bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of rice starch film blended with sugar (trehalose/allose) and oil (canola oil/coconut oil): Part I – Filmogenic solution behavior and mechanical properties
Authors: Ploypetchara Thongkorn , Gohtani Shoichi
Published: September 2020

The concentrations effects of sugars (trehalose and allose) and oils (canola and coconut oil) on the characteristics of rice starch suspension and mechanical properties of rice starch film were studied. The samples were prepared using 3% (w/w) rice starch, with 10% or 30% (w/w) sugar (trehalose or allose) added and 10% or 30% (w/w) oil (canola or coconut). The droplet size of the film suspension increased with increasing oil concentration both in trehalose and allose, which blended with oil. The flow behavior of the film suspensions showed shear‐thinning behavior as calculated by the Power Law model. The apparent viscosity tended to increase with the addition of sugar and oil. The breaking stress of the films blended with sugar and oil was less than that of control. On preparation day and after 7 days’ storage, the breaking strain tended to increase more with the addition of coconut oil than with that of canola oil. However, breaking stress and breaking strain decreased after 28 days’ storage. Adding sugar had correlation with mechanical properties whereas adding oil had correlation with film suspension characteristics, allowed the sugar and oil to interact and inhibited starch chain mobility due to concentration, sugar type, and oil type.

Practical Application

Trehalose, allose, canola oil, and coconut oil could be used as a plasticizer in a starch edible/biodegradable film system. The preparation process of filmogenic solution was depended on the combination of sugar and oil that could change the flow behavior and affected the mechanical properties of the edible film. The sugar and oil might improve the mechanical properties of the film by a hydroxyl group of sugar and lubricating properties of the oil.
Plot‐level technical efficiency accounting for farm‐level effects: Evidence from Chilean wine grape producers
Authors: Bravo‐Ureta Boris E. , Moreira Víctor H. , Troncoso Javier L. , Wall Alan
Published: September 2020

This paper applies alternative panel data models to a cross‐sectional dataset that contains observations at the plot level for a sample of wine‐grape farms in Central Chile. The input–output data as well as key attributes of the production system are at the plot level, at which individualized management exists. However, plots belonging to a particular farm are also subject to overall centralized (farm‐level) management. Thus, this data configuration offers the possibility of analyzing technical efficiency (TE) both across plots and across farms. A Generalized True Random Effects model, which permits the separate identification of farm‐level and plot‐level inefficiency while controlling for unobserved farm‐level heterogeneity, shows that TE varies across farms but not among plots within the same farm. Geographical location also affects grape production and agro‐climatic conditions influence production levels, with grape farms located on cooler zones producing significantly less than their counterparts in warmer zones, as expected. The analysis underscores the value of using recent methodologies typically applied to panel data when cross‐sectional information is available for individual plots within a farm unit or in similar settings.
China's Missing Pigs: Correcting China's Hog Inventory Data Using a Machine Learning Approach
Authors: Shao Yongtong , Xiong Tao , Li Minghao , Hayes Dermot , Zhang Wendong , Xie Wei
Published: September 2020

Small sample size often limits forecasting tasks such as the prediction of production, yield, and consumption of agricultural products. Machine learning offers an appealing alternative to traditional forecasting methods. In particular, support vector regression has superior forecasting performance in small sample applications. In this article, we introduce support vector regression via an application to China's hog market. Since 2014, China's hog inventory data has experienced an abnormal decline that contradicts price and consumption trends. We use support vector regression to predict the true inventory based on the price‐inventory relationship before 2014. We show that, in this application with a small sample size, support vector regression outperforms neural networks, random forest, and linear regression. Predicted hog inventory decreased by 3.9% from November 2013 to September 2017, instead of the 25.4% decrease in the reported data.
Early improvement of daily physical activity after catheter ablation for atrial fibrillation in an accelerometer assessment: A prospective pilot study
Authors: Yanagisawa Satoshi , Inden Yasuya , Fujii Aya , Sakamoto Yusuke , Tomomatsu Toshiro , Mamiya Keita , Okamoto Hiroya , Murohara Toyoaki , Shibata Rei
Published: September 2020

Background

Catheter ablation improves physical activity in patients with atrial fibrillation (AF). However, continuous daily evaluation and time course of improvement in physical activity after ablation have not been fully assessed. This prospective study was conducted to evaluate the daily physical activities and changes in the physical performance in patients undergoing catheter ablation for AF by continuous monitoring of a portable accelerometer.

Methods

Ten patients scheduled for catheter ablation for AF were fitted with a uniaxial accelerometer prior to and 6 months after the procedure. This study evaluated changes in daily steps, activity intensity, and activity duration. We also evaluated changes in activity intensity using a short version of the International Physical Activity Questionnaire (IPAQ).

Results

The maximum daily steps significantly increased from baseline to postablation (baseline, 9,232 [6,716–11,485]; after 1–3 months, 11,605 [8,285–14,802]; and after 4–6 months, 11,412 [8,939–13,808], p = .020). Similarly, Δ maximum‐mean daily steps increased significantly (baseline, 2,431 [1,199–6,181]; after 1–3 months, 4,674 [4,164–6,474]; and after 4–6 months, 4,871 [3,657–6,117], p = .014). These improvements were more pronounced in patients with paroxysmal and symptomatic AF. The total IPAQ score significantly improved from baseline to after 6 months ablation (from 1,170 [693–3,930] to 4,312 [1,865–6,569], p = .037). All patients were recurrence‐free from AF after ablation.

