bluuebunny/crossref_metadata_2025 huggingface dataset:
Eliminating ‘Aesthetics’ from Copyright Law: The Aftermath of Cofemel
Authors: Güven Koray
Published: August 2021

The recent Cofemel judgment of the Court of Justice of the European Union extended the European Union’s (EU) originality criterion (i.e. the author’s own intellectual creation) to the realm of works of applied art. The Court excluded ‘aesthetically significant visual effect’ as a condition of copyright protection. It was condemned as subjective and incompatible with the EU originality criterion. The decision may signal a shift in several national copyright laws, under which requirements relating to ‘aesthetics’ are laid down as a condition to acquire protection. This article will demonstrate that the ‘aesthetics criterion’, as it emerged historically and has been employed in national copyright laws, is associated with a different meaning than it conveys at first glance. The aesthetics criterion designates the elbow room remaining to the author after functional constraints have been taken into account, and thus represents a form of the functionality doctrine in the domain of copyright law. However, to some extent it also excludes – though not uniformly – commonplace designs from the scope of copyright protection. Against this background, this article suggests that the aesthetics criterion can arguably be reconciled with the EU originality criterion. The aesthetics criterion represents a balance struck between the need for copyright protection in the field of applied arts, on the one hand, and competition, on the other. In order not to upset this careful balance, a robust application of the EU originality criterion is advocated, precluding protection not only to functionality, but also to commonplace creations.
Eyes Toward Tomorrow Program Enhancing Collaboration, Connections, and Community Using Bioinspired Design
Authors: Full Robert J , Bhatti H A , Jennings P , Ruopp R , Jafar T , Matsui J , Flores L A , Estrada M
Published: August 2021

The goal of our Eyes Toward Tomorrow Program is to enrich the future workforce with STEM by providing students with an early, inspirational, interdisciplinary experience fostering inclusive excellence. We attempt to open the eyes of students who never realized how much their voice is urgently needed by providing an opportunity for involvement, imagination, invention, and innovation. Students see how what they are learning, designing, and building matters to their own life, community, and society. Our program embodies convergence by obliterating artificially created, disciplinary boundaries to go far beyond STEM or even STEAM by including artists, designers, social scientists, and entrepreneurs collaborating in diverse teams using scientific discoveries to create inventions that could shape our future. Our program connects two recent revolutions by amplifying Bioinspired Design with the Maker Movement and its democratizing effects empowering anyone to innovate and change the world. Our course is founded in original discovery. We explain the process of biological discovery and the importance of scaling, constraints, and complexity in selecting systems for bioinspired design. By spotlighting scientific writing and publishing, students become more science literate, learn how to decompose a biology research paper, extract the principles, and then propose a novel design by analogy. Using careful, early scaffolding of individual design efforts, students build the confidence to interact in teams. Team building exercises increase self-efficacy and reveal the advantages of a diverse set of minds. Final team video and poster project designs are presented in a public showcase. Our program forms a student-centered creative action community comprised of a large-scale course, student-led classes, and a student-created university organization. The program structure facilitates a community of learners that shifts the students' role from passive knowledge recipients to active co-constructors of knowledge being responsible for their own learning, discovery, and inventions. Students build their own shared database of discoveries, classes, organizations, research openings, internships, and public service options. Students find next step opportunities so they can see future careers. Description of our program here provides the necessary context for our future publications on assessment that examine 21st century skills, persistence in STEM, and creativity.
Effect of a carbohydrase admixture in growing pigs fed wheat-based diets in thermoneutral and heat stress conditions
Authors: Oladele Paul , Li Enkai , Lu Hang , Cozannet Pierre , Nakatsu Cindy , Johnson Timothy , Adeola Olayiwola , Ajuwon Kolapo M
Published: August 2021

The efficacy of exogenous carbohydrases in pig diets has been suggested to depend on enzyme activity and dietary fiber composition, but recent evidence suggests other factors such as ambient temperature might be important as well. Therefore, we investigated the effect of heat stress (HS) on the efficacy of a multienzyme carbohydrase blend in growing pigs. Ninety-six (barrows: gilts; 1:1) growing pigs with initial body weight (BW) of 20.15 ± 0.18 kg were randomly assigned to six treatments, with eight replicates of two pigs per pen in a 3 × 2 factorial arrangement: three levels of carbohydrase (0, 1X, or 2X) at two environmental temperatures (20 °C or cyclical 28 °C nighttime and 35 °C day time). The 1X dose (50 g/tonne) provided 1,250 viscosimetry unit (visco-units) endo-β-1,4-xylanase, 4,600 units α-l-arabinofuranosidase and 860 visco-units endo-1,3(4)-β-glucanase per kilogram of feed. Pigs were fed ad libitum for 28 d and 1 pig per pen was sacrificed on day 28. There was no enzyme × temperature interaction on any response criteria; thus, only main effects are reported. Enzyme treatment quadratically increased (P < 0.05) BW on day 28, average daily gain (ADG) (P < 0.05), and average daily feed intake (ADFI) (P < 0.05) with the 1X level being highest. HS reduced the BW at day 14 (P < 0.01) and day 28 (P < 0.01), ADG (P < 0.01), and ADFI (P<0.001). There was a trend of increased feed efficiency (G:F) (P < 0.1) in the HS pigs. HS increased apparent jejunal digestibility of energy (P < 0.05) and apparent ileal digestibility of calcium (P < 0.01). At day 1, HS reduced serum glucose (P < 0.001) but increased nonesterified fatty acid (P < 0.01). In the jejunum, there was a trend of increased villi height by carbohydrases (P < 0.1), whereas HS reduced villi height (P < 0.05). HS increased the jejunal mRNA abundance of IL1β in the jejunum (P < 0.001). There was a trend for a reduction in ileal MUC2 (P < 0.1) and occludin (P < 0.1) by HS, and a trend for increased PEPT1 (P < 0.1). There was no effect of HS on alpha diversity and beta diversity of the fecal microbiome, but there was an increase in the abundance of pathogenic bacteria in the HS group. In conclusion, HS did not alter the efficacy of carbohydrases. This suggests that carbohydrases and HS modulate pig performance independently.
Image-guided Localization Techniques for Nonpalpable Breast Lesions: An Opportunity for Multidisciplinary Patient-centered Care
Authors: Davis Katie M , Raybon Courtney P , Monga Natasha , Waheed Uzma , Michaels Aya , Henry Cameron , Spalluto Lucy B
Published: August 2021

