bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrity and cost evaluation of natural fibers/HDPE composite tailored for piping applications
Authors: Ihueze Christopher Chukwutoo , Okafor Christian Emeka , Obuka Sylvester Nnaemeka , Abdulrahman Jibrilla , Onwurah Uchendu Onwusoronye
Published: April 2021

This paper focused on the establishment of performance level and cost of plantain fibers reinforced High Density Polyethylene (HDPE) matrixes as gas pipeline material using pressure containment of the new materials as performance criterion. The cost of modified plantain fibers, the cost of plantain fibers reinforced HDPE (PFRHDPE) and the cost of PFRHDPE master batch (HDPE resin + plantain fiber particles + stabilizer, plasticizer) for pipes extrusion production and pipelines fittings injection productions were established. The burst pressure evaluated for available standard outside diameter ratio (SDR) using the ultimate tensile strength of PFRHDE is very much greater than the standard SDR design pressures even when the temperature derating factors were applied. The Maximum Allowable Operating Pressure (MAOP) of PFRHDPE and induced stresses of pressurized pipes established indicated that the new material is suitable for pipeline design for natural gas and liquid petroleum (LPG) lines. The PFRHDPE developed has better specific properties than the conventional steel and HDPE pipe material in terms of yield strength, elastic modulus and density of the new material. But in terms of cost, steel and HDPE has approximate desirability for selection with PFRHDPE. The energy required to manufacture and process steel products is about 480 MJ/m2, while that of plastics is about 320 MJ/m2. The study further established that PFRHDPE can be applied in the design of oil and gas gathering, transportation and distribution lines.
Housing Choice Vouchers (HCVs) on the Geographic, Socio-economic, and Public Policy Periphery: A Critical Case Study of Blocked Mobility in the City of San Diego, California
Authors: Silverman Robert Mark , Patterson Kelly L. , Wang Chihuangji
Published: April 2021

This article examines the geographic and socio-economic distribution of housing choice vouchers (HCVs) in the city of San Diego, California. It focuses on how the concentration of HCVs on geographic, socio-economic, and public policy peripheries forms a nexus that limits housing options for low-income residents. The analysis is based on a unique database that combines three datasets. One includes data for 13,973 individual HCV recipients measuring head of household characteristics (race, Hispanic ethnicity, gender, and age) and housing unit characteristics (unit size, rents, public subsidy levels). Another data set includes population and housing characteristics at the ZIP code level from the American Community Survey (ACS). The third data set includes small area fair market rents (SAFMRs) for ZIP codes and fair market rents (FMRs) for metropolitan San Diego. Data are displayed using GIS and analyzed using logistic hierarchical regression models. The results indicated that the public housing authority (PHA) that administers HCVs in the city of San Diego implemented the HCV program in a manner that reinforced the concentration of program participants in low-income areas and impeded moves to higher opportunity areas. The results expand our understanding of how geography, socio-economics, and public policy shape the production and reproduction of the periphery.
Role Stress and Sense of Control Predict Using Food to Cope With Stress in Midlife Women
Authors: Riedy Dana R. , MacPherson Ashley , Dautovich Natalie D.
Published: April 2021

Objective: The current study examined the association between role stress and using food to cope with stress in midlife women and examined sense of control as a potential underlying mechanism. Methods: An archival analysis was performed using data from 638 midlife women from the Midlife in the United States II study. Results: Hierarchical linear regression analyses demonstrated that work stress (β = .180, p < .001) and family stress (β = .138, p < .05) significantly predicted using food to cope with stress. Sense of control was a significant mediator between work stress and using food to cope with stress ( b = 0.02, 95% CI [.0014, .0314]). Discussion: Midlife women with higher role stress related to work and family are more likely to use food to cope with stress, and sense of control seems to be the link between work stress and using food to cope.
Public Service, Private Delivery: Service Workers and the Negotiation of Blurred Boundaries in a Neoliberal State
Authors: Maron Asa
Published: April 2021

Neoliberal restructuring blurs the state/market boundary in introducing the position of ‘private state workers’: employees of for-profit providers who deliver publicly funded, state-prescribed services. Despite their prevalence, these workers have received scant scholarly attention. Addressing this gap, this article studies Employment Goal Planners (EGPs) employed at private for-profit providers of activation services in Israel. Drawing on extensive ethnographic observation and in-depth interviews, it argues that far from detached ‘mercenaries’, private state workers are committed actors who advance a distinct vision of public service delivery suited to the neoliberal state. These workers navigate their liminal position along an ever-shifting state/market divide by intertwining contemporary market tropes onto outdated schemas of state work. While the literature commonly views the market as an imposition on public service workers, this study finds that the market can also serve as a resource for inspiring alternative public service ethics and work models.
Polyoxymethylene/thermoplastic polyamide elastomer blends: Morphology, crystallization, mechanical, and antistatic properties
Authors: Fang Wei , Fan Xiaodong , Li Ruilong , Hu Lin , Zhou Tao
Published: April 2021

