bluuebunny/crossref_metadata_2025 huggingface dataset:
Sample size and power considerations for cluster randomized trials with count outcomes subject to right truncation
Authors: Li Fan , Tong Guangyu
Published: March 2021

Cluster randomized trials (CRTs) are widely used in epidemiological and public health studies assessing population‐level effect of group‐based interventions. One important application of CRTs is the control of vector‐borne disease, such as malaria. However, a particular challenge for designing these trials is that the primary outcome involves counts of episodes that are subject to right truncation. While sample size formulas have been developed for CRTs with clustered counts, they are not directly applicable when the counts are right truncated. To address this limitation, we discuss two marginal modeling approaches for the analysis of CRTs with truncated counts and develop two corresponding closed‐form sample size formulas to facilitate the design of such trials. The proposed sample size formulas allow investigators to explore the power under a large number of scenarios without computationally intensive simulations. The proposed formulas are validated in extensive simulations. We further explore the implication of right truncation on power and apply the proposed formulas to illustrate the power calculation for a malaria control CRT where the primary outcome is subject to right truncation.
Individual markers of cerebral small vessel disease and domain‐specific quality of life deficits
Authors: Fernando Jeevan , Brown Robin B. , Edwards Hayley , Egle Marco , Markus Hugh S. , Tay Jonathan
Published: March 2021

Background

Cerebral small vessel disease (SVD) leads to reduced quality of life (QOL), but the mechanisms underlying this relationship remain unknown. This study investigated multivariate relationships between radiological markers of SVD and domain‐specific QOL deficits, as well as potential mediators, in patients with SVD.

Methods

Clinical and neuroimaging measures were obtained from a pooled sample of 174 SVD patients from the St. George's Cognition and Neuroimaging in Stroke and PRESsure in established cERebral small VEssel disease studies. Lacunes, white matter hyperintensities, and microbleeds were defined as radiological markers of SVD and delineated using MRI. QOL was assessed using the Stroke‐Specific Quality of Life Scale. Multivariate linear regression was used to determine whether SVD markers were associated with domain‐specific QOL deficits. Significant associations were further investigated using mediation analysis to examine whether functional disability or cognition was potential mediators.

Results

Multivariate regression analyses revealed that lacunes were associated with total QOL score (β = −8.22, p = .02), as well as reductions in mobility (β = −1.41, p = .008) and language‐related subdomains (β = −0.69, p = .033). White matter hyperintensities and microbleeds showed univariate correlations with QOL, but these became nonsignificant during multivariate analyses. Mediation analyses revealed that functional disability, defined as reduced activities of daily living, and executive function, partially mediated the relationship between lacunes and total QOL, as well as mobility‐related QOL, but not language‐related QOL.

Conclusions

Lacunar infarcts have the most detrimental effect on QOL in SVD patients, particularly in the mobility and language‐related subdomains. These effects may be partially explained by a reduction in activities of daily living. These results may inform targeted interventions to improve QOL in patients with SVD.
Long‐term clinical outcomes in transradial versus transfemoral access for left main percutaneous coronary intervention
Authors: Gao Lijian , Gao Zhan , Song Ying , Guan Changdong , Xu Bo , Chen Jue , Liu Haibo , Qin Xuewen , Yao Min , Yuan Jinqing , Wu Yongjian , Hu Fenghuan , Qian Jie , Dou Kefei , Yang Weixian , Qiu Hong , Mu Chaowei , Dai Jun , Zhang Pei , Qiao Shu‐Bin , Chen Jilin , Gao Runlin , Yang Yuejin
Published: March 2021

Objective

The present study compared 10‐year clinical outcomes between transradial access (TRA) and transfemoral access (TFA) for left main (LM) percutaneous coronary intervention (PCI).

Background

There are limited data regarding the long‐term safety and efficacy of TRA for LM PCI.

Methods

This retrospective study evaluated consecutive patients who underwent unprotected LM PCI between January 2004 and December 2008 at Fu Wai Hospital. The exclusion criteria were age of less than 18 years and presentation with acute myocardial infarction. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), which was defined as a composite of all‐cause death, myocardial infarction, stroke, and any revascularization at the 10‐year follow‐up.

Results

Among 913 eligible patients, TRA was used for 417 patients (45.7%) and TFA was used for 496 patients (54.3%). The 30‐day clinical outcomes were similar between the two groups. Results from the 10‐year follow‐up revealed that MACCE occurred in 180 patients (46.7%) from the TRA group and in 239 patients (51.2%) from the TFA group (log‐rank p = .3). The TRA and TFA groups also had low and comparable cumulative rates of all‐cause death (14.6% vs. 17.3%, log‐rank p = .56) and cardiac death (7.9% vs. 9.1%, log‐rank p = .7).

