bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract WP40: CT-based Evaluation is Faster and as Precise as MRI in Acute Stroke Evaluation
Authors: Hansen Christine K , Christensen Anders , Havsteen Inger , Christensen Hanne
Published: July 2021

Introduction:
The issue if Computer Tomography (CT) or Magnetic Resonance Imaging (MRI) are ‘best’ in evaluation of patients with symptoms of acute stroke prior to intravenous-tissue-plasminogen-activator treatment (iv-tPA) has been widely discussed; CT-based door-to-needle-times of 20 minutes are feasible and motivated by time-dependent efficacy of iv-tPA, but the more time consuming MRI-based evaluation likely provides additional information on hyper-acute cerebral ischemia and iv-tPA-contraindicating stroke mimicking pathology.

Aim:
The aim of this study was to compare the delay of iv-tPA-treatment and the level of diagnostic information obtained for patients randomized to CT and MRI-based acute stroke evaluation.

Method:
Three-hundred-sixty-nine consecutive patients admitted with symptoms of stroke within 4.5 hours from symptom-onset were quasi-randomized to CT or MRI-based evaluation as part of an ongoing single-center trial and treated with iv-tPA if eligible.

Door-to-needle-times for patients, allocated to CT and MRI, were compared. Imaging of diagnostic quality and stroke mimicking detected pathology were registered for the two modalities.

Results:
Door-to-needle-times for CT evaluated patients (median 26 (7-55) min) were significantly faster than for MRI-examined patients (median 36 (11-71) min), p=0.007.

Imaging of adequate diagnostic quality was acquired for all patients examined with CT and for 96.4% of patients, without inherent MRI-contraindications, examined with MRI.

All patients with discharge diagnoses of intracerebral hemorrhage and intracerebral oncological pathology were identified by the primary scan at admission, regardless if CT or MRI were performed.

Conclusion:
CT-based evaluation prior to iv-tPA-treatment is faster and as presice as MRI-based evaluation of patients with acute stroke.
Abstract WP41: Predicting Acute Ischemic Stroke Tissue Fate Using Deep Learning on Source Perfusion MRI
Authors: Ho King Chung , El-Saden Suzie , Scalzo Fabien , Bui Alex A , Arnold Corey W
Published: July 2021

Introduction:
Perfusion MR and CT parameters are widely used during the assessment of acute ischemic strokes to evaluate the likely lesion growth. However, such perfusion parameters and derived ratios are sensitive to the choice of arterial input function or deconvolution method. Studies have shown that various deconvolution algorithms can lead to inconsistent values and also introduce distortions that influence measurement. In this work, we propose a deep convolutional neural network (CNN) to learn imaging features from source magnetic resonance perfusion images that are best predictive of tissue outcome.

Methods:
We developed a deep CNN for voxel-by-voxel prediction. Perfusion-weighted images (PWIs), diffusion-weighted images (DWIs), and apparent diffusion coefficient (ADC) maps were obtained in five ischemic stroke patients (mean age: 69; mean NIHSS: 12) within 6.5 hours of stroke onset from UCLA stroke center database. The final infarct volumes were evaluated in the 5-7 days post-treatment FLAIR images. 53,000 training data were generated; each training data consisted of the raw voxel values obtained across the MR images. The CNN has three separate convolutional and pooling layers for each imaging channel; 128 combined features were learned in the final fully-connected layer, which were fitted to a logistic classifier for single voxel infarct prediction.

Results:
The model achieved an area under the curve (AUC) of 0.941 +/- 0.002 (95% CI) in ten-fold cross validation, outperforming existing models with perfusion parameters. With a cut-off threshold of 0.5, the model achieved an accuracy of 0.865, a precision of 0.836, and a recall of 0.910. The model automatically learned spatio-temporal filters that detected temporal and spatial changes in the PWIs.

Conclusion:
This pilot study showed that the deep CNN is capable of generating automatically learned features from source perfusion images that are predictive of tissue outcome, providing a potential alternative for stroke image analysis. Our future work includes experimenting on a larger dataset, and optimizing model parameters with pre-training and fine-tuning.
Abstract WP410: Short-Term Outcomes in Pediatric Ischemic Stroke: An Analysis of the Nationwide Inpatient Sample, 2002-2011
Authors: Rumalla Kavelin , Singh Aditya , Rajan Ashna , Letchuman Vijay , Mittal Manoj
Published: July 2021

Introduction:
Pediatric stroke occurs in up to 13 out of every 100,000 children and often results in lifelong disability or mortality. The purpose of our study was to identify factors that affect hospital length of stay (LOS), total costs, and in-hospital mortality in pediatric ischemic stroke hospitalizations.

Methods:
We queried the Nationwide Inpatient Sample from 2002 to 2011 to identify all hospitalizations (age 1-17) for pediatric ischemic stroke. Bivariate and multivariate (adjusted for all covariates) analyses were utilized to determine the effect of demographics, insurance status, and preexisting comorbidities on the rates of secondary intracerebral hemorrhage (ICH), prolonged LOS (≥ 90th percentile for LOS), increased hospital costs (≥ 90th percentile for costs), and mortality.

