bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of spherical learning XR-arenas based on an abstract symbolic environment in physics teaching
Authors: Yavoruk O
Published: April 2021

Augmented/Virtual Reality (AR/VR) teaching technologies are increasingly popular in physics classes. The AR/VR (united by the term Extended Reality or XR) makes the physics course more close and understandable for young people. In addition, an abstract symbolic environment inside XR spherical arenas is easy applicable for physics teaching. The paper describes elements of an AR/VR sphere, abstract and symbolic objects of a learning arena. It deals with some essential findings from the analysis of experimental XR-teaching, controversial and debatable issues. Methodology of the study involved practical using of XR-devices and XR-applications in order to find adequate teaching elements of XR-arenas and the survey of students’ opinions. Nowadays, XR hardware and software are becoming much more prevalent among students. Physics teachers can easily respond to this request due to the specifics of their professional activities. Both teachers and students are interested in the easy use of XR demonstrations, unusual techniques, and pretty staggering opportunities of virtuality.
Practical Application Peculiarities of Geo-Information Technologies While Planning the Protective Forest Belts
Authors: Smirnov V O , Zelentsova M G , Krainyuk E S
Published: April 2021

This article considers methodological and practical aspects of applying geo- informational technologies in assessing environmental and biologic states of the protective forest-belts. The algorithm for geo-informational cartographic database compilation has been suggested to develop the projects of forest-belts restoration, functions assessment and reclamation effect. The examples of computations while planning forest-belts for the Crimean Republic are given here.
Removal of Ni and Zn heavy metal ions from industrial waste waters using modified slag of electric arc furnace
Authors: Changalvaei Morteza , Nilforoushan Mohammad Reza , Arabmarkadeh Arash , Tayebi Morteza
Published: April 2021

In the present study modified slag of electric arc furnace which itself is considered as an industrial waste material was used to eliminate nickel and zinc metals from industrial waste water. The modified slag was characterized by SEM, XRD and XRF analyses and it was demonstrated that it could be used as an efficient novel adsorbent. Experimental and thermodynamic evaluations of heavy metal removal efficiency were carried out at different conditions including temperatures of 25, 35 and 50 °C. In addition, in order to develop this process on an industrial scale, optimization of different parameters such as contact time, metallic ion concentration, adsorbent amount, adsorbent particle size, temperature, pH, etc was carried out. Results showed that the optimum conditions for removal of nickel and zinc ions were at the adsorbent dosage of 30 mg L−1, adsorbent particles size finer than 75 μm and adsorption time of 3 h. Moreover, by increasing the process temperature, the adsorbing efficiency was improved. Kinetic investigations displayed that the adsorption of metallic ions was more likely correlated with the pseudo-first-order model than the pseudo-second-order model and diffusion model. Additionally, the correlation coefficient indicated that the Freundlich adsorption model predicted more precisely than that of the Langmuir model for adsorption of nickel and zinc metallic ions.
Enhanced energy storage properties of La3+ modified 0.92Bi0.5Na0.5TiO3 -0.06Ba(Zr0.2Ti0.8)O3-0.02NaNbO3 ternary ceramic system
Authors: Ali Khan Aqib , Arbab Safeer Ahmad , Manan Abdul , Saboor Abdul , Ullah Atta , Khattak Noor Saeed , Ahmad Iftikhar , Naeem Khan Muhammad , Bashir Tariq , Asif Muhammad , Sadiq Muhammad , Arif Muhammad
Published: April 2021

The development in field of hybrid vehicles, telecommunication and energy sectors require dielectric materials having high-energy storage density with optimum thermal stability to operate in certain environment. To fulfil such requirement a new set of materials along the ternary solid solutions of 0.92Bi0.5(1-x)-La(x)Na0.5TiO3 -0.06Ba(Zr0.2Ti0.8)O3-0.02NaNbO3 (NB1-xLxT-BZT-NN) (x = 0, 0.03, 0.05, 0.07) were fabricated through solid-state mix oxide route. The XRD patterns analysis confirmed a structural phase transformation from rhombohedral to the tetragonal-P4bm phase when x content increased from 0 to 0.07. The SEM study revealed, dense microstructure for all ceramics accompanied by a decrease in the average grain from 1.66 μm to 1.05 μm leading to high densities for these materials with an increase in the x content. The dielectric breakdown field increased from ∼115 to 137 kV cm−1 resulting in an increase in recoverable energy density from ∼0.68 to 1.14 J cm−3 with the increase in x content. Furthermore, excellent temperature stability (±15%) in dielectric permittivity was observed in a wide temperature range for each ceramic. In the present study, a recoverable energy density of 1.14 J cm−3 along with an efficiency of 70.6% was obtained for the composition of x = 0.07.
Self-repairing inorganic phosphors/polymer composite film for restructuring luminescent patterns
Authors: Cheng Long-Xiang , Liu Tao , Li Lei , Yang Liu , He Hong-Wei , Zhang Jun-Cheng
Published: April 2021