Conclusions

The physical activity improved significantly even in the early phase following catheter ablation. The effect of suppressing AF on activity levels was apparent soon after the procedure.
Energy prices and investment in energy efficiency: evidence from Chinese industry 1997–2004
Authors: Tang Le
Published: September 2020

The paper develops and implements a methodology for assessing the role of energy prices and new investment in reducing energy intensity in Chinese industry. Analysing a unique panel data set which reports firm‐level energy consumption and price from 1997 to 2004, the paper finds: the energy prices, not only the current but also the past energy prices, are key factors that driving down firms' energy intensity for all three types of firms: state‐owned enterprises (SOEs), domestic non‐SOEs (NSOEs) and foreign‐funded firms (FFEs); furthermore, SOEs exhibit a robust price‐investment channel: responding to rising energy prices, SOEs tend to invest in new energy‐efficient capital, through which SOEs reduce energy intensity; the same price‐investment channels are less robust for non‐SOEs or foreign‐funded firms.
Vital prostheses: Killing, letting die, and the ethics of de‐implantation
Authors: Aas Sean
Published: September 2020

Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them—and sometimes, permissibly doing so. Stopping a patient’s heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, however, about cases at the boundary—procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it—particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively “bodily” rights and restrictions in at least some implantable devices.
Efficient nonparametric inference on the effects of stochastic interventions under two‐phase sampling, with applications to vaccine efficacy trials
Authors: Hejazi Nima S. , van der Laan Mark J. , Janes Holly E. , Gilbert Peter B. , Benkeser David C.
Published: September 2020

The advent and subsequent widespread availability of preventive vaccines has altered the course of public health over the past century. Despite this success, effective vaccines to prevent many high‐burden diseases, including human immunodeficiency virus (HIV), have been slow to develop. Vaccine development can be aided by the identification of immune response markers that serve as effective surrogates for clinically significant infection or disease endpoints. However, measuring immune response marker activity is often costly, which has motivated the usage of two‐phase sampling for immune response evaluation in clinical trials of preventive vaccines. In such trials, the measurement of immunological markers is performed on a subset of trial participants, where enrollment in this second phase is potentially contingent on the observed study outcome and other participant‐level information. We propose nonparametric methodology for efficiently estimating a counterfactual parameter that quantifies the impact of a given immune response marker on the subsequent probability of infection. Along the way, we fill in theoretical gaps pertaining to the asymptotic behavior of nonparametric efficient estimators in the context of two‐phase sampling, including a multiple robustness property enjoyed by our estimators. Techniques for constructing confidence intervals and hypothesis tests are presented, and an open source software implementation of the methodology, thetxshiftRpackage, is introduced. We illustrate the proposed techniques using data from a recent preventive HIV vaccine efficacy trial.
Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era of COVID‐19
Authors: McGhee Charles N. J. , Dean Simon , Freundlich Simone E. N. , Gokul Akilesh , Ziaei Mohammed , Patel Dipika V. , Niederer Rachael L. , Danesh‐Meyer Helen V.
Published: September 2020

Importance

Determine phacoemulsification cataract surgery risk in a Covid‐19 era.

Background

SARS‐CoV‐2 (Covid‐19) transmission via microdroplet and aerosol‐generating procedures presents risk to medical professionals. As the most common elective surgical procedure performed globally; determining contamination risk from phacoemulsification cataract surgery may guide personal protection equipment use.

Design

Pilot study involving phacoemulsification cataract surgery on enucleated porcine eyes by experienced ophthalmologists in an ophthalmic operating theatre.

Participants

Two ophthalmic surgical teams.

Methods

Standardized phacoemulsification of porcine eyes by two ophthalmologists accompanied by an assistant. Fluorescein incorporated into phacoemulsification irrigation fluid identifying microdroplets and spatter. Contamination documented using a single‐lens reflex camera with a 532 nm narrow bandpass (fluorescein) filter, in‐conjunction with a wide‐field blue light and flat horizontal laser beam (wavelength 532 nm). Quantitative image analysis using Image‐J software.

Main Outcome Measures

Microdroplet and spatter contamination from cataract phacoemulsification.

Results

With phacoemulsification instruments fully within the eye, spatter contamination was limited to <10 cm. Insertion and removal of the phacoemulsification needle and bimanual irrigation/aspiration, with irrigation active generated spatter on the surgeons' gloves and gown extending to >16 cm below the neckline in surgeon 1 and > 5.5 cm below the neckline of surgeon 2. A small tear in the phacoemulsification irrigation sleeve, presented a worse‐case scenario the greatest spatter. No contamination above the surgeons' neckline nor contamination of assistant occurred.

Conclusions and Relevance

Cataract phacoemulsification generates microdroplets and spatter. Until further studies on SARS‐CoV‐2 transmission via microdroplets or aerosolisation of ocular fluid are reported, this pilot study only supports standard personal protective equipment.
Echocardiographic findings in patients with cardiac implantable electronic devices—analysis of factors predisposing to lead‐associated changes
Authors: Nowosielecka Dorota , Polewczyk Anna , Jacheć Wojciech , Tułecki Łukasz , Kleinrok Andrzej , Kutarski Andrzej
Published: September 2020

Background

The constant interaction between intracardiac leads and the heart and veins results in excessive accumulation of fibrous connective tissue around the leads. The extent of this pathological phenomenon, which is visible on transesophageal echocardiography (TEE), and predisposing factors are not well defined.

