bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural Enemies Role in Cost Reduction: An Analysis of Rice Cultivation in Kerala, India
Authors: Hema M.  , Divya K. M.  , Pathrose Berin , Sisira P.
Published: October 2023

Kerala, the state with the highest human development indices, is always concerned about its citizens' health. People's rising knowledge of the adverse effects of chemical inputs on agriculture has resulted in the development of eco-friendly agricultural techniques like organic farming. However, how natural enemies support pest control services in organic farming remains to be discovered at different scales and in diverse landscape contexts. The present study examined the natural enemy population in Kerala's paddy cultivation under conventional and organic systems. The reduction in the cost of cultivation in organic farming was primarily due to reduced labour charges due to the avoidance of pesticides and fertiliser application. Even though the effect of natural predators on organic farming was found to be, the farmers were unaware of the importance of natural enemies. Thus, the study highlighted the significance of organising more awareness programmes, especially the on-farm ones.
Advanced Platelet-Rich Fibrin (A-PRF) Associated with the Tunneling Technique in the Treatment of Cairo Type 1 Gingival Recessions: Randomized and Blinded Clinical Study
Authors: Silva Edson Oliveira , Nadal Leticia , Rothen Simone Karine , Nassar Carlos Augusto , Nassar Patricia Oehlmeyer
Published: October 2023

The use of advanced platelet-rich fibrin (A- PRF) has presented good results in periodontal plastic surgery for treatment of gingival recessions. The present study aims at assessing the effectiveness of the use of A-PRF in root coverage and periodontal clinical parameters of patients with Cairo Type 1 gingival recession. Forty four (44) bilateral Cairo Type 1 gingival recessions were selected. The recessions were split in two groups according to the surgical procedure made (n=44): SCTG: Subepithelial Connective Tissue Graft and A-PRF, using tunnel surgical technique in both sides. The patients were monitored on 0, 90, and 180 days for assessment of the recession height and width; probing depth and bleeding on probing; clinical attachment level; keratinized tissue band width; thickness of keratinized gingival tissue and sensitivity level. The data obtained were initially analyzed and assessed with SHAPIRO-WILK test for normality and later ANOVA and TUKEY tests were used for normal data, or KRUSKALL-WALLIS and DUNN test for non-normal data. For analysis of sensitivity parameter, the test chosen was KRUSKALL-WALLIS and DUNN, with 5% significance level. In the analysis across groups the Student’s t-test was conducted. Both groups presented improvement in periodontal parameters, however without significant statistical difference between them, which suggests that A-PRF can be an alternative to SCTG in root coverage surgeries of Cairo type 1 recession.
Non‐invasive mark–resight surveys for brown bears: Incorporating spatial information to improve landscape‐scale monitoring of density and distribution
Authors: Schmidt Joshua H. , Deacy William W. , Hughes Letty J. , Schertz Dylan T.
Published: October 2023

Effective wildlife monitoring and management are reliant on unbiased estimators of population parameters. Most standard survey approaches ignore spatial pattern in the data although spatial relationships can be leveraged to produce more efficient designs for future surveys, thereby reducing project cost. Landscape‐scale surveys for brown bears are notoriously expensive and difficult to complete, leading to the development of a non‐invasive mark–resight aerial survey approach as a practical alternative to more commonly employed approaches for estimating brown bear density across large areas.

Here we extend that model to accommodate spatial covariate information and explicitly model residual spatial autocorrelation. Using brown bear survey data from northwestern Alaska, USA from 2015 to 2021, we demonstrate how our extension can be useful in exploring ecological factors related to spatial variation in bear density and detection probability.

We found that detection probability was higher in more rugged terrain, and occurrence probability was higher at mid‐elevations where denning habitat was more prevalent and in areas with more salmon streams. The descriptive model of residual autocorrelation confirmed that additional unmeasured factors were associated with bear distribution. While these findings were not unexpected, they are very useful when considering future survey effort.

Using this information, we explored a hypothetical redesign of the 2021 brown bear survey that removed 50% of the survey subunits with elevation values below the mean, where bears were least likely to occur. We demonstrated that the resulting estimates were unbiased, suggesting that adopting the spatial approach to analysis could reduce overall project costs by ~20%–30% going forward.

Overall, our work indicates that directly accounting for spatial pattern within the non‐invasive mark–resight framework has substantive advantages over the original non‐spatial approach and may be useful in increasing the amount of information available for brown bear populations.
Patterns in the Sequential Treatment of Patients With Rheumatoid Arthritis Starting a Biologic or Targeted Synthetic Disease‐Modifying Antirheumatic Drug: 10‐Year Experience From a US‐Based Registry
Authors: Matsson Anton , Solomon Daniel H. , Crabtree Margaux M. , Harrison Ryan W. , Litman Heather J. , Johansson Fredrik D.
Published: October 2023

Objective

Developing and evaluating new treatment guidelines for rheumatoid arthritis (RA) based on observational data requires a quantitative understanding of patterns in current treatment practice with biologic and targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs).

Methods

We used data from the CorEvitas RA registry to study patients starting their first b/tsDMARD therapy, defined as the first line of therapy, between 2012 and the end of 2021. We identified treatment patterns as unique sequences of therapy changes following and including the first‐line therapy. Therapy cycling was defined as switching back to a treatment from a previously used therapeutic class.

