bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enantioselective Synthesis of Distorted π‐Extended Chiral Triptycenes Consisting of Three Distinct Aromatic Rings by Rhodium‐Catalyzed [2+2+2] Cycloaddition
Authors: Aida Yukimasa , Shibata Yu , Tanaka Ken 
Published: December 2019

AbstractThe enantioselective synthesis of distorted π‐extended chiral triptycenes, consisting of three distinct aromatic rings, has been achieved with high ee value of 87 % by the cationic rhodium(I)/segphos complex‐catalyzed enantioselective [2+2+2] cycloaddition of 2,2′‐di(prop‐1‐yn‐1‐yl)‐5,5′‐bis(trifluoromethyl)‐1,1′‐biphenyl with 6‐methoxy‐1,2‐dihydronaphthalene followed by the diastereoselective Diels–Alder reaction and aromatization. Demethoxy derivatives were also synthesized by the C−O bond cleavage. In this synthesis, the use of the electron‐deficient diyne and the electron‐rich alkene is crucial to suppress the undesired strain‐relieving carbocation rearrangement and stabilize the distorted triptycene structure.
Structurally Diverse Acyl Bicyclobutanes: Valuable Strained Electrophiles
Authors: Schwartz Brett D. , Zhang Meng Yao , Attard Riley H. , Gardiner Michael G. , Malins Lara R. 
Published: December 2019

AbstractBicyclo[1.1.0]butanes (BCBs) are highly strained carbocycles that have emerged as versatile synthetic tools, particularly for the construction of functionalized small molecules. This work reports two efficient pathways for the rapid preparation of over 20 structurally diverse BCB ketones, encompassing simple alkyl and aryl derivatives, as well as unprecedented amino acid, dipeptide, bioisostere, and bifunctional linchpin reagents currently inaccessible using literature methods. Analogues are readily forged in two steps and in high yields from simple carboxylic acids or through unsymmetrical ketone synthesis beginning with a convenient carbonyl dication equivalent. The utility of this novel toolbox of strained electrophiles for the selective modification of proteinogenic nucleophiles is highlighted.
Cardiac rehabilitation in older adults: New options
Authors: Kumar Kartik R. , Pina Ileana L. 
Published: December 2019

AbstractCardiac rehabilitation (CR) is an important component in the continuum of care for patients with cardiovascular diseases, including the older population. Benefits of CR which include mortality benefit, decreased hospitalizations, increased functional capacity all extend to an older population. In Medicare beneficiaries which represent an older population, utilization of CR continues to remain low despite evidence that suggests lower hospitalization rates, Medicare costs, and improved symptoms. Given poor referral rates, enrollment rates, and completion rates, a call for new strategies has been made by all major societies. However, several barriers exist. Newer models of CR constructed to overcome these barriers are reviewed below. Some of these new strategies include alternative site CR or home‐based CR and the utilization of technology.
Hypertension in older adults: Assessment, management, and challenges
Authors: Oliveros Estefania , Patel Hena , Kyung Stella , Fugar Setri , Goldberg Alan , Madan Nidhi , Williams Kim A. 
Published: December 2019

AbstractHypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. The global burden of hypertension is increasing due to an aging population and increasing prevalence of obesity, and is estimated to affect one third of the world's population by 2025. Adverse outcomes in older adults are compounded by mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and declining renal function. This review highlights the current evidence and summarizes recent guidelines on hypertension, pertaining to older adults. Management strategies for hypertension in older adults must consider the degree of frailty, increasingly complex medical comorbidities, and psycho‐social factors, and must therefore be individualized. Non‐pharmacological lifestyle interventions should be encouraged to mitigate the risk of developing hypertension, and as an adjunctive therapy to reduce the need for medications. Pharmacological therapy with diuretics, renin‐angiotensin system blockers, and calcium channel blockers have all shown benefit on cardiovascular outcomes in older patients. Given the economic and public health burden of hypertension in the United States and globally, it is critical to address lifestyle modifications in younger generations to prevent hypertension with age.
Mobile health and cardiac rehabilitation in older adults
Authors: Bostrom John , Sweeney Greg , Whiteson Jonathan , Dodson John A. 
Published: December 2019

