bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecotourism Development in Bangka Islands: An Exploratory Study on Participation and Expectations of Local Stakeholders
Authors: Ibrahim I , Zukhri N , Rendy R
Published: November 2020

Participation and expectations in the discourse of local ecotourism development are important and strategic aspects that need to be seriously addressed and managed. Both have close relation in the succession of local ecotourism. Bangka Belitung Islands in recent years has continued to make various efforts to optimize various local ecotourism development and development spaces, particularly in the context of preparing post-tin economy. Of course there are so many challenges and issues related to the process of local socio-economic transformation on the island of Bangka, especially the transition from the era of extractivism to tourism. In the midst of stretching the local government that continues to initiate and optimize various destinations and attractions that are quite potential and varied on Bangka Island, it is necessary to design policies that also address from various views, criticisms, aspirations and constructive input, both from the public, the government, local ecotourism actors and stakeholders. Based from this context, this study seeks to explore in depth related to the reality of participation and expectations that have surfaced at the local ecotourism level so far. This study in turn also aims to examine critically related various input, ideas, and narrative-constructive notes in the flow of local ecotourism management. Through a qualitative analysis method with an in-depth and structured interview approach, and strengthened by in-depth observations in the field, this study concludes that the context of participation and coordination among stakeholders has begun to develop, but it still seems to be not optimal because it tends to 'run' individually. This research also concludes that at least an important problem that arises is the unequal context of inter-regional ecotourism development in accordance with the varied potential of each region. In addition, there are weaknesses in terms of infrastructure and ecotourism infrastructure and access to transportation that is still limited or not sufficient enough for high tourist mobility. Furthermore, there are still some weaknesses related to governance and optimizing the potential for local ecotourism, both physical and non-physical aspects, which in fact require serious attention and cooperation through integrative commitments and interwoven strategic alliances, both by local governments, ecotourism actors, mass media, and all tourism stakeholders on Bangka Island.
Birefringence and Polarization Mode Dispersion Phenomena of Commercial Optical Fiber in Telecommunication Networks
Authors: Saktioto  , Zairmi Yoli , Veriyanti Velia , Candra Wahyu , Syahputra Romi Fadli , Soerbakti Yan , Asyana Vepy , Irawan Dedi , Okfalisa  , Hairi Haryana , Hussein Nor Azman , Syamsudhuha  , Anita Sofia
Published: November 2020

The development of optical fibers from attenuation and absorption of fiber material for efficiency and quality has produced several positive results. However, several natural negative factors and environmental errors cause problems such as birefringence and dispersion mode variations. This article therefore proposed a simulation of birefringence and polarization mode dispersion (PMD) to investigate the emergence of interference and efforts towards finding a solution to the problem of optical fiber. Moreover, a single-mode fiber was investigated at the core refractive index and cladded with a core radius and fixed sample for a wavelength of infrared regimes. The performance of fibers was also evaluated through the determination of the PMD value of the fibers. The simulation results showed the difference observed in birefringence produced the power affecting the output. Meanwhile, the PMD also produced the light waves discovered to be experiencing widening pulses in the cladding.
Optimal minimum time control for a direct current motor using bang-bang control
Authors: Ramírez Vanegas C A , Montoya O D , Rivas-Trujillo E
Published: November 2020

The calculation of variations initially it was a technique that was born in the field of physics and its great contributions have been taken advantage of by the engineering sciences in problems that involve finding a minimum trajectory that minimizes time, energy among other variables of interest. The following document will show how to find an optimal control law in order to minimize the time to bring the system that in this case is a direct current motor from a known initial state to a desired final state, using the Bang-control technique. Bang In direct current motor, the variables to be controlled are the field current, the input voltage and the angular velocity developed by the motor. For all the above, the control technique is not only innovative but also useful and practical for energy systems.
Finite difference method applied to heat transfer in polymers
Authors: Nolasco C , Afanador Garcia N , Guerrero Garcia G
Published: November 2020

Absatract

The study of efficient solution methods for mathematical models from physics is important for the purpose of making predictions. In the study of the equations of mathematical physics, the heat equation has an important place. Techniques for studying heat transfer include topics such as Fourier analysis, Bessel functions, Legendre polynomials, etc. Throughout this article we will study the heat equation from the point of view of calculating its solutions. For this reason, the solution of the heat equation is proposed by the Fourier method and the explicit numerical method. In the last part of the article studies the accuracy of the numerical method in relation to heat transfer in a spherical polymer and raises the advantage of working with numerical methods to solve mathematical models derived from conservative laws.
Control by second order sliding modes for a double-fed induction generator for a wind turbine
Authors: C Ramírez V , González Granada J R , Montoya O D
Published: November 2020

