bluuebunny/crossref_metadata_2025 huggingface dataset:
Demystifying the Institutional Review Board
Authors: Hicks Rodney W. , Hines Kelli , Henson Bradley
Published: September 2021

Perioperative nurses are responsible for generating and using evidence to improve patient care. To protect human participants during research activities, government regulations enacted after widely publicized research misconduct specify that institutions receiving federal funds must have an institutional review board (IRB) comprising at least five members. Board members have many responsibilities, including completing a thorough review of each section of the application and attachments (eg, consent documents). To expedite the IRB approval processes, applicants should create and submit a well‐written application. Applicants should understand that the application addresses the important ethical concepts of respect for persons, beneficence, and justice. Quality improvement activities (ie, local activities that seek to improve patient care or clinical outcomes) differ from research activities that focus on creating new knowledge. Depending on the purpose, design, and generalizability of a quality improvement project, the applicant may need to submit the project to the IRB for approval.
An Overview of Quality Improvement Processes and Data Analysis in Perioperative Nursing Practice
Authors: de Peralta Shelly S. , Dodge Kari A. , Jones Renata A.
Published: September 2021

AORN sets quality improvement (QI) standards that nurses can use to collect and interpret data. There are a variety of benchmarks available from national organizations and regulatory bodies: AORN provides evidence‐based guidelines for perioperative practice, whereas The Joint Commission and the Centers for Medicare & Medicaid Services specify patient care requirements. Nurses can use the subject, objective observations, analysis, and plan (SOAP) format to assess, diagnose, plan, and communicate information related to the QI process to key stakeholders. When participating in QI activities, perioperative nurses may find it helpful to understand the importance of values that measure location (eg, mean, median, mode) and variability; display data in a visual format (eg, histogram, run chart), and determine significance (eg, t test, P value). An understanding of QI processes should help nurses work to improve patient care and evaluate effectiveness of the actions through statistical analysis.
Creating a Cognitive Aid for Use During Intraoperative Power Failures
Authors: Jackson Rachel R. , Morgan Brett , Leddy Regina M. , Tola Denise H.
Published: September 2021

An intraoperative power failure (IOPF) is a complete or partial absence of the electrical power supply with or without the availability of a backup generator system during an operative or other invasive procedure. An IOPF can be stressful for the OR team and puts surgical patients at risk for adverse outcomes. To prepare providers for an IOPF, a CRNA piloted a project to create an evidence‐based, facility‐specific cognitive aid (CA) to guide decision making and enhance patient management and outcomes during an IOPF. The project team tested the battery‐power capabilities of essential anesthesia equipment, including anesthesia gas machines, IV pumps, and vital sign monitors, and included the results in the CA. A needs assessment survey was sent to the anesthesia professionals at the facility to promote clinician buy‐in and solicit feedback for creating the CA.
A new look at the critical observability of finite state machines from an algebraic viewpoint
Authors: Yan Yongyi , Deng He , Chen Zengqiang
Published: September 2021

The traditional critical observability of FSMs refers to the possibility of detecting if the current state of an FSM belongs to a critical set for any input. In practical applications, the input is always of finite length, and we may only care about some critical states at a given time step or the inverse problem that how to find all possible inputs moving an FSM to a critical state of interest. Thus, we propose two new concepts about critical observability to cope with these two cases. Using the algebraic model of FSMs proposed in recent years, we propose several algebraic criteria for these types of critical observability. Moreover, the results are also applicable to large‐scale networks of FSMs.
Multifaceted antiviral therapeutic potential of dietary flavonoids: Emerging trends and future perspectives
Authors: Sharma Varruchi , Sehrawat Nirmala , Sharma Ajay , Yadav Mukesh , Verma Pawan , Sharma Anil K.
Published: September 2021

Phytochemicals are the natural biomolecules produced by plants via primary or secondary metabolism, which have been known to have many potential health benefits to human beings. Flavonoids or phytoestrogens constitute a major group of such phytochemicals widely available in variety of vegetables, fruits, herbs, tea, and so forth, implicated in a variety of bio‐pharmacological and biochemical activities against diseases including bacterial, viral, cancer, inflammatory, and autoimmune disorders. More recently, these natural biomolecules have been shown to have effective antiviral properties via therapeutically active ingredients within them, acting at different stages of infection. Current review emphasizes upon the role of these flavonoids in physiological functions, prevention and treatment of viral diseases. More so the review focuses specifically upon the antiviral effects exhibited by these natural biomolecules against RNA viruses including coronaviruses. Furthermore, the article would certainly provide a lead to the scientific community for the effective therapeutic antiviral use of flavonoids using potential cost‐effective tools for improvement of the pharmacokinetics, bioavailability, and biodistribution of such compounds for the concrete action along with the promotion of human health.
An optimal multiarmed response adaptive design for survival outcome with independent censoring
Authors: Das Soumyadeep , Bhattacharya Rahul
Published: September 2021

