bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncertainty of leukoencephalopathies: a case report
Authors: Taha Mohamed A. , Diesing T. Scott
Published: November 2021

Background

Adult-onset leukoencephalopathies are a group of heterogeneous disorders characterized by white matter abnormalities. Leukoencephalopathy is usually encountered in children, but here we report a case with adult-onset leukoencephalopathy. Also, we explore this concept of uncertainty in medicine by discussing the approach to this case that has multiple possible etiologies.

Case presentation

A 70-year-old Caucasian male presented with a subacute onset of cognitive impairment and mood disturbances associated with behavioral changes. Neuroimaging demonstrated high-intensity lesions involving cerebral white matter. Progressive dementia and cognitive decline followed. Multiple possible etiologies are discussed based on the patient presentation and risk factors.

Conclusion

Adult-onset leukoencephalopathy can become a diagnostic challenge. Certain approaches need to be developed to explore the uncertainty of such conditions and to improve diagnostic yield.
Carney’s triad in an adult male from a tertiary care center in India: a case report
Authors: Tansir Ghazal , Dash Nihar Ranjan , Galodha Saurabh , Das Prasenjit , Shamim Shamim Ahmed , Rastogi Sameer
Published: November 2021

Background

Carney’s triad is a rare syndrome comprising gastrointestinal stromal tumor, extra-adrenal paraganglioma, and pulmonary chondroma along with newer additions of adrenal adenoma and esophageal leiomyoma. The triad is completely manifest in only 25–30% cases, with most patients presenting with two out of three parts of the syndrome. Wild-type succinate-dehydrogenase-deficient gastric gastrointestinal stromal tumor forms the most common component of Carney’s triad and is usually multicentric and multifocal. It usually demonstrates indolent behavior and resistance to imatinib; hence, the management remains predominantly surgical. Pulmonary chondromas are commonly unilateral and multiple with slow-growing nature, which allows for conservative management. Adrenocortical adenomas are found in 20% of patients and are usually detected as incidentalomas.

Case presentation

A 49-year-old Asian male presented with upper gastrointestinal bleed and was diagnosed with multiple gastric succinate-dehydrogenase-deficient gastrointestinal stromal tumors. On evaluation, he was found to have left pulmonary chondroma and non-secretory adrenal adenoma, thus completing the Carney’s triad. He underwent surgery with sleeve gastrectomy and excision of the antral tumor nodule, while the adrenal and pulmonary tumors have been under close follow-up.

Conclusion

Literature regarding Carney’s triad is scarce, especially from the Indian setting. Our report aims to highlight the various manifestations of this syndrome with emphasis on management of wild-type succinate-dehydrogenase-deficient gastrointestinal stromal tumor. Radical gastric surgeries do not offer a survival advantage in this condition; hence, more conservative modalities of resection can be adopted.
Investigation of the robustness of Cupriavidus necator engineered strains during fed-batch cultures
Authors: Boy Catherine , Lesage Julie , Alfenore Sandrine , Guillouet Stéphane E. , Gorret Nathalie
Published: November 2021

It is of major interest to ensure stable and performant microbial bioprocesses, therefore maintaining high strain robustness is one of the major future challenges in industrial microbiology. Strain robustness can be defined as the persistence of genotypic and/or phenotypic traits in a system. In this work, robustness of an engineered strain is defined as plasmid expression stability, cultivability, membrane integrity and macroscopic cell behavior and was assessed in response to implementations of sugar feeding strategies (pulses and continuous) and two plasmid stabilization systems (kanamycin resistance and Post-Segregational Killing hok/sok). Fed-batch bioreactor cultures, relevant mode to reach high cell densities and higher cell generation number, were implemented to investigate the robustness of C. necator engineered strains. Host cells bore a recombinant plasmid encoding for a plasmid expression level monitoring system, based on eGFP fluorescence quantified by flow cytometry. We first showed that well-controlled continuous feeding in comparison to a pulse-based feeding allowed a better carbon use for protein synthesis (avoiding organic acid excretion), a lower heterogeneity of the plasmid expression and a lower cell permeabilization. Moreover, the plasmid stabilization system Post-Segregational Killing hok/sok, an autonomous system independent on external addition of compounds, showed the best ability to maintain plasmid expression level stability insuring a greater population homogeneity in the culture. Therefore, in the case of engineered C. necator, the PSK system hok/sok appears to be a relevant and an efficient alternative to antibiotic resistance system for selection pressure, especially, in the case of bioprocess development for economic and environmental reasons.
Innovation, firm productivity, and export survival: firm-level evidence from ASEAN developing countries
Authors: Jitsutthiphakorn Utumporn
Published: November 2021

