bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving computational fluid dynamics modeling of Direct Injection Spark Ignition cold-start
Authors: Ravindran Arun C , Kokjohn Sage L , Petersen Benjamin
Published: October 2020

Developing a profound understanding of the combustion characteristics of the cold-start phase of a Direct Injection Spark Ignition (DISI) engine is critical to meeting increasingly stringent emissions regulations. Computational Fluid Dynamics (CFD) modeling of gasoline DISI combustion under normal operating conditions has been discussed in detail using both the detailed chemistry approach and flamelet models (e.g. the G-Equation). However, there has been little discussion regarding the capability of the existing models to capture DISI combustion under cold-start conditions. Accurate predictions of cold-start behavior involves the efficient use of multiple models - spray modeling to capture the split injection strategies, models to capture the wall-film interactions, ignition modeling to capture the effects of retarded spark timings, combustion modeling to accurately capture the flame front propagation, and turbulence modeling to capture the effects of decaying turbulent kinetic energy. The retarded spark timing helps to generate high heat flux in the exhaust for the faster catalyst light-off during cold-start. However, the adverse effect is a reduced turbulent flame speed due to decaying turbulent kinetic energy. Accordingly, developing an understanding of the turbulence-chemistry interactions is imperative for accurate modeling of combustion under cold-start conditions. In the present work, combustion characteristics during the cold-start, fast-idle phase is modeled using the G-Equation flamelet model and the RANS turbulence model. The challenges associated with capturing the turbulent-chemistry interactions are explained by tracking the flame front travel along the Borghi-Peters regime diagram. In this study, a modified version of the G-Equation combustion model for capturing cold-start flame travel is presented.
Qualitative analysis at the interface of Indigenous and Western knowledge systems: the Herringbone stitch model
Authors: Andrews Shawana
Published: October 2020

This article describes the methodological challenges and opportunities of qualitative analysis from a position of critical Indigenous inquiry. It does not present findings but rather demonstrates a process of critical engagement with different methodologies to realize the most appropriate way to analyze data generated by Indigenous research. The article explores ‘interface research’, drawing upon multiple knowledge systems for data analysis as a means of producing new knowledge beneficial to Indigenous communities. Linking Western and Indigenous systems of knowledge, the contradictions and congruences of a hermeneutic study are explored as they pertain to the analysis of 15 Indigenous women’s lived experience of family violence. Indigenous methodology, in combination with hermeneutic principles, defined the process of analysis at the interface. As a result, a qualitative analytic model was developed and is offered as an innovative example of Indigenous data analysis that maintains Indigenous integrity and sovereignty and facilitates benefit to Indigenous women.
What if we think of the classroom as a work of art? Performance, collaboration, and social engagement considered as pedagogic practices
Authors: Schmidt Theron
Published: October 2020

This article brings into relation critical perspectives and practical tactics from a range of different fields—performance studies, visual art practice, pedagogy and educational theory, and activism and community organising—in order to create some space for re-imagining what might be possible within the dynamics of the Higher Education classroom. It proceeds through a series of speculative modes: ‘what if we think of the classroom as a market?’, which for many is the currently dominant metaphor under neoliberalist economies; ‘what if we think of the work of art as a classroom?’, which traces the recent ‘pedagogical’ or ‘educational’ turn in visual art practice; and finally, ‘what if we think of the classroom as a work of art?’, in which the creative impulses and tactics drawn from performance practices, activism and community organising, and socially engaged art are speculatively applied to the arts and humanities classroom.
Compact illumination system with variable beam direction and beam divergence
Authors: Rondelez N , Ryckaert WR , Meuret Y
Published: October 2020

Countless approaches to optimise lighting conditions for indoor and outdoor applications are described in the literature by adaptive dimming schemes or control algorithms. Those methods rely on adapting the emitted flux of individual luminaires in order to adjust lighting conditions to varying circumstances. Complex illumination requirements are tackled by controlling the output of every independent luminaire. In this case, the innovation is rather in software than in hardware, and such approaches are limited by how the LED fixtures can be manipulated. Lighting fixtures with a tuneable radiation pattern are rare, or these fixtures are rather large. This paper introduces a compact lighting system with a collimated light beam of which the beam direction and beam divergence can be adjusted electronically. To realise this optical functionality, a focus tuneable lens and rotatable mirror are combined with two custom-made aplanatic lenses in front of a compact, high-brightness LED. This paper elaborates the optical design of this novel illumination system and discusses the experimental performance of the realised demonstrator. The system functionality is validated by comparing the experimental lighting performance to optical simulations conducted with ray-tracing software. With the proposed system, a fast and flexible adaptation of the generated illumination distribution is possible.
Infant-toddler care in Singapore: Journey towards quality
Authors: Wu Sandra , Perisamy Ambika
Published: October 2020

