bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing VOC loss via structure compatible and high lowest unoccupied molecular orbital nonfullerene acceptors for over 17%‐efficiency ternary organic photovoltaics
Authors: Yan Cenqi , Ma Ruijie , Cai Guilong , Liu Tao , Zhu Jingshuai , Wang Jiayu , Li Yuhao , Huang Jiaming , Luo Zhenghui , Xiao Yiqun , Lu Xinhui , Yang Tao , Zhan Xiaowei , Yan He , Li Gang
Published: October 2020

The ternary strategy is effectual to attain high‐performance organic photovoltaics (OPVs). Herein, device processing and performance of PM6:Y6:IT‐4F OPVs is improved, and ITIC‐Th with high‐lying lowest unoccupied molecular orbital is incorporated into PM6: Y6 blend. The PM6:Y6: ITIC‐Th device afforded an excellent PCE of 17.2%, surpassing PM6: Y6 device, and becoming one of the highest PCE. The resulting ITIC‐Th‐based ternary OSCs demonstrated low energy loss (Eloss) of 0.53 to 0.54 eV, as compared to their binary counterparts with either high open‐circuit voltage (VOC) but large Eloss, or less Eloss but low VOC. The incorporation of ITIC‐Th and IT‐4F balanced the charge mobilities, and thereby retained and improved fill factors. Increased crystalline coherence length and smaller d‐spacing of π‐π peaks are also observed in ternary blends, indicating enhanced crystallinity and thus improved active‐layer morphology. These findings demonstrate the feasibility of exploring the exciting pool of nonfullerene acceptors to pursue new breakthroughs of OPVs.

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Parameterized nonintrusive reduced‐order model for general unsteady flow problems using artificial neural networks
Authors: Şugar‐Gabor Oliviu
Published: October 2020

A nonintrusive reduced‐order model for nonlinear parametric flow problems is developed. It is based on extracting a reduced‐order basis from high‐order snapshots via proper orthogonal decomposition and using multilayered feedforward artificial neural networks to approximate the reduced‐order coefficients. The model is a generic and efficient approach for the reduction of time‐dependent parametric systems, including those described by partial differential equations. Since it is nonintrusive, it is independent of the high‐order computational method and can be used together with black‐box solvers. Numerical studies are presented for steady‐state isentropic nozzle flow with geometric parameterization and unsteady parameterized viscous Burgers equation. An adaptive sampling strategy is proposed to increase the quality of the neural network approximation while minimizing the required number of parameter samples and, as a direct consequence, the number of high‐order snapshots and the size of the network training set. Results confirm the accuracy of the nonintrusive approach as well as the speed‐up achieved compared with intrusive hyper‐reduced‐order approaches.
Multimodal imaging of brain reorganization in hearing late learners of sign language
Authors: Banaszkiewicz Anna , Matuszewski Jacek , Bola Łukasz , Szczepanik Michał , Kossowski Bartosz , Rutkowski Paweł , Szwed Marcin , Emmorey Karen , Jednoróg Katarzyna , Marchewka Artur
Published: October 2020

The neural plasticity underlying language learning is a process rather than a single event. However, the dynamics of training‐induced brain reorganization have rarely been examined, especially using a multimodal magnetic resonance imaging approach, which allows us to study the relationship between functional and structural changes. We focus on sign language acquisition in hearing adults who underwent an 8‐month long course and five neuroimaging sessions. We assessed what neural changes occurred as participants learned a new language in a different modality—as reflected by task‐based activity, connectivity changes, and co‐occurring structural alterations. Major changes in the activity pattern appeared after just 3 months of learning, as indicated by increases in activation within the modality‐independent perisylvian language network, together with increased activation in modality‐dependent parieto‐occipital, visuospatial and motion‐sensitive regions. Despite further learning, no alterations in activation were detected during the following months. However, enhanced coupling between left‐lateralized occipital and inferior frontal regions was observed as the proficiency increased. Furthermore, an increase in gray matter volume was detected in the left inferior frontal gyrus which peaked at the end of learning. Overall, these results showed complexity and temporal distinctiveness of various aspects of brain reorganization associated with learning of new language in different sensory modality.
A Field of Striving or Equity? Regional Public Universities and College Access
Authors: Warshaw Jarrett B. , DeMonbrun Matt , McNaughtan Jon
Published: October 2020

Many regional public universities (RPUs) provide college access to diverse groups of undergraduate students and face pressures to pursue prestige in the academic hierarchy. Prior research posits that RPUs will strive for prestige because of status‐ and resource‐based rewards that flow from increasing their admissions selectivity, research‐intensity, and wealth. As this dominant perspective suggests, RPUs may erode historic missions of democratizing educational opportunity to emulate their more elite peers to improve their external ratings and rankings. This chapter draws on multiple indicators of equity to examine whether institutional enrollment data align with, or diverge from, the prestige‐seeking assumptions about these institutions. Descriptive profiles indicate that most RPUs in this analysis have increased over time their enrollment of low‐income and racially diverse groups of students. We discuss implications for adopting a more flexible perspective on RPUs to account for equity‐based orientations in the sector and to inform responsive practices.
Islanded facial artery musculo‐mucosal flap for partial pharyngeal defect reconstruction after total laryngectomy: Case report
Authors: Akali Nisha Rajrattansingh , Jaya Arya Chandrababu , Balasubramanian Deepak , Iyer Subramania , Thankappan Krishnakumar
Published: October 2020

Background

Partial pharyngeal defect reconstruction after total laryngectomy with regional and free fasciocutaneous flaps has been described. However, mucosal flaps for such defects have not been reported.