Conclusion

The present study revealed no significant differences in long‐term clinical outcomes when TRA or TFA were used for LM PCI.
Management of dead space thrombosis during decannulation of peripherally inserted venoarterial extracorporeal membrane oxygenation
Authors: Sulimov Dmitry S. , Markuske Matthias , Desch Steffen , Thiele Holger
Published: March 2021

Ischemic complications after percutaneous decannulation of veno‐arterial extracorporeal membrane oxygenation (va‐ECMO) are not rare and can lead to significant morbidity or even mortality in case of delayed diagnosis or treatment. A possible cause of thromboembolic complications is the formation of thrombus between in the short segment between the large bore retrograde arterial cannula of va‐ECMO and the antegrade limb perfusion sheath due to absence of blood flow (dead space). In this case report, we demonstrate a new technique of flushing the dead space to prevent embolic complications during va‐ECMO decannulation.
Neodymium‐Doped IrO2 Electrocatalysts Supported on Titanium Plates for Enhanced Chlorine Evolution Reaction Performance
Authors: Hu Jiajun , Xu Haoran , Feng Xiangdong , Lei Lecheng , He Yi , Zhang Xingwang
Published: March 2021

The chlorine evolution reaction (CER) is extensively used in disinfection, chlorine products, and water treatment. However, CER catalysts based on noble metals are expensive, limiting their industrial application. For the purpose of enhancing the CER performance with low usage of Ir, Nd‐doped IrO2 electrocatalysts supported on Ti plates were fabricated by using the sol‐gel method. The optimal Ti/Ir0.8Nd0.2Ox electrode exhibited excellent CER performance with a low potential of 1.52 V vs. RHE at 100 mA cm−2 and a great stability of over 210 h in 5 M NaCl solution. Notably, the mass activity of Ti/Ir0.8Nd0.2Ox (96.5 A gIr−1 at 1.5 V vs RHE) was twice as high as that of Ti/IrO2, which was the highest among noble metal electrodes reported. Density functional theory calculations indicated that the doping of Nd could clearly decrease the loss of Gibbs free energy for the rate‐determining step (desorption of chlorine).
CFD investigation of pelletization effect on co‐firing coal with wheat straw
Authors: Mohammed Redha Adel , Lau Anthony , Holuszko Maria , Vakil Ali , Sokhansanj Shahab
Published: March 2021

Biomass co‐firing in existing coal‐fired power plants has been proven successful and practised in many installations worldwide as a greener alternative to coal. Attempts to overcome the low efficiency of transporting raw biomass have resulted in global wood pellets market growth in the past decade. This research studies the effect of biomass densification on biomass co‐firing with coal. A three‐dimensional CFD model was used to simulate the co‐firing of coal and wheat straw. The model was verified by comparing the simulation results and experimental data presented in the literature. The experimental and predicted results were found to be in good agreement and exhibit the same general trends in terms of the gas species (O2, CO, CO2, and H2O) concentrations. The effect of pelletization on biomass particle combustion was then investigated by considering particle shrinkage due to compression during pelletization. The baseline case is for uncompressed particles having particle density of 600 kg/m3, whereas the two cases of densified particles have particle densities of 800 kg/m3 and 1000 kg/m3. Results show that, when compared to the baseline case, compressed particles experience slower volatilization and surface reaction rates, and hence a greater percentage of unburnt carbon. Larger wheat straw particles (>894 μm) have different aerodynamic interaction compared to smaller particles in terms of residence time and particle trajectory. CFD results also show that compressed particles would exhibit lower NO emission, and NH3 as the intermediate product from biomass volatile‐N has contributed to the reduction in NO emission during the volatilization process.
Study on the effect of calcium hypochlorite and air as mixed oxidant and a synthesized low cost Pd‐Ni/C anode electrocatalyst for electrooxidation of glycerol in an air breathing microfluidic fuel cell
Authors: Panjiara Deoashish , Pramanik Hiralal
Published: March 2021

In the present work, glycerol‐based air breathing microfluidic fuel cell (μFC) is investigated. The noble metal Pd and non‐noble metal Ni‐based bimetallic synthesized electrocatalyst (Pd‐Ni/C) were used for glycerol electrooxidation and commercial Pt/CHSA was used as cathode electrocatalyst. The anolyte is glycerol mixed with KOH electrolyte. The atmospheric air and calcium hypochlorite mixture are used as oxidant in cathode and catholyte, respectively. Acetylene black carbon is used as electrocatalyst support with low metal loading of 20 wt% Pd and Ni at their different weight ratios (Pd/Ni) of 16:4, 10:10, and 4:16 to synthesize bimetallic Pd‐Ni/C anode electrocatalysts. The crystal structure of the synthesized electrocatalyst was determined by X‐ray diffraction (XRD) analysis. The surface morphology and surface concentration of synthesized electrocatalyst were determined by scanning electron microscopy (SEM) and energy dispersive X‐ray spectroscopy (EDX), respectively. The particle size of synthesized electrocatalyst was determined by transmission electron microscopy (TEM) analysis. The electrochemical activity of Pd‐Ni/C was investigated by cyclic voltammetry analysis. The electrocatalyst Pd‐Ni (10:10)/C gives higher electrocatalytic activity for glycerol electrooxidation compared to other ratios of electrocatalyst. A single air breathing μFC is investigated using various key parameters where air alone as oxidant gives open circuit voltage (OCV) of 0.42 V and maximum power density of 1.27 mW/cm2. While using calcium hypochlorite and air as mixed oxidant, the OCV was increased to 0.72 V and maximum power density increased to 3.43 mW/cm2, which are 1.71 and 2.7 times, respectively, more than that of air as oxidant only.
Are we undermining the value of palliative care through advanced cancer clinical trial consent language?
Authors: Umaretiya Puja J. , Rubin Jennifer P. , Snaman Jennifer M. , Ullrich Christina , Feraco Angela M. , Dussel Veronica , Wolfe Joanne , Waldman Elisha
Published: March 2021