In Singapore, early childhood care and education has evolved according to the nation’s needs since its independence in 1965. From a welfare scheme to custodial care, early childhood care and education is now recognised as a critical part of children’s learning and development. Over the years, the government has progressively implemented policies to raise the quality of early childhood care and education and while increased efforts have been effective, there is still a gap between policy and practice. This article reviews the policies and frameworks throughout the history of early childhood care and education, with a focus on infant toddler care and examines some of the alignment and gaps. It identifies two key areas for improvement – staff to child ratio and teacher quality for quality infant toddler care. In the current staff to child ratio, an ‘educarer’ oversees 5 children between 2 and 18 months. This indicates that the educarer needs to be well trained for this role to cater to a wide range of learning and developmental needs. However, the quality of teacher training has been disparate and was only harmonised in 2017. This suggests that the quality of educarers is still uneven in the sector. In terms of qualifications, educarers only need to fulfil the minimum level of teacher certification, which means that the youngest children in their most formative years are being taught and cared for by the least qualified educators ( Bull and Bautista, 2018 ). Cognisant of these issues, this article proposes recommendations to address issues of manpower allocation and teacher quality.
Rationale and design of the LIBERATES trial: Protocol for a randomised controlled trial of flash glucose monitoring for optimisation of glycaemia in individuals with type 2 diabetes and recent myocardial infarction
Authors: Everett Colin C , Reynolds Catherine , Fernandez Catherine , Stocken Deborah D , Sharples Linda D , Sathyapalan Thozhukat , Heller Simon , Storey Robert F , Ajjan Ramzi A
Published: October 2020

Hyperglycaemia in individuals with type 2 diabetes (T2D) and myocardial infarction (MI) is associated with guarded clinical prognosis. Studies improving glucose levels in T2D following MI relied on HbA1c as the main glycaemic marker, failing to address potential adverse effects of hypoglycaemia and glucose variability. We describe the design of the LIBERATES trial that investigates the role of flash glucose monitoring in optimising glycaemic markers in high vascular risk individuals with T2D. This multicentre trial is designed to recruit up to 150 insulin and/or sulphonylurea-treated T2D patients, within 5 days of a proven MI. Individuals will be randomised 1:1 into intervention and control groups using flash glucose monitoring sensors and traditional self-monitoring of blood glucose, respectively. The control group will also wear a blinded continuous glucose monitoring sensor. The primary outcome is the difference in time spent in euglycaemia (defined as glucose levels between 3.9–10.0 mmol/l), comparing study groups 3 months following recruitment, assessed daily for 14 days and as an average. Secondary and exploratory end points include time spent in hypoglycaemia and hyperglycaemia, HbA1c, quality of life measures, major adverse cardiac events and cost-effectiveness of the intervention. This study will establish the role of flash glucose monitoring in glycaemic management of individuals with T2D sustaining a cardiac event.

(Trial Registration: ISRCTN14974233, registered 12th June 2017)
Bridging the GAP: Leveraging Partnerships to Bring Quality Nutrition Education to the Gardening Apprenticeship Program
Authors: Orta Lillian , Yepez Esther , Nguyen Nina , Rico Rosario , Leng Trieu Sang
Published: October 2020

In the United States, about 12% of households are food-insecure, which can have negative health outcomes for children, including delayed development and early onset of obesity. Although many programs prioritize children, few evidence-based interventions exist for adolescents that address nutrition education. One promising intervention is teaching adolescents how to cook healthy meals. The Los Angeles Trust for Children’s Health partnered with The Los Angeles Neighborhood Land Trust to integrate nutrition education and hands-on cooking demonstrations into an after-school program called the Gardening Apprenticeship Program at a local high school. Designed as a yearlong intervention, the Gardening Apprenticeship Program involves garden-based activities teaching food and environmental justice. Cultivating partnerships with other community-based organizations can help build capacity to pilot and replicate similar programs in other communities in food deserts.
Application of Thromboelastography to Predict Lung Cancer Stage
Authors: Zhou Yaning , Guo Yijun , Cui Qing , Dong Yun , Cai Xiaoyue , Zhang Zhouji , Wu Xiaoting , Yi Kaiyan , Zhang Ming
Published: October 2020

Objective:

Lung cancer is often associated with hypercoagulability. Thromboelastography provides integrated information on clot formation in whole blood. This study explored the possible relationship between thromboelastography and lung cancer.

Methods:

Lung cancer was staged according to the Tumor, Node, and Metastasis (TNM) classification system. Thromboelastography parameters in different stages of disease were compared. The value of thromboelastography for stage prediction was determined by area under the receiver operating characteristic curve analysis.

Results:

A total of 182 patients diagnosed with lung cancer were included. Thromboelastography parameters, including kinetics time, α-angle, and maximum amplitude, differed significantly between patients with metastatic and limited lung cancers ( P < 0.05). Kinetics time was significantly reduced and maximum amplitude was significantly increased in patients with stage I and II compared with stage III and IV tumors ( P < 0.05). TNM stage was significantly negatively correlated with kinetics time ( r = −0.186), and significantly positively correlated with α-angle ( r = 0.151) and maximum amplitude ( r = 0.251) (both P < 0.05). The area under the curve for kinetics time in patients with stage I cancer was 0.637 ( P < 0.05) and that for α-angle in stage ≥ II was 0.623 ( P < 0.05). The areas under the curves for maximum amplitude in stage ≥ III and stage IV cancer were 0.650 and 0.605, respectively (both P < 0.05). Thromboelastography parameters were more closely associated with TNM stage in patients with lung adenocarcinoma than in the whole lung cancer population.

