bluuebunny/crossref_metadata_2025 huggingface dataset:
A bioengineered lymphatic vessel model for studying lymphatic endothelial cell‐cell junction and barrier function
Authors: Henderson Aria R. , Ilan Isabelle S. , Lee Esak
Published: September 2021

Objective

Lymphatic vessels (LVs) maintain fluid homeostasis by draining interstitial fluid. A failure in lymphatic drainage triggers lymphatic diseases such as lymphedema. Since lymphatic drainage is regulated by lymphatic barrier function, developing experimental models that assess lymphatic barrier function is critical for better understanding of lymphatic physiology and disease.

Methods

We built a lymphatic vessel‐on‐chip (LV‐on‐chip) by fabricating a microfluidic device that includes a hollow microchannel embedded in three‐dimensional (3D) hydrogel. Employing luminal flow in the microchannel, human lymphatic endothelial cells (LECs) seeded in the microchannel formed an engineered LV exhibiting 3D conduit structure.

Results

Lymphatic endothelial cells formed relatively permeable junctions in 3D collagen 1. However, adding fibronectin to the collagen 1 apparently tightened LEC junctions. We tested lymphatic barrier function by introducing dextran into LV lumens. While LECs in collagen 1 showed permeable barriers, LECs in fibronectin/collagen 1 showed reduced permeability, which was reversed by integrin α5 inhibition. Mechanistically, LECs expressed inactivated integrin α5 in collagen 1. However, integrin α5 is activated in fibronectin and enhances barrier function. Integrin α5 activation itself also tightened LEC junctions in the absence of fibronectin.

Conclusions

Lymphatic vessel‐on‐chip reveals integrin α5 as a regulator of lymphatic barrier function and provides a platform for studying lymphatic barrier function in various conditions.
Subclinical heart remodeling and dysfunction in relation to peripheral endothelial dysfunction: A general population study
Authors: Cauwenberghs Nicholas , Godderis Sarah , Sabovčik František , Cornelissen Véronique , Kuznetsova Tatiana
Published: September 2021

Aims

Epidemiological studies should substantiate the paradigm that endothelial dysfunction contributes to the development of heart failure with preserved ejection fraction (HFpEF). We investigated the association of cardiac remodeling and dysfunction with peripheral vasoreactivity in the general population.

Methods

In 424 individuals, we echocardiographically assessed cardiac structure and function and determined digital vasomotor function by photoplethysmography (PPG) during reactive hyperemia (RH). We regressed echocardiographic indexes and abnormalities on RH ratios averaged for 30 s time intervals. We derived sex‐specific peripheral vasoreactivity profiles from PPG time‐series and compared their echocardiographic phenotypes.

Results

Higher left ventricular (LV) mass index and lower E/A ratio and e’ peak and left atrial reservoir strain were independently related to lower RH ratios. Participants with LV hypertrophy or diastolic dysfunction presented significantly lower RH ratios during the 30 to 240s intervals than normal counterparts. Low RH responders (n = 250) presented higher odds for LV hypertrophy (adjusted OR: 2.60; p = .0040) and LV diastolic dysfunction (adjusted OR: 2.66; p = .0037) than moderate‐to‐high responders (n = 174).

Conclusion

The association between subclinical heart maladaptation and decreased microvascular reactivity supports the involvement of endothelial dysfunction in HFpEF pathogenesis. Time‐integrated profiling of microvascular vasoreactivity may enable early detection of HFpEF in the community.
Voice, responsiveness, and alternative policy venues: An analysis of citizen complaints against the local government to the national Ombudsman
Authors: Tavares António F. , Pires Sara Moreno , Teles Filipe
Published: September 2021

The Ombudsman is one of the most relevant and institutionalized tools to give voice to citizens, so they can express their dissatisfaction with local public services. The literature has yet to produce a systematic explanation for the variation in complaints to the national Ombudsman. This article uses classic literature from public administration and public policy to consider arguments of voice, responsiveness and alternative policy venues concerning the role of the Ombudsman in citizen complaints against local governments. Data on all 2139 citizen complaints submitted to the Ombudsman in Portugal (2012–2015) are analyzed using negative binomial regression models. Policy implications drawn from the results show not only that the presence of alternative voice venues reduces the number of complaints to the national Ombudsman but also that context matters. Local politics stimulates civic engagement and difficult local conditions, such as unemployment, crime, and aging populations, activate citizens to resort to the Ombudsman.
Factors associated with graft survival in South African adolescent renal transplant patients at CMJAH over a 20‐year period (GRAFT‐SAT Study)
Authors: Chhiba Priya Darshani , Moore David P. , Levy Cecil , Do Vale Claudia
Published: September 2021

Background

In the developed world, studies on transition of adolescent renal transplant patients have noted high rates of rejection, non‐adherence and graft loss. There is a paucity of data in developing countries and none from South Africa.

Methods

We evaluated patient and graft outcomes during adolescence (10–19 years), of patients who received a renal transplant over a 20‐year period (1990–2010), at a tertiary hospital in Johannesburg. Cox proportional hazards models and Kaplan‐Meier curves were used to analyse graft and patient survival.

