bluuebunny/crossref_metadata_2025 huggingface dataset:
An eco-friendly electric pulse treatment process for improving the microstructure and properties of cold-rolled pure copper sheet
Authors: Xue Ling , Jiang Junda , Yang Yi , Xu Gaolei , Liao Chengzhi , Liu Jian , Wu Mingxia
Published: June 2023

In this study, we performed electric pulse treatment (EPT) on the cold-rolled pure copper sheets. And the effects of the current density of EPT on the microstructure and mechanical properties of the cold-rolled pure copper sheets were investigated. It has been found that the change in the current density of EPT has a remarkable influence on the surface temperature, microstructure, strength, plasticity and microhardness of the samples. Compared with the untreated sample, the elongation after fracture increased by about 3.2 times at a current density of 200 A mm−2, whereas the ultimate tensile strength decreased by only 38.0%. Microstructures indicate that the electric pulse can induce rapid recrystallization in cold-rolled pure copper sheets within a short time, while reducing the dislocation density, weakening the rolling textures and increasing microstructure uniformity, thereby improving the plasticity of the material. Therefore, the present research has the potential to provide an effective alternative way to the traditional heat treatment of copper sheets and strips.
Role of presence of gold nanoparticles on enhancement of RF biosensing sensitivity
Authors: Mazumder Annesha , Bhimalapuram Prabhakar , Syed Azeemuddin , Sau Tapan K
Published: June 2023

In this work, we explore the enhancement of sensitivity of sensing of biomolecules using Radio Frequency (RF) based sensing by utilizing gold particles. In particular, we investigate the impact of various parameters of gold particles such as shape, size and arrangements on enhancing sensitivity. The work uses a Microstrip Patch Antenna designed to resonate at 96.84 GHz. The sensor is facile, rapid and efficient and uses a sample volume of 17.5 nL. The results indicate that the presence of gold particles helps in improving the performance of RF sensors in detecting biomolecules. However, the extent of improvement depends on the properties of gold particles and is in the range of 30%–80% for the different cases studied in this work.
A simple equilibration procedure leading to polynomial-degree-robust a posteriori error estimators for the curl-curl problem
Authors: Chaumont-Frelet T.
Published: June 2023

We introduce two a posteriori error estimators for Nédélec finite element discretizations of the curl-curl problem. These estimators pertain to a new Prager–Synge identity and an associated equilibration procedure. They are reliable and efficient, and the error estimates are polynomial-degree-robust. In addition, when the domain is convex, the reliability constants are fully computable. The proposed error estimators are also cheap and easy to implement, as they are computed by solving divergence-constrained minimization problems over edge patches. Numerical examples highlight our key findings, and show that both estimators are suited to drive adaptive refinement algorithms. Besides, these examples seem to indicate that guaranteed upper bounds can be achieved even in non-convex domains.
Epistemic and Aesthetic Conflict
Authors: Jenkin Zoe
Published: June 2023

Do epistemic and aesthetic values ever conflict? The answer might appear to be no, given that background knowledge generally enhances aesthetic experience, and aesthetic experience in turn generates new knowledge. As Keats writes, ‘Beauty is truth, truth beauty’ (Keats, 1996). Contra this line of thought, I argue that epistemic and aesthetic values can conflict when we over-rely on aesthetically enhancing background beliefs. The true and the beautiful can pull in different directions, forcing us to choose between flavours of normativity.
381 Improved and cleared facial and hand dermatitis with lebrikizumab in patients with moderate-to-severe atopic dermatitis
Authors: Murase Jenny E , Chovatiya Raj , Strowd Lindsay  , Thyssen Jacob P , Bangert Christine  , Atwater Amber Reck , Gallo Gaia  , Bardolet Laia , Yang Fan , Zhong Jinglin  , Staumont-Sallé Delphine
Published: June 2023

