bluuebunny/crossref_metadata_2025 huggingface dataset:
Modern approaches to surgical and minimally invasive treatment of patients with benign prostate hyperplasia
Authors: Zimichev A. A. , Gusev D. O. , Pochivalov A. S. , Sumsky P. V. , Tarasov I. V. , Vinogradov D. S.
Published: January 2021

Adenoma of the prostate gland is one of the most common urological diseases among males. The percentage of those suffering from BPH increases in direct proportion to the age of the patients. Despite the high study of the etiology, pathogenesis and manifestations of this disease, it is not always possible to achieve the desired effect using conservative therapy. Taking into account the middle age of the majority of patients dealing  with  this  problem, the presence of a number of concomitant diseases, if there is a technical  feasibility, priority is given to the least traumatic surgical interventions. The literature review analyzes the existing approaches to surgical and minimally invasive treatment of patients with benign prostatic hyperplasia.
THREE-DIMENSIONAL SEEPAGE ANALYSIS OF A COAL REFUSE PILE RECLAMATION
Authors:   Civil and Environmental Engineering, West Virginia University, Morgantown, WV 26506, Santos Iuri Lira
Published: January 2021

Abstract. A coal refuse pile located in Greenbrier County, West Virginia was studied to restrict generation of acid mine drainage through the use of a cap and cover system. This paper presents results of a finite element method seepage analysis on a proposed reclamation design. The proposed reclamation incorporates a cap and cover system with a 0.3-m thick surface vegetation cap layer over a 0.6-m thick low permeability layer. The low permeability layer is directly above the coal refuse. Unsaturated soil mechanics was utilized, adopting the Fredlund and Xing equation for soil-water characteristic curve (SWCC) estimation. SWCC fitting parameters were calculated using the Zapata and the Hernandez estimation techniques. Different precipitation events were used to evaluate seepage throughout the reclamation area and assess the effectiveness of the cap and cover system. A steep area (>4H:1V) and a flat area were considered. The water balance analysis showed a 50% to 88% reduction in water volume at the coal refuse layer and a reduction in the time for the refuse to return to initial water content due to the cap and cover system implementation. Moisture detainment was observed in the growth layer and is important for supporting vegetation persistence.
PENNSYLVANIA’S ENVIRONMENTAL GOOD SAMARITAN PROGRAM
Authors:   Pennsylvania Department of Environmental Protection, Bureau of Abandoned Mine Reclamation, Harrisburg, PA 17106, Cavazza Eric E. , Stefanko John J. , Beam Richard L.
Published: January 2021

Abstract. Pennsylvania enacted an Environmental Good Samaritan Act (PA EGSA) in 1999. The law is intended to encourage landowners and others to reclaim abandoned mineral extraction lands and abate water pollution caused by abandoned mines or orphaned oil and gas wells. The law protects landowners, groups and individuals who volunteer to do such projects from civil and environmental liability under Pennsylvania law. Prior to the PA EGSA, anyone who voluntarily reclaimed abandoned lands or treated water pollution for which they were not liable could be held responsible for treating the residual pollution under Pennsylvania law. This dissuaded people and groups from pursuing these types of projects. Only projects approved by the Pennsylvania Department of Environmental Protection (PA DEP) prior to construction are eligible for protections under the PA EGSA. PA DEP has developed a project proposal form for participants and landowners. Each proposal must identify the project participants and landowners, describe the location of the project and the environmental problems that will be addressed, and establish a work plan for the proposed project. The PA DEP evaluates each proposal to determine if the project is capable of reclaiming the land or improving water quality. The PA DEP will also advise participants on any permits that may be required. Once the project is approved, PA DEP will maintain a permanent record of the participants and landowners who are protected under the PA EGSA.
IDEOLOGI PRANGGAPAN PAMFLET SOSIALISASI PELESTARIAN LINGKUNGAN DI KABUPATEN BURU
Authors: Sofie Samsudiin , Iye Risman , Tenriawali A. Yusdianti , Susiati Susiati
Published: January 2021

ABSTARCT

This research reveals the presumptive ideology of the socialization of environmental conservation pamphlets in Buru Regency. This research is a qualitative descriptive study. This means that in this study the researcher observed and analyzed the sentences in the Socialization Pamphlet for Environmental Conservation in Buru Regency through a pragmatic approach. The data source used for this study was the Environmental Conservation Socialization Pamphlet in Buru Regency, while the type of data in this study was written data, in the form of sentences in pamphlets containing presuppositions. This research reveals the types of presuppositions in the environmental preservation socialization pamphlet, namely: (1) existential presuppositions, (2) factive presuppositions, (3) lexical presuppositions, (4) structural presuppositions, and (5) counterfactual presuppositions while non-active presuppositions are not found. menemenyekuruh Government and LSM are trying to socialize environmental preservation in real terms in Buru Regency. This means that the pamphlet publisher does not use inactive presuppositions which in fact are presuppositions that are assumed to be incorrect or allow wrong understanding due to the use of uncertain or ambiguous words.

Keywords: ideology; Presumption; Flyer; Buru Regency
Al Ta'liim al Mudammaj fii Tarqiyyah Mahaaraat al Lughah al 'Arabiyyah li Ghair al Nathiqiin bihaa
Authors: Istiqomah Himatul , Kholidiah Nur Faiz
Published: January 2021

 

This research aims to present the role of blended learning in upgrading the skills of the Arabic language to non-native speakers, what are its forms, how it works, and what are its results. The researchers use the qualitative approach through desk study with the content analysis technique. The primary data sources are the research on blended education published in Google Cendekia ten years ago. The results of this research indicate that the forms of blended learning, including the use of applications and the use of e-tools. Its procedures mostly use on the second design model in Zaitun’s perspective. Its results upgrade all the Arabic language skills and two factors that influence the success of qualification skills.

