bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation bottlenecks of the National Health Insurance program in Nepal: Paving the path towards Universal Health Coverage: A qualitative study
Authors: Gurung Gaj Bahadur , Panza Alessio
Published: September 2021

Most low and low‐middle income countries adopting National Health Insurance (NHI) programs to achieve Universal Health Coverage are struggling to implement the program due to underlying problems at implementation. However, there is a lack of research that focuses on these problems. The Nepal NHI program initiated in 2016 has experienced numerous implementation challenges. This qualitative study delves into the NHI program's inputs and throughputs/implementation bottlenecks. The study based in Nepal's four districts included 28 in‐depth interviews, six focus group discussions, and identified 12 themes that pointed to the NHI program's inadequate inputs causing bottlenecks. The analysis employed the Grounded Theory. The main challenges identified were insufficiently defined NHI implementations guidelines, conflicting Act clauses, a lack of HIB organizational guidelines, and inadequate human resources. The major throughput bottlenecks were difficulty enrolling the insurees, the inability to select the health providers competitively and to act as a prudent purchaser of the services. These inadequate inputs and throughput bottlenecks led to negative outputs such as insurees' high dropouts, and low coverage of poor households. The NHI program's sustainability might be at stake if the identified problems persist, further exacerbated by the plummeting economic situation in the country due to COVID‐19.
Implementing a coaching culture in practice
Authors: Davis Rachel
Published: September 2021

There is rising concern regarding wellbeing in the veterinary sector and this is not surprising considering the demands that the veterinary profession can sometimes put on individuals (Bartram and Baldwin 2010). In such high‐performance, high‐stakes environments, it can be difficult to make time for self development (Meehan 2019); however, it is in these sorts of environments that we need self‐management skills the most. How can we encourage vets to prioritise self care? Can we create working environments that are both operationally and financially productive, and that promote, rather than obstruct, professional wellbeing? This article discusses the benefits of adopting a coaching approach in your practice to support and drive both performance and wellbeing.
Effects of soil compaction and moisture on the growth of Juncus tenuis
Authors: McCurdy James D. , Small Zachary D. , Tseng Te‐Ming , Brosnan James T. , Reasor Eric H.
Published: September 2021

Juncus tenuis Willd. is a warm‐season, perennial weed of turfgrass. In wet and compacted soils, it is well documented, yet little is known regarding the interaction effects of compaction and soil moisture on its rooting and foliar growth. A greenhouse experiment examined the effects of soil compaction and moisture on the above‐ and belowground growth of J. tenuis. The experimental design was completely randomized with a 3 × 3 arrangement with four replications and two runs. Factors included soil compaction (bulk densities of 1.56, 1.77, and 2.00 g cm–3) and soil moisture (10.9, 27.9, and 59.6% volumetric water content). Juncus tenuis was transplanted into pots, acclimated for 7 d, and subjected to the treatments for a 10‐wk period. Foliar growth was harvested every 2 wk and root growth was destructively assessed. Cumulative foliar and root biomass varied in response to compaction and soil moisture; however, no significant soil moisture × compaction interactions were detected. The effect of compaction on foliar and root biomass accounted for 15 and 12% of the explained variation, respectively. Increasing the bulk density from 1.56 to 2.00 g cm–3 reduced foliar and root biomass by 29 and 40%, respectively. Soil moisture accounted for ≥84% of the variation in foliar and root biomass. Increasing the soil moisture from 10.9 to 59.6% increased foliar and root biomass by 150 and 230%, respectively. The results suggested that cultural practices that prioritize soil moisture modification while alleviating compaction may reduce the presence of J. tenuis within maintained turfgrass.
Analysis of diffuse reflectance spectroscopy by means of Bayesian inference and separation of the parameters for scattering strength and spectral dependence of the scattering
Authors: Hohmann Martin , Karabayir Ayse , Herzler Paul , Späth Moritz , Klämpfl Florian , Schmidt Michael
Published: September 2021

For many applications in tissue optics, knowledge of the scattering coefficient or at least the reduced scattering coefficient is essential. In addition, its spectral dependence is also an important feature, as this provides information about scatterer sizes. While the characterization of the spectral dependence should be a simple fit, experimental results show strong fluctuations even for the same tissue type. For in‐vivo measurements, this problem is even greater. Therefore, it is the aim of this study to analyze the instabilities of the scattering characterizations and find a solution for it by means of Bayesian inference. In this study, this behavior is investigated using the example of diffuse reflectance spectroscopy. It can be shown that the currently used fitting functions are unstable for the fitting as both parameters for characterizing the reduced scattering coefficient describe the spectral dependence as well as the scattering strength. However, by a simple coordinate transform, a stable mathematical description of the scattering is derived. By the fact that a posteriori probability of the reduced scattering coefficient narrows down significantly with the Bayesian inference, the new fitting function is verified.
The picric acid removal from aqueous solutions by multi‐walled carbon nanotubes/EDTA/carboxymethylcellulose nanocomposite: Central composite design optimization, kinetic, and isotherm studies
Authors: Azadfar Mina , Tahermansouri Hasan , Qomi Mahnaz
Published: September 2021