Conclusion:

This study identified the diagnostic value of thromboelastography parameters for determining tumor stage in patients with lung cancer. Thromboelastography can be used as an independent predictive parameter for lung cancer severity.
Gains Across WHO Dimensions of Function After Robot-Based Therapy in Stroke Subjects
Authors: Wu Jennifer , Dodakian Lucy , See Jill , Burke Quinlan Erin , Meng Lisa , Abraham Jeby , Wong Ellen C. , Le Vu , McKenzie Alison , Cramer Steven C.
Published: October 2020

Background

Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear.

Objective

This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships.

Methods

Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 month after end of therapy.

Results

At baseline, subjects (n = 40) were 134.7 ± 32.4 (mean ± SD) days poststroke and had moderate-severe arm motor deficits (arm motor Fugl-Meyer score of 35.6 ± 14.4) that were stable. Subjects averaged 2579 thumb movements and 1298 wrist movements per treatment session. After robot therapy, there was significant improvement in measures of body function/structure (Fugl-Meyer score) and activity limitations (Action Research Arm Test, Barthel Index, and Stroke Impact Scale–Hand), but not participation restriction (Stroke Specific Quality of Life Scale). Furthermore, while the degree of improvement in loss of body function/structure was correlated with improvement in activity limitations, neither improvement in loss of body function/structure nor improvement in activity limitations was correlated with change in participation restriction.

Conclusions

After a 3-week course of robotic therapy, there was improvement in body function/structure and activity limitations but no reduction in participation restriction.
The LOCalizer Radiofrequency Identification System: An Effective New Technology for Localizing Non-Palpable Breast Lesions for Surgery
Authors: Cullinane Carolyn M. , Byrne James , Akmenkalne Liga , O’ Leary Donal P. , Connors Alissa M. , Corrigan Mark A. , Redmond Henry Paul , Kelly Louise , O’ Sullivan Martin J.
Published: October 2020

Background. Breast screening has decreased morbidity and mortality due to detection of early, non-palpable breast cancers. One of the challenges of performing breast-conserving surgery on non-palpable breast tumours is accurate localization of the cancer. We aimed to perform a feasibility study to examine the outcomes associated with the introduction of a novel radiofrequency identification system (RFID) called LOCalizer as an alternative to traditional wire-guided localization. Methods. Data were prospectively collected on all patients undergoing breast-conserving surgery using the LOCalizer RFID system in a regional cancer centre between July 2019 and March 2020. Patients had a RFID tag placed preoperatively and underwent surgical removal of the tag with the index lesion guided by a handheld LOCalizer probe. The primary aim was successful placement and retrieval of the RFID tag. Re-excision rates, specimen size, specimen weight, cancer subtype and complication rate were all recorded. Results. Sixty-nine patients aged between 50 and 69 years had a LOCalizer tag inserted between July 2019 and March 2020. Of these, 6 (8.7%) were diagnostic and 63 (91.3%) were therapeutic. There was no migration of RFID tags, and all tags were retrieved with the index lesion. The overall re-excision of margin rate was 17.4% (12/69). All re-excision of margins was due to positive radial margins. The overall complication rate was 1.4% with one grade 1 Clavien-Dindo morbidity. Conclusion. The LOCalizer RFID is an effective and safe wire-free localization method for non-palpable breast lesions.
Comparison of Borderline Ultrasound and Nerve Conduction Studies for Carpal Tunnel Syndrome
Authors: Demino Cory , Fowler John R.
Published: October 2020

Background

Choosing cutoff values for nerve conduction studies (NCS) and ultrasound cross-sectional area (CSA) in the diagnosis of carpal tunnel syndrome (CTS) is critical in determining the diagnostic accuracy of the tests. The goals of this study were to: (1) determine the sensitivity and specificity of various electrodiagnostic and ultrasound threshold values for diagnosis of CTS; and (2) determine the number of hands that underwent NCS and ultrasound that were within 10% of threshold values.

Methods

A total of 309 hands of 235 patients were included in this study. Diagnosis of median neuropathy was made based on NCS by the independent physician performing the NCS. Criteria analyzed included distal motor latency of 4.4+ ms, distal sensory latency of 3.6+ ms, difference in median-ulnar mixed nerve palmar latency of 0.4+ ms, and CSA of the median nerve of 10+ mm2.

Results

Median neuropathy was diagnosed in 235 hands, whereas 74 hands were found not to have median neuropathy. Overall, 141 hands (46%) had at least 1 of the 3 electrodiagnostic variables within 10% of the diagnostic cutoff values, and 137 hands (44%) had a median nerve CSA within 10% of 10 mm2. By performing ultrasound in addition to NCS for each patient, an additional 65 hands (21%) had a definitive diagnosis on at least 1 of the 2 diagnostic modalities.

