bluuebunny/crossref_metadata_2025 huggingface dataset:
County-level variation in geographic access to Board Certified Behavior Analysts among children with Autism Spectrum Disorder in the United States
Authors: Yingling Marissa E , Ruther Matthew H , Dubuque Erick M , Mandell David S
Published: March 2021

This study examined variation in geographic access to Board Certified Behavior Analysts for children with autism spectrum disorder. Between March and May 2019, we integrated public data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. The study sample included all U.S. counties and county equivalents in 48 states and D.C. ( N = 3108). Using geographic information systems software, we assigned Board Certified Behavior Analysts to counties based on their residence, allocated children via school districts to counties, and generated per capita autism spectrum disorder/Board Certified Behavior Analyst ratios. We calculated the Getis-Ord G* statistics for each county and each ratio and compared counties in high-ratio clusters with counties in low-ratio clusters by socioeconomic variables. More than half of all counties had no Board Certified Behavior Analysts. Counties in the highest accessibility category had ⩽17.1 children with autism spectrum disorder per Board Certified Behavior Analyst ( n = 770), while counties in the lowest accessibility category had ⩾137.1 children with autism spectrum disorder per Board Certified Behavior Analyst ( n = 12). In all, 55 of the 129 counties with the highest autism spectrum disorder prevalence had no Board Certified Behavior Analysts. Higher accessibility counties were wealthier and had smaller uninsured populations. To improve geographic access, we must identify factors driving unequal distribution that can inform provider recruitment and retention efforts in underserved areas.

Lay abstract

This study looked at whether access to Board Certified Behavior Analysts for children with autism spectrum disorder is different between U.S. counties. The study included all U.S. counties and county equivalents in 48 states and D.C. ( N = 3108). Between March and May 2019, we combined data from the U.S. Department of Education’s Civil Rights Data Collection, Behavior Analyst Certification Board’s certificant registry, and U.S. Census. We assigned Board Certified Behavior Analysts to counties based on their address, matched children in school districts to counties, and determined how many children with autism spectrum disorder there were in a county compared with how many Board Certified Behavior Analysts there were in a county. The results show uneven numbers of Board Certified Behavior Analysts between U.S. counties. More than half of all counties had no Board Certified Behavior Analysts. National maps illustrate clusters of high and low accessibility to Board Certified Behavior Analysts. To improve access to Board Certified Behavior Analysts in underserved areas, we must identify what contributes to the differences in access.
What do the public really know about dementia and its risk factors?
Authors: Nagel Alana K , Loetscher Tobias , Smith Ashleigh E , Keage Hannah AD
Published: March 2021

Dementia has become a major public health concern globally. With no cure available and strong evidence for modifiable risk factors, it is imperative that the public are knowledgeable about dementia and to reduce their risk. The aim of this study was to measure the knowledge of dementia and its risk factors in the Australian public, as well as the number and type of information sources used. An online survey promoted through various social media platforms was completed by 596 Australian adults aged 18–78 years (59% aged 18–44 years; 78% female). Eighty-eight percent of respondents were able to recognise dementia from a vignette, more so from a moderate than from a mild symptom vignette. Only 19% of respondents had a good understanding of dementia, that is describing impairment in both cognition and function. Ninety-five percent of respondents recognised that genetics and old age contributed to a person getting dementia. However, respondents had poor knowledge of empirically supported modifiable risk factors, with most viewed as likely contributors to dementia at chance levels (50%) or below. Respondents reported using informal information sources more often than formal information sources to learn about dementia. The public appear to be able to recognise the symptoms of dementia but lack understanding of how dementia impacts both a person’s cognitive functioning and ability to perform everyday tasks. Furthermore, the public remain largely unaware of empirically supported modifiable risk factors that contribute to the development of dementia. It is imperative that the public are educated on how to access and evaluate dementia-related information sources in order to increase their knowledge and understanding of dementia.
Atypical Ulcerative Necrobiosis Lipoidica Diabeticorum: A Case Study
Authors: Blevins Maryellen
Published: March 2021

Necrobiosis lipoidica is a granulomatous skin condition commonly associated with diabetes. When associated with diabetes mellitus, the name expands to necrobiosis lipoidica diabeticorum (NLD). In these patients, this rare condition has an incidence rate of 0.3% to 1.6%. The cause of NLD remains unknown even though many speculations exist in the medical literature. The treatment of this condition has most researchers agreeing on the use of topical steroids for the anti-inflammatory effect on NLD; however, the role of glucose control in the treatment of this disorder has been debatable. The following case presents a patient who, despite better glucose control, did not improve until the introduction of doxycycline.
Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration
Authors: Ignat Mihaela , Pérouse Madeleine , Lefebvre François , Kadoche Deborah , Imperiale Alessio , Swanstrom Lee , Vix Michel , Mutter Didier
Published: March 2021

Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy—particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85–63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99–64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21–93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19–290.56%, P < 2.2 × 10−16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05–61.42%, P = 3.1 × 10−15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan ( P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy ( P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.
Assessing Laparoscopic Surgical Skills Using Similarity Network Models: A Pilot Study
Authors: Rastegari Elham , Orn Donovan , Zahiri Mohsen , Nelson Carl , Ali Hesham , Siu Ka-Chun
Published: March 2021

Background: Medical devices are becoming more complex, and doctors need to learn quickly how to use new medical tools. However, it is challenging to objectively assess the fundamental laparoscopic surgical skill level and determine skill readiness for advancement. There is a lack of objective models to compare performance between medical trainees and experienced doctors. Methods: This article discusses the use of similarity network models for individual tasks and a combination of tasks to show the level of similarity between residents and medical students while performing each task and their overall laparoscopic surgical skill level using a medical device (eg laparoscopic instruments). When a medical student is connected to most residents, that student is competent to the next training level. Performance of sixteen participants (5 residents and 11 students) while performing 3 tasks in 3 different training schedules is used in this study. Results: The promising result shows the general positive progression of students over 4 training sessions. Our results also indicate that students with different training schedules have different performance levels. Students’ progress in performing a task is quicker if the training sessions are held more closely compared to when the training sessions are far apart in time. Conclusions: This study provides a graph-based framework for evaluating new learners’ performance on medical devices and their readiness for advancement. This similarity network method could be used to classify students’ performance using similarity thresholds, facilitating decision-making related to training and progression through curricula.
Archeology of Abandoned Human Settlements in No Man’s Sky: A New Approach to Recording and Preserving User-Generated Content in Digital Games
Authors: Reinhard Andrew
Published: March 2021

This article presents the tools, methods, and findings of an archaeological survey, excavation, and ethnography of abandoned human settlements within a digital built environment. In 2016, Hello Games (Guildford, UK) released the game No Man’s Sky, set in a procedurally generated universe approximating the size of our own. Future game updates disrupted planetary climate and topography, forcing human players to abandon their homes and farms and relocate elsewhere. As an archaeologist, I was able to apply archaeological principles within a digital/human habitation while also investigating what became of the players and their constructions as well as their in-game community. This approach may well lend itself to efforts in the preservation of these digital environments, and especially for player-created content.
Localization of Brachial Plexopathies Using a Novel Diagnostic Program
Authors: Krishnan Karthik R. , Sneag Darryl B. , Feinberg Joseph H. , Lee Steve K. , Wolfe Scott W.
Published: March 2021

Background: Assessing the extent and specific location of brachial plexus injuries can be difficult given the variety of mechanisms of injury and anatomic complexity of the plexus. We developed a program to accurately assess the location of a patient’s neurologic injury based on electromyographic data. Purpose: We sought to test our hypothesis that the location of traumatic brachial plexopathies could be accurately assessed with a novel program that processed electromyogram (EMG) and mechanism of injury data. Methods: This retrospective diagnostic cohort study was carried out with a novel diagnostic algorithm developed with the Python programming language. The program accepts user input of muscles demonstrating decreased motor unit recruitment, positive sharp waves, or fibrillation potentials. The testing data set was derived from a registry of brachial plexus injuries treated at our center. The primary outcome was the percent concordance of the algorithm’s diagnosis with the surgical diagnosis. Results: Ninety-five cases met the inclusion criteria. Median time from injury onset to EMG examination was 4 months; median time from EMG examination to surgery was 1.2 months. The program diagnosis matched the surgical diagnosis in 92 out of 95 (97%) of cases, including cases with multilevel injuries and additional peripheral nerve injuries. Conclusion: This program accurately localized brachial plexopathies in nearly all cases, including those involving polytrauma or complex patterns of injury. This algorithm may be valuable as an aid to complete electrodiagnostic examinations, a diagnostic adjunct when planning treatment of severe plexus palsies, or an educational tool.
Magnetic levitation planar motor and its adaptive contraction backstepping control for logistics system
Authors: Wang Weiran , Yang Guanjun , Yan Jinghao , Ge Huilin , Zhi Pengfei
Published: March 2021

Magnetic levitation planar motor has the characteristics of no friction loss, fast dynamic response, and real-time change of transportation track according to the demand. Therefore, a kind of magnetic levitation planar motor based on logistics transportation system is designed, which can meet the transportation needs of the logistics system through any combination of unit modules. Firstly, based on the mechanical model of magnetic levitation float in Halbach permanent magnet array magnetic field, establishing the thrust and torque model of maglev float. Secondly, according to the force/current relationship, considering the influence of uncertain parameters and load disturbance on the system, the decoupling control model of six degree of freedom motion system of magnetic levitation planar motor is established. Thirdly the adaptive contraction backstepping (ACB) controller is derived that can eliminate the uncertain disturbance of the nonlinear model and realize the real-time control of the system. The simulation and experimental results demonstrate that the method has expected response speed, strong robustness, and good dynamic tracking performance. Applying it to the logistics transportation system described in this article and has a good control effect.
Inhibition of the phosphoinositide 3-kinase-AKT-cyclic GMP-c-Jun N-terminal kinase signaling pathway attenuates the development of morphine tolerance in a mouse model of neuropathic pain
Authors: Okerman Travis , Jurgenson Taylor , Moore Madelyn , Klein Amanda H
Published: March 2021