Polyoxymethylene/thermoplastic polyamide elastomer (POM/TPAE) blends were prepared through melt extrusion in an attempt to improve the toughness and electrical properties of POM. The TPAE used in the study had the permanent antistatic effect, and its brand was MV2080. Acrylonitrile-butadiene-styrene copolymer grafted maleic anhydride (ABS-g-MAH) was added while preparing the POM/TPAE blends to improve the compatibility between TPAE and POM. The effects of TPAE and ABS-g-MAH on the morphologies, melting crystallization, dynamic mechanical analysis, surface resistivity and mechanical properties were examined in detail with various techniques. It was found that after adding 15 phr MV2080 as the modifier, the distribution of MV2080 in the blends was presented as many continuous long strips, which can be called “antistatic networks.” When using ABS-g-MAH as a compatibilizer, the surface resistivity of the samples 5#, 6#, and 7# which all containing 15 phr MV2080 with the best antistatic properties reached 107 Ω, and the impact strength of the above samples was all increased by more than 66%.
Contribution of a distal radioulnar joint stabilizer on forearm stability: A modeling study
Authors: Khuyagbaatar Batbayar , Lee Sang-Jin , Bayarjargal Ulziikhutag , Cheon Maro , Batbayar Temuujin , Kim Yoon Hyuk
Published: April 2021

Instability of the forearm is a complex problem that leads to pain and limited motions. Up to this time, no universal consensus has yet been reached as regards the optimal treatment for forearm instability. In some cases, conservative treatments are recommended for forearm instability injuries. However, quantitative studies on the conservative treatment of forearm instability are lacking. The present study developed a finite element model of the forearm to investigate the contribution of the distal radioulnar joint stabilizer on forearm stability. The stabilizer was designed to provide stability between the radius and ulna. The forearm model with and without the stabilizer was tested using the pure transverse separation and radial pull test for the different ligament sectioned models. The percentage contribution of the stabilizer and ligament structures resisting the load on the forearm was estimated. For the transverse stability of the forearm, the central band resisted approximately 50% of the total transverse load. In the longitudinal instability, the interosseous membrane resisted approximately 70% of the axial load. With the stabilizer, models showed that the stabilizer provided the transverse stability and resisted almost 1/4 of the total transverse load in the ligament sectioned models. The stabilizer provided transverse stability and reduced the loading on the ligaments. We suggested that a stabilizer can be applied in the conservative management of patients who do not have the gross longitudinal instability with the interosseous membrane and the triangular fibrocartilage complex disruption.
Sustainability Stories to Encounter Competences for Sustainability
Authors: Uhrqvist Ola , Carlsson Lisa , Kall Ann-Sofie , Asplund Therese
Published: April 2021

We communicate, relate, educate and make our world meaningful through stories. Stories are integrated in and are a part of every sustainability issue. In this article, we develop the concept of sustainability stories, and how they can be assessed and developed to correspond with the intentions of education for sustainable development (ESD). Literature shows that valued competences such as action competence, systems perspectives, student engagement and critical reflection have difficulties when it comes to informing educational practices in profound ways. In this article, we argue for the use of sustainability stories as an educational strategy to overcome this problem. Here the didactical tool ecolocigal, pluralism, organisations, social, economic and, agents (EPOSEA) aids teachers in enhancing their ESD classroom activities as well as providing a tool for co-producing sustainability stories. We argue for the potential of serious stories in ESD to holistically engage learners in exploring complex issues.
Statistical micromechanical damage model for SH-SFRC under tensile load considering the interfacial slip-softening and matrix spalling effects
Authors: Zhu Hehua , Wei Xiangyang , Ju J Woody , Chen Qing , Yan Zhiguo , Shen Yi
Published: April 2021

Strain hardening behavior can be observed in steel fiber reinforced concretes under tensile loads. In this paper, a statistical micromechanical damage framework is presented for the strain hardening steel fiber reinforced concrete (SH-SFRC) considering the interfacial slip-softening and matrix spalling effects. With a linear slip-softening interface law, an analytical model is developed for the single steel fiber pullout behavior. The crack bridging effects are reached by averaging the contribution of the fibers with different inclined angles. Afterwards, the traditional snubbing factor is modified by considering the fiber snubbing and the matrix spalling effects. By adopting the Weibull distribution, a statistical micromechanical damage model is established with the fracture mechanics based cracking criteria and the stress transfer distance. The comparison with the experimental results demonstrates that the proposed framework is capable of reproducing the SH-SFRC’s uniaxial tensile behavior well. Moreover, the impact of the interfacial slip-softening and matrix spalling effects are further discussed with the presented framework.
Type of Architecture, Presence of Punctate Necrosis, and Extent of Involvement in Atypical Ductal Hyperplasia Can Predict the Diagnosis of Breast Carcinoma on Excision: A Clinicopathologic Study of 143 Cases
Authors: Zhang Cunxian , Wang Edmond Y. , Liu Fang , Ruhul Quddus M. , James Sung C.
Published: April 2021

