bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptation of the Measure of Processes of Care for the Evaluation of Family-Centeredness of Services in India
Authors: Srinivasan Roopa , Marathe Ashwini , Sane Anushree Arvind , Krishnamurthy Vibha
Published: August 2021

Objective:

This study aims to (1) adapt the Measure of Processes of Care (MPOC-20) for use in India and (2) evaluate family-centered services for children with disabilities and their caregivers in an urban Indian context.

Methods:

In this cross-sectional observational study, we translated the MPOC-20 into Hindi. Caregivers of children diagnosed with developmental disabilities who read and/or understood Hindi and had received services for ≥6 months were recruited. The psychometric properties of the Hindi MPOC-20 were assessed using factor analysis followed by reliability analyses. The Hindi MPOC-20 was used to assess caregiver perceptions about the family-centeredness of services delivered between October 2016 and February 2017 at Ummeed Child Development Center.

Results:

Of the 170 eligible children, 141 (83%) comprised the study sample. Most were boys (66%) with a median age of 67 months. Factor analyses yielded a 4-factor scale with items loading differently from the original measure. The resulting Hindi MPOC-20 had acceptable to good internal consistency (Cronbach's alpha of scales: 0.71–0.86). On the Hindi MPOC-20, Respectful and Coordinated Care, Enabling Partnership, and Providing Specific Information were identified as strengths and Providing General Information as a relative limitation of the service by caregivers across different income and education groups.

Conclusion:

The Hindi MPOC-20 shows acceptable psychometric properties for use with caregivers of children with disabilities in India. The availability of Hindi MPOC-20 paves the way for the assessment of the family-centeredness of services in India and provides a roadmap for adaptations in other low- and middle-income countries.
Efficacy of Botulinum Toxin A for Scar Prevention After Breast Augmentation: A Randomized Double-Blind Intraindividual Controlled Trial
Authors: Disphanurat Wareeporn , Viarasilpa Wongsiya , Thienpaitoon Peera
Published: August 2021

BACKGROUND

Botulinum toxin A benefits postsurgical scar prevention by reducing wound edge tension and inhibiting in vitro scar tissue fibrosis.

OBJECTIVE

To investigate the efficacy of botulinum toxin Type A (BTX) in improving inframammary scar appearance after primary breast augmentation.

MATERIALS AND METHODS

A prospective, double-blinded, randomized controlled trial was performed with 27 participants receiving primary augmentation mammoplasty with inframammary incisions. After skin closure, intradermal injections of BTX were administered to 1 (treated) side of the inframammary incision. The contralateral side was the control. Scars were evaluated at 3 months, 6 months, and 9 months using the Patient and Observer Scar Assessment Scale and multispectral imaging analysis.

RESULTS

Overall, 22 patients completed the study. There were no significant subjective differences between the treated and control sides except the patient's treated side had significantly higher scores than the control side at 9 months. The treated side showed significantly smaller scar widths at 6 months and 9 months (p < .001) and better scar surface textures at 9 months (p = .003) than the control side.

CONCLUSION

Subjectively, intradermal BTX injection immediately after breast augmentation skin closure caused no significant differences. Objectively, scar width and texture significantly improved at 6 months and 9 months.
Bans on Cellphone Use While Driving and Traffic Fatalities in the United States
Authors: Zhu Motao , Shen Sijun , Redelmeier Donald A. , Li Li , Wei Lai , Foss Robert
Published: August 2021

Background:

As of January 2020, 18 of 50 US states comprehensively banned almost all handheld cellphone use while driving, 3 states and the District of Columbia banned calling and texting, 27 states banned texting on a handheld cellphone, and 2 states had no general cellphone ban for all drivers. However, it remains unknown whether these bans were associated with fewer traffic deaths and whether comprehensive handheld bans are more effective than isolated calling or texting bans. We evaluated whether cellphone bans were associated with fewer driver, non-driver, and total fatalities nationally.

Methods:

We conducted a longitudinal panel analysis of traffic fatality rates by state, year, and quarter. Population-based rate ratios and 95% CIs were estimated comparing state–quarters with and without cellphone bans.

Results:

From 1999 through 2016, 616,289 persons including 344,003 drivers died in passenger vehicle crashes in the United States. Relative to no ban, comprehensive handheld bans were associated with lower driver fatality rates (adjusted rate ratio aRR = 0.93, 95% CI = 0.90, 0.97) but not for non-driver fatalities (aRR = 1.01, 95% CI = 0.95, 1.07) or total fatalities (aRR = 0.98, 95% CI = 0.94, 1.01). We found no differences in driver fatalities for calling-only bans (aRR = 1.00, 95% CI = 0.97, 1.03), texting-only bans (aRR = 1.02, 95% CI = 0.99, 1.05), texting plus phone-manipulating bans (aRR = 0.99, 95% CI = 0.93, 1.04), or calling and texting bans (aRR = 0.98, 95% CI = 0.88, 1.09).

