bluuebunny/crossref_metadata_2025 huggingface dataset:
Simultaneous Spectrophotometric Determination of Elbasvir and Grazoprevir in a Pharmaceutical Preparation
Authors: Attia Khalid A M , El-Abasawi Nasr M , El-Olemy Ahmed , Abdelazim Ahmed H
Published: August 2017

Three UV spectrophotometric methods have been developed for the simultaneous determination of two new Food and Drug Administration-approved drugs, elbasvir (EBV) and grazoprevir (GRV), in their combined pharmaceutical dosage form. These methods include dual wavelength (DW), classic least-squares (CLS), and principal component regression (PCR). To achieve the DW method, two wavelengths were chosen for each drug in a way to ensure the difference in absorbance was zero from one drug to the other. GRV revealed equal absorbance at 351 and 315 nm, for which the distinctions in absorbance were measured for the determination of EBV. In the same way, distinctions in absorbance at 375 and 334.5 nm were measured for the determination of GRV. Alternatively, the CLS and PCR models were applied to the spectra analysis because the synchronous inclusion of many unreal wavelengths rather than using a single wavelength greatly increased the precision and predictive ability of the methods. The proposed methods were successfully applied to the assay of these drugs in their pharmaceutical formulation. The obtained results were statistically compared with manufacturing methods. The results conclude that there was no significant difference between the proposed methods and the manufacturing method with respect to accuracy and precision.
Acceptance and Adherence to Continuous Positive Airway Pressure Therapy in patients with Obstructive Sleep Apnea (OSA) in a Southeast Asian privately funded healthcare system
Authors: Lee Cheah Hooi Ken , Leow Leong Chai , Song Pei Rong , Li HuiHua , Ong Thun How
Published: August 2017

BACKGROUND There is limited data on long term Continuous Positive Airway Pressure (CPAP) adherence in Southeast Asian countries. This is a prospective study on CPAP adherence among Obstructive sleep apnea (OSA) patients in a Southeast Asian privately funded healthcare system.

METHODS Patients with moderate-severe OSA who had been initiated on CPAP at least one year previously were contacted for a scripted telephone interview to assess compliance and factors associated with CPAP adherence.

RESULTS Of 135 consecutive patients diagnosed to have moderate to severe OSA, 78 (57.8%) were initiated on CPAP treatment while 57 (42.2%) rejected CPAP upfront. 41 (52.6%) who initiated CPAP remained adherent at one year. OSA severity (AHI, ODI) and symptomatic improvement after CPAP were associated with better adherence. Presence of machine related side effects was associated with lower adherence. Inconvenience, cost and poor disease perception were reported as major barriers to uptake of CPAP therapy.

CONCLUSIONS In this Southeast Asian privately funded healthcare system, almost half of all patients with significant OSA rejected CPAP treatment upfront, but adherence among those who started CPAP is comparable to other reports. Challenges with CPAP acceptance as well as CPAP adherence need to be addressed to improve outcomes.
Electrolyte imbalance and sleep problems during anti-retroviral therapy: an under-recognized problem
Authors: Manzar Md Dilshad , Sony Peter , Salahuddin Mohammed , Kumalo Abera , Geneto Mathewos , Pandi-Perumal Seithikurippu R , Moscovitch Adam , BaHammam Ahmed S
Published: August 2017

Human immunodeficiency virus (HIV) infection, and the anti-retroviral therapy (ART) associated complications necessitate that the medical care system keeps evolving for proper management of this group of patients. Electrolyte imbalance and sleep problems are common in patients on ART. Both of these conditions are associated with increased morbidity (such as acute kidney injury, chronic kidney disease, low CD4 count, non-adherence and depression) and mortality. Therefore, screening for both sleep problems and electrolytes imbalance may help to decrease the risk of complications in patients on ART.
Agreement between two different approaches to assess parent-reported sleep bruxism in children
Authors: Duarte Joyce , Serra-Negra Júnia Maria , Ferreira Fernanda Morais , Paiva Saul Martins , Fraiz Fabian Calixto
Published: August 2017

INTRODUCTION Parents' report is the most used method for the study of sleep bruxism (SB) in children, especially in research with large samples. However, there is no consensus about the questions used to assess SB, what may difficult the comparisons between studies.

OBJECTIVE The aim of this research was to evaluate the agreement between two different approaches to assess possible sleep bruxism (PSB) in children using parents' report.

METHODS This cross-sectional study was conducted with 201 parents/caregivers. Prior to the questionnaire completion, all participants received a standard explanation of SB concept. Subsequently, the parents/caregivers answered a general question (GQ) and a frequency-time question (FTQ) about SB, and the answers were compared.

RESULTS The majority of the participants were the children's mothers (73%) and the childrens mean age was 7.5 years (SD: 2.25). PSB frequency in children did not differ statistically through the two questions [GQ: 30.7% (CI95%: 24.2 - 37.1) and FTQ: 26.6% (CI95%: 20.4 - 32.8)], and an almost perfect agreement was observed between the answers (kp=0.812). Nevertheless, the FTQ showed a more coherent relation with the factors already recognized as associated with childhood bruxism than GQ.