Informed consents for advanced cancer trials contain language that misrepresents palliative care as an alternative to trial participation. This language should be revised to highlight that palliative care is appropriate at any point in the illness trajectory and alongside disease‐directed therapy.
Triphenylphosphonium‐Derived Bright Green Fluorescent Carbon Dots for Mitochondrial Targeting and Rapid Selective Detection of Tetracycline
Authors: Rajendran Sathish , Zichri Shani Ben , Usha Vipinachandran Varsha , Jelinek Raz , Bhunia Susanta Kumar
Published: March 2021

Although various fluorescent‐based nanoparticles are treated as cellular imaging probes, approaching the construction of a biocompatible subcellular imaging probe is challenging. At the same time, the recognition of wasted pharmaceutical drugs by some fluorescent nanoprobes is important and urgently required. We report a “structural memory” concept for simple one‐pot synthesis of bright green fluorescent (quantum yield of up to 61%) carbon dots (C‐dots) from triphenylphosphonium (TPP) as a carbon precursor that will simultaneously act as an effective vehicle for mitochondria labeling in cancer cells and as a selective tetracycline sensor. The ubiquitous TPP residues upon the C‐dots’ surface easily recognize the cellular mitochondria. Tetracycline has been selectively and instantaneously detected through rapid fluorescence on‐off response from C‐dots where other drugs remained silent in nature, even after longer incubation. This quenching response is ascribed to the static quenching effect and position of functional groups of the targeted drug which can play a dominating role. The reason for strong fluorescence exhibition from C‐dots has been well explained by considering different factors. Such types of C‐dots have been shown to be universal mitochondria‐targeting nanoprobes, non‐cytotoxic, and effective as a tetracycline detector. This finding should open a new avenue for in‐vivo therapeutic application and sensing of pharmaceutical drugs in real clinical applications.
Compassion for enemy militants?: A case study
Authors: Rothbart Daniel
Published: March 2021

In stark contrast to detailed studies of negative emotions, peacebuilding scholar‐practitioners pay scant attention to the social psychology of positive emotions that are critical for the long‐term transformation of relations among conflict actors. I offer results from one case study of compassion, the first of its kind, of a group of 23 young people from conflict‐ridden countries who were enrolled in a 2‐year peace education program called Rondine. All of the research participants exhibited compassion for the civilians who suffered from the effects of the violence. Most of them exhibited compassion even for the militants who caused such violence.
Section 504 and Titles II, III of the ADA do not apply to study abroad programs
Authors: Masinter Michael R.
Published: March 2021

Inexplicably, the National Deaf Center on Postsecondary Outcomes, a technical assistance program funded by the Department of Education, has inaccurately opined on the legal question of whether Section 504 and the Americans with Disabilities Act apply to study abroad (see https://bit.ly/2M1X6wQ), asking on its website: “Are institutions required to provide accommodations for students in study abroad programs?”
Focus on passion, personal approach helps learners with disabilities succeed
Authors: Hope Joan
Published: March 2021

Author and entrepreneur Roger James Hamilton founded the Genius School with the understanding that the same approach to education doesn't work for everyone. But everyone has passion and can make an impact on the world. And what many people label as disabilities can be gifts, Hamilton said.
Tweak your office's site to encourage students to register, Part 2
Authors: Hamblet Elizabeth C.
Published: March 2021

In my previous column (January 2020), I provided some initial considerations for making sure your site encourages students to complete the disability services registration process, including that you should provide a time line to let students know how long it can take from start to finish. Besides making sure students know how things work, make sure your site makes them feel comfortable initiating and completing the process. Think about how it feels to students for whom all of this is new (and anxiety provoking).
Be clear about the difference between service animals, ESAs
Authors: Sejdic Alana
Published: March 2021

A service animal and an assistance animal are different. The Americans with Disabilities Act defines a service animal as a dog that is individually trained to do work or perform tasks for people with disabilities. The Fair Housing Act uses the term “assistance animal” to refer to service animals and emotional support animals. This is where the confusion starts.
Disability accreditation standards on the horizon
Authors: Sutton Halley
Published: March 2021

A panel of experts are at work on establishing the first‐ever accreditation standards for programs at postsecondary institutions that serve students with intellectual disabilities.
Student Accommodations
Authors: Lyerly Eric
Published: March 2021

An overview of the key topics faced by disability services providers with citations to noteworthy cases, statutes, regulations, and additional sources.
Non‐native rats detected on uninhabited southern Grenadine islands with seabird colonies
Authors: Smart Wayne A. , Collier Natalia , Rolland Virginie
Published: March 2021

