bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial Differences in Performance‐Based Function and Potential Explanatory Factors Among Individuals With Knee Osteoarthritis
Authors: Flowers Portia P. E. , Schwartz Todd A. , Arbeeva Liubov , Golightly Yvonne M. , Pathak Ami , Cooke Jennifer , Gupta Jyotsna J. , Callahan Leigh F. , Goode Adam P. , Corsi Michela , Huffman Kim M. , Allen Kelli D.
Published: June 2019

Objective

In individuals with knee osteoarthritis (OA), self‐reported physical function is poorer in African Americans than in whites, but whether this difference holds true for objective assessments is unclear. The purpose of this study was to examine racial differences in performance‐based physical function as well as potential underlying factors contributing to these racial differences.

Methods

Participants with knee OA from a randomized controlled trial completed the 2‐minute step test (2MST), timed‐up‐and‐go (TUG), and 30‐second chair stand (30s‐CST) at baseline. Race differences in performance‐based function were assessed by logistic regression. Separate models were adjusted for sets of demographic, socioeconomic, psychological health, and physical health variables.

Results

In individuals with knee OA (n = 322; 72% women, 22% African American, mean ± SD age 66 ± 11 years, mean ± SD body mass index 31 ± 8 kg/m2), African Americans (versus whites) had greater unadjusted odds of poorer function (30s‐CST odds ratio [OR] 2.79 [95% confidence interval (95% CI) 1.65–4.72], 2MST OR 2.37 [95% CI 1.40–4.03], and TUG OR 3.71 [95% CI 2.16–6.36]). Relationships were maintained when adjusted for demographic and psychological health covariates, but they were either partially attenuated or nonsignificant when adjusted for physical health and socioeconomic covariates.

Conclusion

African American adults with knee OA had poorer unadjusted performance‐based function than whites. Physical health and socioeconomic characteristics diminished these differences, emphasizing the fact that these factors may be important to consider in mitigating racial disparities in function.
Relationship Between Varus Thrust During Gait and Low Back Pain in Individuals With Knee Osteoarthritis
Authors: Iijima Hirotaka , Suzuki Yusuke , Aoyama Tomoki , Takahashi Masaki
Published: June 2019

Objective

To test the hypothesis that varus thrust visualized during gait is associated with a higher prevalence of low back pain (LBP) in individuals with knee osteoarthritis (OA).

Methods

Individuals with knee OA (Kellgren/Lawrence grade ≥1) underwent a gait observation to assess varus thrust. The participants identified LBP and its severity using questionnaires. Logistic regression analyses were performed to examine the association between varus thrust and LBP.

Results

We included 205 participants (mean age 68.19 years; 72.20% women). A total of 45 participants (22.0%) showed varus thrust in their painful knee, in whom 31 (68.89%) and 18 (40.00%) were identified as having any LBP and moderate‐to‐severe LBP (numerical rating scale ≥4 points), respectively. Patients with varus thrust demonstrated a 3.6‐fold higher risk of the presence of moderate‐to‐severe LBP (95% confidence interval [95% CI] 1.62–8.10). In patients with LBP, the presence of varus thrust was associated with more severe LBP intensity (proportional odds ratio 2.25 [95% CI 1.02–4.96]).

Conclusion

This study highlights the novel relationship between varus thrust and LBP, which supports the idea of a biomechanical link, the so‐called knee–spine syndrome. These findings provide new insight for clarifying the pathogenesis of LBP related to knee OA.
Low‐Dimensional Perovskites with Diammonium and Monoammonium Alternant Cations for High‐Performance Photovoltaics
Authors: Li Pengwei , Liang Chao , Liu Xiao‐Long , Li Fengyu , Zhang Yiqiang , Liu Xiao‐Tao , Gu Hao , Hu Xiaotian , Xing Guichuan , Tao Xutang , Song Yanlin
Published: July 2019

Low‐dimensional Ruddlesden–Popper (LDRP) perovskites are a current theme in solar energy research as researchers attempt to fabricate stable photovoltaic devices from them. However, poor exciton dissociation and insufficiently fast charge transfer slows the charge extraction in these devices, resulting in inferior performance. 1,4‐Butanediamine (BEA)‐based low‐dimensional perovskites are designed to improve the carrier extraction efficiency in such devices. Structural characterization using single‐crystal X‐ray diffraction reveals that these layered perovskites are formed by the alternating ordering of diammonium (BEA2+) and monoammonium (MA+) cations in the interlayer space (B‐ACI) with the formula (BEA)0.5MAn
PbnI3n+1. Compared to the typical LDRP counterparts, these B‐ACI perovskites deliver a wider light absorption window and lower exciton binding energies with a more stable layered perovskite structure. Additionally, ultrafast transient absorption indicates that B‐ACI perovskites exhibit a narrow distribution of quantum well widths, leading to a barrier‐free and balanced carrier transport pathway with enhanced carrier diffusion (electron and hole) length over 350 nm. A perovskite solar cell incorporating BEA ligands achieves record efficiencies of 14.86% for (BEA)0.5MA3Pb3I10 and 17.39% for (BEA)0.5Cs0.15(FA0.83MA0.17)2.85Pb3(I0.83Br0.17)10 without hysteresis. Furthermore, the triple cations B‐ACI devices can retain over 90% of their initial power conversion efficiency when stored under ambient atmospheric conditions for 2400 h and show no significant degradation under constant illumination for over 500 h.
The Variable Journey in Learning to Interpret Pediatric Point‐of‐care Ultrasound Images: A Multicenter Prospective Cohort Study
Authors: Kwan Charisse , Pusic Martin , Pecaric Martin , Weerdenburg Kirstin , Tessaro Mark , Boutis Kathy
Published: June 2019

Objectives

To complement bedside learning of point‐of‐care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners.

