bluuebunny/crossref_metadata_2025 huggingface dataset:
Desarrollo de un proceso participativo para el diagnóstico de salud comunitaria en estudiantes de la Universidad Miguel Hernández: Proyecto #beUMHealthy
Authors: Valera-Gran Desirée , Prieto-Botella Daniel , Hurtado-Pomares Miriam , Hernández-Sánchez Sergio , Garcia-de-la-Hera Manoli , Navarrete-Muñoz Eva María , Pérez-Vazquez María Teresa
Published: May 2021

Los procesos participativos permiten analizar, comprender, debatir y promover la acción colectiva en asuntos significativos para una comunidad. Estas metodologías activas favorecen la identificación de necesidades y activos en salud para elaborar un diagnóstico de salud comunitaria y promover acciones colectivas. En este sentido, la aplicación de los procesos participativos en el contexto universitario resulta de gran interés para el fortalecimiento de las universidades como comunidades promotoras de la salud. En este trabajo se describe el desarrollo del proceso participativo #beUMHealthy, cuyo objetivo principal fue potenciar el debate sobre la salud y las iniciativas de promoción de la salud en el alumnado de la Universidad Miguel Hernández (UMH). El proyecto se desarrolló entre mayo y noviembre del 2019. Se recogieron 22 participaciones mediante WhatsApp y 173 cuestionarios diligenciados en línea. Este proceso permitió identificar necesidades y activos en salud en el alumnado de la UMH y obtener propuestas para su mejora. Esta información se usará para promover acciones futuras que incrementen la salud de la comunidad universitaria.
Investigating CSR Practices of LIC of India During Pre- and Post-IRDAI’s Compliance, 2013
Authors: Uddin Furquan
Published: May 2021

In modern times, corporate social responsibility (CSR) has become a focus of attention before organisations. The present study purports the critical evaluation of Life Insurance Corporation (LIC) of India pertaining to the CSR activities during the period under the study. The present study includes secondary data through annual reports of the LIC of India from 2010 to 2018. In order to test the hypotheses of the present study, the paired t-test has been applied. The findings of the study reveal that LIC of India has covered around 60 million lives and settled more than 150,000 claims under the group and social security schemes in the year 2017–2018, which is a milestone in the insurance arena. In the year 2017–2018, more than ₹400,000 million had been invested by LIC of India in the social sector, which is a strong indicator of interest of the organisation towards social responsibility. It is also evidenced through this study that there is no significant difference between pre- and post-IRDAI’s compliance, 2013 pertaining to CSR practices of LIC of India.
Research-to-Resource: Confronting and Overcoming Music Teacher Burnout
Authors: Hanson Josef
Published: May 2021

Teaching music can be a stressful endeavor. Decades of research findings indicate that music teachers are especially prone to professional burnout. The purpose of this research-to-resource article is to equip music teachers and other educational stakeholders with research-informed definitions, warning signs, and potential remedies for burnout. Practical recommendations for addressing the macro-level, classroom-level, and intrapersonal contributors to burnout are provided.
Activation of CamKIIα expressing neurons on ventrolateral periaqueductal gray improves behavioral hypersensitivity and thalamic discharge in a trigeminal neuralgia rat model
Authors: Elina K. C. , Oh Byeong Ho , Islam Jaisan , Kim Soochong , Park Young Seok
Published: May 2021

Background

Preceding studies have reported the association of chronic neuropathic orofacial pain with altered ongoing function in the ventrolateral periaqueductal gray (vlPAG). However, its role in trigeminal neuralgia (TN) lacks attention. We here reported the aspect that vlPAG neurons play in TN nociceptive processing by employing excitatory neuron-specific optogenetic approaches.

Methods

TN was generated via unilateral infraorbital nerve chronic constriction in Sprague Dawley rats which induced mechanical and thermal pain sensitivity in air puff and acetone test, respectively. Channelrhodopsin conjugated virus with CamKIIα promoter was used to specifically activate the excitatory vlPAG neuronal population by optogenetic stimulation and in vivo microdialysis was done to determine its effect on the excitatory-inhibitory balance. In vivo extracellular recordings from ventral posteromedial (VPM) thalamus were assessed in response to vlPAG optogenetic stimulation. Depending on the experimental terms, unpaired student’s t test and two-way analysis of variance (ANOVA) were used for statistical analysis.

Results

We observed that optogenetic activation of vlPAG subgroup neurons markedly improved pain hypersensitivity in reflexive behavior tests which was also evident on microdialysis analysis with increase glutamate concentration during stimulation period. Decreased mean firing and burst rates were evident in VPM thalamic electrophysiological recordings during the stimulation period. Overall, our results suggest the optogenetic activation of vlPAG excitatory neurons in a TN rat model has pain ameliorating effect.

Conclusions

This article presents the prospect of pain modulation in trigeminal pain pathway via optogenetic activation of vlPAG excitatory neurons in rat model. This outlook could potentially assist vlPAG insight and its optogenetic approach in trigeminal neuropathic pain which aid clinicians endeavoring towards enhanced pain relief therapy in trigeminal neuralgia patients.
Rapid sequence evolution driven by transposable elements at a virulence locus in a fungal wheat pathogen
Authors: Singh Nikhil Kumar , Badet Thomas , Abraham Leen , Croll Daniel
Published: May 2021

Background

Plant pathogens cause substantial crop losses in agriculture production and threaten food security. Plants evolved the ability to recognize virulence factors and pathogens have repeatedly escaped recognition due rapid evolutionary change at pathogen virulence loci (i.e. effector genes). The presence of transposable elements (TEs) in close physical proximity of effector genes can have important consequences for gene regulation and sequence evolution. Species-wide investigations of effector gene loci remain rare hindering our ability to predict pathogen evolvability.

