bluuebunny/crossref_metadata_2025 huggingface dataset:
A normal section plane method for profile error analysis of five-axis machine tools based on the ideal tool flank milling surface
Authors: Wang Liping , Fu Meng , Guan Liwen , Chen Yanyu
Published: August 2021

The existing studies on profile error analysis and machining accuracy measurement do not consider the impact of the theoretical errors on the machine tool accuracy measurement. Therefore, this study proposes an estimation method of the surface profile error based on the normal section plane, using the theoretical flank milled surface for comparison. This effectively improves the accuracy of profile error estimation. The theoretical flank milled surface is the surface machined by flank milling under ideal conditions. Hence, compared to the traditional analysis method based on the designed three-dimensional model of S-shaped test pieces, the calculated profile error of this method does not include theoretical errors, thereby eliminating the impact of theoretical errors on machine tool accuracy measurement and evaluation. First, an improved method for continuous parameterized dual spline interpolation was proposed. It simplifies the solution of the singular problem of the coefficient matrix of the spline basis function and obtains a continuous ideal machining tool axis trajectory surface with complete geometric characteristics. Next, a method for constructing the theoretical flank milled surface machined with a cylindrical milling tool using equidistant mapping characteristics was proposed; then, the differential transformation relationship at the cutting contact point of the curved surface under the influence of tool path errors was established. Furthermore, the normal section plane method based on the differentiation of the cutting contact point was proposed. The problem of solving the distance from a point to a surface is converted to the problem of solving the distance from a point to a curve in the normal section plane. This improves the accuracy of profile error estimation. The effectiveness of the method was verified by comparing the analysis results of the profile errors of a typical cylindrical surface with the point to surface and the point to curve methods.
Event-triggered control of vehicle platoon under deception attacks
Authors: Bansal Kritika , Mukhija Pankaj
Published: August 2021

This paper addresses the issue of control of a vehicle platoon system with limited on-board energy and communication resources and subjected to cyber-physical attacks. A platoon model for the predecessor-leader following topology under the effect of cyber-attack and time-varying delay is developed. A stochastic type deception attack is considered in this paper at the sensor-controller end of a vehicle. The probability of occurrence of attack is represented using a random variable. In addition, to reduce the usage of resources in a system, a decentralized event-triggering communication mechanism is proposed where each vehicle can decide independently on when to transmit its state to the controller. Further, the criteria for co-designing of control law and triggering parameter ensuring internal stability of the platoon system is developed based on the proposed triggering mechanism. A condition to achieve string stability for the controller is also obtained. Further, to avoid the problem of Zeno phenomena, a lower bound on the transmission period is presented. The effectiveness of the proposed methodology is established through simulation example.
Excluded communities and participatory land-use planning: experience from informal Roma settlements in Serbia
Authors: Vuksanović-Macura Zlata , Miščević Igor
Published: August 2021

Citizen participation in the planning and decision-making process in the European post-socialist context is much debated. Still, the involvement of excluded communities in the urban planning process remains understudied. This paper presents and discusses the application of an innovative participatory approach designed to ensure active involvement of an excluded ethnic minority, the Roma community, in the process of formulating and adopting land-use plans for informal settlements in Serbia. By analysing the development of land-use plans in 11 municipalities, we observe that the applied participatory approach enhanced the inhabitants’ active participation and helped build consensus on the planned solution between the key actors. Findings also suggested that further work with citizens, capacity building of planners and administration, and secured financial mechanisms are needed to move citizen participation in urban planning beyond the limited statutory requirements.
Application of Hybrid Approach in Banking System: An Undesirable Operational Performance Modelling
Authors: Preeti  , Roy Supriyo
Published: August 2021

Non-performing loans (NPLs) is a critical constituent that impacts the operational performance of banks. Rising level of risk leads to poor operational performance, especially when it is beyond the bank’s capabilities to control the increasing bad assets. This calls for real-time performance assessment coupled with futuristic decision making to support banking managers. This observation motivates the authors of this article to develop a two-stage performance prediction assessment model. Accordingly, a hybrid approach combining data envelopment analysis (DEA) and artificial neural network (ANN) is developed to measure and predict the operational efficiency scores of banks. DEA effectively explores the operational performance as well as improvable areas of inefficient banks. The training of ANN model is dependent on estimated operational DEA efficiency scores with the objective to estimate the efficiency scores. Domain for the validation of this study includes dataset derived from Indian banks. The validation result shows that trained ANN model has the prediction capacity with minimum error and maximum accuracy. Finally, the outcome of this study is significantly directed towards business managers who can rely on predictions based on empirical findings of this proposed hybrid modelling.
Prince Kola Beverages Limited (PKBL)
Authors: Shaikh Shazib E.
Published: August 2021

