bluuebunny/crossref_metadata_2025 huggingface dataset:
Fellowship training in robotic colorectal surgery within the current hospital setting: an achievable goal?
Authors: Waters Peadar S. , Flynn Julie , Larach Jose T. , Fernando Diharah , Peacock Oliver , Foster Jake D. , Flood Michael , McCormick Jacob J. , Warrier Satish K. , Heriot Alexander G.
Published: March 2021

Background

Although currently limited, the requirement for colorectal trainees to attain skills in robotic surgery is likely to increase due to further utilization of robotic platforms globally. The aim of the study is to describe the training programme utilized and assess outcomes of fellowship training in robotic colorectal surgery.

Methods

A structured robotic training programme was generated across a tertiary hospital setting. Review of four prospectively maintained fellow operative logbooks was performed to assess caseload and skill acquisition. Operative and patient‐related outcomes were compared with consultant trainer performed cases. Data were analysed using R with a P < 0.05 considered significant.

Results

The structured robotic training scheme is a two‐tiered system over a 12‐month period. The trainer‐directed pathway comprised of a robotic console safety course followed by cart‐side assisting, a wet lab animal course, dual‐console accreditation training course and onsite proctoring, prior to becoming an independent console surgeon. Over 2 years, 265 robotic (n = 143 primary/component surgeon) cases were undertaken with fellows A, B, C and D involved in 63, 77, 75 and 50 robotic colorectal cases, respectively. Individual learning curves revealed independent procedure competency at cases 11, 14, 15 and 12, respectively, for robotic anterior resection. There was no significant difference observed in operative time (P = 0.39), blood loss (P = 0.41), lymph node harvest (P = 0.35), conversion rates (2% versus 4%), anastomotic leaks (1% versus 3%) and R0 resection rates (100% versus 98% colonic, 96% versus 96% rectal, P = 0.48) between surgical fellows and consultant trainers. Clavien‐Dindo(III‐IV) complications were similar (10% versus 6%,P = 0.25) with no mortalities encountered.

Conclusion

It is feasible and safe to train fellows in robotic colorectal surgery without compromise of operative‐ and patient‐related outcomes.
Recurrent pneumothorax following chest tube removal in thoracic stab wounds: a comparative study between end inspiratory versus end expiratory removal techniques at a major trauma centre in South Africa
Authors: Kong Victor , Cheung Cynthia , Rajaretnam Nigel , Sarvepalli Rohit , Weale Ross , Varghese Chris , Xu William , Clarke Damian L.
Published: March 2021

Background

Tube thoracostomy (TT) insertion is a commonly performed procedure in trauma that is standardised, but the optimal removal technique based on the timing in relation to the respiratory cycle remains controversial.

Methods

A prospective study was undertaken at a major trauma centre in South Africa over a 4‐year period from January 2010 to December 2013, and included all patients with pneumothorax secondary to thoracic stab wounds. TTs were removed by either end of inspiration technique (EIT) or end of expiration (EET) technique and the rate of recurrent pneumothorax (RPTX) following removal was compared. We hypothesized that there is no difference in the rate of RPTX between the end inspiratory (EI) and end expiratory (EE) removal technique.

Results

A total 347 patients were included. Of the 184 TTs removed by EIT, there were 17 (9%) RPTXs. Of the 163 with EET, there were 11 RPTXs (7%), (9% versus 7%, chi‐squared, P = 0.395). Of the total 28 (9%) patients with RPTXs following removal of chest tubes, two (7%) required reinsertion of chest tube (0.5% (1/184) in EIT and 0.6% (1/163) in EET, P = 0.747).

Conclusions

Timing of TT removal in relation to the respiratory cycle does not appear to influence the incidence of RPTX in patients with thoracic stab wounds. Technique of removal may well be a more important consideration and more attention must be focused on refining the optimal technique.
Modeling dynamic correlation in zero‐inflated bivariate count data with applications to single‐cell RNA sequencing data
Authors: Yang Zhen , Ho Yen‐Yi
Published: March 2021

Interactions between biological molecules in a cell are tightly coordinated and often highly dynamic. As a result of these varying signaling activities, changes in gene coexpression patterns could often be observed. The advancements in next‐generation sequencing technologies bring new statistical challenges for studying these dynamic changes of gene coexpression. In recent years, methods have been developed to examine genomic information from individual cells. Single‐cell RNA sequencing (scRNA‐seq) data are count‐based, and often exhibit characteristics such as overdispersion and zero inflation. To explore the dynamic dependence structure in scRNA‐seq data and other zero‐inflated count data, new approaches are needed. In this paper, we consider overdispersion and zero inflation in count outcomes and propose a ZEro‐inflated negative binomial dynamic COrrelation model (ZENCO). The observed count data are modeled as a mixture of two components: success amplifications and dropout events in ZENCO. A latent variable is incorporated into ZENCO to model the covariate‐dependent correlation structure. We conduct simulation studies to evaluate the performance of our proposed method and to compare it with existing approaches. We also illustrate the implementation of our proposed approach using scRNA‐seq data from a study of minimal residual disease in melanoma.
The Black–White wage gap among young men in 1990 versus 2011: With sample selection adjustments
Authors: Richey Jeremiah , Tromp Nikolas
Published: March 2021

