bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal Satisfaction and Its Associated Factors towards Spinal Anesthesia for Caesarean Section: A Cross-Sectional Study in Two Eritrean Hospitals
Authors: Idris Idris Mohammed , Weldegiorgis Ghidey Gebreyohanns , Tesfamariam Eyasu Habte
Published: March 2020

Objective. Satisfaction of mothers during caesarean section is an important indicator for measuring quality of obstetric anesthesia. This study aimed to determine mothers’ level of satisfaction and the predicting factors of dissatisfaction towards spinal anesthesia during caesarean section. Methods. Cross-sectional study design was utilized in Orotta Maternity Hospital (OMH) and Sembel Hospital from December 2017 to February 2018, in Asmara, Eritrea. Satisfaction of the mothers was measured using a pretested questionnaire. Bivariate and multivariate logistic regression were utilized to identify predictors of dissatisfaction using SPSS (Version 22.0). Results. Involvement of mothers in the choice of anesthesia (3.3%) and explanation about the stay at operating theater (10%) were the two least reported items. As per the subscale analysis, the lowest satisfaction was observed for the preoperative assessment (16.7%). Overall, 87.9% of the mothers were satisfied with the spinal anesthetic service. Hospital at which anesthesia was administered (p<0.001), marital status (p<0.001), and intraoperative pain (p<0.001) were significant predictors of dissatisfaction towards spinal anesthesia. Moreover, the rate of refusal to have spinal anesthesia in the future was 12.5%. Conclusion. Though overall satisfaction can be considered as fair, preoperative assessment is considerably low. Hence, explaining the benefits and risks of the anesthetic techniques as well as considering patient’s opinion is very important while deciding the type of anesthesia.
CCII and FPGA Realization: A Multistable Modified Fourth-Order Autonomous Chua’s Chaotic System with Coexisting Multiple Attractors
Authors: Yu Fei , Shen Hui , Liu Li , Zhang Zinan , Huang Yuanyuan , He Binyong , Cai Shuo , Song Yun , Yin Bo , Du Sichun , Xu Quan
Published: March 2020

In this paper, a multistable modified fourth-order autonomous Chua’s chaotic system is investigated. In addition to the dynamic characteristics of the third-order Chua’s chaotic system itself, what interests us is that this modified fourth-order autonomous Chua’s chaotic system has five different types of coexisting attractors: double-scroll, single band chaotic attractor, period-4 limit cycle, period-2 limit cycle, and period-1 limit cycle. Then, an inductorless modified fourth-order autonomous Chua’s chaotic circuit is proposed. The active elements as well as the synthetic inductor employed in this circuit are designed using second-generation current conveyors (CCIIs). The reason for using CCIIs is that they have high conversion rate and operation speed, which enable the circuit to work at a higher frequency range. The Multisim simulations confirm the theoretical estimates of the performance of the proposed circuit. Finally, using RK-4 numerical algorithm of VHDL 32-bit IQ-Math floating-point number format, the inductorless modified fourth-order autonomous Chua’s chaotic system is implemented on FPGA for the development of embedded engineering applications based on chaos. The system is simulated and synthesized on Virtex-6 FPGA chip. The maximum operating frequency of modified Chua’s chaotic oscillator based on FPGA is 180.180 MHz. This study demonstrates that the hardware-based multistable modified fourth-order autonomous Chua’s chaotic system is a very good source of entropy and can be applied to various embedded systems based on chaos, including secure communication, cryptography, and random number generator.
The Nonlinear Relationship between Investor Sentiment, Stock Return, and Volatility
Authors: He Gang , Zhu Shuzhen , Gu Haifeng
Published: March 2020

Based on the DSSW model, we analyze the nonlinear impact mechanism of investor sentiment on stock return and volatility by adjusting its hypothesis in Chinese stock market. We examine the relationship between investor sentiment, stock return, and volatility by applying OLS regression and quantile regression. Our empirical results show that the effects of investor sentiment on stock market return are asymmetric. There is “Freedman effect” in Chinese stock market, but only optimistic sentiment has a significant nonlinear impact on stock market returns when the stock market is a balanced market or a bear market. Meanwhile, “create the space effect” does exist in Chinese stock market too. It only exists when the market is in equilibrium, and only pessimistic sentiment has the nonlinear effect on stock market volatility.
A Method for Bus OD Matrix Estimation Using Multisource Data
Authors: Huang Di , Yu Jun , Shen Shiyu , Li Zhekang , Zhao Luyun , Gong Cheng
Published: March 2020