Prince Kola Beverages Limited (PKBL) is an introduction-level decision modelling case that aims to help develop what-if analysis and spreadsheet modelling skills. It has already been taught in three cohorts of my executive course customized for Coca Cola Beverages Pakistan (CCBPL) Limited middle managers, ‘Data Savvy Decision-Making’, and was warmly received. It is also suitable for both MBA and undergraduate business students. The problem involves using elementary forecasting, scenario analysis and sensitivity analysis without the complexity of statistics. This was also part of a 4-hour session in executive courses that included in-lab trainings on Microsoft Excel what-if analysis tools. For 80–90-minute sessions, students must have already been equipped with these tools. Additionally, it would be better to have the spreadsheets of students submitted by an online learning management system in advance of the class so that their models can be displayed in class and debated.
Exploring the Origins of Bhutan’s Gross National Happiness
Authors: Masaki Katsu , Tshering Jit
Published: August 2021

Bhutan’s Gross National Happiness (GNH) is often dismissed by its critics as being an instrument for policy elites to address ‘national security concerns’ that started to threaten their grasp on the state around the turn of the millennium. This study problematizes this line of criticism that relegates GNH to an ‘invented tradition’ of recent origin. For this purpose, this study draws on Roy Wagner’s notion of ‘invention’ that draws attention to how various sets of meanings are brought together. A historical analysis of the country’s development plans points to several origins of GNH, including ‘Buddhism and Bhutan’s traditional socio-economic system’ and ‘outside concepts’ holding sway in international debates on development. GNH has undergone a long and gradual process of elaboration in view of Buddhist mores and development discourses, while also taking into account national security concerns. This study concludes by warning against the reductionistic stance of GNH critics, in favour of a more balanced perspective that captures the multiplicity of the origins of GNH.
Debating the Relevance of Non-alignment in Indian Diplomacy
Authors: Kaura Vinay
Published: August 2021

Zorawar Daulat Singh, Power & Diplomacy: India’s Foreign Policies During the Cold War (Oxford University Press, 2019). pp. 398, ₹950. ISBN 978-0199489640.

Sudhanshu Tripathi, India’s Foreign Policy: Dilemma Over Nonalignment 2.0 (SAGE Publications, 2020). pp. 203, ₹895. ISBN 978-9353286422.
Book review: Rasheed, Adil, Countering the Radical Narrative
Authors: Agha Ambreen
Published: August 2021

Rasheed, Adil, Countering the Radical Narrative (Knowledge World, 2020), Pp. 198, Price ₹1280 ISBN 978-93-89137-71-2 (Hardback).
Care coordination as a collaborative element of recovery oriented services for persons with severe mental illness
Authors: Isaacs Anton N
Published: August 2021

Objective:

To propose a model where care coordination can form part of recovery oriented care when it is included as a collaborative element of services for persons with severe mental illness.

Conclusion:

A recovery-oriented service requires more than clinical interventions. It also needs to address social determinants and be individualised or person centred. Multiple health and community services need to be involved. A care coordination model is capable of addressing multiple needs. It gives the client the first and foremost voice. It facilitates intersectoral collaboration, reduces the burden on clinical mental health services and is supported by mental health and community service personnel.
Burnout: modeling, measuring, and managing
Authors: Parker Gordon , Tavella Gabriela
Published: August 2021

Objective:

As burnout has been neglected in medical and psychiatric education, we seek to provide a summary overview.

Methods:

We extract salient findings from the published literature and offer some challenges.

Results:

We critique the current principal model of burnout, argue for broadening the symptom constructs and for a diathesis-stress model where a perfectionistic personality style is a key predisposing factor, and observe that burnout is not limited by those in formal work. We argue that burnout is not synonymous with depression, overview biological underpinnings, and summarise a three-fold management model.

Conclusion:

As many burnout patients are referred to psychiatrists, awareness of its symptom pattern and management nuances is of key importance.
Leveraging Emergency Department Information Systems to Address Palliative Care Needs of ED Patients During the COVID Pandemic
Authors: Tan Audrey J. , Swartz Jordan , Wilkins Christine , Grudzen Corita
Published: August 2021

The arrival of the COVID-19 pandemic to hospitals in New York City stressed our emergency departments (ED) with high patient volume, stresses on hospital resources and the arrival of numerous high acuity, critically ill patients. Amid this time, we sought to leverage the ED Information Systems (EDIS), to assist in connecting critically ill patients, their families, and providers in the ED with palliative care resources. We discuss 4 innovative, thoughtful solutions to assist ED providers in identifying and addressing the acute and unique palliative care needs of COVID patients.
Building Professionals’ Capacity: The Cascading Coaching Model
Authors: Chung Moon Y. , Lee James D. , Meadan Hedda , Sands Michelle M. , Haidar Ban Sleiman
Published: August 2021