Conclusions:

Comprehensive handheld bans were associated with fewer driver fatalities.
Actigraphy-derived rest--activity rhythms are associated with nocturnal blood pressure in young women
Authors: Hoopes Elissa K. , Patterson Freda , Berube Felicia R. , D’Agata Michele N. , Brewer Benjamin , Malone Susan K. , Farquhar William B. , Witman Melissa A.
Published: August 2021

Introduction:

Misalignment between lifestyle behaviors and endogenous circadian rhythms is associated with elevated nocturnal blood pressure (BP) in experimental studies; however, less is known about free-living (i.e. nonlaboratory) circadian disruption and nocturnal BP. Additionally, sex-specific cardiovascular implications of circadian disruption are unclear.

Objective:

To examine the associations between rest--activity rhythms (RAR), a field-based estimate of circadian disruption, and nocturnal BP characteristics in young men and women.

Methods:

Fifty participants (20 ± 1 years; 20 men/30 women) underwent 24-h ambulatory BP monitoring following 14 days of wrist actigraphy. RAR variables of interdaily stability (day-to-day consistency in RAR), intradaily variability (within-day fragmentation of RAR), and relative amplitude (difference between peak vs. trough activity) were derived from actigraphy. Multivariable regression models of mean nocturnal SBP, DBP, and SBP dipping were generated to test main associations with RAR variables, and sex × RAR interactions. Daytime BP, race, BMI, physical activity, sleep duration, alcohol, caffeine, and sodium intake were considered as covariates.

Results:

In the full sample, no main associations between RAR and nocturnal BP characteristics were found. Sex interacted with RAR such that in women, higher interdaily stability (β = −5.39, 95% CI = −10.04 to −0.73, P = 0.024) and relative amplitude (β = −4.78, 95% CI = −9.22 to −0.34, P = 0.036) were both associated with lower nocturnal SBP. Sex-stratified multivariable models of nocturnal BP also revealed associations between interdaily stability and relative amplitude with SBP dipping in women (all P ≤ 0.01). No associations were apparent in men.

Conclusion:

Consistent and high-amplitude RAR are favorably associated with nocturnal BP characteristics in young women.
Development and Validation of the Workplace Decisional Balance Scale for Exercise (WDBex) in a French Sample
Authors: d’Arripe-Longueville Fabienne , Hayotte Meggy , Planchard Jo-Hanna , Steiner Dirk D. , Corrion Karine
Published: August 2021

Objective:

Despite positive effects of physical activity programs in the workplace, an appropriate measurement instrument to capture employees’ decisional balance to exercise is lacking. This study sought to develop and validate a decisional balance scale for exercise adapted to the workplace.

Methods:

Four complementary studies were carried out, with a total sample of 2398 French volunteer employees, to develop a preliminary version and examine its dimensionality, temporal stability, and construct validity.

Results:

The Workplace Decisional Balance scale for Exercise (WDBex) consists of 21 items with two subfactors, respectively composed of 12 items (facilitators) and nine items (barriers); for each subfactor, three dimensions (ie, physical, psychological, and logistic) were distinguished and presented satisfactory psychometric properties.

Conclusions:

This instrument constitutes a reliable and valid instrument for studying the psychosocial determinants of physical activity engagement in the workplace and for developing health promotion strategies.
A discussion on the ‘dispensable’ amino acids
Authors: Ennis Madeleine A. , Elango Rajavel
Published: August 2021

Purpose of review

Recently, the concept of dietary dispensable amino acids has been increasingly challenged, as more indirect and direct (experimental) evidence has pointed to the need for them in the diet during specific life stages or disease states. Here, we discuss the classification of amino acids, methods to assess the needs for dispensable amino acids with experimental evidence from our recent studies, and highlight the role of specific dispensable amino acids in metabolism and health.

Recent findings

There exist differences among the dispensable amino acids to act as effective nitrogen sources in humans. Glycine, a dispensable amino acid is conditionally indispensable in later stages of human pregnancy.

The so-called ‘dispensable’ amino acids are quantitatively nearly 75% of the daily protein needs in humans. In certain life-stages and diseases, there is a dietary demand for the dispensable amino acids. Future well-designed studies are required to identify the dietary demand for these amino acids, which will certainly be useful for dietary management in specific diseases and to maintain health across all life-stages.
Sarcopenia and microvascular free flap reconstruction
Authors: Chen Joy , Dennis Steven K. , Abouyared Marianne
Published: August 2021

Purpose of review

This article reviews the recent literature regarding the impact of sarcopenia on microvascular free flap reconstruction outcomes.

Recent findings

Malnutrition, and consequent muscle loss, is a prevalent issue among head and neck cancer patients. However, diagnosis remains challenging due to a paucity of reliable objective measures. Traditional markers, such as albumin, have been used in the past to assess nutritional status, but cancer-related inflammation limits their predictive value. Recently, developments in the diagnosis of sarcopenia through the novel use of computed tomography (CT) cross-sectional muscle mass indices to evaluate body composition have proven effective and accessible.