الملخص

هذا البحث يهدف لعرض دور التعليم المدمج في ترقية مهارات اللغة العربية لغير الناطقين بها، ما أشكاله وكيف إجراءاته وما نتائجه. تستخدم الباحثتان المدخل الكيفي من خلال الدراسة المكتبية مع تقنية تحليل المحتوى. ومصادر البيانات الأساسية هي البحوث عن التعليم المدمج المنشورة في Google Cendekia العشر سنوات الحديثة. ونتائج هذا البحث تدل على أن أشكال التعليم المدمج منها: استخدام التطبيقات واستخدام الأدوات الإلكترونية. وأن إجراءاته استخدام على نموذج التصميم الثاني عند زيتون معظما. وأن نتائجه ترقية جميع مهارات اللغة العربية والعاملين المؤثرين على نجاح تأهيل المهارات.
Amputation With Osseointegration for Patients With Intractable Complex Regional Pain Syndrome
Authors: Hoellwarth Jason Shih , Al-Jawazneh Shakib Sameeh , Tetsworth Kevin , Lu William , Roberts Claudia , Al Muderis Munjed
Published: January 2021

Cases:

Three patients with knee-level complex regional pain syndrome type 1 (CRPS1), recalcitrant to conservative interventions, elected for transfemoral amputation and osseointegration. Two patients gained independent ambulation; the third remains on crutches after a disrupted sciatic nerve targeted reinnervation. One uses no pain medication, one is weaning off, and one requires a reduced regimen after revision nerve innervation.

Conclusion:

Osseointegration seems suitable to optimize rehabilitation after amputation for CRPS1.
Synovial Inclusion Cyst Mimicking a Femoral Neck Stress Fracture in an Active Duty Servicemember
Authors: Nowak Matthew J. , Schultz Donald A. , Cognetti Daniel J.
Published: January 2021

Case:

A 19-year-old female servicemember with history of ischiopubic rami stress fractures was referred to orthopaedic surgery for magnetic resonance imaging findings concerning for a tension-sided femoral neck stress fracture. However, her history and symptoms were discordant with the diagnosis of stress fracture. The patient was managed with protected weight-bearing for 6 weeks with gradual return to physical activity.

Conclusion:

Prophylactic surgical fixation is advocated for the management of tension-sided femoral neck stress fractures. However, surgeons should consider a broader differential diagnosis, to include a synovial inclusion cyst, when the clinical presentation is not consistent with a stress fracture.
Shenmai injection alleviates acute lung injury in a severe acute pancreatitis rat model via heme oxygenase-1 upregulation
Authors: Zhang Fei-hu , Hao Hao , Liu Yang , Fan Kai-liang , Dai Wen , Liu Wei-hong , Kong Li
Published: January 2021

Background: To determine the effect of Shenmai injection (SMI) on acute lung injury (ALI) induced by severe acute pancreatitis (SAP) in rats. Methods: Forty male Sprague-Dawley (SD) rats were grouped into 4 categories: SAP group, sham surgery (SS) group, SAP + SMI group, SAP + SMI + Zinc protoporphyrin (ZnPP) group. Rats in the SAP group were intravenously injected with 1.6 ml/kg saline 30 minutes after induction of SAP models. Rats in the SAP + SMI group were intravenously injected with 1.6 ml/kg SMI, while those in the SAP + SMI + ZnPP group rats were intravenously injected with 1.6 ml/kg SMI and 30 mg/kg ZnPP via intraperitoneal injection. Twenty-four hours after SAP induction, the rats were sacrificed. Excised lung tissues were histologically examined, protein concentration in bronchoalvelar lavage fluid (BALF) was measured and lung wet-to-dry (W/D) weight ratio was calculated. The protein and mRNA levels of the tumor necrosis factor (TNF) -α, heme oxygenase (HO) -1 and interleukin (IL) -10 in blood and tissue samples were measured.Results: SMI treatment attenuated SAP-induced ALI as evidenced by lower scores of lung damage compared with untreated SAP group (p＜0.05). SMI also abolished the SAP-induced rise in BALF and W/D ratio protein concentrations (p＜0.05). Moreover, SMI treatment increased HO-1, IL-10 levels but decreased TNF-α level in serum and tissue samples (p＜0.05). However, inhibition of HO-1 expression by ZnPP led to significant inhibition of all the changes.Conclusions: SMI can alleviate SAP-induced ALI through HO-1 upregulation.
Experimental method of permanent magnet rotation
Authors: Tong Weiming
Published: January 2021

Why does the earth rotate? In the 17th century, an accurate description of the earth’s rotation was provided via Newtonian mechanics1. However, the driving force was not given a mechanistic treatment, was merely ascribed to a “push” by God. At present, All kinds of theories about the rotation of the planet are still hypotheses2,3. In this study, It provides experimental evidence for researching the relationship between planet (Earth) rotation and magnetic fields4. The proposed experimental devices and research methods are based on the characteristics of the kinematic relations between the sun and planet. A permanent magnet representing the sun is installed on the shaft of a DC motor, spherical magnet representing the planet is designed at the center of hollow sphere and can float on water, ensure free rotation. Based on the above device5, the method of permanent magnet rotation in magnetic field and the experimental procedure of rotation reason are introduced.
Estimating Remaining Carbon Budgets Using Emulators of CMIP6 Models
Authors: Rypdal Martin , Boers Niklas , Fredriksen Hege-Beate , Eiselt Kai-Uwe , Johansen Andreas , Martinsen Andreas , Mentzoni Endre Falck , Graversen Rune , Rypdal Kristoffer
Published: January 2021