The literature shows a wide range in the frequencies of finding breast carcinoma in the excised specimens following a biopsy diagnosis of atypical ductal hyperplasia (ADH), likely due to a poor diagnostic reproducibility among different pathologists as well as an inherent heterogeneity in ADH. We evaluated whether histologic subtyping of ADH would help predict the risk of breast carcinoma. Our study consisted of 143 cases of ADH diagnosed by core needle biopsy and followed by excision. Of these, 54 cases (37.8%) showed carcinoma in the excised specimens (47 cases of ductal carcinoma in situ alone, 3 cases of invasive ductal carcinoma alone, and 4 cases of mixed invasive ductal carcinoma and ductal carcinoma in situ). We arbitrarily divided ADH into two subtypes: type A was considered when one or more ducts were completely replaced by low-grade ductal carcinoma in situ type cells but the lesion was <2 mm and type B was considered when one or more ducts were partially involved by low-grade ductal carcinoma in situ type cells regardless of lesion size. Type A was associated with a significantly higher frequency of breast carcinoma (63.6%) than type B (30.0%). ADH containing punctate necrosis showed a higher association of carcinoma (66.7%) compared to those without necrosis (35.1%). Within type B ADH, involvement of 3 or more foci had a higher frequency of carcinoma (50.0%) than involvement of fewer foci (26.6%). These histologic features of ADH may prove useful in predicting the likelihood of breast carcinoma and provide helpful information for patient's management.
The burden of polypharmacy and drug–drug interactions in older cancer patients treated with immunotherapy
Authors: Guven Deniz C , Kavgaci Gozde , Aktepe Oktay H , Yildirim Hasan C , Sahin Taha K , Aksoy Sercan , Erman Mustafa , Kilickap Saadettin , Yalcin Suayib
Published: April 2021

Introduction

Polypharmacy is a common problem in older cancer patients, although the data about polypharmacy and potentially inappropriate prescription practices is limited in patients treated with immune checkpoint inhibitors (ICIs). Therefore, we aimed to evaluate the polypharmacy frequency and drug-drug interactions in older cancer patients (≥65 years) treated with ICIs.

Methods

A total of 70 geriatric patients with advanced cancer were included. The polypharmacy was defined as regular use of 5 or more drugs. The START/STOPP Criteria Version 2 was used for the potentially inappropriate medications (PIM) and potential prescription omissions (PPO). The Medscape Drug Interaction Checker was used for potential drug-drug interactions.

Results

The patients had a median of 6 regular drugs, and polypharmacy was present in 77.1%. The polypharmacy risk was significantly increased in patients over 75 years of age (p = 0.028) and with opioid use (p = 0.048). The 50% of patients had category D or X interactions. Patients with higher Charlson Comorbidity Index had significantly increased risk for drug interactions (CCI ≤10 vs. >10, p = 0.017). The PIMs were present in 44.3% and the PPOs in 68.6% of the patients. While the overall survival and immune related adverse events were similar according to polypharmacy, in patients using seven or more drugs, the acute kidney injury risk was increased (HR: 4.667, p = 0.038).

Conclusion

In this study, we observed a high rate of polypharmacy and inappropriate prescription practices in ICI-treated patients. These issues pointed out the need for improved general medical care and attention for better comedication management in ICI-treated patients.
Blood contamination of the pharmaceutical staff by irinotecan and its two major metabolites inside and outside a compounding unit
Authors: Béchet Victoire , Benoist Hubert , Beau Frédéric , Divanon Fabienne , Lagadu Stéphanie , Sichel F , Delépée Raphael , Saint-Lorant Guillaume
Published: April 2021

Background

Caregivers in healthcare settings are exposed to a risk of antineoplastic drug contamination which can lead to adverse health effects. Biological monitoring is necessary to estimate the actual level of exposure of these workers. This study was conducted with the aim of assessing blood contamination levels by irinotecan and its metabolites of pharmaceutical staff operating inside and outside a compounding unit.

Methods

The study took place within the pharmaceutical unit of a French comprehensive cancer centre. Blood samples were collected from the pharmacy workers operating inside and outside the compounding unit, and analysed by UHPLC-MS/MS. Plasma and red blood cell irinotecan and its metabolites (SN-38; APC) were determined with a validated analytical method detection test.

Results

A total of 17/78 (21.8%) plasma and red blood cell-based assays were found to be contaminated among staff. Overall, the total number of positive assays was significantly higher for staff members working outside the compounding unit than for workers working inside it ( P = 0.022), with respectively 5/42 (11.9%) and 12/36 (33.3%) positive assays. For plasma dosages, the “outside” group had a significantly higher number of positive assays ( P = 0.014). For red blood cell-based assays, no significant difference was found ( P = 0.309).

