bluuebunny/crossref_metadata_2025 huggingface dataset:
Social movement studies in post-3.11 Japan: A sociological analysis
Authors: Higuchi Naoto
Published: April 2021

Between the decline of mass protests in the 1970s and the Great East Japan Earthquake and Fukushima nuclear meltdown in the 2010s, which resulted in the resurgence of mass demonstrations, social movements were widely regarded as uncommon in Japan. In this essay, the author reviews Japan’s social movement studies in the last decade, focusing on the influence of the lack of mass protest since the 1970s on scholarly interests. The essay examines the following four topics: (1) slow responses to the resurgence of mass demonstrations in post-3.11 Japan, (2) quick responses to the rise of the radical right movement, (3) the emergence of cynical approaches to studying social movements, and (4) the redemption of the history of Japan’s postwar social movements. Despite some twists and turns, we can see how social protests are a perpetual element of Japanese society that sociologists study as a common phenomenon.
Family sociology in Japan: Recent developments and the current state of the field
Authors: Tabuchi Rokuro
Published: April 2021

Although family sociology in Japan has a long history, sociological family studies in Japan have undergone major changes since the 1990s. This article recounts the ways in which family sociology in Japan has developed and its current state, with a special focus on the developments in the last three decades. The 1990s marked a turning point in the history of Japanese family sociology in terms of the establishment of new academic societies and a paradigmatic shift in theoretical orientations. The trends in family research articles indicate the continuing importance of quantitative research, with the role of qualitative research on the rise over the last two decades. In reviewing the literature over the last three decades, the author summarizes four major strands of empirical research: (a) care and families, (b) social inequality and families, (c) comparative research, and (d) diversity of families.
Neurovascular coupling dysfunction in end-stage renal disease patients related to cognitive impairment
Authors: Li Peng , Mu Junya , Ma Xueying , Ding Dun , Ma Shaohui , Zhang Huawen , Liu Jixin , Zhang Ming
Published: April 2021

We aimed to investigate the neurovascular coupling (NVC) dysfunction in end-stage renal disease (ESRD) patients related with cognitive impairment. Twenty-five ESRD patients and 22 healthy controls were enrolled. To assess the NVC dysfunctional pattern, resting-state functional MRI and arterial spin labeling were explored to estimate the coupling of spontaneous neuronal activity and cerebral blood perfusion based on amplitude of low-frequency fluctuation (ALFF)-cerebral blood flow (CBF), fractional ALFF (fALFF)-CBF, regional homogeneity (ReHo)-CBF, and degree centrality (DC)-CBF correlation coefficients. Multivariate partial least-squares correlation and mediation analyses were used to evaluate the relationship among NVC dysfunctional pattern, cognitive impairment and clinical characteristics. The NVC dysfunctional patterns in ESRD patients were significantly decreased in 34 brain regions compared with healthy controls. The decreased fALFF-CBF coefficients in the cingulate gyrus (CG) were associated positively with lower kinetic transfer/volume urea (Kt/V) and lower short-term memory scores, and were negatively associated with higher serum urea. The relationship between Kt/V and memory deficits of ESRD patients was partially mediated by the fALFF-CBF alteration of the CG. These findings reveal the NVC dysfunction may be a potential neural mechanism for cognitive impairment in ESRD. The regional NVC dysfunction may mediate the impact of dialysis adequacy on memory function.
The racial constitution of neoliberalism
Authors: Kundnani Arun
Published: April 2021

Prevailing scholarship on neoliberalism fails to recognise that it generates its own distinctive forms of racial domination. Influential analysts such as Wolfgang Streeck, David Harvey and Wendy Brown assume or argue that racism exists today because neoliberalism’s defeat of racial legacies is incomplete. This ignores how racism is reconfigured in ways that are specific to the historical moment of neoliberalism and dependent on a distinctive and substantial intellectual and political hinterland. A consideration of Friedrich Hayek’s theory of cultural evolution reveals a contradiction in neoliberal thought between its aspiration to establish a universal market system and its dependence on particularist ideas of western cultural pre-eminence. This ideological contradiction correlates with the fact that globalisation produces masses of surplus populations which are of no market value. A racial idea of culture is the means by which neoliberalism manages and works through its own limitations. Above all, ‘race’ provides a means of coding and managing the material boundaries between different forms of labour under neoliberalism: citizen and migrant, waged and ‘unexploitable’, bearers of entitlements and bare life.
Current Concepts on Tissue Adhesive Use for Meniscal Repair—We Are Not There Yet: A Systematic Review of the Literature
Authors: Marom Niv , Ode Gabriella , Coxe Francesca , Jivanelli Bridget , Rodeo Scott A.
Published: April 2021

Background:

Tissue adhesives (TAs) represent a promising alternative or augmentation method to conventional tissue repair techniques. In sports medicine, TA use has been suggested and implemented in the treatment of meniscal tears. The aim of this review was to present and discuss the current evidence and base of knowledge regarding the clinical usage of TAs for meniscal repair.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic literature search was performed using the PubMed, Embase, and Cochrane Library databases for studies reporting on clinical outcomes of TA usage for meniscal repair in humans in the English language published before January 2020.