A remaining carbon budget (RCB) estimates how much CO2 we can emit and still reach a specific temperature target. The RCB concept is attractive since it easily communicates to the public and policymakers, but RCBs are also subject to uncertainties. The expected warming levels for a given carbon budget has a wide uncertainty range, which we show here to increase with less ambitious targets, i.e., with higher CO2 emissions and temperatures. Leading causes of RCB uncertainty are the future non-CO2 emissions, Earth system feedbacks, and the spread in the climate sensitivity among climate models. The latter is investigated in this paper, using simple emulators of Earth System Models in the Coupled Model Intercomparison Project Phase 6 (CMIP6) ensemble. It is shown that the transient climate response to cumulative emissions of carbon (TCRE) is approximately proportional to the effective equilibrium climate sensitivity (ECS). For temperature targets between 1.5-3.0 degrees C, the models exhibiting low ECS increase RCB by a factor two compared to those with high sensitivity, suggesting that observational constraints imposed on the ECS in the model ensemble also will reduce uncertainty in the RCB estimates.
Mechanical forces switch blood vessel subtypes to arrest adolescent bone growth
Authors: Löhning Max , Dzamukova Maria , Brunner Tobias , Miotla-Zarebska Jadwiga , Heinrich Frederik , Brylka Laura , Mashreghi Mir-Farzin , Kusumbe Anjali , Kuehn Ralf , Schinke Thorsten , Vincent Tonia
Published: January 2021

Bone growth requires a specialised, highly angiogenic blood vessel subtype, so-called type H vessels1,2, which pave the way for osteoblasts surrounding these vessels3. At the end of adolescence, type H endothelial cells differentiate into quiescent type L endothelium lacking the capacity to promote bone growth. Until now, the signals that switch off type H vessel identity and thus arrest adolescent bone growth have remained ill defined. Here we show that mechanical forces, associated with increased body weight at the end of adolescence, trigger the mechanoreceptor PIEZO1 and thereby mediate enhanced production of the kinase FAM20C in osteoblasts. FAM20C phosphorylates dentin matrix protein 1 (DMP1)4, previously identified as a key factor in bone mineralization5. This phosphorylation elicits a burst in DMP1 secretion from osteoblasts. Extracellular DMP1 inhibits vascular endothelial growth factor (VEGF) signalling by preventing VEGFR2 phosphorylation and VEGFR3 expression on the tip cells of type H endothelium. DMP1-mediated VEGF inhibition transforms bone growth-promoting type H vessels into quiescent type L vasculature to arrest bone growth and enhance bone mineralization. This molecular mechanism links mechanical forces and the termination of bone growth via accumulation of an extracellular matrix protein and its regulation of vascular subtypes. It suggests new options for the treatment of diseases characterised by inappropriate turnover or invasion of bone such as osteoarthritis, osteoporosis and osteosarcoma.
Staphylococcus Aureus Bacteremia Due to Central Venous Catheter Infection: A Clinical Comparison of Infections Caused by Methicillin-Resistant and Methicillin-Susceptible Strains
Authors: Ishikawa Kazuhiro , Furukawa Keichi , Hoshino Eri
Published: January 2021

Background: Staphylococcus aureus (S.aureus) bacteremia has a mortality rate ranging from 20-40%. Central venous catheter (CVC) infection is the leading cause of S.aureus bacteremia. We investigated the differences in background characteristics, complications, and prognosis between patients with methicillin resistant S.aureus (MRSA) and methicillin sensitive S.aureus (MSSA) bacteremia due to CVC infection.Methods: We retrospectively investigated patients who had positive peripheral blood cultures versus positive semi-quantitative cultures for MRSA or MSSA from the CVC tip. We compared the clinical background characteristics, complications, and 60-day mortality rates between both groups. We analyzed our data using Mann-Whitney U test, chi-square test, and Fisher’s exact test.Results: This study had 17 (47%) and 19 (53%) MRSA and MSSA bacteremia patients, respectively. The median ages for MRSA and MSSA patients were 72 ± 27 and 55 ± 33 years, respectively (P<0.01). Comparison between baseline disease occurrence (MRSA vs. MSSA) was 10(59%) patients vs. 3(16%) patients (P=0.01), while complications included septic shock were 8(48%) vs. 3(16%) (P=0.07), respectively. The duration of catheter placement, time lag from onset of fever to CVC removal, and time lag from onset of fever to starting antimicrobial therapy were similar in both groups. Sixty-day mortality rates were 35%(6/17) vs. 5.3%(1/19), (P=0.04), in MRSA vs. MSSA groups, respectively. Conclusions: MRSA carriers and older patients were at a higher risk of MRSA CVC infection compared to MSSA bacteremia patients. MRSA bacteremia patients showed relatively higher rate of septic shock, and had significantly higher 60-day mortality rate despite appropriate antimicrobial therapy.
Electronic Patient-Reported Outcomes and Machine Learning in Predicting Immune-Related Adverse Events of Immune Checkpoint Inhibitor Therapies
Authors: Iivanainen Sanna , Ekstrom Jussi , Virtanen Henri , Kataja Vesa , Koivunen Jussi
Published: January 2021

