bluuebunny/crossref_metadata_2025 huggingface dataset:
Can clinical pharmacists utilize telehealth to double the safety and efficacy of oral anticoagulation while reducing health care costs and improving patient satisfaction in patients with atrial fibrillation?
Authors: Bussey Henry I. , Nutescu Edith A. , Harper Paul
Published: August 2021

Background

Published reports from the United States and New Zealand have described excellent control of the international normalized ratio (INR) and improved patient satisfaction in warfarin‐treated patients whose therapy was managed by clinically trained pharmacists using point of care (POC, or “fingerstick”) blood testing and online technology. This report examines the projected impact of such management on clinical outcomes and health care costs by using previously published information which quantified the relationships between anticoagulation control and rates of thromboembolism, major hemorrhage, and death.

Methods

Anticoagulation control was defined as the percent of time that the INR was within the target range (TTR). Published regression equations and adjusted relative risks were used to calculate the rate of thromboembolism, major bleeding, and death associated with various TTR values. The rates of ischemic stroke, myocardial infarction, intracranial hemorrhage, gastrointestinal bleed, and death, and the cost for each type of event, were used to determine a key composite end point rate and associated costs at various TTR values and as reported in the four direct‐acting oral anticoagulant (DOAC) studies.

Results

Both the US and New Zealand online systems achieved comparable TTR values of approximately 75% (or better). Cost avoidance per 1000 patients per year based on projected key composite end point rates at a TTR of 75% ranged from $10.4 million compared with a TTR of 30% to $2.2 million compared with a TTR of 65%,. Cost avoidance compared with the rates reported in the DOAC trials ranged from $1.4 to $4.5 million. Patient satisfaction scores exceeded 90% with both systems as reported previously.

Conclusion

Clinically‐trained pharmacists using POC INR testing and online management may reduce major clinical events by more than 50%, substantially reduce health care costs, and improve patient satisfaction. Data from Europe confirm that these low projected event rates are achievable.
Telehealth and technological applications in patient‐centered care: Implications for pharmacy learners and clinical pharmacists
Authors: Badowski Melissa E. , Bente Jessica A. , Davis Estella M. , Isaacs Diana , Lewis Lindi , Martello Jay L. , Pitlick Matthew , Almodóvar Armando Silva , Stadler Sheila , Sutton Burke Elizabeth , Belk Madeline , Tovey Amber , Kane‐Gill Sandra L.
Published: August 2021

Telehealth has emerged as an essential health care delivery modality to improve patient access to health care and allow providers to meet their patients' health care needs. It is imperative that pharmacy learners and clinical pharmacists have the requisite knowledge and skills to comfortably deliver patient‐centered care via telehealth with devices, software, digital therapeutics, wearables, and other technological applications. This manuscript supplements the existing ACCP resources on this subject, educates clinical pharmacists on the rapidly advancing field of telehealth and its available technologies, and summarizes methods for training current and prospective clinical practitioners.
Feasibility of a CMM telepharmacy service for patients with diabetes in rural and underserved communities: Preliminary results
Authors: Livet Melanie , Levitt Jordana , Cardenas Amy , Thomas Jeremy , Lee Alyssa , Pathak Shweta , Curran Geoffrey
Published: August 2021

Introduction

Patients with uncontrolled diabetes living in rural and underserved communities experience many challenges, including lack of access to needed health and medication management services. Telepharmacy has been identified as a promising approach for addressing this gap. This article describes early insights into the implementation and effectiveness of a comprehensive medication management (CMM) telepharmacy service offered as part of primary care clinics in North Carolina and Arkansas. The CMM service involved pharmacists meeting remotely with patients in their homes to identify and resolve medication‐related problems (MTPs).

Objectives

The purpose of this article is to both describe early successes, challenges, and lessons learned, and summarize preliminary effectiveness results.

Methods

This exploratory study made use of mixed methods data spanning the first three months of implementation. Successes, challenges, and lessons learned were captured through clinic interviews, open‐ended survey questions, and pharmacists' logs. Evidence of implementation progress and success was based on administrative data and implementation outcomes survey results. Medication therapy problems (MTPs) were used as a proxy to assess preliminary service effectiveness.

Results

Key insights centered on the perceived benefits of the service for patients and clinics, the importance of patient outreach and engagement, access to implementation support strategies, and the need for adaptability. Implementation success was rated highly by clinic stakeholders, with significant increases in service acceptability, appropriateness, and feasibility over time, and continued intent to maintain the service. The MTP resolution rate averaged 88% across pharmacists.

Conclusion

These preliminary data are promising for supporting the value of a pharmacist‐led medication optimization service delivered remotely to complex patients with uncontrolled diabetes. Ultimately, this model has the potential to expand access to care and transform the delivery of pharmacy services, while creating an opportunity to evolve the role of the clinical pharmacist beyond the traditional boundaries.
Ectopic Calcification and Hypophosphatemic Rickets: Natural History of ENPP1 and ABCC6 Deficiencies
Authors: Ferreira Carlos R , Kintzinger Kristina , Hackbarth Mary E , Botschen Ulrike , Nitschke Yvonne , Mughal M Zulf , Baujat Genevieve , Schnabel Dirk , Yuen Eric , Gahl William A , Gafni Rachel I , Liu Qing , Huertas Pedro , Khursigara Gus , Rutsch Frank
Published: August 2021