Conclusions

Ultrasound and NCS yielded a similar number of patients within 10% of their diagnostic threshold values. When used together, the number of patients with a nonborderline diagnosis on at least 1 diagnostic modality was increased substantially.
Pro-Inflammatory Cytokines at Ultra-Low Dose Exert Anti-Inflammatory Effect In Vitro: A Possible Mode of Action Involving Sub-Micron Particles?
Authors: Floris Ilaria , Rose Thorsten , Rojas Juan Antonio Collado , Appel Kurt , Roesch Camille , Lejeune Beatrice
Published: October 2020

Tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) are pro-inflammatory cytokines involved in acute and chronic inflammatory diseases. Indeed, immunotherapy blocking these 2 cytokines has been developed. Micro-immunotherapy (MI) also uses ultra-low doses (ULD) of pro-inflammatory cytokines, impregnated on lactose-sucrose pillules, to counteract their overexpression. The study has been conducted with 2 objectives: examine the anti-inflammatory effect in vitro and the capacity of 2 unitary medicines, TNF-α (27 CH) and IL-1β (27 CH), to reduce the secretion of TNF-α in human primary monocytes and THP-1 cells differentiated with phorbol-12-myristate-13-acetate, after lipopolysaccharide (LPS) exposure; then, investigate the presence of particles possibly containing starting materials using tunable resistive pulse sensing technique. The results show that the unitary medicines, tested at 3 pillules concentrations (5.5, 11 and 22 mM), have reduced the secretion of TNF-α in both models by about 10−20% vs. vehicle control, depending on concentration. In this exploratory study, particles (150−1000 nm) have been detected in MI ULD-impregnated pillules and a hypothesis for MI medicines mode of action has been proposed. Conscious that more evaluations are necessary, authors are cautious in the conclusions because the findings described in the study are still limited, and future investigations may lead to different hypothesis.
Categorical Bifurcation: The Rite of Spring at the Threshold of Modernism
Authors: Sgourev Stoyan V.
Published: October 2020

Pursuing a new theoretical link between sociology of culture and ‘categorization’ research, the article articulates the process whereby new categories emerge through bifurcation of pre-existing categories. The contribution is in conceptualizing and documenting the underlying interaction of endogenous and exogeneous factors. The assumption is that bifurcation is likely to occur where and when individual practices of contrast maximization interact with the internal tendency toward dichotomization. This form of interaction is instrumental in identifying and explaining ‘thresholds’ in cultural change. The framework is illustrated with the archetype of ‘modern ballet’ – The Rite of Spring, choreographed by Vaslav Nijinsky, staged in 1913. By reversing the codes of ‘classical’ ballet, centered on elegance, lightness and flow, the Rite redefined movement, codifying a language of tension, interruption and constraint. It marked the key moment when a critical part of the audience interpreted ‘bad’ ballet as ‘new’ ballet. The analysis draws parallels with bifurcation processes in physics and system dynamics.
Prediction of the structural and electronic properties of MoxTi1−xS2 monolayers via first principle simulations
Authors: Verma Ankit Kumar , Raffone Federico , Cicero Giancarlo
Published: October 2020

Two-dimensional transition metal dichalcogenides have gained great attention because of their peculiar physical properties that make them interesting for a wide range of applications. Lately, alloying between different transition metal dichalcogenides has been proposed as an approach to control two-dimensional phase stability and to obtain compounds with tailored characteristics. In this theoretical study, we predict the phase diagram and the electronic properties of Mo xTi1− xS2 at varying stoichiometry and show how the material is metallic, when titanium is the predominant species, while it behaves as a p-doped semiconductor, when approaching pure MoS2 composition. Correspondingly, the thermodynamically most stable phase switches from the tetragonal to the hexagonal one. Further, we present an example which shows how the proposed alloys can be used to obtain new vertical two-dimensional heterostructures achieving effective electron/hole separation.
Can Smart Pens Help Improve Diabetes Management?
Authors: Sy Sarah L. , Munshi Medha M. , Toschi Elena
Published: October 2020

Smart pen technology has evolved over the past decade with new features such as Bluetooth connectivity, bolus dose calculators, and integration with mobile apps and continuous glucose monitors. While similar in appearance to a traditional insulin pen, smart pens have the ability to record and store data of insulin injections. These devices have the potential to transform diabetes management for clinicians, and patients with type 1 and type 2 diabetes on insulin therapy by improving adherence, glycemic control, and addressing barriers to diabetes management. Smart pens can also highlight the relationship between insulin, food, and physical activity, and provide insight into optimizing insulin regimens. Education of clinicians and patients, and more clinical studies showing the benefits of smart pens and cost-effectiveness, are needed.
The many faces of glioblastoma: Pictorial review of atypical imaging features
Authors: Khandwala Kumail , Mubarak Fatima , Minhas Khurram
Published: October 2020

Glioblastoma is an aggressive primary central nervous system tumour that usually has a poor prognosis. Generally, the typical imaging features are easily recognisable, but the behaviour of glioblastoma multiforme (GBM) can often be unusual. Several variations and heterogeneity in GBM appearance have been known to occur. In this pictorial essay, we present cases of pathologically confirmed GBM that illustrate unusual locations and atypical features on neuroimaging, and review the relevant literature. Even innocuous-looking foci, cystic lesions, meningeal-based pathology, intraventricular and infra-tentorial masses, multifocal/multicentric lesions and spinal cord abnormalities may represent GBM. We aim to highlight the atypical characteristics of glioblastoma, clarify their importance and list the potential mimickers. Although a definitive diagnosis in these rare cases of GBM warrants histopathological confirmation, an overview of the many imaging aspects may help make an early diagnosis.
An analysis of the EU Seasonal Workers Directive in the light of two similar regimes: Three dimensions of regulated inequality
Authors: Bregiannis Fotis
Published: October 2020

