bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening of alkali‐assisted storage conditions to define the operational window of deacetylation within storage systems in the bioenergy supply chain
Authors: Wendt Lynn M. , Wahlen Bradley D. , Walton Michelle R. , Nguyen Jason A. , Lin Yingqian , Brown Rebecca M.
Published: September 2021

Overcoming biomass heterogeneity and associated recalcitrance to thermal, chemical, and enzymatic depolymerization is a necessary but challenging aspect of valorizing lignocellulosic biomass to fuels and chemicals. This study explores how this recalcitrance can be reduced during the supply chain unit operation of storage, which is required for seasonally harvested agricultural residues to maintain constant throughput at a biorefinery. In this work, partial alkali pretreatment was performed just prior to corn stover entering storage, which had the benefit of providing a high pH environment entering storage such that soluble sugars were preserved and saponified acetyl groups in hemicellulose. This work investigated a range of viable conditions where saponification and preservation occur simultaneously by varying the moisture content (40% and 60%) and concentrations of sodium hydroxide (low and high) during aerobic and anaerobic storage. Anaerobic conditions preserved overall dry matter below 5% in the three scenarios evaluated, and the highest alkali loading solubilized up to 15% lignin, 18% xylan, and 50% of acetate, meanwhile doubling the extractable components. Scanning electron microscopy images highlighted potential physical impacts including cell‐wall disruption near vascular bundles, pitting within parenchyma cells, and cell‐wall distortion. Techno‐economic assessment indicated that this storage approach and associated logistics system is economically competitive with a conventional approach using low‐moisture bales. © 2021 Society of Chemical Industry and John Wiley & Sons, Ltd
Exploring an experimental combination of analytical quality by design and green analytical chemistry approaches for development of HPTLC densitometric protocol for the analysis of barnidipine hydrochloride
Authors: Shirkhedkar Atul A. , Chaudhari Suraj R.
Published: September 2021

An experimental combination of analytical quality by design and green analytical chemistry approaches is introduced to develop an high‐performance thin‐layer chromatography (HPTLC) approach to quantify barnidipine hydrochloride in the pharmaceutical matrix. The analytical quality by design approach was introduced to green analytical chemistry to enhance protocol knowledge while ensuring efficiency and reducing environmental impacts, energy consumption and analyst visibility. This analytical approach was systematically addressed by exploring failure mode effect analysis, risk assessment and optimization design. Subsequently, a screening of primary variables was performed to select the aptest proportion of solvents in the mobile phase resulting from the principles of green analytical chemistry. Failure mode effect analysis and a risk assessment study were attempted to estimate the critical method parameters (CMPs). The influence of the CMPs on critical analytical attributes, i.e. retention factor and peak area, was assessed through a screening design. A response surface methodology was then executed for the critical analytical attributes as a concern of the determined CMPs, and the conditions for excellent resolution were determined using a desirability procedure. The established protocol was validated in compliance with the International Conference on Harmonization guideline Q2(R1) and showed excellent specificity and sensitivity.
Evaluating the clinical trends and benefits of low‐dose computed tomography in lung cancer patients
Authors: Qiao Edmund M. , Voora Rohith S. , Nalawade Vinit , Kotha Nikhil V. , Qian Alexander S. , Nelson Tyler J. , Durkin Michael , Vitzthum Lucas K. , Murphy James D. , Stewart Tyler F. , Rose Brent S.
Published: September 2021

Background

Despite guideline recommendations, utilization of low‐dose computed tomography (LDCT) for lung cancer screening remains low. The driving factors behind these low rates and the real‐world effect of LDCT utilization on lung cancer outcomes remain limited.

Methods

We identified patients diagnosed with non‐small cell lung cancer (NSCLC) from 2015 to 2017 within the Veterans Health Administration. Multivariable logistic regression assessed the influence of LDCT screening on stage at diagnosis. Lead time correction using published LDCT lead times was performed. Cancer‐specific mortality (CSM) was evaluated using Fine–Gray regression with non‐cancer death as a competing risk. A lasso machine learning model identified important predictors for receiving LDCT screening.

Results

Among 4664 patients, mean age was 67.8 with 58‐month median follow‐up, 95% CI = [7–71], and 118 patients received ≥1 screening LDCT before NSCLC diagnosis. From 2015 to 2017, LDCT screening increased (0.1%–6.6%, mean = 1.3%). Compared with no screening, patients with ≥1 LDCT were more than twice as likely to present with stage I disease at diagnosis (odds ratio [OR] 2.16 [95% CI 1.46–3.20]) and less than half as likely to present with stage IV (OR 0.38 [CI 0.21–0.70]). Screened patients had lower risk of CSM even after adjusting for LDCT lead time (subdistribution hazard ratio 0.60 [CI 0.42–0.85]). The machine learning model achieved an area under curve of 0.87 and identified diagnosis year and region as the most important predictors for receiving LDCT. White, non‐Hispanic patients were more likely to receive LDCT screening, whereas minority, older, female, and unemployed patients were less likely.

