bluuebunny/crossref_metadata_2025 huggingface dataset:
Precast Concrete Paving Repairs at Vancouver International Airport
Authors: Senseney Christopher T. , Smith Peter J. , Snyder Mark B.
Published: March 2021

In 2019, Vancouver International Airport conducted a precast concrete panel replacement pilot project on Taxiway Victor to establish whether precast concrete was a viable option for a planned runway repair project. This was the first major use of precast airfield pavement in North America in nearly 20 years. Twelve panels measuring 6 m × 7.5 m with a thickness of 360 mm and weighing up to 43 metric tons each were installed to demonstrate the viability of in-situ concrete panel replacement in 8-h night work windows. The panels were designed as heavily reinforced “ductile slabs”; conventional pavement design procedures would have required much greater slab thickness and removal/replacement of base material, which would have greatly slowed panel replacements. Load transfer was provided by 38-mm diameter galvanized steel dowels, which were spaced nonuniformly along each panel edge. The use of bottom slots presented a clean surface with minimal potential for foreign object damage. Five of the panels included embedded airfield light cans, which required great placement precision to ensure their proper alignment and function. Seven of the panels were nonplanar, requiring a special first-of-its-kind warped casting bed that was large enough to produce nonplanar airfield-sized panels to the specified fabrication tolerances. Many valuable lessons were learned during this pilot project, which confirmed that long-life jointed precast concrete pavement repairs could be successfully constructed in 8-h overnight work windows on an active airfield using large repair panels and doweled joints, while adhering to strict panel-to-panel elevation tolerances.
Planning Education and “Free-Choice” Learners: Teaching the YouTube Classroom
Authors: Amos Dave
Published: March 2021

“Free-choice” learners are people who learn outside of a formal learning environment. The video platform YouTube is a popular place for free-choice learners to educate themselves. The author of this article produced a YouTube channel with fifty-one videos on city planning topics to determine how many free-choice learners could be taught on the platform. Millions of viewers, most with no prior formal educational experience with city planning, watched the videos over a two-and-a-half year pilot study. YouTube can be a powerful tool for education beyond the classroom, but the platform’s recommendation algorithm poses challenges to reaching all demographic groups.
Outsiders Within Transforming the Academy: The Unique Positionality of Feminist Sociologists
Authors: Laube Heather
Published: March 2021

Several initiatives recognize the importance of transforming institutions, not just changing individuals, to diversify STEM (science, technology, engineering, mathematics) fields. Universities and colleges are distinctive gendered work organizations because workers (faculty) are highly educated and have authority in hiring, evaluation, and policy (shared governance). This article explores whether feminist sociologists are particularly well suited to guide institutional change to diversify the academy. Drawing on data from in-depth interviews with 24 feminist academic sociologists at the rank of associate or full professor, I analyze how their feminist and sociological identities intersect with institutional locations to create opportunities to transform the academy. Outsiders within, feminist sociologists revise and use the master’s tools to produce knowledge that improves recognition of, and ability to reduce, structural inequalities. Proficiency with these tools confers insider legitimacy and access to a “seat at the table” where disciplinary expertise and political commitments contribute to institutional change. Inevitably, these professors confront resistance, and in response develop strategies to advance their goals. Insights from feminist sociologists suggest that to transform universities to reflect the diversity of institutions and lived reality of contemporary faculty, it may be more useful to identify a set of commitments and principles that inform policies and practices, rather than specifying actions to support culture change.
Save the Quinolones! Impact of a Non-Restrictive Fluoroquinolone Reduction Initiative on Antibiotic Use and Resistance at an Urban Teaching Hospital
Authors: Smoke Steven M. , Plotkin Slava , Patel Neeki , Hilden Patrick
Published: March 2021

Background:

Many antibiotic stewardship programs have sought to reduce fluoroquinolone use due to their association with a myriad of negative consequences. In hospital settings with fewer resources, initiatives that are less labor intensive may offer a more feasible approach to addressing fluoroquinolone use and improving patient care.

Objective:

This study assessed the impact of a non-restrictive fluoroquinolone reduction initiative on antibiotic use and resistance.

Methods:

This was a retrospective pre- and post-interventional ecological study conducted from 2016 to 2017. The fluoroquinolone reduction initiative consisted of education on risks and alternatives. Buttons promoting “Save the Quinolones” were also worn to increase visibility. Outcome measures were the rate of fluoroquinolone use and antibiotic resistance in Staphylococcus aureus, Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, and Pseudomonas aeruginosa before and after the intervention.

Results:

Overall, fluoroquinolone use decreased throughout the study, but there was a significantly greater rate of decrease in the post-intervention period (monthly decrease of 3.3% (1.3, 5.1) v. 7.4% (5, 9.8) p = 0.043). S. aureus susceptibility to oxacillin increased from 47.2% to 55.2% (difference 8.0, 95%CI 1.2 to 14.7). P. aeruginosa susceptibility to levofloxacin increased from 60% to 70.7% (difference 10.7, 95%CI 0.8 to 20.6). No differences in susceptibility rates of E. coli, P. mirabilis or K. pneumoniae were detected.