This firm-level study investigates the importance of innovation as a determinant of firm productivity and how firm productivity could impact firm export survival. This is the first integration of the innovation approach, productivity approach, and firm survival approach to explore their linkages at the regional level in ASEAN developing countries. Using the panel database from the World Bank Enterprise Survey, which covers six developing countries in ASEAN—the Philippines, Indonesia, Vietnam, Laos, Cambodia, and Myanmar—and also covers six selected industries, we construct four equations: innovation inputs, innovation output, firm productivity, and export survival. The four equations’ findings suggest that the technology level of the sector, firm size, and exports are significant factors for R&D expenditure (innovation input). R&D expenditure is a significant driver of a firm’s product and process innovation (innovation output). Increasing firm productivity in the six ASEAN developing countries we considered is driven by process innovation rather than product innovation, and productive firms are more likely to survive in the export market.
Resistant starch: Implications of dietary inclusion on gut health and growth in pigs: a review
Authors: Tan Felina P. Y. , Beltranena Eduardo , Zijlstra Ruurd T.
Published: November 2021

Starch from cereal grains, pulse grains, and tubers is a major energy substrate in swine rations constituting up to 55% of the diet. In pigs, starch digestion is initiated by salivary and then pancreatic α-amylase, and has as final step the digestion of disaccharides by the brush-border enzymes in the small intestine that produce monosaccharides (glucose) for absorption. Resistant starch (RS) is the proportion of starch that escapes the enzymatic digestion and absorption in the small intestine. The undigested starch reaches the distal small intestine and hindgut for microbial fermentation, which produces short-chain fatty acids (SCFA) for absorption. SCFA in turn, influence microbial ecology and gut health of pigs. These fermentative metabolites exert their benefits on gut health through promoting growth and proliferation of enterocytes, maintenance of intestinal integrity and thus immunity, and modulation of the microbial community in part by suppressing the growth of pathogenic bacteria while selectively enhancing beneficial microbes. Thus, RS has the potential to confer prebiotic effects and may contribute to the improvement of intestinal health in pigs during the post-weaning period. Despite these benefits to the well-being of pigs, RS has a contradictory effect due to lower energetic efficiency of fermented vs. digested starch absorption products. The varying amount and type of RS interact differently with the digestion process along the gastrointestinal tract affecting its energy efficiency and host physiological responses including feed intake, energy metabolism, and feed efficiency. Results of research indicate that the use of RS as prebiotic may improve gut health and thereby, reduce the incidence of post-weaning diarrhea (PWD) and associated mortality. This review summarizes our current knowledge on the effects of RS on microbial ecology, gut health and growth performance in pigs.
An assessment of nursing mothers’ and young people’s access to proprietary and patent medicine vendors’ services in rural communities of south-eastern Nigeria: implication for review of national drug policy
Authors: Uneke C. J. , Obeka I. , Uneke B. I. , Umeokonkwo A. , Nweze C. A. , Otubo K. I. , Uguru O. E.
Published: November 2021

Background

Patent and proprietary medicine vendors (PPMVs) form part of the informal healthcare system and are the first point of call for 75% of Nigerians who live in rural and underserved areas where there is limited access to healthcare services. This group of healthcare providers are located close to communities and are easily accessible to the people. This study seeks to determine how PPMVs influence access to medicines among nursing mothers and young people and how this progresses South Eastern Nigeria towards universal health coverage.

Methods

A cross-sectional descriptive study was conducted using a purposive sampling technique. Two slightly different pre-tested and validated 5-point Likert scale questionnaires were used to survey the nursing mothers and young people (18–20 years old). The questionnaire for nursing mothers assessed the perception regarding PPMV services and community access to medicines used for the treatment of childhood infections. The questionnaire for young people assessed the services rendered by the PPMVs including family planning, and major enablers/barriers towards to access to medicine.

Results

A total of 159 nursing mothers and 148 youths participated in the study. Up to 60% of both population had a minimum of secondary school qualification. About 90% of the nursing mothers were married and 88% were nursing babies from 1 to 12 months. Results show that the PPMVs were the first point of call for healthcare needs among the respondents and they are easily accessible and sell affordable medicines. The nursing mothers frequently treat their children’s cough with antibiotics with a mean rating (MNR) of 4.7 out of 5 points and most source these antibiotics from PPMV shops. Up to 90% of the nursing mothers reported that the children got well after the treatment. The drugs mostly purchased by the youths from the PPMVs included antimalarials (95%), analgesics (87.7%) and antibiotics (81.3%). Only 25.5% of the respondents purchased family planning commodities. Most of the respondents sought health care from PPMVs with a MNR of 3.4. Patronage of PPMVs for and usage of family planning products by the respondents had MNRs ranging from 1.4 to 1.8.

Conclusion

PPMVs are bridging the gap in healthcare delivery in the rural and underserved areas. Training of this group of practitioners and appropriate monitoring will go a long way in ensuring that the services they render are efficient, effective and improve the health indices in a low-income setting.
Role of small private drug shops in malaria and tuberculosis programs in Myanmar: a cross-sectional study
Authors: Thet May Me , Khaing Myat Noe Thiri , Zin Su Su , Oo Sandar , Aung Ye Kyaw , Thein Si Thu
Published: November 2021

Background

The role of community drug shops in providing primary care has been recognized as important in Myanmar as in other countries. The contribution by private community drug shops to National Tuberculosis case notifications and National Malaria testing and positive cases is significant. Population Services International Myanmar (PSI/Myanmar) has been successfully training and engaging community drug shops to screen presumptive Tuberculosis to make referrals to public health clinics and perform malaria rapid diagnostic tests (mRDT) to malaria fever cases and provide management accordingly.