Methods

An islanded facial artery musculo‐mucosal (FAMM) flap was used to reconstruct a partial pharyngeal defect after total laryngectomy. Surgical, swallowing, and speech outcomes were analyzed at 6 months postoperatively.

Results

At 6 months, videofluoroscopy showed no post swallow residue, fistula, trachea‐esophageal puncture leak, or stricture. Perceptual analysis of recorded cold speech, native language passage sample, and the intelligibility analysis was good. The patient had normal mouth opening and marginal mandibular nerve function.

Conclusion

Islanded FAMM flap is ideal for partial pharyngeal defects, which cannot be closed primarily. Speech and swallowing outcomes were good. It provided a robust and predictable blood supply and adequate reach. There was no significant donor site morbidity. The musculo‐mucosal flap replaced “like‐with‐like” tissue.
Independent professionals as talent: Evidence from individual views of working as a contractor
Authors: McKeown Tui , Pichault Francois
Published: October 2020

In this article we challenge the assumption that independent professionals (IPros), that is professionals who work as contractors, freelancers, and self‐employed individuals, are not within the remit of talent management (TM) theory and practice. The TM literature is almost exclusively focused on traditional employees and largely ignores the external workforce, even if like IPros, they epitomize high‐value talent. Moreover, much of the TM literature takes an organizational perspective while the individual perspective remains marginal. Advancing the notion of institutional factors in the macro environment suggested by King and Vaiman, we draw on interviews with 52 IPros in two contrasted institutional contexts to provide an agentic view of TM from outside of the standard employment relationship. Our findings reveal the importance of volition, emotional stability, internal locus of control, and self‐efficacy play in IPros effectively managing personal TM strategies. These strategies allow IPros to overcome the empowerment/powerlessness tensions Daubner‐Siva et al. call the “talent paradox.” Importantly, the results do not vary between the two national contexts, suggesting that embracing a “total TM” strategy, attentive to the personal characteristics of talent, regardless of the regulatory issues linked to employment status, will produce superior outcomes for all.
Magnetohydrodynamic mixed convective peristaltic slip transport of carbon nanotubes dispersed in water through an inclined channel with Joule heating
Authors: Anwar Talha , Tahir Muhammad , Kumam Poom , Ahmed Saleem , Thounthong Phatiphat
Published: October 2020

Carbon nanotubes are considered to be the latest nanotechnology innovation because of their remarkable physical and mechanical properties. Recently, researchers have shown great interest in the peristaltic transport of nanotube‐based nanofluid as this process involves a wide range of uses in the bioengineering, biomechanics, and medical fields. In this investigation, influence of single‐walled carbon nanotubes (SWCNTs) on magnetohydrodynamic mixed convective peristalsis through an inclined and asymmetric channel is analyzed. The additional physical mechanisms such as velocity slip, viscous dissipation, thermal slip, Joule heating, and heat consumption/injection are also encountered. The principal equations are formulated under the estimation of long wavelength and low Reynolds number. Perturbation method is operated to evaluate the solutions of subsequent nonlinear system of equations for small Brinkman number. To deeply analyze the characteristics of embedded parameters, graphs are presented and comprehensive interpretation is provided. Rate of heat transfer is augmented for higher proportion of SWCNTs in base fluid water. At the center of channel, increasing volume fraction of SWCNTs and strong Lorentz force retard the motion of fluid while flow is accelerated in more inclined channel. Volume fraction of SWCNTs, Grashof number, and inclination parameter encourage the pressure gradient at wider part of the channel. The size of bolus is contracted by strong Lorentz force and large volume fraction of SWCNTs. Three basic models named as Maxwell's, Hamilton‐Crosser's, and Xue's model are utilized to forecast the thermal conductivity of nanofluid and succeeding numerical computations for heat transfer rate are presented through table. It is found that the Xue's model is most effective to anticipate the thermal conductivity of nanofluids. Moreover, the addition of a heat sink in the system significantly influences the heat transfer process and plays a supportive role to rapidly cool down the channel.
Utilization cost of maternity services for childbirth among pregnant women with coronavirus disease 2019 in Nigeria’s epicenter
Authors: Banke‐Thomas Aduragbemi , Makwe Christian Chigozie , Balogun Mobolanle , Afolabi Bosede Bukola , Alex‐Nwangwu Theresa Amaogechukwu , Ameh Charles Anawo
Published: October 2020

Objective

To estimate utilization costs of spontaneous vaginal delivery (SVD) and cesarean delivery (CD) for pregnant women with coronavirus disease 2019 (COVID‐19) at the largest teaching hospital in Lagos, the pandemic's epicenter in Nigeria.