Literature shows compelling evidence that sarcopenia is associated with higher rates of surgical complications that delay recovery and increase mortality. The use of CT imaging to quantify muscle loss offers an objective way to evaluate nutritional status, which is predictive of postoperative rates of complications. Research on ways to optimize muscle mass prior to surgery is limited, however, immunonutrition is emerging as a promising intervention that can attenuate sarcopenia-related inflammation to improve outcomes.
Bilateral Sagittal Split Mandibular Ramus Osteotomy Alters the Temporomandibular Joint
Authors: Wang Xiangshen , Sun Xiumei , Wu Guomin
Published: August 2021

In this retrospective analysis, we examined temporomandibular joint space volume and condyle position in 10 patients undergoing bilateral sagittal split mandibular ramus osteotomy plus Le Fort I osteotomy to correct mandibular asymmetry. Cone beam computed tomography was used to map temporomandibular joint prior to (T0), immediately after (T1), and at 1 year after surgery (T2). In the deviated side, we detected significant lateral shift of the condyle in 5 patients at T1, and the shift disappeared at T2. In the non-deviated side, we detected significant medial shift of the condyle in all 10 patients at T1; the shift continued in 9 patients at T2. Temporomandibular joint space volume increased significantly at T1 and returned to presurgical volume at T2. In conclusion, there is significant shift in position of condyle in majority of the patients after bilateral sagittal split mandibular ramus osteotomy. The most consistent and persisting change was medial shift on the nondeviated side.
Long-Term Results After Head Orthosis Therapy for Early Childhood Position-Related Cranial Deformities: Stability of Treatment Outcome and Parental Satisfaction
Authors: Grandoch Andrea , Lentzen Max-Philipp , Seikel Hanna , Wetzel Christian , Zoeller Joachim E.
Published: August 2021

The purpose of this study was to determine whether different types of position-related cranial deformities show changes after completion of head orthosis therapy. We investigated how children's age at the begin of molding helmet therapy affects the duration and long-term stability of treatment. In addition, parental satisfaction with helmet therapy has been investigated.

Between 2012 and 2019, 47 patients have been analyzed after undergoing helmet therapy. At the beginning of treatment different disease pattern were classified. Posterior deformational Plagiocephalus defined by a cranial vault index (CVA) > 1 cm and a cranial index (CI) ≤ 90%. Posterior deformational Brachycephalus defined by CVA ≤ 1 cm and CI > 90%. Posterior deformational combined Plagio- and Brachycephalus defined by CVA > 1 cm and CI > 90%. At the beginning of therapy, the end of therapy and within 5-year-follow-up CI and CVA was measured by three-dimensional photogrammetry for 2 age groups (4–6 and 7–12 months). Additionally, parents completed a standardized questionnaire to evaluate the personal assessment of treatment outcome.

During treatment CI and CVA of all children decreased significantly (P < 0.001). Furthermore, CI significantly decreased after ending helmet therapy (P < 0.001). Cranial vault index decreased not significantly in the same period (P = 0.361). For the 4 to 6 months old group treatment time was significantly shorter than for the older group. Before starting helmet therapy nearly half of the parents graded the scull as moderate and one-third as severe deformed. After ending treatment, the majority of parents report satisfaction and compliance. However, one-third of parents noted a slight scull deformation and personal load during therapy.

After completion of therapy an improvement of head shape can be expected for the majority of children. This is particularly evident for improvement of the CI and a shorter treatment time until the age of 6 months at the beginning of therapy. Parents reported satisfaction and child compliance. Almost all parents were convinced that treatment was useful and would repeat it again.
Functionality Assessment of Patients With Cleft Hands
Authors: Rosa Marco Felipe Franco , do Monte Thais Miguel , Raposo-Amaral Cassio Eduardo , Raposo-Amaral Cesar Augusto , de Abreu Marcos Felipe Marcatto
Published: August 2021

Background:

Ectrodactyly, commonly referred to as cleft hand, is a rare pathology characterized by a deficiency and/or complete absence of the central ray in each hand. In order to customize treatment and improve the patient's quality of life, a more detailed functional evaluation is required. Although several studies evaluate functionality in different types of cleft hands, there are only a few studies that show self-reported evaluations. The objective of this study is to assess the hand function of cleft hand patients.

Methods:

An observational retrospective study was performed on 12 cleft hand patients who were treated between 2008 and 2018. There were 8 male patients and 4 female patients. Patients were divided into 2 groups according to their ages: (Group 1) 6 patients between 1 and 7 years of age, and (Group 2) 6 patients between 8 and 18 years of age, respectively. Each group was sub-stratified into 5 subgroups according to the classification system created by Manske and Halikis.

Results:

Regardless of age, intragroup hand type comparisons within Groups 1 and 2 did not demonstrate statistically significant differences (P > 0.05) between hand outcomes according to Manske and Halikis classification. Comparison between cleft hand patients and their age matched controls demonstrated statistically significant differences (P < 0.05), as the patients in the control group had higher outcome scores.