Research presented here sought to determine if opioid induced tolerance is linked to activity changes within the PI3Kγ-AKT-cGMP-JNK intracellular signaling pathway in spinal cord or peripheral nervous systems. Morphine or saline injections were given subcutaneously twice a day for five days (15 mg/kg) to male C57Bl/6 mice. A separate cohort of mice received spinal nerve ligation (SNL) one week prior to the start of morphine tolerance. Afterwards, spinal cord, dorsal root ganglia, and sciatic nerves were isolated for quantifying total and phosphorylated- JNK levels, cGMP, and gene expression analysis of Pik3cg, Akt1, Pten, and nNos1. This pathway was downregulated in the spinal cord with increased expression in the sciatic nerve of morphine tolerant and morphine tolerant mice after SNL. We also observed a significant increase in phosphorylated- JNK levels in the sciatic nerve of morphine tolerant mice with SNL. Pharmacological inhibition of PI3K or JNK, using thalidomide, quercetin, or SP600125, attenuated the development of morphine tolerance in mice with SNL as measured by thermal paw withdrawal. Overall, the PI3K/AKT intracellular signaling pathway is a potential target for reducing the development of morphine tolerance in the peripheral nervous system. Continued research into this pathway will contribute to the development of new analgesic drug therapies.
Automatic effects of covert practice
Authors: Liefooghe Baptist , Jim Ariane , De Houwer Jan
Published: March 2021

Automatic behaviour is supposedly underlain by the unintentional retrieval of processing episodes, which are stored during the repeated overt practice of a task or activity. In the present study, we investigated whether covertly practicing a task (e.g., repeatedly imagining responding to a stimulus) also leads to the storage of processing episodes and thus to automatic behaviour. Participants first either responded overtly or covertly to stimuli according to a first categorization task in a practice phase. We then measured the presence of automatic response-congruency effects in a subsequent test phase that involved a different categorization task but the same stimuli and responses. Our results indicate that covert practice can lead to a response-congruency effect. We conclude that covert practice can lead to automatic behaviour and discuss the different components of covert practice, such as motor imagery, visual imagery, and inner speech, that contribute to the formation of processing episodes in memory.
Autoimmune encephalopathies presenting as dementia of subacute onset and rapid progression
Authors: Banks Samantha A. , Sechi Elia , Flanagan Eoin P.
Published: March 2021

The terms autoimmune dementia and autoimmune encephalopathy may be used interchangeably; autoimmune dementia is used here to emphasize its consideration in young-onset dementia, dementia with a subacute onset, and rapidly progressive dementia. Given their potential for reversibility, it is important to distinguish the rare autoimmune dementias from the much more common neurodegenerative dementias. The presence of certain clinical features [e.g. facio-brachial dystonic seizures that accompany anti-leucine-rich-glioma-inactivated-1 (LGI1) encephalitis that can mimic myoclonus] can be a major clue to the diagnosis. When possible, objective assessment of cognition with bedside testing or neuropsychological testing is useful to determine the degree of abnormality and serve as a baseline from which immunotherapy response can be judged. Magnetic resonance imaging (MRI) head and cerebrospinal fluid (CSF) analysis are useful to assess for inflammation that can support an autoimmune etiology. Assessing for neural autoantibody diagnostic biomarkers in serum and CSF in those with suggestive features can help confirm the diagnosis and guide cancer search in paraneoplastic autoimmune dementia. However, broad screening for neural antibodies in elderly patients with an insidious dementia is not recommended. Moreover, there are pitfalls to antibody testing that should be recognized and the high frequency of some antibodies in the general population limit their diagnostic utility [e.g., anti-thyroid peroxidase (TPO) antibodies]. Once the diagnosis is confirmed, both acute and maintenance immunotherapy can be utilized and treatment choice varies depending on the accompanying neural antibody present and the presence or absence of cancer. The target of the neural antibody biomarker may help predict treatment response and prognosis, with antibodies to cell-surface or synaptic antigens more responsive to immunotherapy and yielding a better overall prognosis than those with antibodies to intracellular targets. Neurologists should be aware that autoimmune dementias and encephalopathies are increasingly recognized in novel settings, including post herpes virus encephalitis and following immune-checkpoint inhibitor use.
Tackling social inequalities in health: acceptability and feasibility of a systematic approach toward health impact assessment of urban projects
Authors: Bretagne Geneviève , Blanc-Février Jeanne , Lang Thierry
Published: March 2021

Introduction:

The general objective of this research project was to explore the feasibility and acceptability of an original method intended to systematically identify urban planning projects whose potential impacts on health and social inequalities in health (SIH) would be most damaging. An approach based on a short meeting and a tool would help to discuss whether or not to engage in a more comprehensive health impact assessment.