Selection of a localization method for nonpalpable breast lesions offers an opportunity for institutions to seek multidisciplinary input to promote value-based, patient-centered care. The diverse range of nonpalpable breast and axillary pathologies identified through increased utilization of screening mammography often necessitates image-guided preoperative localization for accurate lesion identification and excision. Preoperative localization techniques for breast and axillary lesions have evolved to include both wire and nonwire methods, the latter of which include radioactive seeds, radar reflectors, magnetic seeds, and radiofrequency identification tag localizers. There are no statistically significant differences in surgical outcomes when comparing wire and nonwire localization devices. Factors to consider during selection and adoption of image-guided localization systems include physician preference and ease of use, workflow efficiency, and patient satisfaction.
Climate Disruption in Canadian Constitutional Law: References Re Greenhouse Gas Pollution Pricing Act
Authors: Stacey Jocelyn
Published: August 2021

This analysis considers the Supreme Court of Canada’s decision in References re Greenhouse Gas Pollution Pricing Act, 2021 SCC 11, in which a majority of the Court upheld as constitutional national carbon pricing legislation. The decision presents an excellent illustration of the legally-disruptive nature of climate change. Illustrating that nothing is static in a climate disrupted world—including constitutional law—this article identifies three shifts the Court makes in relation to climate disruption. First, the decision represents a shift away from climate denialism towards a judicial willingness to confront the environmental, social and legal implications of climate change for Canada. Second, the majority embraces and perhaps strengthens a ‘culture of justification’ in climate decision-making. Third—and more tentatively—the majority moves beyond the erasure of Indigenous peoples from Canadian federalism but still yet fails to engage with Indigenous laws and jurisdiction as part of Canada’s constitutional response to climate change.
Association of tensor fascia lata hypertrophy and fatty infiltration in the presence of abductor tendon tears: a radiographic study
Authors: Quinn Matthew , Levins James , Mojarrad Mohammadali , O’Donnell Ryan , DeFroda Steven , Haggerty Erin , Evangelista Peter , Tabaddor Ramin
Published: August 2021

Hip abductor tendon tears of the gluteus medius and minimus are becoming a well-recognized source of pain and dysfunction, primarily in middle-age females. Like the rotator cuff, fatty infiltration (FI) can occur after tearing of these tendons. While the association of TFL hypertrophy after abductor tendon tears has been established, its association with FI has not been well studied. Our hypothesis is that hypertrophy of the TFL will be associated with FI of the abductors. All patients >18 years old undergoing primary surgical repair for a confirmed tears on MRI, without a history of prior hip surgery or osteoarthritis, were included. The following measurements were obtained from MRI: TFL cross-sectional area, TFL:sartorius volume ratio, and modified Goutallier grade of gluteus medius and minimus. Seventy patients met inclusion criteria and were divided in two groups, those with (n = 28) and those without FI (n = 42) of the abductors. The FI group was on average older (65 versus 58 years, P < 0.00016). TFL hypertrophy and TFL:sartorius volume ratio were significantly associated with FI (P= 0.00069). Following abductor tendon tear and subsequent FI, there exists significant TFL hypertrophy in patients without a prior history of hip surgery in our patient cohort.
Statewide Efficacy Assessment of Insect Growth Regulators Against Aedes albopictus (Diptera: Culicidae) in Sabah, Malaysia: An Alternative Control Strategy?
Authors: Elia-Amira N M R , Chen C D , Low V L , Lau K W , Haziqah-Rashid A , Amelia-Yap Z H , Lee H L , Sofian-Azirun M
Published: August 2021

