bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical applications: analysis of Colombian coffee prices using fractional Brownian motion
Authors: Prada D A , Acevedo A , Fernandez H , Prada S C , Gómez J M
Published: October 2020

Colombia is an exporting country of quality coffee in the world; divergent factors in the short and long term, such as inclement weather, geographic changes, and socio-political development, are some of the factors that influence the price of this product. Knowing the future behavior of this phenomenon is one of the most important studies for economists, academics, coffee growers, entrepreneurs, and exporters. Brownian motion, a physical phenomenon that describes the irregular movement of some particles suspended in a fluid, was described by the probability of finding a particle in a position at a specific time. Fractional Brownian motion describes the random fluctuation of a stochastic process continuous in time and is characterized by the Hurst coefficient to observe persistence and volatility in a time series. The percentage of volatility that changes in the price of coffee present allows generating strategies to maintain the quality of the product and, therefore, its positioning in the market. In this work it was found that the series of data on coffee prices is persistent and that its volatility is 43.77%.
Intangible trajectories of urban connectivity. An application of physics in architecture
Authors: Ayala Garcia E T , Coronel Ruiz L K , Galiano Sanchez A L , Acevedo Salazar N Y
Published: October 2020

This research aims to identify the intangible urban geometries of the physical-environmental, social-cultural, and political-economic components of Avenue 1 East, Caobos, San José de Cúcuta, Colombia. This in order to represent and quantify the connectivity trajectory of the intangible networks that are generated from the analysis of the meso and micro scale of the city. The applied methodology is based on the theory of the urban network, the study used a mixed approach, under a strategy called multi-methods or methodological triangulation. Within this research, physical concepts such as trajectory, displacement and space-time were assumed. This type of research allowed the study topics to be approached through layers through which the implicit dynamics in the sector under study were identified. As relevant results it is obtained that the use of a mathematical and physical logic strengthens the studies focused on city planning, the importance of hierarchically and quantitatively organizing the connection networks (meso and micro) in order to solve problems or phenomena typical of the daily life of the sector under study, guaranteeing a dynamic and real process for its growth.
Exploring spatiotemporal variation characteristics of exceedance air pollution risk using social media big data
Authors: Cao Zheng , Wu Zhifeng , Li Shaoying , Ma Wenjun , Deng Yujiao , Sun Hui , Guan Wenchuan
Published: October 2020

Air pollution in the form of PM2.5 decreases life expectancy considering its contribution to morbidity and mortality. Therefore, scientific and accurate PM2.5 exposure risk assessment is essential. However, the considering daily/hourly mean PM2.5 concentration and overlooking population mobility in exposure risk assessments result in underestimation of its adverse effects. Thus, using social media data and exceedance PM2.5 concentration, two novel indicators named hourly exceedance PM2.5 exposure (HEPE) and daily cumulative variation of exceedance PM2.5 exposure (DCEPE) are developed in our study. Spatiotemporal variation analysis of HEPE showed that the first exceedance PM2.5 exposure risk was observed at 10:00; this lasted till the end of the day. According to the standard deviation ellipse (SDE) method analysis results, at first, the major spatial tendency direction was northeast-southwest, with the average center (AE) located in the Yuangang Township. Then, the HEPE in the western study area increased dramatically. The major spatial tendency direction shifted from northeast-southwest to east-west. Consequently, the AE of HEPE shifted to central study area. The spatiotemporal variation characteristics led us to investigate the mechanisms. A bivariate LISA was applied to detect the spatial association between DCEPE and city functional zones (CFZs). Results showed that highly spatial associations were found between the DCEPE and CFZs in the southwest of the study area. Residential neighborhoods and transportation services showed a closer relationship with the spatial distribution of DCEPE. Based on these results, we found increasing public health threats posed by PM2.5. Thus, HEPE is an essential factor to assess air pollution exposure risk. Moreover, more attention should be paid to the spatial association between DCEPE and city functions, which is important for the development of air pollution mitigation strategies.
The Use of Tomato Waste Juice as an Antioxidant Source for Broiler Chickens
Authors: Indrat Wahyuni Hanny , Yudiarti Turrini , Widiastuti Endang , Sugiharto Sugiharto , Isroli Isroli , Agus Sartono Tri
Published: October 2020

The purpose of this study was to investigate the impact of using tomato waste juice (TWJ) as a source of antioxidants for broiler chickens. The study used 160 day-old-chicks Lohmann MB-202 broiler strains with an average body weight of 43.5+1.23 g which were randomly allotted to one of four treatment groups. The chicks were provided either with no TWJ (TWJ0), 40 (TWJ40), 80 (TWJ80) or 120 mL/day of TWJ (TWJ120) from days 15 to 35. The blood, internal organs and intestinal digesta were collected at day 35. The results showed that provision of TWJ increased (P<0.05) the relative weight of thymus, duodenum, jejunum, caecum and liver of broilers. The treatment, however, did not affect (P>0.05) growth performance, blood profile and ileal and caecal microbial populations. In conclusion, TWJ could be used as an antioxidant source to maintain the normal health and internal organ development of broiler chicks.
98-Enhance of Protein Efficiency Affected by Synbiotic Supplementation in the Diet of Broiler Chicken
Authors: Setyaningrum Sri , Sunarti Dwi , Yunianto Vitus D. , Mahfudz Luthfi D.
Published: October 2020