Conclusion:

This non-restrictive fluoroquinolone reduction initiative led to a significant decrease in fluoroquinolone use that was associated with decreased antibiotic resistance in S. aureus and P. aeruginosa.
Psychological theory as administrative politics: Boris Lomov’s systems approach in the context of the Soviet science establishment
Authors: Konnov Vladimir
Published: March 2021

The article is a study into the advent of the ‘systems approach’ in Soviet psychology in the 1970s. This arose mainly through the theoretical publications of B. F. Lomov, written after he had been appointed director of the newly established Institute of Psychology. These publications are examined as reflections of those interests related to the sociopolitical role of the director of this leading psychology institution, which was officially charged with building a common theoretical and methodological framework for all Soviet psychology. The main goal of these texts, predetermined by the role of their author, was to advance a theoretical scheme that made possible a formal unification of the schools of psychology, and which at the same time promoted an image of psychology as a research field that was both capable of achieving practically applicable results and compatible with the new ‘big science’ trend.
Glucodensities: A new representation of glucose profiles using distributional data analysis
Authors: Matabuena Marcos , Petersen Alexander , Vidal Juan C , Gude Francisco
Published: March 2021

Biosensor data have the potential to improve disease control and detection. However, the analysis of these data under free-living conditions is not feasible with current statistical techniques. To address this challenge, we introduce a new functional representation of biosensor data, termed the glucodensity, together with a data analysis framework based on distances between them. The new data analysis procedure is illustrated through an application in diabetes with continuous-time glucose monitoring (CGM) data. In this domain, we show marked improvement with respect to state-of-the-art analysis methods. In particular, our findings demonstrate that (i) the glucodensity possesses an extraordinary clinical sensitivity to capture the typical biomarkers used in the standard clinical practice in diabetes; (ii) previous biomarkers cannot accurately predict glucodensity, so that the latter is a richer source of information and; (iii) the glucodensity is a natural generalization of the time in range metric, this being the gold standard in the handling of CGM data. Furthermore, the new method overcomes many of the drawbacks of time in range metrics and provides more in-depth insight into assessing glucose metabolism.
Are Brand Value and Firm Value Related? An Empirical Examination
Authors: Kumar Rajesh , Sujit K. S. , Waheed K. A. , Fernandez Manuel
Published: March 2021

This study aims to explore the influence of brand value on firm performance and shareholder wealth creation. This study is based on the top 100 brands ranked by Interbrand. This research article analyses the impact of brand value on firm performance both in terms of stock market performance and operating performance. This study uses panel regression data to understand valuation effects of brands. The results suggest that firms with superior operating performance have higher brand valuation effects. Higher brand valuation is a significant determinant of profitability. Brand quality leads to improved cash flow on account of the likelihood of repurchase. This study establishes the negative relationship between agency conflicts and brand value. The results support the belief that a marketer’s efforts on brand investments are a significant source of value-creating activity.
Farmer Producer Company: India’s Magic Bullet to Realise Select SDGs?
Authors: Mourya Mamta , Mehta Madhavi
Published: March 2021

Sustainable development goals (SDGs) are designed for the betterment of the underprivileged and the marginalised. Some of the sub-goals target doubling agricultural productivity and incomes of the small-scale food producers to realise the SDGs. Access to land, technology, inputs and financial services, opportunities for value addition and markets, non-farm employment and effective and transparent institutions that ensure responsive, inclusive, participatory and representative decision-making at all levels are assumed to be the means to that end. Based on the Alagh Committee report’s recommendations, to address the voids in the existing form of collectives, producer company as a new legal option was introduced in 2003 by amending the Companies Act. This new form of collective is expected to combine efficiency and professional management of the company form and the cooperative principles necessitating ownership and participation of and governance by producers. This study takes a mixed-method approach. It qualitatively inquires about member’s perception of roles farmer producer companies (FPCs) play in their lives and livelihood. With the help of performance data from five FPCs, this study elaborates on the promises this form holds in realising some of the SDGs and challenges FPCs facing that could make achieving these promises a distant dream.
Weathering the Storm: How Foreign Aid and Institutions Affect Entrepreneurship Activity Following Natural Disasters
Authors: Boudreaux Christopher John , Jha Anand , Escaleras Monica
Published: March 2021

This study examines how foreign aid and institutions affect entrepreneurship activity following natural disasters. We use insights from the entrepreneurship, development, and institutions literature to develop a model of entrepreneurship activity in the aftermath of natural disasters. First, we hypothesize the effect of natural disasters on entrepreneurship activity depends on the amount of foreign aid received. Second, we hypothesize that natural disasters and foreign aid either encourages or discourages entrepreneurship activity depending on two important institutional conditions: the quality of government and economic freedom. The findings from our panel of 85 countries from 2006 to 2016 indicate that natural disasters are negatively associated with entrepreneurship activity, but both foreign aid and economic freedom attenuate this effect. In addition, we observe that foreign aid is positively associated with entrepreneurship activity but only in countries with high quality government. Hence, we conclude that the effect of natural disasters on entrepreneurship depends crucially on the quality of government, economic freedom, and foreign aid. Our findings provide new insights into how natural disasters and foreign aid affect entrepreneurship and highlight the important role of the institutional context.
Action Plans as Active Boundary Objects
Authors: Beck Anne-Marie Tyroll , Rasmussen Bo Morthorst , Nielsen Tina K. Harlev
Published: March 2021