Generalized arterial calcification of infancy (GACI) is a rare disorder caused by ENPP1 or ABCC6 variants. GACI is characterized by low pyrophosphate, arterial calcification, and high mortality during the first year of life, but the natural course and possible differences between the causative genes remain unknown. In all, 247 individual records for patients with GACI (from birth to 58.3 years of age) across 19 countries were reviewed. Overall mortality was 54.7% (13.4% in utero or stillborn), with a 50.4% probability of death before the age of 6 months (critical period). Contrary to previous publications, we found that bisphosphonate treatment had no survival benefit based on a start-time matched analysis and inconclusive results when initiated within 2 weeks of birth. Despite a similar prevalence of GACI phenotypes between ENPP1 and ABCC6 deficiencies, including arterial calcification (77.2% and 89.5%, respectively), organ calcification (65.8% and 84.2%, respectively), and cardiovascular complications (58.4% and 78.9%, respectively), mortality was higher for ENPP1 versus ABCC6 variants (40.5% versus 10.5%, respectively; p = 0.0157). Higher prevalence of rickets was reported in 70.8% of surviving affected individuals with ENPP1 compared with that of ABCC6 (11.8%; p = 0.0001). Eleven affected individuals presenting with rickets and without a GACI diagnosis, termed autosomal recessive hypophosphatemic rickets type 2 (ARHR2), all had confirmed ENPP1 variants. Approximately 70% of these patients demonstrated evidence of ectopic calcification or complications similar to those seen in individuals with GACI, which shows that ARHR2 is not a distinct condition from GACI but represents part of the spectrum of ENPP1 deficiency. Overall, this study identified an early mortality risk in GACI patients despite attempts to treat with bisphosphonates, high prevalence of rickets almost exclusive to ENPP1 deficiency, and a spectrum of heterogenous calcification and multiple organ complications with both ENPP1 and ABCC6 variants, which suggests an overlapping pathology. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by US Government employees and their work is in the public domain in the USA.
The outcomes of thrombotic microangiopathy after liver transplantation: A nationwide survey in Japan
Authors: Takatsuki Mitsuhisa , Eguchi Susumu , Yamamoto Masakazu , Yamaue Hiroki , Takada Yasutsugu ,   the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery
Published: August 2021

Background

Although thrombotic microangiopathy (TMA) is recognized as one of the poor‐prognosis factors after liver transplantation, the precise outcome of TMA is unclear. We sought to elucidate the factors affecting the outcome of TMA after liver transplantation in Japan, based on the data from a nationwide survey.

Methods

One hundred cases of post‐transplant TMA were accumulated from 17 Japanese centers of which two cases were excluded because the cause of death was obviously not related to TMA (recurrence of original diseases as primary sclerosing cholangitis and hepatocellular carcinoma), and the remaining 98 cases were enrolled in this study. The patient survival after the development of TMA and the factors that affected the patients' outcomes were retrospectively analyzed.

Results

All cases were living‐donor liver transplant cases, and the 1‐, 3‐, and 5‐year patient survival rates after transplantation were 66.9%, 64.6%, and 62.2%, respectively. In a multivariate analysis, the requirement of renal replacement therapy during TMA treatment was the only factor that was significantly related to poor outcome after the development of TMA.

Conclusion

The outcomes of TMA were generally poor. The progression of renal dysfunction despite intensive treatment might be the only factor related to the poor prognosis after the development of TMA.
My boss' passion matters as much as my own: The interpersonal dynamics of passion are a critical driver of performance evaluations
Authors: Jachimowicz Jon M. , Wihler Andreas , Galinsky Adam D.
Published: August 2021

Companies often celebrate employees who successfully pursue their passion. Academic research suggests that these positive evaluations occur because of the passion percolating inside the employee. We propose that supervisors are also a key piece of this puzzle: Supervisors who are more successful in their own pursuit of passion place more value on passion in their performance evaluations. This produces an interpersonal dynamic whereby employees who are more successful in pursuing their passion may receive higher performance ratings when their supervisors are also more successful in pursuing their passion. We provide support for this core hypothesis across a crowdsourced study with a heterogeneous sample (N = 106 subordinate–supervisor dyads), a field study with a financial services company (N = 321 subordinate–supervisor dyads), and a laboratory experiment (N = 205) that offers both causal and mediating evidence. Crucially, we demonstrate that this interpersonal dynamic is specific to passion and does not apply to less observable motivations (intrinsic and extrinsic motivation). These results demonstrate that supervisors who successfully pursue their passion may overvalue passion relative to other valuable attributes, leading to potential bias. They also give a new perspective on managing upward: Employees may further their own careers by helping their supervisors pursue their passion.
Natural thymol‐based ternary deep eutectic solvents: Application in air‐bubble assisted‐dispersive liquid‐liquid microextraction for the analysis of tetracyclines in water
Authors: Sereshti Hassan , Abdolhosseini Ghazaleh , Soltani Sara , Jamshidi Fatemeh , Nouri Nina
Published: August 2021