Results

A total of 213 kidney transplants were done in 162 patients during the study period, 165 transplants occurred during the adolescent period. Factors associated with graft failure on multivariate analysis included non‐white race, transplant during the adolescent period ([aHR] 3.94; 95% [CI], 2.25–6.91), non‐compliance with follow‐up (aHR 3.89; 95% CI, 1.76–8.60) and receipt of a DD graft (aHR 2.10; 95% CI, 1.27–3.48). Patient survival rates at 1‐, 3‐, 5‐ and 10‐years were 98.8%, 97.6%, 95.1% and 93.9% respectively.

Conclusion

High rates of graft rejection and loss occurred in South African renal transplant recipients in the adolescent period, especially in those retained in paediatric care. Establishment of transition clinics may improve the graft outcomes of this vulnerable group and warrant further research.
Macrophages Modulated by Red/NIR Light: Phagocytosis, Cytokines, Mitochondrial Activity, Ca2+ Influx, Membrane Depolarization and Viability
Authors: Golovynska Iuliia , Stepanov Yurii V. , Golovynskyi Sergii , Zhou Ting , Stepanova Liudmyla I. , Garmanchuk Liudmyla V. , Ohulchanskyy Tymish Y. , Qu Junle
Published: September 2021

Low‐level light therapy (LLLT) is emerging as a promising therapeutic approach to modulate the biochemical and molecular processes within living cells. LLLT is known to produce local and systemic effects; therefore, immune cells in local tissues or in the circulation are affected by light. However, this specific effect remains weakly explored. In this study, the effect of red (650 nm) and NIR (808 nm) light on phagocytosis (respiratory burst), cytokine expression, mitochondrial activity, ROS generation, Ca2+ influx and membrane depolarization in macrophages in vitro is investigated. Both the phagocytic capacity and adhesion of macrophages strongly (~2.5 times) increased in the first hours after exposure to light in a dose‐dependent manner. The light‐evoked upregulation of phagocytosis is found to be less efficient than the maximal pharmacologically induced enhancement of ~3.2 times. Also, red/NIR light reduces the production of pro‐inflammatory cytokines and activates the secretion of anti‐inflammatory cytokines by several times in activated macrophages. At the same time, the viability shows a biphasic dose response: it increases after irradiation with lower doses (0.3–1 J cm−2) and decreases after treatment with higher doses (18–30 J cm−2), which is apparently associated with the upregulation of ROS generation, followed by an increase in the mitochondrial activity.
Time's arrow and self‐locating probability
Authors: Chen Eddy Keming
Published: September 2021

One of the most difficult problems in the foundations of physics is what gives rise to the arrow of time. Since the fundamental dynamical laws of physics are (essentially) symmetric in time, the explanation for time's arrow must come from elsewhere. A promising explanation introduces a special cosmological initial condition, now called the Past Hypothesis: the universe started in a low‐entropy state. Unfortunately, in a universe where there are many copies of us (in the distant “past” or the distant “future”), the Past Hypothesis is not enough; we also need to postulate self‐locating (de se) probabilities. However, I show that we can similarly use self‐locating probabilities to strengthen its rival—the Fluctuation Hypothesis, leading to in‐principle empirical underdetermination and radical epistemological skepticism. The underdetermination is robust in the sense that it is not resolved by the usual appeal to ‘empirical coherence’ or ‘simplicity.’ That is a serious problem for the vision of providing a completely scientific explanation of time's arrow.
Biotechnology of virus eradication and plant vaccination in phytobiome context
Authors: Oberemok V. , Laikova K. , Golovkin I. , Kryukov L. , Kamenetsky‐Goldstein R.
Published: September 2021

A plant’s associated biota plays an integral role in its metabolism, nutrient uptake, stress tolerance, pathogen resistance and other physiological processes. Although a virome is an integral part of the phytobiome, a major contradiction exists between the holobiont approach and the practical need to eradicate pathogens from agricultural crops. In this review, we discuss grapevine virus control, but the issue is also relevant for numerous other crops, including potato, cassava, citrus, cacao and other species. Grapevine diseases, especially viral infections, cause main crop losses. Methods have been developed to eliminate viruses and other microorganisms from plant material, but elimination of viruses from plant material does not guarantee protection from future reinfection. Elimination of viral particles in plant material could create genetic drift, leading in turn to an increase in the occurrence of pathogenic strains of viruses. A possible solution may be a combination of virus elimination and plant propagation in tissue culture with in vitro vaccination. In this context, possible strategies to control viral infections include application of plant resistance inducers, cross protection and vaccination using siRNA, dsRNA and viral replicons during plant ‘cleaning’ and in vitro propagation. The experience and knowledge accumulated in human immunization can help plant scientists to develop and employ new methods of protection, leading to more sustainable and healthier crop production.
Low passive restoration potential following invasive woody species removal in oak woodlands
Authors: Lamb Nathan , Havens Kayri , Holloway Jalen , Steffen James F. , Zeldin Jacob , Kramer Andrea T.
Published: September 2021

