bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of a smart-fit system for CPAP interface selection
Authors: Ma Zhichao , Hyde Philip , Drinnan Michael , Munguia Javier
Published: September 2020

Continuous Positive Airway Pressure (CPAP) therapy is commonly prescribed for longstanding, acute cases of Obstructive Sleep Apnea (OSA) during which patients must wear a tight-fitting breathing mask overnight for the duration of the treatment. Because this condition frequently leads to the permanent use of CPAP masks, interface selection is a crucial factor influencing the treatment quality and effectiveness. Masks/interface selection is normally performed on a trial an error basis with clinicians informing their selection based on OSA-related factors with basic fitting feedback from patients. However, it is not uncommon for patients to abandon the treatment or request additional consultations due to ill-fitting CPAP mask with the main sources of discomfort being perceived air leakage and mask/strap overtightening leading to skin damage. This work introduces a novel system (Smart-Fit), for CPAP interface selection using advanced digital technologies, such as Reverse Engineering and Computational Modeling (Finite Element Analysis) which are paired to evaluate and determine the best fitting interface for each clinical case. The model simplifies the number of 3D facial landmarks to 12 and established that a 2 mm scan resolution is enough for accurate scans. The Von Mises stress map in ANSYS serves as an indicator of potential high-pressure areas, triggering the need for a chance of mask size. Current results indicate the Smart Fit System can enable a “best fit CPAP interface” to be selected considering individual’s physical characteristics and existing CPAP interface configurations. The development of the Smart Fit System is an evolution compared to traditional CPAP interface selection approach, which optimizes the CPAP interface selection process.
Design and evaluation of a novel anti-reflux biliary stent with cone spiral valve
Authors: Wang Yue , Song Xiao-Fei , Su Yu-Shan , Xu Xin-Sheng
Published: September 2020

Endoscopic placement of biliary stent is a well-established palliative treatment for biliary obstruction. However, duodenobiliary reflux after stent placement has been a common problem which may lead to dreadful complications. This paper designed a novel anti-reflux biliary stent with a cone spiral valve. Fluid-Structure Interaction (FSI) simulations were established to evaluate the efficiency of the anti-reflux stent comparing with a clinically applied standard stent. According to the stress distribution of the valve, the fatigue performance in the stress concentration area was analyzed. The results show that when the antegrade flow through the valve, the cone spiral valve could stretch and open to realize adequate drainage under the normal physiological pressure of biliary tract; When the duodenal reflux through the valve, the valve would be compressed and close with a result of nearly zero at the outlet flow rate. Furthermore, the anti-reflux stent achieved improved radial mechanical performance with 2.7 times higher radial stiffness than standard stent. Finite element analysis (FEA) also indicates that compared with the standard stent, the addition of the anti-reflux valve had little negative effect on flexibility of the stent. Fatigue analysis results showed that the valve was reliable. This research provides the new stent with a cone spiral valve and proves that it is technically feasible and effective for preventing the duodenobiliary reflux while ensuring the antegrade bile flow without compromising the other biomechanical performances.
Design and development of model eye for retina laser by using additive manufacturing
Authors: Pugalendhi Arivazhagan , Ranganathan Rajesh , Venkatapathy Narendran , Narendran Kalpana , Shah Parag K
Published: September 2020

Surgical skill of the surgeon can be improved by surgical simulation. Especially in ophthalmology, it is impossible to use real human/non-human primate eyes for ophthalmology surgery practice. However, surgical practice is most important for ophthalmologist. The retina laser surgery is one of the ophthalmology surgeries and it requires more surgical practice for surgeons to use the laser beam precisely to coagulate and fuse small areas of tissue. Dealing with the prospect of vision reduction or vision loss presents a peculiar problem and that can be highly stressful and frustrating for both doctors and patients. In this regard, training for indirect ophthalmoscopy and retinal photocoagulation is undergone using model eyes instead of real eyes. Properties and functioning of an existing model eye are huge and they differ from real human eye such as casings are completely rigid and focusing of retinal fundus is not completely covered. Therefore, this research concentrates to develop a model eye that assimilates close to the human eye by focussing on the maximum viewing area that is not done at the moment. Finally, the design and development of re-engineered model eye for retina laser is fabricated by additive manufacturing. Compared to existing plastic model eye, viewing area and viewing angle of the re-engineered model eye is increased by 16.66% and 6.14%, respectively. Due to design modifications and elimination of the insert, it can be reduced by 18.99% and 13.95% of height and weight of the top casing respectively. Developed re-engineered model eye will improve the surgical and diagnostic skill of the surgeon and increase their confidence and proficiency. It also augments the effective use of essential ophthalmic instruments. Additionally, it can reduce the surgical error and meet the existing demand of actual eyes for surgical practices.
The effect of imatinib administered in the prenatal period on testis development in rats
Authors: Suzan Z Topal , Tumkaya L , Mercantepe T , Atak M , Uydu HA
Published: September 2020

Background:

The purpose of this study was to examine the effects of exposure to imatinib in the prenatal period on testis development in rats.

