bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of pyrolysis gas chromatography/mass spectrometry and hyperspectral FTIR imaging spectroscopy for the analysis of microplastics
Authors: Primpke Sebastian , Fischer Marten , Lorenz Claudia , Gerdts Gunnar , Scholz-Böttcher Barbara M.
Published: October 2020

Analysis of microplastics (MP) in environmental samples is an emerging field, which is performed with various methods and instruments based either on spectroscopy or thermoanalytical methods. In general, both approaches result in two different types of data sets that are either mass or particle number related. Depending on detection limits of the respective method and instrumentation the derived polymer composition trends may vary. In this study, we compare the results of hyperspectral Fourier-transform infrared (FTIR) imaging analysis and pyrolysis gas chromatography-mass spectrometry (Py-GC/MS) analysis performed on a set of environmental samples that differ in complexity and degree of microplastic contamination. The measurements were conducted consecutively, and on exactly the same sample. First, the samples were investigated with FTIR using aluminum oxide filters; subsequently, these were crushed, transferred to glass fiber filters, in pyrolysis cups, and measured via Py-GC/MS. After a general data harmonization step, the trends in MP contamination were thoroughly investigated with regard to the respective sample set and the derived polymer compositions. While the overall trends in MP contamination were very similar, differences were observed in the polymer compositions. Furthermore, polymer masses were empirically calculated from FTIR data and compared with the Py-GC/MS results. Here, a most plausible shape-related overestimation of the calculated polymer masses was observed in samples with larger particles and increased particle numbers. Taking into account the different measurement principles of both methods, all results were examined and discussed, and future needs for harmonization of intermethodological results were identified and highlighted.
Clinical implications of increased uptake in bone marrow and spleen on FDG-PET in patients with bacteremia
Authors: Pijl Jordy P. , Kwee Thomas C. , Slart Riemer H. J. A. , Yakar Derya , Wouthuyzen-Bakker Marjan , Glaudemans Andor W. J. M.
Published: October 2020

Purpose

To investigate which clinical factors and laboratory values are associated with high FDG uptake in the bone marrow and spleen on 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with bacteremia.

Methods

One hundred forty-five consecutive retrospective patients with bacteremia who underwent FDG-PET/CT between 2010 and 2017 were included. Mean standard uptake values (SUVmean) of FDG in bone marrow, liver, and spleen were measured. Bone marrow-to-liver SUV ratios (BLR) and spleen-to-liver SUV ratios (SLR) were calculated. Linear regression analyses were performed to examine the association of BLR and SLR with age, gender, hemoglobin, leukocyte count, platelets, glucose level, C-reactive protein (CRP), microorganism, days of antibiotic treatment before FDG-PET/CT, infection focus, use of immunosuppressive drugs, duration of hospital stay (after FDG-PET/CT), ICU admission, and mortality.

Results

C-reactive protein (p = 0.006), a cardiovascular or musculoskeletal focus of infection (p = 0.000 for both), and bacteremia caused by Gram-negative bacteria (p = 0.002) were independently and positively associated with BLR, while age (p = 0.000) and glucose level before FDG-PET/CT (p = 0.004) were independently and negatively associated with BLR.

For SLR, CRP (p = 0.001) and a cardiovascular focus of infection (p = 0.020) were independently and positively associated with SLR, while age (p = 0.002) and glucose level before FDG-PET/CT (p = 0.016) were independently and negatively associated with SLR.

Conclusion

High FDG uptake in the bone marrow is associated with a higher inflammatory response and younger age in patients with bacteremia. In patients with high FDG uptake in the bone marrow, a cardiovascular or musculoskeletal focus of infection is more likely than other foci, and the infection is more often caused by Gram-negative species. High splenic FDG uptake is associated with a higher inflammatory response as well, and a cardiovascular focus of infection is also more likely in case of high splenic FDG uptake.
Predictors of In‐Hospital Mortality in Surgical Wards: A Multivariable Retrospective Cohort Analysis of 2,800,069 Hospitalizations
Authors: Walicka Magdalena , Tuszyńska Agnieszka , Chlebus Marcin , Sanchak Yaroslav , Śliwczyński Andrzej , Brzozowska Melania , Rutkowski Daniel , Puzianowska‐Kuźnicka Monika , Franek Edward
Published: October 2020

Background

Identifying prognostic factors that are predictive of in‐hospital mortality for patients in surgical units may help in identifying high‐risk patients and developing an approach to reduce mortality. This study analyzed mortality predictors based on outcomes obtained from a national database of adult patients.

Materials and methods

This retrospective study design collected data obtained from the National Health Fund in Poland comprised of 2,800,069 hospitalizations of adult patients in surgical wards during one calendar year. Predictors of mortality which were analyzed included: the patient's gender and age, diagnosis‐related group category assigned to the hospitalization, length of the hospitalization, hospital type, admission type, and day of admission.

Results

The overall mortality rate was 0.8%, and the highest rate was seen in trauma admissions (24.5%). There was an exponential growth in mortality with respect to the patient's age, and male gender was associated with a higher risk of death. Compared to elective admissions, the mortality was 6.9‐fold and 15.69‐fold greater for urgent and emergency admissions (p < 0.0001), respectively. Weekend or bank holiday admissions were associated with a higher risk of death than working day admissions. The “weekend” effect appears to begin on Friday. The highest mortality was observed in less than 1 day emergency cases and with a hospital stay longer than 61 days in any type of admission.

