bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 9720: A New Window on a Cerebral Penumbra at Risk for a Secondary Ischemic Brain Injury in Post-Cardiac Arrest Patients
Authors: Kang Changshin , Park Jung Soo , You Yeonho
Published: December 2021

Aim:
This study aimed to investigate new target having potential neuroprotective effect against a secondary ischemic brain injury in post out-of-hospital cardiac arrest (OHCA) patients.

Methods:
This study analyzed physiological variables among OHCA patients with good or poor neurological outcomes despite having normal diffusion-weighted image findings before targeted temperature management (TTM). The factors affecting cerebral perfusion after OHCA, such as the time-weighted average (TWA) of arterial carbon dioxide (PaCO
2
), oxygen (PaO
2
), and mean arterial pressure (MAP); and the intracranial pressure (ICP) and quotient albumin ratio (Qalb), measured at 0 and 24 h from the return of spontaneous circulation (ROSC), were analyzed retrospectively using prospectively collected data. The primary outcome was the association between the factors and poor neurological outcome.

Results:
Fifty-one patients were included in this study. Among them, 11 had poor neurological outcomes. The pre-hospital factors such as anoxic time, initial rhythm; and TWA of physiological factors (PaCO
2
, PaO
2
, and MAP), were not significantly different between groups (p > 0.05). The inter-group comparisons of Qalb at 0 and 24 h were not significant (p > 0.05), whereas Qalb (median [interquartile range]) significantly increased from 0 to 24 h in the poor outcome group (0.007 [0.003 - 0.011] to 0.013 [0.005 - 0.029]; p = 0.04). Simultaneously, the ICP of the poor outcome group significantly increased over time (12.0 mmHg [8.1 - 13.0] to 16.0 mmHg [9.3 - 22.4]; p = 0.03), and higher than those of good outcome group at 24 h (11.0 mmHg [6.5 - 16.0] vs. 16.0 [9.3 - 22.4]; p < 0.01).

Conclusion:
Blood-brain barrier disruption and increasing ICP were apparent in OHCA patients who progressed into poor outcome despite no significant difference of brain injury before TTM compared with those of good outcome. These factors may be the key window on strategy to prevent the secondary ischemic brain injury after OHCA.
Abstract 9764: Prevalence of Inappropriate Defibrillation Attempts During Pediatric In-Hospital Cardiac Arrest
Authors: Gray James M , Raymond Tia T , Atkins Dianne L , Tegtmeyer Ken , Niles Dana E , Nadkarni Vinay M , Dewan Maya ,   the PediRES-Q Investigators
Published: December 2021

Introduction:
Shockable rhythms (ventricular fibrillation [VF] and ventricular tachycardia [VT]) occur in <25% of pediatric in-hospital cardiac arrest (IHCA) events, yet the prevalence of inappropriate defibrillation attempts for non-VF/VT rhythms is unknown. We aim to describe the prevalence of inappropriate shocks across a large, multi-national pediatric cardiac arrest network.

Methods:
We included children <18y reported to the
pedi
atric
RES
uscitation-
Q
uality (pediRES-Q) network from 2015-2019 with complete defibrillator files who received defibrillation attempts during IHCA (ZOLL R-Series, MA). Two pediatric cardiologists independently classified rhythms immediately prior to shock as: 1) appropriate (VF or wide complex ≥ 150/min), 2) indeterminate (narrow complex ≥150/min or wide complex 100-149/min), or 3) inappropriate (asystole, sinus, narrow complex <150/min, or wide complex <100/min). Rhythms that were undecipherable due to artifact were excluded from analysis (n=22). Disagreements were resolved by arbitration and consensus.

Results:
Of 896 IHCA events, 124 (14%) had defibrillation attempts. A total of 303 shocks were delivered: 87 (29%) in age <1y, 84 (28%) in 1-8y, and 132 (44%) in 9-17y. Of shocks delivered, 206 (68%) were appropriate, 12 (4%) indeterminate, and 85 (28%) inappropriate. There was no difference in inappropriate shock delivery by age category: <1y (24/87, 28%), 1-8y (26/84, 31%), 9-17y (35/132, 27%) (
p
=0.4).

Conclusions:
Across a multi-national pediatric cardiac arrest network, a large proportion (28%) of defibrillation attempts were inappropriate, suggesting significant opportunity for improvement in rhythm identification in pediatric cardiac arrest. There was no difference in inappropriate shock delivery across age groups.

Figure 1. Representation of rhythm classification and appropriateness of defibrillation attempts with exemplar rhythms.
Abstract 9774: Shockable Rhythms Are Common First Rhythms in Cardiac Arrests Involving Patient with Heart Failure with Preserved Ejection Fraction
Authors: Hooks Matthew , Joppa Stephanie , Beard Albertine , Adabag Selcuk
Published: December 2021

Introduction:
Sudden cardiac death (SCD) is responsible from 25% of the total mortality in patients with heart failure with preserved ejection fraction (HFpEF). Whether SCD in HFpEF is due to shockable or unshockable rhythms is unknown.

Hypothesis:
Cardiac arrests in HFpEF are due to ventricular tachycardia/ventricular fibrillation (VT/VF).

Methods:
We determined the initial rhythm in 286 consecutive in-hospital cardiac arrests at the Minneapolis VA Health Care system from 2011 through 2020. Clinical and survival information were obtained from electronic health records. According to their heart failure history, we categorized the patients as HFpEF, heart failure with reduced ejection fraction (HFrEF) or no heart failure (NoHF).