Practical applications of phosphor particles in light sources and displays generally require the adhesion and support of polymer materials. However, these phosphor/polymer composites suffer from the difficulty in self-repairing after fracture. Inspired by the development of self-healing polymers, herein, we prepared phosphor/polymer composite films with self-repairing and restructuring properties. The N,N-dimethylformamide dispersant was used to uniformly disperse the phosphor particles in the self-healing polymer, which is considered to the key process for obtaining self-repairing properties. The developed self-repairing composite films are particularly suitable for restructuring luminescent patterns to provide multidimensional light-emitting modes including photoluminescence, persistent luminescence and mechanoluminescence. These results are expected to provide new insights for designing multifunctional self-repairing and reconstructing composites for anti-counterfeiting, integrated optics, optical communications, and artificial skins.
Preparation and oxidation resistance of polyphenylene sulfide modified by high-temperature antioxidants
Authors: Xing J , Xu Z Z , Li D W
Published: April 2021

Two types of high-temperature antioxidants (Revonox 608 and GA-80) were used to improve the oxidation resistance of polyphenylene sulfide (PPS) through melt blending, and the resistance against oxidation and other properties were characterized. The results showed that GA-80 exhibited better dispersibility and compatibility with the PPS matrix than did Revonox 608. Revonox 608 could act as a heterogeneous nucleation agent that can promote crystallization and improve the crystallinity of PPS, whereas GA-80 could delay the movement of chain segments and limit crystallization. The thermal-oxidative stability of PPS can be improved by adding antioxidants due to prior oxidative decomposition. The dynamic oxidation induction temperature of PPS increased by more than 10 °C because of the capture of free radicals and the decomposition of hydroperoxides by antioxidants. The XPS results showed that both GA-80 and Revonox 608 could retard the oxidative cleavage of the C-S-C bond in the PPS macromolecular chains and protect the S atoms from oxidizing to sulfone groups.
Recent progress on strategies to improve the high-voltage stability of layered-oxide cathode materials for sodium-ion batteries
Authors: Song Tengfei , Kendrick Emma
Published: April 2021

Sodium-ion batteries offer a low-cost sustainable alternative to current lithium-ion batteries and can be made on the same manufacturing lines. The sustainability arises from the low cost, reduction in the use of critical elements and strategic materials, and potential long-life. To maximize their potential, higher energy density batteries are required, this can be achieved in part through the stabilization of higher voltage cathode materials. In this review we summarize the failure and degradation processes associated with the high capacity and higher voltage layered oxide cathode materials. Material crystal structure rearrangements, electrolyte oxidation, particle cracking and reactive surfaces form most of the degradation mechanisms. Strategies to overcome these processes are discussed in detail, and the synergistic requirements to stabilize the materials structure and the interfaces highlighted. The importance of surface engineering in future materials design is emphasized.
Mechanisms of Action in a Behavioral Weight-Management Program: Latent Growth Curve Analysis
Authors: Bates Sarah , Norman Paul , Breeze Penny , Brennan Alan , Ahern Amy L
Published: April 2021

Background

A greater understanding of the mechanisms of action of weight-management interventions is needed to inform the design of effective interventions.

Purpose

To investigate whether dietary restraint, habit strength, or diet self-regulation mediated the impact of a behavioral weight-management intervention on weight loss and weight loss maintenance.

Methods

Latent growth curve analysis (LGCA) was conducted on trial data in which adults (N = 1,267) with a body mass index (BMI) ≥28 kg/m2 were randomized to either a brief intervention (booklet on losing weight), a 12 week weight-management program or the same program for 52 weeks. LGCA estimated the trajectory of the variables over four time points (baseline and 3, 12 and 24 months) to assess whether potential mechanisms of action mediated the impact of the weight-management program on BMI.

Results

Participants randomized to the 12 and 52 week programs had a significantly greater decrease in BMI than the brief intervention. This direct effect became nonsignificant when dietary restraint, habit strength, and autonomous diet self-regulation were controlled for. The total indirect effect was significant for both the 12 (estimate = −1.33, standard error [SE] = 0.41, p = .001) and 52 week (estimate = −2.13, SE = 0.52, p < .001) program. Only the individual indirect effect for dietary restraint was significant for the 12 week intervention, whereas all three indirect effects were significant for the 52 week intervention.

Conclusions

Behavior change techniques that target dietary restraint, habit strength, and autonomous diet self-regulation should be considered when designing weight loss and weight loss maintenance interventions. Longer interventions may need to target both deliberative and automatic control processes to support successful weight management.
The Causal Interpretation of “Overall Vaccine Effectiveness” in Test-Negative Studies
Authors: Feng Shuo , Sullivan Sheena G , Tchetgen Tchetgen Eric J , Cowling Benjamin J
Published: April 2021

Test-negative studies are commonly used to estimate influenza vaccine effectiveness (VE). In a typical study, an “overall VE” estimate based on data from the entire sample may be reported. However, there may be heterogeneity in VE, particularly by age. Therefore, in this article we discuss the potential for a weighted average of age-specific VE estimates to provide a more meaningful measure of overall VE. We illustrate this perspective first using simulations to evaluate how overall VE would be biased when certain age groups are overrepresented. We found that unweighted overall VE estimates tended to be higher than weighted VE estimates when children were overrepresented and lower when elderly persons were overrepresented. Then we extracted published estimates from the US Flu VE network, in which children are overrepresented, and some discrepancy between unweighted and weighted overall VE was observed. Differences in weighted versus unweighted overall VE estimates could translate to substantial differences in the interpretation of individual risk reduction among vaccinated persons and in the total averted disease burden at the population level. Weighting of overall estimates should be considered in VE studies in the future.
Validating Data-Driven Methods for Identifying Transgender Individuals in the Veterans Health Administration of the US Department of Veterans Affairs
Authors: Wolfe Hill L , Reisman Joel I , Yoon Samuel S , Blosnich John R , Shipherd Jillian C , Vimalananda Varsha G , Rao Sowmya R , Hashemi Leila , Berlowitz Dan , Goodman Michael , Livingston Nicholas A , Reece Scott G , Jasuja Guneet K
Published: April 2021

