Excellence Initiative Research Articles

0378 Daytime PAP Accommodation: A Breath of Fresh Air

Abstract Introduction Rising healthcare costs and resource utilization represents a growing problem in the United States, especially for individuals with progressive neuromuscular disorders. Diagnosis and treatment of obstructive sleep apnea has been demonstrated to decrease healthcare resources in the general population; however, there is no well-defined approach to diagnosis and management of sleep-disordered breathing (SDB) in patients with neuromuscular disease (NMD). Many providers believe it best to diagnose and introduce positive airway pressure (PAP) support during a single overnight in-laboratory sleep study. Patients with NMD require a team with understanding of sleep physiology, complex pulmonary pathophysiology, disease process and progression, and advanced PAP therapy modes and indications. Optimal treatment requires patient and caregiver education, frequent monitoring of PAP data, ongoing evaluation of oxygenation and ventilation parameters, as well as assistance with device issues. We hypothesized a focused, personalized approach to managing patients with NMD will improve patient adherence to PAP therapy, nocturnal oxygenation, and ventilation, as well as limit hospital admissions. Methods 10 patients diagnosed with NMD (including muscular dystrophy, diaphragm paralysis, and scoliosis) presented to UPMC Montefiore sleep lab for daytime accommodation study with a pulmonary-sleep physician and dual-trained respiratory therapist-sleep technician. The visit included mask fitting, patient education, and initiation of PAP therapy with titration of bilevel pressure settings. Data collected included: pre- and 3-month-post nocturnal oxygen saturation and serum bicarbonate level; data download at 3 months including device usage, leak, average PAP pressures; and number of hospital admissions. Results All 10 patients demonstrated initiation of PAP therapy with usage on 100% of days for minimum of 6 hours per night. There was improvement in average nocturnal oxygen saturation and serum bicarbonate level after visit compared to prior. 3 patients were hospitalized in 6-12 months following, none for respiratory related reasons. Conclusion In this pilot study, an innovative daytime PAP accommodation study for patients with sleep-disordered breathing due to NMD results in excellent initiation and adherence to PAP therapy, as well as improvement in oxygenation and ventilation and minimal hospitalizations. Future studies are necessary including a larger randomized trial to demonstrate the safety and efficacy of home based NIV initiation. Support (If Any) NIH T32 HL082610-15, American Thoracic Society ASPIRE fellowship

The last challenge for living anionic polymerization of 1,3-cyclohexadiene with the s-butyllithium/cyclopentyl methyl ether system

A well-controlled anionic polymerization of 1,3-cyclohexadiene (1,3-CHD) with the alkyllithium (RLi)/ether system has been achieved for the first time. The type of ether was the predominant factor affecting the polymerization results. Optimization of the nucleophilicity and solubility of the initiator (system) and propagating species was also important for the polymerization reaction. An initiator system of sec -butyllithium ( s -BuLi)/cyclopentyl methyl ether (CPME) in toluene was found to be very effective for forming well-controlled polymer chains of poly(1,3-CHD), and living anionic polymerization was achieved. In this system, the polymer chains mainly consisted of 1,4-cyclohexadiene (1,4-CHD) units. It was confirmed that the s -BuLi/CPME system was a new example of living anionic polymerization of 1,3-CHD. • Living anionic polymerization of 1,3-CHD with the RLi/ether system has been achieved for the first time. • The s -BuLi/cyclopentyl methyl ether system is an excellent initiator system for living anionic polymerization of 1,3-CHD. • The combination of s -BuLi/cyclopentyl methyl ether is a new environmental-friendly and low-toxic initiator system. • This polymerization system enable the synthesis of well-controlled high molecular weight PCHD. • This system is the most effective for forming 1,4-CHD units in the well-controlled polymer chains of PCHD.

Well‐Controlled Living Polymerization of N‐Propargylamides and Their Derivatives by Rhodium Catalysis

AbstractA substantially improved method for living polymerization of N‐propargylamides and their derivatives has been developed. Rhodium(I) complexes bearing an aryl‐substituted 1,3,5‐hexatriene chain can work as excellent initiators of the polymerization of such non‐conjugated terminal alkynes to give the corresponding cis‐stereoregular polymers having a narrow molecular weight distribution. The typical living nature has been confirmed by investigating the effects of initial feed ratios of the monomer to the initiator on the molecular weight of the resulting polymers as well as multistage polymerization. Moreover, we demonstrated that the present method enables functionalization of both polymer chain ends and synthesis of novel block copolymers consisting of poly(N‐propargylamide) and poly(phenylacetylene) blocks with a narrow molecular weight distribution.