Objectives

The study aims to identify barriers to service provision of the trained providers at the drug shops that are currently engaged in PSI/Myanmar Tuberculosis and malaria programs. Exploring their needs enabled us to identify and address barriers, to provide evidence for better linkage with the primary care system.

Method

A mixed method study was conducted with the service providers at the drug shops. A quantitative follow up survey was done with 177 trained Tuberculosis service providers and 65 trained malaria service providers. A total of 32 qualitative in-depth interviews were completed. Seventeen Tuberculosis trained providers and 15 malaria trained providers participated in individual interviews. Content analysis approach was used to generate themes for the data analysis.

Results

From the survey, the majority of drug shops reported that they performed appropriate first steps, particularly referring symptomatic Tuberculosis cases and offering mRDT testing to fever cases. Nevertheless, in-depth interviews with them revealed they did not adhere to the national guidelines for every client. There was a need to emphasize the importance of following the national guidelines for referring patients with prolonged cough and fever cases management. For those who were trained in Tuberculosis case referral, support from program staff was needed to make smooth referrals. Those who were trained in malaria often considered differential diagnosis of fever other than malaria and did not test with malaria rapid diagnostic test due to declining numbers of malaria cases.

Conclusion

The study findings highlighted that the drug shops trained in Tuberculosis referral seemed to have the potential to fully engage into the primary care health system if provided with suitable support and supervision. On the other hand, those trained in malaria case management might be less motivated to engage in the era of declining malaria endemicity.
Barriers and facilitators for integration of guidelines on operating health shops: a case of family planning services
Authors: Zulu Joseph M. , Sitali Doreen , Shroff Zubin Cyrus , Lamba Geetanjali , Sichone George , Michelo Charles , Mpandamabula Chileshe H. , Mwambazi Wesely , Mwenda Cecilia , Chavula Malizgani P.
Published: November 2021

Background

The Zambia Medicines Regulatory Authority (ZAMRA) piloted the implementation of Guidelines on Operating Health Shops in Zambia in 2016, with a view to making basic medicines more accessible to communities. The guidelines aim to transform ordinary drug shops into health shops, which are dispensing facilities permitted to sell a ZAMRA-prescribed list of medicines over the counter. However, studies that explore the integration and uptake of guidelines into the health system are lacking. This study aims to inform future improved implementation of these guidelines by examining the current acceptability of guidelines within the Zambian health system, especially in relation to family planning services.

Methodology

Data collected through documentary review, key informant interviews with district pharmacists, staff from ZAMRA and in-depth interviews with 24 health shop owners and dispensers were analyzed using thematic analysis. A conceptual framework on the integration of health innovations into health systems guided the analysis.

Results

The Guidelines on Operating Health Shops were implemented to address the problem of inadequate access to quality medicines especially in rural areas. Factors that facilitated the acceptability of the guidelines included their perceived relevance and simplicity, comprehensive training and improved knowledge among health shop operators on the guidelines, development of a governance and reporting structure or steering committee at the national level as well as perceived improved health outcomes at the community level. Factors that hindered acceptability of the guidelines included the high cost of implementing them, a restricted list of drugs which affected consumer choice, limited communication between the local council and the operators of health shops, health shop owners not owning the health shop premises restricting their ability to adapt the building, and cultural norms which constrained uptake of family planning services.

Conclusion

In addition to training, facilitating the acceptability of the guidelines among health shop owners requires paying attention to operational issues such as location, ownership of the shop, size of infrastructure as well as financial costs of implementing guidelines through decentralizing the registration process and thus reducing the cost of registration. It is also important to have effective communication strategies between operators and the regulators of health shops.
Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results
Authors: Salimi Ali , Watt Harrison , Harasymowycz Paul
Published: November 2021

Background

The short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up.

Methods

This longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events.

Results

A total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.

Conclusions

Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.
Non-verbal intelligence outperforms selective attention in a visual short-term memory test
Authors: Anunciação Luis , Portugal Anna , Rabelo Ivan , Landeira-Fernandez J.
Published: November 2021

Short-term memory is a dynamic psychological process that operates within a network in which non-verbal intelligence and attentional domains are connected. However, no consensus has been reached about which process has the greatest effect on this memory ability, which was the main objective of the present study. A sample of 1448 Brazilian participants (mean age = 26.62 years, standard deviation = 9.97 years; 53.9% females) were collectively tested on pen-and-paper standardized and validated measures of selective (ROTAS-C), alternating (ROTAS-A), and divided (ROTAS-D) attention. They also performed the R1 Non-verbal Intelligence Test and a visual short-term memory test (Memória Visual de Curto Prazo [MEMORE] test). The statistical analyses consisted of a data mining procedure, in which exhaustive automatic selection screening was performed. The results were compared with Corrected Akaike Information Criteria. The linear model met the classic assumptions of ordinary least squares and only included main effects of selective attention (standardized β = 0.39) and non-verbal intelligence (standardized β = 0.37) as main predictors (F2,39 = 7.01, p < 0.01, adjusted R2 = 24%). The results are discussed within a cognitive psychology framework.
Optical vortices in waveguides with discrete and continuous rotational symmetry
Authors: Pryamikov Andrey , Hadzievski Ljupco , Fedoruk Mikhail , Turitsyn Sergei , Aceves Alejandro
Published: November 2021