The efficacy of three groups of insect growth regulators, namely juvenile hormone mimics (methoprene and pyriproxyfen), chitin synthesis inhibitors (diflubenzuron and novaluron), and molting disruptor (cyromazine) was evaluated for the first time, against Aedes albopictus Skuse (Diptera: Culicidae) larvae from 14 districts in Sabah, Malaysia. The results showed that all field populations of Ae. albopictus were susceptible towards methoprene, pyriproxyfen, diflubenzuron, novaluron, and cyromazine, with resistance ratio values ranging from 0.50–0.90, 0.60–1.00, 0.67–1.17, 0.71–1.29, and 0.74–1.07, respectively. Overall, the efficacy assessment of insect growth regulators in this study showed promising outcomes and they could be further explored as an alternative to conventional insecticides.
The bryophytes Physcomitrium patens and Marchantia polymorpha as model systems for studying evolutionary cell and developmental biology in plants
Authors: Naramoto Satoshi , Hata Yuki , Fujita Tomomichi , Kyozuka Junko
Published: August 2021

Bryophytes are nonvascular spore-forming plants. Unlike in flowering plants, the gametophyte (haploid) generation of bryophytes dominates the sporophyte (diploid) generation. A comparison of bryophytes with flowering plants allows us to answer some fundamental questions raised in evolutionary cell and developmental biology. The moss Physcomitrium patens was the first bryophyte with a sequenced genome. Many cell and developmental studies have been conducted in this species using gene targeting by homologous recombination. The liverwort Marchantia polymorpha has recently emerged as an excellent model system with low genomic redundancy in most of its regulatory pathways. With the development of molecular genetic tools such as efficient genome editing, both P. patens and M. polymorpha have provided many valuable insights. Here, we review these advances with a special focus on polarity formation at the cell and tissue levels. We examine current knowledge regarding the cellular mechanisms of polarized cell elongation and cell division, including symmetric and asymmetric cell division. We also examine the role of polar auxin transport in mosses and liverworts. Finally, we discuss the future of evolutionary cell and developmental biological studies in plants.
Industrial Drug Use Between Young Couples to Improve the Quality of Sex
Authors: Seifi Zahra , Narimani Mohammad
Published: August 2021

Crystal (methamphetamine), as one of the most effective stimulants, has dangerous effects on the body and mind of people, and its negative effects cannot be ignored. In the meantime, the use of this stimulant can have a great impact on sexual desire and disorders, however, there is still a misconception among many young people about using this stimulant to improve the quality of sex. in addition to physical side effects such as liver and kidney failure, the use of these substances also has psychological and social side effects. An important issue is to raise awareness about the harms and effects of industrial narcotics for the youth of the society, which should be considered in the education system, and by using the media, the minds of the youth should be vaccinated against this bitter reality. Therefore, it seems that by increasing social awareness and learning life skills, on the other hand, young people will have the power to say no to the use of substances that have negative consequences for their body and mind.
Effects of Device Limitations on Acquisition of the /t/-/k/ Contrast in Children With Cochlear Implants
Authors: Johnson Allison A. , Bentley Danielle M. , Munson Benjamin , Edwards Jan
Published: August 2021

Objectives:

The present study investigated how development of the /t/-/k/ contrast is affected by the unique perceptual constraints imposed on young children using cochlear implants (CIs). We hypothesized that children with CIs would demonstrate unique patterns of speech acquisition due to device limitations, rather than straightforward delays due to a lack of auditory input in the first year of life before implantation. This study focused on the contrast between /t/ and /k/ because it is acquired early in the sequence of development, requires less advanced motor control than later-acquired place contrasts, is differentiated by spectral cues (which are particularly degraded when processed by CIs), and is not easily differentiated by visual cues alone. Furthermore, perceptual confusability between /t/ and /k/ may be exacerbated in front-vowel contexts, where the spectral energy for /k/ is shifted to higher frequencies, creating more spectral overlap with /t/.

Design:

Children with CIs (n = 26; ages 31 to 66 mo) who received implants around their first birthdays were matched to peers with normal hearing (NH). Children participated in a picture-prompted auditory word-repetition task that included over 30 tokens of word-initial /t/ and /k/ consonants. Tokens were balanced across front-vowel and back-vowel contexts to assess the effects of coarticulation. Productions were transcribed and coded for accuracy as well as the types of errors produced (manner of articulation, voicing, or place of articulation errors). Centroid frequency was also calculated for /t/ and /k/ tokens that were produced correctly. Mixed-effects models were used to compare accuracy, types of errors, and centroid frequencies across groups, target consonants, and vowel contexts.

Results:

Children with CIs produced /t/ and /k/ less accurately than their peers in both front- and back-vowel contexts. Children with CIs produced /t/ and /k/ with equal accuracy, and /k/ was produced less accurately in front-vowel contexts than in back-vowel contexts. When they produced errors, children with CIs were more likely to produce manner errors and less likely to produce voicing errors than children with NH. Centroid frequencies for /t/ and /k/ were similar across groups, except for /k/ in front-vowel contexts: children with NH produced /k/ in front-vowel contexts with higher centroid frequency than children with CIs, and they produced /k/ and /t/ with equal centroid frequencies in front-vowel contexts.

