bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal staffing in community health centers to improve quality of care
Authors: Luo Qian , Dor Avi , Pittman Patricia
Published: October 2020

Objective

To explore optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services.

Data Sources

We linked the Uniform Data System from 2014 to 2016 with Internal Revenue Service nonprofit tax return data. The final database contained 3139 center‐year observations from 1178 CHCs.

Study Design

We estimated a system of two generalized linear production functions, with quality of care and volume of services as outputs, using the average percent of diabetic patients with controlled A1C level and hypertensive patients with controlled blood pressure as quality measures. To explore the substitutability and complementarity between staffing categories, we estimated a revenue function.

Findings

Primary care physicians and advanced practice clinicians achieve similar quality outcomes (3.2 percent and 3.0 percent improvement in chronic condition management per full‐time equivalent (FTE), respectively). Advanced practice clinicians generate less revenue per FTE but are generally less costly to employ.

Conclusion

As quality incentives are further integrated into payment systems, CHCs will need to optimize their workforce configuration to improve quality. Given the relative efficiency of advanced practice clinicians in producing quality, further hiring of these professionals is a cost‐effective investment for CHCs.
Effect of inlet temperature on the physicochemical properties of spray‐dried seed‐watermelon seed protein powder
Authors: Cao Chengxu , Zhao Xiaoyan , Zhang Chao , Ding Zhenzhen , Sun Fenglin , Zhao Chunyan
Published: October 2020

Here, we studied the effects of inlet temperature on the physicochemical properties of the hydrolyzed protein (seed‐watermelon seed hydrolyzed protein [SWSP]) powder in seed‐watermelon seeds. The inlet temperature of the study was in the range of 150 to 180 °C, and the remaining experimental parameters remained constant, that is, the feed flow rate was 0.2 L/hr, the concentration of maltodextrin was 30%, and the outlet temperature was 80 °C. We studied the water activity and moisture content, bulk density, flowability (Carr index and Hausner ratio), angle of repose, solubility, color, hygroscopicity, powder morphology, particle size, crystallinity, and odor of the sample. Inlet temperature of 170 to 180 °C reduced the moisture content and increased the particle size. It was found that the value of measured water activity was less than 0.5, which helped in maintaining stability of the sample. Powders produced at the temperatures showed smoother particle surfaces, whereas higher inlet temperature showed spherical particles with some shrinkage as analyzed by scanning electron microscope. The inlet temperature affected the color of the sample, thus at high temperature, the sample had a brighter color. The sample was approximately 18% crystalline. At a preparation temperature of 160 °C, the sample showed significant antioxidant activity (P < 0.05).
Encapsulation of pea protein in an alginate matrix by cold set gelation method and use of the capsules in fruit juices
Authors: Narin Ceren , Ertugrul Ulku , Tas Ozan , Sahin Serpil , Oztop Mecit Halil
Published: October 2020

Plant‐based proteins gained importance in recent years due to the increase in the awareness of healthy diet and in the consumption of plant‐based foods. However, some features of plant‐based proteins like the undesirable odor and flavor affect the sensorial properties of protein containing foods. Therefore, encapsulation of these proteins could be a good strategy to tackle with this problem. The objective of this study was to design microcapsules (beads) consisting of pea protein by using sodium alginate and to investigate the effect of different alginate concentrations (1.0, 1.5, and 2.0%) on the protein content, encapsulation efficiency, particle size, bead stability, and the morphology of the capsules and then add them to different fruit juices (pomegranate and melon) and examine the release behavior from the capsules. Rheological behavior of the juices including pectin were also investigated. TD‐ nuclear magnetic resonance relaxometry analysis through T2 relaxation times was conducted on the capsules to observe the changes in the beads. In conclusion, alginate was found to be a suitable encapsulation coating for pea protein. Beads containing 1% alginate concentration was found to be the most effective with respect to protein content and bead stability.

Practical Application

This study aims to design and characterize pea protein containing microcapsules capsules and their utilization in fruit juices. The study itself focused on a specific application on the fruit juices.
The thermal, rheological, and structural characterization of grapeseed oil oleogels structured with binary blends of oleogelator
Authors: Choi Kyeong‐Ok , Hwang Hong‐Sik , Jeong Sungmin , Kim Sanghoon , Lee Suyong
Published: October 2020

Combination of oleogelators has recently started to receive scientific attention since single oleogelator may not adequately compensate for the diverse roles of solid fat in a complicated food system. In this study, grapeseed oil oleogels were prepared with candelilla wax (CDW) and glyceryl monostearate (GMS) blends at varying mass ratios (100:0, 75:25, 50:50, 25:75, and 0:100 [w/w]), and their physicochemical characteristics were characterized in terms of thermal, rheological, and microstructural properties. The oleogel with CDW and GMS at a blending ratio of 75 and 25 (CDW‐75:GMS‐25) exhibited the lowest melting point, implying a eutectic behavior. The CDW‐75:GMS‐25 oleogel also had a harder texture, greater viscoelasticity, and lower oiling‐off characteristics that were highly attributed to its small crystals and dense structural network observed from phase‐contrast microscopic images. When GMS from different vendors were examined for melting behavior and hardness of oleogels, it was found that the oleogel properties were highly dependent on the detailed composition of GMS. NMR study showed that the ternary system of CDW, glyceryl 1‐monostearate, and glyceryl 1,3‐distearate was responsible for the eutectic behavior of the CDW‐75:GMS‐25 oleogel. This study reports the unique and improved melting and physical properties of oleogels with the mixture of CDW and GMS, which can increase the feasibility of the oleogel technology in actual food products. However, caution should be taken in selecting the oleogelators because their detailed composition and properties can vary depending on sources and processing conditions.