CONCLUSIONS Different approaches result in similar PSB frequency, however, they show different ability to identify PSB associated factors and suggest the need of questions including frequency and time in further studies.
Lower-limb warming improves sleep quality in elderly people living in nursing homes
Authors: Oshima-Saeki Chika , Taniho Yuiko , Arita Hiromi , Fujimoto Etsuko
Published: August 2017

Sleep disturbances are common in older people. This study was conducted to examine the effects of a hot pack, which was used to warm the lower limbs, on the sleep of elderly people living in a nursing home. This is a prospective cohort involving seven elderly women. Subjects aged 74-93 years old were treated by warming the lower limbs for 40 minutes using hot packs every night over 8 weeks. A hot pack made of a dense polymer and warmed in a microwave oven was used as a warming device. In the first and last week, the subjects were required to wear an activity monitor to determine their sleep-awake status. During the second to ninth week, they received limb-warming treatment by a hot pack heated to 42°C for 40 min every night. Surface skin temperature data were collected by thermographic measurement. As a result, lower-limb warming by a hot pack significantly improved the quality of sleep in the subjects. During warming, the surface temperature of the hands and face rose by approximately 0.5-1.5°C. This study showed that lower-limb warming with a hot pack reduced sleep latency and wake episodes after sleep onset; thus, improving the quality of sleep in elderly people living in a nursing home.
Prepare before Using Internet‐Based Computing Options
Authors: George Bob
Published: August 2017

Internet‐based technologies, such as cloud/fog computing and the Internet of Things, are poised to revolutionize the future of water and wastewater utility management. Such technologies expand the reach of traditional industrial control networks but introduce substantial new risks.
What Are the Top 10 Cybersecurity Mistakes Water Utilities Make?
Authors: Groves Daniel , Cox Joel , Hesse Jeff
Published: August 2017

Water utilities often make mistakes that can expose their systems to cyberattacks. Following a few simple guidelines can improve security substantially.
Re‐evaluate Plant Systems to Optimize Membrane Performance
Authors: Lutge Ron , Gonzalez Raul
Published: August 2017

Reduced groundwater levels from drought, seasonal changes, and excessive pumping poses significant challenges for membrane water treatment plants across California. Review system readiness to identify concerns before fouling events occur.
Make Water Loss Control a Priority
Authors: Mosburg Sue , Jernigan Will
Published: August 2017

There's no simple means to optimize water loss control and ensure the maximum volume of water entering your system reaches your customers. However, a validated water audit is an essential step toward mitigating water losses to achieve a positive effect on your utility's bottom line.
Innovation Initiative Unveils New Strategic Plan
Authors: Moore Randy
Published: August 2017

AWWA's Innovation Initiative, launched in 2013, continues to gain momentum and motivate the water industry to consider implementing innovative processes and new technologies.
L’activité de tutorat conjointe et médiatisée : comment former dans la zone proximale de développement des enseignants novices et susciter leur pouvoir d’agir?
Authors: Ciavaldini-Cartaut Solange
Published: August 2017

Cette étude porte sur l’entretien de tutorat d’enseignants novices en année de formation professionnelle en alternance à l’université en France. Elle interroge la contribution de l’aménagement de ces situations de formation au processus d’apprentissage-développement de l’activité des formés. À l’appui de présupposés issus d’une psychologie culturelle historique et d’une théorie psychologique de l’activité, l’analyse d’une étude de cas apporte deux principales contributions. Tout d’abord, il s’agit de l’apport d’une activité conjointe médiatisée à l’opérationnalisation du conseil dans la zone proximale de développement des enseignants novices. Puis, il s’agit de la contribution de la posture du tuteur comme «agent de développement» du pouvoir d’agir des enseignants novices en classe.
Algunos parámetros para la incorporación de los estándares del sistema interamericano de protección de los derechos humanos en la tutela constitucional, legal y judicial del derecho a un ambiente sano en Panamá
Authors: Solís Félix Wing
Published: August 2017

Durante décadas, las normas internacionales de Derecho Ambiental y Derechos Humanos(DDHH) han evolucionado en paralelo. Sin embargo, el impacto cada vez más evidente de daños ambientales en la dignidad de las personas se ha convertido imperativo parauna mayor interacción entre los dos ramos del Derecho. Este trabajo es una propuestaviable para esa interacción en el contexto de Panamá. Examinando la evolución de losdos regímenes de protección en Panamá, vamos a intentar ofrecer algunos parámetrosdoctrinarios y una política jurisprudencial, que pueden servir como agentes de los tresórganos del Estado para el adecuado incorporar en sus deliberaciones y decisiones, lasnormas del Sistema Interamericano de Derechos Humanos en la defensa del derecho a unambiente saludable.
Estado e sociedade nos espaços de governança ambiental transnacional
Authors: Crisano Glasenapp Maikon , Cruz Paulo Márcio
Published: August 2017

Este artigo apresenta uma re exão inicial sobre o papel do Estado e da sociedade na transnacionalidade da governança ambiental, a par r das teses e teorias contem- porâneas sobre a crise da modernidade e também do seu principal ator: o Estado Cons tucional Moderno. Também se procura apresentar aqui uma ponderação intro- dutória para o desenvolvimento de tese de doutoramento sobre os novos papéis que os Estados e as sociedades estariam assumindo diante da complexidade do fenômeno da globalização e da interdependência na emergente governança socioambiental transna- cional, discu ndo-se a con guração de espaços públicos transnacionais de governança e de busca da sustentabilidade, que se desvelaria em resgatar a natureza emancipatória, pluralista, difusa e cole va dos direitos socioambientais.
O controle de constitucionalidade das políticas públicas no Brasil e a importação de modelos de controle de constitucionalidade pela Constituição de 1988
Authors: Cury Soares Hector
Published: August 2017

