bluuebunny/crossref_metadata_2025 huggingface dataset:
Entrenching Democracy: Education and Cultural Participation in the Spanish Republican Army, 1936–1939
Authors: Bjerström Carl-Henrik
Published: August 2020

This article examines the mobilizing and legitimizing function of educational and cultural activities in the Spanish Republican Army during the Spanish Civil War, 1936–1939. Education and cultural participation played a crucial role in the Republican government’s attempts to co-opt left-wing revolutionary forces emboldened by the war and unite antagonistic constituencies in an inclusive, government-led war effort. Such attempts converged on the construction of a new conscript army, where investment in education was not solely a matter of military expediency but also a means to implement, in the crucible of war, important aspects of a reform programme initiated with the proclamation of the Spanish Second Republic in 1931. Consequently, the Republican Army did not only serve as the Republic’s armed defence force but also as a laboratory of political education in which both civil and military authorities could negotiate, articulate and disseminate new notions of Republican citizenship.

Drawing primarily on army records and trench journals from the Army of the Centre, the article shows how Republican educators and cultural workers employed a diverse range of techniques to deliver a reform programme designed to profoundly change Spanish politics and society. It also examines largely neglected questions of reception. Where soldiers’ engagement was forthcoming, educational activities could equip individuals with experiences and skills that were – and were understood to be – empowering. Yet in quantitative terms, rank-and-file engagement with educational activities was uneven and often quite limited. Contextual factors on all levels – international, national and local – impacted in various ways on soldiers’ educational and cultural participation, but ultimately it was the impending defeat of the Republic that undermined most soldiers’ willingness to engage. As a positive progressive vision of a future Republic faded among the debris of destroyed buildings, enthusiasm for a Republican educational programme inevitably faded too.
Normoxic management of cardiopulmonary bypass reduces myocardial oxidative stress in adult patients undergoing coronary artery bypass graft surgery
Authors: Topcu Ahmet Can , Bolukcu Ahmet , Ozeren Kamile , Kavasoglu Tugba , Kayacioglu Ilyas
Published: August 2020

Introduction:

We aimed to investigate whether normoxic cardiopulmonary bypass would limit myocardial oxidative stress in adults undergoing coronary artery bypass grafting.

Methods:

Patients scheduled to undergo elective isolated on-pump coronary artery bypass grafting were randomized to normoxia and hyperoxia groups. The normoxia group received 35% oxygen during anesthetic induction, 35% during hypothermic bypass, and 45% during rewarming. The hyperoxia group received 70%, 50%, and 70% oxygen, respectively. Coronary sinus blood samples were taken prior to initiation of cardiopulmonary bypass and after reperfusion for myocardial total oxidant and antioxidant status measurements. The primary endpoint was myocardial total oxidant status. Secondary endpoints were myocardial total antioxidant status and length of intensive care unit and hospital stay.

Results:

Forty-eight patients were included. Twenty-two received normoxic management. Mean ± standard deviation of age was 58 ± 9.07 years. Groups were balanced in terms of demographics, risk factors, and operative data. Myocardial total oxidant status was significantly lower in the normoxia group following reperfusion (p = 0.03). There was no statistically significant difference regarding myocardial total antioxidant status and length of intensive care unit and hospital stay (p = 0.08, p = 0.82, and p = 0.54, respectively).

Conclusions:

Normoxic cardiopulmonary bypass is associated with reduced myocardial oxidative stress compared to hyperoxic cardiopulmonary bypass in adult coronary artery bypass patients.
Deriving Daily Activity Schedules from Dynamic, Purpose-Dependent Origin–Destination Matrices
Authors: Ballis Haris , Dimitriou Loukas
Published: August 2020

Emerging transport modeling approaches such as agent/activity-based modeling as well as the shift toward data-driven paradigm have stressed the need for high-quality travel behavior data at a disaggregate level. Despite the advances in personal mobility tracking and capturing, aggregate methods such as origin–destination (OD) matrices are still the most widespread means to organize and represent travel demand information. Nonetheless, traditional ODs cannot directly capture substantial elements which can considerably affect travel behavior (e.g., trip interdependency, trip chaining, etc.) therefore they are not the most suitable mean to facilitate relevant analysis. The currently presented framework alleviates this limitation by combining the individual trips present in multi-period, purpose-dependent OD matrices into sequences of trips originating and ending at users’ home location (i.e., tours). This is achieved by integrating graph-theoretical with combinatorial optimization concepts. A graph theory-based methodology is applied to first examine the spatiotemporal information in ODs and then identify all the plausible tours. Then the sequence of activities (i.e., daily activity schedule [DAS]) taking place during each diurnal tour is inferred based on the trip-purpose information contained in the original ODs. Finally, a combinatorial optimization routine identifies the optimum combination of DAS whose aggregated trips represent the total travel demand as observed in the OD matrices. The resulting DAS by the proposed estimation framework has proven to be of significant accuracy and provide valuable information in relation to the characteristics of the population’s travel behavior within the urban space environment. This information is particularly useful to mitigate against the upcoming challenges in the field of smart mobility management.
Improving Durability of Asphalt Pavements in Louisiana through Increased In-Place Field Density
Authors: Akentuna Moses , Mohammad Louay N. , Kim Minkyum , Cooper Samuel B. , Cooper Samuel B.
Published: August 2020

