bluuebunny/crossref_metadata_2025 huggingface dataset:
On the Security of Smartphone Unlock PINs
Authors: Markert Philipp , Bailey Daniel V. , Golla Maximilian , Dürmuth Markus , Aviv Adam J.
Published: September 2021

In this article, we provide the first comprehensive study of user-chosen four- and six-digit PINs (
n
=1705) collected on smartphones with participants being explicitly primed for device unlocking. We find that against a throttled attacker (with 10, 30, or 100 guesses, matching the smartphone unlock setting), using six-digit PINs instead of four-digit PINs provides little to no increase in security and surprisingly may even decrease security. We also study the effects of blocklists, where a set of “easy to guess” PINs is disallowed during selection. Two such blocklists are in use today by iOS, for four digits (274 PINs) as well as six digits (2,910 PINs). We extracted both blocklists and compared them with six other blocklists, three for each PIN length. In each case, we had a small (four-digit: 27 PINs; six-digit: 29 PINs), a large (four-digit: 2,740 PINs; six-digit: 291,000 PINs), and a placebo blocklist that always excluded the first-choice PIN. For four-digit PINs, we find that the relatively small blocklist in use today by iOS offers little to no benefit against a throttled guessing attack. Security gains are only observed when the blocklist is much larger. In the six-digit case, we were able to reach a similar security level with a smaller blocklist. As the user frustration increases with the blocklists size, developers should employ a blocklist that is as small as possible while ensuring the desired security. Based on our analysis, we recommend that for four-digit PINs a blocklist should contain the 1,000 most popular PINs to provide the best balance between usability and security and for six-digit PINs the 2,000 most popular PINs should be blocked.
Gaussian Elimination versus Greedy Methods for the Synthesis of Linear Reversible Circuits
Authors: De Brugière Timothée Goubault , Baboulin Marc , Valiron Benoît , Martiel Simon , Allouche Cyril
Published: September 2021

Linear reversible circuits represent a subclass of reversible circuits with many applications in quantum computing. These circuits can be efficiently simulated by classical computers and their size is polynomially bounded by the number of qubits, making them a good candidate to deploy efficient methods to reduce computational costs. We propose a new algorithm for synthesizing any linear reversible operator by using an optimized version of the Gaussian elimination algorithm coupled with a tuned LU factorization. We also improve the scalability of purely greedy methods. Overall, on random operators, our algorithms improve the state-of-the-art methods for specific ranges of problem sizes: The custom Gaussian elimination algorithm provides the best results for large problem sizes (n > 150), while the purely greedy methods provide quasi optimal results when n < 30. On a benchmark of reversible functions, we manage to significantly reduce the CNOT count and the depth of the circuit while keeping other metrics of importance (T-count, T-depth) as low as possible.
Educational Psychology Is Evolving to Accommodate Technology, Multiple Disciplines, and Twenty-First-Century Skills
Authors: Graesser Arthur C. , Sabatini John P. , Li Haiying
Published: September 2021

This article covers recent research activities in educational psychology that have an interdisciplinary emphasis and that accommodate twenty-first-century skills in addition to the traditional foundations of literacy, numeracy, science, reasoning (problem-solving), and academic subject matter. We emphasize digital technologies because they are capable of tracking learning data in rich detail and reliably delivering interventions that are tailored to individual learners in particular sociocultural contexts. This is a departure from inflexible pedagogical approaches that previously have been routinely adopted in most classrooms and other contexts of instruction with no precise record of learning and instructional activities. A good design of educational technology embraces the principles of learning science, identifies the basic types of learning that are needed, implements relevant technological affordances, and accommodates feedback from different stakeholders. This article covers research in literacy, collaborative problem-solving, motivation, emotion, and science, technology, engineering, and mathematics (STEM) areas.
Memory and Reward-Based Learning: A Value-Directed Remembering Perspective
Authors: Knowlton Barbara J. , Castel Alan D.
Published: September 2021

The ability to prioritize valuable information is critical for the efficient use of memory in daily life. When information is important, we engage more effective encoding mechanisms that can better support retrieval. Here, we describe a dual-mechanism framework of value-directed remembering in which both strategic and automatic processes lead to differential encoding of valuable information. Strategic processes rely on metacognitive awareness of effective deep encoding strategies that allow younger and healthy older adults to selectively remember important information. In contrast, some high-value information may also be encoded automatically in the absence of intention to remember, but this may be more impaired in older age. These different mechanisms are subserved by different neural substrates, with left-hemisphere semantic processing regions active during the strategic encoding of high-value items, and automatic enhancement of encoding of high-value items may be supported by activation of midbrain dopaminergic projections to the hippocampal region.
Institutionally Adopted Perioperative Blood Management Program Significantly Decreased the Transfusion Rate of Patients Having Primary Total Hip Replacement Surgery
Authors: Dömötör Hargita , Varga Ádám L. , Sződy Róbert , Tóth Ferenc , Nardai Gábor
Published: September 2021