Conclusions:

Children with CIs not only produced /t/ and /k/ less accurately than peers with NH, they also demonstrated idiosyncratic patterns of acquisition, likely resulting from receiving degraded and distorted spectral information critical for differentiating /t/ and /k/. Speech-language pathologists should consider perceptual confusability of consonants (and their allophonic variations) during their assessment and treatment of this unique population of children.
Physical exercise for the management of systemic autoimmune myopathies: recent findings, and future perspectives
Authors: dos Santos Alexandre Moura , Misse Rafael Giovani , Borges Isabela Bruna Pires , Perandini Luiz Augusto Buoro , Shinjo Samuel Katsuyuki
Published: August 2021

Purpose of review

The aim of this review is to present the main pieces of evidence, recent literature and to present future perspectives on the use of exercise/physical training in the treatment and improvement of the quality of life of patients with systemic autoimmune myopathies.

Recent findings

In the last decades, knowledge about the relevance of physical exercise training in preventing and treating chronic diseases and improving quality of life has grown. Following the global trend exemplified by the expression ‘exercise is medicine’, the importance of exercise/physical training has also grown in myopathies. However, the science of exercise has a lot to collaborate on and improve patients’ quality of life with myopathies by appropriating new technological tools, including accessible and low-cost devices and smartphone apps.

Physical exercise, as already consolidated in the literature, is an effective, well tolerated, and low-cost strategy for patients with myopathies. The use of wearable devices, smartphone apps, and online training prescriptions must accompany the global scenario, bringing new research fields and expanding the options for access to training for the individualized basis, and prescribed by qualified professionals.
Systemic Complications of Obesity in Operative Acetabular Fractures
Authors: Lameka Megan , Mabry Scott , Montgomery Tyler , Wilson Anthony L. , Fellows Kenneth , McGwin Gerald , Spitler Clay A.
Published: August 2021

Objective:

To determine the effect of obesity on rates of systemic complications in operatively treated acetabular fractures.

Design:

Retrospective Case–Control study.

Setting:

Level 1 Trauma Center.

Patients/Participants:

All patients with acetabular fractures managed operatively from January 2015 to December 2019. Patients were divided into groups based on their body mass index (BMI) (normal weight = BMI <25 kg/m2, overweight = BMI 25–30, obese = BMI 30–40, and morbidly obese = BMI >40).

Intervention:

Operative management of an acetabular fracture.

Main Outcome Measurement:

Systemic complications, including mortality, sepsis, pneumonia, acute respiratory distress syndrome, deep vein thrombosis, pulmonary embolism, or venous thrombotic event.

Results:

A total of 428 patients were identified. One hundred nine patients (25.4%) were in normal weight, 133 (31.1%) were overweight, 133 (31.1%) were obese, and 53 (12.4%) were morbidly obese. The rate of systemic complications was 17.5%, and overall mortality rate was 0.005%. There were no significant differences between the different BMI groups in all-cause complications or any individual complications. When the morbidly obese group was compared with all other patients, there were also no significant differences in all-cause complications or any individual complications.

Conclusion:

In conclusion, in this study, there was no association with increasing BMI and inpatient systemic complications after operative management of acetabular fractures. As we continue to refine our understanding of how obesity affects outcomes after acetabular fracture surgery, other indices of obesity might prove more useful in predicting complications. In the obese population, there are well-documented risks of postoperative infections and challenges in obtaining an anatomic reduction, but the fear of postoperative systemic complications should not deter surgeons from undertaking operative management of acetabular fractures in the obese population. Because the prevalence of obesity in trauma patients continues to increase, it is incumbent on us to continue to improve our understanding of optimal treatment for our patients.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Development and Initial Internal Validation of a Novel Classification System for Perioperative Expectations Following Minimally Invasive Degenerative Lumbar Spine Surgery
Authors: Louie Philip K. , Vaishnav Avani S. , Gang Catherine H. , Urakawa Hikari , Sato Kosuke , Chaudhary Chirag , Lee Ryan , Mok Jung Kee , Sheha Evan , Lafage Virginie , Qureshi Sheeraz A.
Published: August 2021

Study Design:

This was a prospective consecutive clinical cohort study.

Objective:

The purpose of our study was to develop and provide an initial internal validation of a novel classification system that can help surgeons and patients better understand their postoperative course following the particular minimally invasive surgery (MIS) and approach that is utilized.

Summary of Background Data:

Surgeons and patients are often attracted to the option of minimally invasive spine surgery because of the perceived improvement in recovery time and postsurgical pain. A classification system based on the impact of the surgery and surgical approach(es) on postoperative recovery can be particularly helpful.

Methods:

Six hundred thirty-one patients who underwent MIS lumbar/thoracolumbar surgery for degenerative conditions of the spine were included. Perioperative outcomes—operative time, estimated blood loss, postsurgical length of stay (LOS), 90-day complications, postoperative day zero narcotic requirement [in Morphine Milligram Equivalent (MME)], and need for intravenous patient-controlled analgesia (IV PCA).

