bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of the Thoracoscopic Radiofrequency Epicardial Ablation with a Bipolar Electrode During Longstanding Persistent form of Atrial Fibrillation
Authors: Tuleutaev Rustem , Oshakbayev Alibek , Abzaliyev Kuat , Rakishev Baurzhan , Abzaliyeva Symbat
Published: March 2020

Thoracoscopic ablation using the ‘box lesion’ technique was performed using a bipolar radio frequency clamp. A total of 48 patients, including 38 men and 10 women, mean age 58 years (range 33 74). The mean duration of AF was 4 yrs (range 1.5 months 21), the mean size of the atrium 4.15 ± 0.9 cm (2.9-8.8 cm), mean LVEF was 57.7% (39 -73%). Mitral regurgitation of 1-2 degrees was present in 14 patients, EDV LV 147.7 ml (81-224). Primary catheter ablation was performed in 22 patients, where 5 of them (22,7%) were performed repeatedly. Resection of the left atrial appendage (LAA) during the operation was performed in 44 patients (91%). Input and output block was achieved in all patients. In the postoperative period, all patients were administered supporting antiarrhythmic therapy with amiodarone and β-blockers, anticoagulant therapy with warfarin or PLA for 6-12 months. The effectiveness of treatment was monitored by a cardiomonitor Reveal XT in the period 1, 3, 6, 12, 24 months after surgery, the mean follow-up length was 498 ± 19 days. Sinus rhythm was restored during surgery in all patients and remained until discharge.
Problems of improving the quality of education
Authors: Baitanayeva Bakhyt , Aubakirova Zhanara , Aitbembetova Aida , Sansyzbayeva Aida
Published: March 2020

The article deals with actual problems of improving the quality in higher education school, taking into account the world experience. First of all, attention is paid to the concept of the quality of education, interpretations of various scientists and specialists are given. It is noted that the quality of education in first of all, it depends on the competence and experience of the teacher and the modern technologies used teaching method. The article, based on international experience, concludes about the effectiveness of group learning methods. The article draws a conclusion about the effectiveness of group training methods based on international experience. Special attention is paid to the need to comply with the principles TQM and ISO series quality standards in the educational process. The need to implement a quality management system (QMS) in all universities of the country is emphasized. The article proposes to select students according to their abilities and inclinations to scientific -research activities or work in business structures. The educational process in universities should be aimed at the integration of science, education, industry (business). The article provides examples of successful activities of this chain.
The development of cognitive independence of students based on information technology
Authors: Maygeldiyeva Sharbanu , Bekzhanova Bakytzhamal , Zhamansarieva Lazzat , Stamkulova Sholpan , Usenova Gulnur
Published: March 2020

In the article the authors consider the development of cognitive independence as the leading axiological motive for teaching students at the university. The authors believe that value attitude to the world allows the student to engage in cognitive activity with the whole variety of his or her inner strengths and capabilities. Based on this, the basis for the development of cognitive independence as a personality trait is to determine the personal meaning, needs and motives of the trainees, which is inextricably linked with the value orientations and axiological potential of the individual.

The article also states that cognitive independence successfully develops in the process of studying the discipline “Computer studies” at the university, where technological support for information and educational interaction is carried out by means of Web technologies. The study of the authors of the article shows that the implementation of this idea is based on the creation in the university of an information and communication environment as one of the leading trends in the development of university education and is implemented through the Platonus system, where the teacher’s educational blog was created and forums were created both by the teacher and by themselves students. The authors note that the process of using new information technologies in the development of students’ cognitive independence depends directly on teachers, and therefore, in the future they pay attention to the need to form their information technology culture.
Lösungsmöglichkeiten bei fehlgeschlagenen Osteosynthesen – Ellenbogen
Authors: Graef Frank , Stöckle Ulrich , Thiele Kathi
Published: March 2020

Revisionsoperationen am Ellenbogen gestalten sich aufgrund der hochgradig kongruenten Gelenkpartner sowie der komplexen ligamentären Führung schwierig. Neben biomechanischen Gründen für ein Osteosyntheseversagen wie instabile Frakturversorgungen oder eine falsch rekonstruierte Anatomie können insbesondere ligamentäre Begleitverletzungen, wenn übersehen, eine Revision notwendig machen. Ziel muss die stabile Osteosynthese mit anatomischer Reposition sein. Neben osteosynthetischen Möglichkeiten ist bei frustranen Befunden die endoprothetische Versorgung möglich.
Hämodynamische Stabilisierung im kardiogen-septischen Schock – Einsatz eines ECLS-Systems in Kombination mit einer Mikroaxialpumpe
Authors: Wechsler Lukas , Heigl Johannes , Machann Holger , Witt Sabine , Schwinger Robert H. G.
Published: March 2020

