bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the Economic Impact of the Coronavirus Pandemic on the Production and Distribution of Livestock Across Value Chain Approach: The Case of Kellem Wollega Zone, Oromia National Regional State, Ethiopia
Authors: Temesgen Fikiru , Wakjira Milkessa , Abirham Abdissa
Published: March 2021

The aim of the study was to assess the economic impact of the Coronavirus on the production and distribution of livestock across the value chain approach in the case of Kellem Wollega Zone, Oromia National Regional State, Ethiopia, based on a total survey of 320 farmers. Descriptive statistics were used to present the effects of the pandemic on the marketing and consumption of major crop production and dairy products in the study areas. Survey result indicated that about 160 small holder farmers those involved in agriculture in the study areas were impacted by COVID-19 crises because the revenue of the farmer were close to down from 25 per cent to 50 per cent. The survey results also indicated that more than 37 per cent of the sample households in the study area affected by the COVID-19 crisis on workforce reduced consumer confidence. Lower demand in virus-affected states across the world will be transferred down the value chain, affecting demand and production levels at each stage, even in areas not directly affected by the virus. It seems that logistical issues linked to the COVID-19 crisis are creating extra costs in the coffee marketing system. Logistical and administrative issues regarding to the COVID-19 during the production time in the study areas were very low to providing service particularly input and fertilizer for the farmers on the time. Therefore, this study recommends that both fiscal and monetary policy instruments introduced by the government to fight the pandemic shall be continued, enforced and implemented in a coordinated way to support the effectiveness of interventions until the economy recovers.
The Role of Creative Communications and Gamification in Student Engagement in Higher Education: A Sentiment Analysis Approach
Authors: Bilro Ricardo Godinho , Loureiro Sandra Maria Correia , Angelino Fernando José de Aires
Published: March 2021

This article aims to explore gamification tools in services and higher education environments and their role in creating student engagement. The research adopts a qualitative method based on quasi-experimental design. Participants from a higher education institution are exposed to gamification activities during a full semester. Researchers use the sentiment analysis (SA) technique based on a text-mining approach to analyse the data. Findings reveal that participants perceive gamification in service settings as a useful tool. The global SA reveals a positive sentiment about the gamification approach that contributes to increasing participants’ engagement. This study’s novelty arises from quasi-experimental research to measure gamification activities’ impact on students’ engagement, measured through SA of their opinions.
Locating Leisure and Belonging in Metro Manila: From Hyper-conditioned Environments to Public Green Spaces
Authors: Saloma Czarina , Akpedonu Erik , Alfiler Cherie Audrey , Sahakian Marlyne
Published: March 2021

Leisure practices have implications for belonging. In Metro Manila, a rapidly urbanizing metropolis, leisure is becoming increasingly associated with the most ubiquitous hyper-conditioned environments: privately owned shopping malls. By decontextualizing the built environment from its natural and cultural settings, these malls present a challenge to establishing a sense of belonging within a metropolis. Yet, despite its ubiquity, the mall has not fully displaced outdoor spaces, especially public green spaces, as sites of leisure. What do leisure practices in these two seemingly contrasting environments reveal about belonging in a metropolis? Some answers to these questions are to be found in a socio-material reading of leisure spaces, which reveal how belonging is not only created by actors and social institutions but also by spaces, objects, technologies, infrastructure and the microclimate. On the basis of a qualitative study, our findings demonstrate why public green spaces are more conducive than hyper-conditioned environments for fostering a sense of belonging together and to the metropolis.
Negotiating wage (in)equality: changing union strategies in high-wage and low-wage sectors in Czechia and Slovakia
Authors: Martišková Monika , Kahancová Marta , Kostolný Jakub
Published: March 2021

Reducing wage inequality requires an understanding of the importance of labour market institutions, in particular statutory minimum wages and sectoral collective bargaining. This article argues that the impact of labour market institutions on wage inequality is enhanced by specific strategies of unions and employers. Empirical evidence is provided from the high-wage automotive sector and the low-wage retail sector in Czechia and Slovakia. Against the backdrop of the erosion of collective wage bargaining, trade unions have prioritised increases in the national statutory minimum wage as a mechanism for reducing wage inequalities. Trade unions’ leverage on minimum wages can compensate for their declining influence on wage distribution via collective bargaining.
Design, modeling, and experiment of a multi-bifurcated cantilever piezoelectric energy harvester
Authors: Chen Yu , Yang Zhichun , Chen Zhaolin , Li Kui , Zhou Shengxi
Published: March 2021