The objective of this project was to evaluate the effects of increasing the initial in-place density of asphalt pavements on expected field performance and durability. This study was completed as part of the FHWA’s demonstration project on “Enhanced Durability through Increased In-Place Pavement Density.” Two approaches for increasing in-place density were explored: (i) the addition of an Evotherm warm-mix asphalt (WMA) additive at a dosage rate of 0.6% by the weight of mix; and (ii) the addition of 0.2% asphalt binder (Plus AC) to the design optimum asphalt binder content of standard dense-graded mixtures. The field component of the research involved three 4,000-ft long test sections representing control hot-mix asphalt (HMA) mixtures, Evotherm WMA mixtures, and the Plus AC HMA mixtures. Each test section included a binder and a wearing course for a total of six mixtures. Density measurements were determined in the laboratory from field cores taken at each test section. The high- and intermediate-temperature properties of field cores were evaluated using the Loaded Wheel Tracking and Semi-Circular Bending tests, respectively. Further, the Indirect Tensile Dynamic Modulus (IDT |E*|) test was conducted for full viscoelastic characterization of the asphalt mixtures. The two approaches considered in this study were successful in increasing field density, especially for the binder course mixtures. The two strategies for increasing in-place density also resulted in better than expected resistance to cracking and rutting, as well as an increase in mixture stiffness as measured by the IDT |E*|.
Differential Item and Test Functioning of the Autism Spectrum Rating Scales: A Follow-Up Evaluation in a Diverse, Nonclinical Sample
Authors: McClain Maryellen Brunson , Harris Bryn , Schwartz Sarah E. , Golson Megan E.
Published: August 2020

Although the racial/ethnic demographics in the United States are changing, few studies evaluate the cultural and linguistic responsiveness of commonly used autism spectrum disorder screening and diagnostic assessment measures. The purpose of this study is to evaluate item and test functioning of the Autism Spectrum Rating Scales (ASRS) in a sample of racially/ethnically diverse parents of children (nonclinical) between the ages of 6–18 ( N = 806). This study is a follow-up to a prior publication examining the factor structure of the ASRS among a similar sample. The present study furthers the examination of measurement invariance of the ASRS in racially/ethnically diverse populations by conducting differential item functioning and differential test functioning with a larger sample. Results indicate test-level invariance; however, five items are noninvariant across parent reporters from different racial/ethnic groups. Implications for practice and directions for future research are discussed.
Psychometric Properties of the Teachers’ Sense of Efficacy Scale for Chinese Special Education Teachers
Authors: Lu Ming-Hui , Pang Fei-Fan , Chen Xiao-Meng , Zou Yu-Qing , Chen Jia-Wei , Liang Di-Chao
Published: August 2020

Teacher self-efficacy plays an important role in special education; yet, the literature on the measurement of teacher self-efficacy in this field is limited. This study investigated the psychometric properties of the Teachers’ Sense of Efficacy Scale with a sample of Chinese special education teachers ( N = 401, 24.19% male). Confirmatory factor analysis indicated that the Chinese special educational version of the Teacher's Sense of Efficacy Scale (CS-TSES), modified from the Asian model by Ruan, J., Nie, Y., Hong, J., Monobe, G., Zheng, G., Kambara, H., & You, S. (2015). Cross-cultural validation of teachers’ sense of efficacy scale in three Asian countries. Journal of Psychoeducational Assessment, 33(8), 769-779, showed an excellent fit. Additionally, correlations were observed between the results of the CS-TSES and both the Multidimensional Scale of Perceived Social Support and the Satisfaction with Life Scale, providing criterion-related validity. In sum, the findings indicated that the TSES is applicable to special education teachers in the Chinese context.
From Racial to Reparative Planning: Confronting the White Side of Planning
Authors: Williams Rashad Akeem
Published: August 2020

This paper advances a conceptual apparatus capable of accounting for planning’s entanglement with white supremacy and racial capitalism by developing a theory of racial planning. Racial planning, as the public production of racialized space, has been at the heart of the American planning tradition. It argues that racial planning occurs via three modes (public and private action and public inaction) and that it serves both the expropriative character of racial capitalism and the status hierarchy of white supremacy. The paper concludes with a normative call for the field to embrace reparations via a reparative planning.
Security in the absence of a state: Traditional authority, livestock trading, and maritime piracy in northern Somalia
Authors: Acharya Avidit , Harding Robin , Harris J. Andrew
Published: August 2020

Without a strong state, how do institutions emerge to limit the impact of one group’s predation on another’s economic activities? Motivated by the case of northern Somalia, we develop a model that highlights the monitoring challenges that groups face in making cooperation self-enforcing, and two key factors that influence their likelihood of overcoming this challenge: the ratio of economic interests across productive and predatory sectors, and the existence of informal income-sharing institutions. Our model explains why conflicts between pirates and livestock traders can be resolved in the region of Somaliland, where the ratio of economic interests favors the productive sector and traditional institutions promote income sharing between groups, but not in the region of Puntland, where these conditions do not hold. The model also accounts for several of the empirical patterns in the relationships between piracy, livestock exports, and conflict in both regions.
Effect of graphite addition on mechanical properties of Al2O3 ceramics by directed laser deposition
Authors: Xu Yuan , Yu Chao , Miao Qiu-yu , Yan Shuai , Ma Guang-yi
Published: August 2020

