bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical Derivation of Buckling Knockdown Factors for Isogrid-Stiffened Cylinders with Various Shell Thickness Ratios
Authors: Kim Han-Il , Sim Chang-Hoon , Park Jae-Sang , Lee Keejoo , Yoo Joon-Tae , Yoon Young-Ha
Published: May 2020

This study is aimed at providing a numerical derivation of the shell knockdown factors of isogrid-stiffened cylinders under axial compressive loads. The present work uses two different analysis models such as the detailed model with modeling of numerous stiffeners and the equivalent model without modeling of stiffeners for isogrid-stiffened cylinders. The single perturbation load approach is used to represent the geometrically initial imperfection of the cylinder. Postbuckling analyses using the displacement control method are conducted to calculate the global buckling loads of a cylinder. The shell knockdown factor is numerically derived using the obtained global buckling loads without and with the initial imperfection of the isogrid-stiffened cylinder. The equivalent model is more efficient than the detailed model in terms of modeling time and computation time. The present knockdown factor function in terms of the shell thickness ratio (radius to thickness) for the isogrid-stiffened cylinder is significantly higher than NASA’s knockdown factor function; therefore, it is believed that the present knockdown factor function can facilitate in developing lightweight launch vehicle structures using isogrid-stiffened cylinders.
Combination of PARP Inhibitor Olaparib, and PD-L1 Inhibitor Durvalumab, in Recurrent Ovarian Cancer: a Proof-of-Concept Phase II Study
Authors: Lampert Erika J. , Zimmer Alexandra , Padget Michelle , Cimino-Mathews Ashley , Nair Jayakumar R. , Liu Yingmiao , Swisher Elizabeth M. , Hodge James W. , Nixon Andrew B. , Nichols Erin , Bagheri Mohammad H. , Levy Elliott , Radke Marc R. , Lipkowitz Stanley , Annunziata Christina M. , Taube Janis M. , Steinberg Seth M. , Lee Jung-Min
Published: May 2020

Purpose:

Preclinical studies suggest PARP inhibition (PARPi) induces immunostimulatory micromilieu in ovarian cancer thus complementing activity of immune checkpoint blockade. We conducted a phase II trial of PARPi olaparib and anti–PD-L1 durvalumab and collected paired fresh core biopsies and blood samples to test this hypothesis.

Patients and Methods:

In a single-center, proof-of-concept phase II study, we enrolled women aged ≥18 with recurrent ovarian cancer. All patients were immune checkpoint inhibitor–naïve and had measurable disease per RECISTv1.1, ECOG performance status 0–2, and adequate organ and marrow function. Patients received olaparib 300 mg twice daily and durvalumab 1,500 mg intravenously every 4 weeks until disease progression, unacceptable toxicity, or withdrawal of consent. Primary endpoint was overall response rate (ORR). Secondary objectives were safety and progression-free survival (PFS). Translational objectives included biomarker evaluation for relationships with clinical response and immunomodulatory effects by treatment.

Results:

Thirty-five patients with ovarian cancer [median, four prior therapies (IQR, 2–5.5), predominantly platinum-resistant (86%), BRCA wild-type (77%)] received at least one full cycle of treatment. ORR was 14% [5/35; 95% confidence interval (CI), 4.8%–30.3%]. Disease control rate (PR+SD) was 71% (25/35; 95% CI, 53.7%–85.4%). Treatment enhanced IFNγ and CXCL9/CXCL10 expression, systemic IFNγ/TNFα production, and tumor-infiltrating lymphocytes, indicating an immunostimulatory environment. Increased IFNγ production was associated with improved PFS [HR, 0.37 (95% CI, 0.16–0.87), P = 0.023], while elevated VEGFR3 levels were associated with worse PFS (HR, 3.22 (95% CI, 1.23–8.40), P = 0.017].

Conclusions:

The PARPi and anti–PD-L1 combination showed modest clinical activity in recurrent ovarian cancer. Our correlative study results suggest immunomodulatory effects by olaparib/durvalumab in patients and indicate that VEGF/VEGFR pathway blockade would be necessary for improved efficacy of the combination.
MMAE Delivery Using the Bicycle Toxin Conjugate BT5528
Authors: Bennett Gavin , Brown Amy , Mudd Gemma , Huxley Philip , Van Rietschoten Katerine , Pavan Silvia , Chen Liuhong , Watcham Sophie , Lahdenranta Johanna , Keen Nicholas
Published: May 2020

The EphA2 receptor is found at high levels in tumors and low levels in normal tissue and high EphA2 expression in biopsies is a predictor of poor outcome in patients. Drug discovery groups have therefore sought to develop EphA2-based therapies using small molecule, peptide, and nanoparticle-based approaches (1–3). However, until now only EphA2-targeting antibody–drug conjugates (ADC) have entered clinical development. For example, MEDI-547 is an EphA2-targeting ADC that displayed encouraging antitumor activity in preclinical models and progressed to phase I clinical testing in man. Here we describe the development of BT5528, a bicyclic peptide (“Bicycle”) conjugated to the auristatin derivative maleimidocaproyl-monomethyl auristatin E to generate the Bicycle toxin conjugate BT5528. The report compares and contrasts the Pharmacokinetics (PK) characteristics of antibody and Bicycle-based targeting systems and discusses how the PK and payload characteristics of different delivery systems impact the efficacy—toxicity trade off which is key to the development of successful cancer therapies. We show that BT5528 gives rise to rapid update into tumors and fast renal elimination followed by persistent toxin levels in tumors without prolonged exposure of parent drug in the vasculature. This fast in, fast out kinetics gave rise to more favorable toxicology findings in rats and monkeys than were observed with MEDI-547 in preclinical and clinical studies.

