bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries With Complex Care Needs
Authors: Drzayich Antol Dana , Schwartz Richard , Caplan Ariel , Casebeer Adrianne , Erwin C. Jo , Shrank William H. , Powers Brian W.
Published: October 2022

Importance

Medicare beneficiaries with co-occurring chronic conditions and complex care needs experience high rates of acute care utilization and poor outcomes. These patterns are well described among traditional Medicare (TM) beneficiaries, but less is known about outcomes among Medicare Advantage (MA) beneficiaries. Compared with TM, MA plans have additional levers to potentially address beneficiary needs, such as network design, care management, supplemental benefits, and value-based contracting.

Objective

To compare health care utilization for MA and TM beneficiaries with complex care needs.

Design, Setting, and Participants

This cross-sectional study analyzed beneficiaries enrolled in MA and TM using claims data from a large, national MA insurer and a random 5% sample of TM beneficiaries. Beneficiaries were segmented into the following cohorts: frail elderly, major complex chronic, and minor complex chronic. Regression models estimated the association between MA enrollment and health care utilization in 2018, using inverse probability of treatment weighting to balance the MA and TM cohorts on observable characteristics. The study period was January 1, 2017, through December 31, 2018. All analyses were conducted from December 2020 to August 2022.

Exposures

Enrollment in MA vs TM.

Main Outcomes and Measures

Hospital stays (inpatient admissions and observation stays), emergency department (ED) visits, and 30-day readmissions.

Results

Among a study population of 1 844 326 Medicare beneficiaries (mean [SD] age, 75.6 [7.1] years; 1 021 479 [55.4%] women; 1 524 458 [82.7%] White; 223 377 [12.1%] with Medicare-Medicaid dual eligibility), 1 177 896 (63.9%) were enrolled in MA and 666 430 (36.1%) in TM. Beneficiary distribution across cohorts was as follows: frail elderly, 116 047 with MA (10.0% of the MA sample) and 104 036 with TM (15.6% of the TM sample); major complex chronic, 320 954 (27.2%) and 158 811 (23.8%), respectively; and minor complex chronic, 740 895 (62.9%) and 403 583 (60.6%), respectively. Beneficiaries enrolled in MA had lower rates of hospital stays, ED visits, and 30-day readmissions. The largest relative differences were observed for hospital stays, which ranged from −9.3% (95% CI, −10.9% to −7.7%) for the frail elderly cohort to −11.9% (95% CI, −13.2% to −10.7%) for the major complex chronic cohort.

Conclusions and Relevance

In this cross-sectional study of Medicare beneficiaries with complex care needs, those enrolled in MA had lower rates of hospital stays, ED visits, and 30-day readmissions than similar beneficiaries enrolled in TM, suggesting that managed care activities in MA may influence the nature and quality of care provided to these beneficiaries.
The impact of reminders on implementation intention: A randomized controlled trial
Authors: Messmer Léonie , Fenouillet Fabien , Legrand Eve
Published: October 2022

Implementation intentions are self‐regulatory strategies that increase the probability that desired goals will be achieved. While their effectiveness in the short term is well established in the literature, the long‐term effects are not. The present study, which was conducted in France during the COVID‐19 lockdown, aimed to test whether reminders could support the effects of forming implementation intentions over time. It proposed to help people adopt a new behavior: to set themselves three daily goals for four weeks and send the results to a dedicated website. A total of 118 participants (from an initial sample of 194) sent their three daily goals at least once and constituted our final sample. A 2 (implementation intention: with vs. without), ×2 (reminders: with vs. without), and ×4 (week: 1–4) repeated measures ANOVA was conducted. The results showed significant main effects for all three factors, from small to medium to large. However, no significant interaction emerged. Hence, text message reminders did not seem to intensify the effect of forming implementation intentions.
Events of past two years contribute to growth of CHESS support platform
Authors: Enos Gary
Published: October 2022

Recent growth driven in part by agencies' need to maintain contact with patients with substance use disorders (SUDs) during the COVID‐19 pandemic has helped to fuel further expansions at digital support provider CHESS Health. Having started by offering a smartphone app to guide individuals in their recovery, the company this year signaled its interest in supporting individuals across the life cycle by introducing electronic tools for prevention and early intervention.
Hazelden to publish new ASAM criteria
Authors: Knopf Alison
Published: October 2022

The ASAM Criteria, utilized by treatment providers, insurance companies, and others, is a set of standards for assessment and evaluation of treatment for substance use disorders (SUDs). The new edition will be published by Hazelden Publishing. First developed by the American Society of Addiction Medicine (ASAM) in the 1980s, the criteria define one set of metrics for providing treatment based on outcomes and results. Both ASAM and Hazelden announced the forthcoming publication last week and called for public comments.
3D‐Printed Periodic Hierarchical Porous rGO/Ti3C2Tx Architectures Induced Uniform Lithium Deposition for Li Metal Anodes
Authors: Shi Haiting , Pei Mengfan , Wang Shuo , Yao Fengting , Xia Yuanhua , Xu Zhiwei , Liu Shengkai , Shao Ruiqi , Wang Wei , Liang Shuaitong
Published: October 2022

