bluuebunny/crossref_metadata_2025 huggingface dataset:
Research and Development of Food Industry’s Three-Dimensional Printing
Authors: Nezhmetdinov Ramil , Kovalev Ilya , Melikov Pavel , Sokolov Sergey
Published: October 2021

In the presented article, the problem of building a specialized plant for food 3D printing is considered, which allows printing with various food semi-finished products with minimal changeover or without it. The developed plant, including all its software and hardware components, should be flexible and, according to the principles of construction and use, should approach the analogs of additive equipment existing on the market and to the classical control systems corresponding to it, but have more functionality and a lower price. The development of such compact solutions will make it possible to use them both for small cafes, restaurants, and in large factories.
Possibilities of Using Frequency Energy Functions in Problems of Dynamics of Machines for Transport and Technological Purposes
Authors: Eliseev Andrey , Eliseev Sergey , Kuznetsov Nikolay , Bolshakov Roman
Published: October 2021

New approaches to the evaluation of the dynamic properties of mechanical vibration systems are proposed, which consider as the design schemes for technical objects operating under dynamic vibration loads. The purpose of the study is to develop ideas for the use of frequency energy functions. In this case, the frequency functions represent the ratio of the potential and kinetic energies in a specific form, based on the use of the relations of the coordinates of the system in the stationary mode. The technologies of system analysis and structural mathematical modeling are used. In this approach, the mechanical oscillatory system is correspond with the block diagram of the automatic control system, which is equivalent in dynamic terms. It is proposed to use the analytical apparatus to take into account the features of interpartial relations, to evaluate the specific modes of dynamic interaction of system elements. A method for determining the natural vibration frequencies of the system based on the use of the frequency energy function is proposed. Methodological bases of approaches to solving problems of system dynamics related to the assessment of the influence of system parameters on their frequency properties are developed. The results of computational modeling are presented.
Analysis of the Accident Rate of the Constituent Entities of the Russian Federation
Authors: Shevtsova A. G. , Vasilieva V. V. , Burlutskaya A. G. , Levshina K. V. , Minaeva E. M.
Published: October 2021

Every year, tens of thousands of road traffic accidents occur on the territory of Russia, characterized by different accident rates. Some of the most common are road traffic accidents, in the place of which violations of the mandatory requirements for the operational state of highways and railway crossings have been recorded under the conditions of ensuring road safety. The condition of the asphalt concrete road surface affects the grip performance of the vehicle with the road. It is necessary to study the statistics of road traffic accidents in the constituent entities of the Russian Federation located in different road and climatic zones in order to determine the dependence and the degree of influence of the state of the road surface on the number of accidents occurring.
Methods of Improving the Safety of Drilling Works
Authors: Mukhametzyanov Zinur , Rubtsov Aleksey , Kulakov Petr
Published: October 2021

The article sets the task of developing methods to enhance the safety of drilling operations. The methods should be based on the relationship of technical measures for the mechanization and automation of drilling operations and the level of their safe performance. The measures being developed at oil producing companies to improvement of labor protection conditions and improvement of the labor protection system of most oil producing companies show that the development of such measures does not at all touch upon the issues of enhancing the level of safety during oil production technological processes. Therefore, the task is to maximize the mechanization and automation of these types of work during well drilling in order to increase the safety of their production. Thus, a conceptual approach has been identified for solving the posed problem of increasing the safety of technological processes of oil production. A model has been developed for assessing the effectiveness and efficiency of work safety using a systematic approach to describing the work safety model.
Development of Toolkit for Formalizing the Programming of Canned Cycles on CNC Machine Tools
Authors: Martinov Georgi M. , Martinova Liliya I. , Fokin Nikolay N.
Published: October 2021

The analysis shows that the development of programming tools for CNC systems is focused on the development of new machine canned cycles, including those for processing complicated surfaces, their complex combinations or complex mutual arrangement, but does not concern such issues as the universalization of cycle parameters. This does not make it impossible to transfer control programs from one CNC system to another. This work proposes an approach to the development of tools for creating universal cycles of typical technological transitions of machining on machines with different CNC systems.
Determining the Energy Efficiency of Corn, Sun-flower and Soybean Cultivation with the Use of Ridge Technology
Authors: Zykin Evgeny , Kurdyumov Vladimir , Lazutkina Svetlana
Published: October 2021

The article presents the developed energy-saving, resource-saving ridge technology for cultivating row crops and means of mechanization for its implementation allows increasing the yield of row crops on average in 5 years up to 38% without the use of environmentally unsafe herbicides. The implementation of ridge technology to cultivate corn for grain, sunflower and soybeans, the energy efficiency coefficients, respectively, amounted to 15.54; 9.71 and 3.43 units, which is by 0.6; 3.81 and 4.41 units more in comparison with the traditional technology of cultivation of the aforesaid crops on a flat surface of the field.
Verbal horror and slaughterhouse imagery in media representation of herdsmen violence
Authors: Igwebuike Ebuka Elias
Published: October 2021

Nigerian media reports on herdsmen’s violence present dehumanised images of a slaughterhouse in which farmers are represented as animals being slaughtered by herders. Using a critical discourse analysis and appraisal framework, with a focus on the systems of attitude and graduation, this paper critically examines media representation of herdsmen’s violence as “butchering” in the form of carnism. Analysis reveals that carnist representation is reinforced through death-dealing socio-cognitive labelling, attitudinal lexicalisation and strands of carnism. Also, using attitude and graduation resources, a one-directional and horrific image is painted. The study concludes that the creation as well as consumption of such scary news cultivates cognitive prejudices and stereotypes.
Nutritional value of microalgae for ruminants and implications from microalgae production
Authors: Lamminen Marjukka
Published: October 2021