We sought to operationalize and validate data-driven approaches for identifying transgender individuals in the Veterans Health Administration (VHA) of the US Department of Veterans Affairs (VA) through a retrospective analysis using VA administrative data from 2006–2018. Besides diagnoses of gender identity disorder (GID), a combination of non-GID data elements was used to identify potentially transgender veterans, including 1) an International Classification of Diseases (Ninth or Tenth Revision) code of endocrine disorder, unspecified or not otherwise specified; 2) receipt of sex hormones not associated with the sex documented in the veteran’s records (gender-affirming hormone therapy); and 3) a change in the veteran’s administratively recorded sex. Both GID and non-GID data elements were applied to a sample of 13,233,529 veterans utilizing the VHA of the VA between January 2006 and December 2018. We identified 10,769 potentially transgender veterans. Based on a high positive predictive value for GID-coded veterans (83%, 95% confidence interval: 77, 89) versus non–GID-coded veterans (2%, 95% confidence interval: 1, 11) from chart review validation, the final analytical sample comprised only veterans with a GID diagnosis code (n = 9,608). In the absence of self-identified gender identity, findings suggest that relying entirely on GID diagnosis codes is the most reliable approach for identifying transgender individuals in the VHA of the VA.
Revefenacin, a once-daily, long-acting muscarinic antagonist, for nebulized maintenance therapy in patients with chronic obstructive pulmonary disease
Authors: Hvisdas Christopher
Published: April 2021

Purpose

This article reviews the efficacy and safety of revefenacin, the first once-daily, long-acting muscarinic antagonist, when delivered via a standard jet nebulizer in patients with chronic obstructive pulmonary disease (COPD).

Revefenacin 175 µg is indicated for the maintenance treatment of patients with moderate to very severe COPD. Preclinical studies showed that revefenacin is a potent and selective antagonist with similar affinity for the different subtypes of muscarinic receptors (M1-M5). Furthermore, prevention of methacholine- and acetylcholine-induced bronchoconstrictive effects was dose dependent and lasted longer than 24 hours, demonstrating a long duration of action. In phase 2 and 3 trials, treatment with revefenacin was demonstrated to result in statistical improvements in pulmonary function (≥100 mL, P < 0.05) vs placebo, including among patients with markers of more severe disease and those who received concomitant long-acting β-agonists or long-acting β-agonists together with inhaled corticosteroids. Revefenacin was also demonstrated to have efficacy similar to that of tiotropium. The clinical trial findings indicated no significant difference between revefenacin and tiotropium with regard to rates of adverse events. Overall, revefenacin was well tolerated, with COPD worsening/exacerbation, dyspnea, headache, and cough among the most common adverse events noted in the clinical trials.

Conclusions

Revefenacin treatment delivered via nebulization led to improvements in lung function in patients with COPD. It was also generally well tolerated, with no major safety concerns. Revefenacin provides a viable treatment option for patients with COPD and may be a suitable alternative for those with conditions that may impair proper use of traditional handheld inhalers.
The Inconvenient Truth About Mobile Phone Distraction: Understanding the Means, Motive and Opportunity for Driver Resistance to Legal and Safety Messages
Authors: Wells Helen , Briggs Gemma , Savigar-Shaw Leanne
Published: April 2021

Evidence for how phone-use impacts driving is clear: phone-using drivers are four times more likely to crash; demonstrate poor hazard detection ability; take longer to react to any hazards they notice; and can look yet fail to see. However, drivers are often resistant to research findings and, despite it being an enforceable offence, many still admit to using their phones. This paper combines what is known about the dangers of distracted driving with what research tells us about how drivers think about themselves, the law, and their risk of both crashing and being prosecuted. These blended insights explain why evidence may be resisted both by drivers and policymakers, highlighting the inconvenient truth of the distraction caused by mobile phone-use.
Rethinking Prosecutorial Discretion: Towards A Moral Cartography of Prosecutors
Authors: Tuesta Diego
Published: April 2021

This article examines the justifications that a group of prosecutors employs when coordinating human trafficking investigations in the Amazon. The study is based on interviews with officials who work in Madre de Dios, Peru, a region affected by small-scale gold mining, whose demand for labour has increased the incidence of human trafficking. I draw from Boltanski and Thévenot’s polity model to elucidate three moral principles regularly endorsed by prosecutors in the course of criminal investigations: efficiency, civic and domestic values. Together these comprise a moral cartography of prosecution. This study from the Global South contributes to a more holistic—and pragmatic—understanding of prosecutors’ charging decisions, complementing research approaching this topic from the perspective of bounded rationality.
Removing the idiopathic from the chronic sensory neuropathies
Authors: Roberts Rhys C
Published: April 2021

This scientific commentary refers to ‘RFC1 expansions are a common cause of idiopathic sensory neuropathy’, by Currò et al. (doi:10.1093/brain/awab072).
Determining Cost-Optimal Next-Generation Sequencing Panels for Rare Disease and Pharmacogenomics Testing
Authors: Katragadda Shanmukh , Hall Taryn O , Bettadapura Radhakrishna , Dalton Joline C , Ganapathy Aparna , Ghana Pallavi , Hariharan Ramesh , Janakiraman Anand , Kotha Kumar B V S S P , Manjunath Ashwini , Mannan Ashraf U , MS Niveditha , Saraf Shradha , Tzeng Kathy T H , Veeramachaneni Vamsi
Published: April 2021

Background

Multi–gene panel sequencing using next-generation sequencing (NGS) methods is a key tool for genomic medicine. However, with an estimated 140 000 genomic tests available, current system inefficiencies result in high genetic-testing costs. Reduced testing costs are needed to expand the availability of genomic medicine. One solution to improve efficiency and lower costs is to calculate the most cost-effective set of panels for a typical pattern of test requests.

