bluuebunny/crossref_metadata_2025 huggingface dataset:
The Financial and Psychological Impact of Identity Theft Among Older Adults
Authors: DeLiema Marguerite , Burnes David , Langton Lynn
Published: October 2021

Background and Objectives

Society’s growing reliance on technology to transfer private information has created more opportunities for identity thieves to access and misuse personal data. Research on identity theft specifically among adults aged 65 and older is virtually nonexistent, yet research focusing on victims of all ages indicates a positive association between age, minority status, and more severe economic and psychological consequences.

Research Design and Methods

Identity theft measures come from a sample of more than 2,000 self-reported victims aged 65 and older from the nationally representative National Crime Victimization Survey Identity Theft Supplements administered in 2014 and 2016. Regression was used to examine how socioeconomic status, demographic characteristics, and incident-specific factors relate to how much money is stolen, the likelihood of experiencing out-of-pocket costs, and emotional distress among older identity theft victims.

Results

Older Black identity theft victims were more likely to have greater amounts of money stolen and were more likely to feel distressed by the incident than older White victims. The most disadvantaged older adults living at or below the federal poverty level were significantly more likely to suffer out-of-pocket costs. The length of time information was misused, experiencing subsequent financial problems and problems with friends/family, and the hours spent resolving identity theft were positively associated with emotional distress. Among those aged 65 and older, age was not significantly associated with losses or emotional distress.

Discussion and Implications

Older adults living in poverty need more resources to assist with recovery and reporting identity theft to law enforcement. Limiting the extent of losses from identity theft and reducing the length of time information is misused may reduce the emotional toll of identity theft on older victims.
Disparities in unmet health service needs among people with disabilities in China
Authors: Zhao Xintong , Wang Hongchuan
Published: October 2021

Background

Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population.

Objective

The aim of this study was to examine differences in the prevalence of unmet health-care needs by residential status (hukou status) and disability type among people with disabilities.

Methods

Our data were from the National Survey on Basic Public Service Delivery of Persons with Disabilities. The analysis sample included a nationally representative sample of 9 642 112 adults (aged 16+ years) with disabilities. Associated factors were obtained at both individual level and community level. Cross-sectional multivariable logistic regression analyses were conducted to compare unmet medical, care, rehabilitation and accessibility needs among people with different residential statuses and different types of disabilities.

Results

The estimated prevalence of unmet medical, care, rehabilitation and accessibility needs is 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13–40% increase in unmet health-care needs for people with disabilities in China. These rural–urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation and health professionals. Disparities across the type of disability were smaller, but on average, people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs, whereas those with physical disability had the highest unmet rehabilitation need.

Conclusions

Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.
A New Case for the Study of Individual Events in Political Science
Authors: Torigian Joseph
Published: October 2021

Despite significant advances in both quantitative and qualitative methods over the last few years, the discipline of political science has yet to explicitly address the special challenges and benefits of studying specific historical events marked by high levels of contingency. The field of security studies, where concrete historical cases have always played a major role in the development of the subfield, should place special focus on the specific challenges and benefits to the study of such events. Taking full advantage of what event-specific research can teach us, however, will require thinking about generalizability, evidence, the role of contingency, and falsifiability in ways that are not yet fully understood in the discipline. More clarity on such questions will benefit our understanding of like nuclear crises in particular.
Increasing dietary proportion of wheat grain in finishing diets containing distillers’ grains: impact on nitrogen utilization, ruminal pH, and digestive function
Authors: Ream Cody N , Chibisa Gwinyai E
Published: October 2021

Because of its high crude protein (CP) content, dietary inclusion of corn dried distillers’ grains with solubles (DDGS) in finishing cattle diets can increase the ruminal loss of ammonia-nitrogen (NH3-N), which ends up excreted as urine urea-N (UUN). Increasing dietary fermentable energy supply can enhance ruminal use of N; however, it could also lead to acidotic conditions that compromise digestive function and animal performance. We evaluated the effects of partially replacing dietary corn grain with 20% or 40% (dry matter [DM] basis) wheat grain in finishing diets containing 15% corn DDGS on N utilization, ruminal pH, and digestive function. Nutrient intake and digestion, ruminal fermentation characteristics, microbial protein synthesis, route of N excretion, and blood metabolites were measured. Six ruminally fistulated crossbred beef heifers (initial body weight ± SD; 797 ± 58.8 kg) were used in a replicated 3 × 3 Latin square design with 28-d periods. Dietary treatments were either corn (73% of diet DM; CON), 53:20 corn:wheat blend (20W), or 33:40 corn:wheat blend (40W) as the major fermentable energy source. Dry matter intake (DMI) tended to be lower for heifers fed the 40W than CON and 20W diets. Feeding diets containing wheat grain led to an increase (P = 0.04) in neutral detergent fiber (NDF) intake. However, there was no diet effect (P ≥ 0.60) on apparent total tract DM and NDF digestibility. Feeding wheat grain led to a decrease (P ≤ 0.03) in mean and minimum pH, an increase (P = 0.04) in pH < 5.8 duration, and a tendency for an increase in the area and acidosis index for pH < 5.8 and 5.5. Nitrogen intake, which was lower (P = 0.04) for 40W than 20W heifers did not differ between CON and 20W heifers. There was no diet effect (P = 0.80) on ruminal NH3-N concentration and estimated microbial N flow. However, feeding diets containing wheat grain led to a decrease (P = 0.045) in UUN excretion (% total urine N). Fecal and total N excretion (% of N intake) increased (P < 0.01) following the addition of wheat grain to the diet. Apparent N retention was lower (P = 0.03) for 40W than CON and 20W heifers. In summary, although it led to a desirable decrease in UUN excretion, feeding wheat grain in corn DDGS-containing diets increased acidotic conditions in the rumen, which possibly led to the tendency for a decrease in DMI. The negative apparent N retention at the 40% wheat grain inclusion also suggests a decrease in nutrient supply, which could compromise feedlot performance.
Slavery, Health, and Healing Now: The State of the Field
Authors: Herschthal Eric
Published: October 2021

