bluuebunny/crossref_metadata_2025 huggingface dataset:
Porous Macroligands: Materials for Heterogeneous Molecular Catalysis
Authors: Wisser Florian M. , Mohr Yorck , Quadrelli Elsje Alessandra , Canivet Jérôme
Published: December 2019

The integration of catalytically active centers into a solid support without any loss of performance compared to the homogeneous analogue remains a major challenge. In this context, solid macroligands can be regarded as the key element to combine the advantages of homogeneous and heterogeneous catalysis. Porous materials such as periodic mesoporous organosilica, metal‐organic frameworks, porous organic polymers or covalent‐organic frameworks fulfill all requirements of a macroligand acting as a solid ligand of a molecular complex. They all can be tuned at the molecular scale to adapt the properties of the catalyst for a given application. This important feature also allows to directly compare different macroligands, regardless of their nature, and to choose the most appropriate for a target application.
Enantioselective Synthesis of Distorted π‐Extended Chiral Triptycenes Consisting of Three Distinct Aromatic Rings by Rhodium‐Catalyzed [2+2+2] Cycloaddition
Authors: Aida Yukimasa , Shibata Yu , Tanaka Ken
Published: December 2019

The enantioselective synthesis of distorted π‐extended chiral triptycenes, consisting of three distinct aromatic rings, has been achieved with high ee value of 87 % by the cationic rhodium(I)/segphos complex‐catalyzed enantioselective [2+2+2] cycloaddition of 2,2′‐di(prop‐1‐yn‐1‐yl)‐5,5′‐bis(trifluoromethyl)‐1,1′‐biphenyl with 6‐methoxy‐1,2‐dihydronaphthalene followed by the diastereoselective Diels–Alder reaction and aromatization. Demethoxy derivatives were also synthesized by the C−O bond cleavage. In this synthesis, the use of the electron‐deficient diyne and the electron‐rich alkene is crucial to suppress the undesired strain‐relieving carbocation rearrangement and stabilize the distorted triptycene structure.
Structurally Diverse Acyl Bicyclobutanes: Valuable Strained Electrophiles
Authors: Schwartz Brett D. , Zhang Meng Yao , Attard Riley H. , Gardiner Michael G. , Malins Lara R.
Published: December 2019

Bicyclo[1.1.0]butanes (BCBs) are highly strained carbocycles that have emerged as versatile synthetic tools, particularly for the construction of functionalized small molecules. This work reports two efficient pathways for the rapid preparation of over 20 structurally diverse BCB ketones, encompassing simple alkyl and aryl derivatives, as well as unprecedented amino acid, dipeptide, bioisostere, and bifunctional linchpin reagents currently inaccessible using literature methods. Analogues are readily forged in two steps and in high yields from simple carboxylic acids or through unsymmetrical ketone synthesis beginning with a convenient carbonyl dication equivalent. The utility of this novel toolbox of strained electrophiles for the selective modification of proteinogenic nucleophiles is highlighted.
Cardiac rehabilitation in older adults: New options
Authors: Kumar Kartik R. , Pina Ileana L.
Published: December 2019

Cardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiaries which represent an older population, utilization of CR continues to remain low despite evidence that suggests lower hospitalization rates, Medicare costs, and improved symptoms. Given poor referral rates, enrollment rates, and completion rates, a call for new strategies has been made by all major societies. However, several barriers exist. Newer models of CR constructed to overcome these barriers are reviewed below. Some of these new strategies include alternative site CR or home‐based CR and the utilization of technology.
Hypertension in older adults: Assessment, management, and challenges
Authors: Oliveros Estefania , Patel Hena , Kyung Stella , Fugar Setri , Goldberg Alan , Madan Nidhi , Williams Kim A.
Published: December 2019

Hypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. The global burden of hypertension is increasing due to an aging population and increasing prevalence of obesity, and is estimated to affect one third of the world's population by 2025. Adverse outcomes in older adults are compounded by mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and declining renal function. This review highlights the current evidence and summarizes recent guidelines on hypertension, pertaining to older adults. Management strategies for hypertension in older adults must consider the degree of frailty, increasingly complex medical comorbidities, and psycho‐social factors, and must therefore be individualized. Non‐pharmacological lifestyle interventions should be encouraged to mitigate the risk of developing hypertension, and as an adjunctive therapy to reduce the need for medications. Pharmacological therapy with diuretics, renin‐angiotensin system blockers, and calcium channel blockers have all shown benefit on cardiovascular outcomes in older patients. Given the economic and public health burden of hypertension in the United States and globally, it is critical to address lifestyle modifications in younger generations to prevent hypertension with age.
Mobile health and cardiac rehabilitation in older adults
Authors: Bostrom John , Sweeney Greg , Whiteson Jonathan , Dodson John A.
Published: December 2019

With the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility‐based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth‐CR) and evidence being generated in this field.
Financial distress among cancer survivors in Appalachian Kentucky
Authors: Vanderpool Robin C. , Chen Quan , Johnson Meghan F. , Lei Feitong , Stradtman Lindsay R. , Huang Bin
Published: December 2019

Background

Rural residence may exacerbate cancer‐related financial distress. Limited research has focused on Appalachian cancer survivors' experience with financial distress.