Nonuniform Li+ flux and lithiophilic sites cause uneven lithium deposition, which impedes the application of lithium metal batteries. Herein, a reduced graphene oxide (rGO)/Ti3C2Tx lattice with periodic printed holes is fabricated by 3D printing. Mesoporous structures formed by regularly assembled nanosheets provide abundant lithiophilic sites. The Li+ flux is regulated by the periodic printed holes prepared by 3D printing. The deposition of lithium is homogenized by the synergistic effect of uniform Li+ flux and abundant lithiophilic sites. The resultant 3D‐printed Li anode has excellent cycling stability up to 3000 h and a high average Coulombic efficiency of 98% after a long lifespan of ≈1000 h. Our work highlights the effect of the correlation between macroscopic and microscopic pores formed by 3D printing on inhibiting lithium dendrites, providing a novel pathway for highly 3D‐printed stable lithium metal anode.
Single‐catalyst reactions from depolymerization to repolymerization: Transformation of polyethylene terephthalate to polyisocyanurate foam with deep eutectic solvents
Authors: Lee Pyung Soo , Jung Simon MoonGeun
Published: October 2022

Polyisocyanurate (PIR) has been used as a flame retardant insulation material because of its improved thermal insulation and flame‐retarding effects due to its cyclic structure with an isocyanate trimer group. When a deep eutectic solvent (DES) is used as a catalyst, PET glycolysis produces bis(2‐ hydroxyethyl terephthalate) (BHET) and its derivatives. These recycled polyols react with isocyanate to form PIR foam (PIRF) in the presence of a physical blowing agent. DES‐based glycolysis is a low‐energy process with a relatively low temperature and short reaction time. In this study, a potassium‐based DES system was applied for the sequential depolymerization and repolymerization of waste PET into PIRFs. Potassium‐based DESs were used as hydrogen bond acceptors (HBAs), and ethylene glycol (EG), glycerol, and urea were used as hydrogen bond donors (HBDs). The PIRF was obtained through one‐pot depolymerization and repolymerization with a single‐catalyst DES system. All DES catalyst systems effectively decomposed PET; the PET conversion efficiency reached 95% after 2 h reaction. The recycled PIR was more thermally stable (approximately 26.9% limiting oxygen index (LOI) and approximately 68.8 W/g heat release rate (HRR)). This paper presents an environmentally friendly and robust upcycling process for the transformation of waste PET into PIRF.
Impact of warm sea surface temperature over a Kuroshio large meander on extreme heavy rainfall caused by an extratropical cyclone
Authors: Tochimoto Eigo , Iizuka Satoshi
Published: October 2022

On 12–13 April 2020, an extreme heavy rainfall event associated with an extratropical cyclone occurred over the eastern coastal region of the Kii Peninsula, Japan, when unusual warm sea surface temperature anomalies (SSTAs) over a Kuroshio large meander (KLM) was observed. Here, we carry out numerical experiments to examine the impact of the unusual SSTAs on this heavy rainfall event. The unusual warm SSTAs enhanced the low‐level moisture that was transported toward the coastal region by the cyclone, resulting in an increase in precipitation. In particular, the maximum 3‐hour precipitation is most affected by SSTAs compared with the maximum 1‐hour and 24‐hour precipitation. These findings suggest that the heat and moisture supply from the unusually warm SSTAs over the KLM affected the heavy rainfall event.
Potential use of multikinase inhibitors in immunosuppressed patients with malignancies including thyroid cancer
Authors: Basté Rotllan Neus
Published: October 2022

In this article, we focus on a variety of immunosuppression scenarios and whether multikinase inhibitors, as systemic therapy for advanced thyroid carcinoma (TC), could be useful for the treatment of immunocompromised patients with TC. Lenvatinib and sorafenib, among other MKIs, have become the standard of care for advanced TC based on their efficacy data and despite their adverse effects. Currently, published data on MKIs in immunosuppressed patients are scarce. Secondary malignancies can arise in immunosuppressed patients who have undergone solid organ transplantation, human immunodeficiency virus–infected patients, and hematopoietic stem cell transplant recipients. This review will explore different immunosuppression settings, the risk of secondary malignancies in immunosuppressed patients, and the special characteristics of this population. Some considerations regarding anticancer treatment in immunosuppressed patients with advanced malignancies are reviewed.
Use of multikinase inhibitors/lenvatinib concomitant with locoregional therapies for the treatment of radioiodine‐refractory differentiated thyroid cancer
Authors: Berciano‐Guerrero Miguel‐Ángel
Published: October 2022

Locoregional recurrence of differentiated thyroid cancer (DTC) occurs in 20% of thyroid cancer patients. Currently, there are many strategies for management of locoregional recurrence of DTC that lead to local control of the disease. The introduction of lenvatinib into the therapeutic armamentarium provides a new option for the treatment of radioiodine‐refractory DTC (RR‐DTC). However, results for simultaneous treatment with lenvatinib and locoregional therapies are unknown in patients with RR‐DTC. This paper reviews the current status of this approach and gives recommendations on the management of lenvatinib during concomitant locoregional procedures.
Use of multikinase inhibitors/lenvatinib in patients with high cardiovascular risk/vasculopathy and radioiodine refractory‐differentiated thyroid cancer
Authors: Jimenez‐Fonseca Paula
Published: October 2022