Microalgae are a diverse group of microorganisms that are an interesting alternative feed resource for ruminant production. Microalgae species with high protein concentration and adequate amino acid (AA) composition can be used to substitute conventional protein feeds, whereas species with high carbohydrate or lipid concentration can be used to supply energy. Microalgal polyunsaturated acids and short-chain fatty acids have potential to improve the nutritive value of ruminant milk and meat for human consumption and mitigate enteric methane emissions. Microalgae composition is very plastid in comparison to conventional ruminant feeds and it can be influenced relatively easily by environmental conditions, such as nutrient supply. Microalgae also contain many compounds, especially carbohydrates and cell coverings, which are not usually found in ruminant feeds. Standard feed evaluation methods involving the use of crucibles or nylon bags (detergent fibre method,
in vitro
digestibility and
in vivo
rumen incubation) suit poorly to the analysis of microalgae with microscopic particle size. This paper attempts to give a general overview of the nutritive value (protein, lipids and carbohydrates) of microalgae for ruminant feeding applications and the possibilities to tailor microalgae composition for a certain ruminant feeding objectives. In addition, the key knowledge gaps related to the nutritive value of microalgae for ruminant nutrition are identified.
Plasma biomarkers outperform echocardiographic measurements for cardiovascular risk prediction in kidney transplant recipients: results of the HOME ALONE study
Authors: Emrich Insa E , Scheuer Anja L , Rogacev Kyrill S , Mahfoud Felix , Wagenpfeil Stefan , Fliser Danilo , Schirmer Stephan H , Böhm Michael , Heine Gunnar H
Published: October 2021

Background

Since kidney transplant recipients (KTRs) have a high cardiovascular disease burden, adequate risk prediction is of importance. Whether echocardiographic parameters and plasma biomarkers, natriuretic peptides [N-terminal pro-B-type natriuretic peptide (NT-proBNP)] and troponin T provide complementary or overlapping prognostic information on cardiovascular events remains uncertain.

Methods

The prospective Heterogeneity of Monocytes and Echocardiography Among Allograft Recipients in Nephrology (HOME ALONE) study followed 177 KTRs for 5.4 ± 1.7 years. Predefined endpoints were hospitalization for acute decompensated heart failure or all-cause death (HF/D) and major atherosclerotic cardiovascular events or all-cause death (MACE/D). At baseline, plasma NT-proBNP, plasma troponin T and echocardiographic parameters [left atrial volume index, left ventricular (LV) mass index, LV ejection fraction, and LV filling pressure] were assessed.

Results

Among all echocardiographic and plasma biomarkers measured, only NT-proBNP was consistently associated with HF/D in univariate and multivariate {third versus first tertile: hazard ratio [HR] 4.20 [95% confidence interval (CI) 1.02–17.27]} analysis, and only troponin T was consistently associated with MACE/D in univariate and multivariate [third versus first tertile: HR 8.15 (95% CI 2.75–24.18)] analysis.

Conclusion

Our data suggest that plasma biomarkers are robust and independent predictors of heart failure and atherosclerotic cardiovascular events after kidney transplantation, whereas standard echocardiographic follow-up does not add to risk prediction.
Clinical features, management and outcomes of gastrointestinal bleeding in patients treated with oral anticoagulants
Authors: Marti Sanchez D , Biscotti Rodil B , Delgado Calva F , Duarte Torres J , Marschall A , Dejuan Bitria C , Rueda Linares A , Rodriguez Torres D , Del Castillo Carnevali H , Alvarez Anton S
Published: October 2021

Background

Gastrointestinal (GI) bleeding with the different antithrombotics may present peculiarities in terms of location, precipitating factors, clinical management and prognosis.

Purpose

Our objective was to compare the profile and clinical course of GI bleeding with direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA).

Methods

We carried out a retrospective study of all consecutive patients treated in a tertiary hospital during 2018 and 2019, and who met the following selection criteria: 1) diagnosis of confirmed or probable GI bleeding; 2) red blood cell transfusion; 3) treatment with an oral anticoagulant; 4) absence of concomitant antiplatelet therapy. We collected information on comorbidities, bleeding risk scores, baseline treatments, and clinical course of bleeding. We compared adjusted all-cause mortality at 12-months between DOACs and VKAs groups.

Results

We identified 115 patients with GI bleeding, mean age 83±9 years, 63% women, 50.4% on DOACs and 49.6% on VKAs. NOACs group showed more recent anticoagulation history, and more complex clinical profile, with older age (85 vs. 82 years, p=0.026), number of comorbidities (2.7 vs. 2.1, p=0.049), CHA2DS2VASc score (5.2 vs. 4.2, p=0.001) and ORBIT score (3.9 vs. 3.3, p=0.047). There were no differences in the location of bleeding (60.5% lower GI tract), number of units transfused (mean 2.6), or hemoglobin nadir (mean 7.6 g/dL). Notably, 42% of the patients on DOACs were receiving the high dose at the time of bleeding, 63% of them had some risk criterion for overdose (age>80 years, weight <60 kg, moderate P-glycoprotein inhibitors), and 37% had >1 of these criteria. 12-month cumulative mortality was high, but significantly lower in the DOACs group (15.5% vs. 35.7%, adjusted HR 0.31, p=0.002).

