bluuebunny/crossref_metadata_2025 huggingface dataset:
Concomitant full-thickness cartilage lesions do not affect patient-reported outcomes at minimum 10-year follow-up after ACL reconstruction
Authors: Wang Katherine , Eftang Cathrine N. , Ulstein Svend , Årøen Asbjørn , Jakobsen Rune B.
Published: October 2021

Purpose

To compare patients with a concomitant full-thickness cartilage lesion and anterior cruciate ligament (ACL) injury to patients with an isolated ACL injury at 10–15 years post ACL reconstruction.

Methods

This is a longitudinal follow-up of a cohort of 89 patients that were identified in the Norwegian National Knee Ligament Registry and included in the index study in 2007. The study group consisted of 30 patients that underwent ACL reconstruction and had a concomitant, isolated full-thickness cartilage lesion (International Cartilage Repair Society [ICRS] grade 3–4). Each study patient was matched with two control patients who underwent ACL reconstruction but had no cartilage lesions (ICRS grade 1–4) (n = 59). At a median follow-up of 10.2 years (range 9.9–15.6), 65 patients (74%) completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), which was the main outcome measure, resulting in 23 pairs after matching.

Results

At a follow-up of 10–15 years after ACL reconstruction, no significant differences in KOOS were found between patients with a concomitant full-thickness cartilage lesion and patients without cartilage lesions. There was also no significant difference between the two groups when comparing the change over time in KOOS scores from preoperative to follow-up. Both groups showed significant improvement in all KOOS subscales from preoperative to follow-up, except for in the Symptoms subscale for the control group. The greatest improvement was in the QoL subscale for the study group.

Conclusion

ACL-reconstructed patients with a full-thickness cartilage lesion did not report worse outcomes at 10–15 years after surgery compared with patients with an isolated ACL injury. Our findings support that there is no long-term negative effect of a concomitant cartilage lesion in an ACL-reconstructed knee. These findings should be considered when discussing treatment and informing about the expected long-term outcome after ACL reconstruction to patients with such combined injuries.

Level of evidence

II.
Esophageal Duplication Cysts in 97 Adult Patients: A Systematic Review
Authors: Gonzalez‐Urquijo Mauricio , Hinojosa‐Gonzalez David Eugenio , Padilla‐Armendariz Diana Paola , Saldaña‐Rodriguez Jorge Alberto , Leyva‐Alvizo Adolfo , Rodarte‐Shade Mario , Rojas‐Mendez Javier
Published: October 2021

Background

Esophageal duplication cysts are a rare congenital cystic malformation from faulty intrauterine recanalization of the esophagus during the 4‐8th weeks of development. They account for 20% of all gastrointestinal duplication cysts and commonly involve the distal esophagus. Presenting symptoms may be related to size and location.

Materials and Methods

Following the PRISMA guidelines, a systematic review was performed by searching published literature in various databases. Data from 97 reported case reports were pooled to present a descriptive and statistical analysis.

Results

Patient population was composed of 51(52.5%) males and 46 (47.5%) females, and mean ages was 42.3 years (18–77). Distal cysts were the most prevalent. Seventy‐nine (81.4%) patients were symptomatic; common symptoms included dysphagia, chest pain, cough and weight loss. Fifteen (15.5%) patients were treated conservatively and 75 (84.5%) by surgical treatment, among them thoracotomy in 30 (30.9%) patients and VATS in 17 (17.5%) patients. Mean length of hospital stay was 8.6 days (range: 1–26 days). One fatality was registered. Location, unlike size, was not found to influence presenting symptoms or treatment employed. Frequency of conservative treatment was not significantly different between symptomatic and asymptomatic patients. Open approaches were associated with longer stays than their minimally invasive counterparts.

Conclusion

Esophageal duplication cysts remain rare in adults and are frequently located in the distal esophagus. Larger cysts are more likely to cause symptoms. Various surgical techniques may successfully be employed in the treatment of this pathology. Minimally invasive procedures have a shorter hospital stay.
Real-world survival of US patients with intermediate- to high-risk myelofibrosis: impact of ruxolitinib approval
Authors: Verstovsek Srdan , Parasuraman Shreekant , Yu Jingbo , Shah Anne , Kumar Shambhavi , Xi Ann , Harrison Claire
Published: October 2021