Lebrikizumab (LEB) is a novel, high affinity monoclonal antibody that selectively binds to interleukin (IL)-13. Lebrikizumab has been shown to provide robust improvements in signs and symptoms in adolescent and adult patients with moderate-to-severe AD across three phase 3 clinical trials (ADvocate1, ADvocate2 and ADhere). However, little is known about the efficacy of LEB in difficult to treat regions such as the face and hands. This study aims to report efficacy of LEB in improving facial and hand dermatitis. ADvocate1 and ADvocate2 assessed LEB 250 mg every 2 weeks (LEBQ2W) vs. placebo for 16 weeks in monotherapy. ADhere compared low-to-mid potency topical corticosteroids (TCS) in addition to LEB Q2W vs. TCS and placebo for 16 weeks. In all trials, clinicians assessed for the presence or absence of facial and hand dermatitis. If present at baseline, at Week 16, clinicians assessed the change from baseline on a scale of cleared, improved, no change or worsened. Patients with improved or cleared dermatitis are described. In ADvocate1 at baseline, facial dermatitis was identified in 71.4% (202/283) of LEBQ2W patients and 80.9% (114/141) of placebo. At Week 16, 61.9% (125/202; P < 0.001) of LEBQ2W were improved or cleared vs. 31.6% (36/114) of placebo. At baseline, hand dermatitis was identified in 72.1% (204/283) of LEBQ2W patients vs. 73.0% (103/141) of placebo. At Week 16, 67.2% (137/204; P < 0.001) of LEBQ2W were improved or cleared vs. 29.1% (30/103) of placebo. In ADvocate2 at baseline, facial dermatitis was identified in 73.7% (207/281) of LEBQ2W patients and 78.8% (115/146) of placebo. At Week 16, 57.5% (119/207; P < 0.001) of LEBQ2W were improved or cleared vs. 21.7% (25/115) of placebo. At baseline, hand dermatitis was identified in 73.3% (206/281) of LEBQ2W patients and 72.6% (106/146) of placebo. At Week 16, 61.7% (127/206; P < 0.001) of LEBQ2W were improved or cleared vs. 18.9% (20/106) of placebo. In ADhere at baseline, facial dermatitis was identified in 72.4% (105/145) of LEBQ2W patients and 59.1% (39/66) of placebo. At Week 16, 68.6% (72/105; P = 0.02) of LEBQ2W were improved or cleared vs. 46.2% (18/39) of placebo. At baseline, hand dermatitis was identified in 71.0% (103/145) of LEBQ2W patients and 66.7% (44/66) of placebo. At Week 16, 72.8% (75/103; P = 0.001) of LEBQ2W were improved or cleared vs. 43.2% (19/44) of placebo. Lebrikizumab treatment is efficacious in improving and clearing hand and face dermatitis in most patients at Week 16.
389 A CME virtual patient simulation activity evaluated the management of adults with atopic dermatitis
Authors: Dermer Shari J , Betz Briana , Bell Elaine , Guedj Philippe  , Chatterjee-Shin Piyali
Published: June 2023

Atopic dermatitis (AD) is an inflammatory skin disease with significant burden for patients. Individuals with moderate to severe AD frequently require treatment with systemic agents; however, this does not necessarily occur in clinical practice. This study was intended to evaluate the effect of online virtual patient simulation (VPS)-based CME in improving the management of moderate to severe AD. The educational intervention was designed to close gaps related to (i) underrecognition and undertreatment of patients with AD who would benefit from systemic agents and (ii) improve adoption of new therapies for moderate to severe AD. Case-based interventions in an online VPS platform allowed learners to interview patients via video, order tests, make diagnoses and order treatments supported by an extensive database matching the scope and depth of actual practice. Clinical decisions were analysed, and learners received immediate feedback in a short-form clinical guidance (CG) based on current evidence. Learners were permitted to modify their decisions post-CG. Pre- to post-CG decisions were compared using a McNemar’s test with P < 0.05 as significant. The intervention launched on March 4, 2022, and data were collected through June 2022. We report on data from n = 188 dermatologists and n = 130 allergists who participated in two virtual cases. Significant performance-based improvements were made in Case 1 and Case 2 as a result of education (%pre vs. %post, Case1 and %pre vs. %post, Case2). Assessing appropriateness of systemic AD therapy: ordering evaluation of itch with the NRS (61% vs. 71% and 58% vs. 68%); assessing BSA affected (70% vs. 78% and 70% to 80%); evaluating IGA (39% vs. 54% and 65% vs. 70% [ns]); and asking about itch, sleep and ability to function in daily activities (88% vs. 92% and 91% vs. 99%).Diagnosing moderate to severe AD: 47% vs. 58% and 54% vs. 62%.Selecting an evidence-based AD treatment: start FDA-approved IL-4 receptor blocker (18% vs. 47% and 23% vs. 35%); other treatment choices were topical corticosteroids, topical calcineurin inhibitors, crisaborole, systemic immunosuppressants, systemic steroids, JAK inhibitors (upadacitinib and abrocitinib) and tralokinumab.

This study demonstrated that immediate feedback provided in short-form clinical guidance in a VPS that immerses and engages specialists in an authentic and practical learning experience resulted in changes in performance relating to assessing and treating virtual patients with moderate to severe AD. This initiative also revealed gaps in diagnosing moderate to severe AD, and in selecting evidence-based, FDA-approved systemic treatments. Future education is needed to close these gaps.
402 Efficacy of lebrikizumab in adolescent patients with moderate-to-severe atopic dermatitis: 16-week results from three randomized phase 3 clinical trials
Authors: Hebert Adelaide , Flohr Carsten , Chih-ho Hong H , Irvine Alan , Pierce Evangeline  , Elmaraghy Hany  , Xu Wen , Pillai Sreekumar  , Dawson Zach , Siegfried Elaine , Weidinger Stephan 
Published: June 2023