Compromising ethics and precision in the context of a multiarmed clinical trial, an optimal order adjusted response adaptive design is proposed for survival outcomes subject to independent random censoring. The operating characteristics of the proposed design and the follow‐up inference are studied both theoretically as well as empirically and are compared with those of the competitors. Applicability of the developed design is further illustrated through redesigning a real clinical trial with survival responses.
Manufacturing a chimpanzee adenovirus‐vectored SARS‐CoV‐2 vaccine to meet global needs
Authors: Joe Carina C. D. , Jiang Jinlin , Linke Thomas , Li Yuanyuan , Fedosyuk Sofiya , Gupta Gaurav , Berg Adam , Segireddy Rameswara R. , Mainwaring David , Joshi Amar , Cashen Paul , Rees Byron , Chopra Nitin , Nestola Piergiuseppe , Humphreys Jonathan , Davies Sarah , Smith Nick , Bruce Scott , Verbart Dennis , Bormans Daan , Knevelman Carol , Woodyer Mark , Davies Lee , Cooper Lisa , Kapanidou Maria , Bleckwenn Nicole , Pappas Daniel , Lambe Teresa , Smith Daniel C. , Green Catherine M. , Venkat Raghavan , Ritchie Adam J. , Gilbert Sarah C. , Turner Richard , Douglas Alexander D.
Published: September 2021

Manufacturing has been the key factor limiting rollout of vaccination during the COVID‐19 pandemic, requiring rapid development and large‐scale implementation of novel manufacturing technologies. ChAdOx1 nCoV‐19 (AZD1222, Vaxzevria) is an efficacious vaccine against SARS‐CoV‐2, based upon an adenovirus vector. We describe the development of a process for the production of this vaccine and others based upon the same platform, including novel features to facilitate very large‐scale production. We discuss the process economics and the “distributed manufacturing” approach we have taken to provide the vaccine at globally‐relevant scale and with international security of supply. Together, these approaches have enabled the largest viral vector manufacturing campaign to date, providing a substantial proportion of global COVID‐19 vaccine supply at low cost.
Risk factors associated with suicide in adolescents and young adults (AYA) with cancer
Authors: Heynemann Sarah , Thompson Kate , Moncur Donovan , Silva Sandun , Jayawardana Madawa , Lewin Jeremy
Published: September 2021

Background

Higher rates of death by suicide are recognized both in individuals of any age with cancer and, separately, among adolescents and young adults (AYA) without cancer. Given this intersection, identifying risk factors associated with suicidal risk among AYA with cancer is critical.

Objective

To identify characteristics associated with suicide among AYA with cancer.

Methods

A retrospective analysis of AYA (aged 15–39) during 1975–2016 from the Surveillance, Epidemiology, and End Results database was conducted. Clinical and demographic factors associated with death by suicide among the AYA cancer population were compared to (i) US population normative data (standardized mortality ratios [SMRs]) and (ii) other AYA individuals with cancer (odds ratios).

Results

In total, 922 suicides were found in 500,366 AYA with cancer (0.18%), observed for 3,198,261 person‐years. The SMR for AYA with cancer was 34.1 (95% confidence interval [CI]: 31.4–36.9). Suicide risk was particularly high in females (SMR = 43.4, 95% CI: 37.2–50.4), unmarried persons (SMR = 50.6, 95% CI: 44.7–57.1), those with metastatic disease (SMR = 45.2, 95% CI: 33.1–60.3), or certain histological subtypes (leukemia, central nervous system, and soft tissue sarcoma). Risk generally reduced over time, however remained elevated ≥5 years following a cancer diagnosis (SMR > 5 years = 28.1, 95% CI: 25.4–31.0). When comparing those who died from suicide and those who did not, the following factors demonstrated significant associations: sex (males > females), race (White ethnicity > Black/other ethnicity), relationship status (never married > other), and disease stage (distant > localized).

Conclusions

Death due to suicide/non‐accidental injury is high compared to normative data, requiring increased awareness among health‐care providers, suicide risk monitoring in AYA, and appropriately tailored psychosocial interventions.
Saudi therapists' lived experience of self‐awareness
Authors: Al‐khodair Noor Abdullah , Alrawaf Eiman Abdulrahman
Published: September 2021

Self‐awareness and self‐reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self‐awareness within psychotherapy, by focusing on the therapist's lived experience of self‐awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi‐structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self‐oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self‐awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self‐awareness and personal development.
Salicylic Acid Elimination by Pulsed Corona Discharge Treatment of Wastewater
Authors: Abd El-Gelil Gehad M. , Mansour Moustapha Salem , Ebrahiem Ebrahiem Esmail , Abou-Gabal Hanaa , El Saghir Ahmed
Published: September 2021

Elimination of salicylic acid by pulsed corona discharge in a multipin‐plate reactor was investigated. Corona discharge is an alternative technique that produces highly active species such as HO• that degrade salicylic acid. Salicylic acid was totally eliminated in 60 min of treatment with 200 stainless steel needles. Variables such as pH, initial concentration, conductivity, and Na2SO4 dosage were studied to elucidate their influence on salicylic acid elimination. Salicylic acid elimination increased with decreasing pH, initial concentration, and conductivity of the liquid.
Asymmetric Synthesis of Indoline from Achiral Phthalimide Involving Crystallization‐Induced Deracemization
Authors: Nakamura Takumi , Ban Kazuma , Yoshida Yasushi , Mino Takashi , Kasashima Yoshio , Sakamoto Masami
Published: September 2021