Conclusions:

Regardless of cleft hand type and patient age, patients with cleft hands experience impaired hand function and present lower outcome scores in comparison to their age matched controls.
Influence of Bone-Borne Trans-Sutural Distraction Osteogenesis Therapy on the Hard Palate of Growing Children With Cleft Lip and Palate
Authors: Li Sijia , Zhang Peiyang , Chen Yujie , Fang Lin , Bai Yanjie , Zhao Zhenmin
Published: August 2021

The efficacy of trans-sutural distraction osteogenesis therapy (TSDO) in treating midfacial hypoplasia in children with cleft lip and palate has been confirmed. However, few studies have reported that changes occur in the palate after TSDO treatment. To study the effect of TSDO on palatal morphology and its relative position in the craniofacial region, we retrospectively collected and measured the computed tomography images of 29 growing children with cleft lip and palate and midfacial hypoplasia, before and after TSDO. The results showed that the length and height of the palate did not change significantly, but the width and arch length increased, and the anterior area was more pronounced than the posterior area, with the median palatine suture still centered without obvious deviation. This suggests lateral palate growth after distraction, most likely around the median palatine suture. The distance from the palate to the cranial base also increased after distraction, and the anterior nasal spine moved forward, whereas the palate rotated by an average of 10.04° downward from the center of the anterior nasal spine. The increasing distance between the palate and cranial base may result from the growth of the nasal bone or the skull base. The oropharyngeal airway volume was also increased by an average of 2256.36 mm3, which may be beneficial to children's ventilatory function. In conclusion, TSDO therapy has influence on patients’ palatal morphology and position, which should be considered before surgery.
Total Customized Alloplastic Reconstruction for Treatment of Severe Temporomandibular Joint Pathologic Conditions: A Case Series of Combined Intraoral and Extraoral Approach
Authors: de Sousa Gil Ariane Paredes , Velasques Bibiana Daldasso , Uzun Nelson , Haas Orion Luiz , de Oliveira Rogério Belle
Published: August 2021

Temporomandibular joint (TMJ) reconstruction with customized alloplastic implants has become a safe and effective treatment option of TMJ end-stage pathology with excellent outcomes reported in the literature. The purpose of this study is to report 5 cases of severe TMJ pathology and customized alloplastic reconstruction using a combined intraoral approach and extraoral approach. Four patients with TMJ involved for benign tumor and one patient with severe TMJ resorption were enrolled. Compromised joints were replaced with customized prosthesis under general anesthesia using an association of intraoral approach/extraoral approach. An implant handpiece with adapted drills for bone drilling and the insertion of screws was used to fixate the mandibular component intraorally; the fossa component was inserted via preauricular approach. The hemimandibulectomies/codilectomy with safety margin were successfully performed and for 2 patients Orthognathic Surgery was also required. Follow-up period was from 15 to 28 months (average 22 months), with no history of surgical site infection or damage to the prostheses. Occlusal relationship and function, as well as facial symmetry were kept stable in all patients. The combination of an intraoral and extraoral approach for total TMJ replacement with customized prosthesis may be an alternative and reliable strategy for pathologic reconstruction, keeping function and reducing aesthetic damage.
Le Fort I Osteotomy in Cleft Patients: Maxillary Advancement and Articulation
Authors: Harjunpää Roni , Alaluusua Suvi , Leikola Junnu , Heliövaara Arja
Published: August 2021

Background:

Maxillary advancement may affect speech in cleft patients.

Aims:

To examine whether the amount of maxillary advancement and preoperativecephalometric skeletal and dentoalveolar relationships are associated with articulation errors of the Finnish alveolar consonants /s/, /l/, and /r/ in cleft patients.

Materials and Methods:

Fifty-seven nonsyndromic cleft patients who underwent Le Fort I or bimaxillary osteotomies were evaluated retrospectively. Pre- and post-operative lateral cephalometric radiographs and standardized speech video recordings were analyzed. The Aspin-Welch unequal variance t test, Student t test sign test, intraclass correlation and Kappa statistics were used in the statistical analyses.

Results:

The mean advancement of the maxilla (point A) was 4.65 mm horizontally (range −2.80 to 11.30) and −3.82 mm vertically (range −14.20 to 3.90). The overall articulation (especially the sounds /s/ and /l/) improved significantly postoperatively, but the amount of maxillary advancement did not affect the articulation. The preoperative mean percentages of /s/, /l/, and /r/ errors were 32%, 33%, 46% and the postoperative percentages 23%, 19%, 40%, respectively. Preoperative articulation errors of /s/ were related to palatal inclination of the upper incisors.

Conclusions:

Orthognathic surgery may improve articulation errors. The amount of maxillary advancement is not related to the improvement.
Design and Implementation of an Emergency Undocking Curriculum for Robotic Surgery
Authors: Melnyk Rachel , Saba Patrick , Holler Tyler , Cameron Katherine , Mithal Prabhakar , Rappold Philip , Wu Guan , Cubillos Jimena , Rashid Hani , Joseph Jean V. , Ghazi Ahmed E.
Published: August 2021

Introduction

Current training for robotic surgery crisis management, specifically emergency robotic undocking protocol (ERUP), remains limited to anecdotal experience. A curriculum to impart the skills and knowledge necessary to recognize and complete a successful ERUP was developed using an education approach then evaluated.

Methods

Baseline knowledge and confidence regarding ERUP were established for 5 robotic teams before completing 2 full-immersion simulations separated by an online self-paced learning module. In each simulation, teams operated on a perfused hydrogel model and were tasked to dissect a retroperitoneal tumor abutting a major vessel. During vascular pedicle ligation, a major vascular bleed and nonrecoverable robotic fault were remotely induced, necessitating ERUP with open conversion. After the simulation, participants completed surgery task load index (cognitive load assessment) and realism surveys. Weighted checklists scored participants' actions during each simulation. Surgical metrics including estimated blood loss, time to control bleeding, and undocking time were recorded. Curriculum retention was assessed by repeating the exercise at 6 months.