Antiangiogenic tyrosine kinase inhibitors are the treatment of choice in radioiodine refractory‐differentiated thyroid cancer (RR‐DTC). Nevertheless, these therapies present class toxicities that may impact their feasibility and patient's quality of life. Their mechanism of action explains the high prevalence of hypertension associated with their use, which reaches 68% with lenvatinib. Moreover, up to 85% of patients treated in the SELECT clinical trial were receiving baseline antihypertensive treatment. These data support the need for prevention, detection, and early management of hypertension. Prevention can be accomplished by controlling cardiovascular risk factors (hypertension, diabetes, obesity, and dyslipidemia) and those associated with lifestyle (smoking, harmful alcohol consumption, and physical inactivity) and electrolyte disorders. It is necessary to achieve stabilization of cardiovascular diseases. Detection involves baseline measurement and monitoring of blood pressure and cardiac function. Treatment requires optimization of baseline blood pressure and early initiation of antihypertensive agents.
Bifidobacterium breve predicts the efficacy of anti‐PD‐1 immunotherapy combined with chemotherapy in Chinese NSCLC patients
Authors: Zhao Honghui , Li Dan , Liu Jiayin , Zhou Xinliang , Han Jing , Wang Long , Fan Zhisong , Feng Li , Zuo Jing , Wang Yudong
Published: October 2022

Background and Purpose

Gut microbes play an important role in the occurrence of lung cancer, immunotherapy, and chemotherapy. In this study, we analyzed the characteristics of gut microbes in patients with lung cancer and investigated the effect of gut microbes on anti‐PD‐1 therapy combined with chemotherapy.

Methods

Fecal samples from 21 non‐small cell lung cancer (NSCLC) patients and 22 healthy volunteers who were treated in the Fourth Hospital of Hebei Medical University from 2019 to 2021 were collected. DNA was extracted from all samples, and the V3‐V4 region of the bacterial 16S rRNA gene was PCR‐amplified using the Illumina sequencing platform, and R language was used for data analysis.

Results

There were significant differences in the Beta diversity and metabolic pathways of gut microbes between NSCLC patients and healthy individuals (p < 0.05). Bifidobacterium, Escherichia, and Sarterella were significantly enriched in patients with clinical benefit response (p < 0.05), and these three bacteria had certain predictive value for clinical benefit. Patients with Bifidobacterium breve had significantly longer median progression‐free survival (mPFS) compared with patients with no detectable Bifidobacterium breve feces at baseline (106 days vs. NR, p < 0.001). Multivariate COX analysis showed that the presence of B.breve was an independent good prognostic factor affecting the PFS of patients receiving combination therapy (p < 0.05).

Conclusion

The clinical efficacy of anti‐PD‐1 therapy combined with chemotherapy in Chinese advanced NSCLC patients is closely related to the gut microbiota, and Bifidobacterium breve may be a potential biomarker to predict the efficacy of immune‐combined chemotherapy.
Reflections on dilemmas of presidents and trustees
Authors: Boggs George R.
Published: October 2022

According to John Carver (1990), no single relationship in an organization is as important as that between the board and its chief executive officer. That relationship, well‐conceived, can set the stage for effective governance and leadership. However, the line between governance and administration in community colleges is not always as clear as the experts define it, and this lack of clarity sometimes leads to significant issues for boards and their CEOs. This chapter relates some cases, based upon observations of the author, on the types of dilemmas that occur in the real world and how trustees and CEOs have dealt with them. The lessons learned from these examples can serve to strengthen the relationship between CEOs and boards and inform the important work they do.
Rogue trustees and malice in wonderland
Authors: Cloud Robert C.
Published: October 2022

Effective governance requires high levels of trust and mutual respect among trustees who must commit to serving as stewards of the college's resources. This chapter describes rogue trustees, their tactics, and their negative impact on the governing process and college culture. The chapter includes strategies to mitigate the disruptive and counter‐productive conduct of rogues and concludes with practical advice for presidents and responsible board members dealing with recalcitrant trustees.
Addressing workforce needs and educational opportunity through board action
Authors: D'Amico Mark M. , Turk Jonathan M. , Hancock Anthony , Miller Michael T.
Published: October 2022

Boards of trustees provide the policy, strategy, and accountability that set the direction for community colleges, all while being accountable to the states, regions, districts, and local areas they serve. One of those particular mission areas of community colleges is the preparation of the workforce to meet the needs of local economies and the simultaneous offering of relevant education that helps individuals achieve social and economic mobility. A critical component of that is to provide educational opportunities that allow individuals to continue to build on levels of education so that there are no “dead ends” as they progress through their careers. In this chapter, we discuss how Boards can embrace the TECH (transparency, equity, career, holistic) approach when governing colleges that address workforce needs and advance educational opportunities.
Colchicine poisoning treated with hemoperfusion and hemodialysis: A case report
Authors: Ramezani Maral , Mostafazadeh Babak , Rahimi Mitra , Evini Peyman Erfan Talab , Shadnia Shahin
Published: October 2022

This case report described an improved case of colchicine poisoning using hemoperfusion and hemodialysis.
COVID‐19 hospitalization with later long COVID in a person with Down syndrome
Authors: Amin Mohammad Ashraful , Khan Ishtiakul Islam , Nahin Sabrina , Bonna Atia Sharmin , Afrin Sadia , Hawlader Mohammad Delwer Hossain
Published: October 2022

Viruses that induce pulmonary difficulties and auto‐inflammation are more common in people with Down syndrome. They also have a higher number of comorbidities associated with a worse prognosis than the overall population. Adult patients with acute COVID‐19 are increasingly being diagnosed with Long COVID. However, patients with Down syndrome with later long COVID‐19 are the first example documented in Bangladesh.
Kein Widerspruch, sondern Impulsgeber
Authors: Woppowa Ljuba
Published: October 2022