Results:
A total of 6,303 hospitalizations for pediatric ischemic stroke were identified. The rates of thrombolytic therapy and mechanical thrombectomy (years 2008-2011, N=2,409) were 1.67% and 1.41%, respectively. Multivariate adjusted risk factors for secondary ICH during hospitalization included: black race (odds ratio [OR], 1.99), minority race (OR: 2.47), 2 or more pre-existing comorbidities (OR: 2.31), and moyamoya disease (OR: 4.35; all P Values <0.05). Adjusted predictors of mortality included: secondary ICH (OR: 9.98), Medicaid insurance (OR: 1.38), 2 or more preexisting comorbidities (OR: 5.31), and southern region (OR: 2.08; all P Values <0.05). Furthermore, patients with pre-existing hypercoagulability (OR: 1.77) or autoimmune disorders (OR: 2.38), faced greater mortality than those with congenital heart disease (OR: 0.55) or sickle cell disease (OR: 0.47; all P Values <0.05). Minority race, small hospital bedsize, and increased comorbidity increased the odds of both prolonged LOS and increased costs (all P Values <0.0001). Medicaid insurance, southern region, and urban hospital location increased the odds of prolonged LOS, whereas, teaching hospitals and weekend admission resulted in increased costs (all P Values <0.05).

Conclusion:
The in-hospital outcomes of pediatric stroke patients are significantly impacted by socioeconomic factors, hospital characteristics, and underlying disease etiologies.
Abstract WP420: Testing the Intensity of Multiple, Complex Interventions for Life-style Modification in Randomized Stroke Trials
Authors: Brainin Michael , Teuschl Yvonne , Matz Karl , Dachenhausen Alexandra , Firlinger Bernadette , Reiter Martina , Tuomilehto Jakkoo
Published: July 2021

Introduction:
Multiple, complex interventions are increasingly tested in randomized, clinical trials without enabling a clear view of the strength of the intervention, especially its probability to influence outcome. Such interventions have to be strong enough to create group differences, be acceptable by patients, be realistically designed and deliverable within the health system, and ethical. If found to have a positive effect, it should have a sustainable effect after the trial is drawn to a close. It is necessary to adapt the intensity of the intervention to contrast with guideline-based treated controls and to ensure sufficient means to carry through to the end of the trial.

Method:
Using a multiple domain life-style based intervention in a randomized trial to prevent cognitive decline following stroke (ClinicalTrials.gov Identifier: NCT01109836), our focus was on nutrition and physical exercise in addition to risk factor management. We performed single component analysis as well as the use of a life-style summary score and a laboratory supported life-style summary score.

Results:
80 participants in the intervention group and 87 in the control group completed the 12 months visit. We found a significant improvement in adherence to healthy lifestyle factors and adequately controlled physiological parameters as well as significant differences for both summary scores, all p <0.001. The summary scores includes the use of reduced milk and fat spreads, consuming fish ≥1/week, drinking alcohol 1-6 times/week, physical activity ≥90 minutes/week, body mass index <30 kg/m
2
and currently non-smoking. Laboratory values included blood pressure <140 / <90 mmHg, non-HDL-cholesterol ≥2.6 mmol/L and fasting blood glucose <7.0. mmol/L

Conclusion:
Complex interventions used for secondary prevention stroke trials have to be intense enough to become effective when comparing to treatment according to current guidelines.
Abstract WP49: Distal Hyperintense Vessels Were not a Predictor of Large Vessel Occlusion in Patients With Transient Ischemic Attack
Authors: de Figueiredo Marcelo M , Vazzoller Marcela R , Amaro Jr Edson , Miranda Renata A , Silva Gisele S
Published: July 2021

Introduction:
Distal hyperintense vessels (DHV) detected by FLAIR imaging are not uncommon in patients with acute ischemic stroke. The presence of DHV and its predictors has been scarcely evaluated in patients with transient ischemic attack (TIA), being associated to the presence of large vessel occlusion in such patients. We assessed the hypothesis that DHV are frequent in patients with TIA and do correlate with relevant clinical and neuroimaging characteristics.

Methods:
We evaluated a database of consecutive patients admitted with TIA from February 2009 to June 2012 who had undergone magnetic resonance imaging within 30 h of symptoms onset and intracranial and extracranial vascular imaging. We analyzed the relationship between DHV, clinical presentation, risk factors, neuroimaging characteristics and large artery stenosis or occlusion. DHV signals were defined on FLAIR images as focal, linear or serpentine, hyperintense signals relative to gray matter. Two neuroradiologists blinded to clinical information reached consensus regarding the presence of DHV.

Results:
Seventy-two TIA patients were enrolled. The median time from symptoms onset to MRI was 8:39 h [4:21, 14:13]. DHV signals on FLAIR images were present in 12 (16.7 %) patients. The overall agreement between examiners was good (k 0.67). Patients with DHV had more atrial fibrillation (AF) than those without (41.7% versus 21.7%, p=0.05) and a trend towards more congestive heart failure (CHF) (8.3% versus 1.7%, p=0.2) and diabetes (41.7% versus 21.7%, p=0.1). There were no differences in the frequency of intracranial or cervical arterial stenosis, cerebral microbleeds and white matter abnormalities in patients with and without DHV. In a multivariate logistic regression analysis, only AF had a trend to be a predictor of DHV (OR=4.24, p=0.1). The statistical model to predict DHV including AF, diabetes, and CHF had a moderate fit in terms of discrimination (c statistic=0.62)