Methods

We examined 936 transesophageal echocardiograms prior to transvenous lead extraction (TLE) performed at a high‐volume centre between 2015 and 2019.

Results

The most important echocardiographic findings were fibrous binding sites between leads and cardiovascular structures, lead‐to‐lead adhesions, excessive lead loops, lead‐dependent tricuspid dysfunction (LDTD), asymptomatic masses on endocardial leads (AMEL) and vegetations. Fibrotic reaction within the walls of the heart and veins correlated with the presence of lead loops (OR = 1.771; p < .01) and lead dwell time (OR = 1.111; p < .001). Women were more likely to have excessive lead loops (OR = 1.639; p < .01), and the occurrence of loops increase with the number of implanted leads (OR = 2.557; p < .001). Heart failure (OR = 4.016; p < .001), lead looping (OR = 2.603; p < .01) and longer cumulative lead dwell time (OR = 1.017; p < .05) increased the likelihood of LDTD. A variety of AMEL were identified in this study, most commonly in patients with older leads (OR = 1.043; p < .001).

Conclusions

Lead dwell time is the main factor predisposing to the occurrence of most lead‐associated phenomena visualized by TEE in patients with cardiac implantable electronic devices (CIED). Excessive looping of the lead is an important cause of fibrous binding sites and LDTD. AMEL are frequently detected in CIED patients, and their various forms concurrent with vegetations could represent an evolutionary stage of lead‐associated masses.
Evaluation of the efficacy and safety of a new flex‐rigid pleuroscope
Authors: Ishii Satoru , Watanabe Hiromu , Suzuki Manabu , Hashimoto Masao , Iikura Motoyasu , Izumi Shinyu , Hojo Masayuki , Hara Tetsuo , Sugiyama Haruhito
Published: September 2020

Objective

New flex‐rigid pleuroscope enables observations with a maximum angle of curvature of 180°, allowing visualization of the area near the insertion site of the pleuroscope. And, it improved the image quality and channel inner diameter. The aim of this study was to evaluate the clinical effectiveness and safety of a new flex‐rigid pleuroscope.

Methods

A retrospective analysis of patients who were examined with a new flex‐rigid pleuroscope under local anesthesia at our institution was conducted.

Pleuroscopy was performed in 33 patients with undiagnosed exudative pleural effusions from December 2016 to March 2019.

Results

A total of 33 patients (10 women, 23 men); their median age 74 years (range 24‐90) were investigated. Pleuroscopy showed that 18 had malignant pleural disease (54%), and 15 had benign pleural diseases (46%). The top three most frequent causes of pleural disease were pleural metastases of lung carcinoma (30.3%), pyothorax (15.1%), and malignant pleural mesothelioma (12.1%). In 32 cases (97%), observation at the introducer insertion site was possible. It was not possible in one case due to hard adhesions. The diagnostic rate was 100%, and the complication rate was 6.1%. There were no major complications, and minor complications included mild pain (one case) and minor bleeding (one case) that was stanched spontaneously.

Conclusions

The new flex‐rigid pleuroscope is effective and safe for diagnosing pleural effusions. The improved bending angle is likely to minimize the blind area. The new pleuroscopy fiberscope may improve the diagnostic rate.
Drug safety in hospitalized patients with tuberculosis: Drug interactions and adverse drug effects
Authors: Noor Sidra , Ismail Mohammad , Khan Fahadullah
Published: September 2020

Background

Hospitalized patients with tuberculosis (TB) are prescribed with drugs having high risk of potential drug‐drug interactions (pDDIs) and adverse drug effects (ADEs).

Objectives

To explore the adverse effects of anti‐tuberculosis (anti‐TB) drugs and the prevalence and predictors of pDDIs in hospitalized patients with TB.

Methods

Clinical profiles of 436 TB patients were reviewed for adverse effects induced by anti‐TB drugs and screened for pDDIs using Micromedex‐DrugReax. Prevalence and severity levels of pDDIs were reported. Odds ratios for predictors were calculated using logistic regression analysis.

Results

Of total 436 patients, adverse effects of anti‐TB drugs were found in 36%. ADEs were highly prevalent in patients with high doses of anti‐TB drugs. Hepatotoxicity, neuropathy, insomnia, arthralgia, psychosis, hematological alterations, skin rashes, red color stool, diplopia, and photophobia were the identified ADEs. All drugs types‐ and anti‐TB drugs‐pDDIs were reported in 78.2% and 55.7%, respectively. Major‐pDDIs of anti‐TB drugs were identified in 55.5%. Total 1090 anti‐TB drugs pDDIs were found, among them, 55.6% were of major‐ and 40.5% were of moderate‐severity. Significant association was observed for the pDDIs with ≥7 prescribed medicines (P < 0.001). Potential adverse outcomes of the most frequent interactions were hepatotoxicity, decreased drug’s effectiveness, QT‐interval prolongation, nephrotoxicity, and gastrointestinal ulceration.