Coherent vortex structures are fascinating physical objects that are widespread in nature: from large scale atmospheric phenomena, such as tornadoes and the Great Red Spot of Jupiter to microscopic size topological defects in quantum physics and optics. Unlike classical vortex dynamics in fluids, optical vortices feature new interesting properties. For instance, novel discrete optical vortices can be generated in photonic lattices, leading to new physics. In nonlinear optical media, vortices can be treated as solitons with nontrivial characteristics currently studied under the emerging field of topological photonics. Parallel to theoretical advances, new areas of the engineering applications based on light vortices have emerged. Examples include the possibility of carrying information coded in the vortex orbital angular momentum, understood as a spatial-division-multiplexing scheme, to the creation of optical tweezers for efficient manipulation of small objects. This report presents an overview highlighting some of the recent advances in the field of optical vortices with special attention on discrete vortex systems and related numerical methods for modeling propagation in multi-core fibers.
Development of the Rheumatoid Arthritis Distress Scale (RADS): a new tool to identify disease-specific distress in patients with Rheumatoid Arthritis
Authors: Silke Linda , Kirresh Othman , Sturt Jackie , Lempp Heidi
Published: November 2021

Background

Patients with Rheumatoid Arthritis (RA) may experience psychological distress (depression, anxiety) in addition to their physical symptoms. People with RA may also experience disease-specific distress (DSD), related to the specific burden of living with their life-long condition. DSD is a patient reported outcome in several long-term conditions, including type 1 and 2 diabetes. The aims of this study were to determine whether DSD is experienced by people with RA, and if so, develop a Patient Reported Outcome Measure (PROM) to assess for DSD in people with RA.

Methods

A five-phased qualitative study was conducted which consisted of a secondary data analysis of 61 interviews of people with rheumatological disease (Phase 1), validation of findings via a Patient and Public Involvement (PPI) group of people with RA (n = 4) (Phase 2), item generation for a PROM (Phase 3) and establishing face and content validity of the PROM via PPI group (n = 4) and individual cognitive interviews (n = 9) of people with RA respectively (Phase 4 and 5). The final PROM was presented at a Patient Education Evening for patients with long-term rheumatological conditions, including RA, and carers.

Results

Five themes of rheumatological disease distress emerged from Phase 1, which were validated in the Phase 2 PPI group. After Phases 3–5, the Rheumatoid Arthritis Distress Scale (RADS) was formed of 39 items and 3 supplementary questions. Overall participants reported the content of the RADS to be clear and relevant, and that DSD is a valid concept in RA, distinct from other entities like clinical depression or anxiety.

Conclusions

DSD appears to be an important concept in RA. The 39-item RADS demonstrates acceptable face and content validity in this patient group. Further psychometric testing is needed. The RADS may be a useful tool for healthcare professionals to identify RA distress.
Evaluation of circulating miRNAs and mRNAs expression patterns in autism spectrum disorder
Authors: Abdelrahman Amany H. , Eid Ola M. , Ibrahim Mona H. , Abd El-Fattah Safa N. , Eid Maha M. , Meguid Nagwa A.
Published: November 2021

Background

Autism spectrum disorder is a condition related to brain development that affects a person’s perception and socialization, resulting in problems in social interaction and communication. It has no single known cause, yet several different genes appear to be involved in autism. As a genetically complex disease, dysregulation of miRNA expression and miRNA–mRNA interactions might be a feature of autism spectrum disorder. The aim of the current study was to investigate the expression profile of circulating miRNA-128, miRNA-7 and SHANK gene family in ASD patients and to assess the possible influence of miRNA-128 and miRNA-7 on SHANK genes, which might provide an insight into the pathogenic mechanisms of ASD and introduce noninvasive molecular biomarkers for the disease diagnosis and prognosis. Quantitative real-time PCR technique was employed to determine expression levels of miRNA-128, miRNA-7 and SHANK gene family in blood samples of 40 autistic cases along with 30 age- and sex-matched normal volunteer subjects.

Results

Our study revealed a statistical significant upregulation of miRNA-128 expression levels in ASD cases compared to controls (p value < 0.001). A statistical significant difference in SHANK-3 expression was encountered on comparing cases to controls (p value < 0.001). However, miRNA-7 expression showed no significant difference between the studied groups.

