bluuebunny/crossref_metadata_2025 huggingface dataset:
Adjustment of the scan track spacing and linear input energy to fabricate dense, pseudoelastic Nitinol shape memory alloy parts by selective laser melting
Authors: Zamani Mohammadreza , Kadkhodaei Mahmoud , Badrossamay Mohsen , Foroozmehr Ehsan
Published: December 2021

Nitinol is a well-known shape memory alloy (SMA) which is widely used due to its unique properties such as shape memory effect and pseudoelasticity. However, challenges fabricating Nitinol parts have limited the use of this alloy. Nowadays, additive manufacturing methods, specifically selective laser melting (SLM), are being used as an alternative to conventional methods for fabricating Nitinol specimens. Achieving a dense structure and controlling the transformation temperatures in such products have been among the most important challenges for several research groups. In the present study, fabrication of dense Nitinol parts by SLM together with control of their transformation temperatures is investigated with the main purpose of achieving pseudoelastic products at room temperature. For this purpose, the effect of process parameters on density, transformation temperatures, microstructure, hardness, and shape memory response are studied. The influence of process parameters on transformation temperatures varies depending on the amount of power so that the effect of scan tracks spacing for high powers is more pronounced than that for low powers. The hardness and compressive strength of the parts are also affected by the process parameters. Accordingly, optimal parameters are found to fabricate dense pseudoelastic parts with the ability of strain recovery at ambient temperature.
Psychometric Validation of the CLEFT-Q Patient Reported Outcome Measure: A Prospective Study to Examine Cross-Sectional Construct Validity
Authors: Miroshnychenko Anna , Rae Charlene , Riff Karen Wong , Forrest Christopher , Goodacre Tim , Swan Marc , Slator Rona , Goldstein Jesse , Thoma Achilleas , Harman Karen , Klassen Anne
Published: December 2021

Objective

CLEFT-Q is a condition-specific patient-reported outcome measure (PROM) for patients with cleft lip and/or palate (CL/P). The aim of this study was to examine the cross-sectional construct validity of the CLEFT-Q scales.

Design

Construct validity was assessed through a prospective study that tested hypotheses regarding correlations of scores with other PROMs that measure related constructs.

Setting

Seven cleft centres in Canada, the USA, and UK were involved.

Patients/Participants

Patients were aged eight to 29 years with CL/P.

Interventions

Before undergoing rhinoplasty, orthognathic, cleft lip scar revision, and alveolar bone graft, participants were asked to complete the following PROMs: CLEFT-Q (9 scales), Child Oral Health Impact Profile (socio-emotional subscale) and Cleft Hearing Appearance and Speech Questionnaire (features 1 subscale).

Main Outcome Measure(s)

The correlation coefficients examining the relationship between the scales were the main outcome measures. Correlations (Spearman) were calculated and interpreted as follows: <0.3 weak, 0.30 to 0.50 moderate, ≥0.50 strong.

Results

Participants ( n = 177) were mostly male (61%) and aged between eight and 11 years (42%). Overall, 38 of 52 (73%) hypotheses tested were supported. More specifically, 20 of 26 (77%) hypotheses about correlations between the appearance scales were supported, two of three (67%) hypotheses about correlations between the health-related quality of life scales were supported, and 16 of 23 (70%) hypotheses about correlations between the appearance and health-related quality of life scales were supported.

Conclusions

Cross-sectional construct validity of the CLEFT-Q scales adds further evidence of the psychometric properties of this instrument.
Application of Safety Protocols for International Cleft Outreach Programs During the COVID-19 Pandemic: Global Smile Foundation Precaution Guidelines and Implications
Authors: Al Abyad Omar S. , Annan Beyhan , Melhem Antonio , Chahine Elsa M. , Ramly Elie P. , Vyas Raj M. , Hamdan Usama S.
Published: December 2021

Background

Since COVID-19 was declared a worldwide pandemic by the World Health Organization (WHO) in March of 2020, foundation-based cleft outreach programs to Low- and Middle-Income Countries (LMICs) were halted considering global public health challenges, scarcity of capacity and resources, and travel restrictions. This led to an increase in the backlog of untreated patients with cleft lip and/or palate, with new challenges to providing comprehensive care in those regions. Resumption of international outreach programs requires an updated course of action to incorporate necessary safety measures in the face of the ongoing pandemic. In this manuscript, the authors outline safety protocols, guidelines, and recommendations implemented in Global Smile Foundation's (GSF) most recent outreach trip to Beirut, Lebanon.

Methods

COVID-19 safety protocols for outreach cleft care and an Action Response Plan were developed by the GSF team based on the published literature and recommendations from leading international organizations.