The automated fare collection (AFC) system has gained increasing popularity among transit systems worldwide. The AFC system is usually an entry-only system that only records the serial number of the smart card and the transaction time of each use. Neither the AFC data nor the bus global positioning system (GPS) could reveal the passenger’s alighting information, namely, alighting time and station. Hence, the station-to-station origin-destination (OD) trip information cannot be obtained directly from the available data sources. To address this problem, this paper proposes a methodology that estimates the OD matrix by using smart card and GPS data. In this paper, the characteristics of the basic data sources are first analyzed, based on which the bus arrival time is generated using the density-based clustering algorithm and a time correction strategy, based on which the passenger’s boarding station is identified. The alighting stations are inferred based on the characteristics of bus trip chaining, which could identify over 80% of the alighting stations on average. Finally, the proposed methodology is verified by a comprehensive field survey in Suzhou, China, with 100% sample rate.
Left Atrial Strain as Evaluated by Two-Dimensional Speckle Tracking Predicts Left Atrial Appendage Dysfunction in Chinese Patients with Atrial Fibrillation
Authors: Wang Yu , Li Mingqi , Zhong Lishan , Ren Siqi , Li Hezhi , Tang Yongwen , Li Zhilian , Fei Hongwen
Published: March 2020

Left atrial appendage (LAA) dysfunction identified by transesophageal echocardiography (TEE) is a powerful predictor of stroke in patients with atrial fibrillation (AF). The aim of our study is to assess if there is a correlation between the left atrial (LA) functional parameter and LAA dysfunction in the AF patients. This cross-sectional study included a total of 249 Chinese AF patients who did not have cardiac valvular diseases and were undergoing cardiac ablation. TEE was performed in all the patients who were categorized into two groups according to their left atrial appendage (LAA) function. A total of 120 of the 249 AF patients had LAA dysfunction. Univariate and multivariate logistic regression was conducted to assess the independent factors that correlated with the LAA dysfunction. Different predictive models for the LAA dysfunction were compared with the receiver operating characteristic (ROC) curve. The final ROC curve on the development and validation datasets was drawn based on the calculation of each area under the curves (AUC). Univariate and multivariate analysis showed that the peak left atrial strain (PLAS) was the most significant factor that correlated with the LAA dysfunction. PLAS did not show inferiority amongst all the models and revealed strong discrimination ability on both the development and validation datasets with AUC 0.818 and 0.817. Our study showed that a decrease in PLAS is independently associated with LAA dysfunction in the AF patients.
A New Decomposition Ensemble Learning Approach with Intelligent Optimization for PM2.5 Concentration Forecasting
Authors: Xing Guangyuan , Sun Shaolong , Guo Jue
Published: March 2020

In this study, we focus our attention on the forecasting of daily PM2.5 concentrations. According to the principle of “divide and conquer,” we propose a novel decomposition ensemble learning approach by integrating ensemble empirical mode decomposition (EEMD), artificial neural networks (ANNs), and adaptive particle swarm optimization (APSO) for forecasting PM2.5 concentrations. Our proposed decomposition ensemble learning approach is formulated exclusively to deal with difficulties in quantitating meteorological information with high volatility, irregularity, and complicacy. This decomposition ensemble learning approach mainly consists of three steps. First, we utilize EEMD to decompose original time series of PM2.5 concentrations into a specific amount of independent intrinsic mode functions (IMFs) and residual term. Second, the ANN, whose connection parameters are optimized by APSO algorithm, is employed to model IMFs and residual terms, respectively. Finally, another APSO-ANN is applied to aggregate the forecast IMFs and residual term into a collection as the final forecasting results. The empirical results show that the forecasting of our decomposition ensemble learning approach outperforms other benchmark models in terms of level accuracy and directional accuracy.
Combination Therapy of Wuweizi (Schisandrae Chinensis Fructus) and Dexamethasone Alleviated Dexamethasone‐Induced Glucocorticoid Osteoporosis in Rats with Idiopathic Pulmonary Fibrosis
Authors: Qin Zinan , Li Siyu , Zhang Xiaojuan , Liu Guoxiu , Gu Min , Zhang Nan , Liu Jiao , Ji Zhihong , Li Keao , Han Yongpeng , Zhai Huaqiang
Published: March 2020

Objective. To investigate the therapeutic effect of combined application of Wuweizi (Schisandrae Chinensis Fructus) and dexamethasone in rats with idiopathic pulmonary fibrosis (IPF) and the possible protective effect of Wuweizi against dexamethasone‐induced glucocorticoid osteoporosis (GIOP). Methods. There were five groups in this study, including the sham operation group, model group, Wuweizi group, dexamethasone group, and the combination group. A rat IPF model was made by the endotracheal injection of bleomycin. After modeling, rats were given drug interventions for 7 and 28 days. Rats were sacrificed for pathological morphology examination of the bone and lung and quantitative determination of biochemical markers of bone metabolism and angiogenesis‐related cytokine to observe therapeutic efficacy on the 7th and 28th day. ELISA was used for the quantitative determination of tartrate‐resistant acid phosphatase (TRACP), bone alkaline phosphatase (BALP), hypoxia‐inducible factor (HIF‐1α), platelet‐derived growth factor (PDGF), pigment epithelium‐derived factor (PEDF), and endostatin in serum. The concentrations of calcium (Ca) and phosphorus (P) were detected with the automatic biochemical analyzer. Results. After drug interventions for 7 and 28 days, alveolitis and pulmonary fibrosis in treatment groups showed significant improvement compared with those in the model group (P < 0.05). Bone histopathological figures showed severely damaged trabecular bone and bone marrow cavity in the dexamethasone group, but it was significantly alleviated in the combination group. The concentrations of BALP and Ca in the combination group were significantly higher than those in the dexamethasone group after treatment, while the concentrations of TRACP and P were lower than those in the dexamethasone group (P < 0.05). The concentrations of HIF‐1α and PDGF in treatment groups were significantly lower (P < 0.05) compared with those in the model group, while PEDF and endostatin were increased (P < 0.01). However, the concentration of HIF‐1α in the combination group was higher than that in the dexamethasone group, and the concentration of PEDF was lower than that in the dexamethasone group. Conclusions. The combination therapy of Wuweizi and dexamethasone effectively treated IPF rats by regulating angiogenesis, meanwhile distinctly alleviating dexamethasone‐induced GIOP.
Evaluation of Groundwater Quality for Suitability of Irrigation Purposes: A Case Study in the Udham Singh Nagar, Uttarakhand
Authors: Singh Kshitindra Kr. , Tewari Geeta , Kumar Suresh
Published: March 2020