The objective of this study was to evaluate the effect of synbiotic on enhance of protein efficiency of broiler chicken. The research was used 144 birds of unsexed broiler chicken at one day of age with initial body weight 45.68 g ± 1.52 g. Experimental design used was completely Randomized Designed with 4 treatments and 6 replicates, and every unit experiment consist of 6 birds. The treatments were as follows: T0: basal diet (without synbiotic), T1: basal diet + synbiotic 1 ml/100 g of feed, T2: basal diet + synbiotic 2 ml/100 g of feed and T3: basal diet + synbiotic 3 ml/100 g of feed. The basal diet was formulated to contain 3000 kcal/kg metabolizable energy (ME) and 22% crude protein (CP). Variables observed were nitrogen intake, nitrogen retention and net protein utility. The result showed that synbiotic supplementation significantly (p<0.05) increased nitrogen intake, nitrogen retention and net protein utility. Conclusion of the research is synbiotic supplementation at 2 ml/100 g of feed was enhance of protein efficiency of broiler chicken.
Antioxidant capacity and germination power of NaCl-elicited cowpea (Vigna unguiculata) sprouts with various NaCl concentrations and elicitation durations
Authors: Ariviani Setyaningrum , Maulana R Fiyan , Ishartani Dwi , Fauza Gusti
Published: October 2020

Cowpea (Vigna unguiculata) is one of legumes that have the potential as a source of food antioxidant related to the phenolic compounds. Germination can enhance the antioxidant capacity of cowpea and elicitation using NaCl within the germination process. It has been reported as an effective technique to improve the antioxidant potential of legumes sprouts. This study aimed to evaluate the antioxidant capacity (total phenolic content, DPPH radical scavenging activity, and reducing power (RP)) of NaCl-elicited cowpea sprouts with different concentrations of NaCl (50, 100, 150 mM) and elicitation durations (8, 12, 16 hours). The germination power of the NaCl-elicited cowpea was also investigated. Results showed that the total phenolic content, DPPH radical scavenging activity and RP of NaCl-elicited cowpea sprouts increase in line with the increase in NaCl concentrations and elicitation durations. Both DPPH radical scavenging activity and RP had significant correlation (p<0.01; r = 0.805; 0,785) with the total phenolic content. Nevertheless, germination power decreased along with increasing NaCl concentration and elicitation duration. The results of this study provide an alternative strategy for increasing the antioxidant capacity of cowpea through NaCl-elicitation. Thus, it can be a reference for developing cowpea-based functional food.
The Potential Commodities as a Support of Farm Sustainability and Supply Stability in Grobogan Regency
Authors: Ekowati Titik , Prasetyo Edy , Mukson
Published: October 2020

The research method was a secondary data method with strategic agricultural commodities, namely rice, soybeans and beef cattle. These commodities are also commodities that are the mainstay of Central Java. Data were analyzed by Location Quotient (LQ) and Co Variance. The results showed that Grobogan Regency was the regency with the highest rice and soybean production in Central Java, which were 848,912 tons (43.9%) and 53,969 tons (53.13%) respectively, while the production of rice and soybeans in Central Java respectively was 1,933,627 tons and 105,553 tons. From the results of potential analysis, the three commodities were potential commodities for Grobogan Regency, with LQ values for rice, corn, soybeans and beef cattle respectively 3.37; 3.46; 2.66 and 3.65. This condition was also supported by the Co variance value of 3.37; 2.68; 2.8 and 3.8. The analysis indicated that Grobogan Regency is an area with stable supply or food stocks in Central Java.
Connectivity Matrix Algorithm: A New Optimal Phasor Measurement Unit Placement Algorithm
Authors: Al-Odienat A I , Al-Awasa K , Al-Momani M , Al-Gharaibah S
Published: October 2020

The maximum benefits of the phasor measurement unit (PMU) in state estimation and other applications in the power system can be achieved if the system is completely observed by PMUs only. The minimum number of PMUs needed to obtain full observability is very important in order to reduce the overall cost. This paper presents a new algorithm for optimal PMU placement (OPP) in transmission and distribution systems. A new concept and vision of the optimization problem is presented. A new approach to implement zero-injection buses is proposed which may be also used in other algorithms. The simulation result of IEEE 14, 24, 30, 57 and 118 bus systems as transmission systems, IEEE 33, 34 and 123 bus systems as distribution systems, and Jordanian power system as an actual system are presented and compared with the existing techniques. The proposed technique is simple to implement and accurate compared to other existing methods. The results confirm the efficiency of the proposed algorithm. The computational time is less than 0.2 seconds for all cases. MATLAB 2016a is used to validate the algorithm.
Design of standard security measures database for various types of maintenance operations
Authors: Bu Mingxin , Tan Chang , Jin Xinming , Chen Weigang , Cheng Jiayin , Geng Shaobo , Mao Jianzhong
Published: October 2020