Perioperative transfusion in patients undergoing orthopedic surgery increases the number of postoperative complications. Thus, we have introduced an institution-tailored perioperative blood management program (PBM) to decrease the amount of blood transfused in patients going through primary total hip replacement (THR) surgery. We have conducted a before-after observational cohort study in two predetermined observational periods. Demographic and clinical data, ASA scores, laboratory parameters, features of surgical procedure, and anesthesia were registered. Parameters of perioperative fluid administration, transfusion rate, and postoperative complications were also assessed. One hundred patients in the first and 108 patients in the second observational period were enrolled. Eventhough the ratio of posttraumatic THR procedures increased (9% vs. 17%), the PBM protocol has been utilized effectively and a significant decrease in perioperative blood transfusion rate has been observed (61% vs. 21%). The abolishment of routine preoperative LMWH prophylaxis (90% vs. 16%), intraoperative use of tranexamic acid (10% vs. 84%), and the encouraged exploitation of our postoperative observational facility (5% vs. 39%) were abided by our colleagues. Patients still requiring transfusion had lower preoperative hemoglobin levels (129 vs. 147 g/l), scored higher in ASA (ASA III: 46% vs. 19%), and more often presented postoperative hypotension (40% vs. 7%), oliguria (23% vs. 5%), and infections (9% vs. 2%). We conclude that the individualized perioperative blood management protocol was successfully implemented and yielded a lower transfusion rate and better outcomes. Our study suggests that a partial, institution-tailored PBM program may be suitable and beneficial in countries where the modalities of perioperative blood management are limited.
The Influence of Author Degree Centrality and L‐Index on Scientific Performance of Physical Education and Training Papers in China Based on the Perspective of Social Network Analysis
Authors: Zhang Bin , Wu Jian , Huang Qian , Tan Yujiao , Zhang Lu , Zheng Qian , Zhang Yu , He Miao , Wang Wei
Published: September 2021

With the increasing frequency of scientific cooperation, research on the impact of scientific cooperation on scholars’ scientific performance has become a hot topic in academic research. This paper mainly uses quantitative research methods such as bibliometrics and social network analysis to analyze the correlation between degree centrality, L‐index, and scientific performance of the Chinese author of Physical Education and Training Science and draws the following conclusions: (1) degree centrality is positively correlated with the number of papers, average citations per paper, and H‐index and (2) L‐index is positively correlated with the number of papers, average citations per paper, and H‐index. Unlike previous studies on scientific collaboration networks and scholars’ performance that focused on traditional network characteristics indicators, this study introduces a new network characteristics indicator, L‐index, through which the degree of collaboration between authors and other important authors in the research field can be better assessed, which also provides a new direction for research related to research collaboration networks and scholars’ performance; at the same time, it also provides a theoretical basis for subsequent research on the utility of scientific collaboration, a reference for the assessment of the research performance of scholars in other disciplines, and a theoretical reference for more scientific and comprehensive prediction of scholars’ research performance in the future.
Determination of Concentration of Heavy Metals in Fruits, Vegetables, Groundwater, and Soil Samples of the Cement Industry and Nearby Communities and Assessment of Associated Health Risks
Authors: Yaqub Ghazala , Khan Arooj , Zishan Ahmad Muhammad , Irshad Umadia
Published: September 2021

This study was conducted to estimate the heavy metal pollution in groundwater, soil, fruits, and vegetables within the cement industry and its vicinity. Seven different fruits and vegetables and seven heavy metals (Cd, Zn, Ni, Co, Cu, Cr, and Mn) were selected for analysis in soil, groundwater, fruit, and vegetable samples by atomic absorption spectrometry (AAS). Results of this study were compared with the National and International Standards of Pak NSWQD, WHO, and USEPA. The pH of soil and groundwater samples was within limits (WHO and Pak NSDWQ standards are 6.5–8.5). The concentration of Cr and Cu in groundwater samples was above the WHO and Pak NSDWQ standards (Cr = 0.05 ppm; Cu = 2 ppm). Vegetable samples were contaminated with metals except for Ni and Mn, whereas, in fruit samples, Mn and Cd were not present (WHO limit for Mn = 5 ppm). The mean concentration of Ni was high in fruits (WHO limit = 10 ppm), Zn was high in vegetables (WHO limit = 100 ppm), and Cu was high in soil and groundwater (WHO limit for soil = 36 ppm; for groundwater = 2 ppm). The results of daily intake of metals (DIM) for fruits, vegetables, and groundwater were compared with TDI by USEPA and PTDI of the WHO/FAO, and all were within the recommended limits. Calculated BAF for the selected environmental sample, that is, Indian Squash, lime fruit, and so on, was in order of Co > Cr > Cu and THQ; HRI was calculated to estimate the human health risk, and they were in a trend of Ni > Co > Cd > Cr and for HRI Co > Cr.
Social‐Aware Caching Strategy Based on Joint Action Deep Reinforcement Learning
Authors: Yang Jing , Song Zhuowei , He Peng , Cui Yaping , Wu Dapeng , Wang Ruyan
Published: September 2021

Caching in device‐to‐device (D2D) networks is emerging a promising trend, which enables to reduce backhaul traffic. Moreover, social interaction among users influences the performance of overall system network. Therefore, it is crucial to consider social attributes in the D2D networks to develop a caching strategy to resolve the problem of unbalanced content distributed. In this paper, we consider two types of users according to their activeness, i.e., active users and inactive users. Inactive users assist active users cache contents during off‐peak periods and provide the contents to the active users during peak periods to relieve the pressure of base station (BS). In addition, caching system model is divided into physical domain model and social domain model. In physical domain, the quality of communication links is judged by the delay between D2D users. In social domain, based on a real‐world dataset, CiaoDVD, we calculate user similarity in three dimensions and obtain user trust by a trust topology to measure user relationships. Finally, in order to maximize the cache hit ratio, a joint action deep Q‐networks (JADQN) framework is proposed to pair the active users with inactive users and distribute the contents to inactive users. Simulation results indicate that the proposed strategy improves the cache hit ratio by 42.9% and reduces the download delay by 48.8% compared with least frequency used (LFU) algorithm, which validates the effectiveness of our method.
A Secure and Privacy-Preserving Three-Factor Anonymous Authentication Scheme for Wireless Sensor Networks in Internet of Things
Authors: Xie Qi , Ding Zixuan , Hu Bin
Published: September 2021