In the present study, the groundwater quality for suitability in agriculture from Udham Singh Nagar district, Uttarakhand, has been evaluated. A total of 50 groundwater samples have been collected and analysed for pH, EC, TH, HCO3−, CO32−, Cl−, SO42−, NO3–, Ca2+, Mg2+, Na+ and K+. To assess the groundwater quality for irrigation purpose, parameters like sodium adsorption ratio (SAR), soluble sodium percentage (SSP), residual sodium carbonate (RSC), magnesium hazards (MHs), permeability index (PI), and chloroalkaline index (CAI) values have been calculated. In USSL diagram, most of the groundwater samples fall in the C2S1 category and were safe for irrigation purpose. Only seven groundwater samples fall in the C3S1 category, indicating medium to high salinity which is safe for irrigation purpose for all types of soils but with limited care of exchangeable sodium. On the basis of RSC, all groundwater samples were observed to be suitable for irrigation purpose. Piper diagram indicated that 50% of the groundwater samples belonged to the Mg2+-Ca2+-HCO3− type and 48% was classified as the Ca2+-Mg2+-Cl− type. Durov diagram suggested possibilities of ion mixing and simple dissolution of ions from polluted soil.
Study on Quality Decisions in Supply Chain considering the Lagged Time and Retailers Competition
Authors: Peng Yuan , Ning Liang
Published: March 2020

The lagged time on goodwill is a common phenomenon in the process of quality improvement, which plays an important role in making quality strategy of supply chain. With increasing public attention to quality, supply chain quality management has become a research focus in recent years. This paper probes into the lagged time of quality on goodwill under the competitive environment of retailers and constructs a lagged differential equation of quality on goodwill based on the Nerlove–Arrow model. The results indicate that the optimal goodwill and quality are higher under centralized decision-making than under decentralized decision-making; however, whether or not the profit of the entire supply chain is higher under centralized decision-making depends on the span of the lagged time. Under decentralized decision-making, the lagged time of product quality on goodwill is favorable to retailers but unfavorable to manufacturers and vice versa. Therefore, when competition is low, a supply chain tends to adopt centralized decision-making. When competition is intense, it is appropriate for a supply chain to adopt decentralized decision-making. In conclusion, this paper analyzes the effects of the lagged time on the optimal quality level and supply chain profit as well as the effect of the competition coefficient on research findings concerning supply chain profit under centralized and decentralized decision-making to verify the relevant conclusions of this paper.
Tetrastigma hemsleyanum Vine Flavone Ameliorates Glutamic Acid-Induced Neurotoxicity via MAPK Pathways
Authors: Chu Qiang , Li Yonglu , Hua Zheng , Wang Yaxuan , Yu Xin , Jia Ruoyi , Chen Wen , Zheng Xiaodong
Published: March 2020

Glutamic acid (Glu) is a worldwide flavor enhancer with various positive effects. However, Glu-induced neurotoxicity has been reported less. Tetrastigma hemsleyanum (TH), a rare herbal plant in China, possesses high medicinal value. More studies paid attention to tuber of TH whereas vine part (THV) attracts fewer focus. In this study, we extracted and purified flavones from THV (THVF), and UPLC-TOF/MS showed THVF was consisted of 3-caffeoylquinic acid, 5-caffeoylquinic acid, quercetin-3-O-rutinoside, and kaempferol-3-O-rutinoside. In vitro, Glu caused severe cytotoxicity, genotoxicity, mitochondrial dysfunction, and oxidative damage to rat phaeochromocytoma (PC12) cells. Conversely, THVF attenuated Glu-induced toxicity via MAPK pathways. In vivo, the neurotoxicity triggered by Glu restrained the athletic ability in Caenorhabditis elegans (C. elegans). The treatment of THVF reversed the situation induced by Glu. In a word, Glu could cause neurotoxicity and THVF owns potential neuroprotective effects both in vitro and in vivo via MAPK pathways.
Thermal and Mechanical Properties of Geopolymers Exposed to High Temperature: A Literature Review
Authors: He Rui , Dai Nan , Wang Zhenjun
Published: March 2020