With the continuous deepening of smart grid construction, more and more smart substations are being used in actual projects. Compared with traditional substations, smart substations have realized digitalization of information, communication network, and standardization of sharing. However, the secondary circuit of intelligent substation has high integration and no obvious electrical isolation point, so the traditional safety measures are no longer suitable for the actual situation of intelligent substation. Therefore, based on the analysis of typical equipment security measures, this article designs a set of general rules for automatic generation of security measures according to the relevant specifications of security measures of intelligent substations. Through the modeling of different maintenance tasks, the characteristics of the safety measures applied to the intelligent substation equipment are analyzed, and the designed safety measures are classified according to the equipment type and operation mode to establish a safety measures database; finally, according to the established database Develop an automated ticket generation plan.
Strain-dependent exciton diffusion in transition metal dichalcogenides
Authors: Rosati Roberto , Brem Samuel , Perea-Causín Raül , Schmidt Robert , Niehues Iris , Michaelis de Vasconcellos Steffen , Bratschitsch Rudolf , Malic Ermin
Published: October 2020

Monolayers of transition metal dichalcogenides have a remarkable excitonic landscape with deeply bound bright and dark exciton states. Their properties are strongly affected by lattice distortions that can be created in a controlled way via strain. Here, we perform a joint theory-experiment study investigating exciton diffusion in strained tungsten disulfide (WS2) monolayers. We reveal a non-trivial and non-monotonic influence of strain. Lattice deformations give rise to different energy shifts for bright and dark excitons changing the excitonic landscape, the efficiency of intervalley scattering channels and the weight of single exciton species to the overall exciton diffusion. We predict a minimal diffusion coefficient in unstrained WS2 followed by a steep speed-up by a factor of 3 for tensile biaxial strain at about 0.6% strain—in excellent agreement with our experiments. The obtained microscopic insights on the impact of strain on exciton diffusion are applicable to a broad class of multi-valley 2D materials.
On the numerical solution of second order two-dimensional Laplace equations using the alternating-direction implicit method
Authors: Ezeh I P , Kamoh N M
Published: October 2020

In this manuscript, we consider in detail numerical approach of solving Laplace’s equation in 2-dimensional region with given boundary values which is based on the Alternating Direction Implicit Method (ADI). This method was constructed using Taylor’s series expansion on the second order Laplace equation leading to a linear algebraic system. Solving the algebraic system, leads to the unknown coefficients of the basis function. The techniques of handling practical problems are considered in detail. The results obtained compared favorably with the results obtained from the Finite difference method constructed by Dhumal and Kiwne and the exact solution. Thus the ADI method can as well be used for the numerical solution of steady-state Laplace equations.
Superposition of causal order enables quantum advantage in teleportation under very noisy channels
Authors: Mukhopadhyay Chiranjib , Pati Arun Kumar
Published: October 2020

We show that the fidelity offered by the standard teleportation protocol under noisy channels applied successively can be significantly improved, when used in conjunction with a quantum switch. In particular, we find that for two such teleportation channels conjugated with an indefinite causal order, teleportation fidelity beyond the classical threshold is achieved for significantly larger noise than would be possible conventionally. One can even make the effective teleportation channel perfectly faithful for very large noise. We also discuss the generalization of our scheme for more than two pathways, and define a figure of merit in that context.
Impact of South Asian monsoon on summer dust weather occurrence over the Tarim basin in Northwest China
Authors: Meng Lixia , Zhao Yong , Huang Anning , Wang Tianzhu , Wu Yang
Published: October 2020

Based on the observed dust weather occurrence (DWO), precipitation and 10 m wind speed at 23 stations over the Tarim Basin in northwest China and the National Centers for Environment Prediction/National Center for Atmospheric Research reanalysis data during 1961–2015, we have indicated the relationship between the summer DWO over the Tarim basin and South Asian summer monsoon (SASM) and revealed the possible underlying physical mechanisms. Results show that the DWO displays an obvious declining trend during 1961–2015 and has a good relation with precipitation and 10 m wind speed over the Tarim Basin in summer. Meanwhile, the index of SASM well correlates with the summer DWO over the Tarim basin at both interannual and interdecadal time scales. Further analysis of the underlying mechanism related to the impact of the SASM on the DWO over the Tarim Basin in summer indicates that an anomalous cyclone (anti-cyclone) appears in the upper troposphere over Central Asia responding to an anomalous anti-cyclone (cyclone) in the lower troposphere over Indian monsoon region during weak (strong) SASM years, which can cause cooling (warming) at middle and upper troposphere over Central Asia. Based on the relationship of thermal wind, the cooling (warming) results in an anomalous cyclone (anti-cyclone) at middle and upper troposphere over Central Asia and the anomalous south (north) winds prevail over the Tarim Basin. The south (north) winds are favorable for more (less) precipitation formation and inhibit (promote) the cold (warm) air entering into the basin and weaken (strengthen) the 10 m wind speed, further leading to the decreases (increases) of DWO over the Tarim Basin in summer.
Outlook for artificial intelligence and machine learning at the NSLS-II
Authors: Campbell Stuart I , Allan Daniel B , Barbour Andi M , Olds Daniel , Rakitin Maksim S , Smith Reid , Wilkins Stuart B
Published: October 2020

We describe the current and future plans for using artificial intelligence and machine learning (AI/ML) methods at the National Synchrotron Light Source II (NSLS-II), a scientific user facility at the Brookhaven National Laboratory. We discuss the opportunity for using the AI/ML tools and techniques developed in the data and computational science areas to greatly improve the scientific output of large scale experimental user facilities. We describe our current and future plans in areas including from detecting and recovering from faults, optimizing the source and instrument configurations, streamlining the pipeline from measurement to insight, through data acquisition, processing, analysis. The overall strategy and direction of the NSLS-II facility in relation to AI/ML is presented.
Significance of HER2 in Microinvasive Breast Carcinoma
Authors: Zhang Huina , Moisini Ioana , Turner Bradley M , Wang Xi , Dhakal Ajay , Yang Qi , Kovar Sierra , Schiffhauer Linda M , Hicks David G
Published: October 2020

Objectives

We compared the clinicopathologic features, clinical management, and outcomes of human epidermal growth factor receptor 2 (HER2)–expressing and nonexpressing microinvasive breast carcinomas (MiBC) to explore the significance of HER2 in MiBC.

