bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of open and minimally invasive approaches to colon cancer resection in compliance with 12 regional lymph node harvest quality measure
Authors: Williams Austin D. , Sun Tian , Kakade Sumedh , Wong Sandra L. , Shulman Lawrence N. , Carp Ned Z.
Published: February 2021

Background

There has been a growing trend toward minimally invasive surgery (MIS) for colon cancer. Pathological analysis of a minimum of 12 lymph nodes (LNs) is a benchmark for adequate resection. Here, we present a comparison of surgical techniques in achieving a full oncologic resection.

Methods

Patients undergoing surgery for Stage I–III colon cancer (2010–2016) were identified from the National Cancer Database. Cases were stratified by surgical approach. Trends in approach were assessed, including whether the 12‐LN benchmark was met. Uni‐ and multivariate regression was used to assess overall survival (OS).

Results

A total of 290,776 colectomies were analyzed. MIS increased from 32.8% to 57.2% from 2010 to 2016 (p < .001). An overall median of 18 LNs were harvested and compliance with the 12‐LN benchmark increased (84.6%–91.6%, p < .001); there were no difference between open and MIS. A subset analysis comparing hospital type revealed that regardless of approach, compliance was lower at community hospitals (p < .001). OS was better for patients treated at academic or National Cancer Institute centers, underwent MIS, and in those meeting the 12‐LN benchmark (all p ≤ .002).

Conclusion

As MIS colon resections continue to increase, we demonstrate that there is no difference in the ability to achieve the 12‐LN benchmark with open and MIS approaches.
An accurate, rapid, and sensitive method for simultaneous determination of four typical heterocyclic amines in roasted pork patties: Application in the study of inhibitory effects of astaxanthin
Authors: Yan Xiao‐ting , Zhang Yuan , Yang Min‐li , Feng Xue‐song , Zhang Feng
Published: February 2021

Heterocyclic aromatic amines, as a group of mutagenic and carcinogenic compounds, have gained worldwide concern. In this study, an accurate, rapid, and sensitive confirmation and quantification method of four major heterocyclic aromatic amines in roasted pork was developed based on Q‐Orbitrap along with Quick, Easy, Cheap, Effective, Rugged, and Safe extraction. The limit of detections and limit of quantitations were found to be 0.2–1.2 μg/kg and 0.6–3.5 μg/kg, respectively, revealing the high sensitivity of this method. Obtained results showed recoveries ranging from 78.1 to 97.4%, depending on the different heterocyclic aromatic amines and spiked levels. Precision was in the range of 2.6–4.5% for four heterocyclic aromatic amines at different levels. In addition, the developed method had been applied to investigate the inhibitory effects of astaxanthin on the above‐mentioned heterocyclic aromatic amines in roasted pork. The amount of astaxanthin with the best inhibitory effects was 7.5 mg (0.0375%), which led to significant reduction in heterocyclic aromatic amines levels over 50%.
Characterization of Focal Liver Masses: A Multicenter Comparison of Contrast‐Enhanced Ultrasound, Computed Tomography, and Magnetic Resonance Imaging
Authors: Burrowes David P. , Medellin Alexandra , Harris Allison C. , Milot Laurent , Lethebe Brendan C. , Wilson Stephanie R.
Published: February 2021

Objectives

To demonstrate the usefulness of contrast‐enhanced ultrasound (CEUS) for the evaluation of focal liver masses via a direct comparison to standard ultrasound and computed tomography/magnetic resonance imaging (CT/MRI).

Methods

A cohort of 214 patients with previously undiagnosed focal liver masses were included from 5 different centers. Each patient was imaged using CEUS and CT and/or MRI. Anonymized and randomized images were interpreted by 4 separate blind readers from 3 of the participating centers (2 readers for CEUS and 2 readers for CT/MRI). Readers were blinded to patient demographics and past medical history. Readers were asked to decide if the lesion was benign or malignant, provide a final diagnosis for the lesion, and provide a confidence interval. Results were compared to truth standard from pathology or expert consensus.

Results

In determination of malignancy, CEUS had a sensitivity of 95%, specificity of 82%, PPV of 82%, NPV of 95%, statistically better than standard ultrasound (sensitivity 82%, specificity 56%, PPV 60%, NPV 78%) with P < .01 and not statistically different from CT (sensitivity 90%, specificity 73% PPV 81%, NPV 86%) or MRI (sensitivity 85%, specificity 79%, PPV 68%, NPV 91%) with P ≥ .01. In assigning a final diagnosis, CEUS had an accuracy of 78% statistically better than standard ultrasound (46%) with P < .01 and not statistically different from CT (68%) or MRI (71%) with P > .01.

Conclusions

In the evaluation of focal liver lesions, both for determination of malignancy and in accuracy of final diagnosis, CEUS performs better than standard ultrasound and at least equivalent to both CT and MRI.
Cricopharyngeal Myotomy in Inclusion Body Myositis: Comparison of Endoscopic and Transcervical Approaches
Authors: McMillan Ryan A. , Bowen Andrew J. , Bayan Semirra L. , Kasperbauer Jan L. , Ekbom Dale C.
Published: February 2021

Objective

Inclusion body myositis (IBM) is a progressive inflammatory myopathy with dysphagia as a debilitating sequalae. Otolaryngologists are consulted for surgical candidacy when there are findings of cricopharyngeal dysfunction. We aim to compare transcervical cricopharyngeal myotomy (TCPM) versus endoscopic cricopharyngeal myotomy (ECPM) in the IBM population with particular focus on objective swallow study outcomes, complications, and recurrence rates.