Lebrikizumab, a high-affinity monoclonal antibody targeting IL-13, previously demonstrated clinical efficacy in adults and adolescents with atopic dermatitis (AD) in phase 3 trials. Here we evaluate 16-week efficacy outcomes of lebrikizumab in adolescent patients with moderate-to-severe AD from 3 randomized, double-blind, placebo-controlled phase 3 trials: ADvocate1, ADvocate2 and ADhere. Eligible adolescents (≥12 to <18 years weighing ≥40 kg) were randomized 2 : 1 to subcutaneous lebrikizumab (loading doses of 500 mg at Baseline and Week 2 followed by 250 mg every 2 weeks) or placebo in ADvocate1&2 as monotherapy, and in combination with topical corticosteroids (TCS) in ADhere. Efficacy analyses at Week 16 included IGA (0,1) with ≥2-point improvement, EASI-75, and Pruritus NRS ≥4-point improvement. Adolescent data from ADvocate1 and ADvocate2 were pooled, and ADhere data were analysed separately. ADvocate2 and ADhere analyses were performed on a modified population, excluding 10 adolescent patients from a single site whose eligibility could not be confirmed. Combined adolescent 16-week results from ADvocate1 and ADvocate2 [lebrikizumab (n = 67) vs. placebo (n = 35)] were IGA (0,1) with ≥2-point improvement from baseline 46.6% vs. 14.3% (P < 0.01), EASI-75 62.0% vs. 17.3% (P < 0.001) and Pruritus NRS ≥4-point improvement from baseline 48.9% vs. 13.1% (P < 0.01), respectively. The corresponding proportions in ADhere (lebrikizumab + TCS, n = 32; placebo + TCS, n = 14) were IGA (0,1) 57.3% vs. 28.6% (P = 0.071), EASI-75 88.0% vs. 57.1%, (P < 0.05) and Pruritus NRS 45.8% vs. 13.8%, (P = 0.078), respectively. Lebrikizumab treatment with or without TCS demonstrated clinical efficacy in adolescents with moderate-to-severe AD.
416 Long-term efficacy of dupilumab in adults with moderate-to-severe atopic dermatitis: results from an open-label extension trial up to 5 years
Authors: Beck Lisa A , Bissonnette Robert , Deleuran Mette  , Nakahara Takeshi , Galus Ryszard  , Khokhar Faisal A , Coleman Anna  , Gherardi Guy  , Xiao Jing , Dingman Robert  , Xu Christine , Avetisova Elena  , Dubost-Brama Ariane , Shabbir Arsalan
Published: June 2023

Topical therapies often cannot sufficiently control moderate-to-severe atopic dermatitis (AD), a chronic inflammatory skin disease. Systemic immunosuppressants are not recommended for the long-term treatment of moderate-to-severe AD due to safety concerns. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin (IL)-4 and IL-13, inhibiting the key drivers of type 2 inflammation. Data from the open-label extension (OLE) study, LIBERTY AD OLE, (NCT01949311) previously demonstrated acceptable safety and sustained efficacy of dupilumab in adult patients for up to 204 weeks (approximately 4 years). This study aims to assess the long-term efficacy and safety of dupilumab in adult patients with moderate-to-severe AD up to 5 years (the end of this OLE study). Adults (≥18 years) with moderate-to-severe AD who had participated in any dupilumab parent study (phase 1 through phase 3) were enrolled into the long-term, multicenter OLE with a duration of up to 5 years. Initially, patients enrolled in the OLE were treated with 300-mg dupilumab weekly. In 2019, patients remaining in the study transitioned to dupilumab 300 mg every 2 weeks in alignment with the approved dupilumab dose regimen. Concomitant treatments for AD were permitted, including topical corticosteroids and topical calcineurin inhibitors. Data are presented as observed for the overall study population (n = 2677). Of the 2677 patients who enrolled, 2207 completed treatment up to Week 52, 362 up to Week 172 and 334 up to Week 260. The most common reason for study withdrawals during the OLE study period was dupilumab approval and commercialization in the patient’s country of enrollment [708 (51.3%)]. Fifty (1.9%) patients withdrew due to lack of efficacy. At the end of the study period, 88.9% of patients achieved a 75% reduction in Eczema Area and Severity Index (EASI) score from parent study baseline (PSBL) and 76.2% of patients achieved a 90% reduction in EASI score from PSBL. At Week 260, 66.5% of patients achieved a ≥4-point reduction in the Peak Pruritus Numerical Rating Scale score from PSBL. A total of 2276 (85.0%) patients reported treatment-emergent adverse events, and 101 (3.8%) patients discontinued treatment permanently due to reported adverse events. Dupilumab had an acceptable safety profile over 5 years of treatment. In this long-term (5 year/260 weeks) open-label study, dupilumab demonstrated robust efficacy substantiated by sustained improvement of AD signs and symptoms (including skin lesions and pruritus) in adult patients with moderate-to-severe AD. The safety profile was acceptable and consistent with the known safety profile observed in previous dupilumab placebo-controlled studies.
LGBTQ+ Affirmative State Care for Young People in Sweden: New Knowledge and Old Traditions
Authors: Carlström Charlotta , Andersson Catrine , Lindroth Malin
Published: June 2023

Young LGBTQ+ people are over-represented in various forms of state care. They experience hardships during their placements and staff competence in addressing specific needs among LGBTQ+ youth is lacking. In this article, we investigate whether and how LGTBQ+ issues are considered and described in digital marketing for state care providers. The material consists of the homepages of residential care homes and secure state care institutions, which we analyse using critical discourse analysis. The results show that LGBTQ+ issues are largely invisible. Of the approximately 1,000 existing state care providers, only twenty stated that they worked with or had competence in LGBTQ+ issues. Among these, no secure state care institution offered LGBTQ+ competence at the time of the study. The descriptions of how care providers work with LGBTQ+ issues are characterised by heteronormativity where there is a mix of two types of language on the homepages regarding LGBTQ+ youth; on the one hand, a heteronormative, traditional description based on a binary understanding of gender; and, on the other, an LGBTQ+ inclusive language is used. However, the LGBTQ+ affirmative language has been imposed upon the traditional rather than being integrated into it, which comes across as superficial and unclear.
Post-transcriptional microRNA repression of PMP22 dose in severe Charcot-Marie-Tooth disease type 1
Authors: Pipis Menelaos , Won Seongsik , Poh Roy , Efthymiou Stephanie , Polke James M , Skorupinska Mariola , Blake Julian , Rossor Alexander M , Moran John J , Munot Pinki , Muntoni Francesco , Laura Matilde , Svaren John , Reilly Mary M
Published: June 2023