Seabirds are among the most endangered avian groups, with populations declining worldwide because of various threats, including invasive nest predators. Similar decreasing trends are occurring in the Southern Grenadines; however, the causes of decline remain uncertain, although non‐native rats have been suspected. Therefore, our objective was to determine whether non‐native rats are present on five Southern Grenadine islands that harbor seabird colonies, during May–July 2014–2017, using four methods (chew cards, tunnels, cameras, and questionnaires). Les Tantes East and Lee Rocks were the only two islands where cameras detected black rats (Rattus rattus). Although rat occupancy was low (0.125 ± 0.061) and the number of individuals and nesting attempts increased (except in 2017) for most species, the low detection probability and small number of nests prevented any inference about rat impact on seabirds. Rats might have affected seabird colonies, but other factors, such as seabird harvest, prey availability, or climatic fluctuations, could have also driven previous seabird population declines in the Southern Grenadines. However, non‐native rats are present and future research should focus on estimating their density and distribution on these and other islands of the region before an appropriate rat eradication program can be implemented.
Male competition reverses female preference for male chemical cues
Authors: Vilella‐Pacheco Zorimar , Mitchem Lisa D. , Formica Vincent A. , Brodie Edmund D.
Published: March 2021

Females must choose among potential mates with different phenotypes in a variety of social contexts. Many male traits are inherent and unchanging, but others are labile to social context. Competition, for example, can cause physiological changes that reflect recent wins and losses that fluctuate throughout time. We may expect females to respond differently to males depending on the outcome of their most recent fight. In Bolitotherus cornutus (forked fungus beetles), males compete for access to females, but copulation requires female cooperation. In this study, we use behavioral trials to determine whether females use chemical cues to differentiate between males and whether the outcome of recent male competition alters female preference. We measured female association time with chemical cues of two size‐matched males both before and after male–male competition. Females in our study preferred to associate with future losers before males interacted, but changed their preference for realized winners following male competitive interactions. Our study provides the first evidence of change in female preference based solely on the outcome of male–male competition.
Comparing demography inferred from age vs. stage in a perennial plant
Authors: Alahuhta Kirsi M. , Crone Elizabeth E. , Lesica Peter
Published: March 2021

Life history theories analyze and predict variation in vital rates, such as survival and reproduction, based on age. The age‐from‐stage method to derive age‐specific vital rates from stage data was developed because age‐specific data are rarely obtained for plants. Age‐specific vital rates derived by this method might underestimate effects of age on vital rates, because the models assume that vital rates do not vary within stage classes. Consequently, population models and life history summaries relying on these vital rates could be biased against detecting senescence. Here, we perform a comparative study of methods to estimate age‐specific vital rates using monitoring data with known age and stage. We derived age‐, stage‐, and age‐and‐stage‐specific vital rates with demographic data from a long‐lived perennial, Silene spaldingii. Then, we derived three age‐specific population matrix models (age, age‐from‐stage, and age‐and‐stage). For each model, we derived life history summaries commonly used in ecology: population growth rate, net reproductive value, relative reproductive values, stable age distribution, generation time, and sensitivity and elasticity of population growth rate. Many vital rates depended on both age and stage in S. spaldingii. However, this species does not senesce; in fact, the number of flowers increased with age. As expected, the age‐from‐stage method was not able to accurately recreate the age dependence in some life history summaries, such as relative reproductive value. The age‐from‐stage model suggested faster reproductive dynamics in S. spaldingii than the models based on known age, i.e., plants started to reproduce earlier, and fertility remained constant thereafter, which may lead to biased predictions about evolutionary consequences of age‐dependent life history traits. However, population growth rate, generation time, and net reproductive rate did not differ significantly among the models. Our study demonstrated that some metrics are robust to imprecision in model structure, while others are more sensitive. In spite of these biases, this case study provides another example of the diversity of aging patterns in plants. Age can be essential information when studying senescence in plants, but demographic metrics that were not about age per se were similar across model structures.
Flatpack democracy: Power and politics at the boundaries of transition
Authors: Burnett Amy , Nunes Richard
Published: March 2021

This paper seeks to critically assess how “radical” sustainability approaches that challenge “mainstream” development trajectories—and politics—are crafted and contested within local government. We explore the extent to which these approaches account for a consolidation, break down or transformation of role boundaries and political identities and their implications for the politics of niche–regime dynamics. In our in‐depth study of Independents for Frome (Somerset, UK), an “independent” group who took control of the town council in 2011 and consolidated a non‐partisan approach within its administrative functions, referred to as its “Flatpack Democracy” model, we take a closer look at adversarialism and the intersection of power dynamics within local government. The findings reveal the capture of local mainstream political institutions by niche “protagonists” through an orchestration and consolidation of transition governance, woven in strategically and opportunistically into new forms of localized political identities at the niche–regime interface, which helped to create a community‐level regime of transition governance. We suggest that informal institutional capital, such as the role of personal ties can impact on legitimacy, accountability, or the validation of sustainability agendas. Our findings also advance debates on transition thresholds within “liminal transition spaces”, interstitial spaces between a previous way of knowing and doing, and a new way. Here ground rules dictating socio‐political norms are unclear, collaborative actions are potentially working at cross‐purposes and/or multiple forms of (transformative) power are exercised simultaneously at distinct moments, or instantiations of transition. That is, there remains a much‐needed theoretical debate around the fragile and imperfect processes of democratization within the everyday politics of transition management.
Impact of readmissions on octogenarians with heart failure with preserved ejection fraction: PURSUIT‐HFpEF registry
Authors: Nishino Masami , Yano Masamichi , Ukita Kohei , Kawamura Akito , Nakamura Hitoshi , Matsuhiro Yutaka , Yasumoto Koji , Tsuda Masaki , Okamoto Naotaka , Tanaka Akihiro , Matsunaga‐Lee Yasuharu , Egami Yasuyuki , Shutta Ryu , Tanouchi Jun , Yamada Takahisa , Yasumura Yoshio , Tamaki Shunsuke , Hayashi Takaharu , Nakagawa Akito , Nakagawa Yusuke , Suna Shinichiro , Nakatani Daisaku , Hikoso Shungo , Sakata Yasushi ,   Osaka CardioVascular Conference (OCVC)‐Heart Failure Investigators
Published: March 2021

