bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and Validation of an Electronic Health Record-based Score for Triage to Perioperative Medicine
Authors: Le Sidney T. , Corbin J. Dalton , Myers Laura C. , Kipnis Patricia , Cohn Bradley , Liu Vincent X. 
Published: November 2021

Objective:
To develop an electronic health record-based risk model for perioperative medicine (POM) triage and compare this model with legacy triage practices that were based on clinician assessment.

Summary of Background Data:
POM clinicians seek to address the increasingly complex medical needs of patients prior to scheduled surgery. Identifying which patients might derive the most benefit from evaluation is challenging.

Methods:
Elective surgical cases performed within a health system 2014– 2019 (N = 470,727) were used to develop a predictive score, called the Comorbidity Assessment for Surgical Triage (CAST) score, using split validation. CAST incorporates patient and surgical case characteristics to predict the risk of 30-day post-operative morbidity, defined as a composite of mortality and major NSQIP complications. Thresholds of CAST were then selected to define risk groups, which correspond with triage to POM appointments of different durations and modalities. The predictive discrimination CAST score was compared with the surgeon’s assessments of patient complexity and the American Society of Anesthesiologists class.

Results:
The CAST score demonstrated a significantly higher discrimination for predicting post-operative morbidity (area under the receiver operating characteristic curve 0.75) than the surgeon’s complexity designation (0.63; P < 0.001) or the American Society of Anesthesiologists (0.65; P < 0.001) (Fig. 1). Incorporating the complexity designation in the CAST model did not significantly alter the discrimination (0.75; P = 0.098). Compared with the complexity designation, classification based on CAST score groups resulted a net reclassification improvement index of 10.4% (P < 0.001) (Table 1).

Conclusion:
A parsimonious electronic health record-based predictive model demonstrates improved performance for identifying pre-surgical patients who are at risk than previously-used assessments for POM triage.
Microbiota-targeted interventions for mental health
Authors: Berding Kirsten , Cryan John F. 
Published: November 2021

Purpose of review
The gut microbiota has emerged as a key conduit in mental health and is a promising target for interventions. This review provides an update on recent advances in using microbiota-targeted approaches for the management of mental health.

Recent findings
Approaches that have emerged as microbiota-targeted interventions in the management of mental health include probiotics, prebiotics, synbiotics, fecal microbiota transplant as well as diet. Among these approaches, probiotic supplementation has been investigated most prominently, providing promising evidence for its use in improving mood and anxiety. There is also growing interest in the use of multistrain probiotics, whole dietary interventions or combined approaches, with encouraging results emerging from recent studies.

Summary
Although the current literature preliminarily supports targeting the microbiota to manage mental health and use as adjuvant therapies for certain brain disorders, large gaps remain and especially data including clinical cohorts remains scarce. Research studies including larger cohorts, well-characterized clinical populations and defined duration and dosage of the intervention are required to develop evidence-based guidelines for microbiota-targeted strategies.
Quality Improvement in Clinical Research: ESA Utilization to improve Patient Safety Monitoring, time management, and Research Compliance
Authors: Del Pino Maria , Bonmati Ana , Mendoza Patricia 
Published: November 2021

AbstractWe analyzed the capabilities of Electronic Signature Administrators (ESA) in reporting adverse and serious adverse events (AE/SAE) in clinical trials to improve Principal Investigator (PI) oversight. The current and most conventional way to sing on AE/SAE reports, by wet ink paper signatures, faces long report completion times, miscommunications, and a high rate of error that can put the study and the patient at risk. We demonstrate here that ESAs can easily take over this task, speeding up the process and enhancing patient’s safety and research compliance. Our results show that the average of 31 days to obtain wet-signatures on AE/SAE reports is reduced to merely 3 days after the implementation of ESA. We also found that research professionals spend more than half an hour in commuting each time they need to get PI signatures, while this time is zero if ESAs are used. Finally, an anonymous survey distributed to coordinators shows that ESAs can be well received when implemented since 86% have used an ESA and are satisfied with it or are interested in using it, while only 14% of the participants are either not interested or not satisfied.
Lipid Alterations in African American Prostate Cancer
Authors: Ravindran Anindita , Badrajee Piyarathna Danthasinghe Waduge , Gohlke Jie , Putluri Vasanta , Soni Tanu , Lloyd Stacy , Castro Patricia , Pennathur Subramaniam , Jones Jeffrey A , Ittmann Michael , Putluri Nagireddy , Michailidis George , Rajendiran Thekkelnaycke M , Sreekumar Arun 
Published: November 2021