The importance of family engagement in their children’s education and treatment is emphasized by researchers, professional organizations, and legislatures. Providing services with caregivers via telepractice has gained more support and is becoming especially timely due to the current pandemic and social distancing requirements. Professionals, such as board-certified behavior analysts (BCBAs), who work with caregivers with children with disabilities may benefit from receiving professional development on strategies for building better rapport with caregivers and coaching them to bring about maximum clinical efficacy. The current pilot study replicated an earlier study by Meadan et al. to examine the effects of the Coaching Caregiver Professional Development (CoCarePD) intervention package, in which BCBAs received training and coaching from researchers via telepractice, on their caregiver coaching practices. A single-case, multiple-probe design study across three BCBAs was conducted, and findings support a functional relationship between the CoCarePD and BCBAs’ use of coaching practices.
Use of Surfacer, an inside-out device, in tandem with HeRO graft for creation of vascular access: Case report of three patients with 18-months follow up
Authors: Qi Tian Teo , Hao Yun Yap , Jia Sheng Tay , Tjun Yip Tang , Tieng Chek Edward Choke
Published: August 2021

The Surfacer Inside-Out Access Catheter System (Surfacer) is a novel approach to restore access in total central vein occlusion (TCVO). We report a series of three cases, with mean 18-months follow up, in our institution where this technique was safely and effectively used in tandem with Hemodialysis Reliable Outflow (HeRO) graft for creation of upper limb vascular access in patients with TCVO. Although there have been reports describing the simultaneous combination of Surfacer and HeRO graft, to our knowledge, this is the first time where the outcomes with 18-months mean follow-up are reported. All three patients had failed prior conventional attempts at TCVO crossing and had exhausted most conventional upper limb vascular access methods. The above technique yielded a 100% technical success rate with mean operative time of 140 min. Cannulation rate was 100% with all undergoing successful early cannulation by post-operative day 3. Mean primary patency of 199 days was achieved. Average intervention rate of 1.2 a year was required to maintain patency. The Surfacer device used together with HeRO graft is a feasible technique to avoid femoral catheter in patients where conventional attempts to cross the TCVO have failed.
Barriers for Implementing the Hub and Spoke Model to Expand Medication for Opioid Use Disorder: A Case Study of Montana
Authors: Green Brandn , Rhubart Danielle Christine , Filteau Matthew R
Published: August 2021

Purpose:

Access to medication for opioid use disorder (MOUD) varies across the rural-urban continuum. The Hub & Spoke Model (H&S) emerged to address these gaps in service whereby hubs with staff expertise in MOUD support delivery of specialized care to a network of spoke locations, often located in rural communities with workforce shortages. This paper presents a case study of efforts to implement the hub and spoke model in a frontier and rural (FAR) state: Montana.

Methods:

The primary data are structured interviews with 65 MOUD program staff in hub and spoke locations within Montana. Both inductive and deductive coding were used to analyze the transcripts.

Findings:

Using the H&S structure to expand access to MOUD in Montana led to mixed results. There were consistent themes identified in the interviews about the reasons why hubs struggled to successfully recruit spokes, including (1) geographic barriers, (2) a lack of interest among medical providers, (3) fears about excessive demand, (4) concerns about the financial viability of the model, and (5) a preference for informal technical assistance rather than a formal H&S relationship. In addition to these 5 themes, efforts to implement H&S across different medical systems were unsuccessful, whereas the H&S model worked more effectively when H&S locations were within the same organization.

Conclusion:

This case study identified limits to the H&S model utility in supporting states’ abilities to expand access to MOUD treatment and offers suggestions for adapting it to accommodate variation across divergent rural contexts. We conclude with recommendations for strategies that may assist in expansion of MOUD in rural communities that are like those found in Montana.
Telephones, music and history: From the invention era to the early smartphone days
Authors: Behrendt Frauke
Published: August 2021

This article focusses on the musical history of the telephone, an aspect of telephonic history that is often overlooked and has not yet received systematic academic attention. The article is structured around two musical themes of telephonic history: (1) public performances of telephones as musical instruments and (2) the telephone network as musical instrument. Two historic periods are considered for both themes, (a) the late 1800s/early 1900s and (b) the late 2000s. The article’s approach draws loosely on media historic and media archaeologic perspectives to analyse existing material about telephone history (with a musical focus) alongside empirical field work on the musical use of mobile phones in the late 2000s. The results contribute to debates regarding the ‘newness’ of media, and to sound studies approaches to media histories. The article shows how the theme of the musical telephone has been re-occurring but often overlooked throughout its history, and also sketches out a future research agenda. The article contributes a new understanding of the musical uses of the telephone across history, relevant for both understanding contemporary uses of telephone technologies such as smartphones and the Internet of Things, and for a richer understanding of historic telephone uses.
COVID-19 and the pre-existing language teacher supply crisis
Authors: Moser Kelly , Wei Tianlan
Published: August 2021

The insufficient supply of K-12 language – world language (WL) and English as a second language (ESL) – teachers in the United States has been a pervasive challenge for school administrators seeking to provide language learning opportunities for their students. The issue is complex – including numerous factors that adversely affect the recruitment of future educators as well as their retention once in the classroom. Almost all states report a dearth of WL and/or ESL teachers, and WL is the discipline with the highest predictive teacher turnover rate – whether by leaving the profession entirely ( leavers) or opting to move to a different school ( movers). In spring 2020, the global health pandemic placed additional demands on all educators, and consequently some reports predict an exodus of teachers from K-12 schools. This article presents the results of a study exploring language teachers’ intention to leave the profession as a consequence of school-related responsibilities and experiences during spring 2020. Data revealed three profiles of K-12 language teachers: stayers, leavers, and conditional stayers. Implications related to influential factors in teachers’ potential decisions to remain in or exit the profession are provided.
Role of dynamic water rivulets in the excitation of rain–wind-induced cable vibration: A critical review
Authors: Gao Donglai , Li Wenjie , Jing Haiquan , Wang Jian , Wu Jintuan , Chen Wenli , Hui Li
Published: August 2021