Methods

We compiled rare diseases, associated genes, point prevalence, and test-order frequencies from a representative laboratory. We then modeled the costs of the relevant steps in the NGS process in detail. Using a simulated annealing-based optimization procedure, we determined panel sets that were more cost-optimal than whole exome sequencing (WES) or clinical exome sequencing (CES). Finally, we repeated this methodology to cost-optimize pharmacogenomics (PGx) testing.

Results

For rare disease testing, we show that an optimal choice of 4–6 panels, uniquely covering genes that comprise 95% of the total prevalence of monogenic diseases, saves $257–304 per sample compared with WES, and $66–135 per sample compared with CES. For PGx, we show that the optimal multipanel solution saves $6–7 (27%–40%) over a single panel covering all relevant gene–drug associations.

Conclusions

Laboratories can reduce costs using the proposed method to obtain and run a cost-optimal set of panels for specific test requests. In addition, payers can use this method to inform reimbursement policy.
Long-term variation in skeletal muscle and adiposity in patients undergoing esophagectomy
Authors: Boshier Piers R , Klevebro Fredrik , Jenq Wesley , Puccetti Francesco , Muthuswamy Keerthini , Hanna George B , Low Donald E
Published: April 2021

This study seeks to define long-term variation in body composition in patients undergoing esophagectomy for cancer and to associate those changes with survival. Assessment of skeletal muscle, visceral (VAT) and subcutaneous adipose tissue (SAT) was performed using computed tomography (CT) images routinely acquired: at diagnosis; after neoadjuvant therapy, and; >6 months after esophagectomy. In cases where multiple CT scans were performed >6 months after surgery, all available images were assessed. Ninty-seven patients met inclusion criteria with a median of 2 (range 1–10) postoperative CT images acquired between 0.5 and 9.7 years after surgery. Following surgical treatment of esophageal cancer, patients lost on average 13.3% of their skeletal muscle, 64.5% of their VAT and 44.2% of their SAT. Sarcopenia at diagnosis was not associated with worse overall survival (66.3% vs. 68.5%; P = 0.331). Sarcopenia 1 year after esophagectomy was however associated with lower 5-year overall survival (53.8% vs. 87.5%; P = 0.019). Survival was lower in those patients who had >10% decrease in skeletal muscle index (SMI; 33.3% vs. 72.1%; P = 0.003) and >40% decrease in SAT 1 year after surgery (40.4% vs. 67.4%; P = 0.015). On multivariate analysis, a decline in SMI 1 year after surgery was predictive of worse survival (HR 0.38, 95%CI 0.20–0.73; P = 0.004). This study provides new insight relating to long-term variation in body composition in patients undergoing esophagectomy for cancer. Findings provide further evidence of the importance of body composition, in particular depletion of skeletal muscle, in predicting survival following esophagectomy.
Ancestral plastics exposure induces transgenerational disease-specific sperm epigenome-wide association biomarkers
Authors: Thorson Jennifer L M , Beck Daniel , Ben Maamar Millissia , Nilsson Eric E , Skinner Michael K
Published: April 2021

Plastic-derived compounds are one of the most frequent daily worldwide exposures. Previously a mixture of plastic-derived toxicants composed of bisphenol A, bis(2-ethylhexyl) phthalate, and dibutyl phthalate at low-dose exposures of a gestating female rats was found to promote the epigenetic transgenerational inheritance of disease to the offspring (F1 generation), grand-offspring (F2 generation), and great-grand-offspring (F3 generation). Epigenetic analysis of the male sperm was found to result in differential DNA methylation regions (DMRs) in the transgenerational F3 generation male sperm. The current study is distinct and was designed to use an epigenome-wide association study to identify potential sperm DNA methylation biomarkers for specific transgenerational diseases. Observations indicate disease-specific DMRs called epimutations in the transgenerational F3 generation great-grand-offspring of rats ancestrally exposed to plastics. The epigenetic DMR biomarkers were identified for testis disease, kidney disease, and multiple (≥2) diseases. These disease sperm epimutation biomarkers were found to be predominantly disease-specific. The genomic locations and features of these DMRs were identified. Interestingly, the disease-specific DMR-associated genes were previously shown to be linked with each of the specific diseases. Therefore, the germline has ancestrally derived epimutations that potentially transmit transgenerational disease susceptibilities. Epigenetic biomarkers for specific diseases could be used as diagnostics to facilitate clinical management of disease and preventative medicine.
Forest Ownership, Management, and Water Production in Longleaf Pine Forests: A Stochastic Frontier Analysis
Authors: Susaeta Andres , Alavalapati Janaki
Published: April 2021