Aims

The primary aim of this study was to estimate the prevalence of financial distress among cancer survivors residing in Appalachian Kentucky with a specific focus on the impact of rurality and to elucidate the risk factors impacting financial distress among this population.

Methods and Results

Appalachian Kentucky residents were sampled for receipt of a health survey based on county‐level rurality. Analyses describe the prevalence and predictors of financial distress among cancer survivors. Subsequent analyses were conducted with Health Information National Trends Survey (HINTS) data to compare local versus national estimates of financial distress. Almost two‐thirds of Appalachian survivors reported financial distress compared to one‐third of the HINTS sample. Appalachian survivors residing in the most rural counties reported higher distress; this finding was not supported in the national sample. In multivariable analyses, gender, current age, and household income were associated with financial distress among Appalachians; only income was significant among the national sample.

Conclusion

Appalachian cancer survivors have higher than national estimates of financial distress; rurality and socioeconomics are drivers of this disparity.
Pharmacokinetics, Pharmacodynamics, and Safety of a Single Escalating Dose and Repeated Doses of Rasagiline Transdermal Patch in Healthy Chinese Subjects
Authors: Wang Meng , Zhou Wenjia , Zhang Quanying , Zong Shunlin , Lv Chengzhe
Published: December 2019

A rasagiline transdermal patch can be used to offer continuous rasagiline to patients with Parkinson's disease who cannot take their usual oral medications. This was the first study to investigate the pharmacokinetics, pharmacodynamics, and safety of the rasagiline transdermal patch in healthy Chinese subjects. Thirty subjects were randomized to 3 groups with 10 subjects in each group. The 10 subjects of group 1 received a single 1‐mg dose of rasagiline as a tablet; the 20 subjects of groups 2 and 3 received a single transdermal patch (48‐hour patch‐on period) containing 1.25 mg and 2.5 mg rasagiline, respectively. After a 2‐week washout period, the subjects of group 1 were assigned to receive 1 mg of rasagiline tablets every 24 hours for 7 days, and the subjects of group 2 were assigned to receive 1.25‐mg rasagiline transdermal patches (48‐hour patch‐on period) every 72 hours for 5 time periods. The absorption of rasagiline from the transdermal patch was significantly improved, although the peak plasma concentration was obviously reduced. There was slight accumulation of rasagiline dose after multiple administrations. Inhibition of platelet monoamine oxidase‐B (MAO‐B) activity was dose dependent. The 80% inhibition maintained for at least 48 hours after multiple‐dose administration of 1 mg tablets, and for 72 hours after multiple‐dose administration of 1.25 mg/48 h patch. Compared with rasagiline tablets, the transdermal patch had a prolonged duration of 80% inhibition and increased maximal inhibition of MAO‐B activity. These characteristics permitted an interval of 3 days of dosing, which was convenient for patients to use.
Cost minimization in placing service chains for virtualized network functions
Authors: Wang Chien Ting , Lin Ying‐Dar , Wang Chih‐Chiang , Lai Yuan‐Cheng
Published: December 2019

Network function virtualization (NFV) places network functions onto the virtual machines (VMs) of physical machines (PMs) located in data centers. In practice, a data flow may pass through multiple network functions, which collectively form a service chain across multiple VMs residing on the same or different PMs. Given a set of service chains, network operators have two options for placing them: (a) minimizing the number of VMs and PMs so as to reduce the server rental cost or (b) placing VMs running network functions belonging to the same service chain on the same or nearby PMs so as to reduce the network delay. In determining the optimal service chain placement, operators face the problem of minimizing the server cost while still satisfying the end‐to‐end delay constraint. The present study proposes an optimization model to solve this problem using a nonlinear programming (NLP) approach. The proposed model is used to explore various operational problems in the service chain placement field. The results suggest that the optimal cost ratio for PMs with high, hybrid, and low capacity, respectively, is equal to 4:2:1. Meanwhile, the maximum operating utilization rate should be limited to 55% in order to minimize the rental cost. Regarding quality of service (QoS) relaxation, the server cost reduces by 20%, 30%, and 32% as the end‐to‐end delay constraint is relaxed from 40 to 60, 80, and 100 ms, respectively. For the server location, the cost decreases by 25% when the high‐capacity PMs are decentralized rather than centralized. Finally, the cost reduces by 40% as the repetition rate in the service chain increases from 0 to 2. A heuristic algorithm, designated as common sub chain placement first (CPF), is proposed to solve the service chain placement problem for large‐scale problems (eg, 256 PMs). It is shown that the proposed algorithm reduces the solution time by up to 86% compared with the NLP optimization model, with an accuracy reduction of just 8%.
The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration—A comprehensive review
Authors: Chatwin Katie E. , Abbott Caroline A. , Boulton Andrew J.M. , Bowling Frank L. , Reeves Neil D.
Published: December 2019

