bluuebunny/crossref_metadata_2025_split huggingface dataset:
Calcified Leg Ulcers in Older Patients: Clinical Description, Morphology, and Chemical Characterization
Authors: Colboc Hester , Fontaine Juliette , Bazin Dominique , Frochot Vincent , Letavernier Emmanuel , Daudon Michel , Laporte Naomi , Rouzière Stéphan , Reby Michael , Galezowski Agnes , Forasassi Christine , Meaume Sylvie 
Published: July 2021

Abstract
Chronic wounds, including leg ulcers, constitute an important medical problem among older patients. Dystrophic calcifications (DC) are associated with a variety of disorders, including leg ulcers. The aim of this study was to report the clinical and biological characteristics of older patients with DC in leg ulcers and to determine the morphology and chemical composition of these calcifications. We conducted a prospective monocentric study in our Geriatric-Wound and Healing ward, Rothschild Hospital, Paris, from January 2018 to December 2019. Patients with leg ulcers were screened for DC by palpation. Patients’ clinical, biological, and radiological findings were collected. DC morphology was analyzed using field-emission scanning electron microscopy and chemical composition was analyzed using µFourier transform infra-red spectroscopy and X-ray Fluorescence. Ten (7%) of the 143 patients hospitalized for leg ulcers presented DC. Older patients with DC were more likely to have leg ulcers with venous insufficiency (p = .015), colonized by Pseudomonas aeruginosa (p = .026), with a longer healing evolution (p = .0072) and hypercalcemia (p = .041). Five DC were extracted from ulcers: 2 presented 500 nm lacunar spheres and intermingled fibrils of about 10 nm in diameter, consistent with bacterial and biofilm imprints. DC were always composed of calcium–phosphate apatite and associated to the presence of zinc. Our analyses were consistent with the involvement of microorganisms and inflammatory process in DC formation. Early management of venous insufficiency, treatment of chronic bacterial colonization and use of calcium-solubilizing drugs seem to be rational strategies for calcified leg ulcer management in older patients.
Enhancing co-stimulation of CAR T cells to improve treatment outcomes in solid cancers
Authors: Harrison Aaron J , Du Xin , von Scheidt Bianca , Kershaw Michael H , Slaney Clare Y 
Published: July 2021

Summary
Co-stimulation is a fundamental component of T cell biology and plays a key role in determining the quality of T cell proliferation, differentiation, and memory formation. T cell-based immunotherapies, such as chimeric antigen receptor (CAR) T cell immunotherapy, are no exception. Solid tumours have largely been refractory to CAR T cell therapy owing to an immunosuppressive microenvironment which limits CAR T cell persistence and effector function. In order to eradicate solid cancers, increasingly sophisticated strategies are being developed to deliver these vital co-stimulatory signals to CAR T cells, often specifically within the tumour microenvironment. These include designing novel co-stimulatory domains within the CAR or other synthetic receptors, arming CAR T cells with cytokines or using CAR T cells in combination with agonist antibodies. This review discusses the evolving role of co-stimulation in CAR T cell therapies and the strategies employed to target co-stimulatory pathways in CAR T cells, with a view to improve responses in solid tumours.
Time Fractional Parabolic Equations with Measurable Coefficients and Embeddings for Fractional Parabolic Sobolev Spaces
Authors: Dong Hongjie , Kim Doyoon 
Published: July 2021

Abstract
We consider time fractional parabolic equations in divergence and non-divergence form when the leading coefficients $a^{ij}$ are measurable functions of $(t,x_1)$ except for $a^{11}$, which is a measurable function of either $t$ or $x_1$. We obtain the solvability in Sobolev spaces of the equations in the whole space, on a half space, and on a partially bounded domain. The proofs use a level set argument, a scaling argument, and embeddings in fractional parabolic Sobolev spaces for which we give a direct and elementary proof.
A simple electronic medical record system designed for research
Authors: King Andrew J , Calzoni Luca , Tajgardoon Mohammadamin , Cooper Gregory F , Clermont Gilles , Hochheiser Harry , Visweswaran Shyam 
Published: July 2021

Abstract
With the extensive deployment of electronic medical record (EMR) systems, EMR usability remains a significant source of frustration to clinicians. There is a significant research need for software that emulates EMR systems and enables investigators to conduct laboratory-based human–computer interaction studies. We developed an open-source software package that implements the display functions of an EMR system. The user interface emphasizes the temporal display of vital signs, medication administrations, and laboratory test results. It is well suited to support research about clinician information-seeking behaviors and adaptive user interfaces in terms of measures that include task accuracy, time to completion, and cognitive load. The Simple EMR System is freely available to the research community and is on GitHub.
A mobile application to support bedside nurse documentation and care: a time and motion study
Authors: Ehrler Frederic , Wu Danny T Y , Ducloux Pascal , Blondon Katherine 
Published: July 2021