Results:

Ten studies were eligible for review and included 352 meniscal repairs: 94 (27%) were TA-based repairs and 258 (73%) were combined suture and TA repairs. Concomitant anterior cruciate ligament reconstruction was performed in 224 repairs (64%). All included studies utilized fibrin-based TA. Of the 10 studies, 9 were evidence level 4 (case series), and 8 reported on a cohort of ≤40 meniscal repairs. Rates of meniscal healing were evaluated in 9 of 10 studies, with repair failure seen in 39 repairs (11%).

Conclusion:

The use of TAs, specifically fibrin-based TAs, for meniscal repair shows good results as either an augmentation or primary repair of various configurations of meniscal tears. However, this review reveals an absence of comparative high-quality evidence supporting the routine use of TAs for meniscal repair and emphasizes the lack of an ideal TA designed for that purpose. Further high-quality research, basic science and clinical, will facilitate the development of new materials and enable testing their suitability for use in meniscal repair.
Dementia Care, Fall Detection, and Ambient-Assisted Living Technologies Help Older Adults Age in Place: A Scoping Review
Authors: Gettel Cameron J. , Chen Kevin , Goldberg Elizabeth M.
Published: April 2021

Objectives:

We aimed to describe recent technologic advances in the three domains of dementia care, falls, and home supports; summarize existing literature on usability; and identify knowledge gaps.

Methods:

A comprehensive search of five databases for recent peer-reviewed publications was conducted in May 2020. Independent reviewers performed title/abstract review, full-text screening, data extraction, and study characteristic summarization.

Results:

Out of 2,696 citations, 151 articles were retrieved for full-text evaluation, after which 54 studies were included in this scoping review. For each domain, different technologies are available to enhance the health and well-being of older adults; many users deemed them usable and useful. Technologies targeted improving function, psychosocial and cognitive status, home safety, and caregiver burden. Barriers to widespread uptake include privacy concerns, suboptimal user experience, and willingness to accept assistance.

Conclusion:

Technologic innovations directed toward dementia care, fall detection, and ambient-assisted living can aid older adults “aging in place.”
The Changing Nature of Ministry amongst Children and Families in the UK during the Covid-19 Pandemic
Authors: Holmes Sarah E.
Published: April 2021

Empirical data was gathered from parents, grandparents, and practitioners, which revealed the impact of Covid-19 on UK children and family ministry. Prevailing restrictions and associated needs caused significant change in the nature of this ministry, and may not be temporary. Key observations were reduction in engagement of families with the church, shift in the volunteer structure for church-based children’s activities, increased focus on family faith formation activities, and diversified individual faith journeys of children.
Resistance Capital: Cultural Activism as a Gateway to College Persistence for Minority and First-Generation Students
Authors: Kornbluh Mariah , Bell Sherry , Vierra Kristin , Herrnstadt Zachary
Published: April 2021

This study provides a novel contribution by connecting two sets of literature, school engagement and multicultural university centers, in relation to late adolescent development. The aims of this mixed-method study were to: (a) quantitatively explore the relationship between student perceived cultural leadership experience and support within a multicultural center in relation to school engagement and (b) qualitatively address additional facilitators and barriers. Participants consisted of 134 college students, predominantly identifying as Latino/Hispanic (35.1%), Black/African American (34.3%), or Asian-Pacific Islander (23.9%), and first-generation (60.4%). Qualitative focus groups and a photovoice project engaged a subset of participants ( n = 57, n = 7, respectively). Regression analysis indicated youth voice, supportive staff relationships, and peer support were significant positive predictors of students’ perceived engagement within the multicultural center, however, some but not all of these predictors transferred toward sentiments of school engagement. Qualitative sources elucidated additional factors bolstering student engagement. Social, cultural, and resistance capitals were identified as key protective factors in relation to student perseverance. Findings also indicated institutional barriers against student engagement including a lack of cultural and ethnic representation throughout multiple levels of the university. Implications for expanding conceptions of social capital within late adolescent identity development theory are discussed.
The legacy of weapons grade plutonium production: Health status of Hanford complex workers who manage the waste
Authors: Cherry Debra , Friedman Elizabeth , Vincent Melissa , Maier Andrew
Published: April 2021

The extent and etiology of health effects in workers who maintain underground storage tanks at the Hanford Nuclear Reservation (Hanford) have been subjects of controversy and concern for several decades. Hanford is a decommissioned nuclear production complex managed by the US Department of Energy in southeast Washington State. This integration-of-evidence review evaluates the relationship between exposure to vapors from mixed chemical and radioactive waste stored in underground storage tanks at Hanford and worker health. Hanford workers’ health information was gathered from technical reports, media reports, and published literature, including the systematic search of seven databases. This review describes the health status and health concerns of Hanford tank farm workers based on the integration of the available health effects data from disparate sources. In interviews with external groups, Hanford workers reported both irritant-type symptoms and diseases that they believe are attributable to tank farm vapors. However, the results of this integration-of-evidence review indicated that no pervasive pattern of occupational disease was identified that can be associated with exposure to tank farm vapors. Inhalation exposure to asbestos and beryllium is associated with lung disease from various types of nuclear industry work but not from work on tank farms. This review concluded that while irritant-type symptoms and isolated cases of occupational disease are plausible under certain conditions, the currently available data do not support a pervasive pattern of occupational disease associated with vapor exposure.
Emergency Use of Occlutech® Atrial Flow Regulator Device Facilitates Weaning From Veno-Arterial Extracorporeal Membrane Oxygenation in a Patient With Severe Pulmonary Arterial Hypertension
Authors: Aregullin E. Oliver , Samuel Bennett P. , Girgis Reda , Vettukattil Joseph J.
Published: April 2021