Conclusions

MiRNA-128 and SHANK-3 gene are emerging players in the field of ASD. They are promising candidates as noninvasive biomarkers in autism. Future studies are needed to emphasize their pivotal role.
Radio Frequency MRI coils and safety: how infrared thermography can support quality assurance
Authors: Testagrossa Barbara , Ruello Elisa , Gurgone Sergio , Denaro Lucia , Sansotta Carlo , Salmeri Francesca Maria , Acri Giuseppe
Published: November 2021

Background

The safety controls in Resonance Magnetic Imaging (MRI) diagnostic site are numerous and complex. Some of these are contained in international directives and regularly conducted by medical physics expert after acceptance tests, consisting of a series of checks, measurements, evaluations called quality controls (QCs) and made to guarantee the image quality of the equipment. In this context, ensuring that the coils are in proper operating conditions is important to prevent and reduce errors in use and to preserve patient safety.

Results

A study by thermography was conducted to evaluate temperature changes of MRI coils during Quality Control (QC), in order to prevent any problems for the patient due to Radio Frequency waves. This experiment involves use of a thermal camera to detect temperature variations during MRI scans using head and body coils of two different tomography 1.5 T and 3.0 T static magnetic field. Thermal camera was positioned inside the MRI room to acquire images every 15 s for all the scansions duration. The observations have shown a temperature increase only for body coil of 1.5 MRI tomography, whereas no significative temperature variation has occurred for the other coils under observation. This temperature increase was later related to a fault of such coil.

Conclusions

The authors believe this simple method useful as first approach, during routinely QCs, to verify coils functioning and so to avoid patient hazards and are preparing a methodological study about functioning of the coils with respect to their temperature variation.
Impact of Neuraxial Versus General Anesthesia on Discharge Destination in Patients Undergoing Primary Total Hip and Total Knee Replacement
Authors: Duque Melissa , Schnetz Michael P. , Yates Adolph J. , Monahan Amanda , Whitehurst Steven , Mahajan Aman , Kaynar A. Murat
Published: November 2021

BACKGROUND:

Total knee replacement (TKR) and total hip replacement (THR) are 2 of the most common orthopedic surgical procedures in the United States. These procedures, with fairly low mortality rates, incur significant health care costs, with almost 40% of the costs associated with post acute care. We assessed the impact of general versus neuraxial anesthesia on discharge destination and 30-day readmissions in patients who underwent total knee and hip replacement in our health system.

METHODS:

This was a retrospective cohort study of 24,684 patients undergoing total knee or hip replacement in 13 hospitals of a large health care network. Following propensity score matching, we studied the impact of type of anesthetic technique on discharge destination (primary outcome) and postoperative complications including readmissions in 8613 patients who underwent THR and 13,004 patients for TKR.

RESULTS:

Our results showed that in patients undergoing THR and TKR, neuraxial anesthesia is associated with higher odds of being discharged from hospital to home versus other facilities compared to general anesthesia (odds ratio [OR] = 1.63, 95% confidence interval [CI], 1.52–1.76; P < .01) and (OR = 1.58, 95% CI, 1.49–1.67; P < .01), respectively.

CONCLUSIONS:

Our results suggest an association between use of neuraxial anesthesia for total joint arthroplasty and a higher probability of discharge to home and a reduction in readmissions.
Current Practice Issues in Thoracic Anesthesia
Authors: Cohen Edmond
Published: November 2021

This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of selecting the correct DLT size and the role of videolaryngoscopy in placing a DLT are reviewed. Mechanisms whereby inhaled anesthetics may be protective during one-lung ventilation (OLV) are highlighted. The risk and prevention of fire during thoracic procedures are discussed.
Early Postoperative Outcomes of Super Morbid Obese Compared to Morbid Obese Patients After Ambulatory Surgery Under General Anesthesia: A Propensity-Matched Analysis of a National Database
Authors: Hajmohamed Sherine , Patel Deeran , Apruzzese Patricia , Kendall Mark C. , De Oliveira Gildasio
Published: November 2021

BACKGROUND:

Patients with body mass index (BMI) ≥50 kg/m2, defined as super morbid obesity, represent the fastest growing segment of patients with obesity in the United States. It is currently unknown if super morbid obese patients are at greater odds than morbid obese patients for poor outcomes after outpatient surgery. The main objective of the current investigation is to assess if super morbid obese patients are at increased odds for postoperative complications after outpatient surgery when compared to morbid obese patients.

METHODS:

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2017 to 2018 was queried to extract and compare patients who underwent outpatient surgery and were defined as either morbidly obese (BMI >40 and <50 kg/m2) or super morbidly obese (BMI ≥50 kg/m2). The primary outcome was the occurrence of medical adverse events within 72 hours of discharge. In addition, we also examine death and readmissions as secondary outcomes. A propensity-matched analysis was used to evaluate the association of BMI ≥50 kg/m2 versus BMI between 40 and 50 kg/m2 and the outcomes.