Methods

We collected facility‐based and household costs of all nine pregnant women with COVID‐19 managed at the hospital. We compared their mean facility‐based costs with those paid by pregnant women pre‐COVID‐19, identifying cost‐drivers. We also estimated what would have been paid without subsidies, testing assumptions with a sensitivity analysis.

Results

Total utilization costs ranged from US $494 for SVD with mild COVID‐19 to US $4553 for emergency CD with severe COVID‐19. Though 32%–66% of facility‐based cost were subsidized, costs of SVD and CD during the pandemic have doubled and tripled, respectively, compared with those paid pre‐COVID‐19. Of the facility‐based costs, cost of personal protective equipment was the major cost‐driver (50%). Oxygen was the major driver for women with severe COVID‐19 (48%). Excluding treatment costs for COVID‐19, mean facility‐based costs were US $228 (SVD) and US $948 (CD).

Conclusion

Despite cost exemptions and donations, utilization costs remain prohibitive. Regulation of personal protective equipment and medical oxygen supply chains and expansion of advocacy for health insurance enrollments are needed in order to minimize catastrophic health expenditure.
Prevalence of resurgence during thinning of multiple schedules of reinforcement following functional communication training
Authors: Muething Colin , Pavlov Alexis , Call Nathan , Ringdahl Joel , Gillespie Scott
Published: October 2020

The current study examined resurgence of problem behavior during thinning of multiple schedules of reinforcement following functional communication training replicating previous research (Briggs et al., 2018). Data were analyzed at each thinning step from subjects enrolled in an intensive day treatment program over a 5‐year period. Results indicated that of the 239 thinning steps analyzed, resurgence was observed in 97 of those steps (40.6%), similar to results of Briggs et al. (2018). The data were also analyzed to estimate the magnitude of resurgence when it was observed. In the first session after the thinning step, the rate of problem behavior observed was 7 times higher than the average of the 5 sessions pre‐thinning step.
3D printed bismuth oxide‐polylactic acid composites for radio‐mimetic computed tomography spine phantoms
Authors: Arnold John , Sarkar Korak , Smith Damon
Published: October 2020

Polylactic acid (PLA) composite filaments with varying concentrations of bismuth oxide microparticle additives were fabricated for use with commercially available fused filament fabrication (FFF) printing systems for the production of spine phantoms that mimic the radiopacity of bone. Thermal analysis showed that the additives had limited impact on the glass transition temperature and melting point of the filaments, allowing for their use in commercial FFF systems with standard printer settings. The ultimate strength of the printed test specimens was found to reduce slightly when bismuth oxide was added in high concentrations, with a moderate reduction of 12% compared to PLA at the highest concentration of 30 wt%. The modulus of the specimens increased by up to 24% with the addition of the additive. The radiopacity of specimens printed with the composite filaments were measured by X‐ray microcomputed tomography (micro‐CT) and clinical computed tomography (CT). The CT number was found to increase by approximately 196 HU per wt% of bismuth oxide added to the filaments. A phantom model of a cervical spine deformity was successfully printed by FFF with a composite filament which was calibrated to mimic the radiopacity of cervical and cortical bone. The results indicate that the composite filaments have direct applicability for the production of phantoms used for education and preoperative planning.
On the stability and chemical bond of noble gas halide cations NgX+ (Ng = He – Rn; X = F – I)
Authors: Arrué Lily , Pino‐Rios Ricardo
Published: October 2020

Despite the belief that noble gases (Ng) are completely inert and cannot form stable molecules, a variety of Ng compounds have been reported under laboratory conditions and others were recently detected in the interstellar media, raising interest in knowing and studying their bond nature and the physicochemical properties associated with their stability. In the present work, a systematic analysis of the thermodynamic stability of noble gas halide cations (NgX+) at the CCSD(T)/def2‐QZVP level have been performed. In addition, chemical bond was characterized through Natural Bonding Theory (NBO), Quantum Theory of Atoms in Molecules (QTAIM) and Energy Decomposition Analysis (EDA) with relativistic corrections. All methods suggest that NgX+ compounds possess a strong covalent bond. However, results show that only compounds containing Ar–Rn atoms are thermodynamic stable with a highly energetic and endergonic dissociation process. For these reasons, it is possible to suggest that several compounds that have not yet been reported could be obtained at the laboratory level or observed in the interstellar medium.
De novo generation of optically active small organic molecules using Monte Carlo tree search combined with recurrent neural network
Authors: Tashiro Motomichi , Imamura Yutaka , Katouda Michio
Published: October 2020

Optically active small organic molecules are computationally designed using the ChemTS python library developed by Tsuda and collaborators, which utilizes a combined Monte Carlo tree search (MCTS) and recurrent neural network model. Geometry optimization and excited‐state calculations are performed for each generated molecule, following which the excitation energy and dissymmetry factors are computed to evaluate the score function in the MCTS process. Using this procedure, molecules not contained in existing databases are generated. Molecules having either high dissymmetry factors or high transition dipole strengths can be generated depending on the choice of the score function. In a single trajectory with 100,000 trials, mutually similar high‐scoring molecules are generated frequently after the initial 15,000–20,000 trials. This indicates that it is better to sample high‐scoring molecules from several trajectories having a modest number of trials each than from a single trajectory having a large number of trials.
Is positive mental health and the absence of mental illness the same? Factors associated with flourishing and the absence of depressive symptoms in postpartum women
Authors: Monteiro Fabiana , Fonseca Ana , Pereira Marco , Canavarro Maria C.
Published: October 2020

Objective

Exploring a wide range of factors associated with flourishing and with the absence of depressive symptoms among postpartum women.