Methods

A retrospective cohort study was performed on IBM patients who underwent TCPM or ECPM (1981–2020) in the Department of Otolaryngology at a tertiary academic center with a high volume IBM referral base. Videofluoroscopic swallow studies, Eating Assessment Tool (EAT‐10), Reflux Symptom Index (RSI), and Functional Outcome Swallowing Scale (FOSS) were collected at preoperative and follow‐up visits. Baseline patient characteristics, intraoperative data, and postoperative course were recorded.

Results

Forty‐one patients were identified (18 TCPM; 23 ECPM). There was no significant difference in the recurrence rates, complications, hospitalization length, operative time, or return to preoperative diet between approaches. For the 12 patients (11 ECPM; 1 TCPM) that had subjective swallow data, there was a statistically significant difference in the pre and postoperative scores for EAT‐10, RSI, and FOSS (P < .05). There was a statistically significant improvement in the degree of narrowing between pre and postoperative imaging for both approaches (P < .05).

Conclusion

Both TCPM and ECPM are safe approaches for the management of dysphagia in patients with IBM with objective evidence of cricopharyngeal dysfunction. Cricopharyngeal myotomy is a durable technique that has demonstrated improved subjective and objective outcomes in this patient population.

Level of Evidence

3 Laryngoscope, 131:E2426–E2431, 2021
Spatiotemporal Terahertz Metasurfaces for Ultrafast All‐Optical Switching with Electric‐Triggered Bistability
Authors: Hu Yuze , Tong Mingyu , Xu Zhongjie , Cheng Xiangai , Jiang Tian
Published: February 2021

Optoelectronic terahertz switching achieved by dynamically tuning metamaterials is viewed as a major breakthrough in promoting the advancement of terahertz technology. However, the main thrust toward the development of ultrafast switchable components and optical logic operations is still in a catch‐up stage for progressively increasing information and communication demands. Here, a novel spatiotemporal metadevice is proposed for terahertz wave steering in multidimensional domains with ultrahigh spatial and ultrafast temporal manipulations. By spatially changing the interconnect architecture via the embedded vanadium dioxide bridges, the state of electromagnetically induced transparency resonance is switched between “1” and “0” states under electrical stimuli, exhibiting a typical 1 bit coding bistability with a long retention time. Furthermore, with the characteristic of writable/erasable logic operation, ultrafast photoswitching of each memorized state is manifested by delivering optical excitations. The high‐speed temporal response of terahertz radiation exhibits an on–off–on switching cycle within 16 ps, owing to the defect‐rich germanium photoactive layer. By leveraging both degrees of freedom in space and time domains, this multifunctional spatiotemporal metaphotonic device can upgrade and improve the current capabilities of optical computing, data storage, and ultrahigh‐speed information processing, paving the way for a highly unexplored territory toward manipulations of light.
Sustainable generation of patient‐led resources in a learning health system
Authors: David Jennie , Berenblum Tobi Catalina , Kennedy Samantha , Jofriet Alexander , Huwe Madeleine , Kelekian Rosa , Neihart Melissa , Spotts Michelle , Seid Michael , Margolis Peter ,   ImproveCareNow Pediatric IBD Learning Health System
Published: February 2021

Background

Patient and Family Advisory Councils (PFACs) are an emerging mechanism to integrate patient and family voices into healthcare. One such PFAC is the Patient Advisory Council (PAC) of the ImproveCareNow (ICN) network, a learning health system dedicated to advancing the care of individuals with pediatric inflammatory bowel disease (IBD). Using quality improvement techniques and co‐production, the PAC has made great strides in developing novel patient‐led resources.

Methods

This paper, written by patients and providers from ICN, reviews current ICN data on PAC‐generated resources, including creation processes and download statistics.

Results

Looking at different iterations of PAC infrastructure, this paper highlights specific leadership approaches used to increase patient involvement and improve resource creation. Emerging data suggests that the larger ICN learning health system has had limited interactions with these resources.

Conclusion

ICN provides a novel approach for meaningful integration of patient partners into learning health systems. This paper points to the incredible value of PFAC expertise in the resource creation process. Future work should seek to support PFAC development across other diseases and address the challenges of integrating patient‐led resources into clinical care.
Research on corrosion rate assessment of buried pipelines under dynamic metro stray current
Authors: Du Yanxia , Qin Huimin , Liu Jie , Tang Dezhi
Published: February 2021

To provide a reference for the evaluation of corrosion rate under dynamic metro stray current, both simulated experiments in laboratory and coupon tests in the field were conducted to explore the corrosion behavior and the relationship between corrosion rates and dynamic DC interference parameters of buried pipelines. The results show that the dynamic period has a significant influence on the corrosion rate and the ratio of actual corrosion rate to the theoretical corrosion rate. The statistical data of pipe to soil potentials or current densities of coupons electrically connected to pipelines obtained from the field in many cities of China show that the dynamic fluctuation periods under metro stray current are within the range of 0–300 s, among which the majority of fluctuation periods distribute from 50 to 200 s. The dynamic fluctuation of pipe to soil potentials and current densities of coupons exhibits symmetric or asymmetric characteristics. Under the situation of symmetric positive and negative current density, the ratio of the actual corrosion rate to the theoretical corrosion rate ranges from about 4% to 22% under the typical dynamic periods range from 50 to 200 s based on the simulated experiments results in the laboratory. Besides, two corrosion rate assessment methods, including the positive shifting and time ratios of off‐potentials and symmetrical or asymmetric characteristics of DC current density of coupons were proposed. In addition, the evaluation of the on‐potential criteria to assess the corrosion risk of time‐variant anodic interference was also discussed in the paper.
Don't be rude! The effect of content moderation on consumer‐brand forgiveness
Authors: Christodoulides George , Gerrath Maximilian H. E. E. , Siamagka Nikoletta T.
Published: February 2021

