bluuebunny/crossref_metadata_2025 huggingface dataset:
Microstructure, corrosion behavior and rust resistance of Ti and Ce added invar alloys
Authors: Liu Kailun , Chen Cuixin , He Jun , Liu Baoxi , Ma Bin , Xue Haitao , Yang Bingchen , Wang Shuo , Liu Hao
Published: August 2021

In this study, the effects of Ti and Ce on the microstructure, corrosion behavior and rust resistance of invar alloys were investigated in detail. The precipitation phase which can be used as the core of heterogeneous nucleation can be formed by adding an appropriate amount of Ti and Ce, which promotes microstructure refinement and homogenization of the invar alloy. Moreover, the electrochemical behavior of invar alloys with different Ti and Ce contents was studied. The results show that with the addition of alloying elements, the self-corrosion potential of the alloy becomes positive, and the self-corrosion current decreases, indicating that the addition of Ti and Ce is beneficial for improving the corrosion properties of the alloy. This is primarily because Ti and Ce combine easily with unfavorable elements to form precipitates, which reduces the factors affecting the corrosion resistance of the alloy. The invar alloy with superior corrosion resistance was selected for the dipping test. X-ray diffraction analysis showed that the addition of Ti and Ce increased the amount of α-FeOOH and enhanced the protective effect of the antirust layer.
Pseudoboehmite or graphene oxide, what is the best additive for natural polymer pla—poly (l-lactic acid)?
Authors: Almeida F J M , Massi M , Miranda L F , Lima B L S
Published: August 2021

In cases of severe injuries or burns, skin grafts (scaffold) are often necessary skin substitutes. To not harm the patient or the donor, research is necessary to search for heterografts, that are formed by biomaterials and are also biodegradable and bioabsorbable to the human body, as is the case with poly (L-lactic acid) - PLA. However, the natural polymers placed on the skin suffer great degradation in media with large amounts of carbon and water, have little durability due to their low ductility. For the proposal, the graphene oxide (GO) nanocharge and pseudoboehmite (PB) were obtained. It is believed that the nanofillers dispersed in the polymer matrix can improve mechanical properties regarding ductility and tenacity, without losing thermal properties. Subsequently, the hybrid nanocharge dispersion methods were employed to obtain in the poly (L-Lactic Acid) (PLA) matrix, forming the material for the desired scaffold. For this research, injectable specimens of pure PLA, PLA structured with GO nanoparticles, and PLA structured with PB nanoparticles, were manufactured. The microstructural and mechanical characterizations were performed on the specimens, to compare the effect generated by the nanocharges on the bulk material. The results showed that the increase in the concentrations of PB and GO nanofillers showed an increase in tenacity and ductility compared to pure PLA, a property that is desired in the scaffold structure.
Mason Bees (Hymenoptera: Megachilidae) Exhibit No Avoidance of Imidacloprid-Treated Soils
Authors: Fortuin Christine Cairns , Gandhi Kamal J K
Published: August 2021

1) Many wild bee species interact with soil either as a nesting substrate or material. These soil interactions create a risk of exposure to agrochemicals such as imidacloprid or other neonicotinoid pesticides that can persist in soil for months after application. At the landscape level, concentrations of imidacloprid residue in soil are limited to the immediate treatment area, and thus risks to soil-interacting bees could be low if they avoid contaminated soils. 2) We utilized Osmia lignaria (Say), a solitary cavity nesting bee which collects mud to partition and seal nests, and conducted two laboratory experiments to test whether nesting females select or avoid soils containing various levels of imidacloprid residue. For the first experiment, we assessed behavioral responses of females to treated soil utilizing a choice arena and pairing various choices of soil with imidacloprid residues ranging between 0 and 780 ppb. For the second experiment, we developed a laboratory assay to assess soil selection of actively nesting O. lignaria, by providing choices of contaminated soil between 0 and 100 ppb and 0 and 1,000 ppb to nesting females. 3) We found no evidence that O. lignaria females avoided any level of imidacloprid contamination, even at the highest residue level (1,000 ppb) in both the experiments, which may have implications for risk. The in situ nesting methodology developed in this study has future applications for research on soil or pollen preferences of cavity nesting Osmia species, and potential for breeding of O. lignaria in laboratory.
Unusual interventional treatment of spontaneous coronary artery dissection without stent implantation: a case series
Authors: Fujita Hiroshi , Yokoi Masashi , Ito Tsuyoshi , Nakayama Takafumi , Shintani Yasuhiro , Sugiura Tomonori , Seo Yoshihiro , Ohte Nobuyuki
Published: August 2021

Background

Spontaneous coronary artery dissection (SCAD) is a unique cause of myocardial infarction, and optimal treatment should be selected according to the ischaemic condition. Patients with ongoing ischaemia or haemodynamic instability may require revascularization. Cutting balloon (CB) angioplasty has been acknowledged as an option for revascularization. However, few observations of the coronary artery conditions after CB angioplasty in SCAD patients have been reported. Here, we demonstrate two cases in which we evaluated the angiographic morphology of targeted coronary arteries in the chronic phase after CB angioplasty.