Four new thymol‐based ternary deep eutectic solvents were prepared and evaluated as the extractive phase in air‐bubbles assisted dispersive liquid‐liquid microextraction for extraction of tetracycline, doxycycline, and oxytetracycline from the water before high‐performance liquid chromatography. The maximum extraction efficiencies were obtained using 400 μL of [choline chloride]:[thymol]:[nonanoic acid] in the molar ratio of 1:2:2 at pH = 5. The solvent was characterized by FTIR and NMR spectroscopy. The hydrophobicity of the deep eutectic solvent and its effect on the pH of water samples after mixing was also studied. Besides, the extraction efficiency of the ternary deep eutectic solvent was compared with that of two binary thymol‐based deep eutectic solvents, including [choline chloride]:[thymol] and [thymol]:[nonanoic acid] at the same conditions. Under optimal conditions, limits of detection and quantification were 1.2–8.0 and 3.8–26.6 μg/L, respectively. The linear ranges were 18.2–500 μg/L for oxytetracycline, 26.6–500 μg/L for tetracycline, and 3.8–500 μg/L for doxycycline with the determination coefficients > 0.9912. Intra‐ and inter‐day relative standard deviations were 1.2–3.8 and 7.7–11.2%, respectively. The developed method was applied to the analysis of tetracyclines in unspiked and spiked environmental water samples, and the obtained recoveries were 74.5–95.4% with relative standard deviations of 1.2–4.0%.
Cancer‐Related Activity Limitations Among Head and Neck Cancer Survivors
Authors: Warinner Chloe B. , Bergmark Regan W. , Sethi Rosh , Rettig Eleni M.
Published: August 2021

Objectives/Hypothesis

To characterize self‐reported cancer‐related activity limitations among a broad population of head and neck (HNC) survivors and identify sociodemographic factors associated with these limitations.

Study Design

Cross‐sectional analysis of data from the National Health Interview Survey.

Methods

The study population included individuals who completed the National Health Interview Survey (NHIS) from 1997 to 2018 and self‐reported a cancer diagnosis. Data regarding activity limitations, cancer history, mental health, and demographics were extracted from the NHIS. Poisson regression was used to evaluate associations between demographics and cancer‐related limitations, and a descriptive analysis was performed to identify the most common types of cancer‐related limitations experienced by HNC survivors.

Results

Individuals with HNC were more than twice as likely to report having a disability caused by cancer when compared to individuals with other cancers (24% vs. 11%, P < .001). Cancer‐related disability was highest among HNC survivors who were Black (adjusted prevalence ratio (aPR) = 1.57, 95% CI = 1.13–2.18), were aged 50 to 64 (aPR = 1.74, 95% CI = 1.1–2.74), had high school or lower education (aPR = 2.40, 95% CI = 1.07–5.37), and had Medicaid insurance (aPR = 2.58, 95% CI = 1.62–4.10). Among HNC patients who reported a cancer‐related limitation, the most common limitations included difficulty working (78%), going out (51%), and socializing (42%).

Conclusions

Cancer‐related activity limitations are more common among HNC survivors compared to survivors of other cancers, and disproportionately affect socioeconomically disadvantaged HNC survivors. Clinicians should be aware of the limitations experienced by HNC survivors to provide counseling and resources to help patients cope with these limitations.

Level of Evidence

3 Laryngoscope, 132:593–599, 2022
Quantitative visual analysis of marine barite microcrystals: Insights into precipitation and dissolution dynamics
Authors: Light Tricia , Norris Richard
Published: August 2021

The accumulation rate of authigenic barite (BaSO4) in marine sediments is a promising proxy for reconstructing marine export production, but many aspects of barite precipitation and dissolution in the water column remain unknown. Here, we collected, imaged, and quantitatively analyzed 5481 barite microcrystals in bottle casts from the Eastern Pacific water column to gain a better understanding of in situ barite dynamics. Barite crystal abundance increases rapidly between the surface and 500 m in depth and then declines to predominantly low abundances below ~ 1000 m. The falloff in barite abundance between the oxygen minimum zone (OMZ) and the ocean interior suggests 60% ± 20% loss of barite by dissolution, nearly all of which is complete by water depths of 1000 m. However, there are occasional samples, as deep as 1250 m, with unusually high barite abundance that may represent marine snow deposition events. We found that microcrystals associated with organic matter substrates were smaller and less solid than free crystals, which suggests ongoing barite precipitation toward larger, more regularly shaped microcrystals within organic matter aggregates. Trends in barite microcrystal size with depth suggest that organic matter aggregates also play a role in shielding barite microcrystals from dissolution. In addition, our extensive data set raises new questions regarding marine barite nucleation and spatial heterogeneity. By helping bridge the gap between hypothesized barite dynamics and in situ observations of barite microcrystals, this study advances our understanding of water column Ba processes and the utility of sediment barite as an export production proxy.
Integrating ecosystem metabolism and consumer allochthony reveals nonlinear drivers in lake organic matter processing
Authors: Holgerson Meredith A. , Hovel Rachel A. , Kelly Patrick T. , Bortolotti Lauren E. , Brentrup Jennifer A. , Bellamy Amber R. , Oliver Samantha K. , Reisinger Alexander J.
Published: August 2021