While it is a popular belief that venting helps unload frustrations about negative (customer) experiences, its effects on consumers' emotional states and consumer‐brand forgiveness (CBF) remain to be explored. Given that a lot of customer complaints are made online, brands seem ambivalent about managing these public complaints without violating consumers' right to free speech. In two experiments, we find that writing a customer complaint increases negative emotions regarding an incident. Moreover, brands can mitigate this negative effect by asking consumers to moderate their speech—for example, with the help of a content moderation policy. Specifically, if brands impose restrictions on consumers' freedom to express their frustrations, essentially asking them for self‐censorship, anger levels in their language decrease and CBF increases. We demonstrate that this effect is stronger for consumers with strong self‐brand connection.
Visible Light Induced Step‐Growth Polymerization by Substitution Reactions
Authors: Kiliclar Huseyin Cem , Yilmaz Gorkem , Yagci Yusuf
Published: February 2021

A new visible light induced step‐growth polymerization of dibromoxylene, and diols using dimanganese decacarbonyl and diphenyliodonium salt is described. The polymerization is suggested to proceed by substitution reaction between dixylenium cations formed upon visible light irradiation in the presence of dimanganese decacarbonyl and diphenyl iodonium salt. For the described substitution reaction with diols as nucleophilic component, the scope of the process is studied. Furthermore, the presence of halide groups at chain ends of the resulting polymers provided the possibility of initiating subsequent free radical and free radical promoted cationic resulting in the formation of polyether‐based block copolymers.
Incidence and Progression of Rapid Eye Movement Behavior Disorder in Early Parkinson's Disease
Authors: Zimansky Larissa , Muntean Maria‐Lucia , Leha Andreas , Mollenhauer Brit , Trenkwalder Claudia , Sixel‐Döring Friederike
Published: February 2021

Background

Rapid eye movement (REM) sleep behavior disorder (RBD) is associated with neurodegenerative diseases; however, few longitudinal studies assess the individual evolution of RBD and REM sleep without atonia (RWA) in Parkinson's disease (PD).

Objectives

We aimed to evaluate RBD and RWA changes over time as well as potentially influential factors.

Methods

RBD and RWA were analyzed using video‐supported polysomnography (vPSG) in initially de novo PD patients at baseline and every 2 years for a total of 6 years. The influence of time, age, sex, levodopa equivalent daily dose (LEDD), unified Parkinson's disease rating scale (UPDRS) sum scores, benzodiazepine intake, Mini‐Mental State Examination (MMSE) total scores, and dyskinesia on RWA were investigated using mixed‐effect models to account for intra‐individual correlations.

Results

After 6 years, vPSG data were available from 98 of the initial 159 de novo PD patients. RBD prevalence increased from 25% at baseline to 52%. Of the 31 PD patients with RBD and valid vPSGs at all time‐points, RWA increased from an average of 19% at baseline to 41% at 6‐year follow‐up modeled to grow by 29.7% every 2 years (P < 0.001). Time was an independent factor (P < 0.001) for RWA increase. Age was an independent factor influencing RWA increase (P = 0.04). Sex, LEDD, UPDRS sum scores, benzodiazepines, MMSE total scores, and dyskinesia did not have any significant influence.

Conclusions

RBD and RWA increased significantly over time in PD; time and age were independent factors in a prospective cohort. RBD and RWA can be considered PD progression markers.
A Self‐Reported Clinical Tool Predicts Falls in People with Parkinson's Disease
Authors: Almeida Lorena Rosa S. , Piemonte Maria Elisa Pimentel , Cavalcanti Helen M. , Canning Colleen G. , Paul Serene S.
Published: February 2021

Background

A 3‐step clinical prediction tool including falling in the previous year, freezing of gait in the past month and self‐selected gait speed <1.1 m/s has shown high accuracy in predicting falls in people with Parkinson's disease (PD). The accuracy of this tool when including only self‐report measures is yet to be determined.

Objectives

To validate the 3‐step prediction tool using only self‐report measures (3‐step self‐reported prediction tool), and to externally validate the 3‐step clinical prediction tool.

Methods

The clinical tool was used with 137 individuals with PD. Participants also answered a question about self‐reported gait speed, enabling scoring of the self‐reported tool, and were followed‐up for 6 months. An intraclass correlation coefficient (ICC2,1) was calculated to evaluate test–retest reliability of the 3‐step self‐reported prediction tool. Multivariate logistic regression models were used to evaluate the performance of both tools and their discriminative ability was determined using the area under the curve (AUC).

Results

Forty‐two participants (31%) reported ≥1 fall during follow‐up. The 3‐step self‐reported tool had an ICC2,1 of 0.991 (95% CI 0.971–0.997; P < 0.001) and AUC = 0.68; 95% CI 0.59–0.77, while the 3‐step clinical tool had an AUC = 0.69; 95% CI 0.60–0.78.