In this article, graphite-reinforced Al2O3 ceramic materials were prepared by directed laser deposition. The effects of graphite addition (3–12 wt.%) on the phase composition, microhardness and fracture toughness of Al2O3 ceramics were studied. The results showed that the process was beneficial for maintaining uniform mixing of graphite and ceramics and thus could avoid the delamination caused by the difference in their densities. When adding 6% and 9% graphite, there were fewer internal defects in the samples, and no obvious new phase was generated after adding more graphite. The microhardness of 6% and 9% graphite-reinforced Al2O3 ceramics reached 18.84 and 18.86 GPa, respectively, and it was close to that of pure Al2O3 ceramics. The microhardness of all graphite-reinforced Al2O3 materials was lower than that of pure Al2O3 ceramics, but the value increased first and then decreased with addition of more graphite. The change in microhardness was similar to the trend of the number of defects, thus, these newly forming defects were an important factor affecting the microhardness. With an increase in graphite addition, the fracture toughness increased gradually. Furthermore, the fracture toughness reached 5.89 MPa m1/2 at 12% graphite addition, which was higher than 4.82 MPa m1/2 of pure Al2O3 ceramics. Adding more graphite was beneficial in enhancing the deflection and pinning of the graphite particles against cracks, resulting in higher fracture toughness. Graphite can improve the fracture toughness of Al2O3 ceramic, prepared by directed laser deposition, and the method can solve the uneven distribution caused by the difference in densities between the two powders. This also provides a new idea for the rapid manufacture of high-toughness ceramic parts at lower cost.
Recent trends in sexually transmitted infections among adolescents, Catalonia, Spain, 2012–2017
Authors: Vives N , Garcia de Olalla P , González V , Barrabeig I , Clotet L , Danés M , Borrell N , Casabona J ,   the Catalan HIV and STI Surveillance Group
Published: August 2020

Monitoring sexually transmitted infections (STIs) in adolescents is essential to inform STI prevention strategies at primary and secondary levels in this key population. We aim to describe recent trends in STIs among adolescents and to analyse their socio-demographic and behavioural characteristics in Catalonia, Spain between 2012 and 2017. Data on Chlamydia trachomatis (CT) infection, gonorrhoea and syphilis cases aged from 13 to 19 years reported to the Catalan Mandatory Notifiable System from 2012 to 2017 were analysed. Diagnosis rates were calculated and a descriptive analysis was performed. Between 2012 and 2017, CT infection, gonorrhoea and syphilis cases reported among adolescents aged 13–19 years accounted for more than one-eleventh of all reported cases in Catalonia. The rate of the three nationally-notifiable STIs increased dramatically among adolescents. CT infection rates rose from 13 to 144.1 per 100,000 adolescents between 2012 and 2017, an increase of 1007%; gonorrhoea cases increased by 246% (from 13.4 to 45.4/100,000) and syphilis cases increased by 247% (from 1.7 to 5.9/100,000). Gonorrhoea and syphilis cases affected mainly males while CT infection cases were mostly in females (84%). Adolescents are being increasingly affected by CT infection, gonorrhoea and syphilis. A broader array of intervention strategies aimed at adolescents should be reinforced through strong prevention campaigns, improved sexual health information, as well as encouragement of regular offers of STI screening by healthcare providers.
Participants’ Perspectives on Healthcare Service Quality in Multispecialty Hospitals: A Qualitative Approach
Authors: Upadhyai Raghav , Jain Arvind K. , Roy Hiranmoy , Pant Vimal
Published: August 2020

Professional services like healthcare operate with high degree of information asymmetry, where usually the seeker of service lacks knowledge and skills, and as a result, they cannot evaluate the benefits. Alternative indicators in the service delivery are sought by the seekers to bring evenness in their evaluation, which might not be reflective of providers’ perspectives of care. This study attempts to explore perspectives of both the participants in healthcare service delivery in multispecialty hospital settings. Semi-structured interviews were conducted using snowball sampling with doctors, paramedical staff and managers in multispecialty hospitals and patients and their attendants who have visited the same set of hospitals during past one year. The narratives of the respondents based on a priori interview themes were converted into textual data. Template analysis technique was used to thematically analyse and present the results. Differing accounts of two participants emerged out of the analysis and a gap between providers’ and seekers’ perspectives of each other’s expectations and perceptions of performance was observed. This study is a novel attempt to simultaneously account for both the participants’ perspectives to present a holistic picture rather than a one-sided view of healthcare service quality.
Maritime Theory Approach for Functional Effectiveness in the Indo-Pacific
Authors: Johnson Odakkal , Choudhury Priyanka
Published: August 2020

The Indo-Pacific region is a centre of gravity for the world’s economic, political and strategic interests. It is a home of world’s most densely inhabited states, different forms of governance and includes over half of the world’s population. It is also a theatre of great power politics, competition and rivalry. Piracy in the vital choke points, dispute on the South China Sea and rising China factor in the Indian Ocean are some of the challenges faced in this region. As the maritime domain is unique, cooperation among nations is necessary to ensure peace in the region. Therefore, a maritime theory approach is needed to study good order at sea.