Results:
Of the 286 patients (mean age 70.2±9.0 years old and 97.5% male), 51 (17.8%) had HFpEF, 77 (26.9%) had HFrEF and 158 (55.2%) had NoHF. The initial rhythm was VT/VF in 47.1%, 39.0% and 22.2% of patients with HFpEF, HFrEF and NoHF respectively (p<0.001) (Figure). Return of spontaneous circulation (ROSC)
after VT/VF arrest
was similar amongst the three groups (66.7%, 73.3% and 74.3%, respectively; p=0.8) but the 30-day survival trended higher in HFpEF (54.2%) and NoHF (48.6%) when compared with HFrEF (26.7%) (p=0.08)(Figure). Among patients with HFpEF, 30-day survival was lower after cardiac arrests due to PEA/Asystole when compared to those due to VT/VF (18.5% vs. 54.2%, respectively, p=0.03).

Conclusion:
VT/VF was the initial rhythm in 47% of patients with HFpEF who had in-hospital cardiac arrest. The proportion of VT/VF and ROSC after in-hospital cardiac arrest was similar in HFpEF and HFrEF. These data provide one more piece of evidence that SCD could be a therapeutic target in HFpEF.
Abstract NS1: Mobile Health Technology Is Feasible And Effective For Self-management Support Among Underserved Stroke Survivors
Authors: Anderson Jane , Kimmel Barbara , Sansgiry Shubhada , Evans-Hudnall Gina , Ovalle Anette , Cerra-Stewart Colleen , Jobe Emilia , Venkatasubba Rao Chethan
Published: December 2021

Background and Purpose:
Self-management Support (SMS) helps stroke survivors control risk factors to prevent second stroke. Little is known about feasibility and effectiveness of using mobile health technology (MHT) for SMS among underserved stroke survivors. The investigators studied feasibility and effectiveness of using a video teleconference mobile application to deliver a SMS program to underserved, hard to reach stroke survivors.

Methods:
The Video teleconference Self-management TO Prevent stroke (V-STOP) program was evaluated using longitudinal design with measurements at baseline, immediately post intervention (6 weeks), intermediate (12 weeks), and at study end (18 weeks). Medically underserved stroke survivors with uncontrolled stroke risk factors were included. Feasibility was assessed as time in intervention, telehealth satisfaction, stroke knowledge and SMS effectiveness were measured as psychological (depression, PHQ-8; anxiety, GAD-7), social (community integration questionnaire), and stroke self-management (goal attainment) outcomes. Generalized estimating equations were used with site and time in intervention as covariates.

Results:
V-STOP was successfully delivered to 106 participants using MHT over 2 years. Mean age was 59.3 (±10.9), majority were white (82.1%), males (54.3%), not living alone (85.9%), married (52.8%), with low annual income (<$25,000) ( 58.5%), and health insurance (59.4%). Program feasibility indicated mean number of V-STOP sessions were 4.6 (±1.8), with 4.4 (±2.0) hours of total time for the intervention. Overall satisfaction at 6 weeks with V-STOP (4.8(±0.5)) and telehealth (4.7(±0.5)) was high. Stroke knowledge was high at 12 weeks (9.6(±0.7)). SMS effectiveness indicated improvement in psychological outcomes at 6, 12, and 18 weeks from baseline; depression (18 weeks - β = 0.64 (CI 0.49-0.84)) and anxiety (18 weeks - β = 0.66 (CI 0.51-0.85)). Community integration improved by 18 weeks - β = 1.08 (CI 1.01-1.16) and stroke self-management also improved long term at 12 and 18 weeks (β = 0.92 (CI 0.84-0.99).

Conclusion:
MHT is feasible to deliver SMS to underserved stroke survivors. It improves psycho-social and self-management goal setting and goal attainment outcomes.
Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study
Authors: van Etten Ellis S. , Kaushik Kanishk , Jolink Wilmar M.T. , Koemans Emma A. , Ekker Merel S. , Rasing Ingeborg , Voigt Sabine , Schreuder Floris H.B.M. , Cannegieter Suzanne C. , Rinkel Gabriël J.E. , Lijfering Willem M. , Klijn Catharina J.M. , Wermer Marieke J.H.
Published: December 2021

Background:

Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset.

Methods:

We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors.

Results:

We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8–3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3–6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2–19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7–60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8–55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4–63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6–37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1–95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7–6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9–4.2).