AbstractAfrican-American (AA) men are more than twice as likely to die of prostate cancer (PCa) than European American (EA) men. Previous in-silico analysis revealed enrichment of altered lipid metabolic pathways in pan-cancer AA tumors. Here, we performed global unbiased lipidomics profiling on 48 matched localized PCa and benign adjacent tissues (30 AA, 24 ancestry-verified, and 18 EA, 8 ancestry verified) and quantified 429 lipids belonging to 15 lipid classes. Significant alterations in long chain polyunsaturated lipids was observed between PCa and benign adjacent tissues, low and high Gleason tumors, as well as associated with early biochemical recurrence, both in the entire cohort, and within AA patients. Altered levels of cholesteryl esters, and phosphatidyl inositols delineated AA and EA PCa, while levels of triglycerides, phosphatidyl glycerol, phosphatidyl choline, phosphatidic acid and cholesteryl esters distinguished AA and EA PCa patients with biochemical recurrence. These first-in-field results implicate lipid alterations as biological factors for prostate cancer disparities.
Trends in Homeschooling Rates Following Elimination of Nonmedical Exemptions to Childhood Immunizations, 2012-2020
Authors: Patel Kavin M. , McFadden SarahAnn M. , Mohanty Salini , Joyce Caroline M. , Delamater Paul L. , Klein Nicola P. , Salmon Daniel A , Omer Saad B. , Buttenheim Alison M. 
Published: November 2021

STRUCUTRED ABSTRACTIntroductionIn 2015 California passed Senate Bill No. 277 (SB 277) and became the first state in over 30 years to eliminate nonmedical exemptions to mandatory childhood immunizations for school entry. One concern that emerged was that the law created an incentive for parents to remove children from brick-and-mortar schools to bypass the immunization requirements.ObjectiveTo assess the impact of eliminating nonmedical exemptions to childhood immunizations on homeschooling rates.DesignPre-Post Intervention study. We calculated homeschooling rates as the number of K-8 students enrolled through each of California’s three homeschooling mechanisms (Independent Study Program, Private School Affidavit, and Private School Satellite Program) divided by all K-8 students enrolled in the same academic year. Data on homeschooling rates was obtained from the California Department of Education. We then conducted an interrupted time series analyses in which the outcome variable was percent of students enrolled in a homeschool program pre- and post-SB 277.SettingCalifornia homeschoolsParticipantsK-8 students enrolled through each of the state’s three homeschooling mechanisms (Independent Study Program, Private School Affidavit, and Private School Satellite Program)InterventionPassage of SB 277 which eliminated nonmedical exemptions to childhood immunizations for school entryMain OutcomeK-8 homeschooling ratesResultsThe homeschooling enrollment for K-8 students in California increased from 0.8% (35,122 students) during SY 2012-13 to 1.9% (86,574 students) during SY 2019-20; however, we found no significant increase in the percent of students enrolled in homeschooling programs in California following the implementation of SB 277 beyond the secular trend.Conclusions and RelevanceLegislative action to limit nonmedical exemptions to compulsory vaccination for school entry is not associated with removal from classroom-based instruction in brick- and-mortar institutions.KEY POINTSQuestionWhat is effect of California Senate Bill No. 277, which eliminated nonmedical exemptions to childhood immunizations for school entry, on the homeschooling rates?FindingWe found no evidence that elimination of nonmedical exemptions to mandatory childhood immunizations for school entry was associated with an increase in homeschooling rates for K-8 in California.MeaningLegislative action to limit nonmedical exemptions to compulsory vaccination for school entry is not associated with removal from classroom-based instruction in brick-and-mortar institutions.
Phage-like particle vaccines are highly immunogenic and protect against pathogenic coronavirus infection and disease
Authors: Davenport Bennett J. , Catala Alexis , Weston Stuart M. , Johnson Robert M. , Ardunay Jeremy , Hammond Holly L. , Dillen Carly , Frieman Matthew B. , Catalano Carlos E. , Morrison Thomas E. 
Published: November 2021