Conclusions

Utilization of LDCT screening is increasing, although remains low. Consistent with randomized data, LDCT‐screened patients were diagnosed at earlier stages and had lower CSM. LDCT availability appeared to be the main predictor of utilization. Providing access to more patients, including those in diverse racial and socioeconomic groups, should be a priority.
Analysis of risk factors for Gleason score upgrading after radical prostatectomy in a Chinese cohort
Authors: Zhang Baoling , Wu Shangrong , Zhang Yang , Guo Mingyu , Liu Ranlu
Published: September 2021

Background

To study the risk factors of Gleason score upgrading (GSU) after radical prostatectomy (RP) in a Chinese cohort.

Methods

The data of 637 patients who underwent prostate biopsy and RP in our hospital from January 2014 to January 2021 were retrospectively analyzed. The age, body mass index (BMI), prostate‐specific antigen (PSA) level, testosterone (TT) level, neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), eosinophil‐to‐lymphocyte ratio (ELR), aspartate aminotransferase/alanine transaminase (AST/ALT) ratio, clinical stage, the biopsy method, and pathological characteristics of specimens after biopsy and RP were collected for all patients. Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of GSU after RP. The predictive efficacy was verified with the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. We performed the analysis separately in the overall cohort and in the cohort with Gleason score (GS) = 6.

Results

In the overall cohort, 177 patients (27.79%) had GSU, and in the GS = 6 cohort, 68 patients (60.18%) had GSU. Multivariate logistic regression analysis showed that in the overall cohort, clinical stage ≥T2c (OR = 3.201, p < 0.001), the number of positive cores ≥3 (OR = 0.435, p = 0.04), and positive rate of biopsy (OR = 0.990, p = 0.016) can affect whether GS is upgraded, and the AUC of the combination of the three indicators for predicting the occurrence of GSU was 0.627. In the GS = 6 cohort, multivariate logistic regression analysis showed that clinical stage ≥T2c (OR = 4.690, p = 0.001) was a risk factor for GSU, and the AUC predicted to occur GSU is 0.675.

Conclusion

Clinical stage ≥T2c, the number of positive cores <3, and lower positive rate of biopsy are the risk factors of GSU. This study may provide some references for clinicians to judge the accuracy of biopsy pathological grading and formulate treatment strategies, but the specific effect still needs clinical practice certification.
Levocarnitine for pegaspargase‐induced hepatotoxicity in older children and young adults with acute lymphoblastic leukemia
Authors: Schulte Rachael , Hinson Ashley , Huynh Van , Breese Erin H. , Pierro Joanna , Rotz Seth , Mixon Benjamin A. , McNeer Jennifer L. , Burke Michael J. , Orgel Etan
Published: September 2021

Background

Pegaspargase (PEG‐ASP) is an integral component of therapy for acute lymphoblastic leukemia (ALL) but is associated with hepatotoxicity that may delay or limit future therapy. Obese and adolescent and young adult (AYA) patients are at high risk. Levocarnitine has been described as potentially beneficial for the treatment or prevention of PEG‐ASP‐associated hepatotoxicity.

Methods

We collected data for patients age ≥10 years who received levocarnitine during induction therapy for ALL, compared to a similar patient cohort who did not receive levocarnitine. The primary endpoint was conjugated bilirubin (c.bili) >3 mg/dl. Secondary endpoints were transaminases >10× the upper limit of normal and any Grade ≥3 hepatotoxicity.

Results

Fifty‐two patients received levocarnitine for prophylaxis (n = 29) or rescue (n = 32) of hepatotoxicity. Compared to 109 patients without levocarnitine, more patients receiving levocarnitine were obese and/or older and had significantly higher values for some hepatotoxicity markers at diagnosis and after PEG‐ASP. Levocarnitine regimens varied widely; no adverse effects of levocarnitine were identified. Obesity and AYA status were associated with an increased risk of conjugated hyperbilirubinemia and severe transaminitis. Multivariable analysis identified a protective effect of levocarnitine on the development of c.bili >3 mg/dl (OR 0.12, p = 0.029). There was no difference between groups in CTCAE Grade ≥3 hepatotoxicity. C.bili >3 mg/dl during induction was associated with lower event‐free survival.

Conclusions

This real‐world data on levocarnitine supplementation during ALL induction highlights the risk of PEG‐ASP‐associated hepatotoxicity in obese and AYA patients, and hepatotoxicity's potential impact on survival. Levocarnitine supplementation may be protective, but prospective studies are needed to confirm these findings.
Should I invite them? Bystanders' inclusivity judgements towards outgroup victims and ingroup bullies in intergroup bullying
Authors: Gönültaş Seçil , Yavuz H. Melis , Mulvey Kelly Lynn
Published: September 2021

This study examined bystanders' judgements of bullying and their inclusivity towards refugee victims and ingroup bully peers. Participants included 587 Turkish adolescents (Mage = 13.14, SD = 1.60) who were presented with two stories: intergroup (Syrian refugee victim) and intragroup (Turkish victim) bullying. They indicated acceptability of bullying, retaliation, and how likely they would be to include victims and bullies in different social contexts. Empathy, prejudice, desired social distance, and peer norms towards Syrian refugees were examined as predictors. Adolescents in schools with a higher number of Syrian peers were more likely to expect they would include the Syrian victim than adolescents in schools with a lower number of Syrian peers. Further, adolescents with higher empathy were more likely to include the Syrian victim while adolescents with higher prejudice and desired social distance were less likely to include the Syrian victim. The results highlight the importance of attending to bystanders' future interactions with victims and bullies, as bystanders have the opportunity to challenge injustice by promoting inclusive school climates in diverse societies. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.
Quantifying the target market for advertisers
Authors: Graham Charles , Kennedy Rachel
Published: September 2021