Graphical Abstract: http://mct.aacrjournals.org/content/molcanther/19/7/1385/F1.large.jpg.
Brain Structural Plasticity Associated with Maternal Caregiving in Mothers: A Voxel- and Surface-Based Morphometry Study
Authors: Zhang Kaihua , Wang Mengxing , Zhang Jilei , Du Xiaoxia , Chen Zhong
Published: May 2020

Background: Pregnancy constitutes a significant period in the lives of women, after which they often experience numerous crucial physiological and psychological changes. Functional neuroimaging studies have shown longitudinal changes in functional brain activity in mothers responding to infant-related stimuli. However, the structural changes that occur in the brains of mothers after delivery remain to be explored. Objective: We aimed to evaluate the structural changes in mothers during the postpartum phase. Methods: We recruited 35 primiparous mothers and 26 nonmothers to participate in this voxel- and surface-based morphometry study, and 22 mothers were scanned twice with a follow-up of approximately 2 years. Results: Compared to nonmothers, mothers exhibited reduced gray matter (GM) volumes and increased white matter (WM) volumes in regions associated with empathy and reward networks (supplementary motor area, precuneus, inferior parietal lobe, insula, and striatum), decreased cortical thickness in the precentral gyrus and increased gyrification index in the orbitofrontal cortex. Furthermore, mothers showed longitudinal changes in the GM and WM volumes and cortical thickness of several of these regions (including the superior and medial frontal gyrus, insula, limbic lobe, superior and middle temporal gyrus, and precentral gyrus), which have been associated with maternal networks during the postpartum period. Additionally, the changes in GM and WM volumes were related to changes in empathetic abilities in mothers. Conclusion: These results suggest that the brains of mothers exhibit adaptive structural dynamic plasticity. These findings provide a neuroanatomical basis for understanding how mothers process emotional sensory information during the postpartum period.
At a Moment’s Notice: Community Advisory Board Perspectives on Biobank Communication to Supplement Broad Consent
Authors: Meagher Karen M. , Curtis Susan H. , Gamm Kylie O. , Sutton Erica J. , McCormick Jennifer B. , Sharp Richard R.
Published: May 2020

Introduction: To address ethical concerns about the of future research authorization, biobanks employing a broad model of consent can design ongoing communication with contributors. Notifying contributors at the time of sample distribution provides one form of communication to supplement broad consent. However, little is known about how community-informed governance might anticipate contributor responses and inform communication efforts. Objective: We explored the attitudes of members of a three-site Community Advisory Board (CAB) network. CAB members responded to a hypothetical proposal for notifying biobank contributors at the time of sample distribution to researchers utilizing the biobank. Methods: We used regularly scheduled CAB meetings to facilitate 3 large-group and 6 small-group discussions. Discussions were audio-recorded, transcribed, and analyzed for thematic content using descriptive thematic analysis. Results: The results challenged our expectation of general support for the proposed communications. While CAB members identified some advantages, they were concerned about several potential harms to biobank contributors and the biobank. The CABs understood biobank communication in terms of an ongoing relationship with the biobank and a personal contribution to research. Conclusion:Our findings contribute to the emerging literature on community engagement in biobanking. Additional communication with biobank contributors can serve a variety of value-based objectives to supplement broad consent. Design of communication efforts by biobanks can be improved by CAB members’ anticipation of the unintended consequences of additional contact with contributors. CAB members’ holistic interpretation of communication efforts suggests that biobank leadership considers all communication options as part of a more comprehensive communications strategy.
Peculiar Congenital Factor VII Defect with the Proposita and Her Mother Showing the Same Compound Heterozygosity for Thr384Met and Arg413Gln
Authors: Girolami Antonio , Paoletti Mariano , Ferrari Silvia , Garcia Diana
Published: May 2020

Objective: To investigate a family with factor VII (FVII) deficiency from Argentina. Patients and Methods: The proposita is a 14-year-old girl who presented with a mild to moderate bleeding tendency. Menorrhagia is controlled with periodical administration of small doses of recombinant FVII concentrate. The mother of the proposita has a similar bleeding tendency. Results: FVII activity in both patients was 20% of normal; FVII antigen was 35% of normal. Molecular biology investigation revealed that the proposita was compound heterozygote between Thr384Met and Arg413Gln. The mother had the same mutations. This was due to the fact that the father of the proposita and her maternal grandfather both carried, in spite of no relation, the same mutation, namely Arg413Gln. Conclusions: The identical defect which presented in the propositaand her mother could be explained by the genetic analysis of the father and maternal grandfather of the proposita who happened to have the same mutation (Arg413Gln).
Does YouTube Provide Reliable and High-Quality Information? Assessment of Pap Smear Test Videos
Authors: Gursoy Ali , Peker Hakan
Published: May 2020

