bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of an Interdisciplinary Goals-of-Care Program Among Medical Inpatients at a Comprehensive Cancer Center During the COVID-19 Pandemic: A Propensity Score Analysis
Authors: Hui David , Nortje Nico , George Marina , Wilson Kaycee , Urbauer Diana L. , Lenz Caitlin A. , Wallace Susannah Kish , Andersen Clark R. , Mendoza Tito , Haque Sajid , Ahmed Sairah , Delgado-Guay Marvin , Dalal Shalini , Rathi Nisha , Reddy Akhila , McQuade Jennifer , Flowers Christopher , Pisters Peter , Aloia Thomas , Bruera Eduardo 
Published: October 2022

PURPOSE Many hospitals have established goals-of-care programs in response to the coronavirus disease 2019 pandemic; however, few have reported their outcomes. We examined the impact of a multicomponent interdisciplinary goals-of-care program on intensive care unit (ICU) mortality and hospital outcomes for medical inpatients with cancer. METHODS This single-center study with a quasi-experimental design included consecutive adult patients with cancer admitted to medical units at the MD Anderson Cancer Center, TX, during the 8-month preimplementation (May 1, 2019-December 31, 2019) and postimplementation period (May 1, 2020-December 31, 2020). The primary outcome was ICU mortality. Secondary outcomes included ICU length of stay, hospital mortality, and proportion/timing of care plan documentation. Propensity score weighting was used to adjust for differences in potential covariates, including age, sex, cancer diagnosis, race/ethnicity, and Sequential Organ Failure Assessment score. RESULTS This study involved 12,941 hospitalized patients with cancer (pre n = 6,977; post n = 5,964) including 1,365 ICU admissions (pre n = 727; post n = 638). After multicomponent goals-of-care program initiation, we observed a significant reduction in ICU mortality (28.2% v 21.9%; change −6.3%, 95% CI, −9.6 to −3.1; P = .0001). We also observed significant decreases in length of ICU stay (mean change −1.4 days, 95% CI, −2.0 to −0.7; P < .0001) and in-hospital mortality (7% v 6.1%, mean change −0.9%, 95% CI, −1.5 to −0.3; P = .004). The proportion of hospitalized patients with an in-hospital do-not-resuscitate order increased significantly from 14.7% to 19.6% after implementation (odds ratio, 1.4; 95% CI, 1.3 to 1.5; P < .0001), and do-not-resuscitate order was established earlier (mean difference −3.0 days, 95% CI, −3.9 to −2.1; P < .0001). CONCLUSION This study showed improvement in hospital outcomes and care plan documentation after implementation of a system-wide, multicomponent goals-of-care intervention.
Health Care Professionals' Perspectives on Implementation, Adoption, and Maintenance of a Community Health Worker–Led Advance Care Planning and Cancer Symptom Screening Intervention: A Qualitative Study
Authors: Patel Manali I. , Murillo Ariana , Agrawal Madhuri , Coker Tumaini 
Published: October 2022

PURPOSE: Advance care planning (ACP) and symptom screening are nationally recommended for all patients with advanced stages of cancer. Yet, routine delivery of such care remains challenging because of multilevel barriers. We hired and trained community health workers (CHWs) to assist with delivery of these services across the United States. The aim of this study was to explore health care professionals' perspectives on barriers and facilitators to these team-based approaches. METHODS: We conducted semistructured interviews with 44 health care professionals in 21 cancer clinics in seven US cities using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We recorded, transcribed, and analyzed interviews using the framework analysis approach. RESULTS: Participants noted barriers and facilitators to implementation, adoption, and maintenance of CHW-led ACP and symptom management approaches. Participants were initially skeptical; however, they noted a positive shift in their views over time because of personal experiences and effectiveness in their clinics. There was significant variation in adoption with some using a prescriptive top-down approach and others a bottom-up approach. Most agreed that the combination of top-down and bottom-up approaches would be most efficient and effective for promoting team-based care. All participants discussed implementation and provided suggestions for maintenance including organizational support, leadership, and CHW retention. CONCLUSION: CHW-led ACP and proactive symptom management interventions are effective and accepted by cancer care professionals at scale. Tailoring on the basis of organization and local contexts is required to ensure successful adoption, implementation, and maintenance of these effective team-based care delivery approaches.
Metformin's Impact on the Microvascular Response to Insulin
Authors: Love Kaitlin M , Barrett Eugene J , Horton William B 
Published: October 2022