In recent years, the consumption of electrical energy in the world has increased, increasing the construction of power plants that operate with fossil fuels, which emit a large amount of CO2. Due to this polluting process, it is important to generate efficient alternatives. In this work the model of the double-feed induction generator for a wind turbine is exposed, to which the control by second order sliding modes will be applied to its state variables and these results will be compared with the classic proportional-integral-derivative technique of control. In this work it was found that the responses of the system with a second order sliding mode control compared to a control of the proportional-integral-derivative type, have a shorter establishment time and a slower behavior over time; in some cases the waveforms of the signals have a vibration effect at the moment of the response, but despite this, the response is not affected due to the wind speed to which the turbine is subjected, and reduces quickly system error at any instant of time. Whereas with a proportional-integral-derivative controller, some state variables can be highly dependent on wind speed.
Nanotechnological applications of polymer-drug conjugate as oncological treatment
Authors: Paipa-Álvarez H O , Medina-Delgado B , Palacios Alvarado W
Published: November 2020

In recent years, the popular term “polymer-drug conjugate” has been introduced to describe new drug targets to combat diseases such as cancer. Due to its potential benefits in terms of human health, this concept has managed to gain attention in the pharmaceutical industry. These innovative developments involve detailed processes in materials science, as it is required to encapsulate different types of cells, as an active component within a material that releases the drug or conjugate directly on the tumor or in the affected area. Against this backdrop, the main objective of this work is to explore the state of participation of polymeric materials in medical and pharmaceutical sciences, in a context where recent cancer statistics are provided in some countries. From the review of the literature, it is evident the importance of the synthesis of new materials or polymeric conjugates, because these materials at the beginning have been used only as storage and delivery systems of drugs, but today they are used as direct treatment against diseases such as cancer, that is, as bioactive agents. Finally, it is possible to conclude that the conjugated polymer-proteins or polymer-drugs, currently on the market and others in the clinical research phase, these materials present physical properties such as biocompatibility and biodegradability, that is, compatibility with the living organism.
Current climate conditions and their impact on agricultural production in Stavropol Krai
Authors: Savinova S V , Loshakov A V , Bratkov V V , Lomakin G V , Ivanova N A
Published: November 2020

Stavropol Krai is located within Ciscaucasia and has an area of 6,616 thousand ha. Massive utilization of the territory, associated with the increased man-induced impact on the environment, caused the aggravation of negative processes in the agroecosystems of the region. Throughout all agroclimatic zones of the region, air temperature tends to increase, which is illustrated by both linear and polynomial trends. In 2010 there was also a rise in air temperature. A warmer spell, notably during the effective vegetation period, led to the precipitation falling in the form of short-term intense showers that generally contribute to erosion advancing. Given the prior climate conditions, the studies resulted in the arrangement of cultivated land, based on its agricultural validity, into four categories in hectares and percent of the area of agricultural land.
Ecological bioindication-based zoning of the urbanized area in arid conditions
Authors: Staselko E A , Sangadzhieva S A , Germasheva Y S , Baryshev A V , Nidyulin V N , Mushaeva K B
Published: November 2020

One of the most important problems is the study and conservation of biological diversity of our planet. The study of the flora species composition of any territory is the basis for the botanical and ecological research. One of the ways to control the environment is environmental monitoring. Fungi bacteria, complex symbiotic associations which include lichens, can be indicators of the state of the environment and its components. When predicting the state of the environment, especially air, representatives of lichen biota are widely used: species composition, distribution of lichens in cities, industrial centers, regions and states. Registration of indicators of lichen biota is part of the observation program of many stations of the global environmental monitoring network. It is important to study lichens in areas subject to the excessive economic impact, which includes Kalmykia.
Numerical simulation of the preparation of a compounded oil pitch with reduced carcinogenic activity
Authors: Kolosov A D , Gorovoy V O , Kondrat’ev V V , Doshlov O I
Published: November 2020

The paper presents a numerical simulation of the preparation of a compounded oil pitch, which, in addition to high technological parameters, has high environmental indicators. Environmental friendliness is ensured by the low content of harmful impurities, including carcinogenic benzo (a) pyrene.
Low-temperature deposition and hardness enhancement of α-(Al,Cr)2O3 films by reactive high power pulsed magnetron sputtering
Authors: Cheng Yitian , Chu Chenglin , Zhou Peng
Published: November 2020

This paper offers a method to grow corundum structure thin films of α-(Al,Cr)2O3 in a High Power Pulsed Magnetron Sputtering (HPPMS) system. The films were characterized by grazing incidence x-ray diffraction (GIXRD), scanning electron microscope (SEM), transmission electron microscope (TEM) and nanoindentation. The results indicate that stoichiometric α-(Al,Cr)2O3 film could be deposited at 540 °C without the formation of other metastable phases. The stable process of the magnetron sputtering ensures the smooth and compact surface of the film composed of nano-scale particles. The Cr in films can induce the formation of solid solution and enhance the mechanical property of the films. The hardness of the α-(Al,Cr)2O3 was calculated as ∼25.6 GPa, which is much higher than that of the film deposited using the Al target. These results are considered have positive effect on the low-cost depositing α-phase alumina films on high speed steel substrates as cutting tools.
Rapid prototyping of microwave metasurfaces by ink-jet printing on polyester (PET) transparencies
Authors: Grbovic Dragoslav , Alves Fabio D , Mattish Richard , Lee Dongil , Han Jin-Woo , Meyyappan M
Published: November 2020