Methods

Clinicopathologic and follow-up information of cases with final diagnosis of MiBC with known HER2 status between 2007 and 2019 were analyzed.

Results

Nineteen (41.3%) HER2-positive (HER2+) and 27 (58.7%) HER2-negative (HER2−) MiBCs were identified. HER2 positivity was likely to be associated with high nuclear grade, presence of tumor-infiltrating lymphocytes, hormonal receptor negativity, and increased Ki-67 in both microinvasive and associated in situ carcinomas. Nodal metastases were found in 2 ER+/HER2− cases (5.3%). One HER2+ case was found to have isolated tumor cells in the axillary node. The majority of patients with HER2+ MiBCs (76.5%) did not receive HER2-targeted therapy. All patients with available follow-up were alive without recurrence or distant metastasis, with a median follow-up of 38 months.

Conclusions

Similar to the larger size of invasive breast carcinomas, HER2 positivity is associated with high-grade morphologic features in MiBCs. However, HER2 overexpression in MiBCs does not appear to be associated with nodal metastasis or worse outcome in our study cohort. The role of HER2-targeted therapy in this clinical setting merits additional study.
Development of Job Exposure Matrices to Estimate Occupational Exposure to Solar and Artificial Ultraviolet Radiation
Authors: Boiano James M , Silver Sharon R , Tsai Rebecca J , Sanderson Wayne T , Liu Sa , Whitehead Lawrence W
Published: October 2020

Objectives

Job exposure matrices (JEMs) are important tools for estimating occupational exposures in study populations where only information on industry and occupation (I&O) are available. JEMs The objective of this work was to create JEMs for solar and artificial ultraviolet radiation (UVR) using a US standardized coding scheme.

Methods

Using U.S. Census Bureau industry and occupation codes, separate lists of I&O pairs were developed for solar and artificial UVR by a panel of Certified Industrial Hygienists who assigned exposure ratings to I&O pairs with potential exposure. Parameters for exposure included prevalence (P) and frequency (F) for solar UVR and P, F, and intensity (I) for artificial UVR. Prevalence, or percent of all workers employed in an I&O pair who were exposed, was categorically rated: 0 to <1, 1 to <20; 20 to <80, and ≥80. Frequency of exposure, defined by the number of hours per week workers were exposed, was categorically rated: 0 to <5, 5 to <20, 20 to <35, and ≥35 h per week. For artificial UVR only, intensity of exposure was assigned three ratings: low, low with rare excursions, and >low under normal conditions. Discrepant ratings were resolved via consensus.

Results

After excluding I&O pairs assigned P and F ratings of 0 (solar UVR) and P, F, and I ratings of 0 (artificial UVR) from the JEM, 9206 I&O pairs were rated for solar UVR and 2010 I&O pairs for artificial UVR. For solar UVR, 723 (7.9% of all rated pairs) had ratings in the highest category for P and F; this group included 45 occupations in varied industries. Construction and extraction occupations represented most of the occupations (n = 20; 44%), followed by farming, fishing, and forestry occupations (n = 6; 13%). For artificial UVR, 87 I&O pairs (4.3% of all rated pairs) had maximum ratings for P, F, and I; these comprised a single occupation (welding, soldering, and brazing workers) in diverse industries.

Conclusions

JEMs for solar and artificial UVR were developed for a broad range of I&O pairs in the US population and are available for use by researchers conducting occupational epidemiological studies.
Principal curve approaches for inferring 3D chromatin architecture
Authors: Tuzhilina Elena , Hastie Trevor J , Segal Mark R
Published: October 2020

Three-dimensional (3D) genome spatial organization is critical for numerous cellular processes, including transcription, while certain conformation-driven structural alterations are frequently oncogenic. Genome architecture had been notoriously difficult to elucidate, but the advent of the suite of chromatin conformation capture assays, notably Hi-C, has transformed understanding of chromatin structure and provided downstream biological insights. Although many findings have flowed from direct analysis of the pairwise proximity data produced by these assays, there is added value in generating corresponding 3D reconstructions deriving from superposing genomic features on the reconstruction. Accordingly, many methods for inferring 3D architecture from proximity data have been advanced. However, none of these approaches exploit the fact that single chromosome solutions constitute a one-dimensional (1D) curve in 3D. Rather, this aspect has either been addressed by imposition of constraints, which is both computationally burdensome and cell type specific, or ignored with contiguity imposed after the fact. Here, we target finding a 1D curve by extending principal curve methodology to the metric scaling problem. We illustrate how this approach yields a sequence of candidate solutions, indexed by an underlying smoothness or degrees-of-freedom parameter, and propose methods for selection from this sequence. We apply the methodology to Hi-C data obtained on IMR90 cells and so are positioned to evaluate reconstruction accuracy by referencing orthogonal imaging data. The results indicate the utility and reproducibility of our principal curve approach in the face of underlying structural variation.
Dose–response modeling in high-throughput cancer drug screenings: an end-to-end approach
Authors: Tansey Wesley , Li Kathy , Zhang Haoran , Linderman Scott W , Rabadan Raul , Blei David M , Wiggins Chris H
Published: October 2020