Bei kompliziertem septischen Schockgeschehen mit hämodynamischer Instabilität und kardiomyopathischer Komponente kann ein ECLS-System durch den Einsatz von VA-ECMO, und bei ungenügender Oxygenierung durch die Aufrüstung auf VAV-ECMO, in Kombination mit einer Mikroaxialpumpe zusätzlich zur optimierten Standardtherapie (Antibiose, Volumenstatus, Vasokonstriktoren, etc.) als Ultima-Ratio-Therapie angewandt werden. So konnte im vorliegenden Fall eine Stabilisierung mit Verbesserung der Oxygenierung, Organfunktion und Ventrikelfunktion erreicht werden.
A novel endoscopic hand-suturing technique for defect closure after colorectal endoscopic submucosal dissection: a pilot study
Authors: Abe Seiichiro , Saito Yutaka , Tanaka Yusaku , Ego Mai , Yanagisawa Fumito , Kawashima Kazumasa , Takamaru Hiroyuki , Sekiguchi Masau , Yamada Masayoshi , Sakamoto Taku , Matsuda Takahisa , Goto Osamu , Yahagi Naohisa
Published: March 2020

Background This study aimed to demonstrate the feasibility of endoscopic hand-suturing (EHS) and attainability of sustained closure after colorectal endoscopic submucosal dissection (ESD).

Methods EHS was defined as uninterrupted endoscopic suturing of the mucosal defect after colorectal ESD using an absorbable barbed suture and a through-the-scope needle holder. Following individual EHS training using an ex vivo porcine colonic model, two experienced endoscopists performed EHS. Repeat colonoscopy was performed on the third or fourth day after ESD to examine the EHS site. The primary end point was the complete EHS closure rate, and secondary end points were sustained closure and post-ESD bleeding rates.

Results 11 lesions were included. Median size of the mucosal defect was 38 mm (range 25 – 55 mm) and the lesion characteristics were as follows: lower rectum/upper rectum/ascending colon/cecum = 3/3/2/3, and 0-IIa/0-Is + IIa/others = 5/4/2. EHS was not attempted in two patients owing to difficulty in colonoscope reinsertion after ESD and intraoperative perforation, respectively. EHS was performed for nine lesions, and the complete EHS closure rate was 73 %. Median procedure time for suturing was 56 minutes (range 30 – 120 minutes) and median number of stitches was 8 (range 6 – 12). Sustained closure and post-ESD bleeding rates were 64 % and 9 %, respectively.

Conclusions EHS achieved complete and sustained closure in the colorectum. However, EHS is not currently clinically applicable given the long procedure time. Further modifications of the technique and devices are desirable.
Fratura osteocondral de Segond associada a fratura avulsão da cabeça da fíbula – “Sinal do arqueado”
Authors: Pimenta Frederico Silva , Cunha Renata Gabriela Pereira , Rocha Lorran Fabrini de Araújo , Oliveira Arthur Ribeiro , Caldas Marco Túlio Lopes , Gonçalves Thiago Saldanha
Published: March 2020

Uma fratura osteocondral desviada da tíbia anterolateral associada a avulsão da cabeça da fíbula em um paciente de 50 anos é relatada. A fratura avulsão do trato iliotibial em geral está associada lesões do ligamento cruzado, do menisco, e das estruturas laterais do joelho, como no caso em questão.
Arterial Stiffness as a Measure of Vascular Dysfunction in Hypertensive Women
Authors: Nethi Akshatha , B. Rajiv Kumar , Fatima Farheen , Pauniker Vaishali M. , M. Aswin Kumar , Taranikanti Madhuri
Published: March 2020

Hypertension, affecting a third of the world’s population is associated with many vascular changes in blood vessels, which include rise of peripheral resistance and arterial stiffness. As there are very few studies done on Indian hypertensive women, this project was taken up to determine the prevalence of arterial stiffness in them. In this study, arterial stiffness is determined by assessing the carotid–femoral pulse wave velocity (C-F PWV). Fifty hypertensive female subjects between the ages 25 and 75 years were selected as subjects after informing the procedure and taking their consent. PWV was obtained from blood (BP) and electrocardiogram (ECG) recordings. They showed that subjects belonged to 3 categories depending on the level of their blood pressure—normal, grade I, and grade II hypertensives. PWV increased progressively with level of hypertension (p values = 0.0171 and <0.0001, which are significant for hypertensives having current BP equal to grade I and II hypertension, respectively). Vascular remodeling leading to loss of elasticity and impaired relaxation is believed to play a key role in development of arterial stiffness and subsequent rise of PWV in hypertensives. Arterial stiffness causes vascular dysfunction and is known to be an independent risk factor for many cardiovascular diseases like ventricular remodeling, diastolic dysfunction, myocardial infarction, and so forth. Control of Blood Pressure and its sequelae by dietary interventions and regular exercise is advisable.
Factors Influencing Treatment Decisions among Breast Cancer Patients in the Philippine General Hospital Cancer Institute—Medical Oncology Outpatient Clinic
Authors: de Guzman Bobby G. , Cabaya Norman F. , Ting Frederic Ivan L. , Sandoval-Tan Jennifer
Published: March 2020

Introduction Breast cancer is a chronic disease and its treatment decisions exist over a relatively long time period. This study was done to identify factors influencing treatment decisions among breast cancer patients in the Philippine General Hospital Cancer Institute–Medical Oncology Outpatient Clinic.

Materials and Methods This was a cross-sectional study that made use of a questionnaire and structured interview. Descriptive statistics were utilized in the analysis of the data. This allowed identification of patient demographics, economic profile, cancer profile, sources of financial or medical assistance, and summary of patient’s responses to identify the factors influencing treatment decisions among breast cancer patients.