Lakes process both terrestrial and aquatic organic matter, and the relative contribution from each source is often measured via ecosystem metabolism and terrestrial resource use in the food web (i.e., consumer allochthony). Yet, ecosystem metabolism and consumer allochthony are rarely considered together, despite possible interactions and potential for them to respond to the same lake characteristics. In this study, we compiled global datasets of lake gross primary production (GPP), ecosystem respiration (ER), and zooplankton allochthony to compare the strength and shape of relationships with physicochemical characteristics across a broad set of lakes. GPP was positively related to total phosphorus (TP) in lakes with intermediate TP concentrations (11–75 μg L−1) and was highest in lakes with intermediate dissolved organic carbon (DOC) concentrations. While ER and GPP were strongly positively correlated, decoupling occurred at high DOC concentrations. Lastly, allochthony had a unimodal relationship with TP and related variably to DOC. By integrating metabolism and allochthony, we identified similar change points in GPP and zooplankton allochthony at intermediate DOC (4.5–10 mg L−1) and TP (8–20 μg L−1) concentrations, indicating that allochthony and GPP may be coupled and inversely related. The ratio of DOC:nutrients also helped to identify conditions where lake organic matter processing responded more to autochthonous or allochthonous organic matter sources. As lakes globally face eutrophication and browning, predicting how lake organic matter processing will respond requires an updated paradigm that incorporates nonlinear dynamics and interactions.
A Nonlocal Effective Medium Description of Topological Weyl Metamaterials
Authors: Liu Yachao , Wang Guo Ping , Zhang Shuang
Published: August 2021

Effective medium theory lays the foundation for the development of metamaterials—artificially engineered photonic medium with subwavelength building blocks. However, the nonlocal effects, which are difficult to be incorporated into the effective medium description, are usually unavoidable in most metamaterial systems due to the finite lattice constant, preventing a precise modeling of wave propagation inside a metamaterial of large scale. On the other hand, recent development shows that nonlocal effect is essential for designing certain topological photonic systems such as ideal Weyl metamaterial. The properties of topological metamaterials rely on nonlocal effects, which, for example, determine whether a Weyl degeneracy formed by the linear crossing between a longitudinal and a transverse mode belongs to type I or type II. Here a nonlocal effective medium description of topological metamaterials is developed. For the first time, it is possible to calculate the wave propagation inside this complex medium in a large‐scale based on general numerical programs. To show the potential of the approach, wave propagation inside and at the boundary of a photonic ideal Weyl system are thoroughly studied in this work. By reformulating the electric field equation, the method paves the way toward comprehensive engineering of metamaterials with unrestricted nonlocality.
Direct‐Ink‐Writing of Electroactive Polymers for Sensing and Energy Storage Applications
Authors: Pinto Rafael S. , Serra João P. , Barbosa João C. , Gonçalves Renato , Silva Maria M. , Lanceros‐Méndez Senentxu , Costa Carlos M.
Published: August 2021

Considering the high levels of materials used in the fields of electronics and energy storage systems, it is increasingly necessary to take into consideration environmental impact. Thus, it is important to develop devices based on environmentally friendlier materials and/or processes, such as additive manufacturing techniques. In this work, poly(vinylidene fluoride) (PVDF) and poly(vinylidene fluoride‐co‐hexafluoropropylene) (PVDF‐HFP) are prepared by direct‐ink‐writing (DIW) by varying solvent evaporation temperature and fill density percentage. Different morphologies for both polymers are obtained, including dense films and porous membranes, as well as different electroactive β‐phase content, thermal and mechanical properties. The dielectric constant and piezoelectric d33 coefficient for dense films reaches up to 16 at 1 kHz and 4 pC N−1, respectively for PVDF‐HFP with a fill density of 80 and a solvent evaporation temperature of 50 °C. Porous structures are developed for battery separator membranes in lithium‐ion batteries, with a highest ionic conductivity value of 3.8 mS cm−1 for the PVDF‐HFP sample prepared with a fill density of 100 and a solvent evaporation temperature of 25 °C, the sample showing an excellent cycling performance. It is demonstrated that electroactive films and membranes can be prepared by direct‐ink writing suitable for sensors/actuators and energy storage systems.
COVID‐19 critical success factors in Indian healthcare industry—A DEMATEL approach
Authors: Gedam Vidyadhar , Raut Rakesh , Inamdar Zeeshan , Narkhede Balkrishna , Dharaskar Swapnil , Narvane Vaibhav
Published: August 2021

The prosed study aims to provide COVID‐19 critical success factors (CSF) associated with pandemic circumstances in the Indian healthcare industry (HCI). The CSF was identified via expert team inputs and a detailed literature review. The Decision‐Making Trial and Evaluation Laboratory (DEMATEL) method is used to determine the causal relationship between identified CSF. The methodology was supported by the case study of the Indian HCI. A total of 15 CSF in the Indian HCI during COVID‐19 are identified and prioritized using the DEMATEL method. The findings indicate that the high‐quality personal protective equipment (PPEs; LC8) and testing laboratories/facilities, centres, and kits (LC15) are the significant cause, and appropriate healthcare laws (LC13) are the least effect group. The study shows that policy and decision‐makers need to emphasize on LC8 and LC15 CSF in the Indian HCI and act accordingly to win the battle against post‐COVID‐19 circumstance. The policy/decision‐makers and healthcare administrations can identify the CSF and focus on that particular CSF. The identified CSF will help policy and decision‐makers swiftly build up the HCI to cope with the future pandemic.
A meta‐analysis evaluating risk factors for compound free flaps for upper extremity defect reconstruction comparing complications and functional outcomes of compound free flaps with and without bone components
Authors: Zhang Ying , Gazyakan Emre , Hundeshagen Gabriel , Fischer Sebastian , Bigdeli Amir K. , Marks Patrick Will , Kneser Ulrich , Hirche Christoph
Published: August 2021

Background

Compound flaps offer the advantage of one stage defect reconstruction respecting all relevant tissues and early functional recovery by optimal vascularity of all components. Due to its specific vascular anatomy and the three‐dimensional donor site, compound flaps with bone components may result in higher complication rates compared to soft tissue compound flaps. The meta‐analysis summarizes the available evidence and evaluates whether bone components are a risk factor for periprocedural complications in upper extremity multidimensional defect reconstruction.