Aims

Heart failure (HF) readmissions with preserved ejection fraction (HFpEF) are increasing in the elderly, which is a major socioeconomic problem. We investigated the clinical impact of HF readmissions (HFR) on octogenarians with HFpEF.

Methods and results

We enrolled consecutive octogenarians (≥80 years old) from June 2016 to February 2020 in PURSUIT‐HFpEF registry. We divided them into HFR group readmitted for HF during the follow‐up period and non‐HF readmission (non‐HFR) group. We evaluated the impact of HFR on all‐cause mortality, cardiac death, and quality of life (QOL). Additionally, we evaluated the factors at discharge correlated with HFR. HFR group comprised 116 patients (21.4%). Among all‐cause deaths, 40 patients suffered cardiac deaths (48.2%). The Kaplan–Meier analysis revealed a similar prognosis between HFR and non‐HFR groups as well as similar incidences of HF deaths. The QOL scores had significantly deteriorated by 1 year later in the HFR group (0.71 ± 0.19 vs. 0.59 ± 0.21, P < 0.001), while it was similar at 1 year in the non‐HFR group. In the multivariate analysis, diabetes mellitus (DM) (P = 0.019), N‐terminal pro‐B‐type natriuretic peptide (NT‐pro BNP) levels ≥ 1611 pg/mL (P < 0.001), and serum albumin level ≤ 3.7 g/dL (P = 0.011) were useful markers for HFR in octogenarians.

Conclusions

In octogenarians with HFpEF, HF readmission was not directly correlated with the prognosis but was well correlated with the QOL. Close follow‐up is essential to decrease HFR of octogenarians with HFpEF with DM, high NT‐pro BNP (≥1611 pg/mL) and low albumin (≤3.7 g/dL) levels at discharge.
An empirical transcendental hysteresis model for structural systems with pinching and degradation
Authors: Aloisio Angelo , Sejkot Petr , Iqbal Asif , Fragiacomo Massimo
Published: March 2021

The authors present a novel transcendental hysteresis model based on the piecewise definition of arctangent functions. The definition of the shape parameters of the arctangent functions originates from the features of the experimental hysteresis curves directly. In the first step, the authors present this model's application to the experimental cyclic response of cross‐laminated timber (CLT), light‐timber frame (LTF) shear walls, and a steel angle bracket. Then, the response of a plywood‐coupled laminated‐veneer lumber (LVL) shear wall is used for validation purposes. The paper introduces the arctangent‐based model, labeled Atan model, by illustrating some possible shortcomings of hysteresis models with pinching. The paper concludes with a simple demonstration of these issues in the case of a Bouc‐Wen class hysteresis model, the extended energy‐dependent generalized Bouc‐Wen (eegbw) model. The numerical instabilities of the eegbw model are used to endorse the advantages of the proposed formulation in modeling complex structural arrangements, like wood joints and structural systems. The proposed model originates from the analysis of the experimental response of wood joints. However, it can be of more general application, and the particular reference to wood joints does not preclude other application fields.
Flank margin caves can connect to regionally extensive touching vug networks before burial: Implications for cave formation and fluid flow
Authors: Breithaupt Charles I. , Gulley Jason D. , Moore Paul J. , Fullmer Shawn M. , Kerans Charles , Mejia Jessica Z.
Published: March 2021