This study employed stochastic frontier analysis to determine the effects of forest ownership and management on the technical efficiency of water production from longleaf pine forests in the southern United States. Data at the forest-plot level were obtained from the Forest Inventory Analysis, climatic models, and water supply relationships. Results showed that the provision of water was inefficient and significantly different between public and private ownership. Longleaf pine forests under public ownership were modestly more efficient (2.2%–1.5%) in the production of water than private longleaf pine forests. Forest management had a negative impact on the efficiency in water production for privately and publicly owned longleaf pine forests. If 1 hectare of longleaf pine supplied on average 5,000 cubic meters of water per year, the production of water on public and private lands would be reduced to 4,960 and 4,800 cubic meters per year, respectively, with forest management. Efficiency in water supply was found to decline over time in both types of forest ownership.
PopAmaranth: a population genetic genome browser for grain amaranths and their wild relatives
Authors: Gonçalves-Dias José , Stetter Markus G
Published: April 2021

The combination of genomic, physiological, and population genetic research has accelerated the understanding and improvement of numerous crops. For nonmodel crops, the lack of interdisciplinary research hinders their improvement. Grain amaranth is an ancient nutritious pseudocereal that has been domesticated three times in different regions of the Americas. We present and employ PopAmaranth, a population genetic genome browser, which provides an accessible representation of the genetic variation of the three-grain amaranth species (Amaranthus hypochondriacus, Amaranthus cruentus, and Amaranthus caudatus) and two wild relatives (Amaranthus hybridus and Amaranthus quitensis) along the A. hypochondriacus reference sequence. We performed population-scale diversity and selection analysis from whole-genome sequencing data of 88 curated genetically and taxonomically unambiguously classified accessions. We employ the platform to show that genetic diversity in the water stress-related MIF1 gene declined during amaranth domestication and provide evidence for convergent saponin reduction between amaranth and quinoa. PopAmaranth is available through amaranthGDB at amaranthgdb.org/popamaranth.html
Links Between Mortality and Socioeconomic Characteristics, Disease Burden, and Biological and Physical Functioning in the Aging Chinese Population
Authors: Zhang Yuan S , Strauss John A , Hu Peifeng , Zhao Yaohui , Crimmins Eileen M
Published: April 2021

Objectives

Determinants of mortality may depend on the time and place where they are examined. China provides an important context in which to study the determinants of mortality at older ages because of its unique social, economic, and epidemiological circumstances. This study uses a nationally representative sample of persons in China to determine how socioeconomic characteristics, early-life conditions, biological and physical functioning, and disease burden predict 4-year mortality after age 60.

Methods

We used data from the China Health and Retirement Longitudinal Study. We employed a series of Cox proportional hazard models based on exact survival time to predict 4-year all-cause mortality between the 2011 baseline interview and the 2015 interview.

Results

We found that rural residence, poor physical functioning ability, uncontrolled hypertension, diabetes, cancer, a high level of systemic inflammation, and poor kidney functioning are strong predictors of mortality among older Chinese.

Discussion

The results show that the objectively measured indicators of physical functioning and biomarkers are independent and strong predictors of mortality risk after accounting for several additional self-reported health measures, confirming the value of incorporating biological and performance measurements in population health surveys to help understand health changes and aging processes that lead to mortality. This study also highlights the importance of social and historical context in the study of old-age mortality.
The catabolic triad: case report of fasting, major cardiac surgery and sodium–glucose co-transporter 2 inhibitors leading to perioperative euglycaemic ketoacidosis
Authors: Smyth Coilin Collins , Collins Maghnus , McCarthy James , Galvin Sinead
Published: April 2021

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are novel oral hypoglycaemic agents. For patients with diabetes mellitus, without a prior history of myocardial infarction or atherosclerotic disease, SGLT2i have been shown to reduce incident heart failure and worsening renal function. SGLT2i therapy is increasing among patients presenting for cardiac surgery. However, the perioperative use of SGLT2i carries a significant risk of euglycaemic diabetic ketoacidosis, due to their catabolic mechanism of action. This case report demonstrates euglycaemic ketoacidosis post-coronary artery bypass grafting secondary to SGLT2i, highlighting the multiple risk factors and consequences of this iatrogenic complication.
Implementing structured handoffs to verify operating room blood delivery using a quality academy training program: an interrupted time-series analysis
Authors: Amon Carly C , Paley Adina R , Forbes Judith A , Guzman Leidy V , Rajwani Aliysa A , Trzcinka Agnieszka , Comenzo Raymond L , Drzymalski Dan M
Published: April 2021

Background

Blood transfusion is a complex process at risk for error.

Objective

To implement a structured handoff during the blood transfusion process to improve delivery verification.

Methods

A multidisciplinary team participated in the quality academy training program at an academic medical center and implemented a structured handoff of blood delivery to the operating room (OR) using Plan-Do-Study-Act cycles between 28 October 2019 and 1 December 2019. An interrupted time-series analysis was performed to investigate the proportions of verified deliveries (primary outcome) and of verified deliveries among those without a handoff (secondary outcome). Delivery duration was also assessed.