ABSTRACTThe response by vaccine developers to the COVID-19 pandemic has been extraordinary with effective vaccines authorized for emergency use in the U.S. within one year of the appearance of the first COVID-19 cases. However, the emergence of SARS-CoV-2 variants and obstacles with the global rollout of new vaccines highlight the need for platforms that are amenable to rapid tuning and stable formulation to facilitate the logistics of vaccine delivery worldwide. We developed a “designer nanoparticle” platform using phage-like particles (PLPs) derived from bacteriophage lambda for multivalent display of antigens in rigorously defined ratios. Here, we engineered PLPs that display the receptor binding domain (RBD) protein from SARS-CoV-2 and MERS-CoV, alone (RBDSARS-PLPs, RBDMERS-PLPs) and in combination (hCoV-RBD PLPs). Functionalized particles possess physiochemical properties compatible with pharmaceutical standards and retain antigenicity. Following primary immunization, BALB/c mice immunized with RBDSARS- or RBDMERS-PLPs display serum RBD-specific IgG endpoint and live virus neutralization titers that, in the case of SARS-CoV-2, were comparable to those detected in convalescent plasma from infected patients. Further, these antibody levels remain elevated up to 6 months post-prime. In dose response studies, immunization with as little as one microgram of RBDSARS-PLPs elicited robust neutralizing antibody responses. Finally, animals immunized with RBDSARS-PLPs, RBDMERS-PLPs, and hCoV-RBD PLPs were protected against SARS-CoV-2 and/or MERS-CoV lung infection and disease. Collectively, these data suggest that the designer PLP system provides a platform for facile and rapid generation of single and multi-target vaccines.
Feasibility evaluation of transtympanic laser stimulation of the cochlea from the outer ear
Authors: Uenaka Miku , Nagamura Hidekazu , Hiryu Shizuko , Kobayasi Kohta I. , Tamai Yuta 
Published: November 2021

AbstractInfrared laser stimulation has been studied as an alternative approach to auditory prostheses. This study evaluated the feasibility of infrared laser stimulation of the cochlea from the outer ear bypassing the middle ear function. An optic fiber was inserted into the ear canal and a laser was used to irradiate the cochlea through the tympanic membrane in Mongolian gerbil. A pulsed infrared laser (10.1 mJ/cm2) and clicking sound (70 peak-to-peak equivalent sound pressure level) were presented to the animals. The amplitude of the laser-evoked cochlear response was systematically decreased following insertion of a filter between the tympanic membrane and cochlea; however, the auditory-evoked cochlear response did not decrease. The filter was removed and the laser-evoked response returned to around the original level. The amplitude ratio and the relative change in response amplitude before and during filter insertion significantly decreased as the absorbance of the infrared filter increased. These results indicate that laser irradiation could bypass the function of the middle ear and directly activate the cochlea. Therefore, an auditory prosthesis based on laser stimulation represents a possible noninvasive alternative to conventional auditory prostheses requiring surgical implants.
Paradoxical excitation of lateral habenula neurons by propofol involves enhanced presynaptic release of glutamate
Authors: Shepard Ryan David , Wu Kunwei , Lu Wei 
Published: November 2021