The restoration of oak woodlands often requires removal and management of woody invasive plants. This can trigger germination of the soil seed bank, which can alter restoration trajectories. In degraded deciduous woodlands generally, it is unclear whether the soil seed bank will contribute native plant material in sufficient quantities to help achieve restoration goals and allow practitioners to rely on passive restoration without supplemental seeding. To support restoration decision‐making around passive or active restoration in threeRhamnus cathartica‐invaded forest preserves in the Chicago region, we asked: (1) Does the soil seed bank differ from standing aboveground vegetation at reference and unrestored sites? and (2) Can the species richness, Shannon diversity, floristic quality (measured by abundance‐weighted mean coefficients of conservatism), or density of germinable seeds of native species in the soil seed bank be predicted by a site's restoration status (reference or unrestored)? We found that species composition differed significantly between aboveground vegetation and the soil seed bank at reference and unrestored sites, with a significant interaction between restoration status and location. Despite high variation among the three forest preserves, restoration status also predicted native species richness, diversity, floristic quality, and seed density in the soil seed bank, with unrestored sites significantly lower than reference sites in all measures. Results suggest that reintroduction of native seeds will be necessary to fully restore desired native plant communities in oak woodlands following the removal of invasive woody plants.
Reducing Patient Aggression Through a Nonviolent Patient De‐escalation Program: A Descriptive Quality Improvement Process
Authors: Christensen Scott S. , Lassche Madeline , Banks Dustin , Smith Glenn , Inzunza Trell M.
Published: September 2021

Background

Patients commonly display aggressive and violent behaviors toward nursing staff, contributing to severe consequences. Healthcare institutions must develop and implement systems addressing this global safety problem.

Aim

To improve clinical practice safety for inpatient acute care settings by providing healthcare teams throughout a large academic medical center with a Behavioral Emergency Response Team (BERT) program, that is, a system for reporting and de‐escalating aggressive patient encounters.

Methods

This descriptive quality improvement process took place within two inpatient acute care departments using simulation‐based training, patient safety rounds, and a BERT activation system. Participant groups included nursing personnel who completed a baseline survey (n = 302), telecommunication dispatchers (n = 20), BERT responders (n = 78), and bedside nursing staff (n = 43) recipients of BERT program resources. Methods included a baseline questionnaire, pre‐ and post‐intervention surveys, formal reports of aggressive patient encounters, documentation from patient safety rounds, and records of activated BERT responses. Data analysis included descriptive statistics, boxplots, and the Wilcoxon signed‐rank test.

Results

This project mitigated patient aggression episodes by successfully designing and implementing an evidence‐based BERT program. Findings suggested bedside nursing program participants felt more confident and capable of managing aggressive patient behaviors. A strong partnership between security officers and nursing staff limited the risk of harm to clinical staff by identifying and intervening with 41 potentially aggressive patients. Finally, formal reports of patient aggression episodes did not increase during this project, which may have indicated early prevention and detection of aggression while reflecting the broader problem of aggression under‐reporting in nursing.

Linking Evidence to Action

Healthcare organizations need to have robust systems to manage aggressive patient encounters. Comprehensive strategies for managing patient aggression include simulation‐based training, the use of BERT responders, and a strong partnership between nursing and security officer teams.
Profoundly lower muscle mass and rate of contractile protein synthesis in boys with Duchenne muscular dystrophy
Authors: Evans William J. , Shankaran Mahalakshmi , Smith Edward C. , Morris Carl , Nyangau Edna , Bizieff Alec , Matthews Marcy , Mohamed Hussein , Hellerstein Marc
Published: September 2021

Boys with Duchenne muscular dystrophy (DMD) experience a progressive loss of functional muscle mass, with fibrosis and lipid accumulation. Accurate evaluation of whole‐body functional muscle mass (MM) in DMD patients has not previously been possible and the rate of synthesis of muscle proteins remains unexplored. We used non‐invasive, stable isotope‐based methods from plasma and urine to measure the fractional rate of muscle protein synthesis (FSR) functional muscle mass (MM), and fat free mass (FFM) in 10 DMD (6–17 years) and 9 age‐matched healthy subjects. An oral dose of D3creatine in 70% 2H2O was administered to determine MM and FFM followed by daily 70% 2H2O to measure protein FSR. Functional MM was profoundly reduced in DMD subjects compared to controls (17% vs. 41% of body weight, P < 0.0001), particularly in older, non‐ambulant patients in whom functional MM was extraordinarily low (<13% body weight). We explored the urine proteome to measure FSR of skeletal muscle‐derived proteins. Titin, myosin light chain and gelsolin FSRs were substantially lower in DMD subjects compared to controls (27%, 11% and 40% of control, respectively, P < 0.0001) and were strongly correlated. There were no differences in muscle‐derived sarcoplasmic proteins FSRs (creatine kinase M‐type and carbonic anhydrase‐3) measured in plasma. These data demonstrate that both functional MM, body composition and muscle protein synthesis rates can be quantified non‐invasively and are markedly different between DMD and control subjects and suggest that the rate of contractile but not sarcoplasmic protein synthesis is affected by a lack of dystrophin.

Key points

Duchenne muscular dystrophy (DMD) results in a progressive loss of functional skeletal muscle but total body functional muscle mass or rates of muscle protein synthesis have not previously been assessed in these patients.

D3‐creatine dilution was used to measure total functional muscle mass and oral 2H2O was used to examine the rates of muscle protein synthesis non‐invasively in boys with DMD and healthy controls using urine samples.

Muscle mass was profoundly lower in DMD compared to control subjects, particularly in older, non‐ambulant patients.

The rates of contractile protein synthesis but not sarcoplasmic proteins were substantially lower in DMD.