Results

Here, we performed genome-wide association studies (GWAS) on a highly polymorphic mapping population of 120 isolates of Zymoseptoria tritici, the most damaging pathogen of wheat in Europe. We identified a major locus underlying significant variation in reproductive success of the pathogen and damage caused on the wheat cultivar Claro. ﻿The most strongly associated locus is intergenic and flanked by genes encoding a predicted effector and a serine-type endopeptidase. The center of the locus contained a highly dynamic region consisting of multiple families of TEs. Based on a large global collection of assembled genomes, we show that the virulence locus has undergone substantial recent sequence evolution. Large insertion and deletion events generated length variation between the flanking genes by a factor of seven (5–35 kb). The locus showed also strong signatures of genomic defenses against TEs (i.e. RIP) contributing to the rapid diversification of the locus.

Conclusions

﻿In conjunction, our work highlights the power of combining GWAS and population-scale genome analyses to investigate major effect loci in pathogens.
Validation of the DIGIROP-birth model in a Chinese cohort
Authors: Chen Sizhe , Wu Rong , Chen He , Ma Wenbei , Du Shaolin , Li Chao , Lu Xiaohe , Feng Songfu
Published: May 2021

Background

We aimed to validate the predictive performance of the DIGIROP-Birth model for identifying treatment-requiring retinopathy of prematurity (TR-ROP) in Chinese preterm infants to evaluate its generalizability across countries and races.

Methods

We retrospectively reviewed the medical records of preterm infants who were screened for retinopathy of prematurity (ROP) in a single Chinese hospital between June 2015 and August 2020. The predictive performance of the model for TR-ROP was assessed through the construction of a receiver-operating characteristic (ROC) curve and calculating the areas under the ROC curve (AUC), sensitivity, specificity, and positive and negative predictive values.

Results

Four hundred and forty-two infants (mean (SD) gestational age = 28.8 (1.3) weeks; mean (SD) birth weight = 1237.0 (236.9) g; 64.7% males) were included in the study. Analyses showed that the DIGIROP-Birth model demonstrated less satisfactory performance than previously reported in identifying infants with TR-ROP, with an area under the receiver-operating characteristic curve of 0.634 (95% confidence interval = 0.564–0.705). With a cutoff value of 0.0084, the DIGIROP-Birth model showed a sensitivity of 48/93 (51.6%), which increased to 89/93 (95.7%) after modification with the addition of postnatal risk factors. In infants with a gestational age < 28 weeks or birth weight < 1000 g, the DIGIROP-Birth model exhibited sensitivities of 36/39 (92.3%) and 20/23 (87.0%), respectively.

Conclusions

Although the predictive performance was less satisfactory in China than in developed countries, modification of the DIGIROP-Birth model with postnatal risk factors shows promise in improving its efficacy for TR-ROP. The model may also be effective in infants with a younger gestational age or with an extremely low birth weight.
Tourism experiences and the lower risk of mortality in the Chinese elderly: a national cohort study
Authors: Du Min , Tao Liyuan , Liu Min , Liu Jue
Published: May 2021

Background

Cohort studies about the effects of tourism experiences on the risk of death among Chinese older adults are still lacking. We aimed to examine the association between tourism experiences and mortality in Chinese aged 65 or above.

Methods

We included 9520 participants aged 65 years or above from the Chinese Longitudinal Healthy Longevity Survey at baseline in 23 provinces in 2011. They were followed up in 2014 and 2018. Cox proportional hazards models were used to assess the association between tourism experiences and the risk of death.

Results

Among 9520 participants, 7.85% had at least one tourism experience outside of their local city/county during the past 2 years. During 35,994.26 person-years of follow-up, in total 4635 deaths were observed. The crude rate of death was greater in participants who had no tourism experience than in older travelers (incidence rate: 13.70 versus 5.24 per 100 person-years). Elderly travelers had a significantly lower risk for all-cause mortality (crude hazard ratio: 0.38, 95% CI: 0.33–0.44) compared with non-travelers. After adjustment for all covariates, the risk of all-cause mortality was 27% lower among those with at least one tourism experience than among non-travelers (adjusted hazard ratio: 0.73, 95% CI: 0.62–0.85). Subgroup analysis showed that the associations between tourism and the decreased risk of mortality were stable.

Conclusions

Tourism decreases the risk of mortality in the Chinese elderly. Tourism should be considered as a modifiable lifestyle factor and an effective way to reduce mortality and promote longevity and healthy aging.
Virtue and medical ethics education
Authors: Lyon Will
Published: May 2021

The traditional structure of medical school curriculum in the United States consists of 2 years of pre-clinical study followed by 2 years of clinical rotations. In this essay, I propose that this curricular approach stems from the understanding that medicine is both a science, or a body of knowledge, as well as an art, or a craft that is practiced. I then argue that this distinction between science and art is also relevant to the field of medical ethics, and that this should be reflected in ethics curriculum in medical education. I introduce and argue for virtue ethics as the best opportunity for introducing practical ethical knowledge to medical trainees.
Gastrocnemius muscle flap with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone graft for the phase I treatment of localized osteomyelitis after tibial plateau fracture surgery
Authors: Ruan Weiwei , Li Menglu , Guo Qiaofeng , Lin Bingyuan
Published: May 2021

Purpose

To investigate the clinical effect of gastrocnemius muscle flaps combined with vancomycin/gentamicin-calcium sulfate combined and autologous iliac bone graft in the phase I treatment of traumatic focal osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery.