This article analyses three cumulative situations of inequality suffered by seasonal low-skilled migrant workers in Europe: i) reinforced inequality of bargaining power before the employer, ii) legal inequality between them and the local workforce, and iii) legal inequality between them and high-skilled migrant employees. In this regard, the prioritisation of the needs of national economies rather than a rights-based approach is promoted by the legislators. The EU Seasonal Workers Directive (SWD) is here compared to two Temporary Migration Programmes (TMPs) regulating similar migrant mobility. One of them has been in force for decades in Canada and the other entered more recently into force in New Zealand. It is shown that, despite claiming novelty, the SWD follows the same basic principles of structured and regulated inequality existing in these schemes.
Complement component 3 as biomarker of disease activity and cardiometabolic risk factor in rheumatoid arthritis and spondyloarthritis
Authors: Arias de la Rosa Iván , Font Pilar , Escudero-Contreras Alejandro , López-Montilla María Dolores , Pérez-Sánchez Carlos , Ábalos-Aguilera María Carmen , Ladehesa-Pineda Lourdes , Ibáñez-Costa Alejandro , Torres-Granados Carmen , Jimenez-Gomez Yolanda , Patiño-Trives Alejandra , Luque-Tévar María , Castro-Villegas María Carmen , Calvo-Gutiérrez Jerusalem , Ortega-Castro Rafaela , López-Pedrera Chary , Collantes-Estévez Eduardo , Barbarroja Nuria
Published: October 2020

Objective:

To analyze the relationship between complement component 3 (C3) and the prevalence of cardiometabolic risk factors and disease activity in the rheumatic diseases having the highest rates of cardiovascular morbidity and mortality: rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).

Methods:

This is a cross-sectional study including 200 RA, 80 PsA, 150 axSpA patients and 100 healthy donors. The prevalence of cardiometabolic risk factors [obesity, insulin resistance, type 2 diabetes mellitus, hyperlipidemia, apolipoprotein B/apolipoprotein A (apoB/apoA) and atherogenic risks and hypertension] was analyzed. Serum complement C3 levels, inflammatory markers and disease activity were evaluated. Cluster analysis was performed to identify different phenotypes. Receiver operating characteristic (ROC) curve analysis to assess the accuracy of complement C3 as biomarker of insulin resistance and disease activity was carried out.

Results:

Levels of complement C3, significantly elevated in RA, axSpA and PsA patients, were associated with the prevalence of cardiometabolic risk factors. Hard clustering analysis identified two distinctive phenotypes of patients depending on the complement C3 levels and insulin sensitivity state. Patients from cluster 1, characterized by high levels of complement C3 displayed increased prevalence of cardiometabolic risk factors and high disease activity. ROC curve analysis showed that non-obesity related complement C3 levels allowed to identify insulin resistant patients.

Conclusions:

Complement C3 is associated with the concomitant increased prevalence of cardiometabolic risk factors in rheumatoid arthritis and spondyloarthritis. Thus, complement C3 should be considered a useful marker of insulin resistance and disease activity in these rheumatic disorders.
Retinopathy and microalbuminuria are common microvascular complications in cystic fibrosis-related diabetes
Authors: Kempegowda Punith , Sunsoa Harbinder , Chandan Joht S. , Quinn Lauren M. , Amrelia Prashant M. , Atta Syed Noman , Amir Sidrah , Teh Yee Suh , Chaudhry Sabba , de Bray Anne , Rashid Rifat , Whitehouse Joanna L. , Nash Edward F. , Syed Ateeq
Published: October 2020

Aims:

To study the prevalence of microvascular complications and renal changes associated with cystic fibrosis-related diabetes (CFRD).

Methods:

This retrospective cohort study was conducted at the West Midlands Adult Cystic Fibrosis centre, United Kingdom. Data regarding age, sex, microalbuminuria, retinopathy neuropathy, and biochemical results were collected for all people with CFRD who had an annual review from 1 January 2018 to 31 December 2018 at the centre. Descriptive statistics were analysed using STATAv15.1.

Results:

A total of 189 patients were included, of which 56.6% were male and median age (interquartile range) was 33 (27–39) years; 79.4% (150/189) had their annual review in 2018. Those with a biochemically impaired renal function numbered 7.2% (13/180) and 22.7% (32/141) had microalbuminuria; 17.2% (10/58) had diabetes related retinopathy. No one in our cohort had diabetic ulcers; however, 10.3% (13/126) had absent foot pulses.

Conclusion:

We found a higher prevalence of microalbuminuria compared with retinopathy in a large cohort of cystic fibrosis adults. This study demonstrates the need for regular specialist follow-up to facilitate early identification of such complications and a long-term prospective cohort to understand underlying mechanisms.
Positive and negative well-being of older adults with symptomatic peripheral artery disease: A population-based investigation
Authors: Rafnsson Snorri Bjorn , Fowkes Gerry
Published: October 2020

Objective

We investigated positive and negative subjective well-being in relation to lower-extremity peripheral artery disease (PAD) in a sample of older adults.

Method

4760 participants in the English Longitudinal Study of Ageing (ELSA) provided baseline data on symptomatic PAD, sociodemographic characteristics, lifestyle risk factors, and co-morbid conditions. Baseline and two-year follow-up data were available for life satisfaction, quality of life, and depressive symptoms.