Results

A total of 2606 deliveries occurred from 1 July 2019 to 19 April 2020. The baseline trend for verified deliveries was unchanging [parameter coefficient −0.0004; 95% confidence interval (CI) −0.002 to 0.001; P = 0.623]. Following intervention, there was an immediate level change (parameter coefficient 0.115; 95% CI 0.053 to 0.176; P = 0.001) without slope change (parameter coefficient 0.002; 95% CI −0.004 to 0.007; P = 0.559). For the secondary outcome, there was no immediate level change (parameter coefficient −0.039; 95% CI −0.159 to 0.081; P = 0.503) or slope change (parameter coefficient 0.002; 95% CI −0.022 to 0.025; P = 0.866). The mean (SD) delivery duration during the intervention was 12.4 (2.8) min and during the post-intervention period was 9.6 (1.6) min (mean difference 2.8; 95% CI 0.9 to 4.8; P = 0.008).

Conclusion

Using the quality academy framework supported the implementation of a structured handoff during blood delivery to the OR, resulting in a significant increase in verified deliveries.
UHPLC-MS/MS Method for Determination of Hydroxychloroquine and Its Main Metabolites in Oral Fluid and Whole Blood for Therapeutic Drug Monitoring
Authors: Duarte Nilo J C , Kupa Léonard V K , Ferreira-Filho Julio C R , Fontoura Nicole , Chalom Marc Y , Romano Paschoalina , Ebner Pérsio A R , Silva Clovis A A , Carvalho Valdemir M , Bonfá Eloisa
Published: April 2021

Background

Hydroxychloroquine (HCQ) blood levels are used to monitor efficacy, safety, and patient adherence during treatment. Oral fluid has emerged as an alternative noninvasive, easily accessible, and low-complexity matrix for drug monitoring. However, there is no analytical method to measure HCQ in oral fluid. Therefore, we developed and validated an ultra-high-performance liquid chromatography-tandem mass (UHPLC-MS/MS) method for the measurement of HCQ and its main metabolites in oral fluid and compared to whole blood.

Methods

Ten microliters of matrices were used for sample preparation by protein precipitation with acetonitrile followed by online solid phase extraction. The validation process included assessment of lower limit of quantification, linearity, precision, recovery, matrix effect, interferences assessment, carryover, and sample dilution validation.

Results

The lower limit of quantification was 50 ng/mL for HCQ and metabolites in both oral fluid and whole blood. The calibration curve was linear from 50 to 2000 ng/mL (r2 = 0.999). The coefficient of variation for precision assay was 1.2% to 9.7% for intraday and 1.1% to 14.2% for interday for both HCQ and metabolites in oral fluid and whole blood samples at 150, 750, and 1250 ng/mL. The recovery was 85.3% to 118.5% for 150, 750, and 1250 ng/mL of HCQ and metabolites in both oral fluid and whole blood. Dilution factor up to 5-fold was validated for concentrations higher than the upper limit of quantification.

Conclusions

The validated method is specific, precise, and accurate to determine the analytical range for therapeutic monitoring of HCQ and its main metabolites in oral fluid and blood.
Contemporary clinical decision support standards using Health Level Seven International Fast Healthcare Interoperability Resources
Authors: Strasberg Howard R , Rhodes Bryn , Del Fiol Guilherme , Jenders Robert A , Haug Peter J , Kawamoto Kensaku
Published: April 2021

Objective

To facilitate the development of standards-based clinical decision support (CDS) systems, we review the current set of CDS standards that are based on Health Level Seven International Fast Healthcare Interoperability Resources (FHIR). Widespread adoption of these standards may help reduce healthcare variability, improve healthcare quality, and improve patient safety.

Target Audience

This tutorial is designed for the broad informatics community, some of whom may be unfamiliar with the current, FHIR-based CDS standards.

Scope

This tutorial covers the following standards: Arden Syntax (using FHIR as the data model), Clinical Quality Language, FHIR Clinical Reasoning, SMART on FHIR, and CDS Hooks. Detailed descriptions and selected examples are provided.
Pharmacists’ perceptions of a machine learning model for the identification of atypical medication orders
Authors: Hogue Sophie-Camille , Chen Flora , Brassard Geneviève , Lebel Denis , Bussières Jean-François , Durand Audrey , Thibault Maxime
Published: April 2021

Objectives

The study sought to assess the clinical performance of a machine learning model aiming to identify unusual medication orders.

Materials and Methods

This prospective study was conducted at CHU Sainte-Justine, Canada, from April to August 2020. An unsupervised machine learning model based on GANomaly and 2 baselines were trained to learn medication order patterns from 10 years of data. Clinical pharmacists dichotomously (typical or atypical) labeled orders and pharmacological profiles (patients’ medication lists). Confusion matrices, areas under the precision-recall curve (AUPRs), and F1 scores were calculated.

Results

A total of 12 471 medication orders and 1356 profiles were labeled by 25 pharmacists. Medication order predictions showed a precision of 35%, recall (sensitivity) of 26%, and specificity of 97% as compared with pharmacist labels, with an AUPR of 0.25 and an F1 score of 0.30. Profile predictions showed a precision of 49%, recall of 75%, and specificity of 82%, with an AUPR of 0.60, and an F1 score of 0.59. The model performed better than the baselines. According to the pharmacists, the model was a useful screening tool, and 9 of 15 participants preferred predictions by medication, rather than by profile.

Discussion

Predictions for profiles had higher F1 scores and recall compared with medication order predictions. Although the performance was much better for profile predictions, pharmacists generally preferred medication order predictions.