The Internet of things is playing more and more important role in smart healthcare, smart grids, and smart transportation, and using wireless sensor network (WSN), we can easily obtain and transmit information. However, the data security and users’ privacy are the biggest challenges for WSN because sensor nodes have low computing power and low storage capacity and are easy to be captured, and wireless networks are vulnerable. In 2021, Shuai et al. proposed a lightweight three-factor anonymous authentication scheme for WSN. However, we found that their protocol is vulnerable to stolen-verifier attack, modification of messages’ attack, and no perfect forward secrecy. Then, a new three-factor anonymous authentication scheme using elliptic curve cryptography (ECC) is proposed. Through informal and formal security analyses, our scheme can resist various known attacks and maintains low computational complexity.
Can Orthodontic Treatment Be Stable 20 Years after the End of the Treatment Scheme? Treatment of a Class 2, Division 1 Malocclusion with Severe Skeletal Discrepancy and Its 20-Year Follow-Up
Authors: Aiello Domenico , Nucera Riccardo , Costa Stefania , Figliuzzi Michele Mario , Paduano Sergio
Published: September 2021

Class II malocclusions, after class I malocclusions, are the most frequent in the juvenile Italian population. They are most often skeletal in origin and due to mandibular retrusion. Functional devices seem to have a beneficial effect on the growth of the jaw. Long-term maintenance of the achieved results is essential for therapeutic success in any orthodontic treatment; moreover, the retention phase should last as long as possible, especially in the lower anterior sector. A female patient aged 10 years and 3 months presented a visibly convex profile and a severe mandibular retrusion. The anamnesis brought to light the habit of oral breathing and lower-lip sucking. The cephalometric analysis showed a normodivergent skeletal class II. The first treatment phase involved the use of a Bass type for 12 months at the end of the functional treatment; the second phase of fixed therapy was carried out following the principles of bioprogressive techniques. The photos at the end of treatment show an important improvement in the profile; a full class I ratio of molar and canine teeth was achieved with an excellent interarch relationship and a correction of the V-shaped upper arch. The result is occlusally and profilometrically stable after 2, 4, 5, 10, 14, and 20 years. The maintenance of a stable orthodontic result over time is the result not only of a correct and physiological occlusion but also and above all of a correct diagnosis and correct identification of problems that can cause the malocclusion itself. Flawed habits such as interposition of the lower lip and oral breathing must be intercepted and corrected early in order to correct them and not affect the long-term result of orthodontic treatment. In this case, a functional device associated with an orthodontic fixed finishing and a correct retention phase were necessary to correctly treat a second-class mandibular retrusion whose result remained stable 20 years after the end of therapy.
The Role of miRNAs 340‐5p, 92a‐3p, and 381‐3p in Patients with Endometriosis: A Plasma and Mesenchymal Stem‐Like Cell Study
Authors: Bahramy Afshin , Zafari Narges , Izadi Pantea , Soleymani Fatemeh , Kavousi Saeideh , Noruzinia Mehrdad
Published: September 2021

Background. Endometriosis is the most prevalent gynecological disease with elusive etiology. The mysterious entity and the lack of noninvasive diagnostic methods affect women’s lives negatively. This study is aimed at finding the relationship between miR‐340‐5p, 92a‐3p, and miR‐381‐3p and the pathogenesis of endometriosis in endometrial mesenchymal stem‐like cells (eMSCs) of endometriosis and assessing their potential as a noninvasive biomarker in plasma. Methods. Peripheral blood and eMSC specimens were collected from suspected women of endometriosis before laparoscopy. Total RNA was isolated from plasma and cultured eMSCs to synthesize complementary DNA. The expression of miR‐340‐5p, miR‐92a‐3p, and miR‐381‐3p was analyzed by RT‐qPCR. To understand these miRNAs’ role, we also did a bioinformatic analysis. Results. There was a downregulation of miR‐340‐5p, miR‐92a‐3p, and miR‐381‐3p in plasma, and the upregulation of miR‐340‐5p and the downregulation of miR‐92a‐3p and miR‐381‐3p in eMSCs of women with endometriosis. There was a positive concordance between the expression of miR‐92a‐3p and miR‐381‐3p in plasma and eMSCs. Our study also showed three genes, Solute Carrier Family 6 Member 8 (SLC6A8), Zinc Finger Protein 264 (ZNF264), and mouse double minute 2 (MDM2), as common targets of these miRNAs. Conclusions. This study has been one of the first attempts to examine the expression of miR‐340‐5p, miR‐92a‐3p, and miR‐381‐3p in both plasma and eMSCs and revealed their possible role in endometriosis based on in silico analysis. Biomarkers pave the way to develop a new therapeutic approach to the management or treatment of endometriosis patients. Our result as a first report shows that combined levels of miRNAs 340‐5p and 381‐3p may have the potential to be utilized as diagnostic biomarkers for endometriosis.
Software Implementation and Design of Information Encryption Algorithm Based on DNA Nano Self‐Assembled Sensor Array
Authors: Li Caixia
Published: September 2021