This paper uses unconditional quantile regressions to decompose changes in the black–white wage gap for young men between 1990 and 2011. Introducing a new application of reweighting methods, we control for selection into employment which tends to widen the gap. We find no changes in the gap itself between 1990 and 2011, but reversals in the roles of ability and education across the distribution. Ability loses importance at the bottom and middle but gains importance at the top, while the opposite occurs for education. This results from heterogeneous changes in returns to ability and education across the distribution alongside a widening educational achievement gap.
Presentation and outcomes of adrenal ganglioneuromas: A cohort study and a systematic review of literature
Authors: Dages Kelley N. , Kohlenberg Jacob D. , Young William F. , Murad Mohammad Hassan , Prokop Larry , Rivera Michael , Dy Benzon , Foster Trenton , Lyden Melanie , McKenzie Travis , Thompson Geoffrey , Bancos Irina
Published: March 2021

Objective

To describe the presentation and outcomes of patients with adrenal ganglioneuromas (AGNs).

Design

Single‐centre retrospective cohort study (1 January 1995 to 31 December 2019) and systematic review of literature (1 January 1980 to 19 November 2019).

Patients

Diagnosed with histologically confirmed AGN.

Measurements

Baseline clinical, imaging and biochemical characteristics, recurrence rates and mortality. Subgroup analysis was performed on tumours with histologic elements of ganglioneuroma and pheochromocytoma (ie composite tumours).

Results

The cohort study included 45 patients with AGN, 20 (44%) of which had composite tumours. Compared to pure AGN, patients with composite tumour were older (median age, 62.5 vs. 35 years, p < .001), had smaller tumours (median size, 3.9 vs. 5.7 cm, p = .016) and were discovered incidentally less frequently (65% vs. 84%, p = .009). No recurrences or ganglioneuroma‐specific mortality occurred during follow‐up (range, 0–266 months). The systematic review included 14 additional studies and 421 patients. The mean age of diagnosis was 39 years, and 47% were women. AGNs were discovered incidentally in 72% of patients, were predominantly unilateral (99%) and had a mean diameter of 5.8 cm and an unenhanced computed tomography (CT) attenuation of −118 to 49 Hounsfield units (HU). On imaging, 69% of AGNs were homogenous, 41% demonstrated calcifications, and 40% were lobulated.

Conclusions

AGNs are rare benign tumours that present with variable imaging features including large size, unenhanced CT attenuation >20 HU, calcifications and lobulated shape. Imaging characteristics can assist in establishing a diagnosis and avoiding an unnecessary adrenalectomy. The association of pheochromocytomas with AGNs is frequent. Diagnosis should include biochemical testing.
In vivo reflectance confocal microscopic imaging of Leishmania amastigotes (Leishman bodies): A case report
Authors: Yaman Banu , Karaarslan Işıl , Akalın Taner , Özdemir Fezal
Published: March 2021

Cutaneous leishmaniasis (CL) is an intracellular parasitic infectious skin disease with a chronic self‐limited course. In vivo reflectance confocal microscopy (RCM) findings in CL have been described in only two cases of CL. We report another case with RCM findings; however to our knowledge, this is the first demonstration of Leishmania amastigotes in RCM imaging. A centrally eroded reddish nodular lesion with a diameter of 12 mm was observed on the leg of a 36‐years‐old male with a 1‐month history. On dermoscopy, a central yellowish crust, and irregularly distributed whitish opaque structures ranging in size and shape (round to polygonal) were observed. There were also irregular vessels mostly at the center and dotted/glomerular vessels at the periphery. On RCM, mild epidermal disarray with some scattered bright cells at the basal layer was observed. At the dermis, dense infiltration of polymorphic/roundish cells with heterogeneous reflectivity was seen. These large, mildly reflecting cells with fine granular structures in their cytoplasm were compatible with macrophages. Histopathology was concordant with CL. The Leishmania amastigotes seen as cytoplasmic granularity on RCM were the clue feature for the initial diagnosis.
Preferentially expressed antigen in melanoma expression in nonmelanoma skin cancers and melanocytes in surrounding skin
Authors: Elsensohn Ashley , Hanson Josiah , Ferringer Tammie
Published: March 2021

Background

Immunohistochemistry for preferentially expressed antigen in melanoma (PRAME) has been studied in melanocytic lesions but not nonmelanoma skin cancers (NMSCs). This study evaluated PRAME expression in NMSCs and dermoepidermal junction (DEJ) melanocytes in the surrounding skin.

Methods

Ninety‐nine NMSCs were studied: 23 Merkel cell carcinomas (MCCs), 25 well to poorly differentiated squamous cell carcinomas (SCCs), 14 basal cell carcinomas (BCCs), five basosquamous carcinomas, four sebaceous carcinomas, ten atypical fibroxanthomas, 11 dermatofibrosarcoma protuberans, and seven leiomyosarcomas. Staining quality was considered low or high intensity. Staining quantity was reported as negative 0%, 1% to 24%, 25% to 50%, and >50%. DEJ melanocyte PRAME expression was recorded.