Marketers who want to protect their brand's share or grow it need to know who to reach and nudge with advertising. This paper uses continuous household panel data for 55 leading, advertised brands in 12 CPG categories to quantify their target market over different time frames and conditions (market type, brand size and dynamism). Results demonstrate that the customer base (brand penetration) must swell dramatically over time to maintain, let alone grow, market share. For stable brands, penetration typically doubles from its level in one quarter to a year, then again from 1 to 5 years as brands continue to attract lighter buyers who underpin long run sales. Over 5 years, over a third of brand buyers are so light that they buy the brand just once, but such buyers are vital to sales and critical to growth. As well as quantifying the 5‐year target audience for brands across these conditions, we test the predictive accuracy of the NBD‐Dirichlet as a benchmark. The implications for advertising and media strategy are detailed. The long‐term lessons for targeting become clear—unless brands “target the market”, they have adopted a counter growth strategy.
Glanzmann thrombasthenia complicated by frequent myeloproliferative neoplasm‐related thromboembolism: thrombosis occurring regardless of αIIbβIII integrin deficiency
Authors: Schutgens Roger E. G. , Urbanus Rolf T.
Published: September 2021

A patient with Glanzmann Thrombasthenia developed recurrent venous thrombosis with a JAK2 positive myeloproliferative neoplasm. This indicates that the platelet aIIbβIII integrin has no role in venous thrombosis. We discuss the other potential mechanisms that are involved. In addition, we describe the successful use of dabigatran in this patient.
Accidental ingestion of a long dental crown
Authors: Takaoka Kensuke , Minemura Chikashi , Baba Hiromi , Housyaku Hidehiko
Published: September 2021

It is recommended that a sharp‐pointed object, such as a dental crown, in the proximal duodenum be retrieved endoscopically if this can be accomplished safely.
Inflammatory myofibroblastic tumor of the larynx: Case report
Authors: Foster Henry James , Ow Thomas J. , Bottalico Danielle , Scott Gorthey , Ustun Berrin , Shifteh Keivan
Published: September 2021

Inflammatory myofibroblastic tumor is usually a benign tumor of mesenchymal origin that is rarely found in the larynx. This case explores the unique laryngeal location and presentation of this tumor as well as the challenging radiographic and histologic findings.
Lymphocyte transformation test: The multiple positive results turned to all negative after influenza infection
Authors: Kondo Makoto , Iida Shohei , Umaoka Ai , Nakanishi Takehisa , Matsushima Yoshiaki , Habe Koji , Yamanaka Keiichi
Published: September 2021

Previously positive lymphocyte transformation test (LTT) results changed to negative during influenza infection. As observed in the current article, results of LTT may be influenced by infection; therefore, it is crucial to consider the timing of LTT.
Abdominal wall endometrioma: An insidious cause of delayed diagnosis
Authors: Stavros Sofoklis , Domali Ekaterini , Papapanagiotou Ioannis K. , Drakakis Peter , Rodolakis Alexandros
Published: September 2021

An extremely rare extrapelvic position of endometriosis with a precise incidence of 0.07%–0.47%, leading usually to delayed and false diagnosis. Differential diagnosis should include that rare condition while ultrasonography remains a pivotal tool to unravel that enigma, especially in women with no specific symptoms and surgeries in the past.
Partial molar pregnancy with a normal live fetus and umbilical cord abnormalities: A novel association with long‐term follow‐up: A case report
Authors: Ghalandarpoor Attar Seyedeh Noushin , Ghalandarpoor Attar Seyedeh Mojgan
Published: September 2021

A euploid fetus in a partial molar pregnancy can develop umbilical cord abnormalities as pregnancy goes on. So, careful examination of the umbilical cord can determine fetuses at risk for ominous adverse effects.
Technical and Economic Analysis for the Production of Acrylonitrile from Crude Glycerol
Authors: Braga Eduardo Ramos , Braga Rafael Ramos , Magalhães Pontes Luiz Antônio
Published: September 2021

Glycerol is the main by‐product of biodiesel plants, and new technological routes using it as a raw material are being developed due to the increased global production of biofuels. One possible application is in the production of acrylonitrile, a product with several industrial applications. Here, the production process of acrylonitrile using crude glycerol is proposed and analyzed. The process is shown to be economically viable, requiring an operating time of 5 years to achieve a net present value/investment ratio greater than 2 and an internal rate of return greater than 10 % per annum. The new process was found to be competitive compared to the current route (through propylene ammoxidation), supporting the development of new studies on this new route.
Association of coronary microvascular dysfunction and cardiac bridge integrator 1, a cardiomyocyte dysfunction biomarker
Authors: Pacheco Christine , Wei Janet , Shufelt Chrisandra , C. Hitzeman Tara , Cook‐Wiens Galen , Pepine Carl J. , Handberg Eileen , Anderson R. David , Petersen John , Hong TingTing , M. Shaw Robin , Bairey Merz C. Noel
Published: September 2021

Background

Coronary microvascular dysfunction (CMD) is associated with heart failure with preserved ejection fraction (HFpEF); however, pathophysiology is not well described.