Conclusions

The 3‐step self‐reported prediction tool showed excellent test–retest reliability and was validated with acceptable accuracy in predicting falls in the next 6 months. The 3‐step clinical prediction tool was externally validated with similar accuracy. The 3‐step self‐reported prediction tool may be useful to identify people with PD at risk of falls in e/tele‐health settings.
Do professional norms in the medical industry favor outcome bias?
Authors: Fan Xiaoqian , Cao Qian , Yang Lin
Published: February 2021

This study tests the effect of doctors' professional identity on their outcome bias. We conduct a medical experiment with 264 doctors, a robustness test with 105 doctors, and a public experiment with 170 non‐doctors. The experimental results show that doctors, but not non‐doctors, exhibit more outcome bias when we exogenously render their professional identity more salient. These results indicate that professional norms in the medical industry favor outcome bias.
Differential Inhibition of LRRK2 in Parkinson's Disease Patient Blood by a G2019S Selective LRRK2 Inhibitor
Authors: Bright Jessica M. , Carlisle Holly J. , Toda Alyssa M. A. , Murphy Molly , Molitor Tyler P. , Wren Paul , Andruska Kristin M. , Liu Enchi , Barlow Carrolee
Published: February 2021

Background

A common genetic mutation that causes Parkinson's disease (PD) is the G2019S LRRK2 mutation. A precision medicine approach that selectively blocks only excess kinase activity of the mutant allele could yield a safe and effective treatment for G2019S LRRK2 PD.

Objective

To determine the activity of a G2019S mutant selective leucine‐rich repeat kinase 2 (LRRK2) kinase inhibitor as compared to a nonselective inhibitor in blood of subjects with genetic and idiopathic PD on two LRRK2 biomarkers, pSer935 LRRK2 and pThr73 Rab10.

Methods

Blood was collected from 13 subjects with or without a G2019S LRRK2 mutation with PD and one healthy control. Peripheral blood mononuclear cells were treated ex vivo with a novel G2019S LRRK2 inhibitor (EB‐42168) or the nonselective inhibitor MLi‐2. Quantitative western immunoblot analyses were performed.

Results

EB‐42168 was 100 times more selective for G2019S LRRK2 when compared to wild‐type (WT) LRRK2. Concentrations that inhibited phosphorylation of pSer935 LRRK2 by 90% in homozygous G2019S LRRK2 patients, inhibited pSer935 LRRK2 by 36% in heterozygous patients, and by only 5% in patients carrying only the WT allele. Similar selectivity was seen for pThr73 Rab10. MLi‐2 showed an equivalent level of inhibition across all genotypes.

Conclusions

These findings demonstrate that EB‐42168, a G2019S LRRK2 selective inhibitor, lowers mutant G2019S LRRK2 phosphorylated biomarkers while simultaneously sparing WT LRRK2. Selective targeting of G2019S LRRK2 with a small molecule lays the foundation for a precision medicine treatment of G2019S LRRK2 PD. © 2021 ESCAPE Bio, Inc. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Brain Damage and Gene Expression Across Hereditary Spastic Paraplegia Subtypes
Authors: Servelhere Katiane R. , Rezende Thiago Junqueira Ribeiro , de Lima Fabrício Diniz , de Brito Mariana Rabelo , de França Nunes Renan Flávio , Casseb Raphael F. , Pedroso José Luiz , Barsottini Orlando Graziani P. , Cendes Fernando , França Marcondes C.
Published: February 2021

Background

Spinal cord has been considered the main target of damage in hereditary spastic paraplegias (HSPs), but mounting evidence indicates that the brain is also affected. Despite this, little is known about the brain signature of HSPs, in particular regarding stratification for specific genetic subtypes.

Objective

We aimed to characterize cerebral and cerebellar damage in five HSP subtypes (9 SPG3A, 27 SPG4, 10 SPG7, 9 SPG8, and 29 SPG11) and to uncover the clinical and gene expression correlates.

Methods

We obtained high‐resolution brain T1 and diffusion tensor image (DTI) datasets in this cross‐sectional case–control study (n = 84). The MRICloud, FreeSurfer, and CERES‐SUIT pipelines were employed to assess cerebral gray (GM) and white matter (WM) as well as the cerebellum.

Results

Brain abnormalities were found in all but one HSP group (SPG3A), but the patterns were gene‐specific: basal ganglia, thalamic, and posterior WM involvement in SPG4; diffuse WM and cerebellar involvement in SPG7; cortical thinning at the motor cortices and pallidal atrophy in SPG8; and widespread GM, WM, and deep cerebellar nuclei damage in SPG11. Abnormal regions in SPG4 and SPG8 matched those with higher SPAST and WASHC5 expression, whereas in SPG7 and SPG11 this concordance was only noticed in the cerebellum.

Conclusions

Brain damage is a conspicuous feature of HSPs (even for pure subtypes), but the pattern of abnormalities is genotype‐specific. Correlation between brain structural damage and gene expression maps is different for autosomal dominant and recessive HSPs, pointing to distinct pathophysiological mechanisms underlying brain damage in these subgroups of the disease. © 2021 International Parkinson and Movement Disorder Society
MDMA‐assisted psychotherapy reduces PTSD symptom severity
Authors: Canady Valerie A.
Published: February 2021

Prior use of selective serotonin reuptake inhibitors (SSRIs) may reduce the effectiveness of 3,4‐methylenedioxymethamphetamine (MDMA)‐assisted therapy for post‐traumatic stress disorder (PTSD), say researchers of a recent study who noted that MDMA is close to being considered the first psychedelic drug approved to treat PTSD.
Combined double superficial circumflex iliac artery perforator flap with lymphatic tissue preservation and lymphovenous anastomosis for lymphatic sequelae prevention in thigh defect reconstruction: A case report
Authors: Scaglioni Mario F. , Meroni Matteo , Fritsche Elmar , Fuchs Bruno
Published: February 2021