Conclusions

This study reveals that pharmaceutical staff serving in health care settings are exposed to a risk of antineoplastic drug contamination, not only inside the compounding room but also in adjacent rooms. The results would help to raise awareness and potentially establish protective measures for caregivers working in areas close to the compounding room as well.
The influence of Hanok experience on tourists’ attitude and behavioral intention: An interplay between experiences and a Value-Attitude-Behavior model
Authors: Lee Choong-Ki , Reisinger Yvette , Ahmad Muhammad Shakil , Park Yae-Na , Kang Choong-Won
Published: April 2021

This study examines the impact of Hanok experience on tourists’ attitude and behavioral intention using the experience economy ( Pine and Gilmore, 1998 ) and the experienced utility theory ( Kahneman et al., 1997 ). Specifically, the study explores how tourists’ experiences are associated with a Value-Attitude-Behavior (VAB) model in the context of a heritage tourism attraction such as Jeonju Hanok Village in South Korea. A total of 323 responses were examined using SEM analysis. The results revealed that educational, entertainment, and escapism experiences significantly influenced functional value. Functional value had a significant relationship with attitude, which was positively related to behavioral intention. The results indicate the interplay of tourists’ experiences with the VAB model. The study provides theoretical and practical implications for tourism and hospitality academics and practitioners.
Associations among physical activity tracking, physical activity motivation and level of physical activity in young adults
Authors: O’Loughlin Erin K , Sabiston Catherine M , deJonge Melissa L , Lucibello Kristen M , O’Loughlin Jennifer L
Published: April 2021

Whether physical activity (PA) tracking devices are associated with PA motivation in young adults is largely unknown. We compared total PA minutes per week, total minutes walking/week, meeting moderate-to vigorous PA guidelines, and past-year activity tracking across motivation cluster profiles among 799 young adults. Participants with “self-determined” profiles reported the highest total PA minutes/week followed by participants with “low intrinsic,” “controlled self-determined,” and “high external” proﬁles. A behavior regulation profile X activity tracking frequency interaction was not significant. Behavior regulation profiles may need to be considered in PA interventions using activity trackers.
Membership change, idea generation, and group creativity: A motivated information processing perspective
Authors: Wu Suqing , Nijstad Bernard A. , Yuan Yingjie
Published: April 2021

Membership change has been found to stimulate collective idea generation but to not always benefit group creativity—the generation of final outcomes that are novel and useful. Based on motivated information processing theory, we propose that membership change challenges group members to generate more ideas, but that this only contributes to group creativity when members have high levels of prosocial motivation and are willing to process and integrate each other’s ideas. In a laboratory study of 56 student groups, we found that incremental, but not radical, idea generation mediated the positive effect of membership change on group creativity, and only when group members were prosocially motivated. The present study points to different roles of incremental versus radical ideas and underscores the importance of accounting for prosocial motivation in groups for reaping the benefits of membership change in relation to group creativity.
Lives Interrupted: Navigating Hardship During COVID-19 Provides Lessons in Solidarity and Visibility for Mobile Young People in South Africa and Uganda
Authors: Zuma Thembelihle , King Rachel , Ngwenya Nothando , Kasujja Francis Xavier , Chimbindi Natsayi , Kawuma Rachel , Shahmanesh Maryam , Bernays Sarah , Seeley Janet
Published: April 2021

We examine data from young women and men in South Africa and young female sex workers in Uganda to explore the inequalities and hardships experienced during the COVID-19 pandemic and investigate the opportunities and ability presented to navigate in a virtual world to build an inclusive supportive future for young people on the move. We argue that against the backdrop of a fragile past, young people who see their today disturbed, tomorrow reshaped and their futures interrupted, need support to interact with their social environment and adjust their lives and expectations amidst the changing influences of social forces.
Host-guest interaction: A retrospective analysis of the conflict between sons of second homeowners and local youth – The case of Vall de Lord (Catalonia)
Authors: Datzira-Masip Jordi
Published: April 2021

While various aspects of host-guest conflict have been studied, there has been little published about the relationship between the local community and second homeowners, particularly the male youth population, who often expressed their concerns in a more direct and violent manner. This is a retrospective case study of Vall de Lord, in which one of the authors was a participant, depicted as reflective, ethnographic participant-observation. Combining personal reflection with conversations in the form of interviews and focus group discussions, it provides an opportunity to apply the results to the development of a theoretical model. The findings indicate that the most important factors affecting this relationship were external (environmental), and internal (intrinsic). Appling thematic analysis the study found that the attitudes and behaviour of the local community towards the sons of second home owners sit well with Ajzen’s Theory of Planned Behaviour. This study contributes to our understanding of the relationship between local host communities and second homeowners as a social phenomenon, and how this relationship is affected by the nature of the encounter and the contested identities, values and beliefs of each group when they coexist in the same time and space.
How the practice of commercializing comes together and falls apart in a market of wearable technologies
Authors: Morozova Daria , Gurova Olga
Published: April 2021