Conclusions

Based on the AUPR, this model showed better performance for the identification of atypical pharmacological profiles than for medication orders. Pharmacists considered the model a useful screening tool. Improving these predictions should be prioritized in future research to maximize clinical impact.
Contribution to the Taxonomy and Host-Relations of the Genus Serratacarus (Trombidiformes: Trombiculidae)
Authors: Jacinavicius Fernando de Castro , Huang-Bastos Matheus , Welbourn Cal , Ochoa Ron , Barros-Battesti Darci Moraes , Bassini-Silva Ricardo
Published: April 2021

The genus SerratacarusGoff and Whitaker 1984, currently includes only two species, Serratacarus dietzi Goff and Whitaker, 1994 and Serratacarus lasiurus Goff and Whitaker, 1994, which were recorded on cricetid rodents from natural reserve areas of Brazil. Here, we provide a review of the morphological characters for both species and synonymize of the species Trombewingia brasiliensisGoff and Gettinger, 1991 with S. lasiurus. Additionally, we provide new locality records for both species and the first record for S. dietzi on southeastern four-eyed opossum, Philander frenatus Olfers, 1818 (Didelphimorphia, Didelphidae).
Assessment of Tropical Bed Bug (Hemiptera: Cimicidae), Infestations in Cape Coast, Ghana: Household Control Practices and Efficacy of Commercial Insecticides and Long-Lasting Insecticidal Nets Against Field Bed Bugs
Authors: Deku Godwin , Combey Rofela , Doggett Stephen L , Mensah Benjamin A
Published: April 2021

This study reports the first baseline information on tropical bed bug, Cimex hemipterus (F.) (Hemiptera: Cimicidae), infestations in Ghana. The purpose of this study was to assess bed bug infestation levels, and the efficacy of locally available insecticides and long-lasting insecticidal nets (LLINs) in controlling field bed bugs populations in the Cape Coast region. A survey was undertaken to assess bed bug infestation levels and current control practices by residents. In total, 205 bed bug affected households were identified in 20 communities and live bed bug infestations were associated with most of these premises. Many homeowners knew of other households (from 1 to 3) with a bed bug infestation. Residents reported itching and swelling of the skin from the bed bug bites and the bites were considered severe. The most common household bed bug control strategy was the application of insecticides. However, LLINs and commercially formulated insecticides commonly used by households (notably chloropyrifos and pyrethroid-based formulations) did not efficaciously suppress field collected strains of C. hemipterus. Using a dipping bioassay, mean mortality ranged from 0 to 60% for eggs, nymphs, and adults, and less than 40% mortality was observed in bed bugs placed on insecticide-treated filter paper. Each LLINs (all are pyrethroid based) produced a mean mortality of less than 20% in adult bed bugs. For a more effective response to the global bed bug resurgence in developing countries, government and supporting agencies need to render assistance to bed bug affected residents through the provision of improved pest management strategies.
Abundance and Seasonality of Aedes aegypti (Diptera: Culicidae) in Two Suburban Localities of South Mexico, With Implications for Wolbachia (Rickettsiales: Rickettsiaceae)-Carrying Male Releases for Population Suppression
Authors: Che-Mendoza Azael , Martin-Park Abdiel , Chávez-Trava Juan Manuel , Contreras-Perera Yamili , Delfín-González Hugo , González-Olvera Gabriela , Leirana-Alcocer Jorge , Guillermo-May Guillermo , Chan-Espinoza Daniel , Pavia-Ruz Norma , Méndez-Vales Rosa Eugenia , Alcocer-Gamboa Alberto , Correa-Morales Fabian , Palacio-Vargas Jorge , Zhang Dongjing , Vazquez-Prokopec Gonzalo , Xi Zhiyong , Manrique-Saide Pablo
Published: April 2021

We conducted a baseline characterization of the abundance and seasonality of Aedes aegypti (Linnaeus, 1762)—a vector of dengue, chikungunya, and Zika—in two suburban localities of Yucatan, Mexico, as the first step in the implementation of an integrated vector management (IVM) plan combining ‘traditional Aedes control’ (source reduction/truck-mounted ultra-low volume [ULV] spraying) and incompatible insect technique/sterile insect technique for population suppression in Yucatan, Mexico. Weekly entomological collections with ovitraps and BG-sentinel traps were performed in 1-ha quadrants of both localities for 1 yr. Three distinct periods/phases were identified, closely associated with precipitation: 1) a phase of low population abundance during the dry season (weekly average of Aedes eggs per ovitrap and adults per BG trap = 15.51 ± 0.71 and 10.07 ± 0.88, respectively); 2) a phase of population growth and greatest abundance of Aedes (49.03 ± 1.48 eggs and 25.69 ± 1.31 adults) during the rainy season; and finally 3) a phase of decline among populations (20.91 ± 0.97 eggs and 3.24 ± 0.21 adults) after the peak of the rainy season. Seasonal abundance and dynamics of Ae. aegypti populations suggest that it is feasible to develop and implement time-specific actions as part of an IVM approach incorporating integrating novel technologies (such as rear-and-release of Wolbachia-infected males) with classic (insecticide-based) approaches implemented routinely for vector control. In agreement with the local vector control program, we propose a pilot IVM strategy structured in a preparation phase, an attack phase with traditional vector control, and a suppression phase with inundative releases, which are described in this paper.
Maintenance and Productivity of a Lutzomyia longipalpis (Diptera: Psychodidae) Colony from an Area Endemic for Visceral and Cutaneous Leishmaniasis in Northeastern Brazil
Authors: Ribeiro da Silva Rosa Cristina , Nava Piorsky Dominici Cruz Léo , da Silva Coutinho João Manoel , Correia Santana Núrzia Cristina , Macário Rebêlo José Manuel
Published: April 2021

