bluuebunny/crossref_metadata_2025_split huggingface dataset:
Competitive Effects of Fixed Wireless Access on Wireline Broadband Technologies
Authors: Singer Hal J. , Urschel Augustus H. 
Published: May 2024

Abstract
In this paper, we investigate the potential consumer savings to U.S. home broadband consumers in cable modem monopoly markets, should fixed wireless access technologies become available as a competitive alternative. We use a Choice-Based Conjoint survey and Hierarchical Bayes estimation to calculate the proportion of home broadband consumers that would switch to a fixed wireless access option if it was made available in a cable modem monopoly market. We then utilize a monopoly pricing model to estimate the downward pricing pressure this competition would place on incumbent cable modem monopoly prices. We find that fixed wireless entry at current prices would convert 18 percent of cable-only households and lead to a 37 percent reduction in the price of cable modem service. We also find entry into non-monopoly markets where a fiber-optic broadband alternative already exists, and find muted conversion rates and price reductions. Our results indicate that the deployment of fixed-wireless access would generate substantial consumer savings in cable modem monopoly markets, which constitute 30 precent all cable modem subscribers in the United States.
Enhancement of turbulent heat transfer by using CuO nano-particle and twisted tape
Authors: Mohammed Ali J. , Ali Hussein Hayder Mohammed , Barrak Anwar S. , Hussein A. M. , Mohammed Murad Ramadan 
Published: May 2024

AbstractA computational model is developed to investigate the convective heat transfer properties and the fluid flow characteristics of cupric oxide - water nano-fluid in a horizontal circular pipe aiming to provide insights into optimizing heat transfer in such systems. A twisted tape with varied twist ratios is inserted. This quantitative investigation used five Reynolds number from 4,000 to 12,000 under a uniform heat flux scenario of 25,000 W m−2. All experiments were performed as a single-phase fluid with cupric oxide values of 0, 0.4, 1, and 2% by volume. By reducing the twist ratio and increasing volume concentration, the average heat transfer coefficient of cupric oxide-water nano-fluid was improved. For a twist ratio of 4D, the maximum heat transfer improvement was 228% greater than the plain pipe. The presence of twisted tape with modest step ratios causes the friction factor to grow.
The updated design of university libraries in the digital era
Authors: Liu ShaSha , Liu He , Kovács-Andor Krisztián 
Published: May 2024

AbstractWith the rise of the digital era, digital reading and learning have become widespread. University libraries, as core locations for study and communication, face challenges in fully meeting the demands of modern teaching and learning. This paper takes the library at the Changqing campus of Shandong University of Arts as a case study to explore the environmental space design of constructed libraries in the digital era. By reviewing relevant concepts and theoretical frameworks, analyzing the existing environment, and researching intervention design methods, the paper discusses the positive role of adapting to the digital future in renovating established library spaces.
Individualized Risk of CKD Progression among US Adults
Authors: Tio Maria Clarissa , Butler Javed , Zhu Xiaoqian , Obi Yoshitsugu , Yen Timothy E. , Kalantar-Zadeh Kamyar , Streja Elani , Dossabhoy Neville R. , Hall Michael E. , Shafi Tariq 
Published: May 2024

Key Points

A total of 8.42 million US adults have high CKD progression risk, and 4.77 million of them have eGFR >60 ml/min per 1.73 m2.An individual's absolute risk of CKD progression is important in the diagnosis and prognostication of CKD.

Background
CKD is currently defined using GFR or albuminuria. This is on the basis of the relative risk of mortality and kidney outcomes compared with a healthy population and does not consider an individual's absolute risk of CKD progression.

Methods
Using National Health and Nutrition Examination Survey data from 1999 to 2020, we characterized the individual-level absolute 3-year risk of ≥40% decline in eGFR (ml/min per 1.73 m2) or kidney failure (3-year risk) among US adults. We categorized the 3-year risk and considered ≥5% as high risk.