The predominant risk factor of diabetic foot ulcers (DFU), peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies strive to reduce these high plantar pressures. Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs, which may explain the low prediction ability reported in prospective studies. The majority of studies assess vertical, rather than shear, barefoot plantar pressure in laboratory‐based environments, rather than during daily activity. Few studies investigated previous DFU location‐specific pressure. Previous studies focus predominantly on walking, although studies monitoring activity suggest that more time is spent on other weight‐bearing activities, where a lower “peak” plantar pressure might be applied over a longer duration. Although further research is needed, this may indicate that an expression of cumulative pressure applied over time could be a more relevant parameter than peak pressure. Studies indicated that providing pressure feedback might reduce plantar pressures, with an emerging potential use of smart technology, however, further research is required. Further pressure analyses, across all weight‐bearing activities, referring to location‐specific pressures are required to improve our understanding of pressures resulting in DFUs and improve effectiveness of interventions.
External temperature and distance from nearest entrance influence microclimates of cave and culvert‐roosting tri‐colored bats (Perimyotis subflavus)
Authors: Leivers Samantha J. , Meierhofer Melissa B. , Pierce Brian L. , Evans Jonah W. , Morrison Michael L.
Published: December 2019

Many North American bat species hibernate in both natural and artificial roosts. Although hibernacula can have high internal climate stability, they still retain spatial variability in their thermal regimes, resulting in various “microclimates” throughout the roost that differ in their characteristics (e.g., temperature and air moisture). These microclimate components can be influenced by factors such as the number of entrances, the depth of the roost, and distance to the nearest entrance of the roost. Tri‐colored bats are commonly found roosting in caves in winter, but they can also be found roosting in large numbers in culverts, providing the unique opportunity to investigate factors influencing microclimates of bats in both natural and artificial roost sites. As tri‐colored bats are currently under consideration for federal listing, information of this type could be useful in aiding in the conservation and management of this species through a better understanding of what factors affect the microclimate near roosting bats. We collected data on microclimate temperature and microclimate actual water vapor pressure (AWVP) from a total of 760 overwintering tri‐colored bats at 18 caves and 44 culverts. Using linear mixed models analysis, we found that variation in bat microclimate temperatures was best explained by external temperature and distance from nearest entrance in both caves and culverts. External temperature had a greater influence on microclimate temperatures in culverts than caves. We found that variation in microclimate AWVP was best explained by external temperature, distance from nearest entrance, and proportion from entrance (proportion of the total length of the roost from the nearest entrance) in culvert‐roosting bats. Variation in microclimate AWVP was best explained by external temperature and proportion from entrance in cave‐roosting bats. Our results suggest that bat microclimate temperature and AWVP are influenced by similar factors in both artificial and natural roosts, although the relative contribution of these factors differs between roost types.
Numerical study on enhancing coalbed methane recovery by injecting N2/CO2 mixtures and its geological significance
Authors: Fan Nan , Wang Jiren , Deng Cunbao , Fan Yongpeng , Mu Yongliang , Wang Tingting
Published: December 2019

As an effective carbon utilization technology, the injection of N2/CO2 mixtures into coal seams has significant potential for improving coalbed methane recovery. Considering the technical barrier that injection of pure CO2 decreases the well injectivity index and pure N2 injection leads to the rapid methane recovery, a method of injecting N2‐enriched gas mixtures with a constant component is proposed. In this study, a thermo‐hydro‐mechanical (THM) coupling numerical model for enhanced coalbed methane (CBM) recovery by injecting N2/CO2 mixtures is established. This model includes complex interactions of coal deformation, competitive adsorption, ternary gas seepage, and heat transfer. The THM coupling model is first validated, and then applied to investigate the evolution of mixed gas concentrations, reservoir permeability, reservoir temperature, CH4 production, and N2/CO2 storage during N2/CO2 enhanced CBM recovery. The results show that the displacement radius and concentration of the mixed gas in the coal seam increased with gas injection pressure increase. The concentration of CH4 gradually decreased with time, and the early decline is faster than the later stage. The sweep of the N2 flow accelerates CH4 desorption and migration, promoting a reduction in reservoir temperature near the production well. Reservoir permeability evolution results from the combined effects of ternary gases (CH4, CO2, N2) competitive adsorption, gas pressure, and geostress on the coal seam within the THM fields. At the methane natural depletion stage (within 250 days), the permeability of coal reservoir first decreases and then increases. With the arrival of the N2/CO2 mixture, the permeability decreases dramatically. From the perspective of cumulative CH4 production, the optimal composition is dominated by the synergistic effect of maximizing breakthrough time and minimizing coal matrix swelling. For 30% CO2‐70% N2, the CH4 recovery ratio reached 71.76%, representing an increase of 16.67% compared to natural depletion.
Why Won’t My Patient Act Like a Jerk?
Authors: Baruch Jay
Published: December 2019

I’m avoiding Mr. G’s room. I shouldn’t have read the emergency room notes from the other hospital, where this middle‐aged man raised a stink about the wait. What type of person calls the triage nurse a bitch? From the timestamps on the electronic medical record notes, he stormed from that ER and drove his abdominal pain, vomiting, diarrhea, and discontent directly across town to us.