Wearable technologies, or wearables, are a combination of design and technology worn on one’s body. Regardless of initial optimistic forecasts for wearables’ market growth, there are few examples of successfully commercialized wearables, except those by technology giants like Apple. In contrast, start-ups developing wearables, while numerous, struggle to survive. The goal of this study is to explore how wearable technology is commercialized on a new market and what role consumers play in commercializing of these wearables. Previous studies on commercializing failures suggest that this is due to poor design of wearables, inappropriate business models, or an extended time lag needed for customers to accept such novel technology. In this article, we add to the ongoing discussion by approaching the commercializing process as an integrative practice that consists of materials, skills, and meanings. Drawing on three examples of wearable start-ups that correspond to a proto-practice, reproduced practice, and ex-practice, we analyze how the practice of wearables’ commercializing takes shape, perpetuates and falls apart, what problems accompany the practice, as well as how an understanding of commercializing can go beyond a traditional interpretation of profit increase. We argue that although mass consumption of wearables is yet to be seen, consumers contribute significantly to the formation of the practice of commercializing and integration of its elements, along with other elements and carriers of the practice. Therefore, our aim is to pinpoint the complexity and multiplicity of the commercialization process by outlining different participants in the market.
A novel multi-classifier information fusion based on Dempster–Shafer theory: application to vibration-based fault detection
Authors: Yaghoubi Vahid , Cheng Liangliang , Van Paepegem Wim , Kersemans Mathias
Published: April 2021

Achieving a high prediction rate is a crucial task in fault detection. Although various classification procedures are available, none of them can give high accuracy in all applications. Therefore, in this article, a novel multi-classifier fusion approach is developed to boost the performance of the individual classifiers. This is acquired by using Dempster–Shafer theory. However, in cases with conflicting evidences, the Dempster–Shafer theory may give counterintuitive results. In this regard, a preprocessing technique based on a new metric is devised in order to measure and mitigate the conflict between the evidences. To evaluate and validate the effectiveness of the proposed approach, the method is applied to 15 benchmarks datasets from UCI and KEEL. Furthermore, it is applied for classifying polycrystalline nickel alloy first-stage turbine blades based on their broadband vibrational response. Through statistical analysis with different noise levels, and by comparing with four state-of-the-art fusion techniques, it is shown that the proposed method improves the classification accuracy and outperforms the individual classifiers.
Study of the insulation and mechanical properties of hair-reinforced epoxy
Authors: Salih Rana Mahdi , Al-Zubaydi Ahmed Sattar Jabbar
Published: April 2021

This research reports the study of epoxy reinforced with human hair as a potential building material for the purpose of acoustic and thermal insulation for building industry. The sound insulation and thermal conductivity were studied for an epoxy composite reinforced with 15% human hair, together with a set of mechanical properties (tensile strength and flexural strength). The sound insulation results proved that the addition of hair led to about 75% loss of the sound intensity compared to the sound intensity noticed for the unreinforced specimen. Thermal conductivity decreased by about 20% with reinforcement. Mechanical properties show a significant improvement, such that flexural strength increased by 25%. The tensile test results showed a higher Young’s modulus and tensile strength for the reinforced specimen by about 50% and 27% respectively. Finally, flexural strength also showed an increase by about 20% after reinforcement.
Content Analysis and Predicting Survey Refusal: What Are Respondents’ Concerns about Participating in a Face-to-face Household Mental Health Survey?
Authors: Hyder Sanaa , Bilal Lisa , Mneimneh Zeina , Naseem Mohammad Talal , DeVol Edward , Aradati Maggie , Shahab Mona , BinMuammar Abdulrahman , Al-Subaie Abdullah , Al-Habeeb AbdulHameed , Altwaijri Yasmin
Published: April 2021

Previous studies suggest that refusals form the largest proportion of nonresponse for household surveys. As face-to-face household health surveys are uncommon in several countries, it might be advantageous for prospective surveys to preemptively tackle respondents’ refusal to survey participation. Using contact history data from the Saudi National Mental Health Survey, we examined the relationship between social environmental factors, respondent characteristics, survey request concerns recorded by interviewers, and respondents’ propensity to refuse to participate in the survey. Content analysis and logistic regressions were conducted. Our findings suggest that urbanicity, region, socioeconomic status, age, and gender are associated with refusal. Patriarchal gatekeepers and specific survey-related concerns are more likely to lead to temporary refusals compared to final refusals. These results have implications for survey researchers employing similar recruitment and data collection methods, for example in tailoring refusal conversion strategies for interviewers to address concerns expressed by Saudi and/or culturally similar respondents.
Assessing Variations in Juvenile Court Processing in Urban Versus Rural Courts: Revisiting “Justice by Geography”
Authors: Pupo Jhon A. , Zane Steven N.
Published: April 2021