Results
Among 199.81 million US adults, 8.42 million (4%) had a 3-year risk ≥5%, including 1.04 million adults without CKD (eGFR ≥60 and albuminuria <30 mg/g). These high-risk adults without CKD as currently defined had risk factors including hypertension (98%), heart failure (72%), and diabetes (44%). A total of 15.51 million adults had CKD with preserved eGFR (eGFR ≥60 and albuminuria ≥30 mg/g)—3.73 million had a 3-year risk ≥5%, 41% of whom did not have diabetes and thus would not be screened for albuminuria using current screening recommendations. The 3-year risk of CKD progression was low (risk <5%) in 94% of the 5.66 million US adults with CKD stage G3a-A1 (eGFR 45 to <60 and albuminuria <30 mg/g).

Conclusions
Assessment of the individual's absolute risk of CKD progression allowed further risk stratification of patients with CKD and identified individuals without CKD, as currently defined, who were at high risk of CKD progression.

Podcast
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2024_06_18_ASN0000000000000377.mp3
Modernizing public health communication competencies in Canada: A survey of the Canadian public health workforce
Authors: McAlpine Devon , MacKay Melissa , Grant Lauren E. , Papadopoulos Andrew , McWhirter Jennifer E. 
Published: May 2024

Abstract
Objectives
Since the publication of the Core Competencies for Public Health in Canada in 2008, the public health and communication landscape has changed dramatically. Digital media and infodemics have shifted how practitioners must communicate and respond to health information. The age of the current competency framework, which is relied on for workforce development, alongside emerging public health challenges, have prompted calls for modernized competency statements. This study aims to (i) measure self-reported communication competence in the public health workforce, (ii) measure agreement with new communication competency statements, (iii) identify variation in agreement between sub-groups of professionals, and (iv) explore current and needed communication training.

Methods
Using a mixed-methods online survey, a sample of 378 participants in various Canadian public health roles and regions were asked to rate their current communication competence and agreement with a modernized, evidence-based draft communication competency framework. The survey was distributed in both official languages through partner organizations and social media. Descriptive statistics were performed to assess agreement and variation was analyzed in relation to public health roles and experience.

Results
While most participants self-reported communication competence, specific areas were rated lower. All 21 proposed competency statements received high agreement with some variation observed between expertise and experience levels. Demand for communication training is high.

Conclusion
Strong agreement with statements indicates support for a modernized communication competency framework among sampled professionals. Research to gather more evidence surrounding the communication demands of the public health workforce and observed variation in strong agreement for the proposed statements is underway.
Low-Dose Aspirin Is the Safest Prophylaxis for Prevention of Venous Thromboembolism After Total Knee Arthroplasty Across All Patient Risk Profiles
Authors: Lavu Monish S. , Porto Joshua R. , Hecht Christian J. , Acuña Alexander J. , Kaelber David C. , Parvizi Javad , Kamath Atul F. 
Published: May 2024

Background:
The International Consensus Meeting on Venous Thromboembolism (ICM-VTE) in 2022 proclaimed low-dose aspirin as the most effective agent in patients across all risk profiles undergoing joint arthroplasty. However, data on large patient populations assessing trends in chemoprophylactic choices and related outcomes following total knee arthroplasty (TKA) remain scant. The present study was designed to characterize the clinical use of various chemoprophylactic agents in patients undergoing TKA and to determine the efficacy of aspirin compared with other agents in patient groups stratified by VTE risk profiles.

Methods:
This study utilized a national database to determine the proportion of patients undergoing TKA who received low-dose aspirin versus other chemoprophylaxis between 2012 and 2022. VTE risk profiles were determined on the basis of comorbidities established in the ICM-VTE. The odds ratios (ORs) and 95% confidence intervals (CIs) between various classes of thromboprophylaxis in patients with high and low risk of VTE were calculated. The odds of deep-vein thrombosis (DVT), pulmonary embolus (PE), bleeding events, infections, mortality, and hospitalizations were also assessed in the 90-day postoperative period for propensity-matched cohorts receiving low-dose (81 mg) aspirin only versus other prophylaxis, segregating patients by VTE risk profile.