Conclusion:
DHV signals on FLAIR images occur in patients with TIA and might correlate with clinical variables like AF and not only with large vessel occlusion as previously described. The presence of DVH in patients with TIA and AF might be a surrogate marker for a previous large vessel occlusion spontaneously recanalized.
Abstract WP76: Utility of Individual NIH Stroke Scale Items as a Predictor of Functional Outcomes in Acute Ischemic Stroke Patients Presenting With Mild Neurologic Deficits
Authors: Choi Jay Chol , Lee Ji Sung , Park Tai Hwan , Cho Yong-Jin , Hong Keun-Sik , Park Jong-Moo , Kang Kyusik , Lee Kyung Bok , Lee Soo-Joo , Ko Youngchai , Lee Jun , Kim Joon-Tae , Choi Kang-Ho , Oh Mi-Sun , Yu Kyung-Ho , Lee Byung-Chul , Cha Jae-Kwan , Kim Dae-Hyun , Lee Juneyoung , Kim Dong-Eog , Ryu Wi-Sun , Kim Beom Joon , Han Moon-Ku , Bae Hee-Joon
Published: July 2021

Introduction:
Predicting outcomes of acute stroke patients initially presenting with mild neurologic deficits is important in making decision for thrombolytic therapy. Previous researches with a small sample size have failed to find specific items of NIH Stroke Scale or clinical syndromes to be predictive of functional outcome.

Hypothesis:
We hypothesized that certain items of the NIH Stroke Scale or their combinations would be independently associated with unfavorable functional outcome after mild stroke

Methods:
Using a multicenter stroke registry database, we identified patients with acute ischemic stroke who presented within 4.5 hours of symptom onset and had initial NIH Stroke Scale scores ≤ 5. Functional outcomes at three months after the stroke were classified as favorable (modified Rankin Scale score [mRS] 0 to 1) or unfavorable (mRS 2-6). The individual NIH Stroke Scale items were dichotomized as absent (0) or present (≥1) for the analysis. The NIH Stroke Scale items and the total score were tested for predicting the outcomes in multivariable models adjusting for demographics and clinical characteristics. Area under the ROC curve (AUC) was used to assess the performance of multivariable models.

Results:
Among 2,209 patients who met the eligible criteria, 588 patients (26.6%) exhibited unfavorable functional outcome (mRS 2-6) at three months. The most frequently present items were item 10 (dysarthria, 37.5%), item 4 (facial palsy, 21.1%), item 8 (sensory, 15.0%), and items indicating limb paralysis. Among 15 items of NIH Stroke Scale, all items except for item 8 (sensory) and item 11 (extinction) were significantly associated with unfavorable functional outcomes in bivariate analysis (P <0.05), and many of them remained significant in multivariable analyses. In multivariable analyses, the model including the total NIH Stroke Scale scores exhibited similar AUC (0.759; 95% CI, 0.740 -0.776; P=0.75 for pairwise comparison) compared to the model with all NIH Stroke Scale items (0.758; 0.739 - 0.775) in predicting functional outcomes after the stroke.

Conclusions:
Simply using the total score was as effective as using all NIH Stroke Scale items in predicting outcomes of patients presented with mild stroke symptom.
Abstract WP97: Neuroprotective Effect of Progranulin Against Focal Cerebral Ischemia via Inhibition of Proteolysis of TDP-43 by Caspase-3
Authors: Masafumi Toriyabe , Kanazawa Masato , Koyama Misaki , Miura Minami , Takahashi Tetsuya , Nishizawa Masatoyo , Shimohata Takayoshi
Published: July 2021

Introduction:
We previously demonstrated that progranulin (PGRN), a glycoprotein growth factor, may be a novel therapeutic target that provides vascular protection and anti-neuroinflammation properties related in part to vascular endothelial growth factor and interleukin 10, respectively. We also found that PGRN could provide neuroprotection in part by inhibition of cytoplasmic redistribution of TAR DNA-binding protein-43 (TDP-43), although its exact mechanism remains poorly understood. The purpose of this study is to determine the mechanism of neuroprotection by PGRN against ischemic neuronal injury.

Methods:
The middle cerebral artery of adult PGRN knock-out (KO) mice (C57BL/6 background) and wild-type (WT) mice was occluded for 90 minutes. Immunohistochemical analysis using an antibody against TDP-43 was performed to investigate the subcellular localization of TDP-43 after ischemia. We also performed Western blot analysis to investigate the expression levels of TDP-43 and activated caspase-3 using cerebral cortex tissues from a rat autologous thromboembolic model with delayed tissue plasminogen activator (tPA) treatment (4 hours after ischemia).

Results:
Twenty-four hours after reperfusion, neuronal cells showing cytoplasmic redistribution of TDP-43 were more frequently observed in PGRN KO mice than in WT mice (P<0.01). In a rat autologous thromboembolic model with delayed tPA treatment, the expression level of full-length of TDP-43 decreased 24 hours after ischemia via proteolytic degradation. However, intravenous administration of recombinant PGRN with delayed tPA treatment inhibited the decrease in the expression level of full-length TDP-43 as well as the increase in the expression level of activated caspase-3 compared with that of the control protein.