It has been more than 30 years since Hikami Y and Shiraishi N (1988) Rain–wind-induced vibrations of cable-stayed bridges. Journal of Wind Engineering and Industrial Aerodynamics 29: 409–418 first reported the rain–wind-induced vibration (RWIV) of stay cables in the construction stage of Meikonishi Bridge, Japan. After that, considerable research efforts have been devoted to understanding the RWIV of stay cables, and the role of the upper rivulet has been gradually realized and studied. This study presents a selective review on recent progress of RWIV and its controversial excitation mechanism. The available knowledge and up-to-date understanding of this complex fluid-structure interaction are presented in some detail. The formation, dynamics of water rivulet, and its role in affecting the near-wall boundary layer properties and in the excitation scenario of RWIV are of particular interest in this study. Finally, some limitations of previous studies are concluded, with some perspective suggestions for further study of excitation mechanism of RWIV.
Do you want to receive bad news through your patient accessible electronic health record? A national survey on receiving bad news in an era of digital health
Authors: Rexhepi Hanife , Moll Jonas , Huvila Isto , Åhlfeldt Rose-Mharie
Published: August 2021

Despite the fact that patient accessible electronic health records (PAEHRs) have been around for many years in several countries, there is a lack of research investigating patient’s preferences for receiving bad news, including through PAEHRs. Little is also known about the characteristics of the patients who prefer to receive bad news through the PAEHR in terms of, for example medical diagnosis, age and educational level. This study, based on a national patient survey in Sweden ( N = 2587), investigated this. Results show that, generally, receiving bad news by reading in the PAEHR is still among the least preferred options. Additionally, a higher proportion of men want to receive bad news in the PAEHR compared to women ( p = 0.001), and the same goes for those who are not working/have worked in healthcare ( p = 0.007). An effect of disease groups was also found, showing that diabetes patients in particular, want to receive bad news through the PAEHR.
The meaning and experience of gratitude for people living with dementia
Authors: Pearson Martha , Clarke Chris , Wolverson Emma
Published: August 2021

Rationale

Supporting people to live well with dementia is an international government priority. People living with dementia experience a range of positive emotions despite the challenges associated with dementia. Further research is needed to explore how these positive experiences can be fostered to support well-being. There is empirical evidence of the benefits of gratitude in other clinical groups, but no studies have explored how gratitude is experienced by people living with dementia.

Methods

In this mixed-methods study, eight people living with dementia shared their experiences of gratitude through interviews and gratitude diaries. Qualitative data were analysed using interpretative phenomenological analysis. Quantitative data regarding diary use were analysed using descriptive statistics.

Findings and Conclusions

Gratitude holds interpersonal and transpersonal meanings for people living with dementia, balanced with challenges of dementia and ageing. This study offers insight into the existence and relevance of gratitude for people living with dementia, highlighting the importance of using multiple methods in dementia research. Positive psychology interventions informed by these findings may be effective in supporting well-being for people with dementia.
The “good” and the “bad” subject position in self-injury autobiographies
Authors: Gunnarsson Nina Veetnisha , Lönnberg Mikaela
Published: August 2021

Utilizing published autobiographies, we explore how individuals who self-injure discursively construct their experiences of the self and self-injury. The authors construct their selves into two seemingly opposite subject positions, here named the “bad girl” and the “good girl.” For the most part, the authors identify themselves with the “bad girl” position. Although there is a struggle to uphold normalcy in front of others, they regard evidence of the “good girl” position as fake. We demonstrate how they, to a large extent, accept the dominant discourse of self-injury as an individual and pathological problem for which they tend to blame themselves. However, they also challenge the negative subject position by separating themselves discursively from the bad “side of the self.” Acts of self-injury are described as a way to cope with the negative perception of themselves and at the same time being what causes feelings of self-loathing. Thus, understanding how the psychomedical discourse affects individuals who self-injure as well as the consequences of the medicalization of self-injury are of importance. Furthermore, social workers may be in a legitime position to work with the self-representations and the social factors that may underlie an individual’s need to cut or in other ways physically hurt oneself.
Monitoring of self-healing in concrete with micro-capsules using a combination of air-coupled surface wave and computer-vision techniques
Authors: Ahn Eunjong , Kim Hyunjun , Gwon Seongwoo , Oh Sung-Rok , Kim Cheol-Gyu , Sim Sung-Han , Shin Myoungsu
Published: August 2021