Background: Immune-checkpoint inhibitors (ICIs) have introduced novel immune-related adverse events (irAEs), arising from various organ systems without strong timely dependency on therapy dosing. Early detection of irAEs could result in improved toxicity profile and quality of life (QoL). Symptom data collected by electronic (e) patient-reported outcomes (PRO) could be used as an input for machine learning (ML) based prediction models for early detection of irAEs.Methods: The utilized dataset consisted of two data sources. The first dataset (n=16540) comprised symptoms from 34 ICI-treated cancer patients, including 18 monitored symptoms collected using the Kaiku Health digital platform. The second dataset included prospectively collected irAE data, Common Terminology Criteria for Adverse Events (CTCAE) class, and severity of 26 irAEs. The ML models were built using extreme gradient boosting algorithms. The first model was trained to detect the presence and the second model the onset of irAEs. Results: The model trained to predict the presence of irAEs had an excellent performance based on four metrics: accuracy score 0.97, Area Under the Curve (AUC) value 0.99, F1-score 0.94 and Matthew´s correlation coefficient (MCC) 0.92. The prediction of the irAE onset was more difficult with accuracy score 0.96, AUC value 0.93, F1-score 0.66 and MCC 0.64 but the model performance was still at a good level.Conclusion: Current study suggests that ML based prediction models, using ePRO data as an input, can predict the presence and onset of irAEs with high accuracy, indicating that ePRO follow-up with ML algorithms could facilitate the detection of irAEs in ICI-treated cancer patients. The results should be validated with a larger dataset.
The gut hormone Allatostatin C/Somatostatin regulates food intake and metabolic homeostasis under nutrient stress
Authors: Kubrak Olga , Jensen Line , Ahrentloev Nadja , Koyama Takashi , Malita Alina , Naseem Muhammad Tayyib , Lassen Mette , Nagy Stanislav , Texada Michael , Halberg Kenneth , Rewitz Kim
Published: January 2021

The intestine is a central regulator of metabolic homeostasis. Dietary inputs are absorbed through the gut, which senses their nutritional value and relays hormonal information to other organs to coordinate systemic energy balance. However, the specific gut hormones that communicate energy availability to target organs to induce appropriate metabolic and behavioral responses are poorly defined. Here we show that the enteroendocrine cells (EECs) of the Drosophila gut sense nutrient stress via the intracellular TOR pathway, and in response secrete the peptide hormone allatostatin C (AstC), a Drosophila Somatostatin homolog. Gut-derived AstC induces secretion of glucagon-like adipokinetic hormone (AKH) via its receptor AstC-R2, a homolog of mammalian somatostatin receptors, to coordinate food intake and energy mobilization. Loss of gut AstC or its receptor in the AKH-producing cells impairs lipid and sugar mobilization during fasting, leading to hypoglycemia. Our findings illustrate a nutrient-responsive endocrine mechanism that maintains energy homeostasis under nutrient-stress conditions, a function that is essential to health and whose failure can lead to metabolic disorders.
MicroRNAs Expression Profiles in Platelet-Derived Exosomes From Coronary In-Stent Restenosis and the Potential Markers
Authors: Hua Lingdi , Qiao Yong , Li Linqing , Qin Yuhan , Wang Dong , Yan Gaoliang , Tang Chengchun
Published: January 2021

Background: We conducted this study was to identify any difference in platelet-derived exosome micro-RNA (microRNA) profile between patients with in-stent restenosis and patients without restenosis using gene sequencing.Method: Platelet-derived exosomes(PDEs) were isolated through ultracentrifugation and validated by Western blotting, transmission electron microscope and NanoSight analysis. The platelet-derived exosome microRNA expression profile was identified by Illumina Hiseq2000/2500 sequencing, and validated by qRT-PCR. Finally, the potential functions of microRNAs were predicted using miRNA-gene-GO network and miRNA-gene-KEGG network. Result: We identified several differentially expressed platelet-derived exosome microRNAs. In particular, we found that the microRNA PC-3p-75179_24 was up-regulated, while hsa-miR-133a-3p_R+1 and hsa-miR-589-5p_R-1 were down-regulated in patients with in-stent restenosis which were further validated by qRT-PCR results. Our results also showed their potential miRNA-gene-GO and miRNA-gene-KEGG interaction.Conclusion: In summary, our study reveals for the first time microRNA expression is altered, in platelet-derived exosomes in patients with in-stent restenosis, with specific up-regulation of microRNA PC-3p-75179_24 and down-regulation of hsa-miR-133a-3p_R+1 and hsa-miR-589-5p_R-1. Our findings supports the need to explore the potential of these microRNAs as biomarkers and the pathological effects on in-stent restenosis.
Genome-Wide Identification of Cellulose-Like Synthase D Gene Family in Dendrobium Catenatum
Authors: Xi Hangxian , Li Qing , Chen Xueliang , Liu Chen , Zhao Yuxue , Yao Jinbo , Chen Donghong , Liu Jingjing , Si Jinping , Zhang Lei
Published: January 2021