AbstractWith the ubiquity of mobile devices, the availability of mobile health (mHealth) applications for cardiovascular disease (CVD) has markedly increased in recent years. Older adults represent a population with a high CVD burden and therefore have the potential to benefit considerably from interventions that utilize mHealth. Traditional facility‐based cardiac rehabilitation represents one intervention that is currently underutilized for CVD patients and, because of the unique barriers that older adults face, represents an attractive target for mHealth interventions. Despite potential barriers to mHealth adoption in older populations, there is also evidence that older patients may be willing to adopt these technologies. In this review, we highlight the potential for mHealth uptake for older adults with CVD, with a particular focus on mHealth cardiac rehabilitation (mHealth‐CR) and evidence being generated in this field.
Financial distress among cancer survivors in Appalachian Kentucky
Authors: Vanderpool Robin C. , Chen Quan , Johnson Meghan F. , Lei Feitong , Stradtman Lindsay R. , Huang Bin 
Published: December 2019

AbstractBackgroundRural residence may exacerbate cancer‐related financial distress. Limited research has focused on Appalachian cancer survivors' experience with financial distress.AimsThe primary aim of this study was to estimate the prevalence of financial distress among cancer survivors residing in Appalachian Kentucky with a specific focus on the impact of rurality and to elucidate the risk factors impacting financial distress among this population.Methods and ResultsAppalachian Kentucky residents were sampled for receipt of a health survey based on county‐level rurality. Analyses describe the prevalence and predictors of financial distress among cancer survivors. Subsequent analyses were conducted with Health Information National Trends Survey (HINTS) data to compare local versus national estimates of financial distress. Almost two‐thirds of Appalachian survivors reported financial distress compared to one‐third of the HINTS sample. Appalachian survivors residing in the most rural counties reported higher distress; this finding was not supported in the national sample. In multivariable analyses, gender, current age, and household income were associated with financial distress among Appalachians; only income was significant among the national sample.ConclusionAppalachian cancer survivors have higher than national estimates of financial distress; rurality and socioeconomics are drivers of this disparity.
Pharmacokinetics, Pharmacodynamics, and Safety of a Single Escalating Dose and Repeated Doses of Rasagiline Transdermal Patch in Healthy Chinese Subjects
Authors: Wang Meng , Zhou Wenjia , Zhang Quanying , Zong Shunlin , Lv Chengzhe 
Published: December 2019

AbstractA rasagiline transdermal patch can be used to offer continuous rasagiline to patients with Parkinson's disease who cannot take their usual oral medications. This was the first study to investigate the pharmacokinetics, pharmacodynamics, and safety of the rasagiline transdermal patch in healthy Chinese subjects. Thirty subjects were randomized to 3 groups with 10 subjects in each group. The 10 subjects of group 1 received a single 1‐mg dose of rasagiline as a tablet; the 20 subjects of groups 2 and 3 received a single transdermal patch (48‐hour patch‐on period) containing 1.25 mg and 2.5 mg rasagiline, respectively. After a 2‐week washout period, the subjects of group 1 were assigned to receive 1 mg of rasagiline tablets every 24 hours for 7 days, and the subjects of group 2 were assigned to receive 1.25‐mg rasagiline transdermal patches (48‐hour patch‐on period) every 72 hours for 5 time periods. The absorption of rasagiline from the transdermal patch was significantly improved, although the peak plasma concentration was obviously reduced. There was slight accumulation of rasagiline dose after multiple administrations. Inhibition of platelet monoamine oxidase‐B (MAO‐B) activity was dose dependent. The 80% inhibition maintained for at least 48 hours after multiple‐dose administration of 1 mg tablets, and for 72 hours after multiple‐dose administration of 1.25 mg/48 h patch. Compared with rasagiline tablets, the transdermal patch had a prolonged duration of 80% inhibition and increased maximal inhibition of MAO‐B activity. These characteristics permitted an interval of 3 days of dosing, which was convenient for patients to use.
Cost minimization in placing service chains for virtualized network functions
Authors: Wang Chien Ting , Lin Ying‐Dar , Wang Chih‐Chiang , Lai Yuan‐Cheng 
Published: December 2019