Case summary

Patient 1 was a 46-year-old woman who presented at our hospital with chest pain. Electrocardiography suggested acute coronary syndrome and coronary angiography was performed. The coronary angiography and intravascular ultrasound (IVUS) examinations revealed SCAD in the left anterior descending artery (LAD). Revascularization with CB angioplasty was successful. Follow-up coronary angiography 15 months after the angioplasty showed no visible stenosis in the LAD. Accordingly, the patient no longer needed to antiplatelet therapy. Patient 2 was a 50-year-old woman who was transported to our hospital for ventricular tachycardia. Coronary angiography and IVUS revealed SCAD in the right coronary artery. Coronary flow was restored by CB angioplasty. Follow-up contrast-enhanced computed tomography angiography 36 months after angioplasty showed a healed appearance. Thus, she was able to discontinue antiplatelet therapy.

Discussion

Cutting balloon angioplasty may be a possible method to treat SCAD.
The effect of the employment of experienced physicians in the Emergency Department on quality of care and equality—a quasi-experimental retrospective cohort study
Authors: Lindstroem Mette , Andersen Ove , Kallemose Thomas , Rasmussen Line Jee Hartmann , Rosthoej Susanne , Jervelund Signe Smith
Published: August 2021

Background

Increasing acute admissions in Emergency Departments (EDs) negatively affect quality of care, safety and flow. Thus, the Danish Health Authorities recommend the presence of experienced physicians in the ED. In 2016, consultant-led triage and continuous presence of consultants were introduced at a larger ED in Copenhagen, Denmark. This study investigated whether the employment of consultants in a Danish ED affected the quality of care for acutely admitted medical patients in terms of length of admission, readmission and mortality, as well as socioeconomic equality in quality of care delivery.

Methods

Admission data were collected during two 7-month periods, one prior to and one after the organizational intervention, with 9869 adult medical patients admitted for up to 48 h in the ED. Linear regression and Cox proportional hazards regression analyses adjusted for age, sex, comorbidities, level of education and employment status were applied.

Results

Following the employment of consultants, an overall 11% increase in index-admissions was observed, and 90% of patients were discharged by a consultant with a reduced mean length of admission by 1.4 h (95% CI: 1.0–1.9). No change was found in in-hospital mortality, readmission or mortality within 90 days after discharge. No change in distribution of quality indicators across patients’ socioeconomic status was found.

Conclusions

Consultants in the ED was found to reduce length of hospitalization without a negative effect on the quality of care for ED-admitted medical patients in general or patients with lower socioeconomic status.
Religious Discrimination, Diaspora, and United Nations Voting on Israel
Authors: Haykin Tatyana , Fox Jonathan , Mirilovic Nikola
Published: August 2021

This study examines whether discrimination against religious minorities and diaspora politics influences United Nations General Assembly (UNGA) voting on Israel and the Israeli–Palestinian conflict between 1990 and 2014. We test discrimination against Jews, discrimination against Muslims, and general discrimination against all religious minorities in 183 countries. Our results indicate that repressive countries vote against Israel in the UNGA partly as a diversionary tactic seeking to divert attention from their own poor behavior. This is because discriminating against both Jews and Muslims, as well as religious discrimination in general, predict anti-Israel voting. We also find that countries with larger Jewish minorities are more likely to support Israel and countries with larger Muslim minorities are less likely to support Israel, although the latter effect is more conditional and most consistently pronounced in countries where discrimination against Muslims is low. This suggests that diaspora politics and transnational religious ties influence UNGA voting on Israel.
Muscle Volume and Intramuscular Fat of the Tongue Evaluated With MRI Predict Malnutrition in People Living With Dementia: A 5-Year Follow-up Study
Authors: Borda Miguel G , Bani Hassan Ebrahim , Weon Jang Ho , Wakabayashi Hidetaka , Tovar-Rios Diego A , Oppedal Ketil , Aarsland Dag , Duque Gustavo
Published: August 2021

Malnutrition is highly prevalent in older persons with dementia. Therefore, strong predictors of malnutrition in this population are crucial to initiating early interventions. This study evaluates the association between the probability of having malnutrition with the muscle volume and intramuscular fat (iMAT) of the masseter and the tongue in magnetic resonance imaging (MRI) of community-dwelling older persons diagnosed with mild dementia followed up for 5 years. This is a longitudinal study conducted in the western part of Norway. Muscle volume and iMAT of the tongue and masseter were computed from structural head MRI obtained from 65 participants of the Dementia Study of Western Norway using Slice-O-Matic software for segmentation. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition Index. Linear mixed models were conducted. Having malnutrition at baseline was associated with lower muscle volume (odds ratio [OR] 0.60, standard error [SE] 0.20; p = .010) and higher iMAT (OR 3.31, SE 0.46; p = .010) in the tongue. At 5 years follow-up, those with lower muscle volume (OR 0.55, SE 0.20; p = .002) and higher iMAT (OR 2.52, SE 0.40; p = .022) in the tongue had a higher probability of presenting malnutrition. The masseter iMAT and volume were not associated with malnutrition in any of the adjusted models. In people diagnosed with mild dementia, tongue muscle volume and iMAT were associated with baseline malnutrition and the probability of developing malnutrition in a 5-year trajectory. In the masseter, there were no significant associations after adjustments.
Rich and Balanced Experiences of Daily Emotions Are Associated With Activity Diversity Across Adulthood
Authors: Lee Soomi , Urban-Wojcik Emily J , Charles Susan T , Almeida David M
Published: August 2021

