bluuebunny/crossref_metadata_2025 huggingface dataset:
CPAP as a useful tool in COVID-19 related Acute Hypoxemic Respiratory Failure: Experience from 3 UK Hospitals
Authors: Ahmed Yasser Noeman , Setty Niranjan , Roshdy Ashraf , Powrie Duncan J , Amran Dora A , Elsheikh Alguili , Gokaraju Sriya , Tear Anne , Noeman Maryam , Darda Maria , Sayed Iman El , Karunanithi Vijayalakshmi , Aarani Mahalingam , Shafiq Muhammad , Abdul-Khaliq  , Samuel Johnson
Published: February 2021

Introduction: Severe acute hypoxemic respiratory failure (AHRF) in COVID-19 pneumonia is associated with a high mortality rate, resulting in mounting pressures on intensive care units worldwide. Different oxygenation management protocols are used in different centres. Most centres switch patients who fail to oxygenate adequately using conventional oxygen therapy (COT) methods to non-invasive positive pressure ventilation (NIPPV), usually continuous positive airway pressure (CPAP). Other centres resort to invasive mechanical ventilation (IMV) directly, without a trial of NIPPV. In this trial, we aim to compare the efficacy of different approaches in managing COVID-related AHRF, and ascertain if CPAP therapy reduces the need for IMV. Methods: We carried out a retrospective cohort study on patients with laboratory-confirmed COVID-19 at three university hospitals in Essex, United Kingdom. We included all patients with significant AHRF (defined as needing oxygen therapy FiO2 more than 0.4 to maintain an oxygen saturation of 92%) who were deemed eligible for IMV escalation during a 3-month period (1st March to 31st May 2020).Results: Out of 174 patients who met the criteria, 84 patients received CPAP (Group 1). Half needed intubation (n=42). 90 patients did not have a CPAP trial (Group 2). 76.6% needed intubation (n=69). No difference was found between the two groups in demographic criteria or disease severity. Our results show a significant difference in 60-day mortality between group 1 and 2 (25% versus 37.8%, p=0.02). COT as standalone therapy for COVID-19 patients (group 2) was associated with a trend of more increased risk of intubation and an increased relative risk of death (RR 2.14, 95% CI 1.39 to 3.29). This corresponds to a number needed to treat (NNT) of 3.74 (95% CI 2.47 to 7.73). Patients in group 1 who failed CPAP trial and required intubation did not have an increased risk of mortality when compared to group 2 patients who required intubation.Conclusion: Our results support introducing CPAP rather than escalating FiO2 in cases refractory to COT. Our study suggests CPAP can be safely used to treat patients with AHRF. Clinical trials are needed to guide recommendations for optimum timing and selection of patients most likely to benefit.
The possibility of care engineering to enhance STEAM education in future care through the title analysis
Authors: Fujii Chieko , Ohnishi Kengo , Kajitani Isamu , Homma Keiko , Yoshikawa Masahiro
Published: February 2021

Background

It is necessary to systematise care engineering to solve the social issues related to care in STEAM (Science, Technology, Engineering, Art and Mathematics) education. While the need for engineering and technology in care has increased, current trends are not well understood. This search was conducted using Web of Science, a literature database, with the study period spanning 1900 to 2019. The search term ‘care’ was used, as well as ‘Science’, ‘Technology’, ‘Engineering’, ‘Art’, or ‘Mathematics’. Subsequently, the research field from the Web of Science was extracted every 10 years, from 1980 to 2019. The ‘title’ as selected by the Web of Science was analysed using KH Coder 3.Beta.01e analysis software, with frequent nouns, adjectives, verbs, and adverbs examined.
Results

The most frequently used words were extracted using KH Coder. Of the highest ranked words, ‘children’ was ranked high until 1969; ‘health’, ‘medical’, and ‘cost’ were ranked high in the 1970s; and ‘system’, ‘information’, ‘assessment’, and ‘primary’ were highest in the 1980s, 1990s, 2000s, and 2010s, respectively. Healthcare has always been the most qualified language, and especially in the 1990s, when it accounted for 59.1%. More frequently occurring in the 1980s, 1990s, 2000s, and 2010s were ‘home care’; ‘critical’ or intensive’; ‘patients’ or ‘primary care’; and ‘self’, ‘quality’ or ‘palliative care’, respectively. The co-occurring network diagram most often categorised ‘quality support’, ‘care engineering’, ‘primary’ and ‘intervention’, ‘medical care’, ‘human development’, ‘lifestyle’, and ‘social’ issues.
Conclusion

The use of technology is expected to advance, and research on improving the quality of care is expected to increase. Systematising this as ‘care engineering’ creates a field to face the long-term problems in care. Literature on human development and the quality of care itself are expected to evolve, and new developments should occur from the care perspective.
Unpacking the policy landscape for implementing an Information Communication Technology (ICT) based in Human Resources Management tool in government health sector in Bangladesh: Findings from a policy review
Authors: Bhattacharyya Dipika Shankar , Dutta Goutam Kumar , Nowrin Iffat , Shafique Sohana , Islam Md. Zahidul , Islam B. M. Riazul , Anwar Iqbal
Published: February 2021