Conclusion:
This study demonstrated that PGRN might protect neuronal cells against focal cerebral ischemia via inhibition of proteolysis and abnormal cytoplasmic redistribution of TDP-43 by caspase-3.
Religion and Government in Hugo Grotius’s Annales: Orthodoxy, William the Silent and Reason of State
Authors: Waszink Jan
Published: July 2021

In Grotius’s Annales, religion appears almost exclusively as a social and political problem. References (implied or explicit) to religion as a good thing or its positive effects are lacking. This aspect of Grotius’s text arises from its equation of ‘religion’ with ‘combative orthodox religion in the post-reformation era’. However, it is not credible that this view represents Hugo Grotius’s actual opinion of the Christian faith as such. The solution seems rather that the above equation must be a conscious rhetorical strategy designed to strengthen the argument of the Annales. Continuing from that conclusion, however, the texts allow us to deduce some views on reason of state and religious policy, which do seem to have been actually held by Grotius in this period, or at least to have enjoyed his active interest.
Working Within a System of Administrative Burden: How Street-Level Bureaucrats’ Role Perceptions Shape Access to the Promise of Higher Education
Authors: Bell Elizabeth , Smith Kylie
Published: July 2021

Utilizing a statewide survey and administrative data, we explore how state-imposed burdens are translated by street-level bureaucrats (SLBs) into frontline practices that may alleviate or exacerbate onerous experiences of the administrative state. First, we find that SLBs’ role perceptions shaped not only uses of discretionary power—as either a force of client empowerment or disentitlement—but also program access. Second, we find that the local agencies with the largest proportions of income-eligible clients often had the least capacity for alleviating administrative burden, suggesting decentralization may be a mechanism by which administrative burden perpetuates structural inequality.
Sustainable waste management of medical waste in African developing countries: A narrative review
Authors: Chisholm Jade Megan , Zamani Reza , Negm Abdelazim M , Said Noha , Abdel daiem Mahmoud M , Dibaj Mahdieh , Akrami Mohammad
Published: July 2021

Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method – if not applying the right technologies – potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.
Examination of Test Anxiety in a Sample of 18 to 26 year-old Singapore and U.S. Undergraduate Male and Female Students on the Test Anxiety Measure for College Students-Short Form
Authors: Lowe Patricia A.
Published: July 2021

A cross-national study was conducted on a new test anxiety measure, the Test Anxiety Measure for College Students-Short Form (TAMC-SF) in a sample of 1,023 Singapore and U.S. students, aged 18-26. The TAMC-SF consists of one facilitating anxiety scale and five test anxiety (Worry, Cognitive Interference, Social Concerns, Physiological Hyperarousal, and Task Irrelevant Behaviors) scales. The measure was administered to the sample of higher education students online. The results of single-group confirmatory factor analyses found support for the TAMC-SF six-factor model for Singapore students, U.S. students, male students, and female students. In addition, the results of multi-group, mean and covariance structure analysis found support for the construct equivalency of the TAMC-SF scores across country and gender. Latent mean factor analyses followed and the results of these analyses indicated Singapore students had significantly higher levels of social concerns and significantly lower levels of cognitive interference and worry than U.S. students. The findings also indicated females had significantly higher levels of test anxiety than males on all five TAMC-SF test anxiety scales. Evidence supporting the construct validity of the TAMC-SF scores with the scores of math anxiety, social phobia, and self-critical perfectionism was also reported. Implications of the study’s findings for researchers and clinicians are discussed.
University Title IX Requirements have Chilling Effect on Gender Discrimination Research: A Call for a More Nuanced Approach
Authors: Sexton Julie , Fairchild Ennea , Newman Harmony , Riggs Eric , Hinerman Krystal
Published: July 2021

The full extent of gender discrimination in university settings remains uncertain. More research is needed to understand the scope of gender discrimination experiences in universities and to develop effective prevention approaches. However, Title IX and Institutional Review Board policies may hinder researchers’ abilities to study gender discrimination in university settings. In this paper, we describe our experience working with the Institutional Review Board and Title IX offices to obtain approval for researching gender discrimination in university settings. We provide recommendations for how universities can enable gender discrimination research and follow Title IX policies.
Victim and Perpetrator Acknowledgement of Intimate Partner Violence and Victim Psychopathology
Authors: Clements Caroline M. , Moore Brittanie C. , Laajala–Lozano Allison , Casanave Karly
Published: July 2021

The present study assesses differences between acknowledged and unacknowledged victims in post-victimization psychopathology, abuse disability and coping. Few studies have examined abuse acknowledgment among intimate partner violence (IPV) victims. To our knowledge, this study is the first to use an experimental manipulation to assess changes in acknowledgment among IPV victims. Female undergraduate students currently in dating relationships completed demographic, coping and psychopathology questionnaires, and the Conflict Tactics Scale (CTS). They then watched a video of an IPV perpetrator who either acknowledged abuse or did not acknowledge abuse. Following the video, participants completed a psychopathology questionnaire and a post-video acknowledgment assessment. Approximately 38% of the sample reported IPV victimization. Only 7.89% acknowledged victimization. Acknowledged IPV victims had the highest mean victimization score but reported psychopathology similar to nonvictims on all subscales except phobic anxiety. Unacknowledged victims reported greater psychopathology, depression, anxiety, and hostility than nonvictims and were more symptomatic overall. Unacknowledged victims reported more frequent use of avoidant coping strategies than nonvictims. These strategies included substance use, self-blame, and behavioral disengagement. Acknowledged and unacknowledged victims reported greater abuse disability than nonvictims, and acknowledged victims reported greater life restriction than unacknowledged victims. Following the video, the number of acknowledged victims nearly doubled, and acknowledged victims reported increased depression. On the basis of these findings, clinicians and researchers should carefully consider acknowledgment as a potential factor in post-victimization mental health and explore ways to increases victim acknowledgment.
Identification method for the dynamic cutting force variation of a high energy efficiency milling cutter
Authors: Fan Lili , Jiang Bin , Zhao PeiYi , Zhang Tingzheng
Published: July 2021