Practical Application

Increasing attention has been paid to the combination of oleogelators since single oleogelator may not adequately compensate for the diverse roles of solid fat in a complicated food system. This study showed new eutectic characteristics at a specific blending ratio of candelilla wax and glyceryl monostearate that could be positively correlated with the increased hardness, viscoelasticity, and oiling‐off features. The results may encourage the food industry to utilize this binary oleogelator blend as an alternative to solid fat high in saturated fat by providing new functional properties.
Chinese registry of rheumatoid arthritis (CREDIT): III. The transition of disease activity during follow‐ups and predictors of achieving treatment target
Authors: Xiang Yirong , Wang Qian , Li Hongbin , Duan Xinwang , Fang Yongfei , Yang Pingting , Li Qin , Wu Rui , Huo Yuehong , Shi Xiaofei , Wu Zhenbiao , Wang Yanhong , Jiang Nan , Hsieh Evelyn , Li Mengtao , Tian Xinping , Zeng Xiaofeng ,   Chinese Registry of Rheumatoid Arthritis co‐authors
Published: October 2020

Aim

The Chinese Registry of Rheumatoid Arthritis (CREDIT) is the first nationwide multi‐center prospective rheumatoid arthritis (RA) registration cohort in China. This study aimed at presenting disease activities transition during follow‐ups and identifying predictors to treatment response.

Method

Patients who had baseline, 3‐ and 6‐month follow‐up data from November 2016 to April 2018 were recruited. Then, we selected patients who did not reach remission (REM)/low disease activity (LDA) at baseline to investigate the predictors for treatment response.

Results

There were 979 patients included (83.00% female, mean age 51.8 and median duration 3.84 years). REM/LDA rate at baseline, 3‐, and 6‐month follow‐up were 34.02%, 59.35% and 68.23%. Additionally, early RA has more chance to achieve targets than established RA (6 months: 59.79% vs 48.13%, P = .002). High baseline Disease Activity Score of 28 joints (DAS28) (early RA: odds ratio [OR] 1.319, P = .019; established RA: OR 1.337, P < .001), biologic disease‐modifying anti‐rheumatic drugs (bDMARD)/targeted synthetic DMARD combined conventional DMARD therapy (early RA: OR 9.023, P = .046) and prednisolone usage (early RA: OR 2.526, P < .001) are positively associated with Clinical Disease Assessment Index (CDAI) decreasing at 3 months. Low baseline DAS28 (REM/LDA: early RA: OR 0.650, P < .001; established RA: OR 0.612, P < .001. REM: early RA: OR 0.743, P = .021; established RA: OR 0.674, P < .001), young age (REM: early RA: OR 0.977, P = .048) and decrease of CDAI at 3 months (REM/LDA: early RA: OR 7.185, P < .001; established RA: OR 8.752, P < .001. REM: early RA: OR 5.602, P < .001; established RA: OR 4.955, P < .001) predict REM/LDA at 6 months.

Conclusion

Disease activity decreased during follow‐ups. Disease duration, baseline disease activity, age, treatment strategies, and CDAI decreasing were associated with treatment response.
actel: Standardised analysis of acoustic telemetry data from animals moving through receiver arrays
Authors: Flávio Hugo , Baktoft Henrik
Published: October 2020

Acoustic telemetry data often contain erroneous detections, which need to be addressed before further analysis. It is important that this process is systematic, standardised and reproducible.

The r package actel provides a systematic conditional pipeline to filter and analyse acoustic telemetry data in a reproducible fashion, for animals moving between receiver arrays.

actel outputs a standardised report containing the main results and the steps taken by the user, in addition to summary information for each animal and other content such as efficiency estimations for each receiver array.

actel improves the reproducibility of the acoustic data filtering and analysis, and simplifies the integration of acoustic data sets originating from different studies (in time and/or in space).
Functional limb anatomy in a refugee species: The endangered Patagonian huemul deer (Hippocamelus bisulcus)
Authors: Flueck Werner T.
Published: October 2020

Early naturalists already considered huemul rare, refuged and a stocky, short‐legged mountain deer, 163 years before declared endangered (1972). Anatomically, huemul do not overlap with rock‐climbers previously considered analogous, as corroborated in this paper by including additional huemul cases. Assertions that population declines are caused principally via livestock infections remain unfounded. Instead, osteopathology in multiple populations across 1,000 km, affecting 57% among dead and 86% among live specimens, may relate to micronutrient deficiencies. Historically classified a mountain deer, widespread osteopathology, micronutrient deficiencies and lack of recovery qualify huemul as a refugee species. Recovery strategies thus must include repopulating historical distribution sites.
Work Is Love Made Visible: A Meditation on Grace
Authors: Wishloff Jim
Published: October 2020