Introduction: In Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income-countries are impeded by policy aspects like implementation strategy and poor regulatory framework. We aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh.Methods: We conducted a review of policies related to ICT implementation and human resources management in health sector in Bangladesh using qualitative content analysis method. Twelve policies have been identified and comprehensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpreting the findings. Results: Regarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timeline, and budget allocation. However, lack of explicit monitoring strategy and extent of stakeholders’ engagement was not well-defined, ultimately create chances for making downstream implementation disjointed. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened. Discussion: Findings support the current discourse that national commitment plays a vital role in integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination is crucial.
Screw thermal characteristics analysis and error prediction considering the two-dimensional heat transfer structure
Authors: Chen Yu , Chen Jihong , xu guangda
Published: February 2021

Thermal error is a common problem in machine tool processing. It is usually proposed to take the screw as one-dimensional rod heat transfer system to solve the thermal error of screw by establishing thermal characteristic equation. This method regards the temperature on the nut as the temperature of the screw contact surface without considering the heat transfer distance between screw and the mounting point on the nut. To solve this problem, this paper takes the screw-nut feed system as a two-dimensional heat transfer structure considering both screw and nut. In addition, to solve the low convergence speed and easy fall into local optimum problem in optimal parameter identification. The improved particle swarm optimization algorithm (IPSOA) is proposed to identify the boundary parameters of thermal characteristics equations. Finally, the temperature and thermal error of the screw-nut feed system is calculated by the identified results. Experiments under different working condition show that the maximum prediction residual error of the two-dimensional method (TDM) is less than 7.2 um and the simulating prediction accuracy can reach 86.2%. Besides, compared with one-dimensional model (ODM), TDM has a higher predict accuracy which verifies the effectiveness of the proposed method.
Protein interface redesign facilitates conversion of zero-dimensional protein nanomaterials to their one- and two-dimensional analogues
Authors: Zhang Xiaorong , Liu Yu , Zheng Bowen , Zang Jiachen , Lv Chenyan , Zhang Tuo , Wang Hongfei , Zhao Guanghua
Published: February 2021

Although various artificial protein nanoarchitectures have been constructed, controlling conversion between protein assemblies with different dimensions has largely been unexplored. Here, we describe a simple, effective approach to regulate conversion between 0D protein nanomaterials and their 1D or 2D analogues by adjusting the geometric arrangement of dimeric protein building blocks. Thermotoga maritima ferritin (TmFtn) naturally occurs as a dimeric protein, twelve of which interact with each other in a head-to-side manner to generate 0D 24-meric protein nanocage in the presence of Ca2+. By tuning two contiguous dimeric proteins to interact in a fully or partially side-by-side fashion through protein interface redesign, we can render the conversion of the inherent salt-mediated 0D protein nanocage into 1D or 2D nanomaterials in response to multiple external stimuli. Thus, one kind of dimeric protein building block can generate three protein materials with different dimensions in a manner that highly resembles natural pentamer building blocks from viral capsids that form different protein assemblies.
Numerical and Experimental Study on Microstructure Evolution of Ti-6Al-4V Alloy Shaft Perform in Cross-Wedge Rolling Process
Authors: Yuan Jiayao , Chen Xing , Zhao Zhilong , Sun Baoshou , Shu Xuedao
Published: February 2021

To seek a fundamental understanding for further improving the Ti-6Al-4V alloy utilization of Cross-Wedge Rolling (CWR) and the comprehensive mechanical properties of shaft parts, the effect of the CWR processing parameters on the microstructure evolution of Ti-6Al-4V alloy shaft preform is studied in this paper. An Arrhenius-type microstructure structure evolution model was employed and implemented into the finite element software DEFORM-3D. The average grain size and dynamic re-crystallization volume fraction distribution in the α+β two-phase region and the β single phase region under different rolling temperature, roller rotating speed and area reduction were analyzed, respectively. It is finding that the area reduction, rolling temperature and roller rotating speed significantly affect the microstructure evolution of Ti-6Al-4V alloy. Meanwhile, the corresponding CWR and Metallographic experiments were conducted to verify the reliability of the FE simulation results. Results showed that the agreement of the process parameters effect on dynamic recrystallization in the α+β two-phase region between simulation and experimental is reasonably good. The difference in average grain size in the β phase region between simulation and experimental is ranged from 5.77% to 18.56%. In addition, the evenly distributed microstructure can be found as the area reduction of 50%, rolling temperature of 950℃ and the speed of 5 r⋅min−1 were employed. After rolling under optimized processing conditions, the tensile strength of Ti-6Al-4V alloy shaft preform increased by 18.57% and the plasticity enhanced significantly due to smaller grain size and bi-model microstructure obtained.
Medicine Facing Death: Attitudes Toward Physician-Assisted End of Life – A Cross-Sectional Study
Authors: Dopelt Keren , Cohen Dganit , Amar-Krispel Einat , Davidovitch  , Barach Paul
Published: February 2021