Asymmetric synthesis was performed by combining the photochemical reaction of an achiral substrate followed by crystallization‐induced deracemization. The results indicated that a fused indoline produced by photochemical intramolecular δ‐hydrogen abstraction and cyclization of N‐(5‐chloro‐2‐methylphenyl)phthalimide crystallized as a racemic conglomerate. Since this substrate has an aminal skeleton, racemization involving a ring‐opening and ring‐closing equilibrium process occurred under suitable conditions. Efficient racemization was observed in acetone containing a catalytic base, 1,8‐diazabicyclo[5.4.0]undec‐7‐ene (DBU). Crystallization‐induced dynamic deracemization by Viedma ripening from racemic indoline was performed with an excellent enantioselectivity of 99 % ee. Furthermore, one‐pot asymmetric synthesis of the indoline was achieved by the photochemical reaction of achiral phthalimide followed by continuous attrition‐enhanced deracemization converging to 99 % ee of enantiomeric crystals. This is the first example of asymmetric expression and amplification by photochemical hydrogen abstraction and crystallization‐induced dynamic deracemization.
A pore‐scale investigation for recovering adsorptive capacity of activated carbon fibre felt using electrothermal desorption combined with ozonization in‐situ degradation method
Authors: Weng Lingxiao , Ma Qiang , Xu Qian , Qiao Guanchao
Published: September 2021

Porous activated carbon fibre (ACF) materials, as a recycled absorbent, have been widely applied in the harmless disposal of volatile organic chemicals (VOCs). In order to reduce the energy consumption of cyclic regeneration process and avoid second pollution of high concentration VOCs, there is an urgent need to develop a synergistic regeneration method to recover the adsorptive capacity of ACF and achieve the in‐situ degradation of VOCs simultaneously. Due to the outstanding oxidation performance of ozone, ozonization was used to degrade VOCs adsorbed by absorbent materials and has a potential advantage in combination with the traditional electrothermal desorption technology. In this work, a three‐dimensional pore‐scale lattice Boltzmann method (LBM) is established to solve the convective heat and mass transfer processes considering the desorption and ozonization effects. Using this numerical model, a pore‐scale simulation is performed to investigate the reactive and desorptive transport behaviours in the reconstructed pore structure of ACF felt, which is regenerated using the electrothermal desorption process combined with the ozonization degradation method. The simulation works reveal the effects of key operation parameters on the desorption and degradation mechanisms into the pores of ACF felt during this combined regeneration process. The numerical results show that the flow velocity of carrier gas plays an important role on the performance of the combined regeneration process. The approach of reducing the carrier gas velocity would obviously improve the degradation ratio of VOC and the efficiency of the combined regeneration process.
On the Structure of Sulfur/1,3‐Diisopropenylbenzene Co‐Polymer Cathodes for Li‐S Batteries: Insights from Density‐Functional Theory Calculations
Authors: Kiani Rana , Sebastiani Daniel , Partovi‐Azar Pouya
Published: September 2021

Sulfur co‐polymers have recently drawn considerable attention as alternative cathode materials for lithium‐sulfur batteries, thanks to their flexible atomic structure and the ability to provide high reversible capacity. Here, we report on the atomic structure of sulfur/1,3‐diisopropenylbenzene co‐polymers (poly(S‐co‐DIB)) based on the insights obtained from density‐functional theory calculations. The focus is set on studying the local structural properties, namely the favorable sulfur chain length (Sn with
) connecting two DIBs. In order to investigate the effects of the organic groups and sulfur chains separately, we perform series of atomic structure optimizations. We start from simple organic groups connected via sulfur chains and gradually change the structure of the organic groups until we reach a structure in which two DIB molecules are attached via sulfur chains. Additionally, to increase the structural sampling, we perform temperature‐assisted minimum‐energy structure search on slightly simpler model systems. We find that in DIB‐Sn‐DIB co‐polymers, shorter sulfur chains with
are preferred, where the stabilization is mostly brought about by the sulfur chains rather than the organic groups. The presented results, corresponding to the fully charged state of the cathode in the thermodynamic limit, have direct applications in the field of lithium‐sulfur batteries with sulfur‐polymer cathodes.
Design and validation of the tubular linear vibration generator applied to energy harvester based on VIV
Authors: Liu Min , Xia Hui
Published: September 2021

A tubular linear vibration generator applied to the energy harvester based on vortex‐induced is proposed and analyzed in this paper. First, the permanent magnet of the generator is placed on the inner side of the winding, and the outer side of the winding is improved by adding magnetically permeable housing to increase the generated power. Then, the optimal magnet magnetization method, size of the winding coil, wire diameter, and housing material are evaluated by finite element analysis. Finally, the prototype using radial magnets is fabricated and fixed on the energy harvester. The vibration displacement, the induced voltage of the coil, and the generated power at different water velocities are measured. The generators with different permeable housings are fabricated to verify the accuracy of the theory. The experiment results show the maximum average power harvested is 5.5 mW of the TVLG at the water speed of 0.7 m/s, for the coil of 0.2 mm wire diameter, 8 cm height, and 2,000 turns. Under the effective water speeds, the power obtained by the generator with magnetically permeable housing is more than 70% higher than that obtained by the generator without housing.
Genetic structure and ecological niche segregation of Indian gray mongoose (Urva edwardsii) in Iran
Authors: Oboudi Razie , Malekian Mansoureh , Khosravi Rasoul , Fadakar Davoud , Adibi Mohammad Ali
Published: September 2021

