bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of training strategies to improve healthcare provider practices in low-income and middle-income countries
Authors: Rowe Alexander K , Rowe Samantha Y , Peters David H , Holloway Kathleen A , Ross-Degnan Dennis
Published: January 2021

Introduction

In low/middle-income countries (LMICs), training is often used to improve healthcare provider (HCP) performance. However, important questions remain about how well training works and the best ways to design training strategies. The objective of this study is to characterise the effectiveness of training strategies to improve HCP practices in LMICs and identify attributes associated with training effectiveness.

Methods

We performed a secondary analysis of data from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series, and outcomes measuring HCP practices (eg, percentage of patients correctly treated). Distributions of effect sizes (defined as percentage-point (%-point) changes) were described for each training strategy. To identify effective training attributes, we examined studies that directly compared training approaches and performed random-effects linear regression modelling.

Results

We analysed data from 199 studies from 51 countries. For outcomes expressed as percentages, educational outreach visits (median effect size when compared with controls: 9.9 %-points; IQR: 4.3–20.6) tended to be somewhat more effective than in-service training (median: 7.3 %-points; IQR: 3.6–17.4), which seemed more effective than peer-to-peer training (4.0 %-points) and self-study (by 2.0–9.3 %-points). Mean effectiveness was greater (by 6.0–10.4 %-points) for training that incorporated clinical practice and training at HCPs’ work site. Attributes with little or no effect were: training with computers, interactive methods or over multiple sessions; training duration; number of educational methods; distance training; trainers with pedagogical training and topic complexity. For lay HCPs, in-service training had no measurable effect. Evidence quality for all findings was low.

Conclusions

Although additional research is needed, by characterising the effectiveness of training strategies and identifying attributes of effective training, decision-makers in LMICs can improve how these strategies are selected and implemented.
Interests and needs of eye care providers in clinical decision support for glaucoma
Authors: Stagg Brian , Stein Joshua D , Medeiros Felipe A , Cummins Mollie , Kawamoto Kensaku , Hess Rachel
Published: January 2021

Objective

To study whether clinicians who treat glaucoma are interested in using clinical decision support (CDS) tools for glaucoma, what glaucoma clinical decisions they feel would benefit from CDS, and what characteristics of CDS design they feel would be important in glaucoma clinical practice.

Methods and analysis

Working with the American Glaucoma Society, the Utah Ophthalmology Society and the Utah Optometric Association, we identified a group of clinicians who care for patients with glaucoma. We asked these clinicians about interest in CDS, what glaucoma clinical decisions would benefit from CDS, and what characteristics of CDS tool design would be important in glaucoma clinical practice.

Results

Of the 105 clinicians (31 optometrists, 10 general ophthalmologists and 64 glaucoma specialists), 93 (88.6%) were either ‘definitely’ or ‘probably’ interested in using CDS for glaucoma. There were no statistically significant differences in interest between clinical specialties (p=0.12), years in practice (p=0.85) or numbers of patients seen daily (p=0.99). Identifying progression of glaucoma was the clinical decision the largest number of clinicians felt would benefit from CDS (104/105, 99.1%). An easy to use interface was the CDS characteristic the largest number of clinicians felt would be ‘very important’ (93/105, 88.6%).

Conclusion

Of this group of clinicians who treat glaucoma, 88.6% were interested in using CDS for glaucoma and 99.1% felt that identification of glaucomatous progression could benefit from CDS. This level of interest supports future work to develop CDS for glaucoma.
Lumbosacral injuries in elite Paralympic athletes with limb deficiency: a retrospective analysis of patient records
Authors: Heneghan Nicola R , Collacott Esther , Martin Paul , Spencer Simon , Rushton Alison
Published: January 2021

Background

Compared to injury data in able-bodied athletes, relatively little literature exists for Paralympic athletes. Injury data underpins the design and evaluation of injury prevention strategies in elite sport. The aim of this study was to investigate frequency, characteristics and management of lumbosacral injuries in elite athletes with limb deficiency.

Methods

A retrospective analysis of injuries in elite athletes with limb deficiency (2008 to 2017) was conducted using available data extracted from The English Institute of Sport (EIS) clinical records. Eligibility criteria: funded athletes, eligible for EIS physiotherapy support with full or partial limb deficiency. Data were analysed descriptively using frequencies.

Results

A total of 107 injuries from 32 athletes were included. Participants comprised 18 men (59%), from 9 sports, with mean age for index injuries of 27 years (range 18 to 38 years) and 15 with congenital limb deficiency (47%). Average number of index injuries for congenital and traumatic limb deficient groups were 13 and 19, respectively. Where injury onset was recorded (n=79), half of injuries occurred during training (40%, n=43). Arthrogenic structures accounted for 32.7% of injuries, myogenic 26.2%, with neurogenic, discogenic and osteogenic each <5%. The number of treatments delivered in each injury episode ranged from 1 to 43, with symptom resolution taking 2 to 439 days.

