bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased variance in second electrode accuracy during deep brain stimulation and its relationship to pneumocephalus, brain shift, and clinical outcomes: a retrospective cohort study
Authors: Hart MG , Posa M , Buttery PC , Morris RC
Published: March 2022

Introduction

Accurate placement of deep brain stimulation electrodes within the intended target is believed to be a key variable related to outcomes. However, methods to verify electrode location are not universally established.

Research Question

The aim of this study was to determine the feasibility of post-op lead localisation in clinical practice and its utility to audit our own DBS accuracy.

Material and Methods

A retrospective cohort study was performed of a consecutive series of patients with Parkinson’s disease who underwent deep brain stimulation of either the globus pallidus internus (GPi) or subthalamic nucleus (STN) between 2016 and 2019. Image processing was performed using the Lead-DBS toolbox. Institutional ethical approval was granted as a review of service.

Results

In total 38 participants met the inclusion criteria. Electrode localisation was completed in 79%. Clinical outcomes included improvement in UPDRS III of 46% and PDQ39 of 32%. Overall electrode accuracy was 0.22 +/- 0.4mm for all electrodes to the main nucleus with 9 (12%) outliers but only 3 (4%) electrodes out with 2mm from the intended target. Accuracy was worse for the second electrode implanted and in the GPi but was not affected by pneumocephalus or brain shift. Neither clinical outcomes nor the volume of activated tissue was affected by electrode accuracy.

Discussion and Conclusions

A neuroimaging approach to electrode localisation allows qualitative appraisal of targeting accuracy and is feasible with routine clinical data. Such methods are complimentary to traditional co-ordinate approaches and lend themselves to developing large, collaborative, and quantitative projects.

HIGHLIGHTS

Overall electrode accuracy was 0.22 +/- 0.4mm with only 3 (4%) electrodes out with 2mm from the intended target

Accuracy was significantly worse in the GPi versus the STN and on the second side implanted

Inaccuracy occurred in the X (lateral) plane but was not related to pneumocephalus or brain shift
Risk Factor Stratification for Postoperative Delirium: A Retrospective Database Study
Authors: Vacas Susana , Grogan Tristan , Cheng Drew , Hofer Ira
Published: March 2022

Background

Postoperative Delirium (POD) is a disturbing reality for patients and their families. Absence of easy-to-use and accurate risk scores prompted us to retrospectively extract data from the electronic health records (EHR) to identify clinical factors associated with POD. We seek to create a multivariate nomogram to predict the risk of POD based upon the most significant clinical factors.

Methods

The EHR of patients >18 years of age undergoing surgery and had POD assessment were reviewed. Patient characteristics and study variables were summarized between delirium groups. We constructed univariate logistic regression models for POD using each study variable to estimate odds ratios (OR) and constructed a multivariable logistic regression model with stepwise variable selection. In order to create a clinically useful/implementable tool we created a nomogram to predict risk of delirium.

Results

Overall, we found a rate of POD of 3.7% across our study population. The Model achieved an AUC of the ROC curve of 0.83 (95% CI 0.82-0.84). We found that age, increased ASA score (ASA 3-4 OR 2.81, CI1.49-5.28, p<0.001), depression (OR 1.28, CI1.12-1.47, p<0.001), postoperative benzodiazepine use (OR 3.52, CI3.06-4.06, p<0.001) and urgent cases (Urgent OR 3.51, CI2.92-4.21, p<0.001; Emergent OR 3.99, CI3.21-4.96, p<0.001; Critically Emergent OR 5.30, CI3.53-7.96, p<0.001) were associated with POD.

Conclusions

We were able to distinguish the contribution of individual risk factors to the development of POD. We created a clinically useful easy-to-use tool that has the potential to accurately identify those at high-risk of delirium, a first step to prevent POD.
New Microviridae isolated from Sulfitobacter reveals two cosmopolitan subfamilies of ssDNA phages infecting marine and terrestrial Alphaproteobacteria
Authors: Zucker Falk , Bischoff Vera , Olo Ndela Eric , Heyerhoff Benedikt , Poehlein Anja , Freese Heike M. , Roux Simon , Simon Meinhard , Enault Francois , Moraru Cristina
Published: March 2022