Personalized cancer treatments based on the molecular profile of a patient’s tumor are an emerging and exciting class of treatments in oncology. As genomic tumor profiling is becoming more common, targeted treatments for specific molecular alterations are gaining traction. To discover new potential therapeutics that may apply to broad classes of tumors matching some molecular pattern, experimentalists and pharmacologists rely on high-throughput, in vitro screens of many compounds against many different cell lines. We propose a hierarchical Bayesian model of how cancer cell lines respond to drugs in these experiments and develop a method for fitting the model to real-world high-throughput screening data. Through a case study, the model is shown to capture nontrivial associations between molecular features and drug response, such as requiring both wild type TP53 and overexpression of MDM2 to be sensitive to Nutlin-3(a). In quantitative benchmarks, the model outperforms a standard approach in biology, with $\approx20\%$ lower predictive error on held out data. When combined with a conditional randomization testing procedure, the model discovers markers of therapeutic response that recapitulate known biology and suggest new avenues for investigation. All code for the article is publicly available at https://github.com/tansey/deep-dose-response.
Patient-reported Reasons for Stopping Care or Switching Clinics in Zambia: A Multisite, Regionally Representative Estimate Using a Multistage Sampling-based Approach in Zambia
Authors: Sikazwe Izukanji , Eshun-Wilson Ingrid , Sikombe Kombatende , Beres Laura K , Somwe Paul , Mody Aaloke , Simbeza Sandra , Bukankala Chama , Glidden David V , Mulenga Lloyd B , Padian Nancy , Ehrenkranz Peter , Bolton-Moore Carolyn , Holmes Charles B , Geng Elvin H
Published: October 2020

Background

Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken.

Methods

We traced a simple random sample of LTFU patients (>90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors for re-engagement. We coded reasons into structural, psychosocial, and clinic-based barriers.

Results

Among 1751 LTFU patients traced and found alive, 31% of patients starting antiretroviral therapy (ART) between 1 July 2013 and 31 July 2015 silently transferred or were disengaged (40% male; median age, 35 years; median CD4 level, 239 cells/μL); median time on ART at LTFU was 480 days (interquartile range, 110–1295). Among the 544 patients not in care, median prevalences for patient-reported structural, psychosocial, and clinic-level barriers were 27.3%, 13.9%, and 13.4%, respectively, and were highly variable across facilities. Structural reasons, including, “relocated to a new place” were mostly cited among 289 patients who silently transferred (35.5%). We found that men were less likely to re-engage in care than women (odds ratio, .39; 95% confidence interval, .22–.67; P = .001).

Conclusions

Efforts to improve retention of patients on ART may need to be tailored at the facility level to address patient-reported barriers.
Survival of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Influenza Virus on Human Skin: Importance of Hand Hygiene in Coronavirus Disease 2019 (COVID-19)
Authors: Hirose Ryohei , Ikegaya Hiroshi , Naito Yuji , Watanabe Naoto , Yoshida Takuma , Bandou Risa , Daidoji Tomo , Itoh Yoshito , Nakaya Takaaki
Published: October 2020

Background

The stability of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on human skin remains unknown, considering the hazards of viral exposure to humans. We generated a model that allows the safe reproduction of clinical studies on the application of pathogens to human skin and elucidated the stability of SARS-CoV-2 on human skin.

Methods

We evaluated the stability of SARS-CoV-2 and influenza A virus (IAV), mixed with culture medium or upper respiratory mucus, on human skin surfaces and the dermal disinfection effectiveness of 80% (weight/weight) ethanol against SARS-CoV-2 and IAV.

Results

SARS-CoV-2 and IAV were inactivated more rapidly on skin surfaces than on other surfaces (stainless steel/glass/plastic); the survival time was significantly longer for SARS-CoV-2 than for IAV (9.04 hours [95% confidence interval, 7.96– 10.2 hours] vs 1.82 hours [1.65–2.00 hours]). IAV on other surfaces was inactivated faster in mucus versus medium conditions, while SARS-CoV-2 showed similar stability in the mucus and medium; the survival time was significantly longer for SARS-CoV-2 than for IAV (11.09 hours [10.22–12.00 hours] vs 1.69 hours [1.57–1.81 hours]). Moreover, both SARS-CoV-2 and IAV in the mucus/medium on human skin were completely inactivated within 15 seconds by ethanol treatment.