Method

PubMed and Embase were searched for all publications addressing compound free flaps for upper extremity defect reconstruction with bone or soft tissue components published between January 1988 and May 2018. The methodological quality was assessed with the American Society of Plastic Surgeons Evidence Rating Scale for Therapeutic Studies. Flap loss, thrombosis rate, early infection, hematoma, seroma, as well as donor site complications were extracted and analyzed.

Results

Twelve out of 1157 potentially eligible studies (evidence‐III) comprising 159 patients were finally included with publication bias for all summarized complication rates. Complication rates for flaps with/ without bone components were: total flap loss 5%, 95% CI = 3%–10% (6%/5%); partial flap loss 8%, 95% CI = 5%–15%, (9%/8%); arterial/venous thrombosis 7%, 95% CI = 4%–12%, (8%/5%)/14%, 95% CI = 9%–21% (16%/6%, P < .05) with higher risk for flaps with bone components; infection 6%, 95% CI = 3%–12% (6%/6%); hematoma 6%, 95% CI = 3%–11% (6%/5%); seroma 5%, 95% CI = 3%–10% (5%/5%); dehiscence 10%, 95% CI = 6%–17% (11%/9%).

Conclusion

Compound flaps for upper extremity defect reconstruction including bone components have a higher venous thrombosis rate compared to compound soft‐tissue flaps.
NODDI highlights recovery mechanisms in white and gray matter in ischemic stroke following human stem cell treatment
Authors: Bagdasarian F. Andrew , Yuan Xuegang , Athey Jacob , Bunnell Bruce A. , Grant Samuel C.
Published: August 2021

Purpose

Diffusion MRI offers insight into ischemic stroke progression in both human and rodent models. However, diffusion MRI to evaluate therapeutic application of mesenchymal stem cells is limited. Robust analytical techniques are required to identify potential physiological changes as a function of cell therapy in stroke. Here, we seek to establish Neurite Orientation Dispersion and Density Imaging (NODDI) as a feasible method in evaluating stroke evolution in response to cell‐based therapeutics.

Methods

Diffusion MRI data at 21.1T were acquired from 16 male rats. Rats were grouped randomly: naïve (baseline, N = 5), stroke with injections of phosphate buffered saline (N = 6), stroke with injection of 2D human mesenchymal stem cells (hMSC, N = 5). Data were acquired on days 1, 3, 7, and 21 post‐surgery. DTI and NODDI maps were generated, with regions of interest placed in the ischemic hemisphere external capsule and striatum. Diffusion parameters were compared between groups each day, and within groups across hemispheres and longitudinally. Behavioral characterizations were on days 0 (pre‐surgery), 3, 7, 14, and 21.

Results

The 2D hMSC preserved diffusional restriction in the external capsule compared to saline (day 1: MD,P= .4060; AD,P= .0220). NODDI indicates that hMSC may have preserved intracellular volume fractions (ICVF: day 1,P= .0086; day 3,P= .0021; day 21,P= .0383). Diffusion metrics of hMSC treated animals were comparable to naïve for the external capsule.

Conclusions

NODDI compliments DTI metrics, enhances interpretation of tissue outcome in ischemic stroke following hMSC application, and may be useful in evaluating or predicting therapeutic response.
Nerve ultrasound evaluation of Guillain‐Barré syndrome subtypes in northern China
Authors: Liu Li , Ye Yuqin , Wang Lijuan , Song Xiaonan , Cao Jie , Qi Yajie , Xing Yingqi
Published: August 2021

Introduction/Aims

Ultrasound (US) studies have demonstrated patchy enlargement of spinal and peripheral nerves in Guillain‐Barré syndrome (GBS). However, whether ultrasound yields useful information for early classification of GBS has not been established. We aimed to evaluate nerve ultrasound in patients with GBS in northern China and compare the sonographic characteristics between demyelinating and axonal subtypes.

Methods

Between November 2018 and October 2019, 38 hospitalized GBS patients within 3 wk of disease onset and 40 healthy controls were enrolled. Ultrasonographic cross‐sectional areas (CSA) of the peripheral nerves, vagus nerve, and cervical nerve roots were prospectively recorded in GBS subtypes and controls.

Results

Ultrasonographic CSA exhibited significant enlargement in most patients' nerves compared with healthy controls, most prominent in cervical nerves. The CSA tended to be larger in acute inflammatory demyelinating polyneuropathy (AIDP) than in acute motor axonal neuropathy (AMAN)/acute motor and sensory axonal neuropathy (AMSAN), especially in cervical nerves (C5: 5.9 ± 1.6 mm2 vs. 7.0 ± 1.7 mm2, p = .042; C6: 10.5 ± 1.8 mm2 vs. 12.0 ± 2.1 mm2, p = .033). The chi‐squared test revealed significant differences in nerve enlargement in C5 (p < .001), C6 (p < .001), the proximal median nerve (p < .001), and the vagus nerve (p = .003) between GBS and controls. The vagus nerve was larger in patients with autonomic dysfunction than in patients without it (2.3 ± 1.0 mm2 vs. 1.4 ± 0.5 mm2, p = .003).