Conclusion

Age, male gender, emergency admission, and admission on the weekend or a bank holiday are factors associated with greater mortality in surgical units.
Datenkompetenz – Data Literacy
Authors: Ludwig Thomas , Thiemann Hannes
Published: October 2020

Unsere Zeit der sprunghaft anwachsenden Datenmengen in allen Bereichen erfordert die Ausbildung von Datenkompetenz als Schlüsselkompetenz für das 21. Jahrhundert. Kenntnisse zur Datensammlung, zum Datenmanagement, zur Datenevaluation und zur Datenanwendung bilden die Grundlage für einen kompetenten Umgang mit Daten in Wissenschaft, Wirtschaft und Gesellschaft. Umfangreiche Datenmengen sind heute in allen Lebensbereichen in Wertschöpfungsketten eingebunden, die es zu gestalten und zu bewerten gilt. Insbesondere im Bereich der Wissenschaftsdaten wird dies auch institutionell unterstützt, um aus Daten neues Wissen und neue Einsichten generieren zu können.
Immunotherapy in prostate cancer: new horizon of hurdles and hopes
Authors: Tsaur Igor , Brandt Maximilian P. , Juengel Eva , Manceau Cécile , Ploussard Guillaume
Published: October 2020

Purpose

Prostate cancer (PCa) is the most common malignancy in men and the cause for the second most common cancer-related death in the western world. Despite ongoing development of novel approaches such as second generation androgen receptor targeted therapies, metastatic disease is still fatal. In PCa, immunotherapy (IT) has not reached a therapeutic breakthrough as compared to several other solid tumors yet. We aimed at highlighting the underlying cellular mechanisms crucial for IT in PCa and giving an update of the most essential past and ongoing clinical trials in the field.

Methods

We searched for relevant publications on molecular and cellular mechanisms involved in the PCa tumor microenvironment and response to IT as well as completed and ongoing IT studies and screened appropriate abstracts of international congresses.

Results

Tumor progression and patient outcomes depend on complex cellular and molecular interactions of the tumor with the host immune system, driven rather dormant in case of PCa. Sipuleucel-T and pembrolizumab are the only registered immune-oncology drugs to treat this malignancy. A plethora of studies assess combination of immunotherapy with other agents or treatment modalities like radiation therapy which might increase its antineoplastic activity. No robust and clinically relevant prognostic or predictive biomarkers have been established yet.

Conclusion

Despite immunosuppressive functional status of PCa microenvironment, current evidence, based on cellular and molecular conditions, encourages further research in this field.
Biotic and abiotic controls on carbon storage in aggregates in calcareous alpine and prealpine grassland soils
Authors: Garcia-Franco Noelia , Walter Roswitha , Wiesmeier Martin , Hurtarte Luis Carlos Colocho , Berauer Bernd Josef , Buness Vincent , Zistl-Schlingmann Marcus , Kiese Ralf , Dannenmann Michael , Kögel-Knabner Ingrid
Published: October 2020

Alpine and prealpine grasslands provide various ecosystem services and are hotspots for the storage of soil organic C (SOC) in Central Europe. Yet, information about aggregate-related SOC storage and its controlling factors in alpine and prealpine grassland soils is limited. In this study, the SOC distribution according to the aggregate size classes large macroaggregates (> 2000 μm), small macroaggregates (250–2000 μm), microaggregates (63–250 μm), and silt-/clay-sized particles (< 63 μm) was studied in grassland soils along an elevation gradient in the Northern Limestone Alps of Germany. This was accompanied by an analysis of earthworm abundance and biomass according to different ecological niches. The SOC and N stocks increased with elevation and were associated with relatively high proportions of water-stable macroaggregates due to high contents of exchangeable Ca2+ and Mg2+. At lower elevations, earthworms appeared to act as catalyzers for a higher microaggregate formation. Thus, SOC stabilization by aggregate formation in the studied soils is a result of a joined interaction of organic matter and Ca2+ as binding agents for soil aggregates (higher elevations), and the earthworms that act as promoters of aggregate formation through the secretion of biogenic carbonates (low elevation). Our study highlights the importance of aggregate-related factors as potential indices to evaluate the SOC storage potential in other mountainous grassland soils.

Graphical abstract
Inulin supplementation ameliorates hyperuricemia and modulates gut microbiota in Uox-knockout mice
Authors: Guo Yingjie , Yu Yanan , Li Hailong , Ding Xueli , Li Xiaoyu , Jing Xue , Chen Jianwei , Liu Guilin , Lin Yuan , Jiang Chen , Liu Zhen , He Yuwei , Li Changgui , Tian Zibin
Published: October 2020

Purpose

Inulin is a type of fermentable dietary fiber, which is non-digestible, and can improve metabolic function by modulating intestinal microbiota. This study aimed to evaluate the role of inulin in hyperuricemia and microbial composition of the gut microbiota in a mouse model of hyperuricemia established through knockout of Uox (urate oxidase) gene.

Methods

KO (Uox-knockout) and WT (wild-type) mice were given inulin or saline by gavage for 7 weeks. The effect of inulin to combat hyperuricemia was determined by assessing the changes in serum UA (uric acid) levels, inflammatory parameters, epithelial barrier integrity, fecal microbiota alterations, and SCFA (short-chain fatty acid) concentrations in KO mice.