I’m reminded of this oft‐quoted aphorism from Sir William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease.” It’s cited by medical educators as an invocation to never forget the humanistic heart at the center of clinical care. But what if the patient is a jerk? That I haven’t met Mr. G, only read briefly about him, doesn’t stop these ugly feelings from surfacing.
Dementia and the Death Penalty
Authors: Dresser Rebecca
Published: December 2019

During its 2018–2019 term, the United States Supreme Court considered the constitutionality of executing a prisoner with dementia. In Madison v. Alabama, the Court ruled that, in certain circumstances, executing a prisoner with dementia violates the Eighth Amendment’s ban on cruel and unusual punishment. Vernon Madison was sentenced to death for killing a police officer in 1985. After many years on Alabama’s death row, he had a series of strokes and was diagnosed with vascular dementia. In 2016, Madison’s lawyers unsuccessfully sought a stay of execution, arguing that, in light of his cognitive impairments, imposing the death penalty would violate the Constitution. After Alabama set a 2018 execution date, lawyers returned to the state court, arguing that the finding of competence should be reversed because Madison’s cognitive impairments had worsened. When the trial court refused to grant the stay of execution, Madison’s lawyers asked the Supreme Court to review the constitutionality of the state court decision.
Physician Burnout Calls for Legal Intervention
Authors: Hoffman Sharona
Published: December 2019

Physician burnout is receiving more attention in the medical literature, and deservedly so. For example, in October of 2019, the National Academies of Sciences, Engineering, and Medicine published a lengthy report called Taking Action against Clinician Burnout: A Systems Approach to Professional Well‐Being. The report is comprehensive and well worth reading, and it offers a series of sound recommendations for addressing the burnout problem. However, the recommendations are quite ambitious, and implementing them would require a considerable investment of time, staffing, and financial resources. The medical community should not be left to grapple with the phenomenon of physician burnout alone. The law has a significant role to play in addressing the problem. As a first step, it is useful to consider a few concrete interventions that regulators could realistically implement in the short term.
Toward the Polyphonic Case
Authors: Chambers Tod S.
Published: December 2019

Can one publish a bioethics case ethically? I suspect that most in bioethics would feel comfortable publishing a case if the subject—the patient—gave explicit permission, the amount of biographical information revealed was under the control of the subject, and the subject fully understood the benefits and risks of publishing the case. Some might add that the subject should have a chance to approve the final representation. I think that the ethics of publishing cases needs to be rethought. And this rethinking needs to be focused not on the way publishing a case might harm a patient (that is, nonmaleficence) but, rather, on how a case presentation does not convey the patient’s own voice in the narrative (that is, respect for autonomy). Bioethics needs a new model of case presentation: the polyphonic case, which demands that the subject be a part of the case’s construction.
Not Whether but How: Considerations on the Ethics of Telling Patients’ Stories
Authors: Frank Arthur W.
Published: December 2019

The ethics of telling stories about other people become questionable as soon as humans learn to talk. But the stakes get higher when health care professionals tell stories about those whom they serve. But for all the problems that come with such stories, I do not believe it is either practical or desirable for bioethicists to attempt to legislate an end to this storytelling. What we need instead is narrative nuance. We need to understand how to tell respectful stories in which the patients are fully acknowledged fellow participants, not one‐dimensional objects of a knowing gaze. The problem is not narration itself but a particular version of narrational privilege, and getting rid of that would have benefits far beyond practices of writing case studies. In this essay, I first offer four considerations that I have found either omitted or underemphasized in discussions of the ethics of telling stories about patients. I then sketch a model of medical storytelling that might be the basis for shifting the ethical question from whether to how.
Can the Case Report Withstand Ethical Scrutiny?
Authors: Rosoff Philip M.
Published: December 2019

Since antiquity, doctors have employed case reports as an essential and ongoing part in communicating information about patients and their diseases to their colleagues and, at times, to the wider, nonmedical world. Given how useful case reports have been, a legitimate and persuasive argument could be made to retain them in modern medical literature. But there is an emerging problem with case reports. As the ability to publish and disseminate the information contained in them has become easier, the capacity for individuals to maintain their privacy and restrict access to their personal information has become more strained, and it has become more difficult for doctors who tell clinical stories to respect the confidentiality of their patients while still communicating the pertinent details of their cases. Does the acknowledged educational and scientific value of (some) case reports justify the threat to personal privacy that may be entailed by the format itself?
Between a Rock and a Hard Place: The Collective Good at a Time of Medical Narcissism
Authors: Sabatello Maya
Published: December 2019