Drawing on Feld’s (1991) “justice by geography” thesis, we examined whether juvenile court outcomes and case-level influences on those outcomes varied across urban and rural courts. Using a sample of 60,068 juvenile referrals across 66 counties in one state, we estimated direct effects of urbanism on detention, petition, adjudication, and judicial placement, as well as cross-level interactions between urbanism and several case-level factors for each outcome. We found limited support for the hypotheses. First, findings indicated that odds of detention were significantly greater in more urban courts, but indicated no differences in other outcomes. Second, findings also indicated greater extralegal differences (race, sex, and age) in more urban courts—contrary to hypotheses. Taken together, findings highlight the localized yet complex nature of juvenile justice processing and emphasize the need for additional multilevel research assessing the role of other contextual factors as potential sources of variation across macrosocial units.
Quadricuspid Aortic Valve Repair Facilitated by Geometric Ring Annuloplasty
Authors: McGuire Joseph A. , Hayanga Heather K. , Hayanga Jeremiah W. , Sloyer Daniel , Ellison Matthew , Wei Lawrence , Rankin J. Scott , Badhwar Vinay
Published: April 2021

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.
Impact of an LGBTQ Campus Recreation Student Employee Training Initiative on Professional Competencies
Authors: Anderson Austin R. , Knee Eric , Ramos William D.
Published: April 2021

Campus recreational sport programs strive to create an environment that is accessible to diverse participants, including LGBTQ population groups. While improvement has been made in promoting resources and workgroups related to diversity management practices, little empirical evidence exists as it relates to the efficacy of diversity trainings for recreational sport employees. This study analyzed the impact of a diversity training program geared toward the development of affirming recreational sport practices for LGBTQ populations and exploring the professional competencies related to LGBTQ inclusion that are practiced within in a collegiate recreational sport setting. Results indicated that the targeted training initiative was effective in statistically improving employee confidence as it relates to LGBTQ professional competencies ( p < .000), while nonattendance at the training showed no statistically significant differences in such competencies. This study serves as a starting point for investigating the impact of LGBTQ-specific diversity training programs on recreational sport staff members.
Fenestration of the cavernous internal carotid artery associated with a persistent primitive trigeminal artery
Authors: Chihara Hideo , Kiyosue Hiro , Tanoue Shuuichi , Ide Satomi , Ogura Takenori , Agawa Yuji , Hatano Taketo
Published: April 2021

Fenestration of the cavernous segment of the internal carotid artery (ICA) is an extremely rare variant with unknown clinical significance. We present two cases of this variant, both of which were associated with a persistent primitive trigeminal artery (PPTA). Large dual channels of the ICA were seen extending from the part immediately distal to the origin of the PPTA to the C3 segment of the ICA. We speculate that coexistence of the two vascular anomalies might be due to failed regression or a remnant of the primitive arterial network during the same early gestation period in which development of the PTA takes place (3-5 mm crown-rump length stage).
Histopathological analysis of incompetent great saphenous veins after mechanochemical ablation treatment – An ex-vivo experiment
Authors: Yang Bo , Nie Qiang-Qiang , Fan Xue-Qiang , Zhang Jian-Bin , Liu Peng
Published: April 2021

Background

The endovascular technique of mechanochemical ablation (MOCA) has become popular in treating patients with saphenous reflux. We reported the histopathological findings in human ex-vivo incompetent great saphenous veins following treatment with saline, polidocanol, mechanical ablation and MOCA using ClariVein device.

Methods

Twenty-four vein GSV specimens were obtained via traditional surgery and treated with four methods: Group A: 0.9% normal saline (NS); Group B: 3% polidocanol; Group C: mechanical ablation + 0.9% NS; Group D: mechanical ablation + 3% polidocanol (MOCA). Hematoxylin and eosin (HE), Masson’s trichrome and immunohistochemical staining were performed on each specimen and integrated optical densities were measured with vWF and a-SMA stains and statistically evaluated. vWF staining was used to assess endothelial damage and a a-SMA staining was used to assess media injury.

Results

HE and Masson’s trichrome staining of Groups C and D revealed severe damage to the endothelium and media compared to Groups A and B. The statistical result of vWF staining showed the damage of endothelium was significantly increased by Group D compared to Groups A, B and C. The statistical result of a-SMA staining showed the damage of media was significantly increased by Groups C and D compared to Groups A and B.

Conclusions

The mechanism of MOCA was caused by both endothelium damage and media tearing. The damage of endothelium was significantly increased by MOCA when compared with mechanical ablation alone.
The relation between neutrophil/lymphocyte and platelet/lymphocyte ratios with mortality and limb amputation after acute limb ischaemia
Authors: Pasqui Edoardo , de Donato Gianmarco , Giannace Giovanni , Panzano Claudia , Alba Giuseppe , Cappelli Alessandro , Setacci Carlo , Palasciano Giancarlo
Published: April 2021

Objective

Acute limb ischaemia is still considered a significant event, with considerable early- and long-term amputation and mortality risk. Our study aims to investigate the predictive role of pre-operative neutrophil/lymphocyte and platelet/lymphocyte ratios in terms of mortality and amputation risk in patients with acute limb ischaemia.