SummaryNetwork function virtualization (NFV) places network functions onto the virtual machines (VMs) of physical machines (PMs) located in data centers. In practice, a data flow may pass through multiple network functions, which collectively form a service chain across multiple VMs residing on the same or different PMs. Given a set of service chains, network operators have two options for placing them: (a) minimizing the number of VMs and PMs so as to reduce the server rental cost or (b) placing VMs running network functions belonging to the same service chain on the same or nearby PMs so as to reduce the network delay. In determining the optimal service chain placement, operators face the problem of minimizing the server cost while still satisfying the end‐to‐end delay constraint. The present study proposes an optimization model to solve this problem using a nonlinear programming (NLP) approach. The proposed model is used to explore various operational problems in the service chain placement field. The results suggest that the optimal cost ratio for PMs with high, hybrid, and low capacity, respectively, is equal to 4:2:1. Meanwhile, the maximum operating utilization rate should be limited to 55% in order to minimize the rental cost. Regarding quality of service (QoS) relaxation, the server cost reduces by 20%, 30%, and 32% as the end‐to‐end delay constraint is relaxed from 40 to 60, 80, and 100 ms, respectively. For the server location, the cost decreases by 25% when the high‐capacity PMs are decentralized rather than centralized. Finally, the cost reduces by 40% as the repetition rate in the service chain increases from 0 to 2. A heuristic algorithm, designated as common sub chain placement first (CPF), is proposed to solve the service chain placement problem for large‐scale problems (eg, 256 PMs). It is shown that the proposed algorithm reduces the solution time by up to 86% compared with the NLP optimization model, with an accuracy reduction of just 8%.
The role of foot pressure measurement in the prediction and prevention of diabetic foot ulceration—A comprehensive review
Authors: Chatwin Katie E. , Abbott Caroline A. , Boulton Andrew J.M. , Bowling Frank L. , Reeves Neil D. 
Published: December 2019

AbstractThe predominant risk factor of diabetic foot ulcers (DFU), peripheral neuropathy, results in loss of protective sensation and is associated with abnormally high plantar pressures. DFU prevention strategies strive to reduce these high plantar pressures. Nevertheless, several constraints should be acknowledged regarding the research supporting the link between plantar pressure and DFUs, which may explain the low prediction ability reported in prospective studies. The majority of studies assess vertical, rather than shear, barefoot plantar pressure in laboratory‐based environments, rather than during daily activity. Few studies investigated previous DFU location‐specific pressure. Previous studies focus predominantly on walking, although studies monitoring activity suggest that more time is spent on other weight‐bearing activities, where a lower “peak” plantar pressure might be applied over a longer duration. Although further research is needed, this may indicate that an expression of cumulative pressure applied over time could be a more relevant parameter than peak pressure. Studies indicated that providing pressure feedback might reduce plantar pressures, with an emerging potential use of smart technology, however, further research is required. Further pressure analyses, across all weight‐bearing activities, referring to location‐specific pressures are required to improve our understanding of pressures resulting in DFUs and improve effectiveness of interventions.
External temperature and distance from nearest entrance influence microclimates of cave and culvert‐roosting tri‐colored bats (Perimyotis subflavus)
Authors: Leivers Samantha J. , Meierhofer Melissa B. , Pierce Brian L. , Evans Jonah W. , Morrison Michael L. 
Published: December 2019