Conclusions:

We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.
Textual Memorial Temples: Writing Hagiographies for Mothers in Late Imperial China
Authors: Ma Xu
Published: December 2021

In Chinese culture, the honor of textual immortality was traditionally reserved for a select, extraordinary few. As Martin Huang points out, however, the Ming-Qing era witnessed a general “secularization” process in which eulogistic writings were increasingly dedicated to women who lived relatively “trivial” lives. Building on Huang’s insights, this paper examines another important evolution within this genre of secularized elegies dedicated to women: the simultaneous sacralizing of deceased mothers by filial sons writing their mothers’ lives as hagiography. As these authors energetically extolled their mothers’ religious piety and identified them with Bodhisattvas/deities, the hitherto lackluster biographies became saturated with supernatural occurrences and miraculous events. Transformed into cultural and emotional sites where ordinary women could be commemorated, immortalized, and apotheosized, these otherwise insignificant life stories evoked a kind of textual memorial temple. Such infusions of spirituality into the writing of Confucian mourning both signal and fuel the broader penetration of heterodox worship (Buddhism) into Confucian society. This practice also allows a glimpse into important gender dimensions in the religious syncretism and secularism of late imperial China.
The Gender of Knowledge in Forensic Drama of Late Imperial China
Authors: Wang Guojun
Published: December 2021

In late imperial China practitioners of forensic investigation in legal cases were predominantly male. While crime literature frequently features female characters, the question of how this literature represents the gender dimension of forensic knowledge remains unanswered. This paper aims to answer this question with an examination of a number of late imperial era theatrical works that depict how forensic knowledge differed across the male and female divide. It argues court-case literature increasingly valorized male forensic knowledge and its relevance to the state legal system. At the same time, these theatrical pieces signify female forensic knowledge following two literary traditions, namely, the commendation of exemplary women and the condemnation of “wanton women.” Investigating these theatrical works at the interstices between court-case literature, women’s history, and forensic history, this paper suggests that the representations of forensic knowledge in Chinese drama accord with major developments in the history of women and gender in premodern China.
A taxonomic revision of the genus Phyxioschema (Araneae, Dipluridae), II: species from Central Asia
Authors: SCHWENDINGER PETER J. , ZONSTEIN SERGEI L.
Published: December 2021

Phyxioschema raddei Simon, 1889 is revised. A re-examination of type specimens confirms the synonymy of P. raddei and Ischnothele strandi Spassky, 1937, but the synonymy of Afghanothele lindbergi Roewer, 1960 and A. striatipes Roewer, 1960 cannot be confirmed due to the immature state of their types. The copulatory organs of the female holotype and other females from different localities are illustrated for the first time. Variation in morphological characters is shown. New records are given for Iran, Turkmenistan, Uzbekistan, Kazakhstan and Tajikistan. Phyxioschema females from Pakistan cannot be attributed to any nominal species and are left unnamed. A new species, P. roxana, is described from male and female specimens collected at eight localities in southern Uzbekistan and western Tajikistan. Relationships between Central Asian and Southeast Asian species are discussed. A summary of relevant morphological characters of all Phyxioschema species is given.
Shallow-water species of the genus Aplidium (Ascidiacea) from Kamchatka and Commander Islands
Authors: SANAMYAN KAREN , SANAMYAN NADYA
Published: December 2021

Four shallow-water colonial ascidians of the genus Aplidium (Aplousobranhia: Polyclinidae) are identified in the material collected by SCUBA divers off the coast of East Kamchatka and Commander Islands. Three species from Kamchatka were previously known from this region but were wrongly identified and two of them (A. dissectum n. sp. and A. eborinum n. sp.) are now redescribed as new species. Aplidium redikorzevi nom nov. (for Amaroucium fragile Redikorzev, 1927) is recorded on Commander Islands first time from its original description.
Species of the genus Mallinella Strand, 1906 (Araneae: Zodariidae) from Hainan Island, China BAO-SHI ZHANG, FENG ZHANG & PING CHEN (China)
Authors: ZHANG BAO-SHI , ZHANG FENG , CHEN PING
Published: December 2021

Four species of the spider genus Mallinella are reported from Hainan Island, China, including one already described species: M. hainan Song & Kim, 1997, and three new species: M. digitata sp. nov. (male, female), M. rectangulata sp. nov. (male, female) and M. obtusa sp. nov. (male).
Self-Optimization of Continuous Flow Electrochemical Synthesis Using Fourier Transform Infrared Spectroscopy and Gas Chromatography
Authors: Ke Jie , Gao Chuang , Folgueiras-Amador Ana A. , Jolley Katherine E. , de Frutos Oscar , Mateos Carlos , Rincón Juan A. , Brown Richard C. D. , Poliakoff Martyn , George Michael W.
Published: December 2021

A continuous-flow electrochemical synthesis platform has been developed to enable self-optimization of reaction conditions of organic electrochemical reactions using attenuated total reflection Fourier transform infrared spectroscopy (ATR FT-IR) and gas chromatography (GC) as online real-time monitoring techniques. We have overcome the challenges in using ATR FT-IR as the downstream analytical methods imposed when a large amount of hydrogen gas is produced from the counter electrode by designing two types of gas–liquid separators (GLS) for analysis of the product mixture flowing from the electrochemical reactor. In particular, we report an integrated GLS with an ATR FT-IR probe at the reactor outlet to give a facile and low-cost solution to determining the concentrations of products in gas–liquid two-phase flow. This approach provides a reliable method for quantifying low-volatile analytes, which can be problematic to be monitored by GC. Two electrochemical reactions the methoxylation of 1-formylpyrrolidine and the oxidation of 3-bromobenzyl alcohol were investigated to demonstrate that the optimal conditions can be located within the pre-defined multi-dimensional reaction parameter spaces without intervention of the operator by using the stable noisy optimization by branch and FIT (SNOBFIT) algorithm.
Time for Change: Understanding Teacher Social-Emotional Learning Supports for Anti-Racism and Student Well-Being During COVID-19, and Beyond
Authors: Beard Karen Stansberry , Vakil Joanne Baltazar , Chao Theodore , Hilty Cory D.
Published: December 2021