Methods

This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computer‐based image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4‐week period.

Results

We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most.

Conclusions

Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.
Agricultural firm survival: The case of farmer cooperatives in the United States
Authors: Grashuis Jasper
Published: June 2019

The number of farmer cooperatives in the United States is declining, but empirical investigations of cooperative firm survival have been scarce. With demographic, financial, and strategic characteristics as possible explanations, we conduct survival analysis in relation to 950 U.S. farmers cooperatives for the 2005–2018 period. Following the results of our Cox proportional hazard regressions, we find (a) relatively young and old farmer cooperatives are more susceptible to exit; (b) the relationship of membership size to the survival rate of farmer cooperatives is U‐shaped; (c) farmer cooperatives with intangible asset portfolios have lower survival probabilities; and (d) the survival function of farmer cooperatives is not explained significantly by efficiency, leverage, or liquidity. Overall, we use our findings to inform recommendations in terms of cooperative firm behavior, in particular in relation to member heterogeneity and strategic orientation.
Fifteen year overall survival rates after autologous stem cell transplantation for AL amyloidosis
Authors: Sidana Surbhi , Sidiqi M. Hasib , Dispenzieri Angela , Buadi Francis K. , Lacy Martha Q. , Muchtar Eli , Dingli David , Hayman Suzanne R. , Gonsalves Wilson I. , Kapoor Prashant , Leung Nelson , Warsame Rahma , Kourelis Taxiarchis V. , Wolf Robert C. , Hogan William J. , Kumar Shaji K. , Gertz Morie A.
Published: June 2019

In appropriately selected patients with AL amyloidosis, autologous stem cell transplant (ASCT) is an established treatment modality with excellent outcomes and decreasing transplant related mortality (TRM) over time. We report on 15‐year overall survival (OS) in 159 patients undergoing ASCT from 1996 to 2003, with median follow up of 17.1 years. Day 100 TRM was 13.2% (n = 21). The OS of ≥15 years was observed in 30% (47/159) of patients. Patients surviving ≥15 years were younger (53 vs 56 years, P = .02), less likely to have lambda as the involved light chain (62% vs 78%, P = .03) and were less likely to have heart involvement (32% vs 56%, P = .005). Median OS of patients with heart involvement vs not was 4.0 vs 11.1 years, P = .006 and actuarial 15‐year OS was 23% vs 43%, respectively. A higher proportion of patients with OS ≥15 years received full‐dose melphalan conditioning (81% vs 61%, P = .01), and achieved day 100 complete response (CR) (64% vs 24%, P < .001). Median OS amongst patients who achieved CR vs not was 19.3 vs 5.4 years, P < .001. Heart involvement, receiving full‐dose melphalan and achieving CR remained independent predictors of OS. AL amyloidosis and related complications were the cause of death in 52% of patients overall (1‐5 years post‐transplant: 81%; 5‐10 years: 62% and 10‐15 years: 55%). These results reinforce the key role of ASCT in AL amyloidosis. With improvements in TRM and more options for relapsed disease, we expect the long‐term survival post‐transplant to improve significantly in the future.
Prevalence of, and biochemical and anthropometric risk factors for, dyslipidemia in children and adolescents aged 7 to 18 years in China: A cross‐sectional study
Authors: He Huijing , Pan Li , Du Jianwei , Liu Feng , Jin Yuming , Ma Jingang , Wang Li , Jia Pengben , Hu Zhiping , Shan Guangliang
Published: June 2019

Objective

This study aimed to investigate the prevalence of dyslipidemia and its risk factors in children and adolescents aged 7 to 18 years in China.

Methods

A cross‐sectional study was conducted from November, 2013 to July, 2014. A total of 2283 children and adolescents from urban and rural areas in Hainan (South China) and Shaanxi Provinces (Northwest China) were selected using multi‐stage stratified cluster sampling method. Each participant underwent anthropometric and serum biochemical tests which included serum lipids and hepatitis B virus surface antigen (HBsAg).

Results

The overall prevalence of high total cholesterol (TC), high triglyceride (TG), high low‐density lipoprotein cholesterol (LDL‐C), low high‐density lipoprotein cholesterol (HDL‐C), hyperlipidemia and dyslipidemia were 6.5%, 7.5%, 5.2%, 9.1%, 14.3%, and 20.6%, respectively. After standardization by age, girls had higher prevalence of high TC (8.2%), high LDL‐C (6.6%), and hyperlipidemia (16.4%), but lower prevalence of low HDL‐C (8.21%) than boys (4.2%, 3.4%, 11.9%, and 11.3%, respectively). The risk of dyslipidemia increased with age (OR = 1.067, 95% CI: 1.030‐1.106). Boys had a decreased risk of dyslipidemia (OR = 0.798, 95% CI: 0.640‐0.994). The restricted cubic spline revealed a linear relationship between BMI and the risk of dyslipidemia (P < .001). Subjects who were HBsAg positive had higher risk of dyslipidemia (OR = 1.550, 95% CI: 1.050‐2.287) compared with those who were HBsAg negative.