Geopolymers are prepared by alkali solution‐activated natural minerals or industrial waste materials, which have been widely used as new sustainable building and construction materials for their excellent thermal and mechanical properties. The thermal and mechanical properties of geopolymers at high temperature have attracted great attention from many researchers. However, there are few systematic works concerning these two issues. Therefore, this work reviewed the thermal and mechanical behaviors of geopolymers at high temperature. Firstly, the thermal properties of geopolymers in terms of mass loss, thermal expansion, and thermal conductivity after high temperature were explained. Secondly, the mechanical properties of residual compressive strength and stress‐strain relationship of fly ash geopolymers and metakaolin geopolymers after high temperature were analyzed. Finally, the microstructure and mineralogical characteristics of geopolymers upon heating were interpreted according to the changes of microstructures and compositions. The results show that the thermal properties of geopolymers are superior to cement concrete. The geopolymers possess few mass loss and a low expansion ratio and thermal conductivity at high temperature. The thermal and mechanical properties of the geopolymers are usually closely related to the raw materials and the constituents of the geopolymers. Preparation and testing conditions can affect the mechanical properties of the geopolymers. The stress‐strain curves of geopolymer are changed by the composition of geopolymers and the high temperature. The silicon‐type fillers not only improve the thermal expansion of the geopolymers but also enhance mechanical properties of the geopolymers. But, they do not contribute to reducing the thermal conductivity. the different raw materials, aluminosilicate precursor and reinforcement materials, result in different geopolymer damage during the heating. However, phase transitions can occur during the process of heating regardless of the raw materials. The additional performance enhancements can be achieved by optimizing the paste formulation, adjusting the inner structure, changing the alkali type, and incorporating reinforcements.
The Impact of Violations of Bicycles and Pedestrians on Vehicle Emissions at Signalized Intersections
Authors: Huang Jianchang , Song Guohua , Zhang Jianbo , Li Chenxu , Liu Qiumei , Yu Lei
Published: March 2020

An intersection is a typical emission hot spot in the urban traffic network. And frequent violations such as running the red light have been a critical social problem at signalized intersections in developing countries. This article aimed to quantify the impact of violations (behaviors which will block the fleet) on emissions at signalized intersections. Increased emissions of vehicles affected by violations are of two levels: (1) trajectory level for the first four affected vehicles and (2) traffic flow level for the subsequent vehicles. At the trajectory level, the study focuses on the second-by-second activities of the first four affected vehicles. First, the trajectory model of the first affected vehicle is developed. Then, the trajectory of the other three vehicles is constructed using the Gipps car-following model. At the traffic flow level, a linear emission model is developed to describe the relationship between emission factors and idling time in the one-stop (vehicle stop once) and two-stop (vehicle stop twice) scenarios based on the global position system (GPS)-collected data at 44 intersections in Beijing. Based on the linear emission model, increased emissions at the traffic flow level are calculated as knowing the number of stops and idling time before and after violations. The analysis of the subsequent vehicles is divided into unsaturated and saturated conditions. Under the unsaturated condition, the emissions have barely increased due to the increase of idling time for one-stop vehicles caused by the violations. Under the saturated conditions, the emission increment increases sharply as the one-stop vehicle gradually transforms to a two-stop vehicle because of violations, and the maximum emission increment reaches 45% in half an hour in the case. The increment of emissions decreases steadily as the proportion of two-stop vehicles reaches 100% after violations, while the proportion before violations keeps increasing.
Evaluation of Tensile Force in a Porcine Trachea Using a Reflective Optical Method
Authors: Lomelí-Mejía Pedro A. , Cruz-Orea Alfredo , Araujo-Monsalvo Víctor M. , López-Sánchez Alberto , Huerta-Azuara Andrés , Aguirre-Palomé Crystal , Domínguez-Hernández Víctor M.
Published: March 2020

The trachea serves a variety of functions during breathing and swallowing. In cases requiring a partial resection, the treatment may involve anastomosis of the healthy ends of the trachea. The tension in the anastomosis should not exceed 1,000 g. Traditional methods for estimating tension in the trachea are very invasive. The aim of this work is to develop a noninvasive optical system devoted to estimate the tension of the trachea in vivo. An optical system was designed using a light source and a photosensor. To determine the most suitable wavelength for the light source, a photoacoustic spectroscopy study was performed. To test the system, a cadaveric pig trachea was mounted on a universal testing machine, and it was subjected to three tensile tests of up to 30 mm elongation. The optical response was measured at 0, 10, 20, and 30 mm elongation. An exponential response was observed so that the optical voltage-response curves were adjusted, and three exponential equations were derived to correlate the voltage with the optical response. We can conclude that the proposed optical system is able to noninvasively estimate the tension of a cadaveric porcine trachea.
Diagnosis of Gestational Diabetes Mellitus with Point-of-Care Methods for Glucose versus Hospital Laboratory Method Using Isotope Dilution Gas Chromatography-Mass Spectrometry as Reference
Authors: Kristensen Karl , Wangel Anne-Marie , Katsarou Anastasia , Shaat Nael , Simmons David , Fadl Helena , Berntorp Kerstin
Published: March 2020