During the COVID-19 pandemic, the approximately 3.2 million teachers serving 50.8 million students in U.S. schools were positioned, along with school counselors, as de facto first responders for student well-being. Teachers across the country, already struggling to transition their teaching to online platforms, had to simultaneously implement recently adopted Social and Emotional Learning (SEL) Standards. While prioritizing the social and emotional needs of children is of course a necessity, we wondered about the support needed for teachers who shouldered this work? Of particular interest were the supports for teachers operating in urban schools and with communities of color disproportionately impacted. And within this timeframe, global uprisings protesting police murders of Black bodies revealed the crucial importance of anti-racist educational practices. While we contend that teacher well-being is a key determinate of student well-being, we also explored the ways teachers innovated and created online communities (e.g., Twitter, Facebook) to support one another’s SEL and anti-racist pedagogy. The connection between these practices to research-supported online teacher support structures that influence teacher emotions (e.g., efficacy) was further explored. We conclude with implications from learnings from this crisis for practitioners, educator preparation programs, policy, and future research while adding to the limited literature concerning teacher SEL, anti-racism, and teacher-created communities.
The Effect of Tongue-Tie Release on Speech Articulation and Intelligibility
Authors: Melong Jonathan , Bezuhly Michael , Hong Paul
Published: December 2021

Objective

The relationship between ankyloglossia and speech is controversial. The objective of this study was to determine the effect of tongue-tie release on speech articulation and intelligibility.

Methods

A prospective cohort study was conducted. Pediatric patients (>2 years of age) being referred for speech concerns due to ankyloglossia were assessed by a pediatric otolaryngologist, and speech articulation was formally assessed by a speech language pathologist using the Goldman-Fristoe Test of Articulation 2 (GFTA-2). Patients then underwent a tongue-tie release procedure in clinic. After 1 month, speech articulation was reassessed with GFTA-2. Audio-recordings of sessions were evaluated by independent reviewers to assess speech intelligibility before and after tongue-tie release.

Results

Twenty-five participants were included (mean age 3.7 years; 20 boys). The most common speech errors identified were phonological substitutions (80%) and gliding errors (56%). Seven children (28%) had abnormal lingual-alveolar and interdental sounds. Most speech sound errors (87.9%) were age/developmentally appropriate. GFTA-2 standard scores before and after tongue-tie release were 85.61 (SD 9.75) and 87.54 (SD 10.21), respectively, (P=.5). Mean intelligibility scores before and after tongue-tie release were 3.15 (SD .22) and 3.21 (SD .31), respectively, (P=.43).

Conclusion

The majority of children being referred for speech concerns thought to be due to ankyloglossia had age-appropriate speech errors at presentation. Ankyloglossia was not associated with isolated tongue mobility related speech articulation errors in a consistent manner, and there was no benefit of tongue-tie release in improving speech articulation or intelligibility.
Data Mining Statewide Department of Transportation Volumetrically Designed Asphalt Mixture Records
Authors: Cox Ben C. , Easterling Jonathan , Sullivan W. Griffin , Middleton Alex , Howard Isaac L.
Published: December 2021

In recent years, the asphalt paving industry has been strained by numerous factors including increased asphalt binder costs, funding that has not kept up with material costs, increased societal pressure to recycle, and deteriorating pavement networks. Mix design should account for the market in which it is used, which is very different now than when today’s volumetric mix design practices were developed (many of the aforementioned factors were less present). Given this reality, a statewide database of all 1,452 approved mix designs in Mississippi from 2005 to 2018 was compiled and analyzed, and the objective of this paper is to present findings, trends, and unintended consequences of exclusive reliance on volumetrics. With volumetrics-only mix design, asphalt content is primarily controlled by voids in mineral aggregate (VMA), which is influenced by aggregate bulk specific gravity (Gsb). Minor Gsb deviations (i.e., within AASHTO d2 s limits), can significantly affect VMA, so much so that 99% of Mississippi’s mixes could be failing VMA while reported VMA passes. This allows mix manipulation and economization, with 0.8% asphalt content reductions possible while still meeting volumetric requirements. Recycled materials can exacerbate this issue, and common approaches to increase asphalt content (decreasing design gyration level or using finer gradations) are ineffective with fixed VMA requirements. Overall, the mix design database analysis agrees with numerous smaller studies but does so with an entire state’s actual practice. This presents a compelling case that volumetrics-only mix design has limitations, and supports ongoing efforts to reintegrate mechanical tests.
“That’s How Revolutions Happen”: Psychopolitical Resistance in Youth’s Online Civic Engagement
Authors: Wilf Sara , Wray-Lake Laura
Published: December 2021

This paper describes forms of online youth civic engagement that center the experiences of youth with historically marginalized identities and documents ways that youth are civically engaged. Twenty U.S.-based, digitally active youth ages 16 to 21 years old were interviewed. Seven participants (35%) identified as female, nine (45%) as male, and four (20%) as gender nonbinary. Twelve (60%) identified as a first or second generation immigrant. Youth were recruited through youth-led movement accounts on Twitter and contacted via Direct Messaging. Semi-structured interviews were conducted with youth between March and September 2020, a period spanning the outbreak of COVID-19 and rise in participation in the Black Lives Matter movement. Inductive Constant Comparative Analysis was used to document forms of youth civic engagement on social media and understand how youth ascribed meaning to their civic engagement. Framed by literature on critical consciousness and psychopolitical resistance to oppression, findings highlight three forms of online youth civic engagement: Restorying, Building Community, and Taking Collective Action. These findings indicate that, for youth with identities that have historically been marginalized, social media is an important context to be civically engaged in ways that resist oppression and injustice.
La traduction au prisme du genre et de la pensée islamique
Authors: Bedjaoui Wafa
Published: December 2021