These results may provide non‐invasive biomarkers for disease progression and therapeutic efficacy in DMD and other neuromuscular diseases.
Coupling effects of structure, oxygen availability and temperature on microbial growth in a pastry filling
Authors: Laca Amanda , Diaz Mario , Laca Adriana , Mateos Paula
Published: September 2021

The structure of real food is a key factor to be considered in order to control microbial growth. A pastry filling has been employed as model food to study the growth of Staphylococcus under different conditions. Additionally, the structure of the food system has been characterised by means of rheological measurements. Frequency sweeps showed that, in all cases, the elastic component determines the rheological behaviour of model pastry filling (G' > G''). Values obtained for the coordination number (z) and the proportional coefficient (A) indicated that the model food exhibits more aggregate structures and stronger links at lower temperatures. According to the maximum specific growth rates, the Staphylococcus growth in the model pastry filling was clearly conditioned by oxygen diffusion, which is limited by the food matrix, and also by the incubation temperature. In addition, the analysis of Staphylococcus growth at different temperatures suggested the influence of the pastry filling structure on microorganism behaviour.
PHIDL: Python-based layout and geometry creation for nanolithography
Authors: McCaughan Adam N. , Tait Alexander N. , Buckley Sonia M. , Oh Dylan M. , Chiles Jeffrey T. , Shainline Jeffrey M. , Nam Sae Woo
Published: September 2021

Computer-aided design (CAD) has become a critical element in the creation of nanopatterned structures and devices. In particular, with the increased adoption of easy-to-learn programming languages like python, there has been a significant rise in the amount of lithographic geometries generated through scripting and programming. However, there are currently unaddressed gaps in usability for open-source CAD tools—especially those in the GDSII design space—that prevent wider adoption by scientists and students who might otherwise benefit from scripted design. For example, constructing relations between adjacent geometries is often much more difficult than necessary—spacing a resonator structure a few micrometers from a readout structure often requires manually coding the placement arithmetic. While inconveniences like these can be overcome by writing custom functions, they are often significant barriers to entry for new users or those less familiar with programming. To help streamline the design process and reduce barrier to entry for scripting designs, we have developed PHIDL, an open-source GDSII-based CAD tool for python.
External, Internal, Perceived Training Loads and Their Relationships in Youth Basketball Players Across Different Positions
Authors: Sansone Pierpaolo , Ceravolo Alessandro , Tessitore Antonio
Published: September 2021

Purpose: To quantify external, internal, and perceived training loads and their relationships in youth basketball players across different playing positions. Methods: Fourteen regional-level youth male players (age: 15.2 [0.3] y) were monitored during team-based training sessions across 10 in-season weeks. The players were monitored with BioHarness-3 devices, to measure external (Impulse Load, in Newtons per second) and internal (summated-heart-rate zones [SHRZ], in arbitrary units [AU]) loads, and with the session rating of perceived exertion (sRPE, in AU) method to quantify perceived training load. Multiple linear mixed models were performed to compare training loads between playing positions (backcourt and frontcourt). Repeated-measures correlations were performed to assess the relationships between the load models, for all players and within playing positions. Results: External load (backcourt: 13,599 [2260] N·s; frontcourt: 14,934 [2173] N·s) and sRPE (backcourt: 345 [132] AU; frontcourt: 505 [158] AU) were higher in the frontcourt (P < .05, effect size: moderate), while SHRZ was similar between positions (backcourt: 239 [45] AU; frontcourt: 247 [43] AU) (P > .05; effect size: trivial). The correlations were as follows: large between the external load and SHRZ (r = .57, P < .001), moderate between SHRZ and sRPE (r = .45, P < .001), and small between the external load and sRPE (r = .26, P = .02). The correlation magnitudes were equivalent for external load–SHRZ (large) and SHRZ–sRPE (moderate) across positions, but different for the external load–sRPE correlation (small in backcourt; moderate in frontcourt). Conclusions: In youth basketball, small–large commonalities were found between the training dose (external load) and players’ responses (internal and perceived loads). Practitioners should carefully manage frontcourt players’ training loads because they accumulate greater external and perceived loads than backcourt  players do.
Target Site Pharmacokinetics of Meropenem: Measurement in Human Explanted Lung Tissue by Bronchoalveolar Lavage, Microdialysis, and Homogenized Lung Tissue
Authors: Paal Michael , Scharf Christina , Denninger Ann Katrin , Ilia Luis , Kloft Charlotte , Kneidinger Nikolaus , Liebchen Uwe , Michel Sebastian , Schneider Christian , Schröpf Sebastian , Schuster Carina , Vogeser Michael , Weinelt Ferdinand , Zander Johannes , Zoller Michael , Schroeder Ines
Published: September 2021

Pneumonia is one of the most common infections in intensive care patients, and it is often treated with beta-lactam antibiotics. Even if therapeutic drug monitoring in blood is available, it is unclear whether sufficient concentrations are reached at the target site: the lung.
Cometabolism of Ethanol in Azospirillum brasilense Sp7 Is Mediated by Fructose and Glycerol and Regulated Negatively by an Alternative Sigma Factor RpoH2
Authors: Singh Vijay Shankar , Dubey Basant Kumar , Pandey Parul , Rai Sushant , Tripathi Anil Kumar
Published: September 2021

This study unraveled a hidden ability of
Azospirillum brasilense
to utilize ethanol as a secondary source of carbon when fructose or glycerol were used as a primary growth substrate. It opens the possibility of studying the regulation of expression of the ethanol oxidation pathway for generating high yielding strains that can efficiently utilize ethanol.
Gene Fitness of Azotobacter vinelandii under Diazotrophic Growth
Authors: Knutson Carolann M. , Pieper Meghan N. , Barney Brett M.
Published: September 2021