Background. In Sweden, both glucose analyzers in accredited laboratories and point-of-care glucose devices are used for gestational diabetes mellitus (GDM) diagnosis. The aim of this study was to compare the diagnostic performance of the HemoCue Glucose 201+ (HC201+) and RT (HC201RT) systems with that of the hospital central laboratory hexokinase method (CL) based on lyophilized citrate tubes, using the isotope dilution gas chromatography-mass spectrometry (ID GC-MS) as reference. Methods. A 75 g oral glucose tolerance test was performed on 135 women screened positive for GDM. Diagnosis was based on the World Health Organization 2013 diagnostic thresholds for fasting (n=135), 1 h (n=52), and 2 h (n=135) glucose measurements. Bland-Altman analysis and surveillance error grids were used to evaluate analytical and clinical accuracy. Results. Significantly more women were diagnosed with GDM by HC201+ (80%) and CL (80%) than with the reference (65%, P<0.001) based on fasting and/or 2 h thresholds, whereas the percentage diagnosed by HC201RT (60%) did not differ significantly from the reference. In Bland-Altman analysis, a positive bias was observed for HC201+ (4.2%) and CL (6.1%) and a negative bias for HC201RT (−1.8%). In the surveillance error grid, 95.9% of the HC201+ values were in the no-risk zone as compared to 98.1% for HC201RT and 97.5% for CL. Conclusions. A substantial positive bias was found for CL measurements resulting in overdiagnosis of GDM. Our findings suggest better performance of HC201RT than HC201+ in GDM diagnosis. The results may have possible implications for GDM diagnosis in Sweden and require further elucidation.
Monthly Mean Meteorological Temperature Prediction Based on VMD-DSE and Volterra Adaptive Model
Authors: Li Guohui , Chang Wanni , Yang Hong
Published: March 2020

Climate is a complex and chaotic system, and temperature prediction is a challenging problem. Accurate temperature prediction is also concerned in the fields of energy, environment, industry, and agriculture. In order to improve the accuracy of monthly mean temperature prediction and reduce the calculation scale of hybrid prediction process, a combined prediction model based on variational mode decomposition-differential symbolic entropy (VMD-DSE) and Volterra is proposed. Firstly, the original monthly mean meteorological temperature sequence is decomposed into finite mode components by VMD. The DSE is used to analyze the complexity and reconstruct the sequences. Then, the new sequence is reconstructed in phase space. The delay time and embedding dimension are determined by the mutual information method and G-P method, respectively. On this basis, the Volterra adaptive prediction model is established to modeling and predicting each component. Finally, the final predicted values are obtained by superimposing the predicted results. The monthly mean temperature data of Xianyang and Yan’an are used to verify the prediction performance of the proposed model. The experimental results show that the VMD-DSE-Volterra model shows better performance in the prediction of monthly mean temperature compared with other benchmark models in this paper. In addition, the combined forecasting model proposed in this paper can reduce the modeling time and improve the forecasting accuracy, so it is an effective forecasting model.
Synthesis, Adsorption, and Recognition Properties of a Solid Symmetric Tetramethylcucurbit[6]uril-Based Porous Supramolecular Framework
Authors: Tian Fei-Yang , Cheng Rui-Xue , Zhang Yun-Qian , Tao Zhu , Zhu Qian-Jiang
Published: March 2020

In this work, we reported a porous supramolecular framework (A) constructed of a symmetric tetramethylcucurbit[6]uril (TMeQ[6]) in aqueous HCl solutions; the driving force was the outer surface interaction of cucurbit[n]urils, as well as hydrogen bonding between latticed water molecules and portal carbonyl oxygens of TMeQ[6]. Adsorption experimental results revealed that the porous supramolecular framework can absorb certain fluorophore guests (FGs) to form luminescent assemblies (FG@As) by fluorescence enhancement or colour change, and some of them can respond to certain volatile organic compounds. Thus, the TMeQ[6]-based supramolecular framework could be used as a sensor for certain gas or volatile compounds.
Factors Associated with Cervical Cancer Screening Uptake: Implications for the Health of Women in Jordan
Authors: Al-amro Suzanne Q. , Gharaibeh Muntaha K. , Oweis Arwa I.
Published: March 2020