Abstract
Metformin improves insulin's action on whole-body glucose metabolism in various insulin-resistant populations. The detailed cellular mechanism(s) for its metabolic actions are multiple and still incompletely understood. Beyond metabolic actions, metformin also impacts microvascular function. However, the effects of metformin on microvascular function and microvascular insulin action specifically are poorly defined. In this mini-review, we summarize what is currently known about metformin's beneficial impact on both microvascular function and the microvascular response to insulin while highlighting methodologic issues in the literature that limit straightforward mechanistic understanding of these effects. We examine potential mechanisms for these effects based on pharmacologically dosed studies and propose that metformin may improve human microvascular insulin resistance by attenuating oxidative stress, inflammation, and endothelial dysfunction. Finally, we explore several important evidence gaps and discuss avenues for future investigation that may clarify whether metformin's ability to improve microvascular insulin sensitivity is linked to its positive impact on vascular outcomes.
Oral Dantrolene for Myopathic Symptoms in Malignant Hyperthermia–Susceptible Patients: A 25-Year Retrospective Cohort Study of Adverse Effects and Tolerability
Authors: Ibarra Moreno Carlos A. , Kraeva Natalia , Zvaritch Elena , Jungbluth Heinz , Voermans Nicol C. , Riazi Sheila 
Published: October 2022

BACKGROUND:
Patients susceptible to malignant hyperthermia (MH) may experience disabling manifestations of an unspecified myopathy outside the context of anesthesia, including myalgia, fatigue, or episodic rhabdomyolysis. Clinical observations suggest that oral dantrolene may relief myopathic symptoms in MH-susceptible (MHS) patients. However, high-dose oral dantrolene has been associated with severe hepatotoxicity.

METHODS:
In a retrospective database review (1994–2018), we investigated a cohort of patients who were diagnosed as MHS by a positive caffeine-halothane contracture test (CHCT), had myopathic manifestations, and received oral dantrolene. Our aim was to investigate the occurrence of serious adverse effects and the adherence to oral dantrolene therapy. We also explored factors associated with self-reported clinical improvement, considering as nonresponders patients with intolerable adverse effects or who reported no improvement 8 weeks after starting treatment.

RESULTS:
Among 476 MHS patients with positive CHCT, 193 had muscle symptoms, 164 started oral dantrolene, 27 refused treatment, and 2 were excluded due to abnormal liver function before starting therapy. There were no serious adverse effects reported. Forty-six of 164 patients (28%; 95% confidence interval [CI], 22%–35%) experienced mild to moderate adverse effects. Twenty-two patients (22/164, 13%; 95% CI, 9%–19%) discontinued treatment, among which 16 due to adverse effects and 6 due to lack of improvement. One hundred forty-two patients (87%; 95% CI, 80%–90%) adhered to therapy and reported improvement of myalgia (n = 78), fatigue (n = 32), or rhabdomyolysis/hiperCKemia (n = 32). The proportion of responders was larger among patients with MH history than among those referred due to a clinical myopathy with nonpertinent anesthetic history (97% vs 79%, respectively; 95% CI of the difference, 8.5–28; P < .001). Patients with a sarcoplasmic reticulum Ca2+ release channel ryanodine receptor gene (RYR1) variant had higher odds of responding to dantrolene treatment (OR, 6.4; 95% CI, 1.3–30.9; P = .013). Dantrolene median dose was 50 (25–400) and 200 (25–400) mg·day–1 in responders and nonresponders, respectively.

CONCLUSIONS:
We found that oral dantrolene produced no serious adverse effects within the reported dose range, and was well tolerated by most MH-susceptible patients presenting myopathic symptoms. Our study provides dosing and adverse effect data as a basis for further randomized controlled clinical trials to determine the efficacy of oral dantrolene for symptomatic relief in MHS-related myopathies.
The effects of training, acute exercise and dietary fatty acid composition on muscle lipid oxidative capacity in European starlings
Authors: Price Edwin R. , Bauchinger Ulf , McWilliams Scott R. , Boyles Michelle L. , Langlois Lillie A. , Gerson Alexander R. , Guglielmo Christopher G. 
Published: October 2022