Conclusions

Our study highlights the high prevalence of dyslipidemia in youth in China, and is the first study to reveal a positive association between positive status for HBsAg and abnormal lipid levels in children and adolescents.
Bipolarolides A–G: Ophiobolin‐Derived Sesterterpenes with Three New Carbon Skeletons from Bipolaris sp. TJ403‐B1
Authors: Liu Mengting , Sun Weiguang , Shen Ling , He Yan , Liu Junjun , Wang Jianping , Hu Zhengxi , Zhang Yonghui
Published: June 2019

Bipolarolides A–G (1–7), seven novel ophiobolin‐derived sesterterpenes with three new types of skeletons, were characterized from fungus Bipolaris sp. TJ403‐B1. Their structures were determined via spectroscopic analyses, X‐ray crystallography, and quantum chemical 13C NMR and electronic circular dichroism (ECD) calculations. Compounds 1 and 2 were uniquely defined by a multicyclic caged oxapentacyclo[9.3.0.01,6.05,9.18,12]pentadecane‐bridged system. Compounds 3 and 4 featured an unprecedented 5‐5‐5‐5‐fused core skeleton, while 3 also contained an unexpected C‐3–C‐14 oxygen bridge to construct the caged architecture. Compounds 5–7 form a new class of highly modified pentacyclic oxaspiro[4.4]nonane‐containing sesterterpene‐alkaloid hybrids. Their biosynthetic pathways and potential HMG‐CoA reductase inhibitory and antimicrobial activities are also discussed.
Redescription of Brachiosaurid Sauropod Dinosaur Material From the Upper Jurassic Morrison Formation, Colorado, USA
Authors: D'Emic Michael D. , Carrano Matthew T.
Published: June 2019

Like many long‐standing dinosaur taxa, Brachiosaurus altithorax from the Upper Jurassic Morrison Formation of North America suffers from taxonomic issues stemming from a relatively incomplete holotype. Lack of anatomical overlap has precluded definitive referral of important specimens, including a mostly complete skull discovered in 1883. We redescribe this skull and some other significant brachiosaurid specimens based on new preparation and computed tomographic (CT) data. We argue that these elements are most parsimoniously referred to B. altithorax. Including these tentatively referred elements in a phylogenetic analysis does not alter the hypothesized relationships of B. altithorax, congruent with the presence of a single brachiosaurid taxon across western North America in the Late Jurassic. Based on CT data, we estimate that B. altithorax had a slower tooth replacement rate than Camarasaurus or the diplodocoids it shared Morrison Formation landscapes with, which suggests a difference in diet and/or feeding strategy. Anat Rec, 303:732–758, 2020. © 2019 Wiley Periodicals, Inc.
Investigating the role of eye movements and physiological signals in search satisfaction prediction using geometric analysis
Authors: Wu Yingying , Liu Yiqun , Tsai Yen‐Hsi Richard , Yau Shing‐Tung
Published: June 2019

Two general challenges faced by data analysis are the existence of noise and the extraction of meaningful information from collected data. In this study, we used a multiscale framework to reduce the effects caused by noise and to extract explainable geometric properties to characterize finite metric spaces. We conducted lab experiments that integrated the use of eye‐tracking, electrodermal activity (EDA), and user logs to explore users' information‐seeking behaviors on search engine result pages (SERPs). Experimental results of 1,590 search queries showed that the proposed strategies effectively predicted query‐level user satisfaction using EDA and eye‐tracking data. The bootstrap analysis showed that combining EDA and eye‐tracking data with user behavior data extracted from user logs led to a significantly better linear model fit than using user behavior data alone. Furthermore, cross‐user and cross‐task validations showed that our methods can be generalized to different search engine users performing different preassigned tasks.
Gender comparative research on learning strategies applying the cognitive‐motor model methodology and VISIR remote lab
Authors: Blazquez‐Merino Manuel , Garcia‐Loro Felix , Plaza‐Merino Pedro , López‐Rey Africa , San Cristobal‐Ruiz Elio , Castro‐Gil Manuel A. , Albert Mª José
Published: June 2019

The research work hereby presented shows some findings about the different ways used by girls and boys, at secondary school, to assimilate the electricity concepts and electric magnitudes to be able to design and assemble electric circuits. The methodology applied to learning, the cognitive‐motor model (CMM), is also presented, and it is based on the mutual interaction of cognitive skills and motor capabilities. Students have followed a specific course designed under CMM specifications. The course contains a combination of theoretical activities and practical tasks by means of which cognitive and motor skills have been measured. To carry out the practical tasks, the Virtual Instrument Systems in a reality remote lab have been used by students as the technical resource. In the study, different learning strategies between male and female students, what affects each gender effectiveness, and learning performance have been found.
PD‐L1 and PD1 expression in post‐transplantation lymphoproliferative disease (PTLD) of childhood and adolescence: An inter‐ and intra‐individual descriptive study covering the whole spectrum of PTLD categories
Authors: Schiefer Ana‐Iris , Salzer Elisabeth , Füreder Anna , Szepfalusi Zsolt , Müller‐Sacherer Thomas , Huber Wolf‐Dietrich , Michel‐Behnke Ina , Lawitschka Anita , Pichler Herbert , Mann Georg , Hutter Caroline , Simonitsch‐Klupp Ingrid , Attarbaschi Andishe
Published: July 2019