Methods:

A tool was developed by the research team based on various tools reported in the literature and modified with urban planners. Meetings were organized for each development project with the volunteer planners, who were working on the projects selected. Reviews of six projects at different stages of design made it possible to assess the acceptability and feasibility of this approach to identify public health and social equity issues in health.

Results:

The process and the use of the tool were found to be feasible. The tool was easily understandable, adapted to the practices of planners and usable without real training other than a quick introduction to tool usage. It was also found to be acceptable. Despite an interest in the inclusion of SIH, the integration of the relationship between SIH and urban development was not easy for most of the urban planners.

Conclusion:

This exploratory work suggests that a systematic approach to assessing the impact of urban projects on health and SIH is feasible and acceptable. Dealing with SIH was not found to be easy by the urban planners.
Clinical outcomes of liposomal irinotecan plus fluorouracil/leucovorin for metastatic pancreatic adenocarcinoma in patients previously treated with conventional irinotecan-containing chemotherapy
Authors: Bang Kyunghye , Cheon Jaekyung , Jeong Jae Ho , Im Hyeon-Su , Kim Kyu-pyo , Ryoo Baek-Yeol , Yoo Changhoon
Published: March 2021

Introduction:

Liposomal irinotecan (nal-IRI) plus fluorouracil/leucovorin (5-FU/LV) has shown clinical benefit in patients with metastatic pancreatic adenocarcinoma (mPAC) who progressed on gemcitabine-based chemotherapy. However, its role in patients with mPAC previously treated with conventional irinotecan-containing chemotherapy has not been appropriately investigated.

Methods:

In this retrospective analysis, patients with mPAC who received nal-IRI plus 5-FU/LV after conventional irinotecan-containing regimen between January 2017 and March 2020, were identified from two referral cancer centers in South Korea. The ratio of time to progression (TTP) with nal-IRI plus 5-FU/LV to TTP with conventional irinotecan (TTPr) was analyzed with respect to the duration and cumulative dose of conventional irinotecan treatment.

Results:

In total, 35 patients treated with nal-IRI plus 5-FU/LV after the irinotecan-containing regimen were analyzed. The median age was 58 years and 16 (46%) patients were male. The median duration of conventional irinotecan therapy was 4.6 months at a median cumulative dose of 1230 mg. The objective response rate of nal-IRI plus 5-FU/LV was 2.9%, and stable disease was achieved in 11 (31.4%) patients. During the median follow-up of 9.2 [95% confidence interval (CI): 7.8–10.5] months, the median progression-free survival (PFS) and overall survival (OS) were 2.0 (95% CI: 1.4–2.6) months and 4.4 (95% CI: 3.6–5.7) months, respectively. The 6-month PFS and OS rates were 16.3% and 37.5%, respectively. The median TTPr was 0.41 (range, 0.07–2.07), showing a negative correlation with the cumulative dose of prior irinotecan therapy (R = −0.37, p = 0.041). A tentative negative correlation between TTPr and duration of prior irinotecan therapy was observed ( R = −0.35, p = 0.062). The most common grade 3–4 toxicities were neutropenia (20%) and fatigue (8.6%).

Conclusion:

Nal-IRI plus 5-FU/LV showed modest effectiveness and manageable toxicities for patients with mPAC previously treated with conventional irinotecan-containing chemotherapy. The cumulative dose of prior conventional irinotecan therapy may be inversely correlated with the effectiveness of nal-IRI plus 5-FU/LV.
“Where is Our Space Within this Ivory Tower?” The Teaching Experiences of Black Women Faculty in Education Programs
Authors: Ferguson Tomika L. , Berry Risha R. , Collins Jasmine D.
Published: March 2021

Black women faculty represent a small percentage of full-time faculty in higher education and are often invisible, marginalized, and expected to perform duties beyond teaching, research, and service. Yet, their success in higher education positions them as possibility models for change on their campuses. The purpose of this study is to investigate the experiences of three Black women faculty who teach in graduate education programs. Specifically, we examined how teaching using culturally relevant practices may cause Black women faculty to negotiate their identity within higher education organizational structures. Using a theoretical framework informed by Black feminism and the Culturally Relevant Leadership Learning Model, three salient themes were identified: roles and responsibilities, resistance, and limitations within the academy. Implications for practice include the creation of identity specific support for Black women faculty and attention be given to faculty and student readiness prior to engaging in culturally relevant practices beyond critical self-reflection.
Thrombopoietin receptor agonist for treatment of immune thrombocytopenia in pregnancy: a narrative review
Authors: Agarwal Nikki , Mangla Ankit
Published: March 2021