Not a single day goes by without some news about personalized medicine, especially in its genomic context (precision medicine). In tandem with the scientific excitement, however, come the cautionary notes. These include worries about Big Brother surveillance, concerns about the impact of genomic results on the psychosocial well‐being of patients and research subjects, and attention to issues of social and distributive justice. Personalised Medicine, Individual Choice and the Common Good, coedited by Britta van Beers, Sigrid Sterckx, and Donna Dickenson, falls squarely into this discourse with an aim to “fuel and stimulate the debate about personalised medicine and enable its participants to come to a more balanced understanding of the interests and values at stake.” At its core, the book laments the shift from “We Medicine” to “Me Medicine,” with ostensibly all authors highlighting that, on balance, the costs associated with “Me Medicine” far outweigh the benefits. This is both a strength and a weakness of the book.
Chemical reaction and Dufour effects on nonlinear free convection heat and mass transfer flow near a vertical moving porous plate
Authors: Jha Basant K. , Sarki Muhammad N.
Published: December 2019

A theoretical analysis is made for steady fully developed free convection and mass transfer flow near an infinite vertical moving porous plate by taking into consideration the first‐order chemical reaction and Dufour effects. The mathematical model responsible for the present physical situation is based on the nonlinear density variation with temperature as well as nonlinear density variation with concentration. Exact solutions are derived for heat mass and momentum equations under relevant boundary conditions. The dimensionless velocity, temperature, and concentration are presented in terms of exponential functions. The impact of controlling parameters such as Dufour number (diffusion thermo effect), chemical reaction parameter, Prandlt number, Schmidt number, on velocity, temperature, Nusselt number, and skin friction are discussed with the aid of line graphs, contours, and tables. The analysis of the result shows that Nusselt number, skin friction, and velocity increases with increase in Dufour number. Furthermore, velocity and skin friction are higher in case of nonlinear convection in comparison to linear convection.
Parenting among mothers exposed to ongoing military conflict in childhood: An exploratory study
Authors: Hadar Efrat , Sagron Mirit , Peleg Ora
Published: December 2019

Mothers living in areas exposed to ongoing military conflict are at higher risk for psychological difficulties, such as posttraumatic stress disorder, than those not living in such areas. The aim of this two‐part exploratory study was twofold. The first aim was to examine differences between mothers who grew up under ongoing military conflict in childhood and mothers who did not grow up in affected areas in terms of their levels of differentiation of self and parental self‐efficacy (PSE). The second aim was to identify and describe the parenting experiences of mothers who were exposed to military conflict in childhood. In Part 1 of the study, the sample included 120 mothers (half of whom reported on being exposed to ongoing military conflict in childhood). Findings showed that mothers exposed to ongoing military conflict in childhood reported lower levels of differentiation of self and PSE than their counterparts. In Part 2, 10 mothers who were exposed to ongoing military conflict as children were interviewed about their experience as parents and their PSE. Results indicated that the mothers felt their childhood experiences affected their parenting and PSE negatively, resulting in anxiety, difficulty dealing with stress and sometimes posttraumatic symptoms as well as parental patterns of overprotectiveness, separation anxiety and intergenerational transmission of anxiety. The results highlight the consequences of exposure to ongoing military conflict during childhood on levels of differentiation of self and parenting practices.
Towards e‐judicial services in Malawi: Implications for justice delivery
Authors: Chawinga Winner Dominic , Chawinga Chaupe , Kapondera Sellina Khumbo , Chipeta George Theodore , Majawa Felix , Nyasulu Chimango
Published: December 2019

In Malawi, the judiciary rolled out an electronic case management system in 2015 in response to the ongoing public sector reforms being championed by the Malawi Government. In this study, we employed the information systems (IS) success model to systematically investigate the benefits that an electronic case management system has brought about to the judiciary of Malawi. Specifically, three themes are pursued as follows: the services offered through an electronic case management system in the judiciary of Malawi; benefits of an electronic case management system; and challenges affecting the use of an electronic case management system in the judiciary of Malawi. Methodologically, the study is guided by a survey design and a questionnaire was used to collect data from various staff in the judiciary including judges, court clerks, court registrars, and information technology personnel. The study reveals that the implementation of an electronic case management system has impacted positively on the security of court files by easing the tracking and retrieving of case files thereby contributing to efficiency in justice delivery. However, the implementation of an electronic case management system has not been spared from challenges, which include frequent loss of network and poor Internet connection.
Providers' knowledge and perceptions regarding antibiotic stewardship and antibiotic prescribing in rural primary care clinics
Authors: Kufel Wesley D. , Mastro Keri A. , Mogle Bryan T. , Williams Karen S. , Jester James , Snyder John , Lubowski Teresa , Bohan KarenBeth H.
Published: December 2019

Background

Variation in providers' education and training may contribute to potential antibiotic overprescribing in outpatient settings. Providers in rural settings may not be exposed to or have similar resources readily available as those in urban settings, or be affiliated with academic medical centers. Thus, we sought to evaluate providers' knowledge and perceptions towards antibiotic stewardship (AS) and antibiotic prescribing in rural primary care clinics.