Therapy of children with post‐transplantation lymphoproliferative disorder (PTLD) after hematopoietic stem cell (HSCT) and solid organ transplantation (SOT) can be challenging. In this retrospective study, we investigated PD‐L1 and PD1 expression in all PTLD categories of childhood and adolescence to see whether checkpoint inhibition with PD‐L1/PD1 inhibitors may serve as a therapy option. We included 21 patients aged 19 years or younger (at date of transplant) with PTLD following SOT or HSCT having adequate tumor samples available (n = 29). Using immunohistochemistry, we evaluated PD‐L1/PD1 expression on both tumor cells and cells of the microenvironment in all samples. Availability of consecutively matched tumor samples during 6 of 21 patients' disease courses also allowed an intra‐individual assessment of PD‐L1/PD1 expression. We observed lower PD‐L1 and higher PD1 expression in non‐destructive lesions, and higher PD‐L1 and lower PD1 expression in polymorphic and, in particular, in monomorphic PTLD, mostly diffuse large B‐cell lymphomas (DLBCL, n = 10/21). The amount of PD‐L1‐ and PD1‐positive cells changed in the opposite way in sequential biopsies of the same individual correlating well with the PTLD category. This is the first comprehensive pediatric study assessing PD‐L1 and PD1 expression on tumor cells and in the microenvironment of PTLD including not only monomorphic, but also non‐destructive early lesions. PD‐L1 expression of the tumor cells inversely correlated with PD1 expression in surrounding tissues, with the highest expression in DLBCL. Since PTLD can be therapeutically challenging, our results indicate a potential efficacy of checkpoint inhibitors if standard immune‐ and/or chemotherapy fail or are impossible. We therefore recommend routine staining of PD‐L1 and PD1 in all PTLD categories.
Predictive value of combining the SYNTAX score with reactive hyperemia index in patients with acute coronary syndrome undergoing percutaneous coronary intervention
Authors: He Yun , Cheng X. F. , Wang K. , Liu T. , Fan H. P. , Pan W. X. , He P. X. , Jin Jun
Published: June 2019

Objective

To investigate the predictive value of SYNTAX (Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery) score (SS) combined with reactive hyperemia index (RHI) in predicting 2‐year major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

Background

Both SS and RHI are good predictors of MACE; however, it is unknown whether combining SS and RHI could improve predictability of MACE in patients with ACS undergoing PCI.

Methods

We undertook a prospective study in 401 ACS patients that underwent PCI. The RHI‐SYNTAX score (RSS) was calculated by categorizing and summing up the RHI and SS of individual patients. Patients with RHI < 1.67 are given 1 point, RHI ≥ 1.67 given 0 points, and those with SS ≤ 22 scored as 0 and SS > 22 as 1 point. Patients were classified into three groups: low RSS (group 0), moderate RSS (group 1), and high RSS (group 2).

Results

Among patients in the low, moderate, and high groups, the 2‐year rates of MACE were 5.50, 10.66, and 23.33%, respectively (p < .0001). Total revascularization rates were 1.83, 2.54, and 8.89%, respectively (p = .015). Ischemic stroke rates were 0.00, 3.67, and 5.56%, respectively (p = .031). By multivariate analysis, the RSS was an independent predictor of 2‐year MACE (hazard ratio: 2.09, 95% CI: 1.36–3.21, p = .001). Receiver‐operator characteristic analysis indicated that the area under the curve significantly improved from 0.63 to 0.69, when RHI was added to SS (p < .0001).

Conclusions

RSS is correlated with 2‐year MACE in patients presenting with ACS undergoing PCI.
The efficacy and safety of cangrelor in single vessel vs multivessel percutaneous coronary intervention: Insights from CHAMPION PHOENIX
Authors: Yong Celina M. , Sundaram Vandana , Abnousi Freddy , Olivier Christoph B. , Yang Jaden , Stone Gregg W. , Steg Philippe G. , Michael Gibson C. , Hamm Christian W. , Price Matthew J. , Deliargyris Efthymios N. , Prats Jayne , White Harvey D. , Harrington Robert A. , Bhatt Deepak L. , Mahaffey Kenneth W. ,   on behalf of the CHAMPION PHOENIX Investigators
Published: June 2019

Background

The intravenous, rapidly acting P2Y12 inhibitor cangrelor reduces the rate of ischemic events during PCI with no significant increase in severe bleeding. However, the efficacy and safety of cangrelor compared with clopidogrel in patients treated with single vessel (SV)‐percutaneous coronary intervention (PCI) or multivessel (MV)‐PCI remains unexplored.

Methods

We studied the modified intention‐to‐treat population of patients from the CHAMPION PHOENIX trial who were randomized to either cangrelor or clopidogrel. We used logistic regression and propensity score matching to evaluate the effect of cangrelor compared with clopidogrel on the primary efficacy outcome (composite of death, myocardial infarction, ischemia‐driven revascularization, or stent thrombosis) at 48 hours. The safety outcome was moderate or severe Global Utilization of Streptokinase and tPA for Occluded Arteries bleeding at 48 hours.

Hypothesis

Cangrelor is as efficacious and safe as clopidogrel in both SV and MV PCI.

Results

Among 10 854 patients, 9204 (85%) underwent SV‐ and 1650 (15%) MV‐PCI. After adjustment, cangrelor was associated with similar reductions vs clopidogrel in the primary efficacy outcome in patients undergoing SV‐PCI (4.5% vs 5.2%; odds ratio [OR] 0.81 [0.66‐0.98]) or MV‐PCI (6.1% vs 9.8%, OR 0.59 [0.41‐0.85]; Pint 0.14). Similar results were observed after propensity score matching (SV‐PCI: 5.5% vs 5.9%, OR 0.93 [0.74‐1.18]; MV‐PCI: 6.2% vs 8.9%, OR 0.67 [0.44‐1.01]; Pint 0.17). There was no evidence of heterogeneity in the treatment effect of cangrelor compared with clopidogrel for the safety outcome.