Results:

Postoperative LOS and postoperative narcotic use were deemed most clinically relevant, thus selected as primary outcomes. Type of surgery was significantly associated with all outcomes (P<0.0001), except intraoperative complications. Number of levels for fusion was significantly associated with operative time, in-hospital complications, 24 hours oral MME, and the need for IV PCA and LOS (P<0.0001). Number of surgical approaches for lumbar fusion was significantly associated with operative time, 24 hours oral MME, need for IV PCA and LOS (P<0.001). Based on these parameters, the following classification system (“Qureshi-Louie classification” for MIS degenerative lumbar surgery) was devised: (1) Decompression-only; (2) Fusion—1 and 2 levels, 1 approach; (3) Fusion—1 level, 2 approaches; (4) Fusion—2 levels, 2 approaches; (5) Fusion—3+ levels, 2 approaches.

Conclusions:

We present a novel classification system and initial internal validation to describe the perioperative expectations following various MIS surgeries in the degenerative lumbar spine. This initial description serves as the basis for ongoing external validation.
miR-143-3p represses leukemia cell proliferation by inhibiting KAT6A expression
Authors: Xu Dan , Jiang Jinlong , He Guangsheng , Zhou Haixia , Ji Chengfu
Published: August 2021

The present study is designed to investigate the expressions of microRNA-143-3p (miR-143-3p) and Lysine acetyltransferase 6A (KAT6A) in acute myeloid leukemia (AML) samples and AML cell lines and to explore the possible effects and underlying mechanisms of miR-143-3p on the proliferation of AML cells. The expressions of miR-143-3p and KAT6A in AML samples and cell lines were detected by RT-qPCR assay. CCK-8 and flow cytometry were performed to evaluate the role of KAT6A in viability of AML cells. EdU assay was performed to determine the effects of KAT6A on proliferation of AML cells. Western blot analysis was utilized to assess the impacts of KAT6A on proliferation-related protein expressions of AML cells. ELISA assay was adopted to illustrate the influence of KAT6A on inflammatory responses of AML cells. In addition, the relationship between KAT6A and miR-143-3p was predicted by ENCORI and miRWalk, and confirmed by dual-luciferase reporter assay. Moreover, the effects of KAT6A on the proliferation of AML cells mediated with miR-143-3p were carried out by rescue experiment. The expression of KAT6A was significantly upregulated, while miR-134-4p was downregulated both in the AML tissues and in AML cell lines. In addition, the silence of KAT6A significantly inhibited the viability of AML cells. Besides, KAT6A silencing notably suppressed the proliferation of AML cells and reduced the protein expressions of Ki-67 and PCNA. Knockdown of KAT6A notably decreased the expression levels of IL-1β, TNF-α and IL-6, and increased the expression levels of TGF-β and IL-10. Moreover, overexpression of miR-143-3p repressed viability and proliferation of AML cells and overexpression of KAT6A partially reversed the inhibitory effects of miR-143-3p mimic on viability and proliferation of AML cells. miR-143-3p/KAT6A played an essential role in the viability and proliferation of AML cells.
A Unique Model for Developing Continuing Education Resources for Health Professionals in Geographically Dispersed Health Organizations
Authors: Ohr Se Ok , Maguire Dee , Lord Nina , Talluri Chitti , Solman Annette
Published: August 2021

The provision of high quality, equitable, and accessible education resources is a key to supporting continuing professional development (CPD) in health organizations. The Health Education and Training Institute (HETI) and its operational model for districts (District HETI Operational Model), is a novel approach that supports this imperative for over 155,000 staff working across the state of New South Wales (NSW), Australia. The model uses three principles in education and training development. These include collaborative partnerships, rapid resource development, and effective leadership within virtual teams. A state-wide learning management system has been implemented to support this initiative. Over 451 standardized, education, and training online modules have been developed for medical, nursing and midwifery, dental, allied health, and nonclinical NSW Health employees since 2013. These educational resources are accessible 24 hours a day. Cost-effective online programs have enabled more than 13.6 million learner completions. Program evaluations highlight the value of these resources in providing a positive learning experience. Furthermore, the District HETI Operational Model has been recognized by multiple national and international excellence awards in learning and development. The principles of the District HETI Operational Model apply to other health organizations that may choose to adopt a similar model. Such a model may support equity of access to contemporary, standardized, evidence-based education resources for health professionals working across geographically and clinically diverse environments. Implementation of a similar model for future CPD interventions warrants consideration by practitioners, researchers, and policymakers.
Association of Optimal Lamotrigine Serum Levels and Therapeutic Efficacy in Mood Disorders
Authors: Kumar Rakesh , Nuñez Nicolas A. , Prokop Larry J. , Veldic Marin , Betcher Hannah , Singh Balwinder
Published: August 2021

Purpose

The aim of the study was to appraise the current evidence on the optimal serum level for lamotrigine (LAM) in the treatment of mood disorders (major depressive disorder, bipolar disorder).

Methods

Major databases were searched for randomized controlled trials, open-label trials, and observational studies reporting serum LAM levels in adult patients treated with LAM for mood disorders.