Conclusions

The 9-hour survival of SARS-CoV-2 on human skin may increase the risk of contact transmission in comparison with IAV, thus accelerating the pandemic. Proper hand hygiene is important to prevent the spread of SARS-CoV-2 infections.
Advancing Digital Health Equity: A Policy Paper of the Infectious Diseases Society of America and the HIV Medicine Association
Authors: Wood Brian R , Young Jeremy D , Abdel-Massih Rima C , McCurdy Lewis , Vento Todd J , Dhanireddy Shireesha , Moyer Kay J , Siddiqui Javeed , Scott John D
Published: October 2020

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revolutionized the practice of ambulatory medicine, triggering rapid dissemination of digital healthcare modalities, including synchronous video visits. However, social determinants of health, such as age, race, income, and others, predict readiness for telemedicine and individuals who are not able to connect virtually may become lost to care. This is particularly relevant to the practice of infectious diseases (ID) and human immunodeficiency virus (HIV) medicine, as we care for high proportions of individuals whose health outcomes are affected by such factors. Furthermore, delivering high-quality clinical care in ID and HIV practice necessitates discussion of sensitive topics, which is challenging over video without proper preparation. We describe the “digital divide,” emphasize the relevance to ID and HIV practice, underscore the need to study the issue and develop interventions to mitigate its impact, and provide suggestions for optimizing telemedicine in ID and HIV clinics.
Cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab in patients with a history of myocardial infarction in Sweden
Authors: Landmesser Ulf , Lindgren Peter , Hagström Emil , van Hout Ben , Villa Guillermo , Pemberton-Ross Peter , Arellano Jorge , Svensson Maria Eriksson , Sibartie Mahendra , Fonarow Gregg C
Published: October 2020

Aims

To assess the cost-effectiveness of proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to standard-of-care lipid-lowering treatment [maximum tolerated dose (MTD) of statin and ezetimibe] in Swedish patients with a history of myocardial infarction (MI).

Methods and results

Cost-effectiveness was evaluated using a Markov model based on Swedish observational data on cardiovascular event rates and efficacy from the FOURIER trial. Three risk profiles were considered: recent MI in the previous year; history of MI with a risk factor; and history of MI with a second event within 2 years. For each population, three minimum baseline low-density lipoprotein cholesterol (LDL-C) levels were considered: 2.5 mmol/L (≈100 mg/dL), based on the current reimbursement recommendation in Sweden; 1.8 mmol/L (≈70 mg/dL), based on 2016 ESC/EAS guidelines; and 1.4 mmol/L (≈55 mg/dL), or 1.0 mmol/L (≈40 mg/dL) for MI with a second event, based on 2019 ESC/EAS guidelines. Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab was associated with increased quality-adjusted life-years and costs vs. standard-of-care therapy. Incremental cost-effectiveness ratios (ICERs) were below SEK700 000 (∼€66 500), the generally accepted willingness-to-pay threshold in Sweden, for minimum LDL-C levels of 2.3 (recent MI), 1.7 (MI with a risk factor), and 1.7 mmol/L (MI with a second event). Sensitivity analyses demonstrated that base-case results were robust to changes in model parameters.

Conclusion

Proprotein convertase subtilisin/kexin type 9 inhibition with evolocumab added to MTD of statin and ezetimibe may be considered cost-effective at its list price for minimum LDL-C levels of 1.7–2.3 mmol/L, depending on risk profile, with ICERs below the accepted willingness-to-pay threshold in Sweden.
Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient’s reported outcome measures
Authors: Nieri Michele , Paoloni Valeria , Lione Roberta , Barone Valeria , Marino Merlo Matilde , Giuntini Veronica , Cozza Paola , Franchi Lorenzo
Published: October 2020

Objective

The objective of this study was to compare an expansion screw of the maxilla that generates moderate and continuous forces versus a conventional screw for rapid maxillary expansion (RME) on patient-reported outcome measure during the first 12 weeks of treatment.

Trial design

This is a superiority, multicenter, two-arm parallel balanced randomization trial.

Methods

Patients in the mixed dentition were included with a transverse discrepancy between the two arches of at least 3 mm. An expansion screw using moderate continuous forces (Leaf group, treated with an expansion screw with Ni–Ti springs) was compared to a conventional RME screw that generates intermittent heavy forces (RME group). The primary response variable was the visual analogue scale (VAS) on pain calculated in the first 12 weeks of therapy. The VAS on difficulty on speaking and oral hygiene, patient satisfaction, and complications were also evaluated. A computer-generated block randomization was used with allocation concealed in sequentially numbered opaque-sealed envelopes. Blinding was not applicable. Linear models were used for statistical analysis.

Results

Twenty-eight patients in the Leaf group and 28 patients in the RME group were randomized and included in the study. There were no dropouts. The mean of the VAS for pain was 0.3 ± 0.4 in the Leaf group and 0.6 ± 0.5 in the RME group. The difference was −0.3 (95 per cent CI from −0.5 to −0.0; P = 0.017) in favour of the Leaf group. The difference in pain was marked in the first week (Leaf group 2.2 ± 2.3; RME group 3.7 ± 2.6; difference −1.5; 95 per cent CI from −2.7 to −0.3; P = 0.019).

Conclusions

Patients in the Leaf group experienced a lower degree of pain, especially during the first week following the application of the expander. For the other variables, no significant differences were reported between the two treatments.