Conclusions

In patients undergoing SV‐ or MV‐PCI, cangrelor was associated with similar relative risk reductions in ischemic complications and no increased risk of significant bleeding compared with clopidogrel, which highlights the expanding repertoire of options for use in complex PCI.
A computational model for hepatotoxicity by coupling drug transport and acetaminophen metabolism equations
Authors: Franiatte Sylvain , Clarke Richard , Ho Harvey
Published: June 2019

The spatial distributions of cytochrome P450 (CYP450) and glutathione (GSH) in liver lobules determine the heterogeneous hepatotoxicity of acetaminophen (APAP). Their interplay in conjunction with blood flow is not well understood. In this paper, we integrate a cellular APAP metabolism model with a sinusoidal blood flow to simulate the temporal‐spatial patterns of APAP‐induced hepatotoxicity. The heterogeneous distribution of CYP450 and GSH is modeled by linearly varying their reaction rates along the portal triad to the central vein axis of a sinusoid. We found that the spatial distribution of GSH, glutathione S‐transferases (GSTs), and CYP450 all contributes to the high acetaminophen protein adduct formation at zone 3 of the lobules. The reversed spatial gradients of CYP450 and GSH cause quick depletion of GSH, which is further accelerated by the distribution of GST. The hepatic flow congestion and hyperperfusion however do not seem to play a significant role in the zonal hepatotoxicity. The simulation results may be useful for understanding the APAP‐induced hepatotoxicity and associated pharmaceutical treatment.
Nonadiabatic Dynamics of Hydrogen Diffusion on Cu(001): Classical Mapping Model with Multistate Projection Window in Real Space
Authors: Tao Guohua
Published: June 2019

Diffusion of atomic hydrogen on metallic surfaces is a longstanding research topic of both fundamental and practical interests. However, full understanding of the microscopic mechanisms and development of effective strategy for surface dynamics control at the molecular level remain elusive. In this paper, we propose a new nonadiabatic multistate model for surface diffusion based on a real space decomposition scheme by generalizing the classical mapping theory of Meyer and Miller. The model suggests a general multistate perspective on real‐time surface dynamics by mapping it into spatially disjointed windowing functions, which feature the explicit nonadiabatic controllability. Within this framework, the first nonadiabatic molecular dynamics simulation is performed for atomic hydrogen diffusion on the Cu(001) surface, and the nonequilibrium effect of lattice distortion is studied.
Cerebral palsy and bruxism: Effects of botulinum toxin injections—A randomized controlled trial
Authors: Cahlin Birgitta Johansson , Lindberg Christopher , Dahlström Lars
Published: June 2019

Objective

Cerebral palsy (CP) includes disturbances in muscular control caused by perinatal brain injury. Masticatory muscle involvement hampers functions such as chewing and talking. Bruxism and temporomandibular disorders are overrepresented. Neuromuscular blocks with botulinum toxin type A (BTX‐A) may alleviate problems due to muscular hyperactivity. The aim was to evaluate masticatory muscle BTX‐A injections in subjects with CP and bruxism.

Methods

A prospective, parallel, randomized, placebo‐controlled, and double‐blind trial in 12 patients with CP was performed. End points were alterations in objective and subjective oral capacities after two BTX‐A or corresponding placebo injections. Matched, healthy references were also evaluated.

Results

The reference group demonstrated stronger and more efficient oral functions compared with the CP group. Subjective and objective oral capacities appeared to vary considerably between CP patients and also over time in this patient group and were poorly correlated. No significant effect of BTX‐A compared with placebo on outcome variables was observed at group level, but continued treatment with BTX‐A was requested by the majority of the patients.

Conclusion

The evidence is unable to support the use of BTX‐A for the treatment of affected masticatory muscles in CP, but the findings are inconclusive in certain respects. Larger, more homogeneous groups of CP patients need to be evaluated in future trials.
Cytopathology of anaplastic carcinoma of the pancreas: Review of a rare entity and description of a variant with signet ring cell features
Authors: El Hussein Siba , Khader Samer N.
Published: June 2019

Anaplastic carcinoma of the pancreas (ACP) is a rare and aggressive variant of pancreatic ductal adenocarcinoma (PDAC). Several studies have attempted to characterize this subtype through case series or single case reports; however, ACP remains underrecognized by cytopathologists in particular, and often lumped under the umbrella of classic PDAC. Here, we review the most up to date data that literature provides about ACP, to bring familiarity with this entity to the cytopathology practice, and to elucidate the role cytopathologists can play in recognizing and diagnosing this subtype on pancreatic aspiration biopsy, before surgical resection. We also describe a rare case of ACP, demonstrating signet ring cell features, that was diagnosed on fine needle aspiration of a pancreatic mass.
Malignant risk of indeterminate pediatric thyroid nodules—An institutional experience
Authors: Heider Amer , Arnold Stacy , Lew Madelyn , Pang Judy , Rabah Raja , Bruch Steven , Thomas Inas , Menon Ram , Cantley Richard , Davenport Robertson , Jing Xin
Published: June 2019

Background

Few studies focus on pediatric thyroid nodules categorized under indeterminate diagnostic categories. The current study was conducted to assess the risk of malignancy of indeterminate pediatric thyroid nodules.