Conclusions

Patients who experience GI bleeding with anticoagulants represent a therapeutic challenge, with both high age and prevalence of comorbidities. One-year mortality is remarkably high, particularly in the VKA group. Our findings emphasize the need for close monitoring and optimization of preventive strategies in this complex clinical scenario.

Funding Acknowledgement

Type of funding sources: None.
Necessity 20 Years On: The Limits of Article 25
Authors: Paddeu Federica , Waibel Michael
Published: October 2021

Investment tribunals have fleshed out the requirements of the defence of necessity in Article 25 of the Articles on State Responsibility. This article considers the impact of necessity in international investment law and in general international law. The decided cases of the early twenty-first century have revealed three difficulties in Article 25 and in the defence of necessity. First, rather than assessing necessity from the vantage point of the State invoking necessity, they assess it ex post with hindsight bias. Second, the standard of proof required to demonstrate the existence of a grave and imminent peril is infeasible for many situations of risk and uncertainty. Third, the ‘only way’ criterion is not only unduly strict and virtually impossible to prove, but is wholly unrealistic for macro-level crises, such as pandemics or financial crises. To account for these difficulties, tribunals should avoid hindsight bias, especially with respect to ‘grave and imminent peril’ and the ‘only way’ criterion. The defence of necessity is a blunt instrument and has not afforded States a significant ‘safety valve’. As a result, States have begun to reconsider the substantive standards in investment treaties and to include internal exceptions in their investment treaties.
Clinical and Epidemiological Changes in French Soldiers After Deployment: Impact of Doxycycline Malaria Prophylaxis on Body Weight
Authors: Javelle Emilie , Mayet Aurélie , Allodji Rodrigue S , Marimoutou Catherine , Lavagna Chrystel , Desplans Jérôme , Million Matthieu , Raoult Didier , Texier Gaëtan
Published: October 2021

Background

Antibiotics are growth promotors used in animal farming. Doxycycline (DOXY) is a tetracycline antibiotic taken daily and continued 1 month after return to protect against malaria during travel and deployment in endemic areas. We evaluated DOXY impact on body weight in military international travelers.

Materiel and Methods

A prospective cohort analysis was conducted in 2016-2018, recruiting 170 French soldiers before a 4-month assignment overseas. Many clinical data including anthropometric measures by an investigator were collected before and after deployment. Weight gain was defined by an increase of 2% from baseline. The study protocol was supported by the French Armed Forces Health Services and approved by the French ethics committee (IRB no. 2015–A01961–48, ref promoter 2015RC0). Written, informed consent was obtained with signature from each volunteer before inclusion.

Results

After deployment, 84 soldiers were followed up. Overall, 38/84 (45%) were deployed to Mali with DOXY malaria prophylaxis, and others were deployed to Iraq or Lebanon without malaria prophylaxis according to international recommendations. Body weight increased in 24/84 (30%), of whom 14/24 (58%) were exposed to DOXY. In bivariate analysis, DOXY had a positive but not significant effect on weight gain (P-value = .4). In the final logistic regression model (Fig. 3), weight gain after deployment positively correlated with an increase in waist circumference (odds ratio [OR] 1.23 with 95% CI [1.06-1.47]) suggesting fat gain; with sedentary work (OR 5.34; 95% CI [1.07-31.90]); and with probiotic intake (OR 5.27; 95% CI [1.51-20.40]). Weight impact of probiotics was more important when associated with DOXY intake (OR 6.86; 95% CI [1.52-38.1]; P-value = .016).

Conclusions

Doxycycline (DOXY) malaria prophylaxis during several months did not cause significant weight gain in soldiers. Further studies are required in older and less sportive traveling populations, and to investigate a cumulative effect over time and recurrent DOXY exposure. Doxycycline (DOXY) may enhance other growth-promoting factors including fatty food, sedentariness, and strain-specific probiotics contained in fermented dairy products which are also used as growth promotors.
Dynamic phenotypic heterogeneity and the evolution of multiple RNA subtypes in hepatocellular carcinoma: the PLANET study
Authors: Zhai Weiwei , Lai Hannah , Kaya Neslihan Arife , Chen Jianbin , Yang Hechuan , Lu Bingxin , Lim Jia Qi , Ma Siming , Chew Sin Chi , Chua Khi Pin , Alvarez Jacob Josiah Santiago , Chen Pauline Jieqi , Chang Mei Mei , Wu Lingyan , Goh Brian K P , Chung Alexander Yaw-Fui , Chan Chung Yip , Cheow Peng Chung , Lee Ser Yee , Kam Juinn Huar , Kow Alfred Wei-Chieh , Ganpathi Iyer Shridhar , Chanwat Rawisak , Thammasiri Jidapa , Yoong Boon Koon , Ong Diana Bee-Lan , de Villa Vanessa H , Dela Cruz Rouchelle D , Loh Tracy Jiezhen , Wan Wei Keat , Zeng Zeng , Skanderup Anders Jacobsen , Pang Yin Huei , Madhavan Krishnakumar , Lim Tony Kiat-Hon , Bonney Glenn , Leow Wei Qiang , Chew Valerie , Dan Yock Young , Tam Wai Leong , Toh Han Chong , Foo Roger Sik-Yin , Chow Pierce Kah-Hoe
Published: October 2021