Results

GSF conducted a 1-week surgical outreach program in Beirut, Lebanon, performing 13 primary cleft lip repairs, 7 cleft palate repairs, and 1 alveolar bone grafting procedure. Safety protocols were implemented at all stages of the outreach program, including patient preselection and education, hospital admission and screening, intraoperative care, and postoperative monitoring and follow-up.

Conclusions

Organizing outreach programs in the setting of infectious diseases outbreaks should prioritize the safety and welfare of patients and team members within the program's local community. The COVID-19 protocols and guidelines described may represent a reproducible framework for planning future similar outreach initiatives in high-risk conditions.
Attached to Technology: Exploring Young Adults’ Attachments to Parents, Partners, and Phones
Authors: Mosley Marissa A. , Su Tom , Parker M. L.
Published: December 2021

Cell phone use has become a mainstay in the lives of young adults, with 93% of Millennials owning a smartphone. With the increased accessibility of technology, individuals’ cell phone use may lead to personal distress in various facets of life. Specifically, problematic cell phone use may be the result of attempts to fulfill emotional needs or avoid connection with others. The present study used a systemic, attachment-based lens to investigate the roles of parental and romantic attachment in problematic cell phone use. A sample of 479 young adults (ages 18–26) completed an online survey gauging their cell phone use and attachment styles. Mediation analyzes were run to determine if adult attachment mediates the relationship from parental attachment to problematic cell phone use. The results found that attachment anxiety mediates the relationship between communication and alienation subscales for mother and alienation only for father to problematic cell phone use. Clinical implications are discussed with results informing assessment, prevention, and intervention efforts for individuals, families, and couples.
The Association of Crista Volume With Sesamoid Position as Measured From 3D Reconstructions of Weightbearing CT Scans
Authors: Clarke Audrey J. , Conti Stephen F. , Conti Matthew , Fadle Amr A. , Ellis Scott J. , Miller Mark Carl
Published: December 2021

Background:

Malposition of the sesamoids relative to the first metatarsal head may relate to intersesamoid crista underdevelopment or erosion. Using 3-dimensional models created from weightbearing CT (WBCT) scans, the current work examined crista volume and its relationship to first metatarsal pronation and sesamoid station.

Methods:

Thirty-eight hallux valgus (HV) patients and 10 normal subjects underwent weightbearing or simulated WBCT imaging. The crista was outlined by the inferior articular surface, and a line was drawn to connect the lowest point of each sulcus on either side of the intersesamoidal crista throughout the length of the crista. The volume was calculated. Sesamoid station and first metatarsal pronation were calculated from the 3D reconstructions. The mean crista volumes between HV and normal patients were statistically compared, as were the crista volume and pronation angle between sesamoid stations.

Results:

The mean crista volume in HV patients was 80.10 ± 35 mm3 and in normal subjects was 150.64 ± 24 mm3, which differed significantly between the 2 groups ( P < .001). Mean crista volumes were found to be statistically significantly different between the sesamoid stations ( P < .001) with decreasing crista volumes significantly and strongly correlated with increasing sesamoid station ( r = −0.80, P < .001). There was no difference in the mean pronation angle between the 4 sesamoid stations ( P = .37). The pronation angle was not associated with crista volume ( P = .52).

Conclusion:

HV patients have lower mean crista volume than normal patients. Crista volume is correlated with sesamoid station. Pronation of the first metatarsal was not associated with crista volume.

Clinical Relevance:

Crista volume may offer an additional determinant for the severity of hallux valgus.
Determinants of Second Primary Cancer Type in Survivors of Virus-Related and Non-Virus-Related Cancer Living With HIV in the French Dat’AIDS Cohort
Authors: Poizot-Martin Isabelle , Lions Caroline , Allavena Clotilde , Delobel Pierre , Fresard Anne , Brégigeon Sylvie , Rojas Teresa , Delpierre Cyrille , Makinson Alain ,   The Dat’AIDS study group
Published: December 2021

Objectives

People who survive after primary cancer are at an increased risk for subsequent primary cancers. We aimed to investigate the possible determinants of second primary cancer (SPC) in HIV-positive cancer survivors.

Methods

This was a multicenter retrospective study using longitudinal data from the French Dat’AIDS cohort. Subjects who developed at least 2 primary cancers were selected. Cancer cases were identified using ICD10 codes and distributed in 3 cancer categories: AIDS-defining cancer (ADC), virus-related non-ADC (VR-NADC), and virus-unrelated-NADC (VU-NADC). The possible determinants considered were the first primary cancer category, sex, age, HIV transmission route, duration of HIV infection follow-up, duration of ART exposure, nadir CD4+ T cell count, and hepatitis C and hepatitis B serostatus.