Aim: YouTube is one of the most popular video-sharing platforms and is used by many people as a source of information regarding health conditions. Although there are many studies examining YouTube health-related videos in terms of quality, content and accuracy, there is not any study observing the content of YouTube videos about the “Pap smear test.” Therefore, we intended to evaluate YouTube videos related to the Pap smear test. Methods: We made a search by typing “Pap smear test” and observed the first 100 videos. According to our selection criteria, only 42 videos were reviewed. We used 3 different questionnaires to rate the videos. The videos were independently rated by 2 gynecologists in terms of technical aspects, follow-up protocol, and video quality. Results: Our study showed that clarity of the technical aspects of Pap smear testing (Q1) was 40% and that of the follow-up protocol (Q2) was only 11%. In terms of video quality (Q3), the adequacy rate was 34%. There was a statistically significant negative correlation between search rank and the video power index (which increased as the ranking decreased to rank 1, r: −0.481). Conclusion: We did not find quality and reliable information on YouTube videos about the Pap smear test, which is important for early detection of cervical cancers. While preparing health-related videos for YouTube and similar websites, the support of professional healthcare workers will help provide more accurate content.
Reducing Malignant Ascites and Long-Term Survival in a Patient with Recurrent Gastric Cancer Treated with a Combination of Docetaxel and Mistletoe Extract
Authors: Oh Sung Jin
Published: May 2020

Recurrent gastric cancer with peritoneal seeding is associated with poor overall survival. A 71-year-old man with advanced gastric cancer underwent radical total gastrectomy (stage IIIb, T4b N1 M0). Abdomino-pelvic computed tomography performed 7 months after surgery revealed increased ascites with enhanced peritoneal thickening. He was diagnosed with peritoneal seeding and received second-line chemotherapy (irinotecan). However, he refused chemotherapy due to the side effects (general weakness, nausea, and vomiting) after 1 cycle. He started receiving alternative therapy with Viscum album extract (VAE) (mistletoe) instead of chemotherapy. Malignant ascites gradually decreased after mistletoe therapy. So we started third-line chemotherapy (docetaxel) with VAE. The patient achieved good health with complete response postoperatively 32 months after combination treatment and survived over 60 months after surgery without disease progression. We report a case of recurrent gastric cancer that was successfully treated with a combination of docetaxel monotherapy and long-term mistletoe extract treatment.
The Effect of Lavender Oil on Sleep Quality and Vital Signs in Palliative Care: A Randomized Clinical Trial
Authors: Yıldırım Dilek , Kocatepe Vildan , Can Gülbeyaz , Sulu Ebru , Akış Handan , Şahin Güleser , Aktay Eylem
Published: May 2020

Background: This study was conducted to determine the effect of lavender oil on sleep quality and vital signs in palliative care patients. Methods: We examined 68 patients in a palliative care unit. Vital signs of all the patients were assessed, and also their sleep quality was evaluated using the Richards-Campbell Sleep Questionnaire. Lavender was applied to patients in the experimental group. During the intervention, vital signs of the patients were monitored at 4-h intervals throughout the night, and sleep quality was evaluated during the morning. The same evaluation processes were performed for the control group. Results:It was observed in the evaluation that lavender application did not affect the vital signs of the patients but it ensured a deeper sleep on the 2nd day after the intervention, facilitated their falling asleep and sleeping again when they were awakened and enhanced sleep quality (p < 0.05). Also, this application decreased the awakening frequency on the 1st and 2nd days and enhanced overall sleep quality (p < 0.05) after the intervention. Conclusions: Lavender has no effect on the vital signs of palliative care patients but is an effective and reliable approach to enhance their sleep quality.
Comparison Study of Self-Sampled and Physician-Sampled Specimens for High-Risk Human Papillomavirus Test and Cytology
Authors: Satake Hideo , Inaba Noriyuki , Kanno Keiichiro , Mihara Masato , Takagi Yoshitake , Kondo Nobuo , Sagae Satoru
Published: May 2020

Objective: The objective of this study was to calculate the positive rate and overall concordance rate of high-risk human papillomavirus (hrHPV) test and cytology using self-sampled and physician-sampled cervicovaginal tests and to compare both specimens. Methods: In collaboration with 3 private hospitals in Sapporo city, 300 women visiting these organizations were enrolled in the study by previously signing an informed consent. From these women, both types of samples (self-obtained and physician-sampled) were obtained at the same time. HrHPV test and cytology were performed on both specimens, and the positive rate and overall concordance rate were calculated to compare both specimens. Results: HrHPV-positive women were 13.7% in physician-sampled specimens and 14.7% in self-sampled specimens, with an overall concordance rate of 96.3% (95% confidence interval [CI]: 94–98%). On the other hand, the positive rate of the cases higher than or equal to atypical squamous cells of undetermined significance (ASCUS) on cytology was different between both groups, that is, 12.3% in physician-obtained and 5.3% in self-sampled specimens; the overall concordance rate was 90.7% (95% CI: 87–94%), indicating an apparent decrease in the positive rate of cytology in self-obtained specimens. Conclusion: HrHPV test and cytology were performed on parallel samples obtained by the patients with a self-sampling tool and by the physician. The positive rate of cytology was considerably different between these specimens, while almost equivalent results were obtained for hrHPV test in both specimens. It was concluded that hrHPV test may be safely and accurately performed on self-obtained cervicovaginal samples by the help of a self-sampling device in the Japanese population as a first screening tool, with equivalent results to physician-obtained specimens.
Consilium Smartphone App for Real-World Electronically Captured Patient-Reported Outcome Monitoring in Cancer Patients Undergoing anti-PD-L1-Directed Treatment
Authors: Trojan Andreas , Huber Urs , Brauchbar Mathis , Petrausch Ulf
Published: May 2020