Pulmonary arterial hypertension (PAH) is a severe and progressive disease. Treatment options include anti-PAH medications, continuous intravenous therapies, and diuretics. Lung transplant is required in many cases. Atrial septostomy is an under recognized option in symptomatic patients on maximal PAH therapy. However, creating a sustainable and restrictive atrial communication is challenging with existing devices. We describe emergency use of the Occlutech® Atrial Flow Regulator, a novel device, in a 35-year-old female with PAH supported on veno-arterial extracorporeal membrane oxygenation after postpartum decompensation.
Strategic Boredom: The Experience and Dynamics of Boredom in Refugee Camp. A Mediterranean Case
Authors: Wagner Izabela , Finkielsztein Mariusz
Published: April 2021

This article examines the boredom of asylum seekers living in a refugee camp in southern Europe. It concerns the understudied yet widespread phenomenon of boredom in the detention centers and other places where people wait several months/years to obtain permits to stay in a given state (EU) and cannot work. Boredom is defined as a socially constructed feeling that is an effect of the interaction between people and institutional/organizational ambiance that lacks qualities necessary to arouse engagement. We distinguished three modalities of the phenomenon: “doing nothing,” “life in limbo,” and “strategic boredom.” We claim that the last is the most powerful phenomenon. Strategic boredom is the specific tool of strict control exercised on the asylum seekers by the administration of the camp to force them to be idle and passive. On the other hand, the dominated group uses the expected mood of boredom as a strategy to obtain the favors of camp administration; this strategy—they hope—will conclude in the obtention of a permit of stay and/or the legal status of a refugee.
Mission, Motivation, and the Active Decision to Work for a Social Cause
Authors: Jeworrek Sabrina , Mertins Vanessa
Published: April 2021

The mission of a job affects the type of worker attracted to an organization but may also provide incentives to an existing workforce. We conducted a natural field experiment with 246 short-term workers. We randomly allocated some of these workers to either a prosocial or a commercial job. Our data suggest that the mission of a job has a performance-enhancing motivational impact on particular individuals only, those with a prosocial attitude. However, the mission is very important if it has been actively selected. Those workers who have chosen to contribute to a social cause outperform the ones randomly assigned to the same job by about half a standard deviation. This effect seems to be a universal phenomenon that is not driven by information about the alternative job, the choice itself, or a particular subgroup.
Melancholia Scytharum: the early modern psychiatry of transgender identification
Authors: Janssen Diederik F
Published: April 2021

Herodotus’s enigmatic Scythian theleia nousos/morbus femininus and its Hippocratic interpretation interested many early modern authors. Its seeming dimension of transgender identification invited various medico-psychological and psychiatric reflections, culminating in nosologist de Sauvages’ tentative 1731 term, melancholia Scytharum. This article identifies pertinent discussions and what turn out to have been entangled, tentative psychologizations in late-seventeenth through mid-nineteenth-century mental medicine: of ‘effeminacy of manners’ ( mollities animi such as observed in London’s Beaux and mollies) and male homosexuality ( amour antiphysique/grec); of the mental masculinity of some women ( viragines, Amazones); of ubiquitous attributions of impotence to sorcery ( anaphrodisia magica); and lastly, of transfeminine persons encountered throughout the New World and increasingly beyond.
Development of a model reference computed torque controller for a human lower extremity exoskeleton robot
Authors: Hasan SK , Dhingra Anoop K
Published: April 2021

Exoskeleton robot–based neurorehabilitation has received a lot of attention recently due to positive evidence supporting its ability to provide different forms of physical therapy and in helping evaluate the patient recovery rate accurately. The performance of exoskeleton robot–based physical therapy depends on the accuracy of the motion control system. While the computed torque control scheme based on inverse dynamics is ideal from a theoretical perspective, the stability and tracking performance strongly depends on the model accuracy. Expecting a deterministic payload for a rehabilitation robot is impractical, which makes the computed torque controller unrealistic for such an application. In this article, a 7-degree-of-freedom human lower extremity dynamic model is developed using the Lagrange method and a novel Model Reference Computed Torque Controller is utilized for control. The computed torque controller is used to estimate the joint torque requirements for tracking a trajectory. Calculated joint torques are applied to a similarly structured plant with different parameters. The deviation of the plant from the model is calculated. A proportional–integral–derivative controller is employed to force the plant to behave like the robot model. A realistic friction model is incorporated to simulate joint friction in the plant. The stability and tracking performance of the control system is presented for sequential as well as simultaneous joint movements. To verify the robustness of the developed controller, analysis of variance statistical technique is used.
Hydroxychloroquine prophylaxis for preeclampsia, hypertension and prematurity in pregnant patients with systemic lupus erythematosus: A meta-analysis
Authors: Duan Jiaoniu , Ma Dan , Wen Xiaoting , Guo Qianyu , Gao Jinfang , Zhang Gailian , Xu Ke , Zhang Liyun
Published: April 2021

Objectives

This meta-analysis aimed to evaluate the effectiveness of HCQ in improving the maternal and fetal outcomes in pregnancies with SLE.