Methods:

Although all the study groups received intraperitoneal imatinib on prenatal days 1–8, no pregnancy occurred in the Imatinib-80 group. Immunohistochemical analysis, TUNEL, c-kit and PDGF staining revealed no difference between the groups in terms of positivity scoring.

Results:

A significant decrease was detected in total sperm counts in the Imatinib-20 group compared to the control group, but the sperm count was higher in the Imatinib-60 group than in the Imatinib-20 group. At biochemical measurements, the drug increased oxidative stress in the testis and serum in the Imatinib-20 group, but caused a decrease in tissue in the Imatinib-60 group. Thiol measurements revealed a decrease in the testis and serum in the Imatinib-60 group, while an increase in serum measurements was observed in the Imatinib-40 group. Analysis revealed no difference between the groups in terms of protamine and histone gene expression levels in testis tissue exposed to imatinib.

Conclusion:

Our findings show that prenatal exposure to imatinib can lead to histopathological and biochemical changes in testis tissue, but that no adverse effect occurs in nuclear maturation of germ cells during spermiogenesis.
Argumentative time work for legitimizing homeopathy: Temporal reasons for the acceptance of an alternative medical practice
Authors: Ciocănel Alexandra , Rughiniș Cosima , Flaherty Michael G
Published: September 2020

In Romania, as elsewhere, there is persistent controversy surrounding homeopathy wherein various parties try to draw the boundaries of legitimate medical practice. The literature on complementary and alternative medicine features little discussion on the temporal dimensions of controversies surrounding these therapies, focusing mainly on the temporalities of the lived experience of treatment. Yet time is a powerful resource for challenging and gaining legitimacy. In order to capture the use of time as a resource for legitimating or contesting homeopathy, we advance the theory of time work by examining the rhetorical role of different temporalities in this dispute. We find that proponents and users of homeopathy appeal to temporal properties of treatment, such as the longer duration of consultation, and of healing, namely, a specific sequence of symptoms and reactions, stories of failed biomedical treatments followed by successful homeopathic interventions, and stories of durable efficacy. Critics invoke the temporal properties of science, especially a cumulative record of failed attempts to prove homeopathic efficacy beyond placebo, or to causally account for its putative effects. Argumentative time work also involves manipulation of temporal modalities, in which homeopathy is legitimized both through continuity with the past and through breaking away from the past, with an eye to a promised future. At the same time, critics of homeopathy invoke temporal modalities to cast homeopathy as a relic of an unscientific past. This research illustrates the value of "argumentative time work" as a conceptual tool in examining public controversies.
International Trade Cooperation and Exogenous Economic Shocks in Developing Countries
Authors: Gnangnon Sena Kimm
Published: September 2020

This article explores whether the World Trade Organization (WTO), through its role of promoting multilateral trade liberalisation and mobilising greater financial resources (i.e., Aid for Trade [AfT] flows) in favour of the trade sector in developing countries, contributes to reducing the size of external economic shocks experienced by these countries. An empirical analysis is carried out using a sample of 111 countries over the period 1996–2016 and relying on the two-step system generalised method of moments (GMM) approach. The findings indicate that taken separately, multilateral trade liberalisation and AfT flows reduce the size of shocks. While the two factors are substitutable in negatively influencing countries’ size of shocks, it also appears that multilateral trade liberalisation always results in smaller shocks, irrespective of the amount of AfT that accrues to countries.

JEL: F13, F14, F32, F35
Associations Between Perceived Environmental Pollution and Mental Health in Middle-Aged and Older Adults in East Asia
Authors: Yamashita Takashi , Kim Giyeon , Liu Darren , Bardo Anthony R.
Published: September 2020

Given the widely used objective measures of environmental pollution in previous research, this study investigated subjective measures in relation to mental health among middle-aged and older adults in three East Asian countries—China, Japan, and South Korea. The samples from the 2010 East Asian Social Survey included 2502 Chinese, 1794 Japanese, and 871 South Korean adults aged 40 and older. Linear regression models were used to examine the associations between mental health measure (SF-12) and 4 perceived environmental pollution indicators (ie, air, water, noise, and pollution index). Greater perceived pollution indicators, as well as the perceived pollution index, were associated with poorer mental health, even after adjusting for covariates in all three countries. Although results need to be further verified in future research, national-level efforts to improve perceptions of environmental pollution may be useful to enhance the mental health of East Asian middle-aged and older adults.
A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana
Authors: Sommer Chelsea L. , Wankier Ali P. , Obiri-Yeboah Solomon , Gyamfi Seth , Frimpong Barbara Amponsah , Dickerson Ty
Published: September 2020

Objective:

The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa.

Design:

Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members.

Setting:

A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital.

Participants:

Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana.

Interventions:

Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care.

Results:

Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2.