Results

Inulin supplementation can effectively alleviate hyperuricemia, increase the expressions of ABCG2 in intestine, and downregulate expression and activity of hepatic XOD (xanthine oxidase) in KO mice. It was revealed that the levels of inflammatory cytokines and the LPS (lipopolysaccharide) were remarkably higher in the KO group than those in the WT group, indicating systemic inflammation of hyperuricemic mice, but inulin treatment ameliorated inflammation in KO mice. Besides, inulin treatment repaired the intestinal epithelial barrier as evidenced by increased levels of intestinal TJ (tight junction) proteins [ZO-1 (zonula occludens-1) and occluding] in KO mice. Moreover, serum levels of uremic toxins, including IS (indoxyl sulfate) and PCS (p-cresol sulfate), were reduced in inulin-treated KO mice. Further investigation unveiled that inulin supplementation enhanced microbial diversity and raised the relative abundance of beneficial bacteria, involving SCFAs-producing bacteria (e.g., Akkermansia and Ruminococcus). Additionally, inulin treatment increased the production of gut microbiota-derived SCFAs (acetate, propionate and butyrate concentrations) in KO mice, which was positively correlated with the effectiveness of hyperuricemia relief.

Conclusions

Our findings showed that inulin may be a promising therapeutic candidate for the treatment of hyperuricemia. Moreover, alleviation of hyperuricemia by inulin supplementation was, at least, partially conciliated by modulation of gut microbiota and its metabolites.
Age differences in anticipatory and executory mechanisms of gait initiation following unexpected balance perturbations
Authors: Laudani Luca , Rum Lorenzo , Valle Maria Stella , Macaluso Andrea , Vannozzi Giuseppe , Casabona Antonino
Published: October 2020

Purpose

An age-related decline in anticipatory postural mechanisms has been reported during gait initiation; however, it is unclear whether such decline may jeopardize whole-body stability following unexpected balance perturbations. This study aimed to compare young and older individuals’ ability to generate postural responses and preserve stability in response to external waist perturbations delivered within gait initiation.

Methods

Ten young and ten older participants performed 10 gait initiation trials followed by 48 unperturbed and 12 perturbed trials in a random order. A stereophotogrammetric system and three force platforms were used to quantify mechanical parameters from the preparatory phase (e.g., timing and amplitude of postural adjustments) and from the stepping phase (e.g., step characteristics and dynamic stability). Activation patterns of lower leg muscles were determined by surface electromyography.

Results

Older participants responded to perturbation with lower increase in both magnitude (p < 0.001; η2p = 0.62) and duration (p = 0.001; η2p = 0.39) of preparatory parameters and soleus muscle activity (p < 0.001; η2p = 0.55), causing shorter (p < 0.001; η2p = 0.59) and lower (p < 0.001; η2p = 0.43) stepping, compared to young participants. Interestingly, young participants showed greater correlations between preparatory phase parameters and dynamic stability of the first step than older participants (average r of − 0.40 and − 0.06, respectively).

Conclusion

The results suggest that young participants took more time than older to adjust the anticipatory biomechanical response to perturbation attempting to preserve balance during stepping. In contrast, older adults were unable to modify their anticipatory adjustments in response to perturbation and mainly relied on compensatory mechanisms attempting to preserve stability via a more cautious stepping strategy.
Long-term results of ERCP- or PTCS-directed photodynamic therapy for unresectable hilar cholangiocarcinoma
Authors: Li Zongyan , Jiang Xiaofeng , Xiao Hua , Chen Shaoyi , Zhu Wenfeng , Lu Haiwu , Cao Liangqi , Xue Ping , Li Haiyan , Zhang Dawei
Published: October 2020

Background

Photodynamic therapy (PDT) can be performed as palliative therapy for cholangiocarcinoma, while there is currently insufficient evidence for the efficacy. The aim of this study was to explore the clinical efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP)- or percutaneous transhepatic cholangioscopy (PTCS)-directed PDT combined with stent placement for unresectable hilar cholangiocarcinoma.

Methods

A retrospective analysis was conducted on 62 patients with unresectable hilar cholangiocarcinoma. Thirty patients received PDT using hematoporphyrin combined with biliary stent placement (PDT+stent group), including 22 receiving ERCP-directed PDT and 8 receiving PTCS-directed PDT. Survival time, quality of life, and postoperative adverse events were compared to 32 patients receiving biliary stent placement alone (Stent-only group).

Results

After 42 months of follow-up, median survival time was significantly longer in the PDT+stent group than the Stent-only group (14.2 vs. 9.8 months, P = 0.003). In the PDT+stent group, the median survival time was longer in the 6 patients with recurrence after surgical resection than the 24 patients without prior surgical resection (20.0 vs. 13.0 months, P = 0.017). The QOL total scores was significantly higher in the PDT+stent group than the Stent-only group at postoperative 6, 9, and 12 months (P<0.05). There was no significant difference in the incidence of postoperative adverse events between the two groups (24 [38.7%] vs. 20 [29.0%], P = 0.239).

Conclusion

ERCP- or PTCS-directed PDT + stent placement can prolong the survival of patients with unresectable hilar cholangiocarcinoma, especially those with recurrence and improve quality of life without increasing adverse events.
The learning curve of TaTME for mid-low rectal cancer: a comprehensive analysis from a five-year institutional experience
Authors: Persiani Roberto , Agnes Annamaria , Belia Francesco , D’Ugo Domenico , Biondi Alberto
Published: October 2020

Background

Transanal total mesorectal excision (TaTME) was introduced in 2009 as a dedicated approach for the treatment of mid-low rectal cancer. We aimed to describe and discuss the learning curve for 121 consecutive TaTME procedures performed by the same team.