This article presents how action plans are used as active boundary objects in the meeting between the client, the social worker, and the interprofessional partners within the four core social service areas in Denmark: children and families, handicap, adults at risk, and employment. Empirically, the article is based upon the analysis of 16 action plans and 21 interviews. The theory of boundary objects is applied to illustrate and explore how action plans can create integration across different social and professional domains, or worlds. The degree of integration is illustrated through the theory of interprofessional collaboration, which forms the basis of four ideal types of action plans as boundary objects: the joint plan, the professional one, the administrative one, and the symbolic plan. We find that action plans have a large but often unexploited potential as an active and effective boundary object and only a few functions as joint plans. In order to be an active boundary object, both user and interprofessional involvement are required in making the plans. This requires a highly structured and preferably systematic involvement in face-to-face dialogue meetings led by the social worker as well as frequent follow-up at a distance.
Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate
Authors: Stonehouse-Smith Daniel , Rahman Aida N.A. Abd , Mooney Jeanette , Bellardie Haydn
Published: March 2021

Aim:

To assess occlusal outcomes of orthodontic treatment for patients with complete cleft lip and palate.

Design:

Retrospective assessment using the Peer Assessment Rating (PAR) index.

Setting:

Consecutive patients treated by one consultant orthodontist at a tertiary care cleft center.

Participants:

One hundred twenty-seven patients with either complete unilateral cleft lip and palate (UCLP) or bilateral cleft lip and palate (BCLP) consecutively treated with fixed appliances.

Intervention:

Fixed orthodontic appliance treatment and orthognathic surgery when required.

Outcomes:

The PAR index assessment was carried out by a calibrated-independent assessor. Treatment duration, the number of patient visits, and data on dental anomalies were drawn from patient records and radiographs.

Results:

One hundred two patients’ study models were assessed after exclusions. Mean start PAR score for UCLP (n = 71) was 43.9 (95% CI, 41.2-46.6, SD 11.5), with a mean score reduction of 84.3% (95% CI, 81.9-86.7, SD 10.1). The UCLP mean treatment time was 23.7 months with 20.1 appointments. Mean start PAR score for BCLP (n = 31) was 43.4 (95% CI, 39.2-47.6, SD 11.4), with a mean score reduction of 80.9% (95% CI, 76.3-85.5, SD 12.5). The BCLP mean treatment time was 27.8 months with 20.5 appointments.

Conclusion:

These results compare well with other outcome reports, including those for patients without a cleft, and reflect the standard of care provided by an experienced cleft orthodontist. As with high-volume surgeons, orthodontic treatment for this high need group is favorable when provided by a high-volume orthodontist. These findings may be used for comparative audit with similar units providing cleft care.
MMPI-3 Predictors of Anxiety Sensitivity and Distress Intolerance
Authors: Kremyar Andrew J. , Lee Tayla T. C.
Published: March 2021

Documenting empirical correlates of the Minnesota Multiphasic Personality Inventory–3 (MMPI-3) scale scores is important for expanding the clinical utility of the instrument. To this end, the goals of the current study were to examine associations between scores on MMPI-3 scales and measures of anxiety sensitivity and distress intolerance, two constructs reflecting intolerance of negative emotional states that are implicated in many psychological conditions, and to identify the scales that most strongly predict each construct. Using a sample of 287 undergraduate students (71% women; Mage = 18.90, SD = 1.12; 85% White), zero-order correlational, regression, and dominance analyses were performed to address these goals. Results indicate that when MMPI-3 scale scores are considered conjointly by scale family, they predict meaningful variance in anxiety sensitivity and distress intolerance measure scores, with conceptually implicated scales offering the strongest prediction across scale families. Implications for both research and practice, limitations, and future research directions are discussed.
Association Between Arg72Pro Polymorphism in TP53 and Malignant Abdominal Solid Tumor Risk in Hunan Children
Authors: Liu Zan , Xiao Zhenghui , Li Ming , Xiao Yaling , Wang Xiyang , He Jing , Li Yong
Published: March 2021