Microwave metasurfaces have been developing rapidly for various applications, typically fabricated on rigid substrates such as silicon and printed circuit board using conventional microfabrication and related techniques. Rapid prototyping and production is desirable for quick design changes, design flexibility for different applications, manufacturing and low cost. Here, we report on the production of microwave metasurfaces using inkjet-printed Ag conductive patterns on polyester sheets as transparent and flexible substrates. The design is shown to be easily reconfigurable between single-band absorption achieved with a single layer of metal array pattern and multi-band absorption achieved either by stacking various single-band sheets or by printing a complex pattern on a single sheet. The dielectric thickness is varied by the simple addition of blank polyester sheets between the sheet with the printed pattern and the ground plane. Optimal dielectric thickness for each combination of materials and geometries defining the metasurface has been achieved by varying the number of blank sheets to maximize the absorption to near perfect levels in each case. This method is amenable for rapidly producing narrowband and broadband metasurfaces for various applications.
Phase diagrams of simple models of colloidal nanocrystals in two dimensions
Authors: Padilla Luis A , Ramírez-Hernández Abelardo
Published: November 2020

The self-assembly of colloidal nanocrystals at interfaces provides a bottom-up approach to create functional materials for developing next-generation flexible optoelectronic devices and sensors. In this work, we report phase diagrams of simple models of colloidal nanocrystals confined at a flat interface. By performing extensive computer simulations we elucidate the mesoscale organization that takes place as different parameters are varied. Our simulation results uncover rich phase diagrams where hexagonal, rhomboid, honeycomb and stripe phases as well as hierarchical self-assembly are found. Our results could serve as a guideline for experimentalists to design colloidal nanocrystal arrangements to target specific applications.
Watch and learn—a generalized approach for transferrable learning in deep neural networks via physical principles
Authors: Sprague Kyle , Carrasquilla Juan , Whitelam Stephen , Tamblyn Isaac
Published: November 2020

Transfer learning refers to the use of knowledge gained while solving a machine learning task and applying it to the solution of a closely related problem. Such an approach has enabled scientific breakthroughs in computer vision and natural language processing where the weights learned in state-of-the-art models can be used to initialize models for other tasks which dramatically improve their performance and save computational time. Here we demonstrate an unsupervised learning approach augmented with basic physical principles that achieves fully transferrable learning for problems in statistical physics across different physical regimes. By coupling a sequence model based on a recurrent neural network to an extensive deep neural network, we are able to learn the equilibrium probability distributions and inter-particle interaction models of classical statistical mechanical systems. Our approach, distribution-consistent learning, DCL, is a general strategy that works for a variety of canonical statistical mechanical models (Ising and Potts) as well as disordered interaction potentials. Using data collected from a single set of observation conditions, DCL successfully extrapolates across all temperatures, thermodynamic phases, and can be applied to different length-scales. This constitutes a fully transferrable physics-based learning in a generalizable approach.
Online accelerator optimization with a machine learning-based stochastic algorithm
Authors: Zhang Zhe , Song Minghao , Huang Xiaobiao
Published: November 2020

Online optimization is critical for realizing the design performance of accelerators. Highly efficient stochastic optimization algorithms are needed for many online accelerator optimization problems in order to find the global optimum in the non-linear, coupled parameter space. In this study, we propose to use the multi-generation Gaussian process optimizer for online accelerator optimization and demonstrate that the algorithm is significantly more efficient than other stochastic algorithms that are commonly used in the accelerator community.
Hydrothermal synthesis and characterization of Zinc Oxide nanoparticles of various shapes under different reaction conditions
Authors: Mohan Sonima , Vellakkat Mini , Aravind Arun , U Reka
Published: November 2020

Zinc Oxide (ZnO) nanoparticles were synthesized by hydrothermal method under different conditions and studied various properties. FTIR studies proved the presence of ZnO bonding and purity of the samples. Grain size was found to be decreased with the increase of reaction temperature and increased with reaction time. TEM images show formation of nanorods under same reaction temperature, also nanoflowers and nanospheres for different temperatures. Intensity of luminescence peaks is found to be changed with variation in interplanar spacing. UV–vis spectra helped to identify the increased photon absorption in particles of bigger size. Change in bandgap value is also observed due to the difference in size of nanoparticles.
Feasibility of a Music System Intervention to Affect Mental Stress and Strain of Employees in Inpatient Dementia Care
Authors: Ibenthal Elisabeth , Kehmann Maximilian , Backhaus Claus
Published: November 2020

Objectives

If family caregivers participate with people with dementia in group music therapies, their mental stress can be reduced. The interventions investigated this context are often limited to active music therapies in groups, which do not consider the inclusion of formal caregivers. In the presented study, a music system was implemented in the routine nursing care of a dementia residential community. Aiming to investigate the use and the effects of the music system on employees’ mental stress and strain, hypotheses were derived, which, for the first time, qualitatively describe this connection.