Conclusions

Patients with TB present with a considerable number of clinically important pDDIs and ADEs (particularly hepatotoxicity). TB patients should be monitored for adverse effects of anti‐TB drugs. Attention should be given to major‐pDDIs. Patients more at risk to interactions should be identified and monitored for related adverse outcomes.
Identifying priority areas for restoring mountain ungulates in the Caucasus ecoregion
Authors: Kuemmerle Tobias , Bluhm Hendrik , Ghoddousi Arash , Arakelyan Marine , Askerov Elshad , Bleyhl Benjamin , Ghasabian Mamikon , Gavashelishvili Alexander , Heidelberg Aurel , Malkhasyan Alexander , Manvelyan Karen , Soofi Mahmood , Yarovenko Yuriy , Weinberg Paul , Zazanashvili Nugzar
Published: September 2020

Mountain ungulates around the world have been decimated to small, fragmented populations. Restoring these species often is limited by inadequate information on where suitable habitat is found, and which restoration measures would help to increase and link existing populations. We developed an approach to spatially target threat‐specific restoration actions and demonstrate it for bezoar goats (Capra aegagrus) in the Caucasus. Using a large occurrence dataset, we identified suitable habitat patches and evaluate them in terms of connectivity, protection status, and competition with other mountain ungulates. We found extant bezoar goat populations to be highly isolated, yet with widespread areas of suitable, unoccupied habitat between them. Many unoccupied habitat patches were well‐connected to extant populations, were at least partly protected, and have low potential for competition with other Capra species. This signals substantial pressure on bezoar goats, likely due to poaching, which currently prevents natural recolonization. Our study shows how restoration planning is possible in the face of multiple threats and scarce data. For bezoar goats in the Caucasus, we pinpoint priority patches for specific restoration measures, including reintroductions and anti‐poaching action. We highlight that many patches would benefit from multiple interventions and that transboundary restoration planning is needed, a situation likely similar for many mountain ungulates around the world.
Early persistent hyperparathyroidism post‐renal transplantation as a predictor of worse graft function and mortality after transplantation
Authors: Isakov Ofer , Ghinea Ronen , Beckerman Pazit , Mor Eytan , Riella Leonardo V. , Hod Tammy
Published: September 2020

Background

Persistent hyperparathyroidism (pHPT) is frequently seen after transplantation contributing to post‐transplant complications.

Methods

We conducted a retrospective single center analysis to explore the relationship of early pHPT and long‐term allograft outcome. Patients were divided into high (N = 153) and low (N = 252) PTH groups based on serum parathyroid hormone (PTH) level 3 months post‐transplant (PTH ≥ 150 and < 150 pg/mL, respectively).

Results

High PTH was found to be an independent predictor for reduced kidney allograft function up to 3 years post‐transplant. eGFR decreased by 11.4 mL/min (P < .001) and the odds of having an eGFR < 60 mL/min 3 years post‐transplant were sixfold higher (P < .01) in the high compared to the low PTH group. Subgroup analysis based on eGFR 1 year post‐transplant, presence of slow graft function (SGF), and transplant type revealed similar results. High PTH three months post‐transplant was also independently associated with an increased risk for overall mortality and for death with a functioning graft (P < .05).

Conclusions

pHPT three months post‐renal transplantation is an independent predictor for a worse allograft function up to 3 years post‐transplant and a risk factor for mortality. This relationship remains statistically significant after accounting for baseline allograft function, presence of SGF and serum mineral levels abnormalities.
Expression of Paracrine Effectors in Human Adipose‐Derived Mesenchymal Stem Cells Treated With Plasma From Brown Bears (Ursus arctos)
Authors: Berg von Linde Maria , Johansson Karin , Kruse Robert , Helenius Gisela , Samano Ninos , Friberg Örjan , Frøbert Anne Mette , Fröbert Ole
Published: September 2020

Adipose‐derived mesenchymal stem cells (ADSCs) are promising candidates for novel cell therapeutic applications. Hibernating brown bears sustain tissue integrity and function via unknown mechanisms, which might be plasma borne. We hypothesized that plasma from hibernating bears may increase the expression of favorable factors from human ADSCs. In an experimental study, ADSCs from patients with ischemic heart disease were treated with interventional media containing plasma from hibernating and active bears, respectively, and with control medium. Extracted RNA from the ADSCs was sequenced using next generation sequencing. Statistical analyses of differentially expressed genes were performed using fold change analysis, pathway analysis, and gene ontology. As a result, we found that genes associated with inflammation, such as IGF1, PGF, IL11, and TGFA, were downregulated by > 10‐fold in ADSCs treated with winter plasma compared with control. Genes important for cardiovascular development, ADM, ANGPTL4, and APOL3, were upregulated in ADSCs when treated with winter plasma compared with summer plasma. ADSCs treated with bear plasma, regardless if it was from hibernating or active bears, showed downregulation of IGF1, PGF, IL11, INHBA, IER3, and HMOX1 compared with control, suggesting reduced cell growth and differentiation. This can be summarized in the conclusion that plasma from hibernating bears suppresses inflammatory genes and activates genes associated with cardiovascular development in human ADSCs. Identifying the involved regulator(s) holds therapeutic potential.
Lichen‐planopilaris‐like scarring pattern in a patient with alopecia and pityriasis rubra pilaris
Authors: Fernandez‐Flores Angel , Hermosa‐Gelbard Angela , Novo‐Lens Raquel
Published: September 2020