Methods

A sample of 661 postpartum women completed a set of questionnaires assessing sociodemographic and infant‐related data, flourishing, psychological flexibility, self‐compassion, resilience, and maternal confidence.

Results

Younger infant age, higher levels of maternal confidence, and resilience increased the likelihood of flourishing. In turn, higher income, fewer problems with an infant's sleep, perceiving an infant's temperament as easy, and higher psychological flexibility increased the likelihood of not having depressive symptoms. Appraising the support received by others as good and having higher self‐compassion increased the likelihood of both outcomes.

Conclusions

Our results support positive mental health and mental illness being related but distinct dimensions. Promoting positive mental health in the postpartum period should be an additional goal in public health care as it may efficiently complement the prevention of psychopathology.
Evaluating High Spatial Resolution Diffusion Kurtosis Imaging at 3T: Reproducibility and Quality of Fit
Authors: Kasa Loxlan W. , Haast Roy A.M. , Kuehn Tristan K. , Mushtaha Farah N. , Baron Corey A. , Peters Terry , Khan Ali R.
Published: October 2020

Background

Diffusion kurtosis imaging (DKI) quantifies the non‐Gaussian diffusion of water within tissue microstructure. However, it has increased fitting parameters and requires higher b‐values. Evaluation of DKI reproducibility is important for clinical purposes.

Purpose

To assess the reproducibility in whole‐brain high‐resolution DKI at varying b‐values.

Study Type

Retrospective.

Subjects and Phantoms

In all, 44 individuals from the test–retest Human Connectome Project (HCP) database and 12 3D‐printed phantoms.

Field Strength/Sequence

Diffusion‐weighted multiband echo‐planar imaging sequence at 3T and 9.4T. magnetization‐prepared rapid acquisition gradient echo at 3T for in vivo structural data only.

Assessment

From HCP data with b‐values = 1000, 2000, 3000 s/mm2 (dataset A), two additional datasets with b‐values = 1000, 3000 s/mm2 (dataset B) and b‐values = 1000, 2000 s/mm2 (dataset C) were extracted. Estimated DKI metrics from each dataset were used for evaluating reproducibility and fitting quality in white matter (WM) and gray matter (GM) based on whole‐brain and regions of interest (ROIs).

Statistical Tests

DKI reproducibility was assessed using the within‐subject coefficient of variation (CoV), fitting residuals to evaluate DKI fitting accuracy and Pearson's correlation to investigate the presence of systematic biases. Repeated measures analysis of variance was used for statistical comparison.

Results

Datasets A and B exhibited lower DKI CoVs (<20%) compared to C (<50%) in both WM and GM ROIs (all P < 0.05). This effect varies between DKI and DTI parameters (P < 0.005). Whole‐brain fitting residuals were consistent across datasets (P > 0.05), but lower residuals in dataset B were detected for the WM ROIs (P < 0.001). A similar trend was observed for the phantom data CoVs (<7.5%) at varying fiber orientations for datasets A and B. Finally, dataset C was characterized by higher residuals across the different fiber crossings (P < 0.05).

Data Conclusion

The study demonstrates that high reproducibility can still be achieved within a reasonable scan time, specifically dataset B, supporting the potential of DKI for aiding clinical tools in detecting microstructural changes.
Dipolar mode of precipitation changes between north China and the Yangtze River Valley existed over the entire Holocene: Evidence from the sediment record of Nanyi Lake
Authors: Liu Jianbao , Shen Zhongwei , Chen Wei , Chen Jie , Zhang Xu , Chen Jianhui , Chen Fahu
Published: October 2020

Instrumental data indicate the occurrence of a dipolar pattern of precipitation anomalies between north China and the Yangtze River Valley (YRV), which was termed “northern drought (flood)—southern flood (drought)” scenario. It has been shown that this pattern occurred during the Medieval Climate Anomaly (MCA) and the Little Ice Age (LIA). However, there are questions about whether this dipolar pattern also occurred during the entire Holocene, and the mechanism responsible. Addressing these questions is of fundamental importance for understanding the spatiotemporal evolution of precipitation in East Asian summer monsoon region. Numerous studies of north China have demonstrated that the mid‐Holocene was humid, and the early and late Holocene were dry. However, there are relatively few equivalent studies in the YRV. To this end, we conducted detailed geochemical analysis of an AMS 14C‐dated sediment core from Lake Nanyi in the YRV. Our results indicate humid periods at Lake Nanyi occurred during 11.5–8.0 ka and from 2.0 ka to the present, while dry conditions occurred during ~8.0–2.0 ka. These results, together with published records from Dajiuhu peatland and Heshang Cave, collectively indicate in the YRV, the mid‐Holocene (~8.0–3.0 ka) was dry, while the early and late Holocene were humid, which is the inverse of the pattern in north China. Thus, we conclude there was an asynchronous evolution of hydroclimatic changes between north China and the YRV during the Holocene. We interpret this dipolar pattern as the result of ENSO variations: in a La Niña‐like state, the Western Pacific Subtropical High retreated northeastward, which would enable the rainfall belt to move northward and result in increased (decreased) precipitation in north China (the YRV). Sea surface temperature records from the Pacific Ocean and model simulations support this mechanism: a La Niña‐like state in the mid‐Holocene resulted in more (less) precipitation in north China (the YRV).
Comparison of Equations to Predict Energy Requirements With Indirect Calorimetry in Hospitalized Patients
Authors: Oliveira Ana Caroline da Silva , de Oliveira Carolina Cunha , de Jesus Monique Tavares , Menezes Nara Nayane Brito , de Gois Fernanda Noronha , da Silva Juliana Teixeira , Santos Larissa Menezes
Published: October 2020