The removal of hazardous picric acid is of great importance to making healthy and drinkable water. In this research, a nanocomposite (MWCNT‐EDTA‐CMC) based on carboxylated multiwall carbon nanotubes (MWCNT‐COOH) modified by carboxymethylcellulose (CMC) and ethylenediamintetraacetic acid (EDTA) was prepared for adsorption and removal of picric acid from aqueous solutions. MWCNT‐EDTA‐CMC was characterized by Fourier transform infrared (FT‐IR), field‐emission scanning electron microscopy (FESEM), thermal gravimetric analysis (TGA). Central composite design (CCD) was used to study the influence of pH, adsorbent dosage, and initial picric acid concentrations on the removal percentage of picric acid. At optimum conditions (pH 3.0, MWCNT‐EDTA‐CMC dosage 0.050 g, picric acid concentration 30 mg L−1), high removal efficiency (97.67%) was obtained for picric acid which was reasonably well predicted by the model. The adsorption process was demonstrated by the pseudo‐second‐order kinetic and Freundlich isotherm models for both adsorbents. In addition, the consumed MWCNT‐EDTA‐CMC could be reused up to 3th cycle of regeneration.
Large monochromatic components of small diameter
Authors: Carlson Erik , Martin Ryan R. , Peng Bo , Ruszinkó Miklós
Published: September 2021

Gyárfás conjectured in 2011 that every ‐edge‐colored contains a monochromatic component of bounded (“perhaps three”) diameter on at least vertices. Letzter proved this conjecture with diameter four. In this note we improve the result in the case of : We show that in every 3‐edge‐coloring of either there is a monochromatic component of diameter at most three on at least vertices or every color class is spanning and has diameter at most four.
Socioeconomic and racial/ethnic disparities in receipt of palliative care among patients with metastatic hepatocellular carcinoma
Authors: Alterio Rodrigo E. , Ju Michelle R. , Wang Sam C. , Mansour John C. , Yopp Adam , Porembka Matthew R.
Published: September 2021

Background

Patients with metastatic hepatocellular carcinoma (HCC) suffer symptoms of both end‐stage liver disease and cancer. Palliative care (PC) enhances the quality of life via symptom control and even improves survival for some cancers. Our study characterized rates of PC utilization among metastatic HCC patients and determined factors associated with PC receipt.

Methods

We conducted a retrospective review of adult National Cancer Database patients diagnosed with metastatic HCC between 2004 and 2016. Chi‐square tests were used to analyze two cohorts: those who received PC and those who did not. Logistic regression was performed to assess the impact of clinicodemographic factors on the likelihood of receiving PC.

Results

PC utilization was low at just 17%. Later year of diagnosis, insured status, and higher education level were associated with an increased likelihood of receiving PC. Treatment at academic centers or integrated network cancer programs increased the likelihood of receiving PC compared to treatment at a community center (odds ratio [OR] = 1.17, 95% confidence interval [CI] = 1.03–1.33 and OR = 1.25, 95% CI = 1.07–1.45; respectively). Hispanics were significantly less likely to received PC than non‐Hispanic Whites (OR = 0.73, 95% CI = 0.64–0.82).

Conclusions

PC utilization among patients with metastatic HCC remains low. Targeted efforts should be enacted to increase the delivery of PC in this group.
Balloon dilation of the Eustachian tube with a seeker‐based device: A registry of 169 patients
Authors: Standring Robert T. , O'Malley Ellen M. , Greene Joshua B. , Russell Joseph L. , McCoul Edward D.
Published: September 2021

Objective

To collect real‐world data on the safety and effectiveness of balloon dilation of the Eustachian tube using a seeker‐based device in patients with persistent/chronic symptoms of Eustachian tube dysfunction.

Methods

A multicenter, prospective, single‐arm registry was conducted from June 2018 through August 2020 at 10 US centers, including tertiary care and private practices. Primary endpoints included mean change from baseline in the 7‐item Eustachian Tube Dysfunction Questionnaire (ETDQ‐7) and the serious related adverse event rate. Secondary endpoints include changes in middle ear assessments, surgical intervention rate, and changes in Sino‐Nasal Outcome Test and Work and Activity Impairment (WPAI) questionnaires.

Results

A total of 169 participants were treated with balloon dilation of the Eustachian tube, with 166 and 154 participants completing the 6‐week and 6‐month follow‐ups, respectively. Repeated measures analysis of the change in ETDQ‐7 scores indicated statistically significant improvement (−2.1; 95% CI −2.40, −1.84; P < .0001) at 6‐month follow‐up. The minimum clinically important difference of improvement was achieved by 85% of participants at 6 months. Four nonserious adverse events were reported. Middle ear functional assessments were improved in the majority of participants with abnormal baseline findings. There were no statistically significant differences in the change from baseline ETDQ‐7 scores between participants who had concurrent procedures and those who did not. WPAI scores demonstrated significant improvement.

Conclusion

Real‐world evidence supports the clinical studies demonstrating that balloon dilation of the Eustachian tube with a seeker‐based device is a safe and effective procedure to treat ETD symptoms.