Results

Participants experienced high levels of cognitive demand and agreed that the simulation's realism and stress mimicked live surgery. Longitudinal analysis showed significant knowledge (+37.5 points, p = 0.004) and confidence (+15.3 points, p < 0.001) improvements from baseline to completion. Between simulations, checklist errors, undocking time, and estimated blood loss decreased (38⇾17, −40 seconds, and −500 mL, respectively), whereas action scores increased significantly (+27 points, p = 0.008). At 6 months, insignificant changes from curriculum completion were seen in knowledge (−4.8 points, p = 0.36) and confidence (+3.7 points, p = 0.1).

Conclusions

This simulation-based curriculum successfully improves operative team's confidence, knowledge, and skills required to manage robotic crisis events.
A Cognitive Aid Improves Adherence to Guidelines for Critical Endotracheal Intubation in the Resuscitation Room
Authors: Ben-Haddour Mathieu , Colas Mathilde , Lefevre-Scelles Antoine , Durand Zoé , Gillibert André , Roussel Mélanie , Joly Luc-Marie
Published: August 2021

Introduction

Emergency endotracheal intubation (ETI) is a high-risk procedure. Some of its adverse events are life-threatening, and guidelines emphasize the need to anticipate complications by thorough preparation. The emergency department (ED) can be an unpredictable environment, and we tested the hypothesis that a cognitive aid would help the emergency practitioners better follow guidelines. The main objective of this study was to determine whether the use of a cognitive aid focusing on both preintubation and postintubation items could improve ETI preparation and implementation in the ED resuscitation room regarding adherence to guidelines. The secondary objective was to measure and describe procedure times.

Methods

We conducted a single-blind randomized controlled trial with manikin-based in situ simulation. The participants were not aware of the purpose of the study. The cognitive aid was developed using national guidelines and current scientific literature. The most relevant items were the preparation and implementation of a rapid sequence induction for ETI followed by mechanical ventilation. Emergency department physician-nurse pairs were randomized into a “cognitive aid” group and a “control” group. All pairs completed the same scenario that led to ETI in their own resuscitation room. An adherence to guidelines score of 30, derived from the 30 items of the cognitive aid (1 point per item), and preparation and intubation times were collected.

Results

Seventeen pairs were included in each group. Adherence to guidelines scores were significantly higher in the cognitive aid group than in the control group (median = 28 of 30, interquartile range = 25–28, vs. median = 24 of 30, interquartile range = 21–26, respectively, P < 0.01). Preparation, intubation, and total procedure times were slightly longer in the cognitive aid group, but these results were not significant.

Conclusions

In an in situ simulation, a cognitive aid for the preparation and implementation of an emergency intubation procedure in the ED resuscitation room significantly improved adherence to guidelines without increasing procedure times. Further work is needed in a larger sample and in different settings to evaluate the optimal use of cognitive aids in critical situations.
Consistent inconsistencies in braking: a spatial analysis
Authors: Hammerberg Alexandra G. , Kramer Patricia Ann
Published: August 2021

The dynamic system that is the bipedal body in motion is of interest to engineers, clinicians and biological anthropologists alike. Spatial statistics is more familiar to public health researchers as a way of analysing disease clustering and spread; nonetheless, this is a practical approach to the two-dimensional topography of the foot. We quantified the clustering of the centre of pressure (CoP) on the foot for peak braking and propulsive vertical ground reaction forces (GRFs) over multiple, contiguous steps to assess the consistency of the location of peak forces on the foot during walking. The vertical GRFs of 11 participants were collected continuously via a wireless insole system (MoticonReGo AG) across various experimental conditions. We hypothesized that CoPs would cluster in the hindfoot for braking and forefoot for propulsion, and that braking would demonstrate more consistent clustering than propulsion. Contrary to our hypotheses, we found that CoPs during braking are inconsistent in their location, and CoPs during propulsion are more consistent and clustered across all participants and all trials. These results add to our understanding of the applied forces on the foot so that we can better predict fatigue failures and better understand the mechanisms that shaped the modern bipedal form.
What does ‘toughness’ look like? An examination of the breakdown of young and mature leaves under cyclical loading
Authors: Traff Jordan , Daegling David J.
Published: August 2021

The material property of leaf toughness is considered the crucial mechanical challenge facing folivorous primates. Mature leaves have higher recorded toughness values than young leaves on average, leading to many assumptions about the patterning of food breakdown that follow a tough/not-tough dichotomy. We tested three hypotheses about how leaves break down under repetitive loading cycles, predicting that mature leaves (i) experience more force during simulated occlusal loads, (ii) more effectively resist fragmentation into small pieces, and (iii) show a more gradual decline in resistance over consecutive cycles than young leaves. Under displacement control using a mechanical testing system, we subjected young and mature leaves to 20 cycles of axial loading using interlocking steel wedges, then collected and quantified the size of the leaf fragments. While we found that mature leaves experienced more overall force than young leaves (p< 0.001), they also shattered into smaller pieces (p= 0.004) and showed a steeper decline in their resistance to the cycles over the course of a test (p< 0.01). These results suggest that putatively ‘tougher’ foods (i.e. mature versus young leaves) do not necessarily resist fragmentation as commonly assumed. The current tough/not-tough paradigm of primate foods may not accurately reflect how leaves break down during masticatory behaviour.
The Exposome and its Associations with Broad Mental and Physical Health Measures in Early Adolescence
Authors: Moore Tyler M. , Visoki Elina , Argabright Stirling T. , DiDomenico Grace E. , Sotelo Ingrid , Wortzel Jeremy D. , Naeem Areebah , Gur Ruben C. , Gur Raquel E. , Warrier Varun , Guloksuz Sinan , Barzilay Ran
Published: August 2021