How work is understood and undertaken is a function of particular philosophical and theological assumptions. A meditation on work from the perspective of Catholic social thought must begin with the key articles of the Christian faith, namely, belief in the Trinity and belief in the Incarnation. Human dignity is profoundly grounded in this divine reality. Human persons are made in the image of a triune God and are given a particular vocation to fulfill. The Christian life is a summons to perfect love. Christians are called to love God above all things and to love all others and all of creation for the sake of God. God’s grace elevates Christian disciples to a new level of being, providing them with the supernatural help they need to be co‐creators with him. This mandate is specified more finely by examining the specific commands Jesus gives as to the work that must be done. Jesus sends his followers to reproduce and take care of creation, to be holy, to bear fruit that will last, to meet the needs of the most vulnerable, and to evangelize. In this way, the political economic order is formed according to God’s plan for the world and takes a considerably different shape from the structures that arise from dominant secular premises.
Assessment of current follow‐up for complete molar pregnancies: A single centre review
Authors: Mylvaganam Gaithri , Allanson Emma , Allanson Ben , Philp Shannon , Pather Selvan , Farrell Rhonda , Carter Jonathan , Tejada‐Berges Trevor
Published: October 2020

Background

Current guidelines recommend that resolution of a complete molar pregnancy (CMP) can only be confirmed once a negative β‐human chorionic gonadotropin (β‐hCG) has been maintained for six months following uterine surgical evacuation. However, multiple studies have found that the risk of developing gestational trophoblastic neoplasia (GTN) once a negative β‐hCG had been obtained is negligible, which suggests that a shorter follow‐up may be reasonable.

Aim

To determine the trend in β‐hCG following diagnosis of a CMP and the incidence of GTN, in a single unit.

Materials and Methods

All patients presenting to the tertiary hospital, Royal Prince Alfred Hospital Early Pregnancy Assessment Service (RPAH EPAS), with a histopathological diagnosis of a CMP between 2010 and 2017 were included. Data collected included age, parity, β‐hCG at diagnosis, subsequent β‐hCG levels, incidence of GTN and treatment required.

Results

Sixty‐seven patients were diagnosed with CMP between January 2010 and July 2017 through RPAH EPAS. The mean age of women diagnosed with a CMP was 33 years. None of the 40 patients who spontaneously achieved a negative β‐hCG and completed their six months follow‐up had a subsequent rise in β‐hCG. The median number of days from surgical evacuation to normalisation of β‐hCG was 55.5 days. Sixteen out of 67 patients who had a CMP required further management for persistent GTN. None of these patients achieved a negative β‐hCG prior to further management.

Conclusions

Consideration could be made to decreasing the period of β‐hCG monitoring for women who achieve a spontaneous negative β‐hCG following surgical evacuation of a CMP.
Development of a computational simulator of the extracorporeal membrane oxygenation and its validation with in vitro measurements
Authors: Colasanti Simona , Piemonte Vincenzo , Devolder Emmanuel , Zieliński Krzysztof , Vandendriessche Katrien , Meyns Bart , Fresiello Libera
Published: October 2020

In the recent years, the use of extracorporeal membrane oxygenation (ECMO) has grown substantially, posing the need of having specialized medical and paramedical personnel dedicated to it. Optimization of the therapy, definition of new therapeutic strategies, and ECMO interaction with the cardiorespiratory system require numerous specific skills and preclinical models for patient successful management. The aim of the present work is to develop and validate a computational model of ECMO and connect it to an already existing lumped parameter model of the cardiorespiratory system. The ECMO model was connected between the right atrium and the aorta of the cardiorespiratory simulator. It includes a hydraulic module that is a representation of the tubing, oxygenator, and pump. The resulting pressures and flows within the ECMO circuit were compared to the measurements conducted in vitro on a real ECMO. Additionally, the hemodynamic effects the ECMO model elicited on the cardiorespiratory simulator were compared with experimental data taken from the literature. The comparison between the hydraulic module and the in vitro measurements evidenced a good agreement in terms of flow, pressure drops across the pump, across the oxygenator and the tubing (maximal percentage error recorded was 17.6%). The hemodynamic effects of the ECMO model on the cardiovascular system were in agreement with what observed experimentally in terms of cardiac output, systemic pressure, pulmonary arterial pressure, and left atrial pressure. The ECMO model we developed and embedded into the cardiorespiratory simulator, is a useful tool for the investigation of basic physiological mechanisms and principles of ECMO therapy. The model was sided by a user interface dedicated to training applications. As such, the resulting simulator can be used for the education of students, medical and paramedical personnel.
Cranial morphology of the Stellate Sturgeon, Acipenser stellatus Pallas 1771 (Acipenseriformes, Acipenseridae), with notes on the skulls of other sturgeons
Authors: Hilton Eric J. , Dillman Casey B. , Paraschiv Marian , Suciu Radu
Published: October 2020

Extant members of Acipenseridae are generally classified in four genera: Scaphirhynchus, Pseudoscaphirhynchus, Huso and “Acipenser,” which is widely recognized to be paraphyletic. Advances have been made in understanding the systematic relationships among sturgeons based on both morphological and molecular data. Analysis of mitochondrial DNA data suggested that Pseudoscaphirhynchus should be regarded as nested within “Acipenser,” specifically as sister group to the Stellate Sturgeon, A. stellatus. Recent morphological analyses also recovered this relationship, supported by a number of osteological synapomorphies, although these results were based on few and relatively small individuals. Here we describe the anatomy of the skull of A. stellatus based on newly prepared specimens of adult individuals, as well as examination of a large number of preserved individuals representing a broad range of ontogenetic stages. We present new anatomical data from all regions of the skull (dermatocranium, neurocranium, viscerocranium) and offer interpretations of these and other characters. In particular, we describe the allometry in the snout of A. stellatus, which undergoes substantial elongation relative to other sturgeons. Aspects of the skull of A. stellatus are compared to other members of the family, specifically the course of the occipital sensory canal and the morphology and distribution of cranial spines.
Modeling sparse longitudinal data on Riemannian manifolds
Authors: Dai Xiongtao , Lin Zhenhua , Müller Hans‐Georg
Published: October 2020