O presente artigo tem como objetivos centrais apresentar o modelo de controle constitucionalidade adotado pela Constituição brasileira, bem como a origem desses modelos e os reflexos (ou possíveis) no controle da constitucionalidade. Em especial o controle da constitucionalidade das políticas públicas no Brasil. Da mesma forma, busca mostrar os possíveis limites que possam ser estabelecidos e os efeitos que, porventura, possa ter esse controle, em relação às políticas públicas. Por conseguinte, estabelece-se uma linha que permita identificar os principais problemas da importação desses modelos e tracejar critérios que possam ser universalizáveis ao controle das polí cas públicas no Brasil, carência evidenciada no direito administrativo.
Direitos humanos, povos indígenas e desenvolvimento na expansão da fronteira agrícola na Amazônia brasileira
Authors: Prado Rafael Clemente Oliveira
Published: August 2017

O obje vo deste trabalho é analisar os mecanismos e o papel desempenhado pelas prin- cipais organizações internacionais na proteção dos direitos dos povos indígenas, enten- dendo-os como parte do rol dos direitos humanos e mencionando de forma especial o direito ao desenvolvimento dos povos indígenas, sob o recorte da expansão da fronteira na Amazônia brasileira. O método adotado para a elaboração deste trabalho é o descritivo-analítico, aplicando-se a análise documental baseada em fontes bibliográficas primárias, dando prioridade àquelas advindas de robusta doutrina e de documentos jurídicos a res- peito da matéria. O presente trabalho parte do pressuposto de que o direito dos povos indígenas de a ngirem o desenvolvimento faz parte do rol indivisível dos direitos humanos e que as organizações internacionais possuem formalmente um papel preponderante na necessidade de resguardar e proteger a universalidade e indivisibilidade dos direitos humanos dos povos indígenas, mediante os mecanismos adequados. Ademais, para que não ocorra o fenômeno de letra morta, se discu rá como esses mecanismos podem a ngir e cazmente a região da fronteira, despossuída de respeito pelos direitos humanos.
Tutela ambiental e audiência judicial: pressupostos democráticos via contraditório
Authors: Staffen Márcio Ricardo , Bodnar Zenildo
Published: August 2017

O presente artigo analisa a importância da democratização do processo judicial ambiental como forma de concretização do direito e dever fundamental de proteção do meio ambiente pelo Poder Judiciário. Com a utilização do método indutivo, o presente trabalho destaca a insuficiência da dogmática processual clássica para a resolução dos conflitos ambientais. De-fende-se a necessidade da consolidação de um novo paradigma de prestação jurisdicional que assegure e facilite a participação direta do cidadão no tratamento dos conflitos ambientais, com especial ênfase à audiência judicial participativa. Sob essa óptica, apresenta-se a con-fluência da noção de processo como procedimento em contraditório realizado em simetria de armas.
Regularização fundiária: perspectivas históricas e econômicas da cidade do Rio de Janeiro
Authors: Franco Câmara Andreza Aparecida
Published: August 2017

O presente artigo objetiva abordar algumas questões fundamentais entre os problemas originados quanto ao uso do solo urbano e sua relação com a produção irregular de moradias. Além de discutir a reforma fundiária urbana e a segregação social nos assentamentos informais como resultado de algumas políticas públicas implementadas no município carioca, analisa os principais fatores do processo de segregação socioespacial na cidade do Rio de Janeiro, destacadamente nos anos setenta e oitenta. Contempla a crescente ideia da mercantilização do solo urbano pelos agentes econômicos e seus reflexos para a cidade ao longo de um processo histórico e econômico no Brasil, destacadamente na cidade carioca.
O crescimento econômico e as consequências das externalidades ambientais negativas decorrentes do processo produtivo
Authors: Pioner Sartori Liane , Gewehr Lilian
Published: August 2017

A humanidade não mais convive em harmonia com os recursos naturais que, assim como a economia, são importantes para a sociedade. Considerando a preocupação com a qualidade de vida, verifica-se que o desenvolvimento econômico deve ocorrer de forma concomitante com preservação ambiental. Hoje, não se tolera degradação ambiental apenas sob os propósitos de geração de emprego ou de crescimento econômico. Ocorre que o processo industrial, que alavanca a economia, despeja no ambiente os seus resíduos indesejáveis, provoca contaminação dos ecossistemas e, consequentemente, desequilíbrio ecológico. Economia e ecologia têm, pois, íntima relação, motivo pelo qual se impõe valorar as externalidades ambientais negativas, que são os efeitos prejudiciais advindos do sistema produtivo, para que as externalidades possam ser reparadas, o que se faz por meio da internalização e do princípio do poluidor-pagador. Dessa forma, é possível compatibilizar desenvolvimento econômico com meio ambiente ecologicamente equilibrado e saudável para as presentes e as futuras gerações.
As reservas legais e as áreas de preservação permanente como limitadoras do direito de propriedade e sua destinação econômica
Authors: Dani Felipe André , Borges de Oliveira Álvaro , Sabetzki Barros Débora
Published: August 2017