Flank margin caves are extreme endmembers of vuggy porosity that form as diagenesis drives the progressive coalescence of smaller solutional pore spaces. Due to their morphological isolation during formation, the prevailing hypothesis has been that fluid flow in and out of flank margin caves occurs via the matrix permeability and that adjacent chambers only become hydraulically connected through nonmatrix porosity during burial, collapse, and fracturing. To our knowledge, however, no studies have evaluated how flank margin caves are connected to regional flow systems in modern carbonate platforms. In this study, we evaluate the connectivity of wells, boreholes, blue holes, and flank margin caves in increasingly older bedrock on San Salvador Island, Bahamas, using tidal attenuation analysis. Phreatic karst features are not reported in Holocene bedrock, and permeability magnitudes from wells suggest Holocene deposits connect to the ocean along matrix‐dominated flow paths. Permeability magnitudes in bedrock surrounding wells, boreholes, and karst features deposited during Marine Isotope Substage (MIS) 5e suggest connection to the ocean through matrix and touching vug porosity. Boreholes, blue holes, and flank margin caves in pre‐MIS5 bedrock connect to the ocean via touching vugs. We suggest that increasing bedrock permeability, cave number, and cave size observed within progressively older bedrock on San Salvador is a function of the cumulative number of freshwater lenses emplaced over successive sea‐level stillstands. We suggest that the morphologies of the two largest caves are consistent with dissolution in multiple lenses occupying lower elevations, collapse resulting in breakout domes, and overprinting of collapse chambers during subsequent highstands. As a result, some caves may not reflect connectivity of the bedrock surrounding the main chambers but may reflect connectivity of more diagenetically mature bedrock at lower elevations where their antecedent chambers formed.
Sepsis and the evolution of human increased sensitivity to lipopolysaccharide
Authors: Brinkworth Jessica F. , Valizadegan Negin
Published: March 2021

Among mammals, humans are exquisitely sensitive to lipopolysaccharide (LPS), an environmentally pervasive bacterial cell membrane component. Very small doses of LPS trigger powerful immune responses in humans and can even initiate symptoms of sepsis. Close evolutionary relatives such as African and Asian monkeys require doses that are an order of magnitude higher to do the same. Why humans have evolved such an energetically expensive antimicrobial strategy is a question that biological anthropologists are positioned to help address. Here we compare LPS sensitivity in primate/mammalian models and propose that human high sensitivity to LPS is adaptive, linked to multiple immune tactics against pathogens, and part of multi‐faceted anti‐microbial strategy that strongly overlaps with that of other mammals. We support a notion that LPS sensitivity in humans has been driven by microorganisms that constitutively live on us, and has been informed by human behavioral changes over our species' evolution (e.g., meat eating, agricultural practices, and smoking).
Correlation between cerebral blood flow and olfactory function in mild cognitive impairment and Alzheimer's disease
Authors: Kashibayashi Tetsuo , Takahashi Ryuichi , Fujita Jun , Fujito Ryoko , Kamimura Naoto , Okutani Fumino , Kazui Hiroaki
Published: March 2021

Objective

Olfactory dysfunction is common in patients with mild cognitive impairment (MCI) or Alzheimer's disease (AD). We sought to elucidate brain regions associated with olfactory dysfunction in patients with MCI and early AD by using 123I‐IMP‐SPECT to detect regional cerebral blood flow (CBF).

Methods

We included 218 patients diagnosed with AD or MCI, who underwent a comprehensive battery of neuropsychiatric and neuropsychological tests, Alzheimer's Disease Assessment Scale‐Cognitive Part (ADAS‐Cog), and forward‐ and backward‐digit span. Olfactory function was assessed using T&T olfactometry of five odors; patients stated whether they experienced any smell (detection test) and identified the odor (identification test). The association between single‐photon emission computerized tomography based regional CBF and olfactory function was examined by voxel‐by‐voxel multiple regression analysis, considering sex, age, and education as covariate parameters.

Results

Of the 218 patients, 78 had mildly impaired olfactory detection and 15 had olfactory detection loss; additionally, 213 had mild olfactory identification impairment. The odor detection score correlated significantly with the ADAS‐Cog word recall score (r = 0.193, p = 0.004). The odor identification score correlated significantly with the ADAS memory (r = 0.408, p < 0.001) and ADAS orientation (r = 0.292, p < 0.001) scores. The odor identification score correlated negatively with CBF in the left temporal pole, entorhinal area, and bilateral frontal poles (p < 0.001).

Conclusion

Olfactory identification dysfunction in patients with MCI and AD is attributable to reduced CBF of the left temporal pole, entorhinal area, and bilateral frontal pole.
Electronic medical records and primary care quality: Evidence from Manitoba
Authors: Rodriguez Llorian Elisabet , Mason Gregory
Published: March 2021

Improvements in quality of care through supporting decision‐making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population‐based data for the Canadian province of Manitoba are used in a difference‐in‐differences approach with patient‐ and time‐fixed effects. Evidence of changes in the selected quality‐of‐care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.
A retrospective chart review to determine the safety and efficacy of prazosin for nightmares related to posttraumatic stress disorder in veterans
Authors: Diokpa Chinedu , Backe Kristen , Pinsonnault John
Published: March 2021

Objective

To evaluate the efficacy of prazosin for posttraumatic stress disorder (PTSD)‐related nightmares in veterans and to analyze subgroup benefit/risk to guide prescribing.

Methods

Patients with a previous prescription for prazosin between 1 June 2007 and 30 June 2017 were collected from the institution's electronic records. Efficacy (including nightmare frequency, and clinical PTSD rating scales) and safety (including blood pressure) data were retrospectively analyzed.