The Microviridae family represents one of the major clades of ssDNA phages. Their cultivated members are lytic and infect Proteobacteria, Bacteroidetes, and Chlamydiae. Prophages have been predicted in genomes from Bacteroidales, Hyphomicrobiales, and Enterobacteraceae and cluster within the “Alpavirinae”, “Amoyvirinae” and Gokushovirinae. We have isolated “Ascunsovirus oldenburgi” ICBM5, a novel phage distantly related to known Microviridae. It infects Sulfitobacter dubius SH24-1b and uses both a lytic and a carrier-state life strategy. Using ICBM5 proteins as a query, we uncovered in publicly available resources 65 new microviridae prophages and episomes in bacterial genomes and retrieved 47 environmental viral genomes (EVGs) from various viromes. Genome clustering based on protein content and phylogenetic analysis showed that ICBM5, together with Rhizobium phages, new prophages, episomes, and EVGs cluster within two new phylogenetic clades, here tentatively assigned the rank of subfamily and named “Tainavirinae” and “Occultatumvirinae”. They both infect Rhodobacterales. Occultatumviruses also infect Hyphomicrobiales, including nitrogen-fixing endosymbionts from cosmopolitan legumes. A biogeographical assessment showed that tainaviruses and occultatumviruses are spread worldwide, in terrestrial and marine environments. The new phage isolated here shed light onto new and diverse branches of the Microviridae tree, suggesting that much of the ssDNA phage diversity remains in the dark.
Control of NK cell tolerance in MHC class I-deficiency by regulated SHP-1 localization to the activating immune synapse
Authors: Schmied Laurent , Luu Thuy T. , Søndergaard Jonas N. , Meinke Stephan , Mohammad Dara K. , Singh Sunitha B. , Mayer Corinna , Casoni Giovanna P. , Chrobok Michael , Schlums Heinrich , Rota Giorgia , Truong Hieu M. , Westerberg Lisa S. , Guarda Greta , Alici Evren , Wagner Arnika K. , Kadri Nadir , Bryceson Yenan T. , Saeed Mezida B. , Höglund Petter
Published: March 2022

Signaling via inhibitory KIR/Ly49 receptors preserves natural killer (NK) cell self-tolerance but also conveys NK cell reactivity towards MHC class-I low target cells in an education process. Here, we demonstrate that mouse NK cell education by H-2Dd regulates transcription of several genes in Ly49A+ NK cells including Ptpn6, encoding the phosphatase SHP-1. SHP-1 was highly expressed in uneducated NK cells, in which knock-out of Ptpn6 increased responsiveness. Following NKp46 triggering of uneducated NK cells, a higher synaptic abundance of phosphorylated SHP-1 was found relative to educated NK cells, concomitant with reduced phosphorylation of several signaling molecules, including PLC-g2, SLP-76, ZAP70/Syk and ERK1/2. SHP-1 overlapped extensively with F-actin and SLP-76 in the uneducated activating synapse of Ly49A+ NK cells, whereas a greater association between Ly49A and SHP-1 was observed in educated NK cells. Thus, our results indicate that in addition to transcriptional regulation, a distinct SHP-1 patterning in NK cell activating synapses can determine their tolerance.
A descending inhibitory mechanism of nociception mediated by an evolutionarily conserved neuropeptide system inDrosophila
Authors: Oikawa Izumi , Kondo Shu , Hashimoto Kao , Yoshida Akiho , Hamajima Megumi , Tanimoto Hiromu , Furukubo-Tokunaga Katsuo , Honjo Ken
Published: March 2022

Nociception is a neural process that animals have developed to avoid potentially tissue-damaging stimuli. While nociception is triggered in the peripheral nervous system, its modulation by the central nervous system is a critical process in mammals, whose dysfunction has been extensively implicated in chronic pain pathogenesis. The peripheral mechanisms of nociception are largely conserved across the animal kingdom. However, it is unclear whether the brain-mediated modulation is also conserved in non-mammalian species. Here, we show thatDrosophilahas a descending inhibitory mechanism of nociception from the brain, mediated by the neuropeptide Drosulfakinin (DSK), a homolog of cholecystokinin (CCK) that plays an important role in the descending control of nociception in mammals. We found that mutants lackingdskor its receptors are hypersensitive to noxious heat. Through a combination of genetic, behavioral, histological, and Ca2+imaging analyses, we subsequently revealed neurons involved in DSK-mediated nociceptive regulation at a single-cell resolution and identified a DSKergic descending neuronal pathway that inhibits nociception. This study provides the first evidence for a descending modulatory mechanism of nociception from the brain in a non-mammalian species that is mediated by the evolutionarily conserved CCK system, raising the possibility that the descending inhibition is an ancient mechanism to regulate nociception.
ScrapPaper: A web scrapping method to extract journal information from PubMed and Google Scholar search result using Python
Authors: Rafsanjani Mohd Rifqi
Published: March 2022

This paper introduces a program called ScrapPaper, a simple Python script that use web-scraping method to extract journal information from PubMed and Google Scholar search results page. Currently the motivation behind the program development is trying to solve a problem to obtain scientific literatures information especially the title and link and save as a list for further use such as in meta-analysis and comparative study of literatures. ScrapPaper advantage that it is simple to use with no prior programming experience and get the results ready within minutes (depending on the total search result). Web-scrapping is a very powerful method to extract information from the web and ScrapPaper employ several server friendly approaches accessing both PubMed and Google Scholar site.

Abstract Figure
Community diversity is associated with intra-species genetic diversity and gene loss in the human gut microbiome
Authors: Madi Naïma , Chen Daisy , Wolff Richard , Shapiro B. Jesse , Garud Nandita
Published: March 2022