Digital patient monitoring gains importance for quality of clinical cancer care. Our case report provides insight into usability and acceptance of a smartphone app for monitoring of electronically captured patient-reported outcomes in patients undergoing immunotherapy. During 3 months, 6 patients with advanced or metastatic PD-L1-positive cancer of the lung, prostate, and bladder who underwent checkpoint immunotherapy were using the Consilium app for standardized and structured electronic reporting of symptoms and therapy side effects. We evaluated the number and quality of symptom entries as well as usability and safety of shared reporting between the patient and the treating physician. Duration of anti-PD-L1-directed immunotherapy in the 6 patients ranged from 4 to 10 months and comprised a total of 21 anti-PD-L1-directed immunotherapy cycles. Patients reported between 4 and 16 different symptoms, of which the most frequent (57%) were dry cough, fatigue, shortness of breath, fever, and appetite loss. Overall, 1,279 symptom entries were counted, corresponding to 2.4 symptom entries per patient per day. Symptom severity grading ranged from 0.1 (very slight symptoms) to 7.8 (severe symptoms), which triggered prespecified alerts in 4 of the 6 patients. No unplanned visits were noted, and no safety issues occurred. Satisfaction with the app usability was high, as was the beneficial effect on consultation. Usability and reviewed data entries indicate high shared reporting efforts of patients and treating physicians and overall satisfaction with electronically reported patient outcomes.
Mortality after Transplantation for Hepatocellular Carcinoma: A Study from the European Liver Transplant Registry
Authors: Pommergaard Hans-Christian , Rostved Andreas Arendtsen , Adam René ,   Rasmussen, Salizzoni Mauro , Bravo Miguel Angel Gómez , Cherqui Daniel , De Simone Paolo , Houssel-Debry Pauline , Mazzaferro Vincenzo , Soubrane Olivier , García-Valdecasas Juan Carlos , Prous Joan Fabregat , Pinna Antonio D. , O’Grady John , Karam Vincent , Duvoux Christophe , Thygesen Lau Caspar ,   European Liver and Intestine Transplant Association (ELITA)
Published: May 2020

Background and Aims: Prognosis after liver transplantation differs between hepatocellular carcinoma (HCC) arising in cirrhotic and non-cirrhotic livers and aetiology is poorly understood. The aim was to investigate differences in mortality after liver transplantation between these patients. Methods: We included patients from the European Liver Transplant Registry transplanted due to HCC from 1990 to November 2016 and compared cirrhotic and non-cirrhotic patients using propensity score (PS) calibration of Cox regression estimates to adjust for unmeasured confounding. Results: We included 22,787 patients, of whom 96.5% had cirrhosis. In the unadjusted analysis, non-cirrhotic patients had an increased risk of overall mortality with a hazard ratio (HR) of 1.37 (95% confidence interval [CI] 1.23–1.52). However, the HR approached unity with increasing adjustment and was 1.11 (95% CI 0.99–1.25) when adjusted for unmeasured confounding. Unadjusted, non-cirrhotic patients had an increased risk of HCC-specific mortality (HR 2.62, 95% CI 2.21–3.12). After adjustment for unmeasured confounding, the risk remained significantly increased (HR 1.62, 95% CI 1.31–2.00). Conclusions: Using PS calibration, we showed that HCC in non-cirrhotic liver has similar overall mortality, but higher HCC-specific mortality. This may be a result of a more aggressive cancer form in the non-cirrhotic liver as higher mortality could not be explained by tumour characteristics or other prognostic variables.
Crystalline Lens Resorption Caused by Ciliary Body Melanoma
Authors: Carrera William M. , Denny Matthew R. , Seider Michael I.
Published: May 2020

We report a case of a 51-year-old Caucasian female who presented with a ciliary body melanoma of the right eye leading to focal resorption of the crystalline lens and inducing posterior subcapsular cataract. She underwent successful enucleation, and histopathology demonstrated a ciliary body melanoma with a predominance of epithelioid cells and focal scleral extension. Genetic testing revealed a heterozygous, pathogenic mutation of BAP1 (c.1717delC, p.Leu573fs). Crystalline lens resorption is a rare but potentially important finding in ciliary body melanoma, as early detection of malignancy can be lifesaving.
Over-the-Scope Clip to the Rescue! A Novel Tool for Refractory Acute Nonvariceal Upper Gastrointestinal Hemorrhage
Authors: Amarnath Shivantha , Philipose Jobin , Abergel Jeffrey , Khan Hafiz
Published: May 2020

