bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary care practices’ ability to predict future risk of expenditures and hospitalization using risk stratification and segmentation
Authors: Dorr David A. , Ross Rachel L. , Cohen Deborah , Kansagara Devan , Ramsey Katrina , Sachdeva Bhavaya , Weiner Jonathan P.
Published: March 2021

Background

Patients with complex health care needs may suffer adverse outcomes from fragmented and delayed care, reducing well-being and increasing health care costs. Health reform efforts, especially those in primary care, attempt to mitigate risk of adverse outcomes by better targeting resources to those most in need. However, predicting who is susceptible to adverse outcomes, such as unplanned hospitalizations, ED visits, or other potentially avoidable expenditures, can be difficult, and providing intensive levels of resources to all patients is neither wanted nor efficient. Our objective was to understand if primary care teams can predict patient risk better than standard risk scores.

Methods

Six primary care practices risk stratified their entire patient population over a 2-year period, and worked to mitigate risk for those at high risk through care management and coordination. Individual patient risk scores created by the practices were collected and compared to a common risk score (Hierarchical Condition Categories) in their ability to predict future expenditures, ED visits, and hospitalizations. Accuracy of predictions, sensitivity, positive predictive values (PPV), and c-statistics were calculated for each risk scoring type. Analyses were stratified by whether the practice used intuition alone, an algorithm alone, or adjudicated an algorithmic risk score.

Results

In all, 40,342 patients were risk stratified. Practice scores had 38.6% agreement with HCC scores on identification of high-risk patients. For the 3,381 patients with reliable outcomes data, accuracy was high (0.71–0.88) but sensitivity and PPV were low (0.16–0.40). Practice-created scores had 0.02–0.14 lower sensitivity, specificity and PPV compared to HCC in prediction of outcomes. Practices using adjudication had, on average, .16 higher sensitivity.

Conclusions

Practices using simple risk stratification techniques had slightly worse accuracy in predicting common outcomes than HCC, but adjudication improved prediction.
Prebiotic properties of Bacillus coagulans MA-13: production of galactoside hydrolyzing enzymes and characterization of the transglycosylation properties of a GH42 β-galactosidase
Authors: Aulitto Martina , Strazzulli Andrea , Sansone Ferdinando , Cozzolino Flora , Monti Maria , Moracci Marco , Fiorentino Gabriella , Limauro Danila , Bartolucci Simonetta , Contursi Patrizia
Published: March 2021

Background

The spore-forming lactic acid bacterium Bacillus coagulans MA-13 has been isolated from canned beans manufacturing and successfully employed for the sustainable production of lactic acid from lignocellulosic biomass. Among lactic acid bacteria, B. coagulans strains are generally recognized as safe (GRAS) for human consumption. Low-cost microbial production of industrially valuable products such as lactic acid and various enzymes devoted to the hydrolysis of oligosaccharides and lactose, is of great importance to the food industry. Specifically, α- and β-galactosidases are attractive for their ability to hydrolyze not-digestible galactosides present in the food matrix as well as in the human gastrointestinal tract.

Results

In this work we have explored the potential of B. coagulans MA-13 as a source of metabolites and enzymes to improve the digestibility and the nutritional value of food. A combination of mass spectrometry analysis with conventional biochemical approaches has been employed to unveil the intra- and extra- cellular glycosyl hydrolase (GH) repertoire of B. coagulans MA-13 under diverse growth conditions. The highest enzymatic activity was detected on β-1,4 and α-1,6-glycosidic linkages and the enzymes responsible for these activities were unambiguously identified as β-galactosidase (GH42) and α-galactosidase (GH36), respectively. Whilst the former has been found only in the cytosol, the latter is localized also extracellularly. The export of this enzyme may occur through a not yet identified secretion mechanism, since a typical signal peptide is missing in the α-galactosidase sequence. A full biochemical characterization of the recombinant β-galactosidase has been carried out and the ability of this enzyme to perform homo- and hetero-condensation reactions to produce galacto-oligosaccharides, has been demonstrated.

Conclusions

Probiotics which are safe for human use and are capable of producing high levels of both α-galactosidase and β-galactosidase are of great importance to the food industry. In this work we have proven the ability of B. coagulans MA-13 to over-produce these two enzymes thus paving the way for its potential use in treatment of gastrointestinal diseases.
sparrpowR: a flexible R package to estimate statistical power to identify spatial clustering of two groups and its application
Authors: Buller Ian D. , Brown Derek W. , Myers Timothy A. , Jones Rena R. , Machiela Mitchell J.
Published: March 2021

Background

Cancer epidemiology studies require sufficient power to assess spatial relationships between exposures and cancer incidence accurately. However, methods for power calculations of spatial statistics are complicated and underdeveloped, and therefore underutilized by investigators. The spatial relative risk function, a cluster detection technique that detects spatial clusters of point-level data for two groups (e.g., cancer cases and controls, two exposure groups), is a commonly used spatial statistic but does not have a readily available power calculation for study design.

Results

We developedsparrpowRas an open-source R package to estimate the statistical power of the spatial relative risk function.sparrpowRgenerates simulated data applying user-defined parameters (e.g., sample size, locations) to detect spatial clusters with high statistical power. We present applications ofsparrpowRthat perform a power calculation for a study designed to detect a spatial cluster of incident cancer in relation to a point source of numerous environmental emissions. The conducted power calculations demonstrate the functionality and utility ofsparrpowRto calculate the local power for spatial cluster detection.