Results

Participants with PAD symptoms had lower baseline levels of life satisfaction (β = −0.03, p < .05) and quality of life (β = −0.04, p < .01), and more depressive symptoms (β = 0.03, p < .05). These associations remained statistically significant in multivariate analyses. Baseline PAD did not, however, influence well-being levels at two-year follow-up.

Discussion

Greater awareness of the potential for chronic vascular morbidity to disrupt the lives of older adults is needed to inform effective multidisciplinary support and interventions that help maintain the quality of life of those affected.
Utility of Thrombin Time in Management of Patients with Green Pit Vipers Bite
Authors: Tongpoo Achara , Niparuck Pimjai , Sriapha Charuwan , Wananukul Winai , Trakulsrichai Satariya
Published: October 2020

Objectives:

GGreen pit vipers (GPV) envenomation causes consumptive coagulopathy mainly by thrombin-like enzymes. Fibrinogen levels are generally investigated to help evaluate systemic envenomation. However, tests of fibrinogen levels may not be available in every hospital. This study aimed to determine the sensitivity, specificity and accuracy for a range of various coagulation tests (20 minute whole blood clotting test (20WBCT), prothrombin time, international normalized ratio and thrombin time (TT)), comparing to the two gold standards performed in patients with GPV bite.

Methods:

This was the pilot study which we retrospectively reviewed fibrinogen level results including the hospital records of 24 GPV ( Trimeresurus albolabris or macrops) bite patients visiting Ramathibodi Hospital, Thailand during 2013–2017 with 65 results of fibrinogen levels. The fibrinogen levels <164 and <100 mg/dL were used as the standard cut-off points or gold standards as the abnormal low and critical levels, respectively.

Results:

Most were male. All had local effects. For fibrinogen levels <164 and <100 mg/dL, prolonged TT had the highest sensitivity of 57.1% and 82.4%; the negative predictive value of 74.5% and 93.6%; the accuracy of 81.0% and 92.1%; and the area under a receiver operating characteristic curve of 0.762 and 0.873, respectively. For fibrinogen levels <164, unclotted 20WBCT and prolonged TT had the highest specificity and positive predictive value of 100% all. For fibrinogen levels <100, unclotted 20WBCT had the highest specificity and positive predictive value of 100% both, while prolonged TT had the specificity and positive predictive value of 95.7% and 87.5%, respectively. One patient developed isolated thrombocytopenia without hypofibrinogenemia and coagulopathy.

Conclusions:

Among four coagulation tests, TT was the most sensitive and accurate test to indicate hypofibrinogenemia in GPV bite patients. In case of unavailable fibrinogen levels thrombin time might be investigated to help evaluate patients’ fibrinogen status. Isolated thrombocytopenia could occur in GPV envenomation.
Use of zebrafish larvae lateral line to study protection against cisplatin-induced ototoxicity: A scoping review
Authors: Domarecka Ewa , Skarzynska Magda , Szczepek Agnieszka J , Hatzopoulos Stavros
Published: October 2020

Aim:

The present review aimed to consolidate and analyze the recent information about the use of zebrafish in studies concerning cisplatin-induced ototoxicity and otoprotection.

Material and methods:

The PubMed, Web of Science, and Scopus databanks were searched using the following MESH terms: zebrafish, cisplatin, ototoxicity. The identified publications were screened according to inclusion and exclusion criteria and the 26 qualifying manuscripts were included in the full-text analysis. The experimental protocols, including cisplatin concentrations, the exposure duration and the outcome measurements used in zebrafish larvae studies, were evaluated and the reported knowledge was summarized.

Results:

Twenty-six substances protecting from cisplatin-induced toxicity were identified with the use of zebrafish larvae. These substances include quinine, salvianolic acid B, berbamine 6, benzamil, quercetin, dexmedetomidine, dexamethsanone, quinoxaline, edaravone, apocynin, dimethyl sulfoxide, KR-22335, SRT1720, ORC-13661, 3-MA, D-methionine, mdivi-1, FUT-175, rapamycin, Z-LLF-CHO, ATX, NAC, CYM-5478, CHCP1, CHCP2 and leupeptin. The otoprotective effects of compounds were attributed to their anti-ROS, anti-apoptotic and cisplatin uptake-blocking properties. The broadest range of protection was achieved when the experimental flow used preconditioning with an otoprotective compound and later a co-incubation with cisplatin. Protection against a high concentration of cisplatin was observed only in protocols using short exposure times (4 and 6 h).

Conclusions:

The data extracted from the selected papers confirm that despite the differences between the human and the zebra fish hearing thresholds (as affected by cisplatin), the sensory cells of zebrafish and larval zebrafish are a valuable tool which could be used: (i) for the discovery of novel otoprotective substances and compounds; (ii) to screen their side effects and (iii) to extend the knowledge on the mechanisms of cisplatin-induced inner ear damage. For future studies, the development of a consensus experimental protocol is highly recommended.
COVID-19 and the Case for Medical Management and Primary Care
Authors: Dominguez Luis W. , Willis Joel S.
Published: October 2020