AbstractSleep is a fundamental physiological process conserved across most species. As such, deficits in sleep can result in a myriad of psychological and physical health issues. However, the mechanisms underlying the induction of sleep are relatively unknown. Interestingly, general anesthetics cause unconsciousness by positively modulating GABA-A receptors (GABAARs). Based on this observation, it is hypothesized that GABAARs play a critical role in modulating circuits involved in sleep to promote unconsciousness. Recently, the lateral habenula (LHb) has been demonstrated to play a role in sleep physiology and sedation. Specifically, propofol has been shown to excite LHb neurons to promote sedation. However, the mechanism by which this occurs is unknown. Here, we utilize whole-cell voltage and current clamp recordings from LHb neurons obtained from 8-10 week old male mice to determine the physiological mechanisms for this phenomenon. We show that bath application of 1.5μM propofol is sufficient to increase LHb neuronal excitability involving synaptic transmission, but not through modulation of intrinsic properties. Additionally, although there is increased LHb neuronal excitability, GABAARs localized postsynaptically on LHb neurons are still responsive to propofol, as indicated by an increase in the decay time. Lastly, we find that propofol increases the synaptic drive onto LHb neurons involving enhanced presynaptic release of both glutamate and GABA. However, the greatest contributor to the potentiated synaptic drive is the increased release of glutamate which shifts the balance of synaptic transmission towards greater excitation. Taken together, this study is the first to identify the physiological basis for why LHb neurons are excited by propofol, rather than inhibited, and as a result promote sedation.
Macrophage proliferation machinery leads to PDAC progression, but susceptibility to innate immunotherapy
Authors: Zuo Chong , Baer John M. , Knolhoff Brett L. , Belle Jad I. , Liu Xiuting , Hogg Graham D. , Fu Christina , Kingston Natalie L. , Brenden Marcus A. , De La Lastra Angela Alarcon , Dodhiawala Paarth B. , Zhou Cui , James C. Alston , Ding Li , Lim Kian-Huat , Fields Ryan C. , Hawkins William G. , Zhao Guoyan , Weber Jason D. , DeNardo David G. 
Published: November 2021

AbstractTumor-associated macrophages (TAMs) are involved in many aspects of cancer progression and correlate with poor clinical outcomes in many cancer types, including pancreatic ductal adenocarcinomas (PDACs). Previous studies have shown that TAMs can populate PDAC tumors not only by monocyte recruitment but also by local proliferation. However, the impact local proliferation might have on macrophage phenotype and cancer progression is unknown. Here, we utilized genetically engineered cancer models, single-cell RNA-sequencing data, andin vitrosystems to show that proliferation of TAMs was driven by colony stimulating factor-1 (CSF1) produced by cancer-associated fibroblasts. CSF1 induced high levels of p21 in macrophages, which regulated both TAM proliferation and phenotype. TAMs in human and mouse PDACs with high levels of p21 had more inflammatory and immunosuppressive phenotypes. The p21 expression in TAMs was induced by both stromal interaction and/or chemotherapy treatment. Finally, by modeling p21 expression levels in TAMs, we found that p21-driven macrophage immunosuppressionin vivodrove tumor progression. Serendipitously, the same p21-driven pathways that drive tumor progression, also drive response to CD40 agonist. These data suggest that stromal or therapy-induced regulation of cell cycle machinery can regulate both macrophage-mediated immune suppression and susceptibility to innate immunotherapy.SummaryTAMs are indicative of poor clinical outcomes and in PDAC their number is sustained in part by local proliferation. This study shows that stromal desmoplasia drives local proliferation of TAMs, and induces their immunosuppressive ability through altering cell cycle machinery, including p21 expression. Serendipitously, these changes in p21 in TAMs also potentially render tumors more sensitive to CD40 agonist therapy.
Overstraining international climate finance: when conflicts of objectives threaten its success
Authors: Buchholz Wolfgang , Rübbelke Dirk 
Published: November 2021

Purpose
Climate finance is regularly not only seen as a tool to efficiently combat global warming but also to solve development problems in the recipient countries and to support the attainment of sustainable development goals. Thereby, conflicts between distributive and allocative objectives arise, which threaten the overall performance of such transfer schemes. Given the severity of the climate change problem, this study aims to raise concerns about whether the world can afford climate transfer schemes that do not focus on prevention of (and adaptation to) climate change but might be considered as a vehicle of rent-seeking by many agents.

Design/methodology/approach
Future designs of international transfer schemes within the framework of the Paris Agreement are to be based on experience gained from existing mechanisms. Therefore, the authors examine different existing schemes using a graphical technique first proposed by David Pearce and describe the conflicts between allocative and distributional goals that arise.