Having laid down the emerging mandate of economic interaction across the global, regional and subregional canvas, there is a need for evolving functional mechanisms to ensure interoperability and progressing the overarching mandate. This will further ensure a cooperative solution in the maritime dimension. It also becomes a vital bridge between the apex policymaking and the basic execution of a decisive transaction. The Indo-Pacific region needs mutual cooperation for economic development and threat management. India is rightly positioned to be the facilitator through existing initiatives and harness potential opportunities.

This article examines the aspect of functional mechanisms under the maritime theory approach in the Indo-Pacific. Nations can be encouraged to connect through efforts such as Indian Ocean Naval Symposium (IONS) and Project Mausam to collaborate and bring complementarity. With the region growing significant each day, the development of mutual partnership is of utmost importance. Keeping three principles of workable options, harmonising individual strength and taking all along, the Indo-Pacific nations can build lasting peace and stability in the region.
The average consumer is not a lawyer! Case C-66/19 JC v Kreissparkasse Saarlouis
Authors: Rott Peter
Published: August 2020

The Court of Justice had to decide on the transparency of information on the right of withdrawal in consumer credit law. Under German law, the creditor could describe the start of the withdrawal period by mere reference to a legal provision which then referred to other legal provisions which the consumer then had to interpret, which the Court of Justice considered to be lacking in transparency. In the background, there was a conflict between the referring court and the German Federal Supreme Court on the legal competence of the average consumer that the Court of Justice decided in favour of the referring court.
Challenges and Sensitivities in Assessing Total Ecosystem Service Values: Lessons From Vanuatu for the Pacific
Authors: Buckwell Andrew J. , Fleming Christopher , Smart James C. R. , Ware Dan , Mackey Brendan
Published: August 2020

Ecosystem service valuation (ESV) can inform land-use change policy and adaptation responses to climate change in Pacific Small Island Developing States. Despite Small Island Developing States communities relying acutely and directly on ecosystem service (ES) flows, methodologies must contend with limited valuation data and challenges. We undertake ESV to generate coefficients we then apply to mapped habitat extents for Vanuatu. We find the contribution of ESs to the people of Vanuatu is considerable and significantly larger than its gross domestic product. Therefore, policies that support ecologically sustainable exploitation of ESs are paramount in promoting community well-being. We also identify and discuss context-specific methodological challenges, which, if not addressed, risk distorting valuations, supporting perverse policy responses, and eroding confidence in ESV. We make recommendations to address the challenges of accounting for ecosystem condition, data gaps, and consideration of customary benefits, provide context to the interpretation of our results, and suggest where further research can ameliorate risks.
Online measuring and estimating methods for the unbalancing vector of thin-disc workpiece based on the adaptive influence coefficient
Authors: Zhang Shihai , Zhang Zimiao
Published: August 2020

The thin-disc part is the common part of the rotary mechanism. Because of the large rotating radius of the thin-disc part, the huge unbalancing vector may be formed even if the unbalancing mass is small. So, the unbalance of the thin-disc part is the important exciting factor of the rotary mechanism vibration. Based on the structural characteristics of the thin-disc part, the measuring and estimating methods for the unbalancing vector of the thin-disc workpiece are proposed based on the single-face influence coefficient method. The least square method is introduced to fit the fundamental frequency component from the vibration monitoring signal, and the fundamental frequency component is taken as the unbalancing vibration signal of spindle first. The influence coefficient between the trial weight face and vibration monitoring point on the spindle is tested by trial weight experiments second. The unbalancing vibration difference of the spindle, before and after the thin-disc workpiece is clamped, is monitored and used to estimate the unbalancing vector of the thin-disc workpiece based on the linear reversible principle of unbalancing excitation and vibration response. The signal separation accuracy of the least square method for unbalancing vibration has been proved by simulation and experiment methods. Considering that the accuracy of the influence coefficient may be influenced by the change of the spindle system kinetic characteristic parameters, the signal measurement, analysis error, etc., the adaptive method for the influence coefficient is proposed and proved by the experiment method in the article. The research results show that the unbalancing vector of the thin-disc workpiece can be measured and estimated before the workpiece is taken down from the machine tool spindle. The proposed method can be used to measure and estimate the unbalancing vector of the thin-disc workpiece without dynamic balancing machine, and the measuring efficiency and accuracy can be improved; the measuring cost can be reduced.
Dissecting the Cardiac Conduction System: Is It Worthwhile?
Authors: Tan Serena Y , Fritsch Michael K , White Steven , Arva Nicoleta C
Published: August 2020

Background

Pathologic examination of conduction system (CS) is not routinely performed, and histologic changes are mostly reported in forensic practice.

Methods

We studied the value of dissecting the CS in a cohort of pediatric patients with unexplained sudden death or severe, inexplicable arrhythmias. Histopathologic changes present in CS components were recorded and correlated with findings noted in other cardiac structures.