Results

Forty‐eight percent of NMSCs showed PRAME expression, mostly low intensity in fewer than 25% of cells. High‐intensity expression was noted in one poorly differentiated SCC, six BCCs, and seven MCCs. Only MCCs showed expression in greater than 25% of tumor cells. Focal DEJ melanocytes expressed high‐intensity PRAME in 18% of cases, most commonly SCCs (11/23).

Conclusions

PRAME is negative or expressed with low intensity in a small percentage of NMSCs, with the exception of some MCC showing high‐intensity and diffuse staining. Focal DEJ melanocytes showed high‐intensity PRAME reactivity in the skin surrounding some NMSCs.
Spatial areas of genotype probability: Predicting the spatial distribution of adaptive genetic variants under future climatic conditions
Authors: Rochat Estelle , Selmoni Oliver , Joost Stéphane
Published: March 2021

In a context of rapid global change, one of the key components for the survival of species is their genetic evolutionary potential for adaptation. Many methods have been developed to identify genetic variants underpinning adaptation to climate, but few tools were made available to integrate this knowledge into conservation management. We present here the SPatial Areas of Genotype probability (SPAG), a method to transpose the results of genotype–environment association studies into an evolutionary potential spatial prediction framework. We define a univariate model predicting the spatial distribution of a single‐locus adaptive genotype and three multivariate models allowing the integration of several adaptive loci in a composite genotype. Unlike existing methods, SPAGs provide (a) a flexible approach to combine loci under different types of intergenic relationships and (b) a cross‐validation framework to assess the pertinence of evolutionary potential predictions. SPAGs can be integrated with climate change projections to forecast the future spatial distribution of genotypes. The analysis of the mismatch between current and future SPAGs (“genomic offset”) makes it possible to identify vulnerable populations potentially lacking the adaptive genotypes necessary for future survival. We tested the SPAG approach on a simulated population and applied it to characterize the evolutionary potential of 161 Moroccan goats to bioclimatic conditions. We identified seven regions of the Moroccan goat genome strongly associated with the precipitation seasonality and used the SPAG approach to predict the evolutionary potential. We then forecasted the shift in SPAGs under a strong climate change scenario and uncovered the goat populations likely to be threatened in future conditions. The SPAG methodology is an efficient and flexible tool to characterize the evolutionary potential across a landscape and to transpose evolutionary information into conservation frameworks.
Idea Facilitation—A Tool for Experience and Service Innovation
Authors: Shahid Hina
Published: March 2021

Product and service innovation does not happen in isolation; it requires a cross‐functional team—most of whom are not designers and may not even be familiar with design practices. In digital product or service offering, more often than not the core team developing/enhancing product consists of multiple functions—from design and engineering to marketing and sales, with little or no familiarity with design processes and practices such as creative ideation. In such cases, ideation becomes a platform for groupthink and corporate inertia, deterring lateral thinking and innovation.

Hence, a structured approach to idea facilitation can help achieve the maximum opportunities availed by ideation sessions: innovative experience and service ideas. Structured ideation frameworks can discourage linear thinking and encourage teams to think strategically and laterally—by switching perspectives, identifying multiple points of view, challenging assumptions, and contextualizing problems.

This paper provides a number of idea facilitation frameworks that enable creative and innovative outcomes when working with a multifunctional team—with design and nondesign professionals with various levels of product–service development experience. These frameworks bridge the gap between insights and strategy and create conditions necessary for creative and lateral thinking. Additionally, it provides best practices to help operationalize idea management.
Tracing Design’s Value in Distributed Manufacturing
Authors: Malakuczi Viktor , D’Elia Luca
Published: March 2021

Today, much of “innovative” design tackles purely digital products or physical products extended by digital functionalities or connectivity. Meanwhile, the digital environment of the web deeply impacts the marketing—and increasingly the design process—of purely physical objects that surround our everyday life. The increasing technological maturity of digital fabrication tools has already established the conditions for a wider diffusion of distributed manufacturing, an ever more valid alternative to conventional manufacturing in many product categories. Distributed manufacturing promises a more direct connection between designer and consumer/maker. On the other hand, new challenges emerge around the management and monetization of the work done for an unforeseeable mass of consumers rather than a single business client. Observing recent trends in other creative industries, this paper outlines three possible scenarios for a stimulating compensation of designers: free, pay‐per‐download, and subscription‐based distribution of creative works. Beyond simple economic concepts, each of these scenarios operates on a different metaphor, requires a different kind of digital infrastructure, and offers a different kind of incentive to attract designers and their efforts. The contribution hopes to help identify possible strategies that might lead to sustainable business models of design for distributed manufacturing.
Is there help indeed, if there is help in need? The case of credit unions during the global financial crisis
Authors: Aghabarari Leila , Guettler Andre , Naeem Mahvish , Van Doornik Bernardus
Published: March 2021