Methods

A cross‐sectional, multicenter, electronic survey assessing providers' knowledge and perceptions towards AS and antibiotic prescribing was distributed to family medicine and internal medicine clinic providers in rural New York and Pennsylvania.

Results

Seventy responses were included resulting in a survey response rate of 33.5% (70/209) with 42.9%, 30%, and 27.1% of responses from physicians, advanced practice providers, and resident physicians, respectively. The most common barrier to improving antibiotic prescribing was patient demands (54.3%). Providers felt more pressured to prescribe antibiotics based on appointment visits of ≤20 minutes compared with >20 minutes (46.4% vs 7.1%, P = .006), as well as those that encountered ≥50 patients in a week compared with <50 patients (55% vs 16.7%, P = .001). All providers strongly agreed or agreed that antibiotics are overprescribed and inappropriate antibiotic use can lead to resistance. However, only 42.9% of providers selected correctly that 90% to 98% of rhinosinusitis are viral and only 5.7% recommended supportive care without antibiotics. Ten percent of providers never heard of AS, yet most providers (84.3%) were interested in receiving more AS education. Importantly, most providers (57.1%, 40/70) indicated that pharmacists were useful resources to assist in appropriate antibiotic prescribing.

Conclusions

Variability exists among providers' knowledge and perceptions towards AS and antibiotic prescribing in rural primary care clinics, yet most providers are interested in additional AS education. Pharmacists are well‐positioned to educate providers and implement initiatives related to AS and appropriate antibiotic prescribing.
Economic evaluations of clinical pharmacy services in the United States: 2011‐2017
Authors: Talon Brian , Perez Alexandra , Yan Connie , Alobaidi Ali , Zhang Katherine H. , Schultz Bob G. , Suda Katie J. , Touchette Daniel R.
Published: December 2019

Studies evaluating the cost‐effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient‐level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies were included. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non‐randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59‐95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost‐effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence.
Awareness of and attitudes toward CBT, DBT, and ACT in an acute psychiatric sample
Authors: Kuckertz Jennie M. , Silverman Alexandra L. , Bullis Jacqueline R. , Björgvinsson Thröstur , Beard Courtney
Published: December 2019

Objective

Treatment utilization for psychiatric illness is low, perhaps influenced by limited consumer knowledge of evidence‐based psychological treatments (EBPTs). To inform consumer‐directed dissemination efforts, we characterized preferences, beliefs, and knowledge about specific EBPTs (cognitive behavioral therapy [CBT], dialectical behavior therapy [DBT], and acceptance and commitment therapy [ACT]); and examined potential sociodemographic and treatment history correlates.

Method

Before receiving treatment at a psychiatric partial hospital, patients (n = 249) completed the Psychological Treatment Consumer Questionnaire.

Results

Most (75%) patients felt responsible for being aware of psychotherapy options and that it was important to receive research‐supported psychotherapy (80%), but were split on whether research (42%) or their provider's recommendation (58%) carried greater decisional weight. Most (93%) patients had heard of CBT (93%) and DBT (71%), but not ACT (35%). Prior exposure to these EBPTs increased the likelihood of recommending them to others.

Conclusions

Findings support initiatives to enhance consumer familiarity with these EBPTs and inform dissemination efforts.
Digital light microscopy as a tool in toxicological evaluation of fish erythrocyte morphological abnormalities
Authors: Sula Eldores , Aliko Valbona , Pagano Maria , Faggio Caterina
Published: December 2019

Fish erythrocytes are very sensitive to environmental pollution because they exhibit pathological alterations before appearance of other external symptoms, may be used as reliable toxicity bioindicators. Microscopic analysis can be a useful tool in early detection of alterations in erythrocyte morphology due to different environmental stressors, and in predicting organism's possible response ways. This study aims to evaluate the toxicity of a polluted freshwater lake on the erythrocytes of crucian carp fish, Carassius carassius, using digital light microscopy (DLM). Scanning DLM micrographs revealed the presence of nuclear and cytoplasmic abnormalities like micronucleus, nuclear buds, lobed nucleus, deformed nucleus, vacuolated cytoplasm, and echinocyte in the erythrocytes of crucian carp fish from a polluted lake. The obtained results substantiate that computation of erythrocyte morphological damages as biomarkers of exposure, through digital light microscopy software, can be effectively used as a toxicological tool.
Hepatitis virus B and C infections are associated with an increased risk of non‐Hodgkin lymphoma: A nested case‐control study using a national sample cohort
Authors: Kim Miyoung , Lee Young Kyung , Park Bumjung , Oh Dong Jun , Choi Hyo Geun
Published: December 2019

Background

Hepatitis B virus (HBV) and hepatitis C virus (HCV) are suspected of being associated with non‐Hodgkin lymphoma (NHL); however, persuasive data are lacking. Hence, a nested large‐population case‐control study was performed to investigate such associations in Koreans.