Pityriasis rubra pilaris (PRP) is an erythematous‐desquamative dermatitis that is sometimes associated with non‐scarring alopecia. Despite the fact that the disease can be disfiguring, scarring alopecia has rarely been described in this disease. Here, we present a 69‐year‐old woman who developed an erythrodermic episode of PRP associated with telogen effluvium that left an area of persistent alopecia of the scalp and resulted in hair loss in the eyebrows. The biopsy of that area of the scalp demonstrated a scarring alopecia with lichen‐planopilaris‐like features. Despite this histopathology, the alopecia responded well to treatment. This finding expands the context in which lichen planopilaris features can be found and demonstrates their good prognosis under early treatment.
Branching networks can have opposing influences on genetic variation in riverine metapopulations
Authors: Chiu Ming‐Chih , Li Bin , Nukazawa Kei , Resh Vincent H. , Carvajal Thaddeus , Watanabe Kozo
Published: September 2020

Aim

Fractal networks, represented by branching complexity in rivers, are ubiquitous in nature. In rivers, the number of either distal (e.g. in headwater streams) or confluent (e.g. in mainstems) locations can be increased along with their branching complexity. Distal‐ or confluent‐spatial locations can result in fewer or greater corridor linkages that can alter genetic divergence at the metapopulation scale. These mechanisms underlying the resulting genetic structuring remain poorly understood at the metapopulation scale, particularly in terms of the roles of species‐specific dispersal traits. The objective of this study was to mechanistically understand how branching complexity can simultaneously influence genetic divergence in opposite directions.

Location

North‐eastern Japan.

Methods

To evaluate the integrated influences of network complexity and species dispersal on genetic divergence among populations at the catchment scale, we modelled metapopulation genetic dynamics under a Bayesian inference framework by adapting empirical genetic data from four macroinvertebrate species. Simulations were then performed using empirical and virtual species characteristics on virtual river networks.

Results

Our simulation experiments showed that both greater landscape connectivity (resulting from shorter watercourse distance) and greater isolation of distal locations occurred in the more‐branched river networks. These two spatial features have negative and positive influences on genetic divergence, with their relative importance varying among different species and dispersal characteristics. Specifically, genetic divergence at the metapopulation scale increased for species having higher downstream‐biased dispersal but decreased for species having higher upstream‐biased dispersal. Distal populations (e.g. in headwaters) have higher genetic independence when downstream‐biased asymmetry is higher.

Main conclusions

We found a strong association between species dispersal and evolutionary processes such as gene flow and genetic drift. This association mediates the pervasive influences of branching complexity on genetic divergence in the metapopulation. It also highlights the importance of considering species dispersal patterns when developing management strategies in the face of rapid environmental change scenarios.
Moral distress among healthcare providers and mistrust among patients during COVID‐19 in Bangladesh
Authors: Hossain Fahmida
Published: September 2020

The COVID‐19 pandemic has shaken the world through its first wave, and we have yet to experience the second wave. Even resourceful countries have failed to adequately prevent epidemics in their country, and for countries like Bangladesh, which already has strained an ineffective healthcare system, the challenges to contain the SARS‐CoV‐2 virus are that much more severe. Due to the scarcity of resources and systematic failures the Bangladeshi people deeply mistrust the healthcare system. The mistrust is further magnified as healthcare providers are hesitant to treat the patients because of the lack of proper protective gear. Physicians have a moral obligation to serve and treat patients; however, they have a moral obligation to protect their families. This dilemma places healthcare providers in situations where they experience moral distress. This article specifically discusses the importance of interpersonal relationships in driving change, using the framework of Responsiveness, while stating the need for complementary systematic change in order to rebuild trust in the Bangladeshi healthcare system.
Comparison of cardiac output estimates by echocardiography and bioreactance at rest and peak dobutamine stress test in heart failure patients with preserved ejection fraction
Authors: Sengupta Shantanu P. , Mungulmare Kunda , Okwose Nduka C. , MacGowan Guy A. , Jakovljevic Djordje G.
Published: September 2020

Purpose

To assess the agreement between cardiac output estimated by two‐dimensional echocardiography and bioreactance methods at rest and during dobutamine stress test in heart failure patients with preserved left ventricular ejection fraction (HFpEF).

Methods

Hemodynamic measurements were assessed in 20 stable HFpEF patients (12 females; aged 61 ± 7 years) using echocardiography and bioreactance methods during rest and dobutamine stress test at increment dosages of 5, 10, 15, and 20 μg/kg/min until maximal dose was achieved or symptoms and sign occurred, that is, chest pain, abnormal blood pressure elevation, breathlessness, ischemic changes, or arrhythmia.

Results

Resting cardiac output and cardiac index estimated by bioreactance and echocardiography were not significantly different. At peak dobutamine stress test, cardiac output and cardiac index estimated by echocardiography and bioreactance were significantly different (7.06 ± 1.43 vs 5.71 ± 1.59 L/min, P < .01; and 4.27 ± 0.67 vs 3.43 ± 0.87 L/m2/min; P < .01) due to the significant differences in stroke volume. There was a strong positive relationship between cardiac outputs obtained by the two methods at peak dobutamine stress (r = .79, P < .01). The mean difference (lower and upper limits of agreement) between bioreactance and echocardiography cardiac outputs at rest and peak dobutamine stress was −0.45 (1.71 to −2.62) L/min and −1.35 (0.60 to −3.31) L/min, respectively.