Purpose. The existing factors that influence cervical cancer screening uptake worldwide do not necessarily reflect the situation in Jordan. Therefore, the aim of this study was to determine the factors associated with cervical cancer screening uptake among Jordanian women. Methods. In this cross-sectional study, 500 married Jordanian women aged 21 to 65 years were recruited from eight nongovernmental organisations and community settings in Amman. Data were collected with a self-administered questionnaire regarding sociodemographic and reproductive data, a health utilisation data form, and scales on the perceived benefits of screening, perceived barriers to screening, perceived susceptibility to cervical cancer, and perceptions regarding the severity of cervical cancer. Descriptive statistics, multivariate logistic regressions, and independent t-tests were used in the data analysis. Results. Among the 500 age-eligible women, only 156 (31.2%) had been screened for cervical cancer. Healthcare provider encouragement, years of marriage (odds ratio OR=5.24, confidence interval CI=95%, p=0.00), and use of the private healthcare sector (OR=2.20, CI=95%, p=0.012) were significant predictors of cervical cancer screening. Conclusion. Cervical cancer screening uptake among Jordanian women is significantly low; determining factors for the decision to undergo screening include encouragement from the healthcare provider, the number of years of marriage, and use of the private healthcare sector. To improve uptake, structured screening programmes need to be implemented in collaboration with national partners and institutions to decrease the incidence of cervical cancer in Jordan.
Repression of the Type I Interferon Pathway Underlies MYC- and KRAS-Dependent Evasion of NK and B Cells in Pancreatic Ductal Adenocarcinoma
Authors: Muthalagu Nathiya , Monteverde Tiziana , Raffo-Iraolagoitia Ximena , Wiesheu Robert , Whyte Declan , Hedley Ann , Laing Sarah , Kruspig Björn , Upstill-Goddard Rosanna , Shaw Robin , Neidler Sarah , Rink Curtis , Karim Saadia A. , Gyuraszova Katarina , Nixon Colin , Clark William , Biankin Andrew V. , Carlin Leo M. , Coffelt Seth B. , Sansom Owen J. , Morton Jennifer P. , Murphy Daniel J.
Published: March 2020

MYC is implicated in the development and progression of pancreatic cancer, yet the precise level of MYC deregulation required to contribute to tumor development has been difficult to define. We used modestly elevated expression of human MYC, driven from the Rosa26 locus, to investigate the pancreatic phenotypes arising in mice from an approximation of MYC trisomy. We show that this level of MYC alone suffices to drive pancreatic neuroendocrine tumors, and to accelerate progression of KRAS-initiated precursor lesions to metastatic pancreatic ductal adenocarcinoma (PDAC). Our phenotype exposed suppression of the type I interferon (IFN) pathway by the combined actions of MYC and KRAS, and we present evidence of repressive MYC–MIZ1 complexes binding directly to the promoters of the genes encodiing the type I IFN regulators IRF5, IRF7, STAT1, and STAT2. Derepression of IFN regulator genes allows pancreatic tumor infiltration by B and natural killer (NK) cells, resulting in increased survival.

Significance:

We define herein a novel mechanism of evasion of NK cell–mediated immunity through the combined actions of endogenously expressed mutant KRAS and modestly deregulated expression of MYC, via suppression of the type I IFN pathway. Restoration of IFN signaling may improve outcomes for patients with PDAC.

This article is highlighted in the In This Issue feature, p. 747
Golgi Acidification by NHE7 Regulates Cytosolic pH Homeostasis in Pancreatic Cancer Cells
Authors: Galenkamp Koen M.O. , Sosicka Paulina , Jung Michael , Recouvreux M. Victoria , Zhang Yijuan , Moldenhauer Matthew R. , Brandi Giovanni , Freeze Hudson H. , Commisso Cosimo
Published: March 2020

abstract

Cancer cells reprogram their metabolism to meet elevated energy demands and favor glycolysis for energy production. This boost in glycolytic flux supports proliferation, but also generates acid in the form of hydrogen ions that must be eliminated from the cytoplasm to maintain the alkaline intracellular pH (pHi) associated with transformation. To cope with acid production, tumor cells employ ion transport systems, including the family of sodium–hydrogen exchangers (NHE). Here, we identify NHE7 as a novel regulator of pHi in pancreatic ductal adenocarcinoma (PDAC). We determine that NHE7 suppression causes alkalinization of the Golgi, leading to a buildup of cytosolic acid that diminishes tumor cell fitness mainly through the dysregulation of actin. Importantly, NHE7 knockdown in vivo leads to the abrogation of tumor growth. These results identify Golgi acidification as a mechanism to control pHi and point to the regulation of pHi as a possible therapeutic vulnerability in PDAC.

Significance:

NHE7 regulates cytosolic pH through Golgi acidification, which points to the Golgi as a “proton sink” for metabolic acid. Disruption of cytosolic pH homeostasis via NHE7 suppression compromises PDAC cell viability and tumor growth.

See related commentary by Ward and DeNicola, p. 768.

This article is highlighted in the In This Issue feature, p. 747
Impact of Cardiac Resynchronization Therapy on Heart Transplant-Free Survival in Pediatric and Congenital Heart Disease Patients
Authors: Chubb Henry , Rosenthal David N. , Almond Christopher S. , Ceresnak Scott R. , Motonaga Kara S. , Arunamata Alisa A. , Long Jin , Trela Anthony V. , Hanisch Debra , McElhinney Doff B. , Dubin Anne M.
Published: March 2020

Background
- Cardiac resynchronization therapy (CRT) studies in pediatric and/or congenital heart disease (CHD) patients have shown an improvement in ejection fraction and heart failure symptoms. However, a survival benefit of CRT in this population has not been established. This study aimed to evaluate the impact of CRT upon heart transplant-free survival in pediatric and CHD patients, using a propensity score-matched analysis.