A multi-bifurcated cantilever piezoelectric energy harvester (BCPEH) is designed and verified to achieve a wide and adjustable response frequency band. The theoretical model is derived based on the Euler-Bernoulli beam theory and continuity boundary conditions to investigate the dynamic response of the BCPEH. The displacement frequency response function and the voltage frequency response function of the BCPEH are deduced based on the Galerkin method, and the theoretical results of a typical multi-bifurcated cantilever piezoelectric energy harvester, the Y-shaped BCPEH, are verified by the finite element method (FEM) and experiments. In addition, by comparing experimental output power of the Y-shaped BCPEH with that of the traditional cantilever-based piezoelectric energy harvester with the same mass of the bifurcated part at the beam-tip, it demonstrates that the Y-shaped BCPEH has a wider operational frequency band. Moreover, it is found that the Y-shaped BCPEH can be designed with an asymmetric configuration to adjust its response frequency distribution. The number of resonant frequencies and the output power of the asymmetric Y-shaped BCPEH are higher than that of the symmetric Y-shaped BCPEH. And the Y-shaped BCPEH has even better performance than L-shaped BCPEH. This study provides a new design concept for enhanced energy harvester.
Survival and Complications After Placement of Central Venous Access Ports for Palliative Chemotherapy: A Single-Institution Retrospective Analysis
Authors: Sacks Olivia A. , Chugh Priyanka , He Katherine , Moseley Jennifer M. , Oneal Patrick B. , Whang Edward , Kristo Gentian
Published: March 2021

Background:

Given the lack of empiric recommendations for vascular access for palliative chemotherapy, we aimed to analyze survival and complications after placement of central venous access ports for palliative chemotherapy.

Methods:

We performed a retrospective chart review of 135 patients undergoing port placement for palliative chemotherapy at a single institution from January 2015 – July 2020.

Results:

The median age was 68 (range 47-91). Median overall survival was 7.7 months (95% CI, 6.5-8.9 months). The rate of port-related complications was 11.1% (15 of 135). Patients who developed port-related complications required corrective surgery in 73.3% (11 of 15) of cases. Results were similar among all patients, regardless of their primary diagnoses or central venous access sites.

Conclusions:

Increased awareness about the limited survival of patients after port placement for palliative chemotherapy, and their significant complication risk could be used to help patients and their providers make value-aligned decisions about vascular access.
Discursive Communication Strategies for Introducing Innovative Products: The Content, Cohesion, and Coherence of Product Launch Presentations
Authors: Zhang Huiyu , Song Yiqun , Wei Yuanhong , Liu Jingjiang
Published: March 2021

In the information age, discourse plays an increasingly important role in promoting innovative products. But how language works in the innovation process remains underexplored. This study explores the discursive communication strategies used to introduce innovation by analyzing the content, cohesion, and coherence of product launch presentations by Steve Jobs. It reveals that such discursive communication strategies improve the audience’s understanding, recognition, and acceptance of innovative products. This study contributes to both business communication studies in general and research on innovation communication in product launches in particular.
Choice: Examining a Differentiated Strategy
Authors: Kaplan Sandra N.
Published: March 2021

This article addresses the differentiated strategy of choice. The author describes types of questions and how they affect self-regulation skills that are essential to the multiple personal and social traits necessary to becoming adept at recognizing the responsibility underscoring the making and enactment of “choice.”
Understanding Consumer Experiences and Insurance Outcomes Following Plan Disenrollment in the Nongroup Insurance Market
Authors: Sinaiko Anna D. , Hayes Marai , Kingsdale Jon , Peltz Alon , Galbraith Alison A.
Published: March 2021

Disenrollment from health plans purchased on Affordable Care Act (ACA) Marketplaces is frequent; little is known whether disenrollment from off-Marketplace plans is as common or about the experiences and consequences of disenrollment. Using longitudinal administrative data on 2017-2018 nongroup plan enrollment linked with survey data, we analyze plan disenrollment in one regional insurance carrier servicing three states. Overall, 71% of enrollees disenrolled from their 2017 plan. Disenrollment was associated with purchasing through an ACA Marketplace, the carrier making significant changes to an enrollee’s plan benefit design, being healthier, being younger, and paying a higher premium for their 2017 plan in 2018. Experiencing financial burden or poor access to preferred providers was not associated with disenrollment. Most disenrollees (93.2%) enrolled in other coverage, often at a lower premium, but lacked confidence that they could afford needed care. These results can inform policy to support enrollees through coverage transitions and foster stability in the nongroup market.
Feline thelaziosis (Thelazia callipaeda) in Spain: state-of-the-art and first prophylactic trial in cats
Authors: Marino Valentina , Montoya Ana , Mascuñan Carmen , Domínguez Inés , Gálvez Rosa , Hernández Mauro , Zenker Carla , Checa Rocío , Sarquis Juliana , Barrera Juan Pedro , Portero Miriam , Miró Guadalupe
Published: March 2021

Objectives

Thelaziosis caused by the nematode Thelazia callipaeda (Spirurida, Thelaziidae) affects the eyes of domestic and wild carnivores, lagomorphs and even humans. The role of cats in spreading thelaziosis remains unclear. The present study assesses the current status of feline T callipaeda infection in Spain and presents the results of the first prophylactic trial conducted in this species.

Methods

We retrospectively analysed the occurrence of feline thelaziosis (study 1), examined its prevalence based on cross-sectional sampling of endemic areas (study 2), and assessed the therapeutic/prophylactic benefits of a spot-on (moxidectin) and therapeutic efficacy of an eye drop (ivermectin) formulation (study 3).