Objectives

Studies demonstrate the association between diverse emotions and health. However, we know little about how these emotions are related to activities in daily life. This study examined whether the diversity of daily activities (“activity diversity”) is associated with the diversity of both positive and negative daily emotions (“emodiversity”) in adulthood. We also examined if these associations differed by age.

Method

2 separate samples of participants from the Midlife in the United States Study II (M2: 2004–2009, n = 2,012, Mage = 56 years) and Refresher (MR: 2012–2016, n = 779, Mage = 47 years) provided activity and emotion data for 8 consecutive days. Using Shannon’s entropy, we constructed activity diversity and emodiversity (positive, negative) scores. Analyses adjusted for sociodemographic and health characteristics, total activity time, mean positive/negative emotions, and number of days with positive/negative emotion data.

Results

Greater activity diversity was associated with greater positive emodiversity and greater negative emodiversity in both samples. In the M2 sample, the association between activity diversity and positive emodiversity was stronger among relatively younger adults, such that the positive association among those aged 33–44 years was greater than that observed among those aged 68–84 years. Results held after adjusting for time spent in each of the activities or when using different emodiversity metrics (Gini or Simpson coefficients).

Discussion

Broad and even participation of daily activities may provide more opportunities to experience rich and balanced emotions. Findings suggest that the association between activity diversity and emodiversity exists across adulthood, underscoring the value of including information about daily activities when examining emotional experiences across the life span.
Transcriptional downregulation of FAM3C/ILEI in the Alzheimer’s brain
Authors: Watanabe Naoki , Nakano Masaki , Mitsuishi Yachiyo , Hara Norikazu , Mano Tatsuo , Iwata Atsushi , Murayama Shigeo , Suzuki Toshiharu , Ikeuchi Takeshi , Nishimura Masaki
Published: August 2021

Amyloid-β (Aβ) accumulation in the brain triggers the pathogenic cascade for Alzheimer’s disease (AD) development. The secretory protein FAM3C (also named ILEI) is a candidate for an endogenous suppressor of Aβ production. In this study, we found that FAM3C expression was transcriptionally downregulated in the AD brain. To determine the transcriptional mechanism of the human FAM3C gene, we delineated the minimal 5′-flanking sequence required for basal promoter activity. From a database search for DNA-binding motifs, expression analysis using cultured cells, and promoter DNA-binding assays, we identified SP1 and EBF1 as candidate basal transcription factors for FAM3C, and found that SMAD1 was a putative inducible transcription factor and KLF6 was a transcription repressor for FAM3C. Genomic deletion of the basal promoter sequence from HEK293 and Neuro-2a cells markedly reduced endogenous expression of FAM3C and abrogated SP1- or EBF1-mediated induction of FAM3C. Nuclear protein extracts from AD brains contained lower levels of SP1 and EBF1 than did those from control brains, although the relative mRNA levels of these factors did not differ significantly between the groups. Additionally, the ability of nuclear SP1 and EBF1 in AD brains to bind with the basal promoter sequence-containing DNA probe was reduced compared with the binding ability of these factors in control brains. Thus, the transcriptional downregulation of FAM3C in the AD brain is attributable to the reduced nuclear levels and genomic DNA binding of SP1 and EBF1. An expressional decline in FAM3C may be a risk factor for Aβ accumulation and eventually AD development.
Active Learning and Interpersonal Skills Development among First-Generation College Students
Authors: Acevedo Emily , Lazar Alexandra J
Published: August 2021

Scholars have detailed the benefits of active learning, particularly the impact that simulations can have on promoting engagement and evaluative thinking. Scholars have discussed the positive effects of active learning on first-generation college students, but there is minimal research on how simulations contribute to developing interpersonal skills, especially among first-generation college students. Interpersonal skills, often referred to as soft skills, are challenging to quantify since they focus on how individuals relate and interact with others. These skills include oral and written communication, teamwork, confidence, and leadership skills. This article examines whether stimulations taught within an active learning environment contributed to developing interpersonal skills among first-generation college students. In a retrospective survey administered at a single campus, our findings suggest that active learning contributes to the building of cultural capital for first-generation college students and also contributes developing interpersonal skills for both first-generation and second-generation college students.
Population pharmacokinetics of vancomycin in paediatric patients with febrile neutropenia and augmented renal clearance: development of new dosing recommendations
Authors: Shimamoto Yuko , Verstegen Ruud H J , Mizuno Tomoyuki , Schechter Tal , Allen Upton , Ito Shinya
Published: August 2021

Objectives

The purpose of this study was to evaluate the influence of augmented renal clearance (ARC) on vancomycin clearance and provide dosage recommendations for paediatric patients with febrile neutropenia following HSCT.