Background: Dendrobium catenatum, which grows on the semi humid rocks in the mountains, has been at the top of the "Nine Immortals of China" since ancient times. It is a kind of yin tonic medicine and its main active component is polysaccharide. Cellulose synthase-like D(CslD) genes were predicted to catalyse the biosynthesis of 1,4-β-d-glycan backbone of hemicelluloses, which plays fundamental roles in plant development. Results: To investigate the role of CslD in the development of Dendrobium catenatum, eight CslD genes (DcCslD1,2a,2b,3a,3b,4a,4b,5) were identified. The results of protein prediction and analysis showed that CslD2a/2b/4a/4b proteins were acidic proteins, the rest were basic proteins; Leu, Ser, Ala, Gly, Arg, Pro and Asp were the main amino acids. All the proteins had obvious hydrophobic or hydrophilic regions, and had transmembrane structure. The main elements of protein secondary structure were α-helix, random coil and extended chain. Phylogenetic analysis revealed that the DcCslD family could be divided into Ⅰ, Ⅱ, Ⅲ and Ⅳ groups. DcCslD proteins had typical Cellulose synthase domain and similar protein structures to the CslDs of other plants. Their promoter regions contain cis regulatory elements related to stress and hormone. The results of qRT-PCR showed that the identified DcCslDs were differentially expressed in roots, stems and leaves. Most of them hightly expressed in stems and leaves. What’s more, the environmental stress1es examination showed that the expressions of DcCslD5 were closely associated with drought-recovery treatment, the expression of DcCslD1, DcCslD2a, DcCslD2b, DcCslD3a, and DcCslD5 were significantly influenced by low temperature. Conclusions: This study systematically analyzed the sequence characteristics of CslD protein of D. catenatum, which can provide reference for further study on the function of CslD protein in polysaccharide metabolism of D. catenatum.
Global hotspots of recent and ancestral turnover in birds
Authors: McFadden Ian R. , Coelho Marco Túlio P. , Wüest Rafael O. , Cassemiro Fernanda A. S. , Zimmermann Niklaus E. , Pellissier Loïc , Rangel Thiago F. , Graham Catherine H.
Published: January 2021

A primary goal of biodiversity research is to uncover the processes acting in space and time to create the global distribution of species richness. However, we currently lack an understanding of how recent versus ancient biodiversity dynamics shape patterns of diversity for most groups. Here, we introduce a method to partition lineage turnover into recent and ancestral components, and use it to identify hotspots of turnover at the global scale for 8,296 bird species. Counter to the tropical niche conservatism hypothesis, we find extra-tropical regions such as Greenland and the Sahara are hotspots of ancestral turnover, while areas with high climatic variation such as (sub)tropical mountains and biome transitions are recent turnover hotspots. We can now quantify the relative contribution of contemporary and ancient lineage dynamics to assemblage structure, which enables future research to explore the processes generating earth’s diversity in a more temporally-explicit framework.
Development and Implementation of A LIS-Based Validation System for Autoverification Toward Zero Defects in The Automated Reporting of Laboratory Test Results
Authors: Jin Di , Wang Qing , Peng Dezhi , Wang Jiajia , Cheng Yating , Mo Nanxun , Deng Xiaoyan , Li Bijuan , Tao Ran
Published: January 2021

BackgroundValidation of the autoverification function is the most critical step to confirm its effectiveness before use. It is crucial to verify whether the programmed algorithm follows the expected logic and produces the expected results. In recent years, this process has always been centered on the assessment of human-machine consistency and mostly takes the form of manual recording, which is a time-consuming activity with inherent subjectivity and arbitrariness, and cannot guarantee a comprehensive, timely and continuous effectiveness evaluation of the autoverification function. To overcome these inherent limitations, we independently developed and implemented a laboratory information system (LIS)-based validation system for autoverification.MethodsWe developed a correctness verification and integrity validation method (hereinafter referred to as the "new method") in the form of a human-machine dialogue. The system records the personnel’s review steps and determines if the human-machine review results are consistent. If they are inconsistent, the laboratory personnel analyze the reasons for the inconsistency according to the system prompts, add to or modify the rules, reverify, and finally improve the accuracy of autoverification.ResultsThe validation system was successfully established and implemented. For a dataset consisting of 833 rules for 30 assays, 782 rules (93.87%) were successfully verified in the correctness verification phase, and 51 rules were deleted due to execution errors. In the integrity validation phase, 24 projects were easily verified, while the other 6 projects still required the addition of new rules or changes to the rule settings. From setting the rules to the automated reportion, the time difference between manual validation and the new method, was statistically significant (χ2=11.06, p=0.0009), with the new method greatly reducing validation time. Since 2017, the new method has been used in 32 laboratories, and 15.8 million reports have been automatically reviewed and issued without a single clinical complaint.ConclusionTo the best of our knowledge, this is the first report to realize autoverification validation in the form of a human-machine interaction.The new method can effectively control the risks of autoverification, shorten time consumption, and improve the efficiency of laboratory verification.
Resilience of food sufficiency to future climate and societal changes
Authors: Weil Charlotte , Johnson Justin , Caristan Romain , Brauman Kate , Bodirsky Benjamin , Jalava Mika , Kummu Matti , Queiroz Cibele , Monier Louis , Popp Alexander , Ray Deepak , Chaplin-Kramer Rebecca
Published: January 2021