Methods

From July 2009 to January 2018, 35 patients with localized osteomyelitis (Cierny-Mader type III) who met the inclusion criteria were followed up and treated. All patients were infected after undergoing internal fracture fixation surgery. Among them, 18 cases were plate-exposed, 14 cases were due to sinus tracts, two were due to skin necrosis, and one was bone-exposed. We treated patients with several measures. All cases were then followed up. The follow-up indicators included Hospital for Special Surgery knee scores (HSS), the time of laying drainage pipe, bone healing time, infection control rate, and the incidence of nonunion and other complications.

Results

All patients were followed up for 24–60 months. None of them underwent amputation. For repairing soft tissue defects, 17 cases were covered with a muscle flap using the medial head of gastrocnemius alone, 15 cases were treated with the lateral head of gastrocnemius muscle, and three cases were covered with the combination of the two heads. Compared to the preoperative score, we found that the average HSS improved at the 1-year and 2-year follow-up (54 vs. 86 vs. 87).

Conclusion

Using a gastrocnemius muscle flap combined with vancomycin/gentamicin-calcium sulfate and autogenous iliac bone was an effective method for the phase I treatment of osteomyelitis (Cierny-Mader type III) after tibial plateau fracture surgery. In the primary treatment of focal traumatic osteomyelitis, it can decrease the treatment time, number of surgeries, pain of patients, time of bone healing, postoperative exudation, and infection recurrence rate and increase the healing bone’s strength.
A machine learning platform for the discovery of materials
Authors: Belle Carl E. , Aksakalli Vural , Russo Salvy P.
Published: May 2021

For photovoltaic materials, properties such as band gap $$E_{g}$$

E
g

are critical indicators of the material’s suitability to perform a desired function. Calculating $$E_{g}$$

E
g

is often performed using Density Functional Theory (DFT) methods, although more accurate calculation are performed using methods such as the GW approximation. DFT software often used to compute electronic properties includes applications such as VASP, CRYSTAL, CASTEP or Quantum Espresso. Depending on the unit cell size and symmetry of the material, these calculations can be computationally expensive. In this study, we present a new machine learning platform for the accurate prediction of properties such as $$E_{g}$$

E
g

of a wide range of materials.
A dual-time-window protocol to reduce acquisition time of dynamic tau PET imaging using [18F]MK-6240
Authors: Kolinger Guilherme D. , Vállez García David , Lohith Talakad G. , Hostetler Eric D. , Sur Cyrille , Struyk Arie , Boellaard Ronald , Koole Michel
Published: May 2021

Background

[18F]MK-6240 is a PET tracer with sub-nanomolar affinity for neurofibrillary tangles. Therefore, tau quantification is possible with [18F]MK-6240 PET/CT scans, and it can be used for assessment of Alzheimer’s disease. However, long acquisition scans are required to provide fully quantitative estimates of pharmacokinetic parameters. Therefore, on the present study, dual-time-window (DTW) acquisitions was simulated to reduce PET/CT acquisition time, while taking into consideration perfusion changes and possible scanning protocol non-compliance. To that end, time activity curves (TACs) representing a 120-min acquisition (TAC120) were simulated using a two-tissue compartment model with metabolite corrected arterial input function from 90-min dynamic [18F]MK-6240 PET scans of three healthy control subjects and five subjects with mild cognitive impairment or Alzheimer’s disease. Therefore, TACs corresponding to different levels of specific binding were generated and then various perfusion changes were simulated. Next, DTW acquisitions were simulated consisting of an acquisition starting at tracer injection, a break and a second acquisition starting at 90 min post-injection. Finally, non-compliance with the PET/CT scanning protocol were simulated to assess its impact on quantification. All TACs were quantified using reference Logan’s distribution volume ratio (DVR) and standardized uptake value ratio (SUVR90) using the cerebellar cortex as reference region.

Results

It was found that DVR from a DTW protocol with a 60-min break between two 30-min dynamic scans closely approximates the DVR from the uninterrupted TAC120, with a regional bias smaller than 2.5%. Moreover, SUVR90 estimates were more susceptible (regional bias ≤ 19%) to changes in perfusion compared to DVR from a DTW TAC (regional bias ≤ 10%). Similarly, SUVR90 was affected by late-time scanning protocol delays reaching an increase of 8% for a 20-min delay, while DVR was not affected (regional bias < 1.5%) by DTW protocol non-compliance.

Conclusions

Therefore, such DTW protocol has the potential to increase patient comfort and throughput without compromising quantitative accuracy and is more reliable against SUVR in terms of perfusion changes and protocol deviations, which could prove beneficial for drug effect assessment and patient follow-up using longitudinal [18F]MK-6240 PET imaging.
Innovation practices for survival of small and medium enterprises (SMEs) in the COVID-19 times: the role of external support
Authors: Adam Nawal Abdalla , Alarifi Ghadah
Published: May 2021