This study mainly aims to investigate the applicability of the combination of air-coupled surface-wave and computer-vision techniques to the evaluation of self-healing in in situ concrete members. Small-scale beam specimens were made from ordinary concrete and concretes with solid- and liquid-type capsules; the capsules were employed as self-healing agents. To monitor the crack healing progress, surface-wave tests using an air-coupled transducer and contact receivers were conducted on each specimen in uncracked, cracked, and healed conditions after 7, 14, 28, and 63 days of water immersion. Additionally, a computer-vision technique involving image binarization and registration was applied to measure high-resolution crack information. The specimens containing the micro-capsules showed superior healing performance compared to the ordinary concrete specimens. After 63 days of self-healing, the spectral energy transmission ratio increased up to about 80% of the uncracked, while the crack area decreased up to about 94% of the fully cracked. The healing rate was estimated using the change in spectral energy transmission ratio strongly correlated with that estimated using the change in crack area.
On Black Male Leadership: A Study of Leadership Efficacy, Servant Leadership, and Engagement Mediated by Microaggressions
Authors: Sims Cynthia M. , Carter Angela D. , Sparkman Torrence E. , Morris Lonnie R. , Durojaiye Ande
Published: August 2021

The Problem

Dr. Martin Luther King Jr, and other Black men (and women) successfully used servant leadership to advance U.S. civil rights. Yet, the value of these leadership practices among Black men in contemporary workplaces is not known. The decision to lead may be based upon one’s leadership self-efficacy and influenced by community and as Black men prioritize social justice and developing others, they may be servant leaders. While engaged, the role of microaggression on engagement has not been studied. Thus, research is needed on Black male leadership.

The Solution

This study examined whether Black men possess the antecedent of leadership efficacy, demonstrate servant leadership, experience the outcome of engagement, and microaggressions, whether microaggressions mediated and decreased their engagement, and did socio-identities function as a moderator. Using cross-sectional survey methodology, a confirmatory factor analysis and a causal model was conducted along with a post hoc ANOVA. Black men leaders were about a third of the sample ( n = 364). The structural equation modeling revealed the significant findings that leadership efficacy predicted servant leadership, servant leadership predicted engagement, and, microaggressions partially mediated engagement. Socio-identities did moderate leadership efficacy, engagement, and microaggressions but not servant leadership and the overall measurement model.

The Stakeholders

This study benefits HRD and other scholars and practitioners who study leadership including those with intersecting identities—African American men.
Eco-friendly sorbent of bacterial cellulose/metal–organic framework composite membrane for effective bisphenol a removal
Authors: Sun Yue , Li Xin , Li Dawei , Ke Huizhen , Wei Qufu
Published: August 2021

Environmental hormones such as bisphenol A have attracted enormous attention due to their potential threat to humans and environment. Herein, we synthesized a BC/MIL-53 (Al)-F127 composite membrane by the vacuum filtration method with a mesostructure metal–organic framework MIL-53 (Al)-F127 and bacterial cellulose as the substrate. The BC/MIL-53 (Al)-F127 composite membrane exhibited efficient adsorption of bisphenol A in aqueous solution. The results exhibited that 94% of bisphenol A could be adsorbed in approximately 120 min, and the equilibrium sorption amounts of bisphenol A reached approximately 8.3 mg/g. Meanwhile, the mechanism of adsorption was explored. The optimum pH and temperature for the adsorption of bisphenol A were 6 and 40°C, respectively. The removal efficiency of bisphenol A was maintained at 90% after five repeated cycles, indicating the advantage to separate freely without a complex filtration system. The results of adsorption indicated that the BC/MIL-53 (Al)-F127 membrane has great potential in the aspect of the sewage treatment as a prospective sorbent.
Are They Athletes? A Self-Assessment of Athletic Identity Measurement and Perceived Benefits of Collegiate Esports Participants
Authors: Buzzelli Armand , Draper Jason
Published: August 2021

Collegiate esports is a rapidly growing entity that is managed differently across campuses, with oversight taking place in athletic departments, campus recreation departments, student affairs, and to a lesser degree, academic departments. Esports has the potential to support the recruitment and retention of students while supporting the academic mission of universities through co-curricular opportunities in a variety of subject areas. Despite the broad existence of peer-reviewed research debating the consideration of esports as a sport, limited research is available that asks esports participants if they view themselves as athletes. A total of 120 participants completed a survey instrument that included items from the Athletic Identity Measurement Scale-Plus and the Quality and Importance of Recreational Services instruments. From the collegiate esports players included in this research, we see a complex picture of student-athletes emerging.
Effects of GABAB receptor activation on excitability of IB4-positive maxillary trigeminal ganglion neurons: Possible involvement of TREK2 activation
Authors: Chang Ya-Ting , Ling Jennifer , Gu Jianguo G
Published: August 2021