Conclusion

Elite athletes with limb deficiency experience lumbosacral injuries predominantly involving muscles and joints. While consistency and accuracy of data recording limits definitive conclusions, findings highlight the importance of precision in recording injury data as part of surveillance to enable implementation of effective injury prevention strategies.
NTPDase8 protects mice from intestinal inflammation by limiting P2Y6 receptor activation: identification of a new pathway of inflammation for the potential treatment of IBD
Authors: Salem Mabrouka , Lecka Joanna , Pelletier Julie , Gomes Marconato Danielle , Dumas Aline , Vallières Luc , Brochu Gaetan , Robaye Bernard , Jobin Christian , Sévigny Jean
Published: January 2021

Objective

Nucleotides are danger signals that activate inflammatory responses via binding P2 receptors. The nucleoside triphosphate diphosphohydrolase-8 (NTPDase8) is an ectonucleotidase that hydrolyses P2 receptor ligands. We investigated the role of NTPDase8 in intestinal inflammation.

Design

We generated NTPDase8-deficient (Entpd8–/–) mice to define the role of NTPDase8 in the dextran sodium sulfate (DSS) colitis model. To assess inflammation, colons were collected and analysed by histopathology, reverse transcriptase-quantitative real-time PCR (RT-qPCR) and immunohistochemistry. P2 receptor expression was analysed by RT-qPCR on primary intestinal epithelium and NTPDase8 activity by histochemistry. The role of intestinal P2Y6 receptors was assessed by bone marrow transplantation experiments and with a P2Y6 receptor antagonist.

Results

NTPDase8 is the dominant enzyme responsible for the hydrolysis of nucleotides in the lumen of the colon. Compared with wild-type (WT) control mice, the colon of Entpd8–/– mice treated with DSS displayed significantly more histological damage, immune cell infiltration, apoptosis and increased expression of several proinflammatory cytokines. P2Y6 was the dominant P2Y receptor expressed at the mRNA level by the colonic epithelia. Irradiated P2ry6–/– mice transplanted with WT bone marrow were fully protected from DSS-induced intestinal inflammation. In agreement, the daily intrarectal injection of a P2Y6 antagonist protected mice from DSS-induced intestinal inflammation in a dose-dependent manner. Finally, human intestinal epithelial cells express NTPDase8 and P2Y6 similarly as in mice.

Conclusion

NTPDase8 protects the intestine from inflammation most probably by limiting the activation of P2Y6 receptors in colonic epithelial cells. This may provide a novel therapeutic strategy for the treatment of inflammatory bowel disease.
Sacubitril/valsartan in the treatment of systemic right ventricular failure
Authors: Zandstra Tjitske E , Nederend Marieke , Jongbloed Monique R M , Kiès Philippine , Vliegen Hubert W , Bouma Berto J , Tops Laurens F , Schalij Martin J , Egorova Anastasia D
Published: January 2021

Objective

Pharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients.

Methods

Data on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment.

Results

Six-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p<0.001). Echocardiographic systemic RV fractional area change and global longitudinal strain showed small improvements (19%–22%, p<0.001 and −11% to −13%, p=0.014, respectively). The 6 min walking distance improved significantly from an average of 564 to 600 m (p=0.011). The QOL domains of cognitive function, sleep and vitality improved (p=0.015, p=0.007 and p=0.037, respectively).

Conclusions

We describe the first patient cohort with systemic RV failure treated with sacubitril/valsartan. Treatment appears feasible with improvements in NT-pro-BNP and echocardiographic function. Our positive results show the potential of sacubitril/valsartan for this patient population.
Do healthcare providers assess for risk factors and talk to patients about return to driving after a mild traumatic brain injury (mTBI)? Findings from the 2020 DocStyles Survey
Authors: Sarmiento Kelly , Waltzman Dana , Wright David
Published: January 2021

Background

There is a dearth of information and guidance for healthcare providers on how to manage a patient’s return to driving following a mild traumatic brain injury (mTBI).

Methods

Using the 2020 DocStyles survey, 958 healthcare providers were surveyed about their diagnosis and management practices related to driving after an mTBI.

Results

Approximately half (52.0%) of respondents reported routinely (more than 75% of the time) talking with patients with mTBI about how to safely return to driving after their injury. When asked about how many days they recommend their patients with mTBI wait before returning to driving after their injury: 1.0% recommended 1 day or less; 11.7% recommended 2–3 days; 24.5% recommended 4–7 days and 45.9% recommended more than 7 days. Many respondents did not consistently screen patients with mTBI for risk factors that may affect their driving ability or provide them with written instructions on how to safely return to driving (59.7% and 62.6%, respectively). Approximately 16.8% of respondents reported they do not usually make a recommendation regarding how long patients should wait after their injury to return to driving.

Conclusions

Many healthcare providers in this study reported that they do not consistently screen nor educate patients with mTBI about driving after their injury. In order to develop interventions, future studies are needed to assess factors that influence healthcare providers behaviours on this topic.
Identification of neuroblastoma cell lines with uncommon TAZ+/mesenchymal stromal cell phenotype with strong suppressive activity on natural killer cells
Authors: Canzonetta Claudia , Pelosi Andrea , Di Matteo Sabina , Veneziani Irene , Tumino Nicola , Vacca Paola , Munari Enrico , Pezzullo Marco , Theuer Charles , De Vito Rita , Pistoia Vito , Tomao Luigi , Locatelli Franco , Moretta Lorenzo , Caruana Ignazio , Azzarone Bruno
Published: January 2021

Background

Neuroblastoma (NB) is the most common, extracranial childhood solid tumor arising from neural crest progenitor cells and is a primary cause of death in pediatric patients. In solid tumors, stromal elements recruited or generated by the cancer cells favor the development of an immune-suppressive microenvironment. Herein, we investigated in NB cell lines and in NB biopsies, the presence of cancer cells with mesenchymal phenotype and determined the immune-suppressive properties of these tumor cells on natural killer (NK) cells.