Methods

A search of the institutional electronic pathology database from 01/2011 to 09/2018 was performed to identify pediatric (<21 years old) thyroid nodules that were interpreted as follicular lesion of undetermined significance (FLUS), suspicious for follicular neoplasm (SFN), or suspicious for malignancy (SFM) and subsequently managed with surgery, repeat fine‐needle aspiration (FNA), or ≥ 6 months of clinical/imaging monitoring. Results of follow‐up (F/U) surgical resections and repeat FNA/Afirma tests, and clinical and radiologic data were collected.

Results

We identified 46 cases from 42 patients (11‐20 years old, 33 females and 9 males), including 30 FLUS, 10 SFN, and 6 SFM. Twenty‐five FLUS, ten SFN, and six SFM cases underwent surgery. The histology revealed carcinomas in 36% of FLUS, 20% of SFN, and 100% of SFM categories; follicular adenomas in 32% of FLUS and 80% of SFN categories; and benign nodules in 32% of FLUS category. All five nonsurgically treated FLUS cases were considered benign based on the findings of repeat FNA/Afirma tests (n = 3, 3‐22 months F/U) or clinical/radiologic exams (n = 2, 8‐12 months F/U).

Conclusions

Based on a limited study cohort, malignancy was identified in 36%, 20%, and 100% of surgically managed pediatric thyroid nodules categorized as FLUS, SFN, and SFM, respectively; suggesting a markedly higher malignant rate than the implied malignant risk for FLUS and SFM categories in adults.
High‐efficiency gravel longshore sediment transport and headland bypassing over an extreme wave event
Authors: McCarroll R.J. , Masselink G. , Wiggins M. , Scott T. , Billson O. , Conley D.C. , Valiente N.G.
Published: June 2019

Gravel beaches are common throughout the high latitudes, but few studies have examined gravel transport rates, in particular at high energy levels, and no studies have quantified gravel transport around headlands. Here, we present the first complete sediment budget, including supra‐, inter‐ and sub‐tidal regions of the beach, across multiple headland‐separated gravel embayments, combined with hydrodynamic observations, over an extreme storm sequence, representing at least a 1‐in‐50‐year event. Unprecedented erosion was observed (~400 m3 m−1, −6 m vertical), with alongshore flux of 2 × 105 m3, equivalent to annual rates. Total system volume change was determined to the depth of closure and then used to calculate alongshore flux rates. Alongshore wave power was obtained from a wave transformation model. For an open section of coastline, we derive a transport coefficient (CERC formula) of KHs = 0.255 ± 0.05, exceeding estimates in lower‐energy conditions by a factor of 5 or more. We apply this coefficient to rocky segments of the shoreline, determining rates of headland bypass from 0 to 31% of potential flux, controlled by headland extent and toe depth. Our results support the hypothesis that gravel is transported more efficiently at higher energy levels and that a variable rate or threshold approach may be required. Complete coverage and varying morphology make this dataset uniquely suited to improving model predictions of gravel shoreline change. © 2019 John Wiley & Sons, Ltd. © 2019 John Wiley & Sons, Ltd.
The effect of accelerated soil erosion on hillslope morphology
Authors: Bonetti Sara , Richter Daniel D. , Porporato Amilcare
Published: June 2019

Intensive agricultural land use can have detrimental effects on landscape properties, greatly accelerating soil erosion, with consequent fertility loss and reduced agricultural potential. To quantify the effects of such erosional processes on hillslope morphology and gain insight into the underlying dynamics, we use a twofold approach. First, a statistical analysis of topographical features is conducted, with a focus on slope and gradient distributions. The accelerated soil erosion is shown to be fingerprinted in the distribution tails, which provide a clear statistical signature of this human‐induced land modification. Theoretical solutions are then derived for the hillslope morphology and the associated creep and runoff erosion fluxes, allowing us to distinguish between the main erosional mechanisms operating in disturbed and undisturbed areas. We focus our application on the landscape at the Calhoun Critical Zone Observatory in the US Southern Piedmont, where severe soil erosion followed intensive cotton cultivation, resulting in highly eroded and gullied hillslopes. The observed differences in hillslope morphologies in disturbed and undisturbed areas are shown to be related to the disruption of the natural balance between soil creep and runoff erosion. The relaxation time required for the disturbed hillslopes to reach a quasi‐equilibrium condition is also investigated. © 2019 John Wiley & Sons, Ltd.
What controls the disequilibrium state of gravel‐bed rivers?
Authors: Chartrand Shawn M. , Jellinek A. Mark , Hassan Marwan A. , Ferrer‐Boix Carles
Published: June 2019