Conclusions:

Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.
Use of the Modified Unilateral Cleft Lip Repair Technique to Establish a Cupid’s Bow With a Natural Structure
Authors: Ishigaki Tatsuya , Udagawa Akikazu
Published: September 2020

Introduction:

There are several surgical techniques for unilateral cleft lip repair. In most of these techniques, the points where the postoperative scars cross the vermilion border are on the peak of the Cupid’s bow. These scars make the shape of Cupid’s bow indistinct. To maintain the natural shape of the Cupid’s bow, we modified the surgical technique.

Methods:

We modified the modified Millard’s surgical technique (Onizuka’s surgical technique). The main point of this modification was as follows: we combined a small triangular flap and a vermilion triangular flap (described by Noordhoff). We maintained the projection point on the lateral side of cleft lip which was coordinated to the peak of the Cupid’s bow.

Results:

We could preserve the shape and symmetry of the peak of the Cupid’s bow.

Conclusion:

To keep the projection point on the affected side of cleft lip and the surrounding vermilion border as one curve structure is important in maintaining the natural shape of the Cupid’s bow.
Developing an Understanding of Adolescents’ Knowledge, Attitudes, and Practices Toward COVID-19
Authors: Dardas Latefa Ali , Khalaf Inaam , Nabolsi Manar , Nassar Omayyah , Halasa Suhaila
Published: September 2020

Adolescents are more likely to engage in risky health practices related to COVID-19. Their compliance with infection control measures is a key factor to mitigate the spread of the disease. The purpose of this study was to explore the knowledge, attitudes, and practices toward COVID-19 and their correlates among Jordanian adolescents. An online cross-sectional survey was utilized. A total of 1,054 Jordanian adolescents aged 12–18 completed and returned the survey. Overall, Jordanian adolescents showed a good base of knowledge regarding COVID-19 (regardless of their demographic characteristics) and tended to hold positive attitudes toward the country’s curfew and other protective measures. The majority of adolescents reported that television and social media were their main source of information on COVID-19, while few reported receiving such information from their schools. The majority reported practicing effective health protective behaviors to prevent the spread of COVID-19, which was significantly predicted by their knowledge and attitudes toward these measures. However, there was a relatively small, yet clinically significant, percentage of adolescents who showed poor knowledge on COVID-19, had negative attitudes toward protective measures, and reported being engaged in risky practices related to infection spread. Tailored efforts are needed to improve the levels of knowledge, attitudes, and practices among adolescents. Raising awareness and promoting positive attitudes are vital to change adolescents’ health practices. Policy makers should ensure that school nurses are available in all schools and working to their full scope. School nurses are the eyes and ears of public health and primary care. They are essential members on pandemic preparedness, reopening and reentry planning teams, and can lead health care in schools and practice in a holistic culturally competent proactive manner to address the needs of students.
How Should Cancer Models Be Constructed?
Authors: Beckman Robert A. , Kareva Irina , Adler Frederick R.
Published: September 2020

Choosing and optimizing treatment strategies for cancer requires capturing its complex dynamics sufficiently well for understanding but without being overwhelmed. Mathematical models are essential to achieve this understanding, and we discuss the challenge of choosing the right level of complexity to address the full range of tumor complexity from growth, the generation of tumor heterogeneity, and interactions within tumors and with treatments and the tumor microenvironment. We discuss the differences between conceptual and descriptive models, and compare the use of predator-prey models, evolutionary game theory, and dynamic precision medicine approaches in the face of uncertainty about mechanisms and parameter values. Although there is of course no one-size-fits-all approach, we conclude that broad and flexible thinking about cancer, based on combined modeling approaches, will play a key role in finding creative and improved treatments.
Grief in Times of Corona (Envoi)
Authors: Fowley Cathy
Published: September 2020

This autoethnographic poem tells of personal grief happening in a time of lockdown. It draws on the concept of chronotope, a discrete time and space unit, a parenthesis of sorts, which I have chosen to illustrate as a bubble. In our daily speech, we see bubbles as related to both time and space, now with the added meaning of close relationship of people, those who belong to the same COVID bubble. In this autoethnographic piece, relationships are mediated by technology which anchors our bubbles together, with multimodal links carrying affect and emotion.
Cisplatin-induced nephrotoxicity in children: what is the best protective strategy?
Authors: Ruggiero Antonio , Ariano Anna , Triarico Silvia , Capozza Michele Antonio , Romano Alberto , Maurizi Palma , Mastrangelo Stefano , Attinà Giorgio
Published: September 2020

Introduction

Platinum compounds, which are considerably effective for the treatment of childhood malignancies, have significantly contributed to the increase in long-term survival of children with cancer. Unfortunately, children receiving cisplatin-based chemotherapy have been known to be at risk for severe disabling adverse effects, such as nephrotoxicity.

Methods

A literature research of the MEDLINE PubMed database was conducted to identify articles published between 1980 and 2019 reviewing “Cisplatin AND mannitol.”