Results

Eighty‐four patients were included in the analysis. The primary outcome, item 2 of the PTSD checklist, decreased from 4.00 to 3.19 (on a scale of 1–5), which was statistically significant (p < 0.05). Nightmare frequency was found to have a statistically significant decrease from four to two times per week on average (p = 0.00002, 95% CI 2.36 [1.39–3.33]). Of the patients who reported the greatest response (n = 23), 91% (n = 21) were on an antidepressant and 61% (n = 14) were receiving concurrent psychotherapy. This is compared to 90% (n = 76) and 44% (n = 37) of the total cohort, respectively. No significant differences were found in blood pressure or suicidal ideation (p = 0.58 and p = 0.22, respectively).

Conclusion

Prazosin may be considered as an adjunct option to decrease nightmare frequency in patients already receiving first‐line treatment.
Small‐area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany
Authors: Finke Isabelle , Behrens Gundula , Maier Werner , Schwettmann Lars , Pritzkuleit Ron , Holleczek Bernd , Kajüter Hiltraud , Gerken Michael , Mattutat Johann , Emrich Katharina , Jansen Lina , Brenner Hermann ,   for the German Cancer Survival Working Group
Published: March 2021

Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area‐based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population‐based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area‐based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3‐month, 1‐year, 5‐year and 5‐year conditional on 1‐year age‐standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003‐2005 and 2012‐2014. Model‐based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included. For all cancers combined, 5‐year survival rates by GIMD quintile were 61.6% in Q1 (least deprived), 61.2% in Q2, 60.4% in Q3, 59.9% in Q4 and 59.0% in Q5 (most deprived). For most cancer sites, the most deprived quintile had lower 5‐year survival compared to the least deprived quintile even after adjusting for stage (all cancer sites combined, RER 1.16, 95% confidence interval 1.14‐1.19). For some cancer sites, this association was stronger during short‐term follow‐up. Trend analyses showed improved survival from earlier to recent periods but persisting deprivation differences. The underlying reasons for these persisting survival inequalities and strategies to overcome them should be further investigated.
Elevating dental training to prioritize prevention efforts for reducing HPV‐related oropharyngeal cancer incidence
Authors: Nelson Joni D. , Lubker Irene , Bowers Leah , Neville Brad
Published: March 2021

Human papillomavirus (HPV) infections are commonly recognized in the United States with associations to cancers of the vulva, vagina, penis, anus, and oropharynx; the incidence of HPV‐related oropharyngeal cancer (OPC) in the United States is on the rise.1 The aims of this scoping review were to examine the curricula of pre‐doctoral dental students with respect to dental students: (1) awareness of the connection between OPC and HPV; (2) readiness to screen for OPC; and (3) ability to deliver patient education about OPC and its relation to HPV. We also codified published educational materials related to OPC and HPV for pre‐doctoral dental students. Literature searches were performed in PubMed, Scopus, the Educational Resources Information Center (ERIC), the Cumulative Index to Nursing and Allied Health Literature (EBSCO), and Dissertation Abstracts–ProQuest. After screening titles and abstracts, we selected 36 articles for full text review. Only articles reporting pre‐doctoral dental training in HPV and OPC were included in the review, which resulted in 15 articles being excluded from the study. Only two studies in this review specifically discussed a curriculum that would involve educating dental students on HPV‐related OPC. This scoping review also found that the majority of existing training opportunities for OPC and HPV are through post‐graduate continuing education. To address these deficiencies, competencies regarding the HPV‐OPC connection should be included within pre‐doctoral dental training programs. As such, we identified four key strategies for advancing HPV‐OPC content within pre‐doctoral dental training curricula.
Phosphatase Shp2 regulates biogenesis of small extracellular vesicles by dephosphorylating Syntenin
Authors: Zhang Yuefei , Li Yiqing , Liu Pan , Gong Dacheng , Zhou Hui , Li Wenjuan , Zhang Huilun , Zheng Wenfang , Xu Jiaqi , Cheng Hongqiang , Zhang Xue , Ke Yuehai
Published: March 2021

As novel mediators of cell‐to‐cell signalling, small extracellular vesicles (sEVs) play a critical role in physiological and pathophysiological processes. To date, the molecular mechanisms that support sEV generation are incompletely understood. Many kinases are reported for their roles in sEV generation or composition, whereas the involvement of phosphatases remains largely unexplored. Here we reveal that pharmacological inhibition and shRNA‐mediated down‐regulation of tyrosine phosphatase Shp2 significantly increases the formation of sEVs. By Co‐immunoprecipitation (Co‐IP) and in vitro dephosphorylation assays, we identified that Shp2 negatively controlled sEV biogenesis by directly dephosphorylating tyrosine 46 of Syntenin, which has been reported as a molecular switch in sEV biogenesis. More importantly, Shp2 dysfunction led to enhanced epithelial sEV generation in vitro and in vivo. The increase of epithelial sEVs caused by shRNA‐mediated down‐regulation of Shp2 promoted macrophage activation, resulting in strengthened inflammation. Our findings highlight the role of Shp2 in regulating sEV‐mediated epithelial‐macrophage crosstalk by controlling sEV biogenesis through dephosphorylation of Syntenin Y46. The present study determines the strengthened inflammatory characteristics of alveolar macrophages elicited by epithelial sEVs transferred intercellularly. These findings provide a basis for understanding the mechanism of sEV formation and relevant function in epithelial‐macrophage crosstalk.
Retrospective Camera‐Based Respiratory Gating in Clinical Whole‐Heart 4D Flow MRI
Authors: Gottwald Lukas M. , Blanken Carmen P.S. , Tourais João , Smink Jouke , Planken R. Nils , Boekholdt S. Matthijs , Meijboom Lilian J. , Coolen Bram F. , Strijkers Gustav J. , Nederveen Aart J. , van Ooij Pim
Published: March 2021

Background

Respiratory gating is generally recommended in 4D flow MRI of the heart to avoid blurring and motion artifacts. Recently, a novel automated contact‐less camera‐based respiratory motion sensor has been introduced.