Methods

Pre-operative blood samples of all patients admitted with acute limb ischaemia were used to calculate neutrophil/lymphocyte and platelet/lymphocyte ratios. Population was subdivided into quartiles by platelet/lymphocyte ratio and neutrophil/lymphocyte ratio values, and Kaplan-Meier life tables were obtained for overall survival and limb salvage. The optimal neutrophil/lymphocyte ratio and platelet/lymphocyte ratio cut-offs were obtained from receiver operating characteristic curves with all-cause mortality and all kinds of amputation. Stepwise multivariate analysis was performed in order to identify independent risk and protective factors for mortality and amputations.

Results

A total of 168 patients were included in the analysis. Receiver operating characteristic curves identified cut-off values for neutrophil/lymphocyte ratio and platelet/lymphocyte ratio: neutrophil/lymphocyte ratio ≥5.57 for mortality; neutrophil/lymphocyte ratio ≥6.66 and platelet/lymphocyte ratio ≥269.9 for all amputations. Kaplan-Meier analysis revealed that survival rate in group neutrophil/lymphocyte ratio <5.57 was 83.4%, 78.9%, 73.7%, and 59.8%, respectively, at 12, 24, 36, and 48 months; in neutrophil/lymphocyte ratio ≥5.57 group was 62.4%, 51.3%, 47.8, and 43.7%, respectively ( p < 0.0001). Freedom from all amputations was significantly higher in case of neutrophil/lymphocyte ratio and platelet/lymphocyte ratio below the identified cut-off values ( p < 0.0001). Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were found as independent risk factors.

Conclusion

Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio are reliable markers for stratification of mortality and limb amputations in patients with acute limb ischaemia. The inexpensive nature and ready availability of these biomarkers' values reinforced their usefulness in everyday clinical practice.
Physical assessment in pharmacy practice: Perspectives from pharmacists, nonpharmacist health care providers and the public
Authors: Leong Christine , Soufi Leila
Published: April 2021

Background:

Physical assessment in pharmacy practice is not a new concept, yet the idea is still unfamiliar to many people. Canadian pharmacy graduates are expected to be trained in physical examination as it relates to drug therapy. However, standard delivery of course content in this area has not been clearly established, and previous publications have reported low uptake of this practice despite formal training. To aid the future development of a physical assessment course for pharmacists that is relevant to practice and will contribute to patient care, it is important to gather insight from practising pharmacists, health care providers and the public.

Objective:

To determine the type of physical assessment skills that would be of value to pharmacy practice and the benefits and barriers of these skills in practice from the perspectives of pharmacists, health care providers and the public.

Methods:

This was a cross-sectional online survey of pharmacists, nonpharmacist health care providers and the public. Descriptive statistics and thematic analysis were used to describe data.

Results:

A total of 348 respondents (98 pharmacists, 154 nonpharmacist health care providers, 96 public) completed the survey. Most (64%) nonpharmacist providers were physiotherapists or occupational therapists (only 6.5% physicians). Most respondents felt that performing basic vital signs was relevant to pharmacy practice (79% pharmacists, 69% other providers, 79% public) and felt confident and comfortable about pharmacists using these skills. Palpation, percussion and auscultation were rated less favourably (<50% for most respondents). Nonpharmacist providers tended to be less favourable than pharmacist and public respondents. Seven themes related to benefits and 13 themes related to disadvantages of pharmacists performing physical assessment were identified.

Conclusion:

These findings provide insight into opinions about the value of pharmacists performing physical assessments. Consensus recommendations on performance expectations to improve recognition of pharmacists in this area is needed in the future. Can Pharm J (Ott) 2021;154:xx-xx.
Three-month outcomes of recovered COVID-19 patients: prospective observational study
Authors: Cao Jie , Zheng Xueying , Wei Wei , Chu Xinmin , Chen Xianmeng , Wang Ying , Liu Qiqi , Luo Sihui , Weng Jianping , Hu Xiaowen
Published: April 2021

Aims:

A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined.

Methods:

This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36).

Results:

Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41–64 years group ( p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up.

Conclusions:

At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed. The reviews of this paper are available via the supplemental material section.
Paraganglioma in pregnancy: A case series and literature review
Authors: Eccles-Smith Jade , Hopkins Stephanie , Conn Jennifer , Johnston Stephanie , Szabo Rebecca , Price Sarah , Nankervis Alison
Published: April 2021

Paragangliomas are rare neuroendocrine neoplasms which are often catecholamine-secreting and associated with familial syndromes. Described here are three women with a variety of pathology: isolated secretory paraganglioma diagnosed in pregnancy, secretory metastatic paraganglioma in pregnancy and non-secretory metastatic paraganglioma in pregnancy. Whilst paragangliomas are associated with morbidity and mortality during pregnancy, good maternal and fetal outcomes can be achieved through individualised care within the context of a multidisciplinary team. Although paragangliomas are associated with morbidity and mortality in pregnancy, good maternal and fetal outcomes can be achieved through individualised care within the context of a multidisciplinary team.
Efficacy and safety of trifluridine/tipiracil plus bevacizumab and trifluridine/tipiracil or regorafenib monotherapy for chemorefractory metastatic colorectal cancer: a retrospective study
Authors: Chida Keigo , Kotani Daisuke , Nakamura Yoshiaki , Kawazoe Akihito , Kuboki Yasutoshi , Shitara Kohei , Kojima Takashi , Taniguchi Hiroya , Watanabe Jun , Endo Itaru , Yoshino Takayuki
Published: April 2021