Methods

The primary outcome was the number of operations required to decrease the mean operative time (mOT). The secondary outcomes were the number of operations required to decrease the major complication (MC) rate, the anastomotic leakage (AL) rate, the clinical anastomotic failure rate, and the reoperation rate. A cumulative sum (CUSUM) curve analysis was used to identify the inflection points. As an integrative analysis, Bernoulli CUSUM curves, risk-adjusted CUSUM curves based on the observed-expected outcomes, and CUSUM curves targeting results reported in the literature were created.

Results

Seventy-one cases were needed to overcome the OT learning curve sufficiently to reach mastery. The MC and reoperation rates started to decrease after the 54th case and further decreased after the 69th case. The AL rate started to decrease after the 27th case and remained stable at 5–5.1%. The comparison between the different phases of the learning curves confirmed these turning points.

Conclusions

TaTME had a learning curve of 71 cases for the mOT, 55–69 cases for MCs and reoperation, and 27 cases for AL. According to our results, attention should be paid during the first part of the learning curve to avoid an increased rate of MCs and AL.
High-intensity interval training in the prehabilitation of cancer patients—a systematic review and meta-analysis
Authors: Palma Stefano , Hasenoehrl Timothy , Jordakieva Galateja , Ramazanova Dariga , Crevenna Richard
Published: October 2020

Purpose

To evaluate the impact of high-intensity interval training (HIIT) on health-related outcome parameters in the prehabilitation of patients diagnosed with cancer.

Methods

A systematic review and meta-analysis of comparative studies on HIIT in cancer prehabilitation conducted by screening standard databases from their inception to March 30, 2020. Outcomes of interest included cardiorespiratory fitness, feasibility, safety, clinical, and patient-reported outcomes.

Results

Of the 855 identified studies, 8 articles met the inclusion criteria (7 randomized, 1 non-randomized controlled trial) with a total of 896 patients. The study protocols were heterogeneous, but the methodological quality ranged from good to high according to PEDro scale. Meta-analysis revealed a significant improvement of peak oxygen consumption (VO2peak) achieved with HIIT compared to usual care. Furthermore, HIIT was feasible and safe, showing low risk of adverse events and positive effects on health-related outcomes in prehabilitative settings.

Conclusion

In the phase of prehabilitation, HIIT has potential health benefits in patients diagnosed with cancer and is feasible and safe to perform. Nonetheless, larger randomized controlled trials focusing on long-term effects (such as cancer recurrence or survival rates) are missing, to underline the potential relevance of HIIT for cancer patients.
Impact of clinical and psychological factors associated with depression in patients with rheumatoid arthritis: comparative study between Germany and Brazil
Authors: Morf Harriet , da Rocha Castelar-Pinheiro Geraldo , Vargas-Santos Ana Beatriz , Baerwald Christoph , Seifert Olga
Published: October 2020

Objective

To investigate the prevalence of depressive symptoms and its association with clinical and psychological factors in patients with rheumatoid arthritis (RA) in Germany and in Brazil.

Method

A convenience sample of 267 RA patients, 176 from Germany (age 62.4 ± 12.3 years) and 91 from Brazil (age 56.3 ± 12.6 years), was used in this cross-sectional study. The following questionnaires were used: Beck Depression Inventory (BDI), painDETECT test, Perceived Stress Questionnaire, fatigue questionnaire (FACIT), Health Assessment Questionnaire Disability Index (HAQ-DI), and the SF–36 questionnaires (Short-Form 36 Health Survey). Disease activity score (DAS 28-CRP) and visual analogue scale (VAS) for pain were also evaluated. Statistical analysis is based on comparison of means and proportions. Statistical significance for non-normal data was evaluated by non-parametrical tests.

Results

Depressive symptoms were more prevalent in the Brazilian sample (44% vs 22.9%, p = 0.025). Compared to German patients, the Brazilian ones also experienced more pain (current pain status on VAS: 4.67 ± 3.4 vs 3.67 ± 2.31 respectively, p < 0.01), were physically more limited (1.89 ± 1.85 vs 1.01 ± 0.75, p = 0.012), and had higher C-reactive protein levels (7.78 ± 18.3 vs 5.82 ± 10.45, p = 0.028). Despite receiving a more intensive treatment, German patients presented similar disease activity when compared to Brazilian patients (DAS28-CRP: Brazil 3.4 ± 1.5 vs Germany 3.3 ± 1.3, p = 0.307).

Conclusion

Depressive symptoms are frequent in RA patients from different countries and interact with psychological disorders and the experience of pain. They contribute negatively to their well-being suggesting the need for psychoeducational strategies.