These results provide insights into the functional redundancy in
A. vinelandii
, while also providing a direct measure of fitness for specific genes associated with the process of BNF. These results will serve as a valuable reference tool in future studies to uncover the mechanisms that govern this process.
Loss of Dihydroxyacid Dehydratase Induces Auxotrophy in Bacillus anthracis
Authors: Jelinski Joseph , Cortez Madeline , Terwilliger Austen , Clark Justin , Maresso Anthony
Published: September 2021

Anthrax disease, caused by
B. anthracis
, can cause lethal bacteremia and toxemia, even following treatment with antibiotics. This report identifies the
ilvD
gene, which encodes a dihydroxyacid dehydratase, as necessary for
B. anthracis
to synthesize the amino acid isoleucine in a nutrient-limiting environment, such as its mammalian host.
Meningitis secondary to disseminated gonococcal infection
Authors: Suggs Kelsey S , Tito Emmanuel , Muthukumarasamy Nirmal , Schauer Mark
Published: September 2021

We report one of the unusual presentations of disseminated gonococcal infection. This case report describes a 24-year-old woman who presented with disseminated gonococcal infection manifesting as meningitis. Cerebrospinal fluid (CSF) and throat swab PCR were positive forNeisseria gonorrhoeae. Blood and CSF cultures were negative for bacterial growth. The patient was treated with a total of 14 days of intravenous ceftriaxone. She was discharged with no neurological sequelae.
Acute ST-segment elevation myocardial infarction secondary to vaccine-induced immune thrombosis with thrombocytopaenia (VITT)
Authors: Flower Luke , Bares Zdenek , Santiapillai Georgina , Harris Stephen
Published: September 2021

A 40-year-old man with no cardiac history presented with central chest pain 8 days after receiving the ChAdOx1 nCov-19 vaccine against COVID-19. Initial blood tests demonstrated a thrombocytopaenia (24×109 μg/L) and a raised d-dimer (>110 000 μg/L), and he was urgently transferred to our tertiary referral central for suspected vaccine-induced immune thrombocytopaenia and thrombosis (VITT). He developed dynamic ischaemic electrocardiographic changes with ST elevation, a troponin of 3185 ng/L, and regional wall motion abnormalities. An occlusion of his left anterior descending coronary artery was seen on CT coronary angiography. His platelet factor-4 (PF-4) antibody returned strongly positive. He was urgently treated for presumed VITT with intravenous immunoglobulin, methylprednisolone and plasma exchange, but remained thrombocytopaenic and was initiated on rituximab. Argatroban was used for anticoagulation for his myocardial infarction while he remained thrombocytopaenic. After 6 days, his platelet count improved, and his PF-4 antibody level, troponin and d-dimer fell. He was successfully discharged after 14 days.
Influence of social determinants of health and county vaccination rates on machine learning models to predict COVID-19 case growth in Tennessee
Authors: Wylezinski Lukasz S , Harris Coleman R , Heiser Cody N , Gray Jamieson D , Spurlock Charles F
Published: September 2021

Introduction

The SARS-CoV-2 (COVID-19) pandemic has exposed health disparities throughout the USA, particularly among racial and ethnic minorities. As a result, there is a need for data-driven approaches to pinpoint the unique constellation of clinical and social determinants of health (SDOH) risk factors that give rise to poor patient outcomes following infection in US communities.

Methods

We combined county-level COVID-19 testing data, COVID-19 vaccination rates and SDOH information in Tennessee. Between February and May 2021, we trained machine learning models on a semimonthly basis using these datasets to predict COVID-19 incidence in Tennessee counties. We then analyzed SDOH data features at each time point to rank the impact of each feature on model performance.

Results

Our results indicate that COVID-19 vaccination rates play a crucial role in determining future COVID-19 disease risk. Beginning in mid-March 2021, higher vaccination rates significantly correlated with lower COVID-19 case growth predictions. Further, as the relative importance of COVID-19 vaccination data features grew, demographic SDOH features such as age, race and ethnicity decreased while the impact of socioeconomic and environmental factors, including access to healthcare and transportation, increased.

Conclusion

Incorporating a data framework to track the evolving patterns of community-level SDOH risk factors could provide policy-makers with additional data resources to improve health equity and resilience to future public health emergencies.
Impact evaluation of the efficacy of different doses of vitamin D supplementation during pregnancy on pregnancy and birth outcomes: a randomised, controlled, dose comparison trial in Pakistan
Authors: Nausheen Sidrah , Habib Atif , Bhura Maria , Rizvi Arjumand , Shaheen Fariha , Begum Kehkashan , Iqbal Junaid , Ariff Shabina , Shaikh Lumaan , Raza Syed Shamim , Soofi Sajid Bashir
Published: September 2021

Background

Vitamin D deficiency during pregnancy is a public health problem in Pakistan and is prevalent among most women of reproductive age in the country. Vitamin D supplementation during pregnancy is suggested to prevent adverse pregnancy outcomes and vitamin D deficiency in both the mother and her newborn.