Results

The primary pharmacodynamics and clinical characteristics of cisplatin were described, focusing on its renal toxic effects and potential preventive strategies, in order to improve clinical outcomes among children with cancer aged 1 to 14 years. Currently, selecting either hydration alone or hydration plus mannitol for preventing nephrotoxicity has been controversial considering the lack of guidelines to provide treatment recommendations both among adults and children.

Conclusions

Appropriate knowledge regarding the pharmacokinetics and toxicological profile of cisplatin may help physicians prevent renal toxicity. Unfortunately, published data regarding the nephroprotective utility of adding mannitol appear to be inconclusive. As such, appropriate hydration remains the main fundamental strategy for reducing the risk of cisplatin-induced nephrotoxicity. Considering the increasing number of children safely cured of their tumours, it is imperative that those treated with cisplatin receive the most appropriate nephroprotective strategy for reducing the negative impact of platinum compounds on quality of life.
Heterotopic Nodules in the Placenta, an Immunohistochemical Re-evaluation of the Diagnosis of Adrenocortical Heterotopia
Authors: Heerema-McKenney Amy , Rabinowitz Laura , Bendon Robert , Bruehl Frido , Blank Alexander , Pinar Halit
Published: September 2020

Background

Rare nodules of heterotopic adrenocortical and hepatic tissue are reported in the placenta. A mechanism for adrenocortical tissue in the placenta has been perplexing, while hepatic tissue is generally considered related to yolk sac primordia. The clear cell morphology of these nodules is similar to the adrenal cortex of the adult; however, the fetal adrenal gland does not usually display clear cells.

Methods

We stained 9 placental nodules, histologically identical to “adrenocortical” heterotopia of the placenta, to determine whether adrenocortical differentiation could be confirmed. These cases include 3 archival cases initially diagnosed as “adrenocortical” heterotopia.

Results

Immunohistochemical staining with steroid factor-1 (SF-1), HepPar-1, and Arginase-1 showed that these nodules of clear cells are actually hepatic (SF-1 negative, HepPar-1, and Arginase-1 positive). PAS staining suggests that glycogen accumulation is responsible for the clear cytoplasm. In contrast, a nodule of adrenocortical heterotopia near the testis and the adrenal gland from a 38-week-old neonatal autopsy case confirm SF-1 reactivity as expected.

Conclusion

We propose that adrenocortical heterotopia in the placenta is a misnomer, and that these subchorionic nodules of clear cells demonstrate hepatic differentiation.
Utility of Extrapolating Human S1500+ Genes to the Whole Transcriptome: Tunicamycin Case Study
Authors: Mav Deepak , Phadke Dhiral P , Balik-Meisner Michele R , Merrick B Alex , Auerbach Scott , Niemeijer Marije , Huppelschoten Suzanna , Baze Audrey , Parmentier Celine , Richert Lysiane , van de Water Bob , Shah Ruchir R , Paules Richard S
Published: September 2020

The TempO-Seq S1500+ platform(s), now available for human, mouse, rat, and zebrafish, measures a discrete number of genes that are representative of biological and pathway co-regulation across the entire genome in a given species. While measurement of these genes alone provides a direct assessment of gene expression activity, extrapolating expression values to the whole transcriptome (~26 000 genes in humans) can estimate measurements of non-measured genes of interest and increases the power of pathway analysis algorithms by using a larger background gene expression space. Here, we use data from primary hepatocytes of 54 donors that were treated with the endoplasmic reticulum (ER) stress inducer tunicamycin and then measured on the human S1500+ platform containing ~3000 representative genes. Measurements for the S1500+ genes were then used to extrapolate expression values for the remaining human transcriptome. As a case study of the improved downstream analysis achieved by extrapolation, the “measured only” and “whole transcriptome” (measured + extrapolated) gene sets were compared. Extrapolation increased the number of significant genes by 49%, bringing to the forefront many that are known to be associated with tunicamycin exposure. The extrapolation procedure also correctly identified established tunicamycin-related functional pathways reflected by coordinated changes in interrelated genes while maintaining the sample variability observed from the “measured only” genes. Extrapolation improved the gene- and pathway-level biological interpretations for a variety of downstream applications, including differential expression analysis, gene set enrichment pathway analysis, DAVID keyword analysis, Ingenuity Pathway Analysis, and NextBio correlated compound analysis. The extrapolated data highlight the role of metabolism/metabolic pathways, the ER, immune response, and the unfolded protein response, each of which are key activities associated with tunicamycin exposure that were unrepresented or underrepresented in one or more of the analyses of the original “measured only” dataset. Furthermore, the inclusion of the extrapolated genes raised “tunicamycin” from third to first upstream regulator in Ingenuity Pathway Analysis and from sixth to second most correlated compound in NextBio analysis. Therefore, our case study suggests an approach to extend and enhance data from the S1500+ platform for improved insight into biological mechanisms and functional outcomes of diseases, drugs, and other perturbations.
Genomic Characteristics of Invasive Streptococcus pneumoniae Serotype 1 in New Caledonia Prior to the Introduction of PCV13
Authors: Hanachi Mariem , Kiran Anmol , Cornick Jennifer , Harigua-Souiai Emna , Everett Dean , Benkahla Alia , Souiai Oussama
Published: September 2020