Results A total of 272 participants were included. This study identified the following factors as having influence on treatment decisions: high level of satisfaction to the consultation with their attending physician, caring and sincere communication about prognosis and likelihood of benefit from treatment, family as person of influence, the patient’s collaborative role in the decision making process, the desire of cure, and trust with their doctors.

Conclusion Health practices and treatment decisions among Filipino breast cancer patients are widely affected by an interplay of the following factors: family, community, doctor’s recommendations, patient’s satisfaction and participation in the decision-making, health care access, and adverse treatments.
Inertial focusing in triangular microchannels with various apex angles
Authors: Kim Jeong-ah , Kommajosula Aditya , Choi Yo-han , Lee Je-Ryung , Jeon Eun-chae , Ganapathysubramanian Baskar , Lee Wonhee
Published: March 2020

We consider inertial focusing of particles in channels with triangular cross sections. The number and the location of inertial focusing positions in isosceles triangular channels can change with varying blockage ratios (a/H) and Reynolds numbers (Re). In triangular channels, asymmetric velocity gradient induced by the sloped sidewalls leads to changes in the direction and the strength of the inertial lift forces. Therefore, varying the configuration (specifically, angle) of the triangular cross section is expected to lead to a better understanding of the nature of the inertial lift forces. We fabricated triangular microchannels with various apex angles using channel molds that were shaped by a planing process, which provides precise apex angles and sharp corners. The focusing position shift was found to be affected by the channel cross section, as expected. It was determined that the direction of the focusing position shift can be reversed depending on whether the vertex is acute or obtuse. More interestingly, corner focusing modes and splitting of the corner focusing were observed with increasing Re, which could explain the origin of the inertial focusing position changes in triangular channels. We conducted fluid dynamic simulations to create force maps under various conditions. These force maps were analyzed to identify the basins of attraction of various attractors and pinpoint focusing locations using linear stability analysis. Calculating the relative sizes of the basins of attractions and exhaustively identifying the focusing positions, which are very difficult to investigate experimentally, provided us a better understanding of trends in the focusing mechanism.
Insights on the relationship between total grazing pressure management and sustainable land management: key indicators to verify impacts
Authors: Waters C. M. , McDonald S. E. , Reseigh J. , Grant R. , Burnside D. G.
Published: March 2020

Demonstrating sustainable land management (SLM) requires an understanding of the linkages between grazing management and environmental stewardship. Grazing management practices that incorporate strategic periods of rest are promoted internationally as best practice. However, spatial and temporal trends in unmanaged feral (goat) and native (kangaroo) populations in the southern Australian rangelands can result land managers having, at times, control over less than half the grazing pressure, precluding the ability to rest pastures. Few empirical studies have examined the impacts of total grazing pressure (TGP) on biodiversity and resource condition, while the inability to manage grazing intensity at critical times may result in negative impacts on ground cover, changes in pasture species composition, increased rates of soil loss and reduce the ability for soils to store carbon. The widespread adoption of TGP control through exclusion fencing in the southern Australian rangelands has created unprecedented opportunities to manage total grazing pressure, although there is little direct evidence that this infrastructure leads to more sustainable land management. Here we identify several key indicators that are either outcome- or activity-based that could serve as a basis for verification of the impacts of TGP management. Since TGP is the basic determinant of the impact of herbivory on vegetation it follows that the ability for rangeland pastoral management to demonstrate SLM and environmental stewardship will rely on using evidence-based indicators to support environmental social licence to operate.
Racial disparities in automated speech recognition
Authors: Koenecke Allison , Nam Andrew , Lake Emily , Nudell Joe , Quartey Minnie , Mengesha Zion , Toups Connor , Rickford John R. , Jurafsky Dan , Goel Sharad
Published: March 2020

Automated speech recognition (ASR) systems, which use sophisticated machine-learning algorithms to convert spoken language to text, have become increasingly widespread, powering popular virtual assistants, facilitating automated closed captioning, and enabling digital dictation platforms for health care. Over the last several years, the quality of these systems has dramatically improved, due both to advances in deep learning and to the collection of large-scale datasets used to train the systems. There is concern, however, that these tools do not work equally well for all subgroups of the population. Here, we examine the ability of five state-of-the-art ASR systems—developed by Amazon, Apple, Google, IBM, and Microsoft—to transcribe structured interviews conducted with 42 white speakers and 73 black speakers. In total, this corpus spans five US cities and consists of 19.8 h of audio matched on the age and gender of the speaker. We found that all five ASR systems exhibited substantial racial disparities, with an average word error rate (WER) of 0.35 for black speakers compared with 0.19 for white speakers. We trace these disparities to the underlying acoustic models used by the ASR systems as the race gap was equally large on a subset of identical phrases spoken by black and white individuals in our corpus. We conclude by proposing strategies—such as using more diverse training datasets that include African American Vernacular English—to reduce these performance differences and ensure speech recognition technology is inclusive.
Deficiency in classical nonhomologous end-joining–mediated repair of transcribed genes is linked to SCA3 pathogenesis
Authors: Chakraborty Anirban , Tapryal Nisha , Venkova Tatiana , Mitra Joy , Vasquez Velmarini , Sarker Altaf H. , Duarte-Silva Sara , Huai Weihan , Ashizawa Tetsuo , Ghosh Gourisankar , Maciel Patricia , Sarkar Partha S. , Hegde Muralidhar L. , Chen Xu , Hazra Tapas K.
Published: March 2020