Results

Twenty-one subjects (11 unexplained sudden deaths and 10 life-threatening arrhythmias) were identified; 18 (86%) had CS pathologic abnormalities. In 13 patients (62%), the CS findings mirrored those found in other cardiac sections (inflammation, allograft vasculopathy, vascular fibromuscular dysplasia, cardiomyopathy-related changes, and tumor/tumor-like conditions). Five cases (24%) had abnormalities restricted to CS (bundle of His [BH] with fibrotic scar and patch material following ventricular septal defect repair, inflammation, BH with fibrosis and calcifications, and intimal fibroplasia of sinoatrial node artery).

Conclusions

Pathologic changes within the CS are present in a high number of pediatric patients presenting with unexplained sudden death or life-threatening arrhythmias. Frequently, the findings mirror those observed in other cardiac structures. However, in a significant number of cases (24%), the changes are restricted to CS and likely explain the patients’ symptoms or cause of death, suggesting that systematic dissection of CS unveils valuable information.
Improving the Accuracy of Firearm Identification in a Dynamic Use of Force Scenario
Authors: Martaindale M. Hunter
Published: August 2020

Law enforcement officers are sometimes required to make split-second use of force decisions. One factor that can impact their decision-making process is the presence of a weapon. This experiment sought to improve the speed and accuracy of weapon identification in a dynamic use of force scenario through the principles of deliberate practice. This research utilized randomized control trial with random assignment to either a control or test condition. Eighty-seven participants completed the pretest, intervention, and posttest. Participants’ vision was recorded via a mobile vision-tracker. With only 20 minutes of training, the test group made 1/3 the amount of decision errors as the control group (Cohen’s d = 0.95). The test group was about 16% faster than the control group at visually finding the object in the suspect’s hand and determining if it was a gun or not (Cohen’s d = 0.91).
Uncommon Adverse Effects of Deoxycholic Acid Injection for Submental Fullness: Beyond the Clinical Trials
Authors: Metzger Kristy C. , Crowley Erika L. , Kadlubowska Dorota , Gooderham Melinda J.
Published: August 2020

Deoxycholic acid (BELKYRATM, Allergan, Markham, ON, Canada) is a minimally invasive injectable treatment approved by Health Canada for the nonsurgical reduction of submental fullness. Multiple phase III clinical trials have proven the efficacy and safety of deoxycholic acid. In the clinical trials, the most common adverse events (AEs) reported, such as injection site pain, numbness, swelling, bruising and induration, were transient and mild-to-moderate in severity. Additional postmarketing AEs have been reported in the literature. In this study, we reviewed the uncommon reported events and aimed to increase clinician awareness of the potential adverse effects for patient counselling of risks and benefits, identify AEs of procedures that may be performed outside of the medical environment, and identify factors that increase the risk of an adverse event. Beyond the clinical trials, real-world case reports and case series have been reported for the AEs of alopecia, transient neuropraxia, vascular occlusive events/vascular injury, and skin necrosis. Dermatologists need to be aware of these risks, for the treatment and management of their own patients and for those patients who may be treated outside the medical clinic environment that present for medical management of these AEs.
Lifetime experiences of violence against women and men in Sweden
Authors: Öberg Mariella , Heimer Gun , Lucas Steven
Published: August 2020

Aims: The aims of this cross-sectional study were to examine the prevalence of lifetime exposure to sexual, physical and psychological violence among a representative sample of women and men in Sweden, and to analyze if there were gender differences regarding the types of violence the participants were exposed to and by whom it was perpetrated. Methods: A survey containing questions about lifetime experiences of sexual, physical and psychological violence was sent to a national sample of 10,000 women and 10,000 men aged 18–74; 56.8% of the women and 46.5% of the men agreed to participate. Results: Sexual violence in childhood was reported by 26.4% of women and 22.1% experienced sexual violence in adulthood. Among men, 11% disclosed experiences of sexual violence in childhood and 4.5% in adulthood. Physical violence was experienced by 39.3% of women in childhood and by 18.8% as adults, often by a present or former partner. Among men, 59.3% were exposed to physical violence during childhood, often by a peer, and 20.4% as adults. Psychological violence in childhood was experienced by 58.1% of women in childhood and by 21.8% in adulthood. Among male respondents, 69.2% reported experiences of physiological violence in childhood, often by a peer, and 9.4% in adulthood. Conclusions: Lifetime violence exposure is common in the Swedish population. Though it affects both women and men, the patterns of type of violence and perpetrators are different. The results suggest that violence prevention early in life is important to target.
An online mobile/desktop application for supporting sustainable chronic disease self-management and lifestyle change
Authors: Aria Reza , Archer Norman
Published: August 2020