Level of evidence

3
Telemedicine in Hepatology: Current Applications and Future Directions
Authors: Fung Brian M. , Perumpail Megan , Patel Yuval A. , Tabibian James H.
Published: September 2021

Telemedicine refers to the use of information and communication technologies for providing health care at a distance. Through the use of telecommunication technologies such as cell phones, computers, and other electronic devices, health care providers are able to conduct patient visits, mentor/train other providers, and monitor patients’ chronic diseases remotely, potentially hundreds or thousands of miles away. Over the past 2 decades, the use of telemedicine has grown in the field of hepatology. In this review, we provide a focused primer on telemedicine and its current applications in hepatology. In particular, we discuss the use of telemedicine in the management of chronic hepatitis C, the complications of liver disease, as well as preliver transplantation evaluation and posttransplantation care. In addition, we provide a synopsis of the effect of the coronavirus disease 2019 (COVID‐19) pandemic on the use of telemedicine in hepatology.
Bridging Rigidity and Flexibility: Modulation of Supramolecular Hydrogels by Metal Complexation
Authors: Stach Oliver S. , Breul Katharina , Berač Christian M. , Urschbach Moritz , Seiffert Sebastian , Besenius Pol
Published: September 2021

The combination of complementary, noncovalent interactions is a key principle for the design of multistimuli responsive hydrogels. In this work, an amphiphilic peptide, supramacromolecular hydrogelator which combines metal‐ligand coordination induced gelation and thermoresponsive toughening is reported. Following a modular approach, the incorporation of the triphenylalanine sequence FFF into a structural (C3EG) and a terpyridine‐functionalized (C3Tpy) C3‐symmetric monomer enables their statistical copolymerization into self‐assembled, 1D nanorods in water, as investigated by circular dichroism (CD) spectroscopy and transmission electron microscopy (TEM). In the presence of a terpyridine functionalized telechelic polyethylene glycol (PEG) cross‐linker, complex formation upon addition of different transition metal ions (Fe2+, Zn2+, Ni2+) induces the formation of soft, reversible hydrogels at a solid weight content of 1 wt% as observed by linear shear rheology. The viscoelastic behavior of Fe2+ and Zn2+ cross‐linked hydrogels are basically identical, while the most kinetically inert Ni2+ coordinative bond leads to significantly weaker hydrogels, suggesting that the most dynamic rather than the most thermodynamically stable interaction supports the formation of robust and responsive hydrogel materials.
Survey finds college students bracing themselves for MH issues
Authors: Canady Valerie A.
Published: September 2021

As college students around the country ready themselves for a return to campus or embark on college life for the first time, newly released survey results find a majority of them say that they anticipate experiencing mental health issues and/or that those around them will be impacted.
Controllability and stability analysis of an oscillating system with two delays
Authors: Shah Khadija Ali , Zada Akbar
Published: September 2021

In the current article, controllability and stability analysis of a system of differential equations is investigated. The system is governed by semilinear impulsive differential equations of second order with two delays. Controllability is studied using Rothe's fixed point theory while stability analysis is carried out with the help of Grönwall inequality and some other conditions. Fixed point approach is incorporated in determination of uniqueness of solution.
Singularly perturbed reaction–diffusion problems on a k‐star graph
Authors: Kumar Vivek , Leugering Günter
Published: September 2021

Singularly perturbed reaction–diffusion equations on a star graph (having k + 1 nodes and k edges) resulting in a system with k individual partial differential equations along the edges with coupling conditions at the common junction are presented. In the singular limit, as the diffusion parameter tends to zero, possibly individually along each edge, boundary layers may occur at the multiple nodes as well as at the simple nodes. Numerically, the proposed equations are solved using central finite difference schemes on properly extended Shishkin meshes. Error estimates are discussed and validated by solving a test problem on a graph with three edges (tripod). A more general graph problem with eight edges and three connecting nodes has also been solved numerically.
A new approach for the derivation of bounds for the Jensen difference
Authors: Adil Khan Muhammad , Khan Shahid , Erden Samet , Samraiz Muhammad
Published: September 2021

There are many useful applications of Jensen's inequality in several fields of science, and due to this reason, a lot of results are devoted to this inequality in the literature. The main theme of this article is to present a new method of finding estimates of the Jensen difference for differentiable functions. By applying definition of convex function, and integral Jensen's inequality for concave function in the identity pertaining the Jensen difference, we derive bounds for the Jensen difference. We present integral version of the bounds in Riemann sense as well. The sharpness of the proposed bounds through examples are discussed, and we conclude that the proposed bounds are better than some existing bounds even with weaker conditions. Also, we present some new variants of the Hermite–Hadamard and Hölder inequalities and some new inequalities for geometric, quasi‐arithmetic, and power means. Finally, we give some applications in information theory.
Wireless power transfer system prototype with a wide input power range rectifier and power‐optimized waveforms
Authors: Benhamou Abderrahim , Tellache Mohamed , Hebib Sami
Published: September 2021