Methods

We assessed the mesenchymal stromal cell (MSC)-like phenotype and function of five human NB cell lines and the presence of this particular subset of neuroblasts in NB biopsies using flow-cytometry, immunohistochemistry, RT-qPCR, cytotoxicity assays, western blot and silencing strategy. We corroborated our data consulting a public gene-expression dataset.

Results

Two NB cell lines, SK-N-AS and SK-N-BE(2)C, exhibited an unprecedented MSC phenotype (CD105+/CD90+/CD73+/CD29+/CD146+/GD2+/TAZ+). In these NB-MSCs, the ectoenzyme CD73 and the oncogenic/immune-regulatory transcriptional coactivator TAZ were peculiar markers. Their MSC-like nature was confirmed by their adipogenic and osteogenic differentiation potential. Immunohistochemical analysis confirmed the presence of neuroblasts with MSC phenotype (CD105+/CD73+/TAZ+). Moreover, a public gene-expression dataset revealed that, in stage IV NB, a higher expression of TAZ and CD105 strongly correlated with a poorer outcome.

Among the NB-cell lines analyzed, only NB-MSCs exhibited multifactorial resistance to NK-mediated lysis, inhibition of activating NK receptors, signal adaptors and of NK-cell cytotoxicity through cell-cell contact mediated mechanisms. The latter property was controlled partially by TAZ, since its silencing in NB cells efficiently rescued NK-cell cytotoxic activity, while its overexpression induced opposite effects in non-NB-MSC cells.

Conclusions

We identified a novel NB immunoregulatory subset that: (i) displayed phenotypic and functional properties of MSC, (ii) mediated multifactorial resistance to NK-cell-induced killing and (iii) efficiently inhibited, in coculture, the cytotoxic activity of NK cells against target cells through a TAZ-dependent mechanism. These findings indicate that targeting novel cellular and molecular components may disrupt the immunomodulatory milieu of the NB microenvironment ameliorating the response to conventional treatments as well as to advanced immunotherapeutic approaches, including adoptive transfer of NK cells and chimeric antigen receptor T or NK cells.
Advances in genetic technologies result in improved diagnosis of mismatch repair deficiency in colorectal and endometrial cancers
Authors: Evans D Gareth , Lalloo Fiona , Ryan Neil AJ , Bowers Naomi , Green Kate , Woodward Emma R , Clancy Tara , Bolton James , McVey Rhona J , Wallace Andrew J , Newton Katy , Hill James , McMahon Raymond , Crosbie Emma J
Published: January 2021

Background

Testing cancers for mismatch repair deficiency (dMMR) by immunohistochemistry (IHC) is a quick and inexpensive means of triaging individuals for germline Lynch syndrome testing. The aim of this study was to evaluate tumour dMMR and the prevalence of Lynch syndrome in patients referred to the Manchester Centre for Genomic Medicine, which serves a population of 5.6 million.

Methods

Tumour testing used IHC for MMR proteins with targeted BRAF and MLH1 promotor methylation testing followed by germline mutation and somatic testing as appropriate.

Results

In total, 3694 index tumours were tested by IHC (2204 colorectal cancers (CRCs), 739 endometrial cancers (ECs) and 761 other), of which 672/3694 (18.2%) had protein loss, including 348 (9.4%) with MLH1 loss. MLH1 loss was significantly higher for 739 ECs (15%) vs 2204 CRCs (10%) (p=0.0003) and was explained entirely by higher rates of somatic MLH1 promoter hypermethylation (87% vs 41%, p<0.0001). Overall, 65/134 (48.5%) patients with MLH1 loss and no MLH1 hypermethylation or BRAF c.1799T>A had constitutional MLH1 pathogenic variants. Of 456 patients with tumours showing loss of MSH2/MSH6, 216 (47.3%) had germline pathogenic variants in either gene. Isolated PMS2 loss was most suggestive of a germline MMR variant in 19/26 (73%). Of those with no germline pathogenic variant, somatic testing identified likely causal variants in 34/48 (71%) with MLH1 loss and in MSH2/MSH6 in 40/47 (85%) with MSH2/MSH6 loss.

Conclusions

Reflex testing of EC/CRC leads to uncertain diagnoses in many individuals with dMMR following IHC but without germline pathogenic variants or MLH1 hypermethylation. Tumour mutation testing is effective at decreasing this by identifying somatic dMMR in >75% of cases.
Health awareness as genre: the exigence of preparedness in cancer awareness campaigns and critical-illness insurance marketing
Authors: Gaudet Loren
Published: January 2021