Copy number variation (CNV) may lead to pathological traits, and Charcot-Marie-Tooth disease type 1A (CMT1A), the commonest inherited peripheral neuropathy, is due to a genomic duplication encompassing the dosage-sensitive PMP22 gene. MicroRNAs act as repressors on post-transcriptional regulation of gene expression and in rodent models of CMT1A, overexpression of one such microRNA (miR-29a) has been shown to reduce the PMP22 transcript and protein level.

Here we present genomic and functional evidence, for the first time in a human CNV-associated phenotype, of the 3′ untranslated region (3′-UTR)-mediated role of microRNA repression on gene expression.

The proband of the family presented with an early-onset, severe sensorimotor demyelinating neuropathy and harboured a novel de novo deletion in the PMP22 3′-UTR. The deletion is predicted to include the miR-29a seed binding site and transcript analysis of dermal myelinated nerve fibres using a novel platform, revealed a marked increase in PMP22 transcript levels. Functional evidence from Schwann cell lines harbouring the wild-type and mutant 3′-UTR showed significantly increased reporter assay activity in the latter, which was not ameliorated by overexpression of a miR-29a mimic.

This shows the importance of miR-29a in regulating PMP22 expression and opens an avenue for therapeutic drug development.
Artificial intelligence and the public arena
Authors: Jungherr Andreas , Schroeder Ralph
Published: June 2023

The public arena relies on artificial intelligence (AI) to ever greater degrees. Media structures hosting the public arena—such as Facebook, TikTok, Twitter, and YouTube—increasingly rely on AI-enabled applications to shape information environments, autonomously generate content, and communicate with people. These applications affect the public arena’s functions: make society visible to itself and provide spaces for the formation of publics and counterpublics. We offer a framework that allows for the conceptualization and empirical examination of AI’s structural impact on the public arena. Based on this perspective, we argue that the growing uses of AI will lead to a strengthening of intermediary structures that can exercise a greater degree of control over the public arena. In addition, the data-driven nature of most AI-applications threatens to push challenges to the political status quo out of sight and obstruct the assessability of AI-enabled interventions.
Host use by 2 sibling species of bogus yucca moths in relation to plant hardness and saponin content
Authors: Luna Diego , Mohanbabu Neha , Johnson Josiah , Althoff David M
Published: June 2023

Plant defenses allow plants to deter or kill their insect herbivores and are considered to be a major driver of host use for herbivorous insects in both ecological and evolutionary time. Many closely related species of insect herbivores differ in their ability to respond to plant defenses and in some cases are specialized to specific plant species. Here we tested whether both mechanical and chemical plant defenses are a major factor in determining the host range of 2 sibling species of Prodoxid bogus yucca moths, Prodoxus decipiens (Riley) and Prodoxus quinquepunctellus (Chambers) that feed within the inflorescence stalk of Yucca species. These 2 moth species have separate suites of host plant species, yet narrowly overlap geographically and share 1 Yucca species, Y. glauca. We surveyed the lignin and cellulose content, the force required to the puncture the stalk tissue, and saponin concentration across 5 Yucca species used as hosts. Lignin, cellulose concentrations, and stalk hardness differed among Yucca species but did not correlate with host use patterns by the moths. Saponin concentrations in the stalk tissue were relatively low for yuccas (<1%) and did not differ among species. The results suggest that these moth species should be able to use each other’s hosts for egg deposition. Additional factors such as larval development or competition among larvae for feeding space may serve to keep moth species from expanding onto plants used by its sibling species.
The Political Economy of Peacekeeping: Civil–Military Resource Substitution through International Brokerage
Authors: Sakib Nazmus , Rahman Md Muhibbur
Published: June 2023

What effects does participation in peacekeeping operations (PKO) have on the participating countries’ civil–military resource allocation? Answering this question can widen our understanding of state motivations to contribute to the United Nations PKOs by incorporating the civil–military dynamic. We argue that contributing states can substitute part of their domestic military expenditures with external resources. Governments act as brokers between domestic military interests and international sources of rent, a process which we call civil–military resource substitution through international brokerage. By doing so, governments can (i) reduce part of the bottom-up demands for increased military spending (i.e., salaries and allowances) and (ii) outsource critical resources to meet military organizational priorities (i.e., training, weapons, perks for the military elite, and so on). Using cross-national statistical analysis, we find that the UN PKO contributing states allocate fewer resources to the defense sector than the non-contributing states, and higher troop-contributing states are likely to allocate fewer resources to the defense sector than the lower-contributing or non-contributing states. The implications point to a much wider role of the UN peacekeeping missions than what is previously understood and demonstrate their impacts beyond the host countries.
Impact of 1,6-hexanediol on Schizosaccharomyces pombe genome stability
Authors: Jones Chance E , Forsburg Susan L
Published: June 2023