Well-Controlled Living Polymerization of N-Propargylamides and Their Derivatives by Rhodium Catalysis.

A substantially improved method for living polymerization of N-propargylamides and their derivatives has been developed. Rhodium(I) complexes bearing an aryl-substituted 1,3,5-hexatriene chain can work as excellent initiators of the polymerization of such non-conjugated terminal alkynes to give the corresponding cis-stereoregular polymers having a narrow molecular weight distribution. The typical living nature has been confirmed by investigating the effects of initial feed ratios of the monomer to the initiator on the molecular weight of the resulting polymers as well as multistage polymerization. Moreover, we demonstrated that the present method enables functionalization of both polymer chain ends and synthesis of novel block copolymers consisting of poly(N-propargylamide) and poly(phenylacetylene) blocks with a narrow molecular weight distribution.

When Is Product Personalization Profit-Enhancing? A Behavior-Based Discrimination Model

This paper investigates duopoly competition when horizontally differentiated firms are able to make personalized product-price offers to returning customers, within a behavior-based discrimination model. In the second period, firms can profile old customers according to their preferences, selling them targeted products at personalized prices. Product-price personalization (PP) allows firms to retain all old customers, eliminating second-period customer poaching. The overall profit effects of PP are shown to be ambiguous. In the second period, PP improves the matching between customers’ preferences and firms’ offers, but firms do not make any revenues in the rival’s turf. In the Bertrand outcome, second-period profits only increase for both firms if the size of their old turfs are not too different or initial products are not too differentiated. However, the additional second-period profits may be offset by lower first-period profits. PP is likely to increase firms’ overall discounted profits when consumers’ (firms’) discount factor is low (high) and firms’ initial products are exogenous and sufficiently different. When the location of initial products is endogenous, profits are hurt because of an additional location (strategic) effect aggravating head-to-head competition in the first period. Likewise, when a fraction of active consumers conceals their identity, PP increases second-period profits at the cost of aggressive first-period price competition. Finally, we show that the room for profitable PP enlarges considerably if firms rely on PP as an effective device to sustain tacit collusive outcomes, with firms credibly threatening to respond to first-period price deviations with second-period aggressive relocations of their standard products. This paper was accepted by Matthew Shum, marketing. Funding: D. Laussel gratefully acknowledges support by the French National Research Agency [Grant ANR-17-EURE-0020] and the Excellence Initiative of Aix-Marseille University [Grant A*MIDEX]. J. Resende was supported by Portuguese public funds [Project Reference NORTE-01-0145-FEDER-028540] and through FCT (Fundação para a Ciência e a Tecnologia) [Project Reference POCI-01-0145-FEDER-006890]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/mnsc.2022.4298 .

The Pivotal Role of Quality Technical Structures for Clinical Trials Oversight in the Achievement of Long-Term Capacity Strengthening Outcomes.

BackgroundDevelopment of safe and efficacious medicines in many sub-Sahara African countries remains hampered due to fragmented health research infrastructure and ineffective regulatory oversight. To boost the latter in the area of Clinical Trials (CT) Oversight (CTO), many international programs and Regional Centers for Regulatory Excellence (RCORE) initiatives offer various trainings to help strengthen human resource capacity. Here, we aimed at evaluating the training outcomes (at home-institution level) of sponsored fellows for one of such capacity strengthening interventions; a measure that is less often reported and thus remains poorly understood.MethodThe Global Health Protection Programme's VaccTrain project sponsored nine regulatory staff from eight National Medicines Regulatory Authorities (NMRAs) in sub-Saharan Africa for the RCORE CT Training Fellowship by FDA Ghana in a particular year. Using a systematized evaluation framework based on the theory of change, we assessed the individual- and NMRA-level achievement of pre-defined training outcomes. For this purpose, data was collected at pre-training and at short- and long-term evaluation time-points using a survey instrument.ResultsAt pre-training, our data revealed existence of differential expectations and orientations among the training participants, thus providing an early indication of potential distinctive patterns in achievement of desired training outcomes. In a short-term post-training follow-up evaluation, a two-group clustering of fellows based on the achievement of training outcomes where only one group (representing 44%) reported achievement of CTO-related outcomes was observed. At this time-point, achievement of training outcomes was associated with the vibrancy of CT activity and existence of a comprehensive technical structure for CTO. In a further long-term follow-up evaluation, our data revealed a successful achievement of CTO-related individual- and/or institutional-level outcomes in all but one fellow. Here again, availability of a robust technical structure for CTO (and perhaps fellow affiliation/selection)–but not CT vibrancy–showed a trend of temporal association with achievement of training outcomes.ConclusionGiven the pivotal role operational structures of international standards at home institutions play in translating training-acquired knowledge into measurable CTO-related outcomes, we encourage that capacity strengthening projects aimed at achieving health-related targets of Sustainable Development Goals adopt an approach built on this foundation.