Key Points• New psychoeducational strategies for RA management.• Higher inflammation marker in rheumatoid arthritis patients is associated with depression.• Medical treatment in RA influences depressive symptoms.• Depressive symptoms are dependent on population group.• High disease activity is related to depression.
Ablative laser surgery for allergic tattoo reactions: a retrospective study
Authors: van der Bent S. A. S. , Huisman Sanne , Rustemeyer T. , Wolkerstorfer A.
Published: October 2020

Patients with allergic tattoo reactions are burdened with itch and have a reduced quality of life. Conservative treatment is often insufficient and little is known about treatment options to remove the responsible allergen. We aimed to address the effectiveness and safety of ablative laser therapy including measurement of patient’s satisfaction, in patients with allergic reactions to tattoos. A retrospective study was conducted including patients with allergic tattoo reactions who were treated with a 10,600 nm ablative CO2laser, either by full-surface ablation or fractional ablation. Clinical information originated from medical files and a 25-item questionnaire. Sixteen tattoo allergy patients were treated with a CO2laser between January 2010 and January 2018. Fourteen patients completed the questionnaire. Ten patients were satisfied with laser treatment. On a visual analogue scale, pruritus and burning improved with a median of 5.5 and 4 points in the full surface ablation group and 3 points on both parameters in the fractional ablation group. Despite the relatively small group of patients, our results suggest that CO2laser ablation improves itching, burning and impact on daily life in tattoo allergy.
Quinn’s Formula and Abelian 3-Cocycles for Quadratic Forms
Authors: Braunling Oliver
Published: October 2020

In pointed braided fusion categories knowing the self-symmetry braiding of simples is theoretically enough to reconstruct the associator and braiding on the entire category (up to twisting by a braided monoidal auto-equivalence). We address the problem to provide explicit associator formulas given only such input. This problem was solved by Quinn in the case of finitely many simples. We reprove and generalize this in various ways. In particular, we show that extra symmetries of Quinn’s associator can still be arranged to hold in situations where one has infinitely many isoclasses of simples.
Study on on-Chip Antenna Design Based on Metamaterial-Inspired and Substrate-Integrated Waveguide Properties for Millimetre-Wave and THz Integrated-Circuit Applications
Authors: Alibakhshikenari Mohammad , Virdee Bal S. , Althuwayb Ayman Abdulhadi , Aïssa Sonia , See Chan H. , Abd-Alhameed Raed A. , Falcone Francisco , Limiti Ernesto
Published: October 2020

This paper presents the results of a study on improving the performance parameters such as the impedance bandwidth, radiation gain and efficiency, as well as suppressing substrate loss of an innovative antenna for on-chip implementation for millimetre-wave and terahertz integrated-circuits. This was achieved by using the metamaterial and the substrate-integrated waveguide (SIW) technologies. The on-chip antenna structure comprises five alternating layers of metallization and silicon. An array of circular radiation patches with metamaterial-inspired crossed-shaped slots are etched on the top metallization layer below which is a silicon layer whose bottom surface is metalized to create a ground plane. Implemented in the silicon layer below is a cavity above which is no ground plane. Underneath this silicon layer is where an open-ended microstrip feedline is located which is used to excite the antenna. The feed mechanism is based on the coupling of the electromagnetic energy from the bottom silicon layer to the top circular patches through the cavity. To suppress surface waves and reduce substrate loss, the SIW concept is applied at the top silicon layer by implementing the metallic via holes at the periphery of the structure that connect the top layer to the ground plane. The proposed on-chip antenna has an average measured radiation gain and efficiency of 6.9 dBi and 53%, respectively, over its operational frequency range from 0.285–0.325 THz. The proposed on-chip antenna has dimensions of 1.35 × 1 × 0.06 mm3. The antenna is shown to be viable for applications in millimetre-waves and terahertz integrated-circuits.
Effect of an Electronic Health Record “Nudge” on Opioid Prescribing and Electronic Health Record Keystrokes in Ambulatory Care
Authors: Ancker Jessica S. , Gossey J. Travis , Nosal Sarah , Xu Chenghuiyun , Banerjee Samprit , Wang Yuming , Veras Yulia , Mitchell Hannah , Bao Yuhua
Published: October 2020

Background

Multiple policy initiatives encourage more cautious prescribing of opioids in light of their risks. Electronic health record (EHR) redesign can influence prescriber choices, but some redesigns add to workload.

Objective

To estimate the effect of an EHR prescribing redesign on both opioid prescribing choices and keystrokes.

Design

Quality improvement quasi-experiment, analyzed as interrupted time series.

Participants

Adult patients of an academic multispecialty practice and a federally qualified health center (FQHC) who received new prescriptions for short-acting opioids, and their providers.

Intervention

In the redesign, new prescriptions of short-acting opioids defaulted to the CDC-recommended minimum for opioid-naïve patients, with no alerts or hard stops, such that 9 keystrokes were required for a guideline-concordant prescription and 24 for a non-concordant prescription.

Main Measures

Proportion of guideline-concordant prescriptions, defined as new prescriptions with a 3-day supply or less, calculated per 2-week period. Number of mouse clicks and keystrokes needed to place prescriptions.

Key Results

Across the 2 sites, 22,113 patients received a new short-acting opioid prescription from 821 providers. Before the intervention, both settings showed secular trends toward smaller-quantity prescriptions. At the academic practice, the intervention was associated with an immediate increase in guideline-concordant prescriptions from an average of 12% to 31% of all prescriptions. At the FQHC, about 44% of prescriptions were concordant at the time of the intervention, which was not associated with an additional significant increase. However, total keystrokes needed to place the concordant prescriptions decreased 62.7% from 3552 in the 6 months before the intervention to 1323 in the 6 months afterwards.

Conclusions

Autocompleting prescription forms with guideline-recommended values was associated with a large increase in guideline concordance in an organization where baseline concordance was low, but not in an organization where it was already high. The redesign markedly reduced the number of keystrokes needed to place orders, with important implications for EHR-related stress.