Conclusions

sparrpowRimproves the current capacity of investigators to calculate the statistical power of spatial clusters, which assists in designing more efficient studies. This newly developed R package addresses a critically underdeveloped gap in cancer epidemiology by estimating statistical power for a common spatial cluster detection technique.
Risk factors for breast cancer development by tumor characteristics among women with benign breast disease
Authors: Figueroa Jonine D. , Gierach Gretchen L. , Duggan Máire A. , Fan Shaoqi , Pfeiffer Ruth M. , Wang Yihong , Falk Roni T. , Loudig Olivier , Abubakar Mustapha , Ginsberg Mindy , Kimes Teresa M. , Richert-Boe Kathryn , Glass Andrew G. , Rohan Thomas E.
Published: March 2021

Background

Among women diagnosed with invasive breast cancer, 30% have a prior diagnosis of benign breast disease (BBD). Thus, it is important to identify factors among BBD patients that elevate invasive cancer risk. In the general population, risk factors differ in their associations by clinical pathologic features; however, whether women with BBD show etiologic heterogeneity in the types of breast cancers they develop remains unknown.

Methods

Using a nested case-control study of BBD and breast cancer risk conducted in a community healthcare plan (Kaiser Permanente Northwest), we assessed relationships of histologic features in BBD biopsies and patient characteristics with subsequent breast cancer risk and tested for heterogeneity of associations by estrogen receptor (ER) status, tumor grade, and size. The study included 514 invasive breast cancer cases (median follow-up of 9 years post-BBD diagnosis) and 514 matched controls, diagnosed with proliferative or non-proliferative BBD between 1971 and 2006, with follow-up through mid-2015. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using multivariable polytomous logistic regression models.

Results

Breast cancers were predominantly ER-positive (86%), well or moderately differentiated (73%), small (74% < 20 mm), and stage I/II (91%). Compared to patients with non-proliferative BBD, proliferative BBD with atypia conferred increased risk for ER-positive cancer (OR = 5.48, 95% CI = 2.14–14.01) with only one ER-negative case,P-heterogeneity = 0.45. The presence of columnar cell lesions (CCLs) at BBD diagnosis was associated with a 1.5-fold increase in the risk of both ER-positive and ER-negative tumors, with a 2-fold increase (95% CI = 1.21–3.58) observed among postmenopausal women (56%), independent of proliferative BBD status with and without atypia. We did not identify statistically significant differences in risk factor associations by tumor grade or size.

Conclusion

Most tumors that developed after a BBD diagnosis in this cohort were highly treatable low-stage ER-positive tumors. CCL in BBD biopsies may be associated with moderately increased risk, independent of BBD histology, and irrespective of ER status.
Tamoxifen suppresses brain metastasis of estrogen receptor-deficient breast cancer by skewing microglia polarization and enhancing their immune functions
Authors: Wu Shih-Ying , Sharma Sambad , Wu Kerui , Tyagi Abhishek , Zhao Dan , Deshpande Ravindra Pramod , Watabe Kounosuke
Published: March 2021

Background

Brain metastasis of breast cancer exhibits exceedingly poor prognosis, and both triple negative (TN) and Her2+ subtypes have the highest incidence of brain metastasis. Although estrogen blockers are considered to be ineffective for their treatment, recent evidence indicates that estrogen blockade using tamoxifen showed certain efficacy. However, how estrogen affects brain metastasis of triple negative breast cancer (TNBC) remains elusive.

Methods

To examine the effect of estrogen on brain metastasis progression, nude mice were implanted with brain metastatic cells and treated with either estrogen supplement, tamoxifen, or ovariectomy for estrogen depletion. For clinical validation study, brain metastasis specimens from pre- and post-menopause breast cancer patients were examined for microglia polarization by immunohistochemistry. To examine the estrogen-induced M2 microglia polarization, microglia cells were treated with estrogen, and the M1/M2 microglia polarization was detected by qRT-PCR and FACS. The estrogen receptor-deficient brain metastatic cells, SkBrM and 231BrM, were treated with conditioned medium (CM) derived from microglia that were treated with estrogen in the presence or absence of tamoxifen. The effect of microglia-derived CM on tumor cells was examined by colony formation assay and sphere forming ability.

Results

We found that M2 microglia were abundantly infiltrated in brain metastasis of pre-menopausal breast cancer patients. A similar observation was made in vivo, when we treated mice systemically with estrogen. Blocking of estrogen signaling either by tamoxifen treatment or surgical resection of mice ovaries suppressed M2 microglial polarization and decreased the secretion of C-C motif chemokine ligand 5, resulting in suppression of brain metastasis. The estrogen modulation also suppressed stemness in TNBC cells in vitro. Importantly, estrogen enhanced the expression of signal regulatory protein α on microglia and restricted their phagocytic ability.

Conclusions

Our results indicate that estrogen promotes brain metastasis by skewing polarity of M2 microglia and inhibiting their phagocytic ability, while tamoxifen suppresses brain metastasis by blocking the M2 polarization of microglia and increasing their anti-tumor phagocytic ability. Our results also highlight a potential therapeutic utility of tamoxifen for treating brain metastasis of hormone receptor-deficient breast cancer.
Does smallholder farmers’ awareness of Sustainable Development Goal 2 improve household food security in the Northern Region of Ghana?
Authors: Mabe Franklin Nantui , Mumuni Eliasu , Sulemana Nashiru
Published: March 2021

Background

Sustainable Development Goal 2 aims at ending hunger, achieving food security, improving nutrition and promoting sustainable agriculture. Whilst some smallholder farmers are aware of this goal, others are not. The question that arises is whether or not awareness translates into food security. Therefore, this study assessed whether or not smallholder farmers’ awareness of Sustainable Development Goal 2 improves household food security in the Northern Region of Ghana.