The human gut microbiome contains a diversity of microbial species that varies in composition over time and across individuals. These species (and strains within species) can migrate across hosts and evolve by mutation and recombination within hosts. How the ecological process of community assembly interacts with intra-species diversity and evolutionary change is a longstanding question. Two contrasting hypotheses have been proposed based on ecological observations and theory: Diversity Begets Diversity (DBD), in which taxa tend to become more diverse in already diverse communities, and Ecological Controls (EC), in which higher community diversity impedes diversification within taxa. Previously, using 16S rRNA gene amplicon data across a range of environments, we showed a generally positive relationship between taxa diversity and community diversity at higher taxonomic levels, consistent with the predictions of DBD (Madi et al., 2020). However, this positive ‘diversity slope’ reaches a plateau at high levels of community diversity. Here we show that this general pattern holds at much finer genetic resolution, by analyzing intra-species strain and nucleotide variation in static and temporally sampled shotgun-sequenced fecal metagenomes from cohorts of healthy human hosts. We find that both intra-species polymorphism and strain number are positively correlated with community Shannon diversity. This trend is consistent with DBD, although we cannot exclude abiotic drivers of diversity. Shannon diversity is also predictive of increases in polymorphism over time scales up to ∼4-6 months, after which the diversity slope flattens and then becomes negative—consistent with DBD eventually giving way to EC. Also supporting a complex mixture of DBD and EC, the number of strains per focal species is positively associated with Shannon diversity but negatively associated with richness. Finally, we show that higher community diversity predicts gene loss in a focal species at a future time point. This observation is broadly consistent with the Black Queen Hypothesis, which posits that genes with functions provided by the community are less likely to be retained in a focal species’ genome. Together, our results show that a mixture of DBD, EC, and Black Queen may operate simultaneously in the human gut microbiome, adding to a growing body of evidence that these eco-evolutionary processes are key drivers of biodiversity and ecosystem function.
Mechanical Ventilation induced DNA Damage and P21 in an Acute Aging Model of Lung Injury
Authors: Kamga Gninzeko Franck J. , Tho Cindy K. , Valentine Michael S. , Wandling Emily N. , Heise Rebecca L.
Published: March 2022

Acute respiratory distress syndrome (ARDS) is a form of acute lung injury which leads to a paucity of oxygen. To remedy ARDS, patients are put on mechanical ventilators; however, the stretch resulting from the mechanical ventilator can lead to ventilator-induced lung injury or VILI. VILI is exacerbated by age. The combined effects of ARDS and mechanical ventilation can result in a hostile environment which may lead to senescence (stable cell cycle arrest). The role of senescence in VILI is poorly understood. Senescence is characterized by increased cyclin-dependent kinase inhibitors P16 and P21; however, P21 has been shown to occur in early senescence. We hypothesized that mechanical ventilation would lead to DNA damage and senescence-like phenotype. Both in vivo and in vitro models of VILI were used to investigate senescence and its mechanism in VILI. Mechanical ventilation increased senescence-associated markers such as DNA damage marker characterized by ɣH2AX, P21, senescence-associated secretory phenotype IL6, and decreased proliferation. Moreover, mechanical ventilation led to increased apoptosis. Lung sections were stained for KRT8 proteins, markers of transiently differentiated alveolar type 2 (AT2) cells which were reported to be more prone to DNA damage. Age and mechanical ventilation increased KRT8 positive cells. Finally, we probed a potential mediator of the stretch induced senescence in vitro by inhibiting P38-MAPK, which can be activated by DNA damage response, leading to increased P21. Inhibiting P38 decreased in P21 but did not decrease ɣH2AXThese findings suggest that mechanical ventilation may lead to a senescence-like phenotype involving the P38-MAPK pathway.
Quantitative interactome proteomics identifies proteostasis network for GABAAreceptors
Authors: Wang Ya-Juan , Di Xiao-Jing , Mu Ting-Wei
Published: March 2022

Gamma-aminobutyric acid type A (GABAA) receptors, the primary inhibitory neurotransmitter-gated ion channels in the mammalian central nervous system, inhibit neuronal firing to preserve balanced neuronal activity. Maintenance of GABAAreceptor protein homeostasis (proteostasis) in the cell utilizing its interacting proteins is essential for the function of GABAAreceptors. However, how the proteostasis network orchestrates GABAAreceptor biogenesis in the endoplasmic reticulum (ER) is not well understood. To address this question systematically, we employed a proteomics-based approach to identify the interactomes of GABAAreceptors by carrying out a quantitative immunoprecipitation-tandem mass spectrometry (IP-MS/MS) analysis utilizing stable isotope labeling by amino acids in cell culture (SILAC). To enhance the coverage and reliability of the identified proteins, we performed comparative proteomics by using both wild type α1 subunit and a misfolding-prone α1 subunit carrying the A322D variant as the bait proteins. The wild type α1 interactome contains 125 proteins, the α1(A322D) interactome contains 105 proteins, and 54 proteins overlap within two interactomes. Bioinformatics analysis identified potential GABAAreceptor proteostasis network components, including chaperones, folding enzymes, trafficking factors, and degradation factors. Further, their potential involvement is modelled in the cellular folding, degradation and trafficking pathways for GABAAreceptors. In addition, we verified endogenous interactions between α1 subunit and their selected interactors by carrying out co-immunoprecipitation assay in mouse brain homogenates. This study paves the way for understanding the molecular mechanisms as well as fine-tuning of GABAAreceptor proteostasis to ameliorate related neurological diseases such as epilepsy.
Structure of the IL-27 quaternary receptor signaling complex
Authors: Caveney Nathanael A , Glassman Caleb R , Jude Kevin M , Tsutsumi Naotaka , Garcia K Christopher
Published: March 2022