The treatment of immune thrombocytopenia (ITP) in adults has evolved rapidly over the past decade. The second-generation thrombopoietin receptor agonists (TPO-RAs), romiplostim, eltrombopag, and avatrombopag are approved for the treatment of chronic ITP in adults. However, their use in pregnancy is labeled as category C by the United States Food and Drug Administration (FDA) due to the lack of clinical data on human subjects. ITP is a common cause of thrombocytopenia in the first and second trimester of pregnancy, which not only affects the mother but can also lead to thrombocytopenia in the neonatal thrombocytopenia secondary to maternal immune thrombocytopenia (NMITP). Corticosteroids, intravenous immunoglobulins (IVIGs) are commonly used for treating acute ITP in pregnant patients. Drugs such as rituximab, anti-D, and azathioprine that are used to treat ITP in adults, are labeled category C and seldom used in pregnant patients. Cytotoxic chemotherapy (vincristine, cyclophosphamide), danazol, and mycophenolate are contraindicated in pregnant women. In such a scenario, TPO-RAs present an attractive option to treat ITP in pregnant patients. Current evidence on the use of TPO-RAs in pregnant women with ITP is limited. In this narrative review, we will examine the preclinical and the clinical literature regarding the use of TPO-RAs in the management of ITP in pregnancy and their effect on neonates with NMITP.
Defining polypharmacy: in search of a more comprehensive determination method applied in a tertiary psychiatric hospital
Authors: Govaerts Jeroen , Boeyckens Julie , Lammens Astrid , Gilis Annelies , Bouckaert Filip , De Hert Marc , De Lepeleire Jan , Stubbs Brendon , Desplenter Franciska
Published: March 2021

Aims:

This cross-sectional pharmacoepidemiologic study examined the prevalence of polypharmacy and psychotropic polypharmacy among inpatients in a tertiary psychiatric hospital in Belgium.

Methods:

Current prescriptions of all inpatients suffering from mental disorders were extracted from the hospital Computerized Physician Order Entry. Two methods were used to examine definitive polypharmacy (defined as the concomitant use of at least five medicines): number of medicines per active component and per prescription. Psychotropic polypharmacy was defined as the concomitant use of at least two psychotropic medicines, based on the first counting, i.e., per active component.

Results:

In 292 included patients, the prevalence of definitive polypharmacy was 65.8%, with a mean number of 6.8 ± 4.2 medicines per patient. The most prevalent medicines were related to the central nervous system (55.7%), followed by medicines related to the gastro-intestinal (17.6%) and cardiovascular (9.4%) systems. A prevalence of psychotropic polypharmacy of 78.1% was observed, with a mean of 3.0 ± 1.7 psychotropic medicines per patient. Psychotropic polypharmacy was classified in same-class (71.5%), multi-class (82.5%), augmentation (20.6%), and adjuvant (35.5%) polypharmacy.

Conclusion:

These findings are consistent with previous reports of highly prevalent polypharmacy in patients with mental disorders. Although, in some cases, polypharmacy can be an important part of good clinical practice, the high prevalence of both polypharmacy and psychotropic polypharmacy emphasizes that attention must be paid to the potentially associated risks. Consensus on the definition and method of determination of polypharmacy is needed to support further research.
Computer assisted Doppler waveform analysis and ultrasound derived turbulence intensity ratios can predict early hyperplasia development in newly created vascular access fistula: Pilot study, methodology and analysis
Authors: Bartlett Matthew , Diaz-Zuccarini Vanessa , Tsui Janice
Published: March 2021

Objectives

Following surgical creation of arterio-venous fistulae (AVF), the desired outward remodeling is often accompanied by the development of neointimal hyperplasia (NIH), which can stymie maturation and may lead to thrombosis and access failure. The aim of this study was to investigate the feasibility of using a non-invasive test, to detect and quantify the turbulent flow patterns believed to be associated with NIH development.

Design

This was a prospective, observational study. Ultrasound derived turbulence intensity ratios (USTIR) were calculated from spectral Doppler waveforms, recorded from newly formed AVF, and were compared with haemodynamic and structural changes observed during the initial maturation period.

Setting

Measurements were obtained by accredited Clinical Vascular Scientists, at the Royal Free Hospital, London.

Participants

Patients with newly created AVF were invited to participate in the study. A total of 30 patients were initially recruited with 19 participants completing the 10 week study protocol.

Outcome measures

The primary outcome measure was the development of NIH resulting in a haemodynamically significant lesion. The secondary outcome was successful maturation of the AVF at 10 weeks.

Results

Elevated USTIR in the efferent vein 2 weeks post surgery corresponded to the development of NIH formation (P = 0.02). A cut off of 6.39% predicted NIH development with a sensitivity of 87.5% and a specificity of 80%.