Methods

A population pharmacokinetic analysis was performed based on a two-compartment model structure using a non-linear mixed-effect modelling approach. Monte Carlo simulations were conducted as a target attainment analysis of AUC between 400 mg·h/L and 650 mg·h/L for MRSA at an MIC of 1 mg/L.

Results

A total of 165 paediatric patients and 276 vancomycin serum concentrations were analysed in this study. Age, body weight, estimated glomerular filtration rate (eGFR) and fever (≥38.0°C) were identified as factors that significantly influenced vancomycin clearance. The median eGFR of the population was 143 mL/min/1.73 m2 and 34% of patients showed an eGFR ≥160 mL/min/1.73 m2, which may be classified as ARC. Our simulations showed that current dosing recommendations result in poor target attainment. In particular, children aged 6 months old to 6 years old with ARC require an initial vancomycin dose up to 35%–65% higher than the current dosing guidelines.

Conclusions

ARC is frequently observed in paediatric patients with post-HSCT febrile neutropenia, resulting in a significant increase in vancomycin clearance. We propose a vancomycin dosing strategy for children with febrile neutropenia following HSCT based on eGFR, age, weight and body temperature.
The ecosystem of apps and software integrated with certified health information technology
Authors: Barker Wesley , Johnson Christian
Published: August 2021

Objective

This study: 1) characterized the app market by EHR app gallery and type of app; 2) tracked changes in the EHR app galleries from the end of 2019 through 2020; and 3) examined how apps connect to EHR data systems, and if the apps support the HL7 FHIR standard.

Materials and Methods

We developed a program that gathered data from the public app galleries hosted by Allscripts, athenahealth, Cerner Corporation, Epic Systems Corporation, and SMART. Data collection for this study began in December 2019 and ended December 2020. The program was run 11 times during this period, and the data collected were used to generate the findings and trends observed in this study.

Results

The total number of unique apps increased from 600 to 734 during the study period. The most common types of apps marketed were intended for administrative (42%) and clinical use (38%). About 1 in 5 apps (22%) described support for the FHIR standard. Support for FHIR varied by intended functionality and gallery.

Discussion

This study provides early insights into the number of third-party apps that are connecting to EHRs, what services they provide, and if these connections use standards-based application programming interfaces (APIs).

Conclusion

It is a federal government priority to improve the access and use of electronic health information, including third-party apps that can introduce competition as well as best-of-breed functions and user experiences. This study shows that there is room for growth, and variation exists among some of the largest EHR developers.
Five-year pediatric use of a digital wearable fitness device: lessons from a pilot case study
Authors: Butte Kimayani D , Bahmani Amir , Butte Atul J , Li Xiao , Snyder Michael P
Published: August 2021

Objectives

Wearable fitness devices are increasingly being used by the general population, with many new applications being proposed for healthy adults as well as for adults with chronic diseases. Fewer, if any, studies of these devices have been conducted in healthy adolescents and teenagers, especially over a long period of time. The goal of this work was to document the successes and challenges involved in 5 years of a wearable fitness device use in a pediatric case study.

Materials and methods

Comparison of 5 years of step counts and minutes asleep from a teenaged girl and her father.

Results

At 60 months, this may be the longest reported pediatric study involving a wearable fitness device, and the first simultaneously involving a parent and a child. We find step counts to be significantly higher for both the adult and teen on school/work days, along with less sleep. The teen walked significantly less towards the end of the 5-year study. Surprisingly, many of the adult’s and teen’s sleeping and step counts were correlated, possibly due to coordinated behaviors.

Discussion

We end with several recommendations for pediatricians and device manufacturers, including the need for constant adjustments of stride length and calorie counts as teens are growing.

Conclusion

With periodic adjustments for growth, this pilot study shows these devices can be used for more accurate and consistent measurements in adolescents and teenagers over longer periods of time, to potentially promote healthy behaviors.
Identification of N-linked Glycoproteins in Silkworm Serum Using Con A Lectin Affinity Chromatography and Mass Spectrometry
Authors: Dong Zhaoming , Ye Lin , Zhang Yan , Chen Zhiyong , Li Benchi , Zhang Tao , Zhao Ping
Published: August 2021