Results

A total of 6015 b/tsDMARD‐naïve patients (77% female) were included in the analysis. Their median age was 58 years, and their median disease duration was 3 years. In 2012–2014, 80% of the patients started a tumor necrosis factor inhibitor (TNFi) as their first b/tsDMARD. However, the use of TNFi decreased in favor of Janus kinase inhibitors since 2015. Although the number of treatment patterns was large, therapy cycling was relatively common. For example, 601 patterns were observed among 1133 patients who changed therapy at least four times, of whom 85.3% experienced therapy cycling. Furthermore, the duration of each of the first three lines of therapy decreased over the past decade. For example, the median duration of the first‐line therapy was 153 days in 2018–2021 compared to 208 days in 2015–2017 (P < 0.001).

Conclusion

First‐line therapy was almost always TNFi, but diversity in treatment choice was high after that. This practice variation allows for proposing and evaluating new guidelines for sequential treatment of RA. It also presents statistical challenges to compare patients with different treatment sequences.
Realizing Remarkable Improvement of Electrical Performance in N‐Type BiSbSe3 via In Situ Compositing
Authors: Wang Sining , Zhang Linlin , Hong Tao , Su Lizhong , Wen Yi , Qin Bingchao , Xiao Yu , Wang Yuping , Shi Haonan , Zheng Junqing , Qiu Yuting , Zhao Li‐Dong
Published: October 2023

BiSbSe3 is a Te‐free thermoelectric material with intrinsically low thermal conductivity. Its thermoelectric performance is limited by poor electrical conductivity. To optimize electrical conductivity, Bi2SbSe3 with high carrier concentration and mobility is introduced to BiSbSe3 matrix through in situ reaction and conventional mechanical mixing. In both methods, carrier concentrations are improved by carrier injection and redistribution. Carrier mobility is manipulated based on microstructure. In the conventional method, isolated flake‐shaped Bi2SbSe3 grains with weak‐bonding phase boundaries restrict carrier mobility. For the in situ method, irregular Bi2SbSe3 connects into conductive networks inducing a percolation effect, and in situ formed small‐angle phase boundaries barely impede carriers. Thus, the carrier mobilities of in situ composites are significantly improved and higher than that of conventional composites. Simultaneously optimized carrier concentration and mobility remarkably enhance electrical conductivity over the whole working temperature. Maximum electrical conductivity of 378 S cm−1 is achieved in BiSbSe3‐38 vol% Bi2SbSe3 in situ composites at 300 K, obtaining more than 300% improvement compared with 124 S cm−1 in BiSbSe3 matrix. Lattice thermal conductivity is reduced at a low compositing fraction. Ultimately, a record‐breaking average ZT of 0.65 (300–750 K) is attained in BiSbSe3‐13 vol% Bi2SbSe3 in situ composite. The in situ compositing method in this work effectively optimizes electrical performance, anticipated to be applied in other thermoelectric materials.
Vibrational Coupling to Quasi‐Bound States in the Continuum under Tailored Coupling Conditions
Authors: Watanabe Keisuke , Devi Hemam Rachna , Iwanaga Masanobu , Nagao Tadaaki
Published: October 2023

Photonic resonance modes can be spectrally coupled to the vibrational modes of molecules in the mid‐infrared regime through interactions between localized electric fields and nearby molecules. According to recent studies, radiative loss engineering of coupled systems is a promising approach for tailoring coupling conditions and enhancing the molecular signals. However, this strategy has only been realized using the localized surface plasmon resonances of metal nanostructures, which suffer from increased ohmic loss in the mid‐infrared region and face serious limitations in achieving high quality (Q) factors. In this study, silicon‐based metasurfaces formed on silicon‐on‐insulator wafers are adopted to achieve high Q factors and tune the coupling conditions between the quasi‐bound states in the continuum (qBICs) and molecular vibrations. The coupling between the resonance mode and polymethyl methacrylate molecules is tailored from weak to strong coupling regimes by simply changing the structural asymmetry parameter and utilizing the intrinsically high Q factors of the qBIC modes. In addition, the optimal asymmetry parameter that maximizes the enhanced molecular signal is identified, opening a route toward realizing highly sensitive surface‐enhanced infrared spectroscopy using complementary metal–oxide–semiconductor compatible all‐dielectric materials.
Guidelines for Designing Water‐Stable Hybrid Lead Bromide Perovskites with Broad Emission
Authors: Chen Congcong , Zhang Luming , Ji Xiaoqing , Zhang Xuanyu , Gong Yaping , Chen Rui , Mao Lingling
Published: October 2023

Hybrid lead halide perovskites have generated increasing attention for their high performance in optoelectronic applications. One main drawback of these materials is the sensitivity to moisture, which contributes heavily to the ultimate decomposition. Here, this study takes advantage of the reported representative white‐light emitting lead bromide perovskite and three‐dimensional (3D) perovskite as the subject of water‐stability study. It is reported here that other than observed phase transformation in one case, the majority of these perovskites break down in water rapidly, precipitating out as an inorganic salt compound Pb3Br6[H2O]·H2O. As these materials are studied in detail, it is discovered that better coverage of the hydrophobic organic cation enhances the water stability. Taking this idea further, it is demonstrated here that five new one‐dimensional (1D) lead bromide compounds have superior water stability, where the longest stability when completely immersed in water is more than one year and counting. This work provides a new mechanism regarding the degradation process when encountering moisture and general guidelines to increase the water stability for the lead bromide hybrids.
Direct Synthesis of Metal–Organic Framework Sols: Advances and Perspectives
Authors: Xie Hongshen , Yuan Hongye , Xu Liujie
Published: October 2023