Conclusion

Analysis of Doppler waveforms can successfully identify deleterious flow patterns and predict inward luminal remodelling in maturing AVF. We propose a longitudinal follow up study to assess the viability of this technique as a surveillance tool.
A novel investigation method for axonal damage in neuromyelitis optica spectrum disorder: In vivo corneal confocal microscopy
Authors: Altıntaş Ayşe , Yildiz-Tas Ayse , Yilmaz Sezen , Bayraktutar Betul N , Comert Melis Cansu , Zimmermann Hanna , Brandt Alexander U , Paul Friedemann , Sahin Afsun
Published: March 2021

Background

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory autoimmune disorder that damages optic nerves, brainstem, and spinal cord. In vivo corneal confocal microscopy (IVCM) is a noninvasive technique that provides corneal images with dendritic cells (DCs) and corneal subbasal nerve plexus (SBP), which arises from the trigeminal nerve.

Objective

We investigated corneal SBP changes in NMOSD and proposed IVCM as a potential new disease severity biomarker for NMOSD.

Methods

Seventeen age-sex matched NMOSD patients and 19 healthy participants underwent complete neurologic and ophthalmologic examinations. The duration of disease, first symptom, presence of optic neuritis attack, antibody status, Expanded Disability Status Scale(EDSS) score and disease severity score(DSS) were recorded. Retinal nerve fibre layer (RNFL) thickness was measured with optical coherence tomography, and corneal SBP images were taken with IVCM.

Results

NMOSD patients had significantly reduced corneal nerve fibre lenght-density and corneal nerve branch lenght-density compared with controls, while DC density was increased. NMOSD patients also showed significantly reduced RNFL thickness compared with controls. EDSS,DSS levels were inversely correlated with IVCM parameters.

Conclusion

We observed significant corneal nerve fibre loss in NMOSD patients in relation to disease severity. IVCM can be a candidate noninvasive imaging method for axonal damage assessment in NMOSD that warrants further investigation.
Translational Effect of Provider-Focused, Multi-State, Multi-Clinic Asthma Care Quality Improvement Program on Patient-Level Health Care Costs
Authors: Rojanasarot Sirikan , Carlson Angeline M. , St. Peter Wendy L. , Karaca-Mandic Pinar , Wolfson Julian , Schommer Jon C.
Published: March 2021

Introduction/Objectives:

Enhancing Care for Patients with Asthma (ECPA), a year-long provider-focused, multi-state, multi-clinic quality improvement program, decreased avoidable utilizations among patients with asthma, but its effects on health care expenditures were not determined. This study examined the translational and sustainable effects of improved care through ECPA on individual-level total health care costs due to asthma.

Methods:

We conducted a retrospective pretest-posttest quasi-experimental study in which attributed 1683 patients in a 12-month pre-ECPA implementation period served as their own control. We constructed the total annual asthma-related health care costs per patient occurred during pre-ECPA implementation, ECPA implementation, and post-ECPA completion. We used 3-level generalized linear mixed models (GLMMs) to estimate the ECPA effect on the annual health care costs and account for correlation between the repeated outcome measures for each patient and nested clinic. All costs were adjusted for inflation to 2014 U.S. dollars, the last year of program observation.

Results:

Total asthma-related health care costs among the 1683 included patients decreased from an average of $7033 to $3237 per person-year (pre-ECPA implementation vs implementation). Using the cost data from the 12-month pre-ECPA implementation period as a reference, GLMMs found that the ECPA implementation was associated with a reduction in total annual asthma-related health care costs by 56.4% (95% CI −60.7%, −51.8%). During the 12-months after ECPA completion period, health care costs were also found to be significantly lower, experiencing a 57.3% reduction.

Conclusions:

The economic benefits of ECPA provide a justification to adopt this quality improvement initiative to more primary care clinics at a national level.
Urban and Rural Income Gap: Does Urban Spatial Form Matter in China?
Authors: Liu Yong , Long Cuihong
Published: March 2021

This research uses satellite remote sensing data to measure the urban spatial form and analyzes the impact of changes to urban spatial structure on the income gap between urban and rural residents. The results indicate that the compactness of the urban spatial form is positively correlated with the income gap between urban and rural residents. However, there is no statistically significant relationship between the urban spatial extension rate and the urban–rural income gap. A subsequent analysis of the control variables shows that fiscal policy is positively correlated while urbanization is negatively correlated with the income gap between urban and rural residents. These conclusions provide the basis for formulating policies to narrow the urban–rural income gap. Appropriately reducing the spatial compactness of cities can narrow the income gap. In addition, changing excessive preferences for urban fiscal policy and increasing the level of urbanization can also promote a reduction in the income gap between urban and rural residents.
A Case of Renal Inflammatory Pseudotumor Leading to Nephrectomy
Authors: Tuan Linh Le , Minh Duc Nguyen , Tra My Thieu-Thi , Nhan Hien Phan , Ngoc Minh Tran , Van Lenh Bui
Published: March 2021