Pediatric solid tumors are heterogeneous and comprise various histological subtypes. TP53, a tumor suppressor, orchestrates the transcriptional activation of anti-cancer genes. The gene coding for this protein is highly polymorphic, and its mutations are associated with cancer development. The Arg72Pro polymorphism in TP53 has been associated with susceptibility to various types of cancer. Here, in this hospital-based study, we evaluated the association of this polymorphism with susceptibility toward malignant abdominal solid tumors in children in the Hunan province of China. We enrolled 162 patients with neuroblastoma, 60 patients with Wilms’ tumor, and 28 patients with hepatoblastoma as well as 270 controls. Genotypes were determined using a TaqMan assay, and the strength of the association was assessed using an odds ratio, within a 95% confidence interval identified using logistic regression models. Our results showed that the Arg72Pro polymorphism did not exhibit significant association with susceptibility toward pediatric malignant abdominal solid tumors. Stratification analysis revealed that this polymorphism exerts weak sex- and age-specific effects on Wilms’ tumor and hepatoblastoma susceptibility, respectively. Overall, our results indicate that the Arg72Pro polymorphism may have a marginal effect on susceptibility toward pediatric malignant abdominal solid tumors in Hunan, and this finding warrants further confirmation.
“There’s Girls Who Can Fight, and There’s Girls Who Are Innocent”: Gendered Safekeeping as Virtue Maintenance Work
Authors: Lennox Rebecca A.
Published: March 2021

Women routinely practise taxing safety strategies in public, such as avoiding unlit spaces after dark. To date, scholars have understood these behaviors as means by which women bolster their physical safety in public. My in-depth interviews with women in Greater Vancouver, British Columbia suggest that, much less than reliably enhancing women’s safety, safety work often exacerbates women’s fear of violent crime and unreliably mitigates their exposure to violence. I thus interrogate the protective function of gendered safekeeping and reconceptualize women’s safety work as virtue maintenance work, theorizing that women practice risk-management in public places to attain the ontological security associated with evading subjectivities of gendered imprudence.
Efficacy of Non-pharmacological Treatments on Emotional Symptoms of Children and Adults with Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis
Authors: Guo Chao , Assumpcao Leonardo , Hu Zhiguo
Published: March 2021

Background:

The present meta-analysis aimed to evaluate the efficacy of various non-pharmacological interventions on comorbid emotional symptoms such as depression, anxiety, and emotional dysregulation (ED) in children and adults with ADHD.

Method:

Forty-four randomized controlled trials (23 studies with ADHD children and 21 studies with ADHD adults) were included. Risk of bias, heterogeneity assessment, and subgroup analyses were conducted.

Results:

We found that therapies targeting the relationship between children and others (i.e., parent-training [on ED and depression] and social skills training [on ED]) were efficacious in the treatment of emotional symptoms in children with ADHD at post-intervention. As for adults with ADHD, cognitive behavioral therapy was found to be effective for the improvement of emotional symptoms at both post-intervention and follow-up.

Conclusion:

Our findings demonstrate that the efficacy of non-pharmacological interventions varies substantially across children and adults with ADHD. These results provide important implications for the selection of non-pharmacological interventions for children with ADHD.
High Seroprevalence of Hepatitis C Virus Antibody in Breast Cancer Patients in Egypt
Authors: Hussein Osama , El-Ghitany Engy Mohamed , Omran Mawadda , Matariek Ghadier , Elbadaly Esraa Ahmed , Hamdy Rana , Gamal Amira , Zayed Mai Mohamed , Nasr Ahmed , Hamdy Omar , Elbasiony Mohamed , Abdelwahab Khaled
Published: March 2021

Background:

Hepatitis C virus (HCV) is a known risk factor for hepatocellular carcinoma. Several epidemiological studies have pointed out to an association of HCV infection with other extrahepatic malignancies. The role of chronic HCV in breast cancer causation is less clear. Egypt is an endemic area of HCV infection with resulting significant morbidity. The association between HCV status and breast cancer risk in Egyptian women is hitherto unknown.

Methods:

A retrospective study was performed. The prevalence of anti-HCV seropositivity was estimated in a sample of women with a breast cancer diagnosis, retrieved from the hospital records, and was compared to the raw data of a population study in Egypt. Anti-HCV negative and positive patients were compared regarding the disease course and outcome.

Results:

Retrospective analysis revealed a markedly high prevalence of anti-HCV seropositivity in young breast cancer patients. In patients younger than 45 years, 13.4% were anti-HCV positive. Seropositivity was 6-fold higher in these patients than in adult females of the same age without cancer diagnosis ( P = .003). The biological type, tumor size, nodal status, and disease-free survival were not affected by the patients’ HCV status.

Conclusion:

Young Egyptian breast cancer patients have a dramatically high prevalence of HCV seropositivity. Further population studies are strongly required to investigate the epidemiological association of these two significant health problems.
Engagement in language learning: A systematic review of 20 years of research methods and definitions
Authors: Hiver Phil , Al-Hoorie Ali H. , Vitta Joseph P. , Wu Janice
Published: March 2021