Hospitals and health systems suffer an over-reliance on elective surgeries to remain profitable. As a result, systems report record losses, while demand for emergency room, hospital, and intensive care beds have surged. Studies have admitted that many surgeries are unnecessary, and physician leaders admit that profit plays a role in driving such needless cost and risk. Most diseases are better managed with medications and lifestyle changes. But it pays more to replace a knee than to prevent that replacement. We must bring surgical and medical value closer in-line. Communities of color are suffering disproportionately from coronavirus. The social determinants of health that lead to higher concentrations of hypertension and diabetes can be mitigated by investment in primary care. Such investment has been proven to decrease cost and increase quality of life. However, the United States spends 50% less on primary care, than other developed countries. While showing promise, telehealth is not a panacea. It relies on continued reimbursement parity, and there remains a digital divide. Any meaningful fix will draw the ire from those who profit from such a profligate system. If we want to improve quality, access and equity, while avoiding unnecessary hospitalizations, risky surgeries, and runaway costs, we must invest in primary care.
The Effects of the Face Mask on the Skin Underneath: A Prospective Survey During the COVID-19 Pandemic
Authors: Techasatian Leelawadee , Lebsing Sirirus , Uppala Rattapon , Thaowandee Wilairat , Chaiyarit Jitjira , Supakunpinyo Chanyut , Panombualert Sunee , Mairiang Dara , Saengnipanthkul Suchaorn , Wichajarn Khunton , Kiatchoosakun Pakaphan , Kosalaraksa Pope
Published: October 2020

Purpose:

The study aimed to explore the prevalence and possible risk factors to prevent the face mask related adverse skin reactions during the ongoing COVID-19 after a recommendation of face mask wearing for public use in Thailand.

Results:

The prevalence of face mask related adverse skin reactions was 454 cases (54.5%), of which acne was the most frequent (399; 39.9%), followed by rashes on the face (154; 18.4%), and itch symptoms (130; 15.6%). Wearing a surgical mask showed a higher risk of adverse skin reaction compared to a cloth mask, OR (95% CI) = 1.54 (1.16-2.06). A duration of face mask wearing of more than 4 hours/day and the reuse of face masks increased the risk of adverse skin reactions compared to changing the mask every day, adjusted OR(95% CI) = 1.96 (1.29-2.98), and 1.5 (1.11-2.02).

Conclusion:

Suggestions were made for wearing a cloth mask in non-health care workers (HCW) to decrease the risk of face mask related adverse skin reactions. This suggestion could potentially help in decreasing the demand of surgical masks which should be reserved for the HCW population during the ongoing COVID-19 pandemic.
Physical- and Cognitive-Effort-Based Decision-Making in Depression: Relationships to Symptoms and Functioning
Authors: Tran Tanya , Hagen Amanda E. F. , Hollenstein Tom , Bowie Christopher R.
Published: October 2020

Major depressive disorder (MDD) is associated with persistent, impaired life functioning. Motivational deficits in physical and cognitive effort expenditure have not been evaluated as contributors to functional impairment in MDD. In this study, we adapted parallel measures of choices to expend physical and cognitive effort and assessed their associations with symptoms, cognition, and life functioning in 44 participants with MDD. Higher anhedonia severity predicted lower motivation for physical effort but not for cognitive effort. Lower cognitive effort motivation was associated with poorer life functioning even after controlling for previously established predictors of symptoms and cognitive impairment. Reduced cognitive effort motivation also had an indirect effect on the relationship between impaired cognitive and life functioning. Findings suggest motivational deficits in MDD present different barriers for recovery depending on the type of effort that is avoided. Physical effort motivation is associated with anhedonia severity, whereas cognitive effort motivation is relevant to life functioning.
Interpretation Bias in Paranoia: A Systematic Review and Meta-Analysis
Authors: Trotta Antonella , Kang Jungwoo , Stahl Daniel , Yiend Jenny
Published: October 2020

More than 10% of the general population regularly experience paranoid thoughts. Persecutory delusions occur in one third of psychiatric patients in the United Kingdom and are associated with severe clinical and social impairment. Furthermore, individuals with elevated vulnerability to paranoia interpret ambiguous environmental information more negatively than those with low vulnerability, a cognitive phenomenon called interpretation bias. We conducted a systematic review and meta-analysis of the association between interpretation bias and paranoia. Twenty studies were included, and our meta-analysis indicated that a negative interpretation bias was associated with paranoia both in clinical (standardized mean difference, or SMD = 1.01; 95% confidence interval [CI] = [0.51, 1.52], p < .001) and nonclinical populations ( SMD = 1.06; 95% CI = [0.28, 1.85], p = .008). Our results also showed that higher negative interpretation bias was positively correlated with the severity of paranoia, and results were consistent in nonclinical ( r = .32; 95% CI = [.21, .43], p < .001) and clinical samples ( r = .38; 95% CI = [.27, .48], p < .001). These findings might orient prevention strategies and psychological interventions for paranoia.
Two-Stage Dual-Nerve Facial Reanimation: Outcomes and Complications in a Series of Pediatric Patients
Authors: McNeely Molly M. , Liang Fan , Makar Katelyn , Vercler Christian J. , Kuzon William
Published: October 2020

Background:

In facial reanimation via microneurovascular muscle transfer, dual-nerve reinnervation of the muscle capitalizes on the synergistic effects of spontaneous motion from cross facial nerve grafting (CFNG) and increased excursion from masseteric nerve transfer. Two-stage approaches that delay masseteric nerve transfer until the time of the muscle flap increase spontaneity by maximizing muscle reinnervation from the CFNG. While this 2-stage, dual-nerve approach has been described in adults, we present a series of pediatric patients who underwent this reconstructive technique.