The intrinsic lack of processability in the conventional nano/microcrystalline powder form of metal‐organic frameworks (MOFs) greatly limits their application in various fields. Synthesis of MOFs with certain flowability make them promising for multitudinous applications. The direct synthesis strategy represents one of the simplest and efficient method for synthesizing solution processable MOF sols/suspensions, compared with other approaches, for instance, the post‐synthesis surface modification, the direct dispersion of MOFs in hindered ionic liquids, as well as the calcination method toward a few MOFs with melting behavior. This article reviews the recent direct synthesis strategies of solution processable MOF sols and their typical applications in different fields. The direct synthesis strategies of MOF sols can be classified into two categories: particle size reduction strategy, and selective coordination strategy. The synthesis mechanism of different strategies and the factors affecting the formation of sols are summarized. The application of solution processable MOF sols in different fields are introduced, showing great application potentials. Furthermore, the challenges faced by the direct synthesis of MOF sols and the main methods to deal with the challenges are emphasized, and the future development trend is prospected.
Asymmetric Nanoporous Alumina Membranes for Nanofluidic Osmotic Energy Conversion
Authors: Zhang Yao , Wang Huijie , Wang Jin , Li Lulu , Sun Hanjun , Wang Chen
Published: October 2023

The potential of harnessing osmotic energy from the interaction between seawater and river water has been recognized as a promising, eco‐friendly, renewable, and sustainable source of power. The reverse electrodialysis (RED) technology has gained significant interest for its ability to generate electricity by combining concentrated and diluted streams with different levels of salinity. Nanofluidic membranes with tailored ion transport dynamics enable efficient harvesting of renewable osmotic energy. In this regard, anodic aluminum oxide (AAO) membranes with abundant nanochannels provide a cost‐effective nanofluidic platform to obtain structures with a high density of ordered pores. AAO can be utilized in constructing asymmetric composite membranes with enhanced ion flux and selectivity to improve output power generation. In this review, we first present the fundamental structure and properties of AAO, followed by summarizing the fabrication techniques for asymmetric membranes using AAO and other nanostructured materials. Subsequently, we discuss the materials employed in constructing asymmetric structures incorporating AAO while emphasizing how material selection and design can resist and promote efficient energy conversion. Finally, we provide an outlook on future applications and address the challenges that need to be overcome for successful osmotic energy conversion.
Deep generative models for vehicle speed trajectories
Authors: Behnia Farnaz , Karbowski Dominik , Sokolov Vadim
Published: October 2023

Generating realistic vehicle speed trajectories is a crucial component in evaluating vehicle fuel economy and in predictive control of self‐driving cars. Traditional generative models rely on Markov chain methods and can produce accurate synthetic trajectories but are subject to the curse of dimensionality. They do not allow to include conditional input variables into the generation process. In this paper, we show how extensions to deep generative models allow accurate and scalable generation. Proposed architectures involve recurrent and feed‐forward layers and are trained using adversarial techniques. Our models are shown to perform well on generating vehicle trajectories using a model trained on GPS data from Chicago metropolitan area.
As a matter of fat: Emerging roles of lipid‐sensitive E3 ubiquitin ligases
Authors: Gawden‐Bone Christian M. , Lehner Paul J. , Volkmar Norbert
Published: October 2023

The dynamic structure and composition of lipid membranes need to be tightly regulated to control the vast array of cellular processes from cell and organelle morphology to protein‐protein interactions and signal transduction pathways. To maintain membrane integrity, sense‐and‐response systems monitor and adjust membrane lipid composition to the ever‐changing cellular environment, but only a relatively small number of control systems have been described. Here, we explore the emerging role of the ubiquitin‐proteasome system in monitoring and maintaining membrane lipid composition. We focus on the ER‐resident RNF145 E3 ubiquitin ligase, its role in regulating adiponectin receptor 2 (ADIPOR2), its lipid hydrolase substrate, and the broader implications for understanding the homeostatic processes that fine‐tune cellular membrane composition.
What is unique about sustainable business models for the base of the pyramid?
Authors: Méndez‐León Eduardo , Díaz‐Pichardo René , Reyes‐Carrillo Tatiana , del Rosario Reyes‐Santiago María
Published: October 2023

Research on sustainable business models (SBMs) has been hindered by the use of traditional business model (BM) components indiscriminately applied to explain sustainable value (SV). Moreover, little has been done to reveal key components in BMs aiming to address the needs of the poor; that is, that part of the population referred to as the base of the pyramid (BoP). Following a case study methodology, we observe that conventional components are insufficient to clearly explain SV in SBMs for the BoP. The main contribution of this research is that it discloses that in SBMs for the BoP, activities (grouped into elements and components) are distinctively amalgamated to produce SV. This arrangement might be unique to SBMs for the BoP, and here we opt to present it in the form of a framework that articulates both a priori and emergent components and elements. In this framework, value adoption and value transmission are integrated as new components for analyzing this type of BM.
Intravascular lithotripsy compared to rotational atherectomy for the treatment of calcified distal left main coronary artery disease: A single center experience
Authors: Sandesara Pratik B. , Elhage Hassan Malika , Shekiladze Nikoloz , Turk Ahmad Al , Montrivade Sakolwat , Gold Daniel , Kindya Bryan , Rinfret Stephane , Nicholson William J. , Jaber Wissam A.
Published: October 2023

Background

The safety and efficacy of intravascular lithotripsy (IVL) for the treatment of calcified distal left main (LM) disease remains unclear, especially compared to rotational atherectomy (RA).