Credit unions (CUs) may respond to a financial shock differently than other types of banks because of their unique membership‐based governance structure. We exploit the financial crisis of 2008/09 as a negative shock to Brazilian banks and analyze the lending behavior of CUs in comparison to non‐CUs and the subsequent effects on the commercial clients' labor force. We find that during the financial crisis, CUs tightened their members' access to credit to a lesser extent (insurance effect) than did other bank types. Notably, the labor market impact of the insurance effect of CUs is positive for very small firms.
Automatic analysis of integrated magnetic resonance and positron emission tomography images improves the accuracy of detection of focal cortical dysplasia type IIb lesions
Authors: Lin Yaoyun , Mo Jiajie , Jin Huiwen , Cao Xueliang , Zhao Yang , Wu Changjun , Zhang Kai , Hu Wenhan , Lin Zhiguo
Published: March 2021

We aimed to develop an efficient and objective pre‐evaluation method to identify the precise location of a focal cortical dysplasia lesion before surgical resection to reduce medication use and decrease the post‐operative frequency of seizure attacks. We developed a novel machine learning‐based approach using cortical surface‐based features by integrating MRI and metabolic PET to identify focal cortical dysplasia lesions. Significant surface‐based features of 22 patients with histopathologically proven FCD IIb lesions were extracted from PET and MRI images using FreeSurfer. We modified significant parameters, trained and tested the XGBoost model using these surface‐based features, and made predictions. We detected lesions in all 20 patients using the XGBoost model, with an accuracy of 91%. We used one‐way chi‐squared test to test the null hypothesis that the population proportion was 50% (p = 0.0001), indicating that our classification of the algorithm was statistically significant. The sensitivity, specificity, and false‐positive rates were 93%, 91%, and 9%, respectively. We developed an objective, quantitative XGBoost classifier that combined MRI and PET imaging features to locate focal cortical dysplasia. This automated method yielded better outcomes than conventional visual analysis and single modality quantitative analysis for surgical pre‐evaluation, especially in subtle or visually unidentifiable FCD lesions. This time‐efficient method would also help doctors identify otherwise overlooked details.
Comparative life cycle assessment of bio‐based insulation materials: Environmental and economic performances
Authors: Schulte Maximilian , Lewandowski Iris , Pude Ralf , Wagner Moritz
Published: March 2021

Insulation materials decrease the final energy consumption of buildings. In Germany, fossil and mineral insulations dominate the market despite numerous life cycle assessments (LCAs) showing that bio‐based insulations can offer environmental benefits. Evaluating the results of such LCAs is, however, complex due to a lack of comparability or costs considered. The objective of this study is comparing bio‐based insulations under equal conditions to identify the most environmentally friendly and cost‐efficient material. For this purpose, a comparative LCA and life cycle costing (LCC) were conducted from “cradle to grave” for four bio‐based and two nonrenewable insulations. The bio‐based insulation materials evaluated were wood fiber, hemp fiber, flax, and miscanthus. The nonrenewable insulations were expanded polystyrene (EPS) and stone wool. Key data for the LCA of the bio‐based insulations were obtained from preceding thermal conductivity measurements under ceteris paribus conditions. Eighteen environmental impact categories were assessed, and direct costs were cumulated along the life cycle. Results show that the most environmentally friendly bio‐based insulation materials were wood fiber and miscanthus. A hotspot analysis found that, for agriculturally sourced insulations, cultivation had the largest environmental impact, and for wood fiber insulation, it was manufacturing. The use phase (including installation) constituted a cost hotspot. The environmental impacts of end‐of‐life incineration were strongly influenced by the fossil components of the materials. Overall, bio‐based insulations were more environmentally friendly than EPS and stone wool in 11 impact categories. The LCC found EPS and miscanthus insulation to be most cost‐efficient, yet market integration of the latter is still limited. It can be concluded that miscanthus biomass is an environmentally and economically promising bio‐based insulation material. Comparability of the environmental performance of the bio‐based insulations was increased by applying the same system boundary and functional unit, the same impact assessment methodology, and the preceding ceteris paribus thermal conductivity measurements.
A standardized protocol improves testing rates for Helicobacter Pylori among inpatients with peptic ulcer disease
Authors: Heffley Jason D. , Zubarik Richard
Published: March 2021

Background

Despite a strong link between Helicobacter Pylori infection and peptic ulcer disease (PUD), rates of testing for H. Pylori in hospitalized patients with PUD remain largely unexplored. We aimed to determine H. Pylori testing practices at our institution among inpatients with PUD, and to implement a protocol to improve testing rates.

Materials and Methods

In this quality improvement initiative, baseline H. Pylori testing practices were determined by analysis of historical data on 100 subsequent inpatients with PUD from January 2016 to June 2017 at a tertiary care hospital undergoing esophagogastroduodenoscopy (EGD). Subsequently, a division‐wide testing protocol was implemented, and data were analyzed from 43 consecutive inpatients with PUD from October 2019‐March 2020 to determine the protocol's effects.

Results

The analysis of baseline testing practices showed a 57% testing rate for H. Pylori. Gastric biopsies were less likely to be performed during EGDs done outside the endoscopy unit (5.9% vs 32.7%, P = 0.001), outside of usual business hours (6.7% vs 24.3%, P = 0.04), and in cases where endoscopic therapy was administered (6% vs 32%, P = 0.02). After implementation of the new division‐wide testing protocol, testing rates increased to 93% (P < 0.001).