RESULTS:

A total of 661,729 outpatient surgeries were included in the 2017–2018 NSQIP database. Of those, 7160 with a BMI ≥50 kg/m2 were successfully matched to 7160 with a BMI <50 and ≥40 kg/m2. After matching, 17 of 7160 (0.24%) super morbid obese patients had 3-day medical complications compared to 15 of 7160 (0.21%) morbid obese patients (odds ratio [OR; 95% confidence interval {CI}] = 1.13 [0.57–2.27], P = .72). The rate of 3-day surgical complications in super morbid obese patients was also not different from morbid obese patients. Thirty-five of 7160 (0.48%) super morbid obese patients were readmitted within 3 days, compared to 33 of 7160 (0.46%) morbid obese patients (OR [95% CI] = 1.06 [0.66–1.71], P = .80). When evaluated in a multivariable analysis as a continuous variable (1 unit increase in BMI) in all patients, BMI ≥40 kg/m2 was not significantly associated with overall medical complications (OR [95% CI] = 1.00 [0.98–1.04], P = .87), overall surgical complication (OR [95% CI] = 1.02 [0.98–1.06], P = .23), or readmissions (OR [95% CI] = 0.99 [0.97–1.02], P = .8).

CONCLUSIONS:

Super morbid obesity is not associated with higher rates of early postoperative complications when compared to morbid obese patients. Specifically, early pulmonary complications were very low after outpatient surgery. Super morbid obese patients should not be excluded from outpatient procedures based on a BMI cutoff alone.
Asset pricing from the fundamentals
Authors: Στραβελάκης Νικόλαος
Published: November 2021

Το πόρισμα της διατριβής είναι μία πρωτότυπη ερμηνεία των οικονομικών κρίσεων. Σύμφωνα με αυτή η κατάρρευση των χρηματιστηρίων και των χρηματοπιστωτικών αγορών δεν είναι η αιτία αλλά ο μηχανισμός πυροδότησης των κρίσεων. Είναι ένα συμπέρασμα που εξηγεί σημαντικές πλευρές της κρίσης που ξεκίνησε το 2008 αλλά και τη χρησιμότητα και τα όρια των πολιτικών ρύθμισης των χρηματαγορών. Για να φτάσει σε αυτό το συμπέρασμα η διατριβή ξεκινά με την κριτική επισκόπηση της σύγχρονης "ορθόδοξης" θεωρίας της χρηματοοικονομικής σφαίρας. Σε αυτό το πλαίσιο επισημαίνει τα αναλυτικά προβλήματα της θεωρίας. Τα τελευταία εξηγούν την αδυναμία της να εξηγήσει εμπειρικά τα χρηματοοικονομικά φαινόμενα και ιδιαίτερα την αποτίμηση κεφαλαιακών τίτλων. Σημαντικοί ορθόδοξοι οικονομολόγοι όπως ο Robert Shiller και ο Edward Prescott έχουν επισημάνει τις αδυναμίες αυτές οδηγώντας στην εγκατάλειψη από το επάγγελμα της "υπόθεσης των αποτελεσματικών αγορών". Αλλά και οι προσεγγίσεις που ακολούθησαν τις "αποτελεσματικές αγορές" από τη σκοπιά της νεοκλασικής θεωρίας (behavioural finance, υπόδειγμα των "τριών παραγόντων", ορθολογικές φούσκες, αποκλίσεις ατομικού και συλλογικού συμφέροντος, θεωρίες συλλογικής δράσης και χρηματοπιστωτικού πανικού και, market frictions με χαρακτηριστικότερες τις θεωρίες ασύμμετρης πληροφόρησης) περισσότερο ασχολούνται με το γιατί αποτυγχάνει η θεωρία στην αρχική της μορφή παρά με τη διατύπωση μιας αξιόπιστης θεωρίας αποτίμησης κεφλαιακών τίτλων. Η διατριβή προτείνει μια εναλλακτική θεωρία βασισμένη στην Πραγματική Οικονομική Ανάλυση (Real Economic Analysis), δηλ., στην κλασική πολιτική οικονομία και στην μαρξιστική θεωρία, και ιδιαίτερα στο έργο του καθηγητή Anwar Shaikh. Η θεωρία αυτή εστιάζει στον ρόλο του ποσοστού κέρδους στις νέες επενδύσεις, στην ορολογία της θεωρίας "incremental rate of profit", ως βασικής ερμηνευτικής μεταβλητής των χρηματοοικονομικών φαινομένων. Αυτό σημαίνει ότι οι αποδόσεις των χρηματοπιστωτικών τίτλων τείνουν να εξισωθούν με εκείνες τις "πραγματικής οικονομίας" μέσω της κινητικότητας κεφαλαίου ανάμεσα στον παραγωγικό και χρηματοπιστωτικό τομέα. Η διατριβή επεκτείνει, και εν μέρει διαφοροποιεί τη θεωρία του καθηγητή Anwar Shaikh και την διερευνά εμπειρικά επεκτείνοντας την χρονική περίοδο ελέγχου μέχρι το 2020. Για την εμπειρική διερεύνηση εισάγει νέες μεθόδους δανεισμένες από τη φυσική και ειδικότερα τη θεωρία της "εντροπίας μεταφοράς" (transfer entropy). Αυτές οι μέθοδοι μπορεί να χρησιμεύσουν και για μελλοντική έρευνα.
Pedagogy of Success: Perception in undergraduate and postgraduate students at a Peruvian university
Authors: Valverde-Zavaleta Silvia Ana , Mellin Rubio Ray Harvey , Rafael Sánchez Aurea Elizabeth , Gonzales Loli Martha , Reynosa Navarro Enaidy
Published: November 2021

Background: The study's objective was to compare whether there are differences in the perception of undergraduate and postgraduate students about the pedagogy of success.  