Inflammatory pseudotumor (IPT) of the kidney is a rare benign disorder with unknown etiology. In IPT patients, some nonspecific symptoms might present, such as fever, hematuria, and back pain. As it can appear on computed tomography and magnetic resonance imaging as a hypovascular mass with surrounding fat stranding, IPT can be misdiagnosed as a primary tumor. Since the clinical symptoms, radiographic features, and preoperative findings can be inconsistent, it is imperative to confirm IPT based on histopathological assessment. In the present study, we describe a case of renal IPT in a 13-year-old girl. The patient was treated with nephrectomy of the right kidney since the preoperative diagnosis was renal carcinoma. Pathological examination revealed an IPT. This article emphasizes the importance of preoperative definitive diagnosis in avoiding unnecessary nephrectomy.
Paget-Schroetter Syndrome in a Young Female
Authors: Sangani Vikram , Pokal Mytri , Balla Mamtha , Gayam Vijay , Konala Venu Madhav
Published: March 2021

Paget-Schroetter syndrome or effort thrombosis is a relatively rare primary spontaneous thrombosis of upper extremity deep veins secondary to entrapment of axillary subclavian veins from an abnormality of the thoracic outlet. It is commonly seen in young adults who lift heavy weights or strenuous use of the upper extremities during athletic activities. Repetitive microtrauma to the subclavian vein secondary to narrow costoclavicular space and strenuous activities leads to intimal layer inflammation, hypertrophy, fibrosis, and coagulation cascade activation. Management of Paget-Schroetter syndrome differs from the venous thrombosis of the lower extremity as treatment includes anticoagulation, thrombolysis, and surgical decompression. Early recognition and timely management are required to prevent significant disability from post-thrombotic syndrome and long-term morbidity from recurrent thromboembolism and pulmonary embolism. Internists and emergency physicians should be aware of the disease’s presentation, treatment options, and early referral to vascular surgeons since prompt initiation of appropriate treatment will have better outcomes than delayed treatment. We discussed a case of a 31-year-old female who lifts heavyweight at work, presented with right arm swelling and pain for 2 weeks, and diagnosed with axillary subclavian vein thrombosis secondary to thoracic outlet obstruction. She received a high-dose heparin drip followed by catheter-directed thrombolysis and underwent surgical decompression of axillary subclavian vein via resection of the first rib, subclavius muscle resection, partial anterior scalenectomy, and venolysis. In our review of the literature, randomized controlled studies lack the efficacy and safety of surgical decompression. However, the results are promising based on accumulated experience from vascular surgery experts and small case series. Extensive studies are needed further to delineate the protocol for the management of Paget-Schroetter syndrome.
Neuropsychiatric Symptoms by Cognitive Status for Mexican-Americans Aged 85 and Older
Authors: Vu Lan H. , Markides Kyriakos S. , Downer Brian
Published: March 2021

Few studies have investigated the relationship between neuropsychiatric symptoms (NPS) and cognitive status among older Mexican-American adults. Our objective was to describe the NPS of Mexican-Americans 85 years and older according to cognitive status. Data came from Wave 9 (conducted in 2016) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample consisted of 381 care recipients ≥85 years. The 12-item Neuropsychiatric Inventory was administered to measure NPS among care recipients. Cognitive impairment was defined as a score of ≤18 on the Mini Mental State Exam or by clinical diagnosis of dementia as reported by the caregiver. Logistic regression models were used to estimate the average marginal effect (range = –1 to 1) of cognitive impairment on NPS, controlling for care-recipient characteristics. Overall, 259 (68.0%) participants had one or more NPS. Approximately 87% of care recipients with cognitive impairment had at least one NPS compared to 55.8% of those without cognitive impairment ( p < .01). The predicted probability of having one or more NPS was 0.25% points (95% CI = 0.14–0.35) higher for participants with cognitive impairment than those without. NPS are present in the majority of very old Mexican American adults, particularly in those with cognitive impairment.
Improved Metal Oxide Electrode for CIGS Solar Cells: The Application of an AgOX Wetting Layer
Authors: Neugebohrn Nils , Osterthun Norbert , Götz-Köhler Maximilian , Gehrke Kai , Agert Carsten
Published: March 2021

Oxide/metal/oxide (OMO) layer stacks are used to replace transparent conductive oxides as front contact of thin-film solar cells. These multilayer structures not only reduce the overall thickness of the contact, but can be used for colouring of the cells utilizing interference effects. However, sheet resistance and parasitic absorption, both of which depend heavily on the metal layer, should be further reduced to reach higher efficiencies in the solar cells. In this publication, AgOX wetting layers were applied to OMO electrodes to improve the performance of Cu(In,Ga)Se2 (CIGS) thin-film solar cells. We show that an AgOX wetting layer is an effective measure to increase transmission and conductivity of the multilayer electrode. With the presented approach, we were able to improve the short-circuit current density by 18% from 28.8 to 33.9 mA/cm2 with a metal (Ag) film thickness as low as 6 nm. Our results highlight that OMO electrodes can be an effective replacement for conventional transparent conductive oxides like aluminium-doped zinc oxide on thin-film solar cells.
Identification of a bridge-specific intramolecular exciton dissociation pathway in donor–π–acceptor alternating conjugated polymers
Authors: Jiao Zhaoyong , Jiang Tingting , Zhou Zhongpo , Qin Chaochao , Long Jinyou , Liu Yufang , Jiang Yuhai
Published: March 2021