Methods

The study used cross-sectional primary data collected from two districts and two municipalities in the region. An endogenous switching regression treatment effects model with ordered outcome was used to estimate the effects of smallholder farmers’ awareness of Sustainable Development Goal 2 on household food insecurity level.

Results

The age of household head, distance of households to the regional capital, membership of farmer-based organizations, access to e-extension, education, and ownership of radio are the key drivers of farmers’ awareness of Sustainable Development Goal 2. The results from the endogenous switching regression treatment effects model with ordered outcome showed that households who are aware of the second goal are more food secure than their counterparts.

Conclusions

It is therefore prudent for stakeholders promoting and championing Sustainable Development Goals to educate farmers on goal 2 as their awareness of the goal is critical to achieving food security.
Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage: a cohort study
Authors: You Shoujiang , Wang Yupin , Lu Zian , Chu Dandan , Han Qiao , Xu Jiaping , Liu Chun-Feng , Cao Yongjun , Zhong Chongke
Published: March 2021

Background

Dynamic change of heart rate in the acute phase and clinical outcomes after intracerebral hemorrhage (ICH) remains unknown. We aimed to investigate the associations of heart rate trajectories and variability with functional outcome and mortality in patients with acute ICH.

Methods

This prospective study was conducted among 332 patients with acute ICH. Latent mixture modeling was used to identify heart rate trajectories during the first 72 h of hospitalization after ICH onset. Mean and coefficient of variation of heart rate measurements were calculated. The study outcomes included unfavorable functional outcome, ordinal shift of modified Rankin Scale score, and all-cause mortality.

Results

We identified 3 distinct heart rate trajectory patterns (persistent-high, moderate-stable, and low-stable). During 3-month follow-up, 103 (31.0%) patients had unfavorable functional outcome and 46 (13.9%) patients died. In multivariable-adjusted model, compared with patients in low-stable trajectory, patients in persistent-high trajectory had the highest odds of poor functional outcome (odds ratio 15.06, 95% CI 3.67–61.78). Higher mean and coefficient of variation of heart rate were also associated with increased risk of unfavorable functional outcome (P trend < 0.05), and the corresponding odds ratios (95% CI) comparing two extreme tertiles were 4.69 (2.04–10.75) and 2.43 (1.09–5.39), respectively. Likewise, similar prognostic effects of heart rate dynamic changes on high modified Rankin Scale score and all-cause mortality were observed.

Conclusions

Persistently high heart rate and higher variability in the acute phase were associated with increased risk of unfavorable functional outcome in patients with acute ICH.
Deep learning approaches for natural product discovery from plant endophytic microbiomes
Authors: Aghdam Shiva Abdollahi , Brown Amanda May Vivian
Published: March 2021

Plant microbiomes are not only diverse, but also appear to host a vast pool of secondary metabolites holding great promise for bioactive natural products and drug discovery. Yet, most microbes within plants appear to be uncultivable, and for those that can be cultivated, their metabolic potential lies largely hidden through regulatory silencing of biosynthetic genes. The recent explosion of powerful interdisciplinary approaches, including multi-omics methods to address multi-trophic interactions and artificial intelligence-based computational approaches to infer distribution of function, together present a paradigm shift in high-throughput approaches to natural product discovery from plant-associated microbes. Arguably, the key to characterizing and harnessing this biochemical capacity depends on a novel, systematic approach to characterize the triggers that turn on secondary metabolite biosynthesis through molecular or genetic signals from the host plant, members of the rich ‘in planta’ community, or from the environment. This review explores breakthrough approaches for natural product discovery from plant microbiomes, emphasizing the promise of deep learning as a tool for endophyte bioprospecting, endophyte biochemical novelty prediction, and endophyte regulatory control. It concludes with a proposed pipeline to harness global databases (genomic, metabolomic, regulomic, and chemical) to uncover and unsilence desirable natural products.
Highlight selection of radiochemistry and radiopharmacy developments by editorial board
Authors: Aime Silvio , Al-Qahtani Mohammed , Behe Martin , Bormans Guy , Carlucci Giuseppe , DaSilva Jean N. , Decristoforo Clemens , Duatti Adriano , Elsinga Philip H. , Kopka Klaus , Li Xiang-Guo , Liu Zhibo , Mach Robert H. , Middel Oskar , Passchier Jan , Patt Marianne , Penuelas Ivan , Rey Ana , Scott Peter J. H. , Todde Sergio , Toyohara Jun , Vugts Danielle , Yang Zhi
Published: March 2021

Background

The Editorial Board of EJNMMI Radiopharmacy and Chemistry releases a biyearly highlight commentary to update the readership on trends in the field of radiopharmaceutical development.

Results

This commentary of highlights has resulted in 23 different topics selected by each member of the Editorial Board addressing a variety of aspects ranging from novel radiochemistry to first in man application of novel radiopharmaceuticals.