Results:
A total of 126,692 patients undergoing TKA across 60 health-care organizations were included. The proportion of patients receiving low-dose aspirin increased from 7.65% to 55.29% between 2012 and 2022, whereas the proportion of patients receiving other chemoprophylaxis decreased from 96.25% to 42.98%. Low-dose-aspirin-only use increased to approximately 50% in both high-risk and low-risk populations but was more likely in low-risk populations (OR, 1.17; 95% CI, 1.15 to 1.20) relative to high-risk populations. Both low-risk and high-risk patients in the low-dose-aspirin-only cohorts had decreased odds of DVT, PE, bleeding, infections, and hospitalizations compared with other prophylaxis regimens.

Conclusions:
The findings of the present study on a very large population of patients undergoing TKA support the recent ICM-VTE statement by showing that low-dose aspirin is a safe and effective method of prophylaxis in patients across various risk profiles.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Development of Cost-IS (costing implementation strategies) instrument for digital health solutions: a modified e-Delphi study
Authors: Donovan Thomasina , Abell Bridget , McPhail Steven M , Carter Hannah E 
Published: May 2024

Abstract

Background: It is important to determine the relative value for money of health innovations when allocating limited healthcare resources. Implementation strategies require and consume healthcare resources yet are often excluded from published economic evaluations. This paper reports on the development of a pragmatic implementation costing instrument to assist with the planning, delivery, and evaluation of digital health implementation strategies.
Methods: A modified e-Delphi process was adopted to develop an implementation costing instrument. Purposive sampling was used to recruit a panel of experts in implementation science, health economic evaluations and/or digital health from the academic, government, clinical or health service sectors. In each round, participants were sent an electronic questionnaire and a prototype of the implementation costing instrument. The prototype in the initial round was informed from a literature review and qualitative interview findings. The prototype was updated iteratively between rounds in response to the panel’s feedback. In subsequent rounds, participants also received the anonymous results of items that did not reach consensus in the previous round. Termination occurred once consensus was reached on integral questions (those pertaining specifically to the instrument design) or when three rounds were completed, to prevent sample fatigue. Consensus was defined as at least 75% of experts in agreement for any item.
Results: Consensus was reached on the core components and design of the instrument from a panel of twelve experts in implementation science, health economic evaluations and/or digital health. Areas where consensus was not reached included users’ level of implementation science knowledge, specificity of the tool to digital health and accessibility via digital formats.
Conclusions: Cost-IS is a pragmatic data collection instrument designed to estimate the costs of implementation strategies and activities. Further piloting of Cost-IS is required to establish its feasibility and generalisability.
Critical risk factors analysis of infection-associated hemophagocytic lymphohistiocytosis in children
Authors: Hao Gailing , Geng Wenjin , Li Chunzhen , Li Quanheng , Zhang Nan , Jiang Lian 
Published: May 2024