Results

A total of 814 abstracts were screened and 24 articles were selected for full-text review. Seven studies (226 bipolar disorder and 17 major depressive disorder patients) including 1 randomized controlled trial (n = 43), 3 prospective (n = 53), and 3 retrospective (n = 147) studies met the study criteria with a study duration range from 6 to 96 weeks. Lamotrigine daily dosage varied from 25 to 425 mg/d among the studies. Studies reported inconsistent findings between LAM concentration and efficacy. Three studies did not identify a relationship between LAM levels and a significant improvement in mood symptoms. Two studies (n = 99) reported higher response rates with LAM serum levels of greater than 3.25 μg/mL and 1 study (n = 25) reported a wide therapeutic window of 5 to 11 μg/mL. Overall, LAM was well tolerated with no major significant adverse effects.

Conclusions

Most studies showed a minimum LAM threshold level of 3 μg/mL in patients with mood disorders; however, the data are inconsistent regarding the therapeutic range for LAM. Based on the pooled data, there is inconsistent evidence to make conclusive recommendations on therapeutic LAM serum levels for mood improvement. Further studies including larger sample sizes are required to address this relevant clinical question.
Comparative Effectiveness of Training Alternatives for the EPA's Worker Protection Standard Regulation Among Immigrant Latino Farmworkers
Authors: Grzywacz Joseph G. , Gonzales-Backen Melinda , Liebman Amy , Trejo Maribel , Ordaz Gudino Cecilia , Trejo Maria , Economos Jeannie , Xiuhtecutli Nezahualcoyotl , Tovar-Aguilar J. Antonio
Published: August 2021

Objectives:

To determine the comparative effectiveness of two EPA-approved WPS training strategies.

Methods:

Farmworkers in GA and FL blinded to content before training (N = 339) were randomly assigned to either a video training (n = 121) or a culturally tailored, facilitator-led training (n = 136), or an attention-placebo training focused on heat-related illness (n = 82). Data were obtained immediately before and after training and 3 months after training.

Results:

Both active interventions increased pesticide knowledge. At the 3-month follow-up, participants in the EPA video lost acquired knowledge. Those in the facilitator-led group retained acquired knowledge and showed greater pesticide safety behavior.

Conclusions:

Standardized training through video improves short-term knowledge, but it is not retained and unable to support desired behavior to reduce pesticide exposure among farmworkers. A culturally tailored, facilitator-led training is more effective in achieving the spirit of the WPS regulation.
The value of preoperative 18F-FDG PET metabolic and volumetric parameters in predicting microvascular invasion and postoperative recurrence of hepatocellular carcinoma
Authors: Jiang Chunjuan , Ma Guang , Liu Qiufang , Song Shaoli
Published: August 2021

Background

Microvascular invasion (MVI) is very important in the evaluation of hepatocellular carcinoma (HCC), but diagnosis is determined by postoperative pathology; thus, preoperative noninvasive methods will play an active role. The purpose of the study was to assess the performance of metabolic parameters of preoperative 18F-fluorodeoxyglucose PET/computerized tomography (18F-FDG PET/CT) in the prediction of MVI and postoperative recurrence in primary hepatocellular carcinoma.

Methods

We retrospectively collected 72 patients with HCC who have performed 18F-FDG PET/CT scan before partial hepatectomy between 2016 and 2019. We used both normal liver tissue and inferior vena cava as the reference background and combined with clinicopathological features, 18F-FDG PET/CT metabolic and volumetric indices to predict MVI and postoperative recurrence of primary HCC before surgery.

Results

Twenty-one of the 72 patients recurred, in recurrent cases showed higher maximum standard uptake value (SUVmax), TNR (ratio of tumor SUVmax to mean SUV [SUVmean] of the background tissue), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) than nonrecurrence cases (P < 0.001). All 18F-FDG PET metabolic and volumetric indices for predicting postoperative HCC recurrence were significant on receiver-operating-characteristic (ROC) curve analyses (P < 0.05). TNRIVC, TNRNL, MTVIVC, MTVNL TLGIVC and TLGNL were significant factors for predicting MVI in HCC (P < 0.05). On multivariate analyses, MVI, SUVmax, TNRIVC, TNRNL, MTVIVC, MTVNL, TLGIVC and TLGNL (P < 0.05) are independent risk factors for predicting postoperative HCC recurrence. TNRIVC is the most relevant PET/CT parameter for predicting MVI in HCC, and MTVIVC is the most valuable for predicting postoperative HCC recurrence. Moreover, the PET/CT parameters are more accurate for prognosis with inferior vena cava as a reference background than with normal liver tissue.

Conclusion

18F-FDG PET/CT metabolic and volumetric indices are effective predictors, and could noninvasively provide more comprehensive predictive information on MVI and postoperative recurrence of primary HCC before surgery.
Optimization of cross-calibration factor for quantitative bone SPECT without attenuation and scatter correction in the lumbar spine: head-to-head comparison with attenuation and scatter correction
Authors: Ichikawa Hajime , Onoguchi Masahisa , Shibutani Takayuki , Kato Toyohiro , Ito Toshimune , Shimada Hideki
Published: August 2021

Objectives

Quantitative single-photon emission computed tomography (SPECT) with computed tomography (SPECT/CT) is known to improve diagnostic performance. Although SPECT-alone systems are used widely, accurate quantitative SPECT using these systems is challenging. This study aimed to improve the accuracy of quantitative bone SPECT of the lumbar spine with the SPECT-alone system.