Background: The demand for medical assistance in dying remains high and controversial. The "Dying Patient Act" (2005) legalized requiring Israeli patients to receive medical guidance regarding the care (or non-treatment) they seek at the end of life. Many doctors have made it clear that helping a patient die is opposed by their values and professional goals.Objective: To explore the attitudes of physicians regarding euthanasia and examine the factors that related to these attitudes.Methods: We conducted a cross sectional prospective study in Israel, during January-February 2019. We used logistic regression analyses to describe the association of demographic and professional factors with attitudes toward physician-assisted end of life.Results: We surveyed 135 physicians working at a tertiary-care-hospital about their attitudes regarding euthanasia. About 61% agreed that a person has the right to decide whether to expedite their own death, 54% agreed that euthanasia should be allowed, while 29% thought that physicians should preserve a patient's life even if they expressed the wish to die. Conclusion: The data shows a conflict of values: the sacredness of human life versus the desire to alleviate patient's suffering. Coronavirus outbreak reinforces the urgency of our findings and raises the importance of supporting physicians' efforts to provide ethical, and empathic communication for terminally ill patients. Future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to end-of-life requests.
Endotracheal Intubation in Patients With COVID-19 By Emergency Physicians in The Tokyo Metropolitan Area
Authors: Soh Mitsuhito , Hifumi Toru , Otani Norio , Miyazaki Momoyo , Kobayashi Kentaro , Maki Kenro , Hayashi Munehiro , Hatakeyama Junji , Kurihara Tomohiro , Ishimatsu Shinichi
Published: February 2021

Background: Patients with COVID-19 may require emergency tracheal intubation for mechanical ventilation by emergency physicians. However, the success rate, complications, operator safety, and issues around personal protective equipment (PPE) and barrier enclosure use are not known in this context.Methods: This was a retrospective study of data for adult patients with COVID-19 who underwent endotracheal intubation performed by emergency physicians at four hospitals in the Tokyo Metropolitan Area between January 2020 and September 2020. Patient characteristics, intubation-related factors, and intubation success and complications rates were obtained. Two analyses were then performed. In analysis 1, the intubation success rate in patients was compared among four groups using different types of PPE. In analysis 2, patients were compared by those intubated with or without barrier enclosure.Results: In total, 46 patients met the inclusion criteria, of whom 85% were successfully intubated at the first attempt, 27% experienced hypotension, and 27% experienced hypoxia. No muscle relaxants were used in 8.7% and the Macintosh blade was used in 37%. The four PPE types and the intubation confirmation methods varied considerably, but all met the WHO recommendations. A barrier enclosure device was used in 26%, with a success rate of approximately 80% irrespective of its use.Conclusions: The success rate at the first attempt of intubation was relatively high, albeit with a moderately high complication rate. All PPE types were safe, including when barrier enclosures were used. Success was not affected by using barrier enclosures.
Berberine Interferes With the Abnormal Glomerular Mesangial Cell C Ycle Re-Distribution to Alleviate Diabetic Nephropathy via PI3K/AKT/AS160/GLUT4 Signaling Pathway
Authors: Guan Ximei , Ni Weijian , Zeng Jing , Zhou Hong , Tang Linqin
Published: February 2021

Background: Berberine plays a critical role of the glomerular mesangial cells (GMCs) abnormal proliferation during diabetic nephropathy (DN). This study aims to explore the intervention effect of BBR on DN mice and investigate the potential mechanism targeting abnormal GMCs proliferation. Methods: Streptozotocin-induced mice were used to determine the effect of BBR on the renal injury. In vitro, GMCs are cultured in high glucose (30 mmol/L). EdU and MTT assay are used for screening the optimum BBR concentration and intervention time. Flow cytometry is applied to analyze the cell cycle re-distribution. Western blot and RT-qPCR are devoted to studying the relative expression of molecules in PI3K/AKT/AS160/GLUT4 signaling pathway. Additionally, 2-NBDG assay is selected for measuring the glucose uptake of GMCs. Results: HE and PAS staining revealed that the notable mesangial matrix expansion, glomerular hypertrophy and glycogen deposition in diabetic kidney can be alleviated after BBR treatment. Moreover, BBR significantly reduced the positive expression of GLUT4 in tubulointerstitium and glomerular region. EdU shows that high glucose induces the abnormal proliferation of GMCs, which becomes more apparently as time goes on (20h→28h). Meantime, BBR (60 and 90 μmol/L) can not only increase the proportion of G1 phase, but also reduce the proportion of S phase. After 24 h, the same sort of phenomenon has cropped up in BBR (30 μmol/L) group. BBR (60 μmol/L)) significantly degraded the levels of PI3K-p85, p-AKT, p-AS160, and the membrane-GLUT4, while indistinguishable changes of their total protein expressions. Additionally, BBR prominently reduced the glucose uptake and retard the cell cycle of GMCs to stay at G1 phase. Conclusions: The rearrangement effect of BBR on cell cycle is related with PI3K/AKT signaling pathway and GLUT4 trafficking. The key findings of our study collectively indicate that the treatment of GMCs proliferation can be a novel therapeutic strategy in DN.
Route Towards Efficient Magnetization Reversal Driven by Voltage Control of Magnetic Anisotropy
Authors: One Roxana-Alina , Béa Hélène , Mican Sever , Joldos Marius , Brandao Pedro Veiga , Dieny Bernard , Buda-Prejbeanu Liliana D. , TIUSAN Coriolan
Published: February 2021