Phase separation is a major mechanism of macromolecular condensation within cells. A frequently chosen tool for global disruption of phase separation via weak hydrophobic interactions is treatment with 1,6-hexanediol. This study evaluates the cytotoxic and genotoxic effects of treating live fission yeast with 1,6-hexanediol. We find that 1,6-hexanediol causes a drastic decrease in cell survival and growth rate. We also see a reduction in HP1 protein foci and increase in DNA damage foci. However, there is no evidence for increased genomic instability in two classically phase-separated domains, the heterochromatic pericentromere and the nucleolar rDNA repeats. This study reveals that 1,6-hexanediol is a blunt tool for phase separation inhibition and its secondary effects must be taken into consideration during its in vivo use.
Inferring the distributions of fitness effects and proportions of strongly deleterious mutations
Authors: Charmouh Anders P , Bocedi Greta , Hartfield Matthew
Published: June 2023

The distribution of fitness effects is a key property in evolutionary genetics as it has implications for several evolutionary phenomena including the evolution of sex and mating systems, the rate of adaptive evolution, and the prevalence of deleterious mutations. Despite the distribution of fitness effects being extensively studied, the effects of strongly deleterious mutations are difficult to infer since such mutations are unlikely to be present in a sample of haplotypes, so genetic data may contain very little information about them. Recent work has attempted to correct for this issue by expanding the classic gamma-distributed model to explicitly account for strongly deleterious mutations. Here, we use simulations to investigate one such method, adding a parameter (plth) to capture the proportion of strongly deleterious mutations. We show that plth can improve the model fit when applied to individual species but underestimates the true proportion of strongly deleterious mutations. The parameter can also artificially maximize the likelihood when used to jointly infer a distribution of fitness effects from multiple species. As plth and related parameters are used in current inference algorithms, our results are relevant with respect to avoiding model artifacts and improving future tools for inferring the distribution of fitness effects.
Ten health policy challenges for the next 10 years
Authors: Phillips Kathryn A , Marshall Deborah A , Adler Loren , Figueroa Jose , Haeder Simon F , Hamad Rita , Hernandez Inmaculada , Moucheraud Corrina , Nikpay Sayeh
Published: June 2023

Health policies and associated research initiatives are constantly evolving and changing. In recent years, there has been a dizzying increase in research on emerging topics such as the implications of changing public and private health payment models, the global impact of pandemics, novel initiatives to tackle the persistence of health inequities, broad efforts to reduce the impact of climate change, the emergence of novel technologies such as whole-genome sequencing and artificial intelligence, and the increase in consumer-directed care. This evolution demands future-thinking research to meet the needs of policymakers in translating science into policy. In this paper, the Health Affairs Scholar editorial team describes “ten health policy challenges for the next 10 years.” Each of the ten assertions describes the challenges and steps that can be taken to address those challenges. We focus on issues that are traditionally studied by health services researchers such as cost, access, and quality, but then examine emerging and intersectional topics: equity, income, and justice; technology, pharmaceuticals, markets, and innovation; population health; and global health.
Social determinants of health in Brazil during the COVID-19 pandemic: strengths and limitations of emergency responses
Authors: Lazzari Eduardo A , Paschoalotto Marco A C , Massuda Adriano , Rocha Rudi , Castro Marcia C
Published: June 2023

Economic crises often expose the most vulnerable to higher health risks and tend to exacerbate existing inequalities. The Social Determinants of Health (SDoH) framework illustrates many layers of inequalities that would affect outcomes of the COVID-19 pandemic. The impacts of emergency policy responses considering the SDoH framework are important for all sectors in policymaking. However, its assessment in Global South countries is limited, due to high informality rates and data availability. We address this gap using a unique dataset that allows for the analysis of occupational categories before and after the COVID-19 pandemic in Brazil, incorporating the emergency assistance provided in 2020. Results show that, although labor earnings fell 4% for the self-employed at each death from COVID-19, increasing unemployment and inactivity among the typically most vulnerable, those effects were offset by emergency policies, reducing poverty. Groups often considered less vulnerable, such as formal employees, had an increase. The policy responses to this shock served then as a leveler of previous SDoH, despite ignoring the health-risk gradient there is along the income distribution. A poverty rebound that ensued after the sudden discontinuation of those policies is a lesson for future crises, and on how SDoH inequalities should be addressed.
US practice adoption of patient-engagement strategies and spending for adults with diabetes and cardiovascular disease
Authors: Rodriguez Hector P , Rubio Karl , Miller-Rosales Chris , Wood Andrew J
Published: June 2023

Patient-engagement strategies are being encouraged by payers and governments, but with limited evidence about whether practice adoption of these strategies impacts utilization and spending. We examine the association of physician practice adoption of patient-engagement strategies (low vs moderate vs high) with potentially preventable utilization and total spending for patients with type 2 diabetes and/or cardiovascular disease using US physician practice survey (n = 2086) and Medicare fee-for-service (n = 736 269) data. In adjusted analyses, there were no differences in potentially preventable utilization associated with practice adoption of patient-engagement strategies. Compared with patients attributed to practices with moderate adoption, patients attributed to practices with high adoption had higher total spending ($26 364 vs $25 991; P < .05) driven by spending for long-term services and supports, including home health agency, long-term care, skilled nursing facilities, and hospice payments. In contrast, patients attributed to practices with low adoption had higher total spending ($26 481 vs $25 991; P < .01) driven by spending for tests and acute care and clinical access spending. The results highlight that stakeholders that encourage the use of patient-engagement strategies should not necessarily expect reduced spending.
‘Kontra-partido’: untangling oppositional local politics and healthcare devolution in the Philippines
Authors: Yu Vincen Gregory , Lasco Gideon , David Clarissa C , Baysic Ivyrose S
Published: June 2023