Interleukin 27 (IL-27) is a heterodimeric cytokine that functions to constrain T cell-mediated inflammation and plays an important role in immune homeostasis. Binding of IL-27 to cell surface receptors IL-27Rα and gp130 results in activation of receptor-associated Janus Kinases and nuclear translocation of STAT1 and STAT3 transcription factors. Despite the emerging therapeutic importance of this cytokine axis in cancer and autoimmunity, a molecular blueprint of the IL-27 receptor signaling complex, and its relation to other gp130/IL-12 family cytokines, is currently unclear. We used cryogenic-electron microscopy (cryo-EM) to determine the quaternary structure of IL-27 (p28/Ebi3) bound to receptor subunits, IL-27Rα and gp130. The resulting 3.47 Å resolution structure revealed a three-site assembly mechanism nucleated by the central p28 subunit of the cytokine. The overall topology and molecular details of this binding are reminiscent of IL-6 but distinct from related heterodimeric cytokines IL-12 and IL-23. These results indicate distinct receptor assembly mechanisms used by heterodimeric cytokines with important consequences for targeted agonism and antagonism of IL-27 signaling.
Improved particle filter-based estimation of a quadrotor subjected to uncertainties
Authors: Kaba Aziz , Ermeydan Ahmet
Published: March 2022

Purpose

The purpose of this paper is to present an improved particle filter-based attitude estimator for a quadrotor unmanned aerial vehicle (UAV) that addresses the degeneracy issues.

Design/methodology/approach

Control of a quadrotor is not sufficient enough without an estimator to eliminate the noise from low-cost sensors. In this work, particle filter-based attitude estimator is proposed and used for nonlinear quadrotor dynamics. But, since recursive Bayesian estimation steps may rise degeneracy issues, the proposed scheme is improved with four different and widely used resampling algorithms.

Findings

Robustness of the proposed schemes is tested under various scenarios that include different levels of uncertainty and different particle sizes. Statistical analyses are conducted to assess the error performance of the schemes. According to the statistical analysis, the proposed estimators are capable of reducing sensor noise up to 5x, increasing signal to noise ratio up to 2.5x and reducing the uncertainty bounds up to 36x with root mean square value of as low as 0.0024, mean absolute error value of 0.036, respectively.

Originality/value

To the best of the authors’ knowledge, the originality of this paper is to propose a robust particle filter-based attitude estimator to eliminate the low-cost sensor errors of quadrotor UAVs.
Consistent modelling of hierarchical BPMN collaborations
Authors: Corradini Flavio , Polini Andrea , Re Barbara , Rossi Lorenzo , Tiezzi Francesco
Published: March 2022

Purpose

This paper aims at supporting business process designers in modelling collaborative scenarios in terms of hierarchical BPMN collaboration diagrams, to enforce consistency among different hierarchical levels.

Design/methodology/approach

The proposed approach is based on a set of guidelines to apply during the modelling of hierarchical diagrams. These guidelines address consistency issues related to the hiding capability provided by sub-process and call activity elements, which may obscure behaviours at inner levels, especially exchange of messages, that are inconsistent with those in other hierarchical levels. A laboratory experience validates the guidelines' effectiveness.

Findings

The paper points out the issues of hierarchical diagrams, and the lack of support in this context from the existing BPMN modelling tools. Moreover, through a laboratory experience, the paper shows the benefits carried by the proposed guidelines concerning the quality of the modelled diagrams.

Practical implications

The proposed guidelines have been implemented in a consistency checking tool that avoids consistency errors during the modelling activity. To foster its usage, the tool has been integrated into the Eclipse BPMN modelling environment.

Originality/value

The paper, employing consistency guidelines, provides a novel solution to the weaknesses of hierarchical modelling.
An online marketplace for archival services
Authors: Niu Jinfang
Published: March 2022

Purpose

Online marketplaces, which provide on-demand goods or services through matching providers and consumers, have emerged in many sectors of the society. This paper aims to assess the need and speculate the design features of a specialized, online marketplace for archival services.

Design/methodology/approach

Interview data collected for a previous project were reanalyzed, and the websites of some online marketplaces were explored.

Findings

Existing general-purpose online marketplaces are useful but limited. Archivists and closely related professionals, including conservators, genealogists and public historians, need a specialized online marketplace to connect with their clients. This specialized online marketplace for archival services could adopt some useful features of existing online marketplaces.

Originality/value

To the best of the author’s knowledge, this is the first attempt to assess the need for an online marketplace for archival services.
Explanation and classification of technological entrepreneurship financing policies: lessons from Iran
Authors: Motiei Mohsen
Published: March 2022

Purpose

As technological entrepreneurship has distinctive characteristics and needs particular conceptualizations, it is also important to have specific theoretical developments about its technological entrepreneurship. Studying the related domains like entrepreneurship and technology can be helpful in this path; however, their differences should be considered as well. The purpose of this study is to design a model in support of technological entrepreneurship. Since financing is considered as the main restriction on creating and developing technological entrepreneurship, the focus of this study is the research of financial policies of technological entrepreneurship..