Methods

We retrospectively analyzed the baseline clinical, angiographic, intravascular ultrasound (IVUS) characteristics and procedural outcomes of 107 patients who underwent distal LM percutaneous coronary intervention (PCI) with IVL (with or without adjunct atherectomy) versus RA alone for plaque modification before stenting at a single center between 2020 and 2022.

Results

A total of 50 patients underwent calcium modification with IVL with or without adjunct atherectomy and 57 with RA only. The mean age was 73 years and with a high prevalence of diabetes (58.9%), chronic kidney disease (42.1%), prior revascularization (coronary artery bypass graft surgery [36.4%] or prior PCI [32.7%]). Acute coronary syndrome was the primary indication for PCI in over 50% of the patients in both groups. Medina 1‐1‐1 LM bifurcation disease was identified in 64% and 60% of the IVL and RA groups (p = 0.64) respectively. Final minimum stent area in distal LM (>8.2 mm2), ostial LAD (>6.3 mm2) and ostial LCX (>5.0 mm2) were achieved in 96%, 85% and 89% of cases treated with IVL respectively and 93%, 93% and 100% of cases treated with RA respectively (LM p = 1.00; LAD p = 0.62; LCX; p = 1.00 for difference between the two groups). Procedural success (technical success without in‐hospital major adverse events) was achieved in 98% of the IVL group and 86% of the RA‐only group (p = 0.04). There were eight procedural complications (flow‐limiting dissection, perforation, or slow/no‐reflow) in the RA group compared to four in the IVL group (NS), and one patient in the RA required salvaged mechanical support compared to none in the IVL group.

Conclusion

Plaque modification with coronary IVL appears to be efficacious and safe for the treatment of severely calcified distal LM lesions compared to RA only. Larger randomized studies are needed to confirm these findings.
Fe‐Zeolite as on‐Site Regenerable Adsorber for Chlorohydrocarbons in Groundwater – from Laboratory to Pilot Test
Authors: Georgi Anett , Köhler Robert , Woszidlo Silke , Mackenzie Katrin , Schierz Ariette , Schlosser Alina , Stanger Hans-Jürgen
Published: October 2023

This study describes the design and upscaling of an on‐site regenerable adsorbent fixed bed of Fe‐loaded MFI zeolite for removal of chlorinated hydrocarbons (CHCs) from contaminated groundwater from laboratory studies to pilot scale. The zeolite has an excellent adsorption performance for the hydrophilic CHCs and can be regenerated on‐site by flushing with H2O2 to degrade adsorbed contaminants by a catalytic Fenton‐like reaction. In the pilot test, the Fe‐zeolite (30 kg) maintained its performance over treatment of 1470 m3 of groundwater in 12 adsorption/regeneration cycles.
State‐level working memory and dysregulated eating in children and adolescents: An exploratory ecological momentary assessment study
Authors: Goldschmidt Andrea B. , Goldstein Stephanie P. , Schmiedek Florian , Stalvey Erin , Irizarry Bailey , Thomas J. Graham
Published: October 2023

Background

Children with loss of control (LOC) eating and overweight/obesity have relative deficiencies in trait‐level working memory (WM), which may limit adaptive responding to intra‐ and extra‐personal cues related to eating. Understanding of how WM performance relates to eating behavior in real‐time is currently limited.

Methods

We studied 32 youth (ages 10–17 years) with LOC eating and overweight/obesity (LOC‐OW; n = 9), overweight/obesity only (OW; n = 16), and non‐overweight status (NW; n = 7). Youth completed spatial and numerical WM tasks requiring varying degrees of cognitive effort and reported on their eating behavior daily for 14 days via smartphone‐based ecological momentary assessment. Linear mixed effects models estimated group‐level differences in WM performance, as well as associations between contemporaneously completed measures of WM and dysregulated eating.

Results

LOC‐OW were less accurate on numerical WM tasks compared to OW and NW (ps < .01); groups did not differ on spatial task accuracy (p = .41). Adjusting for between‐subject effects (reflecting differences between individuals in their mean WM performance and its association with eating behavior), within‐subject effects (reflecting variations in moment‐to‐moment associations) revealed that more accurate responding on the less demanding numerical WM task, compared to one's own average, was associated with greater overeating severity across the full sample (p = .013). There were no associations between WM performance and LOC eating severity (ps > .05).

Conclusions

Youth with LOC eating and overweight/obesity demonstrated difficulties mentally retaining and manipulating numerical information in daily life, replicating prior laboratory‐based research. Overeating may be related to improved WM, regardless of LOC status, but temporality and causality should be further explored.