The scholarship on slavery, health, and healing has dramatically transformed over the past two decades. This essay synthesizes several themes within the thriving subfield, highlighting its relevance to historians of medicine and science working in adjacent fields, and suggesting new directions forward. The recent scholarship builds on research begun in the 1970s, but where earlier scholarship relied on quantitative methods and retrospective diagnoses, the new scholarship takes a social constructivist approach. Scholars today are exploring how slavery shaped the natural and built environment to create new disease environments in the New World; how Black healing knowledge was either circulated or suppressed by White physicians; and how gender and race intersected in slave societies to influence diagnoses and the categorization of specific diseases. Most importantly, the new scholarship suggests that medical knowledge produced in slave societies was not marginal—but central—to the rise of early modern medicine. The lack of any synthesis of the recent literature, combined with the recent public attention given to racial health disparities, make this literature vitally important to all historians of medicine and allied sciences. It can provide useful insights for scholars working in other areas, and it can diversify and complicate the stories we tell about the origins of modern medicine.
Biological Parameters of TwoTriatoma protractaSubspecies (Hemiptera: Reduviidae)
Authors: Nogueda-Torres B , Martínez-Ibarra J A , Barboza-López M , Montañez-Valdez O D , Michel-Parra J G
Published: October 2021

In recent years, concerns about Chagas disease in the United States have increased. Triatomine bug (Hemiptera: Reduviidae) populations are the vectors of the parasite Trypanosoma cruzi Chagas (Trypanosomatida: Trypanosomatidae), which causes Chagas disease, although the route of transmission is considered inefficient in United States. However, more studies on triatomine feeding and defecation behavior are needed. In this study, six related biological parameters from two populations of Triatoma protracta protracta (Uhler) and T. p. woodi (Uhler) from Mexican locations near the U.S. border were evaluated. The four population life cycles were less than 6 mo (161–171 d), with 9–10 blood meals needed to molt. Mortality rates were similar (31–38%) among the four populations. Triatoma p. woodi from Hidalgo, Coahuila was the most aggressive one. Feeding times were over 10 min, increasing with instar in all populations. Defecation behaviors varied among populations. High percentages of male and female fourth- and fifth-instar nymphs of T. p. protracta from Imuris and both populations of T. p. woodi defecated immediately after or <1 min of feeding. Lower percentages were observed for T. p. protracta from Jacumé. Because most parameters were similar among the four populations, independent of their subspecies and their geographic origin, we considered that T. p. protracta and T. p. woodi are efficient vectors of T. cruzi. In contrast, defecation patterns were noticeably different among some of the four triatomine populations studied. Our results highlight the importance of studying the biological parameters of local triatomine populations. They also contribute to increasing the knowledge of North American triatomine behavior and defecation patterns.
Kelvin probe force microscopy for material characterization
Authors: Glatzel Thilo , Gysin Urs , Meyer Ernst
Published: October 2021

Kelvin probe force microscopy is a scanning probe method for imaging the surface potential by atomic force microscopy. The surface potential is one of the most important surface properties and is correlated to e.g. the work function, surface dipoles, localized surface charges and structural properties. It gives detailed information on the electrical properties and can be combined with optical and electrical excitation mechanisms providing additional properties like surface band bending and charge carrier mobilities. We will introduce the main concept and will briefly describe the major methods of operation. Based on the analysis of a Si superjunction device, structures dopant profiling and the concept of surface photovoltage measurements will be introduced. The influence of local charge accumulation on these devices will be presented and the effect on the measured contact potential values will be discussed.
Justification by Faith in Christ or Faithfulness of Christ? Updating the ΠΙΣΤΙΣ ΧΡΙΣΤΟΥ Debate in Light of Paul’s Use of Scripture
Authors: Oropeza B J
Published: October 2021