At the turn of the new millennium, in an article published in Language Teaching Research in 2000, Dörnyei and Kormos proposed that ‘active learner engagement is a key concern’ for all instructed language learning. Since then, language engagement research has increased exponentially. In this article, we present a systematic review of 20 years of language engagement research. To ensure robust coverage, we searched 21 major journals on second language acquisition (SLA) and applied linguistics and identified 112 reports satisfying our inclusion criteria. The results of our analysis of these reports highlighted the adoption of heterogeneous methods and conceptual frameworks in the language engagement literature, as well as indicating a need to refine the definitions and operationalizations of engagement in both quantitative and qualitative research. Based on these findings, we attempted to clarify some lingering ambiguity around fundamental definitions, and to more clearly delineate the scope and target of language engagement research. We also discuss future avenues to further advance understanding of the nature, mechanisms, and outcomes resulting from engagement in language learning.
The European Union and the political economy of enforcing international trade rules
Authors: van Ommeren Emile , Poletti Arlo , De Bièvre Dirk
Published: March 2021

The European Commission keeps track of foreign trade barriers through its Market Access Strategy. In this study, we examine some of the key political-economic conditions under which the European Union decides whether and how to address these trade issues. Drawing on an original dataset of (allegedly) illegal foreign trade barriers faced by European Union businesses, we show that industries dominated by a few large companies are more successful in gaining the support of the Commission to challenge these foreign trade barriers. Moreover, we find that the European Commission’s strategy depends on the economic power relationship with the trading partner: the European Union privileges negotiations when seeking to enforce international trade rules against economically weaker states, while it prefers to use litigation against stronger trading partners.
Mirrorless cameras in orthodontic practice
Authors: Shahrul Al Imran
Published: March 2021

Mirrorless cameras have seen rapid advancements in recent years. Orthodontists may benefit from these technological advancements in their daily orthodontic practice. This article will explore the advantages and disadvantages of mirrorless cameras, and assess how these camera compare to the tried-and-tested digital single-lens reflex (DSLR) camera.
The political realism of Jeremy Bentham
Authors: Vitali James
Published: March 2021

Jeremy Bentham is usually seen as an anti-realist political thinker, or a proponent of what Bernard Williams has termed ‘political moralism’. This article questions that prevalent view and suggests instead that there are good grounds for considering Bentham a political realist. Bentham’s political thought has considerable commonalities with that of the sociologist and political realist Max Weber: both agree that politics is a unique domain of human activity defined by its association with power; that consequently, ethical conduct is unavoidably inflected by power in politics; that a commitment to truth in politics can only ever be contingent; and that politics has a set of basic conditions that it would be not only misguided but dangerous to attempt to transcend. Whilst it is often held that Bentham advanced a reductive framework for understanding politics, in fact, his utilitarianism was a far more realistic approach to political ends and means than has generally been acknowledged, and one that contemporary political theory realists would benefit from taking seriously.
Elimination of outlier measurements for damage detection of structures under changing environmental conditions
Authors: Soo Lon Wah William , Xia Yining
Published: March 2021

Damage detection methods developed in the literature are affected by the presence of outlier measurements. These measurements can prevent small levels of damage to be detected. Therefore, a method to eliminate the effects of outlier measurements is proposed in this article. The method uses the difference in fits to examine how deleting an observation affects the predicted value of a model. This allows the observations that have a large influence on the model created, to be identified. These observations are the outlier measurements and they are eliminated from the database before the application of damage detection methods. Eliminating the outliers before the application of damage detection methods allows the normal procedures to detect damage, to be implemented. A multiple-regression-based damage detection method, which uses the natural frequencies as both the independent and dependent variables, is also developed in this article. A beam structure model and an experimental wooden bridge structure are analysed using the multiple-regression-based damage detection method with and without the application of the method proposed to eliminate the effects of outliers. The results obtained demonstrate that smaller levels of damage can be detected when the effects of outlier measurements are eliminated using the method proposed in this article.
On Mining Words: The Utility of Topic Models in Health Education Research and Practice
Authors: Valdez Danny , Picket Andrew C. , Young Belinda-Rose , Golden Shelley
Published: March 2021

Written language is the primary means by which scientific research findings are disseminated. Yet in the era of information overload, dissemination of a field of research may require additional efforts given the sheer volume of material available on any specific topic. Topic models are unsupervised natural language processing methods that analyze nonnumeric data (i.e., text data) in abundance. These tools aggregate, and make sense of, those data making them interpretable to interested audiences. In this perspective piece, we briefly describe topic models, including their purpose, function, and applicability for health education researchers and practitioners. We note how topic models can be applied in several contexts, including social media–based analyses, and mapping trends in scientific literature over time. As a tool for studying words, and patterns of words, topic models stand to improve our understanding of events prior and those occurring in the moment and help us look ahead into the future.
What Are the Burden, Causes, and Costs of Early Hospital Readmissions After Kidney Transplantation?
Authors: Famure Olusegun , Kim Esther D. , Au Magdalene , Zyla Roman E. , Huang Johnny W. , Chen Pei Xuan , Li Yanhong , Kim S. Joseph
Published: March 2021

Introduction:

Kidney transplant recipients are at risk for complications resulting in early hospital readmission. This study sought to determine the incidences, risk factors, causes, and financial costs of early readmissions.

Design:

This single-centre cohort study included 1461 kidney recipients from 1 Jul 2004 to 31 Dec 2012, with at least 1-year follow-up. Early readmission was defined as hospitalization within 30 or 90-days postdischarge from transplant admission. Associations between various parameters and 30 and 90-days posttransplant were determined using multivariable Cox proportional hazards models. The hospital-associated costs of were assessed.