Conclusion

Bioreactance and echocardiography methods provide different cardiac output values at rest and during stress thus cannot be used interchangeably. Ability to continuously monitor key hemodynamic variables such as cardiac output, stroke volume, and heart rate is the major advantage of bioreactance method.
Relationships between mitral annular calcification and cardiovascular events: A meta‐analysis
Authors: Wang Tom Kai Ming , Griffin Brian P. , Xu Bo , Rodriguez Leonardo L. , Popovic Zoran B. , Gillinov Marc A. , Pettersson Gosta B. , Desai Milind Y.
Published: September 2020

Background

Mitral annular calcification (MAC) is prevalent in the aging population, with recent renewed interest regarding its associations with cardiovascular risk factors, outcomes, and influence on valvular heart disease and interventions. This meta‐analysis aimed to report the relationships between MAC and cardiovascular mortality and morbidity events.

Methods

Relevant studies were searched from PubMed, Cochrane, and Embase databases until November 30, 2019. Associations between MAC as a binary variable with death and cardiovascular events were pooled using random‐effects models. The main outcomes of interest were all‐cause and cardiovascular mortality, myocardial infarction, stroke, heart failure, atrial fibrillation, and procedural outcomes.

Results

Among 799 article abstracts and 122 full‐text articles screened, 26 (16 prospective and 10 retrospective) studies totaling 35 070 subjects were analyzed. MAC was associated with higher all‐cause death, hazard ratio (95% confidence interval) 1.76 (1.43‐2.22), and cardiovascular mortality 1.85 (1.45‐23.5). It also positively correlated with myocardial infarction 1.48 (1.22‐1.79), stroke 1.51 (1.22‐2.05), incidental heart failure 1.55 (1.30‐1.84), atrial fibrillation 1.75 (1.43‐2.15), and their composite, major adverse cardiovascular events (MACE). Finally, conversion to mitral valve replacement at time of cardiac surgery was more in patients with MAC than without MAC, with odds ratio (95% confidence interval) 2.82 (1.28‐6.18).

Conclusion

Mitral annular calcification was overall associated with higher rates of death, and both individual and composite cardiovascular events. The presence of increasingly encountered MAC has significant clinical implications for cardiovascular risk assessment and valvular interventions.
The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography
Authors: Fitzgerald Benjamin T. , Logan Jelena K. , Weldon Ashleigh , Kwon Agatha , Scalia Isabel G. , Scalia Gregory M.
Published: September 2020

Background

Stress echocardiography (SE) is an established technique for assessment of coronary artery disease (CAD) which is difficult to perform and interpret. Left ventricular stroke volume (SV) is readily estimated with Doppler echocardiography. It can be affected by myocardial ischemia, with possible adjunctive value during SE.

Methods

Patients underwent Bruce protocol SE with SV estimated before and after maximal treadmill exertion post routine regional wall analysis. Incremental change in SV (ΔSV) with exercise was measured.

Results

A derivation cohort (n = 273) was established to test the hypothesis. An optimal cutoff for detection on inducible ischemia was ΔSV ≤ +10 mL. The validation cohort of consecutive patients (n = 1093, 376 [34%] female; age 59 ± 12 years) were followed clinically after SE for 20 460 patient‐months. There were 1000 patients with nonischemic SE, and 93 patients with studies suggestive of myocardial ischemia. Secondary analysis yielded 831 patients with a normal exercise response (ΔSV > +10 mL) and 192 with an abnormal ΔSV ≤ +10 mL. Time to first combined adverse cardiac event (composite of angina, acute coronary syndrome, cardiac revascularization, worsening New York Heart Association (NYHA) class, a reduction in EF, and cardiovascular death) was analyzed and adjusted using Cox proportional hazards regression. The hazard ratio for an adverse event with an abnormal ΔSV response (≤10 mL) was 10.3 (95% confidence intervals 5.6‐19.1, P < .0001).

Conclusions

Stroke volume assessment during SE is feasible and readily performed. It is simple, practical, and has incremental diagnostic and prognostic value when added to exercise regional wall‐motion analysis.
Evidence mapping and quality assessment of systematic reviews in dental traumatology
Authors: Tewari Nitesh , Mathur Vijay Prakash , Kaur Amandeep , Sardana Divesh , Rahul Morankar , Tamchos Rigzen , Ritwik Priyanshi , Goel Shubhi , Schiavo Julie
Published: September 2020

Background/Aims

Evidence mapping of systematic reviews (SRs) systematically and comprehensively identifies, organizes, and summarizes the distribution of scientific evidence in a field. The aims of this study were to delineate domains in dental traumatology (DT), evaluate the existing SRs within the domains, and identify the paucity of evidence for future research.

Methods

Domains and sub‐domains of DT were established according to the methods of qualitative research. The protocol for evidence mapping was prepared as per the guidelines of GEM and PRISMA. The search strategy was formulated using words and MeSH terms in eight databases without restriction of languages and year of publication. Gray literature, protocol registries, and references of selected articles were also searched. Duplicates were removed, and the final selection of SRs was completed. Data extraction and quality analysis using the ROBIS tool and the PRISMA checklist were performed.