Conclusion

Trends in radiochemistry and radiopharmacy are highlighted demonstrating the progress in the research field being the scope of EJNMMI Radiopharmacy and Chemistry.
Should intramuscular clozapine be adopted into mainstream clinical practice?
Authors: Bhattacherjee Shaun , Young Anthony , Ahuja Niraj , Allen Steven
Published: March 2021

Clozapine is under-used in the UK, and Casetta et al's recent paper in the BJPsych adds to a growing number of small studies that support the use of intramuscular clozapine to initiate and maintain treatment with oral clozapine. However, intramuscular clozapine remains unlicensed and, because of the risks associated with its administration, it should be used only cautiously before it can be adopted more widely into mainstream clinical practice.
Low-Dose Tamoxifen for Mammographic Density Reduction: A Randomized Controlled Trial
Authors: Eriksson Mikael , Eklund Martin , Borgquist Signe , Hellgren Roxanna , Margolin Sara , Thoren Linda , Rosendahl Ann , Lång Kristina , Tapia José , Bäcklund Magnus , Discacciati Andrea , Crippa Alessio , Gabrielson Marike , Hammarström Mattias , Wengström Yvonne , Czene Kamila , Hall Per
Published: March 2021

PURPOSE

Tamoxifen prevents breast cancer in high-risk women and reduces mortality in the adjuvant setting. Mammographic density change is a proxy for tamoxifen therapy response. We tested whether lower doses of tamoxifen were noninferior to reduce mammographic density and associated with fewer symptoms.

PATIENTS AND METHODS

Women, 40-74 years of age, participating in the Swedish mammography screening program were invited to the 6-month double-blind six-arm randomized placebo-controlled noninferiority dose-determination KARISMA phase II trial stratified by menopausal status (EudraCT 2016-000882-22). In all, 1,439 women were accrued with 1,230 participants accessible for intention-to-treat analysis. The primary outcome was proportion of women treated with placebo, 1, 2.5, 5, and 10 mg whose mammographic density decreased at least as much as the median reduction in the 20 mg arm. The noninferior margin was 17%. Secondary outcome was reduction of symptoms. Post hoc analyses were performed by menopausal status. Per-protocol population and full population were analyzed in sensitivity analysis.

RESULTS

The 1,439 participants, 566 and 873 pre- and postmenopausal women, respectively, were recruited between October 1, 2016, and September 30, 2019. The participants had noninferior mammographic density reduction following 2.5, 5, and 10 mg tamoxifen compared with the median 10.1% decrease observed in the 20 mg group, a reduction confined to premenopausal women. Severe vasomotor symptoms (hot flashes, cold sweats, and night sweats) were reduced by approximately 50% in the 2.5, 5, and 10 mg groups compared with the 20 mg group.

CONCLUSION

Premenopausal women showed noninferior magnitude of breast density decrease at 2.5 mg of tamoxifen, but fewer side effects compared with the standard dose of 20 mg. Future studies should test whether 2.5 mg of tamoxifen reduces the risk of primary breast cancer.
Mantis shrimp identify an object by its shape rather than its color during visual recognition
Authors: Patel Rickesh N. , Khil Veniamin , Abdurahmonova Laylo , Driscoll Holland , Patel Sarina , Pettyjohn-Robin Olivia , Shah Ahmad , Goldwasser Tamar , Sparklin Benjamin , Cronin Thomas W.
Published: March 2021

Mantis shrimp commonly inhabit seafloor environments with an abundance of visual features including conspecifics, predators, prey and landmarks used for navigation. Although these animals are capable of discriminating color and polarization, it is unknown what specific attributes of a visual object are important during recognition. Here, we show that mantis shrimp of the species Neogonodactylus oerstedii are able to learn the shape of a trained target. Further, when the shape and color of a target that they had been trained to identify were placed in conflict, N. oerstedii tended to choose the target of the trained shape over the target of the trained color. Thus, we conclude that the shape of the target was more salient than its color during recognition by N. oerstedii, suggesting that the shapes of objects, such as landmarks or other animals, are important for their identification by the species.
Comparison of Activity Monitors Accuracy in Assessing Intermittent Outdoor Walking
Authors: TAOUM ALINE , CHAUDRU SÉGOLÈNE , DE MÜLLENHEIM PIERRE-YVES , CONGNARD FLORIAN , EMILY MATHIEU , NOURY-DESVAUX BÉNÉDICTE , BICKERT SANDRINE , CARRAULT GUY , MAHÉ GUILLAUME , LE FAUCHEUR ALEXIS
Published: March 2021

Purpose

This study aimed to determine and compare the accuracy of different activity monitors in assessing intermittent outdoor walking in both healthy and clinical populations through the development and validation of processing methodologies.

Methods

In study 1, an automated algorithm was implemented and tested for the detection of short (≤1 min) walking and stopping bouts during prescribed walking protocols performed by healthy subjects in environments with low and high levels of obstruction. The following parameters obtained from activity monitors were tested, with different recording epochs0.1s/0.033s/1s/3s/10s and wearing locationsscapula/hip/wrist/ankle: GlobalSat DG100 (GS) and Qstarz BT-Q1000XT/-Q1000eX (QS) speed; ActiGraph wGT3X+ (AG) vector magnitude (VM) raw data, VM counts, and steps; and StepWatch3 (SW) steps. Furthermore, linear mixed models were developed to estimate walking speeds and distances from the monitors parameters. Study 2 validated the performance of the activity monitors and processing methodologies in a clinical population showing profile of intermittent walking due to functional limitations during outdoor walking sessions.

Results

In study 1, GS1s, scapula, QS1s, scapula/wrist speed, and AG0.033s, hip VM raw data provided the highest bout detection rates (>96.7%) and the lowest root mean square errors in speed (≤0.4 km·h−1) and distance (<18 m) estimation. Using SW3s, ankle steps, the root mean square error for walking/stopping duration estimation reached 13.6 min using proprietary software and 0.98 min using our algorithm (total recording duration, 282 min). In study 2, using AG0.033s, hip VM raw data, the bout detection rate (95% confidence interval) reached 100% (99%–100%), and the mean (SD) absolute percentage errors in speed and distance estimation were 9% (6.6%) and 12.5% (7.9%), respectively.