Methods

A controlled feasibility study with pretests and posttests was conducted. Two residential areas of an inpatient care facility for people with dementia participated as an intervention and control groups—these included 28 residents and 18 employees. In the intervention phase, the employees of the intervention group used the music systems during nursing activities and the operations were saved in log files. Mental stress and strain were recorded six times using the BGWmiab questionnaire. In the questionnaire part on mental stress, typical stress factors were assessed, while the part on mental strain records the extent of seven typical symptoms of overstrain.

Results

The music systems were used 1.6 (±1.3) times per day and per resident, dependent on the residents (P < 0.05, n = 13). Changes in total mental stress and strain scores could not be determined. Regarding the strain symptoms, scores of work motivation, fatigue, and aversions decreased. Seventy-one percent of the employees stated an improved daily work routine. The strain changes in employees of the intervention group correlated significantly with their work experience (r = 0.73, P = 0.04, n = 8).

Conclusions

Eight hypotheses on the usage and effect of music systems were generated. These did not represent an additional stress factor and affected single strain symptoms. In addition, the study highlighted a positive impact that the music systems had on the employees’ perception of stress. This is the first time that the positive effects of receptive music interventions on mental stress and strain of formal caregivers are described. Further investigations with an increased frequency of use of the music systems should validate and specify the findings and hypotheses.
Agent-based modeling reveals benefits of heterogeneous and stochastic cell populations during cGAS-mediated IFNβ production
Authors: Gregg Robert W , Shabnam Fathima , Shoemaker Jason E
Published: November 2020

Motivation

The cGAS pathway is a component of the innate immune system responsible for the detection of pathogenic DNA and upregulation of interferon beta (IFNβ). Experimental evidence shows that IFNβ signaling occurs in highly heterogeneous cells and is stochastic in nature; however, the benefits of these attributes remain unclear. To investigate how stochasticity and heterogeneity affect IFNβ production, an agent-based model is developed to simulate both DNA transfection and viral infection.

Results

We show that heterogeneity can enhance IFNβ responses during infection. Furthermore, by varying the degree of IFNβ stochasticity, we find that only a percentage of cells (20–30%) need to respond during infection. Going beyond this range provides no additional protection against cell death or reduction of viral load. Overall, these simulations suggest that heterogeneity and stochasticity are important for moderating immune potency while minimizing cell death during infection.

Availability and implementation

Model repository is available at: https://github.com/ImmuSystems-Lab/AgentBasedModel-cGASPathway.

Supplementary information

Supplementary data are available at Bioinformatics online.
Paradoxical lesions, plasticity and active inference
Authors: Sajid Noor , Parr Thomas , Gajardo-Vidal Andrea , Price Cathy J , Friston Karl J
Published: November 2020

Paradoxical lesions are secondary brain lesions that ameliorate functional deficits caused by the initial insult. This effect has been explained in several ways; particularly by the reduction of functional inhibition, or by increases in the excitatory-to-inhibitory synaptic balance within perilesional tissue. In this article, we simulate how and when a modification of the excitatory–inhibitory balance triggers the reversal of a functional deficit caused by a primary lesion. For this, we introduce in-silico lesions to an active inference model of auditory word repetition. The first in-silico lesion simulated damage to the extrinsic (between regions) connectivity causing a functional deficit that did not fully resolve over 100 trials of a word repetition task. The second lesion was implemented in the intrinsic (within region) connectivity, compromising the model’s ability to rebalance excitatory–inhibitory connections during learning. We found that when the second lesion was mild, there was an increase in experience-dependent plasticity that enhanced performance relative to a single lesion. This paradoxical lesion effect disappeared when the second lesion was more severe because plasticity-related changes were disproportionately amplified in the intrinsic connectivity, relative to lesioned extrinsic connections. Finally, this framework was used to predict the physiological correlates of paradoxical lesions. This formal approach provides new insights into the computational and neurophysiological mechanisms that allow some patients to recover after large or multiple lesions.
Additional prognostic value of heart rate reserve over left ventricular contractile reserve and coronary flow velocity reserve in diabetic patients with negative vasodilator stress echocardiography by regional wall motion criteria
Authors: Cortigiani Lauro , Ciampi Quirino , Carpeggiani Clara , Lisi Cristiano , Bovenzi Francesco , Picano Eugenio
Published: November 2020

Aims 

In diabetic patients, a blunted left ventricular contractile reserve (LVCR) and/or a reduced coronary flow velocity reserve (CFVR) identify patients at higher risk in spite of stress echocardiography (SE) negative for ischaemia. Cardiac autonomic dysfunction contributes to risk profile independently of inducible ischaemia and can be assessed with heart rate reserve (HRR). We sought to assess the added prognostic value of HRR to LVCR and CFVR in diabetic patients with non-ischaemic SE.