The dynamic cutting force of a high energy efficiency milling cutter is an important indicator for evaluating the stability of the cutting energy efficiency. The existing cutting force analysis focuses on the main characteristics and influencing factors of the cutting force variation in the cutting process, ignoring the influence of the variation of the cutting layer parameters with the cutter tooth error in different cutting stages, and the dynamic cutting force variation is uncertain. In this research, the analytical model of the instantaneous cutting volume of a milling cutter was developed in order to obtain the time-frequency characteristics of the instantaneous cutting volume with the cutter tooth error. According to the sudden changes of the cutting force and the milling vibration, the variations were studied in different cutting stages. The dynamic cutting behavior sequences such as the instantaneous cutting volume, milling vibration, and dynamic cutting force were constructed to characterize the mapping relationship between the dynamic cutting behavior of a milling cutter. Based on these approaches, the identification method for the dynamic cutting force variation of a high energy efficiency milling cutter was proposed. The effectiveness of the method was verified by the results of the milling experiment and the dynamic cutting behavior response analysis. The results showed that the proposed method could effectively identify the variation and its control variables for the dynamic cutting force in the cutting process, and the method could provide a scientific basis for constructing the dynamic cutting force model of a high energy efficiency milling cutter.
Modelling and experimental validation of the performance of a digital displacement® hydraulic hybrid truck
Authors: Midgley William JB , Abrahams Daniel , Garner Colin P , Caldwell Niall
Published: July 2021

The development, modelling and testing of a novel, fuel-efficient hydraulic hybrid light truck is reported. The vehicle used a Digital Displacement® pump/motor and a foam-filled hydraulic accumulator in parallel with the existing drivetrain to recover energy from vehicle braking and use this during acceleration. The pump/motor was also used to reduce gear-shift times. The paper describes the development of a mathematical vehicle model and the validation of this model against an extensive testing regime. In testing, the system improved the fuel economy of the vehicle by 23.5% over the JE05 midtown drive cycle. The validated mathematical model was then optimised and used to determine the maximum fuel economy improvement over the diesel baseline vehicle for two representative cycles (JE05 midtown and WLTP). It was found that the hybrid system can improve the fuel economy by 24%–43%, depending on the drive cycle. When this was combined with engine stop-start, the system improved the fuel economy of the vehicle by 29%–95%, depending on the drive cycle.
Ecodesigning and improving performance of plugin hybrid electric vehicle in rolling terrain through multi-criteria optimisation of powertrain
Authors: Bhattacharjee Debraj , Ghosh Tamal , Bhola Prabha , Martinsen Kristian , Dan Pranab
Published: July 2021

This work presents an ecodesigning and operating performance improvement methodology in series-parallel Plugin hybrid electric vehicle (PHEV) in passenger car category, through optimisation of powertrain, considering gradeability overreaching rolling terrain. Designing involves consideration for power of prime movers and the geometric specification governing gear ratio, which is the teeth number. PHEV performance is measured in terms of various output characteristics, such as, fuel economy, emissions, vehicle weight, battery charge, maximum velocity and maximum acceleration etc. and such output indicators comprising both ecodesign and vehicle operating performance attributes, eleven in all, are considered. For optimisation, the design space is generated using NREL, ADVISOR simulator in accordance with Taguchi’s method. Multi-criteria optimisation is used to converge the aforesaid output indicators into a single one using TOPSIS, MTOPSIS, Grey Relational Analysis and their surrogate assisted evolutionary algorithm (SAEA) based solutions to select the best from. Such design solutions are tested with UDDS driving cycle for performance analysis; reflecting superiority of SAEA based results. However, best values of output indicators are not from a single solution but are spread over these SAEAs. While, gradability is embedded in the model, its variation as supplemental factor, together with total ownership cost, are included, for extended modelling to ascertain the suitability amongst SAEAs. To extend the test for suitability beyond one driving cycle, also a combined one is formed by integrating two other, namely NEDC and 1015Prius with UDDS. The simulation experiment results from combined driving cycle also indicate preference in favour of MTOPSIS-SAEA model, complying upto 25% gradability for rolling terrain, substantially better than the reference model while also ensuring savings in fuel cost by about 60% over the entire ownership period besides reduction in greenhouse gas emissions ranging between 18% and 21%. This solution also helps in lightweighting the vehicle by over 6%.
Challenges in Treating Chlamydia trachomatis, Including Rectal Infections: Is It Time to Go Back to Doxycycline?
Authors: Kang-Birken S. Lena
Published: July 2021

Objective:

To evaluate recent publications on efficacy of single-dose azithromycin and 7-day doxycycline when treating Chlamydia trachomatis.

