection. Another attractive point lies in two aspects. On one hand, a periodic term from the nonlinearity in the plant is extracted to be treated in the primary system and the known plant information is used to design controller parameters, which greatly improves the disturbance rejection ability of the system. On the other hand, repetitive control gain, feedback control gain, and the observer gain are optimized through an optimization algorithm by introducing an index to evaluate the overall system performance. System stability criteria and design procedure are developed. Finally, a case study on the tracking control of a chuck‐piece system demonstrates the validity of the proposed method. Comparisons with some existing methods show that the proposed method achieves better performances in both signal tracking and disturbance rejection.
Bioscatter transport by tropical cyclones: insights from 10 years in the Atlantic basin
Authors: Van Den Broeke Matthew S.
Published: July 2021

Tropical cyclones (TCs) can transport birds and insects near their center of circulation. In this study, we examined the maximum altitude, area and density of the radar‐derived bioscatter signature across a set of 42 TC centers of circulation sampled from 2011 to 2020. All TC events contained at least one time when a bioscatter signature was present. More intense hurricanes with closed eyes typically had taller and denser bioscatter signatures, and sometimes larger areas dominated by bioscatter. This indicated a larger number of organisms within the circulation of more intense hurricanes, supporting the speculation that those storms were most likely to trap birds that do not want to risk flying through their eyewall thunderstorms. Larger and denser bioscatter signatures, indicating a larger number of birds, tend to occur when fall migration brings a large bird population to the Gulf and East Coasts where most storms were sampled. TC formation location was not related to bioscatter characteristics, but storms sampled in the Gulf of Mexico and Florida tended to have larger and denser bioscatter signatures.