Results

Among the 44642 patients in the Dat’AIDS cohort, 4855 were diagnosed with cancer between 1 December 1983 and 31 December 2015, of whom 444 (9.1%) developed at least 2 primary cancers: 130 ADCs, 85 VR-NADCs, and 229 VU-NADCs. A longer delay between the first primary cancer and the SPC was associated with an increased risk of occurrence of a VR-NADC rather than a secondary ADC. Having had a first primary VU-NADC, an older age, and a longer delay between the HIV diagnosis and the first primary cancer as well as between the first primary cancer and the SPC were associated with an increased risk of VU-NADC rather than ADC.

Conclusion

SPCs are now a major concern in HIV-positive cancer survivors justifying the development of monitoring strategies after a first cancer.
Longitudinal Dynamics of Coagulation and Angiogenesis Markers in Cancer Patients During and After Chemotherapy
Authors: Beleva Elina A. , Deneva Tanya I. , Stoencheva Snezhana S. , Grudeva-Popova Zhanet G.
Published: December 2021

Hemostatic parameters have been investigated as molecular determinants of tumor progression. To analyze the dynamics of microparticle-associated tissue factor activity (MPTF), tissue factor antigen (TF-Ag), and angiopоietin-2 (ANG-2) in cancer patients before, during, and after active treatment and to explore their potential as biomarkers for metastatic occurrence and death. Blood for the analysis of MPTF, TF-Ag, ANG-2, and conventional hemostatic tests was sampled in 111 patients with various cancers at 4 consecutive visits: before first chemotherapy cycle, after 3 courses, at the sixth course, and 3 months after chemotherapy cessation. Patients were followed up until metastatic progression/death or the end of the study. MPTF did not change during chemotherapy, but increased significantly after treatment cessation. Total TF-Ag and ANG-2 decreased throughout active treatment. Significant drop of their levels was observed 3 months post therapy cessation. Progressive disease was significantly associated with higher pre-chemotherapy TF-Ag and fibrinogen. Elevated baseline levels of fibrinogen were associated with increased risk of shortened progression free survival. Cessation of chemotherapy is associated with significant change of hemostatic parameters. Pre-chemotherapy levels of TF-Ag and fibrinogen may be informative of disease state and prognosis.
The design, implementation and evaluation of hybrid cancer clinic simulations: Escaping the norm
Authors: Norville Kathryn , Philip Ashok , Halford Zachery
Published: December 2021

Introduction

Simulation and gamification are two popular educational tools utilized to enhance student learning and engagement. This study aimed to evaluate the effectiveness of integrating a hybrid cancer clinic simulation into the curricula for third-year pharmacy (P3) students.

Methods

This prospective, single-arm pilot study incorporated a mixed-method learning activity involving patient simulation and escape room elements. Two cancer clinic simulations were developed by faculty members. For each clinic, students were randomly divided into 6 groups and tasked with completing a series of Pharmacist Patient Care Process (PPCP) activities involving patient actors. The PPCP activities were interwoven with engaging puzzles and games to simulate an escape room. Student learning and retention was measured by pre- and post-simulation quizzes and course level exams. A perceptions survey was administered after each simulation activity.

Results

Thirty-six students participated in both cancer clinic simulations, with 100% completing all aspects of the study. Mean student quiz scores improved from 61.4% to 81.7% (p < 0.0001) and 52.6% to 81.8% (p < 0.0001) following the first and second simulations, respectively. Exam performance improved for 16 out of 19 exam questions, with a significant increase in 4 questions (p < 0.05). Students overwhelmingly agreed that the cancer clinic simulations 1) reinforced knowledge, 2) facilitated PPCP, 3) improved their ability to make chemotherapeutic recommendations, 4) enhanced problem-solving skills, and 5) encouraged collaboration.

Conclusion

This innovative hybrid simulation enhanced oncology-related knowledge and supported an interactive environment that improved student confidence and teamwork. Students enjoyed the simulations and recommended continuation for all future cohorts.
A Review of Measurement Equivalence in Organizational Research: What's Old, What's New, What's Next?
Authors: Somaraju Ajay V. , Nye Christopher D. , Olenick Jeffrey
Published: December 2021

The study of measurement equivalence has important implications for organizational research. Nonequivalence across groups or over time can affect the results of a study and the conclusions that are drawn from it. As a result, the review paper by Vandenberg & Lance (2000) has been highly cited and has played an important role in understanding the measurement of organizational constructs. However, that paper is now 20 years old, and a number of advances have been made in the application and interpretation of measurement equivalence (ME) since its publication. Therefore, the goal of the present paper is to provide an updated review of ME techniques that describes recent advances in testing for ME and proposes a taxonomy of potential sources of nonequivalence. Finally, we articulate recommendations for applying these newer methods and consider future directions for measurement equivalence research in the organizational literature.
Unintended Consequences in Transformative Service Research: Helping Without Harming
Authors: Blocker Christopher P. , Davis Brennan , Anderson Laurel
Published: December 2021