Streptococcus pneumoniae serotype 1 is a common cause of global invasive pneumococcal disease. In New Caledonia, serotype 1 is the most prevalent serotype and led to two major outbreaks reported in the 2000s. The pneumococcal conjugate vaccine 13 (PCV13) was introduced into the vaccination routine, intending to prevent the expansion of serotype 1 in New Caledonia. Aiming to provide a baseline for monitoring the post-PCV13 changes, we performed a whole-genome sequence analysis on 67 serotype 1 isolates collected prior to the PCV13 introduction. To highlight the S. pneumoniae serotype 1 population structure, we performed a multilocus sequence typing (MLST) analysis revealing that NC serotype 1 consisted of 2 sequence types: ST3717 and the highly dominant ST306. Both sequence types harbored the same resistance genes to beta-lactams, macrolide, streptogramin B, fluoroquinolone, and lincosamide antibiotics. We have also identified 36 virulence genes that were ubiquitous to all the isolates. Among these virulence genes, the pneumolysin sequence presented an allelic profile associated with disease outbreaks and reduced hemolytic activity. Moreover, recombination hotspots were identified in 4 virulence genes and more notably in the cps locus ( cps2L), potentially leading to capsular switching, a major mechanism of the emergence of nonvaccine types. In summary, this study represents the first overview of the genomic characteristics of S. pneumoniae serotype 1 in New Caledonia prior to the introduction of PCV13. This preliminary description represents a baseline to assess the impact of PCV13 on serotype 1 population structure and genomic diversity.
Effect of Probiotic Administration on Serum Tryptophan Metabolites in Pediatric Type 1 Diabetes Patients
Authors: Mondanelli Giada , Orecchini Elena , Volpi Claudia , Panfili Eleonora , Belladonna Maria Laura , Pallotta Maria Teresa , Moretti Simone , Galarini Roberta , Esposito Susanna , Orabona Ciriana
Published: September 2020

Type 1 diabetes (T1D) is characterized by anomalous functioning of the immuno regulatory, tryptophan-catabolic enzyme indoleamine 2,3 dioxygenase 1 (IDO1). In T1D, the levels of kynurenine—the first byproduct of tryptophan degradation via IDO1—are significantly lower than in nondiabetic controls, such that defective immune regulation by IDO1 has been recognized as potentially contributing to autoimmunity in T1D. Because tryptophan catabolism—and the production of immune regulatory catabolites—also occurs via the gut microbiota, we measured serum levels of tryptophan, and metabolites thereof, in pediatric, diabetic patients after a 3-month oral course of Lactobacillus rhamnosus GG. Daily administration of the probiotic significantly affected circulating levels of tryptophan as well as the qualitative pattern of metabolite formation in the diabetic patients, while it decreased inflammatory cytokine production by the patients. This study suggests for the first time that a probiotic treatment may affect systemic tryptophan metabolism and restrain proinflammatory profile in pediatric T1D.
Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis
Authors: Nappi Francesco , Avtaar Singh Sanjeet Singh , Timofeeva Irina
Published: September 2020

Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.
Diabetes consultation versus diabetes education in patients with poor glycaemic control: A telemedicine intervention study
Authors: Nyenwe Ebenezer A , Ashby Sydney , Tidwell Jamie
Published: September 2020

Introduction

The prevalence of diabetes is increasing around the world, especially in populations with limited health service resources. Diabetes is associated with increased mortality and cost. Therefore, we investigated the impact of increasing access to diabetes care through telemedicine.

Methods

Five rural communities were connected via videoconference. Patients received diabetes consultation (DC) or diabetes self-management education (DSME). DC was performed by an endocrinologist, while DSME was delivered by a certified diabetes educator. Haemoglobin A1c (HbA1c), blood pressure (BP) and lipid profile were evaluated as outcome measures.

Results

Sixty-nine subjects (70% females, 91% Caucasians) were studied, with 33 receiving DC and 36 receiving DSME. Patients were aged 56.7 ± 9.4 and 56.5 ± 6.7 years, respectively ( p > 0.5), and had had diabetes for 11.4 ± 10.1 and 11.7 ± 9.2 years, respectively ( p > 0.5). Both DC and DSME reduced HbA1c equally: DC at baseline 9.3 ± 1.3% compared to at 12 months 7.2 ± 0.9% ( p = 0.0002), and DSME at baseline 9.8 ± 1.6% compared to at 12 months 8.3 ± 1.9% ( p = 0.009). There was no difference in HbA1c between DC and DSME at baseline and at 12 months ( p > 0.1). On the average, BP and lipids were equally controlled in DC and DSME at six months: total cholesterol 178.3 ± 50.5 mg/dL versus 185.9 ± 57.3 mg/dL, low-density lipoprotein cholesterol 91.4 ± 36.1 mg/dL versus 91.5 ± 50.2 mg/dL, high-density lipoprotein cholesterol 46.2 ± 11.0 mg/dL versus 43.5 ± 10.8 mg/dL, systolic BP 136.8 ± 23.6 mmHg versus 131.9 ± 22.3 mmHg, diastolic BP 72.0 ± 13.2 mmHg versus 77.7 ± 11.3 mmHg ( p > 0.1). All subjects found DC and DSME cost effective, while 97% reported better diabetes control.