Background:

The C-TASK-FORCE phase I/II and Danish randomized phase II trials reported the promising efficacy of trifluridine/tipiracil (TAS102) plus bevacizumab (BEV) in patients with chemorefractory metastatic colorectal cancer (mCRC). However, there had been no direct comparative phase III trial to compare the efficacy between TAS102 plus BEV and standard therapy with either TAS102 or regorafenib monotherapy.

Methods:

We retrospectively reviewed the medical records of patients with mCRC who received TAS102 plus BEV, TAS102 monotherapy, or regorafenib monotherapy after standard chemotherapies during 2013–2019.

Results:

Patients received TAS102 plus BEV ( n = 139), TAS102 monotherapy ( n = 153), or regorafenib monotherapy ( n = 133). With a median follow-up of 25.3 months, median overall survival (OS) was 11.5 months [95% confidence interval (CI), 9.9–13.9] for TAS102 plus BEV, 8.1 months (95% CI, 6.8–9.2) for TAS102 monotherapy, and 6.8 months (95% CI, 5.7–8.5) for regorafenib monotherapy. The hazard ratios were 0.67 (95% CI, 0.51–0.88) for TAS102 plus BEV versus TAS102 monotherapy and 0.71 (95% CI, 0.54–0.94) for TAS102 plus BEV versus regorafenib monotherapy. Median progression-free survival (PFS) was 4.4 months (95% CI, 3.7–5.4) for TAS102 plus BEV, 2.5 months (95% CI, 1.6–2.3) for TAS102 monotherapy, and 2.1 months (95% CI, 1.6–2.3) for regorafenib monotherapy. The hazard ratios were 0.57 (95% CI, 0.45–0.73) for TAS102 plus BEV versus TAS102 monotherapy and 0.44 (95% CI, 0.34–0.58) for TAS102 plus BEV versus regorafenib monotherapy. On multivariate analysis, TAS102 plus BEV was independently correlated with better OS and PFS. No unexpected adverse events were observed in any group.

Conclusion:

Our study shows that OS and PFS are longer in patients treated with TAS102 plus BEV than in those treated with TAS102 or regorafenib monotherapy.
Patient-reported outcomes from a randomized, double-blind, placebo controlled, phase III study of baricitinib versus placebo in patients with moderately to severely active rheumatoid arthritis and an inadequate response to methotrexate therapy: results from the RA-BALANCE study
Authors: Yang Yue , Xu Jianhua , Xu Jian , Li Xingfu , Hu Jiankang , Li Xiangpei , Zhang Xiao , He Dongyi , Bao Chunde , Li Zhijun , Wang Guochun , Zerbini Cristiano A. F. , Spindler Alberto J. , Kannowski Carol L. , Wu Hanjun , Ji Fei , Zhan Lujing , Liu Mengru , Li Zhanguo
Published: April 2021

Introduction:

To assess the effect of baricitinib on patient-reported outcomes (PROs) in patients with moderately to severely active rheumatoid arthritis (RA) who had an inadequate response to methotrexate (MTX).

Methods:

This was a 52-week, randomized, double-blind, placebo controlled, phase III study in patients with RA who had an inadequate response to MTX. Patients ( n = 290) receiving stable background MTX were randomly assigned (1:1) to receive placebo or baricitinib 4 mg once daily with a primary endpoint at week 12. PROs assessed included Health Assessment Questionnaire-Disability Index (HAQ-DI), Patient’s Global Assessment of Disease Activity, patient’s assessment of pain, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), European Quality of Life-5 Dimensions-5 Level index scores and visual analogue scale, and measures collected in electronic patient daily diaries: duration of morning joint stiffness, Worst Tiredness, and Worst Joint Pain. Treatment comparisons were made with logistic regression and analysis of covariance models for categorical and continuous variables, respectively.

Results:

Statistically significant ( p ⩽ 0.05) improvements in all PROs were observed in the baricitinib 4 mg group compared to placebo as early as week 1 to week 4; and were sustained to week 24. These improvements were maintained until week 52 for the baricitinib group. A significantly larger proportion of patients met or exceeded the minimum clinically important difference for HAQ-DI (⩾0.22) and FACIT-F (3.56) profiles in the baricitinib group.

Conclusion:

Baricitinib provided significant improvements in PROs compared to placebo to 52 weeks of treatment in patients with RA who had an inadequate response to MTX. Clinicaltrials.gov identifier: https://clinicaltrials.gov/ct2/show/NCT02265705 ; NCT02265705; RA-BALANCE. Registered 13 October 2014