Methods
- This single-center study compared CRT patients (implant date 2004-2017) and controls, matched by 1:1 propensity-score matching (PSM) using 21 comprehensive baseline indices for risk stratification. CRT patients were <21 years or had CHD; had systemic ventricular ejection fraction <;45%; symptomatic heart failure; and had significant electrical dyssynchrony, all prior to CRT implant. Controls were screened from non-selective imaging and ECG databases. Controls were retrospectively enrolled when they achieved the same inclusion criteria at an outpatient clinical encounter, within the same time period.

Results
- Of 133 patients who received CRT during the study period, 84 met all study inclusion criteria. 133 controls met all criteria at an outpatient encounter. Following PSM, 63 matched CRT-control pairs were identified with no significant difference between groups across all baseline indices. Heart transplant or death occurred in 12 (19%) PSM-CRT subjects and 37 (59%) PSM-controls with a median follow-up of 2.7 years (quartiles 0.8-6.1 years). CRT was associated with markedly reduced risk of heart transplant or death (hazard ratio 0.24 [95% CI 0.12-0.46], p<0.001). There was no CRT procedural mortality and one system infection at 54 months post-implant.

Conclusions
- In pediatric and CHD patients with symptomatic systolic heart failure and electrical dyssynchrony, CRT was associated with improved heart transplant-free survival.
Association of Heart Rate Variability With Cognitive Performance: The Multi‐Ethnic Study of Atherosclerosis
Authors: Schaich Christopher L. , Malaver Diego , Chen Haiying , Shaltout Hossam A. , Zeki Al Hazzouri Adina , Herrington David M. , Hughes Timothy M.
Published: March 2020

Background

Heart rate variability (
HRV
) is associated with vascular risk factors for dementia, but whether
HRV
is associated with specific domains of cognitive performance is unclear.

Methods and Results

In the Multi‐Ethnic Study of Atherosclerosis (N=3018; mean age 59.3±9.2 years), we assessed the relationship of 10‐second
HRV
to scores on tests of global cognitive performance (Cognitive Abilities Screening Instrument), processing speed (Digit Symbol Coding), and working memory (Digit Span).
HRV
was computed as the SD of normal‐normal intervals (SDNN) and root mean square of successive differences (RMSSD) at Exam 1 (2000–2002) and Exam 5 (2010–2012). Cognitive tests were administered at Exam 5. We report regression coefficients (β [95% CI]) representing cognitive test score change per 2‐fold increase in
HRV
. After adjustment for age, race/ethnicity, sex, education, apolipoprotein E genotype, and cardiovascular risk factors and incident disease, higher Exam 1 (β=0.37 [0.06, 0.67]) and Exam 5 (β=0.31 [0.04, 0.59]) SDNN were associated with better Cognitive Abilities Screening Instrument performance. Higher Exam 1 (β=0.80 [0.17, 1.43]) and Exam 5 (β=0.63 [0.06, 1.20])
SDNN
, and Exam 5 RMSSD (β=0.54 [0.01, 1.08]) were associated with better Digit Symbol Coding performance. Finally, higher Exam 5 SDNN was associated with better Digit Span performance (β=0.17 [0.01, 0.33]). Associations were attenuated after adjustment for resting heart rate.

Conclusions

Higher
HRV
is generally associated with better cognitive performance in this multi‐ethnic cohort of aging adults, and further study of the relationship of autonomic function to cognition is warranted.
Associations of Benzodiazepine With Adverse Prognosis in Heart Failure Patients With Insomnia
Authors: Sato Yu , Yoshihisa Akiomi , Hotsuki Yu , Watanabe Koichiro , Kimishima Yusuke , Kiko Takatoyo , Kanno Yuki , Yokokawa Tetsuro , Abe Satoshi , Misaka Tomofumi , Sato Takamasa , Oikawa Masayoshi , Kobayashi Atsushi , Yamaki Takayoshi , Kunii Hiroyuki , Nakazato Kazuhiko , Ishida Takafumi , Takeishi Yasuchika
Published: March 2020

Background

The prognostic impact of benzodiazepines has been unclear in patients with heart failure (HF).

Methods and Results

This was a historical observational cohort study. A total of 826 patients who had been hospitalized for HF and were being treated for insomnia with either benzodiazepines or Z‐drugs (zolpidem, zopiclone, or eszopiclone), were enrolled and divided on the basis of their hypnotics: benzodiazepine group (n=488 [59.1%]) and Z group (n=338 [40.9%]). We compared the patient characteristics and postdischarge prognosis between the groups. The primary end points were rehospitalization for
HF
and cardiac death. The benzodiazepine group was older (age, 72.0 versus 69.0 years;
P
=0.010), had a higher prevalence of depression (17.4% versus 8.9%;
P
<0.001), and showed a higher use of loop diuretics (77.9% versus 67.8%;
P
=0.001). In the laboratory data, the benzodiazepine group demonstrated lower levels of hemoglobin (12.3 versus 13.0 g/
dL
;
P
=0.001), sodium (139.0 versus 140.0 
mE
q/L;
P
=0.018), and albumin (3.7 versus 3.9 g/
dL
;
P
=0.003). Kaplan‐Meier analysis showed that both end points were higher in the benzodiazepine group (rehospitalization for
HF
, log‐rank
P
=0.001; cardiac death, log‐rank
P
=0.043). Multiple Cox proportional hazard analysis revealed that the use of benzodiazepines was an independent predictor of rehospitalization for
HF
(hazard ratio, 1.530; 95% CI, 1.025–2.284;
P
=0.038). Furthermore, rehospitalization for
HF
was higher in the benzodiazepine group after propensity score matching (log‐rank
P
=0.036).