The voltage controlled magnetic anisotropy (VCMA) becomes a subject of major interest for spintronics due to its promising potential outcome: fast magnetization manipulation in magnetoresistive random access memories with enhanced storage density and very low power consumption. Using a macrospin approach, we carried out a thorough analysis of the role of the VCMA on the magnetization dynamics of nanostructures with out-of-plane magnetic anisotropy. Diagrams of the magnetization switching have been computed depending on the material and experiment parameters (surface anisotropy, Gilbert damping, duration/amplitude of electric and magnetic field pulses) thus allowing predictive sets of parameters for optimum switching experiments. Two characteristic times of the trajectory of the magnetization were analyzed analytically and numerically setting a lower limit for the duration of the pulses. An interesting switching regime has been identified where the precessional reversal of magnetization does not depend on the voltage pulse duration. This represents a promising path for the magnetization control by VCMA with enhanced versatility.
Preparation and Characterization of CuO/Co3O4/ Poly(Methyl Methacrylate) Nanocomposites Films for Optical and Dielectric Applications
Authors: El-Sayed S. , Sayed Adel El
Published: February 2021

Composites of transition metal oxides (TMOs)/Polymers have many modern technological, industrial, and biological applications. Co3O4 and CuO nanoparticles (Nps) were synthesized by sol-gel. Then they doped into poly(methyl methacrylate) (PMMA) via solution casting method. The obtained Nps and nanocomposite films were then investigated using several techniques. XRD and HR-TEM indicated the high purity of Co3O4 and CuO Nps of face-centered cubic (fcc) with 58 nm average particle size (Dav), and monoclinic structure with Dav = 35 nm, respectively. The amorphous nature of PMMA was influenced after mixing with these Nps. SEM and FTIR confirmed the interaction between Nps and the polymer chains. The pure film showed transparency of about 90% and Nps addition narrowed the optical bandgap effectively while keeping the films with high transmittance. CuO is more effective than Co3O4 on the optical parameters of the films. The dielectric constant improved after adding the Nps, while all films have a low dielectric loss. Additionally, the effects of Co3O4 and CuO on the ac conductivity, Argand plots, and the dielectric modulus are reported. Our nanocomposites are considered a promising candidate for nanotechnology-based devices such as electric stress control, film capacitors and anti-reflective coating for solar cell applications.
μMAX of Saccharomyces Cerevisiae: So Often Used, So Seldom Put into Perspective
Authors: Rodrigues Carla Inês Soares , Della-Bianca Bianca Eli , Gombert Andreas K.
Published: February 2021

The maximum specific growth rate of a microbe in a given growth condition is of primary relevance for biological research and bioprocess development. In the case of the unicellular yeast Saccharomyces cerevisiae, this physiological parameter is routinely calculated in (almost) every laboratory, but this procedure conceals several challenges that are often neglected in scientific works, which might lead to misinterpretation of the reported data and of phenomena. We present here several pitfalls involved in µMAX calculation and interpretation, which was achieved through comparative analyses of: 1) the use of different methodologies for determining cell concentration, 2) different calibration procedures to correlate indirect (e.g. absorbance) to direct (e.g. dry cell mass) cell concentration measurements, 3) different statistical methods for determining the significance of µMAX differences, 4) the influence of culture media composition, and 5) the influence of the cultivation system (e.g. microplate, shake-flask or bioreactor). It becomes clear that each of these factors has a great influence on µMAX calculation and interpretation. We also present a case study involving three yeast strains and three different carbon sources, illustrating that opposite conclusions can be drawn in a screening procedure, if proper caution is not taken during data generation and analysis. Last but not least, we conclude this work with a series of recommendations that we believe could make experimental planning, data generation, µMAX calculation and interpretation more meaningful and scientifically sound, contributing to the improvement of yeast research and of microbiology in general.
A Novel Design and Evaluation of a Low Power Efficient Fault-Tolerant Reversible ALU Using QCA: Applications of Nanoelectronics
Authors: Gade Mary Swarna Latha , S Rooban
Published: February 2021

Reversible logic based on Quantum-dot Cellular Automata (QCA) is the most requirement for achieving nano-scale architecture that promises significantly high device integration density, high-speed calculation, and low power consumption. The arithmetic logic unit (ALU) is the significant component of a processor for processing and computing. The primary objective of this work is to develop a multi-layer fault-tolerant arithmetic logic unit using reversible logic in QCA technology. Additionally, the reversible ALU has divided into arithmetic (RAU) and a logic unit (RLU). A reversible 2:1 MUX using the Fredkin gate has been implemented to select either the arithmetic or logical operations. Besides, to improve the efficiency of arithmetic operations, a novel QCA reversible full adder is implemented. To build the ALU, fault-tolerant reversible logic gates are used. The proposed reversible multilayer QCA ALU is designed to carry out eight arithmetic and sixteen logical operations with a minimum number of gates, constant inputs, and garbage outputs compared to the existing works. The functional verification and simulation of the presented circuits are assessed by the QCADesigner tool.
“Understanding the Complexities of Antibiotic Prescribing Behaviour in Acute Hospitals: A Systematic Review and Meta-Ethnography”
Authors: Wojcik Gosha , Ring Nicola , McCulloch Corrienne , Willis Diane S , Williams Brian , Kydonaki Kalliopi
Published: February 2021