Trial Registration

www.ClinicalTrials.gov protocol 1710018646
Fatou’s Associates
Authors: Evdoridou Vasiliki , Rempe Lasse , Sixsmith David J.
Published: October 2020

Suppose thatfis a transcendental entire function,$$V \subsetneq {\mathbb {C}}$$V⊊Cis a simply connected domain, andUis a connected component of$$f^{-1}(V)$$f-1(V). Using Riemann maps, we associate the map$$f :U \rightarrow V$$f:U→Vto an inner function$$g :{\mathbb {D}}\rightarrow {\mathbb {D}}$$g:D→D. It is straightforward to see thatgis either a finite Blaschke product, or, with an appropriate normalisation, can be taken to be an infinite Blaschke product. We show that when the singular values offinVlie away from the boundary, there is a strong relationship between singularities ofgand accesses to infinity inU. In the case whereUis a forward-invariant Fatou component off, this leads to a very significant generalisation of earlier results on the number of singularities of the mapg. IfUis a forward-invariant Fatou component offthere are currently very few examples where the relationship between the pair (f, U) and the functionghas been calculated. We study this relationship for several well-known families of transcendental entire functions. It is also natural to ask which finite Blaschke products can arise in this manner, and we show the following: for every finite Blaschke productgwhose Julia set coincides with the unit circle, there exists a transcendental entire functionfwith an invariant Fatou component such thatgis associated withfin the above sense. Furthermore, there exists a single transcendental entire functionfwith the property that any finite Blaschke product can be arbitrarily closely approximated by an inner function associated with the restriction offto a wandering domain.
Evaluation of the Sexual Functioning of Individuals Living in Turkey During the COVID-19 Pandemic: An Internet-Based Nationwide Survey Study
Authors: Karsiyakali Nejdet , Sahin Yusuf , Ates Huseyin Aytac , Okucu Emrah , Karabay Emre
Published: October 2020

Introduction

Although many countries in the world prioritize self-isolation measures during the corona virus disease 2019 (COVID-19) pandemic period, the effects of this process on sexual functioning are not yet known.

Aim

To evaluate the effects of the COVID-19 pandemic on the sexual functioning of individuals who declared no medical history of the COVID-19 disease.

Methods

A total of 1,356 participants filled out an Internet-based survey between June 1 and June 20, 2020. The data from these participants were analyzed to determine sexual functioning in terms of sexual intercourse frequency and sexual desire during the COVID-19 pandemic. Subgroups analyses were also performed, wherein the subgroups were developed according to the population density of the cities in which the participants lived to examine whether population density has any effect on the sexual functions of the participants during the COVID-19 pandemic.

Main Outcome Measure

The study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual functioning.

Results

The mean age of the participants was 33.16 ± 8.31 years. There was a statistically significant difference between the participants according to the decrease in the number of weekly sexual intercourses when they were compared in terms of smoking status, alcohol consumption, marital and parental status, being a health-care worker, having a regular sexual partner, and the working status during the COVID-19 pandemic (P < .05, for each). In the subgroup analyses, it was observed that there was a statistically significant difference between the groups for change in the number of sexual intercourses, the number of masturbations, and sexual desire during the COVID-19 pandemic (P < .05, for each).

Conclusion

A decline in sexual functioning was observed during the COVID-19 pandemic period. Living in a metropolitan area was associated with a decline in both sexual intercourse frequency and sexual desire during the COVID-19 pandemic.
Tener persona: Sur l’identité et l’identification dans les sociétés d’Ancien Régime
Authors: Buono Alessandro
Published: October 2020

Tener persona: Sur l’identité et l’identification dans les sociétés d’Ancien Régime

Cet article vise à éclaircir les logiques qui présidaient aux opérations d’identification et de revendication de l’identité personnelle dans la Monarchie espagnole d’Ancien Régime, en les contextualisant au sein de la culture juridique de leur époque. J’analyserai les sources produites par les Juzgados de bienes de difuntos (« Tribunaux des biens des défunts »), chargés d’adjuger les héritages d’attribution incertaine, en vérifiant l’identité et la parenté des personnes impliquées dans des successions à échelle mondiale. Au lieu d’interpréter la « preuve d’identité » de manière évolutionniste, je chercherai à comprendre sa production en partant de la constatation que, durant l’Ancien Régime, la personnalité juridique se concevait comme une possession, revendiquée activement par son usage, publiquement exercé et reconnu. Il s’agira donc de montrer que l’identité était détenue, comme tout autre droit, à travers des « actes de possession », et non simplement grâce à des titres de propriété, considérés plutôt comme une façon de transcrire les actes de possession d’état. L’article avance donc que, dans les sociétés d’Ancien Régime, il fallait continuellement produire la preuve de sa propre identité, en raison non seulement de l’insuffisance des procédures bureaucratiques et des pratiques d’archivage des données, mais, surtout, d’une manière différente de posséder la « chose identité », c’est-à-dire d’une autre façon de « tenir personne ».
Alliés, voisins et ennemis du roi d’Espagne: La puissante faiblesse de la Monarchie hispanique (1580-1620)
Authors: Ibáñez José Javier Ruiz , Sabatini Gaetano
Published: October 2020

Alliés, voisins et ennemis du roi d’Espagne: La puissante faiblesse de la Monarchie hispanique (1580-1620)