The thigh region is often site of soft tissue tumors development. Leiomyosarcoma, in particular, is a malignant tumor that, if not promptly treated, presents a growth rate that often results in large masses. The safest treatment in these cases is margin‐free extensive surgical resection. This leads to rather large defects that in a delicate region, such as the medial thigh, implies a series of possible complications from the lymphatic point of view. In this region run major lymphatic vessels, appointed to drain the whole leg. Now that one is aware of this issue, the best solution is trying to obtain an efficient reconstruction and preventing the development of postoperative lymphedema and lymphocele. Here, we present a case of great saphenous vein leiomyosarcoma resection in the right medial thigh reconstructed by means of two superficial circumflex iliac artery perforator (SCIP) flaps with lymphatic tissue preservation, combined with preventive lymphovenous anastomosis (LVA). A 67‐years‐old woman presented a 22 × 16 cm soft tissue defect after the surgical excision. To fill the defect, we resorted to a larger SCIP flap island, supplied by both the superficial and deep branches of the superficial circumflex iliac artery anastomosed in perforator‐to‐perforator fashion, and to a smaller SCIP flap island supplied only by the superficial branch. Before surgery, the lymphatic vessels running in the flaps area were identified with indocyanine green lymphography and were carefully preserved during the harvest procedure. They were then transferred with the surrounding tissue and orientated in order to match the lymphatic flow direction, providing further fluid drainage. To boost the lymphatic drainage, an LVA was also performed at the superior‐edge‐of‐the‐knee incision point joining a functioning lymphatic vessel to a nearby reflux‐free vein. The postoperative course was uneventful and at 7 months follow‐up, the patient showed good cosmetic and functional outcomes with no swelling and no signs of tumor relapse. This report provides a series of technical insights and adds further evidence to support the efficacy of this procedure for management of soft tissue defects in the medial thigh region.
Semilinear stochastic partial differential equations: Central limit theorem and moderate deviations
Authors: Xiong Jie , Zhang Rangrang
Published: February 2021

In this paper, we establish a central limit theorem (CLT) and the moderate deviation principles (MDP) for a class of semilinear stochastic partial differential equations driven by multiplicative noise on a bounded domain. The main results can be applied to stochastic partial differential equations of various types such as the stochastic Burgers equation and the reaction‐diffusion equations perturbed by space‐time white noise. The Garsia lemma is crucial to our results.
Variational method for p‐Laplacian fractional differential equations with instantaneous and non‐instantaneous impulses
Authors: Qiao Yan , Chen Fangqi , An Yukun
Published: February 2021

We discuss a class of p‐Laplacian fractional differential equations with instantaneous and non‐instantaneous impulsive boundary conditions. The existence of an unbounded sequence of weak solutions is given by a recent critical point theory proposed by Bonanno and Bisci. At the end, an example is presented to illustrate our main results.
Knowledge‐based inverse treatment planning for low‐dose‐rate prostate brachytherapy
Authors: Guthier Christian V. , Orio Peter F. , Buzurovic Ivan , Cormack Robert A.
Published: February 2021

Purpose

Permanent low‐dose‐rate brachytherapy is a widely used treatment modality for managing prostate cancer. In such interventions, treatment planning can be a challenging task and requires experience and skills of the planner. We developed a novel knowledge‐based (KB) optimization method based on previous treatment plans. The purpose of this method was to generate clinically acceptable plans that do not require extensive manual adjustments in clinical scenarios.

Methods

Objective functions used in current inverse planning methods are preferably based on spatial invariant dose objectives rather than spatial dose distributions. Therefore, they are prone to return suboptimal plans resulting in time consuming plan adjustments. To overcome this limitation, a KB approach is introduced. The KB model uses the dose distributions of previous clinical plans projected onto a standardized geometry. From those standardized distributions a template plan is generated. The treatment plans were optimized with an in‐house developed planning system by solving a constraint inverse optimization problem that mimics the projected template dose plan constraint to DVH metrics. The method is benchmarked under an IRB‐approved retrospective study by comparing optimization time, dosimetric performance, and clinical acceptability against current clinical practice. The quality of the KB model is evaluated with a Turing test.

Results

The KB model consists of five high‐quality treatment plans. Those plans were selected by one of our experts and showed all desired dosimetric features. After generating the model treatment plans were created with one run of the optimizer for the remaining 20 patients. The optimization time including needle optimization ranged from 6 to 29 s. Based on a Wilcoxon signed rank test the new plans are dosimetrically equivalent to current clinical practice. The Turing test showed that the proposed method generates plans that are equivalent to current clinical practice and that the dose prediction drives the optimization to achieve high‐quality treatment plans.

Conclusions

This study demonstrated that the proposed KB model was able to capture user‐specific features in isodose lines which can be used to generate acceptable treatment plans with a single run of the optimization engine in under a minute. This could potentially reduce the time in the operating room and the time a patient is under anesthesia.
Whole‐brain functional MRI registration based on a semi‐supervised deep learning model
Authors: Zhu QiaoYun , Sun YuHang , Wu Yi , Zhu HuoBiao , Lin GuoYe , Zhou YuJia , Feng QianJin
Published: February 2021

Purpose

Traditional registration of functional magnetic resonance images (fMRI) is typically achieved through registering their coregistered structural MRI. However, it cannot achieve accurate performance in that functional units which are not necessarily located relative to anatomical structures. In addition, registration methods based on functional information focus on gray matter (GM) information but ignore the importance of white matter (WM). To overcome the limitations of exiting techniques, in this paper, we aim to register resting‐state fMRI (rs‐fMRI) based directly on rs‐fMRI data and make full use of GM and WM information to improve the registration performance.