Even as transformative service initiatives promote greater well-being, they may also create unintentionally negative consequences. Research investigates boundary conditions and boomerang effects that wash out or reverse the intended effects of service initiatives. However, such research generally advances greater depth of insight about unintended consequences in a particular stream rather than bridging this knowledge across service domains. Thus, service research lacks integrative frameworks, theory, and empirical insight to advance more generalizable knowledge about unintended consequences. The purpose of this editorial is to clarify the importance of investigating unintended consequences across service contexts and propose pathways as a catalyst for research. Using theory on unintended consequences, we delineate the types of unintended consequences and discuss the underlying mechanisms. We identify themes that span papers in the special issue and illuminate negative spillover consequences. The editorial concludes with an overview of future research avenues with potential to accelerate important transformative service research.
Neither remnants nor commodities: Spirit objects in early twentieth century Chinese regional fiction
Authors: McConaghy Mark
Published: December 2021

This paper examines the regional fiction of early twentieth century China in order to understand how such texts presented the object world of rural life. In doing so it addresses a gap in the historiography of material culture in modern China, which has emphasized urban commodity regimes and has paid far less attention to the ways in which pre-existing object practices endured into the time of the modern Republic. Building off of the methodological insights of scholars such as Bill Brownand Janet Poole regarding the contribution that literary study can make to historical understandings of material cultures, this paper argues that the regional texts of Lu Xun, Xu Qinwen, Ye Shengtao, and Yu Dafu were bewitched by overlapping life worlds: one represented by the secular rationalism of the text's narrators, and the other represented by the animistic practices of the rural others they encounter, which was expressed through objects such as joss sticks, temple doorsills, and ancestral alters. These literary works reflected upon how objects were used to make meaning in ways that were not reducible to urban commodity fetishism or remnant “superstition.” As presented in these works, spiritual objects remain powerfully active parts of the affective worlds of rural people, collapsing binary distinctions between living language and inanimate matter, the human and the ghostly, the past and the present. For the narrators of these texts, these object practices invoke a complicated mixture of modernizing critique and empathetic recognition. As such, these texts allow readers to witness the early expressions of a complex dialectic of rejection and recognition/accommodation that has marked the attitude modernizing states in China have taken in relation to animistic material cultures over the past century.
Gender equity approach to policing in Kenya: Lessons, challenges and prospects
Authors: Onyango Resila A , Natarajan Mangai
Published: December 2021

Despite ample evidence of women's value, ensuring gender equity–equality is a major challenge for police departments worldwide. Using survey data gathered from a sample of 455 male and female police officers in the Kenya Police Service, this study examines the non-western plights of women in policing and describes a theory change to formulate gender-equity strategies for improved recruitment and retention of women in police service. Findings indicate that women officers can undertake most tasks better than or to the same degree as men, except for a small proportion of line duties, mirroring the literature on women in policing internationally. However, family commitments, an emphasis on physical strength for promotion, performance based on male standards, and male supervisors’ attitudes present severe challenges for women in the police service, reflecting the organizational climate and prevailing cultural norms. Implications for theory, policy and research are discussed.
Stochastic Bayesian optimization for predicting borderline knock
Authors: Tang Jian , Pal Anuj , Dai Wen , Archer Chad , Yi James , Zhu Guoming
Published: December 2021

Engine knock is an undesirable combustion that could damage the engine mechanically. On the other hand, it is often desired to operate the engine close to its borderline knock limit to optimize combustion efficiency. Traditionally, borderline knock limit is detected by sweeping tests of related control parameters for the worst knock, which is expensive and time consuming, and also, the detected borderline knock limit is often used as a feedforward control without considering its stochastic characteristics without compensating current engine operational condition and type of fuel used. In this paper, stochastic Bayesian optimization method is used to obtain a tradeoff between stochastic knock intensity and fuel economy. The log-nominal distribution of knock intensity signal is converted to Gaussian one using a proposed map to satisfy the assumption for Kriging model development. Both deterministic and stochastic Kriging surrogate models are developed based on test data using the Bayesian iterative optimization process. This study focuses on optimizing two competing objectives, knock intensity and indicated specific fuel consumption using two control parameters: spark and intake valve timings. Test results at two different operation conditions show that the proposed learning algorithm not only reduces required time and cost for predicting knock borderline but also provides control parameters, based on trained surrogate models and the corresponding Pareto front, with the best fuel economy possible.
Fitness and Power: The Contribution of Genetics to the History of Differential Reproduction
Authors: Scheidel Walter
Published: December 2021