Methods

We conducted a double-blinded, randomised controlled trial in Karachi, Pakistan to evaluate the effect of different doses of vitamin D supplementation during pregnancy on biochemical markers (serum 25(OH)D, calcium, phosphorus and alkaline phosphatase) in women and neonates, and on pregnancy and birth outcomes (gestational diabetes, pre-eclampsia, low birth weight, preterm births and stillbirths).

Results

Pregnant women (N=350) in their first trimester were recruited and randomised to three treatment groups of vitamin D supplementation: 4000 IU/day (group A, n=120), 2000 IU/day (group B, n=115) or 400 IU/day (group C, n=115). Women and their newborn in group A had the lowest vitamin D deficiency at endline (endline: 75.9%; neonatal: 64.9%), followed by group B (endline: 84.9%; neonatal: 73.7%) and then the control group (endline: 90.2%; neonatal: 91.8%). Vitamin D deficiency was significantly lower in group A than in group C (p=0.006) among women at endline and lower in both groups A and B than in the control group (p=0.001) in neonates. Within groups, serum 25(OH)D was significantly higher between baseline and endline in group A and between maternal baseline and neonatal levels in groups A and B. Participant serum 25(OH)D levels at the end of the trial were positively correlated with those in intervention group A (4000 IU/day) (β=4.16, 95% CI 1.6 to 6.7, p=0.002), with food group consumption (β=0.95, 95% CI 0.01 to 1.89, p=0.047) and with baseline levels of serum 25(OH)D (β=0.43, 95% CI 0.29 to 0.58, p<0.0001).

Conclusion

The evidence provided in our study indicates that vitamin D supplementation of 4000 IU/day was more effective in reducing vitamin D deficiency among pregnant women and in improving serum 25(OH)D levels in mothers and their neonates compared with 2000 IU/day and 400 IU/day.

Trial registration numberNCT02215213.
Knowledge, attitude and practices regarding health self-management among patients with osteogenesis imperfecta in China: an online cross-sectional survey
Authors: Lai Yongjie , Lu Wenchao , Mao Huijia , Zhang Yueyang , Ming Wai-kit , Wu Yibo
Published: September 2021

Objectives

Assessing the knowledge, attitude and practices (KAP) regarding health self-management among patients with osteogenesis imperfecta (OI) in China.

Design

An online cross-sectional survey.

Setting

A structured questionnaire was distributed online through China-Dolls Center for Rare Disorders (CCRD), a non-governmental charity in China.

Participants

Participants were all patients with OI from CCRD. After stratified sampling according to the economic level of residential city, 901 patients were proportionally selected and 869 patients completed the survey (response rate: 96.4%).

Main outcome measures

Demographic characteristics and KAP information were gathered using a 5-point Likert scale. The score of each dimension of KAP was the sum of the scores of all included items. Χ2 test or Fisher’s exact test was used to compare scores of different items. Ordinal regression was employed to determine the significant factors influencing KAP.

Results

A total of 802 questionnaires were included for analysis. Male respondents accounted for 57.1%, and 29.1% of respondents were of 26~30 years. More than half (50~60%) of patients knew the main symptoms of OI and the treatment of OI-related complications. Almost 80% of patients showed positive attitude. Nearly 60~70% of the patients were relatively able to take appropriate practice regarding OI management. There was a significant correlation between scores of knowledge and attitude, attitude and practice, as well as knowledge and practice. Patients aged 26~30 years, from urban areas and big cities, had higher KAP scores. Male patients showed better performance in knowledge, and highly educated patients perform better in practice.

Conclusions

Patients with OI did not have sufficient knowledge on disease care and up-to-date caring guidelines, and their practice regarding health self-management also needs to be improved. Gender, age, educational level and economic level of residence can affect the level of KAP for patients, thus developing targeted and tailored programmes for patients with OI is highly recommended.
Effects of COVID-19 protective measures on the ophthalmological patient examination with an emphasis on gender-specific differences
Authors: Rauchegger Teresa , Osl Antonia , Nowosielski Yvonne , Angermann Reinhard , Palme Christoph , Haas Gertrud , Steger Bernhard
Published: September 2021

Objective

In response to the COVID-19 pandemic, strict hygiene and containment measures have been instituted in the clinical ophthalmological examination to prevent virus transmission. The aim of this study is to assess the effects of these protective measures on the quality of the examination with an emphasis on gender-specific differences.

Methods and analysis

An online survey was sent to ophthalmologists in 10 countries. The collected data included demographics, place of work, current professional status, COVID-19 protective measures and their impact on the quality of the examination. Descriptive statistics were used to analyse the data. Fisher’s exact test was used to analyse gender differences.

Results

A total of 120 responses were collected. 54.0% of the respondents identified as female and 43.4% as male. Over 75% agreed that protective measures made the examination conditions more difficult. The major problems were fogging of the lenses (87.6%) or slit lamp oculars (69.9%), reduced operability of the slit lamp due to protective barriers (60.2%) and time delay due to disinfection measures (68.1%). Significantly more women than men reported that they used filtering face piece (FFP2) instead of surgical masks (p=0.02). More male participants reported that they removed their mask to prevent fogging (p=0.01). 31% of all participants felt that the COVID-19 protective measures reduced the overall quality of slit lamp examination and 43.4% reported a reduced quality of fundoscopic examination.