The main objective of this article is to make the female voice heard in an area of the world where women are discriminated against and prejudiced, despite the progress made regarding their status in status in society. The aim is to demonstrate that the translation of the male discourse produced undergoes fundamental transformations that are the result of choices studied by the translator. She intervenes She intervenes and rewrites the text in her own way, even in the way that allows her to represent herself as a full human being in her own right, not relegated to the background. Through the analysis of samples taken from the work of the Algerian thinker Malek Bennabi “Les conditions de la renaissance” as well as the questioning of the first translation by the Egyptian thinker Abdel Sabbour Chahine, considered reductive and ‘religiously oriented’, we are in line with the feminist approach to translation feminist approach to translation, which advocates taking a stand on the dominant discourse. By invoking some of the methodological tools of Giles' IDRC Model and by referring to the notion of subjectivity developed in the framework of feminism of colour, we proceeded to the analysis of the source and target texts. We found that the doubly masculine discourse (the author and her (the author and his translator) was reproduced differently in the target language by taking into consideration elements that are absent from the source text. The invisibility of the woman in the process since she is considered an object, she passes to the status of visibility through the translational choices, the positions taken, and thus the decisions made.
Extraglomerular immune complex deposition in lupus nephritis
Authors: Papa Valentina , Brainer James , Henriksen Kammi J , Cenacchi Giovanna , Chang Anthony
Published: December 2021

Background

Lupus nephritis (LN) is a common manifestation and a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. It is characterized by glomerular and often extraglomerular immune complex deposition.

Purpose

Given the emerging importance of the tubulointerstitial compartment, we conducted a retrospective study of 78 LN biopsies to enumerate the spectrum of extraglomerular immune complex deposition that can be observed in lupus nephritis by electron microscopy and to identify possible clinical or pathologic correlates.

Results

The presence of tubulointerstitial immune complex deposition often accompanied interstitial inflammation, but some discrepancies were also seen.

Conclusions

As target antigens are identified, correlation with glomerular, tubulointerstitial, and vascular immune complex deposition will be of increasing interest.
Singing at menopause: A systematic review with pedagogical implications
Authors: Fiuza Mauro B. , Sevillano Maria Luisa , Lã Filipa M.B.
Published: December 2021

Menopause is a certainty in a female singer’s life; depletion of estrogens may lead to physical, mental, and vocal symptoms. To investigate the extent to which these symptoms affect singers, a systematic literature review was carried out using eight interdisciplinary bibliographic databases. Combinations of the following key words were used: menopause, climacterium, singing, singers, and choir.

From 18 studies, including three doctoral dissertations and a master’s thesis, only 10 met the inclusion criteria. The heterogeneity of study designs and methods of data collection and analysis precluded the carrying out of a meta-analysis. Instead, descriptors of symptoms affecting the voice, and vocal characteristics associated with menopause (menopause descriptors) were categorized, and their frequency of occurrence determined, according to six types of primary dataset: (1) self-reported symptoms, (2) acoustic characteristics, (3) observations of the larynx, (4) perceptual evaluations, (5) analysis of electrolaryngographic waveform characteristics, and (6) analysis of hormone concentrations. The descriptors that occurred most frequently in the literature concerned aspects of voice production, whereas those concerning vocal health, and vocal practice and performance, were less common. Of the three subsystems that comprise the vocal instrument, the vibrating vocal folds seem to be more affected than breathing and resonance. Changes in vocal range, timbre, endurance, and vocal fold mobility occur during menopause, affecting singers’ voice quality. Some singers reported that their ability to perform was compromised, mainly due to memory lapses and lack of confidence. Maintaining regular singing and practicing semi-occluded vocal tract exercises throughout the menopausal transition seem to help singers to overcome the negative impacts of menopause on vocal performance.
Recognizing careworkers’ contributions to improving the social determinants of health: A call for supporting healthy carework
Authors: Tsui Emma K , Franzosa Emily , Vignola Emilia F , Cuervo Isabel , Landsbergis Paul , Zelnick Jennifer , Baron Sherry
Published: December 2021

Workers engaged in reproductive labor—the caring work that maintains society and supports its growth—contribute to societal health while also enduring the harms of precarious labor and substantial work stress. How can we conceptualize the effects of reproductive labor on workers and society simultaneously? In this commentary, we analyze four types of more relational and less relational careworkers—homeless shelter workers, school food workers, home care aides, and household cleaners—during the COVID-19 pandemic. We then make a case for a new model of societal health that recognizes the contributions of careworkers and healthy carework. Our model includes multi-sectoral social policies supporting both worker health and societal health and acknowledges several dimensions of work stress for careworkers that have received insufficient attention. Ultimately, we argue that the effects of reproductive labor on workers and society must be considered jointly, a recognition that offers an urgent vision for repairing and advancing societal health.
Expression of SATB2 in Neuroendocrine Carcinomas of the Lung: Frequent Immunopositivity of Large Cell Neuroendocrine Carcinoma with a Diagnostic Pitfall
Authors: Inoue Hiromichi , Matsushima Jun , Kobayashi Satoru , Sairenchi Toshimi , Hirata Hirokuni , Chida Masayuki , Ota Satoshi , Ban Shinichi , Matsumura Yuji
Published: December 2021