Modern data collection often entails longitudinal repeated measurements that assume values on a Riemannian manifold. Analyzing such longitudinal Riemannian data is challenging, because of both the sparsity of the observations and the nonlinear manifold constraint. Addressing this challenge, we propose an intrinsic functional principal component analysis for longitudinal Riemannian data. Information is pooled across subjects by estimating the mean curve with local Fréchet regression and smoothing the covariance structure of the linearized data on tangent spaces around the mean. Dimension reduction and imputation of the manifold‐valued trajectories are achieved by utilizing the leading principal components and applying best linear unbiased prediction. We show that the proposed mean and covariance function estimates achieve state‐of‐the‐art convergence rates. For illustration, we study the development of brain connectivity in a longitudinal cohort of Alzheimer's disease and normal participants by modeling the connectivity on the manifold of symmetric positive definite matrices with the affine‐invariant metric. In a second illustration for irregularly recorded longitudinal emotion compositional data for unemployed workers, we show that the proposed method leads to nicely interpretable eigenfunctions and principal component scores. Data used in preparation of this article were obtained from the Alzheimer's Disease Neuroimaging Initiative database.
A close‐up comparison of the misclassification error distance and the adjusted Rand index for external clustering evaluation
Authors: Chacón José E.
Published: October 2020

The misclassification error distance and the adjusted Rand index are two of the most common criteria used to evaluate the performance of clustering algorithms. This paper provides an in‐depth comparison of the two criteria, with the aim of better understand exactly what they measure, their properties and their differences. Starting from their population origins, the investigation includes many data analysis examples and the study of particular cases in great detail. An exhaustive simulation study provides insight into the criteria distributions and reveals some previous misconceptions.
Permeability of Neotropical agricultural lands to a key native ungulate—Are well‐connected forests important?
Authors: Jorge Maria Luisa S. P. , Bradham Jennifer L. , Keuroghlian Alexine , Oshima Júlia Emi F. , Ribeiro Milton Cezar
Published: October 2020

Much of what remains of the Earth's tropical forests is embedded within agricultural landscapes, where forest is reduced and fragmented. As native forest ungulates are critical to maintaining forest function, it is imperative to understand how this functional group responds to declines in forest cover and connectivity resulting from agricultural expansion. We addressed this issue by evaluating selection of forest cover and forest connectivity by a key native ungulate of Neotropical forests, the white‐lipped peccary (Tayassu pecari Link 1795, Tayassuidae, Cetartiodactyla), in agricultural landscapes of Brazil. We evaluated selection using compositional analysis at two hierarchical levels, landscape, and home range. From 2013 to 2019, we GPS‐tracked eight white‐lipped peccary herds in Southwest Brazil, resulting in a total of 14,460 GPS locations. We found that herds can live in landscapes with a wide range of forest cover (35%–81% of home ranges covered by native forest), with significant, but not strong, selection at the landscape level (p = .045). Nevertheless, herds strongly select for forest cover within their home ranges (81%–97% of locations within native forest; highly significant selection at the home‐range level: p = .008). As for connectivity, herds significantly select the largest, most connected forest fragments at the landscape level (p = .04), but not at the home‐range level (p = .07). Our results support that Neotropical forests within agricultural landscapes need to be well connected in order to preserve this key native ungulate and maintain long‐term forest function.

Abstract in Portuguese is available with online material.
Radiological and histological evaluation of horizontal ridge augmentation using corticocancellous freeze‐dried bone allograft with and without autogenous bone: A randomized controlled clinical trial
Authors: Hashemipoor Mahtab , Asghari Najmeh , Mohammadi Mohammad , Kalantari Mahsa , Arabsolghar Mohaddese , Ranjbar Hadi
Published: October 2020

Purpose

The purpose of this study was radiological and histological evaluation of horizontal ridge augmentation using corticocancellous freeze‐dried bone allograft (FDBA) with and without autogenous bone (AB).

Materials and methods

The present research was conducted on 42 patients (27 females and 15 males) with insufficient width of edentulous ridge. The patients were randomly assigned into two groups, FDBA alone + collagen membrane (n = 21) and the combined FDBA and AB + collagen membrane (n = 21). The horizontal alveolar ridge dimensions were measured using cone‐beam computerized tomography before and 6 months after alveolar ridge augmentation. At the time of insertion of implants, biopsy of new bone was taken from 11 patients in each group and was analyzed histologically. The obtained data were statistically analyzed with paired t test and two‐sample t test. The registration number was IRCT201109165305N3.