The Janus kinase inhibitor ruxolitinib is approved for the treatment of myelofibrosis (MF) and improved overall survival (OS) versus control therapy in the phase 3 COMFORT trials. The aim of this retrospective analysis was to examine the real-world impact of ruxolitinib on OS in patients with MF. The US Medicare Fee-for-Service claims database (parts A/B/D) was used to identify patients with ≥ 1 inpatient or ≥ 2 outpatient claims with an MF diagnosis (January 2010–December 2017). Eligible patients with MF were ≥ 65 years old (intermediate-1 or higher risk based on age). Patients were divided into 3 groups based on ruxolitinib approval status at diagnosis and ruxolitinib exposure: (1) preapproval, ruxolitinib-unexposed; (2) post-approval, ruxolitinib-unexposed; and (3) post-approval, ruxolitinib-exposed. In total, 1677 patients with MF were included (preapproval [all ruxolitinib-unexposed], n = 278; post-approval, n = 1399 [ruxolitinib-unexposed, n = 1127; ruxolitinib-exposed, n = 272]). Overall, median age was 78 years, and 39.8% were male. Among patients with valid death dates (preapproval, n = 119 [42.8%]; post-approval, ruxolitinib-unexposed, n = 382 [33.9%]; post-approval ruxolitinib-exposed, n = 54 [19.9%]), 1-year survival rates were 55.6%, 72.5%, and 82.3%, and median OS was 13.2 months, 44.4 months, and not reached, respectively. Risk of mortality was significantly lower post- versus preapproval regardless of exposure to ruxolitinib (ruxolitinib-unexposed: adjusted hazard ratio [HR], 0.67; ruxolitinib-exposed: adjusted HR, 0.36; P < 0.001 for both); post-approval, mortality risk was significantly lower in ruxolitinib-exposed versus ruxolitinib-unexposed patients (adjusted HR, 0.61; P = 0.002). Findings from this study complement clinical data of ruxolitinib in MF by demonstrating a survival benefit in a real-world setting.
Perioperative morbidity of different operative approaches in early cervical carcinoma: a systematic review and meta-analysis comparing minimally invasive versus open radical hysterectomy
Authors: Kampers J. , Gerhardt E. , Sibbertsen P. , Flock T. , Hertel H. , Klapdor R. , Jentschke M. , Hillemanns P.
Published: October 2021

Purpose

Radical hysterectomy and pelvic lymphadenectomy is the standard treatment for early cervical cancer. Studies have shown superior oncological outcome for open versus minimal invasive surgery, but peri- and postoperative complication rates were shown vice versa. This meta-analysis evaluates the peri- and postoperative morbidities and complications of robotic and laparoscopic radical hysterectomy compared to open surgery.

Methods

Embase and Ovid-Medline databases were systematically searched in June 2020 for studies comparing robotic, laparoscopic and open radical hysterectomy. There was no limitation in publication year. Inclusion criteria were set analogue to the LACC trial. Subgroup analyses were performed regarding the operative technique, the study design and the date of publication for the endpoints intra- and postoperative morbidity, estimated blood loss, hospital stay and operation time.

Results

27 studies fulfilled the inclusion criteria. Five prospective, randomized-control trials were included. Meta-analysis showed no significant difference between robotic radical hysterectomy (RH) and laparoscopic hysterectomy (LH) concerning intra- and perioperative complications. Operation time was longer in both RH (mean difference 44.79 min [95% CI 38.16; 51.42]), and LH (mean difference 20.96 min; [95% CI − 1.30; 43.22]) than in open hysterectomy (AH) but did not lead to a rise of intra- and postoperative complications. Intraoperative morbidity was lower in LH than in AH (RR 0.90 [0.80; 1.02]) as well as in RH compared to AH (0.54 [0.33; 0.88]). Intraoperative morbidity showed no difference between LH and RH (RR 1.29 [0.23; 7.29]). Postoperative morbidity was not different in any approach. Estimated blood loss was lower in both LH (mean difference − 114.34 [− 122.97; − 105.71]) and RH (mean difference − 287.14 [− 392.99; − 181.28]) compared to AH, respectively. Duration of hospital stay was shorter for LH (mean difference − 3.06 [− 3.28; − 2.83]) and RH (mean difference − 3.77 [− 5.10; − 2.44]) compared to AH.

Conclusion

Minimally invasive radical hysterectomy appears to be associated with reduced intraoperative morbidity and blood loss and improved reconvalescence after surgery. Besides oncological and surgical factors these results should be considered when counseling patients for radical hysterectomy and underscore the need for new randomized trials.
Early and unrestricted access to high-efficacy disease-modifying therapies: a consensus to optimize benefits for people living with multiple sclerosis
Authors: Filippi Massimo , Danesi Romano , Derfuss Tobias , Duddy Martin , Gallo Paolo , Gold Ralf , Havrdová Eva Kubala , Kornek Barbara , Saccà Francesco , Tintoré Mar , Weber Jörg , Trojano Maria
Published: October 2021

Early intervention with high-efficacy disease-modifying therapy (HE DMT) may be the best strategy to delay irreversible neurological damage and progression of multiple sclerosis (MS). In European healthcare systems, however, patient access to HE DMTs in MS is often restricted to later stages of the disease due to restrictions in reimbursement despite broader regulatory labels. Although not every patient should be treated with HE DMTs at the initial stages of the disease, early and unrestricted access to HE DMTs with a positive benefit–risk profile and a reasonable value proposition will provide the freedom of choice for an appropriate treatment based on a shared decision between expert physicians and patients. This will further optimize outcomes and facilitate efficient resource allocation and sustainability in healthcare systems and society.
Complementary use of stable isotopes and fatty acids for quantitative diet estimation of sympatric predators, the Antarctic pack-ice seals
Authors: Guerrero A. I. , Pinnock A. , Negrete J. , Rogers T. L.
Published: October 2021