Conclusions

Low baseline inpatient testing for H. Pylori represents a missed opportunity to test a substantial number of high‐risk patients with PUD. Implementation of a conceptually simple protocol aimed at increasing rates of gastric biopsy significantly improved testing rates in a prospective follow‐up. Widespread standardization of H. Pylori testing for inpatients with PUD may improve important patient outcomes related to complicated PUD.
BMIstatus and associations between affect, physical activity and anxiety amongU.S.children duringCOVID‐19
Authors: Alves Jasmin M. , Yunker Alexandra G. , DeFendis Alexis , Xiang Anny H. , Page Kathleen A.
Published: March 2021

Background

There is concern regarding how the COVID‐19 pandemic may impact the psychological and physical health of children, but to date, studies on mental health during the pandemic in children are limited. Furthermore, unprecedented lifestyle stressors associated with the pandemic may aggravate the childhood obesity epidemic, but the role of BMI on child activity levels and psychological outcomes during COVID‐19 is unknown.

Objectives

We investigated how emotional responses (positive/negative affect), physical activity (PA) and sedentary behaviours related to anxiety among U.S. children with healthy weight and overweight/obesity during the pandemic.

Methods

Sixty‐four typically developing children (63% girls, 53% healthy weight) aged 9 to 15 years completed two virtual visits during the height of ‘stay‐at‐home’ measures from April 22 to July 29, 2020. Children completed 24‐hours PA recalls, state portion of State‐Trait Anxiety Inventory for Children and the 10‐item Positive and Negative Affect Schedule for Children.

Results

Independent of child BMI status, child anxiety scores were over five standard deviations greater than normative values from paediatric populations prior to the pandemic. Higher positive affect and PA were each associated with reduced anxiety levels in children with overweight/obesity, whereas higher positive affect was associated with reduced anxiety in children with healthy weight. Greater leisure screen time was associated with higher negative affect irrespective of child BMI status.

Conclusions

These associations highlight the potential mental health benefits of maintaining positive affect, engaging in PA and limiting leisure screen time for children during the pandemic and suggest that these associations may be particularly relevant for children with overweight/obesity.
Exploring restrictive measures using action research: A participative observational study by nursing staff in nursing homes
Authors: Bekkema Nienke , Niemeijer Alistair , Frederiks Brenda , de Schipper Clasien
Published: March 2021

Aim

In nursing homes, nursing staff have a key role in the use of restrictive measures. However, their active role in reducing restrictive measures has so far been limited. The aim of this study is to explore how and when the application of restrictive measures in nursing homes occurs including underlying factors, together with nursing staff.

Design

Participatory action research was chosen for a bottom‐up understanding of the use of restrictive measures.

Method

Two Dutch nursing homes participated in 2016/2017 with 18 nursing staff members in the action research team. Nursing staff carried out 33 observations followed by a reflective interview.

Results

Nursing staff observed a wide range of restrictions, including restrictions in freedom of choice, not being able to go outside, not being in charge of medication, and a directive/unresponsive care attitude. Factors influencing restrictions included habits and institutionalization, cognitive ability of the resident, availability of personnel, and responsibility for safety. A responsive care attitude and raising awareness were seen as good practices to enhance freedom.

Conclusions

By taking a distant view on their work, nursing staff discovered a broad range of restrictions, including ‘less obvious’ restrictions. Active forms of learning may position nursing staff to discuss and reduce restrictive measures.

Impact

What problem did the study address?: Restrictive measures are still common in nursing homes. Despite their key role in using restrictive measures, nursing staff's active role in research has been limited. What were the main findings?: By participating as researchers, nursing staff gained a broader perspective on restrictive measures. Many ‘less obvious’ restrictions were related to routines and institutionalization and were considered as eye opening by nursing staff. Where and on whom will the research have impact?: Active forms of learning such as observing and reflecting has the potential to position nursing staff as ‘agents of change’.
Buying and building success: Perceptions of organizational strategies for improvement
Authors: Gillath Omri , Crandall Christian S. , Wann Daniel L , White Mark H
Published: March 2021

What makes people like a team? We suggest and test here whether people’s perceptions of teams and organizations differ as a function of the strategy the teams pick on their way to success. Two main strategies are compared: (1) Development is a strategy focused on building and enhancing the abilities of current team members; and (2) Acquisition is a strategy focused on buying talent from outside the organization. Does the way to success matter? In other words, will the strategy a team endorse affects how much people like the team? In five studies (N = 1,672) we tested whether people prefer teams that were successful by being (a) built through long‐term development of team members or (b) bought by acquiring expensive personal developed elsewhere. Across the five studies, people preferred built teams over bought teams, including sport teams and law firms. Effort and group cohesion were more attributed to build than to bought teams. In a “mediators contest,” effort attributions proved most robust. People like built teams more than bought ones, mostly because they value the effort and hard work that built teams represent.
Proposal of a method for assessing combined flood risk reduction effect by hazard control measures and exposure reduction measures based on limited data
Authors: Itagaki Osamu , Bermudez Dayanara Bianca S. , Zemmoto Takanori , Ohara Miho
Published: March 2021