Dominant understandings of genre-as-form have limited our abilities to perceive health awareness: we recognise, and expect, health awareness campaigns from governmental and non-profit agencies. Inversely, we often fail to recognise, or name, health awareness as such when it comes from other sources, such as commercial marketing or advertisements for products. However, rhetorical genre theory centres attention on action brought about by form and, as such, rhetorical genre provides tools for recognising instances of health awareness often escape our notice. One such example is critical-illness insurance marketing. In this article, I argue that critical-illness insurance marketing draws on the same appeals found in cancer awareness campaigns. Through a comparative analysis, I show that Colorectal Cancer Canada and critical-illness insurance marketing represent unpreparedness, rather than cancer, as the exigence, or the problem to be overcome through public discourse, and as such, share a genre of what I call ‘health awareness as preparedness’.
Diagnosis of cystic fibrosis in adulthood and eligibility for novel CFTR modulator therapy
Authors: Farley Hannah , Poole Sarah , Chapman Stephen , Flight William
Published: January 2021

Background

Cystic fibrosis (CF) is an autosomal recessive condition that primarily manifests as a chronic respiratory disease. CF is usually diagnosed in early childhood or through newborn screening although in a small but important group, diagnosis is not made until adulthood. Highly effective cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies are now available for most genetic causes of CF highlighting the importance of identifying people with late presentations of CF.

Aim

We aimed to identify the clinical characteristics of people diagnosed with CF in adulthood and their resulting eligibility for novel CFTR modulator therapies.

Design

Retrospective single-centre cohort study.

Methods

Patients diagnosed with CF at age 18 years or older were identified from a patient database. Paper and electronic medical records were reviewed and clinical, microbiological and radiological data at diagnosis were recorded.

Results

Nineteen patients were identified. Median age at diagnosis was 38 years (range: 19–71) and 9 (47%) were female. All patients had a history of chronic respiratory symptoms and 18/19 (94%) had radiological evidence of bronchiectasis. All patients had two pathogenic CFTR mutations identified with 16/19 (84%) compound heterozygotes for the F508del mutation. The majority of patients had a CFTR genotype considered eligible for CFTR modulator therapy (84% and 89% according to European and US licences, respectively).

Conclusions

Adult patients with unexplained chronic bronchiectasis should be thoroughly investigated for CF. A low index of suspicion will help to identify adults with undiagnosed CF who are likely to benefit from CFTR modulator therapy.
Effect of peripheral nerve blocks on postanesthesia care unit length of stay in patients undergoing ambulatory surgery: a retrospective cohort study
Authors: Polshin Victor , Petro Julie , Wachtendorf Luca J , Hammer Maximilian , Simopoulos Thomas , Eikermann Matthias , Santer Peter
Published: January 2021

Background

Peripheral regional anesthesia and analgesia may increase the efficiency of ambulatory surgical centers by reducing pain and preventing nausea and vomiting, which are important modifiable causes of prolonged postanesthesia care unit (PACU) length of stay. We hypothesized that the use of peripheral nerve blocks (PNB) was associated with shorter PACU length of stay in ambulatory surgery.

Methods

In this retrospective cohort study, we analyzed data from adult ambulatory surgical cases, in which PNB was a viable anesthetic option (ie, was routinely performed for these procedures), at an academic medical center between 2008 and 2018. We assessed the association between the use of PNB and the primary endpoint of PACU length of stay. As key secondary endpoint, we compared intraoperative opioid doses. Analyses were adjusted for patient demographics, comorbidities and intraoperative factors.

Results

A total of 57 040 cases were analyzed, of whom 13 648 (23.9%) received a PNB. The use of PNB was associated with shorter PACU length of stay (a decrease of 7.3 min, 95% CI 6.1 to 8.6, p<0.001). This association was most pronounced in surgeries of long duration (decrease of 11.2 min, 95% CI 9.0 to 13.4) and in patients undergoing leg and ankle procedures (decrease of 15.1 min, 95% CI 5.5 to 24.6). Intraoperative opioid doses were significantly lower in patients receiving a nerve block (decrease of 9.40 mg oral morphine equivalents, 95% CI 8.34 to 10.46, p<0.001).

Conclusion

The use of PNB significantly reduced PACU length of stay in ambulatory surgical patients, which may in part be attributed to lower intraoperative opioid requirements.
Hydrostatic reduction of intussusception with intermittent radiography: an alternative to fluoroscopy or ultrasound-guided reduction in low-income and middle-income countries
Authors: Chowdhury Tanvir Kabir , Ahsan Md. Qumrul , Chowdhury Mohammad Zonaid , Chowdhury Md. Tameem Shafayat , Imam Md. Sharif , Alam Md. Afruzul , Farooq Md. Abdullah Al
Published: January 2021

Background

Although hydrostatic reduction of intussusception with ultrasound (US) or fluoroscopy guidance is well known, it is not yet well established in many low-income and middle-income countries. The aim of the study is to report our results of hydrostatic reduction with intermittent radiography, which has the potential to be practiced in resource-limited settings.

Methods

We retrospectively analyzed our patients with intussusception from 2009 to 2019 (11 years). Hydrostatic reduction was performed using water-soluble contrast medium (iopamidol), and reduction was followed with intermittent X-rays taken after every 50 mL of diluted contrast injection. The procedure was not continuously monitored by US or fluoroscopy. Differences in outcome based on age and gender, and yearly trends of admission for intussusception, types of treatment and mortality were analyzed.