IB4-positive maxillary trigeminal ganglion (TG) neurons are a subtype of afferent neurons involving nociception in orofacial regions, and excitability of these neurons is associated with orofacial nociceptive sensitivity. TREK-2 channel is a member of two-pore domain potassium (K2P) channel family mediating leak K+ currents. It has been shown previously that TREK-2 channel activity can be enhanced following GABAB receptor activation, leading to a reduction of cortical neuron excitability. In the present study, we have characterized TREK-2 channel expression on maxillary TG neurons and investigated the effect of the GABAB agonist baclofen on electrophysiological properties of small-sized maxillary TG neurons of rats. We show with immunohistochemistry that TREK-2 channels are predominantly expressed in small-sized IB4-positive maxillary TG neurons. Patch-clamp recordings on neurons in ex vivo TG preparations show that baclofen hyperpolarizes resting membrane potentials, increases outward leak currents, and decreases input resistances in IB4-positive maxillary TG neurons. Moreover, baclofen significantly reduces action potential (AP) firing in IB4-positive maxillary TG neurons. In contrast, baclofen shows no significant effect on electrophysiological properties of small-sized nociceptive-like and non-nociceptive-like maxillary trigeminal neurons that are IB4-negatve. Our results suggest that TREK-2 channel activity can be enhanced by baclofen, leading to reduced excitability of IB4-positive maxillary TG neurons. This finding provides new insights into the role of TREK-2 and GABAB receptors in controlling nociceptive sensitivity in orofacial regions, which may have therapeutic implications.
Severe tachypnoea and dyspnoea due to physiological hyperventilation in pregnancy
Authors: Thomson Brady , Velusamy Ragani , Martin Annabel
Published: August 2021

Physiological hyperventilation and dyspnoea in pregnancy are well-established phenomena and commonly lead to a chronic respiratory alkalosis with compensatory renal excretion of bicarbonate. However, the underlying mechanism of dyspnoea during normal pregnancy remains largely undefined. Increasing progesterone levels are a primary factor leading to increased respiratory drive to ensure the rising metabolic demands of the pregnancy are met. Dyspnoea symptoms typically begin in the first or second trimester, are mild, and do not interfere with activities of daily living. We report the case of a 35-year-old female with severe physiological hyperventilation of pregnancy presenting with profound dyspnoea, tachypnoea, and presyncope from 18 weeks of gestation until delivery. Subsequent investigations revealed no identifiable underlying pathology. There remain limited reports of such severe physiological hyperventilation of pregnancy. This case highlights interesting questions regarding the respiratory physiology of pregnancy and underlying mechanisms.
Managing pregnancy-related stroke risk with known bilateral internal carotid artery webs
Authors: Thomas Elin H , Woodward Sarah , Ahmad Shakeel
Published: August 2021

Carotid webs are intraluminal shelf-like projections caused by thickening of the arterial tunica intima. Due to their projections forming a nidus for thrombus formation and subsequent embolus, they are considered to be a rare cause of ischaemic strokes. We report a case of a woman with a background of recurrent ischaemic strokes due to bilateral carotid webs who presented with a twin pregnancy. We use this case to discuss how her pregnancy-related stroke risk was subsequently medically managed.
Non-invasive markers of liver fibrosis and outcome in large vessel occlusion stroke
Authors: Fandler-Höfler Simon , Stauber Rudolf E. , Kneihsl Markus , Wünsch Gerit , Haidegger Melanie , Poltrum Birgit , Pichler Alexander , Deutschmann Hannes , Enzinger Christian , Fickert Peter , Gattringer Thomas
Published: August 2021

Background:

Liver fibrosis has been identified as an outcome predictor in cardiovascular disease and has been associated with hematoma expansion and mortality in patients with primary intracerebral hemorrhage. We aimed to explore whether clinically inapparent liver fibrosis is related to neurological outcome, mortality, and intracranial hemorrhage risk in ischemic stroke patients after mechanical thrombectomy.

Methods:

We included consecutive patients with anterior circulation large vessel occlusion stroke treated at our center with mechanical thrombectomy between January 2011 and April 2019. Clinical data had been collected prospectively; laboratory data were extracted from our electronic hospital information system. We calculated the Fibrosis-4 index (FIB-4), an established non-invasive liver fibrosis test. The main outcomes were postinterventional intracranial hemorrhage, unfavorable functional status (modified Rankin scale scores of 3–6), and mortality three months post-stroke.

Results:

In the 460 patients (mean age 69 years, 49.3% female) analyzed, FIB-4 indicated advanced liver fibrosis in 22.6%. Positive FIB-4 was associated with unfavorable neurological outcomes and mortality three months post-stroke, even after correction for co-factors [Odds Ratio (OR) 2.15 for unfavorable outcome in patients with positive FIB-4, 95% confidence interval (CI) 1.21–3.83, p = 0.009, and 2.16 for mortality, 95% CI 1.16–4.03, p = 0.01]. However, FIB-4 was neither related to hemorrhagic transformation nor symptomatic intracranial hemorrhage. Moreover, atrial fibrillation was more frequent in patients with liver fibrosis ( p < 0.001). Two further commonly-used liver fibrosis indices (Forns index and the Easy Liver Fibrosis Test) yielded comparable results regarding outcome and atrial fibrillation.