This paper describes a wireless power transfer (WPT) system operating at 2.4 GHz, which is based on waveform optimization technique and a wide input power range rectifier. This latter consists of an RF‐to‐dc power conversion circuit based on circulators. The waveform optimization is then applied in order to enhance the power conversion efficiency at very low input power levels. The proposed WPT system was prototyped and tested in open and closed loop configurations with different types of obstacles placed between the transmitter and the receiver. The generation of power‐optimized waveforms and the control process in the closed loop configuration were carried out using software‐defined radio. The obtained experimental results validate the wide input power behavior of the two proposed WPT systems especially when dealing with very low input power levels and relatively dynamic environments. In fact, for the two WPT systems featured a distance of 1 m and a transmitted power of 50mw, dc power levels of about 38 and 11 μW are harvested in the cases of no obstacle and low attenuation obstacle respectively.
Antinociceptive effects of the combined use of butorphanol and buprenorphine in mice
Authors: Sasaki Kazumasu , Ishikawa Tatsuya , Ikeda Kazutaka , Kasai Shinya
Published: September 2021

Butorphanol and buprenorphine are mixed opioid receptor agonist‐antagonist drugs widely used as analgesics in people and animals. There are few reports concerning the interaction of multiple opioids, and their antinociceptive effects, when combined with other opioids, remain unclear. Therefore, we report the preliminary findings of the antinociceptive effects of the combined use of butorphanol and buprenorphine in C57BL/6JJcl mice. Both drugs were administered either simultaneously or in different orders. Compared with the baseline values, the tail‐flick and hot‐plate test latencies increased regardless of the order of administration. Furthermore, enhanced latencies were observed on administration of butorphanol followed by buprenorphine. Combined use of these drugs may not attenuate analgesic efficacy. Besides, enhancement of these effects can be obtained by changing the order of the administration of these drugs. It is necessary to further investigate the molecular basis of the underlying mechanism in future definitive studies.
Conservative unconditionally stable decoupled numerical schemes for the Cahn–Hilliard–Navier–Stokes–Darcy–Boussinesq system
Authors: Chen Wenbin , Han Daozhi , Wang Xiaoming , Zhang Yichao
Published: September 2021

We propose two mass and heat energy conservative, unconditionally stable, decoupled numerical algorithms for solving the Cahn–Hilliard–Navier–Stokes–Darcy–Boussinesq system that models thermal convection of two‐phase flows in superposed free flow and porous media. The schemes totally decouple the computation of the Cahn–Hilliard equation, the Darcy equations, the heat equation, the Navier–Stokes equations at each time step, and thus significantly reducing the computational cost. We rigorously show that the schemes are conservative and energy‐law preserving. Numerical results are presented to demonstrate the accuracy and stability of the algorithms.
Non‐invasive prenatal test uptake in socioeconomically disadvantaged neighborhoods
Authors: van der Meij Karuna R. M. , Kooij Caroline , Bekker Mireille N. , Galjaard Robert‐Jan H. , Henneman Lidewij ,   Dutch NIPT Consortium
Published: September 2021

Objective

Non‐Invasive Prenatal Testing (NIPT) is increasingly being implemented worldwide. In public health programs, equitable access to healthcare is a fundamental principle which also applies to fetal aneuploidy screening. However, the out‐of‐pocket costs of NIPT may lead to sociodemographic disparities in uptake of screening. This study assessed whether there is a difference in the uptake of NIPT in socioeconomically disadvantaged neighborhoods compared to all other neighborhoods in the Netherlands, where NIPT is implemented in a national screening program (TRIDENT‐2 study).

Method

NIPT uptake, postal code and age of 156,562 pregnant women who received pre‐test counselling for prenatal screening in 2018 were retrieved from the national prenatal screening database. Postal codes were used as a proxy to categorize neighborhoods as being either socioeconomically disadvantaged or other. The out‐of‐pocket costs for NIPT were €175.

Results

NIPT uptake in socioeconomically disadvantaged neighborhoods was 20.3% whereas uptake in all other neighborhoods was 47.6% (p < 0.001). The difference in NIPT uptake between socioeconomic disadvantaged neighborhoods and other areas was smaller for the youngest maternal age‐group (≤25 years) compared to other age‐groups.

Conclusion

The variation in uptake suggest underlying disparities in NIPT uptake, which undermines the goals of a national fetal aneuploidy screening program of providing reproductive autonomy and equitable access. This has ethical and policy implications for ensuring fair and responsible implementation of fetal aneuploidy screening.
Off‐label drug use in neonates and infants in Spain: A five‐year observational study
Authors: Lizano‐Díez Irene , Kargodorian Joseph , Piñero‐López M. Ángeles , Lastra Cecilia F. , Mariño Eduardo L. , Modamio Pilar
Published: September 2021

Objectives

To provide information about the off‐label rate of all drug prescriptions in neonates and infants up to 1 year in Spain. Also, to analyse the off‐label prescription of medicines under current practice in this age group according to different evidence sources.

Study design

A five‐year (2015–2019) exploratory observational study about off‐label prescription in neonates and infants (0 to 1 year) at primary health care in Spain. All drug prescriptions in this age group were analysed and classified according to their labelling in off‐label or on‐label. The drugs prescribed off‐label were subsequently reviewed in national formularies and other databases to assess its evidence of use beyond what is recommended in the Summary of Product Characteristics (SmPC).