Significance

Spinocerebellar ataxia type 3 (SCA3) is a neurodegenerative disease with no effective treatments. SCA3 is etiologically linked to an abnormal polyglutamine (polyQ) tract at the C terminus of Ataxin-3 (ATXN3). How this polyQ stretch causes SCA3 pathology remains elusive. Here we provide evidence that wild-type ATXN3 plays an important role in error-free repair of DNA double-strand breaks in the transcribed genes. In contrast, mutant ATXN3 blocks the activity of a DNA end-processing enzyme, polynucleotide kinase 3′-phosphatase (PNKP), leading to progressive accumulation of double-strand breaks and abrogation of global transcription. Since PNKP overexpression in
Drosophila
rescued the SCA3 phenotype, this promising therapeutic avenue for SCA3 is worth exploring.
Bioluminescent backlighting illuminates the complex visual signals of a social squid in the deep sea
Authors: Burford Benjamin P. , Robison Bruce H.
Published: March 2020

Significance

Visually cued animals that inhabit the deep sea must signal to one another in order to facilitate group behaviors, yet the capacity and mechanisms for information transfer in such a dimly lit habitat are largely uninvestigated. By examining in situ behavioral footage of the Humboldt squid,
Dosidicus gigas
, we demonstrate the potential for a deep-living social animal to visually convey and receive large quantities of information by combining complex pigmentation patterning with whole-body luminescence. Our findings reveal a capability for information sharing comparable to advanced forms of animal communication known from well-lit habitats. This may have important implications for ecosystem processes, as information sharing between abundant predators is involved in energy and nutrient transfer throughout the world’s oceans.
Harmonised observations of climate forcing across Africa: an assessment of existing approaches and their applicability
Authors: López-Ballesteros Ana , Beck Johannes , Helmschrot Jörg , Saunders Matthew
Published: March 2020

A crucial aspect of coordinated climate action is the ability to measure, attribute, report and verify the drivers of climate change not only globally, but down to national level. This requires the enhancement of current observation infrastructures around the world, particularly in less-studied regions such as the African continent. Methodological protocols play an essential role in assuring interoperability among existing and new monitoring stations and networks. However, although the availability and accessibility of the body of existing methodological knowledge is crucial to fill existing observational gaps in a harmonised and resource-efficient way, there are very few efforts documented to systematically compile and assess it. This work aims to identify environmental observation methodologies which, on one hand, are applicable in Africa and, on the other hand, compatible with ongoing international and European monitoring initiatives. It draws from a systematic inventory of 140 environmental methodological protocols related to the measurement and estimation of the main climate forcing components within the atmospheric, oceanic, and terrestrial domains. In order to identify existing methodologies readily applicable for various observational purposes in under-studied regions, the feasibility of these protocols was determined based on a basic assessment of the financial and human resources needed for their implementation. Finally, a harmonised approach is proposed to enhance observational capacity in Africa with the differentiation of at least two types of sites. ‘Basic’ sites, where highly feasible environmental measurements can be performed to improve spatial coverage of main biomes, anthromes, and land use types, and advanced ‘key sites’, where a large set of variables measured at a high temporal resolution would enable a better understanding of driving processes in representative systems and managements across the continent, albeit requiring the application of less readily feasible methodologies.
Analysis of the Groundwater Resource Pollution of Coal-Fired Power Plants and Its Impact on Geotechnical Engineering Properties by Numerical Simulation Technology
Authors: Hu Zhaoguang , Shan Wei
Published: March 2020

Objective: The objective is to investigate the impact of groundwater resource pollution of coal-fired power plants and its impact on the properties of geotechnical engineering based on numerical simulation technology, thereby proving the effectiveness and superiority of numerical simulation technology in preventing groundwater resource pollution and forecasting the related information, which would provide direction and guidance for the treatment and management of groundwater resource pollution. Method: First, the regions to be investigated are divided and generalized. Then, relevant experiments are carried out for the calculations of hydrogeological parameters to establish the hydrogeological conceptual model. Next, the real-time water level data recorded by the observations are used to identify and verify the model effectively. Afterward, the numerical simulation of groundwater solute transportation is carried out again. During the process, the establishment of the groundwater quality model is the focus, followed by the application of numerical simulation technology to forecast the environmental impacts of groundwater pollution, including the forecasting of groundwater environmental pollutions caused by Chemical Oxygen Demand (COD) leakage, ash yard, and power plants. Results: Through the application of numerical simulation technology, the current information about groundwater pollution, such as the scope of impact and the movement law of pollution, can be understood clearly and timely. Conclusion: By applying the numerical simulation technology in forecasting groundwater pollution, the groundwater pollution problems can be prevented effectively, which offers great help to the correct and reasonable operation and development of coal-fired power plants, which provides a significant reference for the preventive treatment of groundwater pollution.
Research of Advanced Materials for Volatile Organic Compounds Treatment
Authors: Tian Jie , Liu Baoyou , Li Feng
Published: March 2020