Methods

A literature search was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane database for relevant English language articles, and Wanfang, CNKI and VIP for Chinese articles, from the databases’ inception to April 30, 2020. These studies compared the maternal and/or fetal outcomes between pregnant patients with SLE who were administered HCQ during pregnancy (HCQ+ group) and those who were not administered HCQ (HCQ− group). Two investigators extracted the data and assessed the quality using the Newcastle-Ottawa Scale (NOS) and GRADE criteria independently. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated. All statistical analyses were conducted using the Stata 12.0 software.

Results

Nine studies involving 1132 pregnancies were included in the study (3 case controls, 2 prospective cohorts, 4 retrospective cohorts). Preeclampsia, gestational hypertension, and prematurity were significantly lower in the HCQ+ group than in the HCQ− group (OR 0.35, 95% CI 0.21–0.59), (OR 0.41, 95% CI 0.19–0.89) and (OR 0.55, 95% CI 0.36–0.86), respectively. There were no significant differences in the rates of HELLP Syndrome (OR 0.88, 95% CI 0.19–3.96), gestational diabetes (OR 2.3, 95% CI 0.44–12.12), thrombotic events (OR 0.26, 95% CI 0.05–1.51), spontaneous abortion (OR 1.77, 95% CI 0.96–3.26), premature rupture of membranes (OR 0.58, 95% CI 0.24–1.39), oligohydramnios (OR 0.90, 95% CI 0.38–2.14), live birth (OR 1.22, 95% CI 0.60–2.47), stillbirth (OR 1.00, 95% CI 0.50–2.00), congenital malformation (OR 0.53, 95% CI 0.14–2.04), low birth weight (OR 0.77, 95% CI 0.43–1.39), intrauterine distress (OR 1.07, 95% CI 0.41–2.76,), intrauterine growth restriction (OR 0.57, 95% CI 0.06–5.43), or five-minute APGAR score <7 (OR 0.72, 95% CI 0.20–2.58) between the two groups.

Conclusions

HCQ treatment during pregnancy could reduce the risk of preeclampsia, pregnancy hypertension and prematurity in SLE patients. The certainty of evidence is high but majority of the studies included are retrospective studies and not randomized controlled trials. Therefore, the multidisciplinary management of pregnant patients with SLE should promote HCQ use, irrespective of disease activity or severity.
Pericardial Effusion as a Complication of PICC Line Insertion
Authors: Hrfi Abdah , Mohammed Mohammed H. A. , Tamimi Omar
Published: April 2021

Cardiac tamponade as a result of pericardial effusion (PE) is a serious uncommon condition in the neonatal period. PE in such cases could be associated with hydrops fetalis, neonatal sepsis, metabolic diseases, or as a complication of percutaneous indwelling central catheter. 1 We are reporting a preterm baby, with low birth weight who developed large PE as a complication of total parenteral nutrition via a peripherally inserted central catheter, managed successfully with pericardiocentesis.
Fungal Endocarditis in a Preterm Neonate
Authors: Mukherjee Devdeep , Nayak Hemant Kumar
Published: April 2021

Invasive fungal infections (IFIs) are an important cause of neonatal mortality and morbidity. A total of 5% of IFIs are complicated by fungal endocarditis. Mortality can be as high as 50%. We present a preterm, very low birth weight infant with infective endocarditis. Echocardiography showed a large pedunculated vegetation attached to the inferior vena cava and right atrium junction. Baby had Candida tropicalis in his blood cultures and was managed conservatively with antifungals. Surgery although planned was not possible considering baby being preterm with very low birth weight.
Increased referrals to an Australian Consultation Liaison Psychiatry service during the COVID-19 pandemic
Authors: Lele Kiran , Cartoon Jodi , Griffiths Alison
Published: April 2021

Objective:

It has been widely predicted that the COVID-19 pandemic will have a detrimental impact on the mental health (MH) of individuals. This has been dubbed as the MH ‘second wave’. In Australia, these impacts have been partly mitigated by institutional responses such as increased access to psychotherapy. Consultation Liaison (CL) psychiatry services provide MH care to acutely unwell patients in general hospitals. It was hypothesised that the number of referrals to the studied service had increased since the start of the pandemic.

Methods:

From the Electronic medical records (eMRs), the authors collected daily referral numbers, over 3 consecutive years, to a large CL service in metropolitan Sydney.

Results:

Referrals were significantly increased by 25%, 95% CI [1.14, 1.36], p < .001 since the start of the pandemic. This increase was delayed, and remained elevated despite a reduction in COVID-19 infections.