In the field of information security, DNA cryptography based on DNA molecular configuration and special recognition mechanism between molecules has developed rapidly. DNA molecules have great development potential in the field of information security technology such as information encryption, hiding and authentication, which provides a new way for the development of modern cryptography. The nodes of traditional sensor networks are mostly distributed in the form of a net with strong openness. In the process of node data transmission, the information is likely to be stolen, tampered with, and destroyed at any time. In this paper, an information encryption method based on DNA nano self‐assembled sensor technology is proposed, and the encryption software based on DNA nano self‐assembled sensor array is designed. The information encryption algorithm is designed, tested, simulated and analysed, and compared with other designs. The simulation results show that the encryption algorithm system based on DNA nano self‐assembled sensor array has good function and excellent performance, can fully meet the requirements of network real‐time encryption, has good feasibility and security, and reveals the great application potential of DNA molecules in the field of information security.
Improved Secure and Lightweight Authentication Scheme for Next-Generation IoT Infrastructure
Authors: Chen Chien-Ming , Liu Shuangshuang
Published: September 2021

The Internet of Things (IoT) is a huge network formed by connecting various information sensing devices through the Internet. Although IoT has been popularized in many fields, connected devices can be used only when network security is guaranteed. Recently, Rana et al. proposed a secure and lightweight authentication protocol for the next-generation IoT infrastructure. They claim that their protocol can resist major security attacks. However, in this study, we prove that their protocol is still vulnerable to offline password guessing attacks and privilege internal attacks. In order to solve these shortcomings, we propose an improved protocol, which is proved to be secure by formal and informal analysis. In addition, after comparing the time and memory consumption with other protocols, we find that our protocol has more advantages.
Sustainable Reuse of Dredged Soil as a Substrate Material by Improvement with Polyacrylamide, Straw, and Superabsorbent Polymer
Authors: Mei Ling , Chen Yuxiang , Wang Lei
Published: September 2021

Every year, a significant quantity of dredged soil is generated as a result of channel dredging operations. However, there is relatively little evidence available regarding the sustainable reuse of dredged soils. In this study, an improved substrate material mainly composed of dredged soil was developed to examine the effects of three substrate amendments on the soil’s nutritional content, physical properties, and water retention capacity, as well as the germination rate of tall fescue. The orthogonal combination of the three substrates was controlled in a pot experiment using polyacrylamide (PAM), rice straw, and superabsorbent polymer (SAP) at application rates of 0.5, 1, 1.5, 2, and 2.5 g/kg; 15, 20, 25, 30, and 35 g/kg; and 0, 3, 6, 9, and 12 g/kg, respectively. The results showed that adequate application of PAM may improve the water retention capacity and available N retention capacity of dredged soil. PAM inhibited tall fescue germination significantly when the concentration exceeded 0.5 g/kg (p < 0.05). The addition of rice straw significantly improved the nutritional content of dredging soil and the germination rate of tall fescue (p < 0.05). Increased SAP significantly decreased the bulk density of dredged soil (p < 0.05). The lowest test group was 48.20% less than CK. This study offers novel ideas for the sustainable reuse of dredged soil and serves as a guide for future research aimed at increasing the effectiveness of external‐soil spray seeding technologies.
The Current State of Parkinsonism in West Africa: A Systematic Review
Authors: Quarshie Jude T. , Mensah Esther N. , Quaye Osbourne , Aikins Anastasia R.
Published: September 2021

Parkinsonism is one of the most common neurodegenerative diseases among the elderly. Africa is experiencing an increasing burden of age-related conditions including parkinsonism. However, there is not enough data on the prevalence, symptoms, and management of the disorder in West African patients. This systematic review examines the current state of parkinsonism in West Africa by discussing its epidemiology, symptomatology, and treatment. We searched PubMed, BioMed Central, and AJOL databases from January 2000 to December 2020 for studies on parkinsonism conducted in West African countries. We included 32 studies in this review: 23 from Nigeria, 5 from Ghana, and 1 each from Benin, Mali, Niger, and Senegal. Out of the 32 reviewed studies, 11 focused on the prevalence of parkinsonism, 4 examined the genetics of Parkinson’s disease (PD), and 17 described the symptomatology and therapy of parkinsonism. The prevalence of parkinsonism in West Africa ranges from 6.0% to 8.3% of neurologic admissions/consultations. The estimated crude prevalence of PD in West Africa varies from 15 to 572 per 100,000 people. Thus far, no pathogenic genetic variants have been associated with PD in the region. Levodopa is frequently used singly or in combination with other medications to manage parkinsonian symptoms, which is consistent with reports from other African regions. Most of the reviewed studies focused only on PD, limiting assessment of other forms of parkinsonism. Almost all the prevalence studies were hospital-based and monocentric, making it impossible to accurately estimate the true prevalence of parkinsonism in West Africa. Larger community-based prevalence studies are recommended to enable accurate quantification of disease burden. Future genetic investigations should consider a wider array of gene mutations associated with parkinsonism. Moreover, public health surveillance strategies should be established to monitor the epidemiology of the disorder.
New-Onset Systemic Capillary Leak Syndrome in an Adult Patient with COVID-19
Authors: Knox Daniel B. , Lee Vivian , Leither Lindsay , Brown Samuel M.
Published: September 2021

Systemic capillary leak syndrome (SCLS) is a rare disorder manifesting as shock, hemoconcentration, and hypoalbuminemia, which may be either idiopathic or secondary to an underlying disease process. We report a case of an adult with COVID-19 infection associated with new onset SCLS. Our case joins only two other cases of new SCLS associated with COVID-19 infection reported in the literature. The clinical and laboratory findings in this case are distinct from findings seen in COVID-19 cytokine storm syndrome. Whether our therapeutic approach was efficacious is unknown. Further research into causes and therapies for these syndromes is urgently indicated.
New Weighted Lomax (NWL) Distribution with Applications to Real and Simulated Data
Authors: Alshanbari Huda M. , Ijaz Muhammad , Asim Syed Muhammad , Hosni El-Bagoury Abd Al-Aziz , Dar Javid Gani
Published: September 2021