Background

The accuracy of methods to determine resting energy expenditure (REE) contributes toward the adequate provision of nutrition support to hospitalized patients. Indirect calorimetry (IC) is considered the gold‐standard method to determine REE. The aim of this study is to evaluate the degree of agreement between the REE measured by IC (REE‐IC) and REE estimated by predictive equations in intensive care unit patients.

Methods

The sample is made up of intensive care unit patients aged >18 years, both male and female, undergoing nutrition therapy. The predictive equations to estimate REE were the Harris Benedict (HB), Ireton Jones (IJ), and practical method (PM). Degree of agreement between REE‐predictive equations and REE‐IC was analyzed by the interclass correlation coefficient (ICC) and the Bland‐Altman test.

Results

Average energy obtained by IC was significantly different from HB and IJ equations (P < .001). The HB equation significantly underestimated the REE‐IC for body mass index (BMI) classification. Significant concordance was observed between the REE‐IC and all estimate equations (P < .05). The IJ equation showed the greatest degree of concordance for BMI classification of underweight (ICC = 0.674; P = .011) and presented the least difference between the averages of the energy when compared with REE‐IC (107.8 kcal/d; P < .05).

Conclusion

The IJ equation showed better results with IC, with the greatest degree of concordance for BMI classification of underweight. Further research should develop others equations and validate tools to measure energy expenditure for accurate dietary recommendations for hospitalized patients undergoing nutrition therapy.
Recurrence patterns in patients with Stage II melanoma: The evolving role of routine imaging for surveillance
Authors: Bleicher Josh , Swords Douglas S. , Mali Meghan E. , McGuire Lauren , Pahlkotter Maranda K. , Asare Elliot A. , Bowles Tawnya L. , Hyngstrom John R.
Published: October 2020

Background and Objectives

The relatively recent availability of effective systemic therapies for metastatic melanoma necessitates reconsideration of current surveillance patterns. Evidence supporting surveillance guidelines for resected Stage II melanoma is lacking. Prior reports note routine imaging detects only 21% of recurrent disease. This study aims to define recurrence patterns for Stage II melanoma to inform future surveillance guidelines.

Methods

This is a retrospective study of patients with Stage II melanoma. We analyzed risk factors for recurrence and methods of recurrence detection. We also assessed survival. Yearly hazards of recurrence were visualized.

Results

With a median follow‐up of 4.9 years, 158 per 580 patients (27.2%) recurred. Overall, most recurrences were patient‐detected (60.7%) or imaging‐detected (27.3%). Routine imaging was important in detecting recurrence in patients with distant recurrences (adjusted rate 43.1% vs. 9.4% for local/in‐transit; p = .04) and with Stage IIC melanoma (42.5% vs. 18.5% for IIA; p = .01). Male patients also self‐detected recurrent disease less than females (52.1% vs. 76.8%; p < .01).

Conclusions

Routine imaging surveillance played a larger role in detecting recurrent disease for select groups in this cohort than noted in prior studies. In an era of effective systemic therapy, routine imaging should be considered for detection of asymptomatic relapse for select, high‐risk patient groups.
Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?
Authors: Rouanet Philippe , Rivoire Michel , Gourgou Sophie , Lelong Bernard , Rullier Eric , Jafari Merhdad , Mineur Laurent , Pocard Marc , Faucheron Jean Luc , Dravet François , Pezet Denis , Fabre Jean Michel , Bresler Laurent , Balosso Jacques , Taoum Christophe , Lemanski Claire
Published: October 2020

Background

Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra‐low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10‐year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR).

Methods

ULRC indicated for APR were included (n = 207). Randomization was between high‐dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection.

Results

Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10‐year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease‐free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%).