AbstractMany North American bat species hibernate in both natural and artificial roosts. Although hibernacula can have high internal climate stability, they still retain spatial variability in their thermal regimes, resulting in various “microclimates” throughout the roost that differ in their characteristics (e.g., temperature and air moisture). These microclimate components can be influenced by factors such as the number of entrances, the depth of the roost, and distance to the nearest entrance of the roost. Tri‐colored bats are commonly found roosting in caves in winter, but they can also be found roosting in large numbers in culverts, providing the unique opportunity to investigate factors influencing microclimates of bats in both natural and artificial roost sites. As tri‐colored bats are currently under consideration for federal listing, information of this type could be useful in aiding in the conservation and management of this species through a better understanding of what factors affect the microclimate near roosting bats. We collected data on microclimate temperature and microclimate actual water vapor pressure (AWVP) from a total of 760 overwintering tri‐colored bats at 18 caves and 44 culverts. Using linear mixed models analysis, we found that variation in bat microclimate temperatures was best explained by external temperature and distance from nearest entrance in both caves and culverts. External temperature had a greater influence on microclimate temperatures in culverts than caves. We found that variation in microclimate AWVP was best explained by external temperature, distance from nearest entrance, and proportion from entrance (proportion of the total length of the roost from the nearest entrance) in culvert‐roosting bats. Variation in microclimate AWVP was best explained by external temperature and proportion from entrance in cave‐roosting bats. Our results suggest that bat microclimate temperature and AWVP are influenced by similar factors in both artificial and natural roosts, although the relative contribution of these factors differs between roost types.
Numerical study on enhancing coalbed methane recovery by injecting N2/CO2 mixtures and its geological significance
Authors: Fan Nan , Wang Jiren , Deng Cunbao , Fan Yongpeng , Mu Yongliang , Wang Tingting 
Published: December 2019

AbstractAs an effective carbon utilization technology, the injection of N2/CO2 mixtures into coal seams has significant potential for improving coalbed methane recovery. Considering the technical barrier that injection of pure CO2 decreases the well injectivity index and pure N2 injection leads to the rapid methane recovery, a method of injecting N2‐enriched gas mixtures with a constant component is proposed. In this study, a thermo‐hydro‐mechanical (THM) coupling numerical model for enhanced coalbed methane (CBM) recovery by injecting N2/CO2 mixtures is established. This model includes complex interactions of coal deformation, competitive adsorption, ternary gas seepage, and heat transfer. The THM coupling model is first validated, and then applied to investigate the evolution of mixed gas concentrations, reservoir permeability, reservoir temperature, CH4 production, and N2/CO2 storage during N2/CO2 enhanced CBM recovery. The results show that the displacement radius and concentration of the mixed gas in the coal seam increased with gas injection pressure increase. The concentration of CH4 gradually decreased with time, and the early decline is faster than the later stage. The sweep of the N2 flow accelerates CH4 desorption and migration, promoting a reduction in reservoir temperature near the production well. Reservoir permeability evolution results from the combined effects of ternary gases (CH4, CO2, N2) competitive adsorption, gas pressure, and geostress on the coal seam within the THM fields. At the methane natural depletion stage (within 250 days), the permeability of coal reservoir first decreases and then increases. With the arrival of the N2/CO2 mixture, the permeability decreases dramatically. From the perspective of cumulative CH4 production, the optimal composition is dominated by the synergistic effect of maximizing breakthrough time and minimizing coal matrix swelling. For 30% CO2‐70% N2, the CH4 recovery ratio reached 71.76%, representing an increase of 16.67% compared to natural depletion.
Why Won’t My Patient Act Like a Jerk?
Authors: Baruch Jay 
Published: December 2019

AbstractI’m avoiding Mr. G’s room. I shouldn’t have read the emergency room notes from the other hospital, where this middle‐aged man raised a stink about the wait. What type of person calls the triage nurse a bitch? From the timestamps on the electronic medical record notes, he stormed from that ER and drove his abdominal pain, vomiting, diarrhea, and discontent directly across town to us.I’m reminded of this oft‐quoted aphorism from Sir William Osler: “The good physician treats the disease; the great physician treats the patient who has the disease.” It’s cited by medical educators as an invocation to never forget the humanistic heart at the center of clinical care. But what if the patient is a jerk? That I haven’t met Mr. G, only read briefly about him, doesn’t stop these ugly feelings from surfacing.
Dementia and the Death Penalty
Authors: Dresser Rebecca 
Published: December 2019