Results

Among 672 patients, the ratio of boys to girls was 2.46:1.0, and their ages ranged from 1 month to 15 years (median 8 months). Hydrostatic reduction was performed successfully in 351 (52.23%) patients; 308 (45.83%) patients underwent surgery; and 13 (1.93%) patients died before any intervention. There were significant differences in age between patients with successful hydrostatic reduction (median 7 months) and patients needing surgery (median 9 months) (p<0.001). The number of successful hydrostatic reductions increased during the 11 years of the study (R2=0.88). One patient (0.15%) died after hydrostatic reduction, and 10 (1.49%) died after surgery.

Conclusion

Hydrostatic reduction with intermittent radiography was performed successfully in more than half of the patients with acceptable complication rates.
EDTA as a chelating agent in quantitative1H-NMR of biologically important ions
Authors: Mathuthu Emmanuel , Janse van Rensburg Angelique , Du Plessis Dean , Mason Shayne
Published: January 2021

Biologically important ions such as Ca, K, Mg, Fe, and Zn play major roles in numerous biological processes, and their homeostatic balance is necessary for the maintenance of cellular activities. Sudden and severe loss in homeostasis of just one biologically important ion can cause a cascade of negative effects. The ability to quickly, accurately, and reliably quantify biologically important ions in samples of human bio-fluids is something that has been sorely lacking within the field of metabolomics.1H-NMR spectra. The foundation of our investigation was the a-priori knowledge that free ethylenediaminetetraacetic acid (EDTA) produces two clear single peaks on1H-NMR spectra, and that EDTA chelated to different ions produces unique1H-NMR spectral patterns due to 3D conformational changes in the chemical structure of chelated-EDTA and varying degrees of electronegativity. The aim of this study was to develop and test a1H-NMR-based method, with application specifically to the field of metabolomics, to quantify biologically important ions within the physiological pH range of 6.50–7.50 using EDTA as a chelating agent. Our method produced linear, accurate, precise, and repeatable results for Ca, Mg, and Zn; however, K and Fe did not chelate with EDTA.
Radiated temperature of weaned piglets and the response to in-feed antibiotics with correction for ambient conditions
Authors: Cook Nigel J. , Chabot Brady , Liu Tong , Froehlich Denise , Juàrez Manuel
Published: January 2021

Growth performance, health status, and the radiated thermal temperatures of groups of piglets consuming non-medicated feed and in-feed antibiotics (chlortetracycline hydrochloride and tiamulin) were monitored continuously for up to 35 d, from weaning at 28 d of age until moving to commercial pens at approximately 63 d of age. There was a trend (P = 0.1) for body weight at the time of moving to be higher for the medicated animals. The average daily gain was higher in medicated piglets (P = 0.03). Radiated temperature variables were the maximum (Tmax) and the average (Tmean) pig temperatures, and both were higher for the medicated piglets (P < 0.0001). A threshold temperature was derived to partition the image and derive the background radiated temperature that was used to obtain the expected radiated temperature of the pigs. Temperature data were adjusted for environmental effects by expressing the residual temperature. The residual for Tmax (TmaxRes) and for Tmean (TmeanRes) were higher in medicated piglets (P < 0.0001). In-feed antibiotics were associated with increased growth rates and with an increase in radiated temperature variables, particularly those corrected for environmental conditions, possibly mediated through increased metabolic activity related to growth.
Directed Test Generation for Activation of Security Assertions in RTL Models
Authors: Witharana Hasini , Lyu Yangdi , Mishra Prabhat
Published: January 2021

Assertions are widely used for functional validation as well as coverage analysis for both software and hardware designs. Assertions enable runtime error detection as well as faster localization of errors. While there is a vast literature on both software and hardware assertions for monitoring functional scenarios, there is limited effort in utilizing assertions to monitor System-on-Chip (SoC) security vulnerabilities. We have identified common SoC security vulnerabilities and defined several classes of assertions to enable runtime checking of security vulnerabilities. A major challenge in assertion-based validation is how to activate the security assertions to ensure that they are valid. While existing test generation using model checking is promising, it cannot generate directed tests for large designs due to state space explosion. We propose an automated and scalable mechanism to generate directed tests using a combination of symbolic execution and concrete simulation of RTL models. Experimental results on diverse benchmarks demonstrate that the directed tests are able to activate security assertions non-vacuously.
Improvement of Electrochemical Capacitance of Activated Carbon Electrodes from African Palm Shell Modified with HNO3
Authors: Zapata Zulamita , Arenas Erika , Borrás Daniel , Herrera Penagos Sara Natalia
Published: January 2021

Activated carbon electrodes were synthetized from African palm shell with KOH (CK) at 2/1 KOH/biomass mass ratio and treated thermically at 700°C (1056 m2/g). Then CK was modified at different conditions by surface treatment using HNO3/CK impregnation mass ratios 1 and 12, temperatures between 25 – 80°C, impregnation time 1 – 4 h. The performance of electrodes as supercapacitors was evaluated in 1 M H2SO4 using electrical impedance spectroscopy (EIS) and charge/discharge technique (CP). The results showed that the specific capacitance increases upon oxidation (57 F/g up to 89.7 F/g). The highest capacitance was obtained for sample prepared at impregnation ratio 1, 4 h and 25°C (606 m2/g) without increasing the equivalent resistance series significantly. These results were influenced mainly by the increased of nitrogen functional groups rather than specific surface area, which confirm that the surface composition has a high influence on the electrochemical performance.
Development of Completely Automated Poly Potential Portable Potentiostat
Authors: Baranwal Akhil Raj , Dudala Sohan , Rewatkar Prakash , Mohan Jaligam Murali , Salve Mary , Goel Sanket
Published: January 2021