Health self-management has become a new trend in healthcare management due to its effectiveness in improving patient health, quality of life, and life satisfaction and simultaneously reducing the cost of care. To evaluate the potential of mobile health, we developed an online health self-management system for mobile or desktop environment to help patients self-manage their health in home settings. Certain elements (e.g. education, entertainment, and rewards) were built into the system to encourage patients to both adopt and continue using it. The system was shown to two groups of patients: an Internet-panel group of 198 patients with one or more serious chronic illnesses and 83 peripheral arterial disease patients in an in-person study group. A statistical model based on Unified Theory of Acceptance and use of Technology in a consumer context was used to analyze the results. The results from both groups confirmed that such systems, from the perspectives of patients (in a “pre-use” stage), are useful, beneficial, and rewarding to use.
Efficacy and Safety of Ketamine in Refractory/Super-refractory Nonconvulsive Status Epilepticus: Single-Center Experience
Authors: Dericioglu Nese , Arslan Doruk , Arsava Ethem Murat , Topcuoglu Mehmet Akif
Published: August 2020

Refractory/super-refractory nonconvulsive status epilepticus (r/srNCSE) is an acute life-threatening neurocritical entity with significant morbidity. Failure to control SE in its earlier stages leads to multiple molecular alterations in the brain such as downregulation of GABA-A and upregulation of NMDA receptors. Recently ketamine, an NMDA receptor antagonist, has gained increased attention as a therapeutic choice in controlling refractory/super-refractory SE. We aimed to analyze the efficacy and safety profile of ketamine in our center. We retrospectively identified all the patients with nonconvulsive SE who received ketamine during their follow-up in our neurological intensive care unit between 2009 and 2019. Information about demographic, clinical, and laboratory findings; concurrent antiseizure and anesthetic medications; time of initiation, dose and duration of ketamine infusion; any adverse effects and finally prognosis were collected. The effect of day of ketamine initiation and duration of infusion on ketamine efficacy were analyzed statistically. Seven patients (4 males, 3 females; age: 44-86 years) were included in the study. Encephalitis was the most common etiology. Concurrent antiseizure medications varied between 2 and 5. Six patients received midazolam before/during ketamine infusion. Ketamine was initiated 2 to 7 days after the onset of EEG monitoring and lasted 3 to 24 days with a maximum infusion dose ranging between 1 to 5 mg/kg/h. It was definitely effective in 4 patients, and possibly effective in an additional patient. Earlier initiation was correlated with higher efficacy ( P = .047). There was a trend toward higher efficacy with longer duration of infusion ( P = .285). Overall prognosis was poor with 29% mortality rate. Temporary hepatic failure occurred in 1 patient. Ketamine appears to be a promising drug in r/srNCSE. Earlier and prolonged infusion, as well as combination with benzodiazepines may increase its efficacy. Adverse events are rarely observed.
Development of an improved design methodology and front steering design guideline for small-wheel bicycles for better stability and performance
Authors: Paudel Milan , Yap Fook Fah
Published: August 2020

The maneuverability and compactness of small-wheel and folding bicycles are greatly appreciated. Nonetheless, the performance of these small-wheel bicycles as compared to the big-wheel bicycles has always been questioned. They are often blamed for being less stable, wobbly, or twitchy. It is still unclear how the performance of the small-wheel bicycle designs can be improved. Both small- and big-wheel bicycles are designed with similar ergonomics; therefore, the focus has been on the front steering design. The steering design parameters of 91 big-wheel and 27 small-wheel bicycles were compared, bearing in mind the available front steering design guidelines to understand: (1) the influence of big-wheel bicycle’s frame design on small-wheel bicycles and (2) most common range of design parameters used in current bicycle designs. The analysis showed a strong influence of current big-wheel bicycle design practice on front frame parameter selection of small-wheel bicycles. Furthermore, the self-stability comparison over the most common design range confirmed the lesser stability in the current small-wheel bicycle designs at normal riding speed. However, it was also found that the lesser stability was not the result of small wheels per se, but rather owing to an inadequacy in the current design approach to addressing the complex influence of reducing wheel size and bicycle frame design on its stability and performance. Therefore, an improved design methodology was adopted by incorporating the bicycle dynamics into the current design approach and the front steering design guidelines for small-wheel bicycles have been developed. The guidelines contradict the current small-wheel bicycle design practice, as they recommend steeper headtube angles for small-wheel bicycles. The guidelines were validated with good agreement between the theoretical and experimental results on two prototype 20-inch-wheel bicycles having counter-intuitive steering geometry.
Populist Anti-Scientism, Religious Polarisation, and Institutionalised Corruption: How Indonesia’s Democratic Decline Shaped Its COVID-19 Response
Authors: Mietzner Marcus
Published: August 2020

There is widespread agreement that compared to most other states in Southeast Asia, Indonesia’s central government has offered a poor response to the coronavirus disease 2019 (COVID-19) outbreak. The government of President Joko Widodo initially ignored the threat, and when it did react, the crisis policies were piecemeal and confusing. But what explains this outcome? It would be easy to attribute Indonesia’s response to its lower middle-income status or its democratic governance structures that lack strong repressive capacity. With countries poorer and more democratic than Indonesia performing better, however, this explanation is unsatisfactory. Going beyond simple development and regime categories, this article proposes that Indonesia’s COVID-19 response was the result of its specific process of democratic decline in the last decade. This backsliding produced intensifying populist anti-scientism, religious conservatism, religio-political polarisation, corruption and clientelism, as well as assertiveness among anti-democratic actors. Ultimately, these segmental factors combined into a toxic mix that severely constrained Indonesia’s ability to effectively respond to a massive external shock such as COVID-19.
Through the Lens of Chronic Kidney Disease: A Qualitative Study of the Experiences of Young Women Living With CKD
Authors: Beanlands Heather , McCay Elizabeth , Pahati Sheryll , Hladunewich Michelle A.
Published: August 2020

Background:

Young women may be particularly vulnerable to the negative psychosocial consequences of living with chronic kidney disease (CKD). To date, little is known about how women themselves experience and manage their illness.