The quantitative use of stable isotopes (SIs) for trophic studies has seen a rapid growth whereas fatty acid (FA) studies remain mostly qualitative. We apply the Bayesian tool MixSIAR to both SI and FA data to estimate the diet of three sympatric predators: the crabeater (Lobodon carcinophaga), Weddell (Leptonychotes weddellii) and leopard seal (Hydrurga leptonyx). We used SI data of their vibrissae and FA data of their outer blubber to produce comparable diet estimates for the same individuals. Both SI and FA models predicted the same main diet components, although the predicted proportions differed. For the crabeater seal, both methods identified krill,Euphausia superba, as the main, and almost exclusive, food item, although the FA model estimated a slightly lower proportion, potentially due to the low lipid content of krill compared to the fish species used in the model. For the Weddell seal the FA model identified the fishPleuragramma antarcticumas the most important prey, whereas the SI model was not able to distinguish among prey species, identifying a ‘fish-squid’ group as the main diet component. For the leopard seal, both models identified krill as the main contributor; however, the predicted proportions for the secondary sources differed. Although vibrissae and outer blubber may not represent the same timeframe, the use of MixSIAR with FA data provides diet estimates comparable to those obtained with SI data, thus, both approaches were complimentary. The use of both biotracers offers a feasible option to study diets of wild animals in a quantitative manner.
Inflammatory prognostic scoring systems are risk factors for surgical site infection following wide local excision of soft tissue sarcoma
Authors: Farhan-Alanie Omer M. , Ha Taegyeong Tina , Doonan James , Mahendra Ashish , Gupta Sanjay
Published: October 2021

Introduction

Limb-sparing surgery with negative margins is possible in most soft tissue sarcoma (STS) resections and focuses on maximising function and minimising morbidity. Various risk factors for surgical site infections (SSIs) have been reported in the literature specific to sarcoma surgery. The aim of this study is to determine whether systemic inflammatory response prognostic scoring systems can predict post-operative SSI in patients undergoing potentially curative resection of STS.

Methods

Patients who had a planned curative resection of a primary STS at a single centre between January 2010 and December 2019 with a minimum follow-up of 6 months were included. Data were extracted on patient and tumour characteristics, and pre-operative blood results were used to calculate inflammatory prognostic scores based on published thresholds and correlated with risk of developing SSI or debridement procedures.

Results

A total of 187 cases were included. There were 60 SSIs. On univariate analysis, there was a statistically significant increased risk of SSI in patients who are diabetic, increasing specimen diameter, American Society of Anaesthesiology (ASA) grade 3, use of endoprosthetic replacement, blood loss greater than 1 L, and junctional tumour location. Modified Glasgow prognostic score, C-reactive protein/albumin ratio and neutrophil–platelet score (NPS) were statistically associated with the risk of SSI. On multivariate analysis, ASA grade 3, junctional tumour location and NPS were independently associated with the risk of developing a SSI.

Conclusion

This study supports the routine use of simple inflammation-based prognostic scores in identifying patients at increased risk of developing infectious complications in patients undergoing potentially curative resection of STS.
Brand premia driven by perceived vertical differentiation in markets with information disparity and optimistic consumers
Authors: Cavaliere A. , Crea G.
Published: October 2021

We have considered a duopoly with perceived vertical differentiation, information disparity and optimistic consumers. When firms compete for informed and uninformed consumers, the former contribute to raise product quality, while equilibrium prices increase with optimistic misperception of the latter, in our first equilibrium. Brand premium includes a quality premium and a misperception rent. In our second equilibrium, informed consumers buy low-quality goods and minimum product differentiation without Bertrand competition occurs. The brand premium is just a misperception rent, however, an increase of the informed consumers share implies price re-balancing and rent reduction. Consumers externalities arise in both equilibria. Firms compete only for informed consumers within our third and fourth equilibrium, as uninformed ones are passive and represent a captive market. Uninformed consumers in one case are overoptimistic, they buy the high quality good and can be cheated in equilibrium. Uninformed consumers approach the real quality differential in the fourth equilibrium, and the model reduces to standard vertical differentiation with perfect information.
CXCL13 in laboratory diagnosis of Lyme neuroborreliosis—the performance of the recomBead and ReaScan CXCL13 assays in human cerebrospinal fluid samples
Authors: Haglund Sofie , Lager Malin , Gyllemark Paula , Andersson Gärda , Ekelund Oskar , Sundqvist Martin , Henningsson Anna J.
Published: October 2021

The chemokine CXCL13 is used as complement to serology in the diagnostics of Lyme neuroborreliosis (LNB). We evaluated and compared the semi-quantitative, cassette-based ReaScan CXCL13 assay with the quantitative recomBead CXCL13 assay using a collection of 209 cerebrospinal fluid samples. The categorical agreement between results interpreted as negative, grey zone, and positive by the two methods was 87%. The diagnostic sensitivity was higher using the recomBead assay, whereas specificity was higher using ReaScan. Few manual steps, and a short turn-around time with no batching of samples makes the ReaScan CXCL13 assay an attractive complement to serology in the diagnostics of LNB.
Impact of prior antibiotic therapy on severe necrotizing soft-tissue infections in ICU patients: results from a French retrospective and observational study
Authors: Tanaka Sébastien , Thy Michael , Tashk Parvine , Ribeiro Lara , Lortat-Jacob Brice , Hermieu Jean-François , Zappella Nathalie , Rozencwajg Sacha , Snauwaert Aurelie , Atchade Enora , Grall Nathalie , Assadi Maksud , Tran-Dinh Alexy , Montravers Philippe
Published: October 2021