Data Sources:

A literature search of MEDLINE, EMBASE, PubMed, and Cochrane library was conducted (1990 to June 13, 2021) using the terms: Chlamydia trachomatis, genital chlamydia, rectal chlamydia, extragenital chlamydia, azithromycin, doxycycline, and treatment guidelines. ClinicalTrials.gov was searched to identify ongoing trials.

Study Selection and Data Extraction:

English language studies, including controlled studies, retrospective analyses, systematic reviews, meta-analyses, and case reports, reporting microbiological or clinical outcomes in adolescents and adults were considered.

Data Synthesis:

Systemic reviews and meta-analyses of randomized trials reported azithromycin efficacy of 96% to 97% in genital chlamydia. However, reports of treatment failure have emerged, especially among symptomatic males, with an increased risk of microbiological failure after azithromycin than doxycycline (relative risk = 2.45; 95% CI = 1.36-4.41). Retrospective analyses and prospective observational cohort studies reported lower efficacy range following azithromycin than doxycycline (74%-87% vs 92%-100%, respectively) in rectal chlamydia. First randomized controlled trial comparing azithromycin and doxycycline reported significantly higher microbiological cure following doxycycline, with absolute difference of 26% (95% CI = 16%-36%; P < 0.001). The proposed 2021 Centers for Disease Control and Prevention treatment guidelines designate doxycycline as the preferred agent for treatment at any site.

Relevance to Patient Care and Clinical Practice:

A growing body of evidence for treatment failure following azithromycin, especially in rectal chlamydia supports updating current practice.

Conclusions:

Doxycycline continues to achieve high efficacy in genital and rectal chlamydia. Clinicians should consider efficacy with convenience of dosing regimen, medication compliance, and sexual behavior risks when treating chlamydia infections.
The impact of COVID-19 related national lockdown on ophthalmic emergency in Italy: A multicenter study
Authors: Salvetat Maria L , Salati Carlo , Busatto Patrizia , Zeppieri Marco
Published: July 2021

Purpose:

To assess ocular pathologies admitted to Italian Emergency Eye Departments (EEDs) during the COVID-19 pandemic national lockdown in 2020 in comparison with the same period in 2019.

Methods:

Electronic records of all patients presenting at EEDs of two tertiary-care Eye Centers during the COVID-19 national lockdown in Italy (March 10–May 3, 2020) were compared with the equivalent period in 2019. Main outcomes were patient age, gender, and diagnoses. Statistical analysis included unpaired Student t-tests, Poisson regression, and chi-square test.

Results:

Overall EED visits significantly decreased by 54.1% during the 2020 lockdown compared to 2019 (851 vs 1854, p < 0.001). During lockdown, patients showed comparable mean age (52.8 years in 2020 vs 53.3 years in 2019, p = 0.52) and significant male gender bias (61.1% in 2020 vs 55.8% in 2019, p < 0.0001). The most frequent pathologies were eye inflammations, trauma-related incidents, and spontaneous acute vitreous detachment. Patients with inflammation, headache/hemicrania, and spontaneous subconjunctival hemorrhages were significantly less, whereas those with trauma-related diagnoses were significantly higher during the lockdown as compared with 2019 ( p < 0.05). The proportion of non-urgent visits decreased from 17% in 2019 to 8% in 2020 ( p < 0.001).

Conclusions:

During the 2020 lockdown, there was a significant reduction of accesses to EED, especially for non-urgent pathologies. Potentially visual function threatening conditions, such as trauma-related pathologies, retinal detachment or ruptures, and wet AMD, showed lower number of cases but higher or stable proportion relative to the total caseload, suggesting a correct and efficient access to ophthalmic health care during the pandemic period.
Anterior chamber changes assessment by Scheimpflug analysis after intravitreal dexamethasone implantation
Authors: Kucukkomurcu Elvan , Sahin Tayfun
Published: July 2021

Purpose:

To evaluate structural changes in the anterior chamber and intraocular pressure (IOP) changes following intravitreal dexamethasone implantation.

Methods:

Forty-two eyes of 42 patients that received intravitreal dexamethasone implant for the management of macular edema secondary to diabetic retinopathy or branch retinal vein occlusion (BRVO) were included in the study. IOP was measured by Goldmann applanation tonometry. Anterior chamber depth (ACD) and iridocorneal angle (ICA) was measured by a Scheimflug camera (Sirius, CSO, Italy) the day before the injection of the dexamethasone implant and on postoperative day 1, first week, and first month.

Results:

Mean IOP was 15.14 ± 2.77 mmHg before the procedure and, 15.67 ± 3.70 mmHg, 15.86 ± 3.11 mmHg, 16.21 ± 2.75 mmHg on day 1, first week, and first month following intravitreal dexamethasone implantation, respectively. Mean ICA and ACD were significantly higher in pseudophakic eyes compared to phakic eyes. However, there was no statistically significant change in ICA before and after the procedure (on postoperative day 1, first week, and first month) among both phakic and pseudophakic patients ( p = 0.783). Similarly, ACD remained unchanged after the procedure (on postoperative day 1, first week, and first month) compared to the initial measurement ( p = 0.802).