Methods and results 

Six-hundred and thirty-six diabetic patients (age 68 ± 9 years, 396 men, ejection fraction 58 ± 10%) with sinus rhythm on resting electrocardiogram underwent dipyridamole SE in a two-centre prospective study with assessment of wall motion, force-based LVCR (stress/rest ratio, normal value > 1.1), CFVR of the left anterior descending coronary artery (stress/rest ratio, normal value >2.0), and HRR (stress/rest ratio, normal value >1.22). All-cause death was the only considered endpoint. During a median follow-up of 39 months, 94 (15%) patients died. Independent predictors of death were abnormal CFVR [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.0–2.52, P = 0.05], reduced LVCR (HR 1.76, 95% CI 1.15–2.69, P = 0.009), and blunted HRR (HR 1.92, 95% CI 1.24–2.96, P = 0.003). Eight-year death rate was 9% for patients with triple negativity (n = 252; 40%), 18% for those with single positivity (n = 216; 34%), 36% with double positivity (n = 124; 19%), and 64% for triple positivity (n = 44; 7%) (P < 0.0001).

Conclusion 

Diabetic patients with dipyridamole SE negative for ischaemia still may have a significant risk in presence of an abnormal LVCR and/or CFVR and/or HRR, which assess the underlying myocardial, microvascular, and cardiac autonomic dysfunction.

Clinical trials

Gov Identifier NCT 030.49995.
Coronary and cerebral thrombosis in a young patient after mild COVID-19 illness: a case report
Authors: Ranard Lauren S , Engel David J , Kirtane Ajay J , Masoumi Amirali
Published: November 2020

Background

COVID-19 has spread worldwide and has caused significant morbidity and mortality. Myocardial injury and thrombo-embolism are known complications for those with severe forms of disease. The incidence and risk factors for these complications for those patients who are asymptomatic or with mild forms of COVID-19 is unknown.

Case summary

In this report we describe the case of a 35-year-old man with no past cardiac history who presented with chest pain and a high-sensitivity troponin level of 386 ng/L in the context of an unspecified mild viral illness 1 month previously. Diagnostic evaluation revealed a new cardiomyopathy, left ventricular thrombus, and mid right coronary artery thrombosis. The coronary thrombosis was treated with thrombectomy. SARS-CoV-2 antibodies returned positive. He initially did well post-procedure; however, prior to discharge, he developed a second arterial thrombo-embolism event, a middle cerebral artery stroke. He was treated with thrombectomy and remains hospitalized.

Discussion

Recognition that mild COVID-19 can be complicated by subsequent cardiac injury and/or coagulopathy is important. As more people recover from this viral illness and return to normal activity levels, discussion among cardiac experts has begun regarding screening for occult myocardial injury in those who plan to resume competitive athletic activity. This case highlights the need for investigation regarding (i) the duration of thrombophilia after recovery from illness; (ii) the population that should receive thromboprophylaxis; and (iii) the duration of thromboprophylaxis therapy for COVID-19.
A case report of a large intracardiac thrombus in a COVID-19 patient managed with percutaneous thrombectomy and right ventricular mechanical circulatory support
Authors: Kaki Amir , Singh Hemindermeet , Cohen Gerald , Schreiber Theodore
Published: November 2020

Background

The coronavirus disease 2019 (COVID-19) has caused a global pandemic with an unprecedented burden on health and the economy worldwide. Although it primarily involves the respiratory tract system, cardiovascular complications, particularly arterial and venous thrombosis, are frequently reported and are associated with adverse outcomes.

Case summary

We describe the case of a 57-year-old female who presented with acute hypoxic respiratory failure and shock. She was found to have left lower extremity deep vein thrombosis and a suspected pulmonary embolism. A large mobile right atrial mass was found on echocardiogram. Given the large thrombus burden that portended an extremely high risk for embolization to the pulmonary arteries, emergent percutaneous aspiration of an organized thrombus (rather than thrombolysis) was performed using the AngioVac system (Angiodynamics Inc., Latham, NY, USA) complicated by haemodynamic collapse due to acute right ventricular failure. An Impella RP (Abiomed, Danvers, MA, USA) was then placed, with rapid stabilization of haemodynamics. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). She was treated with antimicrobial and systemic anticoagulation therapy. She was successfully weaned off the Impella RP on post-operative day 4 and was extubated on day 5. She was discharged on day 16 in a stable condition.