ABSTRACT
Migratory birds undergo seasonal changes to muscle biochemistry. Nonetheless, it is unclear to what extent these changes are attributable to the exercise of flight itself versus endogenous changes. Using starlings (Sturnus vulgaris) flying in a wind tunnel, we tested the effects of exercise training, a single bout of flight and dietary lipid composition on pectoralis muscle oxidative enzymes and lipid transporters. Starlings were either unexercised or trained over 2 weeks to fly in a wind tunnel and sampled either immediately following a long flight at the end of this training or after 2 days recovery from this flight. Additionally, they were divided into dietary groups that differed in dietary fatty acid composition (high polyunsaturates versus high monounsaturates) and amount of dietary antioxidant. Trained starlings had elevated (19%) carnitine palmitoyl transferase and elevated (11%) hydroxyacyl-CoA dehydrogenase in pectoralis muscle compared with unexercised controls, but training alone had little effect on lipid transporters. Immediately following a long wind-tunnel flight, starling pectoralis had upregulated lipid transporter mRNA (heart-type fatty acid binding protein, H-FABP, 4.7-fold; fatty acid translocase, 1.9-fold; plasma membrane fatty acid binding protein, 1.6-fold), and upregulated H-FABP protein (68%). Dietary fatty acid composition and the amount of dietary antioxidants had no effect on muscle catabolic enzymes or lipid transporter expression. Our results demonstrate that birds undergo rapid upregulation of catabolic capacity that largely becomes available during flight itself, with minor effects due to training. These effects likely combine with endogenous seasonal changes to create the migratory phenotype observed in the wild.
Highly Ordered Monolayers of an Optically Active Amphiphilic Pyrene Derivative at the Air–Water Interface
Authors: Negi Shigeru , Hamori Mami , Kitagishi Hiroaki , Kano Koji 
Published: October 2022

Abstract
To study the possibility of controlling molecular assemblies such as monolayers by using chirality, we synthesized 1-[1-(6-stearyl)pyrenyl]ethanol (SP6E), a novel amphiphilic molecule with a chiral center in the hydrophilic part and a pyrene ring in the long-chain alkyl backbone. The structures of racemic and optically active monolayers of SP6E were characterized using the π–A isotherm and analyzed by Brewster angle microscopy, surface fluorescence spectroscopy, and atomic force microscopy (AFM). The results showed that (±)-SP6E formed solid solution-like monolayers without any regular structure. By contrast, a one-dimensional columnar structure was observed in the (S)-(−)-SP6E monolayer by AFM, thereby confirming the formation of a relatively controlled monolayer structure. The successful structural control in (S)-(−)-SP6E is considered achieved through the cooperative effects of chirality and π–π stacking of the pyrene ring. Thus, this study demonstrates the possibility of controlling the structure and orientation of molecular assemblies by appropriately combining chirality and other intermolecular interactions based on molecular design. This approach is a promising strategy for developing surface materials and interfacial nanoarchitectonics with precisely controlled molecular orientations.
Synthesis, Properties, and Intermolecular Interactions in the Solid States of π-Congested X-Shaped 1,2,4,5-Tetra(9-anthryl)benzenes
Authors: Nishiuchi Tomohiko , Takeuchi Shino , Makihara Yuta , Kimura Ryo , Saito Shohei , Sato Hiroyasu , Kubo Takashi 
Published: October 2022

AbstractA Negishi coupling based synthesis of 1,2,4,5-tetra(9-anthryl)benzene derivatives, possessing X-shaped molecular structures, is described. The results of X-ray crystallographic analysis show that two-dimensional highly ordered packing structure of the crystalline state of the unsubstituted derivative is a consequence of intermolecular π-π and CH-π interactions between anthracene units. Photoirradiation of the unsubstituted derivative as a precipitated solution promotes intramolecular [4+4] photocycloaddition reactions between both adjacent pairs of anthracene units to produce a crystalline polycyclic product having a unique 1.700 Å long carbon-carbon single bond. Furthermore, charge-transfer complexes, displaying near-infrared absorption and emission, are generated by co-crystallization of the X-shaped unsubstituted member of the group with electron-acceptor molecules.
Risk factors for the incomplete immunization of children of health workers at a tertiary referral hospital in Surabaya, Indonesia
Authors: Puspitasari Yunita , Husada Dominicus , Utomo Budi , Endaryanto Anang , Prasetyo Risky Vitria , Martini Santi 
Published: October 2022