Design/methodology/approach

This research is from the qualitative point of view and in terms of the purpose of application-development that has been done in the second part. At the first step, Iran’s (IRI) national comprehensive policies have been studied from 1993 to 2020; out of 52 documents, 7 were relevant, of which 38 policies were eventually selected. Then, policy statements were explored, and open coding and categorization has been done through theme analysis approach to attain fundamental themes and organizational themes. In the second step, the themes were extracted in the form of soft research method with the approach of interpretive structural modeling to level the financing policies of technological entrepreneurship in Iran.

Findings

The results show that the most important factors influencing financing and entrepreneurship in Iran are increasing the productivity of goods and services, supporting entrepreneurship, increasing the efficiency of monetary policies that are in the first level.

Research limitations/implications

Research limitations include access to upstream documents, strategies, administrative and organizational coordination to study documents.

Practical implications

These findings are very important to scholars, the policymakers and technological entrepreneurship operators in designing their financing strategies. The results show that the most important factors influencing financing and entrepreneurship in Iran are increasing the productivity of goods and services, supporting entrepreneurship, increasing the efficiency of monetary policies.

Originality/value

To the best of the author’s knowledge, this is the first study to explore the explanation and classification of technology-based entrepreneurship financing policies in Iran. Moreover, the findings of this study would prove useful in detailed studies of financing policies in the Middle Eastern countries as well.
COVID-19 and the Pakhtun pregnant women
Authors: Naz Farah
Published: March 2022

Purpose

This exploratory study aims to explore the Pakhtun pregnant women’s experiences/issues during the COVID-19 pandemic.

Design/methodology/approach

This research is based on interviews.

Findings

This research found that plummeting medical services pose not only serious health risks to the Pakhtun women in Khyber Pakhtunkhwa (KP) but expose them to social and cultural challenges resulting in severe mental health issues. This study also found that the policies adopted by the Government of Pakistan for tackling COVID-19 completely threw off track basic health services that both men and women require in times of health emergencies.

Originality/value

This paper is 100% original research based on an exploratory study.
Comparing IT and non-IT firms in corporate social responsibility and financial context for attracting and retaining employees
Authors: Lo Janice , Lam Monica , Wei Sijing
Published: March 2022

Purpose

The purpose of this paper is to investigate how information technology (IT) firms are different from non-IT firms in terms of corporate social responsibility and financial variables for attracting and retaining employees.

Design/methodology/approach

Through logit regression models, the authors used corporate social responsibility and financial variables to examine the differences between 512 Fortune’s Best Companies to Work For and a random sample of 512 Non-Best Companies peer firms.

Findings

The analysis results show that IT firms are stronger in terms of research and development spending, return on assets, Tobin’s q and leverage conditions, as well as employee relations and environmental performance in corporate social responsibility. Moreover, for IT firms, innovativeness (characterized by high research and development expenditures) is by far the strongest predictor of whether a company is selected to be on the Best Companies to Work For list.

Research limitations/implications

This research demonstrated a hybrid, multifaceted research design using different analysis tools to explore new factors of a research topic. The results confirm the associations among variables, which may not represent causal relationships.

Practical implications

The results shed light on the relationship between corporate social responsibility/finance and IT employee turnover, which provides another dimension for management’s consideration beyond the classic psychometric/fringe benefit analysis for examining employee turnover.

Social implications

IT firms’ superior ability to attract and retain employees using their innovativeness may impact the general public’s career planning and training decisions.

Originality/value

This research project integrated data from four different sources and investigated the IT employee turnover issue from the organizational level rather than the individual employee level.
Export logistics infrastructure and export competitiveness in the East African Community
Authors: Olyanga Anthony Moni , Shinyekwa Isaac M.B. , Ngoma Muhammed , Nkote Isaac Nabeta , Esemu Timothy , Kamya Moses
Published: March 2022

Purpose

The purpose of this paper is to examine the influence of export logistics components: shipment arrangements, timely delivery, customs quality, trade infrastructure, and tracking and tracing on export competitiveness of firms in the East African Community (EAC).

Design/methodology/approach

The study adopted the Structural Gravity Model and the Poisson pseudo-maximum likelihood (PPML). PPML a nonlinear estimation method was applied in STATA on a balanced panel data for the period of 2007–2018. Data were obtained from World Bank International Trade Centre (ITC), World Bank Logistics Performance Index (LPI) and World Bank development indicators.

Findings

Results show that timely delivery and tracking and tracing of exports are positive and significant predictors of export competitiveness in EAC countries. Conversely, shipment arrangements, customs quality and trade infrastructure have no influence on export competitiveness.

Research limitations/implications

The results of this study show that export logistics components of shipment arrangements, customs quality and trade infrastructure do not matter at the present in improving export competitiveness in the EAC. There is a need to examine the intricate nature of the EAC economy to further this study's findings.

Practical implications

The EAC partner states should embrace deep integration by removing the behind the border trade barriers in addition to other trade restrictions, to create a common economic space among member states. This will further shrink the delivery time and the tracking and tracing of exports hence improving the competitiveness of EAC exports within the region and outside. Also, common and harmonized trade policies and regulations should be implemented through mutual recognition agreements where countries agree to recognize one another's conformity assessments.