Background
Antimicrobial resistance poses a serious global public health threat. Hospital misuse of antibiotics has contributed to this problem and evidence-based interventions are urgently needed to change inappropriate prescribing practices. This paper reports the first theoretical stage of a longer-term project to improve antibiotic prescribing in hospitals through design of an effective behaviour-change intervention.
Methods
Qualitative synthesis using meta-ethnography of primary studies reporting doctors’ views and experiences of antibiotic prescribing in hospitals for example, their barriers to appropriate prescribing. Twenty electronic databases were systematically searched over a 10-year period and potential studies screened against eligibility criteria. Included studies were quality-appraised. Original participant quotes and author interpretations were extracted and coded thematically into NVivo. All study processes were conducted by two reviewers working independently with findings discussed with the wider team and key stakeholders. Studies were related by findings into clusters and translated reciprocally and refutationally to develop a new line-of-argument synthesis and conceptual model. Findings are reported using eMERGe guidance.
Results
Fifteen papers (13 studies) conducted between 2007–2017 reporting the experiences of 336 doctors of varying seniority working in acute hospitals across seven countries, were synthesised. Study findings related in four ways which collectively represented multiple challenges to appropriate antibiotic medical prescribing in hospitals: loss of ownership of prescribing decisions, tension between individual care and public health concerns, evidence-based practice versus bedside medicine, and diverse priorities between different clinical teams. The resulting new line-of-argument and conceptual model reflected how these challenges operated on both micro- and macro-level, highlighting key areas for improving current prescribing practice, such as creating feedback mechanisms, normalising input from other specialties and reducing variation in responsibility for antibiotic decisions.
Conclusions
This first meta-ethnography of doctors` experiences of antibiotic prescribing in acute hospital settings has enabled development of a novel conceptual model enhancing understanding of appropriate antibiotic prescribing. That is, hospital antibiotic prescribing is a complex, context-dependent and dynamic process, entailing the balancing of many tensions. To change practice, comprehensive efforts are needed to manage failures in communication and information provision, promote distribution of responsibility for antibiotic decisions, and reduce fear of consequences from not prescribing.
Enzymatic Dynamic Reductive Kinetic Resolution Towards 115 g/L (S)-2-Phenylpropanol
Authors: Rapp Christian , Pival-Marko Simone , Tassano Erika , Nidetzky Bernd , Kratzer Regina
Published: February 2021

BackgroundPublished biocatalytic routes towards chiral 2-phenylpropanol by oxidoreductases showed product concentrations of maximally 80 mM. Enzyme deactivation turned out as one major limitation and was attributed to adduct formation of the aldehyde substrate with the catalytic reductase.ResultsA Candida tenuis xylose reductase single-point mutant (CtXR D51A) with very high catalytic efficiency (43·103 s-1M-1) for (S)-2-phenylpropanal was identified. The enzyme showed high enantioselectivity for the (S)-enantiomer but was deactivated by 0.5 mM substrate within 2 h. A whole-cell biocatalyst based on the engineered reductase and a yeast formate dehydrogenase for NADH-recycling provided substantial stabilization of the reductase. The relatively slow in situ racemization of 2-phenylpropanal and the still limited biocatalyst stability required a subtle adjustment of the substrate-to-catalyst ratio. A value of 3.4 gsubstrate/gcell-dry-weight turned out as compromise between product enantiopurity and conversion. A catalyst loading of 40 gcell-dry-weight was used to convert 1 M racemic 2-phenylpropanal to (S)-phenylpropanol in 93.1 % e.e. ConclusionMainly hydrolases have been exploited for the production of profenols at industrial scale so far. The herein established bioreduction presents an alternative route towards profenols that is competitive to hydrolase-catalyzed kinetic resolutions.
A Robust and Simple Patient-derived Multicellular Spheroid Model Enables Liver Cancer Precision Drug Screening
Authors: Cherradi Sara , Almeida Nuno , Saviano Antonio , Durand Sarah , Felli Emanuele , Pessaux Patrick , Schuster Catherine , Baumert Thomas , Duong Hong Tuan
Published: February 2021

Background & Purpose. Hepatocellular carcinoma (HCC) is the second leading and fastest rising cause of cancer death worldwide. HCC is often diagnosed when it is not curable. Thus, there are many challenges associated with the treatment of HCC. Until now there is no simple and robust system for reliable pre-treatment screening of approved drugs. Methods. We developed a simple and robust patient-derived multicellular cell clustering model from 18 liver resections. We applied this technology on 9 HCC liver tissues and assessed FDA-approved drug responses.Results. The success rate of our model is 100% independently from the type of liver underlying disease. The model shows differential responses to HCC targeted- and immune-based treatments with a high reproducibility. Our work highlights that preserving the integrity of the primary liver architecture permits to perpetuate the physiopathology. Conclusion. This model system will help to understand the biological role of the tumor microenvironment and to accelerate the clinical research program for personalized liver cancer treatment based on functional screening.
Characterization of Urinary Cotinine Concentrations Among Non-smoking Adults in Smoking and Smoke-free Homes in the Korean National Environmental Health Survey (KoNEHS) Cycle 3 (2015–2017)
Authors: Kim Jeonghoon , Shim In-Keun , Won Soo Ran , Ryu Jungmin , Lee Jongchun , Chung Hyen-Mi
Published: February 2021