Intramolecular exciton dissociation is critical for high efficient mobile charge carrier generations in organic solar cells. Yet despite much attention, the effects of π bridges on exciton dissociation dynamics in donor–π–acceptor (D-π-A) alternating conjugated polymers remain still unclear. Here, using a combination of femtosecond time-resolved transient absorption (TA) spectroscopy and steady-state spectroscopy, we track ultrafast intramolecular exciton relaxation dynamics in three D-π-A alternating conjugated polymers which were synthesized by Qin's group and named HSD-A, HSD-B, HSD-C. It is found that the addition of thiophene unit as π bridges will lead to the red shift of steady-state absorption spectrum. Importantly, we reveal the existence of a new intramolecular exciton dissociation pathway mediated by a bridge-specific charge transfer (CT′) state with the TA fingerprint peak at 1200 nm in π-bridged HSD-B and HSD-C. This CT′ state results in higher electron capture rates for HSD-B and HSD-C as compared to HSD-A. Depending on the proportion of CT′ state and nongeminate recombination are important step for the understanding of high power conversion efficiencies in HSD-B than in HSD-C. We propose that this bridge-specific exciton dissociation pathway plays an important role in ultrafast intramolecular exciton dissociation of organic photovoltaic material D-π-A alternating conjugated polymers.
Early behavioral and physiological markers of social anxiety in infants with fragile X syndrome
Authors: Black Conner J. , Hogan Abigail L. , Smith Kayla D. , Roberts Jane E.
Published: March 2021

Background

Social anxiety is highly prevalent in neurotypical children and children with fragile X syndrome (FXS). FXS is a genetic syndrome that is characterized by intellectual disability and an increased risk for autism spectrum disorder. If social anxiety is left untreated, negative outcomes are highly prevalent later in life. However, early detection of social anxiety is challenging as symptoms are often subtle or absent very early in life. Given the prevalence and impairment associated with childhood social anxiety, efforts have accelerated to identify risk markers of anxiety. A cluster of early features of anxiety have been identified including elevated behavioral inhibition, attentional biases, and physiological dysregulation that index early emerging markers of social anxiety. Infants with FXS provide a unique opportunity to study the earlier predictors of social anxiety. The current study utilized a multi-method approach to investigate early markers of social anxiety in 12-month-old infants with FXS.

Method

Participants included 32 infants with FXS and 41 low-risk controls, all approximately 12 months old. Parent-reported social behavioral inhibition was recorded from the Infant Behavior Questionnaire (IBQ-R). Direct observations of behavioral inhibition and attention were measured during a stranger approach task with respiratory sinus arrhythmia collected simultaneously.

Results

Parent-reported social behavioral inhibition was not significantly different between groups. In contrast, direct observations suggested that infants with FXS displayed elevated behavioral inhibition, increased attention towards the stranger, and a blunted respiratory sinus arrhythmia response.

Conclusions

Findings suggest that infants with FXS show both behavioral and physiological markers of social anxiety at 12 months old using a biobehavioral approach with multiple sources of input. Results highlight the importance of a multi-method approach to understanding the complex early emergent characteristics of anxiety in infants with FXS.
RETRACTED ARTICLE: Light Harvesting-like Protein 3 Interacts with Phytoene Synthase and Is Necessary for Carotenoid and Chlorophyll Biosynthesis in Rice
Authors: Yang Feng , Debatosh Das , Song Tao , Zhang Jian-hua
Published: March 2021

Background

Carotenoid biosynthesis is essential for the generation of photosynthetic pigments, phytohormone production, and flower color development. The light harvesting like 3 (LIL3) protein, which belongs to the light-harvesting complex protein family in photosystems, interacts with geranylgeranyl reductase (GGR) and protochlorophyllide oxidoreductase (POR) both of which are known to regulate terpenoid and chlorophyll biosynthesis, respectively, in both rice and Arabidopsis.

Results

In our study, a CRISPR-Cas9 generated 4-bp deletion mutantoslil3showed aberrant chloroplast development, growth defects, low fertility rates and reduced pigment contents. A comparative transcriptomic analysis ofoslil3suggested that differentially expressed genes (DEGs) involved in photosynthesis, cell wall modification, primary and secondary metabolism are differentially regulated in the mutant. Protein-protein interaction assays indicated that LIL3 interacts with phytoene synthase (PSY) and in addition the gene expression ofPSYgenes are regulated byLIL3. Subcellular localization of LIL3 and PSY suggested that both are thylakoid membrane anchored proteins in the chloroplast. We suggest that LIL3 directly interacts with PSY to regulate carotenoid biosynthesis.

Conclusion

This study reveals a new role of LIL3 in regulating pigment biosynthesis through interaction with the rate limiting enzyme PSY in carotenoid biosynthesis in rice presenting it as a putative target for genetic manipulation of pigment biosynthesis pathways in crop plants.