Exposures to perinatal, familial, social, and physical environmental stimuli can have substantial effects on human development. Yet the complex network structure of the environment (i.e., exposome) makes it challenging to investigate. Here, we analyze the exposome using data from the Adolescent Brain Cognitive Development Study (ABCD, N = 11,235, mean age = 10.9, 52% male) and replicate key findings in an age and sex matched sample from the Philadelphia Neurodevelopmental Cohort (PNC, N = 4,993). Both these cohorts are large, diverse samples of US adolescents with phenotyping at multiple levels of environmental exposure. In ABCD, applying data-driven iterative factor analyses and bifactor modeling, we reduced dimensionality from n=798 exposures to six exposome subfactors and a general (adverse) exposome factor. These factors revealed quantitative differences among racial and ethnic groups. Exposome factors increased variance explained in mental health by 10-fold (from <4% to >38%), over and above other commonly used sociodemographic factors. The general exposome factor was associated with psychopathology (β=0.28, 95%CI 0.26-0.3) and key health-related outcomes: obesity (OR=1.4, 95%CI 1.3-1.5) and advanced pubertal development (OR=1.3, 95%CI 1.2-1.5). In PNC, using substantially fewer available environmental exposures (n=29), analyses yielded consistent associations of the general exposome factor with psychopathology (β =0.15, 95%CI 0.13-0.17), obesity (OR=1.4, 95%CI 1.3-1.6) and advanced pubertal development (OR=1.3, 95%CI 1-1.6). Findings demonstrate how incorporating the exposome framework can be useful to study the role of environment in human development.
The production of anti-PF4 antibodies in anti-phospholipid antibody-positive patients is not affected by COVID-19 vaccination
Authors: Lonati Paola A. , Bodio Caterina , Scavone Mariangela , Martini Giuliana , Pesce Elisa , Bandera Alessandra , Lombardi Andrea , Gerosa Maria , Franceschini Franco , Tincani Angela , Podda Gianmarco , Abrignani Sergio , Grifantini Renata , Cattaneo Marco , Borghi Maria Orietta , Meroni Pier Luigi
Published: August 2021

Antibodies against cationic platelet chemokine, platelet factor 4 (PF4/CXCL4) have been described in heparin-induced thrombocytopenia (HIT) but also in patients positive for anti-phospholipid antibodies (aPL) even in the absence of heparin treatment and HIT-related clinical manifestations. Anti-PF4 antibodies have been recently described also in subjects who developed thrombosis with thrombocytopenia syndrome (TTS) in association with adenoviral vector-based, but not with mRNA-based COVID-19 vaccines.

We investigated whether COVID-19 vaccination affects the production of anti-PF4 immunoglobulins detectable by solid phase assay in aPL-positive patients and their ability to induce in vitro platelet activation. Anti-PF4 were found in 9/126 aPL-positive patients, 4/50 COVID-19, 9/49 other infections and 1/50 aPL-negative systemic lupus erythematosus patients. Clinical manifestations of TTS were not observed in any aPL patient positive for anti-PF4, whose sera failed to cause platelet aggregations. The administration of COVID-19 vaccines did not affect the production of anti-PF4 immunoglobulins or their ability to cause platelet aggregation in 44 aPL-positive patients tested before and after vaccination. In conclusion, heparin treatment-independent anti-PF4 antibodies can be found in aPL-positive patients and asymptomatic carriers, but their presence, titer as well as in vitro effect on platelet activation are not affected by COVID-19 vaccination.
No evidence for three functionally specialized subregions in the subthalamic nucleus: A model-based 7 T fMRI study
Authors: Miletić Steven , Keuken Max C. , Mulder Martijn , Trampel Robert , de Hollander Gilles , Forstmann Birte U.
Published: August 2021

The subthalamic nucleus (STN) is a small, subcortical brain structure. It is a target for deep brain stimulation, an invasive treatment that reduces motor symptoms of Parkinson’s disease. Side effects of DBS are commonly explained using the tripartite model of STN organization, which proposes three functionally distinct subregions in the STN specialized in cognitive, limbic, and motor processing. However, evidence for the tripartite model exclusively comes from anatomical studies and functional studies using clinical patients. Here, we provide the first experimental tests of the tripartite model in healthy volunteers using ultra-high field 7 Tesla (T) functional magnetic resonance imaging (fMRI). 34 participants performed a random-dot motion decision-making task with a difficulty manipulation and a choice payoff manipulation aimed to differentially affect cognitive and limbic networks. Moreover, participants responded with their left and right index finger, differentially affecting motor networks. We analysed BOLD signal in three subregions of equal volume of the STN along the dorsolateral-ventromedial axis, identified using manually delineated high resolution anatomical images. Our results indicate that all segments responded equally to the experimental manipulations, and did not support the tripartite model.
Another step toward final call on Remdesivir efficacy as a treatment for hospitalized COVID-19 patients: a multicenter open-label trial
Authors: Hosseini Hamed , Sadeghi Anahita , Tabarsi Payam , Etemadimanesh Azin , Darazam Ilad Alavi , Aghdami Nasser , Kalantari Saeed , Hasibi Mehrdad , Hadadi Azar , Babamahmoodi Farhang , Momen-Heravi Mansooreh , Hormati Ahmad , Panahi Yunes , Khodashahi Rozita , Salehi Mohammadreza
Published: August 2021