Chemie, Klimaschutz und nachhaltige Wirtschaft sind kein Widerspruch, sondern sich gegenseitig bedingende Impulsgeber. Der VDI bietet zahlreiche fachlich fundierte Informationsquellen dazu.
Multiphysikalische Batteriesimulation
Authors: Fontes Ed , Ekström Henrik
Published: October 2022

Für die Entwicklung neuer – und die Verbesserung etablierter – Batterietechnologien bieten Modellierung und Simulation effiziente und kostengünstige Ansätze. Welcher Ansatz der Richtige ist, hängt davon ab, welcher Aspekt einer Batterie das Ziel der Analyse und Verbesserung ist.
Die Wasserstoff‐Farbpalette
Authors: Herrig Stefan
Published: October 2022

Er ist das kleinste und leichteste chemische Element, aber einer der größten Hoffnungsträger auf dem Weg in Richtung Klimaneutralität: Wasserstoff (H2). Welche Hindernisse stehen einer Wasserstoffwirtschaft im Wege? Und was bedeuten die vielen Farben – von grün über blau bis türkis?
Die Anfänge der Normen zur funktionalen Sicherheit
Authors: Grimsehl Andreas
Published: October 2022

Mit dem Erscheinen der 1. Ausgabe der Reihe IEC/EN 61508 (“Funktionale Sicherheit sicherheitsbezogener elektrischer/elektronischer/programmierbarer elektronischer Systeme”) im Jahre 2001 war der offizielle Beginn der Funktionalen Sicherheit gelegt. Doch ihre Anfänge der reichen weiter zurück und die Funktionalen Sicherheit ist in den Entwicklungsabteilungen von Pepperl+Fuchs seit fast 50 Jahren verankert.
Cyber Security für Industrieanlagen
Authors: Ullrich Steffen
Published: October 2022

In viele Industrieanlagen verlieren Betreiber durch fremdverwaltete Dienste, zum Beispiel Cloud Computing heute zunehmend die Kontrolle über ihre OT‐ und IT‐Sicherheit. Zero‐Trust‐Architekturen aus der IT‐Welt helfen Betreibern, die Netzwerkhoheit über ihre OT zu behalten und damit das Vertrauen in ihre Infrastruktur und Betriebstechnologie wiederzugewinnen.
Ein Vierteljahrhundert CITplus: Die Summe macht den Erfolg 25 Jahrgänge Studium Generale der Verfahrenstechnik
Authors: Woppowa Ljuba , Rübberdt Kathrin
Published: October 2022

Grußwort zum 25‐jährigen Jubiläum CITplus
Use ofmulti‐perturbationShapley analysis inlesion studiesof functional networks: The case of upper limb paresis
Authors: Ofir‐Geva Shay , Meilijson Isaac , Frenkel‐Toledo Silvi , Soroker Nachum
Published: October 2022

Understanding the impact of variation in lesion topography on the expression of functional impairments following stroke is important, as it may pave the way to modeling structure–function relations in statistical terms while pointing to constraints for adaptive remapping and functional recovery.Multi‐perturbation Shapley‐value analysis(MSA) is a relatively novel game‐theoretical approach for multivariate lesion‐symptom mapping. In this methodological paper, we provide a comprehensive explanation of MSA. We use synthetic data to assess the method's accuracy and perform parameter optimization. We then demonstrate its application using a cohort of 107 first‐event subacute stroke patients, assessed for upper limb (UL) motor impairment (Fugl‐Meyer Assessment scale). Under the conditions tested, MSA could correctly detect simulated ground‐truth lesion‐symptom relationships with a sensitivity of 75% and specificity of ~90%. For real behavioral data, MSA disclosed a strong hemispheric effect in the relative contribution of specific regions‐of‐interest (ROIs): poststroke UL motor function was mostly contributed by damage to ROIs associated with movement planning (supplementary motor cortex and superior frontal gyrus) following left‐hemispheric damage (LHD) and by ROIs associated with movement execution (primary motor and somatosensory cortices and the ventral brainstem) following right‐hemispheric damage (RHD). Residual UL motor ability following LHD was found to depend on a wider array of brain structures compared to the residual motor ability of RHD patients. The results demonstrate that MSA can provide a unique insight into the relative importance of different hubs in neural networks, which is difficult to obtain using standard univariate methods.
Presentation and outcomes of patients with clinically T1‐2, N0 oropharynx squamous cell carcinoma: The interplay of primary treatment modality and human papillomavirus status
Authors: Al‐Qurayshi Zaid , Zhu Vivian L. , Bayon Rodrigo , Buchakjian Marisa R.
Published: October 2022

Background

To examine the pattern of utilization and outcomes of definitive radiotherapy (RT) versus primary robotic‐assisted surgery in patients with early‐stage oropharyngeal squamous cell carcinoma (OPSCC).

Methods

A retrospective cohort analysis of patients with clinically T1‐2, N0 OPSCC was performed using the National Cancer Database, 2010–2016.

Results

A total of 1451 patients were included. Prevalence of human papillomavirus (HPV)‐positive tumors was 58.30%. Primary surgery was performed in 30.25% of the sample. Tongue base and clinically T1 tumors were each associated with a higher likelihood of undergoing surgery (p < 0.05). Histopathology of patients who underwent surgery demonstrated a prevalence of 15.95% with lymphovascular invasion, 16.67% with extranodal extension, 19.36% were T updated, and 30.00% were N upstaged. Improved survival was observed in the surgery + adjuvant RT group compared to RT alone for HPV‐positive tumors (HR: 0.27; 95%CI: 0.12, 0.62; p = 0.002).