Conclusion:

This study adds evidence to the existence of the MH ‘second wave’, highlights a key impact on healthcare workers’ well-being and will assist in guiding resource allocation decisions in the near future.
Determinants of Breast Cancer Screening in Three Arab American Women Subgroups
Authors: Alatrash Manal
Published: April 2021

Introduction

Arab American women (AAW) have significantly low mammography screening (MS) rates; religious and sociocultural factors may serve as facilitators or barriers to screening. Understanding associations with screening practices and attitudes is imperative. The purpose of this study was to examine associations of sociodemographic characteristics with perceived benefits and barriers to MS and explore relationships of MS with sociodemographics, and perceived benefits and barriers in Muslim and Christian AAW from three Arab countries, Jordan, Lebanon, and Egypt.

Method

In this exploratory, cross sectional study, a convenience sample of 316 AAW completed a survey that combined sociodemographics and the Arab Specific-Culture Barriers instrument.

Results

Religion was significantly associated with perceived benefits and country of birth had a significant association with perceived barriers. Significant relationships were found between some variables and MS.

Discussion

This study provided insights into facilitators and barriers influencing behaviors and attitudes regarding MS in AAW. Additional efforts are to be made to overcome barriers within a religious and cultural context to empower these women.
Virtual Study-Abroad Through Web Conferencing: Sharing Knowledge and Building Cultural Appreciation in Nursing Education and Practice
Authors: King Tara Spalla , Bochenek Jeanie , Jenssen Unni , Bowles Wendy , Morrison-Beedy Dianne
Published: April 2021

Background:

With a focus on building global citizens, a U.S. and Norwegian academic collaborative partnership fostered clinical learning experiences addressing cultural and health care comparisons. High-impact educational practices integrated into international clinical experiences, combined with virtual global learning classrooms, highlighted the Sustainable Development Goals.

Problem:

Given nursing education’s requirements, devising innovative strategies expanded global learning in brief but transformative experiences while integrating nontraveling students, especially relevant considering current pandemic-related travel restrictions.

Approach:

We developed an educational experience pairing U.S. students (17 in person; 64 through web conference) and Norwegian students (50 in person; 3 for web conference) in population health experiences, providing required clinical hours and a shared cultural exchange. Integration of nontraveling students in joint virtual global experiences broadened the global learning opportunity for all.

Conclusion:

This work offers insight into how faculty used a virtual global learning experience as a synergistic tool with traditional study abroad.
Research-Based Game Design for Serious Games
Authors: Watt Keith , Smith Tamarah
Published: April 2021

Background:

Research into serious games has produced confusing and sometimes conflicting results regarding the effectiveness of using games in education. This confusion can make designing an effective serious game challenging if one wishes to follow the recommendations found in the literature. When we examine these recommendations in light of theoretical models of cognitive and social development along with Universal Design for Learning principles, many of these apparent contradictions can be resolved.

Aim:

In reviewing the literature we identified social learning and motivation factors that when considered in designing serious games can improve their effectiveness. Using these factors, we provide a concise set of guidelines for developing serious games.

Conclusion:

The research-informed guidelines presented here can be utilized by all game designers wishing to maximize serious game effectiveness.
Biweekly DoceAqualip in mCRPC patients beyond 20 cycles: A case series
Authors: Tiwari Srikant , Bisaria Abhaya , Kaur Harmeet , Joshi Nisarg , Sejpal Jaykumar , Khan Mujtaba A
Published: April 2021

Introduction

Docetaxel 75 mg/m2 every 3 weeks for up to 10 cycles is an accepted standard regimen in metastatic castration-resistant prostate cancer (mCRPC). We report our experience with >20 cycles of biweekly nanosomal docetaxel lipid suspension (NDLS) treatment in patients with mCRPC.

Case reports

Cases with long-term treatment of NDLS treatment in mCRPC patients were identified from the medical records of Jawaharlal Nehru Cancer Hospital & Research Centre Bhopal, India. A total of three cases with >20 cycles of NDLS are presented here.

Management and outcomes

Overall, the 3 patients received biweekly NDLS at a dose of 45 mg/m2 for 22, 36, and 40 cycles, respectively, except for one patient where NDLS was initiated at 50 mg/m2 and later reduced to 45 mg/m2. All the 3 patients reported prostate-specific antigen (PSA) response (>50% decline in PSA levels from baseline). The time to treatment failure (TTF) was 14.8, 18.2, and 20.6 months in these 3 patients, respectively. PSA nadir occurred after 14, 6 and 13 cycles, respectively. The OS was 21.6, 22.2 and 25.8 months, respectively. Anemia, lymphopenia, and neutropenia were the most common adverse events. NDLS treatment was overall well-tolerated without any new safety concerns.