Discussion

The demyelinating subtype presented with more significant cervical nerve enlargement in GBS. Vagus nerve enlargement may be a useful marker for autonomic dysfunction.
Improving competencies and skills across clinical contexts of care: a qualitative study on Malawian nurses' experiences in an institutional health and training programme
Authors: Aukrust Camilla Grøver , Kamalo Patrick Dongosolo , Prince Ruth Jane , Sundby Johanne , Mula Chimwemwe , Manda‐Taylor Lucinda
Published: August 2021

Aim

To explore what competencies and skills Malawian nurses gained after participating in an institutional health and training programme in Norway and how they viewed these competencies applicable upon return to Malawi. Furthermore, to examine facilitators and challenges experienced on the exchange programme and opportunities and obstacles to make the competencies usable in own local hospital context.

Design

Qualitative study with an explorative design.

Methods

Fourteen interviews and one focus group discussion were conducted at Queen Elizabeth Central Hospital, Blantyre, Malawi, from August to September 2018.

Results

Competencies gained in Norway included clinical skills, teamwork, coordination and strengthened professionalism. The main finding was that the exchange programme was a transformative experience. Upon return to Malawi, the competencies gained on the exchange were helpful. However, the return was characterized by mixed emotions due to the considerable difference between the two clinical settings.
Reliability of measurements of energy expenditure and substrate oxidation using whole‐room indirect calorimetry
Authors: Allerton Timothy D. , Carnero Elvis A. , Bock Christopher , Corbin Karen D. , Luyet Pierre‐Philippe , Smith Steven R. , Ravussin Eric
Published: August 2021

Objective

This analysis aimed to measure the intraparticipant reliability—the intraclass correlation coefficient—of all the components of daily energy expenditure (EE) (24‐hour EE, sleep EE, resting EE, basal EE, and thermic effect of food) over a period of 3 consecutive days in 35 study participants.

Methods

The components of daily EE and substrate use (respiratory exchange ratio) were measured over 3 consecutive days before and after a 3‐week 1,000‐kcal/d caloric restriction/weight‐loss intervention.

Results

There was a high degree of reliability for sleep EE (96.8%), 24‐hour EE (97.8%), basal EE (90.6%), and resting EE (93.2%) during the run‐in period. The intraclass correlation coefficient for the follow‐up period after weight loss (3.67 ± 1.10 kg) remained high for sleep EE (95.6%), 24‐hour EE (100%), basal EE (96.1%), and resting EE (92.5%). The minimal detectable differences in EE were reduced by 30% for both 24‐hour EE and sleep EE when comparing 2 days versus 1 day spent in the whole‐room indirect calorimeter.

Conclusions

The reliability of the daily components of EE is very high both prior to and after a weight‐loss intervention. We here provide instrumental data for investigators to adequately power studies investigating energy metabolism using whole‐room indirect calorimetry.
Registration of ‘ARS Crescent’ soft white winter club wheat
Authors: Garland Campbell Kim , Allan Robert , Burke Adrienne , Chen Xianming , DeMacon Patricia , Higginbotham Ryan , Engle Doug , Johnson Stephen , Klarquist Emily , Mundt Chris , Murray Timothy , Morris Craig , See Deven , Wen Nuan
Published: August 2021

Soft white club winter wheat (Triticum aestivum L. ssp. compactum) represents 8–10% of the wheat crop in Washington, but most of the current club wheat production is located in the <350‐mm annual precipitation zone. Our goal was to develop a club wheat cultivar targeted to the >350‐mm annual precipitation zones of the Pacific Northwest. ‘ARS Crescent’ (Reg. no. CV‐1181, PI 665048), an awned white‐kernel club wheat, was selected using the bulk‐pedigree breeding method from the cross ‘Dusty’//‘Madsen’ sib/Dusty///WA7665/‘Rulo’. At the time of release, ARS Crescent was rated as resistant to stripe rust races PSTv‐4 and PSTv‐51, segregating for resistance to race PSTv‐37, and susceptible to races PSTv‐14 and PSTv‐40 in the seedling stage. In the adult‐plant stage in the field, ARS Crescent has demonstrated high‐temperature adult plant resistance to stripe rust. Several years after release, the grain yields of ARS Crescent are equivalent to the club wheat ‘Bruehl’ and to soft white wheat checks for all growing regions. ARS Crescent combines better test weight than Bruehl with better resistance to environmental conditions that result in low falling numbers in wheat. ARS Crescent has excellent milling properties and greater sponge cake volume than other club wheat cultivars and increases the quality of the crop in Washington.
Structural evidence that MOAP1 and PEG10 are derived from retrovirus/retrotransposon Gag proteins
Authors: Zurowska Katarzyna , Alam Ayaan , Ganser‐Pornillos Barbie K. , Pornillos Owen
Published: August 2021