Introduction

After emerging the global pandemic of SARS-CoV2 some preliminary studies demonstrated the efficacy of antiviral treatments. But shortly thereafter, inconsistencies in the results of further clinical trials raised doubts on the efficacy of these agents. In this study, we aimed to evaluate the effect of Remdesivir on hospitalized COVID-19 patients’ outcomes.

Material and methods

This study was an open-label, single-armed, clinical trial on hospitalized patients diagnosed with COVID-19 who had progressive respiratory symptoms despite receiving standard care. All patients received Remdesivir and their characteristics, outcomes, time of treatment initiation, and respiratory support stages during hospitalization were registered and followed up for 14 days.

Results

145 patients with the mean age of 52.89 ± 1.12 years enrolled in this study, 38 (26.2%) died at the end of 14 days period. The mean time interval from the onset of the symptoms to antiviral treatment was 10.63±0.56 days. Thirty deceased patients (78.9%) were men, showing 2.8 times higher mortality chance compared to women (ORadj=2.77; 95%CI=1.08-7.09). The type of respiratory support on the first day of treatment initiation showed a significantly lower mortality chance in patients receiving O2only than those who needed non-invasive and/or mechanical ventilation (ORadj=3.91; 95%CI=1.64-9.32). The start time (early vs late administration) and duration (less or more than 7 days) of antiviral treatment had no statistically significant association with mortality or ventilation escalation among the patients (p-value > 0.05).

Conclusion

In this study, we showed that Remdesivir probably is not effective on the outcome of hospitalized COVID-19 patients.
A Gene Replacement Humanization Platform for Rapid Functional Testing of Clinical Variants in Epilepsy-associatedSTXBP1
Authors: McCormick Kathryn , Brock Trisha , Wood Matthew , Guo Lan , McBride Kolt , Kim Christine , Resch Lauren , Pop Stelian , Bradford Chandler , Kendrick Preston , Lawson Jennifer A. , Saunders Adam , McKeown Sarah , Helbig Ingo , Bainbridge Matthew N. , Hopkins Christopher E
Published: August 2021

Purpose

Functional evidence is a pillar of variant interpretation according to ACMG guidelines. Functional evidence can be obtained in a variety of models and assay systems, including patient-derived tissues and iPSCs, in vitro cellular assays, and in vivo assays. Here we evaluate the reliability and practicality of variant interpretation in the small animal model,C.elegans, through a series of experiments evaluating the function of syntaxin binding protein, STXBP1, a well-known causative gene for Early infantile epileptic encephalopathy 1 (EIEE1).

Methods

Using CRISPR, we replaced the coding sequence for unc-18 with the coding sequence for the human orthologSTXBP1. Next, we used CRISPR to introduce precise point mutations in the humanSTXBP1coding sequence, reflecting three clinical categories (benign, pathogenic, and variants of uncertain significance (VUS)). We quantified 26 features of the resulting worms’ movement to train Random Forest (RF) and Support Vector Machines (SVM) machine learning classifiers on known pathogenic and benign variants. We characterized the classifiers, and then used the behavioral data from the VUS-expressing animals to predict the categorization of the VUS.

Results

Whereas knock-out worms without unc-18 are severely impaired in motor function, worms expressingSTXBP1in its place have restored motor function. We produced worms withSTXBP1variants previously classified by ACMG criteria, including 25 benign variants, 32 pathogenic, and 24 variants of uncertain significance (VUS). Using either SVM or RF classifiers, we were able to obtain a sensitivity of 0.84-0.97 on known benign and pathogenic strains. By comparing multiple ML classification methods, we were able to classify 9 of the VUS as functionally abnormal, suggesting that these VUS are likely to be pathogenic.

Conclusions

We demonstrate that automated analysis of a small animal system is an effective, scalable, and fast way to understand functional consequences of variants inSTXBP1, one of the most common causes of genetic epilepsies and neurodevelopmental disorders.
Design of reflective phase retarders in the extreme ultraviolet based on chirped Mo/Si multilayer mirrors
Authors: Yang Song , Chen Shujing , Lin Chengyou
Published: August 2021

The extreme ultraviolet (EUV) phase retarder is an important optical element for polarization analysis and conversion of EUV synchrotron radiation. In this paper, a linearly chirped Mo/Si multilayer mirror is used to design an EUV phase retarder. With increasing thickness variation of the chirped multilayer, the reflective phase retardation between s- and p-polarized light increases at first and then reaches its maximum value. When the bilayer number increases from 2 to 20, the maximum phase retardation for an EUV source with a photon energy of 90 eV increases from 5.97° to 245.10° for a linearly chirped Mo/Si multilayer with 14.7 nm central thickness. In addition, the phase retardations of chirped mirrors at different photon energies (80 eV, 85 eV and 90 eV) are also investigated and compared. Furthermore, the physical mechanism of reflective phase retardation improvement is also studied by investigating the field intensity distributions inside chirped mirrors.
Tirumala Tirupati: Wait a Moment
Authors: Maiden Stephen E. , Yemen Gerry , Weiss Elliott N. , Wight Oliver
Published: August 2021