Intra-tumor heterogeneity (ITH) is a key challenge in cancer treatment, but previous studies have focused mainly on the genomic alterations without exploring phenotypic (transcriptomic and immune) heterogeneity. Using one of the largest prospective surgical cohorts for hepatocellular carcinoma (HCC) with multi-region sampling, we sequenced whole genomes and paired transcriptomes from 67 HCC patients (331 samples). We found that while genomic ITH was rather constant across stages, phenotypic ITH had a very different trajectory and quickly diversified in stage II patients. Most strikingly, 30% of patients were found to contain more than one transcriptomic subtype within a single tumor. Such phenotypic ITH was found to be much more informative in predicting patient survival than genomic ITH and explains the poor efficacy of single-target systemic therapies in HCC. Taken together, we not only revealed an unprecedentedly dynamic landscape of phenotypic heterogeneity in HCC, but also highlighted the importance of studying phenotypic evolution across cancer types.
The Crown and the Constitution
Authors: Kim Marie Seong-Hak
Published: October 2021

This chapter discusses the operation of the early modern French monarchy from the perspectives of civil law and constitutional law. Exploration of the sale of offices at the nexus of the law of obligations and constitutional principles sheds important light on the state as enterprise. When venality is viewed as a royal commercial venture, the significance of extending the king’s dominion to private law becomes evident. The reformation of customs was carried out with the support of legal professionals who entered the royal bureaucracy by purchasing offices. The evolving relationship between judges and the crown over venality spurred Jean Bodin’s theory of royal sovereignty. A lawful government ruled by the sovereign with the established law became the crux of the new constitutional consciousness.
Introduction
Authors: Wiebe Gregory D.
Published: October 2021

The Introduction sets the context of the project within scholarly suspicion that demons are an archaic holdover from the Christianity of Augustine’s historical setting. It proceeds to suggest that before demons are dismissed in this manner, a greater effort should be made to understand what Augustine means in the first place when he speaks of demons, and that this is the principle goal of the work as a whole. Following an overview of the chapter structure of the work, some notes on sources are offered to provide additional context for the project. First, the principal works of Augustine’s consulted throughout the study are identified, with particular attention paid to the City of God. After this, the principle sources Augustine himself used for his demonology are highlighted, especially Apuleius of Madaura and Porphyry of Tyre.
Context
Authors: Banerjee Mukulika
Published: October 2021

Chapter 2 provides a detailed account of the three key stories of change that form the backdrop to this study—in paddy cultivation, electoral politics, and the practice of Islam. The two villages of Madanpur and Chishti (pseudonyms) are described. The changing dynamics of paddy cultivation and the challenges of the Green Revolution are introduced, as are the basic programs of land reform undertaken by communist governments. The story of huge electoral change from near-complete dominance of the communist parties of the Left Front from 1977 to their rout by Trinamool Congress in 2013 thirty four years later is outlined. The particular story of Islam, the origin of the elite Syeds from an Iranian ancestor, and present-day dynamics with reformist Islam are presented. Charles Taylor’s idea of “social imaginaries”—a key concept in the book—is discussed here.
A modern view of placebo and placebo-related effects
Authors: Benedetti Fabrizio
Published: October 2021

This chapter approaches the placebo effect from a modern point of view, namely, as a psychobiological phenomenon worthy of scientific inquiry. By definition, the placebo effect is the effect that follows the administration of an inert treatment (the placebo), whereas in a placebo-related effect no placebo is given but similar mechanisms are at work. Today, the placebo effect, or placebo response, is considered a psychobiological phenomenon that must not be confounded with other phenomena such as spontaneous remission and statistical regression to the mean. The nocebo effect, or nocebo response, is a negative placebo effect which goes in the opposite direction. There is not a single but many placebo effects across different medical conditions and therapeutic interventions, and different biological mechanisms are involved. Expectation of a future outcome plays a central role but learning is important as well.
Prevalent, incident, and persistent insomnia in a population-based cohort tested before (2018) and during the first-wave of COVID-19 pandemic (2020)
Authors: Morin Charles M , Vézina-Im Lydi-Anne , Ivers Hans , Micoulaud-Franchi Jean-Arthur , Philip Pierre , Lamy Manon , Savard Josée
Published: October 2021

Study Objectives

High rates of sleep and mental health problems have been reported during the COVID-19 pandemic, but most of the evidence is retrospective without pre-pandemic data. This study documented rates of prevalent, incident, and persistent insomnia and psychological symptoms during the COVID-19 pandemic (2020) compared to pre-pandemic data (2018).

Methods

Data were derived from a longitudinal, population-based study of insomnia in Canada. When the first lockdown started in the province of Quebec, a subsample of participants who had completed the latest 2018 follow-up were surveyed (April to May 2020) about their sleep, insomnia, and psychological symptoms since the beginning of the pandemic. Prevalence, incidence, and persistence rates of insomnia, and severity of stress, anxiety, and depressive symptoms were estimated, as well as their associations with confinement, loneliness, social support, use of electronics, and other lifestyle changes occurring during the pandemic. A sleep/health survey and validated questionnaires of insomnia, sleep quality, stress, fatigue, anxiety, and depression were administered at both assessments.