The debate over Paul’s use of πίστις Χριστοῦ as ‘faith in Christ’ or ‘faithfulness of Christ’ remains an unsettled one. After discussing theological and exegetical arguments for and against the two positions, this study explores Paul’s use of Scripture, primarily Psalms and Habakkuk in Romans 1:17, 3:1–19, and 4:6–8, which may be informative on how the apostle intended πίστις Χριστοῦ to be understood by his auditors in 3:21–26. Although the study concludes that the objective genitive reading of πίστις Χριστοῦ makes better sense of the evidence, it also suggests a trajectory from Christ’s faithfulness, to faith in the gospel message about Christ, to confession of Christ as Lord at baptism, as a robust way of understanding the term.
Using binaries in globular clusters to catch sight of intermediate-mass black holes
Authors: Aros Francisco I , Sippel Anna C , Mastrobuono-Battisti Alessandra , Bianchini Paolo , Askar Abbas , van de Ven Glenn
Published: October 2021

The dynamical evolution of globular clusters (GCs) is tied to their binary population, as binaries segregate to the cluster centre, leading to an increased binary fraction in the core. This central overabundance of mainly hard binaries can serve as a source of energy for the cluster and has a significant effect on the observed kinematics, such as artificially increasing the observed line-of-sight velocity dispersion. We analyse the binary fractions and distributions of 95 simulated GCs, with and without an intermediate-mass black hole (IMBH) in their centre. We show that an IMBH will not only halt the segregation of binaries towards the cluster centre, but also, directly and indirectly, disrupt the binaries that segregate, thus, depleting binaries in the cluster core. We illustrate this by showing that clusters with an IMBH have fewer binaries and flatter radial binary distributions than their counterparts without one. These differences in the binary fraction and distribution provide an additional indicator for the presence of a central IMBH in GCs. In addition, we analyse the effects of the binary fraction on the line-of-sight velocity dispersion in the simulated GCs and find that binaries can cause an overestimation of up to $70 \rm {per \, cent}$ of the velocity dispersion within the core radius. Using recent VLT/MUSE observations of NGC 3201 by Giesers et al. (2019), we find an overestimation of $32.2\pm 7.8 \rm {per \, cent}$ in the velocity dispersion that is consistent with the simulations and illustrates the importance of accurately accounting for the binary population when performing kinematic or dynamical analysis.
Periodicities in X-ray solar flare occurrences and coherency with daily mean magnetic field
Authors: Joshi C , Sobha B , Erdélyi R
Published: October 2021

We present here the study of periodic behaviour of occurrence of solar X-ray flares over a wide range of time-scales during four solar cycles. We have also investigated the coherency between the value of daily mean magnetic field of the Sun and solar flare occurrences. Data of daily X-ray flare counts from the GOES network and daily mean magnetic field values from Wilcox Observatory are used to carry out the investigations reported here. Wavelet analysis method was employed to search for and identify the periodicities and to test the coherency between these two values parameters. Oscillatory periods of squared daily mean magnetic field (SMF) and weighted flare count (WFC) were found in the data. The results are consistent with and support the conjecture of the existence of wave guide concept of the solar upper atmosphere. For SMF, we found a common shortest period of 29 d in solar cycles 21–24 while the longer periods are different in different cycles. The longest period found is 890 d during SC 22. In WFC, the shortest period of 25.5 d is identified in SC 22, while the longest one of 950 d is in SC 24.
The COMBS Survey – III. The chemodynamical origins of metal-poor bulge stars
Authors: Lucey Madeline , Hawkins Keith , Ness Melissa , Nelson Tyler , Debattista Victor P , Luna Alice , Bensby Thomas , Freeman Kenneth C , Kobayashi Chiaki
Published: October 2021

The characteristics of the stellar populations in the Galactic bulge inform and constrain the Milky Way’s formation and evolution. The metal-poor population is particularly important in light of cosmological simulations, which predict that some of the oldest stars in the Galaxy now reside in its centre. The metal-poor bulge appears to consist of multiple stellar populations that require dynamical analyses to disentangle. In this work, we undertake a detailed chemodynamical study of the metal-poor stars in the inner Galaxy. Using R ∼ 20 000 VLT/GIRAFFE spectra of 319 metal-poor (−2.55 dex ≤ [Fe/H] ≤ 0.83 dex, with $\overline{\rm {[Fe/H]}}$ = −0.84 dex) stars, we perform stellar parameter analysis and report 12 elemental abundances (C, Na, Mg, Al, Si, Ca, Sc, Ti, Cr, Mn, Zn, Ba, and Ce) with precisions of ≈0.10 dex. Based on kinematic and spatial properties, we categorize the stars into four groups, associated with the following Galactic structures: the inner bulge, the outer bulge, the halo, and the disc. We find evidence that the inner and outer bulge population is more chemically complex (i.e. higher chemical dimensionality and less correlated abundances) than the halo population. This result suggests that the older bulge population was enriched by a larger diversity of nucleosynthetic events. We also find one inner bulge star with a [Ca/Mg] ratio consistent with theoretical pair-instability supernova yields and two stars that have chemistry consistent with globular cluster stars.
Lateral spreading effects on VLBI radio images of neutron star merger jets
Authors: Fernández Joseph John , Kobayashi Shiho , Lamb Gavin P
Published: October 2021