Results

In study 1, 69 Thelazia-infected cats were examined. Autochthonous cases were detected in 18/26 municipalities surveyed in Spain, which corresponds to 88.4% (n = 61/69) of the total number of cases. In study 2, 74 cats (20 from La Vera region and 54 from Orense province) were examined from 2011 to 2013. Ten of these cats (13.5%) were infected with T callipaeda. The infection prevalence was 40% (n = 8/20) in La Vera and 3.7% (n = 2/54) in Orense. The therapeutic efficacy of ivermectin was assessed over a summer (2011) in 12 cats, while that of moxidectin was examined over a 17-month period in seven cats. Four of these seven cats were subsequently included in an all-year-round prophylaxis trial. Treatment efficacy ranged from 91.7% (ivermectin) on day 28 after treatment to 100% (moxidectin) on day 14. Moxidectin prevented reinfections in cats.

Conclusions and relevance

Our data confirm the endemic status of T callipaeda infection in Spain, revealing its high prevalence in cats living in known endemic areas. Moxidectin was effective in treating and preventing infection. We strongly recommend the inclusion of thelaziosis in the differential diagnosis of pets and humans presenting with ocular manifestations, along with adequate preventive measures.
Factors Associated with the Establishment of New Occupational Therapist Positions in Norwegian Municipalities after the Coordination Reform
Authors: Maass Ruca , Bonsaksen Tore , Gramstad Astrid , Sveen Unni , Stigen Linda , Arntzen Cathrine , Horghagen Sissel
Published: March 2021

Community-based occupational therapy is an increasingly important domain of work for occupational therapists. In Norway, this has been emphasized by the Coordination reform (2012), which assigned municipalities increased responsibility to protect and promote the health of their inhabitants. However, even if approximately 400 positions have been established between 2012 and 2017, little is known whether they have contributed to increased and/or more equal coverage across municipalities. To explore this matter, survey data was gathered among members of the Norwegian Occupational Therapy Association during 2017. Data was analyzed statistically (descriptive, comparative and associative) with SPSS 25. Results suggest large regional variations in the establishment of new positions. Moreover, most new positions were established in medium-sized municipalities that already had (an) occupational therapist(s) in the community. Number of prior positions, as well as being in the process of merging with another municipality were the only significant predictors for the establishment of new positions during regression analysis. Findings suggest that no levelling-out of geographical distributions of OT-coverage has occurred, even if new positions might have contributed to level-out workload (number-of-patients-per-therapist). Further, we discuss implications of our findings for policy-making and recruitment of Occupational Therapists for rural positions.
Management of Spontaneous Isolated Mesenteric Artery Dissection: A Systematic Review
Authors: Acosta S. , Gonçalves F. B.
Published: March 2021

Background and Aims:

There are increasing reports on case series on spontaneous isolated mesenteric artery dissection, that is, dissections of the superior mesenteric artery and celiac artery, mainly due to improved diagnostic capacity of high-resolution computed tomography angiography performed around the clock. A few case–control studies are now available, while randomized controlled trials are awaited.

Material and Methods:

The present systematic review based on 97 original studies offers a comprehensive overview on risk factors, management, conservative therapy, morphological modeling of dissection, and prognosis.

Results and Conclusions:

Male gender, hypertension, and smoking are risk factors for isolated mesenteric artery dissection, while the frequency of diabetes mellitus is reported to be low. Large aortomesenteric angle has also been considered to be a factor for superior mesenteric artery dissection. The overwhelming majority of patients can be conservatively treated without the need of endovascular or open operations. Conservative therapy consists of blood pressure lowering therapy, analgesics, and initial bowel rest, whereas there is no support for antithrombotic agents. Complete remodeling of the dissection after conservative therapy was found in 43% at mid-term follow-up. One absolute indication for surgery and endovascular stenting of the superior mesenteric artery is development of peritonitis due to bowel infarction, which occurs in 2.1% of superior mesenteric artery dissections and none in celiac artery dissections. The most documented end-organ infarction in celiac artery dissections is splenic infarctions, which occurs in 11.2%, and is a condition that should be treated conservatively. The frequency of ruptured pseudoaneurysm in the superior mesenteric artery and celiac artery dissection is very rare, 0.4%, and none of these patients were in shock at presentation. Endovascular therapy with covered stents should be considered in these patients.
Introducing the EU exit index measuring each member state’s propensity to leave the European Union
Authors: Gastinger Markus
Published: March 2021

Which member states could leave the European Union in the years ahead? To answer this question, I develop the ‘EU Exit Index’ measuring the exit propensities of all European Union member states. The index highlights that the United Kingdom was an outlier and uniquely positioned to leave the European Union. While all other states are far behind the United Kingdom, the index still reveals substantial variation among them. Moreover, the index allows monitoring the development of exit propensities over time. It shows that the European Union is in better shape today than before the Brexit referendum and that, currently, no further exits are on the horizon. Still, this could change in the future and the EU Exit Index provides systematic and reproducible measurements to track this development.
Challenges and strategies of translation in a qualitative and sensitive research
Authors: Turhan Zeynep , Bernard Claudia
Published: March 2021