The Gag proteins of retroviruses play an essential role in virus particle assembly by forming a protein shell or capsid and thus generating the virion compartment. A variety of human proteins have now been identified with structural similarity to one or more of the major Gag domains. These human proteins are thought to have been evolved or “domesticated” from ancient integrations due to retroviral infections or retrotransposons. Here, we report that X‐ray crystal structures of stably folded domains of MOAP1 (modulator of apoptosis 1) and PEG10 (paternally expressed gene 10) are highly similar to the C‐terminal capsid (CA) domains of cognate Gag proteins. The structures confirm classification of MOAP1 and PEG10 as domesticated Gags, and suggest that these proteins may have preserved some of the key interactions that facilitated assembly of their ancestral Gags into capsids.
Design of ideal vibrational signals for stinkbug male attraction through vibrotaxis experiments
Authors: Caorsi Valentina , Cornara Daniele , Wells Karen E , Moser Damiano , Berardo Alice , Miselli Roberto , Torriani Michele , Pugno Nicola M , Tasin Marco , Maistrello Lara , Mazzoni Valerio
Published: August 2021

BACKGROUND

Many groups of insects utilize substrate‐borne vibrations for intraspecific communication. This characteristic makes them a suitable model for exploring the use of vibrations as a tool for pest control as an alternative to the use of chemicals. Detailed knowledge of species communication is a prerequisite to select the best signals to use. This study explored the use of substrate‐borne vibrations for pest control of the brown marmorated stink bug (BMSB), Halyomorpha halys Stål (Heteroptera: Pentatomidae). For this purpose, we first identified the spectral and temporal characteristics that best elicit male responsiveness. Bioassays were conducted with artificial signals that mimicked the natural female calling signal. Second, we used the acquired knowledge to synthesize new signals endowed with different degrees of attractiveness in single‐ and two‐choice bioassays using a wooden custom‐made T stand.

RESULTS

The results from this study showed that males were attracted to female signals along a high range of amplitudes, especially starting from a threshold of 100 μm s−1, a high pulse repetition time (1 s) and frequency peak corresponding to the first harmonic (76 Hz). This resulted in an “optimal” signal for use to attract males, while the choice test in the T arena showed that this signal elicits searching behavior and attracts BMSB males towards a stimulation point.

CONCLUSION

We confirm the use of vibrational signals as a strong tool for behavioral manipulation of male BMSB and suggest its possible use in the development of field traps and further management of this pest. © 2021 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
Influence of Material Parameters on the Stability of Artificial Skyrmion in Hard/Soft Magnetic Bilayers
Authors: Liu Yi , Qian Zheng-Hong , Zhu Jian-Guo
Published: August 2021

Herein, the influence of material parameters on the core diameter of the artificial skyrmions in hard magnetic/soft magnetic bilayer thin film is investigated. It is found that the perpendicular magnetic anisotropy (PMA) constant and the interlayer exchange constant play a key role in the realization of artificial skyrmions. Through simulation, the PMA constant of the hard magnetic materials should be between 1.0 × 105 and 4.5 × 105 J m−3. Therefore, some rare earth materials with high magnetic anisotropy or other materials with low magnetic anisotropy do not meet the requirement. The initial skyrmion spin texture is Bloch‐type artificial skyrmion in the hard/soft magnetic bilayer system. In the presence of 1.0–1.5 × 105 J m−3 PMA constant and 0 J m−1 interlayer exchange constant, the Néel‐type artificial skyrmions are formed in the hard/soft magnetic bilayer system. The size of the hard magnetic layer material has little effect on the stability of skyrmions, so the stability of skyrmions should mainly be adjusted with the PMA of the hard magnetic materials or by changing the material types.
Trilobolide‐6‐O‐isobutyrate suppresses hepatocellular carcinoma tumorigenesis through inhibition of IL‐6/STAT3 signaling pathway
Authors: Zhou Xiu‐Qiao , Mao Xiao‐Mei , Fan Rui , Li Si‐Yang , Shang Jin , Zhang Tong , Li Rui‐Han , Li Hui‐Qi , Hui Yang , Chen Wen‐Hao , Wang Zhan‐Xiang , Shen Dong‐Yan
Published: August 2021

Currently available therapies for hepatocellular carcinoma (HCC), with a high morbidity and high mortality, are only marginally effective and with sharp adverse side effects, which makes it compulsory to explore novel and more effective anticancer molecules. Chinese medicinal herbs exhibited prominent anticancer effects and were applied to supplement clinical cancer treatment. Here, we reported a compound, trilobolide‐6‐O‐isobutyrate (TBB), isolated from the flowers of Wedelia trilobata with a markedly cytotoxic effect on HCC cells. We found that TBB time‐ and dose‐dependently inhibited HCC cells' growth and colony formation in vitro. Moreover, TBB induced cell cycle arrest at the G2/M phase, mitochondrial caspase‐dependent apoptosis, and suppressed migration and invasion, as well as the glycolysis of HCC cells. Mechanistically, our data indicated that TBB inhibited the STAT3 pathway activation by directly interacting with the TYR 640/657 sites of the STAT3 protein and decreasing the level of p‐STAT3. TBB also regulated the expression of PCNA, Ki67, Cyclin B1, Cyclin E, Bax, Bcl2, MMP2/9, and PGK1 through the inhibition of the IL‐6/STAT3 signaling pathway. Lastly, we confirmed that TBB effectively eliminated tumor growth without causing overt toxicity to healthy tissues in the xenograft tumor model. The exploration of anticancer activity and the underlying mechanism of TBB suggested its usage as a promising chemotherapeutic agent for HCC.
Attenborough's beauty: exceptional pattern preservation in a frog‐legged leaf beetle from the Eocene Green River Formation, Colorado (Coleoptera, Chrysomelidae, Sagrinae)
Authors: Krell Frank‐Thorsten , Vitali Francesco
Published: August 2021