Combining genetic data with ecological niche models is an effective approach for exploring climatic and nonclimatic environmental variables affecting spatial patterns of intraspecific genetic variation. Here, we adopted this combined approach to evaluate genetic structure and ecological niche of the Indian gray mongoose (Urva edwardsii) in Iran, as the most western part of the species range. Using mtDNA, we confirmed the presence of two highly differentiated clades. Then, we incorporated ensemble of small models (ESMs) using climatic and nonclimatic variables with genetic data to assess whether genetic differentiation among clades was coupled with their ecological niche. Climate niche divergence was also examined based on a principal component analysis on climatic factors only. The relative habitat suitability values predicted by the ESMs for both clades revealed their niche separation. Between‐clade climate only niche comparison revealed that climate space occupied by clades is similar to some extent, but the niches that they utilize differ between the distribution ranges of clades. We found that in the absence of evidence for recent genetic exchanges, distribution models suggest the species occurs in different niches and that there are apparent areas of disconnection across the species range. The estimated divergence time between the two Iranian clades (4.9 Mya) coincides with the uplifting of the Zagros Mountains during the Early Pliocene. The Zagros mountain‐building event seems to have prevented the distribution of U. edwardsii populations between the western and eastern parts of the mountains as a result of vicariance events. Our findings indicated that the two U. edwardsii genetic clades in Iran can be considered as two conservation units and can be utilized to develop habitat‐specific and climate change‐integrated management strategies.
HFA of the ESC position paper on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider Part 3: at the hospital and discharge
Authors: Gustafsson Finn , Ben Avraham Binyamin , Chioncel Ovidiu , Hasin Tal , Grupper Avishai , Shaul Aviv , Nalbantgil Sanemn , Hammer Yoav , Mullens Wilfried , Tops Laurens F. , Elliston Jeremy , Tsui Steven , Milicic Davor , Altenberger Johann , Abuhazira Miriam , Winnik Stephan , Lavee Jacob , Piepoli Massimo Francesco , Hill Lorrena , Hamdan Righab , Ruhparwar Arjang , Anker Stefan , Crespo‐Leiro Marisa Generosa , Coats Andrew J.S. , Filippatos Gerasimos , Metra Marco , Rosano Giuseppe , Seferovic Petar , Ruschitzka Frank , Adamopoulos Stamatis , Barac Yaron , De Jonge Nicolaas , Frigerio Maria , Goncalvesova Eva , Gotsman Israel , Itzhaki Ben Zadok Osnat , Ponikowski Piotr , Potena Luciano , Ristic Arsen , Jaarsma Tiny , Ben Gal Tuvia
Published: September 2021

The growing population of left ventricular assist device (LVAD)‐supported patients increases the probability of an LVAD‐ supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient‐device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD‐supported patients for the non‐LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD‐supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non‐cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end‐of‐life approaches are described.
Machine learning‐based risk prediction of malignant arrhythmia in hospitalized patients with heart failure
Authors: Wang Qi , Li Bin , Chen Kangyu , Yu Fei , Su Hao , Hu Kai , Liu Zhiquan , Wu Guohong , Yan Ji , Su Guohai
Published: September 2021

Aims

Predicting the risk of malignant arrhythmias (MA) in hospitalized patients with heart failure (HF) is challenging. Machine learning (ML) can handle a large volume of complex data more effectively than traditional statistical methods. This study explored the feasibility of ML methods for predicting the risk of MA in hospitalized HF patients.

Methods and results

We evaluated the baseline data and MA events of 2794 hospitalized HF patients in the HF cohort in Anhui Province and randomly divided the study population into training and validation sets in a 7:3 ratio. The Lasso‐logistic regression, multivariate adaptive regression splines (MARS), classification and regression tree (CART), random forest (RF), and eXtreme gradient boosting (XGBoost) algorithms were used to construct risk prediction models in the training set, and model performance was verified in the validation set. The area under the receiver operating characteristic curve (AUC) and Brier score were employed to evaluate the discrimination and calibration of the model, respectively. Clinical utility of the Lasso‐logistic regression model was analysed using decision curve analysis (DCA). The median (Q1, Q3) age of the study population was 70 (61, 77) years, and 39.5% were female. MA events occurred in 117 patients (4.2%) during hospitalization. In the training set (n = 1964), the AUC of the XGBoost model was 0.998 [95% confidence interval (CI) 0.997–1.000], which was higher than the other models (all P < 0.001). In the validation set (n = 830), there was no significant difference in AUC of Lasso‐logistic model 1 [AUC: 0.867 (95% CI 0.819–0.915)], Lasso‐logistic model 2 [AUC: 0.828 (95% CI 0.764–0.892)], MARS model [AUC: 0.852 (95% CI 0.793–0.910)], RF model [AUC: 0.804 (95% CI 0.726–0.881)], and XGBoost model [AUC: 0.864 (95% CI 0.810–0.918); all P > 0.05], which were higher than that of CART model [AUC: 0.743 (95% CI 0.661–0.824); all P < 0.05]. Brier scores for all prediction models were less than 0.05. DCA results showed that the Lasso‐logistic model had a net clinical benefit. Oral antiarrhythmic drug, left bundle branch block, serum magnesium, d‐dimer, and random blood glucose were significant predictors in half or more of the models.