Hypothesis

We hypothesized that CMD in women with suspected ischemia with no obstructive coronary artery disease (INOCA) is associated with cardiomyocyte dysfunction reflected by plasma levels of a cardiomyocyte calcium handling protein, cardiac bridge integrator 1 (cBIN1).

Methods

Women with suspected INOCA undergoing coronary function testing were included. Coronary flow reserve, vasodilation to nitroglycerin, change in coronary blood flow (ΔCBF), and vasodilation to acetylcholine (ΔAch) were evaluated. cBIN1 score (CS) levels in these women (n = 39) were compared to women with HFpEF (n = 20), heart failure with reduced ejection fraction (HFrEF) (n = 36), and reference controls (RC) (n = 50). Higher CS indicates cardiomyocyte tubule dysfunction.

Results

INOCA, HFpEF, and HFrEF women were older than RC (p < .05). Higher CS was associated with vasoconstriction to acetylcholine (r = −0.43, p = .011) with a trend towards lower ΔCBF (r = 0.30, p = .086). Higher CS was specific for ΔAch and ΔCBF but had limited sensitivity. INOCA women had higher CS than RC, but lower CS than HFpEF/HFrEF groups (p < .001).

Conclusions

CS, a plasma biomarker indicating poor cardiomyocyte health, was higher in women with suspected INOCA as compared to RC, but lower than in women with HFpEF. Elevated CS in suspected INOCA patients represents an intermediate group between health and disease, supporting the hypothesis that CMD may progress to HFpEF. Larger prospective cohort studies are needed to confirm the pathophysiological relationship between cBIN1, CMD, and HFpEF.
Cancer‐related impairments and functional limitations among long‐term cancer survivors: Gaps and opportunities for clinical practice
Authors: Nekhlyudov Larissa , Campbell Grace B. , Schmitz Kathryn H. , Brooks Gabriel A. , Kumar Anita J. , Ganz Patricia A. , Von Ah Diane
Published: September 2021

This commentary provides a concise overview of the epidemiology of cancer survivorship and work, common functional limitations experienced by cancer survivors, and evidence‐based recommendations for interventions available to improve function. It also describes the US Social Security Administration's disability claims process, its eligibility requirements, and barriers for long‐term survivors in securing approval for disability claims, and offers insights for practicing clinicians in holistically addressing functional limitations in practice.
Trends in the incidence of early‐onset colorectal cancer in all 50 United States from 2001 through 2017
Authors: Shah Rajesh R. , Millien Valentine O. , da Costa Wilson L. , Oluyomi Abiodun O. , Gould Suarez Milena , Thrift Aaron P.
Published: September 2021

Background

The rate of change in the incidence of colorectal cancer (CRC) among persons younger than 50 years in the United States appears to vary by demographics, tumor location, and geography. This study analyzed data from all 50 states to examine recent changes in the incidence of CRC among persons younger than 50 years and to identify key subgroups with disproportionate risk.

Methods

Annual incidence rates for CRC, colon cancer, and rectal cancer in persons aged 20 to 49 years were extracted from the US Cancer Statistics for the period 2001‐2017. Secular trends were examined overall and by age group, sex, race/ethnicity, stage, and state. Joinpoint regression was used to compute annual percent changes and average annual percent changes (AAPCs) as well as corresponding 95% confidence intervals (95% CIs).

Results

The incidence of CRC increased by 1.27% (95% CI, 0.95%‐1.60%) annually from 2001 to 2012 and by 3.00% (95% CI, 2.06%‐3.95%) annually from 2012 to 2017. AAPCs for the period 2001‐2017 were higher among persons aged 20 to 24 years (AAPC, 6.62%; 95% CI, 3.86%‐9.45%) in comparison with other age groups and higher among non‐Hispanic Whites (AAPC, 2.38%; 95% CI, 1.98%‐2.79%) in comparison with other racial/ethnic groups. In 2001‐2002, only 1 state had an age‐standardized incidence rate > 13.0 per 100,000, but this number increased to 32 states by 2016‐2017.

Conclusions

CRC rates among US adults aged 20 to 49 years increased from 2001 to 2017, with the fastest increases observed from 2012 to 2017. Increases were observed among the youngest age groups, among non‐Hispanic Whites, and in states in the West, Midwest, and Rocky Mountain regions. Increasing rates across all tumor stages suggest a real increase in CRC incidence.
Metal‐Organic Frameworks Deliver a Conjugate of Functional Oligonucleotides and Photosensitizer to Induce Apoptosis for Enhancing Chemotherapy
Authors: Han Zhaoyu , Qian Yue , Wu Yiyang , Cai Yanfei , Jin Jian , Yang Zhaoqi
Published: September 2021