Inicia-se o presente artigo abordando-se o princípio da propriedade e suas transformações diante da mutabilidade e anseios sociais. Parte-se de um conceito clássico de propriedade, adotado pelo Código Civil Brasileiro, para uma definição que dá ênfase a propriedade dinâmica, bem como, sua função social, com apego à função social ambiental da propriedade, sob o prisma de limitador do absolutismo do proprietário. Explana-se sobre as reservas legais e as áreas de preservação permanente, como institutos do Direito Ambiental restritivos à propriedade, porém, através de um viés econômico, buscando uma destinação a estas áreas. Ao final do presente artigo, busca-se um equilíbrio entre o Direito Ambiental e o Direito Econômico, aparentemente conflitantes, decorrente da limitação econômica sofrida pela propriedade privada, vista como direito individual e absoluto, e a função social, com caráter ambiental, diante da obrigação ao particular de preservar e manter o meio ambiente para atingir a função social da propriedade, de acordo com corolários constitucionais.
A legitimidade democrática das decisões proferidas pelo Tribunal Constitucional Alemão: a constitucionalidade do “mecanismo europeu de estabilidade”
Authors: Pinheiro Lameira Daniella Maria
Published: August 2017

O caso ora a ser tratado refere-se à decisão do Tribunal Constitucional Alemão, que ganhou as atenções da mídia mundial ao se pronunciar sobre a validação de um novo mecanismo europeu de estabilidade destinado a socorrer os países com dificuldades de financiamento perante o mercado, sendo tal decisão proferida pela Corte Constitucional Alemã, cujo país é o maior contribuinte. Assim, cabe indagar qual a “força” desse julgado em nível internacional, haja vista que a Corte Constitucional nacional estaria em posição de obediência às decisões da Corte de Justiça Europeia. Assim, o propósito deste artigo é analisar a repercussão e a autoridade desse julgamento.
Associations Between Treatment Satisfaction, Medication Beliefs, and Adherence to Disease-Modifying Therapies in Patients with Multiple Sclerosis
Authors: Thach Andrew V. , Brown Carolyn M. , Herrera Vivian , Sasane Rahul , Barner Jamie C. , Ford Kentya C. , Lawson Kenneth A.
Published: August 2017

Background:

Adherence to disease-modifying therapy (DMT) remains problematic for many patients with multiple sclerosis (MS). An improved understanding of factors affecting DMT adherence may inform effective interventions. This study examined associations between treatment satisfaction, medication beliefs, and DMT adherence.

Methods:

A survey was mailed in 2016 to 600 adult patients with relapsing-remitting MS taking an injectable or oral DMT. Patients were sampled from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry. The survey measured self-reported DMT adherence (doses taken divided by doses prescribed during previous 2-week period—adherence ≥0.80), DMT satisfaction using the Treatment Satisfaction Questionnaire for Medication version II, medication beliefs using the Beliefs About Medicines Questionnaire, and demographic and clinical covariates. Relationships between variables were examined using multivariate logistic regression.

Results:

Final analyses included 489 usable surveys. Mean ± SD participant age was 60.5 ± 8.3 years. Most respondents were white (93.8%), female (86.6%), taking an injectable DMT (66.9%), and adherent to DMT (92.8%). Significant predictors of DMT adherence were age (odds ratio [OR], 1.086; 95% CI, 1.020–1.158; P = .011), type of DMT (oral vs. injectable; OR, 23.350; 95% CI, 2.254–241.892; P = .008), and DMT experience (naive vs. experienced; OR, 2.831; 95% CI, 1.018–7.878; P = .046).

Conclusions:

In patients with MS sampled from a patient registry, treatment satisfaction and medication beliefs were not significantly associated with DMT adherence. Based on significant predictors, younger patients, patients taking injectable DMTs, and patients with previous experience with another DMT(s) are at higher risk for nonadherence. Future research is warranted to assess relationships between variables in more diverse MS populations.
An Imaged-Based Three-Dimensional Study of First Metatarsal Protrusion Distance in Women with and Without Hallux Valgus
Authors: Rodriguez Michael W. , Pioske Kara E. , Glasoe Ward M.
Published: August 2017

Background:

First metatarsal protrusion distance (MPD) has been commonly studied as a characteristic of hallux valgus deformity. To date, the majority of investigations have used radiographic methods, with most reporting first metatarsal (ray) protrusion to be associated with deformity. As an alternative, this study used a three-dimensional (3-D) image acquisition and data analysis method to quantify MPD.

Methods:

Magnetic resonance images were acquired in weightbearing on 29 women (19 with hallux valgus; 10 controls). After the 3-D images were reconstructed into virtual bone models, two examiners measured MPD in relation to the navicular. In addition to a reliability analysis, a t test assessed for group differences in demographics, foot posture (hallux valgus, intermetatarsal angles), and MPD.

Results:

Group demographics were not different, while measures of hallux valgus and intermetatarsal angles were different (P < 0.01) between groups. The measurement of MPD was highly reliable (ICC 0.99; SEM 0.78 mm). Metatarsal protrusion averaged approximately –2.0 mm in both groups. There was no statistical group difference (P = 0.89) in MPD.