Glycosylation is one of the most common post-translational modifications to occur during protein biosynthesis, but remains poorly understood in insects. In this study, we collected serum proteins from two silkworm developmental stages, namely day 7 of the fifth instar larval stage and day 2 of the pupal stage. Results of SDS–PAGE and periodic acid-Schiff staining revealed that most serum proteins with high abundance were putative glycoproteins. LC-MS/MS identified 149 larval and 303 pupal serum proteins in the Con A lectin-enriched fractions. GO analysis revealed that many serum proteins were involved in the proteolysis and carbohydrate metabolic process. 82 N-linked glycoproteins with at least one glycosylation site were identified. N-Linked glycosylation occurred at the sequon, Asn-X-Ser/Thr, and the proportions of Ser and Thr glycosylation at the hydroxy position were found 39.6% and 60.3%, respectively. The N-glycan structures found in serum glycoproteins were mainly Man2FucGlcNAc2 (67.9%). Since storage protein 1 and transferrin had a relatively high abundance in the serum and could be significantly enriched by Con A lectin, their glycosylation was analyzed in detail. Glycoside hydrases, serine proteases and serpins were found to form three interacting glycoprotein networks using the website STRING. This study provides important clues for the understanding of the function of N-linked glycosylation in metabolism, immunity, and metamorphosis.
Current status of medical oncology in Japan and changes over the most recent 7-year period: results of a questionnaire sent to designated cancer care hospitals
Authors: Arai Makoto , Ohno Izumi , Takahashi Koji , Fan Meng Meng , Tawada Akinobu , Ishioka Chikashi , Takiguchi Yuichi
Published: August 2021

Background

According to a questionnaire sent to Designated Cancer Care Hospitals in Japan in 2013, only 39.4% of the institutes had medical oncology departments. Furthermore, most of these medical oncology departments were primarily responsible for the treatment of limited disease categories and the administration of newly developed therapeutic modalities, including molecular-targeted therapy. The aim of the present study was to update these previous findings and to clarify the changes over the intervening 7-year period.

Methods

The questionnaire was sent to all 393 Designated Cancer Care Hospitals on 13 March 2020. Similar to the previous questionnaires, questions were asked regarding the presence of a medical oncology department, the number of physicians in the department and the degrees of responsibility for drug therapies provided by medical oncologists to adult patients with solid cancers.

Results

In total, 270 institutions (68.7%) responded. Overall, 145 of these 270 institutions (53.7%) had medical oncology departments, representing a significant increase compared with the results of the previous study (P < 0.01). Among the institutions with a medical oncology department, these departments were responsible for the administration of over 30% of all cytotoxic and molecular-targeted drug therapies for extragonadal germ cell tumors, cancers of unknown primary site, soft tissues, head and neck, esophagus, stomach, colon and rectum, and pancreas as well as the administration of immune checkpoint inhibitors (ICI) for microsatellite instability-high tumors, cancers of the stomach, esophagus and head and neck, and melanoma.

Conclusion

The proportion of institutes with medical oncology departments in Japan has increased. In addition, the responsibility of medical oncology departments has expanded to include newly emerging drugs, such as ICIs.
Frameless immobilization system with roll correction for stereotactic radiosurgery of intracranial brain metastases
Authors: Park So-Yeon , Choi Noorie , Jang Na Young
Published: August 2021

The objectives of this study were to develop a frameless immobilization system that allows roll rotation corrections and to investigate the performance of this system for stereotactic radiosurgery (SRS) treatment. We designed the support frame of a frameless immobilization system based on the commercial Brainlab immobilization system. The support frame consisted of a fixed component and a rotating component. With rack and pinion gears and guide holes installed in the system, the rotating component was configured to be rotated along the longitudinal axis of the patient with respect to the fixed component. To evaluate the performance of the system, the six degree-of-freedom (6D) positioning corrections (translational and rotational corrections) were assessed by image verification between planning computed tomography (CT) and cone-beam computed tomography (CBCT) images. The commercial immobilization system was evaluated in the same manner for comparison. The mean translational shifts for the commercial system were 0.68 ± 0.19 mm, 0.73 ± 0.24 mm and 0.78 ± 0.19 mm, while those for the developed system were 0.44 ± 0.31 mm, 0.43 ± 0.25 mm and 0.60 ± 0.14 mm in the lateral, longitudinal and vertical directions, respectively. The mean rotational shifts for the commercial system were 0.37° ± 0.12°, 0.32° ± 0.16° and 0.38° ± 0.14°, while those for the developed system were 0.04° ± 0.04°, 0.11° ± 0.06° and 0.15° ± 0.12° along the lateral, vertical and longitudinal axes of the patient, respectively. For institutions that do not have 6D robotic couches installed, the use of the developed immobilization system can provide 6D corrections, resulting in shorter treatment times and higher patient positioning accuracy.
Post-Traumatic Growth Interventions
Authors: Roepke Ann Marie , Zikopoulos Areti , Forgeard Marie
Published: August 2021

Individuals who live through adverse experiences such as natural disasters, abuse, combat, and chronic illness have the potential to develop post-traumatic stress symptoms, which have been the target of various therapeutic interventions. This chapter provides an overview of what is known about interventions to promote post-traumatic growth, the limitations of existing studies, and an outline for future research on how such interventions can be successfully designed and evaluated. This chapter also highlights the utility of interventions that promote post-traumatic growth following adversity and how this relates to shaping the cultural narrative that surrounds growth following adversity, challenge, or failure.
Labels and Language Related to Sexual Assault
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