Conclusions

The current study findings suggest that ML models based on the Lasso‐logistic regression, MARS, RF, and XGBoost algorithms can effectively predict the risk of MA in hospitalized HF patients. The Lasso‐logistic model had better clinical interpretability and ease of use than the other models.
In‐process image of machine tools – Transient‐thermal and dynamic simulation of moving structures
Authors: Kreißl Tim , Regel Joachim , Wabner Markus , Putz Matthias
Published: September 2021

The aim of structural mechanics simulation is to better represent the working accuracy of machine tools. The visualization is done in process, that is, during the machine movement. It is realized by reading out the control values and the subsequent simulation of the structural–mechanical behavior of the machine. This procedure allows deviations in the working accuracy outside the control loop to be taken into account, which cannot be detected by the measuring system. This allows an improved statement on the achievable working accuracy and enables the operator to react to any deviations in the machine accuracy. In contrast, the thermal behavior of machine tools focuses on an observation level which is characterized by long and strongly varying time constants. In contrast to process control, the term “thermal real time” addresses the seconds to hours range. For the implementation, a three‐axis demonstrator machine with discrete elements was modeled.
The dynamics of introgression across an avian radiation
Authors: Singhal Sonal , Derryberry Graham E. , Bravo Gustavo A. , Derryberry Elizabeth P. , Brumfield Robb T. , Harvey Michael G.
Published: September 2021

Hybridization and resulting introgression can play both a destructive and a creative role in the evolution of diversity. Thus, characterizing when and where introgression is most likely to occur can help us understand the causes of diversification dynamics. Here, we examine the prevalence of and variation in introgression using phylogenomic data from a large (1300+ species), geographically widespread avian group, the suboscine birds. We first examine patterns of gene tree discordance across the geographic distribution of the entire clade. We then evaluate the signal of introgression in a subset of 206 species triads using Patterson's D-statistic and test for associations between introgression signal and evolutionary, geographic, and environmental variables. We find that gene tree discordance varies across lineages and geographic regions. The signal of introgression is highest in cases where species occur in close geographic proximity and in regions with more dynamic climates since the Pleistocene. Our results highlight the potential of phylogenomic datasets for examining broad patterns of hybridization and suggest that the degree of introgression between diverging lineages might be predictable based on the setting in which they occur.
The effect of short radiation treatment breaks on chemo‐radiotherapy for oropharyngeal cancers
Authors: Rybkin Alisa , Kang Jung Julie , Lee Anna , Kitpanit Sarin , Fan Ming , Mohamed Nader , Cartano Olivia , Zakeri Kaveh , Gelblum Daphna , Sherman Eric , Dunn Lara , Boyle Jay , Wong Richard , Chen Linda , Yu Yao , McBride Sean M. , Tsai C. Jillian , Riaz Nadeem , Lee Nancy Y.
Published: September 2021

Background

Numerous studies and guidelines suggest an outcome detriment from radiation treatment breaks (rTBs) and the need for compensatory dosing in patients with head and neck cancer.

Methods

In a consecutive cohort of 521 patients with oropharyngeal squamous cell carcinoma (OPSCC), we investigated the impact of rTBs and prolongation of overall treatment time (OTT) on OS, DFS, LRC, and cancer recurrence using competing risk and multivariate analyses.

Results

Neither OTT prolongation by ≤2 days nor rTBs of ≤3 days were associated with detriments to clinical outcomes. Consecutive breaks of ≥3 days were also not significantly associated with detriment to clinical outcomes. There was significantly increased competing mortality in those with longer breaks.

Conclusions

In OPSCC patients treated with definitive concurrent chemoradiotherapy, there is no significant association between disease failure and total rTBs of ≤3 consecutive or scattered days. Further investigation is needed for longer breaks.
A Novel Approach to Evaluating Cardiac Surgery Providers: An Alternative to the RAMR
Authors: Pitocco Christine , Sexton Thomas R.
Published: September 2021

Objective

We propose an alternative to the Risk Adjusted Mortality Rate (RAMR), about which we identify four serious concerns. We apply our method to cardiac surgery.

Design

We present a methodology that uses the upper and lower tail probabilities (UTP/LTP) of the binomial distribution to screen for poor/high performing providers.

Study Setting

The New York State Department of Health (NYS DOH) publicly releases data on all cardiac surgery patients in the state. We download cardiac surgery data from the NYS DOH website for the years 2011 through 2013. The state's objective is to identify poorly performing hospitals and surgeons and thereby reduce deaths. NYS employs the RAMR.

Results

The UTP/LTP approach agrees with the RAMR in its classification of all 132 surgeons and all 40 hospitals. However, performance is a continuous construct and strict categorization can lead to failure to identify marginal providers.