Conclusions

Biweekly NDLS for >20 cycles was effective and well-tolerated in patients with mCRPC. NDLS can potentially be used for long-term management, which may be a requirement for most patients with mCRPC.
Combined Liver Kidney Transplant in Adult Patient With Alagille Syndrome and Pulmonary Hypertension
Authors: McGahan Rose K. , Tang Jonathan E. , Iyer Manoj H. , Flores Antolin S. , Gorelik Leonid A.
Published: April 2021

In this article, we describe a case of a 33-year-old female with Alagille syndrome complicated by bilateral branch pulmonary artery stenosis resulting in moderate pulmonary hypertension, end-stage liver disease complicated by portal hypertension, and chronic renal disease who presented for combined liver-kidney transplant. Alagille syndrome is an autosomal dominant disease affecting the liver, heart, and kidneys. Multidisciplinary preoperative evaluation was performed with a team consisting of a congenital heart disease cardiologist, a cardiac anesthesiologist, a nephrologist, and a transplant surgeon. We describe Alagille syndrome and our intraoperative management. To our knowledge, this is the first description of a combined liver-kidney transplant in an adult patient with Alagille syndrome.
Detecting the prevalence of bacterial colonization on tunneled cuffed hemodialysis catheters using quantitative PCR targeting 16S rRNA and scanning electron microscopy
Authors: Onder Ali Mirza , Cuff Christopher F , Liang Xiaobing , Billings Anthony A , Onder Songul , Yu Jing Jie , King Judy Ann
Published: April 2021

Background and objectives:

Tunneled cuffed hemodialysis catheters (TCC) get colonized by microorganisms, increasing risk for catheter related bacteremia (CRB). Our objective was to detect the prevalence of bacterial colonization of TCC by using quantitative PCR (qPCR) targeting 16S rRNA and by determining the intraluminal adherent biological material (ABM) coverage.

Methods:

A total of 45 TCC were investigated. The 16S rRNA qPCR technique was used to detect bacterial colonization after scraping the intraluminal ABM. Proximal, middle, and distal TCC were evaluated by scanning electron microscopy (SEM) to determine the percentage (%) of intraluminal ABM coverage. All catheters were cultured following sonication.

Results:

A total of 45 TCC were removed: 7 due to CRB, 3 for suspected CRB and 35 were removed for non-infectious etiologies. Bacterial colonization was detected in 27 TCC by documenting 16S rRNA qPCR (+) results (60%). Seven of these 16S rRNA qPCR (+) catheters were removed due to CRB. There was no difference in demographic, clinical, or laboratory values between the 16S rRNA (+) versus (−) TCC. The 16S rRNA qPCR (−) outcome was highly associated with CRB-free status with negative predictive value of 100%. Bacterial colonization was documented in 10 TCC using catheter cultures (22%), which was significantly less compared to qPCR method ( p = 0.0002). ABM were detected in all catheter pieces, with mean intraluminal surface coverage (ABMC) of 68.4 ± 26.1%. ABM was unlikely to be microbial biofilm in at least 36% of removed TCC as their 16S rRNA qPCR and catheter culture results were both negative.

Conclusions:

Detecting bacterial colonization of TCC was significantly higher with 16S rRNA qPCR compared to catheter cultures. The 16S rRNA qPCR (−) cannot be predicted and was strongly associated with absence of CRB. Intraluminal ABM was not associated with microbial presence in about 1/3 of the TCC. These pieces of evidence may help to improve prophylactic strategies against CRB.
Switch from sequestering to anti-CD20 depleting treatment: disease activity outcomes during wash-out and in the first 6 months of ocrelizumab therapy
Authors: Signoriello Elisabetta , Lus Giacomo , Bonavita Simona , Lanzillo Roberta , Saccà Francesco , Landi Doriana , Frau Jessica , Baroncini Damiano , Zaffaroni Mauro , Maniscalco Giorgia Teresa , Curti Erica , Sartori Arianna , Cepparulo Simone , Marfia Girolama Alessandra , Nicoletti Carolina Gabri , Carotenuto Antonio , Nociti Viviana , Caleri Francesca , Sormani Maria Pia , Signori Alessio
Published: April 2021

Objectives:

Switching between treatments is an opportunity for patients with multiple sclerosis (MS) to ameliorate disease control or safety. The aim of this study was to investigate the impact of switching from fingolimod (FTY) or natalizumab (NTZ) to ocrelizumab (OCR) on disease activity.

Methods:

We retrospectively enrolled 165 patients treated with OCR from 11 MS centres. We assessed the association of demographic and clinical characteristics on relapse rate (RR) and activity on magnetic resonance imaging (MRI) during wash-out and after 6 months of treatment with OCR through univariable and multivariable negative binomial regression models.

Results:

We registered a total of 35 relapses during the wash-out period. Previous treatment with FTY, relapses in the previous year, and relapsing-remitting course were associated with higher RR. In the first 6 months of OCR, 12 patients had clinical or MRI disease activity. Higher Expanded Disability Status Scale (EDSS) and higher lymphocyte count at OCR start were associated with a reduced probability of relapse.

Discussion and Conclusion:

This study confirms that withdrawal from sequestering agents as FTY increases the risk of relapses in the wash-out period. Nevertheless, starting OCR before achieving complete immune reconstitution could limit its effectiveness in the first 6 months probably because trapped lymphocytes escape the CD20-mediated depletion.
Understanding the subjective experiences of South African women with recurrent breast cancer: A qualitative study
Authors: Smit Anri , Coetzee Bronwyne , Roomaney Rizwana , Swartz Leslie
Published: April 2021