Producing sufficient food to meet rising demand is a precondition for resilience of the global food system in the face of climate and societal changes. Leveraging machine learning techniques, we project total caloric yields, aggregating 100 crops and assuming crop mix adaptation to climate, soil and management conditions. We then estimate terrestrial caloric sufficiency considering population growth, diets, and production driven by climate, agricultural management, and cropland expansion under five climate change and socio-economic scenarios (SSPs). We show that global caloric sufficiency is likely to decrease, despite increased food production, because those gains are outweighed by population growth and higher animal products consumption. Caloric sufficiency decreases for most countries. Among countries facing hunger today, most remain vulnerable, and around 25 countries, mostly in Africa, become more vulnerable. Our results suggest that adapting crop mixes to new climate conditions will likely be insufficient to cope with global changes by 2050.
Application of Failure Mode Effect Analysis (FMEA) to Improve Medication Safety in the Dispensing Process – A Study at A Teaching Hospital, Sri Lanka
Authors: Anjalee J.A.Lakshika , Rutter Victoria , Samaranayake Nithushi
Published: January 2021

Background: Failure Mode Effect Analysis (FMEA) is a prospective, team based, structured process used to identify system failures of high risk processes before they occur. Medication dispensing is a risky process that should be analysed for its inherent risks using FMEA. Objectives: The objective of this study was to identify possible failure modes, their effects and causes in the dispensing process of a selected tertiary care hospital using FMEA. Methods: Two independent teams (Team A and Team B) of pharmacists conducted the FMEA for two months in the Department of Pharmacy of a selected teaching hospital, Colombo, Sri Lanka. Each team had five meetings of two hours each, where the dispensing process and sub processes were mapped, and possible failure modes, their effects, and causes, were identified. A score for potential severity (S), frequency (F) and detectability (D) was assigned for each failure mode. Risk Priority Numbers (RPNs) were calculated (RPN=SxFxD) to prioritise identified failure modes. Results: Team A identified 48 failure modes while Team B identified 42. Among all 90 failure modes, 69 were common to both teams. Using the RPN, Team A prioritised one failure mode, while Team B prioritised three (having identical RPNs). Both teams identified overcrowded dispensing counters as a cause for 57 failure modes. Redesigning of, dispensing tables, dispensing labels, the dispensing and medication re-packing processes, and establishing a patient counseling unit were the major suggestions for correction.Conclusion: FMEA was successfully used to identify and prioritise possible failure modes of the dispensing process through active involvement of pharmacists.
Experiences of Persons in COVID-19 Institutional Quarantine in Uganda: A Qualitative Study
Authors: Ndejjo Rawlance , Naggayi Gloria , Tibiita Ronald , Mugahi Richard , Kibira Simon
Published: January 2021

Background Quarantine has been adopted as a key public health measure to support the control of the Coronavirus disease (COVID-19) pandemic in many countries including Uganda. Uganda adopted institutional quarantine for individuals suspected of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to be placed in institutions like hotels and/or hostels of institutions for at least 14 days. This study explored experiences of individuals who underwent institutional quarantine in Uganda to inform measures to increase its effectiveness and reduce its associated negative impact.Methods We conducted a qualitative description using in-depth interviews with 20 purposively selected individuals who had spent time in institutional quarantine facilities. These were mainly phone-based interviews that were audio recorded and transcribed verbatim. Electronic data coding was conducted using Atlas.ti 7 software. Thematic content analysis was used to synthesize the findings with similar codes grouped to form sub-themes and ultimately study themes. The findings are presented thematically with typical participant quotes.Results Study participants spent between 14 to 25 days in institutional quarantine. Four themes emerged describing the experiences of study participants during institutional quarantine, which determined whether participants’ experiences were positive or negative. These themes were: quarantine environment including facility related factors, compliance with COVID-19 measures; quarantine management factors of entity paying the costs, communication, days spent in quarantine; individual factors including attitude towards quarantine, fears during and post-quarantine and coping mechanisms; and linkage to other services such as health care and post-quarantine follow-up. Conclusion The planning, management and implementation of the quarantine process is a key determinant of the experiences of individuals who undergo the measure. To improve the experience of quarantined individuals and reduce its associated negative impact, the pre-quarantine process should be better managed to comply with standards, quarantined persons should be provided as much information as possible, their quarantine duration should kept short and costs of the process ought to be minimized. Furthermore, quarantine facilities should be assessed for suitability and monitored to comply with guidelines while avenues for access to healthcare for the quarantined need to be established and any potential stigma addressed.
Entropic Measures of Complexity in a New Medical Coding System
Authors: Niyirora Jerome
Published: January 2021

BackgroundTransitioning from an old medical coding system to a new one can be challenging, especially when thetwo coding systems are signiﬁcantly diﬀerent. The US experienced such a transition in 2015.ObjectiveThis research aims to introduce entropic measures to help users prepare for the migration to a newmedical coding system by identifying and focusing preparation initiatives on clinical concepts with morelikelihood of adoption challenges.MethodsTwo entropic measures of coding complexity are introduced. The ﬁrst measure is a function of thevariation in the alphabets of new codes. The second measure is based on the possible number of validrepresentations of an old code.ResultsA demonstration of how to implement the proposed techniques is carried out using the 2015 mappingsbetween ICD-9-CM and ICD-10-CM/PCS. The signiﬁcance of the resulting entropic measures is discussed inthe context of clinical concepts that were likely to pose challenges regarding documentation, coding errors,and longitudinal data comparisons.ConclusionThe proposed entropic techniques are suitable to assess the complexity between any two medical coding systems where mappings or crosswalks exist. The more the entropy, the more likelihood of adoptionchallenges. Users can utilize the suggested techniques as a guide to prioritize training eﬀorts to improve documentation and increase the chances of accurate coding, code validity, and longitudinal data comparisons.
Relationship between Cardiopulmonary Bypass Time, Platelet Count, Fibrinogen, ROTEM Measurements, Antithrombin Level, and Bleeding Amount during Cardiovascular Surgery and Intensive Care Unit Stay: A Observational Study
Authors: Kodaka Mitsuharu , Ichikawa Junko , Ando Kazuyoshi , Komori Makiko
Published: January 2021