Results

The mean ± SD ridge width gain after 6 months at the distance of 0, 2, 4, and 6 mm from crest of alveolar ridge was 2.78 ± 1.44, 3.05 ± 1.21, 2.82 ± 1.62, and 2.23 ± 1.95 mm in the FDBA group and 2.40 ± 1.60, 3.10 ± 1.80, 3.60 ± 1.87, and 2.65 ± 2.39 mm in the combined group, respectively, which was statistically significant in both groups using paired t test (P < .001). However, the difference between two groups analyzed by two‐sample t test was not statistically significant (P > .05). Amount of new bone generation, remained particles, and connective tissue was not statistically different between two groups (P = .367, P = .428, and P = .598, respectively).

Conclusion

Based on the results of this study, corticocancellous FDBA granules along with collagen membrane can successfully be used for horizontal augmentation of edentulous ridge, and adding AB to the granules of FDBA does not significantly increase the quality and quantity of regenerated bone.
Applying a values‐based decision process to facilitate comanagement of threatened species in Aotearoa New Zealand
Authors: McMurdo Hamilton Thalassa , Canessa Stefano , Clark Katie , Gleeson Pani , Mackenzie Fiona , Makan Troy , Moses‐Te Kani Gena , Oliver Shona , Parker Kevin A. , Ewen John G.
Published: October 2020

Ko koe ki tēnā, ko ahau ki tēnai kīwai o te kete (you at that, and I at this handle of the basket). This Māori (New Zealanders of indigenous descent) saying conveys the principle of cooperation—we achieve more through working together, rather than separately. Despite decades of calls to rectify cultural imbalance in conservation, threatened species management still relies overwhelmingly on ideas from Western science and on top‐down implementation. Values‐based approaches to decision making can be used to integrate indigenous peoples’ values into species conservation in a more meaningful way. We used such a values‐based method, structured decision making, to develop comanagement of pekapeka (Mystacina tuberculata) (short‐tailed bat) and tara iti (Sternula nereis davisae) (Fairy Tern) between Māori and Pākehā (New Zealanders of European descent). We implemented this framework in a series of workshops in which facilitated discussions were used to gather expert knowledge to predict outcomes and make management recommendations. For both species, stakeholders clearly stated their values as fundamental objectives from the start, which allowed alternative strategies to be devised that naturally addressed their diverse values, including mātauranga Māori (Māori knowledge and perspectives). On this shared basis, all partners willingly engaged in the process, and decisions were largely agreed to by all. Most expectations of conflicts between values of Western science and Māori culture were unfounded. Where required, positive compromises were made by jointly developing alternative strategies. The values‐based process successfully taha wairua taha tangata (brought both worlds together to achieve the objective) through codeveloped recovery strategies. This approach challenges the traditional model of scientists first preparing management plans focused on biological objectives, then consulting indigenous groups for approval. We recommend values‐based approaches, such as structured decision making, as powerful methods for development of comanagement conservation plans between different peoples.
The epidemic of contact allergy to methylisothiazolinone—An analysis of Danish consecutive patients patch tested between 2005 and 2019
Authors: Havmose Martin , Thyssen Jacob P. , Zachariae Claus , Menné Torkil , Johansen Jeanne D.
Published: October 2020

Background

In 2005, methylisothiazolinone (MI) was allowed as a stand‐alone preservative in cosmetics. This resulted in an epidemic of allergic contact dermatitis to MI, mainly affecting women exposed to leave‐on cosmetics. Consequently, a regulation of Annex V in the European Union in 2017 banned the use of MI in leave‐on cosmetics and reduced the allowed concentration in rinse‐off products.

Objective

To analyze the temporal trends in contact allergy to MI in Danish patients in relation to key events including European regulations over time.

Methods

A retrospective study of consecutive patients patch tested with methylisothiazolinone from 2005 to 2019. Demographics and clinical characteristics in terms of MOAHLFA (male, occupational, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis and age >40 years), sources of exposure, and clinical relevance were analyzed in relation to key historical events.

Results

Three hundred eighty of 12 494 patients (3.0%, 95CI: 2.7–3.4%) tested from 2005 to 2019 were sensitized to MI. An increasing trend in the prevalence of MI contact allergy from 2005 to 2019 (P < .01) was observed, although a decline in the absolute number of patch‐test positive patients was seen from 2013 and onward. A reduction in leave‐on cosmetics as a source of exposure was observed following the legislative ban in 2017, from 24.8% from in 2010 to 2013 to 6.2% in 2017 to 2019 (P < .01).

Conclusion

The epidemic of MI contact allergy is declining in absolute terms, although the prevalence in the patch‐tested population has not returned to its pre‐epidemic levels. The legislative regulation of MI in 2017 has been effective in terms of leave‐on cosmetics as a source of exposure in MI allergic patients. The process of post‐marketing risk assessment of contact allergens in the European Union needs improvement.
An experimental approach to evaluate machine learning models for the estimation of load distribution on suspension bridge using FBG sensors and IoT
Authors: Mohapatra Ambarish G. , Khanna Ashish , Gupta Deepak , Mohanty Maitri , de Albuquerque Victor Hugo C.
Published: October 2020