Conclusion

COVID-19 related safety measures reduce the feasibility of the clinical ophthalmological examination. Practicable solutions are required to maintain good examination quality without compromising personal safety.
MSF Paediatric Days: a step forward in operationalising ‘Humanitarian Paediatrics’
Authors: Janet Sophie , Russell Neal , Morton Nikola , Martinez Daniel , Tamannai Mona , Lafferty Nadia , Roggeveen Harriet , Ogundipe Oluwakemi F. , Carreras Inmaculada , Gao Anja , Didier Elise , Petrucci Roberta
Published: September 2021

Around the world, one in four children live in a country affected by conflict, political insecurity and disaster. Healthcare in humanitarian and fragile settings is challenging and complex to provide, particularly for children. Furthermore, there is a distinct lack of medical literature from humanitarian settings to guide best practice in such specific and resource-limited contexts. In light of these challenges, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, created the MSF Paediatric Days with the aim of uniting field staff, policymakers and academia to exchange ideas, align efforts, inspire and share frontline research and experiences to advance humanitarian paediatric and neonatal care. This 2-day event takes place regularly since 2016. The fourth edition of the MSF Paediatric Days in April 2021 covered five main topics: essential newborn care, community-based models of care, paediatric tuberculosis, antimicrobial resistance in neonatal and paediatric care and the collateral damage of COVID-19 on child health. In addition, eight virtual stands from internal MSF initiatives and external MSF collaborating partners were available, and 49 poster communications and five inspiring short talks referred to as ‘PAEDTalks’ were presented. In conclusion, the MSF Paediatric Days serves as a unique forum to advance knowledge on humanitarian paediatrics and creates opportunities for individual and collective learning, as well as networking spaces for interaction and exchange of ideas.
Effectiveness of an impedance cardiography guided treatment strategy to improve blood pressure control in a real-world setting: results from a pragmatic clinical trial
Authors: Wang Luyan , Lu Yuan , Wang Hongyi , Gu Jianlei , Ma Zheng J , Lian Zheng , Zhang Zhiying , Krumholz Harlan , Sun Ningling
Published: September 2021

Objective

To test the effectiveness of an impedance cardiography (ICG) guided treatment strategy on improving blood pressure (BP) control in real-world clinical practice.

Design

A single-centre, pragmatic randomised trial.

Setting

A hypertension clinic of the Peking University People’s Hospital in Beijing, China.

Participants

Adults who sought outpatient care for hypertension in the hypertension clinic at the Peking University People’s Hospital between June and December 2019.

Interventions

A computerised clinical decision support of recommending treatment choices to providers based on patients’ haemodynamic profiles measured by ICG.

Main outcome measures

Changes in systolic BP (SBP) and diastolic BP (DBP) levels at the follow-up visit 4–12 weeks after baseline. Secondary outcomes included achievement of BP goal of <140/90 mm Hg and the changes in BP by baseline BP, age, sex and body mass index (BMI).

Results

A total of 102 adults (mean age was 54±14 years; 41% were women) completed the study. The mean baseline SBP was 150.9 (SD of 11.5) mm Hg and mean baseline DBP was 91.1 (11.3) mm Hg. At the follow-up visit, the mean SBP and DBP decreased by 19.9 and 11.3 mm Hg in the haemodynamic group, as compared with 12.0 and 4.9 mm Hg in the standard care group (p value for difference between groups <0.001). The proportion of patients achieving BP goal of <140/90 mm Hg in the haemodynamic group was 67%, as compared with 41% in the standard care group (p=0.017). The haemodynamic group had a larger effect on BP reduction consistently across subgroups by age, sex, BMI and baseline BP.

Conclusions

An ICG-guided treatment strategy led to greater reductions in BP levels than were observed with standard care in a real-world population of outpatients with hypertension. There is a need for further validation of this strategy for improving blood pressure treatment selection.

Trial registration number

NCT04715698.
Impacts of point cloud density reductions on extracting road geometric features from mobile LiDAR data
Authors: Gargoum Suliman A. , El-Basyouny Karim
Published: September 2021

The variation in point cloud density is driven by many different factors. This variation is expected to affect the quality of the information extracted from the point clouds, however, the extent to which these variations impact the ability to accurately extract and assess geometric features of highways from point cloud data are unknown. This paper investigates the impacts of point density reduction on the extraction and assessment of four critical geometric features. The density of light detection and ranging (LiDAR) data was first reduced and the different features were extracted at varying levels of point density and on a selection of different highway segments in Alberta, Canada. The information obtained at lower point density was then compared to what was obtained at 100% point density. It was found that clearance assessments and sight distance assessments had low sensitivity to reductions in point density (i.e., reducing the point density to as low as 10% of the original data (30 ppm2 on the pavement surface) yielded results comparable to what was obtained at 100% density (300 ppm2) In contrast, for cross section slope estimation and curve attribute estimation higher sensitivity to point density was observed. These findings are critical for transportation agencies considering the adoption of LiDAR technology to manage elements of their infrastructure and for researchers developing data processing tools and algorithms for the semantic segmentation of transportation features from remotely sensed point clouds.
Nanoparticle-eluting stents for coronary intervention: formulation, characterization, and in vitro evaluation
Authors: Agrawal Ankit A. , Raval Ankur J. , Velhal Shilpa M. , Patel Vainav V. , Patravale Vandana B.
Published: September 2021