Global epidemic crises, such as the coronavirus (COVID-19), usually expose small and medium enterprises (SMEs) to various kinds of challenges and may put their lives at risk. This study aims to develop a theoretical model to provide insights about the association between innovation practices and the SMEs’ performance and survival while underlining the auxiliary role of external support in such a relationship. Online questionnaire has been used to collect the data from 259 randomly selected SME managers in Saudi Arabia, and the data was analyzed using the SmartPLS3 software. The structural equation modeling results showed that the innovation practices adopted by SMEs to face the repercussions of COVID-19 had a positive impact on the performance and likelihood of business survival. PLS-SEM bootstrap results indicated that external support aids strengthen the positive impact of SMEs’ innovation practices on business survival rather than its performance. The study has several significant practical implications for SME managers, governments, and policy makers that have been stated.
Characterisation of materials and techniques in first archaeological findings of Nasca wall paintings
Authors: Boucherie Nathalie , Nowik Witold , Pingaud Nathalie
Published: May 2021

The pre-Colombian wall paintings in Peru were already known from north and central coast sites, but little information exists on the southern coast corresponding to the Nasca region. The recent excavations on Cahuachi site provided fragments of plaster with paint layers found near Great Pyramid, corresponding to phases III and IV of the construction of the site, and dating back to the Early Intermediate Period (from 200 BC to 350 AD). A series of fragments from three locations from these two respective periods were transferred directly from the excavation to the laboratory and analyzed. A panel of observation and analysis methods was applied in order to describe the stratigraphy and materials used for these paintings, with special attention to the paint layer. The stratigraphy was observed by optical and electron microscopies and X-ray fluorescence, Raman and infrared spectroscopies were employed for elemental and molecular characterization of the plaster and paintings. The obtained results show the large presence in painting layers of iron oxides and copper based pigments, as well as calcium sulfate, siliceous clay materials and graphite. Although most of these pigments could be provided by local deposits, the detection of graphite is probably linked to the use of charcoal. The variety of painting materials between phases III and IV are related to the palette of colours and pigments. The colours for phase III seem limited to the red and yellow ochre pigments, and unidentified black and gypsum white. During phase IV, additional pigments were identified such as: paratacamite, malachite and chrysocolla for greens, hematite for purple, charcoal and siliceous white, which replaced gypsum white. The paintings were sometimes applied in several layers and occasionally separated by a white coating layer. The painting materials and techniques identified on Cahuachi site, and especially the differences between the phases observed, constitute a new insight into the knowledge of wall painting tradition in Southern Peru.
The improvement of functional handwashing facilities during COVID-19: the perspective of Tanzania
Authors: Shao Magdalena , Mushi Vivian , Mwelange Luco , Mwakitalima Anyitike
Published: May 2021

Fighting against coronavirus disease-2019 (COVID-19) goes hand in hand with the provision of proper water, sanitation, and hygiene (WASH) services. In this case, proper handwashing with soap and water plays a major role in the prevention of COVID-19, since it helps to deactivate and remove virus particles from the hands. This letter points out the drivers for the improvement of functional handwashing facilities during the COVID-19 pandemic in Tanzania, whereby three out of every 20 non-functional handwashing facilities were improved to make them functional. The letter also provides several recommendations to maintain momentum for improving functional handwashing facilities.
Hepatocellular Carcinoma in Sub-Saharan Africa
Authors: Kedar Mukthinuthalapati V. V. Pavan , Sewram Vikash , Ndlovu Ntokozo , Kimani Stephen , Abdelaziz Ashraf Omar , Chiao Elizabeth Yu , Abou-Alfa Ghassan K.
Published: May 2021

More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.
Venetoclax Combined With FLAG-IDA Induction and Consolidation in Newly Diagnosed and Relapsed or Refractory Acute Myeloid Leukemia
Authors: DiNardo Courtney D. , Lachowiez Curtis A. , Takahashi Koichi , Loghavi Sanam , Xiao Lianchun , Kadia Tapan , Daver Naval , Adeoti Maria , Short Nicholas J. , Sasaki Koji , Wang Sa , Borthakur Gautam , Issa Ghayas , Maiti Abhishek , Alvarado Yesid , Pemmaraju Naveen , Montalban Bravo Guillermo , Masarova Lucia , Yilmaz Musa , Jain Nitin , Andreeff Michael , Jabbour Elias , Garcia-Manero Guillermo , Kornblau Steven , Ravandi Farhad , Konopleva Marina Y. , Kantarjian Hagop M.
Published: May 2021

PURPOSE

Sixty percent of newly diagnosed patients with acute myeloid leukemia (ND-AML) receiving frontline therapy attain a complete response (CR), yet 30%-40% of patients relapse. Relapsed or refractory AML (R/R-AML) remains a particularly adverse population necessitating improved therapeutic options. This phase Ib/II study evaluated the safety and efficacy of fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin combined with the B-cell lymphoma-2 inhibitor venetoclax in ND-AML and R/R-AML.

MATERIALS AND METHODS

The phase IB portion (PIB) enrolled patients with R/R-AML using a 3 + 3 dose escalation and de-escalation algorithm for identification of maximum tolerated dose and dose-limiting toxicities. The phase II portion enrolled patients into two arms to evaluate response and time-to-event end points: phase IIA (PIIA): ND-AML and phase IIB (PIIB): R/R-AML.