Background: Although many indoor public places have implemented smoke-free regulations, private homes have remained sources of tobacco smoke pollutants. The purpose of this study was to determine urinary cotinine concentrations in the Korean non-smoking adult population who lived in smoking and smoke-free homes, and to examine the relationship of urinary cotinine concentrations with socio-demographic factors. Methods: Samples from 2575 non-smoking adults (≥19 years old) in the Korean National Environmental Health Survey Cycle 3 (2015–2017), a representative Korean study, were used. Smoking and smoke-free homes were defined based on whether there were smokers at homes. Weighted linear regression models were used to determine urinary cotinine concentrations and identify factors associated with urinary cotinine. Results: The geometric mean of urinary cotinine concentrations for non-smoking adults living in smoking homes was 2.4 μg/g creatinine (Cr; 95% confidence interval [CI] = 2.1–2.7), which was significantly higher than the mean of 1.4 μg/g Cr (95% CI = 1.3–1.6) for those living in smoke-free homes. In adults living in smoking homes, the urinary cotinine concentration was only associated with job classification. In adults living in smoke-free homes, several factors were associated with urinary cotinine concentration. Urinary cotinine concentration in adults living in smoke-free homes was significantly higher in those who lived in homes with ventilation duration <30 min/day, those who spent more time indoors at home, those who spent less time outdoors, and those who worked in non-manual occupations.Conclusions: The urinary cotinine concentration in Korean non-smoking adults living in smoking homes was higher than that in adults living in smoke-free homes. Even in smoke-free homes, home-related factors, such as ventilation duration and time spent indoors, were associated with urinary cotinine concentration. Further study is warranted to examine potential sources of tobacco smoke pollution in smoke-free homes.
The Impact of Land Use and Land Cover Changes on Soil Erosion in Western Iran
Authors: Damaneh Hadi Eskandari , Khosravi Hassan , Habashi Khalil , Damaneh Hamed Eskandari , Tiefenbacher John P.
Published: February 2021

Estimates of long-term change and land cover changes using satellite imagery update data about effects erosion on the destruction. This is relevant on semi-arid land where soil resources are scarce, and proper management requires matching LULC to the conditions to achieve sustainability. This study evaluates the impact of LULC changes on soil erosion using Landsat satellite images and the RUSLE model on plains around the Jarahi River and Shadegan International Wetlands. The maps of LULC were prepared with supervised classification and maximum-likelihood methods applied to pre-processed TM, ETM, and OLI images for 1989, 2003, and 2017. This study investigated the impacts of LULC changes on soil erosion. Based on the results, we observe that an assessment of LULC changes from 1989 to 2003 revealed diminishing bare land and wetland vegetation with increases in agricultural land and water features. The areas of agricultural lands and wetlands decreased from 2003 to 2017, while bare lands increased in the area. The areas with soil erosion rates < 1 Mg ha-1 y-1 have diminished, and areas having rates >1 Mg ha-1 y-1 increased in extent. We conclude that LULC changes led to increased soil erosion in Shadegan International Wetlands. Our study highlights the need to plan LULC changes to reduce soil erosion rates to achieve sustainable management. We argue that nature-based solutions can effectively reduce soil losses.
Correction of over-dosed insulin in a type-2- diabetic led to a better control of glycemia and arterial hypertension: a case report
Authors: Abobarin-Adeagbo Abimbola , Kraya Torsten , Girndt Matthias , Pliquett Rainer Ullrich
Published: February 2021

Background:An association between hypoglycemia and arterial hypertension has been proposed. Here, for the first time, we report a case of a chronically over-dosed insulin therapy with uncontrolled hypertension, which improved after insulin-dose reduction.Case Presentation: A 73-year-old, male type-2 diabetic of Caucasian ethnicity was hospitalized for uncontrolled arterial hypertension and weakness. Prior to hospitalization, a fixed-dose insulin therapy (160 units per day) and antihypertensive medication with urapidile, valsartan and bisoprolol were prescribed. Hemoglobin A1c was 11.2%, symptomatic hypoglycemic episodes were not reported. During hospitalization, metformin, empagliflozin, and dulaglutide (1.5 mg per week) were added to insulin. Conventional insulin therapy was switched to an intensified insulin therapy with a cumulative daily dose of 46 units. 22 months after discharge, the medical therapy consisted of metformin, liraglutide, and insulin glargine (26 units per day), antihypertensive medication was reduced to bisoprolol and valsartan. Blood pressure was well controlled, hemoglobin A1c was 6.6%. As a likely explanation, undocumented, asymptomatic hypoglycemic events with a post-hypoglycemic hormonal stimulation were the cause for the poor glycemic and blood-pressure control. A step-wise reduction of insulin translated into a better glycemic and blood-pressure control.Conclusions: Undocumented, asymptomatic hypoglycemic events and post-hypoglycemic hormonal stimulation were the likely cause for the poor glycemic and blood-pressure control prior to index hospitalization. A step-wise reduction of insulin concurrently translated into a better glycemic and blood-pressure control.
Is Virtual Clinic the Way Forward: Patient Satisfaction Comparing Phone Clinic vs. Conventional Clinic
Authors: Wall Benjamin , Daly Patrick , Dunnill Aidan , Osan Jessica , Brogan Kit
Published: February 2021