Conclusions

Our methodology addresses all four concerns regarding the RAMR. The UTP/LTP approach avoids inappropriate hypothesis testing and is consistent with standard statistical theory and practice in its approach to case volume. It does not require confidence intervals and it applies to all providers regardless of case volume.
Iodine excess induces hepatic, renal and pancreatic injury in female mice as determined by attenuated total reflection Fourier‐transform infrared spectrometry
Authors: Guo Yang , Hu Chunhui , Xia Bintong , Zhou Xianwen , Luo Sihan , Gan Ruijia , Duan Peng , Tan Yan
Published: September 2021

Limited knowledge of the long‐term effects of excessive iodine (EI) intake on biomolecular signatures in the liver/pancreas/kidney prompted this study. Herein, following 6 months of exposure in mice to 300, 600, 1200 or 2400 μg/L iodine, the biochemical signature of alterations to the liver/pancreas/kidney was profiled using attenuated total reflection Fourier‐transform infrared (ATR‐FTIR) spectroscopy coupled with principal component analysis‐linear discriminant analysis (PCA‐LDA). Our research showed that serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), serum creatinine (Scr), insulin, blood glucose levels and homeostasis model assessment for insulin resistance (HOMA‐IR) index in the 1200 and 2400 μg/L iodine‐treated groups were significantly increased compared with those in the control group. Moreover, histological analysis showed that the liver/kidney/pancreas tissues of mice exposed to EI treatment displayed substantial morphological abnormalities, such as a loss of hepatic architecture, glomerular cell vacuolation and pancreatic neutrophilic infiltration. Notably, EI treatment caused distinct biochemical signature segregation between EI‐exposed versus the control liver/pancreas/kidney. The main biochemical alterations between EI‐exposed and control groups were observed for protein phosphorylation, protein secondary structures and lipids. The ratios of amide I‐to‐amide II (1674 cm−1/1570 cm−1), α‐helix‐to‐β‐sheet (1657 cm−1/1635 cm−1), glycogen‐to‐phosphate (1030 cm−1/1086 cm−1) and the peptide aggregation (1 630 cm−1/1650 cm−1) level of EI‐treated groups significantly differed from the control group. Our study demonstrated that EI induced hepatic, renal and pancreatic injury by disturbing the structure, metabolism and function of the cell membrane. This finding provides the new method and implication for human health assessment regarding long‐term EI intake.
Synergistic effect of anethole and doxorubicin alleviates cell proliferation, cell cycle arrest, and ER stress and promotes ROS‐mediated apoptosis in triple‐negative breast cancer cells
Authors: Arumugam Poornima , Sampathkumar Banupriya , Perumalsamy Haribalan , Balusamy Sri Renukadevi , Ramesh Vignesh , Sundaravadevel Sumathi
Published: September 2021

The heterogeneity and poor prognosis of triple‐negative breast cancer (TNBC) have limited the treatment options and made clinical management challenging. This has nurtured a major effort to discover druggable molecular targets. Currently, chemotherapy is the primary treatment strategy for this disease. Doxorubicin is the most frequently used chemotherapeutic drug for TNBC and due to the fact that chemotherapeutic drugs have a lot of side effects, we evaluated the synergistic effect of the phytocompound anethole and doxorubicin. The cytotoxic effect of anethole in combination with doxorubicin on MDA‐MB‐231 cells was evaluated by various parameters, including apoptosis, cell cycle analysis, DNA damage, and cell proliferation. Furthermore, mitochondrial membranepotential (MMP), endoplasmic reticulum (ER) stress, and reactive oxygen species (ROS) levels were also evaluated in the cells treated with/without anethole and doxorubicin. Expression of the apoptotic proteins was evaluated by Western blot analysis. Initial evaluation of cytotoxicity of anethole on MDA‐MB‐231 cells demonstrated preferential suppression of cell proliferation and when treated along with doxorubicin it showed enhanced cytotoxicity with a synergistic effect. Cell cycle analysis revealed arrest at different stages of the cell cycle, such as sub G0‐G1, G0‐G1, S, and G2M in various treatment groups and apoptotic cell death was subsequently evident with propidium iodide (PI) staining. The synergistic action of anethole and doxorubicin effectively induced mitochondrial membrane potential loss, which, in turn, led to a burst of ROS production, which eventually produced unfolded protein response by damaging the ER. Synergistic anticancer effect was observed on exposure of MDA‐MB‐231 cells to anethole and doxorubicin in inducing cell death.
L‐serine polymorphism controlled by optical trapping with high‐repetition‐rate femtosecond laser pulses
Authors: Wang Wen‐Chi , Wang Shun‐Fa , Sugiyama Teruki
Published: September 2021