Metal‐organic frameworks are highly porous and biodegradable and have found numerous applications in biomedicine. However, the traditional chemotherapy of MOF‐drug delivery system remains a great challenge because of adverse side effects and cell tolerance. In this work, we have fabricated a hybrid drug delivery system based on ZIF‐90 encapsulated with Doxorubicin (DOX) and Ce6‐G3139 for enhanced chemotherapy. The released DOX can enter cell nucleus and trigger cell death. In addition, the G3139 binds to the anti‐apoptotic gene Bcl‐2 in tumor cells and related proteins are downregulated to inhibit cell proliferation. Meanwhile, the photosensitizer Ce6 carried by the nucleic acid will generate abundant reactive oxygen species under a near‐infrared (NIR) laser irradiation thus induces more cell apoptosis. It was worth mentioning that in vitro MTT test in the MCF‐7 cells assays revealed that DOX@ ZIF‐90/Ce6‐G3139 nanoparticles possessed stronger anticancer capability than free DOX or DOX@ ZIF‐90 nanoparticles indicating that the investigation offers an exciting new therapeutic strategy for the treatment of chemotherapy.
Analysis of the Effect of Cusp‐Shaped Magnetic Fields on Heat, Mass, and Oxygen Transfer Using a Coupled 2D/3D Global Model
Authors: Kakimoto Koichi , Liu Xin , Nakano Satoshi
Published: September 2021

The recent development of power devices requires silicon wafers in the radial direction as well as in the depth direction in a low oxygen concentration. Magnetic fields such as transverse or cusp‐shaped magnetic fields are then applied to the silicon melt to reduce the oxygen concentration in the crystal, especially those 300 mm in diameter or larger. Several studies reported calculated results of reduced oxygen concentration in the melt with cusp‐shaped magnetic fields. However, few studies have reported on the 3D transfer processes of oxygen in the melt. This paper reports on the transfer mechanism of oxygen in silicon melts with 300‐mm‐diameter crystals under cusp‐shaped magnetic fields during the growth of silicon crystals via the Czochralski method. Using in‐house software with a coupled 2D/3D global model, this study examines the effects of the flow fields in the melt on heat, mass, and oxygen transfer as a function of the relative position between the zero‐Gauss plane and the melt.
Photocatalytic C−H Azolation of Arenes Using Heterogeneous Carbon Nitride in Batch and Flow
Authors: Wen Zhenghui , Wan Ting , Vijeta Arjun , Casadevall Carla , Buglioni Laura , Reisner Erwin , Noël Timothy
Published: September 2021

The functionalization of aryl C(sp2)−H bonds is a useful strategy for the late‐stage modification of biologically active molecules, especially for the regioselective introduction of azole heterocycles to prepare medicinally‐relevant compounds. Herein, we describe a practical photocatalytic transformation using a mesoporous carbon nitride (mpg‐CNx) photocatalyst, which enables the efficient azolation of various arenes through direct oxidation. The method exhibits a broad substrate scope and is amenable to the late‐stage functionalization of several pharmaceuticals. Due to the heterogeneous nature and high photocatalytic stability of mpg‐CNx, the catalyst can be easily recovered and reused leading to greener and more sustainable routes, using either batch or flow processing, to prepare these important compounds of interest in pharmaceutical and agrochemical research.
Pleomorphic liposarcoma with liver metastasis diagnosed by combined fine‐needle aspiration cytology and core‐needle biopsy
Authors: Ciliberti Valeria , Cretella Pasquale , Zeppa Pio , Caputo Alessandro
Published: September 2021

Pleomorphic liposarcoma (PLPS) is the rarest liposarcoma subtype, with high‐local recurrence and metastasis rates. Fine‐needle aspiration cytology (FNAC) is successfully used in the diagnosis of primary or metastatic soft tissue tumors, but liver metastases of PLPS diagnosed by FNAC have never been reported. The cytological diagnosis depends on the identification of lipoblasts with sharply defined cytoplasmic vacuoles indenting and distorting the nucleus in the context of a pleomorphic tumor and in a proper clinical and imaging context. Despite its aggressive behavior, hematogenous liver metastases are rare, with just one case reported in literature. A case of PLPS liver metastasis and concomitant primary tumor diagnosed by FNAC and core needle biopsy is herein described.
Combining DNA metabarcoding and ecological networks to inform conservation biocontrol by small vertebrate predators
Authors: Mata Vanessa A. , da Silva Luis P. , Veríssimo Joana , Horta Pedro , Raposeira Helena , McCracken Gary F. , Rebelo Hugo , Beja Pedro
Published: September 2021

In multifunctional landscapes, diverse communities of flying vertebrate predators provide vital services of insect pest control. In such landscapes, conservation biocontrol should benefit service‐providing species to enhance the flow, stability and resilience of pest control services supporting the production of food and fiber. However, this would require identifying key service providers, which may be challenging when multiple predators interact with multiple pests. Here we provide a framework to identify the functional role of individual species to pest control in multifunctional landscapes. First, we used DNA metabarcoding to provide detailed data on pest species predation by diverse predator communities. Then, these data were fed into an extensive network analysis, in which information relevant for conservation biocontrol is gained from parameters describing network structure (e.g., modularity) and species roles in such network (e.g., centrality, specialization). We applied our framework to a Mediterranean landscape, where 19 bat species were found to feed on 132 insect pest species. Metabarcoding data revealed potentially important bats that consumed insect pest species in high frequency and/or diversity. Network analysis showed a modular structure, indicating sets of bat species that are required to regulate specific sets of insect pests. A few generalist bats had particularly important roles, either at network or module levels. Extinction simulations highlighted six bats, including species of conservation concern, which were sufficient to ensure that over three‐quarters of the pest species had at least one bat predator. Combining DNA metabarcoding and ecological network analysis provides a valuable framework to identify individual species within diverse predator communities that might have a disproportionate contribution to pest control services in multifunctional landscapes. These species can be regarded as candidate targets for conservation biocontrol, although additional information is needed to evaluate their actual effectiveness in pest regulation.
Clinical and prognostic implications of capillary density in patients with cardiac light chain amyloidosis
Authors: Kim Darae , Choi Jin‐Oh , Kim Kihyun , Kim Seok Jin , Kim Jung‐Sun , Jeon Eun‐Seok
Published: September 2021