A river at equilibrium is described by a statistically‐stationary mean bed elevation profile that arises in response to steady supplies of relief, water and sediment. Outside of the profile shape, how is the equilibrium state of a river most reliably identified and rigorously defined? Motivated by a proposed link between equilibrium and physical processes, we use scaling theory to develop the dimensionless channel response number ξ=KUb/Up. ξ is a metric for the local disequilibrium state of gravel‐bed mountain streams, which reflects a balance between the rate of topographic adjustment Ub, and the rate of bed sediment texture adjustment Up. The coefficient K can take one of two forms depending on choice of length scale for topographic adjustment. We hypothesize that equilibrium occurs where and when ξ≈O(1), and consequently, disequilibrium is the more general state captured by conditions of ξ≉O(1). The rates Ub and Up are controlled by the mechanics of sediment deposition and entrainment at the local scale of the channel width. The extent to which either process regulates disequilibrium depends on the bed strength, which is set by the time‐varying grain size distribution and packing. We use flume experiments to understand ξ and find that in the limit ξ>>1, the time‐varying response of an experimental channel depends sensitively on the spatially‐averaged bed shear stress ratio τ/τref. When τ/τref≈1.5, Ub was the dominant control on disequilibrium. However, when τ/τref≈2.0, Up contributed more significantly to disequilibrium. These results suggest that after an upstream supply perturbation, the equilibrium timescale is governed by Up, which we show is consistent with expectations from linear damping theory. Our experimental test of ξ is promising, but inconclusive with respect to our hypothesis. This uncertainty can be readily addressed with numerical or additional physical experiments. © 2019 John Wiley & Sons, Ltd.
Asylum, Refuge, and Justice in Health
Authors: Straehle Christine
Published: July 2019

We are, as of May 2019, witnessing yet another “caravan” of people fleeing violence in Latin America, bonding together to reach the territory of safer states in the North. Similarly, in the fall of 2015, Europe experienced the movement of many refugees fleeing war, persecution, and grave human rights violations in Syria. These new waves of people on the move have raised anew important questions about asylum and refuge: who should be able to claim asylum? Should the fear of persecution be sufficient, or do asylum seekers need to show that they have actually suffered it? And maybe most controversially, how should asylum‐granting states respond to the plight of those asking for asylum on their territory?

The moral principles guiding asylum and refuge are different from the rules usually regulating immigration, which are based on the principle of territorial sovereignty that allows nation‐states to discriminate and select among those who hope to immigrate. Asylum and refuge instead call upon nation‐states to provide refugees with a new home, protect human rights, and over time, provide access to the social, political and civic rights that characterize membership. Included in the list of human rights, I will argue, is the provision of the means for individual physical and psychological well‐being.
Actions and Uncertainty: How Prenatally Diagnosed Variants of Uncertain Significance Become Actionable
Authors: Werner‐Lin Allison , Mccoyd Judith L. M. , Bernhardt Barbara A.
Published: July 2019

The development of genomic technologies has seemed almost magical. Excitement about it, both in medicine and among the public, stems from the belief that genomic techniques will illuminate the causes of health and disease, will lead to effective interventions for both rare and common genetic conditions, and will inform reproductive decision‐making. Novel diagnostic tools, however, are often deployed before targeted therapies are developed, tested, or available and before their psychosocial implications are explored. Newer technologies such as prenatal whole exome screening are seen as offering “decisional autonomy” to expectant parents, although such technologies identify information about genetic sequencing that may not have clear meaning. The “therapeutic gap” between the ability to conduct genetic sequencing and the ability to fully understand what the test results mean, much less what treatments to offer, leaves families with complex and unclear information they cannot act upon with confidence during pregnancy. In this essay, we will consider the psychosocial and ethical implications of such assumptions—and of the uncertain information produced by these technologies—for individuals and families and for societal aspects such as medical service usage and demographic inequities.
The influence of vegetation cover on evapotranspiration atop waste rock piles, Elk Valley, British Columbia
Authors: Nicholls Erin M. , Drewitt Gordon B. , Fraser Stephanie , Carey Sean K.
Published: June 2019

Surface mining in the Elk Valley, British Columbia, involves removing vegetation, soil, and rock to access underlying metallurgical coal. Subsequent waste rock is placed into adjacent valleys, frequently burying headwater streams. Due to their coarse texture, waste rock piles increase infiltration and percolation, increasing solute transport and concentration of geochemicals in downstream surface waters. Previous research suggests that weathering solutes are transport limited, and it is hypothesized that revegetation will enhance evapotranspiration (ET) and reduce percolation through the waste rock, potentially reducing loading. This study examined the surface‐atmosphere water and energy exchanges using the eddy covariance technique for three waste rock surfaces with different levels of reclamation: (a) an ~25‐year‐old mixed coniferous forest, (b) a grass site, and (c) bare waste rock. Measurements were taken from May to October in 2013 and 2014. Soil moisture and matric suction were measured to 1‐m depth. Sap flow at the forested site was measured to partition transpiration from total ET. In all years, ET rates were greatest at the forested site, followed by the grass cover and lowest at the bare waste rock site. Growing season ET rates at the forest were 56% higher than grass in 2013 and 35% higher in 2014. At the vegetated sites, climate was the main driver of ET, with high radiation, and warm and dry conditions enhancing fluxes. Maximum ET at these sites corresponded with peak growing season, with vegetation increasing both transpiration and rainfall interception. At the bare rock site, ET was weakly related to atmospheric conditions, and ET rates briefly increased during periods following rainfall when near‐surface soil moisture was enhanced. Transpiration comprised 29% of overall ET at the forest site from late July to early October. Results suggest that vegetation establishment can be incorporated into mine reclamation plans to enhance ET rates and limit percolation, potentially reducing downstream geochemical loads.
Quality‐of‐life effects of screening mammography in Norway
Authors: Zahl Per‐Henrik , Kalager Mette , Suhrke Pål , Nord Erik
Published: June 2019