Textual evidence from pre-modern societies supports the prediction that status differences among men translate to variance in reproductive success. In recent years, analysis of genetic data has opened up new ways of studying this relationship. By investigating cases that range over several millennia, these analyses repeatedly document the replacement of local men by newcomers and reveal instances of exceptional reproductive success of specific male lineages. These findings suggest that violent population transfers and conquests could generate considerable reproductive advantages for male dominants. At the same time, this does not always seem to have been the case. Moreover, it is difficult to link such outcomes to particular historical characters or events, or to identify status-biased reproductive inequalities within dominant groups. The proximate factors that mediated implied imbalances in reproductive success often remain unclear. A better understanding of the complex interplay between social power and genetic fitness will only arise from sustained transdisciplinary engagement.
Learning Communities: A Sound Investment in Higher Education
Authors: Gwebu Kabongwe (KB) , Compton Jonathan , Holtman Kyle , Kollasch Aurelia , Leptien Jennifer R , Pistilli Matthew D. , Shelley Mack
Published: December 2021

University and college leaders are tasked with enhancing student outcomes with fewer resources. Student retention is one such key outcome of interest for many policy makers as well as for university administrators. Over the years, administrators have turned to High Impact Practices (HIPs) such as Learning Communities (LCs) to aid in retention. This quantitative study explores the impact LCs have on student retention at a large R1 university in the Midwest. Additionally, the financial return on investment in LCs at this institution is measured via tuition dollars generated from students who are retained as a result of their participation in a LC at the institution. Two key findings of this study are that LCs are positively associated with increased odds of student retention, and that investing in LCs makes good financial sense. Our research contributes to the scholarship on retention attributable to LCs and provides researchers and practitioners with a “template” to evaluate the efficacy of specific retention initiatives in relation to their financial return on investments.
Pure and Mixed Tubular Carcinoma of the Breast: Mammographic Features, Clinicopathological Characteristics and Prognostic Analysis
Authors: Wen Chanjuan , Xu Weimin , Qin Genggeng , Zeng Hui , He Zilong , Wang Sina , Xu Zeyuan , Ma Mengwei , Luo Zhendong , Chen Weiguo
Published: December 2021

Objective: To evaluate the mammographic features, clinicopathological characteristics, treatments, and prognosis of pure and mixed tubular carcinomas of the breast. Materials and methods: Twenty-five tubular carcinomas were pathologically confirmed at our hospital from January 2011 to May 2019. Twenty-one patients underwent preoperative mammography. A retrospective analysis of mammographic features, clinicopathological characteristics, treatment, and outcomes was performed. Results: Altogether, 95% of the pure tubular carcinomas (PTCs) and mixed tubular carcinomas (MTCs) showed the presence of a mass or structural distortions on mammography and the difference was not statistically significant ( P = .373). MTCs exhibited a larger tumor size than PTCs ( P = .033). Lymph node metastasis was more common ( P = .005) in MTCs. Patients in our study showed high estrogen receptor and progesterone receptor positivity rates, but low human epidermal growth factor receptor 2 positivity rate. The overall survival rate was 100% in both PTC and MTC groups and the 5-year disease-free survival rates were 100% and 75%, respectively with no significant difference between the groups ( P = .264). Conclusion: Tubular carcinoma of the breast is potentially malignant and has a favorable prognosis. Digital breast tomosynthesis may improve its detection. For patients with PTC, breast-conserving surgery and sentinel lymph node biopsy are recommended based on the low rate of lymph node metastasis and good prognosis. MTC has a relatively high rate of lymph node metastasis and a particular risk of metastasis. Axillary lymph node dissection should be performed for MTC even if the tumor is smaller than 2 cm.
MicroRNA-133b Inhibits nTumor Cell Proliferation, Migration and Invasion by Targeting SUMO1 in Endometrial Carcinoma
Authors: Liao Lingyun , Chen Yun , Zhou Jieli , Ye Jing
Published: December 2021

Objectives: An increasing number of studies have confirmed that microRNAs (miRNAs/miRs), as oncogenes or tumor suppressor genes, play an important regulatory role in the occurrence and development of numerous types of cancer. The aim of the present study was to investigate the potential role and mechanism of miR-133b and small ubiquitin like modifier 1 (SUMO1) in the development of endometrial carcinoma (EC). Methods: First, Venn diagrams are used to identify the differential expressions of miRNAs in EC from GSE35794 and GSE25405 datasets. Next, we conduct a series of functional tests, including Cell Counting Kit-8, wound healing, and transwell and matrigel assays. Then, a bioinformatics tool, is used to identify downstream target genes of miR-133b and to verify the predicted results by RT-qPCR, Western blotting and double luciferase reporter gene analysis. Finally, in order to further study whether the cellular function of miR-133b is mediated by the expression of SUMO1, rescue experiments were carried out. Results: The results of bioinformatics studies showed that the expression of miR-133b was down-regulated in EC tissues, and the expression level of miR-133b was lower in patients with high grade, different histology or menopausal status. The results of functional assay showed that overexpression of miR-133b reduced cell proliferation, migration and invasion. On the contrary, miR-133b silence has the opposite effect. SUMO1 was the direct target of miR-133b and was negatively regulated by miR-133b. The decrease of SUMO1mRNA expression inhibited the proliferation, migration and invasion of EC cells, and reversed the effect of miR-133b on EC cells. Conclusion: The findings from the present study suggested that miR-133b may be a tumor suppressor gene and a potential therapeutic target for the treatment of EC.
Long-term monitoring of dynamic characteristics of high-rise and super high-rise buildings using strong motion records
Authors: Dong Yinfeng , Tian Hui , Zhang Man , Wei Lejun
Published: December 2021