Abstract Documentation at the bedside is still often initiated on paper before being entered in electronic charts, even after implementing electronic health records (EHRs). This 2-step process is time-consuming, a potential source of error, and hinders the use of real-time information. We developed the “Bedside mobility” smartphone application to facilitate bedside documentation in the EHR.ObjectiveThis study aims to evaluate the impact of our app in 2 wards of a teaching hospital with a pre-post design.Materials and methodsThe duration and location of all documentation activities were recorded using a time motion study.ResultsUsing the app significantly decreased the duration of EHR documentation per hour of observation by 4.10 min (P = 0.003), while the time spent interacting with patient increased by 1.45 min although not significantly. Also, in the intervention period, the average duration of uninterrupted documentation episodes increased by 0.27 min (P = 0.16) and the uninterrupted interaction with patient increased by 8.50 min (P = 0.027).DiscussionBy reducing the fragmentation of documentation workflow, decreasing the overall EHR documentation time and allowing nurses to spend more time with their patients, app use led to potential higher quality of care and higher patient satisfaction and may help maintain a smoother workflow.ConclusionOur mobile app has the potential to positively impact bedside nurses’ clinical workflow and documentation, as well as patient–provider communication and relationship.
Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge
Authors: Habib Bettina , Buckeridge David , Bustillo Melissa , Marquez Santiago Nicolas , Thakur Manish , Tran Thai , Weir Daniala L , Tamblyn Robyn 
Published: July 2021

Abstract

Objective
The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events.

Materials and Methods
We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up.

Results
Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%).

Conclusion
The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial.

Trial registration
Clinicaltrials.gov, registration number NCT04676165.
Evolutionary history and climate conditions constrain the flower colours of woody plants in China
Authors: Wang Qinggang , Guo Qiang , Chi Xiulian , Zhu Shaoqi , Tang Zhiyao 
Published: July 2021

AbstractIn this study, we investigated (i) the differences in flower colour composition among growth forms of woody plants in China and (ii) the influences of biogeographic regions, evolutionary age and climatic conditions on geographic variation in the proportions of different flower colours. Using distribution maps and flower colour information (white, red, yellow, yellow-green, green and blue-purple) of 7673 Chinese woody plant species and a dated genus-level phylogenetic tree, we compared flower colour composition among different growth forms (shrubs, trees and lianas). We further estimated the relationships of geographical patterns in the proportions of different flower colours with seven different biogeographic regions, evolutionary age and different contemporary climatic variables. Compared with trees or lianas, shrubs showed a higher proportion of species with anthocyanin-based red and blue-purple flowers. The geographic patterns of flower colour composition of woody plants in China were strongly influenced by regional effects and contemporary climate, especially precipitation and ultraviolet B irradiance. The proportion of species with presumably bee-pollinated yellow and blue-purple flowers and stress tolerant anthocyanin-based red and blue-purple flower colours tended to be high in the northwestern part of China. Green flowers tended to evolve earlier than others, but evolutionary age had quite weak influences on the geographic pattern of flower colours. Our results reflect both evolutionary and environmental constraints on the distribution of flower colours of woody plants in China.
Rhus coriaria L., a new candidate for controlling metabolic syndrome: a systematic review
Authors: Hashem-Dabaghian Fataneh , Ghods Roshanak , Shojaii Asie , Abdi Leila , Campos-Toimil Manuel , Yousefsani Bahareh Sadat 
Published: July 2021

Abstract

Objectives
Rhus coriaria L. (RC) is a deciduous shrub with several pharmacological activities. Evidence of the effects of RC on weight, hyperlipidaemia, hypertension and diabetes mellitus have been presented in this study. Books, thesis and internet-based resources such as PubMed, Web of Science, Scopus, EMBASE, Cochrane, Ovid and Google Scholar were searched for the English, Arabic and Persian literature from 1966 to 2020 (December). The keywords were Rhus coriaria L., Sumac, metabolic syndrome and all its medical conditions (hyperlipidaemia, hypertension, obesity and diabetes mellitus). The inclusion criteria were full-text animal and human studies conducted on RC to evaluate its efficacy on any components of metabolic syndrome (MetS). Jadad scale was used to assess the quality of evidence.