Conclusion

This study provides epidemiological perspective regarding management pattern and outcomes of patients with early‐stage OPSCC.
Meta‐evaluation of studies on community physical activity programs in Brazil
Authors: da Silva Alanna Gomes , Sá Guerreiro Cátia , Malta Deborah Carvalho
Published: October 2022

Background

The use of the meta‐evaluation, especially in health promotion programs, is still scarce.

Aim

To verify if the evaluation studies conducted about the Academia da Cidade Programme and the Academia da Saúde Programme comply with the principles and standards of the meta‐evaluation.

Methods

This meta‐evaluation study was conducted using articles from scientific databases. The parameters of utility, propriety, and accuracy, as defined by the Joint Committee on Standards for Educational Evaluation, and specificity, were applied. The classification of the studies was based on the Stufflebeam's checklist.

Results

Of the 18 selected articles, the principle of utility was fully met in 50%, given that 27.8% were classified as very good, 5.6% as good, and 16.7% as fair. The principle of propriety mostly received the result of very good (44.4%), followed by excellent (38.9%), good (11.15), and weak (5.6%). The principle of accuracy was classified as excellent in 44.4% of the studies, considering that in 33.3% it was considered very good; 11.1% good, and 11.1% fair. Specificity was classified as very good in 94.4% of the studies.

Conclusion

The physical activity community programs evaluations were carried out in accordance to the principles and standards of meta‐evaluation tenets. Most studies were classified as excellent regarding the principle of utility and accuracy, or very good as for the principle of propriety and specificity.
Psychological adaptation level optimization to attain the goal of sustainable education
Authors: Ning Qinliang , Shi Junyan
Published: October 2022

The article aimed to study the psychological adaptability of university students. Along with that, the influence of sports activities on enhancing the psychology of students is also examined. The study also analyzes the impact of music on the psychoogy of students. A two‐factor model is used for analyzing the level of college students' mental health. In this study, data was collected from 555 first‐year undergraduate university students through an online questionnaire survey. Levels of both positive and negative psychological factors among students are examined. The findings indicate that students who participate in sports appear to have higher levels of positive psychological characteristics than students who do not exhibit any interest in participating in sports. Additionally, students that participate in sports have lower levels of negative psychological effects than nonparticipants. As a result, the study concluded that sports and other physical activities have a positive effect on the psychology of university students. The advantages of physical activities and sports in enhancing the mental and emotional health of students are highlighted in this study. To improve students' psychology and attain better academic results, educational institutions should provide students with various opportunities for sports.
The present circumstances of pediatric practice by family physicians in Japan: Cross sectional research
Authors: Takamura Akiteru , Machino Ako , Sugiyama Yukari , Sako Atsunori , Kohashi Kosuke , Yabe Chizuru , Ichinose Hidefumi , Kitanishi Fuminao , Kubota Mitsuru , Miyazaki Kei ,   for the Japan Primary Care Association, Pediatric and Adolescent Health Committee
Published: October 2022

Background

In Japan, pediatric primary care has often been provided not by general practitioners, but by specialists. Although official pediatric training of general practitioners started in Japan in 2018 no studies to date show the extent to which Japanese general practitioners are committed to pediatric care.

Methods

We conducted a questionnaire survey on pediatric training and current pediatric practice for family physicians certified by the Japan Primary Care Association.

Results

Of 1067 Japan Primary Care Association certified family physicians, 288 (27%) responded to the survey. More than 90% had received at least 3 months of pediatric training. Family physicians who completed 6 or more months of pediatric training provided significantly more pediatric care (p = 0.005). However, nearly 40% were currently not involved in pediatric care. Japan Primary Care Association certified family physicians are treating acute and chronic common diseases as well as diseases that may intersect with other departments. However, most respondents indicated there are not many opportunities to learn systematically about the care of these diseases.

Conclusions

In Japan, general practitioners are still not actively involved in pediatric care, but they treat patients with diseases that make it difficult to determine the most appropriate department to see and a wide range of age groups. It will become increasingly important to provide learning opportunities and better training environments in these areas with related organizations.
Morphine disrupts macrophage functions even during HIV infection
Authors: Barbaro John M , Jaureguiberry-Bravo Matias , Sidoli Simone , Berman Joan W
Published: October 2022

HIV-associated neurocognitive impairment (HIV-NCI) is a debilitating comorbidity that reduces quality of life in 15–40% of people with HIV (PWH) taking antiretroviral therapy (ART). Opioid use has been shown to increase neurocognitive deficits in PWH. Monocyte-derived macrophages (MDMs) harbor HIV in the CNS even in PWH on ART. We hypothesized that morphine (MOR), a metabolite of heroin, further dysregulates functional processes in MDMs to increase neuropathogenesis. We found that, in uninfected and HIV-infected primary human MDMs, MOR activates these cells by increasing phagocytosis and up-regulating reactive oxygen species. Effects of MOR on phagocytosis were dependent on μ-opioid receptor activity and were mediated, in part, by inhibited lysosomal degradation of phagocytized substrates. All results persisted when cells were treated with both MOR and a commonly prescribed ART cocktail, suggesting minimal impact of ART during opioid exposure. We then performed mass spectrometry in HIV-infected MDMs treated with or without MOR to determine proteomic changes that suggest additional mechanisms by which opioids affect macrophage homeostasis. Using downstream pathway analyses, we found that MOR dysregulates ER quality control and extracellular matrix invasion. Our data indicate that MOR enhances inflammatory functions and impacts additional cellular processes in HIV-infected MDMs to potentially increases neuropathogenesis in PWH using opioids.
Influence of body mass index and anterior cruciate ligament reconstruction on gait biomechanics
Authors: Pamukoff Derek N. , Holmes Skylar C. , Garcia Steven A. , Vakula Michael N. , Shumski Eric J. , Moffit Tyler J.
Published: October 2022