Nonvariceal upper gastrointestinal hemorrhage (NVUGIH) is more prevalent than lower gastrointestinal hemorrhage and carries a high risk of mortality in the elderly, especially those with significant cardiovascular comorbidities. Traditional endoscopic methods, such as through-the-scope clips, electrocautery, and epinephrine injection, are frequently used to control these bleeds; however, they carry a 10% risk of rebleeding, and this itself carries a mortality risk of 36%. The larger over-the-scope clips (OTSC) that were initially used for the closure of fistulas and perforations are now gradually being implemented to manage NVUGIH. To our knowledge, we present the first cases to be reported in the literature where OTSC was successfully used as salvage therapy for refractory acute upper gastrointestinal bleeders who failed traditional endoscopic management and interventional radiology-guided embolization of the bleeding artery. We also provide an up-to-date literature review on the use of OTSC and its superiority to traditional endoscopic interventions in the management of complicated NVUGIH.
Factors Associated With Potentially Inappropriate Phosphodiesterase-5 Inhibitor Use for Pulmonary Hypertension in the United States, 2006 to 2015
Authors: Gillmeyer Kari R. , Rinne Seppo T. , Glickman Mark E. , Lee Kyung Min , Shao Qing , Qian Shirley X. , Klings Elizabeth S. , Maron Bradley A. , Hanlon Joseph T. , Miller Donald R. , Wiener Renda Soylemez
Published: May 2020

Background:

Use of phosphodiesterase-5 inhibitors (PDE5i) for groups 2 and 3 pulmonary hypertension (PH) is rising nationally, despite guidelines recommending against this low-value practice. Although receiving care across healthcare systems is encouraged to increase veterans’ access to specialists critical for PH management, receiving care in 2 systems may increase risk of guideline-discordant prescribing. We sought to identify factors associated with prescribing of PDE5i for group 2/3 PH, particularly, to test the hypothesis that veterans prescribed PDE5i for PH in the community (through Medicare) will have increased risk of subsequently receiving potentially inappropriate treatment in Veterans Health Administration (VA).

Methods and Results:

We constructed a retrospective cohort of 34 775 Medicare-eligible veterans with group 2/3 PH by linking national patient-level data from VA and Medicare from 2006 to 2015. We calculated adjusted odds ratios (ORs) of receiving daily PDE5i treatment for PH in VA using multivariable models with facility-specific random effects. In this cohort, 1556 veterans received VA prescriptions for PDE5i treatment for group 2/3 PH. Supporting our primary hypothesis, the variable most strongly associated with PDE5i treatment in VA for group 2/3 PH was prior treatment through Medicare (OR, 6.5 [95% CI, 4.9–8.7]). Other variables strongly associated with increased likelihood of VA treatment included more severe disease as indicated by recent right heart failure (OR, 3.3 [95% CI, 2.8–3.9]) or respiratory failure (OR, 3.7 [95% CI, 3.1–4.4]) and prior right heart catheterization (OR, 3.8 [95% CI, 3.4–4.3]).

Conclusions:

Our data suggest a missed opportunity to reassess treatment appropriateness when pulmonary hypertension patients seek prescriptions from VA—a relevant finding given policies promoting shared care across VA and community settings. Interventions are needed to reinforce awareness that pulmonary vasodilators are unlikely to benefit group 2/3 pulmonary hypertension patients and may cause harm.
Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes
Authors: Fanaroff Alexander C. , Peterson Eric D. , Kaltenbach Lisa A. , Anstrom Kevin J. , Fonarow Gregg C. , Henry Timothy D. , Cannon Christopher P. , Choudhry Niteesh K. , Cohen David J. , Atreja Nipun , Bhalla Narinder , Eudicone James M. , Wang Tracy Y.
Published: May 2020

Background:

Cost is frequently cited as a barrier to optimal medication use, but the extent to which copayment assistance interventions are used when available, and their impact on evidence-based medication persistence and major adverse cardiovascular events is unknown.

Methods and Results:

The ARTEMIS trial (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) randomized 301 hospitals to usual care versus the ability to provide patients with vouchers that offset copayment costs when filling P2Y
12
inhibitors in the 1 year post-myocardial infarction. In the intervention group, we used multivariable logistic regression to identify patient and medication cost characteristics associated with voucher use. We then used this model to stratify both intervention and usual care patients by likelihood of voucher use, and examined the impact of the voucher intervention on 1-year P2Y
12
inhibitor persistence (no gap in pharmacy supply >30 days) and major adverse cardiovascular events (all-cause death, myocardial infarction, or stroke). Among 10 102 enrolled patients, 6135 patients were treated at hospitals randomized to the copayment intervention. Of these, 1742 (28.4%) never used the voucher, although 1729 (99.2%) voucher never-users filled at least one P2Y
12
inhibitor prescription in the 1 year post-myocardial infarction. Characteristics most associated with voucher use included: discharge on ticagrelor, planned 1-year course of P2Y
12
inhibitor treatment, white race, commercial insurance, and higher out-of-pocket medication costs (c-statistic 0.74). Applying this propensity model to stratify all enrolled patients by likelihood of voucher use, the intervention improved medication persistence the most in patients with high likelihood of voucher use (adjusted interaction
P
=0.03, odds ratio, 1.86 [95% CI, 1.48–2.33]). The intervention did not significantly reduce major adverse cardiovascular events in any voucher use likelihood group, although the odds ratio was lowest (0.86 [95% CI, 0.56–1.16]) among patients with high likelihood of voucher use (adjusted interaction
P
=0.04).