Small cell lung carcinoma (SCLC) and pulmonary large cell neuroendocrine carcinoma (LCNEC) are both classified as lung neuroendocrine carcinoma (NEC). It has recently been reported that the special AT-rich sequence-binding protein 2 (STAB2), known as a colorectal cancer marker, is also expressed in NECs occurring in various organs including the lung. However, few studies have examined any differences of SATB2 immunopositivity between SCLC and LCNEC. We investigated SATB2 expression in 45 SCLC and 14 LCNEC cases using immunohistochemistry as well as the expression of caudal-type homeobox 2 (CDX2) and keratin (KRT) 20. The LCNEC cases were more frequently positive for SATB2 (ten out of 14, 71%) than the SCLC ones (seventeen out of 45, 38%) with a statistically significance (P = 0.035). Furthermore, two LCNEC cases were positive for CDX2 while no positive findings were observed for any SCLC cases, the difference of which, however, was not statistically significant (P = 0.053). KRT20 was negative in all LCNEC and SCLC cases. These results require our attention when we use SATB2 and CDX2 as colorectal cancer markers because their expression in pulmonary NECs can lead to a misdiagnosis that the tumor is of metastatic colorectal adenocarcinoma, especially when the patient has a past history of colorectal cancer. Analyzing the relationship between the demographic/clinical variables and the SATB2 expression in the SCLC cases, just high Brinkman index (≥ 600) was significantly related to the positivity of SATB2 (P = 0.017), which is interesting considering the strong relationship between SCLC and smoking.
Adaptive control to actively damp bistabilities in highly interrupted turning processes using a hardware-in-the-loop simulator
Authors: Sahu Govind N. , Law Mohit , Wahi Pankaj
Published: December 2021

Interruptions in turning make the process forces non-smooth and nonlinear. Smooth nonlinear cutting forces result in the process of being stable for small perturbations and unstable for larger ones. Re-entry after interruptions acts as perturbations making the process exhibit bistabilities. Stability for such processes is characterized by Hopf bifurcations resulting in lobes and period-doubling bifurcations resulting in narrow unstable lenses. Interrupted turning remains an important technological problem, and since experimentation to investigate and mitigate instabilities are difficult, this paper instead emulates these phenomena on a controlled hardware-in-the-loop simulator. Emulated cutting on the simulator confirms that bistabilities persist with lobes and lenses. Cutting in bistable regimes should be avoided due to conditional stability. Hence, we demonstrate the use of active damping to stabilize cutting with interruptions/perturbations. To stabilize cutting with small/large perturbations, we successfully implement an adaptive gain tuning scheme that adapts the gain to the level of interruption/perturbation. To facilitate real-time detection of instabilities and their control, we characterize the efficacy of the updating scheme for its dependence on the time required to update the gain and for its dependence on the levels of gain increments. We observe that higher gain increments with shorter updating times result in the process being stabilized quicker. Such results are instructive for active damping of real processes exhibiting conditional instabilities prone to perturbations.
Consumers’ Trust in Persuasion: Objective Versus Biased Elaboration Likelihood in China’s E-Commerce Advertising
Authors: Deng Fengyi , Huang Heshui , Cheng Hong
Published: December 2021

Based on the elaboration likelihood model (ELM), this study examined the role of consumers’ initial trust in the persuasion process in e-commerce advertising in China. The results of two experiments revealed two significant moderators of the central route for processing of information: the disposition to trust (negative moderator) and institution-based trust (IBT; positive moderator). Specifically, low disposition to trust strengthened the influence of argument quality on consumers’ product attitude and purchase intention. The same effect occurred under conditions of high IBT. However, when it came to the peripheral route, the effects of disposition to trust and IBT were not significant.
Personalising the dilemma: research ethics in fiction
Authors: Dalton-Brown Sally
Published: December 2021

Learning about research ethics and research integrity is greatly facilitated by case studies, which illuminate, ground and personalise abstract questions. This paper argues that fiction can provide similar learning experiences, incarnating ethical dilemmas through a medium that is highly accessible yet sophisticated in its depictions of how researchers behave. Examples of fictional illustrations are given to illustrate various themes such as animal experimentation, exploitation of the vulnerable, researcher bias and research fraud.
Comparing High School Sport Specialization Trends Between Division I and Club Collegiate Athletes
Authors: Biese Kevin M. , Winans Madeline , Hernandez Mayrena I. , Schaefer Daniel A. , Post Eric G. , Sanfilippo Jennifer L. , Bell David R.
Published: December 2021

Background:

Adolescent athletes report that sports specialization improves their ability to receive a collegiate athletics scholarship, though this is not well-understood. The purpose of this study was to examine self-reported trends in high school specialization and influences for sport participation between Division I (D-I) and college-aged club (club) athletes.

Hypothesis:

There would be no difference in high school sport specialization or sport participation influences between D-I and club athletes.

Study Design:

Retrospective cross-sectional study.

Level of Evidence:

Level 3.