This article verifies the applicability of an assessment method on flood risk reduction, combining and assessing hazard control measures and exposure reduction measures together. The method develops collated flood risk curves and uses limited data, so it is an approach which can be readily applied in developing countries, where an understanding of flood risk reduction measures are become increasingly important. The method was proposed as a result of studies conducted by the National Institute for Land and Infrastructure Management, Ministry of Land, Infrastructure, Transport and Tourism, Japan. When applying the method to a river improvement and relocation scheme with land mounding in Mindanao, the Philippines, the advantages and limitations of the method are considered.
Flood hazard mapping of Sangu River basin in Bangladesh using multi‐criteria analysis of hydro‐geomorphological factors
Authors: Zzaman Rashed Uz , Nowreen Sara , Billah Maruf , Islam Akm Saiful
Published: March 2021

Flood havoc during 2019 in the Sangu River basin caused widespread damage to residents, crops, roads, and communications in parts of hills in Bangladesh. Developing flood hazard maps can play an essential step in risks management. For this purpose, this study assessed 12 hydro‐geomorphological factors, namely, topographic wetness index, elevation, slope, extreme rainfall, land‐use and land‐cover, soil type, lithology, curvature, drainage density, aspect, height above the nearest drainage, and distance from streams. Maps prepared by individual application of the Analytical Hierarchy Process (AHP) and Analytical Network Process (ANP) exhibit validation scores ranging from 0.77 to 0.79. It is found that the ANP‐based model under 1‐day maximum rainfall denotes a reliable hazard map presenting comparable accuracy to the field results. The hazard map under 100‐year return periods shows that a total of 0.71 million population living downstream is prone to “very high” flood because of its lowland morphology, mild slope, and high drainage density. Alarmingly, 39% of roads, 43% of farming lands, and 25% of education buildings are observed to lie in the highest flood‐prone area. Details on subdistrict level exposures have the potential to serve the decision‐makers and planners in site selection for flood management strategies and setting priorities for remedial measures.
Remarkable inhibition effects of afatinib alone or combining with paclitaxel in esophageal squamous cell carcinoma
Authors: Yang Li‐Yan , Cheng Zhi‐Jian , Liu Zou , Wang Di , Zhang Na , Fan Zhi‐Lu , Cai Hong‐Qing , Zhang Yu , Cai Yan , Xu Xin , Wang Jin‐Hua , Du Guan‐Hua , Hao Jia‐Jie , Wang Ming‐Rong
Published: March 2021

Background and Aim

Chemotherapy drugs do not work well in esophageal squamous cell carcinoma (ESCC), and none of the targeted drugs have been applied in clinic. This study aims to identify effective targeted drugs and related biomarkers for the treatment of ESCC.

Methods

The effect of 40 Food and Drug Administration‐approved small‐molecule inhibitors was first tested in five ESCC cell lines. CCK8 assays and xenografts derived from ESCC cell lines were performed to evaluate the anti‐ESCC effects of inhibitors or chemotherapeutic agents in vitro and in vivo, respectively. Immunohistochemistry was utilized to analyze the p‐EGFR expression in tissues. Western blot combining with gray analysis was conducted to detect the expression of interest protein. Flow cytometry and immunofluorescence assay were used to analyze apoptosis, cell cycle, and mitotic changes after drug treatment.

Results

Afatinib showed remarkable effects on inhibiting ESCC cells with higher expression of p‐EGFR. Results from combinatorial screening in ESCC cells expressing lower phosphorylation level of EGFR showed that paclitaxel and afatinib presented a significant synergistic inhibitory effect (P < 0.001). Molecular analysis revealed that paclitaxel sensitized afatinib by activating EGFR, and afatinib in combination with paclitaxel effectively blocked MAPK pathway and induced G2/M cell arrest and apoptosis that is an indicator of mitotic catastrophe.

Conclusions

Our data demonstrate that afatinib is an effective drug for patients with ESCC expressing higher phosphorylation level of EGFR. And for patients with lower p‐EGFR in tumors, paclitaxel in combination with afatinib might be a promising therapeutic strategy in ESCC.
Effect of new Medicare enrollment on health, healthcare utilization, and cost: A scoping review
Authors: Yeung Kai , Dorsey Caitlin N. , Mettert Kayne
Published: March 2021

Background

More than three million Americans turn 65 each year and newly enroll in Medicare, making this one of the most common insurance transitions. Non‐Medicare insurance transitions are associated with changes in health, healthcare utilization and costs. In addition, older Americans have higher morbidity, mortality, healthcare utilization, and healthcare costs than the general population. However, the effect of new Medicare enrollment on these outcomes is unclear.

Design

We conducted a scoping review to rigorously identify the scope of evidence on the association between new Medicare enrollment and health, healthcare utilization and costs.

Setting

We included English‐language, peer‐reviewed, studies cataloged in Medline (PubMed) and EconLit from 1998 to 2018.

Participants

Individuals newly enrolling in Medicare.

Measurements

We measured health (e.g., self‐reported health), healthcare utilization (e.g., provider visits, preventive care, and hospitalizations) and costs (e.g., patient out‐of‐pocket and health plan spending).