Purpose:Hemoglobin levels after a cardiopulmonary bypass (CPB) are easily estimated; however, decreased fibrinogen and platelet levels before and after CPB are difficult to predict because of the adsorption and consumption. We hypothesized that fibrinogen levels, platelet count, and measurements by ROTEMTM may decrease in proportion to CPB time; moreover, we compared the perioperative blood loss by conducting a observational study. Methods:A total of 160 patients were enrolled and divided into three groups depending on the CPB time: < 2, 2–3, and >3 h. Blood samples were obtained at four time points, i.e., baseline, CPB start, CPB end, and intensive care, and platelet counts, ROTEM, fibrinogen, and antithrombin were measured. Results:A total of 74 patients were included in the <2 h, 63 in the 2–3 h, and 23 in the >3 h groups.No difference was observed in the platelet counts and fibrinogen between each group while weaning CPB, whereas the amplitude 10 min of EXTEM A10, FIBTEM A10, and antithrombin in the >3 h group were lower than those in the other groups. Furthermore, blood loss and each transfusion component were higher in the >3 h group than those in the other groups.Conclusions:The longer the CPB times, the greater perioperative bleeding loss and transfusion, particularly if >3 h, due to decreased (EXTEM A10 and FIBTEM A10) represented by ROTEMTM.Trial registration: This trial is registered with University hospital Medical Information Network (UMIN) Center, https://www.umin.ac.jp/. (ID: UMIN000017412) on May 5, 2015.
Population pharmacokinetic model development and its relationship with adverse events of oxcarbazepine in adult patients with epilepsy
Authors: Jang Yoonhyuk , Yoon Seonghae , Kim Tae-Joon , Lee SeungHwan , Yu Kyung-Sang , Jang In-Jin , Chu Kon , Lee Sang Kun
Published: January 2021

This study aimed to develop a pharmacokinetic (PK) model of oxcarbazepine (OXC) and analyse the relationship between monohydroxylated derivative (MHD), an active metabolite of OXC, and the adverse events of OXC. We obtained 711 OXC samples from 618 patients with epilepsy who were enrolled in the Epilepsy Registry Cohort of Seoul National University Hospital from February 2011 to January 2014. The plasma PK model was developed using a nonlinear mixed-effect modelling method with NONMEM (ver 7.3). A one-compartment model with a first-order absorption model and proportional residual error adequately described the MHD concentration–time profiles. The only covariate incorporated for CL/F and V/F was body weight. Of the 447 patients analysed, 28 (6.26%) had dose-related adverse events (DRAEs), which were dizziness, somnolence, headache, and diplopia. For DRAE occurrence, the cut-off values of the MHD trough and AUC were 12.27 mg/L (specificity 0.570, sensitivity 0.643) and 698.5 mg⋅h/L (specificity, sensitivity 0.571), respectively. Multivariate analysis showed the sole dizziness symptom was significantly associated with both the MHD trough and the AUC (p = 0.013, p = 0.038, respectively). We newly developed a population PK model using sparse sampling data from patients with epilepsy, and the model better reflects the actual clinical situation.
Clinical Usefulness of 16S Ribosomal RNA Real-Time PCR for The Diagnosis of Scrub Typhus
Authors: Kim Dong-Min , Yun Na Ra , Kim Choon-Mee , Kim Da Young , Seo Jun-Won
Published: January 2021

Background: Scrub typhus is a major acute febrile disease in the Asia-Pacific region. The purpose of the present study is to investigate the clinical usefulness of real-time PCR (Q-PCR) of 16S rRNA for the diagnosis of scrub typhus.Methods: We examined blood specimens from 148 adult patients who were confirmed to have scrub typhus from September 2008 to December 2009. Among the 148 scrub typhus patients, 36 patients were treated with antibiotics before admission. To evaluate the clinical usefulness of 16S rRNA Q-PCR, we compared its diagnostic accuracy to the accuracy of the following methods: nested PCR (N-PCR) targeting the gene encoding the 56-kDa protein, Q-PCR targeting the gene encoding the 47-kDa protein, and conventional PCR (C-PCR) targeting the 16S rRNA gene.Results: According to 16S rRNA Q-PCR and 47-kDa Q-PCR, the mild group had copy numbers of 234.4 and 130.5, whereas the severe group had copy numbers of 584.4 and 244.7, respectively. In both tests, the mean copy numbers were significantly greater in the severe group (P<0.01 and P=0.01). 16S rRNA Q-PCR detected Orientia tsutsugamushi infections with a sensitivity of 91.9%, and 56-kDa N-PCR, 47-kDa Q-PCR, and 16S rRNA C-PCR exhibited lower sensitivities of 81.1%, 74.3%, and 87.8%, respectively, for all 148 patients. In addition, 16S rRNA Q-PCR exhibited a sensitivity of 99.1% in the 112 patients who were not treated with antibiotics before admission.Conclusion: 16S rRNA Q-PCR is clinically useful for the rapid diagnosis of scrub typhus and is more accurate than the 56-kDa N-PCR, 47-kDa Q-PCR, and 16S C-PCR methods.
Using Human Centered Design to Identify Opportunities for Reducing Inequities in Perinatal Care
Authors: Nijagal Malini , Patel Devika , Lyles Courtney , Liao Jennifer , Chehab Lara , Williams Schyneida , Sammann Amanda
Published: January 2021