Methods:

A survey included specialization classification (low, moderate, and high) for 9th to 12th grade, age that the athlete started organized sport and his or her collegiate sport, and several influential factors for participation in one’s primary high school sport (1 = no influence to 5 = extremely influential). Chi-square analyses were used to compare specialization classifications between groups. Nonparametric tests were used to determine significant differences in age-related variables and influential factors between D-I and club athletes. All analysis were also conducted with boys and girls separately.

Results:

Participants included 266 D-I (girls, 155; 58%) and 180 club (girls, 122; 68%) athletes. Club athletes were more likely to be classified as low specialization at every grade in high school, and this difference was more pronounced between D-I and club female athletes than male athletes. The number of years an athlete was classified as highly specialized in high school was not different between D-I and club athletes. Club athletes were more influenced by playing with friends than D-I athletes and D-I athletes were more influenced by pursuing a collegiate scholarship than club athletes.

Conclusion:

High levels of specialization in high school sport may not be necessary for playing at the collegiate level, though some level of specialization in high school might be necessary.

Clinical Relevance:

Clinicians should advocate for healthy long-term athlete development, which does not support high specialization in high school sports.
The results of a 24-month controlled, prospective study of relapsing multiple sclerosis patients at risk for progressive multifocal encephalopathy, who switched from prolonged use of natalizumab to teriflunomide
Authors: Cohan Stanley , Gervasi-Follmar Tiffany , Kamath Aneesh , Kamath Vineetha , Chen Chiayi , Smoot Kyle , Baraban Elizabeth , Edwards Keith
Published: December 2021

Background

Natalizumab (NTZ) is a highly effective disease modifying treatment for relapsing multiple sclerosis (RMS), but it increases risk of progressive multifocal leukoencephalopathy (PML) in patients with serum anti- John Cunningham virus (JCV) antibodies.

Objective

To assess the safety and efficacy of rapid transition, from NTZ to teriflunomide (TFM) in RMS patients.

Methods

Clinically stable NTZ-treated, anti-JCV antibody positive RMS patients were switched to TFM 28 ± 7 days after their last dose of NTZ. The primary endpoint was proportion of relapse free patients at 24 months.

Results

Median [IQR] age of the 55 enrolled patients was 47 [40.7, 56.3] years, 76% were female. The median [IQR] number of prior NTZ treatments was 34 [18, 64]. annualized relapse rate (ARR) was 0.07 and 77% of the patients were relapse free at 24 months. Mean time to first GAD + lesion was 19.6 months, and to new/enlarging T2 lesion was 19.2 months. Mean time to 3 month sustained disability worsening (SDW) was 22 months and proportion free of 3-month SDW was 0.87. There were no cases of PML.

Conclusions

The washout-free transition of NTZ to TFM was an efficacious and safe strategy for patients at risk of developing PML. ClinicalTrials.gov Identifier: NCT01970410
ERS statement on paediatric long-term noninvasive respiratory support
Authors: Fauroux Brigitte , Abel François , Amaddeo Alessandro , Bignamini Elisabetta , Chan Elaine , Corel Linda , Cutrera Renato , Ersu Refika , Installe Sophie , Khirani Sonia , Krivec Uros , Narayan Omendra , MacLean Joanna , Perez De Sa Valeria , Pons-Odena Marti , Stehling Florian , Ferreira Rosario Trindade , Verhulst Stijn
Published: December 2021

Long-term noninvasive respiratory support, comprising continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV), in children is expanding worldwide, with increasing complexities of children being considered for this type of ventilator support and expanding indications such as palliative care. There have been improvements in equipment and interfaces. Despite growing experience, there are still gaps in a significant number of areas: there is a lack of validated criteria for CPAP/NIV initiation, optimal follow-up and monitoring; weaning and long-term benefits have not been evaluated. Therapeutic education of the caregivers and the patient is of paramount importance, as well as continuous support and assistance, in order to achieve optimal adherence. The preservation or improvement of the quality of life of the patient and caregivers should be a concern for all children treated with long-term CPAP/NIV. As NIV is a highly specialised treatment, patients are usually managed by an experienced paediatric multidisciplinary team. This statement written by experts in the field of paediatric long-term CPAP/NIV aims to emphasise the most recent scientific input and should open up new perspectives and research areas.
Is single-inhaler triple therapy for COPD cost-effective in the UK? The IMPACT trial
Authors: Martin Alan , Shah Dhvani , Ndirangu Kerigo , Anley Glenn A. , Okorogheye Gabriel , Schroeder Melanie , Risebrough Nancy , Ismaila Afisi S.
Published: December 2021

Background

The IMPACT trial demonstrated superior outcomes following 52 weeks of once-daily single-inhaler treatment with fluticasone furoate (FF)/umeclidinium (UMEC)/vilanterol (VI) (100/62.5/25 μg) compared with once-daily FF/VI (100/25 μg) or UMEC/VI (62.5/25 μg). This study evaluated the cost-effectiveness of FF/UMEC/VI compared with FF/VI or UMEC/VI for the treatment of chronic obstructive pulmonary disease (COPD) from a UK National Health Service perspective.

Methods

Patient characteristics and treatment effects from IMPACT were populated into a hybrid decision tree/Markov economic model. Costs (GB£ inflated to 2018 equivalents) and health outcomes were modelled over a lifetime horizon, with a discount rate of 3.5% per annum applied to both. Sensitivity analyses were performed to test the robustness of key assumptions and input parameters.