This work first demonstrates polymorph control of amino acids by optical trapping with high‐repetition‐rate (80 MHz) femtosecond (fs) laser pulses. A saturated aqueous solution of L‐serine (L‐Ser) is irradiated by laser pulses to trigger crystallization, and the polymorphism of the resultant crystals is systematically investigated as a function of laser power and polarization. Irradiating near the contact line (three‐phase point) of the solution triggers L‐Ser crystallization, either at the laser focus or away from the laser focus. In‐situ Raman spectroscopy for all the generated crystals reveals that fs laser irradiation yields two types of L‐Ser polymorphs, which are identified as monohydrate and anhydrous forms (Form 1 and Form 2, respectively). When the average laser power is constant, only left‐circular polarization produces Form 1 with a 60% probability, whereas all other polarizations, linear and right‐circular polarization, produce Form 2 with 100% probability. The dynamics of this unique polymorphism depending on the handedness of the circular polarization and the mechanism behind it are discussed in terms of the trapping efficiency of the pre‐nucleation (liquid‐like) clusters, which depends on the differences in refractive index and the arrangement of the liquid‐like clusters reflecting the given laser polarization.
Tubeless Anesthesia in Subglottic Stenosis: Comparative Review of Apneic Low‐Flow Oxygenation With THRIVE
Authors: Youssef Daniel Luke , Paddle Paul
Published: September 2021

Objective

Managing the shared airway in subglottic stenosis presents a unique challenge. Tubeless anesthesia with apneic oxygenation is increasingly being adopted as it overcomes the limitations of access to and visualization of the narrowed subglottis. Low‐flow oxygenation (LFO) and transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE) are two delivery techniques. We sought to compare their utility in this patient cohort.

Study Design

Retrospective cohort study.

Methods

Thirty‐five cases of endoscopic debridement of subglottic stenosis were retrospectively studied. Operative technique was consistent among the cases. Oxygen was delivered at low‐flow rates at the laryngeal inlet with LFO (n = 23) or high‐flow rates at the nares with THRIVE (n = 12). Data regarding apnea time, the need for rescue ventilation, and relevant patient and disease factors were recorded for analysis.

Results

Median apnea time for LFO and THRIVE were 34 and 25 minutes, respectively. Rescue with intermittent supraglottic jet ventilation was required more often with LFO than THRIVE (61% vs 33%) and was sufficient for the case to be completed in all but one instance. Elevated BMI was the sole significant predictor of early oxygen desaturation (24.8 vs 37.95 kg/m2, P = .002) with LFO. Median stenosis diameter was 6 mm (range 2–14).

Conclusion

Apneic techniques are safe and feasible for the endoscopic management of subglottic stenosis of all severities. Elevated BMI is the only significant predictor for early oxygen desaturation. In the many healthcare settings where THRIVE is not available, LFO is a valid alterative in the nonobese patient. Laryngoscope, 132:1231–1236, 2022
Weakly and locally positive Robinson theories
Authors: Belkasmi Mohammed
Published: September 2021

We introduce the notions of weakly and locally positive Robinson theories. We give a characterization of weakly positive Robinson theories by the amalgamation property, and a syntactic characterization of locally positive Robinson theories.
Assimilation of OLCI total column water vapour in the Met Office global numerical weather prediction system
Authors: Saunders Roger
Published: September 2021

The representation of water vapour in numerical weather prediction models is still subject to significant uncertainties, which are partly due to the lack of observations of water vapour in the lower troposphere over land and sea‐ice areas. There are now several satellite datasets of total column water vapour available, which make use of the reflected radiances from the surface in the near‐infrared spectral region where there are water vapour absorption bands. The ocean and land cover imager (OLCI) on the Sentinel‐3A and 3B satellites measures the top of atmosphere radiances in the near infrared, and a total column water vapour product is retrieved and made available in near real time. Comparisons of the total column water vapour from OLCI with NWP model 6‐h forecasts, collocated ground‐based GNSS measurements and radiosonde profiles have been undertaken to determine the accuracy of the product. Following the monitoring, some experiments were made to assimilate the OLCI total column water vapour over land using the Met Office 4D‐Var assimilation system. A 5‐month trial assimilating the OLCI data has shown consistently positive impacts on the forecast scores with some changes to the water vapour distribution in the model.
Persistent homology of tumor CT scans is associated with survival in lung cancer
Authors: Somasundaram Eashwar , Litzler Adam , Wadhwa Raoul , Barker‐Clarke Rowan , Scott Jacob
Published: September 2021

Purpose

Radiomics, the objective study of nonvisual features in clinical imaging, has been useful in informing decisions in clinical oncology. However, radiomics currently lacks the ability to characterize the overall topological structure of the data. This niche can be filled by persistent homology, a form of topological data analysis that analyzes high‐level structure. We hypothesized that persistent homology features quantified using cubical complexes could be extracted from lung tumor scans and related to survival.

Methods

We obtained segmented computed tomography (CT) lung scans (n = 565) from the NSCLC‐Radiomics and NSCLC‐Radiogenomics datasets in The Cancer Imaging Archive. These scans are three‐dimensional images whose pixel intensity corresponds to a number of Hounsfield units. Cubical complexes are a topological image analysis method that effectively analyzes the number of topological features in an image as the image is thresholded at different intensities. We calculated a novel output called a feature curve by plotting the number of zero‐dimensional (0D) topological features counted from the cubical complex filtration against each Hounsfield value. This curve's first moment of distribution was utilized as a summary statistic to show association with survival in a Cox proportional hazards model. We hypothesized that persistent homology features quantified using cubical complexes could be extracted from lung tumor scans and related to survival.