Conclusions:

Among patients discharged after myocardial infarction, those with higher copayments and greater out-of-pocket medication costs were more likely to use a copayment assistance voucher, but some classes of patients were less likely to use a copayment assistance voucher. Patients at low likelihood of voucher use benefitted least from copayment assistance, and other interventions may be needed to improve medication-taking behaviors and clinical outcomes in these patients.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02406677.
A new species of Myrsine (Primulaceae-Myrsinoideae) from New Guinea

Authors: UTTERIDGE TIMOTHY M.A. , LEPSCHI BRENDAN J.
Published: May 2020

Myrsine exquisitorum Utteridge & Lepschi (Primulaceae-Myrsinoideae) is described and illustrated as a new species endemic to the Western Highlands Province from Papua New Guinea. The new species is unique in the relatively large, almost orbicular leaves with entire margins, and the tetramerous flowers arranged in axillary fascicles without forming short shoots.
Morphology and phylogenetic position of three new raphid diatoms (Bacillariophyceae) from Hangang River, South Korea

Authors: TAN LING , WANG PENGBIN , CHO IN-HWAN , HWANG EUN-A , LEE HYUK , KIM BAIK-HO
Published: May 2020

Epilithic diatoms were isolated and cultured during ecological investigations of the Hangang River, South Korea. Three species belonging to the genera Fragilaria, Nitzschia, and Encyonema were investigated using morphological and molecular data. Their morphological characteristics were analyzed using light microscopy (LM) and scanning electron microscopy (SEM). The nuclear small subunit (SSU) rRNA and ribulose-1, 5-bisphosphate carboxylase/oxygenase (rbcL) genes were used to study the molecular characteristics of these taxa. We herein describe three new species: 1) Fragilaria thornata, which has spatulate spines tapering towards their tips; 2) Nitzschia hantanense, which has a small-sized frustule with convex margins and parallel striae in the central part of the valve that become strongly radial towards the poles; 3) Encyonema equalis, which has a space between projections, located on the upper siliceous struts, that is consistent whether near the margin or near the raphe. According to the molecular analysis of three species, there also give a strong evidence to separate these three species as new species based on the phylogenetic tree and genetic distance of SSU rRNA and rbcL gene. The result of all analyses support that Fragilaria thornata, Nitzschia hantanense and Encyonema equalis are new to science.
Stellaria multipartita (Caryophyllaceae), a new species from Chongqing, China

Authors: SONG YAN-FENG , LI MENG , XU BO , CHEN SHUI-FEI , CHEN LIN , XIE CHUN-PING
Published: May 2020

Stellaria multipartita sp. nov. (Caryophyllaceae) from Chongqing, China, is described and illustrated based on morphological and molecular data. The new species is similar to S. radians by the palmately fimbriate petals with more linear divisions. Different characters are: shape of the leaves (oblong-triangular to ovate-triangular vs. oblong-lanceolate to ovate-lanceolate in S. radians), petals (10–12-cleft vs. 5–7-cleft in S. radians), and seeds (with mamillate ornamentation vs. scrobiculate ornamentation in S. radians). A molecular phylogenetic analysis supports the recognition of Chongqing population as a new species for science.
Continued Increases in the Intensity of Strong Tropical Cyclones
Authors: Elsner James B.
Published: May 2020

In a 2008 paper, using satellite-derived wind speed estimates from tropical cyclones over the 25-yr period 1981–2006, we showed the strongest tropical cyclones getting stronger. We related the increasing intensity to rising ocean temperatures consistent with theory. Oceans have continued to warm since that paper was published, so the intensity of the strongest cyclones should have continued upward as well. Here I show that this is the case, with increases in the upper-quantile intensities of global tropical cyclones amounting to between 3.5% and 4.5% in the period 2007–19 relative to the earlier base period (1981–2006). All basins individually show upward intensity trends for at least one upper quantile considered, with the North Atlantic and western North Pacific basins showing the steepest and most consistent trends across the quantiles.
The Influences of Effective Inflow Layer Streamwise Vorticity and Storm-Relative Flow on Supercell Updraft Properties
Authors: Peters John M. , Nowotarski Christopher J. , Mulholland Jake P. , Thompson Richard L.
Published: May 2020