Very long baseline interferometry radio images recently proved to be essential in breaking the degeneracy in the ejecta model for the neutron star merger GW170817. We discuss the properties of synthetic radio images of merger jet afterglows by using semi-analytical models of laterally spreading or non-spreading jets. The image centroid initially moves away from the explosion point in the sky with apparent superluminal velocity. After reaching a maximum displacement, its motion is reversed. This behaviour is in line with that found in full hydrodynamic simulations. We show that the evolution of the centroid shift and the image size are significantly different when lateral spreading is considered. For Gaussian jet models with plausible model parameters, the morphology of the laterally spreading jet images is much closer to circular. The maximum displacement of the centroid shift and its occurrence time are smaller/earlier by a factor of a few for spreading jets. Our results indicate that it is crucial to include lateral spreading effects when analysing radio images of neutron star merger jets. We also obtain the viewing angle θobs by using the centroid shift of radio images provided the ratio of the jet core size θc and θobs is determined by afterglow light curves. We show that a simple method based on a point-source approximation provides reasonable angular estimates ($10{-}20{{\ \rm per\ cent}}$ errors at most). By taking a sample of laterally spreading structured Gaussian jets, we obtain θobs ∼ 0.32 for GW170817, consistent with previous studies.
pyaneti
– II. A multidimensional Gaussian process approach to analysing spectroscopic time-series
Authors: Barragán Oscar , Aigrain Suzanne , Rajpaul Vinesh M , Zicher Norbert
Published: October 2021

The two most successful methods for exoplanet detection rely on the detection of planetary signals in photometric and radial velocity time-series. This depends on numerical techniques that exploit the synergy between data and theory to estimate planetary, orbital, and/or stellar parameters. In this work, we present a new version of the exoplanet modelling code pyaneti. This new release has a special emphasis on the modelling of stellar signals in radial velocity time-series. The code has a built-in multidimensional Gaussian process approach to modelling radial velocity and activity indicator time-series with different underlying covariance functions. This new version of the code also allows multiband and single transit modelling; it runs on Python 3, and features overall improvements in performance. We describe the new implementation and provide tests to validate the new routines that have direct application to exoplanet detection and characterization. We have made the code public and freely available at https://github.com/oscaribv/pyaneti. We also present the codes citlalicue and citlalatonac that allow one to create synthetic photometric and spectroscopic time-series, respectively, with planetary and stellar-like signals.
Binary black hole signatures in polarized light curves
Authors: Dotti Massimo , Bonetti Matteo , D’Orazio Daniel J , Haiman Zoltán , Ho Luis C
Published: October 2021

Variable active galactic nuclei showing periodic light curves have been proposed as massive black hole binary (MBHB) candidates. In such scenarios, the periodicity can be due to relativistic Doppler-boosting of the emitted light. This hypothesis can be tested through the timing of scattered polarized light. Following the results of polarization studies in type I nuclei and of dynamical studies of MBHBs with circumbinary discs, we assume a coplanar equatorial scattering ring, whose elements contribute differently to the total polarized flux, due to different scattering angles, levels of Doppler boost, and line-of-sight time delays. We find that in the presence of an MBHB, both the degree of polarization and the polarization position angle have periodic modulations. The polarization angle oscillates around the semiminor axis of the projected MBHB orbital ellipse, with a frequency equal either to the binary’s orbital frequency (for large scattering screen radii), or twice this value (for smaller scattering structures). These distinctive features can be used to probe the nature of periodic MBHB candidates and to compile catalogues of the most promising sub-pc MBHBs. The identification of such polarization features in gravitational-wave (GW) detected MBHBs would enormously increase the amount of physical information about the sources, allowing the measurement of the individual masses of the binary components, and the orientation of the line of nodes on the sky, even for monochromatic GW signals.
Determination of dynamical ages of open clusters through the A+ parameter – I
Authors: Rao Khushboo K , Vaidya Kaushar , Agarwal Manan , Bhattacharya Souradeep
Published: October 2021

The sedimentation level of blue straggler stars (BSS) has been shown to be a great tool to investigate the dynamical states of globular clusters (GCs). The area enclosed between the cumulative radial distributions of BSS and a reference population up to the half-mass radius of the clusters, $A^+_{\mathrm{rh}}$, is known to be a measure of the sedimentation of BSS in GCs. In this work, we calculate $A^+_{\mathrm{rh}}$ for 11 open clusters (OCs) using a combined list of main-sequence turn-off stars, sub-giant branch stars, and red giant branch stars as reference population. The BSS, the reference populations, and the cluster members are identified using the proper motions and parallaxes from the Gaia DR2 data. In a subset of clusters, the BSS are confirmed cluster members on the basis of radial velocity information available in the literature. Using the Pearson and Spearman rank correlation coefficients, we find weak correlations between the estimated values of $A^+_{\mathrm{rh}}$ and other markers of dynamical ages of the clusters, i.e. the number of central relaxations a cluster has experienced since its formation, and the structural parameters of the clusters. Based on statistical tests, we find that these correlations are similar to the corresponding correlations among the less evolved GCs, albeit within large errors.
Non-canonical LexA proteins regulate the SOS response in the Bacteroidetes
Authors: Sánchez-Osuna Miquel , Cortés Pilar , Lee Mark , Smith Aaron T , Barbé Jordi , Erill Ivan
Published: October 2021