Aims

Cardiac involvement is crucial factor determining outcomes of light chain (AL) amyloidosis. This study evaluated whether capillary density (CD) quantified from endomyocardial biopsy is associated with structural and functional parameters of amyloid heart. Also, we investigated whether capillary density improves the prognostic value of the current staging system in AL amyloidosis patients with cardiac involvement.

Methods and results

A total of 67 patients with biopsy‐proven AL cardiac amyloidosis were prospectively enrolled in this study. All patients underwent transthoracic echocardiography and EBM at the time of diagnosis. Left ventricle global longitudinal strain was evaluated on two‐dimensional strain echocardiography. The primary endpoint was all‐cause mortality. Amyloid load and capillary density were calculated on endomyocardial biopsy stained immunohistochemically with antibody against amyloid P and CD31, respectively.

Among the study population, 37 patients (55.2%) were classified as Stage IV, and the cumulative incidence of death at 1 year was 34% (23 patients). A total of 65 (97%) patients underwent chemotherapy. CD showed a significant correlation with left ventricle global longitudinal strain (r = 0.274, P = 0.025), log N‐terminal pro‐B type natriuretic peptide (r = −0.311, P = 0.005), and amyloid load (r = −0.438, P < 0.001). Patients with a CD ≤ 220/mm2 were at significantly higher risk of death than those with a CD > 220/mm2 (P = 0.026 by log‐rank test). A model based on the 2012 Mayo staging system and CD showed significantly better discrimination and reclassification ability than a model using the 2012 Mayo staging system alone (C‐index 0.582 vs.0.689, P for difference <0.001).

Conclusions

Capillary density was significantly related to the severity of amyloid deposits in the myocardium and showed incremental prognostic value in addition to the 2012 Mayo staging system.
The Current Understanding of how 2D Polymers Grow Photochemically
Authors: Lackinger Markus , Schlüter A. Dieter
Published: September 2021

2D polymers are a relatively new class of macromolecules. Therefore, it is not astounding that so far research focused on how to provide access to this intriguing class of organic 2D materials, how to prove their existence, and how to assess their structural quality. Studies concerning the formation mechanism are comparatively scarce. We here collect and compare all the mechanistic information available for 2D polymer synthesis by photochemical means and point towards research directions to be followed in order to advance the fundamental understanding and, thus, fast development of this field. Because the two current starting situations for the photochemical synthesis of 2D polymers are layered single crystals and surface‐supported monolayers, the prominent analytical tools are X‐ray diffraction (XRD), local vibration spectroscopy, e. g. tip enhanced Raman spectroscopy (TERS), and scanning probe microscopy (SPM), e. g. low temperature scanning tunnelling microscopy (LT STM) in ultra‐high vacuum (UHV), but also atomic force microscopy (AFM). With their advantages and shortcomings, they will therefore play an important role throughout this mini review.
Dance and yoga reduced functional abdominal pain in young girls: A randomized controlled trial
Authors: Högström Sofie , Philipson Anna , Ekstav Lars , Eriksson Mats , Fagerberg Ulrika L. , Falk Elin , Möller Margareta , Sandberg Elin , Särnblad Stefan , Duberg Anna
Published: September 2021

Background

Functional abdominal pain disorders (FAPDs) affect children, especially girls, all over the world. The evidence for existing treatments is mixed, and effective accessible treatments are needed. Dance, a rhythmic cardio‐respiratory activity, combined with yoga, which enhances relaxation and focus, may provide physiological and psychological benefits that could help to ease pain.

Objectives

The aim of this study was to evaluate the effect of a dance and yoga intervention on maximum abdominal pain in 9‐ to 13‐year‐ old girls with FAPDs.

Methods

This study was a prospective randomized controlled trial with 121 participants recruited from outpatient clinics as well as the general public. The intervention group participated in dance and yoga twice weekly for 8 months; controls received standard care. Abdominal pain, as scored on the Faces Pain Scale–Revised, was recorded in a pain diary. A linear mixed model was used to estimate the outcomes and effect sizes.

Results

Dance and yoga were superior to standard health care alone, with a medium to high between‐group effect size and significantly greater pain reduction (b = −1.29, p = 0.002) at the end of the intervention.

Conclusions

An intervention using dance and yoga is likely a feasible and beneficial complementary treatment to standard health care for 9‐ to 13‐year‐old girls with FAPDs.