Conclusions:

Clinically inapparent liver fibrosis (based on simple clinical and laboratory parameters) represents an independent risk factor for unfavorable outcomes, including mortality, at three months after stroke thrombectomy. Elevated liver fibrosis indices warrant further hepatological work-up and thorough screening for atrial fibrillation in stroke patients.
Update on the management of overactive bladder
Authors: Fontaine Christina , Papworth Emma , Pascoe John , Hashim Hashim
Published: August 2021

Overactive bladder (OAB) syndrome is a common condition characterised by urinary urgency, with or without urgency incontinence, frequency and nocturia, in the absence of any other pathology. Clinical diagnosis is based upon patient self-reported symptomology. Currently there is a plethora of treatments available for the management of OAB. Clinical guidelines suggest treatment via a multidisciplinary pathway including behavioural therapy and pharmacotherapy, which can be commenced in primary care, with referral to specialist services in those patients refractory to these treatments. Intradetrusor botulinum A and sacral neuromodulation provide safe and efficacious management of refractory OAB. Percutaneous tibial nerve stimulation and augmentation cystoplasty remain available and efficacious in a select group of patients. Unfortunately, there remains a high rate of patient dissatisfaction and discontinuation in all treatments and thus there remains a need for emerging therapies in the management of OAB.
Real-life patient experiences of TTNS in the treatment of overactive bladder syndrome
Authors: te Dorsthorst Manon , van Balken Michael , Janssen Dick , Heesakkers John , Martens Frank
Published: August 2021

Introduction and objectives:

Overactive bladder syndrome (OAB) is defined as urinary urgency, with or without urgent urinary incontinence; it is often associated with urinary frequency and nocturia, in the absence of any pathological or metabolic conditions that may cause or mimic OAB. The aim of this study was to evaluate the long-term real-life adherence of transcutaneous tibial nerve stimulation (TTNS) in the treatment of OAB, patient satisfaction of the treatment, and reasons for quitting therapy.

Materials and methods:

In this single center study, all patients who had a positive effect on percutaneous tibial nerve stimulation (PTNS) and continued to receive home-based treatment with TTNS since 2012 were included for analysis. Patients were retrospectively asked to fill out a questionnaire regarding satisfaction, reasons for quitting, and additional or next line of therapy.

Results:

We included 42 patients for this study, 81% of these patients were female ( n = 34). The median age was 67 years (range 36–86). Most of the patients (64%, n = 27) were diagnosed with OAB wet. The median TTNS treatment persistence was 16 months (range 1–112 months). Reasons and percentages for stopping therapy were: 55% stopped treatment due to loss of effect, and 24% stopped because of preferring other type of neuromodulation. The mean satisfaction score (scale 1–10) in patients who continued TTNS was 6.2 ( n = 9, SD 1.30) versus 5.4 ( n = 29, SD 2.24) for patients who quit therapy. We did not find a statistically significant difference between the two groups ( p = 0.174).

Conclusion:

TTNS, although effective in the short-term, is not effective in the long-term. In combination with a low satisfaction rate among patients, there is a need for improvement in terms of OAB treatment modalities.
Management of adrenocortical carcinoma: are we making progress?
Authors: Kiesewetter Barbara , Riss Philipp , Scheuba Christian , Mazal Peter , Kretschmer-Chott Elisabeth , Haug Alexander , Raderer Markus
Published: August 2021

Adrenocortical carcinoma (ACC) is a rare malignancy characterized by aggressive biology and potential endocrine activity. Surgery can offer cure for localized disease but more than half of patients relapse and primary unresectable or metastasized disease is frequent. Prognosis of metastatic ACC is still limited, with less than 15% of patients alive at 5 years. Recent advances in understanding the molecular profile of ACC underline the high complexity of this disease, which is characterized by limited drugable molecular targets as well as by a complex interplay between a yet scarcely understood microenvironment and potential endocrine activity. Particularly steroid-excess further complicates therapeutic concepts such as immunotherapy, which have markedly improved outcome in other disease entities. To date, mitotane remains the only approved drug for adjuvant and palliative care in ACC. Standard chemotherapy-based protocols with cisplatin, doxorubicin and etoposide offer only marginal improvement in long-term outcome and the number of clinical trials conducted is low due to the rarity of the disease. In the current review, we summarize principles of oncological management for ACC from localized to advanced disease and discuss novel therapeutic strategies, including targeted therapies such as tyrosine kinase inhibitors and antibodies, immunotherapy with a focus on checkpoint inhibitors, individualized treatment concepts based on molecular characterization by next generation sequencing methods, the role of theranostics and evolvement of adjuvant therapy.
Apatinib for patients with metastatic biliary tract carcinoma refractory to standard chemotherapy: results from an investigator-initiated, open-label, single-arm, exploratory phase II study
Authors: Wang Chenchen , Huang Mingzhu , Geng Qirong , Li Wenhua , Chang Jinjia , Tang Wei , Guo Weijian
Published: August 2021

Background:

There is no standard therapy for metastatic biliary tract carcinoma (BTC) refractory to first-line chemotherapy. Apatinib, a VEGFR2 tyrosine kynase inhibitor, showed an activity against BTC xenografts in preclinical models. We conducted an exploratory study to evaluate the efficacy and safety of apatinib in patients with metastatic BTC.