Background: Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. Methods: We used human-centered design (HCD) to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. The HCD method has three phases: Inspiration, Ideation, and Implementation. This study focused on the first and second. In the Inspiration phase we conducted semi-structured interviews with a purposeful sample of stakeholders who had either received or participated in the care of Medicaid-insured pregnant people within our community. Using a general inductive approach to thematic analysis, we identified themes, which were then framed into design opportunities. In the Ideation phase, we conducted structured brainstorming sessions to generate potential prototypes of solutions, which were tested and iterated upon through a series of community events. Results: We engaged a total of 171 stakeholders across both phases of the HCD methodology. In the Inspiration phase, interviews with 23 community members and an eight-person focus group revealed seven insights centered around two main themes: (1) racism and discrimination create major barriers to access, experience, and the ability to deliver high-value pregnancy care; (2) pregnancy care is overmedicalized and does not treat the pregnant person as an equal and informed partner. In the Ideation phase, 162 ideas were produced and translated into eight solution prototypes. Community scoring and feedback events with 140 stakeholders led to the progressive refinement and selection of three final prototypes: (1) implementing telemedicine (video visits) within the safety-net system, (2) integrating community-based peer support workers into healthcare teams, and (3) delivering co-located pregnancy-related care and services into high-need neighborhoods as a one-stop shop. Conclusions: Using HCD methodology and a collaborative community-health system approach, we identified gaps, opportunities and solutions to address perinatal care inequities within our urban community. Given the urgent need for implementable and effective solutions, the design process was particularly well-suited because it focuses on understanding the needs and values of stakeholders, is multi-disciplinary through all phases, and results in prototyping and iteration of real-world solutions.
High Expression of Cyclin D1 Is An Independent Marker for Favorable Prognosis in Middle Eastern Breast Cancer
Authors: Siraj Abdul , Parvathareddy Sandeep , Annaiyappanaidu Padmanaban , Ahmed Saeeda , Siraj Nabil , Al-Dayel Fouad , Tulbah Asma , Ajarim Dahish , Al-Kuraya Khawla
Published: January 2021

Background: The cyclin D1 protein regulates cell cycle progression which is mediated by its interactions with cyclin-dependent kinases. Over-expression of cyclin D1 has been observed in several human cancers. This study was conducted to evaluate cyclin D1 expression in a large cohort of Middle Eastern breast cancers and determine its prognostic significance. Methods: Cyclin D1 expression was assessed immunohistochemically and its association with clinico-pathological parameters was analyzed. Results: Cyclin D1 was over-expressed in 59.4% (596/1003) of cases and significantly associated with a subset of breast cancers having favorable prognostic features such as low grade (p < 0.0001), low stage (p = 0.0276), estrogen receptor (p < 0.0001) and progesterone receptor positive (p < 0.0001) tumors. An inverse association was found with triple negative breast cancers (p < 0.0001). More importantly, cyclin D1 expression was an independent predictor of favorable overall survival in our cohort (Hazard ratio = 0.69; 95% confidence interval = 0.48 – 0.98; p = 0.0394). Also, tumors that highly expressed cyclin D1 had a longer recurrence free survival. However, this significant association was seen only in univariate analysis. Conclusion: Our results reinforced the role of cyclin D1 in breast cancer pathology and revealed its expression as a valuable independent prognostic indicator for breast cancer from Middle Eastern ethnicity.
Association Between Serum Uric Acid Levels and Progression of Coronary Artery Calcification in Asian Population
Authors: Ohmoto-Sekine Yuki , Ishihara Makiko , Amakawa Kazuhisa , Ohike Yumiko , Arase Yasuji
Published: January 2021

Background: Coronary artery calcium (CAC) is associated coronary heart disease risk. In addition, CAC progression is associated with worsening coronary atherosclerosis and predicts future cardiac events. We aimed to investigate risk factors for the progression of CAC in an asymptomatic Japanese population using low dose computed tomography (CT) lung cancer screening performed during routine health checkup.Methods: The risk factors for CAC progression were analyzed in 771 asymptomatic subjects who underwent repeated CAC measurement. Results: Of the 771 subjects, 632 (82.0%) were males with a mean age of 56 years old, 208 (27.0%) had a history of hypertension, 299 (38.8%) had dyslipidemia, 81 (10.5%) had diabetes mellitus, and 180 (23.3%) had hyperuricemia. During observation, 103 (13.4%) subjects had CAC progression, while 515 subjects (66.8%) showed no calcification. On multivariate analysis, increasing uric acid level was significantly associated with the progression of CAC (odds ratio 1.203, 95% confidence interval 1.045-1.387, P = 0.010).Conclusions: The results of this study show that hyperuricemia is associated with CAC progression in asymptomatic Japanese subjects.
Indoor Visible Light Localization Based on Finite State Markov Chain
Authors: Shen Hongjie , Shao Jianhua , Deng Lianjia , Du Cong
Published: January 2021

In the study of indoor visible light localization, the variance of the RSS(Received Signal Strength) distribution will be affected by environmental noise, resulting in a larger range of RSS value fluctuations. A method is proposed to decompose the RSS value into the disturbance component caused by the target and the noise component caused by the environment, and then a linear transfer model based on the finite state Markov chain is used to extract the disturbance component in RSS value. Finally, the DTW(Dynamic Time Warping) algorithm is used to match the real-time disturbance component with the fingerprint database to achieve target positioning.