Registration

The study was registered in the ISRCTN register on 8 November 2016 with the number ISRCTN18263886.
Deconstructing the patient pathway to (in)effective care for hypertension: an application to the Philippines
Authors: Balabanova D
Published: October 2020

Patient pathways for hypertension care are clinically-determined and depicted as a linear process: from diagnosis and initiation of treatment, to subsequent follow-up. However, increasing evidence suggests that patient journeys are more complex, involving different points of diagnosis; starting, stopping and changing treatment-in the formal and informal sectors-and multiple re-entries into the system. This longitudinal qualitative study sought to obtain in depth knowledge of these pathways over time.

We thematically analysed data from 40 interviews with hypertensive Filipino patients of low socio-economic status, repeated after 12 months to capture health events and actions taken. Data was also collected using mobile phone-based digital diaries in the interim.

Low-income hypertensive patients in the Philippines navigate a complex terrain to manage their condition. Barriers facing patients and their coping strategies differ at each stage. The pluralistic health system affects pathway through conflicting and alternative information from outside the formal health sector, social networks and commercial bodies. Patients proactively make decisions on how to manage their condition in relation to these formal and informal systems. Barriers to adherence include factors beyond the health system, notably precarious work contexts which require patients to compromise their livelihoods to follow provider-proscribed treatment. Families act as enables of care, motivating patients to follow or modify their pathway.

The concept of an optimal ‘patient pathway' is normative and often ignores the complex reality of patients' lives as they manage multiple priorities. In reality, pathways are cyclical and iterative. Advocating rigid pathways that patients must follow for life is unrealistic, especially for the poor. Instead, health systems need to adapt to reflect patients' fluid life trajectories and expectations to enable them to effectively manage their condition alongside other demands.
Is the firearm epidemic in the US getting worse?
Authors: Tedesco D , Adja K Y C , Rallo F , Reno C , Fantini M P , Hernandez-Boussard T
Published: October 2020

Background

The US is the least regulated firearm market in the Western world and firearm violence is a major public health issue. Firearms account for 40,000 deaths in the US annually, which is higher than other high-income countries. Although most of the gun-related deaths in the US are the result of suicide attempts and self-inflicted injuries, nearly 40% of them come from accidents, assaults, or police intervention.

Methods

We measured the number of non-self-inflicted firearm-related ED visits, by including patients discharged with diagnostic ICD-9-CM (ICD-10 for 2016) codes of accidents, assaults or legal intervention resulting in firearm injuries between 2006-2016. We used data from the Healthcare Cost and Utilization Project (HCUPnet). From the CDC Wide-ranging Online Data for Epidemiologic Research we obtained data on non-suicidal firearm-related deaths over the period 2006-2017. To identify the cause of death we used the ICD-10 codes. Temporal changes of rates of ED visits and deaths were evaluated using Joinpoint Software.

Results

In 2006 there were a total of 79,998 ED visits with a diagnostic code of firearm-related injury, and this number showed a non-significant 2.7% annual decline between 2006-2013 (p = 0.06) followed by a significant 19.4% annual increase between 2013-2016 (p < 0.05), resulting in 111.305 visits in 2016. The number of non-suicidal firearm-related deaths showed a significant 2.2% annual decline between 2006-2014 (p < 0.05), followed by a significant 10.3% APC (p < 0.05) between 2014-2017.

Conclusions

Data showed steady rates until 2013 and a striking increasing trend starting from 2013. Firearm-related deaths followed the same trends. Our data show that in the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities. Analysis limitations: we used national-level aggregate data and coding accuracy may be not consistent nationwide.

Key messages

In the last four detectable years there has been a new concerning wave of gun violence and consequently a higher number of fatalities nationwide. The US firearm related deaths epidemic urges for new policies and preventive measures, such as stricter background checks and restrictions on guns ownership.
The role of the trainer in adapted physical activity for osteoporosis to improve quality of life
Authors: Marini S , Masini A , Maietta Latessa P , Sanna T , Raggi A , Buffa A , Malavolta N , Barone G , Leoni E , Dallolio L
Published: October 2020

Background

Osteoporosis is a major health burden worldwide and require a multi-modal approach including exercise. Fractures have a substantial impact on quality of life (QoL) so exercise programs may to be conducted by trainers able to deal with this condition, because exercise alone, even if in the right dosage, seems to be not enough to improve QoL. A quasi-experimental pilot study performed to determine the feasibility and safety of an Adapted Physical Activity (APA) protocol specifically designed for osteoporotic women with vertebral fractures and its effect on QoL, with a specific focus on trainer's role.

Methods

The Experimental Group (EG) performed APA protocol 1hour twice a week for 6 months, while the Control Group (CG) received standard care. QoL was assessed at baseline and follow-up with ECOS-16 questionnaire and semi structured interviews to understand women perceptions regarding trainer's role. Using mixed-methods quantitative and qualitative data were analyzed using SPSS 5 and NVivo 12, respectively.

Results

40 post-menopausal women (mean age: 67.6±4.6) divided in 2 groups EG = 22 and CG = 18, completed the study. At follow-up, EG improved significantly QoL (EG: -0.5±0.5 vs CG: 0.0±0.3 p = 0.02). The APA intervention had a significant effect on all the components of QoL, as measured by the disease-specific ECOS-16 questionnaire: Physical Component Summary (PCS) (EG: -0.4±0.5 vs CG: 0.0±0.4 p = 0.06) and Mental Component Summary (MCS) (EG: -0.5±0.6 vs CG: 0.1±0.5 p = 0.02). The interviews confirmed this result, emphasizing the key role of the trainer in improving their QoL. The adherence calculated as number of sessions performed compared to the sessions proposed was 75.8%. No injuries were observed.