Mammography screening may save women from dying of breast cancer, although it has not been shown to reduce all‐cause mortality. Screening also leads to overdiagnosis and many false positive mammograms aggravating women's quality‐of‐life. Quality adjusted life years (QALY) analyses of mammography screening have so far, calculated life years gained assuming that all prevented breast cancer deaths translate into a reduction in all‐cause mortality. We calculated net QALYs in two hypothesized cohorts of 100,000 Norwegian women; one screened biennially from age 50 to 69 years and one not screened. We followed both cohorts to age 85 years. We used EQ‐5D and an alternative equity weighted QALY instrument to estimate utility losses. In the screening cohort, we assumed 20% false positive tests during screening, different levels of overdiagnosis (20–75%) and different levels of breast cancer mortality reduction (10–30%). We assumed that reductions in breast cancer mortality only to a limited extent (20, 50 or 80%), resulted in reductions in all‐cause mortality. We calculated both undiscounted and discounted (4%) QALYs. Assuming that 50% of the reduction in breast cancer mortality translated to a reduction in all‐cause mortality and using estimated levels of benefits and harms in modern screening programs (50–75% overdiagnosis and 10% reduction in breast cancer mortality), undiscounted equity weighted QALY loss varied from 437 to 875 per 100,000 women. Using the levels of benefit and harms as reported in 30–40 years old randomized trials (30% overdiagnosis and 15% reduction in breast cancer mortality), undiscounted equity weighted QALY gain was 535 per 100,000. Net QALY in modern mammography screening in Norway is negative. Results could also be representative for Sweden, Denmark, UK and the US.
Medication therapy management delivery by community pharmacists: Insights from a national sample of Medicare Part D beneficiaries
Authors: Adeoye Omolola A. , Farley Joel F. , Coe Antoinette B. , Pestka Deborah L. , Farris Karen B. , Zillich Alan J. , Snyder Margie E.
Published: June 2019

Introduction

The Medicare Part D medication therapy management (MTM) program positions pharmacists to optimize beneficiaries' medications and improve care. Little is known regarding Part D MTM delivery by community pharmacists and other pharmacist provider types.

Objectives

To (a) characterize Medicare Part D MTM delivery by community pharmacists, (b) compare MTM delivery by community pharmacists to other pharmacists, and (c) generate hypotheses for future research.

Methods

A descriptive cross‐sectional study using merged data from a 20% random sample of Medicare beneficiary enrollment data with a 100% sample of recently available 2014 Part D MTM files was conducted. Andersen's Behavioral Model was applied to describe MTM delivery across beneficiary characteristics. Descriptive and bivariate statistics were used to compare delivery of MTM between community and other pharmacist providers.

Results

Among beneficiaries sampled, community pharmacists provided comprehensive medication reviews (CMRs) to 22% (n = 26 337) of beneficiaries receiving at least one CMR. Almost half (49.4%) were provided face‐to‐face. Across pharmacist cohorts, median days to CMR offer of post‐MTM program enrollment were within the 60‐day policy requirement. The community pharmacist cohort had fewer days from CMR offer to receipt (median 47 days). Community pharmacists provided more medication therapy problem (MTP) recommendations (mean [SD] of 1.8 [3.5]; P < .001), but resolved less MTPs (0.2 [0.7]; P < .001), and most commonly served beneficiaries that were in the south but less in the west/northeast. Additionally, community pharmacists served a smaller proportion of black beneficiaries, yet a larger proportion of Hispanic beneficiaries (P < .001).

Conclusion

Community pharmacists provided approximately one in five CMRs for MTM eligible beneficiaries in 2014, with CMRs occurring more quickly, resulting in more MTP recommendations, but resolving less MTPs than those provided by noncommunity pharmacists. Future research should explore geographic/racial‐ethnic disparities in beneficiaries served and strategies to increase negligible MTP resolution by community pharmacists.
Superhalogen and Superacid
Authors: Kulsha Andrey V. , Sharapa Dmitry I.
Published: June 2019

A superhalogen F@C20(CN)20 and a corresponding Brønsted superacid were designed and investigated on DFT and DLPNO‐CCSD(T) levels of theory. Calculated compounds have outstanding electron affinity and deprotonation energy, respectively. We consider superacid H[F@C20(CN)20] to be able to protonate molecular nitrogen. The stability of these structures is discussed, while some of the previous predictions concerning neutral Brønsted superacids of record strength are doubted. © 2019 Wiley Periodicals, Inc.
Controlled‐advancement rigid‐body optimization of nanosystems
Authors: Popov Petr , Grudinin Sergei , Kurdiuk Andrii , Buslaev Pavel , Redon Stephane
Published: June 2019

In this study, we propose a novel optimization algorithm, with application to the refinement of molecular complexes. Particularly, we consider optimization problem as the calculation of quasi‐static trajectories of rigid bodies influenced by the inverse‐inertia‐weighted energy gradient and introduce the concept of advancement region that guarantees displacement of a molecule strictly within a relevant region of conformational space. The advancement region helps to avoid typical energy minimization pitfalls, thus, the algorithm is suitable to work with arbitrary energy functions and arbitrary types of molecular complexes without necessary tuning of its hyper‐parameters. Our method, called controlled‐advancement rigid‐body optimization of nanosystems (Carbon), is particularly useful for the large‐scale molecular refinement, as for example, the putative binding candidates obtained with protein–protein docking pipelines. Implementation of Carbon with user‐friendly interface is available in the SAMSON platform for molecular modeling at https://www.samson-connect.net. © 2019 Wiley Periodicals, Inc.