A new fossil leaf beetle species,Pulchritudo attenboroughi(Chrysomelidae, Sagrinae), is described from the Eocene Green River Formation in Colorado and is the second known fossil representative of this subfamily from North America. The fossil stands out by its remarkable preservation of elytral patterns. Such sharp and high‐contrast preservation of exoskeletal colouration is extremely rare in the fossil record of beetles and unique in its definition and fidelity. Sagrinae currently do not occur in North America, but two extant species are present in tropical and subtropical South America, one of which is similar in several aspects to the new fossil. Many extant Sagrinae live in a warm, humid climate similar to that suggested for the Early Eocene Climatic Optimum of the Green River Formation.
Improving simulation specification with MBSE for better simulation validation and reuse
Authors: Sohier Henri , Lamothe Pascal , Guermazi Sahar , Yagoubi Mouadh , Menegazzi Pascal , Maddaloni Aldo
Published: August 2021

A simulation can be a complex architecture of simulation models, simulation tools, and computing hardware. However, its development often relies on informal procedures and can begin without a clear, complete, and formal definition of the simulation needs. Simulation traceability is then compromised, which prevents from easily validating whether a simulation meets the needs, or understanding the purpose of a simulation model that can be reused. This paper proposes an approach to improve the definition of simulation needs using Model‐Based Systems Engineering. Based on the semi‐automatic processing of a system architecture, it presents a new method to formulate a so‐called “simulation request” which covers (1) the part of the system to be simulated; (2) the objective of the simulation; (3) the simulation quality, cost, and delivery; (4) the test scenarios; (5) the data for simulation calibration and validation; and (6) the verification and validation of the simulation. All the tooling required for the formulation of the simulation request were prototyped in a SysML editor, with machine learning capabilities for the choice of test scenarios. The method and tooling were tested for the case of an autonomous car passing under traffic lights.
Designing multifunctional urban agroforestry with people in mind
Authors: Taylor John R. , Lovell Sarah Taylor
Published: August 2021

Urban landscapes combining trees and crops—urban agroforestry (UAF) systems—may offer greater ecological and cultural benefits than annual cropping systems. Interest in UAF is growing, as evidenced by an increasing number of built projects and articles in the popular press and the academic literature on the subject. However, the practice of UAF appears to far outpace research on its scientific underpinnings or its design. Developing sustainable, resilient UAF sites can be challenging because of biophysical and sociocultural conditions unique to the city; however, cities offer opportunities not found in rural environments including the potential to close open nutrient loops between consumers and sites of food production. We argue that these biophysical and sociocultural challenges and opportunities can be best addressed through an evidence‐based approach to the design of UAF systems and a complex ecological aesthetic design language integrating theory, principles, and practices from urban agroecology and allied fields, environmental psychology, and landscape architecture. The resulting multifunctional UAF systems would be socially sustainable and equitable and promote the circular metabolism of the city. Drawing on a purposive review of literature from these disciplines, we propose a preliminary framework consisting of 14 guidelines and complementary principles and strategies for the design of multifunctional, culturally preferred UAF and offer recommendations for future research.
Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta‐analysis
Authors: Guerriero S. , Martinez L. , Gomez I. , Pascual M. A. , Ajossa S. , Pagliuca M. , Alcázar J. L.
Published: August 2021

Objective

To evaluate the accuracy of transvaginal sonography (TVS) for detecting parametrial deep endometriosis, using laparoscopy as the reference standard.

Methods

A search was performed in PubMed/MEDLINE and Web of Science for studies evaluating TVS for detecting parametrial involvement in women with suspected deep endometriosis, as compared with laparoscopy, from January 2000 to December 2020. The Quality Assessment of Diagnostic Accuracy Studies‐2 (QUADAS‐2) tool was used to evaluate the quality of the studies. Pooled sensitivity, specificity and positive and negative likelihood ratios for TVS in the detection of parametrial deep endometriosis were calculated, and the post‐test probability of parametrial deep endometriosis following a positive or negative test was determined.

Results

The search identified 134 citations. Four studies, comprising 560 patients, were included in the analysis. The mean prevalence of parametrial deep endometriosis at surgery was 18%. Overall, the pooled estimated sensitivity, specificity and positive and negative likelihood ratios of TVS in the detection of parametrial deep endometriosis were 31% (95% CI, 10–64%), 98% (95% CI, 95–99%), 18.5 (95% CI, 8.8–38.9) and 0.70 (95% CI, 0.46–1.06), respectively. The diagnostic odds ratio was 26 (95% CI, 10–68). Heterogeneity was high. Visualization of a lesion suspected to be parametrial deep endometriosis on TVS increased significantly the post‐test probability of parametrial deep endometriosis.

Conclusion

TVS has high specificity but low sensitivity for the detection of parametrial deep endometriosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
APHA thin ewe investigation project
Authors: Bell Suzi , Carson Amanda , Collins Rachael , Dunnett Lizzy , Reichel Rudolf , Richey Moyna
Published: August 2021

This focus article has been prepared by Suzi Bell, Amanda Carson, Rachael Collins, Lizzy Dunnett, Rudolf Reichel and Moyna Richey of the APHA Small Ruminant Expert Group.