Conclusions:

The reconstructed image datasets captured the 3-D spatial relationship of the anatomy. Measurements of MPD were reliable. The first ray measured 2 mm shorter than the second ray in both the hallux valgus and control groups. Though unexpected, this result may prompt future study of the pathokinematics associated with hallux valgus that include the quantification of metatarsal protrusion with 3-D methods, instead of relying solely on single-plane radiograph reports.
A cross-sectional study of chiropractic students' research readiness using the Academic Self-Concept Analysis Scale
Authors: Whillier Stephney , Au Kent , Feng Louie , Su Helen
Published: August 2017

Objective:

The shift toward evidence-based health care has reoriented tertiary clinical education in a way that necessitates and incorporates research. This study assesses the inclination and suitability of chiropractic students for research over a 5-year educational program.

Methods:

Research attributes of chiropractic students were assessed in this cross-sectional study using a validated and modified academic self-concept analysis scale. Students in first and final year were assessed in 4 domains: creativity, motivation, self-regulation, and general intellectual ability. Univariable differences were assessed using Welch 2-sample t tests, and multivariable analysis was carried out with multiple linear regression models.

Results:

The response rate was 71% (n = 165). First- and fifth-year students scored highly on all 4 domains (80% to 96%). Compared to first-year students, fifth-year students rated themselves significantly lower in 3 of the domains: general intellectual abilities (t[126] = −2.01; p = 0.047), motivation (t[115] = −4.82; p < 0.001), and creativity (t[136] = −3.00; p = 0.003).

Conclusion:

Research suitability is high in chiropractic students. Both cohorts scored high in all domains despite the disparity between first and fifth years. First-year students outperformed fifth-year students in 3 domains, indicating a potential decline in the inclination to do research over time. However, unaccounted factors, such as the Dunning-Kruger effect, life changes, and “burnout,” may have contributed to these differences. Future studies should include questions about stress, fatigue, clinical orientation, and educational environment to inform the interpretation of findings.
Changes in adjustment force, speed, and direction factors in chiropractic students after 10 weeks undergoing standard technique training
Authors: Owens Edward F. , Russell Brent S. , Hosek Ronald S. , Sullivan Stephanie G.B. , Dever Lydia L. , Mullin Linda
Published: August 2017

Objective:

To assess the force profiles of high-velocity low-amplitude thrusts delivered to a mannequin on a force platform by novice students given only verbal instructions.

Methods:

Student volunteers untrained in adjusting delivered a series of adjustments to a mannequin on a force platform. Participants performed 3 light, 3 normal, and 3 heavy thrusts on 5 listings specifying contact point, hand, and direction. Force profiles were analyzed for speed and amplitude, consistency, and force discrimination. Two recording sessions occurred 10 weeks apart.

Results:

Sixteen participants (11 females, 5 male) completed the study. Peak forces ranged from 880 to 202 N for heavy thrusts and 322- to 66 N for light thrusts. Thrust rate was from 8.1 to 1.8 Newtons per millisecond. Average coefficients of variability (CV = STD/mean) at each load level (initial/final) were heavy: 17%/15%; normal: 16%/15%; and light: 20%/20%, with 0 as ideal. A force ratio measured students' abilities to distinguish thrust magnitude. The heavy/normal ratio (initial/final) was 1.35/1.39, and the light/normal ratio was 0.70/0.67.

Conclusions:

At this point, without force feedback being used in the classroom, novice students can produce thrusts that look like those of their teachers and of experienced practitioners, but they may not produce similar speed and force values. They are consistent within and between sessions and can discriminate between light and heavy loads. A natural next step in our educational research will be to measure adjustment factors on more experienced cohorts of students with and without the presence of force-feedback training apparatus.
Mpox Clinical Presentation, Diagnostic Approaches, and Treatment Strategies
Authors: Titanji Boghuma K. , Hazra Aniruddha , Zucker Jason
Published: October 2024

Importance

A global outbreak of clade IIb Monkeypox virus (MPXV) infections spread rapidly across at least 118 countries resulting in a Public Health Emergency of International Concern (PHEIC) from July 2022 to May 2023. This outbreak affected more than 99 000 persons worldwide and caused more than 33 000 infections and 60 deaths in the US. In 2024, there have been approximately 200 new infections per month in the US. On August 14, 2024, the World Health Organization declared mpox a PHEIC for a second time due to a rapid increase in infections with clade I MPXV in Central Africa.

Observations

Mpox is primarily acquired through direct skin to skin contact with MPXV. With clade IIb MPXV, infections are most commonly associated with sexual activity among individuals who are gay, bisexual, and other men who have sex with men. After a median incubation period of 7 to 10 days, prodromal symptoms include fever (62%-72%), lymphadenopathy (56%-86%), myalgias (31%-55%), malaise (23%-57%), and headache (25%-55%). Skin lesions progress through 4 well-defined stages (macules, papules, vesicles, and pustules) over 2 to 4 weeks. Clade IIb MPXV is typically a self-limited illness with a low mortality rate (<0.2% in the US); however, severe illness and death may occur in immunocompromised individuals, especially those with advanced HIV (CD4 count <200 cells/μL). Mpox should be suspected in patients with potential exposure to MPXV who have skin lesions, and the diagnosis is confirmed with polymerase chain reaction testing of lesions. Management is supportive and focuses on skin care and symptom relief with analgesics. While no antiviral treatments are currently approved for mpox by the US Food and Drug Administration, several therapeutics, such as tecovirimat, brincidofovir, and vaccinia immune globulin intravenous, are available through expanded access programs or clinical trials. Vaccination with the 2-dose Modified Vaccinia Ankara-Bavarian Nordic vaccine is recommended for high-incidence populations and has an efficacy of 66% to 86%.