Discussion

Incident venous thrombo-embolism is frequently encountered in COVID-19 patients. We report the first case of a large intracardiac thrombus associated with SARS-CoV-2 infection managed successfully with percutaneous thrombectomy and right ventricular mechanical circulatory support.
Appendicular Muscle Physiology and Biomechanics inCrocodylus niloticus
Authors: Michel Krijn B , West Tim G , Daley Monica A , Allen Vivian R , Hutchinson John R
Published: November 2020

Archosaurian reptiles (including living crocodiles and birds) had an explosive diversification of locomotor form and function since the Triassic approximately 250 million years ago. Their limb muscle physiology and biomechanics are pivotal to our understanding of how their diversity and evolution relate to locomotor function. Muscle contraction velocity, force, and power in extinct archosaurs such as early crocodiles, pterosaurs, or non-avian dinosaurs are not available from fossil material, but are needed for biomechanical modeling and simulation. However, an approximation or range of potential parameter values can be obtained by studying extant representatives of the archosaur lineage. Here, we study the physiological performance of three appendicular muscles in Nile crocodiles (Crocodylus niloticus). Nile crocodile musculature showed high power and velocity values—the flexor tibialis internus 4 muscle, a small “hamstring” hip extensor, and knee flexor actively used for terrestrial locomotion, performed particularly well. Our findings demonstrate some physiological differences between muscles, potentially relating to differences in locomotor function, and muscle fiber type composition. By considering these new data from a previously unstudied archosaurian species in light of existing data (e.g., from birds), we can now better bracket estimates of muscle parameters for extinct species and related extant species. Nonetheless, it will be important to consider the potential specialization and physiological variation among muscles, because some archosaurian muscles (such as those with terrestrial locomotor function) may well have close to double the muscle power and contraction velocity capacities of others.
Five Tips for Successful Conflict Negotiation in the Breast Imaging Workplace
Authors: Fishman Michael D C , Slanetz Priscilla J
Published: November 2020

Conflict in the workplace is inevitable and disruptive to the team dynamic, ultimately leading to suboptimal patient outcomes if not addressed. Especially in breast imaging, where an interprofessional team is commonplace, spending time to address conflict is critical to building and maintaining relationships among team members. Although institutions may adopt a just culture, workplace paradigms can be challenged when two or more team members encounter misunderstandings around work-related or personal issues. Multiple factors can contribute to promoting workplace conflict, including a toxic culture (the antithesis of just culture), ineffective leadership, hierarchy, unclear expectations or goals, pre-existing assumptions and beliefs, lack of effective communication, and low levels of trust. Developing skills to engage in the difficult conversations to address and resolve conflict are essential to create an efficient and effective team to care for patients. In this manuscript, we provide tips on how each of us can build skills in conflict management and resolution, illustrated in several vignettes. These tips provide practical advice, which ultimately will translate into allowing us to provide better patient care every day.
Improving Readiness: Preventive Maintenance of the Human Operating System that Drives Readiness and Lethality
Authors: Howell George
Published: November 2020

Improving the readiness and lethality of the U.S. fighting forces has always been a key priority, and it received renewed emphasis in the National Defense Authorization Act of 2017. A major rearrangement of the Defense Health Agency and the Military Health System is ongoing with this emphasis. Although revising features to improve our military health service is essential, the health, well-being, and readiness of our people will also rely on the culture created at the Command level where soldiers, sailors, airmen and civilians operate daily. In alignment with our military health care community and in support of our renewed emphasis on warfighting readiness, USS Missouri began a journey to address foundational mindset that drives the core behaviors, training, and procedures of the submarine force and Naval Nuclear Propulsion Principles leading to enhanced readiness, resilience, and accountability.
Genomic mosaicism due to homoeologous exchange generates extensive phenotypic diversity in nascent allopolyploids
Authors: Wu Ying , Lin Fan , Zhou Yao , Wang Jie , Sun Shuai , Wang Bin , Zhang Zhibin , Li Guo , Lin Xiuyun , Wang Xutong , Sun Yue , Dong Qianli , Xu Chunming , Gong Lei , Wendel Jonathan F , Zhang Zhiwu , Liu Bao
Published: November 2020