Conclusions

GPS receivers and AG demonstrated high performance in assessing intermittent outdoor walking in both healthy and clinical populations.
Fasciectomy for Recurrent Chronic Exertional Compartment Syndrome of the Anterior Leg
Authors: VOGELS SANNE , VAN ARK WENDELA , JANSSEN LOES , SCHELTINGA MARC R. M.
Published: March 2021

Purpose

This study aimed to determine whether a fasciectomy for recurrent chronic exertional compartment syndrome of the anterior leg (ant-CECS) after a minimally invasive fasciotomy is safe and beneficial.

Methods

Demographics and clinical course of patients undergoing a fasciectomy for ongoing exercise-related leg pain (ERLP) after an earlier minimally invasive fasciotomy for ant-CECS were prospectively obtained using questionnaires. Patient-reported severity and frequency of pain, tightness, weakness, cramping, and paresthesia in rest and during exercise were scored before and after surgery. A successful outcome was defined as a self-reported good or excellent result.

Results

Between January 2013 and March 2019, 24 of the 958 patients evaluated for ERLP were included in the study (15 females; median age, 24 yr; range, 14–37 yr). Intracompartmental pressure values before the minimally invasive fasciotomy and before the fasciectomy were not different. Perioperative findings were fibrotic bands, pseudofascias, or complete fusions of fascial edges. Postoperative superficial wound infections requiring oral antibiotics occurred in four legs. After rehabilitation, the total symptom scores during exercise and resting conditions decreased threefold compared with preoperatively (exercise, 55 ± 5 to 17 ± 3, P < 0.001; rest, 30 ± 4 to 10 ± 2, P < 0.001). All cardinal symptoms decreased significantly, but the largest improvements were reported for pain and tightness. At follow-up (median, 12 months; range, 2–65 months), 79% of patients reported a successful outcome, whereas 75% had returned to physical activity.

Conclusion

An anterior fasciectomy with associated treatment of correlated pathologies can be safe and beneficial in patients with ongoing ERLP who previously underwent a minimally invasive fasciotomy for ant-CECS.
Time Course of Skeletal Muscle miRNA Expression after Resistance, High-Intensity Interval, and Concurrent Exercise
Authors: TELLES GUILHERME DEFANTE , LIBARDI CLEITON AUGUSTO , CONCEIÇÃO MIGUEL SOARES , VECHIN FELIPE CASSARO , LIXANDRÃO MANOEL EMÍLIO , DE ANDRADE ANDRÉ LUÍS LUGNANI , GUEDES DANIEL NOVAIS , UGRINOWITSCH CARLOS , CAMERA DONNY MICHAEL
Published: March 2021

Introduction

Exercise-induced microRNA (miRNA) expression has been implicated in the regulation of skeletal muscle plasticity. However, the specificity and acute time course in miRNA expression after divergent exercise modes are unknown. In a randomized crossover design, we compared the acute expression profile of eight skeletal muscle miRNAs previously reported to be involved in skeletal muscle development, growth, and maintenance after a bout of either resistance exercise (RE), high-intensity interval exercise (HIIE), and concurrent resistance and high-intensity interval exercises (CE).

Methods

Nine untrained young men (23.9 ± 2.8 yr, 70.1 ± 14.9 kg, 177.2 ± 3.0 cm, 41.4 ± 5.2 mL·kg−1·min−1) underwent a counterbalanced crossover design in which they performed bouts of RE (2 × 10 repetitions maximum 45° leg press and leg extension exercises), HIEE (12 × 1-min sprints at V˙O2peak with 1-min rest intervals between sprints), and CE (RE followed by HIIE), separated by 1 wk. Vastus lateralis biopsies were harvested immediately before (Pre) and immediately (0 h), 4 h, and 8 h after each exercise bout.

Results

There were similar increases (main effect of time; P < 0.05) in miR-1-3p, miR-133a-3p, miR-133b, miR-181a-3p, and miR-486 expression at 8 h from Pre with all exercise modes. Besides a main effect of time, miR-23a-3p and miR-206 presented a main effect of condition with lower expression after HIIE compared with RE and CE.

Conclusions

Select miRNAs (miR-1-3p, miR-133a-3p, miR-133b, miR-23a-3p, miR-181a-3p, miR-206, miR-486) do not exhibit an expression specificity in the acute recovery period after a single bout of RE, HIIE, or CE in skeletal muscle. Our data also indicate that RE has a higher effect on the expression of miR-23a-3p and miR-206 than HIIE. As upregulation of these miRNAs seems to be confined to the 8-h period after exercise, this may subsequently affect the expression patterns of target mRNAs forming the basis of exercise-induced adaptive responses.
Initial Weight Change and Long-Term Changes in Weight and Compensation during Supervised Exercise Training
Authors: DORLING JAMES L. , HÖCHSMANN CHRISTOPH , FEARNBACH S. NICOLE , APOLZAN JOHN W. , HSIA DANIEL S. , JOHANNSEN NEIL M. , CHURCH TIM S. , MARTIN CORBY K.
Published: March 2021

Introduction

Our primary aim was to investigate the association between initial weight change and longer-term changes in weight and compensation (predicted weight loss–observed weight loss) during exercise. As secondary aims, we investigated if initial weight change was related to change in cardiometabolic risk markers and energy balance modulators.

Methods

Two 6-month randomized controlled exercise trials conducted in individuals with overweight or obesity were analyzed (study 1, n = 312; study 2, n = 102). In both studies, participants in an exercise condition (4 kcal·kg−1·wk−1 [KKW], 8 KKW, 12 KKW, or 20 KKW) were split into tertiles based on percent weight change from baseline to week 4. Tertiles 1 and 3 exhibited the least and most initial weight loss, respectively. Changes in end points were compared between tertiles.