Objectives:

This study explored the experiences of young women living with CKD.

Design:

Qualitative descriptive study.

Setting:

Nephrology program in an urban setting in Ontario, Canada.

Participants:

Women with category G1-3 glomerular-based CKD between 18 and 40 years of age.

Methods:

Focus group discussions guided by semi-structured interview questions. Qualitative content analysis was used to analyze interview transcripts.

Results:

Eleven women participated in 3 separate focus group discussions. Participants described living life through the lens of CKD, which was the central theme unifying their experiences of encountering CKD, re-encountering CKD, and getting on with life. Life decisions significant to women like pursuing a career or motherhood were often colored by CKD, particularly by illness-related challenges, such as unsatisfactory health care support and the physical implications of chronic illness. The women used a variety of strategies including seeking information and relying on supportive people to mitigate these challenges. Although these strategies sometimes enabled them to balance the demands of illness with other life priorities, the lack of resources directed toward their unique needs as young women with CKD often caused them difficulties in managing their illness.

Limitations:

Participants were from one nephrology program in an urban setting and were well educated overall. Their experiences may not be reflective of young women in other settings or from diverse backgrounds.

Conclusions:

The women’s emotional well-being and life choices were considerably influenced by CKD. Although the women were often able to manage challenges associated with CKD, they acknowledged the need to seek additional professional resources to complement their own self-identified strategies. As the women sought out these supports, they identified gaps in resources specific to women with CKD. This article summarizes recommendations from their perspective.

Trial Registration:

Not applicable as this was a qualitative study.
Women With Generalized Anxiety Disorder Show Increased Repetitive Negative Thinking During the Luteal Phase of the Menstrual Cycle
Authors: Li Sophie H. , Denson Thomas F. , Graham Bronwyn M.
Published: August 2020

Repetitive negative thinking (RNT) is a transdiagnostic feature of psychiatric disorders. Women report greater RNT than do men, yet the association between uniquely female characteristics, such as fluctuating sex hormones during the menstrual cycle, and RNT has not been established. Here we examined changes in RNT and anxiety symptoms across the menstrual cycle in women with ( n = 40) and without ( n = 41) generalized anxiety disorder (GAD). Women with GAD reported an increase in RNT and negative affect from the follicular phase to the luteal phase; unexpectedly, this was not associated with changes in anxiety symptoms, estradiol, or progesterone. Nonanxious women reported no changes in RNT or anxiety symptoms over the menstrual cycle, but higher within-participants progesterone was associated with reduced RNT and negative affect. These results indicate that uniquely female biological processes may influence core cognitive processes that underlie anxiety disorders, but further investigations to determine the implications for symptom severity are required.
The Spine Physical Examination Using Telemedicine: Strategies and Best Practices
Authors: Iyer Sravisht , Shafi Karim , Lovecchio Francis , Turner Robert , Albert Todd J. , Kim Han Jo , Press Joel , Katsuura Yoshihiro , Sandhu Harvinder , Schwab Frank , Qureshi Sheeraz
Published: August 2020

Study Design:

Technical note.

Objectives:

To provide spine surgeons new to telemedicine with a structured physical examination technique based on manual motor testing principles.

Methods:

Expert experience describing a series of specific maneuvers for upper and lower extremity strength testing that can be performed using a telemedicine platform. In addition, we offer instruction on “setting up” for these visits and highlight special tests that can be used to diagnose specific cervical and lumbar spine conditions.

Results:

From our experiences in conducting telemedicine visits, we provide a means of testing and scoring upper and lower extremity strength for interpretation of weakness in the context of traditional manual motor testing. Also, we acknowledge the limitations of a remote examination and discuss maneuvers that cannot be performed remotely.

Conclusions:

COVID-19 has drastically altered the delivery of care for patients with spine-related complaints. The need for social distancing has led to the widespread adoption of telemedicine. This technical note provides an urgently needed framework for the standardization of the remote physical exam. Validation of the exam as a diagnostic tool will be a crucial next step in studying the impact of telemedicine.
Minimally Invasive Lateral Corpectomy of the Thoracolumbar Spine: A Case Series of 20 Patients
Authors: Le Hai , Barber Joshua , Phan Eileen , Hurley Richard K. , Javidan Yashar
Published: August 2020

Study Design:

Retrospective case series.

Objective:

To report our experience with corpectomy of the thoracolumbar (TL) spine through a minimally invasive lateral retropleural or retroperitoneal approach.

Methods:

This is a retrospective case series of 20 consecutive patients who underwent minimally invasive TL corpectomy and spinal reconstruction. Electronic medical records were reviewed for demographic, operative, and clinical outcome data.