High-efficient lignin-based polymerizable macromolecular photoinitiator with UV-blocking property for visible light polymerization

Developing high-efficient visible light macromolecular photoinitiator (macro PI) with excellent initiation performance, low migration, high biosafety and multi-function is beneficial to broaden the application of photopolymer. Lignin contains chromophores which could generate free radicals under light irradiation. In this study, a lignin-based polymerizable macro PI (DAL-11ene-amine) was designed and synthesized through covalent grafting 10-undecenoyl chloride (11ene) and hydrogen donor 4-(dimethylaminobenzoic acid) ethyl ester (EDAB) into dealkaline lignin (DAL) skeleton. The structure of DAL-11ene-amine was characterized by UV–vis, FTIR, 1H NMR, GPC, and 31P NMR spectra. Under the irradiation of a 405 nm LED, DAL-11ene-amine can directly produce active species and initiate the polymerization of acrylate monomers or thiol-ene click reaction. The photoinitiation efficiency of DAL-11ene-amine is higher than that of DAL-11ene or the two-component combination of DAL-11ene and EDAB. Using DAL-11ene-amine as PI, the prepared polymer films exhibit excellent UV-blocking property. With only 0.5 wt% addition of DAL-11ene-amine, nearly 100% of UVB + UVC and the most of UVA can be blocked by the films. Moreover, DAL-11ene-amine exhibits higher migration stability and biosafety because it can be covalently linked into polymer cross-linking networks. The results indicate that DAL-11ene-amine has great application potentials in preparing environmentally friendly UV-blocking films and biosafety coatings.

Controls on turnover of marine dissolved organic matter—testing the null hypothesis of purely concentration‐driven uptake: Comment on Shen and Benner, “Molecular properties are a primary control on the microbial utilization of dissolved organic matter in the ocean”

Controls on turnover of marine dissolved organic matter—testing the null hypothesis of purely concentration‐driven uptake: Comment on Shen and Benner, “Molecular properties are a primary control on the microbial utilization of dissolved organic matter in the ocean”

Enhancing Competitiveness of the Russian Higher Education: The 5-100 University Excellence Program through the Lens of Efficiency and Performance

ABSTRACT Recent decades have witnessed a distinct worldwide trend of launching national programs and projects to develop and expand a group of the so-called “world-class” universities with the aim of enhancing the quality and prestige of respective national systems of higher education. This article presents a case study that matches the results of 5–100 Project, an ambitious university excellence initiative in Russia (terminated in December 2020) against the originally set targets and criteria of success. In addition, the key elements of the project are compared to similar programs in other countries (e.g., the German Universities Excellence Initiative – Exzellenzinitiative). The following research questions determine the focus of the research efforts: (1) “What are the challenges in introducing university excellence programs in Russia and other countries? (2) What are the weaknesses of the program design and implementation? and 3) What strategy would likely ensure effective achievement of the program objectives?” Data are derived from published and unpublished materials, archival records, and interviews. Though primarily a comparative case study, this article offers implicit and explicit contributions to knowledge and literature on higher education systems worldwide. Institutional theory and resource dependence theory as well as political economy of “marketization” help frame a theoretical grounding for this primarily case study article. The undertaken study also seeks to contribute to the identification of key nationally and globally tied factors that define favorable conditions for enhancing excellence of higher educational institutions with measurable outcomes. It further outlines two major areas for further research on the subject.