Results:

The rates of early readmission were 19.4% at 30 days and 26.8% at 90 days posttransplant. Mean cost per 30-day readmission was 11 606 CAD. Infectious complications were the most common reasons and resulted in the greatest cost burden. Factors associated with 30 and 90-days in multivariable models were recipient history of chronic lung disease (hazard ratio or HR 1.78 [95%CI: 1.14, 2.76] and HR 1.68 [1.14, 2.48], respectively), median time on dialysis (HR 1.07 [95% CI: 1.01, 1.13]and HR 1.06 [95% CI: 1.01, 1.11], respectively), being transplanted preemptively (HR 1.75 [95% CI: 1.07, 2.88] and HR 1.66 [95% CI: 1.07, 2.57], respectively), and having a transplant hospitalization lasting of and more than 11 days (HR 1.52 [95% CI: 1.01, 2.27] and HR 1.65 [95% CI: 1.16, 2.34], respectively).

Discussion:

Early hospital readmission after transplantation was common and costly. Strategies to reduce the burden of early hospital readmissions are needed for all patients.
PD-1 Immune Checkpoint Inhibitor Therapy Malignant Tumor Based on Monotherapy and Combined Treatment Research
Authors: Zhang Yu , Mou Guang-Ze , Li Tian-Zhu , Xu Wan-Ting , Zhang Tong , Xue Hui , Zuo Wen-Bo , Li Yan-Nan , Luo Ying-Hua , Jin Cheng-Hao
Published: March 2021

Recently, immunotherapy has become the fourth pillar of cancer treatment in addition to surgery therapy, chemotherapy, and radiation therapy. The inhibitors of programed cell death protein 1 (PD-1) and its ligand PD-L1 are the new stars in immunotherapy, as they can overcome tumor immunosuppression. However, the efficacy of PD-1 inhibitors still needs to be further developed for clinical treatment. Therefore, research into treatment with anti-PD-1 drugs has emerged as a new development field. This review provides novel insights into the role and mechanism of PD-1 combination anti-tumor therapy, thereby promoting its clinical application in anti-tumor immunotherapy.
Response analysis of 3D braided two-stage gear system excited by different frequency signals
Authors: Zhang Weiliang , Wang Xupeng , Ji Xiaomin , Tang Xinyao , Liu Fengfeng , Liu Shuwei , Xue Tengyuan
Published: March 2021

The knitting principle of 3D braided gear was studied, and the dynamic model of the two-stage gear system was established. The fourth-order Runge-Kutta method was used to numerically simulate the dynamic characteristics of common gear and 3D braided gear. The results showed that the fundamental frequency ω1 of the static transmission error excitation had the greatest effect on the speed and frequency characteristics of the first-stage gear along the meshing line. The research on frequency characteristics of common gear and 3D braided gear shows that the fundamental frequency ω1 of the static transmission error excitation has a large effect on the speed and frequency characteristics of the first-stage gear along the meshing line. With the reduction of the gear mass and moment of inertia, the amplitude in the low-frequency band increases. The vibration resonance of the system is studied by defining the amplitude gain of the response of the system output at the low-frequency signal ω3. The results show that with the reduction of gear mass and moment of inertia, when the input stage torque fluctuation frequency is Ω > 5, the fluctuation of amplitude gain Q disappears, which indicates that the vibration resistance of the 3D braided gear to high-frequency input stage torque fluctuation frequency is greatly improved.
Trial of a New Diabetes Education Model: Closing the Gap in Health Disparity for People with Diabetes
Authors: Martens Thomas W. , Lima Janet S. , Johnson Elizabeth A. , Conry Jessica A. , Hoppe Jennifer J. , Bergenstal Richard M. , Carlson Anders L. , Davidson Janet L.
Published: March 2021

Background:

Quality measures relating to diabetes care in America have not improved between 2005 and 2016, and have plateaued even in areas that outperform national statistics. New approaches to diabetes care and education are needed and are especially important in reaching populations with significant barriers to optimized care.

Methods:

A pilot quality improvement study was created to optimize diabetes education in a clinic setting with a patient population with significant healthcare barriers. Certified Diabetes Care and Education Specialists (CDCES) were deployed in a team-based model with flexible scheduling and same-day education visits, outside of the traditional framework of diabetes education, specifically targeting practices with underperforming diabetes quality measures, in a clinic setting significantly impacted by social determinants of health.

Results:

A team-based and flexible diabetes education model decreased hemoglobin A1C for individuals participating in the project (and having a second A1C measured) by an average of −2.3%, improved Minnesota Diabetes Quality Measures (D5) for clinicians participating in the project by 5.8%, optimized use of CDCES, and reduced a high visit fail rate for diabetes education.