Lesions to DNA compromise chromosome integrity, posing a direct threat to cell survival. The bacterial SOS response is a widespread transcriptional regulatory mechanism to address DNA damage. This response is coordinated by the LexA transcriptional repressor, which controls genes involved in DNA repair, mutagenesis and cell-cycle control. To date, the SOS response has been characterized in most major bacterial groups, with the notable exception of the Bacteroidetes. No LexA homologs had been identified in this large, diverse and ecologically important phylum, suggesting that it lacked an inducible mechanism to address DNA damage. Here, we report the identification of a novel family of transcriptional repressors in the Bacteroidetes that orchestrate a canonical response to DNA damage in this phylum. These proteins belong to the S24 peptidase family, but are structurally different from LexA. Their N-terminal domain is most closely related to CI-type bacteriophage repressors, suggesting that they may have originated from phage lytic phase repressors. Given their role as SOS regulators, however, we propose to designate them as non-canonical LexA proteins. The identification of a new class of repressors orchestrating the SOS response illuminates long-standing questions regarding the origin and plasticity of this transcriptional network.
Using Technology to Improve Assessment Facilitation on a Policing Apprenticeship Programme: From COVID-19 Contingency to Best Practice
Authors: Honess Richard , Clarke Scott , Jones Gary , Owens and Jane
Published: October 2021

This article evaluates the introduction of an online assessment protocol to student officers on a Police Constable Degree Apprenticeship (PCDA) programme in the aftermath of the implementation of the COVID-19 global pandemic lockdown. This evaluation comes from conducting two cycles of action research to examine and improve the provision of an online multiple choice/short question exam which came about as a result of the lockdown, and the necessary withdrawal of university staff from face-to-face contact. The study shows that the introduction of the online exam was successful and contributed to a positive student experience, while providing vital feedback to the programme team to make continual improvements and can be progressed after lockdown and into the ‘new normal’.
Amino acid imbalance with excess methionine in late-finishing pigs: effects on performance and carcass quality
Authors: Edmonds Michael S , Smith James W
Published: October 2021

Limitations in harvest facility capacity can necessitate feeding strategies to slow growth rate in late-finishing pigs. In Exp. 1, six dietary treatments were used with 423 late-finishing pigs (initial weight of 109.5 kg) randomly allotted (mixed-sex) across 24 pens in a 35 d study. The treatments consisted of: 1) Positive Control (PC, 11.7% CP (Crude Protein) diet with added amino acids (AA), 2) Methionine (Met) 0% (8.8% CP with added AA), 3) Met 1% (8.8% CP with added AA plus 1% added Met for 35 d), 4) Met 1-1.8% (8.8% CP with added AA plus 1, 1.2, 1.4, 1.6 and 1.8% added Met for d 0-7, 7-14, 14-21, 21-28 and 28-35 d, respectively), 5) Met 2% (8.8% CP with added AA plus 2% added Met for 35 d) and 6) Met 1.5-2.3% (8.8% CP with added AA plus 1.5, 1.7, 1.9, 2.1 and 2.3% added Met for d 0-7, 7-14, 14-21, 21-28 and 28-35 d, respectively). Overall, pigs on the PC had improved ADG and G:F (P < 0.05) compared to the other five treatments. Pigs on Met 1% had reduced overall ADG and ADFI (P < 0.05) with similar G:F compared to pigs on Met 0%. Compared to pigs on Met 1%, pigs on Met 1-1.8%, Met 2%, and Met 1.5-2.3% had reduced (P < 0.05) ADG of 28, 54 and 53%, respectively; and decreased (P < 0.05) ADFI of 12, 26 and 26%, respectively. Dressing percent was similar among all six treatments. In Exp. 2, three dietary treatments were used with 393 late-finishing pigs (average initial weight was 108.8 kg) randomly allotted (mixed-sex) across 24 pens in a 35-d study. The treatments consisted of 1) Met 2%, 2) Met 1.5-2.3% and 3) Met 2.0-2.8% (8.8% CP with added AA plus 2.0, 2.2, 2.4, 2.6 and 2.8% added Met for d 0-7, 7-14, 14-21, 21-28 and 28-35 d, respectively). Treatments 1 and 2 were identical to Exp. 1. Overall, pigs on Met 1.5-2.3% had ADG of 241 g and ADFI of 2,040 g which were greater (P < 0.001) compared to pigs on Met 2% with ADG of 57 g and ADFI of 1,515 g. Furthermore, pigs on Met 2-2.8% had an overall ADG of -62 g and ADFI of 1,254 g which were less (P < 0.05) than those pigs on Met 2%. Percent lean and dressing percent were similar among the three treatments. These data suggest that late-finishing growth can be manipulated in a concise and effective manner by creating amino acid imbalances with varying levels of excess Met.
Thymic stromal lymphopoietin and alarmins as possible therapeutical targets for asthma
Authors: Salvati Lorenzo , Maggi Laura , Annunziato Francesco , Cosmi Lorenzo
Published: October 2021

Purpose of review

Overview of epithelial cytokines, particularly thymic stromal lymphopoietin (TSLP), released by the airway epithelium and the effects of their inhibition on the outcomes of patients with asthma.