Public significance statement

Our findings suggest that youth with loss of control eating and overweight/obesity may experience difficulties mentally retaining and manipulating numerical information in daily life relative to their peers with overweight/obesity and normal‐weight status, which may contribute to the maintenance of dysregulated eating and/or elevated body weight. However, it is unclear whether these individual differences are related to eating behavior on a moment‐to‐moment basis.
Eanes Leads York College into the Future
Authors: Elfman Lois
Published: October 2023

Dr. Berenecea Johnson Eanes, president of York College (City University of New York), embraces creating and sustaining supportive networks, noting that succeeding in academic leadership requires like‐minded people who share your goals.
Metal–Organic Framework‐Derived SnS2/C/CNT as Anode Material for Lithium‐Ion Batteries with High Capacity and Stability
Authors: Xu Zuxin , Lv Wenhan , Zhang Tong , Ye Zhangran , Li Qingtian , Jin Di , Qiu Hailong
Published: October 2023

SnS2 is considered to be an ideal replacement material for graphite anodes, and has attracted much attention from scientific researchers due to its high theoretical capacity and low cost. However, the application of SnS2 is restricted by its low electrical conductivity and severe volume expansion during cycle. Herein, SnS2/C/CNT material is obtained by high temperature vulcanization and solvent heat treatment with Sn metal–organic framework (MOF) as precursor, while the carbon skeleton of the MOF is preserved. The carbon nanotubes(CNTs) are evenly distributed across the MOF‐derived C frameworks to create a carbon network that improves the electrical conductivity of SnS2 and inhibits its volume expansion. Therefore, the modified SnS2/C/CNT anode has still maintained a high discharge capacity of 954.2 mAh g−1 after 100 cycles at the current density of 200 mA g−1 with a high capacity retention rate of 89.3%. It also exhibits excellent rate capability (739.8, 669.1, and 575.8 mAh g−1 for 0.5, 1, and 2 A g−1). In addition, the SnS2/C/CNT material also shows good electrochemical performance even without conductive additives.
A techno‐economic assessment and optimization of Dumat Al‐Jandal wind farm in Kingdom of Saudi Arabia
Authors: Marouani Haykel , Fouad Yasser , Mrad Hatem
Published: October 2023

One major criterion in the selection of wind farm location is the cost of energy (COE). COE is the cost of producing 1 kWh electric energy on an annual basis. Mathematical model of COE includes site‐specific constants (such as reference height, mean wind speed, shape factors, wind shear coefficient, average temperature, and turbine altitude) and wind turbine parameters (such as maximum power coefficient, total loss of energy, cut‐in/cut‐off wind speed, rated wind speed, rated power, and the fix charge rate). In this work, we evaluate the COE of an onshore wind farm located at Dumat Al‐Jandal (Saudi Arabia) according to the hub height and rotor size. The 99 Vestas turbines can be mounted at a hub height ranging from 105 to 166 m with available rotor diameters of 105, 112, 117, 126, 136, 150, 155, or 163 m. Particle swarm optimization with a normal distribution is used to optimize the COE. Results show that COE is varying around the average value of $0.029335/kWh by ±$0.00021/kWh. The minimum COE was achieved with a rotor diameter of 150 m at hub height of 105 m. COE increases with the increase of hub height. At 105 m‐hub height, COE is almost the same, with a variation of 0.03% (It ranges between $0.029125/kWh and $0.029133/kWh). COE is more sensitive to rotor size than hub height. This investigation revealed that the COE estimation is in a range of 39%–48% greater than that announced COE by the developing project consortium.
Downregulation of fibromodulin attenuates inflammatory signaling and atrial fibrosis in spontaneously hypertensive rats with atrial fibrillation via inhibiting TLR4/NLRP3 signaling pathway
Authors: Liang Yuming , Zhou Yun , Wang Jialin , He Yan
Published: October 2023

Background

Myocardial fibrosis is an important factor in the induction and maintenance of atrial fibrillation (AF). Fibromodulin (FMOD) promotes fibrotic gene expression. However, its specific role in spontaneously hypertensive rats (SHR)‐AF remains unclear.

Methods

We analyzed FMOD mRNA and protein expression in rat atrial tissues using RT‐qPCR, Western blot analysis, and immunohistochemistry. Histopathological examination of atrial tissues was performed using hematoxylin and eosin (H&E), Masson's trichrome, and Picrosirius red staining. The levels of inflammatory and fibrosis‐related proteins were measured using Western blot analysis.

Results

FMOD relative mRNA and protein expression levels were notably upregulated in atrial tissues of both AF groups (normal‐AF and SHR‐AF groups) than that in atrial tissues of the no‐AF group (normal and SHR group). This effect was particularly pronounced in the SHR‐AF group. Pathological changes revealed that the extracellular matrix, collagen, collagen fibers, and left atrial diameter were notably increased in the atrial tissues from the SHR‐AF group compared to those in the atrial tissues from the SHR group, whereas the left ventricular fractional shortening and left ventricular ejection fraction were notably lower. Expression of TLR4, MyD88, NLRP3, TGF‐β1, collagen I, and collagen II mRNA were clearly higher in atrial tissues from the SHR‐AF group than in those from the SHR group. Protein levels of TLR4, MyD88, NLRP3, Cleavage‐Caspase‐1, Cleavage‐IL‐1β, TGF‐β1, p‐Smad2, collagen I, and collagen II were clearly higher in atrial tissues from the SHR‐AF group than in those from the SHR group. FMOD knockdown inhibited atrial fibrosis, collagen accumulation, and the TLR4/MyD88/NLRP3 signaling pathway.