Necrotizing soft-tissue infection (NSTI) is a life-threatening pathology that often requires management in intensive care unit (ICU). Therapies consist of early diagnosis, adequate surgical source control, and antimicrobial therapy. Whereas guidelines underline the need for appropriate routine microbiological cultures before starting antimicrobial therapy in patients with suspected sepsis or septic shock, delaying adequate therapy also strongly increases mortality. The aim of the present study was to compare the characteristics and outcomes of patients hospitalized in ICU for NSTI according to their antimicrobial therapy exposure > 24 h before surgery (called the exposed group) or not (called the unexposed group) before surgical microbiological sampling. We retrospectively included 100 consecutive patients admitted for severe NSTI. The exposed group consisted of 23(23%) patients, while 77(77%) patients belonged to the unexposed group. The demographic and underlying disease conditions were similar between the two groups. Microbiological cultures of surgical samples were positive in 84 patients and negative in 16 patients, including 3/23 (13%) patients and 13/77 (17%) patients in the exposed and unexposed groups, respectively (p = 0.70). The distribution of microorganisms was comparable between the two groups. The main antimicrobial regimens for empiric therapy were also similar, and the proportions of adequacy were comparable (n = 60 (84.5%) in the unexposed group vs. n = 19 (86.4%) in the exposed group, p = 0.482). ICU and hospital lengths of stay and mortality rates were similar between the two groups. In conclusion, in a population of severe ICU NSTI patients, antibiotic exposure before sampling did not impact either culture sample positivity or microbiological findings.
The benefit of an ambulant psychiatric rehabilitation program in Vienna, Austria: an uncontrolled repeated measures study
Authors: Schosser Alexandra , Senft Birgit , Rauner Marion
Published: October 2021

We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program’s effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program’s cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.
Meta-analysis of risk factors associated with oxaliplatin hypersensitivity reactions in cancer patients
Authors: Zhu Linhui , Li Huan , Du Qiong , Ye Xuan , Yu Sijia , Luo Xin , Zhai Qing
Published: October 2021

This study aimed to investigate risk factors associated with oxaliplatin hypersensitivity reactions in cancer patients through a meta-analysis. A comprehensive retrieve of Chinese databases China National Knowledge Infrastructure, Wanfang Data, VIP Database and English databases PubMed, ScienceDirect, Embase and Cochrane library was conducted. The studies that meet the requirements for meta-analysis according to inclusion and exclusion criteria were screened and assessed for eligibility. Odds ratio (OR) / Weighted mean difference (WMD) and 95% confidence intervals (95% CIs) or calculable dichotomous and continuous raw data were extracted to perform meta-analysis using random effect model or fixed effect model on the basis of heterogeneity between studies through Review Manager 5.4 software. A total of 14 cross-sectional studies and 3367 cancer patients were included. Meta-analysis results showed that platinum exposure history (OR value 3.13, 95% CI 2.19–4.48, heterogeneity P = 0.26), allergy history (OR value 1.76, 95% CI 1.09–2.85, heterogeneity P = 0.61), platinum free interval (OR value 3.75, 95% CI 2.00–7.06, heterogeneity P = 0.83), dexamethasone premedication dose (OR value 0.28, 95% CI 0.13–0.58, heterogeneity P = 0.21) were significantly correlated to oxaliplatin hypersensitivity reactions. Gender, age, metastasis, combination with bevacizumab, XELOX regimen and cancer types were detected to have no statistically significant effect on oxaliplatin hypersensitivity reactions. Platinum exposure history, allergy history and long platinum-free interval are risk factors of oxaliplatin hypersensitivity reactions. High dexamethasone premedication dose is a protective factor of oxaliplatin hypersensitivity reactions.
Strategic framing of genome editing in agriculture: an analysis of the debate in Germany in the run-up to the European Court of Justice ruling
Authors: Siebert Robin , Herzig Christian , Birringer Marc
Published: October 2021

New techniques in genome editing have led to a controversial debate about the opportunities and uncertainties they present for agricultural food production and consumption. In July 2018, the Court of Justice of the European Union defined genome editing as a new process of mutagenesis, which implies that the resulting organisms count as genetically modified and are subject, in principle, to the obligations of EU Directive 2001/18/EG. This paper examines how key protagonists from academia, politics, and the economy strategically framed the debate around genome editing in agriculture in Germany prior to its legal classification by the Court of Justice. It is based on an analysis of 96 official statements, including position papers, press releases, and information brochures. Our study reveals eight strategic frames used in the discourse on genome editing and uncovers the strategies used to disconnect from or connect with the previous discourse on green genetic engineering in the 1970s, 1980s and 1990s. Building on competitive framing theory, the study provides explanations for the use and emergence of counter-framing strategies and their success or failure in the debate around genome editing.
PrEP Care Continuum Engagement Among Persons Who Inject Drugs: Rural and Urban Differences in Stigma and Social Infrastructure
Authors: Walters Suzan M. , Frank David , Van Ham Brent , Jaiswal Jessica , Muncan Brandon , Earnshaw Valerie , Schneider John , Friedman Samuel R. , Ompad Danielle C.
Published: October 2021