RESULTS

Sixty-eight patients have enrolled to date (PIB, 16; PIIA, 29; PIIB, 23). Median age was 46 years (range, 20-73). Grade 3 and 4 adverse events occurring in ≥ 10% of patients included febrile neutropenia (50%), bacteremia (35%), pneumonia (28%), and sepsis (12%). The overall response rate for PIB, PIIA, and PIIB was 75%, 97%, and 70% with 75%, 90%, and 61%, respectively, achieving a composite CR. Measurable residual disease–negative composite CR was attained in 96% of ND-AML and 69% of R/R-AML patients. After a median follow-up of 12 months, median overall survival (OS) for both PII cohorts was not reached. Fifty-six percent of patients proceeded to allogeneic hematopoietic stem-cell transplantation (ND-AML, 69%; R/R-AML, 46%). In R/R-AML, allogeneic hematopoietic stem-cell transplantation resulted in a significant improvement in OS (median OS, NR; 1-year OS, 87%). One-year survival post-HSCT was 94% in ND-AML and 78% in R/R-AML.

CONCLUSION

Fludarabine, cytarabine, granulocyte colony-stimulating factor, and idarubicin + venetoclax represents an effective intensive treatment regimen in ND-AML and R/R-AML patients, associated with deep remissions and a high rate of transition to successful transplantation.
Sensitivity of Psychosocial Distress Screening to Identify Cancer Patients at Risk for Financial Hardship During Care Delivery
Authors: Maldonado J. Alberto , Fu Shuangshuang , Chen Ying-Shiuan , Acquati Chiara , Yabroff K. Robin , Banegas Matteo P. , Chang Shine , Conti Rena M. , Checka Cristina M. , Peterson Susan K. , Advani Pragati , Ku Kimberly , Jagsi Reshma , Giordano Sharon H. , Volk Robert J. , Shih Ya-Chen T. , Smith Grace L.
Published: May 2021

PURPOSE:

Patients with cancer frequently encounter financial hardship, yet systematic strategies to identify at-risk patients are not established in care delivery. We assessed sensitivity of distress-based screening to identify patients with cancer-related financial hardship and associated care delivery outcomes.

METHODS:

A survey of 225 patients at a large cancer center assessed cancer-related financial hardship (0-10 Likert scale; highest quintile scores ≥ 5 defined severe hardship). Responses were linked to electronic medical records identifying patients’ distress screening scores 6 months presurvey (0-10 scale) and outcomes of missed cancer care visits and bad debt charges (unrecovered patient charges) within 6 months postsurvey. A positive screen for distress was defined as score ≥ 4. We analyzed screening test characteristics for identifying severe financial hardship within 6 months and associations between financial hardship and outcomes using logistic models.

RESULTS:

Although patients with positive distress screens were more likely to report financial hardship (odds ratio [OR], 1.21; 1.08-1.37; P < .001), a positive distress screen was only 48% sensitive and 70% specific for identifying severe financial hardship. Patients with worse financial hardship scores were more likely to miss oncology care visits within 6 months (for every additional point in financial hardship score from 0 to 10, OR, 1.28; 1.12-1.47; P < .001). Of patients with severe hardship, 72% missed oncology visits versus 35% without severe hardship ( P = .006). Patients with worse hardship were more likely to incur any bad debt charges within 6 months (OR, 1.32; 1.13-1.54; P < .001).

CONCLUSION:

Systematic financial hardship screening is needed to help mitigate adverse care delivery outcomes. Existing distress-based screening lacks sensitivity.
Perioperative Code Status Discussions: How Are We Doing?
Authors: O’Leary Sian , Pimentel Marc Philip , Ford Shauna , Vacanti Joshua C. , Bleday Ronald , Salmasian Hojjat , Mendu Mallika L.
Published: May 2021

Approximately 15% of patients with a code status of do-not-resuscitate (DNR) or do-not-intubate (DNI) present for surgery. Despite professional guidelines requiring discussions with patients regarding perioperative resuscitation, it is unclear whether these recommendations are consistently followed. Our review of 158 patient encounters with established DNR/DNI code status found that code status discussions (CSDs) were documented only 70% of the time, and code status orders were inconsistently entered to reflect those discussions. We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review.
Πολυμορφισμοί αλληλομόρφων MICA στον Ελληνικό πληθυσμό
Authors: Μπίρτσας Βασίλειος
Published: May 2021