Most of the tragedies on any bridge structure have been the cause of high‐density crowd behavior as a response to trampling as well as the crushing scenario. Therefore, it is most important to monitor such unforeseen situations by sensing the load imposed on the bridge structures. This scenario may arise where crowd movement is huge on these types of bridges. Similarly, the fiber Bragg grating (FBG) is a promising technology for structural health monitoring applications. In this work, an Internet of Things based FBG optical sensing scheme is proposed to monitor real‐time strain distribution throughout the bridge structures and localization of load imposed on the structure from a central control room. A suspension bridge model is designed by referring to a real bridge scenario and these FBG sensors are deployed to validate the proposed machine learning models. In this article, the performances of two machine learning strategies are discussed for the accurate estimation of load and its position by acquiring high sensitive FBG sensors signals at a very high data rate. The algorithms include K‐nearest neighbor (KNN) and random forest (RF); which are applied on each sensing data source, and then validated using a prototype suspension bridge model integrated with three FBG sensors (1532 nm, 1538 nm, and1541 nm) on a single optical fiber cable.
Pleomorphic mastocytoma associated with loss of chromosome 5, PDGFRA, and HRAS mutations: A case of cutaneous mastocytosis with severe atypia and indolent behavior
Authors: Tirado Mariantonieta , Dobin Sheila M. , Fernandez Martin P. , Rao Arundhati
Published: October 2020

A 21‐year‐old female presented with a 5‐year history of an erythematous papule on her right breast. The biopsy showed a dense, dermal nodular infiltrate, extending focally into the subcutaneous tissue. The infiltrate was composed predominantly of pleomorphic cells with bi‐lobed, multi‐lobed, horseshoe, or ring‐shaped nuclei. There was a smaller subset of monomorphous cells characterized by a round, reniform, or elongated single‐lobed nucleus. Accompanying cells included few foamy histiocytes, lymphocytes, and numerous scattered eosinophils. No necrosis, vascular invasion, or ulceration was present. The pleomorphic and monomorphic granular cells were positive for Giemsa stain as well as for tryptase, CD117, CD68, CD2, and CD30 immunohistochemistry and negative for S100, CD1a, myeloperoxidase, lysozyme, and CD56. Clinical examination was negative for any additional similar lesions and serum tryptase was within normal limits. The bone marrow was not biopsied. In addition, fluorescent in situ hybridization revealed multiple clones with loss of number 5 chromosome and PDGFRA and HRAS mutations. The lesion did not recur or progress after a 6‐year clinical follow‐up. To our full knowledge, we report the first case of pleomorphic mastocytoma with loss of chromosome 5 and PDGFRA and HRAS mutations.
Diagnostic value of laboratory parameters for the discrimination between erysipelas and limited cellulitis
Authors: Drerup Christian , Eveslage Maria , Sunderkoetter Cord , Ehrchen Jan
Published: October 2020

Background and objectives

Erysipelas, caused by beta‐hemolytic streptococci, and limited cellulitis, frequently caused by Staphylococcus aureus or other bacteria, are skin and soft tissue infections characterized by typical clinical signs. However, despite the therapeutical relevance they are often not differentiated (e.g in clinical trials). Erysipelas are efficiently treated with penicillin, while limited cellulitis is treated with more wide‐spectrum antibiotics. This study investigates whether parameters such as CRP, blood counts or novel parameters like immature granulocytes could serve as biomarkers to distinguish between these entities.

Patients and methods

For this retrospective analysis 163 patients were included. We compared laboratory markers in patients with erysipelas (n = 68) to those with limited cellulitis (n = 41) of the leg. Both erysipelas and limited cellulitis were defined clinically, with an additional aspect for erysipelas being a prompt response to penicillin.

Results

Erysipelas were characterized by higher levels of inflammation. CRP and leukocyte counts are the best parameters to discriminate between both infections. A CRP value ≥ 3.27 mg/dl indicated the diagnosis of erysipelas with 75 % sensitivity and 73.2 % specificity.

Conclusions

Our results support the thesis that erysipelas and limited cellulitis are distinct infections as defined in the German guidelines and that an assessment of CRP and leukocytes is useful for differential diagnosis.
Application of CO2 carbon stable isotope analysis to ant trophic ecology
Authors: Balzani Paride , Venturi Stefania , Muzzicato Daniela , Tassi Franco , Vaselli Orlando , Frizzi Filippo , Frasconi Wendt Clara , Nisi Barbara , Masoni Alberto , Santini Giacomo
Published: October 2020

Stable isotope analysis of animal tissues is commonly used to infer diet and trophic position. However, it requires destructive sampling. The analysis of carbon isotopes from exhaled CO2 is non‐invasive and can provide useful ecological information because isotopic CO2 signatures can reflect the diet and metabolism of an animal. However, this methodology has rarely been used on invertebrates and never on social insects. Here, we first tested whether this method reflects differences in δ13C‐CO2 between workers of the Mediterranean ant Crematogaster scutellaris (Olivier) (Hymenoptera: Formicidae, Crematogastrini) fed with sugar from beet (C3; Beta vulgaris L., Amaranthaceae) or cane (C4; Saccharum officinarum L., Poaceae). We found that a significant difference can be obtained after 24 h. Consequently, we used this technique on wild co‐occurring ant species with different feeding preferences to assess their reliance on C3 or C4 sources. For this purpose, we sampled workers of C. scutellaris, the invasive garden ant Lasius neglectus (van Loon et al.) (Lasiini), and the harvester ant Messor capitatus (Latreille) (Stenammini). No significant differences in their carbon isotopic signatures were recorded, suggesting that in our study site no niche partitioning occurs based on the carbon pathway, with all species sharing similar resources. However, further analysis revealed that M. capitatus, a seed‐eating ant, can be regarded as a C3 specialist, whereas L. neglectus and C. scutellaris are generalists that rely on both C3 and C4 pathways, though with a preference for the former. Our results show that this methodology can be applied even to small animals such as ants and can provide useful information on the diets of generalist omnivores.
Personality, learning styles and handedness: The use of the non‐dominant hand in pre‐clinical operative dentistry training
Authors: Qutieshat Abubaker , Aouididi Rayhana , Salem Abdurahman , Kyranides Melina Nicole , Arfaoui Rayan , Atieh Mohammad , Samarah Mohammad Rasool , Al Masri Mahmoud , Al Sharif Zain
Published: October 2020