Pre-exposure prophylaxis (PrEP) is a medication that prevents HIV acquisition, yet PrEP uptake has been low among people who inject drugs. Stigma has been identified as a fundamental driver of population health and may be a significant barrier to PrEP care engagement among PWID. However, there has been limited research on how stigma operates in rural and urban settings in relation to PrEP. Using in-depth semi-structured qualitative interviews (n = 57) we explore PrEP continuum engagement among people actively injecting drugs in rural and urban settings. Urban participants had more awareness and knowledge. Willingness to use PrEP was similar in both settings. However, no participant was currently using PrEP. Stigmas against drug use, HIV, and sexualities were identified as barriers to PrEP uptake, particularly in the rural setting. Syringe service programs in the urban setting were highlighted as a welcoming space where PWID could socialize and therefore mitigate stigma and foster information sharing.
The linearization problem of a binary quadratic problem and its applications
Authors: Hu Hao , Sotirov Renata
Published: October 2021

We provide several applications of the linearization problem of a binary quadratic problem. We propose a new lower bounding strategy, called the linearization-based scheme, that is based on a simple certificate for a quadratic function to be non-negative on the feasible set. Each linearization-based bound requires a set of linearizable matrices as an input. We prove that the Generalized Gilmore–Lawler bounding scheme for binary quadratic problems provides linearization-based bounds. Moreover, we show that the bound obtained from the first level reformulation linearization technique is also a type of linearization-based bound, which enables us to provide a comparison among mentioned bounds. However, the strongest linearization-based bound is the one that uses the full characterization of the set of linearizable matrices. We also present a polynomial-time algorithm for the linearization problem of the quadratic shortest path problem on directed acyclic graphs. Our algorithm gives a complete characterization of the set of linearizable matrices for the quadratic shortest path problem.
Cardiac late effects after modern 3D-conformal radiotherapy in breast cancer patients: a retrospective cohort study in Germany (ESCaRa)
Authors: Merzenich Hiltrud , Baaken Dan , Schmidt Marcus , Bekes Inga , Schwentner Lukas , Janni Wolfgang , Woeckel Achim , Bartkowiak Detlef , Wiegel Thomas , Blettner Maria , Wollschläger Daniel , Schmidberger Heinz
Published: October 2021

Purpose

Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivors treated with recent RT in Germany.

Methods

A total of 11,982 breast cancer patients treated between 1998 and 2008 were included. A mortality follow-up was conducted until 06/2018. In order to assess cardiac morbidity occurring after breast cancer treatment, a questionnaire was sent out in 2014 and 2019. The effect of breast cancer laterality on cardiac mortality and morbidity was investigated as a proxy for radiation exposure. We used Cox Proportional Hazards regression analysis, taking potential confounders into account.

Results

After a median follow-up time of 11.1 years, there was no significant association of tumor laterality with cardiac mortality in irradiated patients (hazard ratio (HR) for left-sided versus right-sided tumor 1.09; 95% confidence interval (CI) 0.85–1.41). Furthermore, tumor laterality was not identified as a significant risk factor for cardiac morbidity (HR = 1.05; 95%CI 0.88–1.25).

Conclusions

Even though RT for left-sided breast cancer on average incurs higher radiation dose to the heart than RT for right-sided tumors, we found no evidence that laterality is a strong risk factor for cardiac disease after contemporary RT. However, larger sample sizes, longer follow-up, detailed information on individual risk factors and heart dose are needed to assess clinically manifest late effects of current cancer therapy.
Genome-wide SNP analysis of three moose subspecies at the southern range limit in the contiguous United States
Authors: Ferrante Jason A. , Smith Chase H. , Thompson Laura M. , Hunter Margaret E.
Published: October 2021

Genome-wide evaluations of genetic diversity and population structure are important for informing management and conservation of trailing-edge populations. North American moose (Alces alces) are declining along portions of the southern edge of their range due to disease, species interactions, and marginal habitat, all of which may be exacerbated by climate change. We employed a genotyping by sequencing (GBS) approach in an effort to collect baseline information on the genetic variation of moose inhabiting the species’ southern range periphery in the contiguous United States. We identified 1920 single nucleotide polymorphisms (SNPs) from 155 moose representing three subspecies from five states: A. a. americana (New Hampshire), A. a. andersoni (Minnesota), and A. a. shirasi (Idaho, Montana, and Wyoming). Molecular analyses supported three geographically isolated clusters, congruent with currently recognized subspecies. Additionally, while moderately low genetic diversity was observed, there was little evidence of inbreeding. Results also indicated > 20% shared ancestry proportions between A. a. shirasi samples from northern Montana and A. a. andersoni samples from Minnesota, indicating a putative hybrid zone warranting further investigation. GBS has proven to be a simple and effective method for genome-wide SNP discovery in moose and provides robust data for informing herd management and conservation priorities. With increasing disease, predation, and climate related pressure on range edge moose populations in the United States, the use of SNP data to identify gene flow between subspecies may prove a powerful tool for moose management and recovery, particularly if hybrid moose are more able to adapt.
Out of Sync Subnational Housing Markets and Macroprudential Policies in the UK
Authors: Funke Michael , Mihaylovski Petar , Wende Adrian
Published: October 2021