Results:

Between 2015 and 2019, 20 consecutive cases of minimally invasive TL corpectomy were performed, comprising 12 men (60%) and 8 women (40%) with a mean age of 54.3 years. Indications for surgery were infection (n = 6, 30%), metastatic disease (n = 2, 10%), fracture (n = 6, 30%), and calcified disc herniation (n = 6, 30%). Partial and complete corpectomy was performed in 5 patients (25%) and 15 patients (75%), respectively. Mean operative time and estimated blood loss was 276.2 minutes and 558.4 mL, respectively. Mean length of stay from admission and surgery were 14.6 and 11.4 days, respectively. Mean length of stay from surgery for elective cases was 4.2 days. Mean follow-up time was 330.4 days. Visual analogue scale score improved from 7.7 to 4.5 ( P < .01). There were a total of 3 postoperative complications in 2 patients, including 1 mortality for urosepsis. One patient had revision spinal surgery for adjacent segment disease.

Conclusions:

Corpectomy and reconstruction of the TL spine is feasible and safe using a minimally invasive lateral retropleural or retroperitoneal approach. Since this is a relatively new technique, more studies are needed to compare the short- and long-term radiographic and clinical outcomes between minimally invasive versus open corpectomy of the TL spine.
Impact on Dental Economics and Dental Healthcare Utilization in COVID-19: An Exploratory Study
Authors: Patel Naiya
Published: August 2020

Aim:

The current exploratory research establishes a correlation between the general unemployment rate due to COVID-19 and its effect on dental healthcare service utilization, workforce, and education attainments.

Materials and methods:

The conceptual model utilized in the study is the circular flow diagram explaining economy organization. The study is an exploratory research review. PRISMA guidelines are followed for the review of articles. The literature data for the current review study is obtained from Web of Science, Statista, Grey Literature like, the Federal Bank St. Louis, American Dental Association (ADA), Health Policy Institute, to justify the economic impact in the dental industry sector. The search terms employed to search for literature from the Web of Science database are “Dental” and “COVID-19.” Only research articles published in the past one year in English language are included as the final sample of literature review. Statista, Federal Bank, and ADA are utilized to take into consideration evolving economic impact data due to COVID-19.

Results:

Much less of research has been performed on the impact of COVID-19 on dental economics, and this study is one of the insights of projections about COVID-19 impact in the dental healthcare sector. The projected hardships of the economy during and post pandemic demand for timely measures in place. The dental regulating bodies must undertake those protocols to save the dental healthcare industry.

Conclusions:

Unlike other healthcare sectors, the impact of COVID-19 will disproportionately affect the dental healthcare sector for several reasons. Given dental healthcare services aid in generating nation’s revenue like any other sector, it demands urgent actions from regulating authorities.
Isolated Erythrocytosis Associated With 3 Novel Missense Mutations in the EGLN1 Gene
Authors: Moore Joseph A. , Hubbi Maimon E. , Wang Chenliang , Wang Yingfei , Luo Weibo , Hofmann Sandra , Rambally Siayareh
Published: August 2020

Hypoxia-inducible factor-1 (HIF-1) is a key regulator of erythropoiesis. In this article, we report 3 novel mutations, P378S, A385T, and G206C, on the EGLN1 gene encoding the negative HIF-1α regulator prolyl hydroxylase domain-2 (PHD2) in 3 patients with isolated erythrocytosis. These mutations impair PHD2 protein stability and partially reduce PHD2 activity, leading to increased HIF-1α protein levels in cultured cells.
An Unusual Case of Drug-Induced Thrombocytopenia
Authors: Wang Shiyu , Sawalha Khalid , Khan Atif
Published: August 2020

Drug-induced thrombocytopenia (DIT) is a differential diagnosis for consideration when acute thrombocytopenia is encountered in the outpatient or inpatient setting. The mechanism of thrombocytopenia induced by different antiplatelet therapies varies. DIT may occur due to antibody formation following the exposure to a drug, or naturally occurring preexisting antibodies may produce rapid-onset thrombocytopenia when a drug molecule binds to a platelet receptor inducing a conformational change thus rendering it to be an antigen target for naturally occurring antibodies. A 66-year-old female with history of hypertension presented with non-ST elevation myocardial infarction, had drug eluting stent placed in first obtuse marginal artery of left circumflex coronary artery. Started on antiplatelet medications aspirin 81 mg, ticagrelor 90 mg (which was later transitioned to clopidogrel 75 mg), as well as tirofiban 12.5 mg (for 12 hours only). Tirofiban is a GP IIb/IIIa antagonist, other drugs in this class have been documented to induce thrombocytopenia as well, but rates for tirofiban appear to be the highest, the reason is unclear. These antibodies are thought to be either naturally occurring or induced from conformational changes to GP IIb/IIIa binding site after binding to the GP IIb/IIIa receptor, binding of these drugs to the receptor precipitates an epitope much more specific for platelet surface antigens. Tirofiban and clopidogrel/ticagrelor can cause thrombocytopenia, but onset in this case is unusual: acute antibody reaction would be expected within hours, not delayed 30 hours after starting antiplatelet medication, and nonacute reaction would present 1 to 2 weeks out.