Originality/value

This study explains the complex dynamic interactions of export logistics factors in the EAC using quantitative data and that this interaction has an effect on the export competitiveness in import-dominated countries with less harmonization in their trade policies.
Evaluating implementation strategies to support documentation of veterans' care preferences
Authors: Carpenter Joan G. , Scott Winifred Josephine , Kononowech Jennifer , Foglia Mary Beth , Haverhals Leah M. , Hogikyan Robert , Kolanowski Ann , Landis‐Lewis Zach , Levy Cari , Miller Susan C. , Periyakoil V. J. , Phibbs Ciaran S. , Potter Lucinda , Sales Anne , Ersek Mary
Published: March 2022

Objective

To evaluate the effectiveness of feedback reports and feedback reports + external facilitation on completion of life‐sustaining treatment (LST) note the template and durable medical orders. This quality improvement program supported the national roll‐out of the Veterans Health Administration (VA) LST Decisions Initiative (LSTDI), which aims to ensure that seriously‐ill veterans have care goals and LST decisions elicited and documented.

Data Sources

Primary data from national databases for VA nursing homes (called Community Living Centers [CLCs]) from 2018 to 2020.

Study Design

In one project, we distributed monthly feedback reports summarizing LST template completion rates to 12 sites as the sole implementation strategy. In the second involving five sites, we distributed similar feedback reports and provided robust external facilitation, which included coaching, education, and learning collaboratives. For each project, principal component analyses matched intervention to comparison sites, and interrupted time series/segmented regression analyses evaluated the differences in LSTDI template completion rates between intervention and comparison sites.

Data Collection Methods

Data were extracted from national databases in addition to interviews and surveys in a mixed‐methods process evaluation.

Principal Findings

LSTDI template completion rose from 0% to about 80% throughout the study period in both projects' intervention and comparison CLCs. There were small but statistically significant differences for feedback reports alone (comparison sites performed better, coefficient estimate 3.48, standard error 0.99 for the difference between groups in change in trend) and feedback reports + external facilitation (intervention sites performed better, coefficient estimate −2.38, standard error 0.72).

Conclusions

Feedback reports + external facilitation was associated with a small but statistically significant improvement in outcomes compared with comparison sites. The large increases in completion rates are likely due to the well‐planned national roll‐out of the LSTDI. This finding suggests that when dissemination and support for widespread implementation are present and system‐mandated, significant enhancements in the adoption of evidence‐based practices may require more intensive support.
Screening for Fabry disease among male patients on hemodialysis in Awaji Island
Authors: Shimizu Mao , Fujii Hideki , Kono Keiji , Watanabe Kentaro , Goto Shunsuke , Nozu Kandai , Nakamura Kimitoshi , Nishi Shinichi
Published: March 2022

Fabry disease (FD) manifests decreased α‐galactosidase A (α‐Gal A) activity and multiorgan damage. There are some undiagnosed cases of the condition among patients on dialysis. The prevalence of FD may also vary with the region. Among 227 male patients undergoing maintenance hemodialysis in Awaji Island, a remote island in Japan, 201 (88.5%) were included in this study. Patients with α‐Gal A activity <5.0 pmol/h/disk proceeded to secondary screening. Patients with positive secondary screening underwent further genetic analysis. The number of patients with a family history of cardiac, cerebrovascular, and kidney diseases was 31 (15.4%), 23 (11.4%), and 31 (15.4%) patients, respectively. Although three patients (1.5%) had low α‐Gal A activity, none of them was positive in the secondary screening. We could not identify any male hemodialysis patient with FD in Awaji Island, even though some patients had a family history of kidney and cardiovascular diseases.
Irradiation immunity interactions
Authors: Simon Davis David A , Atmosukarto Ines I , Garrett Jessica , Gosling Katharine , Syed Farhan M , Quah Ben JC
Published: March 2022

The immune system can influence cancer development by both impeding and/or facilitating tumour growth and spread. A better understanding of this complex relationship is fundamental to optimise current and future cancer therapeutic strategies. Although typically regarded as a localised and immunosuppressive anti‐cancer treatment modality, radiation therapy has been associated with generating profound systemic effects beyond the intended target volume. These systemic effects are immune‐driven suggesting radiation therapy can enhance anti‐tumour immunosurveillance in some instances. In this review, we summarise how radiation therapy can positively and negatively affect local and systemic anti‐tumour immune responses, how co‐administration of immunotherapy with radiation therapy may help promote anti‐tumour immunity, and how the use of immune biomarkers may help steer radiation therapy‐immunotherapy personalisation to optimise clinical outcomes.
Coordination of mitochondrial and lysosomal homeostasis mitigates inflammation and muscle atrophy during aging
Authors: Irazoki Andrea , Martinez‐Vicente Marta , Aparicio Pilar , Aris Cecilia , Alibakhshi Esmaeil , Rubio‐Valera Maria , Castellanos Juan , Lores Luis , Palacín Manuel , Gumà Anna , Zorzano Antonio , Sebastián David
Published: March 2022