Background: Health workers as role models play a key role in increasing immunization coverage. The coverage of complete basic immunization in the city of Surabaya is 98.1%, a figure not similar to the incidences of infectious diseases that can be prevented by immunization. This study aims to determine the risk factors for incomplete immunization of the children of health workers. Methods: A case-control questionnaire study comparing incompletely immunized children (case group) and completely immunized children (control group) was done. Participants were children of health workers at a tertiary referral hospital in Surabaya. We conducted interviews and distributed and collected questionnaires from December 2021 to April 2022. Bivariate and multivariate analyses were conducted using the Pearson chi-square test and binary logistic regression. Results: Overall, 148 questionnaires were distributed, 33 of which were excluded due to incomplete data. Therefore, 115 health workers’ children were eligible participants. 62 participants (53.9%) made up the case group, while the control group consisted of 53 participants (46.1%). The average age of the children was 12.5 months, 51.3% were boys and 48.7% were girls. The parental age, parental knowledge, mother's education, and the presence of the coronavirus disease 2019 (COVID-19) pandemic has a significant association with the children’s immunization status with p-values of 0.043, 0.005, 0.002, and p < 0.001, respectively. The children of health workers with a low level of knowledge are 4.8 times more likely to be incompletely immunized (OR 4.887, 95% CI 1.346–35.152). In addition, the possibility of the incomplete immunization of a child is eight times higher for a low-income family (OR 8.679; 95% CI 1.429–52.701). Conclusions: Low levels of parental knowledge and income are associated with the occurrence of incomplete immunization among the children of health workers at a tertiary referral hospital in Surabaya.
Quantum network security dependent on the connection density between trusted nodes
Authors: Gaidash Andrei , Miroshnichenko George , Kozubov Anton 
Published: October 2022

Besides true quantum repeaters, a trusted node paradigm seems to be inevitable for practical implementations (at least in the short term), and one should consider configurations of trusted nodes as the basis for global quantum networks. In this paper, we estimate how the introduction of additional connections between trusted nodes through one, two, etc., nodes (i.e., connection density) to a quantum network with serial connections of trusted nodes affects its security. We provide proper scaling of the failure probability of authentication and quantum key distribution protocols to the level of the whole quantum network. Expressions of the failure probability dependent on the total number of connected nodes between users and the connection density for the given mean failure probability of each element are derived. The result provides an explicit trade-off between an increase of key transport security and a consequent increase of spent resources. We believe that the obtained result may be useful for both the design of future networks and optimization of existing ones.
A descriptive analysis of calls to the NSW Teratogen Information Service regarding use of anti-infectives during pregnancy
Authors: Ritchie Helen E. , Hegedus Elizabeth , Ma Joanne , Kennedy Debra 
Published: October 2022

Background
MotherSafe is a free telephone-based counseling service for Australian consumers and health-care providers concerned about drug exposures during pregnancy and breastfeeding. Anti-infectives are the most commonly prescribed drugs for pregnant women. This study aims to provide a descriptive analysis of prospectively collected calls received by MotherSafe regarding anti-infective exposures during pregnancy between 2000 and 2020. Aggregate data were examined by type of caller, reason for call, pregnancy category and exposure type. Inductive thematic analysis of the comments recorded by MotherSafe counsellors at the time of call was undertaken.

Results
Over the study period, 25,890 calls related to exposure to anti-infectives during pregnancy (antibiotic, antiviral, and antifungal medications). Calls from patients were dominated by low-risk exposures (pregnancy category A) to drugs while calls from health care professionals related to drugs with limited human information (pregnancy category B3). Analysis of MotherSafe counsellor comments revealed over 200 instances of concerns relating to health care professional advice to the patient. Three themes emerged: incorrect or conflicting advice, poor counselling, and refusal to treat, prescribe or dispense. It is likely that these comments are biased to the negative as patients would not call MotherSafe if they were happy with HCP advice. However, the findings are concerning as they reveal an underlying lack of knowledge in some health care professionals which may have led to undertreatment of patients. This study reinforced the importance of Teratogen Information Services such as MotherSafe in providing counselling and clear communication of evidence-based information to guide decision-making, reducing potential emotional distress in pregnant women, and optimizing maternal, pregnancy and infant outcomes.
A GC-MC analysis of chemical compounds and identification of the antibacterial characteristics of the essential oil of two species exclusive to Iranian habitats: New chemotypes
Authors: Ghavam Mansureh 
Published: October 2022