Conclusion

Downregulation of FMOD attenuated inflammatory signaling and atrial fibrosis in SHR‐AF by inhibiting the TLR4/NLRP3 signaling pathway. Therefore, FMOD may be a promising therapeutic target in AF.
Analysis of gastrin‐17 and its related influencing factors in physical examination results
Authors: Zeng Junchao , Shen Yan , Xu Sanping , Yang Rui
Published: October 2023

Background

To analyze the difference of serum gastrin‐17 (G17) level in healthy people with different sex, age, and body mass index (BMI), to explore the correlation between G17 and pepsinogen, and to study the influences of Helicobacter pylori (H. pylori) infection and various inflammatory factors on G17 secretion level.

Methods

A total of 531 subjects who received physical examination in our center from April 2019 to December 2019 were enrolled in the study. All subjects were tested for G17, pepsinogen I (PGI), pepsinogen II (PGII), PGI/PGII ratio (PGR), H. pylori, serum amyloid A (SAA), C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR). The difference of G17 secretion in different subjects and its correlation with PG were analyzed to investigate H. pylori infection and expound the effects of inflammatory indicators on G17.

Results

There was no significant difference in G17 secretion level in people with different sex, age and BMI (p > .05). G17 positively correlated with PGI and PGII, but negatively correlated with PGR. The G17 level of H. pylori‐positive subjects was 10.16 ± 12.84, and prominently higher than that of H. pylori‐negative subjects (3.27 ± 6.65). SAA and H. pylori infection were the greater risk factors for G17 abnormality among various indicators. CRP and ESR had no effect on G17 abnormality.

Conclusions

G17 secretion is closely related to PG and H. pylori. Combined screening contributes to early screening of gastrointestinal diseases in normal people or groups at high risk for gastric cancer, but the influence of inflammatory indicators on G17 should be excluded to improve the reliability of the results.
Market Meditopia A Glimpse at American Health Care in 2005
Authors: Churchill Larry R.
Published: October 2023

Images of the future are usually only caricatures of the present. Perhaps this picture of the future of medical care will also prove to be a caricature. Whether it does depends on choices that Americans have still to make.

—Paul Starr

The Social Transformation of American Medicine
Use of Cost‐Consequence Models in Managed Care
Authors: Blissenbach Henry F.
Published: October 2023

Functioning effectively as a pharmacy benefit manager has been defined as purchasing the best product at the lowest possible cost. In the simplest terms, this means purchasing discounted drugs; in the most complex terms, it means managing drug use. However, if the entire medical picture were analyzed, use of more expensive drugs might actually lower total direct medical costs. Currently, formulary decisions are based on both therapeutic necessity and cost. The decision to administer one drug rather than another is directed by community practice patterns and the final price. The availability of information to demonstrate differences, if any, in total treatment costs between the two agents would considerably enhance therapeutic decision making and would guide treatment by an outcome‐based drug formulary. The question that requires an answer is centered on the value equation: Value = outcomes/cost. Before paying more for drug A than for drug B, the payer will demand to see value. When available, direct and indirect cost information will be applied to position drugs appropriately in a drug formulary.
The Health Status of Adults With Epilepsy Compared With That of People Without Chronic Conditions
Authors: Wagner Anita K. , Bungay Kathleen M. , Kosinski Mark , Bromfield Edward B. , Ehrenberg Bruce L.
Published: October 2023

Study Objectives. To examine the feasibility of administering and the psychometric properties of a general health status questionnaire in adults with epilepsy, and to assess the health status of these patients.

Design. Prospective, cross‐sectional, observational study.

Setting. Neurology clinic of a tertiary care medical center.

Patients. One hundred forty‐eight ambulatory adults with epilepsy.

Interventions. Patients completed the SF‐36, a general health status questionnaire. Respondent burden and data quality as well as psychometric characteristics were evaluated. Patients' SF‐36 scale scores, adjusted for comorbidities, were compared with those of 641 people without chronic conditions with the same sociodemographic characteristics.

Measurements and Main Results. Administering the SF‐36 to adult outpatients with epilepsy is feasible and results are psychometrically sound. Compared with those who were not ill, patients had significantly (p<0.001) lower (0 = worst, 100 = best) scores in six of the eight SF‐36 domains: general health perceptions (57.7 vs 82.1), mental health (61.3 vs 79.6), vitality (53.5 vs 67.8), role limitations owing to physical (69.6 vs 95.0) and emotional problems (67.2 vs 88.4), and social functioning (75.2 vs 89.9).

Conclusions. Lower SF‐36 scores may reflect patients' assessments of the balance among epilepsy, seizures, and antiepileptic drug therapy‐related effects. Incorporating health status information into therapeutic decision making may help to attain the ultimate goal of improving patients' health.
Exploration of Once‐Daily Dosing of Aminoglycosides Through Bayesian Simulation
Authors: Garrelts James C.
Published: October 2023

Study Objectives. To simulate peak and trough concentrations, using Bayesian forecasting, achieved with a variety of once‐daily dosing (ODD) regimens; to evaluate dosing regimens required to produce target peak and trough concentrations; to compare the peak‐to‐MIC (minimum inhibitory concentration) ratios and time above MIC for various dosing regimens and MICs; to stratify the information based on renal function estimates; and to use the results from these simulations to make recommendations regarding optimum ODD of aminoglycosides.

Design. Simulation of ODD using a Bayesian technique and existing patient data.

Setting. A tertiary referral, community teaching hospital.

Patients. One hundred consecutive adults from the author's data base, with a wide variety of infections and underlying illnesses, who met strict inclusion criteria.