Methods

We provide a robust representation of WM functional connectivity features using tissue‐specific patch‐based functional correlation tensors (ts‐PFCTs) as auxiliary information to assist registration. Furthermore, we propose a semi‐supervised deep learning model that uses GM and WM information (GM ts‐PFCTs and WM ts‐PFCTs) during training as a fine tweak to improve registration accuracy when such information is not provided in new test image pairs. We implement our method on the 1000 Functional Connectomes Project dataset. To evaluate our method, a group‐level analysis was implemented in resting‐state brain functional networks after registration, resulting in t maps.

Results

Our method increases the peak t values of the t maps of default mode network, visual network, central executive network, and sensorimotor network to 21.4, 20.0, 18.4, and 19.0, respectively. Through comparison with traditional methods (FMRIB Software Library(FSL), Statistical Parametric Mapping _ Echo Planar Image(SPM_EPI), and SPM_T1), our method achieves an average improvement of 67.39%, 12.96%, and 25.14%.

Conclusion

We propose a semi‐supervised deep learning network by adding GM and WM information as auxiliary information for resting‐state fMRI registration. GM and WM information is extracted and described as GM ts‐PFCTs and WM ts‐PFCTs. Experimental results show that our method achieves superior registration performance.
Magnetization‐prepared GRASP MRI for rapid 3D T1 mapping and fat/water‐separated T1 mapping
Authors: Feng Li , Liu Fang , Soultanidis Georgios , Liu Chenyu , Benkert Thomas , Block Kai Tobias , Fayad Zahi A. , Yang Yang
Published: February 2021

Purpose

This study aimed to (i) develop Magnetization‐Prepared Golden‐angle RAdial Sparse Parallel (MP‐GRASP) MRI using a stack‐of‐stars trajectory for rapid free‐breathing T1 mapping and (ii) extend MP‐GRASP to multi‐echo acquisition (MP‐Dixon‐GRASP) for fat/water‐separated (water‐specific) T1 mapping.

Methods

An adiabatic non‐selective 180° inversion‐recovery pulse was added to a gradient‐echo‐based golden‐angle stack‐of‐stars sequence for magnetization‐prepared 3D single‐echo or 3D multi‐echo acquisition. In combination with subspace‐based GRASP‐Pro reconstruction, the sequence allows for standard T1 mapping (MP‐GRASP) or fat/water‐separated T1 mapping (MP‐Dixon‐GRASP), respectively. The accuracy of T1 mapping using MP‐GRASP was evaluated in a phantom and volunteers (brain and liver) against clinically accepted reference methods. The repeatability of T1 estimation was also assessed in the phantom and volunteers. The performance of MP‐Dixon‐GRASP for water‐specific T1 mapping was evaluated in a fat/water phantom and volunteers (brain and liver).

Results

ROI‐based mean T1 values are correlated between the references and MP‐GRASP in the phantom (R2 = 1.0), brain (R2 = 0.96), and liver (R2 = 0.73). MP‐GRASP achieved good repeatability of T1 estimation in the phantom (R2 = 1.0), brain (R2 = 0.99), and liver (R2 = 0.82). Water‐specific T1 is different from in‐phase and out‐of‐phase composite T1 (composite T1 when fat and water signal are mixed in phase or out of phase) both in the phantom and volunteers.

Conclusion

This work demonstrated the initial performance of MP‐GRASP and MP‐Dixon‐GRASP MRI for rapid 3D T1 mapping and 3D fat/water‐separated T1 mapping in the brain (without motion) and in the liver (during free breathing). With fat/water‐separated T1 estimation, MP‐Dixon‐GRASP could be potentially useful for imaging patients with fatty‐liver diseases.
The invisible‐hand heuristic for origin‐destination integer multicommodity network flows
Authors: Barr Richard S. , McLoud Thomas
Published: February 2021

Origin‐destination integer multicommodity flow problems differ from classic multicommodity models in that each commodity has one source and one sink, and each commodity must be routed along a single path. A new invisible‐hand heuristic that mimics economic markets' behavior is presented and tested on large‐scale telecommunications networks, with solution times two orders of magnitude faster than CPLEX's LP relaxation, more dramatic MIP ratios, and small solution value differences.
Extended material point method for the three‐dimensional crack problems
Authors: Liang Yong , Zhang Xiong , Liu Yan
Published: February 2021

The material point method (MPM) has demonstrated itself as an effective numerical method to simulate extreme events with large deformations including fracture problems. However, the traditional MPM encounters difficulties in simulating discontinuities due to its continuous nodal shape function. In this paper, The eXtended Material Point Method (XMPM) is proposed to simulate the three‐dimensional (3D) crack propagation. The XMPM modifies the particle displacement approximation by introducing the local enrichment functions based on the partition of unity into the MPM framework. To accurately trace the evolution of the crack surface, the XMPM employs both the level set method and an extra set of crack surface mesh, which is independent of the background grid. Only locally enriching the nodes near the crack makes the XMPM efficient and able to multiple cracks without extra tricks. Besides, a series of adaptive crack front processing methods, including crack front splitting, merging and locking with its meeting the material boundary, are developed in the XMPM framework to ensure the continuity and smoothness of the crack surface. Numerical examples demonstrate the capability of XMPM to simulate the discontinuity, calculate the fracture parameters and handle the evolution of the crack surface growth in 3D dynamic crack propagation.
Treatment withdrawal of the patient on end of life: An analysis of values, ethics and guidelines in palliative care
Authors: Nnate Daniel A.
Published: February 2021

Aim

Family surrogate decision‐making during the later stage of a patient's life may sometimes result in conflict and emotional distress among the parties involved. The present article aims to promote ethical end‐of‐life decision‐making among healthcare professionals in a view to eliminating any misunderstanding that may arise while meeting the care needs of the patient.