Key strategies and challenges of translating the interview data should be considered to do justice to the meanings and voices of the participants and remove misrepresentation. This article aims to investigate the key issues around translation in qualitative and sensitive research of the examination of the men’s engagement in domestic violence interventions in the UK. While many studies report on the importance of providing credibility to the meanings of the participants’ stories, there are limited studies that explore how researchers deal with difficulties and the techniques for translating the data. This research focuses on the key issues around the translation of interview data from Turkish to English. It highlights how the researcher’s position as a translator and a researcher impacted on collecting the data from the participants in a native language and presenting them in English. This addresses methodological and ethical questions that many migrant researchers might encounter during the translation of data.
Nation branding in Zimbabwe: Archaeological heritage, national cohesion, and corporate identities
Authors: Thondhlana Thomas Panganayi , Chitima Simbarashe Shadreck , Chirikure Shadreck
Published: March 2021

This article critically assesses how heritage has been appropriated in various contexts to create national, partisan, and corporate identities in Zimbabwe. Using iconography, we attempt to establish how various players have created visual identities based on iconic archaeological artefacts and places. We discern that archaeological evidence has played a vital role in the invention and re-invention of national identity and patriotic iconography. Archaeological evidence has influenced the branding of corporate bodies, including universities, which are the major focus of this paper. Visual manifestations of the ancient Zimbabwe Culture ( madzimbahwe), especially Great Zimbabwe, dominate the branding process. The Zimbabwe bird, Conical Tower, and motifs associated with the drystone built heritage form the key visual elements in the country’s branding enterprise. We advance the argument that the period associated with madzimbahwe has been projected as the only ‘Golden Age’ of ancient Zimbabwe. Consequently, other heritages, diverse histories, and past cultural achievements have been marginalised.
Collective efficacy and disorder through the eyes of neighbourhood inhabitants and key informants
Authors: Hardyns Wim , Snaphaan Thom , Willems Sara , Pauwels Lieven J. R.
Published: March 2021

This study examines the ecological reliability, convergent validity and ecological stability of neighbourhood (dis)organizational processes measured by means of two methods: inhabitant surveys and the so-called key informant analysis technique. Considering that ecological processes play a major role in many contemporary criminological theories and research, it is vital to take into account methodological challenges and to question the reliability, validity and stability of the measures reflecting these underlying processes. (Dis)organizational processes are predominantly measured by means of questionnaires surveying neighbourhood inhabitants. To yield ecologically reliable and valid measures this approach requires large numbers of respondents. In this study we analyse the relationships between ecological measures of neighbourhood processes based on surveys of inhabitants versus key informants. The findings suggest that key informants can provide reliable, valid and stable measures of (dis)organizational neighbourhood processes. Therefore, the key informant analysis technique is an essential complementary, or even substitutive, method in the measurement of neighbourhood processes; shared survey-method variance is eliminated and it is possible to survey fewer key informants than inhabitants to obtain reliable and valid information on social trust and disorder. Nevertheless, this method is not suitable for measuring all neighbourhood processes, such as informal social control. Therefore, outstanding challenges and avenues for future research are discussed as well.
Beyond the austerity-driven hypothesis: Political economic theses on penality and the recent prison population decline
Authors: Brandariz José A.
Published: March 2021

In what might be called the ‘austerity-driven hypothesis’, a consistent strand of literature has sought to explain the prison downsizing witnessed in many jurisdictions of the global north over the past decade by referring to the financial crisis of the late 2000s to early 2010s and its effects in terms of public spending cuts. Since this economic phase is essentially over, whereas the (moderate) decarceration turn is still ongoing, there are good reasons to challenge this hypothesis. This article delves into the non-economic forces that are fostering a prison population decline that, 10 years on, is becoming the new ‘penal normal’. The article thereby aims to spark a dialogue not only with the scholarship exploring the prison downsizing but also with certain theoretical frameworks that have played a key role in examining the punitive turn era. Additionally, the article contributes to the conversation on the need to reframe materialist readings on penality in a ‘non-reductionist’ fashion. By revisiting heterodox theses and scrutinizing the impact of recent penal changes on traditional materialist accounts, the article joins the collective endeavour seeking to update political economic perspectives on punishment and the penal field.
A novel recycled polyethylene terephthalate/polyamide 11 (rPET/PA11) thermoplastic blend
Authors: Khan Zahid Iqbal , Mohamad Zurina Binti , Rahmat Abdul Razak Bin , Habib Unsia , Abdullah Nur Amira Sahirah Binti
Published: March 2021