Conclusions:

Diabetes education provided in a team-based and flexible model may better meet patient needs and improve diabetes care metrics, in settings with a patient population with significant barriers.
Foot and Ankle Injections in Athletes
Authors: Ochoa Jonathan K. , Gross Christopher E. , Anderson Robert B. , Hsu Andrew R.
Published: March 2021

Context:

Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety.

Evidence Acquisition:

An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles.

Study Design:

Clinical review.

Level of Evidence:

Level 4.

Results:

Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results.

Conclusions:

Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.
Review of the role of big data and digital technologies in controlling COVID-19 in Asia: Public health interest vs. privacy
Authors: Nageshwaran Gopinath , Harris Rebecca C , Guerche-Seblain Clotilde El
Published: March 2021

Background

Asia has been at the forefront of leveraging big data and digital technologies to strengthen measures against SARS-CoV-2 spread. Understanding strengths and challenges of these new approaches is important to inform improvements and implementation. In this review, we aimed to explore how these tools were utilized in four countries in Asia to facilitate COVID-19 preventative control measures.

Methods

We conducted a pragmatic review of English-language literature and web-based information in Pubmed, MedRxiv, national and international public health institution websites and media sources between 1st January-3rd August 2020 to identify examples of big data and digital technologies to facilitate COVID-19 preventative control measures in Taiwan, South Korea, Hong Kong, and Singapore. Results were summarized narratively by common technological themes, and examples of integration highlighted.

Results

Digital tools implemented included real-time epidemiological dashboards, interactive maps of case location, mobile apps for tracing patients’ contacts and geofencing to monitor quarantine compliance. Examples of integration of tools included linkage of national health and immigration databases to identify high-risk individuals in Taiwan, and the use of multiple digital surveillance sources to map patients’ movements in South Korea. Challenges in balancing privacy and public good were identified.

Conclusions

Digital technologies have facilitated and strengthened traditional public health measures for prevention of SARS-CoV-2 spread in Asia. Resolving issues around privacy concerns would improve future preparedness, implementation speed and uptake of digital measures. The significant technological advances and lessons learned can be adopted or adapted by other countries to ensure public health preparedness for future waves of COVID-19 and other pandemics.
Determinants of Workforce Preparedness during Pandemics Among Healthcare Workers at the U.S. Department of Veterans Affairs
Authors: Balut Michelle D. , Der-Martirosian Claudia , Dobalian Aram
Published: March 2021

Objective:

An infectious disease outbreak can place a significant burden on healthcare systems, however, our understanding of the broader healthcare workforce’s preparedness during a pandemic is limited. This study examines factors that influence perceived workforce preparedness at the U.S. Department of Veterans Affairs (VA) during a pandemic.

Methods:

The VA Preparedness Survey was a random, anonymous, web-based survey fielded nationwide October to December 2018. Multivariate statistical analyses examined the effects of study relevant factors (sociodemographic, work-related, general health, and household-related characteristics of VA employees) on perceptions of workforce preparedness, including institutional readiness and understanding of individual roles during a pandemic.

Results:

Four thousand and twenty-six VA employees responded. Overall, 55% were confident in their VA medical facility’s ability to respond; 49% understood their role; and 68% reported their role to be important during a pandemic. After controlling for study-relevant factors, household preparedness, having plans that address the health care needs of family members, and higher self-reported health status were associated with all 3 workforce preparedness variables. Clinical staff (compared to non-clinical staff) were less likely (OR:0.80, 95% CI:0.68-0.94, P < .01) to have confidence in their medical facility’s ability to respond but more likely (OR:1.77, 95% CI:1.49-2.10, P < .001) to believe their role was important. Employees who have been at the VA longer (OR:1.07, 95% CI:1.01-1.14, P < .05) or have experienced a disaster while working at the VA (OR:1.29, 95% CI:1.04-1.59, P < .05) were more likely to understand their role during a pandemic.

Conclusion:

The findings from this study suggest the need for identifying ways to increase VA employees’ confidence in their medical facility’s ability to respond to a pandemic; develop trainings to improve understanding of their different yet critical roles, for both clinical and non-clinical staff, during a pandemic; create different workforce trainings for newly hired employees; and identify ways to improve household preparedness for a pandemic outbreak.
Incidence of venous thromboembolism in Asian patients undergoing anterior cruciate ligament reconstruction without the use of mechanical or chemical prophylaxis
Authors: Liu Xuan , Tan Andrew Hwee Chye
Published: March 2021

Background:

Venous thromboembolism (VTE) is a clinically relevant complication of major orthopedic surgeries. The prevalence of VTE and the indications for VTE thromboprophylaxis in Asian patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction are not clear. This study aims to evaluate the prevalence of clinically significant venous thromboembolic events (VTE) in Asian patients undergoing arthroscopic ACL reconstruction without mechanical or chemical thromboprophylaxis.