Significance

FAPDs affect children, especially girls, all over the world. The negative consequences such as absence from school, high consumption of medical care and depression pose a considerable burden on children and their families and effective treatments are needed. This is the first study examining a combined dance/yoga intervention for young girls with FAPDs and the result showed a reduction of abdominal pain. These findings contribute with new evidence in the field of managing FAPDs in a vulnerable target group.
Disability Access and Digital Platforms
Authors: Bowen Liz
Published: September 2021

The shift to online programming prompted by the Covid‐19 pandemic has enabled more people to attend more events. But there are dangers to drawing the conclusion that “online” automatically means “more accessible.” For people with disabilities, the platforms that have defined life during the pandemic have facilitated some forms of access while making others more difficult. Regardless of reopening plans, the possibility of remote work and learning will undoubtedly continue to develop and shape daily life for many years to come. What, then, do digital platforms owe the diverse range of users who depend on their technologies?
The Vaccination Cold War
Authors: Moreno Jonathan D. , Sándor Judit , Schmidt Ulf
Published: September 2021

Surveying the early responses to the Covid‐19 pandemic among nation states, one finds a veritable babel of responses, some predictable and some not. Would these results have been different half a century or more ago, when smallpox was eradicated and hopes were high that international cooperation would yield similar results for other infectious diseases? Is this a story about the stability provided by the bipolar postwar world, juxtaposed with the complex geopolitical repositioning that finally followed the collapse of the Soviet Union, or is that too rich an irony? A multipolar world may indeed be less prepared to cope with an international health crisis than a bipolar one. In any case, the patterns of global response are not only reminiscent of the Cold War era itself but also suggestive of a new vaccination cold war.
The University of California Crisis Standards of Care: Public Reasoning for Socially Responsible Medicine
Authors: Rajczi Alex , Daar Judith , Kheriaty Aaron , Dastur Cyrus
Published: September 2021

During the Covid‐19 pandemic, the University of California convened the University of California Critical Care Bioethics Working Group, a team of twenty individuals tasked with developing a set of triage procedures. This article highlights several crucial components of the UC procedures and describes the reasoning behind them. The recommendations and the reasoning in the UC protocol are distinctive because of the emphasis the working group placed on grounding its decisions on the public's preferences for triage protocols. To highlight the distinctiveness of the recommendations and reasoning, this article contrasts the UC procedures with the triage procedures known as the “Pittsburgh framework.” Among the specific topics discussed are age discrimination, disability discrimination, the prioritization of critical workers for scarce resources, and triage priority for pregnant patients.
Structural Inequities, Fair Opportunity, and the Allocation of Scarce ICU Resources
Authors: White Douglas B. , Lo Bernard
Published: September 2021

The September‐October 2021 issue of the Hastings Center Report highlights the important topic of allocating scarce critical care resources during the Covid‐19 pandemic. The article by Alex Rajczi and colleagues urges that policy‐makers use public reasoning, not private reasoning, when developing triage policies. We completely agree. We show how the allocation framework we developed as private scholars, the “Pittsburgh framework,” has been supported by public reasoning.

The article by MaryKatherine Gaurke and colleagues criticizes rationing based on maximizing life‐years saved and mistakenly claims that our framework recommended this approach. We explain that our framework never contained such a criterion but instead included a more limited consideration of near‐term prognosis. In December 2020, in response to emerging data and important criticisms, we modified our framework to further strengthen equity. We are committed to improving allocation guidelines during crisis standards of care through reflective discussions and debates.
Against Exclusive Survivalism: Preventing Lost Life and Protecting the Disadvantaged in Resource Allocation
Authors: Persad Govind
Published: September 2021

When life‐saving medical resources are scarce and not everyone can be saved, is the only relevant goal saving the most lives? Or can other factors be considered, at least as tiebreakers, such as how early in life the people we don't save will die or how much future life they are likely to lose? This commentary defends a multiprinciple allocation approach that considers objectives in addition to saving more lives, including preventing early death and preventing harm in the form of lost future life. Particularly compared to an arbitrary, coin‐flip tiebreaker, this multiprinciple approach more effectively prevents harm, prioritizes the worst‐off, mitigates socioeconomic and racial health disparities, and tracks public values regarding allocation under scarcity—and is legally sound.
Values across Ages
Authors: Gilleard Chris
Published: September 2021

Ending Midlife Bias: New Values for Old Age, by Nancy Jecker, addresses what she sees as Western society's overvaluing of autonomy and undervaluing of dignity, a bias that she sees as particularly unsuited to old age. While she makes a strong case, two main problems challenge her approach. First, she characterizes later life by the diseases and disabilities associated with it, compressing its ever‐expanding social space into a narrow location where need trumps desire, and comfort companionship. Second, she considers few other values beyond the antagonism between being granted autonomy and being granted dignity. Human values extend beyond such pairing – and beyond the confines of any particular phase or stage of life. It is as if the author sees old age as an endless succession of Sundays, punctured by dull but respectful visits from grandchildren and great grandchildren. Later life lasts more than one day and deserves more than one value.
Frailty is associated with increased risk of cirrhosis disease progression and death
Authors: Wang Sarah , Whitlock Reid , Xu Chelsea , Taneja Sunil , Singh Surender , Abraldes Juan G. , Burak Kelly W. , Bailey Robert J. , Lai Jennifer C. , Tandon Puneeta
Published: September 2021

Background and Aims

The Liver Frailty Index (LFI) is a well‐studied tool that evaluates frailty in patients with cirrhosis. Consisting of grip strength, chair stands, and balance testing, the LFI has been associated with increased mortality in patients awaiting liver transplant. We aimed to extend our understanding of frailty in cirrhosis by exploring the relationship between the LFI and the risk of (1) cirrhosis progression, (2) mortality, and (3) unplanned hospitalizations, in both compensated and decompensated disease.