Results

We screened 5265 articles and included 20 articles. New Medicare enrollment was found to increase self‐reported health and healthcare utilization overall, as well as reduce disparities across racial and socioeconomic strata. Provider visits, preventive care and hospitalizations all increased. However, patient out‐of‐pocket spending decreased, and health plan spending also decreased, when Medicare's lower prices were accounted for. Few studies compared outcomes among new Medicare Advantage enrollees with new Medicare fee‐for‐service enrollees. None of the studies specifically evaluated the effect of new Medicare enrollment on adults with multiple chronic conditions.

Conclusion

New Medicare enrollment improves access overall and reduces access disparities. However, the impact of new Medicare enrollment among subgroups defined by insurance coverage type and number of chronic conditions is less clear. Future work should also evaluate the mechanism for increases in hospitalizations.
The efficacy and safety of autologous stromal vascular fraction transplantation for infraorbital skin rejuvenation: A clinical prospective study
Authors: Pattayadeekul Teerasak , Pawcsuntorn Tanomkit , Nararatwanchai Thamthiwat
Published: March 2021

Background

The stromal vascular fraction of fat tissue contributes to its rejuvenation properties. The stromal vascular fraction is a minimal processed cell population. Therefore, it is purportedly a suitable cell therapy for skin rejuvenation.

Objectives

This clinical trial aimed to evaluate the efficacy and safety of transplantation of autologous stromal vascular fraction to aging skin in the infraorbital region.

Patients/Methods.

Nineteen patients were candidates for stromal vascular fraction isolation and transplantation. They underwent lipoaspiration of the abdomen to obtain samples of fat tissue. The stromal vascular fraction was thereafter harvested and transplanted in each infraorbital area. The patients’ outcomes were measured and were based on surface evaluation of wrinkles, surface evaluation of scaliness, and melanin evaluation with a Mexameter. The red blood cell volume and skin elasticity were measured with an erythrometer and cutometer, respectively.

Results

Three months and 6 months after autologous stromal vascular fraction transplantation, the elasticity, wrinkle, and pigmentation of the infraorbital skin improved significantly, but not surface evaluation of scaliness and erythema. The phenotype also improved in the infraorbital skin area, as evaluated by physicians.

Conclusion

The stromal vascular fraction of adipose tissue represents an attractive cell source. In our study, preliminary data showed that clinical outcomes were also generally satisfactory with no serious adverse effects. Thus, stromal vascular fraction cells are safe for clinical rejuvenation use. We encourage future evidence‐based controlled studies to maintain a strong focus on the efficacy and safety profile of stromal vascular fraction therapy.
RETRACTED: Expert consensus on the facial rejuvenation using the Mint Lift® in Koreans: Perspectives of plastic surgeons
Authors: Kim Tae Seob , Kim Seung Soo , Jeong Cheol , Song Yu Kwan
Published: March 2021

Background

It would be mandatory for plastic surgeons to consider anthropometric and anatomical differences between Asians and Caucasians in performing facial rejuvenation procedures using absorbable threadlifts in Asians.

Methods

A consensus meeting was convened to discuss indications, treatment procedures, possible combination treatments, clinical outcomes, and safety of an absorbable polydioxanone (PDO) monofilament threadlift (Mint Lift®; HansBiomed Co. Ltd., Seoul, Korea), for which the “Mint Aesthetics Expert Group” was organized with four Korean board‐certified specialists in plastic and reconstructive surgery.

Results

Our recommendations are as follows: First, the entry and exit points should be determined considering anatomical characteristics of the face (Level of evidence III). Second, treatment procedures may vary depending on indications (Level of evidence III). Third, short‐term efficacy and safety of facial rejuvenation using the Mint Lift® have been well documented (Level of evidence I and III). Third, facial rejuvenation using the Mint Lift® may be combined with a liposuction (Level of evidence III).

Conclusions

Here, we propose expert consensus on facial rejuvenation using a novel absorbable PDO monofilament threadlift in Koreans. Of note, this is the only expert consensus prepared by board‐certified specialists in plastic surgery in Korea. But more evidence‐based efforts should be made to update and to expand the current recommendations.
Ingestion of metallic foreign bodies: A Paediatric Emergency Research in the United Kingdom and Ireland survey of current practice and hand‐held metal detector use
Authors: Lafferty Max , Lyttle Mark D , Mullen Niall ,   PERUKI
Published: March 2021

Aim

To describe variation in the initial management of children presenting to Emergency Departments (ED) with coins lodged in the oesophagus. To determine the usage of hand‐held metal detectors (HHMDs) in EDs, including their role in clinical decision‐making, and training in their use.

Methods

Online multicentre cross‐sectional survey of EDs in the UK and Ireland, with results described using descriptive statistics.

Results

Fifty‐five (90%) of 61 sites responded. The two main strategies described for lodged oesophageal coins were endoscopic removal or observation with reassessment, dependent on location. For coins in the proximal third of the oesophagus 43/55 (78.2%) referred for endoscopic removal, 6/55 (10.9%) observed and the remaining 10.9% used a variety of methods, including: Foley catheter removal with fluoroscopy, blind Foley catheter removal, referral to paediatric surgery/ENT. Thirty (55%) of 55 used HHMDs, 21/30 (70%) had guidelines for their use, and 3/30 (10%) provided formal training. Twenty (67%) of 30 used the xiphisternum as the anatomical cut‐off for assuming safe passage of metallic foreign bodies (FB) beyond the lower oesophageal sphincter.