This work explores a novel blend of recycled polyethylene terephthalate/polyamide 11 (rPET/PA11). The blend of rPET/PA11 was introduced to enhance the mechanical properties of rPET at various ratios. The work’s main advantage was to utilize rPET in thermoplastic form for various applications. Three different ratios, i.e. 10, 20 and 30 wt.% of PA11 blend samples, were prepared using a twin-screw extruder and injection moulding machine. The mechanical properties were examined in terms of tensile, flexural and impact strength. The tensile strength of rPET was improved more than 50%, while the increase in tensile strain was observed 42.5% with the addition of 20 wt.% of PA11. The improved properties of the blend were also confirmed by the flexural strength of the blends. The flexural strength was increased from 27.9 MPa to 48 MPa with the addition of 30 wt.% PA11. The flexural strain of rPET was found to be 1.1%. However, with the addition of 10, 20 and 30 wt.% of PA11, the flexural strain was noticed as 1.7, 2.1, and 3.9% respectively. The impact strength of rPET/PA11 at 20 wt.% PA11 was upsurged from 110.53 to 147.12 J/m. Scanning electron microscopy analysis revealed a dispersed PA11 domain in a continuous rPET matrix morphology of the blends. This work practical implication would lead to utilization of rPET in automobile, packaging, and various industries.
A Scoping Review of Behavior Change Interventions to Decrease Health Care Disparities for Patients With Disabilities in a Primary Care Setting: Can Social Marketing Play a Role?
Authors: Makris Angela , Khaliq Mahmooda , Perkins Elizabeth
Published: March 2021

Background:

One in four Americans have a disability but remain an overlooked minority population at risk for health care disparities. Adults with disabilities can be high users of primary care but often face unmet needs and poor-quality care. Providers lack training, knowledge and have biased practices and behaviors toward people with disabilities (PWD); which ultimately undermines their quality of care.

Focus of the Article:

The aim is to identify behavior change interventions for decreasing health care disparities for people with disabilities in a healthcare setting, determine whether those interventions used key features of social marketing and identify gaps in research and practice.

Research Question:

To what extent has the social marketing framework been used to improve health care for PWD by influencing the behavior of health care providers in a primary health care setting?

Program Design/Approach:

Scoping Review.

Importance to the Social Marketing Field:

Social marketing has a long and robust history in health education and public health promotion, yet limited work has been done in the disabilities sector. The social marketing framework encompasses the appropriate features to aligned with the core principles of the social model of disability, which espouses that the barriers for PWD lie within society and not within the individual. Incorporating elements of the social model of disability into the social marketing framework could foster a better understanding of the separation of impairment and disability in the healthcare sector and open a new area of research for the field.

Results:

Four articles were found that target primary care providers. Overall, the studies aimed to increase knowledge, mostly for clinically practices and processes, not clinical behavior change. None were designed to capture if initial knowledge gains led to changes in behavior toward PWD.

Recommendations:

The lack of published research provides an opportunity to investigate both the applicability and efficacy of social marketing in reducing health care disparities for PWD in a primary care setting. Integrating the social model of disability into the social marketing framework may be an avenue to inform future interventions aimed to increase health equity and inclusiveness through behavior change interventions at a systems level.
Life Expectancy after Liver Transplantation for Non-Cirrhotic Hepatocellular Carcinoma
Authors: Shavelle Robert M. , Kwak Ji Hun , Saur Rachel , Brooks Jordan C. , Rosenthal Philip
Published: March 2021

Background:

Hepatocelluar carcinoma typically occurs with underlying cirrhosis. However roughly 20% of cases arise in a non-cirrhotic liver. There is limited literature that addresses the long-term survival of the narrow subgroup who received transplantation. For such patients we sought to calculate life expectancies both at time of transplant and several years later, stratified by key risk factors, and to determine if survival has improved in recent years. Such information can be helpful in making treatment decisions.

Methods:

Data on 4,373 non-cirrhotic HCC patients who underwent liver transplantation in the MELD era (2002-2018) from the United States OPTN database were analyzed using the Cox proportional hazards regression model and life table methods.

Results:

Demographic and past medical history factors related to survival were patient age, donor age over 20, and the presence of ascites or severe hepatic encephalopathy. Survival did not vary by race or sex. HCC-specific factors significantly related to survival were the total number of tumors, extrahepatic spread, lymph node involvement, satellite lesions, micro- or macrovascular invasion, tumor differentiation (grade), and pre-transplant treatment. Survival improved over the study period, at 4% per calendar year during the first 5 years post transplant and 1% per year thereafter.

Conclusions:

Life expectancy in non-cirrhotic HCC transplant patients is much reduced from normal, and varies according to age and tumor-related factors. Survival improved modestly over the study period.
Critical Interpretations of Global-Local Co-Productions in Subscription Video-on-Demand Platforms: A Case Study of Netflix’s YG Future Strategy Office
Authors: Kim Taeyoung
Published: March 2021

This study examines the dynamics of co-production between a global subscription video-on-demand (SVOD) platform and a local producer. Based on a case study of “YG Future Strategy Office” co-produced by YG Entertainment and Netflix, it examines how various expectations of both companies are embedded in this series. On one hand, YG considers co-production as a means of promoting its artists for the global market which otherwise cannot be produced through pre-existing broadcasters. On the other hand, Netflix expects such co-productions to target the Asian market so that it can respond to the entry of incumbent media moguls into the SVOD market. While such co-productions seem to benefit both global platforms and local producers on the surface, however, this relationship may result in deteriorating the position of local actors as potential subcontractors considering the importance of distribution in the mediascape.
The Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention and Overall Survival Following Endovascular Aortic Aneurysm Repair
Authors: Ferrel Benjamin , Patel Shiv , Castillo Antonio , Gryn Oscar , Franko Jan , Chew David
Published: March 2021

Objective:

The purpose of this study was to identify the effect of abdominal aortic aneurysm (AAA) size on endoleak development and secondary intervention after endovascular repair (EVAR), as well as to examine the effect on overall survival and cause of mortality.