A long-recognized problem of healthcare devolution in many developing countries is its inextricability from the influences of local politics. This has been particularly self-evident in the Philippines, where, since the adoption of the Local Government Code of 1991, the devolution of health governance, planning, administration and service delivery has placed the health system largely under the control of individual provinces, cities, municipalities and villages or barangays. In this article, we utilize the notion of ‘kontra-partido’ (the Filipino term connoting ‘oppositional politics’) to concretize local, oppositional politics as a lived experience of health workers, government officials and ordinary citizens in the country. Through multi-sited qualitative fieldwork, we demonstrate how ‘kontra-partido’ politics ultimately worsens health outcomes in any locality. We show how such politics figures in the relational dynamics of health governance, often resulting in petty infighting and strained relationships among local health authorities; how it leads to the politicization of appointments and prevents the local workforce, especially those at the grassroots, from doing their jobs efficiently amid environments rife with hostile patronage; and how it impedes service delivery as politicians prioritize ‘visible’ projects (over sustainable ones) and selectively deliver health care to their known supporters. In turn, health workers and ordinary citizens alike have been actively negotiating their roles within this political milieu, either by joining the so-called political frontlines or by engaging in the transactional relationships that develop between politicians and their constituents during perennial election seasons. We conclude with a reflection on the vulnerability of health to politicization and the visceral consequences of ‘kontra-partido’ politics to health workers, as well as an identification of possible areas of intervention for future policy reform, given the deepening political polarization in the country and the upcoming implementation of the recently passed Universal Health Care Law.
Small effect sizes are achievable in offshore wind monitoring surveys
Authors: Livermore J , Truesdale C , Ransier K , McManus M C
Published: June 2023

Understanding the prospective environmental impacts of offshore wind energy development requires monitoring that allows for adequate testing of conditions for comparison of unimpacted vs. impacted states. A critical component when designing impact studies is determining the required sampling needed to statistically measure a difference between before and after states in the system, which is often challenging because there are little observational data available for the system of interest at the proper spatiotemporal scales. Here, we present the survey design with power and effect size analyses that were used to design a before-after gradient survey to assess American lobster impacts from an offshore wind submarine cable installation in coastal United States waters. By leveraging long-term monitoring data collected from a random-stratified sampling design survey, a gradient survey testing for effects on lobster at distance intervals from the cable using similar sampling methods was developed. Generalized linear mixed models were employed to determine the needed sampling frequency to assess varied catch-per-unit-effort impacts. We present the survey design and our findings from the power analyses to serve as an example of methodology for designing before and after impact surveys for offshore wind energy, and how preexisting data may be used to do so.
An augmented fully mixed formulation for the quasistatic Navier–Stokes–Biot model
Authors: Li Tongtong , Caucao Sergio , Yotov Ivan
Published: June 2023

We introduce and analyze a partially augmented fully mixed formulation and a mixed finite element method for the coupled problem arising in the interaction between a free fluid and a poroelastic medium. The flows in the free fluid and poroelastic regions are governed by the Navier–Stokes and Biot equations, respectively, and the transmission conditions are given by mass conservation, balance of fluid force, conservation of momentum and the Beavers–Joseph–Saffman condition. We apply dual-mixed formulations in both domains, where the symmetry of the Navier–Stokes and poroelastic stress tensors is imposed in an ultra-weak and weak sense. In turn, since the transmission conditions are essential in the fully mixed formulation, they are imposed weakly by introducing the traces of the structure velocity and the poroelastic medium pressure on the interface as the associated Lagrange multipliers. Furthermore, since the fluid convective term requires the velocity to live in a smaller space than usual, we augment the variational formulation with suitable Galerkin-type terms. Existence and uniqueness of a solution are established for the continuous weak formulation, as well as a semidiscrete continuous-in-time formulation with nonmatching grids, together with the corresponding stability bounds and error analysis with rates of convergence. Several numerical experiments are presented to verify the theoretical results and illustrate the performance of the method for applications to arterial flow and flow through a filter.
Permanent deformation of unsaturated granular material under multiple drying and wetting cycles
Authors: Jing Peng , Song Xin Tong , Nowamooz Hossein , Zhang Jin Xi , Tang Fu Jiao
Published: June 2023

This investigation proposes an empirical–analytical model for the soil–water retention curve (SWRC) as well as the permanent deformation prediction of unsaturated granular materials under multiple hydraulic cycles. To calibrate and verify the proposed approach, the normalized SWRC model was firstly applied to predict the normalized SWRCs of two unsaturated soils under multiple drying and wetting cycles. The predicted and experimental results showed a good correspondence of the model. The normalized permanent deformation model is subsequently used to estimate the final permanent deformations of two granular materials (clay-crushed tuff aggregates (CTAs) mixture and Missillac sand), with suction under multiple drying and wetting cycles. The results showed that the proposed approach can effectively evaluate the normalized SWRCs and the final permanent deformations of the studied granular materials.
Diversity within the species Clostridium butyricum: pan-genome, phylogeny, prophage, carbohydrate utilization, and antibiotic resistance
Authors: Pei Zhangming , Liu Yufei , Yi Zhi , Liao Jingyi , Wang Hongchao , Zhang Hao , Chen Wei , Lu Wenwei
Published: June 2023

Aims

Clostridium butyricum has been recognized as a strong candidate for the “next generation of probiotics” due to its beneficial roles on humans. Owing to our current understanding of this species is limited, it is imperative to unveil the genetic variety and biological properties of C. butyricum on sufficient strains.