Results

At month 6, weight loss was lower in tertile 1 than tertile 3 (study 1: −3.6%, 95% confidence interval [CI] = −4.6 to −2.6; study 2: −1.8%, 95% CI = −3.1 to −0.4; P ≤ 0.034). Tertile 1 also showed greater compensation than tertile 3 in study 1 (3.0 kg, 95% CI = 2.2 to 3.9) and study 2 (1.5 kg, 95% CI = 0.3 to 2.6; P ≤ 0.048). Changes in triglycerides and, in study 1, HDL cholesterol were less favorable in tertile 1 versus tertile 3 (P ≤ 0.043); however, changes in other cardiometabolic markers were similar (P ≥ 0.209). In study 2, tertile 1 increased energy intake and exhibited maladaptive changes in eating behaviors relative to tertile 3 (P < 0.050). No between-tertile differences in cumulative exercise energy expenditure and physical activity were evident (P ≥ 0.321).

Conclusions

Less initial weight loss was associated with longer-term attenuated weight loss and greater compensation during aerobic exercise training. Individuals who display less initial weight loss during exercise may require early interventions to decrease compensation and facilitate weight loss.
Change in Force-based Metrics during Outdoor 2- and 4-Mile Runs
Authors: RENNER KRISTEN , QUEEN ROBIN M.
Published: March 2021

Changes in running gait may contribute to injury risk, but currently, this research is restricted to laboratory settings because of limitations with currently available and used technology.

Purpose

The purpose of this study was to determine if peak ground reaction force (GRF), loading rate (LR), and impulse metrics change across an outdoor run using force sensing insoles. We hypothesize that over the course of the run there would be a decline in limb symmetry for all measures and a decrease in LR and GRF values.

Methods

Thirty healthy participants (15 male, 15 female) were recruited for a two-visit study during which a 2- or 4-mile run was completed on the first visit and the other run distance was completed on the second visit (order was randomized). Force data were collected at 100 Hz for the duration of the run. Peak GRF, impulse, LR, and limb symmetry indices (LSI) of these variables were calculated at 25%, 50%, and 75% of the run.

Results

GRF decreased over the course of the runs, but the GRF LSI remained unchanged. No changes in LR were detected over the 2- or 4-mile run for either limb. The impulse LSI during the 2-mile run did indicate decreased symmetry from 25% of the run to 50% of the run, the LR LSI improved, and there was no difference in GRF LSI or any of the LSI metrics during the 4-mile run.

Conclusions

We posit that the lack in change in LSI was due to the courses/distance not inducing fatigue in our population. Future studies should investigate the effect of outdoor fatigue protocols and various types of terrain on force metrics and potential injury risk factors.
Repeatability and reproducibility of apparent diffusion coefficient and fat fraction measurement of focal myeloma lesions on whole body magnetic resonance imaging
Authors: Barwick Tara , Orton Matthew , Koh Dow Mu , Kaiser Martin , Rockall Andrea , Tunariu Nina , Blackledge Matthew , Messiou Christina
Published: March 2021

Objective:

To assess intra- and inter-reader variability of apparent diffusion coefficient (ADC) and fat fraction (FF) measurement in focal myeloma bone lesions and the influence of lesion size.

Methods:

22 myeloma patients with focal active disease on whole body MRI were included. Two readers outlined a small (5–10 mm) and large lesion (>10 mm) in each subject on derived ADC and FF maps; one reader performed this twice. Intra- and inter-reader agreement for small and large lesion groups were calculated for derived statistics from each map using within-subject standard deviation, coefficient of variation, interclass correlation coefficient measures, and visualized with Bland–Altman plots.

Results:

For mean ADC, intra- and inter-reader repeatability demonstrated equivalently low coefficient of variation (3.0–3.6%) and excellent interclass correlation coefficient (0.975–0.982) for both small and large lesions. For mean FF, intra- and inter-reader repeatability was significantly poorer for small lesions compared to large lesions (intra-reader within-subject standard variation estimate is 2.7 times higher for small lesions than large lesions (p = 0.0071), and for inter-reader variations is 3.8 times higher (p = 0.0070)).

Conclusion:

There is excellent intra- and inter-reader agreement for mean ADC estimates, even for lesions as small as 5 mm. For FF measurements, there is a significant increase in coefficient of variation for smaller lesions, suggesting lesions >10 mm should be selected for lesion FF measurement.

Advances in knowledge:

ADC measurements of focal myeloma have excellent intra- and inter-reader agreement. FF measurements are more susceptible to lesion size as intra- and inter-reader agreement is significantly impaired in lesions less than 10 mm.
Design of networks with limited resources
Authors: Μαυριδόπουλος Στάθης
Published: March 2021