Academia as a league system

In this paper, we explain the stability of top university ranks and discuss attempts to create top national universities. Firstly, it is shown theoretically that in a world with differently-gifted poor and rich students, a three-tier university system may become very stable, with a super league of the best research universities that attract the best students, whether rich or poor. Secondly, it is empirically demonstrated that half of the highest ranked universities enjoy very stable competitive advantages. Thirdly, we examine attempts of China, France and Germany to overcome these disadvantages and to get into this super league. The recent attempt of China to create such super league universities shows the financial and societal costs of these attempts. France demonstrates how the concentration of financial resources on two newly built universities that complement the forces of existing ones—either real or only by labelling—may succeed. Despite the complexly designed and competitive German Excellence Initiative, ongoing since 2004, no German university was among the top 50 in the Shanghai ranking in 2021 (compared to one university in 2004). The mixed results of all these worldwide attempts may reflect the problem that late market entry into the super league may be too costly, given that the classical university business model is in the mature phase of its life cycle.

Sensitive structural motifs separately distributed in azide-based 3D EMOFs: a primary explosive with an excellent initiation ability and enhanced stability

The unique type of molecular architectures with a remarkable initiation ability and enhanced stability is proposed. The relationship between the structure and sensitivity of Cu(N3)2-based primary explosive is revealed.

Sensitive Structural Motifs Separately Distributed by Triazene-Bridged Linkers in Azide-Based 3d Emofs: A Primary Explosive with Excellent Initiation Ability and High Stability

Sensitive Structural Motifs Separately Distributed by Triazene-Bridged Linkers in Azide-Based 3d Emofs: A Primary Explosive with Excellent Initiation Ability and High Stability

Gender and Internationalization in STEM Graduate Education: Case of the German Excellence Initiative

Gender and Internationalization in STEM Graduate Education: Case of the German Excellence Initiative

Epigenomics in trees: decoding the plastic lives of mangroves.

This article is a Commentary on Miryeganeh et al. (2022), 233: 2094–2110.

Molecular surveillance of resistance to pyrethroids insecticides in Colombian Aedes aegypti populations

In Colombia, organochloride, organophosphate, carbamate, and pyrethroid insecticides are broadly used to control Aedes aegypti populations. However, Colombian mosquito populations have shown variability in their susceptibility profiles to these insecticides, with some expressing high resistance levels. In this study, we analyzed the susceptibility status of ten Colombian field populations of Ae. aegypti to two pyrethroids; permethrin (type-I pyrethroid) and lambda-cyhalothrin (type-II pyrethroid). In addition, we evaluated if mosquitoes pressured with increasing lambda-cyhalothrin concentrations during some filial generations exhibited altered allelic frequency of these kdr mutations and the activity levels of some metabolic enzymes. Mosquitoes from all field populations showed resistance to lambda-cyhalothrin and permethrin. We found that resistance profiles could only be partially explained by kdr mutations and altered enzymatic activities such as esterases and mixed-function oxidases, indicating that other yet unknown mechanisms could be involved. The molecular and biochemical analyses of the most pyrethroid-resistant mosquito population (Acacías) indicated that kdr mutations and altered metabolic enzyme activity are involved in the resistance phenotype expression. In this context, we propose genetic surveillance of the mosquito populations to monitor the emergence of resistance as an excellent initiative to improve mosquito-borne disease control measures.

Successful factors determining the significant relationship between e-governance system and government operational excellence

Every government's major objective is to provide the greatest services in order to establish efficiency and quality of performance. Syria's government has understood how critical it is to go in the direction of information technology. However, there are gaps and poor links across government sectors, which has tainted the image of Syrian e-governance. As a result, one of the main aims of this study is to figure out what factors impact Syrians' acceptance of the e-government system. A total of 600 questionnaires were delivered to Syrian individuals as part of a survey. The data was analysed using the structural equation model (SEM) using AMOS version 21.0. User intention to utilise an e-government system was shown to be influenced by performance expectations, effort expectations, system flexibility, citizens-centricity, and facilitating conditions. Assurance, responsiveness, reliability, tangibles, and empathy are five fundamental factors that have a major impact on government operation excellence. Behavioural Intention is being utilised as a mediator between the government operation excellence (GOE) initiative and the e-government platform.

The Motherhood Penalty in Obstetrics and Gynecology Training.