Results

Compared with FF/VI and UMEC/VI, FF/UMEC/VI provided an additional 0.296 and 0.145 life years (LYs) (discounted) and 0.275 and 0.118 quality-adjusted life years (QALYs), at an additional cost of £1129 and £760, respectively. Incremental cost-effectiveness ratios (ICERs) for FF/UMEC/VI were £4104/QALY and £3809/LY gainedversusFF/VI and £6418/QALY and £5225/LY gainedversusUMEC/VI. At a willingness-to-pay threshold of £20 000/QALY, the probability that FF/UMEC/VI was cost-effective was 96%versusFF/VI and 74%versusUMEC/VI. Results were similar in a subgroup of patients recommended triple therapy in the 2019 National Institute for Health and Care Excellence COPD guideline.

Conclusions

FF/UMEC/VI single-inhaler triple therapy improved health outcomes and was a cost-effective option compared with FF/VI or UMEC/VI for patients with symptomatic COPD and a history of exacerbations in the UK at recognised cost-effectiveness threshold levels.
Evaluation of spirometry-gated computed tomography to measure lung volumes in emphysema patients
Authors: Bakker Jens T. , Klooster Karin , Bouwman Jan , Pelgrim Gert Jan , Vliegenthart Rozemarijn , Slebos Dirk-Jan
Published: December 2021

Introduction

In emphysema patient being evaluated for bronchoscopic lung volume reduction (BLVR), accurate measurement of lung volumes is important. Total lung capacity (TLC) and residual volume (RV) are commonly measured by body plethysmography but can also be derived from chest computed tomography (CT). Spirometry-gated CT scanning potentially improves the agreement of CT and body plethysmography. The aim of this study was to compare lung volumes derived from spirometry-gated CT and “breath-hold-coached” CT to the reference standard: body plethysmography.

Methods

In this single-centre retrospective cohort study, emphysema patients being evaluated for BLVR underwent body plethysmography, inspiration (TLC) and expiration (RV) CT scan with spirometer guidance (“gated group”) or with breath-hold-coaching (“non-gated group”). Quantitative analysis was used to calculate lung volumes from the CT.

Results

200 patients were included in the study (mean±sdage 62±8 years, forced expiratory flow in 1 s 29.2±8.7%, TLC 7.50±1.46 L, RV 4.54±1.07 L). The mean±sdCT-derived TLC was 280±340 mL lower compared to body plethysmography in the gated group (n=100), and 590±430 mL lower for the non-gated group (n=100) (both p<0.001). The mean±sdCT-derived RV was 300±470 mL higher in the gated group and 700±720 mL higher in the non-gated group (both p<0.001). Pearson correlation factors were 0.947 for TLC gated, 0.917 for TLC non-gated, 0.823 for RV gated, 0.693 for RV non-gated, 0.539 for %RV/TLC gated and 0.204 for %RV/TLC non-gated. The differences between the gated and non-gated CT results for TLC and RV were significant for all measurements (p<0.001).

Conclusion

In severe COPD patients with emphysema, CT-derived lung volumes are strongly correlated to body plethysmography lung volumes, and especially for RV, more accurate when using spirometry gating.
Using DNA testing for the precise, definite, and low-cost diagnosis of sickle cell disease and other Haemoglobinopathies: findings from Tanzania
Authors: Christopher Heavenlight , Burns Adam , Josephat Emmanuel , Makani Julie , Schuh Anna , Nkya Siana
Published: December 2021

Background

Sickle cell disease (SCD) is an important cause of under-five mortality. Tanzania is the 5th country in the world with the highest births prevalence of SCD individuals. Significant advances in the neonatal diagnosis of SCD using rapid point-of-care testing have been made. However genetic confirmation is still required for positive cases, in uncertain cases, in multiply transfused patients, to resolve compound heterozygosity (Hb S/ β0 Thal or Hb S/ β+ thal) not uncommon in the coastal regions of East Africa and increasingly also for pre-marital counselling and potentially for future curative approaches such as gene therapy. The currently available DNA tests are prohibitively expensive. Here, we describe an easy-to-use, affordable and accurate β-globin sequencing approach that can be easily integrated within existing NBS for SCD and other haemoglobinopathies especially in Low- and Middle-income Countries.

Aim

To evaluate an affordable DNA technology for the diagnosis of Sickle cell disease and other haemoglobinopathies in a resource-limited setting.

Methods

Laboratory-based validation study was conducted by Muhimbili University of Health and Allied Sciences and the University of Oxford involving sequencing of the entire β -haemoglobin locus using the Oxford Nanopore MinION platform. A total number of 36 Dried blood spots and whole blood samples were subjected to conventional protein-based methods (isoelectric focusing, HPLC), and/or sequenced by the Sanger method as comparators.

Results

Sequencing results for SCD using the MinION were 100% concordant with those from the Sanger method. In addition, the long-read DNA sequencing method enabled the resolution of cases with unusual phenotypes which make up 1% of all children in Tanzania. The cost is £11/ sample for consumables, which is cheaper compared to other sequencing platforms.

Conclusions

This is the first report of a comprehensive single DNA assay as a definitive diagnostic test for SCD and other haemoglobinopathies. The test is fast, precise, accurate and affordable.