Volatile organic compounds (VOCs) are one of the important pollutants, which are easy to cause serious harm to the environment and human body. In this paper, solid adsorbents based on carbon-based adsorbents and porous molecular sieves, organic adsorbents and chemical materials based on chemical catalysts and photocatalysts are introduced. The effects of pore structure, specific surface area and acid base functional groups on the saturated adsorption capacity of carbon based adsorbents and porous molecular sieves were discussed. The differences between volatile organic solvents and new microemulsion systems and ionic liquids in terms of volatility, solubility and selectivity were compared. The latest progress of conventional thermal catalysts (noble metals, transition metals) and Photocatalysts (Metal/Nonmetal Doping, Nanomaterial Composite, Dye Sensitization) in VOCs treatment was discussed. The application prospects of new materials around biosurfactants and ionic liquids in the treatment of volatile organic compounds were pointed out.
Preparation and application of a silver deodorant
Authors: Zhang Lin , Dai Shiyu , Leng Chunbo , Sun Zhaonan , Zhang Jingyu
Published: March 2020

Based on the strong adsorption, bacteriostatic and bactericidal effects of fulvic acid and silver ions, the preparation of silver alginate deodorizing gel with fulvic acid and its adsorption properties for formaldehyde toxic and harmful gas were studied. In the experiment, silver fulvate was used as the main ingredient, then sodium alginate was used as stabilizer. Under the heating condition, the mixture of fulvic acid silver and sodium alginate was mixed by mass ratio of 0, 0.3:1, 0.5:1, 0.7:1 and 0.9:1, and then immersed in calcium chloride solution to form gel. The new type of silver alginate deodorant gel was prepared and the deodorization of silver fulvate and sodium fulvate silver alginate was prepared. The colloid was characterized. IR analysis showed that fulvic acid was complexed with Ag+. Thermogravimetric analysis showed that the stability of the deodorant gel was greatly improved when the mass ratio of fulvic acid to Ag+ was 1:10.
Design of a comprehensive experiment of the synthesis of biodiesel catalyzed by CaO
Authors: Zhang Zhifang , Liu Huan , Tang Ying , Xiang Yulin , Gao Wenwen
Published: March 2020

An applied chemistry comprehensive experiment has been designed using CaO for synthesis of biodiesel. Effects of calcination temperature, methanol concentration, reaction temperature, reaction time and amount of catalyst on transesterification reaction are investigated. Based on experiment, the relationship between the catalyst structure and its properties was analyzed. Furthermore, this experiment can cultivate student's abilities of analyzing and solving problem. And it can build up the innovation consciousness, competition and team spirit of students. At the same time, the biodiesel and its preparation are line with the development requirements of green chemistry, so that students can establish environmental protection concept.
Study on the Pyrolysis Characteristics and thermal Kinetics of Tea
Authors: Xu Shanfeng , Chen Yuzhu , Xiao Hui , Xia Sanshan , Li Wei , Jin Mingwei
Published: March 2020

The pyrolysis characteristics of tea under nitrogen atmosphere were investigated, and the heating rate was 5, 10, 15, 20, 25 °C/min. The Kissinger and FWO methods were used to calculate the pyrolysis activation energy of tea. The results showed that the pyrolysis of tea can be divided into three pyrolysis stages: dehydration stage, rapid pyrolysis stage and carbonization stage. As the heating rate increasing, the peak temperature of the maximum pyrolysis rate shifts to the higher temperature, and the conversion rate increased at the peak of the maximum pyrolysis rate. The average value of pyrolysis activation energy of tea was 193.59 kJ/mol.
Study of a diagnosis method of watershed water problems based on control units-- Taking Ashihe river basin as an example
Authors: Ya Tao , Liang Cheng , Zhao Xiliang , Song Lingling , Yi Xu
Published: March 2020

The water quality often showed obvious spatial and temporal changes characteristics of a river system in the basin. However, the conventional water quality diagnosis method which based on the standard of cross-section, easily overlook the spatial-temporal characteristics of pollution load in the basin. Under the concept of ecological environment spatial management and control, the method for diagnosing water environmental problems which had been named the Equivalent pollution Load Duration Curve method was proposed. Combining the hydrological process of the main stream with the water quality concentration of the section, it could been used to effectively identify the main over standard pollutants and their sources in different control units of the river basin. From the results of the application evaluation of a certain basin, it showed that the excessive period was concentrated in the flood season. The main excessive factor was total phosphorus (TP) in the upstream area of the basin, which indicates that for the upstream control unit of the Basin, agricultural and other non-point sources were the main pollution sources. Meanwhile the main over standard pollutant was NH3-N, which was over standard in the whole period in the river estuary area. The pollution reduction control scheme of this control unit should focus on the industrial and living sources.
The Cheshire Cat That Is International Law
Authors: Klabbers Jan
Published: March 2020