Body mass index (BMI) and history of anterior cruciate ligament reconstruction (ACLR) independently influence gait biomechanics and knee osteoarthritis risk, but the interaction between these factors is unclear. The purpose of this study was to compare gait biomechanics between individuals with and without ACLR, and with and without overweight/obesity. We examined 104 individuals divided into four groups: with and without ACLR, and with low or high BMI (n = 26 per group). Three‐dimensional gait biomechanics were evaluated at preferred speed. The peak vertical ground reaction force, knee flexion angle and excursion, external knee flexion moment, and external knee adduction moment were extracted for analysis. Gait features were compared between groups using 2 (with and without overweight/obesity) × 2 (with and without ACLR) analysis of variance. Primary findings indicated that those with ACLR and high BMI had a larger external knee adduction moment compared with those with low BMI and with (p = 0.004) and without ACLR (p = 0.005), and compared with those without ACLR and high BMI (p = 0.001). The main effects of ACLR and BMI group were found for the knee flexion moment, and those with ACLR and with high BMI had lower knee flexion moments compared with those without ACLR (p = 0.031) and with low BMI (p = 0.021), respectively. Data suggest that individuals with ACLR and high BMI may benefit from additional intervention targeting the knee adduction moment. Moreover, lower external knee flexion moments in those with high BMI and ACLR were consistent, but high BMI did not exacerbate deficits in the knee flexion moment in those with ACLR. [Correction added on 9 November 2022, after first online publication: In the preceding sentence, for clarity, the words “reductions in the lower” was removed from the initial sentence to read “Moreover, lower external knee flexion moments”.]
WhatsApp supervision for a lay‐led Islamic trauma‐focused intervention in Somaliland: Qualitative content analysis
Authors: Klein Alexandra B. , Egeh Mumin H. , Bowling Alexandra R. , Holloway Ash , Ali Ayaan Abdillahi , Abdillahi Zeinab Adam , Abdi Mohamed Ahmed , Ibrahim Salma Hassan , Bootan Khadar Hindi , Ibrahim Hibaaq Isse , Ali Aden Mohamed , Tubeec Abdirahman Muse , Dolezal Michael L. , Angula Dega A. , Bentley Jacob A. , Feeny Norah C. , Zoellner Lori A.
Published: October 2022

Clinical supervision is critical for the uptake of psychotherapy but difficult to facilitate in countries with limited providers, resources, and internet infrastructure. Innovative supervision approaches are needed to increase access to mental health treatments in low‐to‐middle income countries (LMICs). This study examined the content and feasibility of remote WhatsApp text supervision conducted as part of an open clinical trial in Somaliland. Islamic Trauma Healing ITH) is a brief, group, lay‐lead, trauma‐focused, mosque‐based intervention that has demonstrated initial efficacy in pilot studies in the United States and Somaliland. After a 2‐day, in‐person training, lay leaders led four groups of five to seven members focused on trauma‐related psychopathology and community reconciliation. Somali lay leaders trained in ITH (n = 9) and the research team (n = 6) attended weekly WhatsApp supervision during the intervention. Content was logged and subjected to qualitative analysis by two coders. Comments related to intervention implementation indicated that lay leaders understood the treatment rationale, adhered to treatment procedures, and believed the intervention components to be helpful and culturally relevant. Themes related to engagement suggested perfect attendance across groups and high levels of participation. Lay leader psychoeducation and skill development; supervisor praise, support, and encouragement; and supervisee gratitude emerged as additional themes. Remote text supervision conducted via WhatsApp was technologically feasible and may have facilitated skill development and the effective implementation of this lay‐led intervention. When tailored to the local context, remote supervision approaches hold promise for increasing access to services in LMICs with limited resources.
Cultivation of Encapsulated Primary Human B Lymphocytes: A First Step toward a Bioartificial Germinal Center
Authors: Helm Moritz , Huang Songyan B. , Gollner Katrin , Gollner Ulrich , Jérôme Valérie , Freitag Ruth
Published: October 2022

Polyelectrolyte microcapsules based on sodium cellulose sulfate (SCS) and poly‐diallyl‐dimethyl‐ammonium chloride (PDADMAC) have previously been proposed as a suitable ex vivo microenvironment for the cultivation and differentiation of primary human T lymphocytes. Here, the same system is investigated for the cultivation of human primary B cells derived from adult tonsillar tissue. Proliferation and differentiation into subtypes are followed and compared to suspension cultures of B cells from the same pool performed in parallel. Total cell expansion is somewhat lower in the capsules than in the suspension cultures. More importantly, however, the differentiation of the initially mainly memory B cells into various subtypes, in particular into plasma cell (PC), shows significant differences. Clearly, the microenvironment provided by the microcapsules is beneficial for an accelerated induction of a germinal center‐like B cell phenotype and afterward supports the long‐term survival of the PC cells. Then, varying the encapsulation conditions (i.e., presence of human serum and dedicated cytokines in the capsule core) provides a tool for finetuning the B cell response. Hence, this methodology is suggested to pave the way toward ex vivo development of human immune organoids.
Stacked profunda artery perforator flaps with intra‐flap anastomosis for moderate to large breast autologous reconstruction
Authors: Scaglioni Mario F. , Meroni Matteo , Fritsche Elmar
Published: October 2022

Background

The profunda artery perforator (PAP) flap is a reliable alternative for autologous breast reconstruction; however, the amount of tissue provided is quite limited. For medium to large sized breast reconstruction two PAP flaps can be harvested and inset in “stacked” fashion. This procedure consists in placing the two flaps side by side, normally supplied by antegrade and retrograde anastomoses performed with the mammary vessels. In the present article, we report the employment of stacked PAP flaps with intra‐flap anastomosis in breast reconstruction setting.