Methods:

This is a single-arm phase II study [ClinicalTrials.gov identifier: NCT03427242]. Eligible patients were aged 18 years or older; histologically confirmed metastatic BTC; refractory or intolerance to at least one chemotherapeutic regimen; no prior use of anti-angiogenic targeted drugs; Eastern Cooperative Oncology Group performance status of 0–2. Patients received oral apatinib 500 mg each day continuously until unacceptable toxicity or tumor progression. The primary endpoint was progress free survival (PFS). The secondary endpoint was overall survival (OS), objective response rate (ORR) and treatment safety.

Results:

A total of 22 patients were recruited. All of them received apatinib medication. The median age was 63 (44–75) years old. Twenty patients received efficacy evaluation after treatment. The objective response rate (ORR) and disease control rate (DCR) were 15.0% and 60.0%, respectively. The median PFS was 2.73 months [95% confidence interval (CI): 1.74–3.72 months], with 6 months PFS rate of 27.3% (95% CI: 8.7–45.9%). The median OS was 4.81 months (95% CI: 3.16–10.9 months), with 12 months OS rate of 36.4% (95% CI: 16.2–56.6%). Nine out of 22 patients (40.9%) had grade 3/4 adverse events. The most common grade 3/4 adverse events were hand-foot skin syndrome [three (13.6%) patients] and hypertension [two (9.1%) patients]. No treatment-related death occurred.

Conclusions:

For patients with metastatic BTC, apatinib showed an anti-tumor activity with acceptable safety, which deserves the further clinical trial. This trial was prospectively registered on ClinicalTrials.gov [NCT03427242]. Date of first patient enrollment: 26 January 2018. Date of registration (date of first posted): 9 February 2018.
Current treatments and future potential of surufatinib in neuroendocrine tumors (NETs)
Authors: Xu Jianming
Published: August 2021

Neuroendocrine tumors (NETs) are rare, heterogeneous, often indolent tumors that predominantly originate in the lungs and gastrointestinal tract. An understanding of the biology and tumor microenvironment of NETs has led to the development of molecularly targeted treatment options including somatostatin analogs, tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors and peptide receptor radionuclide therapy. Although increases in progression-free survival have been demonstrated, most currently approved NET therapies are limited by the development of tumor resistance. Surufatinib (HMPL-012, previously known as sulfatinib) is a new, oral, small-molecule tyrosine kinase inhibitor that potently inhibits vascular endothelial growth-factor receptor 1–3, fibroblast growth-factor receptor 1, and colony-stimulating-factor-1 receptor. This unique combination of molecular activities inhibits tumor angiogenesis, regulates tumor-immune evasion, and may decrease tumor resistance. Surufatinib demonstrated statistically significant, clinically meaningful antitumor activity, including tumor shrinkage, in two phase III studies recently completed in China in advanced pancreatic NETs and advanced extrapancreatic NETs. The safety profile of surufatinib in neuroendocrine tumors studies was consistent with previous surufatinib clinical studies. In an ongoing study in United States (US) patients with NETs of pancreatic origin and NETs of extrapancreatic origin previously treated with everolimus or sunitinib, surufatinib has also demonstrated promising efficacy. Furthermore, the pharmacokinetic and safety profile of surufatinib in US patients is similar to data collected in studies done in China. These positive phase III results support the efficacy of surufatinib in patients with advanced, progressive, well-differentiated NETs regardless of tumor origin.
Idea selection of new service for courier business: The opportunity of data analytics
Authors: Jintana J , Sopadang A , Ramingwong S
Published: August 2021

E-commerce growth enforces the courier business to focus on developing a new business model decision. This paper aims to explore a suitable new business idea for courier business if the Data Analytics (DA) can be advantageous, using small courier company as a case study. The study investigates Logistics Service Provider (LSP) activities and the Gap Analysis and SWOT analysis were conducted to explore Data Analytics (DA) opportunity. Then, the alternative business models were pre-screened by the requirements of company, i.e. reasonable investment cost and the opportunity in using Data Analytics (DA). Ansoff Matrix is used to classify the alternative of new service idea into two segments; 1) offer development, i.e. Market development, and 2) New business development, i.e. Service development and Diversification. Fuzzy Analytic Hierarchy Process (FAHP) is used to select suitable business idea by weighted summation on five of Data Analytics (DA) accommodation criteria, i.e. company capability; the ability performs of demand; vision, strategy, and desire of executive, investment strategy and customer data opportunity. The business models that are mostly desirable are 1) Suppliers-Consignees recommendation, 2) Fulfillment service model and 3) Sourcing model. These three models were elaborated and discussed in the perspectives of company and customer. Additionally, this research proposes several challenges in Data Analytics (DA) related in logistics activity, key decision criteria and methods of idea selection implemented guidelines for logistics business practice.