Recent findings

The epithelial cytokines are early mediators at the top of the inflammatory cascade and are attractive therapeutic targets to prevent exacerbations and improve lung function in patients with type 2 and nontype 2 asthma.

Clinical trials demonstrated that tezepelumab, an anti-TSLP monoclonal antibody, is a promising alternative treatment for asthma that is effective also in nontype 2 asthma. The PATHWAY and NAVIGATOR trials have assessed its effects in improving outcomes on broad clinically diverse populations. The identification of biomarkers will help to predict potential responders and help in asthma treatment personalization.
Outpatient surgery for the inpatient: an introduction to postacute care
Authors: Davila Victor R.
Published: October 2021

Purpose of review

This article considers how postacute care (PAC) facilities such as skilled nursing facilities, inpatient rehabilitation facilities and long-term care hospitals could represent an opportunity for outpatient surgical facilities to improve patient care. In order to understand how these facilities interact with outpatient surgical services, it is first necessary to understand the types of facilities that provide PAC.

Recent findings

The significant costs associated with PAC have led to some proposed regulatory changes. Evidence examining postacute costs following total joint replacement has indicated that these costs may be decreased with cooperative efforts between perioperative physicians and PAC facilities. However, the lack of currently published data on the interaction between outpatient surgery and inpatient PAC facilities creates a need to explore how greater cooperation between these types of facilities could lead to improvements in patient care.

PAC facilities are inpatient facilities focused on the rehabilitation of patients recovering from an acute illness or surgical intervention. This article seeks to provide ambulatory practitioners a fundamental understanding of PAC as a starting point for future collaborative efforts with PAC facilities; improving care for patients referred to and from PAC facilities for outpatient surgical care.
Graduate medical education in anaesthesiology and COVID-19: lessons learned from a global pandemic
Authors: Chu Larry F. , Kurup Viji
Published: October 2021

Purpose of review

The recent global pandemic has dramatically altered the anaesthesiology educational landscape in unexpected ways. It is important that we pause to learn from this crisis.

Recent findings

Most resident trainees actively caring for COVID-19 patients present with probable or subclinical finding of post-traumatic stress disorder. Anaesthesia resident training programmes evolved to continue the mission of anaesthesia education in the face of institutional restrictions and evolving clinical crises.

The recent global COVID-19 pandemic has illustrated how external stressors can cause significant disruption to traditional medical education pathways. Resilience to external disruptive forces in anaesthesia education include a willingness of leadership to understand the problem, flexibility in adapting to the needs of learners and instructors in the face of key challenges, deployment of technology and innovation-minded solution-finding where appropriate, and attention to Maslow's hierarchy of needs.

Video abstract

http://links.lww.com/COAN/A77
Putting patients first: ambulatory surgery facilitates patient-centered care
Authors: Joshi Girish P.
Published: October 2021

Purpose of review

Ambulatory surgery is associated with improved patient experience while reducing overall costs without compromising patient safety. Patient-centered care is crucial for further expansion and success of ambulatory surgery because it is associated with superior patient experience and improved patient satisfaction. This article discusses the approach to improving patient-centered care and patient-reported outcomes (PROs).

Recent findings

It is necessary to recognize that each patient is different and may have different needs and preferences. Patient education and shared decision-making are critical components of patient-centered care. Shared decision-making emphasizes patient engagement in an effort to improve PROs. Implementation of enhanced recovery after surgery principles in ambulatory surgery is necessary to improve PROs.

Delivery of patient-centered care will require modification of the current approach to perioperative care. It is imperative to measure PROs by implementing a comprehensive continuous quality improvement program.
A narrative review and future considerations of spinal cord stimulation, dorsal root ganglion stimulation and peripheral nerve stimulation
Authors: Malinowski Mark N. , Chopra Pooja R. , Tieppo Francio Vinicius , Budwany Ryan , Deer Timothy Ray
Published: October 2021

Purpose of review

In recent years, neuromodulation has experienced a renaissance. Novel waveforms and anatomic targets show potential improvements in therapy that may signify substantial benefits. New innovations in peripheral nerve stimulation and dorsal root ganglion stimulation have shown prospective evidence and sustainability of results. Sub-perception physiologic bursting, high-frequency stimulation and feedback loop mechanisms provide significant benefits over traditional tonic spinal cords stimulation (SCS) in peer reviewed investigations. We reviewed the themes associated with novel technology in the context of historical stalwart publications.

Recent findings

New innovations have led to better nerve targeting, improvements in disease-based treatment, and opioid alternatives for those in chronic pain. In addition, new neural targets from both structural and cellular perspectives have changed the field of Neurostimulation.