The rationale of the paper is to present a new probability distribution that can model both the monotonic and nonmonotonic hazard rate shapes and to increase their flexibility among other probability distributions available in the literature. The proposed probability distribution is called the New Weighted Lomax (NWL) distribution. Various statistical properties have been studied including with the estimation of the unknown parameters. To achieve the basic objectives, applications of NWL are presented by means of two real-life data sets as well as a simulated data. It is verified that NWL performs well in both monotonic and nonmonotonic hazard rate function than the Lomax (L), Power Lomax (PL), Exponential Lomax (EL), and Weibull Lomax (WL) distribution.
Stress‐Strength Parameter Estimation under Small Sample Size: A Testing Hypothesis Approach
Authors: Alsuhabi Hassan , Saber Mohammad Mehdi , El-Raouf M. M. Abd
Published: September 2021

In this paper, uniformly most powerful unbiased test for testing the stress‐strength model has been presented for the first time. The end of the paper is recommending a method which is appropriate for no large data where a normal asymptotic distribution is not applicable. The previous methods for inference on stress‐strength models use almost all the asymptotic properties of maximum likelihood estimators. The distribution of components is considered exponential and generalized logistic. A corresponding unbiased confidence interval is constructed, too. We compare presented methodology with previous methods and show the method of this paper is logically better than other methods. Interesting result is that our recommended method not only uses from small sample size but also has better result than other ones.
Electrochemical Anodic Synthesis and Analysis of TiO2 Nanotubes for Biomedical Applications
Authors: Sivaprakash V. , Natrayan L. , Suryanarayanan R. , Narayanan R. , Paramasivam Prabhu
Published: September 2021

Nowadays, titanium and alloy materials are encouraged for biomedical applications. Fabrication of the passive layer over the titanium materials is limited. Typically, a plain titanium sample is not suitable for bioimplant applications because the adhesion of biological elements like blood cells, tissues, and bones is poor. The use of surface-modified titanium resolves this issue. Surface modifications on titanium by electrochemical methods are simple and cost-effective. The addition of water to the ethylene-based electrolyte-enhanced the oxidation process to increase the length of the nanotubes. Surface morphological analysis shows that the length of the nanotubes has been increased, nanoindentation analysis delivers that increasing the length has been increased the hardness level, and corrosion analysis indicates that the length of nanotubes encouraged the corrosion resistance. Potentiodynamic polarization, Bode and Nyquist plots were models fit analyzed with equivalent electrical circuits. Sample cell viability was characterized with NIH-3T3 cells using an inverted microscopy analyzer.
Clinical Treatment Experience in Severe and Critical COVID-19
Authors: Li Mingliang , Zhu Donglin , Yang Jianghua , Yan Ling , Xiong Zhiyong , Lu Jiahai , Bi Xiaogang , Xi Yun , Chen Zeliang
Published: September 2021

Compared with other deadly diseases, the coronavirus disease 2019 (COVID-19) is highly infectious with a relatively low mortality rate. Although critical cases account for only 5% of cases, the mortality rate for the same is nearly 50%. Therefore, the key to the COVID-19 treatment is to effectively treat severe patients and reduce the transition from severe to critical cases. A retrospective study was carried out to evaluate outcomes of treatment in patients with severe and critical COVID-19 admitted to a COVID-19 special hospital in Wuhan, China. A total of 75 severe and critical COVID-19 patients were admitted and treated with immunomodulation as the main strategy combined with anti-inflammatory therapy and appropriate anticoagulation. Leukocyte levels in patients with 7-14 days of onset to diagnosis were significantly lower than in those with >14 days. Higher levels of globulin and D-dimer and lower lymphocyte levels were found in the older age group (>65 years) than in the middle-aged group (50-64 years). Patients with comorbidity had higher levels of inflammatory indicators. After treatment, 65 (86.67%) patients were cured, 7 (9.33%) had improved, and 3 (4.00%) had died. Median hospitalization duration was 23 days. Fatal cases showed continuously increased levels of globulin, dehydrogenase (LDH), hypersensitive C-reactive protein (hs-CRP), D-dimer, and cytokines during treatment. Time from onset to diagnosis, age, and comorbidity are important influencing factors on treatment effects. The occurrence of immunosuppression, “cytokine storm,” and thrombosis may be an important cause of death in severely infected cases. In conclusion, high cure rate and low mortality suggested that immunomodulation combined with anti-inflammatory therapy and appropriate anticoagulant therapy is a good strategy for treatment of patients with severe and critical COVID-19.
Uso de Elementos de Protección Personal en Unidad de Emergencia HBLT en contexto Pandemia COVID-19
Authors: Moris Vidal Hilda Francisca , Reyne Nicolas , Vázquez Joaquín , Secchi Alfio , Moreno Jorge , Astorga Felipe , Amorín Pablo
Published: September 2021