Conclusions

There is considerable variation in the management of oesophageal coins in children, though two dominant strategies were identified. As endoscopy is significantly more invasive than observation, future research should aim to determine whether either is more effective and safer in children. There is a clear division in departmental adoption of HHMDs. However, in those sites using HHMDs there was little formal training in their use, and there are large variations in techniques and their role in clinical decision‐making.
Assembly of species’ climatic niches of coastal communities does not shift after invasion
Authors: Saldaña‐López Asunción , Vilà Montserrat , Lloret Francisco , Manuel Herrera José , González‐Moreno Pablo
Published: March 2021

Question

Do invasions by invasive plant species with contrasting trait profiles (Arctotheca calendula, Carpobrotus spp., Conyza bonariensis, and Opuntia dillenii) change the climatic niche of coastal plant communities?

Location

Atlantic coastal habitats in Huelva (Spain).

Methods

We identified the species composition of 216 paired (non‐invaded and invaded) 10 × 10 m plots along the coast. For each species, we calculated its climatic niche based on the two main axis of a PCA constructed with nine climatic variables. We defined the community ensemble niche by the union of the overall climate niches of co‐occurring species within a plot. We compared niche overlap metrics between non‐invaded and invaded paired communities.

Results

There was an almost complete overlap in the community ensemble niches between non‐invaded and invaded plots for the four invaders. Plots invaded by Carpobrotus spp. presented the lowest niche stability and those invaded by A. calendula had the highest. Plots invaded by Carpobrotus spp. showed the highest values of niche unfilling and expansion. In contrast, plots invaded by O. dillenii exhibited the lowest niche unfilling. Species similarity between non‐invaded and invaded plots was on average 58%. The community ensemble niches differed depending on the invasive species and were related to differences in community species similarity between non‐invaded and invaded plots. Overall, there was a positive correlation between community species similarity and climatic niche stability, and a negative correlation between community difference in taxonomic richness and climatic niche stability.

Conclusions

Species assemblages in coastal vegetation did not change their community ensemble climatic niches after invasion by plants with contrasted life forms. This pattern is likely the result of invasion which did not trigger major changes in species richness and composition, or alternatively, because the species that were locally displaced by invasion have been substituted by others with similar climatic requirements.
Interactions between organic compounds and olivine under aqueous conditions: A potential role for organic distribution in carbonaceous chondrites
Authors: Muneishi Keisuke , Naraoka Hiroshi
Published: March 2021

Olivine is a principal anhydrous silicate mineral in chondritic meteorites. The structure of this mineral is composed of independent SiO4 tetrahedra linked by divalent cations (mainly Mg). Under hydrothermal conditions, olivine is transformed into serpentine, which is a major hydrated phyllosilicate in the matrix of carbonaceous chondrites. Although carbonaceous chondrites contain various types of organic matter, the interaction between organic compounds and olivine at low temperature has not been considered in the literature. We performed an experiment to test the adsorption of N‐containing organic compounds (i.e., alkylpyridines and alkylimidazoles) on olivine using liquid chromatography under aqueous conditions (pH = 2.5–10.5) at 20–40 °C. The N‐containing cyclic compounds were interacted with the SiO4 tetrahedra of olivine and their different adsorption abilities depended on the organic structures. Because alkylpyridines often occur at different locations than alkylimidazoles in carbonaceous chondrites, the results of this study suggest that olivine can separate the N‐containing compounds associated with aqueous fluid flows by asteroidal chromatography in the meteorite parent body. Liquid chromatography based on solid phase minerals may hence be a useful technique for simulating the behavior of organic compounds in carbonaceous asteroids under aqueous activity.
A knowledge‐enhanced deep reinforcement learning‐based shape optimizer for aerodynamic mitigation of wind‐sensitive structures
Authors: Li Shaopeng , Snaiki Reda , Wu Teng
Published: March 2021

Structural shape optimization plays an important role in the design of wind‐sensitive structures. The numerical evaluation of aerodynamic performance for each shape search and update during the optimization process typically involves significant computational costs. Accordingly, an effective shape optimization algorithm is needed. In this study, the reinforcement learning (RL) method with deep neural network (DNN)‐based policy is utilized for the first time as a shape optimization scheme for aerodynamic mitigation of wind‐sensitive structures. In addition, “tacit” domain knowledge is leveraged to enhance the training efficiency. Both the specific direct‐domain knowledge and general cross‐domain knowledge are incorporated into the deep RL‐based aerodynamic shape optimizer via the transfer‐learning and meta‐learning techniques, respectively, to reduce the required datasets for learning an effective RL policy. Numerical examples for aerodynamic shape optimization of a tall building are used to demonstrate that the proposed knowledge‐enhanced deep RL‐based shape optimizer outperforms both gradient‐based and gradient‐free optimization algorithms.