Since 2017, the number of women enrolled in medical schools in the United States has increased steadily. For the average female graduate, residency training will coincide with peak childbearing years. Despite increasingly well-defined parental leave policies in other industries, there is no standardized approach across graduate medical education programs. Physician mothers, particularly those in surgical specialties, have also been shown to be at increased risk for major pregnancy complications and postpartum depression. In addition, despite excellent initiation rates, the majority of breastfeeding trainees struggle with low milk supply, and as few as 7% of physician mothers continue to breastfeed for 1 year. Although the medical field routinely advocates for the benefits of parental leave and breastfeeding for our patients, significant and comprehensive change is needed to ensure that graduate medical education trainees can follow physician-recommended postpartum guidelines without meaningful implications for their careers. In February 2020, the American Board of Obstetrics and Gynecology changed its leave policy, allowing residents to take up to 12 weeks of paid or unpaid leave in a single year for vacation, parenting, or medical issues without extending their training. This change represents an important first step, and, as comprehensive women's health care professionals, our specialty should be leaders in normalizing family building for physicians-in-training. A culture change toward an environment of support for pregnant and parenting trainees and access to affordable, extended-hour childcare are also critical to enabling physicians at all levels to be successful in their careers.

Demonstrating Equitable and Inclusive Crisis Leadership in Higher Education

Academic leadership faces tremendous pressure to build sustainable environments that demonstrate a commitment to the principles of inclusive excellence. Currently, the convergence of dual global crises—the COVID-19 pandemic and reckoning of systemic violence and racism toward individuals from historically marginalized and oppressed groups—has led to prioritizing impactful inclusive excellence leadership processes that address justice, equity, diversity, and inclusion. However, too often, in times of crisis, the strategic prioritizing and, more importantly, allocation of resources to support inclusive excellence initiatives are seen as secondary, tangential, or nonessential to the core operational mission of academic units. In this article, the authors discuss the unique realities, challenges, and opportunities academic leaders face when leading an equitable and inclusive academic workplace and culture during and after a crisis. The authors provide fundamental inclusive excellence and justice, equity, diversity, and inclusion terminology and definitions. In addition, the authors provide attributes, behaviors, and action steps for demonstrating equitable and inclusive crisis leadership.

U.S. FDA Drug Approvals for Gynecological Malignancies: A Decade in Review.

Over the last decade, there has been tremendous progress in the treatment of patients with gynecologic cancers with a changing therapy landscape. This summary provides an overview of U.S. Food and Drug Administration (FDA) approvals for gynecologic cancers from 2010 to 2020, totaling 17 new indications. For each of the approved indications, endpoints, trial design, results, and regulatory considerations are outlined. Among these 17 indications, six received accelerated approval (AA) and 11 received regular approval (RA). As of September 2021, of the six AA, three have subsequently demonstrated clinical benefit resulting in conversion to RA and the remaining three have ongoing clinical trials that have not yet reported results. Approval decisions for these 17 indications were supported by primary efficacy endpoints of progression-free survival (n = 10), objective response rate (n = 6), and overall survival (n = 1) and showed a favorable benefit-risk profile. Among the 17 indications, 15 received priority review and three applications participated in one or more novel Oncology Center of Excellence initiatives, including Real Time Oncology Review, Assessment Aid, and Project Orbis. Current FDA thinking on drug development opportunities and regulatory initiatives currently under way will be discussed.

Dispositives of newness and change: academic organisations\u2019 discursive practice at the intersection of excellence and gender

On the basis of a genealogical discourse analysis, Weber distinguishes four dispositives of creation. The ‘new’ is created and organised within systematic rationalities of creation. It emerges in (a) an organic cyclical transcendence, (b) a top-down pattern, (c) an entrepreneurial mode that designates man as creator and (d) a collective cyclical dynamic. The dispositives of man as creator and creation as an act are becoming particularly dominant in today’s academic organisations and these dispositives systematically produce institutional programmatics and organisational strategies. In this paper, we analyse how the new emerges in two academic organisations. The starting points of our analyses are two institutional innovations that emerged in Germany in the 2000s: the Excellence Initiative and the gender equality programme. Although they derive from different fields of discourse, both innovations share common features. The Excellence Initiative required universities to relate discourses of excellence and gender equality to each other, and this article investigates how the new emerges in academic organisations to understand whether these innovations produce equality or perpetuate traditional inequalities. Based on Foucault’s dispositive methodology, we use website analyses and interviews with gender equality officers and heads of early-career researchers’ departments. We highlight the discursive connections between gender and excellence for early-career researchers and outline various discursive organisational strategies.