We examine whether regionally differentiated macroprudential policies can address financial stability concerns and moderate house price differences in the UK. We disaggregate both the household sector and the housing stock in a two-region DSGE model with out of sync subnational housing markets and compare four policy types: standard monetary policy, leaning against the wind monetary policy, national macroprudential policy or one that targets region-specific LTV ratios. In terms of reducing variances of house prices, regionally differentiated macroprudential policy performs best, provided the policy authorities are concerned with stabilising output and house prices rather than simply minimising the variance of inflation.
Organizational Learning for Intelligence Amplification Adoption: Lessons from a Clinical Decision Support System Adoption Project
Authors: Wijnhoven Fons
Published: October 2021

Intelligence amplification exploits the opportunities of artificial intelligence, which includes data analytic techniques and codified knowledge for increasing the intelligence of human decision makers. Intelligence amplification does not replace human decision makers but may help especially professionals in making complex decisions by well-designed human-AI system learning interactions (i.e., triple loop learning). To understand the adoption challenges of intelligence amplification systems, we analyse the adoption of clinical decision support systems (CDSS) as an organizational learning process by the case of a CDSS implementation for deciding on administering antibiotics to prematurely born babies. We identify user-oriented single and double loop learning processes, triple loop learning, and institutional deutero learning processes as organizational learning processes that must be realized for effective intelligence amplification adoption. We summarize these insights in a system dynamic model—containing knowledge stocks and their transformation processes—by which we analytically structure insights from the diverse studies of CDSS and intelligence amplification adoption and by which intelligence amplification projects are given an analytic theory for their design and management. From our case study, we find multiple challenges of deutero learning that influence the effectiveness of IA implementation learning as transforming tacit knowledge into explicit knowledge and explicit knowledge back to tacit knowledge. In a discussion of implications, we generate further research directions and discuss the generalization of our case findings to different organizations.
Handgrip Strength Features in Rheumatoid Arthritis Patients Assessed Using an Innovative Cylindrical-Shaped Device: Relationships With Demographic, Anthropometric and Clinical Variables
Authors: Salaffi Fausto , Carotti Marina , Farah Sonia , Ceccarelli Luca , Di Carlo Marco
Published: October 2021

To investigate the relationship between handgrip strength (HGs) features, evaluated with an innovative cylindrical-shaped grip device, and demographic, anthropometric and clinical variables, in patients with rheumatoid arthritis (RA). Consecutive RA patients were prospectively enrolled for this cross-sectional study. For each patient were collected demographic, anthropometric, clinical data related to disease activity. HGs was assessed in terms of area under the force–time curve (AUC-FeT), peak grip force and time to reach the curve plateau. The correlations between the variables were studied with the Spearman’s rho correlation coefficient. The receiver operating characteristic (ROC) curve analysis was used to test the discriminant accuracy of HGs features in identifying patients in moderate/high disease activity. A multivariate analysis was performed to estimate the contribution of covariates on the AUC-FeT. A significant correlation was found among AUC-FeT, age, Simplified Disease Activity Index (SDAI), Ultrasound-Clinical Arthritis Activity (US-CLARA) (all at p < 0.0001), and body mass index (BMI) (p = 0.0001). Any correlation was found between HGs and radiographic damage. The discriminatory power of AUC-FeT was good [area under-ROC curve = 0.810 (95% CI 0.746–0.864)]. Variables significantly associated with AUC-FeT in multivariate analysis were age (p = 0.0006), BMI (p = 0.012), gender (p = 0.004), SDAI (p = 0.047) and US-CLARA (p = 0.023). HGs is negatively influenced by demographic (gender and age), anthropometric (BMI), and disease activity variables (SDAI and US-CLARA). These findings highlight the role of HGs in RA patients' functional impairment and disability.
Effect of new crystalline phase on the ionic conduction properties of sodium perchlorate salt doped carboxymethyl cellulose biopolymer electrolyte films
Authors: Shetty Supriya K , Ismayil  , Noor I. M.
Published: October 2021

Dopant induced modifications in the microstructure of sodium carboxymethyl cellulose (NaCMC) were characterized by FTIR, XRD, DSC and EIS techniques. FTIR analysis exhibited a considerable microstructural modification in NaCMC upon NaClO4⋅H2O doping invoked through complex formation via Lewis acid-base interaction and hydrogen bond formation between ions and dipoles. This resulted in the modification in the orderliness/disorderliness of polymer chains as observed from XRD deconvolution. At higher salt concentrations, the complexity of the network causes the formation of new amorphous and crystalline phases as reflected in the XRD studies. DSC analysis showed an increase in Tg as the salt concentration increased, indicating a reduction in polymer chains flexibility. The contribution of free ions has masked over the enhancement in amorphous content to conductivity at a lower concentration of salt in the matrix, later on, the formation of a new crystalline phase due to transient crosslinks by Na+…ClO4−…Na+ has affected the ion transport process.
Surface and optical properties of ethylene glycol-based nanofluids containing silicon dioxide nanoparticles: an experimental study
Authors: Traciak Julian , Sobczak Jolanta , Kuzioła Rafał , Wasąg Joanna , Żyła Gaweł
Published: October 2021