Methods:

We retrospectively reviewed all pediatric patients who underwent 2-stage, dual-nerve reconstruction with CFNG and ipsilateral masseteric nerve transfers. Procedures were performed between 2004 and 2016 by 2 surgeons at a single centre. Degree of facial paralysis before and after surgical intervention was measured using House-Brackmann scores.

Results:

Nine patients with a mean age of 8.6 (range: 5-15 years) years at time of surgery underwent 2-stage, dual-nerve reconstruction. Average time between CFNG and transfer of the free gracilis with masseteric nerve transfer was 13.3 (SD 2.4) months. Mean follow-up was 27.3 months (SD 25.7). Patients demonstrated initiation of voluntary movement on paralyzed side by 3.6 months (SD 0.6) on average, with 3 patients demonstrating spontaneous movement at 3 months.

Conclusion:

The 2-stage, dual innervation technique using CFNG and delayed ipsilateral masseteric nerve transfer with a free gracilis is a promising reconstructive option to maximize spontaneous expression in pediatric patients. Validated, objective scoring systems for excursion are needed before meaningful comparisons can be made to other reconstructive strategies.
A Framework for Résumé Decisions: Comparing Applicants’ and Employers’ Reasons
Authors: Randazzo Chalice
Published: October 2020

What reasons do applicants use to write résumés, and what reasons do employers use to evaluate them? This article advocates for teaching reasons as a way to empower writers to make more nuanced, adaptive résumé decisions. Drawing from a study of 63 students, 20 advisors, and 24 employers, the article touches on résumé format, sections, and items; then it moves beyond formal features to compare eight reasons that participants used as a framework in their decision making: relevance, recency, value, personality, fluff, unprofessionalism, discrimination, and applicant fit. It ends with pedagogical suggestions for teaching this framework alongside résumé formal features.
Kidney Disease Knowledge and Its Determinants Among Patients With Chronic Kidney Disease
Authors: Okoro Roland Nnaemeka , Ummate Ibrahim , Ohieku John David , Yakubu Sani Ibn , Adibe Maxwell Ogochukwu , Okonta Mathew Jegbefume
Published: October 2020

The alarming rise in the incidence of end-stage renal disease in Nigeria is likely to continue if patients with chronic kidney disease (CKD) lack knowledge of this disease, its management, and practices to support effective self-management. The study aimed to assess CKD knowledge and to investigate its predictors. A cross-sectional survey was conducted using a paper-based questionnaire at the medical and nephrology outpatients' clinics of a secondary and tertiary hospital in Maiduguri. The study enrolled 220 patients with CKD stages 1 to 4. Sixty-five percent of the participants had poor CKD knowledge. The patients who had a tertiary level of education were significantly more likely to have higher CKD knowledge compared to those with no formal education (adjusted odds ratio: 2.62, 95% CI: 1.20-5.72). The study shows that the majority of the participants had poor CKD knowledge. Tertiary educational level was the only significant independent predictor of higher CKD knowledge. Therefore, targeted educational interventions are needed among patients with no or low formal education to be able to support them with self-management behaviors.
Patient Perceptions about Professional Dental Services during the COVID-19 Pandemic
Authors: Moffat R.C. , Yentes C.T. , Crookston B.T. , West J.H.
Published: October 2020

Background:

Dental professionals are at high risk of being infected by and transmitting COVID-19 to patients. Patients’ perceived risk for infection and attitudes about receiving dental care during the pandemic are important to understand as patients consider returning to routine dental care as the pandemic progresses.

Objective:

The purpose of this study was to explore dental patients’ perceptions of susceptibility to contracting COVID-19, their related attitudes and beliefs regarding dental care visits, and their considerations for returning to routine care during and after the pandemic.

Method:

Data for this cross-sectional study came from an electronic survey of 464 US adults. Survey variables include demographics, dental hygiene behaviors, perceived susceptibility to COVID-19, attitudes and beliefs regarding risk for attending dental appointments, and the necessary conditions and events for them to feel comfortable returning to regular dental appointments.

Results:

Over half of study participants had a 4-y degree, an annual income of at least $50,000, and good oral hygiene practices of frequent brushing and routine dental visits. Older age and agreement with positive attitudinal statements and beliefs about professional dental care were positively related to perceived susceptibility for contracting COVID-19 in a dental setting. Perceptions of susceptibility, a higher valuation of dentistry, and agreement that COVID-19 is a serious infection were each positively related to attitudinal statements and beliefs reflecting caution in attending dental visits. Last, assurance from public health officials confirming the safety to return for routine dental care was the largest reported factor necessary for a return to routine dental visits.

Conclusion:

This study provides early data about patient perceptions of susceptibility and attitudes toward COVID-19 in a professional dental setting and necessary conditions for returning to regular visits. This information can help formulate messaging related to returning to professional dental care, specifically targeting fears among the most susceptible populations.

Knowledge Transfer Statement:

Government and public health agencies can play an important role in alleviating concerns and instilling confidence that dental settings are safe. With this information from the public, dental professionals and public health agencies can work together to share messaging that will consistently inform the public regarding the safety of returning to professional dental care as it relates to the reopening of states and cities.