Conclusion

GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long‐term oncologic follow‐up validates this attitude.
Metabolic profiling of ligustilide and identification of the metabolite in rat and human hepatocytes by liquid chromatography combined with high‐resolution mass spectrometry
Authors: Tao Simei , Li Huidi , Liu Jie
Published: October 2020

Ligustilide is one of the most abundant bioactive ingredients in Rhizoma Chuanxiong that has been widely prescribed for medicinal purposes in China. To better understand the disposition and action of ligustilide, it is necessary to investigate the metabolic profiles. The in vitro metabolism was elucidated through incubating ligustilide with human and rat hepatocytes at 37°C. The incubation samples were collected at predefined time points to determine the metabolic stability. Upon metabolite identification and profiling, the incubation samples were analyzed by ultra‐high‐performance liquid chromatography combined with diode array detector and high‐resolution mass spectrometry. The structures of the metabolites were characterized based on their mass spectrometry spectra, tandem mass spectrometry spectra, and fragmentation patterns. Ligustilide showed fast metabolism with high intrinsic clearance both in rat and human hepatocyte incubations. The half‐lives of ligustilide in rat and human hepatocyte incubations were 8.0 and 15.0 min, respectively. Most of the parent (>90%) was biotransformed into the metabolites. Among these metabolites, M1 (senkyunolide I) was the major metabolite both in rat and human hepatocytes with the percentage of 42 and 70%, respectively. The metabolic pathways of ligustilide included epoxidation, epoxide hydrolysis, aromatization, hydroxylation, and glutathionylation. This work provided an overview of the metabolic profiles of ligustilide, which would be helpful for us to understand the action of this compound.
Management of Head and Neck Cancers With or Without Comorbid HIV Infection in Botswana
Authors: McGinnis Gwendolyn J. , Ning Matthew S. , Bvochora‐Nsingo Memory , Chiyapo Sebathu , Balang Dawn , Ralefala Tlotlo , Lin Alexander , Zetola Nicola M. , Grover Surbhi
Published: October 2020

Objectives/Hypothesis

Head and neck cancer (HNC) is the fifth most common malignancy in sub‐Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)‐infection. HIV patients have higher rates of HNC, yet the effect of HIV‐infection on oncologic outcomes and treatment toxicity is poorly characterized.

Study Design

Prospective observational cohort study.

Methods

HNC patients attending a government‐funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV‐status. Overall survival (OS) was evaluated via Kaplan–Meier.

Results

The study enrolled 149 patients with a median follow‐up of 23 months. Patients presented with advanced disease (60% with T4‐primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5 months). Median OS was 36.2 months. Anemia was associated with worse survival (HR 2.74, P = .001). Grade ≥ 3 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, P = .03) and BMI < 20 kg/m2 (OR 6.04, P = .012). Forty percent of patients (n = 59) were HIV‐infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with ≤400 copies/mL), and had immunocompetent CD4 counts (median 400 cells/mm3). HIV‐status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity.

Conclusions

Despite access to government‐funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV‐status does not adversely affect outcomes.

Level of Evidence

2c Laryngoscope, 131:E1558–E1566, 2021
Effects of the planting of legume species and soil conditions on the recovery of a sand and pebble mining area
Authors: de Souza Rocha Rauny , Monteiro Victor Freitas , de Abreu Luiz Carlos Pantoja Chuva , Fernandes Ana Paula Donicht , dos Santos Cassio Rafael Costa
Published: October 2020

Extensive areas have been degraded worldwide through mineral extraction. Mining class II, especially sand and pebble mining (gravel extraction), has grown significantly in Brazilian Amazonia mainly in the State of Pará. In this context, the development of suitable and efficient recovery techniques is necessary to ensure mined land restoration. The objective of this study was to evaluate the effects of different types of management and green manure methods to recover degraded soil after the mining of pebbles and sand. The experiment was implemented in the northern region of the municipality of Capitão Poço, State of Pará. The procedures we used were: a randomized block design experiment, with a 4 × 3 factorial arrangement. Four legume species were tested: Cajanus cajan (L.), Canavalia ensiformis (L.) DC, Crotolaria juncea (L.), and Mucuna pruriens (L.); in addition, three soil conditions were also tested: exposed soil, topsoil, and hydrogel. Results of the analyses showed how the root collar diameter, stem length, fertility, germination, green and dry biomass varied; the variable topsoil had better results when compared to the samples that used hydrogel and those established on exposed soil in practically all the mean comparisons for isolated factors. Besides this, C. ensiformis (L.) DC and M. pruriens (L.) showed a better development, especially when grown in soils with topsoil deposition as a reconformed substrate. From these studies we conclude that the use of this substrate is to be recommended. C. ensiformis (L.) DC and M. pruriens (L.) are also recommended for restoration.
Upregulation of Cellular Palmitoylation Mitigates α‐Synuclein Accumulation and Neurotoxicity
Authors: Ho Gary P.H. , Ramalingam Nagendran , Imberdis Thibaut , Wilkie Erin C. , Dettmer Ulf , Selkoe Dennis J.
Published: October 2020

Background

Synucleinopathies, including Parkinson's disease (PD), are characterized by α‐synuclein (αS) cytoplasmic inclusions. αS‐dependent vesicle‐trafficking defects are important in PD pathogenesis, but their mechanisms are not well understood. Protein palmitoylation, post‐translational addition of the fatty acid palmitate to cysteines, promotes trafficking by anchoring specific proteins to the vesicle membrane. αS itself cannot be palmitoylated as it lacks cysteines, but it binds to membranes, where palmitoylation occurs, via an amphipathic helix. We hypothesized that abnormal αS membrane‐binding impairs trafficking by disrupting palmitoylation. Accordingly, we investigated the therapeutic potential of increasing cellular palmitoylation.