Results

The sample consisted of 594 adults (mean age: 48.3 ± 13.1 years; 64.0% women). Prevalence of insomnia increased from 25.4% to 32.2% (symptoms) and from 16.8% to 19% (syndrome) from 2018 to 2020, for an overall 26.7% increase in insomnia rates. Of those classified as good sleepers in 2018 (n = 343), 32.6% (n = 112) had developed new insomnia during the COVID-19 pandemic. Among participants who had insomnia in 2018, the persistence rate was 76.5% 2 years later. There was a significant worsening of sleep quality, fatigue, anxiety, and depression (all ps < .005) during the COVID-19 pandemic compared to 2018. Significant associations were found between sleep and psychological symptoms and with living alone and being in confinement, lower social support, increased time using electronic devices, reduced physical exercise, and higher financial stress.

Conclusions

The COVID-19 pandemic is associated with significant increases in insomnia and psychological symptoms compared to the pre-pandemic period. Large scale public sleep and mental health intervention programs should be prioritized during and after a pandemic such as the COVID-19.
Sex Differences in Common Measures of Concussion in College Athletes
Authors: Teramoto Masaru , Grover Eliza Banchoff , Cornwell Jordan , Zhang Rachel , Boo Marie , Ghajar Jamshid , Lumba-Brown Angela
Published: October 2021

Objective:

Female athletes may be more likely to sustain a concussion and may vary in symptom presentation and neurocognitive impairments as compared with males. Scientific literature is limited by subjective assessments and underproportioned representation of women—the scope and etiology of sex-based differences are unknown. This study investigates sex-based differences in sports concussion assessments among college varsity athletes.

Design and Setting:

Retrospective study of an institution's athletic head injury database.

Participants:

Acute postinjury and baseline data from 111 college athletes sustaining concussions between 2016 and 2018, diagnosed by a concussion specialist physician.

Main Outcome Measures:

Concussion assessments examined included the Sports Concussion Assessment Tool (SCAT5) and Vestibular Oculomotor Screening (VOMS) performed within 3 days (24-72 hours) of injury.

Results:

No significant difference by sex was observed in the SCAT5 total symptom evaluation scores or severity scores, Standardized Assessment of Concussion, or Balance Error Scoring System (P > .05) within 3 days of head injury. Females did report more “pressure in the head” severity scores from baseline to postconcussion (2.7 ± 1.5 increased symptomatology in females vs 1.8 ± 1.3 increase in males, P = .007). The VOMS test resulted in significant sex differences in smooth pursuit [0.6 ± 1.4 increase in females (P < .001) vs 0.2 ± 0.6 increase in males (P = .364)], horizontal saccades [0.6 ± 1.2 increase in females (P < .001) vs 0.2 ± 0.5 increase in males (P = .149)], and vertical saccades [0.9 ± 1.9 increase in females (P < .001) vs 0.3 ± 0.7 increase in males (P = .206)].

Conclusion:

Our study did not show sex-based differences in baseline or acute postconcussive symptom reporting in most concussion assessment parameters, challenging previous research suggesting that females report more symptoms than males. Females did have significant differences in symptom provocation using the VOMS.
Postconcussion Symptoms After an Uncomplicated Mild Traumatic Brain Injury in Older Adults: Frequency, Risk Factors, and Impact on Quality of Life
Authors: Chung Jia-Wei , Liu Doresses , Wei Li , Wen Ya-Ting , Lin Hsin-Ying , Chen Huan-Chieh , Chiu Hsiao-Yean
Published: October 2021

Background:

Postconcussion symptoms (PCSs) are common complaints reported by patients after a mild traumatic brain injury (TBI), and these symptoms may lower quality of life. Previous investigations have primarily focused on PCSs in children, adults, and athletes. The frequency, and risk factors, and effects of PCSs for older adults with mild TBIs are unclear.

Purpose:

To investigate the frequency and risk factors of PCSs, and investigate their effects on quality of life over time after mild TBI in older adults.

Methods:

A prospective longitudinal study was performed. All participants were enrolled from the emergency department or neurosurgical outpatient clinics of a medical center. The measurement tools were the Rivermead Post-Concussion Symptoms Questionnaire and the Quality of Life after Traumatic Brain Injury. Measurements were performed on the seventh day, at the first month, and at the sixth month after the head injury. A generalized estimating equation model was used for data analyses.

Results:

One hundred and one older adults (mean age of 76.0 years) with mild TBIs with negative neuroimaging findings were included. Overall, 32.7%, 4%, and 15.8% of the sample reported PCS after 7 days, 1 month, and 6 months of head injury, respectively, revealing a U-shaped trend. We observed that comorbidity measured using the modified Charlson Comorbidity Index was associated with differences in PCSs (P < .05). PCSs were an independent predictor of changes in postinjury quality of life (P < .001).

Conclusions:

The results indicate that PCS after a mild TBI in older adults is prevalent, even in the chronic phase after a TBI, and PCSs significantly affected the quality of life of our cohort. Therefore, to improve patient quality of life, healthcare providers should employ effective interventions to manage PCSs at different phases after a TBI.
Overground and Virtual Reality Gait Speed Are Associated With Atypical Symptom Reporting in Active Duty Service Members With a History of Mild to Moderate Traumatic Brain Injury
Authors: Lippa Sara M. , Rosen Kerry B. , Delpy Kathleen B. , Pape Marcy M. , Kruger Sarah E.
Published: October 2021

Objective:

Physical therapy following traumatic brain injury (TBI) can be negatively impacted by psychological symptoms, atypical symptom reporting, and response bias. We examined rates of Symptom Validity Test (SVT) failure in active duty military service members with a history of mild-moderate TBI and its impact on gait speed.