Seismic behavior of a structure is directly related to its dynamic characteristics, which include natural frequency, damping ratio, and mode shape. This study focuses on the long-term monitoring of dynamic characteristics of six selected target structures. The covariance-driven stochastic subspace identification (SSI) approach is used to estimate the fundamental natural frequency and damping ratio of target buildings based on long-term motion records in order to examine the temporal variation of dynamic properties. The fundamental natural frequency and damping ratio variations over time are first discussed. It is found that the fundamental natural frequency of some structures reduces dramatically after the 2011 Tohoku Earthquake, accompanied by a rise in damping ratio. Then, regression analysis is used to assess the relationship between dynamic characteristics and ground motion parameters (Peak ground acceleration (PGA), magnitude, focal depth, and epicentral distance) and structural response (root mean square acceleration, maximum response amplitude). It is discovered that the identified natural frequency has no clear correlation with the focal depth, a slight negative correlation with the epicentral distance, and a strong negative correlation with the magnitude and PGA. The root mean square acceleration and the maximum response amplitude are negatively correlated to the target buildings’ natural frequencies. Finally, the influence of environmental factors on dynamic properties is investigated.
COVID-19 induced aorto duodenal fistula following evar in the so called “negative” patient
Authors: Traina Luca , Mucignat Marianna , Rizzo Roberta , Gafà Roberta , Bortolotti Daria , Passaro Angelina , Zamboni Paolo
Published: December 2021

Objectives

Since October 2019, SARS-CoV-2 pandemic represents a challenge for the international healthcare system and for the treatment and survival of patients. We normally focus on symptomatic patients, and symptoms can range from the respiratory to the gastrointestinal system. In addition, we consider patients without fever and respiratory symptoms, with both a negative RT nasopharyngeal swab and lung CT, as a “Covid-19 negative patient.” In this article, we present a so called Covid-19 “negative” patient, with an unsuspected vascular clinical onset of the viral infection.

Methods

An 80 y.o. man, who previously underwent endovascular aortic repair for an infrarenal abdominal aortic aneurysm, presented to our department with an atypical presentation of an aorto-enteric fistula during the pandemic. While in hospital, weekly nasopharyngeal swab tests were always negative for SARS-CoV-2. However, the absence of aortic endograft complications, the gross anatomy of duodenal ischemic injury, and the recent history of the patient who lived the last months in Bergamo, the Italian city with the highest number of COVID-19 deaths, lead the senior Author to suspect an occult SARS-CoV-2 infection. The patient underwent to resection of the fourth portion of the duodenum and the first jejunal loop, with subsequent duodenum–jejunal latero-lateral anastomosis and the direct suture of the aortic wall. The intestinal specimen was investigated as suspected SARS-CoV-2 bowel infection by the means of immune-histochemistry (IHC). An ileum sample obtained in the pre-COVID-19 era was used as a control tissue.

Results

The histological analysis of the bowel revealed sustained wall ischemia and liponecrosis of the duodenal wall, with intramural blood vessels thrombosis. Blood vessel endotheliitis and neo-angiogenesis were also observed. Finally, the IHC was strongly positive for SARS-CoV-2 RNA and for HLA-G presence, with a particular concentration both in blood vessels and in the intestinal villi. The control tissue sample was not positive for both SARS-CoV-2 and HLA-G.

Conclusions

Coronavirus pandemic continues to be an international challenge and more studies and trials must be done to learn its pathogenesis and its complications. As for thromboembolic events caused by SARS-COV-2, vascular surgeons are involved in treatment and prevention of the complications of this syndrome and must be ready with general surgeons to investigate atypical and particular cases such as the one discussed in this article.
External force estimation for robotic manipulator base on particle swarm optimization
Authors: Liu Huaimin , Wang Xiangjiang , Li Meng
Published: December 2021