Design

A case study involving a request for treatment withdrawal by the family of a patient on end of life.

Methods

This paper draws upon a scenario encountered during practice to analyse the moral commitments in delivering high‐quality end‐of‐life care with much emphasis on pre‐existing palliative care guidelines for adults.

Results

Healthcare professionals are bound by the principle of beneficence, non‐maleficence, autonomy and justice. Although the use of guidelines may be tenable, decisions often take into consideration the patient's choice and then weighed against the moral values of healthcare specialists and those required in the profession.
Evaluation of the Arabic version of the Chronic Pain Grade scale: Psychometric properties
Authors: Alhalal Eman , Jackson Kimberley T.
Published: February 2021

To increase our understanding of chronic pain in clinical and research contexts, an assessment of its dimensions using reliable and valid self‐reported pain measures is imperative. However, well‐validated Arabic chronic pain assessment scales are lacking. The Chronic Pain Grade (CPG) scale has been used worldwide, yet an Arabic version of the CPG scale has not yet been validated. Thus, we conducted this study to demonstrate the psychometric properties, including reliability, convergent validity, and construct validity of the Arabic CPG scale. A cross‐sectional study was conducted in two hospitals in Saudi Arabia. Data were collected from a convenience sample of 233 chronic pain patients. The confirmatory factor analysis showed an excellent fit with the factor structure of the CPG scale and, thus, supported construct validity. The two identified subscales were pain intensity and pain disability. Convergent validity was supported by having significant correlations between the short‐form McGill Pain Questionnaire and CPG subscales. Internal consistency reliability was demonstrated, as Cronbach's α was 0.916 for pain intensity and 0.815 for pain disability. This study provides evidence that the Arabic CPG scale is a reliable and valid measure of chronic pain dimensions, including pain intensity, and pain‐related disability. This Arabic version of the CPG scale has the potential to expand research and clinical assessment in the Arab world. Future studies are required for further validation.
Review on transesterification in polycarbonate–poly(butylene terephthalate) blend
Authors: Ganguly Anirban , Channe Priyanka , Jha Roshan , Mitra Susanta , Saha Sampa
Published: February 2021

Various polycarbonate ‐ poly(butylene terephthalate) polyester (PC‐PBT) blend prepared by reactive melt blending primarily in extruder with range of temperature and time are discussed in this review article. In the melt blended PC‐PBT blend system, transesterification plays a major role in formation of PC‐PBT blend. Transesterification reactions between these two polymers have been analyzed by proper polymer sample, end‐capped or having reactive chain end group. The kinetics of mechanism is a function of temperature and PC‐PBT ratio. Trace catalyst residue present in PBT catalyzes the transesterification reaction. As the extent of transesterification is increased, it forms various composition of copolymer. Inhibition in the transesterification reaction of PC‐PBT blend has been observed when different type of alkyl, aryl, and alkyl‐aryl group of phosphite are introduced into it, otherwise there has been collateral change in the morphology, thermal, and mechanical property of blend. Therefore, this PC‐PBT blend has been an interesting topic of research in academia and industries.
Influence of nucleation and growth mechanisms on the heat deflection temperature of a reactively processed polypropylene nanocomposite
Authors: Bandyopadhyay Jayita , Mekoa Caroline , Makwakwa Dimakatso , Skosana Sifiso , Ray Suprakas Sinha
Published: February 2021

The development of a reactively processed polypropylene nanocomposite (PPNC) with consequential improvements in the heat deflection temperature (HDT), Vicat softening temperature (VST), and crystallization peak temperature (Tc) is reported herein. Neat PP without nanoclay was also reactively processed to elucidate the effects of fillers on the improvement in physical properties. The results show a considerable improvement in the HDT of PPNC (77.9 °C) compared to those of neat PP (62.6 °C) and reactively processed branched PP (BPP; 69.2 °C). Moreover, the Tc of PP in PPNC improved by ~14% compared to that of neat PP. Various models of nonisothermal crystallization kinetics were employed to elucidate the nucleation and crystal growth mechanisms, and to correlate them with the observed HDT improvement in PPNC. Thermal transitions investigated by modulated differential scanning calorimetry explained the changes observed in the VSTs of all the samples. To the best of our knowledge, this is the first report on a significant improvement in HDT along with a marked increase in Tc. Such simultaneous improvements in HDT, VST, and Tc are highly desirable for applications involving the use of PP‐based materials in rigid packaging.
Use of psychiatric medication by college students: A decade of data
Authors: Morris Marcia R. , Hoeflich Carolin C. , Nutley Sara , Ellingrod Vicki L. , Riba Michelle B. , Striley Catherine W.
Published: February 2021

Objectives

Given the rising prevalence of psychiatric symptomatology among college students, this analysis aims to identify temporal trends in psychiatric medication usage.