Studies on experimental sand fly infection require the availability of colonies and laboratory conditions. In Brazil, Lutzomyia longipalpis (Diptera: Psychodidae) (Lutz and Neiva 1912) is responsible for the highest infection rates by Leishmania spp. and this species is one of the most suitable species for laboratory colonization. In this study, we describe a method for growing Lu. longipalpis in laboratory conditions (10 generations) from natural populations sampled from a region of high endemicity for visceral leishmaniasis in the state of Maranhão, Northeastern Brazil. Using two methods (individualized or grouped females), the colony’s highest productivity occurred in the first four generations, where all stages presented with high frequency. Nonviable eggs represented more than 50% of the total eggs produced by engorged females, while pupae were more resistant to fungal contamination, with a mortality rate of only 2%. In both methods, there was a predominance of female emergence; however, the ratio between males and females did not show significant differences, IF (P = 0.8023) and GF (P = 0.1831). Using the method of individualized females, the F4 generation took the longest to appear (234 d; 64 ± 57 d); by grouped females, F3 took the longest to appear (102 d; 47 ± 20 d). This method provides sufficient numbers of insects to perform vector competence tests for Leishmania spp. that cause the cutaneous form of leishmaniasis, usually found in Lu. longipalpis sampled from the study location.
Susceptibility ofIxodes scapularis(Acari: Ixodidae) to Permethrin Under a Long-Term 4-Poster Deer Treatment Area on Shelter Island, NY
Authors: Burtis James C , Poggi Joseph D , Payne Beau , Campbell Scott R , Harrington Laura C
Published: April 2021

Pesticide resistance in medically significant disease vectors can negatively impact the efficacy of control efforts. Resistance research on ticks has focused primarily on species of veterinary significance that experience relatively high degrees of control pressure. Resistance in tick vectors of medical significance has received little attention, in part because area-wide pesticide applications are not used to control these generalist tick species. One of the few effective methods currently used for area-wide control of medically important ticks, including Ixodes scapularis Say (Acari: Ixodidae), is deployment of 4-poster devices. Deer self-apply a topical acaricide (permethrin) while feeding on corn from the devices. A 4-poster program using permethrin has been deployed on Shelter Island, NY to control I. scapularis populations since 2008. We collected engorged female ticks from deer in this management area and a location in the Mid-Hudson River Valley, NY without area-wide tick control. Larvae were reared from egg masses and their susceptibility to permethrin was tested. Larvae originating from a long-term laboratory colony were used as a susceptible baseline for comparison. Compared against the laboratory colony, resistance ratios at LC-50 for Shelter Island and Hudson Valley I. scapularis were 1.87 and 1.51, respectively. The susceptibilities of the field populations to permethrin were significantly lower than that of the colony ticks. We provide the first data using the larval packet test to establish baseline susceptibility for I. scapularis to permethrin along with information relevant to understanding resistance emergence in tick populations under sustained control pressure from 4-poster devices.
Harming and Wronging in Creating
Authors: Cohen Shlomo
Published: April 2021

The nonidentity problem (NIP) is a deep puzzle challenging the moral intuition that what is bad must be bad for someone. The first part of the paper constructs a new theory of harming, whereas the second part builds on the conclusions of the first to offer a new solution to the NIP. The first part discusses the neglected question of when a burden inflicted in the context of overall benefitting can be discretized as a separate entity—only when it can, is it possible to identify the burden as harm, and only then is it possible to harm in bringing into overall good existence. The second part explains how, in those cases where creating is indeed harming, we can use the logic of concept expansion to construct a concept of wronging that applies to creation cases.
Children, Fetuses, and the Non-Existent: Moral Obligations and the Beginning of Life
Authors: Jackson Elizabeth
Published: April 2021

The morality of abortion is a longstanding controversy. One may wonder whether it is even possible to make significant progress on an issue over which so much ink has already been spilled and there is such polarizing disagreement (Boyle, 1994, The Journal of Medicine and Philosophy 19:183–200). The papers in this issue show that this progress is possible—there is more to be said about abortion and other crucial beginning-of-life issues. They do so largely by applying contemporary philosophical tools to moral questions involving life’s beginning. The first two papers defend the pro-life view from recent objections involving miscarriage and abortion doctors. The third shows how the social model of disability and the concept of transformative experience apply to classic debates like abortion and euthanasia. The final two papers address how rights and harms apply to children and to beings that do not yet exist. All five papers make a noteworthy contribution to the moral issues that arise at the beginning of life.
Optimality of the Recursive Neyman Allocation
Authors: Wesołowski Jacek , Wieczorkowski Robert , Wójciak Wojciech
Published: April 2021

We derive a formula for the optimal sample allocation in a general stratified scheme under upper bounds on the sample strata sizes. Such a general scheme includes SRSWOR within strata as a special case. The solution is given in terms of V-allocation with V being the set of take-all strata. We use V-allocation to give a formal proof of optimality of the popular recursive Neyman algorithm, rNa. We also propose a quick proof of optimality of the algorithm of Stenger and Gabler, SGa, as well as of our proposed modification, coma. Finally, we compare running times of rNa, SGa, and coma. Ready-to-use R-implementations of these algorithms are available on CRAN repository at https://cran.r-project.org/web/packages/stratallo.