À la fin du xvie siècle, le roi d’Espagne et sa monarchie occupent aux yeux de l’Europe une position de prééminence. Non seulement de petits États, mais de nombreux mouvements insurrectionnels réclament son aide militaire et financière pour combattre leurs ennemis locaux et éviter d’être absorbés par leurs voisins. La Monarchie hispanique accroît alors sa capacité d’intervention en dehors de ses frontières, avec la possibilité d’incorporer de nouveaux territoires, tant en Europe qu’en Asie ou en Afrique ; à tout le moins, le pouvoir ibérique s’invite dans la politique intérieure de ces États, devenant un acteur supplémentaire de la scène politique locale. Cette sensation d’hégémonie est telle qu’elle nourrit en retour un puissant rejet : à de nombreux points du globe, jouer sur ce sentiment anti-espagnol devient un élément clef pour délégitimer des rivaux politiques et étayer les prétentions des vainqueurs dans les conflits civils de la fin du xvie siècle et du début du xviie siècle. Il faut dire que, dans une certaine mesure, l’hégémonie espagnole relevait d’un mirage : elle ne correspondait pas aux forces réelles du roi d’Espagne, mais plutôt à une image surévaluée du pouvoir de celui-ci, véhiculée par ceux qui placèrent en lui leurs espoirs ou leurs craintes. Analyser cette discordance entre représentation et réalité nous permet de comprendre, d’une part, comment la prédominance politique se fonde, pour partie, sur un imaginaire et des intérêts partagés, et, d’autre part, que son succès et son échec dépendent largement des illusions, des frustrations et des attentes divergentes qu’elle suscitait.
Emerging Standards and the Hybrid Model for Organizing Scientific Events During and After the COVID-19 Pandemic
Authors: Hanaei Sara , Takian Amirhossein , Majdzadeh Reza , Maboloc Christopher Ryan , Grossmann Igor , Gomes Orlando , Milosevic Milos , Gupta Manoj , Shamshirsaz Alireza A. , Harbi Amine , Burhan Amer M. , Uddin Lucina Q. , Kulasinghe Arutha , Lam Chi-Ming , Ramakrishna Seeram , Alavi Abass , Nouwen Jan L , Dorigo Tommaso , Schreiber Michael , Abraham Ajith , Shelkovaya Natalya , Krysztofiak Wojtek , Ebrahimi Warkiani Majid , Sellke Frank , Ogino Shuji , Barba Francisco J. , Brand Serge , Vasconcelos Clara , Salunke Deepak B. , Rezaei Nima
Published: October 2020

Since the beginning of 2020, the coronavirus disease (COVID-19) pandemic has dramatically influenced almost every aspect of human life. Activities requiring human gatherings have either been postponed, canceled, or held completely virtually. To supplement lack of in-person contact, people have increasingly turned to virtual settings online, advantages of which include increased inclusivity and accessibility and a reduced carbon footprint. However, emerging online technologies cannot fully replace in-person scientific events. In-person meetings are not susceptible to poor Internet connectivity problems, and they provide novel opportunities for socialization, creating new collaborations and sharing ideas. To continue such activities, a hybrid model for scientific events could be a solution offering both in-person and virtual components. While participants can freely choose the mode of their participation, virtual meetings would most benefit those who cannot attend in-person due to the limitations. In-person portions of meetings should be organized with full consideration of prevention and safety strategies, including risk assessment and mitigation, venue and environmental sanitation, participant protection and disease prevention, and promoting the hybrid model. This new way of interaction between scholars can be considered as a part of a resilience system, which was neglected previously and should become a part of routine practice in the scientific community.
An Epistemic Argument for an Egalitarian Public Sphere
Authors: Bennett Michael
Published: October 2020

The public sphere should be regulated so the distribution of political speech does not correlate with the distribution of income or wealth. A public sphere where people can fund any political speech from their private holdings is epistemically defective. The argument has four steps. First, if political speech is unregulated, the rich predictably contribute a disproportionate share. Second, wealth tends to correlate with substantive political perspectives. Third, greater quantities of speech by the rich can “drown out” the speech of the poor, because of citizens’ limited attention span for politics. Finally, the normative problem with all this is that it reduces the diversity of arguments and evidence citizens become familiar with, reducing the quality of their political knowledge. The clearest implication of the argument is in favour of strict contribution limits and/or public funding for formal political campaigns, but it also has implications for more informal aspects of the public sphere.
The Role of the Joint Procurement Agreement during the COVID-19 Pandemic: Assessing Its Usefulness and Discussing Its Potential to Support a European Health Union
Authors: MCEVOY Emma , FERRI Delia
Published: October 2020

In 2014, the European Joint Procurement Agreement (JPA) was introduced as an innovative instrument to organise the procurement of vaccines and medications in preparation for pandemics. An overriding purpose of the JPA is to secure equitable and cost-effective access to medical supplies for participating EU Member States during serious health crises. This article aims to understand the current use of the JPA in response to the COVID-19 pandemic. Post-analysis of the recent use of the JPA, the article will discuss how the regional procurement mechanism can be strengthened to support the development of a European Health Union. In particular, the article will firstly question whether the four recent JPA procurement actions facilitated equitable access to medical supplies and services. Secondly, it will ask whether the centralised procurement actions preserved the integrity of the Internal Market. The importance and originality of this study are that it addresses an instrument, the JPA, which has been largely overlooked by legal scholars, and it explores how the provisions for the joint procurement of medical countermeasures as included in Article 5 of Decision 1082/2013/EU on serious cross-border threats to health could be extended to support the functioning of a European Health Union.
International Humanitarian Law and Non-State Actors: A Contradiction of Terms?
Authors: Arnold Roberta
Published: October 2020