Key findings
Reviewing 23 relevant studies demonstrated that RC is able to decrease the level of blood glucose, glycated haemoglobin, serum insulin and insulin resistance. Studies on hyperlipidaemia and obesity have very contradicting results, and there is no definite conclusion on the effect of RC on lipid profile. However, the hypotensive and effect of RC was confirmed in the existing studies.

Summary
According to the literature, RC can be considered as a promising curative candidate for MetS. However, further studies with larger sample size and higher methodological quality are needed.
Masculinity, Madness and Empire in Kipling’s ‘Thrown Away’ and ‘The Madness of Private Ortheris’
Authors: Griffiths Andrew 
Published: July 2021

Abstract
Institutional records suggest that the grounds for anxiety about insanity in late-nineteenth-century India were many and varied. Amongst other causes, one might have been rendered insane by sunstroke, fever, head injury, strong drink, and inherited tendency, the loss of money, grief, jealousy, anger, sexual excess, excessive joy, or (perhaps disturbingly) excessive study.1 With such a panoply of anxieties to explore, it is scarcely surprising that Rudyard Kipling’s Indian fiction abounds with characters who experience madness of various kinds and degrees. This paper focuses on two short stories collected in Kipling’s 1888 volume Plain Tales from the Hills: ‘Thrown Away’ and ‘The Madness of Private Ortheris’. These two stories offer particular insight into madness, its relationship to masculinity, and its consequences for the social order of British India. As Jonathan Saha has pointed out, madness in a colonial context was doubly significant. Since insanity ‘could strike anyone, rulers and the ruled, men and women . . . madness threatened to undermine the colonial racial boundary and disrupt the established norms of masculinity and femininity’.2 Both ‘Thrown Away’ and ‘The Madness of Private Ortheris’ explore or expose a psychological crisis that takes the form of a deviation from gender norms and is resolved by an enforced return to those norms. Reading the stories alongside asylum records, this paper contextualizes their representation of gender and madness and argues that the fiction offers a glimpse of what might fill important gaps in the archival record.
QUiC Clinics in the Central Texas Market: Value-Based Primary Care in Military Medicine
Authors: Malish Richard , Flannery Brian J , Meyers Garrett , Hall Brian T 
Published: July 2021

ABSTRACT

Introduction
For the past 16 years, Military Health System primary care providers have been incentivized to pursue work in a fee-for-service (FFS) model. The system values documentation of productivity to earn as many relative value units as possible. The result is densely packed clinic schedules that often lack the space or flexibility to accommodate patients when sick. Leakage ensues. Furthermore, prevention and patient experience are not directly incentivized.

Methods
The Central Texas Market’s Accountable Care Organization reformed incentives in its #5 FFS-designed community-based medical homes to value outcomes over productivity. The resulting quality, urgent, internet, and phone care (QUiC) clinics are value-based and, therefore, better structured to achieve the Quad aim (better care, better health/readiness, and low cost). Forsaking deeply ingrained FFS practices, QUiC clinics funnel all routine (information-sharing) appointments into efficient internet or phone appointments. With the time freed by managing common needs in short bursts, QUiC clinics see sick patients with no notice (urgent care). They also focus on prevention and patient experience. We measured the effectiveness of the QUiC clinics in the value-based metrics of (1) patient experience, (2) Healthcare Effectiveness Data and Information Set measures of quality and prevention. (3) access-to-care, (4) leakage, and (5) enrollment.

Results
Over a 19 month period, the five community-based medical homes improved significantly in all areas. Specifically, measures of patient satisfaction improved from the mid-80s percent satisfied to the mid-90s percent satisfied. Healthcare Effectiveness Data and Information Set measures increased from average compared to national benchmarks (&lt;50th percentile to 75th percentile) to the 90th percentile in four of five measures of quality and the 75th percentile in the remaining measure. Access to care for routine appointments decreased from 15.4 days to the third next available appointment to 2.8 days. Leakage decreased from 12.2% to 9.6%. These successes were attained without cost or significant reductions in patient enrollments. In changing workflows, the market became the #1 user of virtual video visits in the DOD.