Results

On average 34.50% of total prescriptions were prescribed off‐label according to the SmPC. 17.93% of total prescriptions in neonates and infants up to 1 year old were not based on clinical evidence from SmPC, Pediamécum, BNF or DailyMed. In more than 88% of cases, off‐label use was related to the posology section of the SmPC, followed by the therapeutic indications and contraindications sections, in 35.20% and 24.10% of cases, respectively. Almost 13% of off‐label drugs were over‐the‐counter. Salbutamol followed by topical tobramycin and colecalciferol were the drugs most prescribed off‐label.

Conclusions

Off‐label use of drugs remains as an important public health concern, especially for neonates and infants up to 1 year, who receive the greatest proportion of off‐label prescriptions. The evidence‐based off‐label prescription is a widespread practice that has shown a stable trend during the 5‐year study period providing also a certain extent of flexibility to paediatricians in some therapeutic decisions.
How is type D personality associated with the major psychological outcomes in noncardiac chest pain patients?
Authors: Roohafza Hamidreza , Bagherieh Sara , Feizi Awat , Khani Azam , Yavari Niloufar , Saneian Parsa , Teimouri Zahra , Sadeghi Masoumeh
Published: September 2021

Noncardiac chest pain (NCCP) may lead many problems on the health‐care system. Having type D personality has been shown to adversely affect NCCP patients. This study aimed to determine the psychological comorbidities that type D personality is associated with, in patients with NCCP. The participants of this cross‐sectional study were 360 patients diagnosed with NCCP. Patients filled out questionnaires about sociodemographic, behavioral, and clinical factors (severity of pain, somatization, cardiac anxiety, fear of body sensations, depression, and type D personality). Type D personality was more prevalent among female (p < 0.005), and those people having this personality showed lower sleep quality (p = 0.001) and sexual life satisfaction (p < 0.001) and more likely to be smoker (p < 0.001). Type D personality is strongly associated with fear of body sensations (β = 5.92, SE = 1.95, p = 0.003), pain intensity (β = 3.53, SE = 0.98, p < 0.001), depression (β = 2.91, SE = 0.62, p < 0.001), and somatization (β = 1.75, SE = 0.55, p < 0.001). Type D personality and major psychological comorbidities were strongly associated. Physicians should consider that having type D personality can be linked to NCCP in an effort to help patients receive effective psychological consultations.
Ion transport in polymerized lyotropic liquid crystals containing ionic liquid
Authors: Bandegi Alireza , Kim Kyungtae , Foudazi Reza
Published: September 2021

In this work, we investigate the effect of morphology and segmental dynamics on ion transport in polymerized lyotropic liquid crystals (polyLLCs) containing 1‐butyl‐3‐methylimidazolium tetrafluoroborate as ionic liquid (IL). We demonstrate that two important factors, which affect ion conduction in polyLLCs, are grain size and chain density at the interface. The polyLLC with large grain size (70 nm) shows significant reduction in ion conductivity (one order of magnitude) compared to its homopolymer/IL mixture. However, the polyLLC with small grain size (20 nm) has little difference in ion conductivity compared to its homopolymer/IL mixture. It is observed that decreasing the chain density enhances the interaction of IL with polymer chains and consequently slows the relaxation of polymer chains. In addition, comparing the dynamics of polymer chains in mixtures of homopolymer/IL and templated LLC mesophases shows that the confinement in LLC structure prolongs the relaxation of polymer chains.
Childhood diabetes and sleep
Authors: Monzon Alexandra D. , Patton Susana R. , Koren Dorit
Published: September 2021

Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.
High flow nasal cannula versus standard low flow nasal oxygen during flexible bronchoscopy in children: A randomized controlled trial
Authors: Sharluyan Artur , Osona Borja , Frontera Guillem , Brandstrup Kay Boris , Figuerola Joan , Sanz‐Ruiz Isabel , Salas Alberto , Garrido Beatriz , Eva Chocano‐González , Fernandez Andrea , Peña‐Zarza Jose Antonio , Gil Jose Antonio , Bover‐Bauzà Catalina , Sailer Sebastian
Published: September 2021

Background

Hypoxemia is the most frequent complication of fiberoptic bronchoscopy (FB) in children. Guidelines recommend oxygen supplementation and conventional nasal prongs (NC) are used for this purpose. The aim of this study was to evaluate if the use of high‐flow nasal cannula therapy (HFNC) in children undergoing FB result in a lower incidence of hypoxemia than standard oxygen administration.

Methods

Patients aged 1 month–16 years undergoing elective FB were included in a prospective randomized controlled, nonblinded, single‐center clinical trial and randomly assigned to receive oxygen via NC or HFNC. Patients’ baseline characteristics were recorded pre‐bronchoscopy. The primary outcome was oxygen desaturation during the procedure defined as saturation less than 94%.