Conclusions and Relevance

Mpox is a viral infection transmitted primarily through close skin to skin contact that typically causes a self-resolving illness but can result in severe illness and death in immunocompromised individuals. First-line therapy is supportive care, although patients with severe mpox infection may be treated with advanced therapeutics. Mpox vaccination is effective and, if available, should be offered to individuals at risk of exposure to mpox.
The Policy to Override Policies—One Policy to Rule Them All
Authors: Spellberg Brad
Published: October 2024

This Viewpoint describes allowing for hospital staff discretion regarding strict adherence to policy vs best interest of the patient.
Collaborative Dementia Care During the New Therapeutic Era
Authors: Possin Katherine L. , Burns Jeffrey M. , Forester Brent P.
Published: October 2024

This Viewpoint advocates for the implementation of collaborative care with care navigation in the diagnosis and treatment of Alzheimer disease.
Free Summer Programming and Body Mass Index Among Schoolchildren From Low-Income Households
Authors: Beets Michael W. , Burkart Sarah , Pfledderer Christopher , Adams Elizabeth , Weaver R. Glenn , Armstrong Bridget , Brazendale Keith , Zhu Xuanxuan , Chen Brian , McLain Alexander
Published: October 2024

Importance

Children experience accelerated gains in body mass index (BMI) during the summer months when school is not in session. Children from low-income households are most susceptible. Accelerated BMI gain in summer may be due to the removal of the health-promoting structure provided by schools. During summer, a common form of health-promoting structure is summer day camps (SDCs). Summer day camps are predominately fee for service, which creates a financial barrier for children from low-income households. One solution to mitigate accelerated BMI gain is providing free access to an existing SDC.

Objective

To investigate whether providing free access to an existing community SDC can mitigate accelerated BMI z score (zBMI) gain in elementary school–age children.

Design, Setting, and Participants

This randomized clinical trial was conducted during the summers of 2021, 2022, and 2023 in the southeastern United States. Participants were children (kindergarten through fourth grade) from predominantly low-income households who were randomized to attend an SDC operated by a parks and recreation commission or continue summer as usual (control).

Intervention

Free SDC every weekday (Monday through Friday) for 8 to 10 weeks.

Main Outcomes and Measures

The primary outcome was between-group differences in change of zBMI measured before school ended (May) and on return to school from summer (late August). Secondary analyses examined the dose response of zBMI change with parent-reported child attendance at SDCs during the summer for all children (intervention and control).

Results

A total of 422 children (mean [SD] age, 8.2 [1.5] years; 202 [48%] female, 220 [52%] male, 292 [69%] at or below 200% federal poverty level, 127 [30%] with food insecurity) were randomized to 1 of 2 conditions: summer as usual (control, n = 199) or free SDC (n = 223). Intent-to-treat analysis indicated mean (SE) change in zBMI at the end of the summer was 0.046 (0.027) for the control and −0.048 (0.025) for the intervention group, representing a significant between-group difference of −0.094 (95% CI, −0.166 to −0.022). Dose-response analyses indicated that every 1 day per week increase in attending an SDC resulted in a −0.034 to −0.018 zBMI reduction, which translates to a gain of 0.046 to 0.080 zBMI for children never attending summer programming vs −0.09 to −0.04 zBMI reduction for children attending summer programming every weekday.

Conclusions and Relevance

Providing children free access to existing community summer programming can have a meaningful effect on children’s zBMI gain during the summer. Future studies should replicate these findings across different regions and identify the optimal dose of programming to mitigate unhealthy zBMI gains.

Trial Registration

ClinicalTrials.gov Identifier: NCT04072549
Hippocampal tau‐induced GRIN3A deficiency in Alzheimer's disease
Authors: Lee Sang‐Eun , Park Soomin , Kang Rian , Lee Taehoon , Yu Won Jong , Chang Sunghoe , Park Jong‐Chan
Published: October 2024

Alzheimer's disease (AD) is characterized by significant alterations in hippocampal function and structure, but the molecular mechanisms underlying the hippocampal region remain elusive. We integrated multiple transcriptome datasets including human or rat hippocampus (GSE173955, GSE129051, GSE84422) to identify candidate genes. Subsequent analyses including gene ontology analysis and protein–protein interaction mapping were performed to identify key genes and pathways. We found that glutamate ionotropic receptor NMDA‐type subunit 3A (GRIN3A) and glutamate metabotropic receptor 8 (GRM8), which are related to the glutamatergic system, were the top two annotated genes and directly related to MAPT, which encodes a tau protein. Since there is no direct evidence of interaction between tauopathy and these genes in AD, further transcriptomic data (GSE125957, GSE56772) from tau transgenic mice and experimental validations through primary rat hippocampal neurons and induced pluripotent stem cell (iPSC)‐derived brain organoids were performed. Interestingly, we identified that decreased NR3A (encoded by GRIN3A) and mGluR8 (encoded by GRM8) are correlated with tauopathy and loss of postsynaptic function in AD. Taken together, our results identified a novel tauopathy biomarker GRIN3A in AD. Furthermore, our findings suggest that an integrated approach combining public databases and diverse experimental validations can contribute to the advancement of precision medicine therapies.
Stream‐breeding salamander use of headwater stream networks in managed forests of western Washington, USA
Authors: Ojala‐Barbour Reed , McIntyre Aimee P. , Lund Eric M. , Hayes Marc P.
Published: October 2024

Stream‐associated amphibians are sensitive bioindicators in headwater streams across the Pacific Northwest moist coniferous forests of North America. Much of this landscape is intensively managed for timber. Forest Practice (FP) rules determine harvest prescriptions on most private lands in Washington State and cover over 3.7 million hectares. Under these rules, non‐fish‐bearing headwater streams receive buffers on at least 50% of the stream length, including FP Sensitive Sites that receive 15–17 m radius no‐cut patch buffers.