Approach and Results

Adult patients with cirrhosis from four centers in North America and one in India were included. Frailty was measured at baseline using the LFI and categorized as robust (LFI < 3.2), prefrail (LFI 3.2–4.5), and frail (LFI > 4.5). Progression of cirrhosis was defined by an increase in clinical stage, ranging from 1 to 5, from baseline using the D’Amico classification. Factors associated with progression, mortality, and hospitalizations were evaluated using multivariate regression models, with transplant as a competing risk. In total, 822 patients with cirrhosis were included. Average Model for End‐Stage Liver Disease (MELD) score was 15.5 ± 6.0. In patients with compensated cirrhosis, being frail versus robust was associated with increased risk of progression to the next cirrhosis stage or to death (HR, 2.45; 95% CI, 1.14–5.29) and with an increased risk of unplanned hospitalizations (2.32; 95% CI, 1.13–4.79), after adjusting for age, sex, and MELD score. Similar HRs were observed in patients with decompensated cirrhosis.

Conclusions

Frailty was an independent predictor of cirrhosis progression or death and unplanned hospitalization across patients with compensated and decompensated cirrhosis. Future studies are needed to evaluate the possibility of slowing cirrhosis disease progression by reversing or preventing frailty.
Understanding culturally safe aged care from the perspectives of older Aboriginal Australians in rural and remote communities
Authors: Parrella Adriana , Pearson Odette , Davy Carol , Barrie Helen , Mott Kathy , Morey Kim , D’Angelo Shane , Sambo Roxanne , Aitken Richard , Franks Christine , Canuto Kootsy , Brown Alex , Braunack‐Mayer Annette
Published: September 2021

Issue addressed

Aboriginal and Torres Strait Islander peoples face challenges in accessing aged care and are less likely to use some services than their non‐Indigenous counterparts. Culturally safe care is increasingly recognised as an enabler to improve access and quality of care. This study explored older Aboriginal peoples’ perceptions and experience of culturally safe aged care.

Methods

We conducted semi‐structured interviews with sixty‐three older Aboriginal people, purposively sampled from three rural and remote geographic locations in South Australia, between April and October 2018, with participants who were both receiving and not receiving aged care services. We asked participants how organisations do or could meet their aged care needs. We analysed interview data inductively into themes. These themes were incorporated into six principles of culturally safe aged care which were subsequently endorsed by participants and study stakeholders.

Results

Participants described culturally safe aged care services as those which facilitated or maintained connection to participants’ culture, traditional lands and community. Five themes were identified: maintaining cultural identity, culturally informed service delivery, culturally competent workforce, culturally supportive environments and partnerships and collaboration within the aged care service system.

Conclusion

Addressing cultural safety in aged care will require organisations to adapt their policies, service delivery, environments and work practices to meet the needs of older Aboriginal peoples. SO WHAT? Identifying culturally safe aged care from the perspectives of older Aboriginal and Torres Strait Islander peoples provides timely insight to how services may be better designed and implemented to promote quality of life.
Anabolic androgenic steroids used as performance and image enhancing drugs in professional and amateur athletes: Toxicological and psychopathological findings
Authors: Piacentino Daria , Sani Gabriele , Kotzalidis Georgios D. , Cappelletti Simone , Longo Livia , Rizzato Salvatore , Fabi Francesco , Frati Paola , Fineschi Vittorio , Leggio Lorenzo
Published: September 2021

Objective

The use of anabolic androgenic steroids (AASs) as performance and image enhancing drugs (PIEDs), once restricted to professional athletes, now includes amateurs and regular gym visitors. AAS use is associated with psychopathology, yet this relationship is complex and not fully understood. We aimed to assess the presence of AASs and other misused substances in athletes' biological samples and link toxicological to psychopathological findings.

Methods

A multicentre, cross‐sectional study in fitness centres in Italy recruited 122 professional and amateur athletes training in several sports (84 men; age range = 18‐45 years). Athletes completed questionnaires, interviews, and toxicology testing for AASs, other PIEDs, illicit drugs, and non‐prescribed psychotropics. Toxicology was conducted in blood, urine, and hair.

Results

Self‐reported and toxicologically detected use rates of AASs and other misused substances showed slight‐to‐fair agreement (Fleiss' κ = 0.104‐0.375). There was slight‐to‐moderate agreement among the three biological samples used for AAS testing (κ = 0.112‐0.436). Thirty‐one athletes (25.4%) tested positive for AASs. More sport hours/week, narcissistic or antisocial personality disorders, and higher nonplanning impulsiveness scores predicted AAS use (pseudo‐R2 = 0.665). AAS users did not differ significantly from non‐users in major psychopathology, but their Hypomania Checklist‐32 score, which also predicted AAS use, was significantly higher (p < 0.001), suggesting increased odds for cyclothymic disorder or subthreshold hypomania.

Conclusions

Our results have implications for studying AAS users, as they identify a cluster of variables that may be relevant in future understanding of AAS use risks (e.g., personality disorders). Possible disagreements between AAS assessment methods should be considered when implementing harm reduction interventions, such as needle and syringe distribution, health education, and counselling, as well as surveillance programmes.