Patients and methods

From April 2018 to December 2021, seven patients received unilateral breast reconstruction with stacked PAP flaps. Patients' average age was 47.5 (range 39–58 years old). Mean body mass index was 19.4 kg/m2 (range 18.5–20.1 kg/m2). The two flaps were linked by means of intra‐flap anastomosis resorting to side branches of one of the two pedicles. In all cases the internal mammary vessels were dissected sparing the ribs and used as recipient vessels for antegrade end‐to‐end anastomosis.

Results

The flaps size ranged from 15 cm × 6 cm to 20 cm × 7 cm with an average weight of 250 g (range 190–290 g). The mean pedicle length was 11.1 cm (range 10–12.5 cm) on the left side and 7.9 cm (range 7–9 cm) on the right side. All flaps survived completely after surgery. The donor sites were all primarily closed with no morbidities. The mean follow‐up was 8 months (range 6–12 months). All patients were satisfied with the result.

Conclusions

Stacked PAP flaps performed with intra‐flap anastomosis may represent a valid alternative solution for the reconstruction of moderate to large breast in case of unavailable abdominal tissue.
A novel high‐order collocation indirect boundary element method based on the Leis formulation for three‐dimensional high frequency exterior acoustic problems
Authors: Zhang Chao , Fu Zhuojia , Zhang Yaoming
Published: October 2022

High‐order finite element method (FEM) has recently achieved significant success in solving acoustic problems and has proved to be accurate, robust, and capable of reducing the pollution effect. Inspired by the high‐order FEM, this study presents a novel high‐order collocation indirect BEM for solving three‐dimensional high‐frequency exterior acoustic problems. Due to the difficulty of evaluating hypersingular integrals on curved surface elements with complex density functions, the high‐order BEM scheme for acoustic problems has long been a challenging task, especially for relatively large‐scale problems. In the developed scheme, the Leis formulation is used to overcome the well‐known nonuniqueness problem in the indirect BEM, and an auxiliary integral equation method is presented and employed to regularize the hypersingular integrals in this formulation. The derived regularized boundary integral formulation is mathematically simple and amenable to the elements of arbitrary shape and arbitrary variable interpolation order, and leads to a simple, efficient, and robust algorithm for the calculation of all integrals. Several benchmark examples are investigated to verify the performance of the proposed method. Results demonstrate that the present method is very effective in stimulating the far‐field solution with large wavenumber.
The use of pharmacological chaperones in rare diseases caused by reduced protein stability
Authors: Gil‐Martínez Jon , Bernardo‐Seisdedos Ganeko , Mato José M , Millet Oscar
Published: October 2022

Rare diseases are most often caused by inherited genetic disorders that, after translation, will result in a protein with altered function. Decreased protein stability is the most frequent mechanism associated with a congenital pathogenic missense mutation and it implies the destabilization of the folded conformation in favour of unfolded or misfolded states. In the cellular context and when experimental data is available, a mutant protein with altered thermodynamic stability often also results in impaired homeostasis, with the deleterious accumulation of protein aggregates, metabolites and/or metabolic by‐products. In the last decades, a significant effort has enabled the characterization of rare diseases associated to protein stability defects and triggered the development of innovative therapeutic intervention lines, say, the use of pharmacological chaperones to correct the intracellular impaired homeostasis. Here, we review the current knowledge on rare diseases caused by reduced protein stability, paying special attention to the thermodynamic aspects of the protein destabilization, also focusing on some examples where pharmacological chaperones are being tested.
A comprehensive assessment of insecticide resistance mutations in source and immigrant populations of the diamondback moth Plutella xylostella (L.)
Authors: Shen Xiu‐Jing , Cao Li‐Jun , Chen Jin‐Cui , Ma Li‐Jun , Wang Jia‐Xu , Hoffmann Ary A. , Wei Shu‐Jun
Published: October 2022

BACKGROUND

The diamondback moth (DBM) Plutella xylostella has developed resistance to almost all insecticides used to control it. Populations of DBM in temperate regions mainly migrate from annual breeding areas. However, the distribution pattern of insecticide resistance of DBM within the context of long‐distance migration remains unclear.

RESULTS

In this study, we examined the frequency of 14 resistance mutations for 52 populations of DBM collected in 2010, 2011, 2017 and 2018 across China using a high‐throughput KASP genotyping method. Mutations L1041F and T929I conferring pyrethroid resistance, and mutations G4946E and E1338D conferring chlorantraniliprole resistance were near fixation in most populations, whereas resistant alleles of F1020S, M918I, A309V and F1845Y were uncommon or absent in most populations. Resistance allele frequencies were relatively stable among different years, although the frequency of two mutations decreased. Principal component analysis based on resistant allele frequencies separated a southern population as an outlier, whereas the immigrants clustered with other populations, congruent with the migration pattern of northern immigrants coming from the Sichuan area of southwestern China. Most resistant mutations deviated from Hardy–Weinberg equilibrium due to a lower than expected frequency of heterozygotes. The deviation index of heterozygosity for resistant alleles was significantly higher than the index obtained from single nucleotide polymorphisms across the genome. These findings suggest heterogeneous selection pressures on resistant mutations.