Methods:

All patients who underwent ACL reconstruction by a single surgeon from 2006 to 2018 in a single tertiary institution were reviewed. The inclusion criteria for the study included Asian patients of common ethnic groups in Singapore (Chinese, Malay, Indian) and underwent primary or revision ACL reconstruction, or ACL reconstruction combined with meniscal surgery. The exclusion criteria were patients with incomplete medical records, pre-existing anticoagulant treatment within 1 year prior to the surgery and additional procedures that altered the standard rehabilitation protocol, less than 6 months of follow-up duration. All patients received general anesthesia. The single-bundle ACL technique with autologous hamstring tendon reconstruction was performed. No chemical DVT prophylaxis was given. The patients were screened for clinically for VTE. Symptomatic patients were referred for ultrasonography.

Results:

Of the 581 patients reviewed, 3 patients had a clinical suspicion of deep vein thrombosis, but subsequent ultrasonography showed no thrombosis. Hence, the prevalence of clinically significant VTE was 0%.

Conclusion:

Given the low prevalence of clinically significant VTE, there is no need for routine mechanical or chemical thromboprophylaxis or radiologic screening in Asian patients undergoing arthroscopic ACL reconstruction.
Cost-efficient factors in local public spending: Detecting relationships between local environments, population size and urban area category
Authors: Baba Hiroki , Asami Yasushi
Published: March 2021

This study examines regional differences in local environment factors to better understand the sustainability of local governments indexed by per capita public spending. Under the condition of heterogeneous population size, we examine how factor characteristics differ depending on the spatial context represented by the urban area category. By employing a Cobb–Douglas cost function with congestion effects on public service provision, the estimated factors enable us to articulate major factors and differences in cost-efficiency between urban area categories. We found that statistical significance and even the signatures of local environment factors differ depending on the urban employment area category. Regarding factors such as the ratios of employees in secondary and tertiary industries, these did not tend to be statistically significant in small-sized urban areas, while small-sized cities in large-sized urban areas were likely to gain confidence intervals. Moreover, we did not observe any statistical significance for the ratio of elderly people due to the balance of spending between national and local governments. These findings could contribute to sustainable management of cities in the advent of population decline.
Clinical outcomes after intracorneal ring segment implantation for keratoconus management in corneas with mild apical haze
Authors: Elalfy Mohamed , Maqsood Sundas , Reinhold Aja , Panos Georgios D. , Khine Aye , Lake Damian , Hamada Samer , Gatzioufas Zisis
Published: March 2021

Purpose:

The implantation of intracorneal ring segments represents an effective and safe therapeutic option for visual improvement in patients with keratoconus. The presence of corneal opacities is considered an exclusion criterion for this operation.

Methods:

This is a retrospective cohort study of six eyes of six keratoconus patients at Queen Victoria Hospital, East Grinstead, UK, between January 2012 and December 2016. Femtosecond laser-assisted intracorneal ring segment implantation was performed in six eyes with apical corneal haze. Preoperative and postoperative visual acuity, keratometry readings, as well as corneal pachymetry were compared at 6-month follow-up.

Results:

Uncorrected visual acuity (UCVA) [LogMAR] improved significantly from median 1.05 [95% confidence interval (CI): 0.83–0.13] preoperatively to 0.9 (95% CI: 0.63–1.00) at 6 months postoperatively ( p = 0.03). Corrected visual acuity (CDVA) also improved significantly from median 0.75 (95% CI: 0.43–1.00) preoperatively to 0.4 (95% CI: 0.23–0.50) at 6 months postoperatively ( p = 0.03). Keratometric readings, K-max (diopters) and K-mean (diopters), decreased significantly from 54.5 and 47.85 preoperatively to 53.45 and 46.42 postoperatively, respectively ( p = 0.03). Corneal pachymetry showed no significant changes postoperatively.

Conclusion:

The results of this study show that the presence of apical haze should not exclude the implantation of intracorneal ring segments in patients with keratoconus.
Natural variability in the disease course of SSc-ILD: implications for treatment
Authors: Vonk Madelon C. , Walker Ulrich A. , Volkmann Elizabeth R. , Kreuter Michael , Johnson Sindhu R. , Allanore Yannick
Published: March 2021

Interstitial lung disease (ILD) affects approximately 50% of patients with systemic sclerosis (SSc) and is the leading cause of death in SSc. Our objective was to gain insight into the progression of SSc-associated ILD (SSc-ILD). Using data from longitudinal clinical trials and observational studies, we assessed definitions and patterns of progression, risk factors for progression, and implications for treatment.

SSc-ILD progression was commonly defined as exceeding specific thresholds of lung function worsening and/or increasing radiographic involvement. One definition used in several studies is decline in forced vital capacity (FVC) of ≥10%, or ≥5–10% plus a decline in diffusing capacity of the lung for carbon monoxide ≥15%. Based on these criteria, 20–30% of patients in observational cohorts develop progressive ILD, starting early in the disease course and progressing at a highly variable rate.

Risk factors such as age, FVC, extent of fibrosis and presence of anti-topoisomerase I antibodies can help predict progression of SSc-ILD, though composite risk scores may offer greater predictive power. Whilst the variability of the disease course in SSc-ILD makes risk stratification of patients challenging, the decision to initiate, change or stop treatment should be based on a combination of the current disease state and the speed of progression.