Los elementos de protección personal (EPP) son el conjunto de equipamiento, componente de las precauciones estándares, destinados a proteger la piel y mucosas del operador evitando el contacto con agentes infecciosos. Los funcionarios de salud que tratan con pacientes COVID-19 se encuentran más expuestos a infectarse en comparación con el resto de los funcionarios de salud, razón por la cual deben utilizar de manera adecuada estos elementos de protección, para protegerse de una posible infección por COVID-19. El objetivo del estudio es determinar disponibilidad, manejo y uso EPP utilizados por los funcionarios del Servicio de Urgencia del Complejo Asistencial Barros Luco Trudeau. Este es un estudio transversal descriptivo realizado por medio de encuesta a los funcionarios de la Unidad de Emergencia HBLT a través de Google Forms®. Del total de funcionarios de la Unidad de Emergencia del Hospital Barros Luco Trudeau, un total de 123 funcionarios realizaron la encuesta cumpliendo con los criterios de inclusión, de los cuales 78 fueron mujeres y 45 hombres, con edades dentro del rango desde los 20 años a mayores de 61 años. Se observó que 39,0% de los funcionarios fue notificado como COVID-19 positivo. Un 60,2% de los funcionarios tuvo una secuencia predeterminada para instalación de los EPP y un 68,3% para el retiro de los EPP. Los más utilizados fueron mascarillas quirúrgicas (95,9%), mascarilla KN 95 (88,6%) y guantes (90,2%). Este estudio contribuye a destacar la importancia en la correcta utilización de los EPP por parte de los funcionarios de la salud, para limitar los contagios y mejorar el cuidado de los equipos de salud durante la pandemia de COVID-19. Además, se describir un patrón de sintomatología más frecuente en los profesionales sanitarios del servicio de urgencia.
A Case of Combined Oxidative Phosphorylation Deficiency 35 Associated with a Novel Missense Variant of the TRIT1 Gene
Authors: Yıldırım Miraç , Bektaş Ömer , Tunçez Ebru , Yeniay Süt Nurşah , Sayar Yavuz , Öncül Ümmühan , Teber Serap
Published: September 2021

Combined oxidative phosphorylation deficiency 35 (COXPD35) is a rare autosomal recessive disorder associated with homozygous or compound heterozygous mutations in the tRNA isopentenyltransferase (TRIT1) gene in chromosome 1p34.2. To date, only 10 types of allelic variants in the TRIT1 gene have been previously reported in 9 patients with COXPD35. Herein, we describe a case with a novel homozygous missense variant in TRIT1. A 6-year, 6-month-old boy presented with global developmental delay, microcephaly, intractable seizures, and failure to thrive. The other main clinical manifestations were intellectual disability, spastic tetraparesis, truncal hypotonia, malnutrition, polyuria and polydipsia, ketotic hypoglycemia, dysmorphic facial features, strabismus, bicuspid aortic valve, and nephrolithiasis. The detailed biochemical, radiological, and metabolic evaluations were unremarkable. Chromosomal analysis confirmed a normal male 46,XY karyotype and the array comparative genomic hybridization analysis revealed no abnormalities. We identified a novel homozygous missense variant of c.246G>C (p.Met82Ile) in the TRIT1 gene, and the variant was confirmed by Sanger sequencing. The present case is the first report describing strabismus, ketotic hypoglycemia, nephrolithiasis, and bicuspid aortic valve in TRIT1-related COXPD35. This study expands the genotype-phenotype spectrum of TRIT1-related COXPD35.
Duodenal and Biliary Obstruction due to Extrinsic Compression by Recurrent Lobular Breast Carcinoma: A Case Report
Authors: Bashir Hamidu Rukaiya , Asif Bilal , Lavu Harish , Kowalski Thomas , Silver Daniel P.
Published: September 2021

Metastases to the gastrointestinal tract (GIT) from breast carcinoma are rare, detected in approximately <5% of all breast cancer patients. Invasive lobular carcinoma (ILC) is the most common histological type of breast cancer to metastasize to the GIT. We report a case of abdominal recurrence of ILC of the breast causing intra-abdominal contracture leading to extrinsic compression of the duodenum and periampullary biliary tree. Four years after the patient’s diagnosis of a left breast pT1c, pN2, cM0 invasive lobular breast cancer, she presented with liver function tests consistent with biliary obstruction, and there was concern for a periampullary malignancy. Definitive diagnosis was achieved at laparotomy. This case demonstrates the importance of considering metastatic breast cancer as a potential cause of GI symptoms and radiological abnormalities affecting any part of the GIT of women with a previous history of lobular breast cancer. This case also highlights the effectiveness of chemotherapy in improving the survival and quality of life of these patients. Early recognition of this scenario enables prompt initiation of systemic therapy and avoids unnecessary surgical treatment. Despite the rarity, such patients will be encountered in clinical practice given the high prevalence of breast cancer. Moreover, the fact that the presenting symptoms of GI metastasis from breast cancer are usually not specific to the origin and mimic a primary intestinal disorder, health-care professionals beyond oncologists, especially gastroenterologists and primary care physicians, should be aware of this entity.
“Low Cost” Negative Pressure Wound Therapy for Acute and Chronic Wounds: A Case Series
Authors: Sifi Nazim , Bouguenna Ryad , Kaci Lamia
Published: September 2021

Negative pressure wound therapy (NPWT) is an alternative to standard treatment of acute wounds (such as traumatic or postoperative wounds) but also in that of chronic wounds (such as ulcers or stage 3 and 4 pressure ulcers). With cellular, extracellular effects and bacterial clearance, it leads to the rapid formation of healthy budding granulation tissue, which provides wound bed for directed healing or secondary coverage by skin graft or flap. However, the exorbitant cost of VAC (vacuum-assisted closure) devices for our limited resources health facilities and their unavailability led us to opt for a “low cost” solution using wall suction and disposable materials readily available in all surgical departments. We present the technique used in our department and its results through a series of 3 cases with both acute and chronic lesions evolving in septic environment and where NPWT enabled us to ensure a genuine care protocol until healing while reducing the cost of therapy, the number of dressings and the length of hospital stay.
Topographic Evolution of Anterior Cerebral Artery Infarction and Its Impact on Motor Impairment
Authors: Thirugnanachandran Tharani , Ma Henry , Vuong Jason , Mitchell Melissa , Wong Chloe , Singhal Shaloo , Slater Lee-Anne , Beare Richard , Srikanth Velandai , Phan Thanh G.
Published: September 2021