Allopolyploidy is an important process in plant speciation, yet newly formed allopolyploid species typically suffer from extreme genetic bottlenecks. One escape from this impasse might be homoeologous meiotic pairing, during which homoeologous exchanges (HEs) generate phenotypically variable progeny. However, the immediate genome-wide patterns and resulting phenotypic diversity generated by HEs remain largely unknown. Here, we analyzed the genome composition of 202 phenotyped euploid segmental allopolyploid individuals from the fourth selfed generation following chromosomal doubling of reciprocal F1 hybrids of crosses between rice subspecies, using whole-genome sequencing. We describe rampant occurrence of HEs that, by overcoming incompatibility or conferring superiority of hetero-cytonuclear interactions, generate extensive and individualized genomic mosaicism across the analyzed tetraploids. We show that the resulting homoeolog copy number alteration in tetraploids affects known-function genes and their complex genetic interactions, in the process creating extraordinary phenotypic diversity at the population level following a single initial hybridization. Our results illuminate the immediate genomic landscapes possible in a tetraploid genomic environment, and underscore HE as an important mechanism that fuels rapid phenotypic diversification accompanying the initial stages of allopolyploid evolution.
Clinical course of COVID-19 infection in inflammatory rheumatological patients: a monocentric Belgian experience
Authors: Pistone Aureliano , Tant Laure , Soyfoo Muhammad S
Published: November 2020

Objective

Little is known about the incidence and consequences of coronavirus disease 2019 (COVID-19) infection in patients with rheumatic diseases. To improve our knowledge in this field, we collected data from patients with inflammatory rheumatic diseases who developed COVID-19 infection.

Methods

We performed a monocentric observational longitudinal study and collected data retrospectively from patients with inflammatory rheumatic diseases who developed a confirmed or suspected COVID-19 infection between 3 March and 10 June 2020.

Results

A total of 23 patients developed COVID-19 infection. Seven patients needed hospitalization [female 57%, mean age 59 +/− 9 years], and 16 patients were followed as outpatients [female 80%, mean age 50  +/− 14 years]. All hospitalized patients had more than one co-morbidity. At the time of infection, all patients were on immunosuppressive therapy consisting of either conventional synthetic DMARDs and/or biotherapy, with or without CSs. A minority received Corticoids (CSs) only. The most common symptoms of COVID-19-infected patients were fever, dyspnoea, cough and fatigue. PCR and chest CT were performed in all hospitalized patients to confirm the diagnosis (100% positive PCR, 71% positive CT). All outclinic patients were diagnosed clinically (confirmed by PCR in only one). The mean length of hospital stay was 21 +/− 19 days. Three patients developed an ARDS, including one who died.

Conclusion

A limited number of patients with inflammatory rheumatic diseases suffered from COVID-19 infection. Two patients needed mechanical ventilation and survived, whereas one patient died. All patients with a severe form of infection had at least one co-morbidity.
Emigration and Electoral Outcomes in Mexico: Democratic Diffusion, Clientelism, and Disengagement
Authors: Lu Yao , Villarreal Andrés
Published: November 2020

Does emigration deepen or depress democratic transitions in migrant-sending countries? This study examines the multifaceted and countervailing influences of migration on democratic outcomes in sending societies, as operationalized by electoral participation and competition. Drawing on longitudinal data compiled from several Mexican sources, we find that international migration, but not domestic migration, increases voter turnout and electoral competition in sending communities in Mexico. This pattern holds for low-to-moderate levels of emigration but is reversed for high levels of migration. The positive political impact of migration is limited to current emigration from communities of origin rather than return migration. Both documented and undocumented migration influence electoral outcomes, but the political impact of undocumented migration is more pronounced. These comparisons of different types of migration and different functional forms allow us to explore the mechanisms through which migration affects electoral outcomes. The results are consistent with several proposed mechanisms: migration-driven democratic diffusion, weakened clientelism, and disengagement. Overall, the findings demonstrate the value of integrating demographic processes into explanations of political change.
Cost-effectiveness of digital cognitive behavioral therapy (Sleepio) for insomnia: a Markov simulation model in the United States
Authors: Darden Michael , Espie Colin A , Carl Jenna R , Henry Alasdair L , Kanady Jennifer C , Krystal Andrew D , Miller Christopher B
Published: November 2020

Study Objectives

To examine the cost-effectiveness and potential net monetary benefit (NMB) of a fully automated digital cognitive behavioral therapy (CBT) intervention for insomnia compared with no insomnia treatment in the United States (US). Similar relative comparisons were made for pharmacotherapy and clinician-delivered CBT (individual and group).

Methods

We simulated a Markov model of 100,000 individuals using parameters calibrated from the literature including direct (treatment) and indirect costs (e.g. insomnia-related healthcare expenditure and lost workplace productivity). Health utility estimates were converted into quality-adjusted life years (QALYs) and one QALY was worth $50,000. Simulated individuals were randomized equally to one of five arms (digital CBT, pharmacotherapy, individual CBT, group CBT, or no insomnia treatment). Sensitivity was assessed by bootstrapping the calibrated parameters. Cost estimates were expressed in 2019 US dollars.

Results

Digital CBT was cost beneficial when compared with no insomnia treatment and had a positive NMB of $681.06 (per individual over 6 months). Bootstrap sensitivity analysis demonstrated that the NMB was positive in 94.7% of simulations. Relative to other insomnia treatments, digital CBT was the most cost-effective treatment because it generated the smallest incremental cost-effectiveness ratio (−$3,124.73).