Objectives

We asked whether upregulating palmitoylation by inhibiting the depalmitoylase acyl‐protein‐thioesterase‐1 (APT1) ameliorates pathologic αS‐mediated cellular phenotypes and sought to identify the mechanism.

Methods

Using human neuroblastoma cells, rat neurons, and iPSC‐derived PD patient neurons, we examined the effects of pharmacologic and genetic downregulation of APT1 on αS‐associated phenotypes.

Results

APT1 inhibition or knockdown decreased αS cytoplasmic inclusions, reduced αS serine‐129 phosphorylation (a PD neuropathological marker), and protected against αS‐dependent neurotoxicity. We identified the APT1 substrate microtubule‐associated‐protein‐6 (MAP6), which binds to vesicles in a palmitoylation‐dependent manner, as a key mediator of these effects. Mechanistically, we found that pathologic αS accelerated palmitate turnover on MAP6, suggesting that APT1 inhibition corrects a pathological αS‐dependent palmitoylation deficit. We confirmed the disease relevance of this mechanism by demonstrating decreased MAP6 palmitoylation in neurons from αS gene triplication patients.

Conclusions

Our findings demonstrate a novel link between the fundamental process of palmitoylation and αS pathophysiology. Upregulating palmitoylation represents an unexplored therapeutic strategy for synucleinopathies. © 2020 International Parkinson and Movement Disorder Society
JAMA viewpoint a call to action on suicide mitigation amid COVID‐19
Authors: Canady Valerie A.
Published: October 2020

This pandemic represents a moment in history when suicide prevention must be prioritized as a serious public health concern, the chief medical officer of the American Foundation for Suicide Prevention (AFSP) stated in a new JAMA Psychiatry article. The commentary represents a call to action for policymakers, health system leaders, organizational leaders and the community to mitigate suicide risk during and after the pandemic.
Advocates praise new National Suicide Prevention Lifeline law
Authors: Canady Valerie A.
Published: October 2020

Calling it a “groundbreaking moment,” mental health advocates are applauding the designation of 988 as the new, universal hotline telephone number for suicide prevention and mental health crises. The bipartisan National Suicide Hotline Designation Act of 2020 was signed into law by President Trump on Oct. 17. The new number is expected to be active by July 2022.
Contracts in a procurement supply chain with intermediation: Combating collusion in price competition
Authors: Fan Xiaoshuai , Chen Ying‐Ju
Published: October 2020

This paper provides a novel explanation for collusion between two procurement service providers (PSPs) and investigates effective contracts to collapse tacit collusion. By analyzing a benchmark contract with compensation designed solely by a retailer, we find that compensation alone has no effect on intensifying PSPs' competition such that the PSPs still fully control the total service fee by increasing/decreasing the commission fee imposed on manufacturers. To effectively abate collusion, we propose two potential tactics to intensify PSPs' competition: setting a reserve price and introducing a direct sourcing channel. We find that both are effective in combating PSPs' pricing power. The underlying force is that both tactics create credible threats to walk away from this transaction with PSPs, and hence, both incentivize PSPs to lower the total service fee. However, the retailer reduces total welfare to improve its own profit: (a) when the retailer sets a strategic reserve price and the product's value in the market is moderate or (b) when the retailer introduces a direct channel but its search capability is weak. By comparing these two proposed contracts, we find that the retailer should introduce a direct sourcing channel when the product's value is high.
Equal‐order finite elements with nodal projection stabilization forDarcy–Forchheimermodel
Authors: Zhang Xianqiang , Xu Qiuyan
Published: October 2020

In this paper, we propose and analyze a stabilized mixed finite element method based on a local Scott–Zhang projector for Darcy–Forchheimer model, using continuous equal‐order finite elements for the velocity and pressure. This type of method belongs to the class of symmetric stabilization techniques, which provides additional control over the fluctuations of the velocity divergence and pressure gradient. An optimal error estimate in theH(div)‐norm for the velocity and quasi‐optimal error estimates in theL2‐norm for the velocity and pressure are derived. Numerical experiments are performed to demonstrate the convergence properties of the method.
Magnetic halloysite‐based molecularly imprinted polymer for specific recognition of sunset yellow in dyes mixture
Authors: Foroughirad Sahar , Haddadi‐Asl Vahid , Khosravi Alireza , Salami‐Kalajahi Mehdi
Published: October 2020