Methods:

Retrospective analysis was performed on all non-ruptured AAA treated by elective EVAR using FDA-approved endografts in our facility from July 2004 to December 2017. Patients were grouped into 3 cohorts based on preoperative aneurysm size: Group I (<5.5 cm), Group II (5.5-6.4 cm), and Group III (≥ 6.5 cm). Occurrences of endoleak, secondary intervention and overall survival underwent univariate and multivariate analysis. Cause of death data on deceased patients was similarly examined.

Results:

A total of 517 patients were analyzed. There was no difference between size groups in the rate of endoleak (Group I 48/277, 17.3%; Group II 33/160, 20.6%; Group III 18/80, 22.5%; p = 0.46) or time until endoleak development. Univariate analysis showed no difference in the rate of secondary intervention (Group I 36/277, 13.0%; Group II 24/160, 15.0%; Group III 18/80, 22.5%; p = 0.11), time until intervention or number of interventions performed. Multivariate analysis showed an association with shorter time to secondary intervention for both Group III aneurysms (HR 2.03, 95% CI 1.11-3.73; p = 0.02) and female patients (HR 1.79, 95% CI 1.02-3.13; p = 0.04). There was no difference in overall survival, aneurysm-related mortality or overall cause of mortality.

Conclusion:

AAA diameter prior to EVAR was not associated with any differences in rates of endoleak or secondary intervention, and was not associated with poorer overall survival or greater aneurysm-related mortality. Patients with suitable anatomy for EVAR can be considered for this intervention without concern for increased complications or poorer outcomes related to large aneurysm diameter alone.
Addressing Phantom Pain Through Occupational Participation: A Qualitative Study of Support Group Participants
Authors: Camacho Victor M. , Carlson Anna N. , Bondoc Salvador
Published: March 2021

The purpose of this qualitative phenomenological study was to explore the adaptation process of support group participants who are survivors of lower limb amputation (LLA) experiencing phantom limb pain (PLP). The study followed a qualitative, descriptive phenomenological design. Ten adult participants with LLA met inclusion criteria and through semi-structured interviews shared their lived experience. A qualitative descriptive methodology was used to analyze the data collected from interview transcriptions. Analysis involved coding and theme development. Three themes emerged: PLP interrupted but does not prevent participation, adapting to PLP allowed for continued participation in meaningful occupations, and education to promote self-management of PLP. Themes identified highlight the importance of social support and early education on PLP to facilitate the adaption process and promote occupational participation. The finding underscores the value of empowering survivors to self-manage pain through their own personal and unique ways.
Time-constrained strong multi-designated verifier signature suitable for Internet of things–based collaborative fog computing systems
Authors: Lin Han-Yu
Published: March 2021

Fog computing is viewed as an extended technique of cloud computing. In Internet of things–based collaborative fog computing systems, a fog node aggregating lots of data from Internet of things devices has to transmit the information to distributed cloud servers that will collaboratively verify it based on some predefined auditing policy. However, compromised fog nodes controlled by an adversary might inject bogus data to cheat or confuse remote servers. It also causes the waste of communication and computation resources. To further control the lifetime of signing capability for fog nodes, an appropriate mechanism is crucial. In this article, the author proposes a time-constrained strong multi-designated verifier signature scheme to meet the above requirement. In particular, a conventional non-delegatable strong multi-designated verifier signature scheme with low computation is first given. Based on its constructions, we show how to transform it into a time-constrained variant. The unforgeability of the proposed schemes is formally proved based on the famous elliptic curve discrete logarithm assumption. The security requirement of strong signer ambiguity for our substantial constructions is also analyzed by utilizing the intractable assumption of decisional Diffie–Hellman. Moreover, some comparisons in terms of the signature size and computational costs for involved entities among related mechanisms are made.
There is an Association of Synovial Interleukin-6 Levels With Chondral Damage in Anterior Cruciate Ligament–Deficient Knees
Authors: Gupta Ravi , Kapoor Anil , Khatri Sourabh , Sandal Dinesh , Masih Gladson David
Published: March 2021