Various research activities related to profiling chemicals employ detection or measurement of the response from a specimen in terms of electric fields or currents. Hence, a portable poly-potential device forms one of the necessary measuring equipment essential to these domains. This work aims to propose a Poly-Potential Portable Potentiostat (P4), that can perform electrochemical analysis of solutions through easily integrable data-acquisition hardware and flexible software post-processing. The P4 device is based on a commercial development board, which provides an analog front-end (AFE) for working with 2-lead and 3-lead amperometric cells. An economical and portable design approach is prioritised while keeping the basic functions of the research-grade commercial instruments. A novel technique of dynamically changing the bias and reference potential is used to achieve a finer resolution, enabling qualitative estimation. P4 works by performing detailed mathematical post-processing on-board and therefore relies on hardware integrity as much as on software flexibility. Calibration of P4 was done using a standardised solution to function independently of any external hardware or software tools. P4 makes electrochemical analysis truly portable in remote or resource-constrained applications.
Analysis and Simulation of SIRS Model for Dengue Fever Transmission in South Sulawesi, Indonesia
Authors: Sanusi Wahidah , Badwi Nasiah , Zaki Ahmad , Sidjara Sahlan , Sari Nurwahidah , Pratama Muhammad Isbar , Side Syafruddin
Published: January 2021

This study is aimed at building and analysing a SIRS model and also simulating the model to predict the number of dengue fever cases. Methods applied for this model are building the SIRS model by modifying the SIR model, analysing the SIRS model using the Lyapunov function to prove three theorems (the existence, the free disease, and the endemic status of dengue fever), and simulating the SIRS model using the number of dengue case data in South Sulawesi by Maple. The results obtained are the SIRS model of dengue fever transmission, stability analysis, global stability, and the value of the basic reproduction number

R

0

. The simulation done for the dengue fever case in South Sulawesi found the basic reproduction number

R

0

=
26.47609
>
1

; it means that South Sulawesi is in the endemic stage of transmission for dengue fever disease. Simulation of the SIRS model for dengue fever can predict the number of dengue cases in South Sulawesi that could be a recommendation for the government in an effort to prevent the number of dengue fever cases.
Self-Adaptive Image Encryption Algorithm Based on Quantum Logistic Map
Authors: Dong Youxia , Huang Xiaoling , Mei Qixiang , Gan Yuanju
Published: January 2021

This study proposes a self-adaptive image encryption algorithm based on the quantum logistic map. First, the initial values are substituted into the quantum logistic map based on an iteration process to generate three random sequences. After preprocessing, three new random sequences with better randomicity were obtained from the generated random sequences. In particular, the correlation coefficients for random sequences before and after preprocessing are compared to determine the best model to make the correlation coefficients closer to zero. Second, one random sequence in the scrambling stage is selected with respect to the plain image. The selected random sequence is then used to perform row-column perturbation on the plain image. Finally, the remaining two random sequences are used to perform forward and reverse diffusion to obtain the final cipher image. Because of the dependence on the plain image, the algorithm can frustrate the chosen-plaintext and known-plaintext attacks. Experimental results show that the proposed encryption algorithm can achieve secure communications.
Safety and Feasibility of a Novel Protocol for Percutaneous Dilatational Tracheostomy in Patients with Respiratory Failure due to COVID-19 Infection: A Single Center Experience
Authors: Boujaoude Ziad , Madisi Nagendra , Patel Bhavi , Rachoin Jean-Sebastien , Dellinger R. Phillip , Abouzgheib Wissam
Published: January 2021

Introduction. The rapidly spreading Novel Coronavirus 2019 (COVID-19) appeared to be a highly transmissible pathogen in healthcare environments and had resulted in a significant number of patients with respiratory failure requiring tracheostomy, an aerosol-generating procedure that places healthcare workers at high risk of contracting the infection. Instead of deferring or delaying the procedure, we developed and implemented a novel percutaneous dilatational tracheostomy (PDT) protocol aimed at minimizing the risk of transmission while maintaining favorable procedural outcome. Patients and Methods. All patients who underwent PDT per novel protocol were included in the study. The key element of the protocol was the use of apnea during the critical part of the insertion and upon any opening of the ventilator circuit. This was coupled with the use of enhanced personnel protection equipment (PPE) with a powered air-purifying respirator (PAPR). The operators underwent antibody serology testing and were evaluated for COVID-19 symptoms two weeks from the last procedure included in the study. Results. Between March 12th and June 30th, 2020, a total of 32 patients underwent PDT per novel protocol. The majority (80%) were positive for COVID-19 at the time of the procedure. The success rate was 94%. Only one patient developed minor self-limited bleeding. None of the proceduralists developed positive serology or any symptoms compatible with COVID-19 infection. Conclusion. A novel protocol that uses periods of apnea during opening of the ventilator circuit along with PAPR-enhanced PPE for PDT on COVID-19 patients appears to be effective and safe for patients and healthcare providers.
Fueling the Fire: Inflammatory Forms of Cell Death and Implications for Cancer Immunotherapy
Authors: Rosenbaum Sheera R. , Wilski Nicole A. , Aplin Andrew E.
Published: January 2021

Unleashing the immune system with immune checkpoint inhibitors (ICI) has significantly improved overall survival for subsets of patients with stage III/IV cancer. However, many tumors are nonresponsive to ICIs, in part due to a lack of tumor-infiltrating lymphocytes (TIL). Converting these immune “cold” tumors to “hot” tumors that are thus more likely to respond to ICIs is a major obstacle for cancer treatment. Triggering inflammatory forms of cell death, such as necroptosis and pyroptosis, may alter the tumor immune microenvironment and the influx of TILs. We present an emerging view that promoting tumor-localized necroptosis and pyroptosis may ultimately enhance responses to ICI.