Methods: This is non-experimental research with a comparative descriptive design, and a hypothetical deductive method was used. The perception of success pedagogy questionnaire was applied as a data collection technique with a sample of 50 university students with 23 items based on three dimensions: opportunity to learn (nine items), feedback (eight items), and consideration of the person (six items), with the following qualitative value scale, always = high, sometimes = middle, and never = low; the scale of quantitative value was from two to zero. To find the instrument's validity, it was subjected to expert judgment, calculating the content validity ratio for each item and considering the criteria of clarity and relevance. The instrument's reliability was determined using Cronbach's alpha, which found a high consistency between the items. For the questionnaire application, Google Forms was used to obtain fast, timely, and reliable answers. The data were processed through the SPSS V. 25.  

Results: The pedagogical support of the postgraduate teacher is more effective than that of the undergraduate. The undergraduate teacher stands out for listening and being more empathic. Didactics is crucial for students to develop their cognitive and human potential. Academic success is related to the teacher's pedagogical skills and the student's motivation. In addition, teachers and students can develop cognitive skills through effective communication and socialization. Finally, the affective dimension allows students to achieve personal and professional goals. 

Conclusions: There are significant differences in the perception of the pedagogy of success among undergraduate and postgraduate university students; therefore, the application of this methodology is more promoted towards postgraduate students than to their undergraduate peers.
Formation and development of the network self-learning organization of additional professional education
Authors: Belova Elena N.
Published: November 2021

The thesis presents the solution of an actual socially significant pedagogical problem on the basis of the implementation of a theoretical-methodological, conceptual substantiation, methodological and technological support of the formation and development of the network self-learning organization of additional professional education. The leading scientific idea is that the formation and development of a network self-learning organization is carried out on the basis of the continuous development of the readiness and ability of its employees to improve the performance of their professional activities in the process of their learning, mutual learning, self-actualization, self-learning and self-development in the context of a system of continuous professional education using distance learning. educational technologies, motivational and value corporate culture of the studied organization and networks and team interactions. Among the main characteristics of the organization under study, we single out the structure of the triple network, the key managerial competence of its employees and the motivational and valuable corporate culture of the organization, orienting these employees to increase their professional performance. Scientifically substantiated, developed the concept and model of the formation and development of the network self-learning organization. At the practical level, the pedagogical and organizational conditions for the formation and development of a network of self-learning organizations are defined and implemented, and organizational, educational and methodological support has been developed and tested. The verification of the model of the formation and development of the network self-learning organization, which proved the effectiveness and perspectivity of the scientific idea of the development of the network self-learning organization of additional professional education.
Screw Fixation Method through Temporary Kirschner Wire Hole for Coronal Hamate Fracture
Authors: Jo Yong Gil , Lee Yohan , Lee Joonha , Bae Kee Jeong , Kim Min Bom , Lee Young Ho
Published: November 2021

Purpose: Hamate coronal body fracture is a rare injury and often associated with dislocation of the carpometacarpal joint. For preserving the carpometacarpal joint, open reduction and rigid internal fixation is needed to displaced fracture. The purpose of this study was to evaluate the outcome of treating hamate coronal fracture with the screw fixation method through a temporary Kirschner wire (K-wire) fixation hole.Methods: From August 2016 to January 2021, eight patients who had displaced coronal hamate body fractures were enrolled. All patients were performed open reduction and multiple K-wires fixations. After that, the cortical screws were then inserted directly into the holes made by removing the K-wires one by one. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores and visual analogue scale (VAS) scores.Results: The average follow-up period was 11.5 months (range, 5–8 months) after surgery, and the bone union was observed at the 8 weeks after surgery. We confirmed that bone union had been completed for all the patients, and functional tests showed that the average DASH score was 3.95 (range, 0–8.3) and VAS score was 0.8 (range, 0–3).Conclusion: In coronal hamate body fractures, open reduction and screw fixation method through temporary K-wire fixation hole is simple and effective treatment technique.
Practice Summary: A Multiobjective Assignment Model for Optimal Socially Distanced Classrooms for the Spears School of Business at Oklahoma State University
Authors: Johnson Carol , Wilson Rick L.
Published: November 2021