Sarcopenia is one of the main factors contributing to the disability of aged people. Among the possible molecular determinants of sarcopenia, increasing evidences suggest that chronic inflammation contributes to its development. However, a key unresolved question is the nature of the factors that drive inflammation during aging and that participate in the development of sarcopenia. In this regard, mitochondrial dysfunction and alterations in mitophagy induce inflammatory responses in a wide range of cells and tissues. However, whether accumulation of damaged mitochondria (MIT) in muscle could trigger inflammation in the context of aging is still unknown. Here, we demonstrate that BCL2 interacting protein 3 (BNIP3) plays a key role in the control of mitochondrial and lysosomal homeostasis, and mitigates muscle inflammation and atrophy during aging. We show that muscle BNIP3 expression increases during aging in mice and in some humans. BNIP3 deficiency alters mitochondrial function, decreases mitophagic flux and, surprisingly, induces lysosomal dysfunction, leading to an upregulation of Toll‐like receptor 9 (TLR9)‐dependent inflammation and activation of the NLRP3 (nucleotide‐binding oligomerization domain (NOD)‐, leucine‐rich repeat (LRR)‐, and pyrin domain‐containing protein 3) inflammasome in muscle cells and mouse muscle. Importantly, downregulation of muscle BNIP3 in aged mice exacerbates inflammation and muscle atrophy, and high BNIP3 expression in aged human subjects associates with a low inflammatory profile, suggesting a protective role for BNIP3 against age‐induced muscle inflammation in mice and humans. Taken together, our data allow us to propose a new adaptive mechanism involving the mitophagy protein BNIP3, which links mitochondrial and lysosomal homeostasis with inflammation and is key to maintaining muscle health during aging.
Combined conventional and regenerative treatment in molars with coexistent closed and open apices: A case series
Authors: Cehreli Zafer C. , Erbas Unverdi Gizem , Eymirli Pinar , Mergen Irem , Arslan Ezgihan , Esenturk Gulce
Published: March 2022

Regenerative endodontic treatment (RET) may not be suitable in some necrotic young permanent molars due to coexistent roots with closed and open apices, and/or inadequate apical bleeding in one or more roots. Here, we present a combined treatment approach utilising conventional root canal treatment in the closed‐apex roots and RET on the open‐apex roots of necrotic young molars. The closed‐apex roots of 8 molars received root fillings, and their open‐apex roots were treated with a regenerative endodontic procedure. In another molar, the failed RET on one root was retreated by conventional root canal filling, preserving other revitalised roots. After 4–6 years, all teeth showed periapical healing in the absence of clinical symptoms. The combined conventional and regenerative treatment approach can yield favourable healing outcomes in necrotic, young molar roots with different levels of apical closure. Likewise, failed revitalised roots can be retreated separately with conventional root filling.
Ethics of U.S. government policy responses to the COVID‐19 pandemic: A utilitarianism perspective
Authors: Herron Terri L. , Manuel Timothy
Published: March 2022

COVID‐19 hit the United States in January 2020, quickly resulting in stay‐at‐home orders that sent the U.S. economy into a major recession. The federal government leveraged fiscal, regulatory, and monetary policies to provide relief. Decisions had to be made in a complex environment wrought with difficult choices, complicated by the federalist governing system in the United States. Myers (2016, p. 202) asserted, “If an event like the [1918 influenza] pandemic were to occur in the United States, it is important that the government be prepared, not only in terms of material, but ethically.” We analyze the ethical choices of the initial responses by reviewing early U.S. government responses and the impact of culture, federalism, and justice. We conclude that utilitarian analyses of balancing infection rates and economic impacts must be supplemented with Kantian principles of not treating people as means to an end, balancing the protection of individual freedoms with the good of society, and protecting vulnerable groups. As governments prepare for future crises, ethical considerations should be built into those plans as guardrails to guide decision‐makers.
Venous thromboembolism in patients with autoimmune disorders: a comparison between bleeding complications during anticoagulation and recurrences after its discontinuation
Authors: Ruiz‐Sada Pablo , Mazzolai Lucia , Braester Andrei , Ballaz Aitor , Madridano Olga , Accassat Sandrine , Fernández‐Reyes José Luis , López‐Sáez Juan Bosco , del Carmen Díaz‐Pedroche María , Monreal Manuel ,   Registro Informatizado de Enfermedad TromboEmbólica (RIETE) Investigators
Published: March 2022

The ideal duration of anticoagulation therapy in patients with autoimmune disorders and venous thromboembolism (VTE) is controversial. We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) database to compare the incidence rate of major bleeding during anticoagulation versus the incidence rate of VTE recurrences after its discontinuation. We included 1061 patients with autoimmune disorders and VTE followed‐up after discontinuing anticoagulant therapy: rheumatoid arthritis, 321; polymyalgia rheumatica, 159; ulcerative colitis, 134; Crohn’s disease, 111; systemic lupus erythematosus (SLE), 82; giant cell arteritis, 58; ankylosing spondylitis, 39; Behcet disease, 17; other vasculitides, 140. During anticoagulation (median, 183 days), 64 patients had major bleeding. After discontinuing anticoagulation (median, 190 days), 112 patients developed symptomatic VTE recurrences. In most subgroups, the incidence rate of major bleeding during therapy was similar to the incidence rate of VTE recurrences after its discontinuation. However, in patients with SLE (10.0 major bleeds, 95% confidence interval [CI] 4.07–20.9) per 100 patient‐years vs. 3.62 VTE recurrences, 95% CI 1.15–8.74) or ankylosing spondylitis (10.9 major bleeds [95% CI 3.47–26.3] vs. 4.69 VTE recurrences, 95% CI 1.19–12.8) the incidence rates of major bleeding during anticoagulation were over twofold higher than the incidence rates of VTE recurrences after its discontinuation.
Sarcoidosis and sarcoidal foreign body reaction after permanent eye makeup application: Analysis by immunohistochemistry with commercially available antibodies specific to Cutibacterium acnes and Mycobacteria
Authors: Hirai Yuka , Hamada Yuko , Sasaki Shun , Suzuki Marie , Ito Yuta , Katayama Keiko , Uno Hirokazu , Nakada Tokio , Kitami Yuki , Uchida Keisuke , Eishi Yoshinobu , Sueki Hirohiko
Published: March 2022