Background:Outpatient clinics play a vital role in assessing and treating patients. They traditionally involve face-to-face consultation with a clinician to diagnose and treat many medical and surgical conditions. During the COVID-19 pandemic many of these traditional methods were replaced with telemedicine to minimise patient interaction and therefore potential exposure. This study utilises data from patient questionnaires with the aim of determining patient satisfaction in regard to telemedicine.Method:A list of patients who attended the Rockingham General hospital outpatient Orthopaedic phone clinic was obtained between 23rd of March and 30th of May, this list was then filtered into a randomised generator to provide a call list of patients. Patients were contacted and verbal consent was obtained to participate in satisfaction questionnaire that was completed via phone.Results: A total of 100 patients completed the questionnaire - 50 from elective surgery clinics and 50 from fracture clinics. The mean time for participants’ one-way commute to the hospital was 21 minutes (2 to 60 minutes). Only 4% of telehealth consultations resulted in patients being forced to miss work or school. 13% of patients were required to attend the hospital on the day of their consultation for either radiological imaging or for application or removal of casts or splint. We observed consistently high satisfaction scores across all parameters, in both elective and fracture clinics, culminating in a mean score of 9.08/10 on the Likert scale. In the qualitative component of the questionnaire, patients frequently acknowledged a high quality of care despite adverse circumstances.Conclusion:Telemedicine continues to develop and become a more widely accessible tool in the provision of outpatient orthopaedic care. With its ever-increasing availability and acceptance, it should play a more central role in delivering effective and efficient healthcare to all patients.
Ground Cover Vegetation Promotes Ecological Intensification of Pear Production
Authors: Ji Xiang-Yun , Wang Jin-Yan , Dainese Matteo , Zhang Hao , Chen Yi-Juan , Cavalieri Andrea , Jiang Jie-Xian , Wan Nian-Feng
Published: February 2021

The use of ground cover vegetation is becoming a prominent intervention for promoting biodiversity and associated ecosystem services in Chinese orchards. Despite the large number of studies that have examined the effects of ground cover vegetation on promoting natural enemy populations and related natural pest control, it is less understood whether enhanced natural pest control translates to increase yield and reduced pesticide use. We conducted a 2-year experiment comparing three cover vegetation (ryegrass, clover, and hairy vetch) practices versus a bare ground control in commercial pear orchards in the Yangtze River Delta of East China (YRDEC), China. Natural enemy density (predator and parasitoid abundance), invertebrate herbivore performance (piercing-sucking herbivore abundance and branch-boring and fruit-boring percentage), pesticide input and pear fruit yield were recorded. The results indicated that cover vegetation decreased herbivore abundance and boring percentage by 49.95 and 63.6% respectively, and thus decreased pesticide use by 26.10%. Meanwhile, we found that cover vegetation increased the abundance of natural enemies by 620.75%, and increased pear fruit yield by 6.82%. Piecewise structural equation modelling indicated that increased natural enemy densities, decreased herbivore performance and pesticide use, while increasing fruit yield. Our results confirm that the use of ground cover vegetations (especially with clover and hairy vetch) can promote ecological intensification and biological pest control in pear orchards.
Application of a simple skin stretching system and negative pressure wound therapy in repair of complex diabetic foot wounds
Authors: Wu Yaojun , Chen Liang , Wu Shaokun , Yu Liying , Chen Mimi , Wang Jingnan , Chen Jiejie , Pang Qingjiang
Published: February 2021

Management of complex diabetic foot wounds with large skin defects poses a challenge for surgeon. We presented a simple skin stretching system and negative pressure wound therapy for the repair of complex diabetic foot wounds to examine the effectiveness and safety.A total of 16 patients with diabetic foot ulcers were retrospectively reviewed between January 2015 to October 2020. All patients underwent the treatment by 3 stages. In stage 2, these difficult-to-close wounds of diabetes foot were residual. This method was applied to the wounds with a median defect size of 20.42 cm² (range: 4.71 -66.76 cm²).The median time for closure of complex diabetic foot wounds was 14 days ranging from 8 days to 19 days. With respect to the absolute rates of reduction, it was observed with a median of 1.86 cm² per day, ranging from 0.29 cm² per day to 8.35 cm² per day. In accordance with the localization of the defect, the patients were divided into 3 groups: side of the foot (37.5%), dorsum of the foot (50.0%), and others (12.5%). There was no statistically difference between side of the foot and dorsum of the foot in terms of the median defect size with P = 0.069 (Kruskal–Wallis test). Otherwise, there were statistically significant differences regarding the median time and the median absolute rates (P < 0.05; Kruskal–Wallis test). No severe complications were encountered in this study.In summary, our results show that application of the simple skin stretching system and NPWT is an effective and safe approach for complex diabetic foot wounds. Nevertheless, more attentions should be paid for the appropriate patient selection and intraoperative judgment to ensure wound closure and avoid undue complications.
An examination of three prescribing cascades in a cohort of older adults with dementia
Authors: Trenaman Shanna Claire , Bowles Susan K , Kirkland Susan , Andrew Melissa K
Published: February 2021

Background

Prescribing cascades are a source of inappropriate prescribing for older adults with dementia. We aimed to study three prescribing cascades in older Nova Scotians with dementia using administrative databases.
Methods