Professionals need to critically consider the language they use when working with survivors of sexual assault because it can convey they are empathic helpers or, conversely, may inadvertently alienate survivors. This chapter discusses the inconsistencies in definitions within the literature, the importance of clarifying how others use terms, the significance of particular words (e.g., survivor vs. victim), the role of the survivor’s conceptualization of the incident(s), and the influence of sociocultural factors on our understanding of sexual violence. Professionals need to recognize that people’s knowledge and use of particular words and definitions will vary widely and that beliefs engrained in our society (e.g., gender roles, masculinity) create barriers to care for many survivors. Ultimately, intentional work focused on the language that professionals use is fundamental to providing survivor-centered support because it serves as an indicator of nonjudgmental and affirming services.
Case Example 1
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

Addressing disclosures of sexual assault in an empathic manner while being efficient with time is a crucial assessment skill for clinicians to develop. This chapter provides a case example of an intake evaluation with a survivor of sexual assault. The authors provide recommendations for handling discrepancies in reporting across measures, limiting the level of detail obtained during an assessment, using the client’s language to describe the experience, discussing social reactions to disclosures, and presenting case conceptualizations that link the client’s sexual assault to their current mental health symptoms. The importance of these recommendations is discussed along with the case example.
Case Example 3
Authors: Newins Amie R. , Wilson Laura C.
Published: August 2021

Exposure therapy is one of the treatment strategies identified as being effective in treating posttraumatic stress disorder. However, conducting exposure therapy with a survivor of sexual assault requires clinicians to be skilled in how to conduct imaginal exposure to ensure that the survivor includes sufficient detail for the exposure to be effective. This chapter contains a case example in which a clinician works with a client to begin imaginal exposure therapy for posttraumatic stress disorder secondary to a sexual assault. This chapter provides recommendations to help clinicians elicit more details about the sexual assault and encourage the client to use sexual terminology while recounting their memory of the traumatic event.
Relationships of pelagic ciliates with the microbial food web components at a coastal station in the oligotrophic Eastern Mediterranean Sea: temporal and vertical variability
Authors: Romano Filomena , Pitta Paraskevi
Published: August 2021

The annual/temporal and vertical dynamics of the microbial food web (MFW) was studied in a coastal station of the oligotrophic Eastern Mediterranean Sea. The present study analyzed the changes of all components of the MFW with a specific focus on the relationships between different size classes of heterotrophic and mixotrophic ciliates with their potential prey. The MFW was dominated by heterotrophic picoplankton in all months and depths analyzed, whereas autotrophic nanoplankton took advantage in cold months with higher nutrient availability. On the other hand, mixotrophic microplankton biomass was higher in summer when nutrients and chlorophyll-a were scarce.

As part of the mixotrophic biomass, mixotrophic ciliates were correlated with their “potential” prey at the surface and deep chlorophyll maximum. Large mixotrophic ciliates (L. strobila) were more selective in terms of potential prey, showing a correlation with Synechococcus. On the other hand, mixotrophic nanociliates (Strombidium dalum) were correlated differently with different potential prey according to depth, supporting the idea that nanociliates could be more generalists in terms of prey selection. Because the relationships between mixotrophic ciliates and their potential prey are still poorly studied, this work represents the start for further investigation.
Determinants of Global Value Chain Participation: Cross-Country Evidence
Authors: Fernandes Ana Margarida , Kee Hiau Looi , Winkler Deborah
Published: August 2021

The past decades have witnessed big changes in international trade with the rise of global value chains (GVCs). Some countries, such as China, Poland, and Vietnam rode the tide, while other countries, many in the Africa region, faltered. This paper studies the determinants of countries’ GVC participation, based on a panel database of more than 100 countries from 1990 to 2015. Results from a three-pronged empirical approach show that factor endowments, geography, political stability, liberal trade policies, foreign direct investment and domestic industrial capacity are very important in determining GVC participation. These factors matter more for GVC trade than traditional trade.
Peripheral Arterial Lines in Extremely Preterm Neonates
Authors: Mense Lars , Rose Stephanie , Bruck Antje , Rüdiger Mario , Kaufmann Maxi , Seipolt Barbara
Published: August 2021

Background:

Arterial catheterization is a routine procedure in extremely preterm neonates. Umbilical arterial catheters (UACs) are typically used for this purpose, but life-threatening complications have been described. Peripheral arterial lines (PALs) might offer a valuable alternative, but their feasibility in extremely preterm newborns is unclear.

Purpose:

To investigate efficacy and complications of PALs in extremely preterm neonates.

Methods:

Retrospective analysis of patients born below 26 weeks of gestation in 2011-2014 (cohort 1, UAC as primary arterial access) and 2015-2019 (cohort 2, PAL as primary arterial access). Arterial line placement during their first 14 days of life, duration of arterial access, reasons for discontinuation, and long-term complications were recorded from health records.

Results:

In total, 161 of 202 newborns had an arterial line during their first 14 days of life. In cohort 2, the life span of a PAL was significantly longer than that in cohort 1. Signs of dysfunction were the primary reason to discontinue a PAL. Signs of peripheral ischemia were present in 36 of 105 cases (34%) when the PAL was removed but persisted in only 2 patients. UAC-associated persistent ischemic damage occurred in 2 of 97 patients.