Background: Osteoarthritis (OA) in the anterior cruciate ligament (ACL)–deficient knee is seen in approximately 50% of affected patients. Possible causes include biochemical or biomechanical changes. Purpose: We sought to study the correlation between inflammatory cytokines and chondral damage in ACL-deficient knees. Methods: Seventy-six male patients who underwent ACL reconstruction were enrolled in a cross-sectional study. Synovial fluid was aspirated before surgery and analyzed for levels of the inflammatory cytokines tumor necrosis factor-α, interleukin-1 (IL-1), and interleukin-6 (IL-6). At the time of ACL reconstruction, the severity of chondral damage was documented as described by the Outerbridge classification. Results: Patients with grade 2 or higher chondral damage were observed to have elevated IL-6 levels when compared to patients who had no chondral damage. Interleukin-6 levels had no correlation with the duration of injury. Conclusion: Elevated levels of IL-6 in synovial fluid were associated with chondral damage in ACL-deficient knees. Further study is warranted to determine whether inflammatory cytokines contribute to the development of OA of the knee after ACL injury.
Leaflet Dimensions as a Guide to Remodeling Annuloplasty During Aortic Valve Repair
Authors: Jasinski Marek J. , Rankin J. Scott , Mazzitelli Domenico , Fischlein Theodor , Choi Yeong-Hoon , Wei Lawrence M. , Deja Marek A. , Badhwar Vinay
Published: March 2021

Objective

In chronic aortic insufficiency (AI), the method and degree of annular downsizing required to achieve durable coaptation in aortic valve repair (AVr) remains poorly defined. This study evaluated the relationship between leaflet size and annular diameter to predict adequate annular sizing in remodeling AVr.

Methods

Under regulatory supervision, 74 patients with chronic tri-leaflet AI underwent AVr using ring annuloplasty and leaflet reconstruction. Fifty-four (73%) had ascending aortic ( n = 25) and/or root ( n = 29) aneurysms, and aortic grafts were sized 5 to 7 mm larger than the rings. Intraoperatively, leaflet free-edge length (FEL) was measured with special ball sizers positioned in the coronary sinus, and “normal” annular diameter was predicted from the validated formula: Required “normal” diameter = FEL/1.5. “Normal” annular diameters predicted from FEL were compared with pathologic diameters measured intraoperatively with Hegar dilators, and both were correlated with gender, age, and BSA.

Results

Average age was 62.1 ± 13.3 years (mean ± SD), 73% (54/74) were male, and 96% (71/74) had moderate-to-severe AI. All patients had annular dilatation, with a pathologic diameter 26.6 ± 2.3 mm before repair, and a predicted “normal” diameter of 21.7 ± 1.7 mm ( P < 0.001). Both predicted and pathologic annular diameters were larger in men ( P < 0.001), but no relationship existed with age. BSA correlated with both predicted and pathologic diameters, although variability was large.

Conclusions

Based on a simple validated method to predict “normal” annular diameter, all patients with chronic AI have some degree of annular dilatation. This finding implies that most AVr should include annuloplasty, with adequate and precise annular reduction based on leaflet size.
Deterioration in Sleep Quality Affects Cognitive Depression in Prostate Cancer Patients
Authors: Sharpley Christopher F. , Christie David R. H. , Bitsika Vicki
Published: March 2021

Men who suffer from prostate cancer (PCa) need to make important decisions regarding their treatment options. There is some evidence that these men may suffer from sleep difficulties due to their cancer or its diagnosis and treatment. Although sleep difficulties have been associated with cognitive depression in other samples of men, they have not been examined in PCa patients, despite the importance of decision-making for these men. This study was designed to investigate the association between sleep difficulties and cognitive depression in PCa patients. A sample of 96 PCa patients completed a background questionnaire, the Zung Self-Rating Depression Scale, and the Insomnia Severity Index. Comparison was made between sleep difficulty scores from before the patients received their diagnosis of PCa to the time of survey, allowing use of a “retrospective pretest” methodology. Just over 61% of the sample reported a deterioration in sleep quality, and this was significantly associated with cognitive depression ( r = .346, p = .007). At the specific symptom level, having a clear mind significantly contributed to the variance in difficulty falling asleep (R2 change = .140, F for change = 9.298, p = .003). Sleeping difficulties, particularly falling asleep, are common and associated with depression-related to ability to think clearly in PCa patients. This has potentially adverse effects upon the ability of men with PCa to understand their treatment options and make decisions about them.
Identification and triage of a Morel-Lavallée lesion using point of care ultrasound
Authors: Annison David R , Smith Mike
Published: March 2021

Introduction

A Morel-Lavallée lesion is a relatively rare, closed, degloving injury. Polytrauma and severe injuries through to seemingly innocuous trauma can distract the clinician from thorough assessment of the affected site. Missed or misdiagnosis of the closed lesion is reported from both a clinical and imaging perspective.

Case report

A 46-year-old male is discharged from accident and emergency with a shoulder injury following a cycling accident. Ten days post trauma, an advanced practice physiotherapist suspects a lateral thigh Morel-Lavallée lesion during a telephone assessment (Covid-19 restrictions). A face to face appointment with imaging the following day confirmed the suspicion.

Discussion

The aetiology, imaging and clinical management of a Morel-Lavallée lesion is discussed. The addition of diagnostic ultrasound skills to clinical assessment in this case report may have improved patient care and experience by offering a ‘one stop shop’ to care. Formal training in musculoskeletal ultrasound imaging is emphasised.