Methods

The cross-calibration factor (CCF) was measured using three kinds of phantoms and the optimal values were determined. The recovery coefficient with and without attenuation and scatter correction (ACSC) were compared. Bone SPECT/CT was performed on 93 consecutive patients with prostate cancer, and the standardized uptake values (SUVs) were compared using the respective CCFs. The first 60 patients were classified according to body weight, and the correlation coefficient between SUVs with and without ACSC were calculated; the slopes were defined as body weight-based coefficients (BWCs). In the remaining 33 patients, the SUV was adjusted according to BWC, and the accuracy of the adjustment was verified.

Results

The quantitative SPECT values obtained from the CCF using SIM2 bone phantom showed nearly accurate radioactivity concentrations, even without ACSC. The recovery coefficients with and without ACSC were similar. Unadjusted SUVs with and without ACSC were strongly correlated; however, SUVs without ACSC were significantly higher than those with ACSC (P < 0.0001). The mean difference between the SUVs with and without ACSC disappeared when the SUVs without ACSC were adjusted by BWC (P = 0.9814).

Conclusions

Our cross-calibration method for quantitative bone SPECT enables interpretation with a harmonized SUV even in SPECT-alone systems.
The new world: hematopoietic stem cell transplant during a pandemic
Authors: Riches Marcie
Published: August 2021

Purpose of review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted every facet of hematopoietic cell transplantation. This article reviews the adjustments to recipient and donor care that occurred in response to this unprecedented event.

Recent findings

Transplant centers modified algorithms, patient flow, education, and how we provided care. Our donor center partners reworked how donors were evaluated and products delivered to the transplant center. Our professional societies provided guidelines for patient and donor care and rapidly modified these based upon the never-ending stream of new data learned about SARS-CoV-2. Our research organizations provided rapid analyses to ensure the care modifications necessitated did not have a profound negative impact on our patients or donors.

The efforts of transplant providers and donor centers worldwide allowed patients to receive the transplant needed with assurances that they were receiving the best care available despite the worldwide challenge.
Clinical experience of coronavirus disease 2019 in hematopoietic cell transplant and chimeric antigen receptor T-cell recipients
Authors: Sharma Akshay , Bhatt Neel S. , Hijano Diego R.
Published: August 2021

Purpose of review

To discuss the clinical experience of coronavirus disease 2019 (COVID-19) in hematopoietic cell transplant and chimeric antigen receptor T-cell therapy recipients over the past year and to identify key knowledge gaps for future research.

Recent findings

Immunocompromised individuals and those with chronic health conditions are especially susceptible to infections, which have had a disproportionate impact on health outcomes during the COVID-19 pandemic. Several studies have evaluated the clinical characteristics and outcomes of transplant and cellular therapy (TCT) recipients who developed COVID-19. Age, sex, comorbid conditions, and social determinants of health are important predictors of the risk of severe acute respiratory syndrome coronavirus 2 infection and of the eventual severity of the disease. Various treatment approaches have been investigated over the last year. The paradigm of management strategies continues to evolve as more experience is accumulated.

In this review, we summarize some important findings as they relate to the clinical characteristics of TCT recipients who develop COVID-19. We also discuss some treatment approaches that are currently recommended and opine on vaccination in this population.
Elucidating measures of systemic racism to mitigate racial disparities in kidney transplantation
Authors: Wilson Elena M. , Chen Andy , Johnson Morgan , Perkins Jamilah A. , Purnell Tanjala S.
Published: August 2021

Purpose of review

Given recent national attention to the role of racism in perpetuating racial inequities in society and health, this review provides a timely and relevant summary of key measures of systemic racism in kidney transplantation. More specifically, the review identifies current and promising interventions, whereas highlighting the need for more sustainable and impactful interventions.

Recent findings

Racial disparities persist in kidney transplantation. Black and Hispanic individuals are less likely to receive a kidney transplant than non-Hispanic Whites despite disproportionately higher rates of kidney failure. Studies demonstrate that socioeconomic factors do not fully explain existing racial disparities in transplantation. Systemic racism at all levels, individual, interpersonal, institutional, and structural, is at the core of racial disparities, and current interventions are insufficient in mitigating their effects. Thus, targeted and sustainable interventions must be implemented to mitigate systemic racism in kidney transplantation.