In response to Oklahoma State University’s goal to provide safe face-to-face course options for as many students as possible in fall 2020, the Spears School of Business leadership developed a strategy based on data analytics and multiobjective optimization that allowed the implementation of a smooth transition plan for classes in fall 2020. OpenSolver was used (within Excel) to create an effective and efficient tool that successfully implemented classroom assignments that maximized face-to-face offerings while minimizing disruptions to the schedule, faculty, and registrar’s office.
Value of Online–Off-line Return Partnership to Off-line Retailers
Authors: Hwang Elina H. , Nageswaran Leela , Cho Soo-Haeng
Published: November 2021

Problem definition: This paper examines whether and, if so, how much an online–off-line return partnership between online and third-party retailers with physical stores (or “location partners”) generates additional value to location partners. Academic/practical relevance: Online shoppers often prefer to return products to stores rather than mailing them back. Many online retailers have recently started to collaborate with location partners to offer the store return option to their customers, and we quantify its economic benefit to a location partner. Methodology: We analyze proprietary data sets from Happy Returns (which provides return services for more than 30 online retailers) and one of its location partners, using a panel difference-in-differences model. In our study, a treatment is the initiation of the return service at each of the location partner’s stores, and an outcome is the store and online channel performance of the location partner. We then explore the mechanisms of underlying customer behavior that drive these outcomes. Results: We find that the partnership increases the number of unique customers, items sold, and net revenue in both store and online channels. We identify two drivers for this improved performance: (1) the location partner acquires new customers in both store and online channels, and (2) existing customers change their shopping patterns only in the store channel after using the return service; in particular, they visit stores more often, purchase more items, and generate higher revenue after their first return service. Managerial implications: To our knowledge, we provide the first direct empirical evidence of value to location partners from a return partnership, and as these partnerships become more prevalent, our findings have important managerial implications for location partners and online retailers alike.
Optimal Market-Integration Decisions by Policymakers: Modeling and Analysis of Agriculture Market Data
Authors: Gupta Shivam , Bansal Saurabh
Published: November 2021

Policymakers often seek to integrate markets as a way to maximize social welfare. In this article, the authors consider the spectrum of all possible integration policies, from full isolation to complete integration, and characterize the socially optimal market integration, under general demands. They identify market conditions under which social surplus is indeed maximized at partial market integration. For the linear price-responsive demand model that is used extensively in the operations management literature, these conditions are identified as thresholds on (i) the relative size of the markets being integrated, and (ii) the relative price sensitivity of consumers in these markets. The authors then apply the model to the commercial seed market in the European Union (EU). Their analysis shows that socially optimal market integration for these countries provides a further improvement in the social surplus for the EU by 2.80%, relative to complete integration. Results show that policymakers should exercise caution in determining the extent to which markets are integrated.
(SOBRE)VIVER EM SITUAÇÃO DE SEM-ABRIGO EM PORTUGAL: A EMERGÊNCIA DE RESPOSTAS INOVADORAS
Authors: Pina Andreia Filipa Marque , Fernandes Bárbara Salomé Ferreira , Lourenço Beatriz Simões , Santos Eduardo João Ribeiro
Published: November 2021

Resumo: Assinalado como um fenómeno de extrema vulnerabilidade social, em Portugal, consideram-se em situação de sem-abrigo todos os indivíduos que se encontrem em circunstância de sem-teto, a subsistir em espaços públicos, alojados em abrigos de curta duração, ou sem-casa integrados em alojamento temporário. O artigo em apreço tem como objetivo principal compreender, caracterizar e analisar, do ponto de vista institucional, as tipologias de intervenção que são operacionalizadas pelo setor social junto das pessoas em situação de sem-abrigo. A aditar, pretende examinar a repercussão que a situação pandémica atual do Coronavirus Disease 2019 (COVID-19) teve na presente população e na prática profissional. Neste sentido, foram realizadas três entrevistas semiestruturadas a profissionais da área das Ciências Sociais e Humanas que integram respostas sociais orientadas para a atuação com este público-alvo. Concluiu-se que, para além da intervenção direta e integrada junto dos mesmos, é basilar efetuar um trabalho para e com a sociedade, no que toca a consciencialização do seu papel e o combate da discriminação e preconceito, sendo a implementação de práticas inovadoras que integrem atividades de cariz educativo a via privilegiada para alcançar esse fim.Palavras-Chave: Situação de sem-abrigo. Exclusão social. Intervenção social. Projetos inovadores. Abstract: Pointed out as a phenomenon of extreme social vulnerability, in Portugal are in a homeless situation all individuals who are without a roof, subsisting in public spaces, housed in short-term shelters, or integrated in temporary accommodations. The main goal of this article is to understand, characterize and analyze, from an institutional point of view, the types of intervention that are operationalized by the social sector with people in homeless situations. In addition, it intends to examine the repercussions of the current situation of Coronavirus Disease 2019 (COVID-19) on the studied population and in professional practice. Therefore, three semi-structured interviews were conducted with professionals who work daily in this context and integrate social responses designed to act with the targeted audience. It was concluded that, in addition to direct and integrated interventions, it is essential to work for and with society regarding the awareness of its role and the fight against its discrimination and prejudice, with essential implementation of innovative practices as the privileged route.Keywords: Homelessness. Social exclusion. Social intervention. Innovative projects.