Interventions. Two methods of dosing, weight‐based (4–7 mg/kg) and target concentration‐based (peak 10, 15, or 20 μg/ml, trough ≤ 0.3 μg/ml), were evaluated. Each patient had a known dosing‐sampling history, stable renal function, and at least two measured serum concentrations, and were being treated with either gentamicin or tobramycin.

Measurements and Main Results. A wide range of peak and trough serum concentrations are achieved when dosages are chosen based on patient weight. Even with large dosages, some patients had very low peak‐to‐MIC ratios and time above the MIC, and vice versa. Variations in MIC had a much greater effect on dosing target values than did variations in dosage. A large degree of variability was also noted in doses and dosing intervals when using a target serum concentration approach. For both methods, an inverse relationship existed between calculated creatinine clearance and time above MIC, although there was little change over the range of 60–119 ml/minute.

Conclusions. Bayesian simulation showed that weight‐based ODD of aminoglycosides did not produce clinically acceptable serum concentrations or target values in many patients. Young and elderly patients, and any patient with a creatinine clearance below 60 or above 119 ml/minute, are especially likely not to achieve an optimum serum concentration profile. Aminoglycoside ODD should be individualized by evaluating the peak‐to‐MIC ratio, time above MIC, and patient response.
Does Acyclovir Increase Serum Lithium Levels?
Authors: Sylvester Robert K. , Leitch John , Granum Cindy
Published: October 2023

A 42‐year‐old woman was admitted to the hospital to receive intravenous acyclovir for a herpes zoster infection. At the time she was taking lithium carbonate 450 mg twice/day. Six days after starting acyclovir she exhibited signs of lithium toxicity. When measured, the serum lithium level had increased 4‐fold during acyclovir therapy. Both agents are excreted by the kidneys, raising the possibility that acyclovir at high serum concentrations may interfere with the renal excretion of lithium. A MEDLINE search did not identify any citation describing the possibility of an interaction between the drugs. This case suggests that acyclovir when given intravenously in doses of 10 mg/kg may result in increased serum lithium concentrations. Until additional data are available, if intravenous acyclovir is administered concurrently with lithium, we recommend closely monitoring patients for signs of lithium toxicity and measuring serum lithium levels every second or third day.
Treatment of Supraventricular Tachyarrhythmias with Intravenous Calcium Channel Blockers: Are Subtle Differences Worth the Cost?
Authors: Cheiman Dina M. , Shea Brian F. , Kelly Ralph A.
Published: October 2023

Verapamil and diltiazem are effective in terminating paroxysmal supraventricular tachycardias and slowing ventricular response during atrial fibrillation or flutter. Results from clinical trials for each individual drug demonstrate comparative efficacy rates, and both drugs share the same contraindications and relative precautions. Well‐designed comparative clinical trials are needed to establish if either drug has any clinical advantages in a particular patient population.
A Pharmacoeconomic Analysis of Neuromuscular Blocking Agents in the Operating Room
Authors: Loughlin Kathleen A. , Weingarten Cindy M. , Nagelhout John , Stevenson James G.
Published: October 2023

A cost‐minimization analysis was performed to compare the direct costs of various neuromuscular blocking agents (NMBAs) in procedures of specific durations. Secondary objectives were to review the role of the NMBAs studied with respect to their place on our hospital formulary, and to develop a pharmacoeconomic methodology to be applied to other formulary decisions. Patients were stratified according to estimated length of surgical procedure; group 1 (55 patients) included surgeries estimated to take less than 2 hours, and group 2 (55 patients) included those estimated to be 2–4 hours long. Patients were then randomized to one of three intermediate‐acting NMBAs: atracurium, vecuronium, or rocuronium. Anesthesia records were used to obtain all anesthetic agents administered in the operating room, and drug costs were calculated from hospital drug acquisition costs as of December 1994. Postanesthesia care unit (PACU) costs were estimated from patient charges and converted to costs using our hospital's cost‐to‐charge ratio. Costs that were common to all study treatments or unrelated to the use of NMBAs were excluded from the analysis. Two time‐adjusted costs were calculated to determine the cost of neuromuscular blockade/hour and the total anesthesia drug costs/hour. In group 1 there were no statistical differences in NMBA cost/hour, anesthesia cost/hour, or PACU times or costs. In group 2, a significant difference was found in NMBA cost/case between atracurium ($54.23 ± 41.26, mean ± SD) and vecuronium ($31.95 ± 15.33, p=0.046). Atracurium was also significantly more costly than either vecuronium or rocuronium/hour ($21.95 ± 7.42 vs $14.39 ± 7.02 and $16.07 ± 8.15, respectively, p=0.011) and anesthesia cost/hour ($28.77 ± 7.43 vs $22.82 ± 7.46 and $23.32 ± 6.54, respectively, p=0.03). There were no differences in PACU times or costs. Based on these results, vecuronium or rocuronium is preferred over atracurium in procedures with an estimated duration of 2–4 hours. In the patient population evaluated, there were no significant cost differences among the three NMBAs in surgeries with an estimated duration of less than 2 hours.
Comparison of a Weight‐Based Heparin Nomogram with Traditional Heparin Dosing to Achieve Therapeutic Anticoagulation
Authors: Shalansky Karen E , FitzGerald J. Mark , Sunderji Rubina , Traboulay Susie J. , O'Malley Byron , McCarron Bonnie I. , Naiman Shelley
Published: October 2023