Methods and results

We isolated 53 C. butyricum strains and collected 25 publicly available genomes to comprehensively assess the genomic and phenotypic diversity of this species. Average nucleotide identity and phylogeny suggested that multiple C. butyricum strains might share the same niche. Clostridium butyricum genomes were replete with prophage elements, but the CRISPR-positive strain efficiently inhibited prophage integration. Clostridium butyricum utilizes cellulose, alginate, and soluble starch universally, and shows general resistance to aminoglycoside antibiotics.

Conclusions

Clostridium butyricum exhibited a broad genetic diversity from the extraordinarily open pan-genome, extremely convergent core genome, and ubiquitous prophages. In carbohydrate utilization and antibiotic resistance, partial genotypes have a certain guiding significance for phenotypes.
Higher Initial Formula for Resuscitation After Severe Burn Injury Means Higher 24-Hour Volumes
Authors: Rizzo Julie A , Coates Elsa C , Serio-Melvin Maria L , Aden James K , Stallings Jonathan D , Foster Kevin N , Abdel Fattah Kareem R , Pham Tam N , Salinas Jose
Published: June 2023

Initial fluid infusion rates for resuscitation of burn injuries typically use formulas based on patient weight and total body surface area (TBSA) burned. However, the impact of this rate on overall resuscitation volumes and outcomes have not been extensively studied. The purpose of this study was to determine the impact of initial fluid rates on 24-hour volumes and outcomes using the Burn Navigator (BN). The BN database is composed of 300 patients with ≥20% TBSA, >40 kg that were resuscitated utilizing the BN. Four study arms were analyzed based on the initial formula—2 ml/kg/TBSA, 3 ml/kg/TBSA, 4 ml/kg/TBSA or the Rule of Ten. Total fluids infused at 24 hours after admission were compared as well as resuscitation-related outcomes. A total of 296 patients were eligible for analysis. Higher starting rates (4 ml/kg/TBSA) resulted in significantly higher volumes at 24 hours (5.2 ± 2.2 ml/kg/TBSA) than lower rates (2 ml/kg/TBSA resulted in 3.9 ± 1.4 ml/kg/TBSA). No shock was observed in the high resuscitation cohort, whereas the lowest starting rate exhibited a 12% incidence, lower than both the Rule of Ten and 3 ml/kg/TBSA arms. There was no difference in 7-day mortality across groups. Higher initial fluid rates resulted in higher 24-hour fluid volumes. The choice of 2ml/kg/TBSA as initial rate did not result in increased mortality or more complications. An initial rate of 2ml/kg/TBSA is a safe strategy.
Sublethal effects of halofenozide on larval development and detoxification inPhaedon brassicae(Coleoptera: Chrysomelidae)
Authors: Ma Long , Xu Changxia , Peng Yingchuan , Zhang Jing , Zhang Wanna
Published: June 2023

The brassica leaf beetle, Phaedon brassicae, is a serious defoliator of cruciferous crops. Halofenozide (Hal), an ecdysone agonist, is a new class of insect growth-regulating insecticide. Our preliminary experiment revealed the outstanding larval toxicity of Hal against P. brassicae. However, the metabolic degradation of this compound in insects remains unclear. In this study, oral administration of Hal at LC10 and LC25 caused severe separation of the cuticle and epidermis, leading to larval molting failure. Sublethal dose exposure also significantly reduced the larval respiration rate as well as their pupation rates and pupal weights. Conversely, the activities of the multifunctional oxidase, carboxylesterase (CarE), and glutathione S-transferase (GST) were significantly enhanced in Hal-treated larvae. Further analysis using RNA sequencing identified 64 differentially expressed detoxifying enzyme genes, including 31 P450s, 13 GSTs, and 20 CarEs. Among the 25 upregulated P450s, 22 genes were clustered into the CYP3 clan, and the other 3 genes belonged to the CYP4 clan. Meanwhile, 3 sigma class GSTs and 7 epsilon class GSTs were dramatically increased, accounting for the majority of the upregulated GSTs. Moreover, 16 of the 18 overexpressed CarEs were clustered into the coleopteran xenobiotic-metabolizing group. These results showed the augmented expression of detoxification genes in P. brassicae after exposed to sublethal dose of Hal, and helped to better understand the potential metabolic pathways that could contribute to the reduced sensitivity to Hal in this pest. Overall, a deep insight into the detoxification mechanisms would provide practical guidance for the field management of P. brassicae.
Direct and indirect landscape-scale pathways structure carnivore communities in an agro-prairie ecosystem
Authors: Werdel Ty J , Piper Colleen W , Ricketts Andrew M , Peek Matthew S , Ahlers Adam A
Published: June 2023