Aim

This research was undertaken with the aim of using personality traits, learning styles and handedness to develop and evaluate a scale to measure a new concept in operative dentistry, symmetrisation. An initial hypothesis was proposed, stating that handedness, personality trait and learning style could be used to predict symmetrisation potential in the domain of operative dentistry.

Methods

Participants completed three questionnaires: the Edinburgh handedness inventory assessment; the Keirsey Temperament Sorter‐II (KTS‐II); and the learning style assessment (VARK). Then, participants prepared a cavity on an artificial third molar tooth in the traditional phantom head using their non‐dominant hand. For evaluation and comparison purposes, Standard Tessellation Language images were obtained from prepared teeth using a CAD/CAM scanner and then aligned against a reference “unprepared” tooth image using a custom software developed by the authors based on the Iterative Closest Point algorithm.

Results

Extroverts, intuitive and participants characterised as relying on their feelings were more accurate compared to introverts, sensory and toughminded participants, respectively. Extroverts were faster to complete the task compared to introverts. Participants with a preference for read/writing learning style produced more errors than any of the other groups. Handedness, however, did not show any significant association with performance.

Conclusions

It was concluded that both the KTS‐II and the learning style assessment (VARK) questionnaires possess potential as useful measures of symmetrisation potential and the ability to use the non‐dominant hand in operative dentistry, as well as platform for continuing research.
Protein tyrosine phosphatase receptor type Q in cerebrospinal fluid reflects ependymal cell dysfunction and is a potential biomarker for adult chronic hydrocephalus
Authors: Nakajima M. , Rauramaa T. , Mäkinen P. M. , Hiltunen M. , Herukka S.‐K. , Kokki M. , Musialowicz T. , Jyrkkänen H.‐K. , Danner N. , Junkkari A. , Koivisto A. M. , Jääskeläinen J. E. , Miyajima M. , Ogino I. , Furuta A. , Akiba C. , Kawamura K. , Kamohara C. , Sugano H. , Tange Y. , Karagiozov K. , Leinonen V. , Arai H.
Published: October 2020

Background and purpose

Protein tyrosine phosphatase receptor type Q (PTPRQ) was extracted from the cerebrospinal fluid (CSF) of patients with probable idiopathic normal‐pressure hydrocephalus (iNPH) by proteome analysis. We aimed to assess the feasibility of using CSF PTPRQ concentrations for the additional diagnostic criterion of iNPH in Japanese and Finnish populations.

Methods

We compared PTPRQ concentrations among patients with probable iNPH and neurologically healthy individuals (normal control [NC] group), patients with normal‐pressure hydrocephalus (NPH) of acquired and congenital/developmental aetiologies, patients with Alzheimer’s disease and patients with Parkinson’s disease in a Japanese analysis cohort. A corresponding iNPH group and NC group in a Finnish cohort was used for validation. Patients in the Finnish cohort who underwent biopsy were classified into two groups based on amyloid and/or tau deposition. We measured PTPRQ expression levels in autopsied brain specimens of iNPH patients and the NC group.

Results

Cerebrospinal fluid PTPRQ concentrations in the patients with NPH of idiopathic, acquired and congenital/developmental aetiologies were significantly higher than those in the NC group and those with Parkinson’s disease, but iNPH showed no significant differences when compared with those in the Alzheimer’s disease group. For the patients with iNPH, the area under the receiver‐operating characteristic curve was 0.860 in the Japanese iNPH and 0.849 in the Finnish iNPH cohorts. Immunostaining and in situ hybridization revealed PTPRQ expression in the ependymal cells and choroid plexus. It is highly possible that the elevated PTPRQ levels in the CSF are related to ependymal dysfunction from ventricular expansion.

Conclusions

Cerebrospinal fluid PTPRQ levels indicated the validity of this assay for auxiliary diagnosis of adult chronic hydrocephalus.
Immunology of COVID‐19 and disease‐modifying therapies: The good, the bad and the unknown
Authors: Zrzavy Tobias , Wimmer Isabella , Rommer Paulus S. , Berger Thomas
Published: October 2020

Objective

The outbreak of the SARS‐CoV‐2 pandemic, caused by a previously unknown infectious agent, posed unprecedented challenges to healthcare systems and unmasked their vulnerability and limitations worldwide. Patients with long‐term immunomodulatory/suppressive therapies, as well as their physicians, were and are concerned about balancing the risk of infection and effects of disease‐modifying therapy. Over the last few months, knowledge regarding SARS‐CoV‐2 has been growing tremendously, and the first experiences of infections in patients with multiple sclerosis (MS) have been reported.