Conclusions

The feasibility, the safety, and the positive effect of the proposed exercise protocol on QoL confirmed also by the interviews, show that principles of exercise education applied by trainers should be extended also to patients with other chronic condition.

Key messages

Trainers specifically educated, could be a means of achieving the goal improving people’s QoL, as they occupy the role of exercise experts and also an educational, relational and support role. The management of osteoporosis is multi-modal and includes exercise, often recommended as a beneficial non-pharmacological treatment to slow the rate of bone loss and improve quality of life.
Future visions for medical education, the importance of public health themes in education and beyond
Authors: Ghazal Asswad A , Fundano N , Holm S , Khan H , Petráková A
Published: October 2020

Steps for the future improvement of competencies evaluation and fulfilment were studied, with the eventual goal of the unification of guidelines internationally to ensure the standardisation and uniformity of the quality of medical education. The future vision for the integration of public health into medical education curriculums, highlighting the importance of public health in medical education and its application in a wide variety of situations across medical education and beyond in practise as a medical professional in a range of specialities. The need for ways to increase engagement of medical students within public health issues will also be discussed.
Burden of breast cancer in Serbia 2007-2017
Authors: Todorovic J , Santric-Milicevic M , Stamenkovic Z , Bjegovic-Mikanovic V , Terzic-Supic Z , Vasic M
Published: October 2020

Background

Breast cancer is the third highest incidence of cancer globally. It is the leading cause of cancer-associated mortality among females in the world. In Serbia, the incidence rate of breast cancer in 2015 was 61.0/100000 and breast cancer attributed to 18.9% of total cancer mortality among females. The aim of this study was to examine the incidence rate, years lived with disability (YLD) and disability-adjusted life-years (DALY) in Serbia in the ten-year period, from 2007 to 2017.

Methods

We analyzed data from the global burden of disease study (GBD) 2017. The data for the breast cancer incidence, prevalence, YLD, DALY counts and DALY rates per 100,000 were used for analyses.

Results

The prevalence of breast cancer in Serbia (in thousands) in 2017 was 44.6 (95% CI: 39.9-50.6), the incidence (in thousands) was 5.6 (95% CI: 5.0-6.4), YLD (in thousands) in 2017 was 3.5 (95% CI: 2.5-4.9). In the period between 2007 and 2017, YLD counts increased by 11.7%, while the age-standardized rates increased by 5.8%. Total all age DALY counts for both sexes were 51.8 (95% CI: 49- 55.3) in 2007 and 51.5 (95% CI: 45.7-58.3) in 2017. Age-standardized DALY rates per 100,000 decreased from 388.8 (95% CI: 368.3-415.7) in 2007 to 366.3 (95% CI: 323.8-415.4) in 2017.

Conclusions

The data from the GBD study show that the total YLD counts in Serbia increased by more than 10% in the past decade. However, the total DALY counts did not change significantly and the age-standardized DALY rate per 100,000 decreased in the period between 2007 and 2017.

Key messages

The total years-lived with disability as a consequence of the breast cancer increased for 10% in Serbia between 2007 and 2017. The decrease in age-standardized DALYs may reflect aging and depopulation effects in Serbia.
Why provision of clinical decision support (CDS) is not enough? Factors influencing the CDS adoption
Authors: Laka M , Milazzo A , Merlin T
Published: October 2020

Background

Clinical decision support (CDS) can improve the quality and efficiency of care by increasing access to evidence-based data at the point-of-care. However, CDS adoption is limited in clinical settings. The focus on the technical design have overlooked end-users’ perceptions, social and organisational factors that may influence uptake. Using the Unified Theory of Acceptance and Use of Technology (UTAUT) model, we aimed to identify different challenges and opportunities for CDSS adoption in clinical settings.

Methods

A cross-sectional online survey was conducted from June-October 2019 with general practitioners, physicians and surgeons in Australia. To measure the impact of UTAUT moderators (age, gender and experience) and care settings (primary care vs. hospitals) on perceived barriers and facilitators to CDS implementation, multivariate logistic regression was carried out. Qualitative data was thematically analysed for emerging patterns and themes.

Results

Many respondents indicated that CDS can promote evidence-based care (79%) and improve quality and safety (52%). Overall CDS adoption is dependent on factors such as effort expectancy (ease of use), performance expectancy and a facilitating environment for system use. Clinician perceptions of barriers and facilitators to uptake are associated with type of care setting. There was higher likelihood of perceiving ease of use (OR 1.39, 95% CI 1.15-2.07), time limitations (OR 1.95, 95%CI 1.10-3.77), patient' preferences (OR 2.17, 95% CI 1.14-3.37) and threat to professional autonomy (OR 2.15, 95%CI 1.39-3.41) as factors that influence adoption in primary care. Providing relevant information in right format at right time is critical for successful CDS use.

Conclusions

CDS implementation requires a holistic approach addressing users' perceptions and preferences determined through stakeholder consultation. The system design must be easy to use but also facilitated through the provision of on-site training and support.

Key messages

CDS adoption is determined by systems’ ease of use and provision of enabling environment. Users and setting characteristics are important moderators and must be considered in CDS implementation.