Εισαγωγή: Το γονίδιο MICA είναι ένα πολύ πολυμορφικό λειτουργικό γονίδιο που βρίσκεται κοντά στον τόπο HLA-B. Ορισμένα αλληλόμορφα MICA έχουν συσχετιστεί με φλεγμονώδεις και αυτοάνοσες ασθένειες, ενώ τα αντισώματα MICA έχουν εμπλακεί σε απόρριψη αλλομοσχεύματος οργάνων ή νόσο μοσχεύματος έναντι ξενιστή (GVHD). Σκοπός: Ο σκοπός αυτής της μελέτης ήταν να εντοπίσει τις συχνότητες των αλληλόμορφων MICA στον ελληνικό πληθυσμό, καθώς, όσο γνωρίζουμε, αυτά τα δεδομένα είναι ακόμη περιορισμένα. Τα δεδομένα συσχετίστηκαν με τα HLA-B. Μέθοδοι: Ελήφθη DNA από 277 μη συγγενείς μεταξύ τους, υγιείς, Καυκάσιους, Έλληνες, εθελοντές δότες Προγονικών Αιμοποιητικών κυττάρων (Stem Cells) Ο γονότυπος MICA* πραγματοποιήθηκε με αντίστροφη PCR-SSOP. Αποτελέσματα: Συνολικά 18 MICA αλληλόμορφα τυποποιήθηκαν στην παρούσα μελέτη. Τα πέντε πιο συχνά αλληλόμορφα στον ελληνικό πληθυσμό ήταν MICA*008 (24,6%), MICA*009 (22,36%), MICA 018 (16,03%), MICA*002 (8,02%) και MICA*004 (7,17%) τα οποία συνολικά αντιπροσωπεύουν το 77,8% όλων των αλληλίων. Σε συσχέτιση με τα HLA-B πιο συνηθισμένοι απλότυποι MICA ~ HLA-B που εντοπίστηκαν ήταν οι MICA*018 ~ B*18 (12,5%) και MICA*009 ~ B*51 (11,5%). Συμπεράσματα: Τα πέντε πιο συχνά αλληλόμορφα MICA στον ελληνικό πληθυσμό ήταν *008, *009, *018, *002, *004. Σε άλλους Καυκάσιους πληθυσμούς, δύο από αυτά τα αλληλόμορφα (*008 και *004) παρατηρήθηκαν σε παρόμοιες συχνότητες. Το MICA*002 παρατηρήθηκε λιγότερο συχνά (8,02%) στον ελληνικό πληθυσμό σε σύγκριση με άλλες Καυκάσιες ομάδες (συχνότητες > 15%). Επίσης, τα MICA*009 και MICA*018 είχαν αυξημένες συχνότητες (πάνω από 15%), ενώ σε άλλους πληθυσμούς βρέθηκαν περίπου 10% ή λιγότερο. Αυτά τα δεδομένα μπορεί να είναι σημαντικά για την αποσαφήνιση του ρόλου που παίζουν οι πολυμορφισμοί MICA στη μεταμόσχευση οργάνων και βλαστικών κυττάρων και για τον προσδιορισμό της σχέσης ορισμένων MICA με την συσχέτιση με συγκεκριμένες ασθένειες.
Epidemiology of Alzheimer’s disease and other dementias: rising global burden and forecasted trends
Authors: Javaid Syed Fahad , Giebel Clarissa , Khan Moien AB , Hashim Muhammad Jawad
Published: May 2021

Background: The burden associated with Alzheimer’s disease is recognized as one of the most pressing issues in healthcare. This study aimed to examine the global and regional burden of Alzheimer’s disease and related dementias.

Methods: Epidemiological data from the latest Global Burden of Disease (GBD) dataset were analysed to determine the prevalence, incidence and mortality rates from 1990 to 2019 for 204 countries and world regions. This dataset derives estimates for health metrics by collating primary data from research studies, disease registries and government reports. Temporal forecasting was conducted using the GBD Foresight tool.

Results: An estimated 0.7% of the global population has dementia, translating to 51.6 million people worldwide. The total number of persons affected has more than doubled from 1990 to 2019. Dementia metrics showed a continuous increase in prevalence, incidence, mortality, and disability adjusted life years (DALYs) rates worldwide during the last three decades. Japan has the highest prevalence (3,079 cases per 100,000), followed by Italy, Slovenia, Monaco, Greece and Germany. The prevalence is higher in high-income regions such as Western Europe compared to Asia and Africa. However, total number of affected individuals is substantial in South and East Asian regions, in particular China, Japan and India. Dementia related deaths are projected to increase from the current 2.4 million per year to 5.8 million by 2040. Women are more likely to be affected by dementia than men. Age-standardized rates have not changed indicating possible stability of risk factors.

Conclusions: Alzheimer’s disease and other dementias are rising rapidly and will more than double in mortality burden over the next 20 years. The tremendous burden in high- and middle-income countries can potentially overwhelm communities and health systems. Urgent measures are needed to allocate funding and provide residential care for affected persons.
Case Article—Machine Learning, Ethics, and Change Management: A Data-Driven Approach to Improving Hospital Observation Unit Operations
Authors: Pachamanova Dessislava , Tilson Vera , Dwyer-Matzky Keely
Published: May 2021

This case discusses a process improvement project aimed at maximizing the use of hospital capacity as the flu season looms. Dr. Erin Kelly heads the observation unit and turns to predictive models to improve the assignment of patients to her unit. The case covers three major themes: (1) data analytics life cycle and interface of predictive and prescriptive analytics in the context of process improvement, (2) design and ethical application of machine learning models, and (3) effecting organizational change to operationalize the findings of the analysis. Realistic data, R code, and Excel models are provided. The rich context of the case allows for discussing change management in a healthcare organization, analytics problem framing and model mapping, service process capacity analysis and Little’s law, data summaries and visualizations, interpretable machine learning algorithms, evaluations of predictive model performance, algorithmic bias, and dealing with dirty data. The case is appropriate for use in courses in machine learning, business analytics, operations management, and operations research, both at the advanced undergraduate level and at the master’s/MBA level.
Quality Assessment and Implications for Further Study of Acupotomy: Case Reports Using the Case Report Guidelines and the Joanna Briggs Institute Critical Appraisal Checklist
Authors: Jun Hyungsun , Yoon Sang-Hoon , Roh Minyeong , Kim Seon-hye , Lee Jisu , Lee Jihyun , Kwon Miri , Leem Jungtae
Published: May 2021