Conclusion

Thorough history taking, clinical reasoning and subsequent application of robust imaging led to the identification of a Morel-Lavellée lesion and, in this case, highlights the value of a point of care ultrasound model in a triage setting.
‘I’m fine!’: Assertions of lack of support need among patients with chronic obstructive pulmonary disease: A mixed-methods study
Authors: Gardener A Carole , Moore Caroline , Farquhar Morag , Ewing Gail , Massou Efthalia , Duschinsky Robbie
Published: March 2021

Objectives

To understand how people with Chronic Obstructive Pulmonary Disease (COPD) disavow their support needs and the impact on care.

Methods

Two stage mixed-method design. Stage 1 involved sub-analyses of data from a mixed-method population-based longitudinal study exploring the needs of patients with advanced COPD. Using adapted criteria from mental health research, we identified 21 patients who disavowed their needs from the 235 patient cohort. Qualitative interview transcripts and self-report measures were analysed to compare these patients with the remaining cohort. In stage 2 focus groups (n = 2) with primary healthcare practitioners (n = 9) explored the implications of Stage 1 findings.

Results

Patients who disavowed their support needs described non-compliance with symptom management and avoidance of future care planning (qualitative data). Analysis of self-report measures of mental and physical health found this group reported fewer needs than the remaining sample yet wanted more GP contact. The link between risk factors and healthcare professional involvement present in the rest of the sample was missing for these patients. Focus group data suggested practitioners found these patients challenging.

Discussion

This study identified patients with COPD who disavow their support needs, but who also desire more GP contact. GPs report finding these patients challenging to engage.
Judgements of effort as a function of post-trial versus post-task elicitation
Authors: Ashburner Michelle , Risko Evan F
Published: March 2021

Cognitive effort is a central construct in our lives, yet our understanding of the processes underlying our perception of effort is limited. Performance is typically used as one way to assess effort in cognitive tasks (e.g., tasks that take longer are generally thought to be more effortful); however, Dunn and Risko reported a recent case where such “objective” measures of effort were dissociated from judgements of effort (i.e., subjective effort). This dissociation occurred when participants either made their judgements of effort after the task (i.e., reading stimuli composed of rotated words) or without ever performing the task. This leaves open the possibility that if participants made their judgements of effort more proximal to the actual experience of performing the task (e.g., right after a given trial) that these judgements might better correspond to putatively “objective” measures of effort. To address this question, we conducted two experiments replicating Dunn and Risko with additional probes for post-trial judgements of effort (i.e., a judgement of effort made right after each trial). Results provided some support for the notion that judgements of effort more closely follow reading times when made post-trial as opposed to post-task. Implications of the present work for our understanding of judgements of effort are discussed.
Evolving ischemic stroke subtypes in 15 years: A hospital-based observational study
Authors: Ip Bonaventure , Au Lisa , Chan Anne , Fan Florence , Ip Vincent , Ma Sze H , Ma Karen , Mok Vincent , Lau Alexander , Leng Xinyi , Leung Howan , Wong Adrian , Abrigo Jill , Wong Jeffrey , Yu Simon , Wong Lawrence , Soo Yannie , Leung Thomas
Published: March 2021

Background

Depicting the time trends of ischemic stroke subtypes may inform healthcare resource allocation on etiology-based stroke prevention and treatment.

Aim

To reveal the evolving ischemic stroke subtypes from 2004 to 2018.

Methods

We determined the stroke etiologies of consecutive first-ever transient ischemic attack or ischemic stroke patients admitted to a regional hospital in Hong Kong from 2004 to 2018. We analyzed the age-standardized incidences and the two-year recurrence rate of major ischemic stroke subtypes.

Results

Among 6940 patients admitted from 2004 to 2018, age-standardized incidence of ischemic stroke declined from 187.0 to 127.4 per 100,000 population (p < 0.001), driven by the decrease in large artery disease (43.0–9.67 per 100,000 population (p < 0.001)), and small vessel disease (71.9–45.7 per 100,000 population (p < 0.001)). Age-standardized incidence of cardioembolic stroke did not change significantly (p = 0.2). Proportion of cardioembolic stroke increased from 20.4% in 2004–2006 to 29.3% in 2016–2018 (p < 0.001). Two-year recurrence rate of intracranial atherothrombotic stroke reduced from 19.3% to 5.1% (p < 0.001) with increased prescriptions of statin (p < 0.001) and dual antiplatelet therapy (p < 0.001). In parallel with increased anticoagulation use across the study period (p < 0.001), the two-year recurrence of AF-related stroke reduced from 18.9% to 6% (p < 0.001).

Conclusion

Etiology-based risk factor control might have led to the diminishing stroke incidences related to atherosclerosis. To tackle the surge of AF-related strokes, arrhythmia screening, anticoagulation usage, and mechanical thrombectomy service should be reinforced. Comparable preventive strategies might alleviate the enormous stroke burden in mainland China.