Many carnivore populations have experienced substantial declines and are at increased risk of extinction, mainly due to negative interactions with humans and biological traits that make them susceptible to habitat loss and fragmentation, often driven by agricultural expansion. Carnivore community richness is likely influenced by many direct and indirect factors, though it is unclear how carnivore communities are structured in prairie landscapes that are considered one of the most imperiled ecosystems worldwide. Our goal was to identify landscape-scale effects driving carnivore community richness in a contemporary agro-prairie ecosystem. We used 3 years of presence data (2018–2020) from camera-trap sites (n = 381) distributed across western Kansas, United States and developed a structural equation model (SEM) to test a priori hypotheses explaining carnivore richness. Measures of water availability, native prairie, and agriculture—as well as sampling effort (i.e., days cameras were active)—were all positively associated with carnivore richness. Additionally, our index of rabbit abundances at sites had a direct positive effect on our measure of carnivore richness. Our SEM explained 42% of the variance in carnivore richness (χ2 = 8.76, d.f. = 21, P = 0.99) in this human-dominated landscape. Our results suggest that carnivore communities in agro-prairie landscapes are structured through multiple direct and indirect landscape-scale pathways. Contemporary agro-prairie mosaics may act as filters for the agricultural tolerance of carnivores, with species more vulnerable to native prairie loss becoming locally extirpated.
Tomato miR156-targetedSlSBP15represses shoot branching by modulating hormone dynamics and interacting withGOBLETandBRANCHED1b
Authors: Barrera-Rojas Carlos Hernán , Vicente Mateus Henrique , Pinheiro Brito Diego Armando , Silva Eder M , Lopez Aitor Muñoz , Ferigolo Leticia F , do Carmo Rafael Monteiro , Silva Carolina M S , Silva Geraldo F F , Correa Joao P O , Notini Marcela M , Freschi Luciano , Cubas Pilar , Nogueira Fabio T S
Published: June 2023

The miRNA156 (miR156)/SQUAMOSA PROMOTER-BINDING PROTEIN-LIKE (SPL/SBP) regulatory hub is highly conserved among phylogenetically distinct species, but how it interconnects multiple pathways to converge to common integrators controlling shoot architecture is still unclear. Here, we demonstrated that the miR156/SlSBP15 node modulates tomato shoot branching by connecting multiple phytohormones with classical genetic pathways regulating both axillary bud development and outgrowth. miR156-overexpressing plants (156-OE) displayed high shoot branching, whereas plants overexpressing a miR156-resistant SlSBP15 allele (rSBP15) showed arrested shoot branching. Importantly, the rSBP15 allele was able to partially restore the wild-type shoot branching phenotype in the 156-OE background. rSBP15 plants have tiny axillary buds, and their activation is dependent on shoot apex-derived auxin transport inhibition. Hormonal measurements revealed that indole-3-acetic acid (IAA) and abscisic acid (ABA) concentrations were lower in 156-OE and higher in rSBP15 axillary buds, respectively. Genetic and molecular data indicated that SlSBP15 regulates axillary bud development and outgrowth by inhibiting auxin transport and GOBLET (GOB) activity, and by interacting with tomato BRANCHED1b (SlBRC1b) to control ABA levels within axillary buds. Collectively, our data provide a new mechanism by which the miR156/SPL/SBP hub regulates shoot branching, and suggest that modulating SlSBP15 activity might have potential applications in shaping tomato shoot architecture.
Market Analysis of Video Laryngoscopy Equipment for the Role 1 Setting
Authors: Fuller Robert G , Rossetto Marika A , Paulson Matthew W , April Michael D , Ginde Adit A , Bebarta Vikhyat S , Flarity Kathleen M , Keenan Sean , Schauer Steven G
Published: June 2023

Introduction

Airway compromise is the second leading cause of potentially preventable prehospital combat death. Endotracheal intubation (ETI) remains the most common role 1 airway intervention. Video laryngoscopy (VL) is superior to direct laryngoscopy (DL) for first-attempt intubation, especially in less-experienced providers and for trauma patients. The cost has been a major challenge in pushing VL technology far-forward; however, the cost of equipment continues to become more affordable. We conducted a market analysis of VL devices under $10,000 for possible options for role 1.

Materials and Methods

We searched Google, PubMed, and the Food and Drug Administration database from August 2022 to January 2023 with a combination of several keywords to identify current VL market options under $10,000. After identifying relevant manufacturers, we then reviewed individual manufacturer or distributor websites for pricing data and system specifications. We noted several characteristics regarding VL device design for comparison. These include monitor features, size, modularity, system durability, battery life, and reusability. When necessary, we requested formal price quotes from respective companies.

Results

We identified 17 VL options under $10,000 available for purchase, 14 of which were priced below $5,000 for individual units. Infium (n = 3) and Vimed Medical (n = 4) provided the largest number of unique models. VL options under $10,000 exist in both reusable and disposable modalities. These modalities included separate monitors as well as monitors attached to the VL handle. Disposable options, on a per-unit basis, cost less than reusable options.

Conclusions

Several VL options exist within our goal price point in both reusable and disposable options. Clinical studies assessing the technology performance of ETI and deliberate downselection are needed to identify the most cost-effective solution for role 1 dispersion.