Setting:

Intensive Outpatient Program at the National Intrepid Center of Excellence at Walter Reed National Military Medical Center.

Participants:

Participants were 84 active duty service members with a history of mild-moderate TBI classified as SVT pass (n = 49) or SVT fail (n = 35).

Design:

Retrospective study.

Main Measures:

Overground preferred and fast walking speed as well as Computer Assisted Rehabilitation Environment (CAREN) gait speed were recorded. Participants completed the Neurobehavioral Symptom Inventory and the Validity-10 was used to assign patients into the SVT pass and SVT fail groups. Gait speed metrics were compared across these groups and test operating characteristics were calculated.

Results:

Approximately 42% of the sample was classified into the SVT fail group. All 3 gait speed measures were significantly slower in the SVT fail group than in the SVT pass group (Ps < .001, ds = 0.60-0.80). Gait speed cutoffs for screeners or indicators of atypical reporting were identified.

Conclusions:

The potential for response bias is a critical area for the clinician to consider when conducting physical therapy evaluations. Participants in the SVT fail group had slower walking speed on all 3 measures assessed. Several useful cutoffs were identified to serve as screeners or indicators of SVT failure, though these preliminary findings have limitations and need to be replicated.
Association Between TBI-Related Hearing Impairment and Cognition: A TRACK-TBI Study
Authors: Hwang Phillip H. , Nelson Lindsay D. , Sharon Jeffrey D. , McCrea Michael A. , Dikmen Sureyya S. , Markowitz Amy J. , Manley Geoff T. , Temkin Nancy R.
Published: October 2021

Objective:

To examine the association between hearing impairment and cognitive function after traumatic brain injury (TBI).

Setting:

A total of 18 level I trauma centers throughout the United States in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study.

Participants:

From February 2014 to June 2018, a total of 2697 participants with TBI were enrolled in TRACK-TBI. Key eligibility criteria included external force trauma to the head, presentation to a participating level I trauma center, and receipt of a clinically indicated head computed tomographic (CT) scan within 24 hours of injury. A total of 1267 participants were evaluated in the study, with 216 participants with hearing impairment and 1051 participants without hearing impairment. Those with missing or unknown hearing status or cognitive assessment were excluded from analysis.

Design:

Prospective, observational cohort study.

Main Measures:

Hearing impairment at 2 weeks post-TBI was based on self-report. Participants who indicated worse hearing in one or both ears were defined as having hearing impairment, whereas those who denied worse hearing in either ear were defined as not having hearing impairment and served as the reference group. Cognitive outcomes at 6 months post-TBI included executive functioning and processing speed, as measured by the Trail Making Test (TMT) B/A and the Wechsler Adult Intelligence Scale, Fourth Edition, Processing Speed Index subscale (WAIS-IV PSI), respectively.

Results:

TBI-related hearing impairment had a small but significantly greater TMT B/A ratio than without TBI-related hearing impairment: mean difference (B) = 0.25; 95% CI, 0.07 to 0.43; P = .005. No significant mean differences on WAIS-IV PSI scores were found between participants with and without TBI-related hearing impairment: B = 0.36; 95% CI, −2.07 to 2.60; P = .825.

Conclusion:

We conclude that TBI-related hearing impairment at 6 months postinjury was significantly associated with worse executive functioning but not cognitive processing speed.
Effect of Race and Nativity on Functional Outcomes Following Traumatic Brain Injury Among Asian, Hispanic, and Non-Hispanic White Survivors in the United States: A NIDILRR TBI Model Systems Study
Authors: Kuerban Aliya , Dams-O'Connor Kristen
Published: October 2021

Objective:

To compare the racial/ethnic differences in traumatic brain injury (TBI) recovery among Asians, Hispanics, and Whites, and explore the effect of nativity in the recovery process.

Setting:

Six Traumatic Brain Injury Model Systems (TBIMS) centers.

Participants:

In total, 7953 patients who had at least 1 severe TBI between 2000 and 2016 were admitted to one of the TBIMS centers.

Design:

Secondary data analysis.

Main Measures:

Functional Independent Measure (FIM instrument) ratings.

Results:

Asians had the lowest injury severity at admission, but they failed to make the improvements made by the Hispanics and the Whites between the rehabilitation discharge and the 1-year follow-up. The magnitude of improvement made by the foreign-born Asians was less than that made by their native-born counterparts. Both Asian and the Hispanic groups had lower functional outcomes at the 1-year follow-up, and the differences in functional outcomes between the Asian and Hispanic groups were not statistically significant. The above racial/ethnic disparities in functional outcomes were not fully explained by differences in sociodemographic status, injury characteristics, and immigration-related factors. The effect of nativity was mediated by covariates.