This review aimed to evaluate the quality of case reports where acupotomy was performed according to the CAse REport (CARE) guidelines and the Joanna Briggs Institute (JBI) critical appraisal checklist. Case reports on acupotomy published in Korea from 2013 to October 2020 were included in this review. A total of 28 acupotomy related case reports were selected, and a quality evaluation was verified using the CARE guidelines and JBI critical appraisal checklist. Among the case reports, spinal conditions/diseases were most commonly reported. The overall complete reporting rate for each study was relatively high (median of 63.4% according to the CARE guidelines and 73.4% according to JBI critical appraisal checklist for case reports and 62% for case series). However, low reporting rates were determined in several subcategories namely, “Intervention adherence and tolerability,” “Timeline,” “Diagnostic challenges,” “Patient perspective,” and “Adverse or unanticipated events” for case reports, and “Reporting of the presenting site/clinic,” “Demographic information,” “Statistical analysis,” and “Clear criteria for inclusion” for case series. When reporting cases where acupotomy was performed, it is recommended that the CARE guidelines are followed to improve the quality of research. In addition, new guidelines and tools for the clinical situation of Korean medicine should be developed.
La Picadora: A Case Study in Cuban Agroecotourism
Authors: Moon Krystyn R. , Ward Jennifer Rhode , Rodriguez José Vazquez , Foyo Jorge
Published: May 2021

Agroecotourism is growing worldwide, with a Latin American focus on both cultural and environmental sustainability. In this case study, the authors immersed themselves in the seven-year-old agroecotourism venture of La picadora, living among neighbours and conducting formal interviews with 14 persons to learn about agricultural practices, hosting approaches, and the effects of tourism on life at La picadora. Results showed a community practising and committed to sustainable use of land and human resources, and revealed agricultural practices typical of broader Cuba. Foods served to tourists reflected a combination of Cuban tradition and ingredient availability. Residents noted cultural and monetary benefits of welcoming tourists to their communities. In conclusion, the La picadora collective is a microcosm of sustainable tourism, affecting and affected by broader socioeconomic forces. It is likely that this early agroecotourism adopter will become a model for other Cuban visitor hubs operating outside traditional beach-based ventures.
Framework for quantitative three-dimensional choroidal vasculature analysis using optical coherence tomography
Authors: Saxena Ashish , Yao Xinwen , Wong Damon , Chua Jacqueline , Ang Marcus , Hoang Quan V. , Agrawal Rupesh , Girard Michael , Cheung Gemmy , Schmetterer Leopold , Tan Bingyao
Published: May 2021

Choroidal vasculature plays an important role in the pathogenesis of retinal diseases, such as myopic maculopathy, age-related macular degeneration, diabetic retinopathy, central serous chorioretinopathy, and ocular inflammatory diseases. Current optical coherence tomography (OCT) technology provides three-dimensional visualization of the choroidal angioarchitecture; however, quantitative measures remain challenging. Here, we propose and validate a framework to segment and quantify the choroidal vasculature from a prototype swept-source OCT (PLEX Elite 9000, Carl Zeiss Meditec, USA) using a 3×3 mm scan protocol centered on the macula. Enface images referenced from the retinal pigment epithelium were reconstructed from the volumetric data. The boundaries of the choroidal volume were automatically identified by tracking the choroidal vessel feature structure over the depth, and a selective sliding window was applied for segmenting the vessels adaptively from attenuation-corrected enface images. We achieved a segmentation accuracy of 96% ± 1% as compared with manual annotation, and a dice coefficient of 0.83 ± 0.04 for repeatability. Using this framework on both control (0.00 D to −2.00 D) and highly myopic (−8.00 D to −11.00 D) eyes, we report a decrease in choroidal vessel volume (p<0.001) in eyes with high myopia.
Photonic generation of terahertz dual-chirp waveforms ranging from 364 to 392 GHz
Authors: Wang Shiwei , Zhang Lu , Lu Zijie , Zhang Hongqi , Qiao Mengyao , Idrees Nazar , Saqlain Muhammad , Zheng Shilie , Jin Xiaofeng , Zhang Xianmin , Yu Xianbin
Published: May 2021

In this paper, we propose and experimentally demonstrate a photonic scheme based on frequency doubling and photo-mixing to generate dual-chirp signals in the terahertz (THz) band. A broadband dual-chirp THz signal with 28 GHz bandwidth, ranging from 364 GHz to 392 GHz, is successfully generated in the proof-of-concept experiment, resulting in a chirp rate of 0.028 GHz/ns for both up chirp and down chirp signals. THz dual-chirp signals featuring a large bandwidth are beneficial to enable high resolution and high accuracy by mitigating the range measurement error induced by the range-Doppler coupling effect. Therefore, the proposed system is expected to have a great potential for future THz radar applications.
Thermocavitation: a mechanism to pulse fiber lasers
Authors: Zaca-Morán R. , Amaxal-Cuatetl C. , Zaca-Morán P. , Castillo-Mixcóatl J. , Ramos-García R. , Padilla-Martínez J. P.
Published: May 2021

In this paper, we present a novel mechanism for the generation of laser pulses based on the phenomenon of thermocavitation. Thermocavitation bubbles were generated within a glass cuvette filled with copper nitrate dissolved in water, where the tip of an optical fiber was placed very close to the bubble generation region. Once the bubble is generated, it expands rapidly and the incoming laser light transmitted through the optical fiber is reflected at the vapor-solution interface and reflected back into the fiber, which is coupled to an erbium-doped fiber ring laser. Laser pulses were extracted from the ring cavity and detected by a fast photodetector, which corresponds to a single thermocavitation event, obtaining a pulse repetition rate from 118 Hz to 2 kHz at 1560 nm, with a pulse width ranging from 64 to 57 µs. The repetition rate can be controlled by adjusting the laser power to induce thermocavitation. To our knowledge, this novel mechanism of laser pulses has not been reported in the literature.
Mid-infrared nonlinear optics in thin-film lithium niobate on sapphire
Authors: Mishra Jatadhari , McKenna Timothy P. , Ng Edwin , Stokowski Hubert S. , Jankowski Marc , Langrock Carsten , Heydari David , Mabuchi Hideo , Fejer M. M. , Safavi-Naeini Amir H.
Published: May 2021