Implications for Practice and Research:

PALs are a valuable alternative to UACs even in preterm newborns below 26 weeks of gestational age. A special focus on ischemic complications is warranted. Prospective, multicenter studies to verify safety and efficacy of arterial line management and complications in extremely preterm infants are warranted.
Performing Multiple Posterior Spinal Fusions in 1 Day: A Comparison of Perioperative Outcomes Between Morning and Afternoon Cases
Authors: O’Neill Nora P. , Hedequist Daniel J. , Glotzbecker Michael , Cook Danielle , Yang Troy , McCann Mary E. , Chacko Sabeena , Cravero Joseph , Hresko Michael Timothy
Published: August 2021

Background:

High-volume centers for idiopathic scoliosis (IS) have difficulty in scheduling posterior spinal fusions (PSFs) due to operating room availability, particularly during school vacation. A solution is for 1 surgeon to perform 2 PSF cases back-to-back. This study aims to compare morning and afternoon PSF cases performed by the same surgeon for perioperative outcomes.

Methods:

A retrospective review of PSF cases for IS that occurred on the same day as another PSF by the same surgeon between January 2013 and December 2019 was conducted. Perioperative outcomes included surgical time, estimated blood loss, length of stay, and inpatient opioid consumption normalized by the patient’s weight. Postoperative outcomes included complications, revision rate, curve correction, and patient-reported outcomes using the Scoliosis Research Society-30.

Results:

A total of 95 patients (87% female), mean age 15.6 years, were analyzed, with 48 morning cases and 47 afternoon cases. The median follow-up was 1.9 years (range: 0.3 to 6.1 y). Tests for equivalency determined equivalence in median anesthesia and mean surgical duration (P=0.05). The groups had similar initial curve correction (P=0.43) and rate of complications at 90 days postoperative (2 in each group for a total of 4 complications). No significant differences were seen between Scoliosis Research Society-30 scores at 6 months or in those who have reached 2 years postoperative.

Conclusions:

Little literature exists on the safety of a surgeon performing 2 PSF cases in 1 day, particularly in regard to pain outcomes, 30- and 90-day complication rates, and quality of life measures. This study indicates that few differences in safety, pain, and quality of life outcomes may appear between morning and afternoon PSF cases.

Level of Evidence:

Level II.
Inhibition of human lung cancer cells by anti-p21Ras scFv mediated by the activatable cell-penetrating peptide
Authors: Du Yu , Lin Xinrui , Feng Qiang , Pan Xinyan , Song Shuling , Yang Julun
Published: August 2021

Activatable cell-penetrating peptide (ACPP) is a tumour-targeting cell-penetrating peptide. Here, we used ACPP to carry anti-p21Ras scFv for Ras-driven cancer therapy. The ACPP-p21Ras scFv fusion protein was prepared by a prokaryotic expression system and Ni-NTA column purification. The human tumour cell lines A549, SW480, U251 and Huh7 and the normal cell line BEAS 2B were used to study the tumor-targeting and membrane-penetrating ability of ACPP-p21Ras scFv. The antitumour activity of ACPP-p21Ras scFv on A549 cells and H1299 cells in vitro was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide, scratch wound healing, plate cloning and apoptosis assays. The penetration pathway of ACPP was determined by enhanced green fluorescent protein. The ACPP-p21Ras scFv fusion protein was successfully obtained at a concentration of 1.8 mg/ml. We found that ACPP-p21Ras scFv could penetrate tumour cell membranes with high expression of matrix metalloproteinase-2 (MMP-2), effectively inhibit the migration and proliferation of A549 cells and H1299 cells, and promote the apoptosis of A549 cells and H1299 cells. The membrane penetration experiment demonstrated that ACPP could enter A549 cells by direct penetration. The ability of ACPP to penetrate the membrane was affected by the addition of a membrane affinity inhibitor and a change in the potential difference across the cell membrane but not by the addition of endocytosis inhibitors and a change in temperature. The ACPP-p21Ras scFv fusion protein can penetrate tumour cells with MMP-2 expression and has antitumour activity against A549 cells and H1299 cells in vitro. This molecule is expected to become a potential antitumour drug for Ras gene-driven lung cancer.
Time-Dissociated Pharmacokinetic Pharmacodynamic Model of Cyclosporine Among Malaysian Renal Transplant Recipients
Authors: Albitar Orwa , Harun Sabariah Noor , Ballouze Rama , Mohamed Noor Dzul Azri , Sheikh Ghadzi Siti Maisharah
Published: August 2021

Background:

Cyclosporine is an essential component of many immunosuppressive regimens. However, its pharmacokinetic and pharmacodynamic (PKPD) modeling has not been widely investigated. This study aims to develop a time-dissociated PKPD model of cyclosporine in renal transplant patients.