AbstractDuring its 2018–2019 term, the United States Supreme Court considered the constitutionality of executing a prisoner with dementia. In Madison v. Alabama, the Court ruled that, in certain circumstances, executing a prisoner with dementia violates the Eighth Amendment’s ban on cruel and unusual punishment. Vernon Madison was sentenced to death for killing a police officer in 1985. After many years on Alabama’s death row, he had a series of strokes and was diagnosed with vascular dementia. In 2016, Madison’s lawyers unsuccessfully sought a stay of execution, arguing that, in light of his cognitive impairments, imposing the death penalty would violate the Constitution. After Alabama set a 2018 execution date, lawyers returned to the state court, arguing that the finding of competence should be reversed because Madison’s cognitive impairments had worsened. When the trial court refused to grant the stay of execution, Madison’s lawyers asked the Supreme Court to review the constitutionality of the state court decision.
Physician Burnout Calls for Legal Intervention
Authors: Hoffman Sharona 
Published: December 2019

AbstractPhysician burnout is receiving more attention in the medical literature, and deservedly so. For example, in October of 2019, the National Academies of Sciences, Engineering, and Medicine published a lengthy report called Taking Action against Clinician Burnout: A Systems Approach to Professional Well‐Being. The report is comprehensive and well worth reading, and it offers a series of sound recommendations for addressing the burnout problem. However, the recommendations are quite ambitious, and implementing them would require a considerable investment of time, staffing, and financial resources. The medical community should not be left to grapple with the phenomenon of physician burnout alone. The law has a significant role to play in addressing the problem. As a first step, it is useful to consider a few concrete interventions that regulators could realistically implement in the short term.
Toward the Polyphonic Case
Authors: Chambers Tod S. 
Published: December 2019

AbstractCan one publish a bioethics case ethically? I suspect that most in bioethics would feel comfortable publishing a case if the subject—the patient—gave explicit permission, the amount of biographical information revealed was under the control of the subject, and the subject fully understood the benefits and risks of publishing the case. Some might add that the subject should have a chance to approve the final representation. I think that the ethics of publishing cases needs to be rethought. And this rethinking needs to be focused not on the way publishing a case might harm a patient (that is, nonmaleficence) but, rather, on how a case presentation does not convey the patient’s own voice in the narrative (that is, respect for autonomy). Bioethics needs a new model of case presentation: the polyphonic case, which demands that the subject be a part of the case’s construction.
Not Whether but How: Considerations on the Ethics of Telling Patients’ Stories
Authors: Frank Arthur W. 
Published: December 2019

AbstractThe ethics of telling stories about other people become questionable as soon as humans learn to talk. But the stakes get higher when health care professionals tell stories about those whom they serve. But for all the problems that come with such stories, I do not believe it is either practical or desirable for bioethicists to attempt to legislate an end to this storytelling. What we need instead is narrative nuance. We need to understand how to tell respectful stories in which the patients are fully acknowledged fellow participants, not one‐dimensional objects of a knowing gaze. The problem is not narration itself but a particular version of narrational privilege, and getting rid of that would have benefits far beyond practices of writing case studies. In this essay, I first offer four considerations that I have found either omitted or underemphasized in discussions of the ethics of telling stories about patients. I then sketch a model of medical storytelling that might be the basis for shifting the ethical question from whether to how.
Can the Case Report Withstand Ethical Scrutiny?
Authors: Rosoff Philip M. 
Published: December 2019

AbstractSince antiquity, doctors have employed case reports as an essential and ongoing part in communicating information about patients and their diseases to their colleagues and, at times, to the wider, nonmedical world. Given how useful case reports have been, a legitimate and persuasive argument could be made to retain them in modern medical literature. But there is an emerging problem with case reports. As the ability to publish and disseminate the information contained in them has become easier, the capacity for individuals to maintain their privacy and restrict access to their personal information has become more strained, and it has become more difficult for doctors who tell clinical stories to respect the confidentiality of their patients while still communicating the pertinent details of their cases. Does the acknowledged educational and scientific value of (some) case reports justify the threat to personal privacy that may be entailed by the format itself?