Systemic racism in all its forms continues to influence disparities at all stages of kidney transplantation. This paper highlights recent findings that shed light on how racism contributes to racial disparities in kidney transplantation. Using these findings to identify targets and strategies for mitigation, relevant interventions and policies that show promise are detailed.
Creation of a Nursing Intervention Model to Support Decision Making by Elderly Advanced Cancer Patients and Their Families About the Place of Death, and Evaluation of the Model's Appropriateness and Clinical Applicability
Authors: Minamiguchi Yoko , Suzuki Kumi
Published: August 2021

Elderly patients with advanced cancer and their families need to be supported in the process of making a decision about a place to die. The objective of this research was to evaluate the appropriateness and clinical applicability of a nursing intervention model we developed to support decision making by elderly advanced cancer patients and their families about the place of death. We created the Nursing Intervention Model using the framework of the nursing intervention model reported by McEvoy and Egan (1979). Our survey was performed on 5 physicians and 9 nurses engaged in decision making about the place of terminal care and death for cancer patients. Focus group interviews were conducted to determine the appropriateness of the model. A content analysis technique was used to analyze the data obtained. Survey participants expressed an overall view that the contents of “Intervention Focus” and “Nursing Activity” are generally appropriate. On the other hand, the challenges to be addressed include clarification of which patients the model is applicable to support their decision making, positioning within the model of factors that influence the decision-making process, and further identification of the roles of nurses in an interdisciplinary approach to health care.
From Development to Implementation
Authors: Brohard Cheryl , Moreland Earline , Shammas Samer , Tonsul Roberto
Published: August 2021

This study describes the development and implementation of a high-fidelity simulation as the teaching strategy to enhance undergraduate nursing students' satisfaction, self-confidence, knowledge and learning, collaboration, and communication in providing advance care planning to a terminally ill patient. This original simulation was created using the Healthcare Simulation Standards of Best Practice to incorporate the CARES: Competencies And Recommendations for Educating Undergraduate Nursing Students Preparing Nurses to Care for the Seriously Ill and their Families into the nursing curriculum. A descriptive, quantitative study was conducted for 3 years, evaluating feasibility, sustainability, and student outcomes. Student outcomes were measured with the Frommelt Attitude toward the Care of the Dying Scale, the Student Satisfaction and Self-Confidence in Learning Scale, and Educational Practices Questionnaire. The findings showed the average global scores for the Student Satisfaction and Self-Confidence in Learning Scale (n = 174; mean [SD], 4.28 [0.86]) and for the Educational Practices Questionnaire (n = 164; mean [SD], 4.46 [0.7]), and item scores of each scale were heavily skewed toward the maximum score of 5. The high-fidelity simulation for advance care planning was demonstrated to be feasible and sustainable. As an investment in student learning, it increased the students' active learning, collaboration, communication, satisfaction, and self-confidence while learning how to conduct advance care planning for the terminally ill.
Correction of Psycho-Emotional Status Using Neuromuscular Relaxation of the Face
Authors: Dubinskaya Anastasia D. , Yurova Olga V. , Fesyun Anatoliy D. , Kukshina Anastasia A.
Published: August 2021

This article is relevant, as most healthy women face the problem of increased facial muscle tone. The purpose of the study was to investigate current problems of the relationship between tonic activity of the facial muscles and psycho-emotional states. The study included a group of 151 women subjected to psychological testing. According to its results, they were randomized into five study groups depending on sex and age. The frequency and severity of psycho-emotional states and parameters of tonic activity of the facial muscles were studied. Currently accepted methods for the correction of psycho-emotional states based on the feedback mechanism were analyzed. The efficacy of myofascial facial massage as an instrument for psychological status correction was evaluated. The long-term effects of various massage techniques aimed at facial muscle relaxation on the psycho-emotional state were established. The most effective tools for muscle tone correction were proposed for psycho-emotional status correction.
Diagnostic Capability of a New Objective Method to Assess Meibomian Gland Visibility
Authors: García-Marqués José Vicente , García-Lázaro Santiago , Talens-Estarelles Cristian , Martínez-Albert Noelia , Cerviño Alejandro
Published: August 2021

SIGNIFICANCE

The diagnosis of dry eye disease and meibomian gland dysfunction (MGD) is challenging. Measuring meibomian gland visibility may provide an additional objective method to diagnose MGD.

PURPOSE

This study aimed to evaluate the ability of new metrics to better diagnose MGD, based on measuring meibomian gland visibility.

METHODS

One hundred twelve healthy volunteers (age, 48.3 ± 27.5 years) were enrolled in this study. Ocular surface parameters were measured using the Oculus Keratograph 5M (Oculus GmbH, Wetzlar). Subjects were classified according to the presence or absence of MGD. New metrics based on the visibility of the meibomian glands were calculated and later compared between groups. The diagnostic ability of ocular surface parameters and gland visibility metrics was studied through receiver operating characteristic curves. Logistic regression was used to obtain the combined receiver operating characteristic curve of the metrics with the best diagnostic ability.

RESULTS

Statistically significant differences were found between groups for all ocular surface parameters and new gland visibility metrics, except for the first noninvasive keratograph breakup time and gland expressibility. New gland visibility metrics showed higher sensitivity and specificity than did current single metrics when their diagnostic ability was assessed without any combination. The diagnostic capability increased when gland visibility metrics were incorporated into the logistic regression analysis together with gland dropout percentage, tear meniscus height, dry eye symptoms, and lid margin abnormality score (P < .001). The combination of median pixel intensity of meibography gray values and the aforementioned ocular surface metrics achieved the highest area under the curve (0.99), along with excellent sensitivity (1.00) and specificity (0.93).

CONCLUSIONS

New meibomian gland visibility metrics are more powerful to diagnose MGD than current single metrics and can serve as a complementary tool for supporting the diagnosis of MGD.