The relationship between storm-relative helicity (SRH) and streamwise vorticity ωs is frequently invoked to explain the often robust connections between effective inflow layer (EIL) SRH and various supercell updraft properties. However, the definition of SRH also contains storm-relative (SR) flow, and the separate influences of SR flow and ωs on updraft dynamics are therefore convolved when SRH is used as a diagnostic tool. To clarify this issue, proximity soundings and numerical experiments are used to disentangle the separate influences of EIL SR flow and ωs on supercell updraft characteristics. Our results suggest that the magnitude of EIL ωs has little influence on whether supercellular storm mode occurs. Rather, the transition from nonsupercellular to supercellular storm mode is largely modulated by the magnitude of EIL SR flow. Furthermore, many updraft attributes such as updraft width, maximum vertical velocity, vertical mass flux at all levels, and maximum vertical vorticity at all levels are largely determined by EIL SR flow. For a constant EIL SR flow, storms with large EIL ωs have stronger low-level net rotation and vertical velocities, which affirms previously established connections between ωs and tornadogenesis. EIL ωs also influences storms’ precipitation and cold-pool patterns. Vertical nonlinear dynamic pressure acceleration (NLDPA) is larger at low levels when EIL ωs is large, but differences in NLDPA aloft become uncorrelated with EIL ωs because storms’ midlevel dynamic pressure perturbations are substantially influenced by the tilting of midlevel vorticity. Our results emphasize the importance of considering EIL SR flow in addition to EIL SRH in the research and forecasting of supercell properties.
Regional Dynamic Sea Level Simulated in the CMIP5 and CMIP6 Models: Mean Biases, Future Projections, and Their Linkages
Authors: Lyu Kewei , Zhang Xuebin , Church John A.
Published: May 2020

The ocean dynamic sea level (DSL) is an important component of regional sea level projections. In this study, we analyze mean states and future projections of the DSL from the global coupled climate models participating in phase 5 and phase 6 of the Coupled Model Intercomparison Project (CMIP5 and CMIP6, respectively). Despite persistent biases relative to observations, both CMIP5 and CMIP6 simulate the mean sea level reasonably well. The equatorward bias of the Southern Hemisphere westerly wind stress is reduced from CMIP5 to CMIP6, which improves the simulated mean sea level in the Southern Ocean. The CMIP5 and CMIP6 DSL projections exhibit very similar features and intermodel uncertainties. With several models having a notably high climate sensitivity, CMIP6 projects larger DSL changes in the North Atlantic and Arctic associated with a larger weakening of the Atlantic meridional overturning circulation (AMOC). We further identify linkages between model mean states and future projections by looking for their intermodel relationships. The common cold-tongue bias leads to an underestimation of DSL rise in the western tropical Pacific. Models with their simulated midlatitude westerly winds located more equatorward tend to project larger DSL changes in the Southern Ocean and North Pacific. In contrast, a more equatorward location of the North Atlantic westerly winds or a weaker AMOC under current climatology is associated with a smaller weakening of the AMOC and weaker DSL changes in the North Atlantic and coastal Arctic. Our study provides useful emergent constraints for DSL projections and highlights the importance of reducing model mean-state biases for future projections.
Centrifugal and Symmetric Instability during Ekman Adjustment of the Bottom Boundary Layer
Authors: Wenegrat Jacob O. , Thomas Leif N.
Published: May 2020

Flow along isobaths of a sloping lower boundary generates an across-isobath Ekman transport in the bottom boundary layer. When this Ekman transport is down the slope it causes convective mixing—much like a downfront wind in the surface boundary layer—destroying stratification and potential vorticity. In this manuscript we show how this can lead to the development of a forced centrifugal or symmetric instability regime, where the potential vorticity flux generated by friction along the boundary is balanced by submesoscale instabilities that return the boundary layer potential vorticity to zero. This balance provides a strong constraint on the boundary layer evolution, which we use to develop a theory that explains the evolution of the boundary layer thickness, the rate at which the instabilities extract energy from the geostrophic flow field, and the magnitude and vertical structure of the dissipation. Finally, we show using theory and a high-resolution numerical model how the presence of centrifugal or symmetric instabilities alters the time-dependent Ekman adjustment of the boundary layer, delaying Ekman buoyancy arrest and enhancing the total energy removed from the balanced flow field. Submesoscale instabilities of the bottom boundary layer may therefore play an important, largely overlooked, role in the energetics of flow over topography in the ocean.
Effect of Scale-Aware Nonlocal Planetary Boundary Layer Scheme on Lake-Effect Precipitation at Gray-Zone Resolutions
Authors: Choi Hyun-Joo , Han Ji-Young
Published: May 2020

The effects of a nonlocal planetary boundary layer (PBL) scheme that considers scale dependency in the parameterized turbulent vertical transport are investigated for a case of wintertime lake-effect precipitation over Korea at gray-zone resolutions using a mesoscale model. An experiment using the scale-aware PBL scheme is compared with that using a conventional PBL scheme, which shows that the simulated precipitation amount at a resolution of less than 1 km is smaller with the scale-aware PBL scheme. The role of turbulent processes in simulating lake-effect precipitation is understood through interaction with microphysical processes. When the scale-aware PBL scheme is used, liquid water content is increased while ice water content is reduced. The higher cloud water content is because of enhanced condensation with stronger updrafts, attributed to the suppression of parameterized turbulent mixing. This results in higher rainwater content by enhancing autoconversion and accretion from cloud water to rainwater. The cloud ice content is reduced mainly because of the suppressed deposition and enhanced sublimation centered near the PBL top, and the snow content is reduced mainly because of the enhanced sublimation below and near the PBL top and suppressed growth of cloud ice to snow. The lower ice water content is mainly due to the drier PBL, attributed to the enhanced resolved (suppressed parameterized) turbulent moisture transport and enhanced condensation. The melting of a smaller amount of snow under dominant cold rain processes is responsible for the reduced surface precipitation with the scale-aware PBL scheme.
Induced Abortion and the Increased Risk of Maternal Mortality
Authors: Marmion Patrick J. , Skop Ingrid
Published: May 2020