Methods:

Medical records of renal transplant patients at Penang General Hospital were retrospectively analyzed. A time-dissociated PKPD model with covariate effects was developed using NONMEM to evaluate renal graft function response, quantified as estimated glomerular filtration rate (eGFR), toward the cyclosporine cumulative exposure (area under the concentration–time curve). The final model was integrated into a tool to predict the potential outcome. Individual eGFR predictions were evaluated based on the clinical response recorded as acute rejection/nephrotoxicity events.

Results:

A total of 1256 eGFR readings with 2473 drug concentrations were obtained from 107 renal transplant patients receiving cyclosporine. An Emax drug effect with a linear drug toxicity model best described the data. The baseline renal graft level (E0), maximum effect (Emax), area under the concentration–time curve achieving 50% of the maximum effect, and nephrotoxicity slope were estimated as 12.9 mL·min−1·1.73 m−2, 50.7 mL·min−1·1.73 m−2, 1740 ng·h·mL−1, and 0.00033, respectively. The hemoglobin level was identified as a significant covariate affecting the E0. The model discerned acute rejection from nephrotoxicity in 19/24 cases.

Conclusions:

A time-dissociated PKPD model successfully described a large number of observations and was used to develop an online tool to predict renal graft response. This may help discern early rejection from nephrotoxicity, especially for patients unwilling to undergo a biopsy or those waiting for biopsy results.
Lessons Learned From 2 Large Community-based Glaucoma Screening Studies
Authors: Kolomeyer Natasha N. , Katz Leslie J. , Hark Lisa A. , Wahl Madison , Gajwani Prateek , Aziz Kanza , Myers Jonathan S. , Friedman David S.
Published: August 2021

Community-based screening programs have had limited success in preventing vision loss from glaucoma due to overall low prevalence of glaucoma, screening limitations, and barriers to follow-up appointments. This editorial highlights lessons learned from 2 large prospective trials: the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study and the Screening To Prevent Glaucoma Study. While some lessons are specific to ophthalmology, many lessons are applicable to screening for asymptomatic diseases in underserved, vulnerable communities.
Toward Standardization of the Placement Process Used in Full-Time Clinical Education Experiences: Findings and Recommendations of the Placement Process Task Force
Authors: Rindflesch Aaron , Flom-Meland Cindy , McCallum Christine , Prescher Kelly , Reynolds Emily , Scardillo Janette , Gusman Lori Nolan , Maes Kristel , Cohoon Christie , Cookinham Brittani , Ellerbe Redd Terri
Published: August 2021

Background and Purpose.

The Placement Process Task Force (PPTF), a combined effort of the Clinical Education Special Interest Group and the National Consortium of Clinical Educators, has developed recommendations for the placement process of students in full-time clinical education experiences following data collection from stakeholders. The PPTF submitted a report to both boards and highlights its methods and rationale for the recommendations here.

Position and Rationale.

To reduce variability and administrative burden shared among stakeholders, there should be a common definition of the process. Additionally, a common clinical calendar should be developed and adopted with accepted deadlines for placement requests, offer acceptance, offer release, student assignment, and onboarding requirements. Training should be required for new directors of clinical education (DCEs) and site coordinators of clinical education (SCCEs) to initiate them to the common calendar. Only the DCE/ACCE or employed members of the DCE/ACCE team should be responsible for securing clinical education placement offers. Adoption of these recommendations will allow progress toward the goal of reducing administrative burden with the potential of creating opportunities for DCEs and SCCEs to participate in the advancement of clinical education development and scholarship.

Discussion and Conclusion.

The current variability of placement processes commonly used in full-time clinical education has negative effects on SCCEs and clinics, DCEs and academic programs, and students. Reducing variability and administrative burden can result in additional productivity of stakeholders for tasks, such as clinical instructor development, student development, and clinical education research.
The utility and complications of plasma administration in cirrhotic patients undergoing minimally invasive procedures
Authors: Diaz Kelly E. , Tremblay Douglas , Ozturk Begum , Ezaz Ghideon , Arinsburg Suzanne , Jhang Jeffrey , Schiano Thomas D.
Published: August 2021

Patients with cirrhosis have coagulopathy often necessitating correction with blood products, such as plasma products (fresh frozen plasma and plasma frozen within 24 h) prior to certain invasive procedures. However, plasma administration has the potential for substantial negative adverse effects such as volume overload, transfusion-related lung injury and allergic/anaphylactic reactions. In addition, its effectiveness in preventing bleeding is similarly unclear. The purpose of this study was to determine the safety and efficacy of plasma administration in cirrhotic patients undergoing minimally invasive procedures, specifically vascular access placement, transjugular liver biopsies, renal biopsies and thoracenteses. In this retrospective cohort study, we identified patients receiving plasma products in preparation for an invasive procedure, with the primary outcomes of volume overload and bleeding. Of the 145 transfusion events that met the criteria from 2015 to 2018, the median INR decreased from 2.7 to 2.2 pre and post plasma administration and 13.8% of recipients had complications of volume overload. The cost of acquisition of plasma administered below clinically impactful doses accumulates to an estimated 19 000 dollars over this time period, not including nursing preparation or production costs. Plasma products minimally, if at all, improved laboratory values of coagulation and in some patients led to adverse effects.