Background
The diversity found in the chemical compounds of a single species in different regions results in different biologic characteristics which can be considered as a strong source for identifying new chemotypes. Hymenocrater incanus Bunge and Dracocephalum kotschyi Boiss. are exclusive species of the Lamiaceae family which grow in the western and central habitats of Iran. This study was designed and carried out to determine the yield, identify the chemical compounds, and evaluate the antimicrobial characteristics of the essential oil (EO) of these two species in Iran for the first time.

Methods
The flowering twigs of the species D. kotschyi and H. incanus were collected from the villages of Totmach and Kamu in Isfahan province respectively, in May 2019. The EO of these plants was extracted and separated using the water distillation method, utilizing the Clevenger device. The EO compounds were analyzed using a gas chromatograph coupled with a mass spectrometer (GC-MS). The evaluation of antimicrobial characteristics was carried out by determining the growth inhibition zone implementing the Agar method, the minimum inhibition concentration (MIC), and the minimum bactericidal/fungicidal concentration (MFC/MBC) utilizing liquid dilution culture.

Results
The results indicated that the highest yield belonged to the EO of D. kotschyi at %2.6 (w/w). In this EO there were citral (%25.44), neral (%20.87), α-pinene (%14.48), trans-geranic acid methyl ester (%9.74), and D-limonene (%6.87). Moreover, H. incanus had the dominant compounds (-)-Spathulenol (%12.61), caryophyllene (%10.00), linolenic acid (%8.54), 1,8-cineole (%5.95), palmitic acid (%5.35), and α-cadinol (%5.17). The largest diameter of growth inhibition zone belonged to the H. incanus EO against the Gram-positive bacteria S. pyogenes (~17.67mm). The strongest inhibition activities in the form of growth inhibition diameter exhibited by the D. kotschyi EO were against the Gram-negative bacteria S. paratyphi-A serotype (~ 12 mm), K. pneumoniae, and Sh. dysenteriae (~ 11 mm) which was significant compared to the Gram-positive rifampin (~ 8 mm).

Conclusions
It can be seen that these species are new chemotypes with special and novel chemical compounds which can potentially be used to manufacture natural antibiotics against some bacterial strains.
Prognostic value of FOXP3+ regulatory T cells for patients with locally advanced oropharyngeal squamous cell carcinoma
Authors: Hur Joon Young , Ku Bo Mi , Park Sehhoon , Jung Hyun Ae , Lee Se-Hoon , Ahn Myung-Ju 
Published: October 2022

BackgroundOropharyngeal squamous cell carcinoma (OPSCC) is the most common neoplasm originating at the base of the tongue or in the tonsils or soft palate. In this study, we investigated the prognostic value of FOXP3+ regulatory T cells in OPSCC.MethodsTumor tissues of patients with locally advanced OPSCC were analyzed using quantitative multiplex immunohistochemistry. Staining of CD8+ T cells, conventional CD4+FOXP3- T cells (Tconv cells), CD4+FOXP3+ regulatory T cells (Treg cells), CD20+ B cells, and CD68+ macrophages was performed, and cell density was evaluated in both the tumor and its stroma.ResultsAmong the 71 patients included in this study, males constituted 93.0% of the cohort, and the median age was 59 years (range: 42–80 years). A total of 56 patients (78.9%) had a smoking history, and 53 (74.6%) patients were positive for human papillomavirus (HPV). The most frequent site of OPSCC was the tonsils (70.4%), followed by the base of the tongue (25.4%). The proportion of Treg cells was lower in the tumors of patients with HPV than in those of patients without HPV. Patients with OPSCC whose tumor Treg cell levels were above the median had longer relapse-free survival (RFS) periods than those with tumor Treg cell levels below the median (HR, 0.12; 95% CI, 0.03–0.46; p = 0.02). Our multivariate analysis identified high Treg levels (HR, 0.13; 95% CI, 0.02–1.00; p = 0.05) as an RFS factor that predicted a good prognosis.ConclusionsOur results demonstrated that high Treg cell density in locally advanced OPSCC tumors was correlated with longer RFS.