Findings
In line with the famous Tinbergen rule, the authors argue that other sustainability problems and issues of global fairness should not be primarily addressed by climate finance but should be mainly tackled by other means.

Research limitations/implications
As there is still ongoing, intense discussion about how the international transfer schemes addressed in Article 6 of the Paris Agreement should be designed, the research will help to sort some of the key arguments.

Practical implications
There are prominent international documents (like the Paris Agreement and the UN 2030 Agenda for Sustainable Development) seeking to address different goals simultaneously. While synergies between policies is desirable, there are major challenges for policy coordination. Addressing several different goals using fewer policy instruments, for example, will not succeed as the Tinbergen Rule points out.

Social implications
The integration of co-benefits in the analysis allows for taking into account the social effects of climate policy. As the authors argue, climate finance approaches could become overstrained if policymakers would consider them as tools to also solve local sustainability problems.

Originality/value
In this paper, the authors will not only examine what can be learnt from the clean development mechanism (CDM) for future schemes under Article 6 of the Paris Agreement but also observe the experiences gained from a non-CDM scheme. So the authors pay attention to the Trust Fund of the Global Environment Facility (GEF) which was established with global benefit orientation, i.e. – unlike the CDM – it was not regarded as an additional goal to support local sustainable development. Yet, despite its disregard of local co-benefits, the authors think that it is of particular importance to include the GEF in the analysis, as some important lessons can be learnt from it.
Procurement professionals' perceptions of skills and attributes of procurement negotiators: a cross-sectional survey in Tanzania
Authors: Mwagike Leonada Raphael , Changalima Ismail Abdi 
Published: November 2021

PurposeThis paper analyzes procurement negotiators' skills and attributes by considering perceptions of procurement professionals in Tanzania.Design/methodology/approachThis study employed a cross-sectional research design in which procurement professionals' opinions were collected through questionnaires. The study proposed that the skills and attributes of procurement negotiators are necessary for negotiation proceedings, and they were tested through confirmatory factor analysis.FindingsFindings suggest that listening skills, persuasion skills, communication skills and planning skills are all important skills that contribute to overall procurement negotiation skills. Furthermore, trust, flexibility, honesty and emotion are statistically determined to be necessary attributes for procurement negotiators. All of the observed variables were statistically significant (p < 0.001) and contributed positively to explaining the skills and attributes of procurement negotiators.Research limitations/implicationsThe sample included only respondents from a single country. This may affect the generalization of results as there is a variation in institutional regulatory compliance governing public procurement undertakings in different countries. Also, the study did not include the outcome of negotiation proceedings and relied only on opinions collected from the procurement professionals in Tanzania.Practical implicationsThis study's findings provide suggestions for practitioners on the necessary skills and attributes of procurement negotiators that might be well considered when appointing members of negotiation teams for procurement deals.Originality/valueThis paper adds value to the existing literature on the necessary skills and attributes of members of negotiation teams for procurement undertakings in the public sector.
The effects of COVID-19 on trade, production, environmental quality and its implications for green economy
Authors: Borojo Dinkneh Gebre , Yushi Jiang , Miao Miao 
Published: November 2021

PurposeThis study examines the effects of COVID-19 on trade, production and environmental quality and provides policy implications on green recovery.Design/methodology/approachThe two-step Heckman method is applied to estimate the structural gravity specification of trade. Besides, the two-step system GMM model is used to estimate the effects of COVID-19 on production and environmental quality. Additionally, descriptive analysis and literature review have been used.FindingsThe findings disclose that COVID-19 adversely affected the trade performance of the countries. The results further imply that the regional trade agreements (RTAs) can play a key mediating role in the post-COVID-19 trade recovery. Besides, the impact of COVID-19 on the output is substantially negative. However, the effect of COVID-19 on environmental quality is significantly positive.Originality/valueIt is the first study of its kind to examine the effects of COVID-19 on trade, production and CO2 emissions covering panel countries. Second, it provides a detailed analysis of firms planning to engage in the export sector. Moreover, it offers policy suggestions to consider environmental quality and green recovery. Besides, it examines the mediating role of RTAs in the relationship between trade and the pandemic.