For many years, tonic SCS was representative of neuromodulation, but as this review examines, the progression of the field in the past decade has reshaped patient options.
Learning Together: Engaging Patients as Partners in CPD
Authors: McMahon Graham T.
Published: October 2021

The goal of continuing professional development (CPD) is to improve patient care. However, traditionally, CPD has been planned and taught by clinicians, for clinicians, who tend to be protective of the professional-only environment for learning and are wary of the contributions and participation of patients. Although patients are sometimes included as guest speakers, this role has not typically extended to planning, content development, or serving as key faculty—ultimately excluding the patient perspective from the development and delivery of CPD. The absence of the patient perspective in CPD creates an inadvertent blind spot, hindering the opportunity for clinicians to hone patient-centric skills that are learned and practiced through training. As shared decision-making rises in importance among expected clinician competencies, the involvement of patients is becoming more essential. Patients can be our best teachers, and their inclusion in CPD can engage clinicians' hearts as well as minds and reinforce the reasons why our work matters. Patients are often more willing to engage in clinician education than we may realize, but educators must take the first step and invite them to participate and collaborate. This article will describe how to create a plan for engaging patients as partners, including guidance for gaining buy-in from leadership and faculty; recruiting, training, and nurturing patients; determining roles and responsibilities; and creating a safe space for patient participation.
Facilitator Reflections on Shared Expertise and Adaptive Leadership in ECHO Autism: Center Engagement
Authors: Vinson Alexandra H. , Iannuzzi Dorothea , Bennett Amanda , Butter Eric M. , Curran Alicia B. , Hess Amy , Hyman Susan L. , Kelly Amy , Murray Donna S. , Nowinski Lisa , Zwaigenbaum Lonnie , Sohl Kristin
Published: October 2021

Introduction:

Project Extension for Community Healthcare Outcomes (ECHO) is used to increase provider capacity in a wide range of health care specialties. ECHO Autism: Center Engagement is a program that promotes improvement in autism care by improving the management of autism care centers. The program's focus brought experienced clinicians together as both facilitators and participants in an ECHO series. ECHO Autism: Center Engagement facilitators devised a reflective writing exercise to prospectively study their experience leading this new curriculum.

Methods:

Drawing on a qualitative thematic analysis of longitudinal reflective writing exercises from seven “Hub Team” facilitators, we describe how ECHO leaders cultivate a learning environment that emphasizes shared learning and acknowledges the expertise of ECHO participants.

Results:

The analysis generated three main themes: (1) Hub Team facilitators valued reciprocal exchange with Spoke sites, a theme we name “shared learning,” (2) Hub Team facilitators demonstrated high levels of awareness about their facilitation styles, and (3) Hub Team facilitators cultivated an interactional style they described as “all teach, all learn.”

Discussion:

Examining the experiences of ECHO facilitators produces qualitative accounts of continuing professional development that may not be captured in other program evaluation approaches. In the case of ECHO Autism: Center Engagement, facilitators cultivated an environment of shared learning, which acknowledged the expertise of both facilitators and participants. These findings are pertinent for scholars of continuing education in health professions who lead educational programs where participants and facilitators have high levels of overlap in their areas of expertise and years of experience.
Standard-Setting for Continuing Education Assessment of Select New Competencies
Authors: Thomas Dixon , Abdalla Amal , McKeirnan Kimberly , Khalifa Sherief
Published: October 2021

Introduction:

Completion of continuing education hours might not guarantee the achievement of new competencies. Influenza vaccination training was provided to pharmacists in the United Arab Emirates (UAE), who had no similar training in their pharmacy degree. The training was developed and conducted at Gulf Medical University, UAE. Influenza vaccine administration is not yet a privilege for pharmacists in the UAE. This study focuses on determining whether a defensible cut score for the influenza vaccination training multiple-choice questions examination is feasible.

Methods:

Influenza vaccination training and assessment happened on the same day. The Angoff (modified), Beuk, and Hofstee methods were used for standard-setting. Six subject matter experts who were involved in developing and conducting the first influenza vaccination training in the UAE evaluated the cut score using the Angoff method with the Delphi technique.

Results:

The criterion-based cut score was 34.23 of 46 questions, with mean 74% and SD 2.24. Inter-rater reliability was 0.92 with standard errors of judgment 0.29 (0.63%).

Discussion:

The modified Angoff is a credible method to set cut scores, reassured with Beuk and Hofstee methods for assessment of influenza continuing education. It is feasible and perhaps essential to determine a formal cut score for the continuing education assessment of health professionals on select new competencies.
Targeting the elabela/apelin-apelin receptor axis as a novel therapeutic approach for hypertension
Authors: Song Jiawei , Tang Jianqiong , Zhang Zhenzhou , Liu Ying , Zhong Jiuchang
Published: October 2021