Conclusions:

This study reveals racial/ethnic disparities post-TBI functional recovery. Despite lower injury severity and apparent financial resource advantages, Asians did not experience better functional outcomes. Although the effect of nativity was not established in this study, contextual factors related to ethnicity and immigration experiences should be further investigated.
Detection of circulating tumor cells as therapeutic markers in patients with penile squamous cell carcinoma: A preliminary study
Authors: Kao Chien-Chang , Xu Ting , Yang Yung-Ning , Tsai Yi-Ta , Liu Shu-Yu , Wu Sheng-Tang , Meng En , Tsao Chih-Wei , Chen Chin-Li , Sun Guang-Huan , Yu Dah-Shyong , Chang Sun-Yran , Cha Tai-Lung , Yang Ming-Hsin
Published: October 2021

Background:

This study aimed to investigate the presence of circulating tumor cells (CTCs) in patients with penile squamous cell carcinoma (PSCC).

Methods:

CTCs were isolated from 14 patients with PSCC, 6 patients with balanoposthitis, and 6 healthy individuals. CTCs were enriched based on cell surface markers and filtered through the IsoFlux device, followed by identification according to cell morphology and immunofluorescence studies.

Results:

CTCs were found in all PSCC blood samples but not in balanoposthitis samples and samples from healthy individuals. Immunofluorescence studies confirmed the tumor origin. When the patients with PSCC were stratified according to metastatic inguinal lymph node status, a statistically significant difference was observed in the number of detected CTCs.

Conclusion:

Our study showed that CTCs in PSCC may represent a valuable marker for differentiating PSCC from other tumors. Based on the correlation with some clinical parameters, CTC analysis is possibly relevant for noninvasive monitoring of disease progression and prognosis. The results also suggested a potential role of CTCs in preventing overtreatment, such as inguinal lymph node dissection.
Reducing Cardiovascular Risk for Patients With Diabetes: An Evidence-Based, Population Health Management Program
Authors: Levitz Carly , Jones Maggie , Nudelman Jean , Cox Michael , Camacho Diana , Wielunski Alexis , Rothman Michael , Tomlin Juliane , Jaffe Marc
Published: October 2021

Those with diabetes are at an increased risk of cardiovascular disease (CVD). Safety net clinics serve populations that bear a significant burden of disease and disparities and are a key setting in which to focus on reducing CVD. An integrated health system provided funding and technical assistance (TA) to safety net organizations (community health centers and public hospitals) in Northern California to decrease the risk of cardiovascular events for patients with diabetes. This was a program called Preventing Heart Attacks and Strokes Everyday (PHASE), which combined an evidence-based medication protocol with population health management and team-based care strategies. The TA supported organizations by sharing best practices, providing quality improvement coaching, and facilitating peer learning. A mixed-methods evaluation found that organizations involved in PHASE improved rates of blood pressure control and cardioprotective medication prescriptions for patients with diabetes. They made progress on these measures through strategies such as leveraging team-based care, providing education on evidence-based protocols, and using data to drive improvements. The evaluation concluded that financially supporting and providing focused TA to safety net organizations can help them build capacity and leverage their strengths to improve outcomes and potentially decrease the risk of heart attacks and strokes in communities.
Course Review
Authors: Dhillon Dharminder , Teklay Samuel , Li Zoe
Published: October 2021

Hand trauma encompasses a wide range of problems from amputations to complex fracture patterns, presenting the plastic surgeon with a number of unique challenges. The hand is of paramount importance to work and activities of daily living, therefore, restoration of normal function is critical to every patient.

The St. Thomas' Cadaveric Hand Trauma course is a 2-day interactive practical course that uses fresh-frozen cadaveric specimens to provide participants the opportunity to develop their skills in the management of common traumatic hand injuries. The course is held annually in London, United Kingdom at a cost of £600 GBP ($794). Here, we provide a critical evaluation of the course.
Shear Stress Causing Hemolytic Anemia and Congestive Heart Failure as an Initial Presentation of Cor Triatriatum in an Infant
Authors: Meyer Sarah , Quirk Lindsay , Pick Justin , Takao Cheryl , Mody Ameer P.
Published: October 2021

Among congenital cardiac defects, cor triatriatum sinistrum is a rare formation of 3 distinct atrial chambers in the heart. Depending on the size of the defect in the membranous septum, the symptoms can range from asymptomatic to severe pulmonary hypertension. Individuals can go years, sometimes to the second and third decades of life, before presenting with symptoms. Although it is well known to be associated with pulmonary veno-occlusive disease, the association with hemolytic anemia is much less well known. Identifying the subtle signs and symptoms of cor triatriatum in the emergency department can save a life. Here, we present the case of a 6-month-old infant with hemolytic anemia in the setting of right-sided congestive heart failure leading to the diagnosis of cor triatriatum. Anemia developed secondary to shearing stress caused by the heart defect itself. Complete resolution of symptoms occurred status post septectomy and repair of the defect.
Home Health Care Nursing Impacts on Emergency Department Utilization
Authors: Ruel Jennifer
Published: October 2021

With health care costs continuing to rise, much attention has been focused on appropriate emergency department (ED) utilization, and nationwide interventions have been developed to support reduction in health care costs and ED use including primary care, community, and home health models. The following is a review of the current state of the evidence regarding patients receiving home health care nursing (HHN) services and impacts on ED utilization. There are significant gaps in the literature regarding the transition from home to ED in patients receiving HHN services; what tools are utilized by home health nurses for triage of patients at home in order to recommend transfer to the ED or other care sources; and what measures are in place for HHN patients regarding variables that are considered to have a higher impact on ED utilization. There is a substantial lack of evidence about whether the effects of HHN services have any relation to, in particular decreasing, ED utilization. There is increasing evidence of the impacts of nurse practitioner care within the community.
Cognitive Adverse Effects of Electroconvulsive Therapy
Authors: Hammershøj Lisa G. , Petersen Jeff Z. , Jensen Hans M. , Jørgensen Martin B. , Miskowiak Kamilla W.
Published: October 2021

Objectives

The character and duration of cognitive adverse effects of electroconvulsive therapy (ECT) are unclear. This study investigated (1) the sensitivity of a short cognitive test battery to cognitive adverse effects of ECT, (2) the relation between subjective and objective cognitive adverse effects, and (3) patient characteristics associated with more subjective than objective adverse effects.