Coronary artery disease (CAD) is currently a leading cause of death worldwide. In the history of percutaneous coronary intervention for the treatment of CAD, a drug-eluting stent (DES) is recognized as a revolutionary technology that has the unique ability to significantly reduce restenosis and provide both mechanical and biological solutions simultaneously to the target lesion. The aim of the research work was to design and fabricate DES coated with a nanoparticulate drug formulation. Sirolimus, an inhibitor of the smooth muscle cell (SMC) proliferation and migration, was encapsulated in polymeric nanoparticles (NPs). The NP formulation was characterized for various physicochemical parameters. Cell viability and cell uptake studies were performed using human coronary artery smooth muscle cells (HCASMCs). The developed NP formulation showed enhanced efficacy compared to plain drug solution and exhibited time-dependent uptake into the HCASMCs. The developed NP formulation was coated on the Flexinnium™ ultra-thin cobalt-chromium alloy coronary stent platform. The NP-coated stents were characterized for morphology and residual solvent analysis. In vitro drug release was also evaluated. Ex vivo arterial permeation was carried out to evaluate the NP uptake from the surface of the stents. The characterization studies together corroborated that the developed NP coated stent can be a promising replacement of the current DESs.
Quadrotor motion control using deep reinforcement learning
Authors: Jiang Zifei , Lynch Alan F.
Published: September 2021

We present a deep neural-net-based controller trained by a model-free reinforcement learning (RL) algorithm to achieve hover stabilization for a quadrotor unmanned aerial vehicle (UAV). With RL, two neural nets are trained. One neural net is used as a stochastic controller, which gives the distribution of control inputs. The other maps the UAV state to a scalar, which estimates the reward of the controller. A proximal policy optimization (PPO) method, which is an actor–critic policy gradient approach, is used to train the neural nets. Simulation results show that the trained controller achieves a comparable level of performance to a manually tuned proportional-derivative (PD) controller, despite not depending on any model information. The paper considers different choices of reward function and their influence on controller performance.
Perturbed thermodynamics and thermodynamic geometry of a static black hole in f(R) gravity
Authors: Upadhyay Sudhaker , Soroushfar Saheb , Saffari Reza
Published: September 2021

In this paper, we consider a static black hole in [Formula: see text] gravity. We recapitulate the expression for corrected thermodynamic entropy of this black hole due to small fluctuations around equilibrium. Also, we study the geometrothermodynamics (GTD) of this black hole and investigate the adaptability of the curvature scalar of geothermodynamic methods with phase transition points of this black hole. Moreover, we study the effect of correction parameter on thermodynamic behavior of this black hole. We observe that the singular point of the curvature scalar of Ruppeiner metric coincides completely with zero point of the heat capacity and the deviation occurs with increasing correction parameter.
Experimental Evidence of Chaos Generated by a Minimal Universal Oscillator Model
Authors: Ricci Leonardo , Perinelli Alessio , Castelluzzo Michele , Euzzor Stefano , Meucci Riccardo
Published: September 2021

Detection of chaos in experimental data is a crucial issue in nonlinear science. Historically, one of the first evidences of a chaotic behavior in experimental recordings came from laser physics. In a recent work, a Minimal Universal Model of chaos was developed by revisiting the model of laser with feedback, and a first electronic implementation was discussed. Here, we propose an upgraded electronic implementation of the Minimal Universal Model, which allows for a precise and reproducible analysis of the model’s parameters space. As a marker of a possible chaotic behavior the variability of the spiking activity that characterizes one of the system’s coordinates was used. Relying on a numerical characterization of the relationship between spiking activity and maximum Lyapunov exponent at different parameter combinations, several potentially chaotic settings were selected. The analysis via divergence exponent method of experimental time series acquired by using those settings confirmed a robust chaotic behavior and provided values of the maximum Lyapunov exponent that are in very good agreement with the theoretical predictions. The results of this work further uphold the reliability of the Minimal Universal Model. In addition, the upgraded electronic implementation provides an easily controllable setup that allows for further developments aiming at coupling multiple chaotic systems and investigating synchronization processes.
Delegation Using Forward Induction
Authors: Bhattacharjee Swagata
Published: September 2021

This paper explores how delegation can be used as a signal to sustain cooperation. I consider a static principal–agent model with two tasks, one resembling a coordination game. If there is asymmetric information about the agent’s type, the principal with high private belief can delegate the first task as a signal. This is also supported by the forward induction argument. However, in the laboratory setting, this equilibrium is chosen only sometimes. When the subjects have information about past sessions, there is a significant increase in the use of delegation. This finding sheds light on equilibrium selection in Bayesian games.
Designing Bankers’ Pay: Using Contingent Capital to Reduce Risk-Shifting Incentives
Authors: Hilscher Jens , Lazar Sharon Peleg , Raviv Alon
Published: September 2021

Including contingent convertible bonds (coco) in the capital structure of a bank affects the sensitivity to risk of its equity-based compensation. Such risk-shifting incentives can be reduced if the coco bonds are well-designed. Similarly, we show that compensating executives with well-designed coco bonds can also reduce risk-shifting incentives. In practice, however, most coco bonds have characteristics that result in both stock and coco compensation having large sensitivities to changes in asset risk — equity-based compensation encourages executives to increase risk, coco compensation to reduce risk. We show that a pay package combining both stock and coco can practically eliminate risk-shifting incentives and that it can be implemented with a bank’s preexisting coco bonds.