Discussion

In patients with long-standing uncontrolled diabetes who lived in rural communities with high diabetes-related mortality rates, DC or DSME delivered by videoconference improved glycemic control. No difference was found between the two interventions.
From the humanism of critical theory to critical humanism
Authors: Kozlarek Oliver
Published: September 2020

Following Max Horkheimer, I will first attempt to reconstruct an anthropology that essentially wants to be understood as critical social research. I will then pursue the question of humanism in critical theory. In doing so, I want to show that a reference to a normatively substantive humanism does actually exist in critical theory. On the other hand, I want to show that this humanism is anything but unambiguously and systematically formulated but has been reflected and articulated differently by different representatives of critical theory. The two examples I will refer to here are Theodor W. Adorno and Erich Fromm. I will define Adorno’s humanism as ‘dialectical humanism’, whereas Fromm’s humanism could be described as ‘emphatic humanism’. My reading, however, attempts to interrogate the two positions as to their complementarity. Not ‘Adorno or Fromm’, but ‘Adorno and Fromm’ is the motto that guides me. Finally, I will relate this complementary reading of both approaches in such a way that the possibility of a ‘Critical Humanism’ can be derived from it, which above all also wants to be understood as a sociological research program.
Management of diastasis of the rectus abdominis muscles: recommendations for swedish national guidelines
Authors: Carlstedt Anders , Bringman Sven , Egberth Mattias , Emanuelsson Peter , Olsson Anders , Petersson Ulf , Pålstedt Joakim , Sandblom Gabriel , Sjödahl Rune , Stark Birgit , Strigård Karin , Tall Jael , Theodorsson Elvar
Published: September 2020

Background:

Diastasis of the rectus abdominis muscle is a common condition. There are no generally accepted criteria for diagnosis or treatment of diastasis of the rectus abdominis muscle, which causes uncertainty for the patient and healthcare providers alike.

Methods:

The consensus document was created by a group of Swedish surgeons and based on a structured literature review and practical experience.

Results:

The proposed criteria for diagnosis and treatment of diastasis of the rectus abdominis muscle are as follows: (1) Diastasis diagnosed at clinical examination using a caliper or ruler for measurement. Diagnostic imaging by ultrasound or other imaging modality, should be performed when concurrent umbilical or epigastric hernia or other cause of the patient’s symptoms cannot be excluded. (2) Physiotherapy is the firsthand treatment for diastasis of the rectus abdominis muscle. Surgery should only be considered in diastasis of the rectus abdominis muscle patients with functional impairment, and not until the patient has undergone a standardized 6-month abdominal core training program. (3) The largest width of the diastasis should be at least 5 cm before surgical treatment is considered. In case of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered in patients with a smaller diastasis. (4) When surgery is undertaken, at least 2 years should have elapsed since last childbirth and future pregnancy should not be planned. (5) Plication of the linea alba is the firsthand surgical technique. Other techniques may be used but have not been found superior.

Discussion:

The level of evidence behind these statements varies, but they are intended to lay down a standard strategy for treatment of diastasis of the rectus abdominis muscle and to enable uniformity of management.
‘FAST positive’ reversal & pneumoperitoneum: A novel sign of traumatic bladder rupture
Authors: Chennatt Jaine J , Rattan Amulya , Dhiman Ajay K
Published: September 2020

Urinary bladder injuries are uncommon, accounting for just 1.6% of all abdominal trauma. The most common presenting symptoms are hematuria, abdominal pain and inability to void. Ascites is the most typical manifestation on CT. We hereby report a case of a 24-year-old male victim of a road traffic injury with an unusual presentation of pneumoperitoneum and “reversal” of FAST positive status as the presenting signs of bladder injury. Prior awareness of urinary bladder injury as the etiology of pneumoperitoneum can possibly decrease morbidity with consideration of minimal access surgery for management. Compared to pneumoperitoneum, “FAST reversal” in catheterized patients is quite peculiar and sufficiently specific per se to warrant a cystogram or thorough intraoperative bladder evaluation.
Effects of rapid conductive heating and passive cooling with cold dies on hot-forming formability and final mechanical properties of boron steel sheets
Authors: Kocar O , Livatyali H
Published: September 2020