Results

After controlling for tumor image size, age, and stage, the first moment of the 0D topological feature curve was associated with poorer survival (HR = 1.118; 95% CI = 1.026–1.218; p = 0.01). The patients in our study with the lowest first moment scores had significantly better survival (1238 days; 95% CI = 936–1599) compared to the patients with the highest first moment scores (429 days; 95% CI = 326–601; p = 0.0015).

Conclusions

We have shown that persistent homology can generate useful clinical correlates from tumor CT scans. Our 0D topological feature curve statistic predicts survival in lung cancer patients. This novel statistic may be used in tandem with standard radiomics variables to better inform clinical oncology decisions.
A high‐Z inorganic scintillator–based detector for time‐resolved in vivo dosimetry during brachytherapy
Authors: Jørgensen Erik B. , Johansen Jacob G. , Overgaard Joakim , Piché‐Meunier Dominique , Tho Daline , Rosales Haydee M. L. , Tanderup Kari , Beaulieu Luc , Kertzscher Gustavo , Beddar Sam
Published: September 2021

Purpose

High‐dose rate (HDR) and pulsed‐dose rate (PDR) brachytherapy would benefit from an independent treatment verification system to monitor treatment delivery and to detect errors in real time. This paper characterizes and provides an uncertainty budget for a detector based on a fiber‐coupled high‐Z inorganic scintillator capable of performing time‐resolved in vivo dosimetry during HDR and PDR brachytherapy.

Method

The detector was composed of a detector probe and an optical reader. The detector probe consisted of either a 0.5 × 0.4 × 0.4 mm3 (HDR) or a 1.0 × 0.4 × 0.4 mm3 (PDR) cuboid ZnSe:O crystal glued onto an optical‐fiber cable. The outer diameter of the detector probes was 1 mm, and fit inside standard brachytherapy catheters. The signal from the detector probe was read out at 20 Hz by a photodiode and a data acquisition device inside the optical reader. In order to construct an uncertainty budget for the detector, six characteristics were determined: (1) temperature dependence of the detector probe, (2) energy dependence as a function of the probe‐to‐source position in 2D (determined with 2 mm resolution using a robotic arm), (3) the signal‐to‐noise ratio (SNR), (4) short‐term stability over 8 h, and (5) long‐term stability of three optical readers and four probes used for in vivo monitoring in HDR and PDR treatments over 21 months (196 treatments and 189 detector calibrations, and (6) dose‐rate dependence.

Results

The total uncertainty of the detector at a 20 mm probe‐to‐source distance was < 5.1% and < 5.8% for the HDR and PDR versions, respectively. Regarding the above characteristics, (1) the sensitivity of the detector decreased by an average of 1.4%/°C for detector probe temperatures varying from 22 to 37°C; (2) the energy dependence of the detector was nonlinear and depended on both probe‐to‐source distance and the angle between the probe and the brachytherapy source; (3) the median SNRs were 187 and 34 at a 20 mm probe‐to‐source distance for the HDR and PDR versions, respectively (corresponding median source activities of 4.8 and 0.56 Ci, respectively); (4) the detector response varied by 0.6% in 11 identical irradiations over 8 h; (5) the sensitivity of the four detector probes decreased systematically by 0–1.2%/100 Gy of dose delivered to the probes, and random fluctuations of 4.8% in the sensitivity were observed for the three probes used in PDR and 1.9% for the probe used in HDR; and (6) the detector response was linear with dose rate.

Conclusion

ZnSe:O detectors can be used effectively for in vivo dosimetry and with high accuracy for HDR and PDR brachytherapy applications.
Towards robust glucose chemical exchange saturation transfer imaging in humans at 3 T: Arterial input function measurements and the effects of infusion time
Authors: Seidemo Anina , Lehmann Patrick M. , Rydhög Anna , Wirestam Ronnie , Helms Gunther , Zhang Yi , Yadav Nirbhay N. , Sundgren Pia C. , van Zijl Peter C. M. , Knutsson Linda
Published: September 2021

Dynamic glucose‐enhanced (DGE) magnetic resonance imaging (MRI) has shown potential for tumor imaging using D‐glucose as a biodegradable contrast agent. The DGE signal change is small at 3 T (around 1%) and accurate detection is hampered by motion. The intravenous D‐glucose injection is associated with transient side effects that can indirectly generate subject movements. In this study, the aim was to study DGE arterial input functions (AIFs) in healthy volunteers at 3 T for different scanning protocols, as a step towards making the glucose chemical exchange saturation transfer (glucoCEST) protocol more robust. Two different infusion durations (1.5 and 4.0 min) and saturation frequency offsets (1.2 and 2.0 ppm) were used. The effect of subject motion on the DGE signal was studied by using motion estimates retrieved from standard retrospective motion correction to create pseudo‐DGE maps, where the apparent DGE signal changes were entirely caused by motion. Furthermore, the DGE AIFs were compared with venous blood glucose levels. A significant difference (p = 0.03) between arterial baseline and postinfusion DGE signal was found after D‐glucose infusion. The results indicate that the measured DGE AIF signal change depends on both motion and blood glucose concentration change, emphasizing the need for sufficient motion correction in glucoCEST imaging. Finally, we conclude that a longer infusion duration (e.g. 3–4 min) should preferably be used in glucoCEST experiments, because it can minimize the glucose infusion side effects without negatively affecting the DGE signal change.