We report two cases of eyebrow granulomas in patients who underwent a permanent eye makeup procedure. A rash was observed 16 months after the procedure in Case 1, and 10 years after the procedure in Case 2. Histopathologically, both patients exhibited noncaseating epithelioid cell granulomas. In Case 1, most of the black‐brown granules of the permanent makeup were not present in the granulomas but were localized in the upper dermis. In contrast, in Case 2, some of the black‐brown granules were phagocytized in the granulomas, preferentially within the giant cells. Based on systemic examinations, the patients from Cases 1 and 2 were diagnosed with sarcoidosis and sarcoidal foreign body reaction, respectively. To clarify the pathogenesis of our cases, we performed immunohistochemistry using commercially available monoclonal antibodies specific to Cutibacterium acnes, previously Propionibacterium acnes (PAB), and Mycobacteria (LAM antibody). PAB antibody results were positive in granulomas only in Case 1, and the LAM antibody results were negative in both cases. Immunohistochemical detection of C. acnes in granulomas could provide useful information for differentiating between cutaneous sarcoidosis and sarcoidal foreign body reactions.
Diagnosis, differential diagnosis and misdiagnosis of Susac syndrome
Authors: Triplett James D. , Qiu Jessica , O'Brien Billy , Gopinath Sumana , Trewin Benjamin , Spring Penelope J. , Shaffi Mohamed , Ip Jerome , Chan Fiona , Chen Luke , Wilson Ian , Muller Claire , Beadnall Heidi N. , Boggild Mike , Van der Walt Anneke , Roxburgh Richard , Seery Nabil , Kalincik Tomas , Barnett Michael H. , Parratt John D. E. , Reddel Stephen W. , Tsang Benjamin , Hardy Todd A.
Published: March 2022

Background and purpose

Susac syndrome (SuS) is an inflammatory condition of the brain, eye and ear. Diagnosis can be challenging, and misdiagnosis is common.

Methods

This is a retrospective review of the medical records of 32 adult patients from an Australasian cohort of SuS patients.

Results

An alternative diagnosis prior to SuS was made in 30 patients (94%) with seven patients receiving two or more diagnoses. The median time to diagnosis of SuS was 3 months (range 0.5–100 months). The commonest misdiagnoses were migraine in 10 patients (31%), cerebral vasculitis in six (19%), multiple sclerosis in five (16%) and stroke in five (16%). Twenty‐two patients were treated for alternative diagnoses, 10 of whom had further clinical manifestations prior to SuS diagnosis. At presentation seven patients (22%) met criteria for definite SuS, 19 (59%) for probable SuS and six (19%) for possible SuS. Six patients (19%) presented with brain–eye–ear involvement, 14 with brain–ear (44%), six with brain–eye (19%) and six (19%) with only brain involvement. In patients with the complete triad of symptoms the median delay to diagnosis was 3 months (range 1–9 months) compared to 5.25 months (range 0.5–100 months) for patients with encephalopathy and ocular symptoms at presentation.

Conclusions

Susac syndrome patients are frequently misdiagnosed at initial presentation, despite many having symptoms or radiological features that are red flags for the diagnosis. Delayed diagnosis can lead to patient morbidity. The varied ways in which SuS can present, and clinician failure to consider or recognize SuS, appear to be the main factors leading to misdiagnosis.
Self‐adaptive‐deer hunting optimization‐based optimal weighted features and hybrid classifier for automated disease detection in plant leaves
Authors: Sahu Kalicharan , Minz Sonajharia
Published: March 2022

This main intention of this paper is to adopt a new disease detection model for plant leaves. The proposed model involves several steps such as pre‐processing, leaf segmentation, abnormality segmentation, feature extraction and detection. Image scaling and contrast enhancement are performed during the pre‐processing phase. Once the pre‐processing is done, the segmentation phase starts with leaf segmentation by binary thresholding method and abnormality segmentation by K‐means clustering. Further, the local binary pattern and grey‐level co‐occurrence matrix features are extracted and a dimensionality reduced technique called principle component analysis is determined. As the main novelty, the weighted feature extraction is performed, in which the weight functions are optimized by the self‐adaptive deer hunting optimization (SA‐DHOA). Another contribution of this paper is to implement a hybrid classifier for disease detection. Here, the extracted weighted features are subjected to a support vector machine, and the abnormality segmented image is subjected to convolutional neural network (CNN), which is a deep learning algorithm that can learn the features automatically. Here, the same SA‐DHOA is used to improve the performance of CNN, which is termed as SA‐DHOA‐SCNN. Finally, the performance analysis confirms the maximum success rate of the proposed model over other conventional methods.