In this paper, the results of the experimental study on density, surface tension and optical properties of ethylene glycol-based nanofluids containing silicon dioxide have been presented. The nanofluid-air surface tension values were determined in the temperature range from 283.15 K to 318.15 K with Du Noüy ring method with the commercial equipment and self-made station. To determine the surface tension of a fluid, the information about its density is required; therefore, density of all examined nanofluids was measured in the same temperature range, and results were summarized in the paper. The refractive index of SiO$$_2$$

2

-EG nanofluids was determined in the same temperature range in which the surface tension was examined. Finally, the extinction (UV–Vis spectra) of these materials was examined and presented.
Microwave heating of water–ethanol mixtures
Authors: Schiraldi Alberto , Paoli Alberto
Published: October 2021

A simple measure of the susceptibility of a substance to microwaves (MW) is the resulting heating rate that depends on its heat capacity, density, starting temperature, MW extinction coefficient at the used MW frequency and distance from the irradiated surface. Water, that is ubiquitous in many products, currently treated with MW, shows a large susceptibility at 2450 MHz MW. This is why water is a suitable reference to rank the MW susceptibility of other compounds. Aqueous solutions are the simplest systems to investigate how the presence of extra compounds can modify (normally, reduce) this property. The present work provides a very simple evidence of a peculiar MW susceptibility of the water–ethanol mixture with azeotropic composition, XEtOH = 0.90 mol fraction, at temperatures rather below the respective boiling point at ambient pressure. The available literature reports a number of experimental and theoretical investigations that suggest the formation of (EtOH)n·(H2O)m ring clusters that change the hydrogen bond network and/or favor intermolecular hydrophobic hydration. The decamer, (EtOH)9·H2O, could be responsible for the peculiar MW susceptibility of the azeotropic mixture.
The inulin hydrolysis by recombinant exo-inulinases: determination the optimum temperatures and activation energies
Authors: Miłek Justyna
Published: October 2021

The advantages of recombinant enzymes over native include the control in a production environment, product purity and also high yield. The paper presents the determination the optimum temperatures and the activation energies for various origin recombinant exo-inulinases, among others from Aspergillus niger, A. awamori, Kluyveromyces marxianus and K. cicerisporus. The parameters were estimated based on the literature of the activity curves versus temperature for hydrolysis of inulin. It was assumed that both the hydrolysis reaction process and the deactivation process of recombinant exo-inulinase were first-order reactions by the enzyme concentration. A mathematical model describing the effect of temperature on recombinant exo-inulinase activity was used. Based on the comparison analysis, values of the activation energies $${E_{\rm a }}$$

E
a

were in the range from $${32.01 \pm 7.80}$$

32.01
±
7.80

to $${43.83 \pm 4.87}$$

43.83
±
4.87

kJ mol$$^{-1}$$

-
1

, the deactivation energies $${E_{\rm d }}$$

E
d

were in the range from $${83.93 \pm 4.82}$$

83.93
±
4.82

to $${352.44 \pm 14.26}$$

352.44
±
14.26

kJ mol$$^{-1}$$

-
1

and the optimum temperature $${T_{\rm opt }}$$

T
opt

were obtained in the range from $${318.91 \pm }$$

318.91
±

1.19 to $${328.76 \pm 0.25}$$

328.76
±
0.25

K.
Abortion and the Mission of MCH: Perspectives of MCH and Family Planning Professionals in Health Departments
Authors: Woodruff Katie , Wingo Erin , Berglas Nancy F. , Roberts Sarah C. M.
Published: October 2021

Introduction

Prior research shows that maternal and child health (MCH) and family planning (FP) divisions in health departments (HDs) engage in some abortion-related activities, largely when legally mandated; some agencies also initiate abortion-related activities. Yet little is known about health department MCH/FP professionals’ views on how abortion-related work aligns with their professional mission.

Methods

Between November 2017 and June 2018, we conducted in-depth interviews with 29 MCH/FP professionals working in 22 state and local HDs across the U.S. We conducted inductive thematic analysis to identify themes regarding participants’ professional mission and values in relation to abortion-related work.

Results

Participants described a strong sense of professional mission. Two contrasting perspectives on abortion and the MCH/FP mission emerged: some participants saw abortion as clearly outside the scope of their mission, even a threat to it, while others saw abortion as solidly within their mission. In states with supportive or restrictive abortion policy environments, professionals’ views on abortion and professional mission generally aligned with their overall state policy environment; in states with middle-ground abortion policy environments, a range of perspectives on abortion and professional mission were expressed. Participants who saw abortion as within their mission anchored their work in core public health values such as evidence-based practice, social justice, and ensuring access to health care.