Significance:

Many tumor types respond poorly to ICIs or respond but subsequently acquire resistance. Effective therapies for ICI-nonresponsive tumors are lacking and should be guided by evidence from preclinical studies. Promoting inflammatory cell death mechanisms within the tumor may alter the local immune microenvironment toward an ICI-responsive state.
The morphology of the parasitic isopod Tachaea chinensis (Isopoda, Cymothoida) revealed through scanning electron microscopy and histological analysis
Authors: Li Xin , Chen Qijun , Li Yingdong
Published: January 2021

Parasitic isopods have negative effects on several commercially important fishes and crustaceans. However, studies on these parasites, especially on their morphology, are limited. In the present study, scanning electron microscopy and simultaneous histological analysis were carried out to examine the external structure and composition of the internal organs of Tachaea chinensis (Isopoda, Corallanidae). Seven pairs of pereopods are sharp and hook-like, which are used for attaching to the host. Four pairs of the paddle-shaped pleopods indicate that it has the ability to swim freely. Analysis of the mouth appendages revealed that T. chinensis mainly feeds on the host’s blood. Moreover, we found numerous glands, including the salivary glands and hepatopancreas, in the coelom; loose connective tissue was also found in the ventral body cavity, which appeared to be a vestigial gonad. In addition, the description of the gland also provides valuable empirical data for future research.
Is the Term “Savar” in the Babylonian Talmud Ever Used to Indicate an Opinion that Is Not Ultimately Rejected?
Authors: Sabato Mordechai
Published: January 2021

The term “savar” in the Babylonian Talmud indicates an opinion that is ultimately rejected. According to some Rishonim, however, in certain places this term introduces an opinion that is not rejected. This article examines these instances and concludes that indeed in these places the term “savar” is references an opinion that is not ultimately rejected. In most of these places, the reading in most of the textual witnesses was emended, and the word “savar” was erased, apparently in accordance with the other approach. In those places where the text was not emended, some of the commentators interpreted the passage not in accordance with its plain meaning, and, according to their interpretation, the opinion that was introduced by the “savar” was indeed rejected.
Reimagining the icc: Exploring Practitioners’ Perspectives on the Effectiveness of the International Criminal Court
Authors: Muhammad Samaria , Holá Barbora , Dirkzwager Anja
Published: January 2021

This exploratory study documents International Criminal Court (icc) personnel’s perspectives on the effectiveness of the icc. It examines practitioner views on the icc’s goals, strengths, weaknesses, and effectiveness. Interviews with nine professionals from the Office of the Prosecutor, Defense, and Chambers reveal several themes. Professionals agreed upon the icc’s greatest strengths: its foundation and its symbolic value. They also named common weaknesses, including its reliance on state cooperation, challenges in administrative functions, and, from the perspective of largely Defense personnel, an unfair disadvantage against the Defense. While personnel often agreed upon which factors needed improvement, they diverged on precisely how to improve them. However, they alluded to several potential paths forward. Interviews ultimately suggested the Court has several areas requiring improvement, but a solid foundation and considerable potential. These interviews coincide with ongoing reviews of the Court, providing a fuller picture of its effectiveness.
History with Feeling
Authors: Greenberg Susan L.
Published: January 2021

The Macmillan Company New York, led by the Bretts, was a major player in American life. But it had a secret: the company was majority owned by the London parent. As the US came to eclipse the UK, the arrangement led to growing tensions. Finally, in 1951, London was persuaded to sell its stake. But the UK firm found itself unable to use the family name for a new American venture, sparking a legal fight that lasted until 2002. This account of an important event in publishing history adds new detail from archival sources, supporting a fresh reading and correcting earlier errors. It also brings into view a significant amount of material that is published for the first time. The article argues that, although there were hard business reasons for the sale, cultural and personal factors were also consequential and these two types of agency, rational and emotional, work in interrelated ways.
Minecrafting Bar Mitzvah: Two Rabbis Negotiating and Cultivating Learner-Driven Inclusion through New Media
Authors: Gottlieb Owen
Published: January 2021

In 2013, a boy with special needs used the video game Minecraft to deliver the sermon at his bar mitzvah at a Reform synagogue, an apparently unique ritual phenomenon to this day. Using a narrative inquiry approach, this article examines two rabbis’ negotiations with new media, leading up to, during, and upon reflection after the event. The article explores acceptance, innovation, and validation of new media in religious practice, drawing on Campbell’s (2010) framework for negotiation of new media in religious communities. Clergy biography, philosophy, and institutional context all impact the negotiations with new media. By providing context of a set of factors influencing a particular negotiation and validation of a ritual and educational innovation using new media, the article intends to demonstrate the importance of clergy narrative for understanding new media negotiations in religious settings, and in particular in progressive religious communities
Judgements of the Duration of Auditory and Visual Stimuli
Authors: Wearden John H. , Jones Luke A.
Published: January 2021