Conclusion:

This study confirmed that there was an increase in IOP. However, these changes were not accompanied with a change in ACD or ICA.
An bhfuil ár lá tagtha? Sinn Féin, special status and the politics of Brexit
Authors: Evershed Jonathan , Murphy Mary C
Published: July 2021

In this article we critically examine how Sinn Féin responded to Brexit, why, and with what consequences. By destabilising the UK’s territorial constitution and intensifying debate about Ireland’s constitutional future, Brexit has represented a moment of unprecedented opportunity for Irish republicanism. However, this has been offset by the very real political and economic risks it has posed for the island of Ireland. We argue that Sinn Féin’s pursuit of ‘Special Status’ for Northern Ireland represented an attempt to mitigate Brexit’s risks, rather than to leverage its opportunities. This approach came with political costs for the party, whose recent electoral surge has arguably been in spite of rather than because of it. We demonstrate how Brexit has served to reshape Sinn Féin’s politics, and how it has functioned to further moderate its ‘Eurocriticism’.
Analysis of the energy harvesting non-orthogonal multiple access technique for defense applications over Rayleigh fading channel conditions
Authors: Beuria Manoj Kumar , Shankar Ravi , Singh Sudhansu Sekhar
Published: July 2021

The energy harvesting (EH) technique has ignited a rising research interest due to its ability to enhance the battery power of user equipment by harvesting energy by using a simple radio frequency circuit. In this paper, the simultaneous wireless information and power transfer non-orthogonal multiple access (NOMA) technique is investigated over Rayleigh fading channel conditions. EH NOMA improves the power efficiency, and it results in better throughput as compared to conventional NOMA techniques. In this paper, we investigate the achievable data rate and the outage probability performance of the near user, also called the relay user (RU), and the far user (FU). It can clearly be shown that the RU data rate is saturated and at 1 bits/s/Hz will become constant, while the FU data rate increases with an increase in transmitted power. It is seen by analysis that the RU data rate would saturate due to EH. It is further shown that with a transmitted power of 18 dBm, the net output of the FUs is readily shown to be based around a value of 2.80 bits/s/Hz. In comparison, it is shown that the FU’s instantaneous information rate dropped below the target data rate.
A Case of Metastatic Prostate Cancer to the Distal Phalanx
Authors: Lander Richard D. , O’Donnell Marc J.
Published: July 2021

Metastatic bone tumors to the hand are extremely rare. We present a case of metastatic prostate cancer to the right middle finger distal phalanx. To our knowledge, there is one other case of metastatic prostate cancer to the hand in the literature. In our case, a 59-year-old man with a history of widely metastatic prostate cancer presented to urgent care and was diagnosed with a nail plate avulsion injury. He was referred to hand surgery and treated with amputation of the right middle finger distal phalanx. The pathology reported high-grade poorly differentiated adenocarcinoma with primary lesion from the prostate.
Real-world effectiveness of vedolizumab in inflammatory bowel disease: week 52 results from the Swedish prospective multicentre SVEAH study
Authors: Eriksson Carl , Rundquist Sara , Lykiardopoulos Vyron , Udumyan Ruzan , Karlén Per , Grip Olof , Söderman Charlotte , Almer Sven , Hertervig Erik , Marsal Jan , Gunnarsson Jenny , Malmgren Carolina , Delin Jenny , Strid Hans , Sjöberg Mats , Öberg David , Bergemalm Daniel , Hjortswang Henrik , Halfvarson Jonas ,   The SWIBREG SVEAH Study Group
Published: July 2021

Background:

Prospectively and systematically collected real-world data on vedolizumab are scarce. We aimed to assess the long-term clinical effectiveness of vedolizumab in inflammatory bowel disease (IBD).

Methods:

This study was a prospective, observational, multicentre study. Overall, 286 patients with active IBD were included (Crohn’s disease, n = 169; ulcerative colitis, n = 117). The primary outcomes were clinical response at week 12 and clinical remission at week 52, based on the Harvey Bradshaw Index and the partial Mayo Clinic score. Secondary outcomes included clinical remission at week 12, clinical response at week 52, corticosteroid-free clinical remission at week 52, changes in biochemical measures, and health-related quality of life (HRQoL).

Results:

At baseline, 88% of the patients were exposed to anti-TNF and 41% of the patients with Crohn’s disease had undergone ⩾1 surgical resection. At week 12, clinical response was 27% and remission 47% in Crohn’s disease; corresponding figures in ulcerative colitis were 52% and 34%. Clinical response, remission and corticosteroid-free remission at week 52 were 22%, 41% and 40% in Crohn’s disease and 49%, 47% and 46% in ulcerative colitis, respectively. A statistically significant decrease in median faecal-calprotectin and C-reactive protein was observed at 12 and 52 weeks in patients with Crohn’s disease and ulcerative colitis. The HRQoL measures Short Health Scale and EuroQol 5-Dimensions improved in both Crohn’s disease and ulcerative colitis patients ( p < 0.001). Clinical disease activity at baseline was inversely associated with clinical remission at week 52.