Discussion

There appears to be a lack of consensus about whether and how abortion fits into the mission of MCH/FP. More work is needed to articulate whether and how abortion aligns with the MCH/FP mission.
Molecular dynamics modeling of the Vibrio cholera Na+-translocating NADH:quinone oxidoreductase NqrB–NqrD subunit interface
Authors: Dibrov Alexander , Mourin Muntahi , Dibrov Pavel , Pierce Grant N.
Published: October 2021

The Na+-translocating NADH:quinone oxidoreductase (Na+-NQR) is the major Na+ pump in aerobic pathogens such as Vibrio cholerae. The interface between two of the NQR subunits, NqrB and NqrD, has been proposed to harbor a binding site for inhibitors of Na+-NQR. While the mechanisms underlying Na+-NQR function and inhibition remain underinvestigated, their clarification would facilitate the design of compounds suitable for clinical use against pathogens containing Na+-NQR. An in silico model of the NqrB–D interface suitable for use in molecular dynamics simulations was successfully constructed. A combination of algorithmic and manual methods was used to reconstruct portions of the two subunits unresolved in the published crystal structure and validate the resulting structure. Hardware and software optimizations that improved the efficiency of the simulation were considered and tested. The geometry of the reconstructed complex compared favorably to the published V. cholerae Na+-NQR crystal structure. Results from one 1 µs, three 150 ns and two 50 ns molecular dynamics simulations illustrated the stability of the system and defined the limitations of this model. When placed in a lipid bilayer under periodic boundary conditions, the reconstructed complex was completely stable for at least 1 µs. However, the NqrB–D interface underwent a non-physiological transition after 350 ns.
Surgical strategies for older patients with glioblastoma
Authors: Barak Tanyeri , Vetsa Shaurey , Nadar Arushii , Jin Lan , Gupte Trisha P. , Fomchenko Elena I. , Miyagishima Danielle F. , Yalcin Kanat , Vasandani Sagar , Gorelick Evan , Zhao Amy Y. , Antonios Joseph , Theriault Brianna Carusillo , Lifton Nathan , Marianayagam Neelan , Omay Bulent , Omay Zeynep Erson , Huttner Anita , McGuone Declan , Blondin Nicholas A. , Corbin Zachary , Fulbright Robert K. , Moliterno Jennifer
Published: October 2021

Objective

While adjuvant treatment regimens have been modified for older patients with glioblastoma (GBM), surgical strategies have not been tailored.

Methods

Clinical data of 48 consecutive patients aged 70 years or older, who underwent surgical resection for GBM with intraoperative ultrasonography (IoUS) alone or combination with intraoperative MRI (IoMRI) at Yale New Haven Hospital were retrospectively reviewed. Variables were analyzed, and comparative analyses were performed.

Results

The addition of IoMRI was not superior to IoUS alone in terms of overall survival (OS) (P = 0.306), Karnofsky Performance Score (KPS) at postoperative 6 weeks (P = 0.704) or extent of resection (P = 0.263). Length of surgery (LOSx), however, was significantly longer (P = 0.0002) in the IoMRI group. LOSx (P = 0.015) and hospital stay (P = 0.025) were predictors of postoperative complications. Increased EOR (GTR or NTR) (P = 0.030), postoperative adjuvant treatment (P < 0.0001) and postoperative complications (P = 0.006) were predictive for OS. Patients with relatively lower preoperative KPS scores (<70) showed significant improvement at postoperative 6 weeks (P<0.0001). Patients with complications (P = 0.038) were more likely to have lower KPS at postoperative 6 weeks.

Conclusions

Aggressive management with surgical resection should be considered in older patients with GBM, even those with relatively poor KPS. The use of ioMRI in this population does not appear to confer any measurable benefit over ioUS in experienced hands, but prolongs the length of surgery significantly, which is a preventable prognostic factor for impeding care.
Regional differences in cognitive dissonance in evacuation behavior at the time of the 2011 Japan earthquake and tsunami
Authors: Kono Tatsuhito , Okuno Masaya , Yamaura Kazuho
Published: October 2021

This paper constructs an evacuation decision-making model that takes cognitive dissonance into consideration. The purpose of this construction is to clarify the psychological mechanism for the evacuation behavior of residents during an emergency, based on Akerlof and Dickens (Akerlof and Dickens Am Econ Rev 72:307–319, 1982) "The economic consequences of cognitive dissonance". Specifically, we empirically explore people’s psychological mechanism (e.g., cognitive dissonance) for evacuation behavior when a tsunami disaster occurs. As a result, we show that the level of anxiety depends on the area where residents live and that the average anxiety of residents is mostly correlated with the level of damage of past disasters, and that it is affected also by the ages of residents. Since the level of anxiety largely affects an individual’s evacuation behavior, this result can indicate for what kinds of people intervention and assistance are required based on the level of anxiety. A high level of anxiety basically promotes evacuation. Since our results show that anxiety is increased by the experience of tsunamis, education having people virtually experience tsunamis may increase evacuation rates efficiently.