This paper is focused on the assessment of hot-forming limits and post-process properties of the 22MnB5 steel sheets heated to 950°C using rapid conductive heating, which is proposed as a fast and efficient method. An experimental axisymmetric bulging die set appropriate for conductive heating was designed and manufactured. Stretch-forming tests were conducted on rectangular specimens with three different widths until failure using dies at room temperature. The die set at room temperature performed passive cooling as well as deformation. The tests showed the limits of formability. Microhardness and microstructure analyses of the formed steel proved the bainitic–martensitic nature obtained at the end of the process. The results show good agreement with the published data collected by conventional furnace heating, which is a slower and more inefficient process.
Life in a news desert: The perceived impact of a newspaper closure on community members
Authors: Mathews Nick
Published: September 2020

This study, utilizing 19 in-depth interviews, offers a systematic qualitative investigation of the perceived impact of a newspaper’s closure on community members’ everyday lives and their sense of community. Results demonstrate a negative impact on community members’ sense of community, with participants missing celebrated gatherings and noting increased isolation and diminished pride in their community. Findings also show the impact on residents’ daily lives, with one participant declaring ‘life is harder’ without the newspaper. Overall, these findings present a picture of life in Caroline County, Virginia, following the Caroline Progress’ closure after 99 years of service to the county.
The effect of high-pressure injection variations on the mixing state of underexpanded methane jets
Authors: Sakellarakis VD , Vera-Tudela W , Doll U , Ebi D , Wright YM , Boulouchos K
Published: September 2020

This work presents a joint experimental and numerical study of global characteristics and mixing behavior of underexpanded methane jets at high-pressure conditions in a Constant Volume Chamber. Injection pressures of 200, 250, and 300 bar and pressure ratios of 4, 5, 6, 8, and 10 at each of those pressures have been investigated. Tracer LIF with acetone as tracer has been applied to experimentally quantify the mixing of methane and quiescent air. In order to exploit the symmetry of the configuration, accompanying simulations have been carried out in Reynolds-Averaged Navier-Stokes framework with the k – w SST turbulence model and real-gas modelling based on the Soave-Redlich-Kwong Equation of State has been employed to account for high-pressure corrections in thermodynamic and caloric properties. The experiments confirm the hyperbolic decay of axial fuel concentration and the Gaussian shape of traverse concentration profiles in the self-similar region of the jets, while simulation results match well with experimentally determined fuel concentration fields. It is found that scaling laws proposed in literature for steady-state jet propagation can qualitatively interpret the effect of injection variations on jet tip penetration and volume. Increasing pressure ratio at fixed injection pressure leads to the formation of slightly richer jets, with slightly smaller mass percentage in the range of air-to-fuel ratios most favorable to autoignition. By contrast, increasing pressure ratio at fixed chamber pressure leads to virtually identical Probability Distribution Functions of local air-to-fuel ratios and the same is observed when employing a fixed pressure ratio at higher pressure levels.
Dyeless iliac vein stenting
Authors: Ahmed Taqwa , Chait Jesse , Kibrik Pavel , Alsheekh Ahmad , Ostrozshynskyy Yuriy , Hingorani Anil , Ascher Enrico
Published: September 2020

Objective

Iliac vein stenting is increasingly being explored for the treatment of chronic venous insufficiency. While venography is considered the gold standard for assessing iliac veins, some have proposed that intravascular ultrasound should be utilized instead due to its greater sensitivity at detecting stenotic lesions. Routinely, our service uses both intravascular ultrasound and venography, but we have noted that some patients cannot tolerate dye due to allergy, renal insufficiency, or deemed high-risk by the interventionalist due to uncontrolled medical co-morbidities. This study aimed to investigate whether forgoing dye had an impact on iliac vein stent thrombosis.

Methods

From 2012 to 2016, 1482 iliac vein procedures (91 intravascular ultrasound-only and 1391 intravascular ultrasound plus venography) were performed on 992 patients who failed conservative treatment for chronic venous insufficiency. Our mean patient age was 65.8 years (range 21–99; SD ± 14.3) with 347 male and 645 female patients. The clinical presenting symptoms per clinical–etiology–anatomy–pathophysiology classification for the intravascular ultrasound-only cohort were C1:0, C2:3, C3:31, C433, C5:5, C6:20 and for the intravascular ultrasound plus venography cohort were C1:0, C2:24, C3:566, C4:583, C5:30, C6:188. Stent thrombi that developed within or at 30 days of stenting were categorized as early and greater than 30 days as late. Transcutaneous duplex ultrasound classified stent thrombi as either partial or occlusive. Our average follow-up time was 19.4 months (0–42, SD ± 12.5).