This brief article, partly a comment on the articles by Danae Azaria, Kristina Daugirdas and Orfeas Chasapis Tassinis elsewhere in this issue, suggests that when it comes to discussing the sources of international law international legal scholarship would do well to be sensitive to issues related to democracy, representativeness, accountability and other staples of political theory. No matter how brilliant doctrinal sources scholarship may be in its own right, sources doctrine, in particular, is never politically innocent. Such scholarship is both about taming politics and facilitating politics, and this realization, in turn, engages the judgment to realize which to apply when.
The pressures of getting it right: Expertise and victims’ voices in the work of the Sierra Leone Truth and Reconciliation Commission (TRC)
Authors: Menzel Anne
Published: March 2020

Abstract∞

This article contributes to scholarship on power, agency and ownership in professional transitional justice. It explores and details the relationship between ‘professional’ agency arising from recognized expertise and ‘unprofessional’ voices relaying lived experiences, concerns and needs. I approach this relationship via a microperspective on the work of the Sierra Leone Truth and Reconciliation Commission (2002-2004), specifically its work on women and sexual violence, which the commission was mandated to pay special attention to. Based on interviews and rich archival materials, I show how this work was driven by the notion that there was a right way of dealing with women and sexual violence. To avoid mistakes, commissioners and staff members demanded and relied on recognized expertise. This led to a marginalization of victims’ voices. I argue that, to some degree at least, such marginalization belongs to professional transitional justice and will persist despite improved victim participation.
In vitro activity of the novel antibacterial agent ibezapolstat (ACX-362E) against Clostridioides difficile
Authors: Murray Beverly , Wolfe Cindy , Marra Andrea , Pillar Chris , Shinabarger Dean
Published: March 2020

Background

Ibezapolstat (ACX-362E) is the first DNA polymerase IIIC inhibitor undergoing clinical development for the oral treatment of Clostridioides difficile infection (CDI).

Methods

In this study, the in vitro activity of ibezapolstat was evaluated against a panel of 104 isolates of C. difficile, including those with characterized ribotypes (e.g. 027 and 078) and those producing toxin A or B and was shown to have similar activity to those of comparators against these strains.

Results

The overall MIC50/90 (mg/L) for ibezapolstat against evaluated C. difficile was 2/4, compared with 0.5/4 for metronidazole, 1/4 for vancomycin and 0.5/2 for fidaxomicin. In addition, the bactericidal activity of ibezapolstat was evaluated against actively growing C. difficile by determining the MBC against three C. difficile isolates. Time–kill kinetic assays were additionally performed against the three C. difficile isolates, with metronidazole and vancomycin as comparators.

Conclusions

The killing of C. difficile by ibezapolstat was observed to occur at concentrations similar to its MIC, as demonstrated by MBC:MIC ratios and reflected in time–kill kinetic assays. This activity highlights the therapeutic potential of ibezapolstat for the treatment of CDI.
Conflict resolution as cultural brokerage: how refugee leaders mediate disputes in Uganda’s refugee settlements
Authors: Vancluysen Sarah , Ingelaere Bert
Published: March 2020

Looking through the lens of disputes and their resolution, this article examines the efforts undertaken by refugees to guarantee peaceful coexistence within and around settlements in northern Uganda. Based on extensive fieldwork, we examine which disputes occur within and around the settlements and which actors intervene to mediate and solve them. We identify a hierarchy among the different formal and informal actors involved in the resolution of disputes and show how refugee leaders operate as brokers between Ugandan law and South-Sudanese customs, between here and there, a recent past and imagined future in the home country. This finding comes to clarify the process of local integration, by foregrounding the link between law and culture. Some of the dispute-settlement outcomes facilitate the refugees’ integration into Uganda as a host country, while other resolution strategies are geared towards a long-awaited return to South-Sudan.
Emphysematous cholecystitis following routine colonoscopy
Authors: Campbell Cassidy , Cooper Edward A , Kennedy Philip
Published: March 2020

Cholecystitis is a rare sequela of colonoscopy, the relationship between which has not yet been defined. This case study reviews a rural elderly patient who developed right upper quadrant pain following routine colonoscopy. He developed emphysematous cholecystitis, which required laparoscopy with conversion to open via Kocher’s incision and underwent a subtotal cholecystectomy due to the severity of necrosis and inflammation. He had an uncomplicated recovery. Colonoscopy is an important diagnostic procedure, the most common complications of which are haemorrhage and perforation. There are less than 10 cases of associated cholecystitis and no reports of emphysematous cholecystitis. The hypothesized pathogenesis is dehydration and lithogenesis associated with traumatic translocation of organisms, however, no definitive correlation has been determined. Due to the potential health impact, cholecystitis cannot be excluded regarding post-colonoscopy abdominal pain, however, the correlation between procedure and pathology remains unclear.
Physician Assistants Employed by the Federal Government
Authors: Smith Noël E , Kozikowski Andrzej , Hooker Roderick S
Published: March 2020

Objective

Physician assistants (PAs) are health professionals who have received advance medical training and are licensed to diagnose illness, develop and manage treatment plans, prescribe medications, and serve as principal health care provider. Although the U.S. federal government is the largest single employer of PAs, at the same time little is known about them across the wide array of diverse settings and agencies. The objective of this project was to determine the census of PAs in federal employment, their location, and personal characteristics. This included approximating the number of uniformed PAs. Taking stock of a unique labor force sets the stage for more granular analyses of how and where PAs are utilized and are deployed.