Conclusions

Digital CBT was the most cost-effective insomnia treatment followed by group CBT, pharmacotherapy, and individual CBT. It is financially prudent and beneficial from a societal perspective to utilize automated digital CBT to treat insomnia at a population scale.
Building a custom high-throughput platform at the Joint Genome Institute for DNA construct design and assembly—present and future challenges
Authors: Blaby Ian K , Cheng Jan-Fang
Published: November 2020

The rapid design and assembly of synthetic DNA constructs have become a crucial component of biological engineering projects via iterative design–build–test–learn cycles. In this perspective, we provide an overview of the workflows used to generate the thousands of constructs and libraries produced each year at the U.S. Department of Energy Joint Genome Institute. Particular attention is paid to describing pipelines, tools used, types of scientific projects enabled by the platform and challenges faced in further scaling output.
Negative Patient Reviews and Online Defamation
Authors: Moutos Christopher P. , Verma Kajal , Phelps John Y.
Published: November 2020

Physician review websites can serve as a means for patients to address physician actions, both good and bad. At times, patient reviews may be negative and perceived as defamatory. Yet there are specific legal requirements that must be met for an online review to be considered defamatory. Prior cases indicate that pursuing a defamation lawsuit, although appropriate in some circumstances, is oftentimes a difficult and futile endeavor. To avoid litigation, physicians can take proactive approaches to address questionable reviews and to bolster their online reputations.
Primary orbital ganglioneuroblastoma in a child
Authors: Zhang Yi , He Weimin
Published: November 2020

Rationale:

Ganglioneuroblastoma (GNB) is a transitional tumor of sympathetic origin that has never been described as primarily involving the orbit. Herein we report an extremely rare case of GNB with primary orbital involvement and its treatment strategies.

Patient concerns:

A 9-year-old girl presented with progressive and recurring right orbital mass for 2 years.

Diagnosis:

Computed tomography (CT) showed a well-defined, well-circumscribed, and homogeneous extraconal soft tissue mass occupying most of the right superior orbital area. Magnetic resonance imaging (MRI) revealed that there was a neoplasm of the right superior orbit molding around the globe with long T1 and T2 signals, and contrast-enhanced MR image showed a heterogeneous enhancement of the mass. Histopathologic examinations were performed after surgery and the characteristics were consistent with a diagnosis of GNB.

Interventions:

Surgery was performed and the mass was completely resected.

Outcomes:

Postoperatively, the patient was on a regular follow-up for 19 months and so far, has had no orbital mass recurrence.

Lessons:

Herein we present a rare case of GNB primarily involving the orbit, and the findings showed that GNB could originate from the orbit. The patient underwent surgical tumor resection. The histopathological and immunohistochemical features were consistent with the diagnosis of GNB. For this case, there was no recurrence for 19 months after complete surgical excision of the tumor; however, a regular long-term follow-up is required.
Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort
Authors: Beres Laura K. , Schwartz Sheree , Simbeza Sandra , McGready John , Eshun-Wilson Ingrid , Mwamba Chanda , Sikombe Kombatende , Topp Stephanie M. , Somwe Paul , Mody Aaloke , Mukamba Njekwa , Ehrenkranz Peter D. , Padian Nancy , Pry Jake , Moore Carolyn Bolton , Holmes Charles B. , Sikazwe Izukanji , Denison Julie A. , Geng Elvin
Published: November 2020

Background:

Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement.

Methods:

From a probability-based sample of lost to follow-up, adult patients traced by peer educators from 31 Zambian health facilities, we prospectively followed disengaged HIV patients for return clinic visits. We estimated the cumulative incidence of return and the time to return using Kaplan–Meier methods. We used univariate and multivariable Cox proportional hazards regression to conduct a risk factor analysis identifying predictors of incident return across a social ecological framework.

Results:

Of the 556 disengaged patients, 73.0% [95% confidence interval (CI): 61.0 to 83.8] returned to HIV care. The median follow-up time from disengagement was 32.3 months (interquartile range: 23.6–38.9). The rate of return decreased with time postdisengagement. Independent predictors of incident return included a previous gap in care [adjusted Hazard Ratio (aHR): 1.95, 95% CI: 1.23 to 3.09] and confronting a stigmatizer once in the past year (aHR: 2.14, 95% CI: 1.25 to 3.65). Compared with a rural facility, patients were less likely to return if they sought care from an urban facility (aHR: 0.68, 95% CI: 0.48 to 0.96) or hospital (aHR: 0.52, 95% CI: 0.33 to 0.82).

Conclusions:

Interventions are needed to hasten re-engagement in HIV care. Early and differential interventions by time since disengagement may improve intervention effectiveness. Patients in urban and tertiary care settings may need additional support. Improving patient resilience, outreach after a care gap, and community stigma reduction may facilitate return. Future re-engagement research should include causal evaluation of identified factors.