The safe disposal of nuclear waste in radioactive environment urgently needs cost-effective approaches. Toward this goal, this article developed a method to external force estimation based on the identified model without force sensors. Firstly, the mathematical model including joint friction was obtained and transformed into the linear combination of unknown parameter to be estimated. Secondly, the unknown parameters were identified based on the improved particle swarm optimization algorithm, the identification procedure was implemented by optimizing the excitation trajectories to excite joint motion and sampling relevant data. Identified results were compared with the biogeography-based optimization algorithm and the cuckoo search algorithm. Then, the identified dynamic parameter was applied to external force estimation. Finally, the verification of external force estimation has been carried out using the Kinova Jaco2 robot manipulator, and the experimental results showed that the external forces by the proposed method could be estimated with an root mean square error of 0.7 N.
The developmental activities of skilled youth CONCACAF soccer players and the contribution of their development system
Authors: Andrew Matthew , Baptiste Giltan Z. , Reeves Matthew J. , Roberts Simon J. , McRobert Allistair P. , Ford Paul R.
Published: December 2021

Small/er soccer nations rely strongly on developing youth athletes into experts in adulthood due to financial, logistical, and coach education constraints. One factor that contributes to this expertise is activities engaged in during childhood. Researchers have described these activities by focusing on larger, well-developed countries that often have larger participation rates and higher competition levels than their smaller counterparts. Therefore, to provide more specific information to support talent development in smaller soccer nations, a survey of the youth development system of a small soccer nation was conducted, alongside recording the developmental activities of skilled and less-skilled soccer players within this system. Key stakeholders (e.g., technical director) completed a youth development system survey. Skilled soccer players ( n = 12) who were representing their country at U17 level and less-skilled players ( n = 13) that had never played for their country completed a Participation History Questionnaire. Skilled players engaged in significantly higher amounts of individual practice in both childhood and early adolescence compared to less-skilled players. Survey data indicated that the greater amounts of individual practice for the skilled players stemmed from a lack of finances, playing facilities, and a formal coach education program. Results from this study may inform future practices and processes in the youth development systems of small/er soccer nations and their national associations.
Post-LASIK keratectasia in the context of a thicker than intended flap detected by anterior segment optical coherence tomography
Authors: Mohammadpour Mehrdad , Khorrami-Nejad Masoud
Published: December 2021

The corneal flap created in LASIK is responsible for most of its advantages in comparison with surface ablation. However, lamellar dissection of the corneal layers in LASIK can also result in serious complications such as corneal ectasia. A 23-year-old man underwent LASIK for correction of −4.75 −2.00@15 in the right eye and −4.50 −2.00@160 in the left eye with a preoperative thinnest corneal thickness of 518 µm/right eye and 513 µm/left eye in 2009. An intended flap thickness and ablation depth in both eyes were 160 µm and 94 µm, respectively, and subsequently, residual stromal bed thickness was 264 µm/right eye and 259 µm/left eye. Several years after surgery, he was referred for the decreased vision. His corrected-distance visual acuity was 0.50 in both eyes. A scissoring reflex was found in retinoscopy. Orbscan imaging was compatible with keratoconus. Anterior segment optical coherence tomography was performed to measure the LASIK flap. It was much thicker (200 µm) than intended (160 µm), and therefore, the residual stromal bed thickness was much thinner. In summary, keratectasia may develop in cases where thicker than expected flaps result in excessive thinning of the residual stromal bed. The obtained results from this case emphasize and remind the importance of intraoperative measurement of flap thickness and using femtosecond and new criteria for patient selection to avoid post-LASIK keratectasia.
Is COVID-19 infection triggering oral herpes zoster? A case report
Authors: Saleh Wafaa , Ata Fatma , Elashry Mohamed M
Published: December 2021

Patients affected with COVID-19 are at risk of developing serious and life-threatening conditions. The clinical manifestations of COVID-19 were detected in asymptomatic cases to severe clinical symptoms with a major impact on the respiratory system. A few cases of cutaneous as well as an oral lesion of herpes zoster in patients with COVID-19 were reported in the literature. We present a case of the rapid appearance of the oral lesion as a manifestation of herpes zoster associated with COVID-19 infection. Our case highlights the importance of oral examination as well as oral care in patients with COVID-19 infection.
Surgical management of patient with left ventricular aneurysm and ventricular tachycardia
Authors: Hage Fadi , Hage Ali , Al-Amodi Hussein , Goela Aashish , Guo Lin-Rui
Published: December 2021

The management of patients with dilated cardiomyopathy and large anterior ventricular aneurysm presenting with ventricular tachycardia is not well-described. We report the case of 45-year-old male who presented with recurrent episodes of prolonged polymorphic ventricular tachycardia and previously failed medical management and endocardial and epicardial transcatheter ablation. We performed a Dor procedure to exclude the left ventricular aneurysm in conjunction with cryoablation to terminate his ventricular tachycardia. This surgical approach was found to be successful with conversion of the patient into normal sinus rhythm and restoration of the patient’s left ventricular morphology and function. We also propose a methodology for the surgical management of patients with left ventricular aneurysm and intractable ventricular tachycardia focused on a discussion with the patient and the cardiac team about the options for treatment, including surgery or continuing pharmacological and electrical cardioversion therapy, choosing the surgical technique that would exclude the most diseased and akinetic myocardial segment, and being more liberal with the use of cryoablation.
A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database
Authors: Jenkins James , Foy Christopher , Davenport Kim
Published: December 2021

Objectives:

While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database.