Methods

No one central database identifies all federally employed PAs. To undertake this project, three sources were examined. Data were derived from the U.S. Office of Personnel Management and the National Commission on Certification of Physician Assistants. Uniformed PA numbers were the result of networking with senior chiefs in the military services and the U.S. Public Health Service. The data were collolated and summarized for comparison and discussion.

Results

As of 2018, approximately 5,200 PAs were dispersed in most branches and agencies of the government that provide health care services, including the Departments of Defense, Veterans Affairs, Health and Human Services, Justice, and Homeland Security. Federally employed PAs are civil servants or hold a commission in the uniformed services (ie, Army, Navy, Air Force, Coast Guard, and Public Health Service). Most PAs are in clinical roles, although a few hundred are in management positions. Approximately 81% of civilian PAs have had less than 15 years of federal employment.

Conclusion

The diverse utilization and deployment of PAs validate the importance of the role they serve as medical professionals in the federal government. From 2008 to 2019, PA employment in the federal government grew by approximately 50% supporting the forecast that substantial national PA growth is on track.
Massive Nambu–Goldstone fermions and bosons for non-relativistic superconformal symmetry: Jackiw–Pi vortices in a trap
Authors: Fujimori Toshiaki , Nitta Muneto , Ohashi Keisuke
Published: March 2020

We discuss a supersymmetric extension of a non-relativistic Chern–Simons matter theory, known as the supersymmetric Jackiw–Pi model, in a harmonic trap. We show that the non-relativistic version of the superconformal symmetry, called the super-Schrödinger symmetry, is not spoiled by an external field including the harmonic potential. It survives as a modified symmetry whose generators have explicit time dependences determined by the strength of the trap, the rotation velocity of the system, and the fermion number chemical potential. We construct 1/3 Bogomol'nyi–Prasad–Sommerfield (BPS) states of trapped Jackiw–Pi vortices preserving part of the modified superconformal symmetry and discuss fluctuations around static BPS configurations. In addition to the bosonic massive Nambu–Goldstone modes, we find that there exist massive Nambu–Goldstone fermions associated with broken generators of the modified super-Schrödinger symmetry. Furthermore, we find that eigenmodes form supermultiplets of a modified supersymmetry preserved by the static BPS backgrounds. As a consequence of the modified supersymmetry, infinite towers of explicit spectra can be found for eigenmodes corresponding to bosonic and fermionic lowest Landau levels.
Citrus Tristeza Virus Isolates of the Same Genotype Differ in Stem Pitting Severity in Grapefruit
Authors: Cook Glynnis , Coetzee Beatrix , Bester Rachelle , Breytenbach Johannes H. J. , Steyn Chanel , de Bruyn Rochelle , Burger Johan T. , Maree Hans J.
Published: March 2020

Two isolates of the T68 genotype of citrus tristeza virus (CTV) were derived from a common source, GFMS12, by single aphid transmission. These isolates, named GFMS12-8 and GFMS12-1.3, induced stem pitting with differing severity in ‘Duncan’ grapefruit (Citrus × paradisi [Macfad.]). Full-genome sequencing of these isolates showed only minor nucleotide sequence differences totaling 45 polymorphisms. Numerous nucleotide changes, in relatively close proximity, were detected in the p33 open reading frame (ORF) and the leader protease domains of ORF1a. This is the first report of full-genome characterization of CTV isolates of a single genotype, derived from the same source, but showing differences in pathogenicity. The results demonstrate the development of intragenotype heterogeneity known to occur with single-stranded RNA viruses. Identification of genetic variability between isolates showing different pathogenicity will enable interrogation of specific genome regions for potential stem pitting determinants.
Planned home births
Authors: Tedesco-Schneck Mary
Published: March 2020

Over the past 15 years, there has been a steady resurgence of planned home births in the US. Multiple factors may impact health outcomes for mother and baby. NPs have the opportunity to provide reliable information to women to help ensure a safe delivery and to optimize care for the neonate.
Acute kidney injury
Authors: Dinh Nhan L.A.
Published: March 2020

Community-acquired acute kidney injury (CA-AKI) can be a devastating diagnosis for any patient and can increase mortality during hospitalization. There can be long-term consequences for those who survive the initial insult. This article discusses CA-AKI and its implications for APRNs.
Psychometric Validation of the Danish Version of the Oswestry Disability Index in Patients With Chronic Low Back Pain
Authors: Comins Jonathan , Brodersen John , Wedderkopp Niels , Lassen Michael Rud , Shakir Hassan , Specht Kirsten , Brorson Stig , Christensen Karl Bang
Published: March 2020

Study Design.

Registry-based repeated-measures psychometric validation of the Danish Oswestry Disability Index (ODI).

Objective.

The goal was to use classical and modern psychometric validation methods to assess the measurement properties and the minimally clinical important difference (MCID) of the ODI in a Danish cohort of patients with chronic low back pain being treated with spinal surgery.

Summary of Background Data.

Scores for the ODI, EQ-5D, SF-36, leg pain, back pain, and a general rating of pain item from 800 patients with chronic low back pain were extracted from the National Danish Spine Registry (DaneSpine) at baseline and 1-year postspine surgery.

Methods.