Periodically poled thin-film lithium niobate (TFLN) waveguides have emerged as a leading platform for highly efficient frequency conversion in the near-infrared. However, the commonly used silica bottom-cladding results in high absorption loss at wavelengths beyond 2.5 µm. In this work, we demonstrate efficient frequency conversion in a TFLN-on-sapphire platform, which features high transparency up to 4.5 µm. In particular, we report generating mid-infrared light up to 3.66 µm via difference-frequency generation of a fixed 1 µm source and a tunable telecom source, with normalized efficiencies up to

200
%

/

W

c
m

2

. These results show TFLN-on-sapphire to be a promising platform for integrated nonlinear nanophotonics in the mid-infrared.
Modifying light–matter interactions with perovskite nanocrystals inside antiresonant photonic crystal fiber
Authors: Machnev Andrey A. , Pushkarev Anatoly P. , Tonkaev Pavel , Noskov Roman E. , Rusimova Kristina R. , Mosley Peter J. , Makarov Sergey V. , Ginzburg Pavel B. , Shishkin Ivan I.
Published: May 2021

Structured environments are employed in a plethora of applications to tailor dynamics of light–matter interaction processes by modifying the structure of electromagnetic fields. The promising example of such a system is antiresonant photonic crystal fibers (AR-PCFs), which allow light–analyte interactions in a very long channel. Here we probe contribution of microstructuring and nontrivial mode hierarchy on light–matter interactions in AR-PCFs by investigating lifetime shortening of perovskite (

CsPbBr

3

) nanocrystals grown to fiber capillaries. The crystals have been deposited using a wet chemistry approach and then excited by a supercontinuum source in the 450–500 nm range. Emission spectra have been measured and analyzed via the time-correlated single photon counting (TCSPC) technique, unravelling contributions of core and cladding modes. Fluorescence lifetime imaging inside an AR-PCF enables mapping input of various electromagnetic channels into light–matter interaction processes. Our results pave the way for tailoring the dynamics of high-order quantum processes, promoting the concept of AR-PCF as a light-driven reactor.
Equity in clinical trials for HIV-associated cryptococcal meningitis: A systematic review of global representation and inclusion of patients and researchers
Authors: Lawrence David S. , Leeme Tshepo , Mosepele Mosepele , Harrison Thomas S. , Seeley Janet , Jarvis Joseph N.
Published: May 2021

Background

It is essential that clinical trial participants are representative of the population under investigation. Using HIV-associated cryptococcal meningitis (CM) as a case study, we conducted a systematic review of clinical trials to determine how inclusive and representative they were both in terms of the affected population and the involvement of local investigators.

Methods

We searched Medline, EMBASE, Cochrane, Africa-Wide, CINAHL Plus, and Web of Science. Data were extracted for 5 domains: study location and design, screening, participants, researchers, and funders. Data were summarised and compared over 3 time periods: pre-antiretroviral therapy (ART) (pre-2000), early ART (2000 to 2009), and established ART (post-2010) using chi-squared and chi-squared for trend. Comparisons were made with global disease burden estimates and a composite reference derived from observational studies.

Results

Thirty-nine trials published between 1990 and 2019 were included. Earlier studies were predominantly conducted in high-income countries (HICs) and recent studies in low- and middle-income countries (LMICs). Most recent studies occurred in high CM incidence countries, but some highly affected countries have not hosted trials. The sex and ART status of participants matched those of the general CM population. Patients with reduced consciousness and those suffering a CM relapse were underrepresented. Authorship had poor representation of women (29% of all authors), particularly as first and final authors. Compared to trials conducted in HICs, trials conducted in LMICs were more likely to include female authors (32% versus 20% p = 0.014) but less likely to have authors resident in (75% versus 100%, p < 0.001) or nationals (61% versus 93%, p < 0.001) of the trial location.

Conclusions

There has been a marked shift in CM trials over the course of the HIV epidemic. Trials are primarily performed in locations and populations that reflect the burden of disease, but severe and relapse cases are underrepresented. Most CM trials now take place in LMICs, but the research is primarily funded and led by individuals and institutions from HICs.
Promiscuous specialists: Host specificity patterns among generalist louse flies
Authors: Lehikoinen Aleksi , Pohjola Pekka , Valkama Jari , Mutanen Marko , Pohjoismäki Jaakko L. O.
Published: May 2021

Ectoparasites such as louse flies (Diptera: Hippoboscidae) have tendency for host specialization, which is driven by adaptation to host biology as well as competition avoidance between parasites of the same host. However, some louse fly species, especially in genera attacking birds, show wide range of suitable hosts. In the presented study, we have surveyed the current status of bird specific louse flies in Finland to provide comprehensive host association data to analyse the ecological requirements of the generalist species. A thorough sampling of 9342 birds, representing 134 species, recovered 576 specimens of louse flies, belonging to six species:Crataerina hirundinis,C.pallida,Ornithomya avicularia,O.chloropus,O.fringillinaandOrnithophila metallica. Despite some overlapping hosts, the threeOrnithomyaspecies showed a notable pattern in their host preference, which was influenced not only by the host size but also by the habitat and host breeding strategy. We also provide DNA barcodes for ten Finnish species of Hippoboscidae, which can be used as a resource for species identification as well as metabarcoding studies in the future.