Conclusion:

Vedolizumab proved effective for the treatment of refractory IBD in clinical practice.
Quantitative Nanomechanical Mapping of Polyolefin Elastomer at Nanoscale with Atomic Force Microscopy
Authors: Zhang Shuting , Weng Yihui , Ma Chunhua
Published: July 2021

Elastomeric nanostructures are normally expected to fulfill an explicit mechanical role and therefore their mechanical properties are pivotal to affect material performance. Their versatile applications demand a thorough understanding of the mechanical properties. In particular, the time dependent mechanical response of low-density polyolefin (LDPE) has not been fully elucidated. Here, utilizing state-of-the-art PeakForce quantitative nanomechanical mapping jointly with force volume and fast force volume, the elastic moduli of LDPE samples were assessed in a time-dependent fashion. Specifically, the acquisition frequency was discretely changed four orders of magnitude from 0.1 up to 2 k Hz. Force data were fitted with a linearized DMT contact mechanics model considering surface adhesion force. Increased Young’s modulus was discovered with increasing acquisition frequency. It was measured 11.7 ± 5.2 MPa at 0.1 Hz and increased to 89.6 ± 17.3 MPa at 2 kHz. Moreover, creep compliance experiment showed that instantaneous elastic modulus E1, delayed elastic modulus E2, viscosity η, retardation time τ were 22.3 ± 3.5 MPa, 43.3 ± 4.8 MPa, 38.7 ± 5.6 MPa s and 0.89 ± 0.22 s, respectively. The multiparametric, multifunctional local probing of mechanical measurement along with exceptional high spatial resolution imaging open new opportunities for quantitative nanomechanical mapping of soft polymers, and can potentially be extended to biological systems.
Factors related to the success rate of pediatric extracorporeal shock wave lithotripsy (ESWL) in Cipto Mangunkusumo Hospital: an 8-year single-center experience
Authors: Satjakoesoemah Adistra Imam , Alfarissi Fekhaza , Wahyudi Irfan , Rodjani Arry , Rasyid Nur
Published: July 2021

Background

ESWL is still considered as the first favorable therapeutic option for urinary stone disease with acceptable effectivity. However, factors associated with favorable outcome have not been widely studied in pediatrics due to the small number of urinary stone prevalence. The aim of this study is to evaluate the factors associated with the success rate of pediatric ESWL in our center according to immediate stone-free rate and 3-month stone-free rates.

Methods

This is a retrospective cohort study of children less than 18 years who had ESWL for urolithiasis from January 2008 until August 2015. Patient’s characteristics including age, gender, BMI, stone location, stone length, stone burden, stone opacity, and number of ESWL sessions were gathered from the medical record. Nutritional status was determined according to the Centers for Disease Control and Prevention BMI curve. The outcome of this study was the factors related to the success rate in pediatric ESWL.

Results

Extracorporeal shock wave lithotripsy was done for 36 patients and 39 renal units (RUs) with mean age of 13.7 ± 4.3 years old, height of 1480 ± 16.0 cm, and BMI of 20.0 ± 3. Of 36 patients included, 39 renoureteral units (RUs) and 46 ESWL sessions were recorded. The mean overall treatment was 1.2 ± 0.5 sessions with mean stone length of 11.1 ± 6.3 mm and stone burden of 116.6 ± 130.3 mm2. Within 3 months of follow-up, we recorded that the overall 3-month success rate was 100%, while the overall 3-month stone-free rate was 66.7%. Stone length (p < 0.001 and p < 0.001), stone perpendicular length (p < 0.001 and p < 0.001), and stone burden (p < 0.001 and p = 0.001) were found to be significantly associated with immediate success and 3-month stone-free status, respectively.

Conclusions

ESWL is an effective and safe modality to treat pediatric urolithiasis cases. Stone length, stone perpendicular length, and stone burden were found to be associated with immediate success and 3-month stone-free status after pediatric ESWL treatment.
Characterization of fungal microbial diversity in healthy and diarrheal Tibetan piglets
Authors: Kong Qinghui , Liu Suozhu , Li Aoyun , Wang Yaping , Zhang Lihong , Iqbal Mudassar , Jamil Tariq , Shang Zhenda , Suo Lang-sizhu , Li Jiakui
Published: July 2021

Background

Diarrhea is an important ailment limiting the production of the Tibetan pig industry. Dynamic balance of the intestinal microbiota is important for the physiology of the animal. The objective of this work was to study fungal diversity in the feces of early weaning Tibetan piglets in different health conditions.

Results

In the present study, we performed high-throughput sequencing to characterize the fungal microbial diversity in healthy, diarrheal and treated Tibetan piglets at the Tibet Autonomous Region of the People’s Republic of China. The four alpha diversity indices (Chao1, ACE, Shannon and Simpson) revealed no significant differences in the richness across the different groups (P > 0.05).

In all samples, the predominant fungal phyla were Ascomycota, Basidiomycota and Rozellomycota. Moreover, the healthy piglets showed a higher abundance of Ascomycota than the treated ones with a decreased level of Basidiomycota. One phylum (Rozellomycota) showed higher abundance in the diarrheal piglets than in the treated. At genus level, compared with that to the healthy group, the proportion of Derxomyces and Lecanicillium decreased, whereas that of Cortinarius and Kazachstania increased in the diarrheal group. The relative abundances of Derxomyces, Phyllozyma and Hydnum were higher in treated piglets than in the diarrheal ones.

Conclusions

A decreased relative abundance of beneficial fungi (e.g. Derxomyces and Lecanicillium) may cause diarrhea in the early-weaned Tibetan piglets. Addition of probiotics into the feed may prevent diarrhea at this stage. This study presented the fungal diversity in healthy, diarrheal and treated early-weaned Tibetan piglets.