Hypertension is the leading risk factor for global mortality and morbidity and those with hypertension are more likely to develop severe symptoms in cardiovascular and cerebrovascular system, which is closely related to abnormal renin-angiotensin system and elabela/apelin-apelin receptor (APJ) axis. The elabela/apelin-APJ axis exerts essential roles in regulating blood pressure levels, vascular tone, and cardiovascular dysfunction in hypertension by counterbalancing the action of the angiotensin II/angiotensin II type 1 receptor axis and enhancing the endothelial nitric oxide (NO) synthase/NO signaling. Furthermore, the elabela/apelin-APJ axis demonstrates beneficial effects in cardiovascular physiology and pathophysiology, including angiogenesis, cellular proliferation, fibrosis, apoptosis, oxidative stress, and cardiovascular remodeling and dysfunction during hypertension. More importantly, effects of the elabela/apelin-APJ axis on vascular tone may depend upon blood vessel type or various pathological conditions. Intriguingly, the broad distribution of elabela/apelin and alternative isoforms implicates its distinct functions in diverse cardiac and vascular cells and tissue types. Finally, both loss-of-function and gain-of-function approaches have defined critical roles of the elabela/apelin-APJ axis in reducing the development and severity of hypertensive diseases. Thus, targeting the elabela/apelin-APJ axis has emerged as a pre-warning biomarker and a novel therapeutic approach against progression of hypertension, and an increased understanding of cardiovascular actions of the elabela/apelin-APJ axis will help to develop effective interventions for hypertension. In this review, we focus on the physiology and biochemistry, diverse actions, and underlying mechanisms of the elabela/apelin-APJ axis, highlighting its role in hypertension and hypertensive cardiovascular injury and dysfunction, with a view to provide a prospective strategy for hypertensive disease therapy.
Cardiovascular Disease in Patients With Systemic Lupus Erythematosus
Authors: Ballarano Carmine A. , Frishman William H.
Published: October 2021

Cardiovascular disease (CVD) is a significant cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). This is especially true in SLE patients with traditional CVD risk factors (eg, hypertension, hyperlipidemia, obesity) and disease-related risk factors (eg, increased SLE disease activity, elevated C-reactive protein levels, and antiphospholipid antibodies). The only guidelines in the primary prevention of CVD in SLE patients involve reducing traditional risk factors, but there are additional therapies that may be beneficial, including statin use. Current data on statin use for prevention of CVD in SLE patients are limited, but there have been some promising results. Statin use has been shown to be especially important in SLE patients for decreasing low-density lipoprotein levels and preventing CVD in hyperlipidemic patients. In addition, there is evidence suggesting that it may be beneficial to use statins in SLE patients with chronically elevated high-sensitivity C-reactive protein levels and antiphospholipid antibodies. It is important to continue to investigate the impact of statins on CVD in SLE patients, as they could significantly improve outcomes in patients with this disease.
#Botox 101: Subgroup Analysis of Twitter's Top 101 Neurotoxin Influencers
Authors: Zajac Jocelyn , Chandawarkar Akash , Sherber Noëlle
Published: October 2021

BACKGROUND

Recent studies demonstrate that board-certified plastic surgeons and dermatologists are underrepresented in posting public-directed marketing content about botulinum toxin A on YouTube. However, educational content and peer-to-peer social media influence regarding the topic of neurotoxins has not been studied. Twitter is a social media platform that has emerged as a unique network for public education and for the exchange of ideas among physicians.

OBJECTIVE

The purpose of this study is to identify Twitter's top social media influencers on #botox, to describe their characteristics and to relate their social media influence to academic influence.

METHODS

Twitter influence scores for the topic search #botox were collected in January 2019 with Right Relevance software. #Botox was the only neurotoxin term with sufficient activity to generate an influencer list. The user accounts associated with top influencers were connected to individual names, identification as a plastic surgeon or dermatologist, board certification status, location, and academic h-index.

RESULTS

The top 101 Twitter influencers on #botox are presented. Seventy-five percent of influencers are physically located in the United States. Academic h-index of #botox social media influencers ranged from 0 to 62 (mean, 8.6).

CONCLUSION

This study shows that the top #botox social media influencers on Twitter and primarily board-certified or eligible plastic surgeons located in the United States. This study also elucidates the influencer network within which other plastic surgeons and dermatologists can interact to augment their own influence within the social media network. This is the first study to describe social media influencers in this way.
Study of a 532/1064 Fractional Picosecond Laser for Facial Rejuvenation
Authors: Ross Edward V. , Tidwell William J. , Guss Lark , Sutton Adam V.
Published: October 2021

BACKGROUND AND OBJECTIVES

Picosecond (ps) fractional lasers create small wounds, presumably by laser-induced optical breakdown. We studied a ps fractional laser in the treatment of wrinkles and mottled pigment.

MATERIALS AND METHODS

This was a single center, prospective, open-label clinical trial. Patients with at least 2 facial areas, with visible wrinkles and dyschromia, were enrolled in the study and received 3 treatments at monthly intervals and appeared at 3 follow-up visits at 1, 3, and 6 months after treatment. The laser is an 800 ps fractional system with nominal 10 mm macrospot diameter. Both 532 nm and 1,064 nm wavelengths were applied in each subject. Wrinkle and pigmentation clearance were assessed by 2 blinded investigators using a 5-point clearance scale. Skin improvement was assessed by investigators using the 5-point Global Aesthetic Improvement (GAI) Scale based on before/after photographs for the following categories: (1) fine lines/wrinkles and (2) pigmentation.

RESULTS

A total of 18 healthy subjects at a single site were enrolled. At least moderate pigmentation and fine line/wrinkles improvement were observed in 93% and 79% of patients at 1 month after the last treatment according to GAI, respectively. Pigment clearance approached a mean of approximately 40%.

CONCLUSION

A ps 1,064/532 fractional laser achieves reduction in fine lines and pigment.