Conclusions
This performance improvement project proved the concept that a military market can vastly improve value-based primary care outcomes at no cost and within multiple community-based clinics.
What Would it Take to Put a Chiropractor in Khakis? Effecting Chiropractors as Commissioned Officers in the U.S. Military—A Historical Brief
Authors: Barassi James P 
Published: July 2021

ABSTRACT
The purpose of this article is to provide a historical perspective on the commissioning of chiropractors within the U.S. Military and to propose a pathway by which this can be accomplished. A comprehensive review of Congressional actions proposed and enacted, and historical documents to create a chronology of actions that influence and support a proposed pathway for commissioning. The authority to commission chiropractors within the U.S. Military has long been provided to the Secretary of Defense, but it has never been acted upon despite decades of legislation. Chiropractors currently serve within the DoD as contractors or government employees; however, the direct association with the military in terms of commissioning has remained elusive. Musculoskeletal injuries are statistically one of the most prevalent combat-related injury classifications within the active duty military and subsequent veteran population. Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.
Constraining cosmological parameters from strong lensing with DECIGO and B-DECIGO sources
Authors: Hou Shaoqi , Fan Xi-Long , Zhu Zong-Hong 
Published: July 2021

ABSTRACTGravitational lensing has long been used to measure or constrain cosmology models. Although the lensing effect of gravitational waves has not been observed by LIGO/Virgo, it is expected that there can be a few to a few hundred lensed events to be detected by the future Japanese space-borne interferometers DECIGO and B-DECIGO, if they are running for 4 years. Given the predicted lensed gravitational wave events, one can estimate the constraints on the cosmological parameters via the lensing statistics and the time delay methods. With the lensing statistics method, the knowledge of the lens redshifts, even with the moderate uncertainties, will set the tight bound on the energy density parameter ΩM for matter, that is, 0.288 ≲ ΩM ≲ 0.314 at best. The constraint on the Hubble constant H0 can be determined using the time delay method. It is found out that at 5σ, |δH0|/H0 ranges from $3{{\ \rm per\ cent}}$ to $11{{\ \rm per\ cent}}$ for DECIGO, and B-DECIGO will give less constrained results, $8{{\ \rm per\ cent}}\ \mathrm{ to}\ 15{{\ \rm per\ cent}}$. In this work, the uncertainties on the luminosity distance and the time delay distance are set to be $10{{\ \rm per\ cent}}$ and $20{{\ \rm per\ cent}}$, respectively. The improvement on measuring these distances will tighten the bounds.
Stability of superthermal strahl electrons in the solar wind
Authors: Schroeder J M , Boldyrev S , Astfalk P 
Published: July 2021

ABSTRACT
We present a kinetic stability analysis of the solar wind electron distribution function consisting of the Maxwellian core and the magnetic-field aligned strahl, a superthermal electron beam propagating away from the sun. We use an electron strahl distribution function obtained as a solution of a weakly collisional drift-kinetic equation, representative of a strahl affected by Coulomb collisions but unadulterated by possible broadening from turbulence. This distribution function is essentially non-Maxwellian and varies with the heliospheric distance. The stability analysis is performed with the Vlasov–Maxwell linear solver leopard. We find that depending on the heliospheric distance, the core-strahl electron distribution becomes unstable with respect to sunward-propagating kinetic-Alfvén, magnetosonic, and whistler modes, in a broad range of propagation angles. The wavenumbers of the unstable modes are close to the ion inertial scales, and the radial distances at which the instabilities first appear are on the order of 1 au. However, we have not detected any instabilities driven by resonant wave interactions with the superthermal strahl electrons. Instead, the observed instabilities are triggered by a relative drift between the electron and ion cores necessary to maintain zero electric current in the solar wind frame (ion frame). Contrary to strahl distributions modelled by shifted Maxwellians, the electron strahl obtained as a solution of the kinetic equation is stable. Our results are consistent with the previous studies based on a more restricted solution for the electron strahl.
An approximation for the capture radius of gaseous protoplanets
Authors: Valletta Claudio , Helled Ravit 
Published: July 2021

ABSTRACT
Determining the heavy-element accretion rate of growing giant planets is crucial for understanding their formation and bulk composition. The solid (heavy-element) accretion rate should be carefully modelled during the various stages of giant planet formation and therefore the planetary capture radius must be determined. In some simulations that model the heavy-element accretion rate, such as in N-body simulations, the presence of the gaseous envelope is either neglected or treated in an oversimplified manner. In this paper, we present an approximation for the capture radius that does not require the numerical solution of the stellar structure equations. Our approximation for the capture radius works extremely well for various planetesimal sizes and compositions. We show that the commonly assumed constant density assumption for inferring the capture radius leads to a large error in the calculated capture radius and we therefore suggest that our approximation should be implemented in future simulations.