We evaluated how torrent (Rhyacotriton spp.) and giant (Dicamptodon spp.) salamander relative abundance is influenced by headwater stream network features that correspond to FP Sensitive Sites. In particular, we examined how salamander relative abundance in the two most common FP Sensitive Sites, tributary junctions (TJs) and perennial initiation points (PIPs), compared to densities in non‐Sensitive Site stream reaches, hereafter branches. We also evaluated salamander relative abundance and two hydrologic characteristics, dry channel and seeps. We analysed data collected in 2006 and 2007 from 17 amphibian‐occupied, non‐fish‐bearing basins in Western Washington with managed forest ages 30–80.

We found no relationship between torrent salamander relative abundance and PIPs and TJs or between giant salamander relative abundance and TJs compared to branches. Consistent with expectations, giant salamander relative abundance was less in PIPs than in TJs and branches, and less in first‐order than second‐ and third‐order streams. Conversely, torrent salamander relative abundance lacked a clear relationship to stream order. Giant and torrent salamander relative abundance showed a negative relationship with the proportion of dry channels, but torrent salamanders were observed in short reaches of surface water located in predominantly dry channels.

Importantly, reaches with seeps had 123% (CI: +103% to +146%) and 81% (CI: +49% to +121%) greater relative abundance of torrent and giant salamanders, respectively, than reaches without seeps.

Practical implication: Current FP rules protect select side‐slope seeps as another category of Sensitive Sites but may too narrowly define the criteria of seeps to protect the full range of those being utilized by stream‐breeding salamanders. Studies focused on seeps and adjacent stream channel characteristics may better inform features important to stream‐breeding salamanders.
Clinical Presentation, Care Pathways, and Delays in Access to Specialized Care in Patients With Systemic Lupus Erythematosus: A Study From Lupus Midwest Network (LUMEN)
Authors: Sanchez‐Rodriguez Alain , Meade‐Aguilar Jose Antonio , Yang Jeffrey X. , Figueroa‐Parra Gabriel , Hanson Andrew C. , Langenfeld Hannah E. , Thanarajasingam Uma , Chamberlain Alanna M. , Greenlund Kurt J. , Barbour Kamil E. , Crowson Cynthia S. , Duarte‐García Alí
Published: October 2024

Objective

We aimed to characterize presentation and care pathways of patients with systemic lupus erythematosus (SLE), and delays in access to SLE‐specialized care.

Methods

We included patients with incident SLE from the Lupus Midwest Network registry. Time from the first medical encounter for SLE clinical manifestation to access to SLE‐specialized care, physician diagnosis, and treatment was estimated. Delays were defined as ≥6 months to access specialized care. We compared SLE manifestations, disease activity, and Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage indexes (SDI) between patients with and without delays. Logistic regression models assessed associations with delays.

Results

The study included 373 patients with SLE. The median time to access SLE‐specialized care was 1.1 (95% confidence interval [CI] 0.9–1.5) months, time to diagnosis was 30.6 (95% CI 18.9–48.1) months, and time to treatment initiation was 4.7 (95% CI 3.9–8.4) months. Approximately 25% of patients (93 out of 373) experienced delays accessing specialized care, which were associated with fewer SLE manifestations at first SLE‐related encounter (fewer than two SLE domains; 92% vs 72%, P < 0.001). Patients with mucocutaneous or musculoskeletal manifestations were less likely to experience delays, whereas hematologic (odds ratio [OR] 1.71, 95% CI 1.03–2.84) or antiphospholipid antibodies domains (OR 6.05, 95% CI 2.46–14.88) were associated with delays. Delays were associated with damage at first access to SLE‐specialized care (SDI ≥1; 30% vs 7%, P < 0.001).

Conclusion

Patients follow a heterogeneous pathway to receive care. One‐fourth of patients experienced delays accessing SLE‐specialized care, which was associated with disease‐related damage. Fewer manifestations, hematologic manifestations, or antiphospholipid antibodies were associated with delays.