Studies of judgements of the durations of filled auditory and visual stimuli were reviewed, and some previously unpublished data were analysed. Data supported several conclusions. Firstly, auditory stimuli have longer subjective durations than visual ones, with visual stimuli commonly being judged as having 80–90% of the duration of auditory ones. Secondly, the effect was multiplicative, with the auditory/visual difference increasing as the intervals became longer. Only a small number of exceptions to both these conclusions were found. Thirdly, differences in variability between judgements of auditory and visual stimuli derived from most procedures were small and sometimes not statistically significant, although differences almost always involved visual stimuli producing more variable judgements. Currently, the most viable explanation of the effects appears to be some sort of pacemaker-counter model with higher pacemaker speed for auditory stimuli, although this approach cannot, in its present form, deal quantitatively with all the findings usually obtained.
Species delimitation of Hymenasplenium obliquissimum group (Aspleniaceae) in southwestern China

Authors: ZHANG GUO-CHENG , HONG HUA-FENG , CHEN GE-HONG , LU SHU-GANG , CHANG YAN-FEN
Published: January 2021

The Hymenasplenium obliquissimum group contains the widespread H. obliquissimum and several geographically restricted species, including H. retusulum, H. wuliangshanense, H. latidens, H. changputungense, H. quercicola, H. szechuanense, H. furfuraceum, H. adiantifrons, and H. filipes. However, the taxonomy of this group is still unclear and needs to be revised because some entities were treated infraspecifically or as synonyms and the validation of some species still needs to be assessed. To formulate a natural classification and investigate the relationships in this group, we collected and studied specimens of species related to the H. obliquissimum group and obtained specimens of species described by Ching at their locus classicus in southwestern China. An integrative taxonomic approach was taken to delimit species in the group using cytological, morphological, and DNA sequence data. Specifically, in the phylogenetic analyses, the H. obliquissimum group was recovered as a monophyletic group, comprising five principal chloroplast lineages. Based on our inferences, we provided taxonomic implications of chloroplast lineages discovered in this study and suggested possible reticulate evolution in the H. obliquissimum group which was interpreted by the incongruence of chloroplast and nuclear phylogenies. Further studies to strengthen the taxonomic of taxa especially those with the co-existence of different ploidy levels are still warranted.
A correction to the Lepanthes guatemalensis group (Orchidaceae: Pleurothallidinae) in Costa Rica, with a new species

Authors: PUPULIN FRANCO
Published: January 2021

The true Lepanthes edwardsii is first recorded for the flora of Costa Rica, described and illustrated on the basis of a Costa Rican voucher. The taxon previously recorded under that name is described as new to science as Lepanthes bogariniana; it is closely related to L. edwardsii, L. durikäensis, and L. viquezii, but can be distinguished by the narrowly elliptic lateral sepals, the tails straight to curved inward, the lobes of the petals with rounded apices, the blades of the lip straight and not bent towards the lateral sepals, and the yellowish-white column.
Ardisia recurvisepala (Primulaceae-Myrsinoideae), a new species from Peninsular Malaysia
Authors: JULIUS AVELINAH , UTTERIDGE TIMOTHY M.A.
Published: January 2021

Ardisia recurvisepala Julius & Utteridge sp. nov. (Primulaceae-Myrsinoideae), a member of Ardisia subgenus Crispardisia on account of the vascularized leaf marginal glands, is herein described and illustrated as new species. The new species can be easily recognized by the elliptic-oblong calyx lobes recurving at the apex, and is also characterized by the narrowly elliptic to narrowly oblong-elliptic leaf laminas with an attenuate-decurrent base and acuminate-caudate apex. Ardisia recurvisepala is known so far from a single locality in Perak and its conservation status is assessed as Vulnerable (VU). An updated key to Ardisia subgenus Crispardisia in Peninsular Malaysia is provided.
A new genus and two new species of planthopper in the tribe Cenchreini (Hemiptera: Auchenorrhyncha: Derbidae) from lowland tropical rainforest in Costa Rica
Authors: BAHDER BRIAN W. , ECHAVARRIA MARCO A. ZUMBADO , BARRANTES EDWIN A. BARRANTES , HELMICK ERICKA E. , BARTLETT CHARLES R.
Published: January 2021

Recent survey work for planthoppers at La Selva Biological Station in Costa Rica found two new species allied with Cenchrea Westwood. The cytochrome c oxidase subunit I (COI) and 18S were sequenced for the new taxa and used these data to assess the genus-level standing of the new taxa. The new taxa do not cluster with Cenchrea dorsalis Westwood, the type species of Cenchrea. A new genus Tico gen. n. described for the reception of new species described as Tico emmettcarri sp. n. (the type species) and Tico pseudosororius sp. n. Cenchrea sororia Fennah is moved to Tico gen. n., to form the new combination Tico sororius (Fennah). Tico gen. n. is compared with allied genera, and review genus-level diagnostic features and the species composition of Cenchrea, which appears to be compositionally heterogenous, but additional data is needed to evaluate genus-level placement of most species.