Results

An intention to treat analysis for 53 patients receiving NC and 51 receiving HFNC, showed HFNC patients were less likely to have hypoxemia than were NC patients (p = .011), with an absolute risk reduction of 0.27 (95% confidence interval [CI]: 0.08–0.45) and a number needed to treat of 3.75 (95% CI: 2.22–12.04). Moderate hypoxemia (SpO2 ≥ 90% and <94%, and <60 s) was observed significantly less often with HFNC than with NC (p = .012). Severe hypoxemia (SpO2 < 90% and >30 s) was not different between groups. Patients undergoing bronchoalveolar lavage (BAL) presented fewer desaturations with HFNC (p = .0003).

Conclusions

HFNC offers optimized oxygenation during elective FB with a significant reduction in desaturations and can be considered for oxygen administration, especially when BAL is performed.
Surface modification of nucleopolyhedrovirus with polydopamine to improve its properties
Authors: Yan Guangyao , Wang Hongmei , Lv Jiajing , Li Changyou , Zhang Baohua
Published: September 2021

BACKGROUND

Baculoviruses have been developed as promising biopesticides to control pests due to their high host specificity and virulence, and nontoxicity to humans and nontarget animals. However, their sensitivity to ultraviolet (UV) radiation and instability in the natural environment are major constraints to its large‐scale application. In this study, polydopamine‐nucleopolyhedrovirus microcapsules were established to improve the instability of baculoviruses in sunlight.

RESULTS

The optimal conditions for the preparation of polydopamine‐nucleopolyhedrovirus microcapsules were as follows:  Spodoptera exigua nucleopolyhedrovirus (SeMNPV)concentration of 2 × 108  polyhedral inclusion body（PIB） mL–1, reaction time of 6 h, and pH of 9.0. The particle size of the obtained microcapsules was about 1 μm. The microencapsulated baculovirus improved its thermal stability and wettability, and enhanced its insecticidal activity against Spodoptera exigua. Moreover, under the same UV treatment, the insecticidal effect against S. exigua larvae of microencapsulated baculovirus was only reduced by 8.89%, whereas that of the nonmicroencapsulated baculovirus was reduced by 27.27%.

CONCLUSION

Polydopamine‐nucleopolyhedrovirus microcapsules provided better UV resistance and preparation stability compared with unmodified SeMNPV, and demonstrate an idea for the development of a baculovirus‐based stabilized product. © 2021 Society of Chemical Industry.
Efficient GLM‐based control charts for Poisson processes
Authors: Mahmood Tahir , Iqbal Anam , Abbasi Saddam Akber , Amin Muhammad
Published: September 2021

The control charts are essential instruments that can impart crucial insights to quality controllers for maintaining the productivity of manufacturing processes. The conventional charting designs are based on a single study variable without exerting auxiliary information. Control charts derived from simple linear regression, generally with normality assumption, are one straightforward way of overcoming this difficulty. But, for a count distributed process, the generalized linear model (GLM) based strategy yields better outcomes. Hence, this study presents GLM‐based progressive mean (PM) and double progressive mean (DPM) charting structures by employing the standardized residuals of the Poisson regression model. The functioning of the suggested and existing schemes (i.e., SR‐EWMA) is investigated in the matter of run length distributions. The comparative analysis demonstrated that PM structures based on standardized residuals (i.e., SR‐PM and SR‐DPM) outperform the existing counterpart (i.e., SR‐EWMA). Specifically, the SR‐DPM chart is found to be more productive in identifying increasing alterations in the process mean. Finally, a case study about a 3D manufacturing procedure is presented to accentuate the significance of the suggested methods.
A thematic analysis of teachers' perspectives on supporting victims of childhood bereavement in British primary schools
Authors: Abraham‐Steele Maya , Edmonds Casey
Published: September 2021

There is a distinct lack of literature considering childhood bereavement within the United Kingdom. There is particularly a lack of age‐specific research into childhood bereavement and the types of support schools are providing for this group of children. In light of this lack of research, the aim of this study was to explore the experiences, perspectives and views of teachers on supporting children in British primary schools. Interviews were analysed using thematic analysis (TA). Analysis revealed four major themes relating to bereavement support: ‘support available is inconsistent’, ‘systemic limitations’, ‘lack of policy and guidance’ and ‘speaking to children about death’. The research showed that bereavement support in British primary schools is varied and inconsistent, with examples of good practice and areas for improvement. At the same time, both childhood bereavement and the support available to bereaved children are socially biased, with those in socioeconomically deprived areas more likely to experience a bereavement and receive lower quality support. This study indicates that government policy or guidance with regards to childhood bereavement would be advantageous, for staff and children alike.

Context and implications

Rationale for this study

This study was undertaken due to the distinct lack of research into childhood bereavement in the UK. One in 29 children in the UK will be bereaved of a parent or sibling before their 16th birthday (McLaughlin et al., 2019) and evidence suggests schools are well placed to support bereaved children in the aftermath of loss.

Why the new findings matter

The research investigates the perspectives and experiences of teachers supporting bereaved children in British primary schools, highlighting what support currently exists, that teachers do not feel confident supporting bereaved children, and the systemic limitations which hinder the support they can provide.