Introduction: Motor deficit is common following anterior cerebral artery (ACA) stroke. This study aimed to determine the impact on the motor outcome, given the location of descending corticofugal fiber tracts (from the primary motor cortex [M1], dorsal and ventral premotor area [PMdv], and supplementary motor area [SMA]) and the regional variations in collateral support of the ACA territory. Methods: Patients with ACA vessel occlusion were included. Disruption to corticofugal fibers was inferred by overlap of tracts with a lesion on computed tomography perfusion at the onset and on magnetic resonance imaging (MRI) poststroke. The motor outcome was defined by dichotomized and combined National Institute of Health Stroke Scale (NIHSS) sub-scores for the arm and leg. Multivariate hierarchical partitioning was used to analyze the proportional contribution of the corticofugal fibers to the motor outcome. Results: Forty-seven patients with a median age of 77.5 (interquartile range 68.0–84.5) years were studied. At the stroke onset, 96% of patients showed evidence of motor deficit on the NIHSS, and the proportional contribution of the corticofugal fibers to motor deficit was M1-33%, SMA-33%, and PMdv-33%. By day 7, motor deficit was present in <50% of patients and contribution of M1 fiber tracts to the motor deficit was reduced (M1-10.2%, SMA-61.0%, PMdv-28.8%). We confirmed our findings using publicly available high-resolution templates created from Human Connectome Project data. This also showed a reduction in involvement of M1 fiber tracts on initial perfusion imaging (33%) compared to MRI at a median time of 7 days poststroke (11%). Conclusion: Improvements in the motor outcome seen in ACA stroke may be due to the relative sparing of M1 fiber tracts from infarction. This may occur as a consequence of the posterior location of M1 fiber tracts and the evolving topography of ACA stroke due to the compensatory capacity of leptomeningeal anastomoses.
Safety and Effectiveness of Mycophenolate Mofetil in Interstitial Lung Diseases: Insights from a Machine Learning Radiographic Model
Authors: Karampitsakos Theodoros , Kalogeropoulou Christina , Tzilas Vasilios , Papaioannou Ourania , Kazantzi Alexandra , Koukaki Evangelia , Katsaras Matthaios , Bouros Evangelos , Tsiri Panagiota , Tsirikos Georgios , Zarkadi Eirini , Ntoulias Nikolaos , Sotiropoulou Vasilina , Efthymiou Panagiotis , Chrysikos Serafeim , Malakounidou Elli , Sampsonas Fotios , Bouros Demosthenes , Tzouvelekis Argyrios
Published: September 2021

Introduction: Treatment of interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF) often includes systemic corticosteroids. Use of steroid-sparing agents is amenable to avoid potential side effects. Methods: Functional indices and high-resolution computed tomography (HRCT) patterns of patients with non-IPF ILDs receiving mycophenolate mofetil (MMF) with a minimum follow-up of 1 year were analyzed. Two independent radiologists and a machine learning software system (Imbio 1.4.2.) evaluated HRCT patterns. Results: Fifty-five (n = 55) patients were included in the analysis (male: 30 [55%], median age: 65.0 [95% CI: 59.7–70.0], mean forced vital capacity %predicted [FVC %pred.] ± standard deviation [SD]: 69.4 ± 18.3, mean diffusing capacity of lung for carbon monoxide %pred. ± SD: 40.8 ± 14.3, hypersensitivity pneumonitis: 26, connective tissue disease-ILDs [CTD-ILDs]: 22, other ILDs: 7). There was no significant difference in mean FVC %pred. post-6 months (1.59 ± 2.04) and 1 year (−0.39 ± 2.49) of treatment compared to baseline. Radiographic evaluation showed no significant difference between baseline and post-1 year %ground glass opacities (20.0 [95% CI: 14.4–30.0] vs. 20.0 [95% CI: 14.4–25.6]) and %reticulation (5.0 [95% CI: 2.0–15.6] vs. 7.5 [95% CI: 2.0–17.5]). A similar performance between expert radiologists and Imbio software analysis was observed in assessing ground glass opacities (intraclass correlation coefficient [ICC] = 0.73) and reticulation (ICC = 0.88). Fourteen patients (25.5%) reported at least one side effect and 8 patients (14.5%) switched to antifibrotics due to disease progression. Conclusion: Our data suggest that MMF is a safe and effective steroid-sparing agent leading to disease stabilization in a proportion of patients with non-IPF ILDs. Machine learning software systems may exhibit similar performance to specialist radiologists and represent fruitful diagnostic and prognostic tools.
Discurso, midiatização e circulação de sentidos em relações públicas
Authors: Pinheiro Lidiane Santos de Lima
Published: September 2021