After years of failure to obtain accurate statistics on maternal mortality, the United States noted a sharp increase in its maternal mortality rate with widening racial and ethnic disparities. The 2016 report shocked the nation by documenting a 26 percent increase in maternal mortality from 18.8/100,000 live births in 2000 to 23.8 in 2014. Suggested etiologies of this increase included artifact as a result of improved maternal death surveillance, incorrect use of ICD- 10 codes, healthcare disparities, lack of family support and other social barriers, substance abuse and violence, depression and suicide, inadequate preconception care, patient noncompliance, lack of standardized protocols for handling obstetric emergencies, failure to meet expected standards of care, aging of the pregnant patient cohort with associated increase in chronic diseases and cardiovascular complications, and lack of a comprehensive national plan. While some of the increase in maternal mortality may be a result of improved data collection, pregnancy-related deaths are occurring at a higher rate in the United States than in other developed countries. Some have suggested that the increased maternal mortality is due to limiting women’s access to legal abortion. In order to discover effective strategies to improve pregnancy outcomes, maternal mortality must be investigated in an unbiased manner. This review explores the relationship between legal-induced abortion and maternal mortality.

In Finland, where epidemiologic record linkage has been validated, the risk of death from legal induced abortion is reported to be almost four times greater than the risk of death from childbirth. It is difficult to do this comparison in the United States not only because prior induced abortion history is often not recorded for a pregnancy-related death but also because less than one-quarter of the states require health care providers to report abortion deaths for investigation. These omissions are important because mortality risk in pregnancies subsequent to abortion is increased due to abortion-induced morbidities such as preterm birth and abnormal placentation. Legal induced abortion is a root cause of the racial and ethnic disparity noted in maternal mortality. In the United States, the death rate from legal induced abortion performed at 18 weeks gestation is more than double that observed for women experiencing vaginal delivery.
Establishing a Genetic Algorithm-Back Propagation model to predict the pressure of girdles and to determine the model function
Authors: Jie Zhou , Qiurui Ma
Published: May 2020

A Genetic Algorithm-Back Propagation (GA-BP) neural network method has been proposed to predict the clothing pressure of girdles in different postures. Firstly, a Back Propagation (BP) neural network model was used to predict the clothing pressure based on seven parameters, and three optimal functions of the model were derived. However, the prediction error 0.85411 of the network was more than the forecast requirement of 0.5 and the optimal initial weights and thresholds for the network could not be calculated. Therefore, a GA model and the BP neural network model were combined into a new GA-BP neural network model, which was used to predict the clothing pressure based on the three optimal functions. The results showed that the prediction error for this GA-BP neural network model was 0.41652, which was less than the forecast requirement of 0.5. Hence, the model was shown to predict the girdle pressure with acceptable accuracy. Finally, the internal calculation function equation for the GA-BP neural network was derived.
5-HT7 receptorsare over-expressed in patients with nasal polyps
Authors: Yayla Muhammed , Halici Zekai , Kose Duygu , Tatar Arzu , SitkiGozeler Mustafa
Published: May 2020

Nasal polyposis (NP) is an inflammatory disease of the paranasal sinuses and nasal cavity. The primary purpose of our study is to determine the expression of 5-HT7 receptors both in nasal polyps and in healthy tissue in the nasal cavity. The subsequent aim is to compare the expression of 5-HT7 receptors in patients with NP and in inferior turbinate tissue (control).The study included 60 participants (40 with NP and 20 controls) aged 35 to 62 years. Nasal polyp samples were collected from all patients and relative 5-HT7 receptor expression analyses were performed. RT-PCR analysis of nasal polyps and control tissue identified 5-HT7 receptor expression in the nasal cavities of controls. This expression was approximately 67 times higher in nasal polyp tissue than in healthy tissue. Our study identifies the expression of 5-HT7 receptors in the nasal cavity for the first time. It is also the first demonstration of increased 5-HT7 receptor expression in tissue from nasal polyps, which occur in the paranasal sinuses and nasal cavity.
Management of Foreign Bodies in the Ear: A Retrospective Review of 123 Cases in Nigeria
Authors: Olajide Toye G. , Ologe Foluwasayo E. , Arigbede Oluwabukola O.
Published: May 2020

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant ( p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.
Articulatory and perceptual cues to non-native phoneme perception: Cross-modal training for early learners
Authors: Cibelli Emily
Published: May 2020

Non-native phoneme perception can be challenging for adult learners. This article explores two routes to strengthening early representations of non-native targets: perceptual training, which focuses on auditory discrimination of novel contrasts, and articulatory training, which highlights the articulatory gestures of non-native categories. Of particular interest is whether cross-modal transfer from production to perception is beneficial to improving discrimination. A longitudinal experiment integrating both training types found that articulatory training did not improve discrimination once perceptual learning had taken place. However, a follow-up experiment found an equivalent benefit for perceptual and articulatory training when each was presented as the only learning style to separate groups of learners. These findings suggest that articulatory learning can ‘cross over’ to assist acquisition in the perceptual domain, and may play a key role for second language (L2) learners struggling with both perception and production of novel phoneme categories.