Ο σχεδιασμός της αρχιτεκτονικής ενός δικτύου επηρεάζεται από τους περιορισμένους πόρους του δικτύου. Η προσπάθεια βελτίωσης ενός δικτύου διεξάγεται αφενός σε φυσικό επίπεδο, με την ανάπτυξη βελτιωμένου υλικού και συσκευών, αλλά και σε επίπεδο λογισμικού, όπου εφευρίσκονται ολοένα και πιο γρήγοροι και έξυπνοι αλγόριθμοι. Αυτή η διατριβή εξετάζει τους περιορισμούς πόρων σε δίκτυα εκπομπής, σε ασύρματα δίκτυα αισθητήρων και σε μοριακά νανοδίκτυα. Τα δίκτυα εκπομπής χαρακτηρίζονται από περιορισμένη χωρητικότητα επικοινωνίας των πελατών προς τον σταθμό βάσης. Η κύρια πρόκληση είναι η κατασκευή ενός προγράμματος εκπομπής που na ελαχιστοποιεί την καθυστέρηση για τους πελάτες. Η καλύτερη γνωστή μέθοδος, καταφέρνει πρόγραμμα εκπομπής πολύ κοντά στο βέλτιστο, αλλά πάσχει από απαγορευτική χρονική πολυπλοκότητα. Η προτεινόμενη μέθοδος, που παρουσιάζεται στο πρώτο μέρος αυτής της διατριβής, επιτυγχάνει σχεδόν βέλτιστη απόδοση με χαμηλή υπολογιστική πολυπλοκότητα. Χρησιμοποιεί μια ειδικά σχεδιασμένη δομή δεδομένων, η οποία οργανώνει τα δεδομένα αναλόγως της δημοτικότητάς τους. Η μέθοδος είναι υπολογιστικά αποδοτική, καθώς κατασκευάζει το πρόγραμμα εκπομπής απλά διασχίζοντας αυτή τη δομή δεδομένων. Τα ασύρματα δίκτυα αισθητήρων αποτελούνται από απλούς κόμβους αισθητήρων περιορισμένων δυνατοτήτων. Η εκτίμηση απόστασης είναι σημαντικό πρόβλημα αυτών των δικτύων, καθώς ο ακριβής εντοπισμός της θέσης των αισθητήρων μπορεί να ωφελήσει την απόδοση και την αποτελεσματικότητα του δικτύου. Συνήθως οι τεχνικές της βιβλιογραφίας για την εκτίμηση των αποστάσεων μεταξύ αισθητήρων απαιτούν από ορισμένους ειδικούς κόμβους να περιέχουν εξειδικευμένο υλικό, ώστε να έχουν ακριβή γνώση της θέσης τους. Όμως, βασική απαίτηση των δικτύων αισθητήρων είναι η απλότητα των κόμβων. Στο δεύτερο κομμάτι αυτής της διατριβής, προτείνεται μια μέθοδος, η οποία καταφέρνει εκτίμηση απόστασης μέσω μαθηματικής έκφρασης και χωρίς να χρειάζεται εξειδικευμένο υλικό για τους κόμβους. Στο τελευταίο κομμάτι της διατριβής γίνεται εισαγωγή στα νανοδίκτυα. Παρόλο που τα νανοδίκτυα είναι ένας πολλά υποσχόμενος χώρος, ένας από τους βασικότερους περιορισμούς τους είναι ότι προϋποθέτουν τεχνολογία, η οποία δεν είναι ακόμη ευρέως διαθέσιμη. Ένα νέο μοντέλο επικοινωνίας προτείνεται όπου η συγκέντρωση των βακτηρίων χρησιμοποιείται ως μέσο μετάδοσης πληροφοριών. Η μέθοδος αυτή είναι σχετικά απλή στην υλοποίησή της, και όταν χρησιμοποιεί χημειοτακτισμό, επιτυγχάνει επικοινωνία σε αποστάσεις ως το ένα cm. Όλες οι προτεινόμενες μέθοδοι αυτής τη διατριβής υποστηρίζονται θεωρητικά και η απόδοσή τους αξιολογείται με προσομοίωση. Τα αποτελέσματα προσομοίωσης που παρουσιάζονται σε αυτή τη διατριβή, καταδεικνύουν την εγκυρότητα και χρησιμότητα αυτών των μεθόδων υπό μια ποικιλία σεναρίων.
THE DEFORMATION OF AZ31 MAGNESIUM ALLOY DURING WARM CONSTRAINED GROOVE PRESSING
Authors: Hong Dang Hue Thi , Thi Thuy Pham , Minh Ngung Dao , Quang Pham , Shchukin Valery Y.
Published: March 2021

A magnesium alloy AZ31 as plate of dimensions (60 x 60 x 3) mm has been constrained groove pressed (CGP) four deformation passes (16 pressings) at 250 oC by simulation and experiments. On the basis of the analysis of calculation results about the deformation distribution in the alloy AZ31 workpieces, the mechanism for its microstructure evolution during the severe plastic deformation (SPD) process was partly clarified. On the other hand, deformation heterogeneity distribution developed in the workpieces by applying CGP caused the evolution of a non-uniform microstructure. The TEM microstructure analysis results provided clear evidence that across the plate both the banded deformed microstructure where dislocation cell structure and/or partially or fully recovered polygonized subgrain microstructure are present. The recovering dynamic and local polygonization process contributes significantly to the formation of ultra-fine materials (UFG) microstructure.
Benders Cut Classification via Support Vector Machines for Solving Two-Stage Stochastic Programs
Authors: Jia Huiwen , Shen Siqian
Published: March 2021

We consider Benders decomposition for solving two-stage stochastic programs with complete recourse based on finite samples of the uncertain parameters. We define the Benders cuts binding at the final optimal solution or the ones significantly improving bounds over iterations as valuable cuts. We propose a learning-enhanced Benders decomposition (LearnBD) algorithm, which adds a cut classification step in each iteration to selectively generate cuts that are more likely to be valuable cuts. The LearnBD algorithm includes two phases: (i) sampling cuts and collecting information from training problems and (ii) solving testing problems with a support vector machine (SVM) cut classifier. We run the LearnBD algorithm on instances of capacitated facility location and multicommodity network design under uncertain demand. Our results show that SVM cut classifier works effectively for identifying valuable cuts, and the LearnBD algorithm reduces the total solving time of all instances for different problems with various sizes and complexities.
A Toolkit for Robust Risk Assessment UsingF-Divergences
Authors: Kruse Thomas , Schneider Judith C. , Schweizer Nikolaus
Published: March 2021

This paper assembles a toolkit for the assessment of model risk when model uncertainty sets are defined in terms of an F-divergence ball around a reference model. We propose a new family of F-divergences that are easy to implement and flexible enough to imply convincing uncertainty sets for broad classes of reference models. We use our theoretical results to construct concrete examples of divergences that allow for significant amounts of uncertainty about lognormal or heavy-tailed Weibull reference models without implying that the worst case is necessarily infinitely bad. We implement our tools in an open-source software package and apply them to three risk management problems from operations management, insurance, and finance.