A fim de contribuir com a comunicação organizacional via estudos dos discursos e da midiatização, o artigo sugere atualizar a compreensão das relações públicas. A partir de pesquisa bibliográfica, defende que modelos funcionalistas e lineares não dão conta da complexidade dos processos comunicacionais em sociedades midiatizadas ou em vias de midiatização e conclui que, se a circulação é, por excelência, a zona de disputa e negociação de sentidos, deve ganhar relevância em trabalhos sobre gestão de conflitos entre atores sociais.
Compreendendo o discurso organizacional: características, materialidades e materializações
Authors: Silva Magno Vieira da
Published: September 2021

Este trabalho busca refletir sobre a natureza do discurso organizacional. Reconhecendo que o discurso é constituidor e organizador da realidade, apresenta-se uma compreensão de discurso organizacional e a forma como ele é traduzido em/por meio de diversas materialidades e materializações. Para ilustrar como esse discurso se manifesta, são analisadas produções discursivas e comunicacionais das organizações Johnson & Johnson, Secretaria do Tesouro Nacional, Microsoft e Rede Extra, empregando-se, em termos metodológicos, a análise do discurso de orientação francesa.
Protein Aggregation Is an Early Manifestation of Phospholamban p.(Arg14del)–Related Cardiomyopathy: Development of PLN-R14del–Related Cardiomyopathy
Authors: Eijgenraam Tim R. , Boogerd Cornelis J. , Stege Nienke M. , Oliveira Nunes Teixeira Vivian , Dokter Martin M. , Schmidt Lukas E. , Yin Xiaoke , Theofilatos Konstantinos , Mayr Manuel , van der Meer Peter , van Rooij Eva , van der Velden Jolanda , Silljé Herman H.W. , de Boer Rudolf A.
Published: September 2021

Background:

The p.(Arg14del) pathogenic variant (R14del) of the
PLN
(phospholamban) gene is a prevalent cause of cardiomyopathy with heart failure. The exact underlying pathophysiology is unknown, and a suitable therapy is unavailable. We aim to identify molecular perturbations underlying this cardiomyopathy in a clinically relevant PLN-R14del mouse model.

Methods:

We investigated the progression of cardiomyopathy in PLN-R14
Δ/Δ
mice using echocardiography, ECG, and histological tissue analysis. RNA sequencing and mass spectrometry were performed on cardiac tissues at 3 (before the onset of disease), 5 (mild cardiomyopathy), and 8 (end stage) weeks of age. Data were compared with cardiac expression levels of mice that underwent myocardial ischemia-reperfusion or myocardial infarction surgery, in an effort to identify alterations that are specific to PLN-R14del–related cardiomyopathy.

Results:

At 3 weeks of age, PLN-R14
Δ/Δ
mice had normal cardiac function, but from the age of 4 weeks, we observed increased myocardial fibrosis and impaired global longitudinal strain. From 5 weeks onward, ventricular dilatation, decreased contractility, and diminished ECG voltages were observed. PLN protein aggregation was present before onset of functional deficits. Transcriptomics and proteomics revealed differential regulation of processes involved in remodeling, inflammation, and metabolic dysfunction, in part, similar to ischemic heart disease. Altered protein homeostasis pathways were identified exclusively in PLN-R14
Δ/Δ
mice, even before disease onset, in concert with aggregate formation.

Conclusions:

We mapped the development of PLN-R14del–related cardiomyopathy and identified alterations in proteostasis and PLN protein aggregation among the first manifestations of this disease, which could possibly be a novel target for therapy.
Associations of Medicaid Expansion With Access to Care, Severity, and Outcomes for Acute Ischemic Stroke
Authors: McGee Blake T. , Seagraves Karen B. , Smith Eric E. , Xian Ying , Zhang Shuaiqi , Alhanti Brooke , Matsouaka Roland A. , Reeves Mathew , Schwamm Lee H. , Fonarow Gregg C.
Published: September 2021

Background:

Multiple states have not expanded Medicaid under the Affordable Care Act, resulting in higher uninsured rates in states with high stroke burdens. This study aimed to evaluate the association of Medicaid expansion with changes in health insurance coverage, severity of presentation, access to care, and outcomes among patients with acute ischemic stroke.

Methods:

A retrospective, difference-in-differences analysis of Get With The Guidelines–Stroke registry data. The study population comprised first-time ischemic stroke admissions from 2012 to 2018 for patients aged 19 to 64 in 45 states (27 that expanded Medicaid and 18 that did not). A probable low-income cohort was defined based on having Medicaid, no insurance/self-pay, or undocumented insurance. Outcomes analyzed were indicators of health insurance status, stroke severity, use of emergency services, time to acute care, in-hospital mortality, receipt of rehabilitation, discharge disposition, and level of disability.

Results:

In the starting population (N=342 765), Medicaid-covered stroke admissions rose from 12.2% to 18.1% in expansion states and from 10.0% to only 10.6% in nonexpansion states, while uninsured admissions declined from 15.0% to 6.7% in expansion states and from 24.0% to 19.2% in nonexpansion states. In the low-income cohort (N=95 086; 28% of starting population), Medicaid expansion was associated with increased odds of discharge to a skilled nursing facility (adjusted odds ratio, 1.33 [95% CI, 1.12–1.59]) and transfer to any rehabilitation facility among those eligible (adjusted odds ratio, 1.24 [95% CI, 1.08–1.41]) and lower odds of discharge home (adjusted odds ratio, 0.89 [95% CI, 0.80–0.98]). Expansion was not associated with any other outcomes.

Conclusions:

Medicaid expansion is associated with fewer uninsured hospitalizations for acute ischemic stroke and increased rehabilitation at skilled nursing facilities. More targeted interventions may be needed to improve other stroke outcomes in the low-income US population. Future research should evaluate the impact of health care reform on primary stroke prevention.