Results

A total of 2.2% intravascular ultrasound-only patients versus 2.75% intravascular ultrasound plus venogram patients developed early stent thrombosis, p = 0.35. Early partial stent thrombosis occurred in 1.1% of the intravascular ultrasound-only group versus 2.6% of the intravascular ultrasound plus venogram group, p = 0.38. Early occlusive stent thromboses occurred in 1.1% of intravascular ultrasound-only patients and 0.15% of intravascular ultrasound plus venogram patients, p = 0.06. Late stent thromboses developed in 4% of patients in the intravascular ultrasound-only cohort and 4% in the intravascular ultrasound plus venogram cohort, p = 0.97. Late partial stent thromboses occurred in 2.7% of intravascular ultrasound-only patients versus 2.6% in intravascular ultrasound plus venogram patients, p = 0.99. Late occlusive stent thromboses occurred in 1.3% of intravascular ultrasound-only patients versus 1.4% of intravascular ultrasound plus venogram patients, p = 0.95. Moreover, the formation of any stent was 6.2% in the intravascular ultrasound-only versus 6.75% in the intravascular ultrasound plus venogram group, p = 0.55.

Conclusion

Results of our study show no significant difference in stent thrombosis between the intravascular ultrasound-only and intravascular ultrasound plus venogram cohorts. This concludes that using intravascular ultrasound alone is safe for iliac vein stenting.
Trajectory tracking control for quad-rotor system in the presence of velocity constraint
Authors: He Yuping , Zhang Shijie
Published: September 2020

This article mainly considers the problem of trajectory tracking control problem of quad-rotor system with velocity constrain under the consideration of safety. A model-based nonlinear controller is proposed which can guarantee not only the asymptotical stability for control system but also the velocity under a safe range. Firstly, based on backstepping design, a position tracking controller with velocity constraint is proposed to ensure that the desired position can be tracked with velocity constrains. At the second step, considering attitude subsystem, an attitude controller is proposed to improve the attitude dynamic response performance. Finally, the validity and superiority of the design has been verified in simulation results.
Parental health in fellowship trainees: Fellows’ satisfaction with current policies and interest in innovation
Authors: Marshall Ariela L , Dines Virginia , Wahner Hendrickson Andrea , Warsame Rahma , Thanarajasingam Gita , Thompson Carrie , Petterson Tanya , Wolanskyj-Spinner Alexandra
Published: September 2020

Background:

Parenthood during medical training is common and impacts trainee well-being. However, current graduate medical education parental health policies are often limited in scope. We explored current fellowship trainees’ knowledge of/satisfaction with current policies as well as interest in potential changes/additions to existing policies.

Methods:

Fellowship program directors/coordinators at a three-site academic institution were surveyed and information was collected from 2015 to 2019 regarding fellow demographics and parental health policies. We distributed an electronic survey to fellows containing Likert-type-scale questions rating knowledge/level of satisfaction with current parental health policies and interest in potential additions/modifications to current policies.

Results:

Thirty-five of 47 (74%) fellowship programs responded. An average of 11% of female fellows and 15% of male fellows took parental leave during the study period. Three (9%) of the programs had at least one additional parental health policy beyond institutional graduate medical education policies. In the fellow survey, 175 of 609 fellows responded (28.7%), of which 84 (48.6%) were female. Although 89.1% agreed/strongly agreed that parental health is an important part of health and well-being for fellows, only 32% were satisfied/very satisfied with current policies (no significant sex-related differences). Fellows reported the following potential interventions as important/very important: 79.2% increased (paid) maternity leave (72.7% male, 86.7% female, p = 0.02), 78% increased (paid) paternity leave (76.4% male, 81.9% female, p = 0.37), 72.3% part-time return to work (60.2% male, 84.3% female, p = 0.0005), 63% coverage for workup/management of infertility (52.3% male, 74.7% female, p = 0.002), and 79.9% on-site day care (70.7% male, 89.2% female, p = 0.003).

Conclusions:

Parental health includes multiple domains, not all of which are covered by current policies. Fellows feel that parental health is an important part of overall health and well-being, but most are not satisfied with current policies. Expanded access to parental leave and new policies (part-time return to work, infertility management, and on-site day care) are opportunities for innovation.
Increased perceptual distraction and task demand enhances gaze and non-biological cuing effects
Authors: Gregory Samantha EA , Jackson Margaret C
Published: September 2020

This study aims to improve understanding of how distracting information and target task demands influence the strength of gaze and non-biological (arrow and moving line) cuing effects. Using known non-predictive central cues, we manipulated the degree of distraction from additional information presented on the other side of the target, and target task difficulty. In Experiment 1, we used the traditional unilateral cuing task, where participants state the location of an asterisk and the non-target location is empty (no distraction). Experiment 2 comprised a harder localisation task (which side contains an embedded oddball item) and presented distracting target-related information on the other side. In Experiment 3, we used a discrimination task (upright or inverted embedded T) with distracter information that was unrelated or related to the target (low vs. high distraction, respectively). We found that the magnitude of cuing scaled with the degree of combined distraction and task demands, increasing up to six-fold from Experiments 1 and 2 to the high-distraction condition in Experiment 3. Thus, depleting attentional resources in this manner appears to weaken the ability to ignore uninformative directional cues. Findings are discussed within the framework of a resource-limited account of cue inhibition.