This case examines the queueing issues caused by the growth in popularity of one of the most visited Hindu temples in the world. On January 2, 2015, Ramesh and Vasantha Gupta visit Tirumala Venkateswara Temple, just a day after some 210,000 people crowded the 2,000-year-old site. The case describes the many enhancements that the temple administrator, Tirumala Tirupati Devasthanams (TTD), has implemented since its management of the temple complex began in 1932. The soaring popularity of the temple, however, has led to safety and comfort concerns for pilgrims. While challenging students to consider additional improvements that might benefit pilgrim throughput rate and time in the temple system, the case highlights the tension TTD must manage between maximizing efficiency and maintaining religious traditions. Additionally, the case demonstrates the importance of perceived waiting times in the management of queues.
Lac Leman Festival de la Musique (A)
Authors: Bodily Samuel E. , Tyler John , Jenkins Robert
Published: August 2021

The organizers of a music festival may use video from the Friday concert to create a DVD to sell to those who come to the Saturday concert. Attendance on Saturday is uncertain, as is the percentage of those who attend on Saturday who will buy the DVD. Is this a good project? If so, what number of DVDs should be burned early Saturday morning and offered for sale at that evening’s performance? By that time, Friday attendance is known, as well as whether it rained on Friday, and there is a forecast for whether it will rain on Saturday. Historical information on these variables may help us predict Saturday attendance using multiple regression; together with the results of a marketing survey, such analysis will help us make better purchasing decisions. This case series (see also the B case, UVA-QA-0708) can be used to illuminate a multitude of concepts that are covered in basic decision-analysis courses. The series starts by examining the role of uncertainty in decision-making, proceeds through the estimation of probability distributions from sample data with multiple regression, culminates in the development of a full decision model, and ends with a qualitative and quantitative analysis (with a tornado diagram) of how to add value and reduce risk. Key pitfalls for students are failing to recognize both limits on sales (supply and demand), incomplete reasoning in the determination of the attendance probability distribution, and oversimplifying the full forecast model.
A/B Testing at Vungle
Authors: Grushka-Cockayne Yael , Lichtendahl Kenneth C. , De Reyck Bert , Fragkos Ioannis
Published: August 2021

Two recently graduated MBA students are tasked with developing an ad-serving learning algorithm for a mobile ad-serving company. The case illustrates the way in which hypotheses can be tested in an A/B format or “horse race” in order to establish customer preferences and superior profitability. The case was written for a course elective covering hypothesis testing.
Predictors of work alienation: differences between hierarchical levels
Authors: Vanderstukken Arne , Caniëls Marjolein C.J.
Published: August 2021

Purpose

The current study is aimed at analyzing whether and how organizational constraints (i.e. lack of autonomy) and individual characteristics (i.e. psychological capital) are related to work alienation in subordinates and supervisors, and whether the often hypothesized relationship between autonomy and work alienation is moderated in a three-way interaction (autonomy × psychological capital × hierarchical level). The hypotheses are developed by drawing on the tenets of the job demands-resources model.

Design/methodology/approach

The study is based on two-wave survey data from 294 Dutch employees (subordinates and supervisors).

Findings

The paper finds that autonomy is more negatively related to work alienation for subordinates with low psychological capital than for subordinates with high psychological capital. Autonomy is negatively related to work alienation for leaders, independent of their level of psychological capital.

Originality/value

Antecedents of work alienation have received substantial attention from researchers. The authors aim to better understand these antecedents by highlighting differences between supervisors and subordinates.
An information classification model for public sector organizations in Sweden: a case study of a Swedish municipality
Authors: Bergquist Jan-Halvard , Tinet Samantha , Gao Shang
Published: August 2021

Purpose

The purpose of this study is to create an information classification model that is tailored to suit the specific needs of public sector organizations in Sweden.

Design/methodology/approach

To address the purpose of this research, a case study in a Swedish municipality was conducted. Data was collected through a mixture of techniques such as literature, document and website review. Empirical data was collected through interviews with 11 employees working within 7 different sections of the municipality.

Findings

This study resulted in an information classification model that is tailored to the specific needs of Swedish municipalities. In addition, a set of steps for tailoring an information classification model to suit a specific public organization are recommended. The findings also indicate that for a successful information classification it is necessary to educate the employees about the basics of information security and classification and create an understandable and unified information security language.

Practical implications

This study also highlights that to have a tailored information classification model, it is imperative to understand the value of information and what kind of consequences a violation of established information security principles could have through the perspectives of the employees.

Originality/value

It is the first of its kind in tailoring an information classification model to the specific needs of a Swedish municipality. The model provided by this study can be used as a tool to facilitate a common ground for classifying information within all Swedish municipalities, thereby contributing the first step toward a Swedish municipal model for information classification.