CONCLUSION

Our results provide a picture of resistant mutation patterns in DBM shaped by insecticide usage and migration of this pest, and highlight the widespread distribution of resistance alleles in DBM. © 2022 Society of Chemical Industry.
Techniques and Survey for 3D Modeling of Touristic Caves: Valdemino Case
Authors: Pisoni Isabella Nicole , Cina Alberto , Grasso Nives , Maschio Paolo
Published: October 2022

Nowadays, touristic caves are a relevant topic among topographical and geological studies. Modern techniques allow to elaborate 3D models with high accuracy and precision. Anyway, underground surveys are always delicate to perform, due to narrow and difficult to reach environments. In this paper, we show a case study, “Valdemino” cave, that involved the utilization of different point cloud acquisition methods: UAV, TLS, SLAM. The first purpose was to obtain 3D models of outdoor and indoor environments with a medium and high accuracy. These models were used to calculate the thickness of the rock between surface and cave’s roof and will be used for further studies, taking part in the PRIN 2017 project, concerning the impact of the tourist on show caves. The second purpose was to discuss about the feasibility and precision of the different survey methods, when studying a cave. The results showed how SLAM technology is enough accurate for speleological purposes, if compared with the more accurate TLS method. It is precise, maneuverable, easy to use and it allowed to get into environments that TLS can’t reach, such as non-touristic areas.
Multi-platform, Multi-scale and Multi-temporal 4D Glacier Monitoring. The Rutor Glacier Case Study
Authors: Macelloni Myrta Maria , Corte Elisabetta , Ajmar Andrea , Cina Alberto , Giulio Tonolo Fabio , Maschio Paolo Felice , Pisoni Isabella Nicole
Published: October 2022

At present most alpine glaciers are not in equilibrium with the current climate, as a result they are undergoing a dramatic mass loss. Monitoring glacial variations is crucial to assess the consequences of climate change on the territory. In this work different geomatics techniques are exploited to measure and monitor the Rutor glacier over the years. In this study two different techniques were adopted to generate 3 digital surface models (DSMs): aerial and satellite photogrammetry. Two photogrammetric aerial surveys were carried out: at the end of the hydrological year 2019/20 and at the end of the following hydrological year. Additionally, a very high-resolution satellite stereo pair, acquired by the Pléiades-1A platform in 2017, was processed to assess whether satellite images can be applied to extract the 3D surface of the Rutor glacier. In order to evaluate the Rutor glacier mass-balance throughout the years several reference points were positioned and measured before the 2021 aerial flight. Thanks to the presence of the materialized points the 2021 model is considered as the ‘Reference Model’ against which subsequent models can be compared for glacier analysis. This model was validated by means of a comparison with the authoritative Regional DSM based on LiDAR surveys. In alpine glaciers, the positioning of artificial square cross target in time invariant areas is crucial to enable a multitemporal 4D analysis. The use of very high-resolution satellite imagery allows large areas to be mapped in 3D, but with lower accuracies proportionally decreasing with respect to slope and exposure.
Small Schwarzschild de Sitter black holes, quantum extremal surfaces and islands
Authors: Goswami Kaberi , Narayan K.
Published: October 2022

Abstract

We study 4-dimensional Schwarzschild de Sitter black holes in the regime where the black hole mass is small compared with the de Sitter scale. Then the de Sitter temperature is very low compared with that of the black hole and we study the black hole, approximating the ambient de Sitter space as a frozen classical background. We consider distant observers in the static diamond, far from the black hole but within the cosmological horizon. Using 2-dimensional tools, we find that the entanglement entropy of radiation exhibits linear growth in time, indicative of the information paradox for the black hole. Self-consistently including an appropriate island emerging at late times near the black hole horizon leads to a reasonable Page curve. There are close parallels with flat space Schwarzschild black holes in the regime we consider.
„Clinical variant“-Galaktosämie: Andere Länder, andere Phänotypen …
Authors: Grünert Sarah Catharina , Schumann Anke , Härtling Anton , Hörster Friederike , Spiekerkoetter Ute , Pohl Martin
Published: October 2022

Ein 2 Monate altes afrikanisches Mädchen wurde mit Gedeihstörung, Exsikkose und renalem Fanconi-Syndrom vorgestellt. Eine Hepatopathie bestand nicht, und das Neugeborenenscreening war unauffällig. Die genetische Abklärung aufgrund des Fanconi-Syndroms ergab eine „Clinical-variant“-Galaktosämie. Diese Form der Galaktosämie, die typischerweise in der afrikanischen Bevölkerung vorkommt, ist mit einer hohen Restaktivität in der Leber und somit niedrigen Galaktosemetaboliten im Blut assoziiert, sodass die Diagnose im Neugeborenenscreening verpasst werden kann. Unser Fall zeigt, dass bei Kindern mit anderem ethnischen Hintergrund andere Phänotypen genetischer Erkrankungen vorliegen können, die den etablierten Screeningmethoden entgehen können und daher bei differenzialdiagnostischen Überlegungen Beachtung finden müssen.