There seems to have been a shift in the state-centric vision of international relations, following the increasing role of non-state actors (NSAs) on the international scene, particularly in the context of armed conflicts. Ezequiel Heffes, Marcos Kotlik and Manuel Ventura, editors of International Humanitarian Law and Non-State Actors, present through this collection of contributions an overview of legal issues arising from this new reality. The editors draw on their personal experience to explain how NSAs contribute to the development of international humanitarian law (IHL) and to suggest that in order to promote respect for IHL by all parties involved in an armed conflict, this new role should be given due consideration from a legal standpoint. The review aims to confront critically the position taken in the volume, assessing the pros and cons of an increased recognition (and potential legitimisation) of NSAs, with a particular focus on non-state armed groups. It discusses, in particular, the implications of this process for the exercise of sovereign rights and respect for fundamental guarantees, especially in relation to the powers to detain and to adjudicate.
Cercarial trematodes in freshwater snails from Bangkok, Thailand: prevalence, morphological and molecular studies and human parasite perspective
Authors: Wiroonpan Pichit , Chontananarth Thapana , Purivirojkul Watchariya
Published: October 2020

We investigated the prevalence, morphological characters and molecular classifications of trematode cercariae in freshwater snails randomly collected from 59 sampling localities in Bangkok from May 2018 to March 2019. We used a crushing technique to observe the cercarial stage inside each snail body and amplified the internal transcribed spacer 2 regions of cercarial DNA using polymerase chain reaction methodology. The associated phylogenetic tree was reconstructed using Bayesian inference analyses. A total of 517 of 15 621 examined snails were infected with trematode cercariae, and the infected snails were classified into 11 species of seven families with a 3.31% overall prevalence of the infection. The Bithynia siamensis siamensis snail displayed the highest prevalence of infection (16.16%), whereas the Physella acuta snail exhibited the lowest prevalence (0.08%) of infection. Eight morphological types of cercariae were observed. The highest prevalence of infection was observed in mutabile cercaria (1.86%). Based on molecular investigations, the phylogram revealed eight cercaria types assigned to at least nine digenean trematode families, of which five belong to groups of human intestinal flukes. Although, with the exception of schistosome cercaria, trematode cercariae are not known to directly damage humans, understanding the general biology of trematode cercariae (including diversity, distribution, infection rates and host range) is important and necessary for the prevention and control of parasitic transmission that impacts aquatic cultivations, livestock farming and human health.
Eimeria bovis infections induce G1 cell cycle arrest and a senescence-like phenotype in endothelial host cells
Authors: Velásquez Zahady D. , López-Osorio Sara , Waiger Daniel , Manosalva Carolina , Pervizaj-Oruqaj Learta , Herold Susanne , Hermosilla Carlos , Taubert Anja
Published: October 2020

Apicomplexan parasites are well-known to modulate their host cells at diverse functional levels. As such, apicomplexan-induced alteration of host cellular cell cycle was described and appeared dependent on both, parasite species and host cell type. As a striking evidence of species-specific reactions, we here show that Eimeria bovis drives primary bovine umbilical vein endothelial cells (BUVECs) into a senescence-like phenotype during merogony I. In line with senescence characteristics, E. bovis induces a phenotypic change in host cell nuclei being characterized by nucleolar fusion and heterochromatin-enriched peripheries. By fibrillarin staining we confirm nucleoli sizes to be increased and their number per nucleus to be reduced in E. bovis-infected BUVECs. Additionally, nuclei of E. bovis-infected BUVECs showed enhanced signals for HH3K9me2 as heterochromatin marker thereby indicating an infection-induced change in heterochromatin transition. Furthermore, E. bovis-infected BUVECs show an enhanced β-galactosidase activity, which is a well-known marker of senescence. Referring to cell cycle progression, protein abundance profiles in E. bovis-infected endothelial cells revealed an up-regulation of cyclin E1 thereby indicating a cell cycle arrest at G1/S transition, signifying a senescence key feature. Similarly, abundance of G2 phase-specific cyclin B1 was found to be downregulated at the late phase of macromeront formation. Overall, these data indicate that the slow proliferative intracellular parasite E. bovis drives its host endothelial cells in a senescence-like status. So far, it remains to be elucidated whether this phenomenon indeed reflects an intentionally induced mechanism to profit from host cell-derived energy and metabolites present in a non-dividing cellular status.
The spread of English in Morocco
Authors: R'boul Hamza
Published: October 2020

Morocco is a multilingual country where the official languages, as indicated in the constitution of 2011, are standard Arabic and Tamazight, while French is the nation's second language, pervading sectors of business, administration, diplomacy and higher education. English and Spanish are used as foreign languages in many contexts for different purposes and tasks (Ennaji, 2009). Unlike French and Spanish, whose presence in the Moroccan linguistic situation is due to colonial policy in the 20th century, English does not ‘have a colonial legacy in Morocco’ (Buckner, 2011: 213). With ‘strong demand for a lingua franca’ brought about by the media, economic incentives and globalization, the presence of English has consequently been furthered in Morocco ‘as a global language’ (Zouhir, 2013: 275).