This study explored the subjective experiences of 12 South African women diagnosed with recurrent breast cancer. Women were invited to take part in unstructured narrative interviews, and to complete a diary in which they could reflect on their breast cancer experiences. Most responded to their recurrence with an optimistic stance. Religious beliefs and support structures were important coping strategies. Women’s perceptions of their changed bodies varied from being of least concern, to becoming the most distressing aspect. The findings highlight the complexity of illness experience and the different ways in which women make sense of a second episode of cancer.
When women support the status quo: Gender moderates the relationship between openness to experience and system-justifying beliefs
Authors: Howard Chloe , Sibley Chris G. , Osborne Danny
Published: April 2021

Although epistemic needs motivate the endorsement of system-justifying beliefs, few studies have investigated moderators of this association. Here, we argue that because being the target of discrimination should undermine one’s sense of control, the association between epistemic needs and system-justifying beliefs should be stronger for disadvantaged (vs. advantaged) groups. As hypothesized, analyses of a nation-wide random sample of adults ( N = 14,929) revealed that the negative relationship between openness to experience (i.e., an indicator of low epistemic needs) and multiple system-justifying beliefs (i.e., gender-based system justification, right-wing political preference, and conservative party support) was stronger for women (vs. men), and that these moderated associations were mediated by perceptions of gender discrimination. Our results suggest that women may sometimes endorse beliefs that conflict with their self and group interests in order to satisfy their epistemic needs.
Laparoscopic repair of transdiaphragmatic intercostal hernia following blunt trauma
Authors: Nho Woo Young , Kim Jae Oh , Nam Soon Young , Kee Se Kook
Published: April 2021

Background

Transdiaphragmatic intercostal hernia (TIH) is a rare clinical entity that generally occurs following trauma or surgical intervention, but it may occur spontaneously

Case Report

An 82-year-old Korean man presented with left-sided chest pain after falling off an agricultural vehicle. Physical examination revealed a bruised painful swelling in the left lower chest wall confirmed as hernia of the transverse colon and omentum through a defect in the diaphragm into the 7th intercostal space. Laparoscopic repair with a prosthetic mesh was successful with no sign of hernia recurrence 3 years after injury.

Discussion

TIH is uncommon. Depending on the associated injuries they may be repaired via the chest or abdomen and with the widespread advent of minimally invasive surgery this can be achieved laparoscopically or thoracoscopically. Small defects can be closed directly, but larger defects will require mesh coverage. Care should be taken to avoid using fixation tacks close to the central tendon and are best suited to peripheral defect repairs.
The appropriateness of clinical decision support systems alerts in supporting clinical workflows: A systematic review
Authors: Olakotan Olufisayo Olusegun , Mohd Yusof Maryati
Published: April 2021

A CDSS generates a high number of inappropriate alerts that interrupt the clinical workflow. As a result, clinicians silence, disable, or ignore alerts, thereby undermining patient safety. Therefore, the effectiveness and appropriateness of CDSS alerts need to be evaluated. A systematic review was carried out to identify the factors that affect CDSS alert appropriateness in supporting clinical workflow. Seven electronic databases (PubMed, Scopus, ACM, Science Direct, IEEE, Ovid Medline, and Ebscohost) were searched for English language articles published between 1997 and 2018. Seventy six papers met the inclusion criteria, of which 26, 24, 15, and 11 papers are retrospective cohort, qualitative, quantitative, and mixed-method studies, respectively. The review highlights various factors influencing the appropriateness and efficiencies of CDSS alerts. These factors are categorized into technology, human, organization, and process aspects using a combination of approaches, including socio-technical framework, five rights of CDSS, and Lean. Most CDSS alerts were not properly designed based on human factor methods and principles, explaining high alert overrides in clinical practices. The identified factors and recommendations from the review may offer valuable insights into how CDSS alerts can be designed appropriately to support clinical workflow.
Integrating multiple blockchains to support distributed personal health records
Authors: Roehrs Alex , da Costa Cristiano A , Righi Rodrigo R , Mayer André H , da Silva Valter F , Goldim José R , Schmidt Douglas C
Published: April 2021

Blockchain technologies have evolved in recent years, as have the use of personal health record (PHR) data. Initially, only the financial domain benefited from Blockchain technologies. Due to efficient distribution format and data integrity security, however, these technologies have demonstrated potential in other areas, such as PHR data in the healthcare domain. Applying Blockchain to PHR data faces different challenges than applying it to financial transactions via crypto-currency. To propose and discuss an architectural model of a Blockchain platform named “OmniPHR Multi-Blockchain” to address key challenges associated with geographical distribution of PHR data. We analyzed the current literature to identify critical barriers faced when applying Blockchain technologies to distribute PHR data. We propose an architecture model and describe a prototype developed to evaluate and address these challenges. The OmniPHR Multi-Blockchain architecture yielded promising results for scenarios involving distributed PHR data. The project demonstrated a viable and beneficial alternative for processing geographically distributed PHR data with performance comparable with conventional methods. Blockchain’s implementation tools have evolved, but the domain of healthcare still faces many challenges concerning distribution and interoperability. This study empirically demonstrates an alternative architecture that enables the distributed processing of PHR data via Blockchain technologies.
Towards optimising chronic kidney disease detection and management in primary care: Underlying theory and protocol for technology development using an Integrated Knowledge Translation approach
Authors: Manski-Nankervis Jo-Anne , Alexander Karyn , Biezen Ruby , Jones Julia , Hunter Barbara , Emery Jon , Lumsden Natalie , Boyle Douglas , Gunn Jane , McMorrow Rita , Prictor Megan , Taylor Mark , Hallinan Christine , Chondros Patty , Janus Edward , McIntosh Jennifer , Nelson Craig
Published: April 2021