Novel magnetic halloysite‐based molecularly imprinted polymer (MMIP) is fabricated for sunset yellow dye removal from water solution. Field emission scanning electron microscopy, vibrating sample magnetometer, Zeta potential test, thermogravimetric, and nitrogen gas adsorption analysis were all employed for characterizations of the obtained magnetic halloysite and the final adsorbent. Transmission electron microscope images proved the synthesis of polymeric shell onto the magnetic nanotubes with the thickness of 10 nm. The adsorption kinetics were assessed by pseudo‐first order, pseudo‐second order, and intraparticle diffusion models and the results revealed that the obtained MMIP adsorption procedure would be controlled by chemical adsorption due to the high correlation coefficient (R2 ≥ 0.99) achieved for pseudo‐second order model. The effect of dye initial concentration was observed on the pseudo‐second order rate constant and the final equilibrium capacity of the MMIP. The adsorption isotherm at different temperatures (30 and 60°C) was assessed by two popular models, Langmuir and Freundlich. The resulting data were well fitted by Langmuir isotherm model, suggesting that the monolayer adsorption of sunset yellow onto the MMIP would occur. The exothermic behavior of the adsorption was justified by determining the effect of temperature on the Langmuir isotherm constant. The fabricated MMIP represented high adsorption capacity and imprinting factor of 46.43 μmol/g and 1.33, respectively. Moreover, the high selective recognition ability toward sunset yellow was observed for MMIP in the dyes mixture solution.
Thermoplastic polyurethane/graphene nanosheets composites with reduced microplastics release and enhanced mechanical properties
Authors: Huang Xin , Wang Yuting , Liu Jize , Zheng Zhuo , Zhang Xinxing
Published: October 2020

Microplastics are of increasing environmental concern as emerging contaminants worldwide. However, very limited studies are focused on the treatment of microplastics based on material design. Here, we propose a cut‐from‐the‐source strategy through incorporating graphene nanosheets (GNs) into thermoplastic polyurethane (TPU) to prepare high performance composites via melt‐processing. The effects and mechanism of GNs on microplastics release of TPU are first investigated. Benefiting from the barrier effect of GNs and the strong interfacial interaction, microplastics release of the obtained composites is effectively inhibited during oxidative degradation and the mechanical properties are simultaneously enhanced. This work provides a novel strategy for the source reduction of microplastics, inspiring the microplastics governance in the future.
Relation between anticholinergic burden and cognitive impairment: Results from the Monzino 80‐plus population‐based study
Authors: Pasina Luca , Lucca Ugo , Tettamanti Mauro
Published: October 2020

Purpose

We examined data collected in the Monzino 80‐plus study to assess the relations between cognitive performance and ACB scores according to the hypothesis that a higher anticholinergic burden is associated with reduced cognitive performance.

Methods

The Monzino 80‐plus is an ongoing, prospective, door‐to‐door population‐based study started in 2002 among all residents 80 years or older in eight municipalities of Varese province, Italy. To establish the relation between cognitive impairment and the anticholinergic drug burden we recorded the ACB score for each patient at baseline. The relations between ACB score and dementia or MMSE scores were also examined after exclusion of patients taking any antipsychotic.

Results

A sample of 2140 elderly people was eligible for analysis. A significant dose‐effect relationship was observed between total ACB score and diagnosis of dementia in univariate and multivariate models. Patients in ACB class ≥4 had about 4.5 times the risk of diagnosis of dementia. A relation was also found between higher ACB scores and lower MMSE scores; patients who scored 4 or more had a mean of 6.4 points lower than those not taking anticholinergic drugs. The dose‐effect relationship between ACB score and diagnosis of dementia was not maintained after exclusion of patients using antipsychotics, while the association between higher ACB scores and lower MMSE scores was still present, with patients in ACB class ≥4 having a mean score about 4.4 lower.

Conclusions

There are clear relations between anticholinergic load and reduced cognitive performance, while the association with dementia remains uncertain. For primary care and geriatric clinicians, an ACB score ≥ 4 can be considered the cut‐off to identify high‐risk populations who may benefit from the evaluation of anticholinergic burden with the ACB scale.
Monitoring real‐life utilization of pembrolizumab in advanced melanoma using the Portuguese National Cancer Registry
Authors: Borges Fábio C. , Ramos Catarina , Ramos Adriana , Mendes Gonçalo P. , Murteira Rodrigo , Soares Patrícia , Furtado Claudia , Miranda Ana C. , Costa Filipa A. ,   the RON network
Published: October 2020

Objectives

To evaluate the effectiveness and safety of pembrolizumab use in advanced melanoma in a real‐life context; and to explore the existence of an efficacy‐effectiveness gap, comparing registry data with the reference clinical trial.

Methods

This study followed the guidelines for good pharmacoepidemology practice. An ambispective cohort was constituted, initiating the observation upon drug approval (17/07/2015) and following exposed patients until death or cut‐off date (15/11/2019). The primary outcome was overall survival (OS); secondary outcomes comprised progression‐free survival (PFS), overall response rate (ORR) and the occurrence of adverse events (AE). For all survival analyses, the Kaplan‐Meier estimator was used, considering a 95% confidence interval (CI), aside with one‐year survival rates.

Results

A total of 125 patients constituted the cohort, originating from 16 hospitals in Portugal. Median OS was estimated to be 16.9 months (CI95% 11.3‐25.5) and the probability of survival after 1 year was 57.5% (CI95% 48.4%‐65.6%). Median PFS was estimated to be 4.8 months (CI95% 3.9‐6.7) and the probability of remaining progression‐free after 1 year was 32.8% (CI95% 24.8‐41.1). ORR was 30.4% (CI95% 22.5%‐39.3%). AEs were experienced by 82% of patients, and 27% experienced AE≥ grade 3.

Conclusions

Our data suggest lower effectiveness in a real‐life context than the efficacy reported in the clinical trial. Safety data seems, however, quite comparable to KEYNOTE‐006.