Methods

Forty-one patients with unipolar or bipolar depression referred to ECT underwent assessments at baseline, 5 to 7 days post-ECT, and 3 months post-ECT. Patients rated their fear of various aspects of ECT on a visual analog scale. At each assessment, patients were evaluated for depressive symptoms, completed the Screen for Cognitive Impairment in Psychiatry (SCIP) and Trail Making Test-Part B (TMT-B), and rated their cognitive difficulties.

Results

Patients feared cognitive adverse effects and lack of treatment efficacy more than other aspects of ECT. The SCIP and TMT-B revealed transient decline in objective cognition after ECT, which was reversed after 3 months. Patients presented with more subjective than objective cognitive difficulties at baseline and more subjective than objective cognitive adverse effects of ECT. This discrepancy was significantly reduced at follow-up. Younger age and poorer objective cognition pretreatment were associated with more subjective than objective cognitive adverse effects 5 to 7 days after ECT.

Conclusions

The SCIP and TMT-B are sensitive to cognitive adverse effects of ECT. Patients show more subjective than objective cognitive adverse effects of ECT. These insights can be used clinically to inform patients of treatment choice and expected cognitive consequences.
Disease tolerance alters host competence in a wild songbird
Authors: Ruden Rachel M. , Adelman James S.
Published: October 2021

Individuals can express a range of disease phenotypes during infection, with important implications for epidemics. Tolerance, in particular, is a host response that minimizes the per-pathogen fitness costs of infection. Because tolerant hosts show milder clinical signs and higher survival, despite similar pathogen burdens, their potential for prolonged pathogen shedding may facilitate the spread of pathogens. To test this, we simulated outbreaks of mycoplasmal conjunctivitis in house finches, asking how the speed of transmission varied with tissue-specific and behavioural components of tolerance, milder conjunctivitis and anorexia for a given pathogen load, respectively. Because tissue-specific tolerance hinders pathogen deposition onto bird feeders, important transmission hubs, we predicted it would slow transmission. Because behavioural tolerance should increase interactions with bird feeders, we predicted it would speed transmission. Our findings supported these predictions, suggesting that variation in tolerance could help identify individuals most likely to transmit pathogens.
Antibiotic resistance and the presence of bla
CfxA and bla
CSP genes in β-lactamase-producing clinical Capnocytophaga isolates from a university hospital in Japan
Authors: Matsumoto Takehisa , Matsumoto-Matsubara Miki , Horiuchi Kazuki , Arai Eriko , Negishi Tatsuya , Natori Tatsuya , Kawakami Yoshiyuki
Published: October 2021

Introduction

. Capnocytophaga species are common inhabitants of the oral cavity and can be responsible for systemic diseases in immunocompromised patients with granulocytopenia. Furthermore, it has been reported that some clinical isolates of

Capnocytophaga

species produce extended-spectrum β-lactamases (ESBLs).

Gap statement. Information is lacking about the types of β-lactamase genes possessed by

Capnocytophaga

spp. and the antimicrobial susceptibility of

Capnocytophaga

spp. possessing each β-lactamase gene.

Aim. The aim of this study was to investigate the presence of β-lactamase genes in clinical strains of β-lactamase-producing

Capnocytophaga

species isolated from clinical samples acquired at Shinshu University Hospital and examine the antimicrobial susceptibility of those strains.

Methodology. The β-lactamase-producing

Capnocytophaga

species (n=49) were obtained from clinical specimens. PCR assays were used to detect bla
CfxA, bla
CSP, bla
TEM, bla
CepA/CblA and transposon Tn4555 genes. Southern hybridization assays were used to detect bla
CfxA and bla
CSP. The minimum inhibitory concentration of some β-lactams was determined using the E-test method.

Results. PCR analysis indicated that the bla
CfxA gene was present in 15 (30.6 %) and the bla
CSP gene in 35 (69.3 %) of the 49

Capnocytophaga

strains investigated, . Both bla
CfxA and bla
CSP genes were detected in a

Capnocytophaga gingivalis

strain. The PCR results were confirmed by Southern hybridization assays. Transposon Tn4555 was only detected in

Capnocytophaga

spp. harbouring the bla
CfxA gene. All the β-lactamase-producing

Capnocytophaga

isolates were susceptible to ceftazidime–clavulanic acid, cefoxitin and imipenem. In contrast, most of the isolates were resistant to amoxicillin.

Conclusions. The clinical isolates of

Capnocytophaga

spp. showed a high prevalence of the bla
CSP gene in Japan. The presence of the bla
CSP gene was distributed in

Capnocytophaga sputigena

as well as other

Capnocytophaga

spp. These results seem to suggest the dissemination of bla
CfxA and bla
CSP β-lactamase genes among

Capnocytophaga

species.