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Reliable Finite‐Time Control for Nonlinear Chaotic Semi‐Markov Jump Systems With Incomplete Transition Rates
Authors: Abinandhitha R. , Sakthivel R. , Tatar N. , Ren Yong
Published: October 2024

This article studies the finite‐time control problem for a class of nonlinear chaotic semi‐Markov jump systems with incomplete transition rates described by the T‐S fuzzy model approach. As a means to depict the dynamical properties pertaining to the examined system, parametric uncertainties, faults, external disturbances and input saturation are taken into consideration. The foremost objective of this study is to come up with a composite control mechanism that effectively rejects and attenuates the repercussions of faults and disturbances. In particular, we primarily built a disturbance observer in order to obtain a precise estimation of the external disturbances. After which, the fault diagnosis observer is designated to effectively estimate the faults. Specifically, a composite reliable control mechanism is developed by fusing the output of the constructed observers with the mode‐dependent fuzzy‐rule based state feedback controller. By employing suitable Lyapunov functions in conjunction with the linear matrix inequality technique, a set of mode‐dependent conditions is derived to ensure the finite‐time stochastic boundedness of the underlying closed‐loop and estimation error systems. Following this, the anticipated controller and observer gain matrices are elicited by resolving the established linear matrix inequalities. Thereafter, intending to ascertain the efficacy and usefulness of accrued theoretical findings, simulation results performed on Chua's circuit system is endowed.
Security Enhancement Scheduling Model for IoT‐Based Smart Cities Through Machine Learning Method
Authors: Dwivedi Anuj Kumar , Prasad Sanjeev Kumar
Published: October 2024

The Internet of Things (IoT) is rapidly evolving, and this has supported the adoption of a new computing paradigm that moves processing power to the network's edge. The job must be assigned to the computer nodes, where their associated data is available, to minimize overheads generated by data transmissions in the network, because the edge nodes have limited processing power and are vulnerable to security. Hence, the paper introduces a novel security‐enhanced scheduling model for IoT‐based smart cities utilizing machine learning techniques. Initially, nodes are initialized using the LHK‐Means algorithm. Subsequently, tasks, representing requests from multiple users to access IoT data, are scheduled. Anomaly detection tasks are then identified using an L2‐Norm‐based fuzzy model. Normal tasks are processed by the BN‐CNN model, which schedules data collection tasks through the initialized IoT device nodes. Comparative analysis with existing models illustrates the effectiveness of the proposed approach in terms of accuracy, precision, recall, sensitivity, specificity, and f‐measure.
Improvement of Arc Erosion Resistance of Ag–SnO2 Contact Materials by Reducing Molten Pool Size
Authors: Chen Pengyu , Wang Yaping
Published: October 2024

The splash of molten Ag under arc erosion is the major reason for the failure of Ag‐based contact materials. Changing the size of the molten pool may manipulate the splash process and suppress the arc erosion. Herein, the size effect by fabricating a SnO2 network with pores smaller than the typical Ag molten pool is investigated. Silver is subsequently infiltrated into the SnO2 network to form Ag–SnO2 interpenetrating contact materials. It is found that the SnO2 network with small pore sizes separates the Ag matrix into smaller regions, reducing the melting volume. Compared with the particle‐dispersed one, the interpenetrating composite decreases ≈90% mass loss and temperature rise, as well as provides superior microstructure stability. This finding demonstrates a promising way to improve the arc erosion resistance of contact materials by tailoring the size of molten pool, benefiting long‐lifetime contact materials for smart grid applications.
Impact of Iron Contamination on Liquid Properties and Microstructural Evolution in AlSi20
Authors: Tisha Layla Shams , Toenjes Anastasiya , Ellendt Nils
Published: October 2024

Additive manufacturing processes enable highly flexible and scalable shaping while maintaining rapid solidification processing conditions. This combination makes additive manufacturing particularly attractive for recycling contaminated alloys, as it allows critical brittle phases to be refined and utilized as alloying elements. However, little is known about the impact of contaminants on the fluid properties of liquid metals. Herein, thermodynamic modeling and experimental methods are combined to investigate the properties of AlSi20 and its contaminated variant, (AlSi20)95Fe5. The oscillating droplet method is used to experimentally determine surface tension and analyze solidified droplets to evaluate microstructure for different cooling rates. The findings indicate that while contaminants have a minor effect on fluid properties, they significantly influence microstructural properties.
Assembly‐Glued Ligands and Warheads for Hypoxia‐Activatable Supramolecular Covalent Inhibitors
Authors: Hu Binbin , Qin Weida , Wang Yushi , Zhang Zeyu , Chen Ninglin , Wang Hongbo , Li Gongyu , Shi Yang , Yu Zhilin
Published: October 2024

Targeted covalent inhibitors are promising for drug discovery and challenged by the strict structural features for target proteins to sustain proximity‐induced conjugations. Herein, an assembly‐glued strategy is reported to create surface‐displayed supramolecular covalent inhibitors that leverage the display‐induced proximity between noncovalent ligands and warheads. The ligand and warhead are obtained via attaching an epidermal growth factor receptor (EGFR)‐binding segment or nitroreductase (NTR)‐activated moiety to bola‐amphiphilic peptides, respectively. Co‐assembling the ligand and warhead with a filler peptide glues them and forms the surface‐displayed covalent inhibitor. While the ligand associates with EGFR, the warhead undergoes NTR‐induced cysteine conjugation facilitated by the ligand‐EGFR association. In vitro studies show the reliable hypoxia‐activated inhibition of EGFR phosphorylation and enhanced cytotoxicity of the covalent inhibitor under hypoxic condition. In addition, this strategy also allows for creating covalent inhibitors targeting proteins without small molecular covalent drugs, due to the display‐induced proximity between ligands and warheads. In vivo results illustrate the prolonged retention of the covalent inhibitor and its efficacy in inhibiting tumor growth. These findings demonstrate that simultaneous surface display of ligands and warheads via assembly adhesives allows for implementation of covalent inhibition functions, thus providing a new strategy for developing covalent inhibitors in the future.