Methods

Data were collected from 929 patients with NHL and 3716 healthy subjects, who were matched 1:4 for age, sex, income, and region of residence, from the Korean Health Insurance Review and Assessment Service‐National Sample Cohort. The diagnoses of NHL and HBV/HCV infection were based on the International Classification of Diseases (version 10) codes. Conditional logistic regression models were used to assess odds ratios (ORs) for NHL with respect to HBV or HCV with adjustment for the Charlson comorbidity index.

Results

HBV and HCV rates were higher in the NHL group (3.3% and 1.3%, respectively) than in the control group (0.9% and 0.3%, respectively; P < .001 for each). The adjusted OR of hepatitis infection in patients with NHL were 3.25 (95% confidence interval [CI] = 1.99‐5.31) for HBV and 3.36 (95% CI = 1.51‐7.46) for HCV (P < .001 for each). Subgroups categorized by age (<55 vs ≥55 years) or sex showed significantly higher adjusted ORs of HBV for NHL. Moreover, patients with NHL ≥ 55 years of age or those who were female showed significantly higher adjusted ORs of HCV; those <55 years or who were male also tended to have higher ORs of HCV.

Conclusion

Infection with either HBV or HCV is associated with NHL in Koreans.
Use of mycorrhizal fungi releases the application of organic fertilizers to increase the production of leaf vitexin in yellow passion fruit
Authors: de Oliveira Paula Tarcila Félix , dos Santos Emanuela Lima , da Silva Wliana Alves Viturino , Ferreira Magda Rhayanny Assunção , Soares Luiz Alberto Lira , da Silva Francineyde Alves , da Silva Fábio Sérgio Barbosa
Published: December 2019

BACKGROUND

Low‐cost organic fertilizers, such as coconut powder and vermicompost, and arbuscular mycorrhizal fungi (AMF) may benefit the Passiflora edulis f. flavicarpa plant. However, it has not been established whether the joint application of these inputs may increase the production of vitexin and other molecules associated with the phytotherapeutic properties of this plant. Here, we tested the hypothesis that the application of AMF and organic fertilizers maximizes the production of bioactive compounds in leaves of P. edulis.

RESULTS

The inoculation of Acaulospora longula into P. edulis grown in fertilization‐free soil promoted an increase of 86% in the concentration of leaf vitexin, 10.29% in the concentration of total phenols, and 13.78% in the concentration of total tannins in relation to the AMF‐free control, rendering soil fertilization superfluous.

CONCLUSION

The application of A. longula increases the production of foliar biomolecules, such as vitexin, in yellow passion fruit plants. Thus, the addition of coconut powder and vermicompost to the substrate composition is not necessary, leading to the commercialized production of phytomass in the herbal medicines industry. © 2019 Society of Chemical Industry
Dissipation behavior, residue distribution and risk assessment of three fungicides in pears
Authors: Fang Qingkui , Wu Ruifeng , Hu Guixian , Lai Aiping , Wu Kaixin , Zhang Linwei , Feng Jiajun , Cao Haiqun
Published: December 2019

BACKGROUND

Fungicides are often applied to pears before they are kept in storage facilities. The scientific application of pesticides can reduce unnecessary exposure, which in turn could benefit both humans and the environment.

RESULTS

We investigated dissipation behavior and residue distribution, and conducted risk assessments for prochloraz, pyraclostrobin, and tebuconazole in pears stored under different conditions using ultra‐performance liquid chromatography (UPLC). The recoveries of the three fungicides ranged from 76.5% to 114.5%, and the coefficients of variation were 1.0%–8.5%. The half‐life (t1/2) ranges for degradation of the three fungicides in Dangshan Su pear peel were 8.8–13.9 days after storage at 25 °C and 99.0–346.6 days after storage at 2 °C. Among the three fungicides, tebuconazole had the lowest residue concentration in pear pulp (maximum of 0.226 mg·kg−1) and the longest half‐life (≥ 231.0 days). Accordingly, among these fungicides, tebuconazole is the most suitable for the preservation of Dangshan Su pears during storage. Finally, we analyzed samples of six pear varieties from markets in China and found that the residue concentrations of the three fungicides in pear pulp and fruit met Chinese standards.