Abstract

Objective: To analyze the critical factors of infection-associated Hemophagocytic lymphohistiocytosis (HLH) in children, so as to provide theoretical basis for clinicians to evaluate the disease condition, formulate treatment plan and improve prognosis.
Methods: This study is a retrospective analysis. 60 cases of children with infection-associated HLH were divided into critical and non-critical groups based on the presence of multiple organ dysfunction syndrome (MODS), and the clinical characteristics and laboratory data of the two groups of children were analyzed. A multifactor logistic regression analysis model was used to assess the independent risk factors affecting critical illness in children with infection-associated HLH, and the Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the predictive value of risk factors for critical illness in children with infection-associated HLH.
Results: Children in the critical group with HLH had a younger age at onset. Alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), gamma-glutamyl transferase (GGT), D-dimer (DD), and triglycerides (TG) were significantly higher in the critical group, while albumin (ALB) was significantly lower, showing statistical significance (P<0.05). Multifactorial logistic regression analysis of age, ALB, and TG showed that younger age and lower ALB were associated with a higher risk of MODS in children with infection-associated HLH, with age and ALB being independent risk factors for critical illness. ALB predicted the ROC area under the curve for critical children with infection-associated HLH was 0.765 (95% CI: 0.643-0.888, P=0.011), with the optimal cut-off value being 32.50 g/L (sensitivity=68.3%, specificity=84.2%); age predicted the ROC area under the curve for critical children with infection-associated HLH was 0.711 (95% CI: 0.570-0.851, P=0.009), with the optimal cut-off value being 1.50 years (sensitivity=70.7%, specificity=68.4%).
Conclusion: Children with infection-associated HLH are prone to develop MODS. Early diagnosis and intervention are crucial for critically ill children with HLH. For young children and those with hypoalbuminemia, heightened vigilance is necessary to identify critical children early, implement effective treatment promptly, improve survival rates, and enhance prognosis.
Oral microbiome related blood borne bacterial DNA signature in toddlers is associated with elevated inflammatory cytokines and anti-viral IgGs
Authors: Arana Carlos , Pichilingue-Reto Patricia , Zhu Chengsong , Zhang Bo , Raman Indu , Relangi Tulasi Rao , Selvakumar Pratibha , Brock Matthew , Liu Yang , SoRelle Jeffrey , Tareen Naureen , Kahn Jeffrey , Copley Lawson A. , Hooper Lora V. , Raj Prithvi , Oers Nicolai van 
Published: May 2024

Abstract

Background.
Young children have frequent viral/bacterial infections and antibiotic exposures. Whether these events promote translocation of bacterial factors from oral cavity into the bloodstream remains poorly studied.
Method.
We performed 16S sequencing and immune profiling of blood in 210 healthy children of 1–2-year age range. Observed bacterial DNA signatures were analyzed in the context of host cytokine and antibody responses.
Results.
About 12% of toddlers showed a DNA signature related to oral commensals and pathogenic bacteria in their blood. These bacterial species included Streptococcus, Staphylococcus, Haemophilus, Deinococcus, Neisseria and Veillonella. Streptococcus had the most prominent (9%) signature. High resolution 16S rRNA sequencing revealed that majority of the observed signature belonged to commensal Streptococci including S. oralis, S. mitis, S. parasanguinis, and S. salivaris, S. pneumoniae. This signature was enriched in those with history of multiple bacterial and viral infections. Some children retained the Streptococcus DNA signature overtime. Serum IFN-γ, IL-1a, Il-1b, IL-6, and IL-8 were significantly associated with the observed Streptococcus DNA signature. Host transcriptome analysis showed upregulated antigen presentation and inflammatory pathways in Streptococcus DNA positive subset. Antibody repertoire profiling suggested that Streptococcus DNA positive was correlated with Influenza B and Respiratory Syncytial Virus (RSV) antibodies.
Conclusions.
A commensal Streptococci DNA signature was identified in the pediatric blood, which correlated with elevated inflammatory cytokines and anti-viral antibodies.
Drug-gene interactions in older patients with coronary artery disease
Authors: Zhang Shizhao , Lv Chao , Dong Lisha , Wu Yangxun , Yin Tong 
Published: May 2024