Optimum anticoagulation with heparin within the first 24 hours of a thrombotic event is critical in preventing a recurrence. We believed that traditional nonweight‐based heparin dosing at our institution resulted in delayed anticoagulation. A weight‐based heparin nomogram was therefore created and compared to traditional heparin dosing in patients with a diagnosis of acute deep vein thrombosis or pulmonary embolism. Fifty historical control patients were compared to 50 consecutive patients treated prospectively using the weight‐based nomogram. The primary outcome assessed was time to achieve therapeutic anticoagulation, defined as an activated partial thromboplastin time (aPTT) of 46–70 seconds (1.5–2.5 times the control aPTT). The weight‐based nomogram achieved an aPTT above the therapeutic threshold more rapidly than the control group (10.7 hrs nomogram vs 33.3 hrs control group, p < 0.004). Similarly, the proportion of patients who exceeded the therapeutic threshold at the first aPTT measurement, at 24 hours, and at 48 hours was significantly higher in the nomogram group. There was no difference in the frequency of bleeding complications or recurrent thrombotic events between the two groups. The initial nomogram was revised for patients weighing more than 80 kg owing to a greater frequency of excessive anticoagulation in these patients. Subsequent analysis of 29 patients using the modified nomogram revealed sustained efficacy and a reduced number of supratherapeutic aPTTs. We concluded that a weight‐based heparin nomogram is superior to traditional therapy in achieving rapid therapeutic anticoagulation without an increase in adverse outcomes.
Direct Comparison of Three Methods For Predicting Digoxin Concentrations
Authors: Williams Paul J. , Lane James R. , Capparelli Edmund V. , Kim Yong Ho , Coleman Robert
Published: October 2023

Three methods of determining digoxin population pharmacokinetic parameters were compared for their abilities to predict 118 measured serum digoxin concentrations (SDCs) in 49 patients. NONMEM software (version IV) was used to generate a residual and a weighted residual for each measured‐concentration—predicted‐concentration pair. Prediction error analysis was done by a maximum likelihood technique that accounted for several within‐patient measures. Data analysis also included graphic observation of weighted residuals (WRES) and calculation of the mean WRES and median absolute prediction error. A further parallel analysis was also carried out on subpopulations with and without concurrent quinidine and congestive heart failure (CHF). Method III was without bias in all subpopulations studied and had the smallest WRES in all populations. Method I was without bias in the overall population, however, it underpredicted SDCs in patients receiving quinidine and in those with CHE Method II underpredicted SDCs in the overall population, those receiving quinidine, and in patients without CHF. There were no between‐method differences in precision as assessed by absolute prediction error.
Recurrent Clostridium difficile Diarrhea Associated with Mitoxantrone and Etoposide: A Case Report and Review
Authors: Jarvis Blair , Shevchuk Yvonne M.
Published: October 2023

Clostridium difficile colitis most commonly occurs in association with antibiotic administration and infrequently with antineoplastic agents. Our patient experienced recurrent C. difficile diarrhea associated with mitoxantrone and etoposide. He received antibiotics during the 6 months, but each episode of diarrhea was preceded by at least a 6‐week antibiotic‐free period. In addition, antineoplastic therapy preceded each episode by 8 or 9 days. Clinicians should be aware that antineoplastic drugs may precipitate overgrowth of C. difficile in the bowel.
Experience with Crystalline Niacin as the Preferred Drug for Dyslipidemia in a Specialty Clinic
Authors: Rindone Joseph P. , Arriola O. Greg
Published: October 2023

To determine the tolerability and efficacy of crystalline niacin in reaching target lipid goals, we conducted a retrospective review of medical records of 62 patients treated with the agent over 2 years in a lipid clinic at a nonacademic veterans hospital. Most patients received niacin for hypercholesterolemia. Thirty‐one patients (50%) stopped therapy due to adverse events, principally, intolerable cutaneous reactions. Twenty‐nine withdrew from therapy during the first 6 weeks of treatment. Of those who tolerated niacin, 23 did not achieve target lipid serum concentrations at the maximum tolerated dosage; 8 did achieve target concentrations. Thus crystalline niacin was largely ineffective in treating patients with dyslipidemia.
A Pharmacokinetic Comparison of Two Oral Liquid Glucocorticoid Formulations
Authors: Kamada Alan K. , Wiener Matthew B. , LaVallee Nicole M. , Scott Maryanne Bartoszek , Seiner John C. , Szefler Stanley J.
Published: October 2023

To compare pharmacokinetics of liquid prednisolone and prednisone solutions and to assess relative bioavailability, six healthy adult men were administered 15 mg of each formulation. Blood samples were obtained and assayed for plasma prednisolone concentrations by high‐performance liquid chromatography. Peak concentration was significantly higher with liquid prednisolone (mean ± SD 430.3 ± 62.5 vs 333.0 ± 27.8 ng/ml, p=0.013), with similar times to peak concentration. Prednisolone liquid gave higher concentrations at every time point (statistically significant for all except 0.25 hrs after the dose), resulting in a significantly greater total area under the curve (2029.8 ± 246.9 vs 1633.3 ± 221.1 ng/ml•hour, respectively, p=0.002). Clearance was slower for prednisolone (128.3 ± 15.1 vs 149.1 ± 17.6 ml/min/1.73 m2, p=0.01), and the relative bioavailability of the prednisolone liquid using prednisone liquid as the reference standard was 116 ± 14%. Thus, prednisolone liquid has similar pharmacokinetic characteristics as prednisone liquid, with improved bioavailability.