CONCLUSION

The results provide a scientific basis for rationalizing the use of prochloraz, pyraclostrobin, and tebuconazole, and improving the safety of pears for eating. © 2019 Society of Chemical Industry
Development of a model predicting the risk of eight major postoperative complications after esophagectomy based on 10 826 cases in the Japan National Clinical Database
Authors: Ohkura Yu , Miyata Hiroaki , Konno Hiroyuki , Udagawa Harushi , Ueno Masaki , Shindoh Junichi , Kumamaru Hiraku , Wakabayashi Go , Gotoh Mitsukazu , Mori Masaki
Published: December 2019

Background

Esophagectomy is a highly invasive procedure with a high incidence of complications. The objectives of this study were to create risk prediction models for postoperative morbidity associated with esophagectomy and to test their performance using a population‐based large database.

Methods

A total of 10 862 patients who underwent esophagectomy between January 2011 and December 2012 derived from the Japanese national clinical database (NCD) were included. Based on the 148 preoperative clinical variables collected, risk prediction models for eight major postoperative morbidities were created using 80% (8715 patients) of the study population and validated using the remaining 20% (2147 patients) of the patients.

Results

The mortality rate was 3.1% and postoperative morbidity was observed in 42.6% of the patients. The c‐statistics of the eight risk models established by the training set were surgical site infection (0.564), anastomotic leakage (0.531), need for transfusion (0.636), blood loss >1000 mL (0.644), pneumonia (0.632), unplanned intubation (0.607), prolonged mechanical ventilation over 48 hours (0.614), and sepsis (0.618) in the validation analysis.

Conclusions

Risk prediction models for postoperative morbidity after esophagectomy using the population‐based large database showed relatively fair performance. The current models may offer baseline information for risk stratification in clinical decision makings and help select more suitable surgical and nonsurgical treatment options and future clinical studies.
Pseudo‐c‐archimedean and pseudo‐finite cyclically ordered groups
Authors: Leloup Gérard
Published: December 2019

Robinson and Zakon gave necessary and sufficient conditions for an abelian ordered group to satisfy the same first‐order sentences as an archimedean abelian ordered group (i.e., which embeds in the group of real numbers). The present paper generalizes their work to obtain similar results for infinite subgroups of the group of unimodular complex numbers. Furthermore, the groups which satisfy the same first‐order sentences as ultraproducts of finite cyclic groups are characterized.
Breather wave, periodic, and cross‐kink solutions to the generalized Bogoyavlensky‐Konopelchenko equation
Authors: Manafian Jalil , Mohammadi Ivatloo Behnam , Abapour Mehdi
Published: December 2019

The present article deals with multi‐waves and breather wave solutions of the generalized Bogoyavlensky‐Konopelchenko equation by virtue of the Hirota bilinear operator method and the semi‐inverse variational principle. The obtained solutions for solving the current equation represent some localized waves including soliton, periodic, and cross‐kink solutions in which have been investigated by the approach of the bilinear method. With certain parameter constraints in the multi‐waves and breather, all cases of the periodic and cross‐kink solutions can be captured from the one and two soliton(s). The obtained solutions are extended with numerical simulation to analyze graphically, which results into 1‐ and 2‐soliton solutions and also periodic and cross‐kink solutions profiles, that will be extensively used to report many attractive physical phenomena in the fields of acoustics, heat transfer, fluid dynamics, classical mechanics, and so on.
Balanced steady‐state free precession thoracic imaging with half‐radial dual‐echo readout on smoothly interleaved archimedean spirals
Authors: Bauman Grzegorz , Bieri Oliver
Published: December 2019

Purpose

To investigate the prospects of a minimal‐TR half‐radial dual‐echo balanced steady‐state free precession (bSSFP) acquisition for high‐resolution and artifact‐free thoracic imaging at 1.5T.

Methods

Feasibility of bSSFP imaging using isotropic half‐radial dual‐echo (hr‐de) projections with TE1/TE2/TR of 0.12/1.18/1.39 ms acquired along Archimedean spiral trajectories was demonstrated for phantoms and in vivo thorax scans at 1.5T. The centered‐out projection offers an ultra‐short echo (UTE) comparable to contemporary spoiled gradient echo (SPGR) UTE radial acquisitions used for the assessment of chest morphology. Signal intensities of hr‐de‐bSSFP were measured and compared to UTE‐SPGR in a phantom and for parenchyma and blood in vivo and compared to theory.

Results

For the lung parenchyma and the blood, hr‐de‐bSSFP provided more than 4 times higher signal intensity than contemporary UTE‐SPGR imaging. The measured hr‐de‐bSSFP and UTE‐SPGR signal ratios were in the agreement with theoretically simulated values. Overall, the very short TR of hr‐de‐bSSFP successfully mitigated off‐resonance artifacts offering high‐quality breath‐hold thoracic imaging at isotropic resolution of 1.7 mm. The application of a smooth interleaved spiral trajectory for half‐radial readouts improved the robustness of hr‐de‐bSSFP to cardiac motion.

Conclusion

Thoracic hr‐de‐bSSFP offers artifact‐free chest images with considerably improved signal intensity as compared to contemporary UTE‐SPGR imaging at 1.5T.