Implications for policymakers and education professionals

The study has implications for policy makers, particularly the Department for Education (DfE), who may consider devising a national bereavement policy akin to those available abroad. Education professionals, including teachers and educational psychologists, might consider the findings in light of their own practice and develop local authority level bereavement protocols to support children. There are implications for teacher training providers who might consider the lack of bereavement training available at present (both in initial teacher training and continued professional development) and address this. Other researchers may consider the gaps in research found in our study and conduct further research to deepen the knowledge base.
A Scalable System for Generation of Mesenchymal Stem Cells Derived from Induced Pluripotent Cells Employing Bioreactors and Degradable Microcarriers
Authors: Rogers Robert E. , Haskell Andrew , White Berkley P. , Dalal Sujata , Lopez Megan , Tahan Daniel , Pan Simin , Kaur Gagandeep , Kim Hyemee , Barreda Heather , Woodard Susan L. , Benavides Oscar R. , Dai Jing , Zhao Qingguo , Maitland Kristen C. , Han Arum , Nikolov Zivko L. , Liu Fei , Lee Ryang Hwa , Gregory Carl A. , Kaunas Roland
Published: September 2021

Human mesenchymal stem cells (hMSCs) are effective in treating disorders resulting from an inflammatory or heightened immune response. The hMSCs derived from induced pluripotent stem cells (ihMSCs) share the characteristics of tissue derived hMSCs but lack challenges associated with limited tissue sources and donor variation. To meet the expected future demand for ihMSCs, there is a need to develop scalable methods for their production at clinical yields while retaining immunomodulatory efficacy. Herein, we describe a platform for the scalable expansion and rapid harvest of ihMSCs with robust immunomodulatory activity using degradable gelatin methacryloyl (GelMA) microcarriers. GelMA microcarriers were rapidly and reproducibly fabricated using a custom microfluidic step emulsification device at relatively low cost. Using vertical wheel bioreactors, 8.8 to 16.3-fold expansion of ihMSCs was achieved over 8 days. Complete recovery by 5-minute digestion of the microcarriers with standard cell dissociation reagents resulted in >95% viability. The ihMSCs matched or exceeded immunomodulatory potential in vitro when compared with ihMSCs expanded on monolayers. This is the first description of a robust, scalable, and cost-effective method for generation of immunomodulatory ihMSCs, representing a significant contribution to their translational potential.
The dynamic history of gymnosperm plastomes: Insights from structural characterization, comparative analysis, phylogenomics, and time divergence
Authors: Lubna  , Asaf Sajjad , Khan Abdul Latif , Jan Rahmatullah , Khan Arif , Khan Adil , Kim Kyung‐Min , Lee In‐Jung
Published: September 2021

Gymnosperms are among the most endangered groups of plant species; they include ginkgo, pines (Conifers I), cupressophytes (Conifers II), cycads, and gnetophytes. The relationships among the five extant gymnosperm groups remain equivocal. We analyzed 167 available gymnosperm plastomes and investigated their diversity and phylogeny. We found that plastome size, structure, and gene order were highly variable in the five gymnosperm groups, of which Parasitaxus usta (Vieill.) de Laub. and Macrozamia mountperriensis F.M.Bailey had the smallest and largest plastomes, respectively. The inverted repeats (IRs) of the five groups were shown to have evolved through distinctive evolutionary scenarios. The IRs have been lost in all conifers but retained in cycads and gnetophytes. A positive association between simple sequence repeat (SSR) abundance and plastome size was observed, and the SSRs with the most variation were found in Pinaceae. Furthermore, the number of repeats was negatively correlated with IR length; thus, the highest number of repeats was detected in Conifers I and II, in which the IRs had been lost. We constructed a phylogeny based on 29 shared genes from 167 plastomes. With the plastome tree and 13 calibrations, we estimated the tree height between present‐day angiosperms and gymnosperms to be ∼380 million years ago (mya). The placement of Gnetales in the tree agreed with the Gnetales–other gymnosperms hypothesis. The divergence between Ginkgo and cycads was estimated as ∼284 mya; the crown age of the cycads was 251 mya. Our time‐calibrated plastid‐based phylogenomic tree provides a framework for comparative studies of gymnosperm evolution.
Precision blade deflection measurement system using wireless inertial sensor nodes
Authors: Grundkötter Eike , Melbert Joachim
Published: September 2021

Structural health monitoring on wind turbine blades is a great enhancement for operational safety and failure avoidance. Blade deflection is a key parameter, which is a function of blade geometry and material properties. The absolute blade deflection is affected by wind load, gravitational, and centrifugal forces and must exceed neither material stress limits nor tower clearance. In this paper, we introduce a novel method for real time reconstruction of blade movement using inertial measurement units (IMUs) located at defined positions along the blade. An algorithm is introduced that combines IMU measurements and a priori information of the fundamental blade mode shapes to accurately reconstruct the blade movement. A low‐power wireless sensor node for blade deflection monitoring is presented. The autonomous sensor node is equipped with an IMU together with a low‐power wireless transceiver and powered by a compact translational electromagnetic energy harvester. Sufficient energy is harvested each rotor revolution for continuous measurement data streaming within the wind turbine's operating range. A data stream of six‐axis IMU measurements enables real time, three‐dimensional reconstruction of the entire blade movement in the back end positioned in the tower. The reconstruction of blade tip deflection is possible even under high wind turbulences with a minimum accuracy of 0.22 m for an onshore 5 MW and 0.58 m for an offshore 15‐MW reference turbine. The complete system has been tested thoroughly under conditions similiar to a real wind turbine. Realistic stimulation of the reconstruction algorithm is performed by means of OpenFAST simulations.
End of Life, Food, and Water: Ethical Standards of Care
Authors: Eleuteri Stefano , Caruso Arianna , Pulle Ranjeev C.
Published: September 2021