Methods

This review summarizes the currently still limited knowledge about SARS‐CoV‐2 immunology and the commonly agreed modes of action of approved drugs in immune‐mediated diseases of the central nervous system (MS and neuromyelitis optica spectrum disorder). Specifically, we discuss whether immunosuppressive/immunomodulatory drugs may increase the risk of SARS‐CoV‐2 infection and, conversely, may decrease the severity of a COVID‐19 disease course.

Results

At present, it can be recommended in general that none of those therapies with a definite indication needs to be stopped per se. A possibly increased risk of infection for most medications is accompanied by the possibility to reduce the severity of COVID‐19.

Conclusions

Despite the knowledge gain over the last few months, current evidence remains limited, and, thus, further clinical vigilance and systematic documentation is essential.
Idiopathic normal‐pressure hydrocephalus: the cost‐effectiveness of delivering timely and adequate treatment in Germany
Authors: Tinelli M. , Guldemond N. , Kehler U.
Published: October 2020

Background and purpose

Idiopathic normal‐pressure hydrocephalus (iNPH) is a progressive, severe brain disorder, which mainly affects people above the age of 65 years. iNPH is characterized by the accumulation of excess cerebrospinal fluid in the brain's ventricles. In most cases, iNPH patients can be effectively treated with shunt surgery, which involves placing a tube into the brain to drain the excess fluid. As part of the European Brain Council‐led Value of Treatment project, this study aimed to investigate the cost‐effectiveness of delivering timely and adequate iNPH treatment in Germany.

Methods

The study identified treatment gaps that prevent iNPH patients from receiving adequate and timely treatment. The cost‐effectiveness of delivering shunt surgery to iNPH‐prevalent patients aged ≥65 years in Germany was calculated using decision‐analytical modelling. The model compared two alternatives, current care (shunt surgery in 25% of iNPH cases) and target care (shunt surgery in 90% of iNPH cases), and looked at healthcare costs (diagnosis, shunt intervention and follow‐up care) from the public health insurance perspective, as well as effectiveness outcomes in terms of lives saved and quality‐adjusted life‐years (QALYs) gained.

Results

Delivering timely and adequate iNPH treatment proved to be cost‐effective. Cost per life saved varied between €27 921 at 5 years and €246 726 at 15 years. Cost‐per‐QALY estimates varied between €10 202 at 5 years and €35 128 at 15 years.

Conclusions

Idiopathic normal‐pressure hydrocephalus is a treatable but often not‐treated disease, resulting in unnecessary and avoidable disease burden for the healthcare system. Actions required to close this treatment gap are straightforward and their implementation has been modelled with successful outcomes.
A niche in the spotlight: Could external factors critically disturb hair follicle homeostasis and contribute to inflammatory hair follicle diseases?
Authors: Vogt Annika , Constantinou Andria , Rancan Fiorenza , Ghoreschi Kamran , Blume‐Peytavi Ulrike , Combadiere Behazine
Published: October 2020

The anatomy of the hair follicle and the dynamics of its barrier provide a special space for interactions between macromolecules and the underlying tissue. Translocation across the hair follicle epithelium and immune recognition has been confirmed for proteins, nucleic acids, engineered particles, virus particles and others. Tissue responses can be modulated by pro‐inflammatory stimuli as demonstrated in penetration and transcutaneous immunization studies. Even under physiological conditions, hair follicle openings are filled with exogenous material ranging from macromolecules, engineered particles to natural particles including diverse communities of microbes. The exposed position of the infundibulum suggests that local inflammatory insults could disturb the finely tuned balance and may trigger downstream responses that initiate or facilitate local outbreaks of inflammatory hair diseases typically occurring in close spatial association with the infundibulum as observed in cicatricial alopecia. The question as to how microbial colonization or deposition of contaminants on the surface of the hair follicle epithelium interact with the barrier status under the influence of individual predisposition may help us understand local flare‐ups of inflammatory hair diseases. Specifically, learning more about skin barrier alterations in the different types of inflammatory hair diseases and cross‐talk with exogenous compounds could give new insights in this less explored aspect of hair follicle homeostasis. Such knowledge may not only be used to develop supportive measures to maintain a healthy scalp. It may have wider implications for our understanding on how external factors influence inflammation and immunological responses in the skin.
Subcritical crack growth in hard alloys under cyclic loading
Authors: Brackmann Lukas , Röttger Arne , Weber Sebastian , Theisen Werner
Published: October 2020

In this work, the subcritical crack growth in Fe‐, Ni‐ and Co‐base hard alloys was investigated. Specimens were cyclically loaded in the pressure threshold range until a ring crack resulted as a failure criterion. Crack propagation along with the individual microstructural constituents and the associated resistance of the individual materials to crack propagation was investigated by scanning electron microscopy and by the methods adapted to it. For the Ni‐base alloys, the formation of a closed ring fracture occurred after the lowest load cycle number, followed by the Co‐ and Fe‐base alloys. Almost no crack deflection by the hard phases was detected in the Ni‐base alloys. The higher number of loading cycles to produce a closed crack ring in the Fe‐base alloys is attributed to the pronounced crack deflection by the hard phases and to the higher matrix strength. Besides, phase transformations were registered in front of the crack tip of the Co‐ and the partially austenitic Fe‐base alloy. This phase transformation counteracts crack formation in the case of the Fe‐base matrix but promotes crack propagation in the Co‐base alloy.