Confirmatory factor analysis and item response theory (IRT) models were used to assess the psychometric properties of the ODI. MCID was also calculated based on generic legacy PROMs (EQ-5D and SF-36) and follow-up pain scores.

Results.

While ODI did not fit a Rasch model, adequate fit to a confirmatory factor analysis and a two-parameter item response theory model was found when accounting for differential item functioning across diagnostic subgroups (degenerative spondylolisthesis, spondylosis, spinal stenosis, and herniated intervertebral disc). In addition, each group exhibited substantially different MCID values.

Conclusion.

The Danish version of the ODI is valid and responsive, but only within each of the four major diagnosis subgroups: degenerative spondylolisthesis, spondylosis, spinal stenosis, and herniated intervertebral disc.

Level of Evidence: 4
Identification of Risk Factors for Readmission in Patients Undergoing Anterior Cervical Discectomy Fusion
Authors: Siracuse Brianna L. , Ippolito Joseph A. , Shin John , Harris Colin B. , Vives Michael J.
Published: March 2020

Study Design:

This was a retrospective cohort study.

Objective:

The objective of this study was to analyze readmission rates among patients undergoing anterior cervical discectomy and fusion (ACDF), determine which factors were associated with higher readmission rates, and develop a scale for utilization during surgical planning.

Summary of Background Data:

ACDF is the most common surgical treatment for many cervical disk pathologies. With the Centers for Medicare and Medicaid Services selecting readmissions as a measure of health care quality, there has been an increased focus on reducing readmissions.

Materials and Methods:

There were 114,174 recorded ACDF surgeries in the derivation cohort, the State Inpatient Database (SID) of New York and California between 2006 and 2014. There were 115,829 ACDF surgeries recorded in the validation cohort, the SID from Florida and Washington over the same time period. After identification of risk factors using univariate and multivariate analysis of the derivation cohort, a predictive scale was generated and tested utilizing the validation cohort.

Results:

Overall, readmission rates within 30 days of discharge were 5.87% and 5.52% in the derivation and validation cohorts, respectively. On multivariate analysis of the derivation cohort, age older than 80 years [odds ratio (OR), 1.67] male sex (OR, 1.16), Medicaid insurance (OR, 1.90), Medicare insurance (OR, 1.64), revision ACDF (OR, 1.43), anemia (OR, 1.45), chronic lung disease (OR, 1.23), coagulopathy (OR, 1.42), congestive heart failure (OR, 1.31), diabetes (OR, 1.23), fluid and electrolyte disorder (OR, 1.56), liver disease (OR, 1.37), renal failure (OR, 1.59), and myelopathy (OR, 1.19) were found to be statistically significant predictors for readmission. These factors were incorporated into a numeric scale that, that when tested on the validation cohort, could explain 97.1% of the variability in readmission rate.

Conclusions:

Overall, 30-day readmission following ACDF surgery was 5%–6%. A novel risk scale based on factors associated with increased readmission rates may be helpful in identifying patients who require additional optimization to reduce perioperative morbidity.

Level of Evidence:

Level III—prognostic.
Pre-anaesthesia ultrasonography of the subclavian/infraclavicular axillary vein for predicting hypotension after inducing general anaesthesia
Authors: Choi Min Hee , Chae Ji Seon , Lee Hyun Jung , Woo Jae Hee
Published: March 2020

BACKGROUND

Bedside sonography of the inferior vena cava has been demonstrated to be a reliable tool for assessing intravascular volume status. Subclavian vein (SCV) assessment was proposed as a reasonable adjunct for measuring the inferior vena cava.

OBJECTIVE

We examined whether the preoperative diameter and collapsibility index of the SCV or the infraclavicular axillary vein could predict the incidence of hypotension after induction of general anaesthesia in patients undergoing laparoscopic cholecystectomy.

DESIGN

Prospective, observational study.

SETTING

Tertiary university hospital.

PATIENTS

Adults scheduled for laparoscopic cholecystectomy.

INTERVENTION

Sonographic evaluation of the SCV or the axillary vein (SCV-AV) before induction of anaesthesia.

MAIN OUTCOME MEASURES

The main outcome was the association between the SCV-AV measurements (diameter an collapsibility index) and intra-operative hypotension (IOH) after induction of anaesthesia.

RESULTS

Patients who developed IOH had a higher collapsibility index of the SCV-AV during spontaneous breathing (P = 0.009) and deep inspiration (P = 0.002). After adjusting for confounding variables, the collapsibility index of the SCV-AV during spontaneous breathing was not a significant predictor of a decrease in mean arterial blood pressure (MAP) after inducing anaesthesia (P = 0.127), whereas the collapsibility index of the SCV-AV during deep inspiration was a significant predictor (P < 0.001).

CONCLUSION

The collapsibility index of the SCV-AV during deep inspiration was a significant predictor of IOH occurrence and the percentage decrease in MAP after inducing anaesthesia. Further studies in patients with higher collapsibility index are needed to confirm our findings, before the collapsibility index of the SCV-AV can be recommended unequivocally for clinical use.

TRIAL REGISTRATION

This trial was registered on 8 September 2017 at the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp; Identifier: KCT0001078KCT0002457), and the first patient was enrolled on 14 October 2017.