Methods

This analysis used data from the Healthy Minds Study Survey administered between 2007 and 2019, yielding a sample of 320,817 university students. Survey data were examined via descriptive analyses.

Results

Over the last decade from 2007 to 2018–2019, there was an increase in use of nearly all classes of psychiatric medications, with reported antidepressant medication (selective serotonin reuptake inhibitors [SSRIs], serotonin‐norepinephrine reuptake inhibitors [SNRIs], etc.) use increasing from 8.0% to 15.3%, anti‐anxiety medication (benzodiazepines, buspirone, etc.) from 3.0% to 7.6%, psychostimulants from 2.1% to 6.3%, antipsychotics from 0.38% to 0.92%, and mood stabilizers from 0.8% to 2.0% (all p < 0.0001), respectively. In addition, the use of more than one category of medication at a time has increased, from 28.2% in 2007 to 40.8% in 2018–2019 (p < 0.0001). The proportion of students who received their most recent prescription for psychiatric medication from primary care providers has risen from 49.1% in 2007 to 58.8% in 2018–2019 (p < 0.0001), while the proportion receiving these prescriptions from psychiatric providers did not increase significantly and stands at 36.1% in 2018–2019. The percentage of students taking psychiatric medication without a prescription varied from year to year, starting at 11.9% in 2007 and ending at 7.7% in 2018–2019 (p < 0.0001). The proportion of students who discussed their use of psychiatric medication with their doctor or other health professional three or more times in the previous year has increased from 39.2% in 2007 to 49.5% in 2018–2019 (p < 0.0001).

Conclusions

The proportion of college students who have taken psychiatric medications of all categories has risen in the last decade; these students are increasingly likely to be on more than one kind of psychiatric medication and be treated by healthcare providers at a greater frequency. Despite the growing complexity of student treatment, the proportion of students receiving psychiatric medication management by psychiatric providers has not changed, while the proportion receiving services in primary care settings has increased.
Prophylactic norepinephrine infusion for postspinal anesthesia hypotension in patients undergoing cesarean section: A randomized, controlled, dose‐finding trial
Authors: Chen Yi , Zou Lili , Li Zhenzhou , Guo Lei , Xue Wei , He Ling , Ma Shuqin , Ni Xinli
Published: February 2021

Study Objective

Prophylactic norepinephrine infusion effectively lowers the incidence of postspinal anesthesia hypotension. The optimal prophylactic dose of norepinephrine remains undefined. The purpose of this study was to investigate the optimal prophylactic dose of norepinephrine to prevent postspinal anesthesia hypotension in patients undergoing cesarean section.

Design

Prospective, double‐blind, randomized, controlled, dose‐finding trial.

Setting

Operating room from March 2020 to June 2020.

Patients

Ninety nine primipara or multipara women 18 ‐ 40 years of age, singleton pregnancy ≥ 37 weeks, American Society of Anesthesiologists’ physical status 1 or 2, scheduled for elective cesarean section under spinal anesthesia were included in this study.

Intervention

Patients were randomly assigned into groups to receive normal saline (NS) or one of four different prophylactic doses (0.025 [NE25], 0.05 [NE50], 0.075 [NE75], and 0.1 [NE100] ug/kg/min) of norepinephrine. The primary end point was the incidence of postspinal anesthesia hypotension (systolic blood pressure [SBP] < 80% of baseline) within 15 min after spinal anesthesia. Secondary outcomes included the overall stability of SBP control versus baseline (median performance error [MDPE] and median absolute performance error [MDAPE]), the dose that would be effective in preventing postspinal anesthesia hypotension in 50% (effective dose, ED 50) and 90% (ED90) of patients, other adverse events (bradycardia, nausea, vomiting, hypertension, and the total additional bolus of norepinephrine and atropine), and neonatal outcomes (blood gas values and Apgar scores).

Measurements and Main Results

The incidence of postspinal anesthesia hypotension in NS, NE25, NE50, NE75, and NE100 groups was 68.42% (13/19), 40.00% (8/20), 20.00% (4/20), 15.00% (3/20), and 10.00% (2/20), respectively. With increasing prophylactic doses of norepinephrine, the incidence of postspinal anesthesia hypotension decreased (p < 0.001), SBP was maintained closer to the baseline (MDPE, p < 0.001; MDAPE, p = 0.001), and the total additional bolus of norepinephrine decreased (p < 0.001). The ED50 and ED90 values of norepinephrine were 0.016 (95% CI: ‐0.014 ‐ 0.033) and 0.088 (95% CI: 0.068 ‐ 0.133) ug/kg/min, respectively. Other adverse effects, neonatal outcomes, and the total additional bolus of atropine did not differ among the five groups.

Conclusions

A prophylactic dose of 0.05 or 0.075 μg/kg/min norepinephrine prevents postspinal anesthesia hypotension in patients undergoing cesarean section.
Adapting the good behavior game for special education classrooms
Authors: Groves Emily A. , May Richard J. , Rees Rachel E. , Austin Jennifer L.
Published: February 2021

The good behavior game (GBG) is a classroom management intervention that employs a group contingency to support appropriate behavior and reduce classroom disruptions. To date, the majority of GBG research has included participants of typical development in mainstream education classrooms or alternative schools. The current study evaluated the GBG across two classrooms in a special education school in Wales. Children included those with both intellectual and physical disabilities. Although some adaptations were made to accommodate individual student needs, those adjustments were minimal and required little additional effort from teachers. Results were evaluated using a single‐case withdrawal design and indicated that the GBG was effective at reducing disruptive and off‐task behavior in both classrooms.