Results

The overall search resulted in 64 SRs from 1999 to 2020 with 44 published in last six years. The highest number of SRs had been performed in the Prognostic domain (n = 19) followed by the domains of Epidemiology (n = 15), Therapeutics (n = 10), Oral Biology (n = 7), Diagnostics (n = 6), Preventive (n = 5), and Research Methods (n = 2). Within each domain, there were variabilities in the number of reviewers, a priori protocols, search limitations, risk of bias methods, and meta‐analysis. Of the SRs, including 4 Cochrane reviews, 28.4% were inconclusive. A low risk of bias was found in 48.4% of the SRs. Among the registered and ongoing SRs, six were from the domain of epidemiology, two in the domain of therapeutics, five from prognostics, and one each in the domains of prevention and research methods.

Conclusion

The SRs in DT could be mapped in seven domains with variabilities in the methods. The majority had an a priori registered protocol and a low risk of reporting errors. Within the Epidemiology and Preventive domains, SRs were present in all the sub‐domains with the majority demonstrating low‐risk of bias (ROB). The domain of prognosis had SRs in most sub‐domains but with a high ROB. Insufficient numbers of SRs were present in most sub‐domains of the Diagnostics, Therapeutics, Research Methods and Oral Biology domains.
A common European Curriculum for Dental Hygiene ‐ Domain II: Safe and Effective Clinical Practice
Authors: Öhrn Kerstin , van Boxtel Agnes , Field James
Published: September 2020

This position paper outlines the areas of competence and learning outcomes of the Common European Curriculum for Dental Hygiene (CECDH) that specifically relate to Safe and Effective Clinical Practice. Dental hygienists are required to ensure that they are capable of providing safe and appropriate care for their patients, whilst operating effectively within a wider team. The care provided should be based on contemporaneous evidence wherever possible, and the quality of care and the management systems that underpin it should be regularly audited and improved.
Exploring the impact of digital professionalism awareness training on dental undergraduate students
Authors: Gormley Mark , Collins Laura , Schofield Susie , Neville Patricia
Published: September 2020

Introduction

Since the publication of GDC guidance, there have been small, but rising numbers of Fitness to Practise (FtP) cases made against qualified dentists, relating to the use of social media. Prior to graduation, dental students currently receive training in the appropriate use of social media, but more work is needed to determine the most effective methods do this. The aim of this study is to explore the impact of the digital professionalism awareness training provided at one UK‐based institution.

Materials and Methods

In year 2, a "brown envelope" is compiled using an online publicly available Facebook profile search for every student. All year 2 to 5 dental undergraduate students at one UK dental school who had completed the "brown envelope" were invited to participate in focus groups to examine its impact on behaviour change. A qualitative framework analysis method was applied to the transcripts.

Results

Eleven dental undergraduate students participated in two focus groups. All students had experienced the "brown envelope" intervention. Four main themes emerged, including: a clear expression of dental student autonomy and rejection of regulation; that online activity in dentistry is different to medicine; that the intervention is useful and changed online behaviour; and constructive suggestions for improving training.

Conclusion

The interactive "brown envelope" intervention for digital professionalism awareness training was well received and appeared to result in actionable behavioural change on student profiles (eg alterations in privacy settings or restricting access to their own "friends lists").
Midostaurin in combination with chemotherapy is most effective in patients with acute myeloid leukemia presenting with high FLT3‐ITD allelic ratio who proceed to allogeneic stem cell transplantation while in first complete remission
Authors: Ofran Yishai , Leiba Ronit , Frisch Avraham , Horesh Nurit , Henig Israel , Yehudai‐Ofir Dana , Moshe Yakir , Neaman Miriam , Ganzel Chezi , Gal‐Rabinovich Kinneret , Hellmann Ilana , Weinstein Vladimir , Berger Tamar , Wolach Ofir
Published: September 2020

Objectives

Midostaurin, a multikinase and FLT3 inhibitor, is the first non‐chemotherapy agent approved and widely adopted for the treatment of FLT3‐ITD acute myeloid leukemia (AML). Yet, its role in improving survival of patients referred to allogeneic stem cell transplantation (allo‐SCT) in first complete remission (CR1) needs to be defined.

Methods

This multicenter study retrospectively evaluated the outcome of 119 FLT3‐ITD AML patients [59 (49.6%) males and 60 females] intensively treated between 2015 and 2019 at five Israeli centers. In our cohort, allo‐SCT in CR1 was widely implemented (47%) and patient stratification was based on the current allelic ratio (AR) cutoff of 0.5.

Results

Ninety‐eight patients (82.3%) achieved CR1/CR with incomplete count recovery (CRi). Death during induction was reported in 7 (5.9%) patients. In multivariate analysis, midostaurin use and allo‐SCT in CR1 were the most significant factors affecting overall survival (OS). Midostaurin incorporation in chemotherapy regimens significantly improved CR + CRi rates (P = .002), reduced relapse rates (P = .02), and was remarkably advantageous for high‐AR patients (2‐year OS 82%). In low‐AR patients, the midostaurin effect was much less prominent.