Purpose

To compare camera‐based respiratory gating (CAM) with liver‐lung‐navigator‐based gating (NAV) and no gating (NO) for whole‐heart 4D flow MRI.

Study Type

Retrospective.

Subjects

Thirty two patients with a spectrum of cardiovascular diseases.

Field Strength/Sequence

A 3T, 3D‐cine spoiled‐gradient‐echo‐T1‐weighted‐sequence with flow‐encoding in three spatial directions.

Assessment

Respiratory phases were derived and compared against each other by cross‐correlation. Three radiologists/cardiologist scored images reconstructed with camera‐based, navigator‐based, and no respiratory gating with a 4‐point Likert scale (qualitative analysis). Quantitative image quality analysis, in form of signal‐to‐noise ratio (SNR) and liver‐lung‐edge (LLE) for sharpness and quantitative flow analysis of the valves were performed semi‐automatically.

Statistical Tests

One‐way repeated measured analysis of variance (ANOVA) with Wilks's lambda testing and follow‐up pairwise comparisons. Significance level of P ≤ 0.05. Krippendorff's‐alpha‐test for inter‐rater reliability.

Results

The respiratory signal analysis revealed that CAM and NAV phases were highly correlated (C = 0.93 ± 0.09, P < 0.01). Image scoring showed poor inter‐rater reliability and no significant differences were observed (P ≥ 0.16). The image quality comparison showed that NAV and CAM were superior to NO with higher SNR (P = 0.02) and smaller LLE (P < 0.01). The quantitative flow analysis showed significant differences between the three respiratory‐gated reconstructions in the tricuspid and pulmonary valves (P ≤ 0.05), but not in the mitral and aortic valves (P > 0.05). Pairwise comparisons showed that reconstructions without respiratory gating were different in flow measurements to either CAM or NAV or both, but no differences were found between CAM and NAV reconstructions.

Data Conclusion

Camera‐based respiratory gating performed as well as conventional liver‐lung‐navigator‐based respiratory gating. Quantitative image quality analysis showed that both techniques were equivalent and superior to no‐gating‐reconstructions. Quantitative flow analysis revealed local flow differences (tricuspid/pulmonary valves) in images of no‐gating‐reconstructions, but no differences were found between images reconstructed with camera‐based and navigator‐based respiratory gating.

Level of Evidence

3

Technical Efficacy

Stage 2
COVID‐19 and entrepreneurship: Future research directions
Authors: Ratten Vanessa
Published: March 2021

Innovation and futuristic thinking are needed to derive better policies to address the COVID‐19 pandemic. Policy considerations in terms of entrepreneurship will help understand the importance of future research on digital transformation, leadership, business impact, and social inclusiveness. The societal shifts due to COVID‐19 impacts unveil opportunities for entrepreneurial adjustments to achieve competitiveness and growth.
The resilience of the cooperative model: How do cooperatives deal with the COVID‐19 crisis?
Authors: Billiet Adrien , Dufays Frédéric , Friedel Stefanie , Staessens Matthias
Published: March 2021

The centrality of user‐members in cooperatives and cooperatives' embeddedness in their community and in a global network influence positively their resilience in times of crisis, as illustrated by cases of cooperatives that acted entrepreneurially during the COVID‐19 crisis. Cooperatives are hybrid organizations that maximize value, instead of profit. They are owned, governed, and controlled by their members. They are more resilient than the conventional enterprises in times of crisis, thanks to their peculiar governance characteristics that ensure member centrality. Next to member centrality, the embeddedness of cooperatives in their local environment and a global movement enhances mission centrality as well as trust and solidarity among their members, local communities, and other cooperatives.
Repercussions of COVID‐19 on small restaurant entrepreneurs: The Indian context
Authors: Vig Shinu , Agarwal Richa N.
Published: March 2021

In the pre‐COVID period, the restaurant industry had significantly grown in India in the past decade due to rapid urbanization and modernization. In the post‐COVID period, the small restaurant entrepreneurs are fighting for their survival due to the lack of funds, a shift in the consumers' behaviour and perception, and negative cash flows. It has led to the closure of restaurants, loss of employment, and adversely affected the allied industries. The small restaurant entrepreneurs are exploring some new opportunities amid the crisis and adopting innovative approaches, technological and digital interventions to meet the consumers' need for a contact‐less dining experience. However, a joint effort on the part of entrepreneurs and government bodies will facilitate and fuel the restaurant industry's growth again.