End-of-life care constitutes an important situation of extreme nutritional vulnerability for older adults. Feeding decisions in late-stage dementia often provoke moral and ethical questions for family members regarding whether or not to continue hand-feeding or opt for tube-feeding placement. Despite the knowledge that starvation and dehydration do not contribute to patient suffering at the end of life and in fact may contribute to a comfortable passage from life, the ethics of not providing artificial nutrition and hydration (ANH) continue to be hotly debated. However, in the past two decades, voluntary stopping of eating and drinking (VSED) has moved from a palliative option of last resort to being increasingly recognized as a valid means to intentionally hasten death for cognitively intact persons dealing with a serious illness. Across many settings globally, when oral intake is deemed unsafe, decisions to withhold oral feeding and to forgo artificial means of providing nutrition are deemed to be ethically and legally sanctioned when the decision is made by a capable patient or their legally recognized substitute decision-maker. Decision-making at the end of life involves knowledge of and consideration of the legal, ethical, cultural, religious, and personal values involved in the issue at hand. This chapter attempted to illustrate the unique complexities when considering nutrition therapy (by oral and artificial means) at the end of life.
The Goal of the Universal Design for Learning: Development of All to Expert Learners
Authors: Navaitienė Julita , Stasiūnaitienė Eglė
Published: September 2021

Over the past 10 years, every learner’s ability to achieve the highest level of learning success has become quite an important topic. The Universal Design for Learning (UDL) sets a goal to allow all learners to achieve their optimal learning experience that matches inclusive education. Learners who can assess their own learning needs set their personal learning goals, and monitor their progress are termed the expert learners (McDowell. Developing expert learners: a roadmap for growing confident and competent students. Corwin, 2019). This chapter focuses on theoretical backgrounds for expert learners’ paradigm. It starts from fundamental constructivist theories and moves towards the theory of self-regulation and cognitive neuroscience approach. It concentrates on the theory of self-determination, which, in our opinion, validates in the best way the nature of the expert learners’ development. Implementation of the Universal Design for Learning allows all learners to access, participate in, and progress in the general-education curriculum. This chapter presents the specific profile of the expert learners covering their main characteristics and qualities and revealing the essence of the UDL framework. Educators could use the profile as the educational guidelines conductive to understand how the process of becoming the expert learner proceeds.
Traditional Teaching–Learning Process in the Class of Polish School Through Lens of UDL Approach
Authors: Baran Jolanta , Cierpiałowska Tamara , Dyduch Ewa
Published: September 2021

Education researchers have long advocated modifications to the teaching–learning process in order to make the school a more inclusive space and conducive to individual and group development of students with diverse (including special) educational needs. This is to develop competences, skills and values that will allow students to better prepare for adult life in a rapidly changing world. This demand is not new and is not only a demand but refers to reforming the education process. In Poland, for many years the schools have been undergoing dynamic changes in many different dimensions, partly because of facilitating students with special needs. In the considerations of education researchers, as well as in the daily educational practice of teachers, the question arises as to what should be done to optimise the teaching–learning process and how. One possible idea for such optimisation is to implement the Universal Design for Learning (UDL) approach. The purpose of this chapter is to seek an answer to the question of to what extent the reality of the Polish schools corresponds to the principles of the UDL. An analysis of the traditional learning process through the UDL lens has identified those areas in which UDL approach solutions are provided and also where it is worthwhile to implement them.
Transformations of the Teaching–Learning Process Towards Inclusive Education as a Result of the UDL Approach Implementation
Authors: Baran Jolanta , Cierpiałowska Tamara , Dyduch Ewa
Published: September 2021

This chapter discusses the assumptions, implementation and deliverables of an action research project in a selected Polish class of integrated form. The main objective of the project was to trigger changes in the learning–teaching process based on the Universal Design for Learning (UDL) approach and thus promote inclusive education. The action research lasted one school semester. The empirical data, mainly qualitative, triangulating various sources of information and synthesising perspectives, were used to identify specific topics and threads identified in the gathered inputs, to present it in an orchestrated manner and to interpret it. It has been indicated that UDL approach implementation has a positive impact on the course of the teaching–learning process and optimises it to enhance the activity, commitment, self-reliance and responsibility of students and develops their cooperation, which breeds inclusion in education. Meanwhile, it stimulates teachers to change their mindset with a view to the essence of success in education and supports their daily practice.