Conclusions

Our results demonstrate benefits of midostaurin incorporation in intensive chemotherapy regimens, particularly for high‐AR AML patients to whom it should be offered along with allo‐SCT in CR1.
Splitting event‐related potentials: Modeling latent components using regression‐based waveform estimation
Authors: Brouwer Harm , Delogu Francesca , Crocker Matthew W.
Published: September 2020

Event‐related potentials (ERPs) provide a multidimensional and real‐time window into neurocognitive processing. The typical Waveform‐based Component Structure (WCS) approach to ERPs assesses the modulation pattern of components—systematic, reoccurring voltage fluctuations reflecting specific computational operations—by looking at mean amplitude in predetermined time‐windows. This WCS approach, however, often leads to inconsistent results within as well as across studies. It has been argued that at least some inconsistencies may be reconciled by considering spatiotemporal overlap between components; that is, components may overlap in both space and time, and given their additive nature, this means that the WCS may fail to accurately represent its underlying latent component structure (LCS). We employ regression‐based ERP (rERP) estimation to extend traditional approaches with an additional layer of analysis, which enables the explicit modeling of the LCS underlying WCS. To demonstrate its utility, we incrementally derive an rERP analysis of a recent study on language comprehension with seemingly inconsistent WCS‐derived results. Analysis of the resultant regression models allows one to derive an explanation for the WCS in terms of how relevant regression predictors combine in space and time, and crucially, how individual predictors may be mapped onto unique components in LCS, revealing how these spatiotemporally overlap in the WCS. We conclude that rERP estimation allows for investigating how scalp‐recorded voltages derive from the spatiotemporal combination of experimentally manipulated factors. Moreover, when factors can be uniquely mapped onto components, rERPs may offer explanations for seemingly inconsistent ERP waveforms at the level of their underlying latent component structure.
Interrater agreement of classification of photoparoxysmal electroencephalographic response
Authors: Beniczky Sándor , Aurlien Harald , Franceschetti Silvana , Martins da Silva Antonio , Bisulli Francesca , Bentes Carla , Canafoglia Laura , Ferri Lorenzo , Krýsl David , Rita Peralta Ana , Rácz Attila , Cross J. Helen , Arzimanoglou Alexis
Published: September 2020

Our goal was to assess the interrater agreement (IRA) of photoparoxysmal response (PPR) using the classification proposed by a task force of the International League Against Epilepsy (ILAE), and a simplified classification system proposed by our group. In addition, we evaluated IRA of epileptiform discharges (EDs) and the diagnostic significance of the electroencephalographic (EEG) abnormalities. We used EEG recordings from the European Reference Network (EpiCARE) and Standardized Computer‐based Organized Reporting of EEG (SCORE). Six raters independently scored EEG recordings from 30 patients. We calculated the agreement coefficient (AC) for each feature. IRA of PPR using the classification proposed by the ILAE task force was only fair (AC = 0.38). This improved to a moderate agreement by using the simplified classification (AC = 0.56; P = .004). IRA of EDs was almost perfect (AC = 0.98), and IRA of scoring the diagnostic significance was moderate (AC = 0.51). Our results suggest that the simplified classification of the PPR is suitable for implementation in clinical practice.
Value of 7T MRI and post‐processing in patients with nonlesional 3T MRI undergoing epilepsy presurgical evaluation
Authors: Wang Irene , Oh Sehong , Blümcke Ingmar , Coras Roland , Krishnan Balu , Kim Sanghoon , McBride Aaron , Grinenko Olesya , Lin Yicong , Overmyer Margit , Aung Tin Tun , Lowe Mark , Larvie Mykol , Alexopoulos Andreas V. , Bingaman William , Gonzalez‐Martinez Jorge A. , Najm Imad , Jones Stephen E.
Published: September 2020

Objective

Ultra‐high‐field 7‐Tesla (7T) magnetic resonance imaging (MRI) offers increased signal‐to‐noise and contrast‐to‐noise ratios, which may improve visualization of cortical malformations. We aim to assess the clinical value of in vivo structural 7T MRI and its post‐processing for the noninvasive identification of epileptic brain lesions in patients with pharmacoresistant epilepsy and nonlesional 3T MRI who are undergoing presurgical evaluation.

Methods

Sixty‐seven patients were included who had nonlesional 3T MRI by official radiology report. Epilepsy protocols were used for the 3T and 7T acquisitions. Post‐processing of the 7T T1‐weighted magnetization‐prepared two rapid acquisition gradient echoes sequence was performed using the morphometric analysis program (MAP) with comparison to a normal database consisting of 50 healthy controls. Review of 7T was performed by an experienced board‐certified neuroradiologist and at the multimodal patient management conference. The clinical significance of 7T findings was assessed based on intracranial electroencephalography (ICEEG) ictal onset, surgery, postoperative seizure outcomes, and histopathology.

Results

Unaided visual review of 7T detected previously unappreciated subtle lesions in 22% (15/67). When aided by 7T MAP, the total yield increased to 43% (29/67). The location of the 7T‐identified lesion was identical to or contained within the ICEEG ictal onset in 13 of 16 (81%). Complete resection of the 7T‐identified lesion was associated with seizure freedom (P = .03). Histopathology of the 7T‐identified lesions encountered mainly focal cortical dysplasia (FCD). 7T MAP yielded 25% more lesions (6/24) than 3T MAP, and showed improved conspicuity in 46% (11/24).

Significance

Our data suggest a major benefit of 7T with post‐processing for detecting subtle FCD lesions for patients with pharmacoresistant epilepsy and nonlesional 3T MRI.