Abstract

Background: Older patients with coronary artery disease (CAD) are particularly vulnerable to the efficacy and adverse drug reactions, and may therefore particularly benefit from personalized medication. Drug–gene interactions (DGIs) occur when an individual’s genotype affects the pharmacokinetics and/or pharmacodynamics of a victim drug.
Objectives: This study aimed to investigate the impact of cardiovascular-related DGIs on the clinical efficacy and safety outcomes in older patients with CAD.
Methods: Hospitalized older patients (≥65 years old) with CAD were consecutively recruited from August 2018 to May 2022. Eligible patients were genotyped for the actionable pharmacogenetic variants of CYP2C9, CYP2C19, CYP2D6, CYP3A5, and SLCO1B1, which had clinical annotations or implementation guidelines for cardiovascular drugs. Allele frequencies and DGIs were determined in the cohort for the 5 actionable PGx genes and the prescribed cardiovascular drugs. All patients were followed up for at least 1 year. The influence of DGIs on the cardiovascular drug-related efficacy outcomes (all-cause mortality and/or major cardiovascular events, MACEs) and drug response phenotypes of “drug-stop” and “dose-decrease” were evaluated.
Results: A total of 1,017 eligible older patients with CAD were included, among whom 63.2% were male, with an average age of 80.8 years old, and 87.6% were administrated with polypharmacy (≥5 medications). After genotyping, we found that 96.0% of the older patients with CAD patients had at least one allele of the 5 pharmacogenes associated with a therapeutic change, indicating a need for a therapeutic change in a mean of 1.32 drugs of the 19 cardiovascular-related drugs. We also identified that 79.5% of the patients had at least one DGI (range 0–6).The median follow-up interval was 39 months. Independent of age, the number of drugs, comorbidities, hepatic and renal function, and drug-drug interaction, the number of DGIs was associated with decreased all-cause mortality (adjusted HR: 0.84, 95% CI: 0.73-0.96, P = 0.008), and MACEs (adjusted HR: 0.84, 95% CI: 0.72-0.98, P = 0.023), but increased drug response phenotypes (adjusted OR: 1.24, 95% CI: 1.05-1.45, P = 0.011) in the older patients with CAD.
Conclusions: The association between cardiovascular DGIs and the clinical outcomes emphasized the necessity for the integration of genetic and clinical data to enhance the optimization of cardiovascular polypharmacy in older patients with CAD.
Optimization of Demand Forecasting in the Supply Chain Management of Apparel Industry
Authors: Ranawaka Amalsha , Jawwadh Saadh 
Published: May 2024

Abstract

Accurate demand forecasting is a key component of a well-built supply chain management process in the ever-changing apparel industry, where precise predictions are vital for optimizing the production, inventory, and transportation levels. Traditional methods on numerous occasions fail to comprehensively understand the nature of this field, thus resulting in inefficiencies within the Sri Lankan apparel supply chain. The research answers this problem through the identification and development of the context-specific methods that are effective for enhanced demand forecasting in the apparel supply chain. The project explores the use of deep learning, particularly Long Short-Term Memory (LSTM) networks and their combinations with other models (CNN, ARIMA, BPNN) to develop a demand forecasting application. Experiments with six models identified a CNN-LSTM architecture as the optimal solution, achieving the lowest MAE of 2.9710, MAPE of 24.6802, MSE of 85.0358, and RMSE of 9.2215. Hyperparameter tuning and cross-validation were employed to optimize and validate the chosen model.
Unsustainable groundwater-fed irrigation drives deltaic water scarcity and compound flooding
Authors: Getirana Augusto , Biswas Nishan Kumar , kumar Sujay , Nie Wanshu , Ahmad Shahryar , Maina Fadji Zaouna , Sakib Nazmus , Hossain Md Sazzad , Biswas Robin Kumar 
Published: May 2024

Abstract

Southern Asia benefits from groundwater pumping for dry-season irrigation by increasing both crop productivity and monsoon aquifer recharge rates in the region. Based on a data-driven integrated modeling system, we provide numerical evidence that the impacts of unsustainable groundwater-fed irrigation surface freshwater availability go beyond what was previously understood. Our results confirm findings from previous studies that increased groundwater recharge rates during wet seasons over 2002-2021, but they are insufficient for aquifers to recover, gradually depleting groundwater across the Ganges-Brahmaputra-Meghna delta. Main findings are that such an increased recharge causes a drop in runoff generation during the monsoons, resulting in lower flood risk, a good outcome, but also less surface freshwater available for farming, which may trigger additional groundwater demand during monsoons. Drop in coastal flooding induced by groundwater-fed irrigation exceeds by ~5-10 fold the flooding increase caused by sea level rise. Reduced runoff also increases seawater intrusion, driven by less freshwater to push ocean water away. This is particularly concerning, since the region has been under rising sea levels and sinking lands. These findings over this delta have global implications, as humans and climate are increasingly pressuring coastal and deltaic ecosystems worldwide.