Worldwide, Chronic Kidney Disease (CKD), directly or indirectly, causes more than 2.4 million deaths annually with symptoms generally presenting late in the disease course. Clinical guidelines support the early identification and treatment of CKD to delay progression and improve clinical outcomes. This paper reports the protocol for the codesign, implementation and evaluation of a technological platform called Future Health Today (FHT), a software program that aims to optimise early detection and management of CKD in general practice. FHT aims to optimise clinical decision making and reduce practice variation by translating evidence into practice in real time and as a part of quality improvement activities. This protocol describes the co-design and plans for implementation and evaluation of FHT in two general practices invited to test the prototype over 12 months. Service design thinking has informed the design phase and mixed methods will evaluate outcomes following implementation of FHT. Through systematic application of co-design with service users, clinicians and digital technologists, FHT attempts to avoid the pitfalls of past studies that have failed to accommodate the complex requirements and dynamics that can arise between researchers and service users and improve chronic disease management through use of health information technology.
Fabrication of bionanocomposites reinforced with hemp nanocellulose and evaluation of their mechanical, thermal and dynamic mechanical properties
Authors: Rana SS , Gupta MK
Published: April 2021

The present study aims to fabricate the epoxy-based bionanocomposites reinforced with hemp nanocellulose and the evaluation of their mechanical, thermal and dynamic mechanical properties. Nanocellulose from hemp fibres was isolated via the chemo-mechanical method and its bionanocomposites were prepared using the in situ polymerization method. Although many researchers have reported studies on the preparation and characterization of bionanocomposites however, studies on the mechanical, thermal, and dynamic mechanical properties of epoxy-based bionanocomposites reinforced with hemp nanocellulose are still unreported. The mechanical properties (i.e. tensile, flexural, hardness, and impact) and dynamic mechanical properties (i.e. glass transition temperature, damping behaviour, storage, and loss modulus) of the developed bionanocomposites were investigated. Further, the crystalline behaviour and thermal stability were also studied using the X-ray diffraction and thermogravimetric analysis techniques, respectively. The results revealed that an addition of nanocellulose considerably improved the mechanical, thermal, and viscoelastic properties of the bionanocomposites. As much as 52.17%, 48.17%, 89.08%, and 15.67% improvements in the tensile strength, flexural strength, impact strength, and hardness, respectively, for the 2 wt.% nanocellulose composites were found over the epoxy matrix.
Mode count and modal density of nonsymmetric cross-ply laminated composite beams
Authors: Bachoo Richard
Published: April 2021

Fiber-reinforced composites are used in many weight critical applications owing to their high strength-to-weight and stiffness-to-weight ratios. In certain applications, fiber-reinforced composites are subjected to broadband excitation sources that act over a significant portion of the audible frequency range leading to the response of a large number of higher order structural modes. In predicting the response levels of such systems, regardless of whether it is modeled in isolation or using a statistical energy analysis framework, it becomes necessary to quantify the number of resonant modes available to receive and store energy within a frequency band. Conventionally, the mode count and modal density are two parameters used for this purpose. Generally, the analysis of the mode count and modal density of anisotropic fiber-reinforced composite structures have received considerably less attention compared to their isotropic metallic counterparts, and as a result a number of key analytical formulations are yet to be derived and investigated. In this work, the modal distribution and density of nonsymmetric cross-ply laminated composite beams coupled in bending and longitudinal extension are analyzed. A wave approach is used to derive an expression for the mode count of the beam having generalized boundary conditions. Using numerical examples and nonlinear regression analysis, simplified expressions are then obtained for the average mode count function of the beam for different boundary conditions. An analytical expression for the modal density is obtained by taking the differential of the average mode count function with respect to frequency. The wave approach employed in this study is validated based on comparison with results from past literature in addition to finite element simulations. The expression for the modal density is also validated using a finite element model and is shown to be independent of boundary conditions.
Study on impact fracture behavior of G18CrMo2-6 steel after tempering
Authors: Li Zhenjiang , Liu Yujing , Zhang Ruyi , Luo Chao , Qi Huiping
Published: April 2021

The evolution of microstructure of low alloy CrMo steel has a great influence on the mechanical properties. Three different tempering heat treatment conditions were made on the material, and the influence of the microstructure on the impact toughness under different test temperatures was studied. The type, morphology, size and distribution of the second phase will evolve with the change of tempering temperature and time. Impact energy of all samples increases gradually from the lower shelf to upper shelf with the testing temperature increasing. In the lower shelf, the fracture is controlled by the crack nucleation. In the ductile-to-brittle transition temperature (DBTT) range, the fracture is determined by the size of the initial crack initiating on the second phase. In the upper shelf, the cleavage fracture is controlled by the propagation of the carbide crack into continuous grains, and the critical event for fracture is the plasticity of the matrix. The scattering of impact energy in DBTT range is caused by the uneven distribution and size of the brittle second phase.