This paper was accepted by Baris Ata, stochastic models and simulation.
nomen omen. una narrativa pedagógica sobre una comunidad de indagación en contexto de formación docente
Authors: Rodriguez Gonzalo Santiago
Published: March 2021

This paper recounts the experience of a community of inquiry in a Philosophy with Children´s workshop directed at teacher training students. The workshop experience is documented in the form of pedagogical narrative, a practice-training-research strategy that seeks to make school practice visible from the teacher´s point of view. Our narrative documents the experience of the workshop in the students’ voices. Between August and October 2018, each session was audio-recorded and transcribed. The critical issue of the narrative analyzed here is the question of names; the discussion shows how the name not only constitutes a fundamental issue for identity definition, but also problematizes identity. The students’ experience of naming and being named opens questions about the teacher’s role in the classroom context, and problematizes the concept of the human subject in current pedagogical discourse, particularly in its opposition to the concept of community of inquiry in current philosophy of education  discourse.
Percepção dos nutricionistas do Programa Nacional de Alimentação Escolar sobre educação alimentar e nutricional
Authors: Dos Santos Priscila Sousa Oliveira , De Carvalho Vivian Carla Honorato dos Santos
Published: March 2021

Introdução: Os fatores que determinam o comportamento e as práticas de alimentação são múltiplos e complexos. No âmbito do Programa Nacional de Alimentação Escolar (PNAE), a abordagem a este tema deve ser realizada de forma multidisciplinar e intersetorial, tendo como estratégia a educação alimentar e nutricional (EAN). O nutricionista está inserido nesse contexto como o responsável técnico, ou quadro técnico do programa, sendo assim um importante componente entre os atores responsáveis pelo desenvolvimento das ações de EAN no ambiente escolar. Objetivo: Conhecer a percepção do nutricionista atuante no PNAE quanto às atividades de educação alimentar e nutricional, o impacto da formação nas práticas e identificar as facilidades e barreiras existentes nesse contexto. Métodos: Realizou-se pesquisa de natureza qualitativa com entrevistas e gravação das falas para posterior análise do conteúdo. Analisou-se o confronto de ideias por convergências, divergências e complementaridades. Resultados e Conclusão: Percebeu-se que, apesar do recente fortalecimento da EAN, ainda existe uma lacuna entre o proposto pela legislação e a prática empreendida pelos profissionais. As principais deficiências descritas por estes foram: ausência de base teórico-metodológica consistente que oriente as práticas de EAN, quadro técnico insuficiente e dificuldade de integralização das diferentes áreas, o que gera descontinuidade no processo de aprendizagem e ineficiência das ações. Estratégias como cursos periódicos, capacitação para melhor planejar e envolver equipes, assim como melhoria das condições de trabalho e quantitativo de profissionais em toda dimensão do PNAE, são indispensáveis para a execução plena do programa.
Leadership and management for nurses working at an advanced level
Authors: Wood Cate
Published: March 2021

Leadership and management form a key part of advanced clinical practice (ACP) and work in synergy with the other pillars of advanced practice. Advanced clinical practitioners focus on improving patient outcomes, and with application of evidence-based practice, using extended and expanded skills, they can provide cost-effective care. They are equipped with skills and knowledge, allowing for the expansion of their scope of practice by performing at an advanced level to assist in meeting the needs of people across all healthcare settings and can shape healthcare reform. Advanced practice can be described as a level of practice, rather than a type of practice. There are four leadership domains of advanced nursing practice: clinical leadership, professional leadership, health system leadership and health policy leadership, each requiring a specific skill set, but with some overlaps. All nurses should demonstrate their leadership competencies—collectively as a profession and individually in all settings where they practice.
Factors influencing retention among hospital nurses: systematic review
Authors: Marufu Takawira C , Collins Alexandra , Vargas Liavel , Gillespie Lucy , Almghairbi Dalal
Published: March 2021

Background:

Recruitment and retention of nursing staff is the biggest workforce challenge faced by healthcare institutions. Across the UK, there are currently around 50 000 nursing vacancies, and the number of people leaving the Nursing and Midwifery Council register is increasing.

Objective:

This review comprehensively compiled an update on factors affecting retention among hospital nursing staff.

Methods:

Five online databases; EMBASE, MEDLINE, SCOPUS, CINAHL and NICE Evidence were searched for relevant primary studies published until 31 December 2018 on retention among nurses in hospitals.

Results:

Forty-seven studies met the inclusion criteria. Nine domains influencing staff turnover were found: nursing leadership and management, education and career advancement, organisational (work) environment, staffing levels, professional issues, support at work, personal influences, demographic influences, and financial remuneration.

Conclusion:

Identified turnover factors are long-standing. To mitigate the impact of these factors, evaluation of current workforce strategies should be high priority.
Promoting safety in the home during the pandemic and beyond
Authors: Boddy Bethany
Published: March 2021

With families home schooling their children, caring for young babies and managing housework during lockdown, it is important for health visitors to promote home safety advice to help prevent unintentional accidents and injuries