Cohort entry for Nova Scotia Seniors’ Pharmacare Program beneficiaries was at the date of dementia diagnosis. Prescription drug dispensation data was extracted for inciting medication and second treatment (cholinesterase inhibitor and bladder anticholinergic, metoclopramide and Parkinson’s disease medication, or calcium channel blocker (CCB) and diuretic) over the six-year period from April 1, 2009 to March 31, 2015. In three separate analyses, dispensation of an inciting medication signaled a look back of 365 days from the date of first dispensation to confirm that the second treatment was started after the inciting medication. The prescribing cascade was considered when second treatment was started within 180 days of the inciting treatment. Sex differences in the prescribing cascade were tested using t-tests or chi square tests as appropriate. Both univariate (unadjusted) and multivariate (adjusted) logistic regression (adjusted for age, rurality, and sex) and Cox proportional hazards regression was used to identify risk factors for the prescribing cascade.
Results

In the period from March 1, 2005 to March 31, 2018 28,953 Nova Scotia Seniors Pharmacare beneficiaries with dementia (NSSPBD) were identified. There were 60 cases of bladder anticholinergics following cholinesterase inhibitors, 11 cases of Parkinson’s disease medication following metoclopramide, and 289 cases of a diuretic following CCB. Regression analysis demonstrated that risk of bladder anticholinergics following cholinesterase inhibitors and diuretics following CCBs were associated with female sex. Cox regression analyses suggested that bladder anticholinergics were less often used by those on cholinesterase inhibitors but did not identify CCB use as leading more frequently to diuretic use.
Conclusions

Of the three prescribing cascades investigated, diuretics following CCB was the most common and bladder anticholinergics following cholinesterase inhibitors the second most common. Both these prescribing cascades were more common for women suggesting clinicians need increased attention to monitor for prescribing cascades among women.
The allometry of cellular DNA and ribosomal gene content among microbes and its use for the assessment of microbiome community structure
Authors: de Salceda Luis Gonzalez , Garcia-Pichel Ferran
Published: February 2021

BackgroundThe determination of taxon-specific composition of microbiomes by combining high-throughput sequencing of ribosomal genes with phyloinformatic analyses has become routine in microbiology and allied sciences. Systematic biases to this approach based on the demonstrable variability of ribosomal operon copy number per genome were recognized early. The more recent realization that polyploidy is probably the norm, rather than the exception, among microbes from all domains of life, points to an even larger source bias.ResultsWe found that the number of 16S or 18S RNA genes per cell, a combined result of the number of RNA gene loci per genome and ploidy level, follows an allometric power law of cell volume with an exponent of 2/3 across 6 orders of magnitude in small subunit copy number per cell and 9 orders of magnitude in cell size. This stands in contrast to cell DNA content, which follows a power law with an exponent of ¾.ConclusionIn practical terms, that relationship allows for a single, simple correction for variations in both copy number per genome and ploidy level in ribosomal gene analyses of taxa-specific abundance. In biological terms, it points to the uniqueness of ribosomal gene content among microbial properties that scale with size.
The potential genes mediate the pathogenicity of allogeneic CD4+T cell in aGVHD mouse model
Authors: Yu Zheng-Yu , Qin Chen-Chen , Cao Min , He Xiao-Ya , Ren Han-Yun , Liu Hui-Hui
Published: February 2021

Acute graft-versus-host disease (aGVHD) remains a significant and severe complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Due to the occurrence of aGVHD, allo-HSCT significantly increases the mortality rate compared with autologous hematopoietic stem cell transplantation (auto-HSCT). As a transcriptome sequencing technique, ribonucleic acid sequencing (RNA-Seq) is used to study alternative splicing and other forms of alternative isoform expression. Major histocompatibility complex (MHC)-matched and MHC-mismatched mouse bone marrow transplant (BMT) models were built to detect the difference of CD4+ lymphocyte in different tissues based on RNA-seq analysis. Four critical pathways were identified by enrichment analysis, including a lymphoid and a non-lymphoid cell, chemokine receptor binding chemokine, cytokine and cytokine receptor interaction pathway. At the same time, 11 novel hub genes that are most likely to participate in immunoregulatory and enriched pathways were identified, which were further validated by qRT-PCR. Besides, Cxcl7 was verified at the protein level. In summary, we revealed that DEGs and pathways related to immunoregulation played a vital role in the onset of aGVHD. These findings may provide some new clues for probing the pathogenesis and treatment of aGVHD.
Dynamics of a Discrete-time Pioneer–climax Model
Authors: Gilbertson Nora , Kot Mark
Published: February 2021

We present a simple mathematical model for the dynamics of a successional pioneer–climax system using difference equations. Each population is subject to inter- and intraspecific competition; population density growth is dependent on the combined densities of both species. Nine different geometric cases, corresponding to different orientations of the zero-growth isoclines, are possible for this system. We fully characterize the long-term dynamics of the model for each of the nine cases, uncovering diverse sets of potential behaviors. Competitive exclusion of the pioneer species and exclusion of the climax species are both possible depending on the relative strength of competition. Stable coexistence of both species may also occur; in two cases, a coexistence state is destabilized through a Neimark–Sacker bifurcation and an attracting invariant circle is born. The invariant circle eventually disappears into thin air in a heteroclinic or homoclinic bifurcation, leading to the sudden transition of the system to an exclusion state. Neither global bifurcation has been observed in a discrete-time pioneer–climax model before. The homoclinic bifurcation is novel to all pioneer–climax models. We conclude by discussing the ecological implications of our results.