Patients and methods:

All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed.

Results:

Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach.

Conclusion:

Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon.

Level of evidence:

4
Co-design and ethical artificial intelligence for health: An agenda for critical research and practice
Authors: Donia Joseph , Shaw James A.
Published: December 2021

Applications of artificial intelligence/machine learning (AI/ML) in health care are dynamic and rapidly growing. One strategy for anticipating and addressing ethical challenges related to AI/ML for health care is patient and public involvement in the design of those technologies – often referred to as ‘co-design’. Co-design has a diverse intellectual and practical history, however, and has been conceptualized in many different ways. Moreover, AI/ML introduces challenges to co-design that are often underappreciated. Informed by perspectives from critical data studies and critical digital health studies, we review the research literature on involvement in health care, and involvement in design, and examine the extent to which co-design as commonly conceptualized is capable of addressing the range of normative issues raised by AI/ML for health care. We suggest that AI/ML technologies have amplified and modified existing challenges related to patient and public involvement, and created entirely new challenges. We outline three pitfalls associated with co-design for ethical AI/ML for health care and conclude with suggestions for addressing these practical and conceptual challenges.
Cardiac Interventions for Patients With Trisomy 13 and Trisomy 18: Experience, Ethical Issues, Communication, and the Case for Individualized Family-Centered Care
Authors: Cleary John P. , Janvier Annie , Farlow Barbara , Weaver Meaghann , Hammel James , Lantos John
Published: December 2021

This report is informed by the themes of the session Trisomy 13/18, Exploring the Changing Landscape of Interventions at NeoHeart 2020—The Fifth International Conference of the Neonatal Heart Society. The faculty reviewed the present evidence in the management of patients and the support of families in the setting of trisomy 13 and trisomy 18 with congenital heart disease. Until recently medical professionals were taught that T13 and 18 were “lethal conditions” that were “incompatible with life” for which measures to prolong life are therefore ethically questionable and likely futile. While the medical literature painted one picture, family support groups shared stories of the long-term survival of children who displayed happiness and brought joy along with challenges to families. Data generated from such care shows that surgery can, in some cases, prolong survival and increase the likelihood of time at home. The authors caution against a change from never performing heart surgery to always—we suggest that the pendulum of intervention find a balanced position where all therapies including comfort care and surgery can be reviewed. Families and clinicians should typically be supported and empowered to define the best care for their children and patients. Key concepts in communication and case vignettes are reviewed including the importance of supportive relationships and the fact that palliative care may serve as an additional layer of support for decision-making and quality of life interventions. While cardiac surgery may be beneficial in some cases, surgery should not be the primary focus of initial family education and support.
Short- and Mid-Term Autograft Outcomes Following the Reinforced Ross Operation
Authors: Leeds Hayden , Ashfaq Awais , McGrath Lidija , Dewey Elizabeth N. , Ungerleider Ross M. , Shen Irving , Muralidaran Ashok
Published: December 2021

Background

The Ross operation for aortic valve replacement continues to be a controversial option because of concerns related to late autograft dilation and progressive neo-aortic insufficiency. In 2005, the reinforced Ross procedure was described at our institution to address this problem. We aim to analyze the short and mid-term outcomes following this procedure.

Methods

This is a retrospective study of patients who underwent the reinforced Ross operation between 2004 and 2019. A comprehensive chart review was performed. Echocardiograms were independently reviewed by an adult congenital cardiologist. The time to reintervention was evaluated with a Kaplan-Meier curve. Analysis was conducted in JMP 15.1 (SAS Inc., Cary, NC).

Results

Twenty-five patients underwent the reinforced Ross operation. Twenty-three patients (92%) had bicuspid aortic valve and the most common indication for surgery was a combination of aortic insufficiency and stenosis (n = 18, 72%). The mean follow-up was 6.1 ± 5.0 years. All patients were alive at the time of follow-up. Six patients (24%), from early in our experience, required subsequent aortic reintervention. Median time to reintervention was 41.8 months (0-81.5 months). Sixteen (64%) patients had less than moderate aortic insufficiency at last follow-up. Additionally, average aortic root measurements remained unchanged.

Conclusions

The reinforced Ross technique was initially proposed as a way to mitigate aortic root dilation seen in the traditional Ross procedure. Our experience suggests an associated learning curve with the majority of aortic reinterventions occurring within the first few years following surgery. Continued follow-up is warranted to assess its long-term durability and functionality.