Conclusions

Benzodiazepine is associated with higher risk of rehospitalization for
HF
compared with Z‐drugs in patients with
HF
.
Renal Fibrosis Is Significantly Attenuated Following Targeted Disruption of
Cd40
in Experimental Renal Ischemia
Authors: Zhang Shungang , Breidenbach Joshua D. , Khalaf Fatimah K. , Dube Prabhatchandra R. , Mohammed Chrysan J. , Lad Apurva , Stepkowski Stanislaw , Hinds Terry D. , Kumarasamy Sivarajan , Kleinhenz Andrew , Tian Jiang , Malhotra Deepak , Kennedy David J. , Cooper Christopher J. , Haller Steven T.
Published: March 2020

Background

Renal artery stenosis is a common cause of renal ischemia, contributing to the development of chronic kidney disease. To investigate the role of local
CD
40 expression in renal artery stenosis, Goldblatt 2‐kidney 1‐clip surgery was performed on hypertensive Dahl salt‐sensitive rats (S rats) and genetically modified S rats in which
CD
40 function is abolished (
Cd40

mutant

).

Methods and Results

Four weeks following the 2‐kidney 1‐clip procedure,
Cd40

mutant

rats demonstrated significantly reduced blood pressure and renal fibrosis in the ischemic kidneys compared with S rat controls. Similarly, disruption of Cd40 resulted in reduced 24‐hour urinary protein excretion in
Cd40

mutant

rats versus S rat controls (46.2±1.9 versus 118.4±5.3 mg/24 h;
P
<0.01), as well as protection from oxidative stress, as indicated by increased paraoxonase activity in
Cd40

mutant

rats versus S rat controls (
P
<0.01). Ischemic kidneys from
Cd40

mutant

rats demonstrated a significant decrease in gene expression of the profibrotic mediator, plasminogen activator inhibitor‐1 (
P
<0.05), and the proinflammatory mediators, C‐C motif chemokine ligand 19 (
P
<0.01), C‐X‐C Motif Chemokine Ligand 9 (
P
<0.01), and interleukin‐6 receptor (
P
<0.001), compared with S rat ischemic kidneys, as assessed by quantitative
PCR
assay. Reciprocal renal transplantation documented that
CD
40 exclusively expressed in the kidney contributes to ischemia‐induced renal fibrosis. Furthermore, human
CD
40‐knockout proximal tubule epithelial cells suggested that suppression of
CD
40 signaling significantly inhibited expression of proinflammatory and ‐fibrotic genes.

Conclusions

Taken together, our data suggest that activation of
CD
40 induces a significant proinflammatory and ‐fibrotic response and represents an attractive therapeutic target for treatment of ischemic renal disease.
Deep Learning–Based Algorithm for Detecting Aortic Stenosis Using Electrocardiography
Authors: Kwon Joon‐Myoung , Lee Soo Youn , Jeon Ki‐Hyun , Lee Yeha , Kim Kyung‐Hee , Park Jinsik , Oh Byung‐Hee , Lee Myong‐Mook
Published: March 2020

Background

Severe, symptomatic aortic stenosis (
AS
) is associated with poor prognoses. However, early detection of
AS
is difficult because of the long asymptomatic period experienced by many patients, during which screening tools are ineffective. The aim of this study was to develop and validate a deep learning–based algorithm, combining a multilayer perceptron and convolutional neural network, for detecting significant
AS
using ECGs.

Methods and Results

This retrospective cohort study included adult patients who had undergone both
ECG
and echocardiography. A deep learning–based algorithm was developed using 39 371
ECG
s. Internal validation of the algorithm was performed with 6453
ECG
s from one hospital, and external validation was performed with 10 865
ECG
s from another hospital. The end point was significant
AS
(beyond moderate). We used demographic information, features, and 500‐Hz, 12‐lead
ECG
raw data as predictive variables. In addition, we identified which region had the most significant effect on the decision‐making of the algorithm using a sensitivity map. During internal and external validation, the areas under the receiver operating characteristic curve of the deep learning–based algorithm using 12‐lead
ECG
for detecting significant
AS
were 0.884 (95% CI, 0.880–0.887) and 0.861 (95% CI, 0.858–0.863), respectively; those using a single‐lead
ECG
signal were 0.845 (95% CI, 0.841–0.848) and 0.821 (95% CI, 0.816–0.825), respectively. The sensitivity map showed the algorithm focused on the T wave of the precordial lead to determine the presence of significant
AS
.

Conclusions

The deep learning–based algorithm demonstrated high accuracy for significant
AS
detection using both 12‐lead and single‐lead
ECG
s.
Risk‐Standardizing Rates of Return of Spontaneous Circulation for In‐Hospital Cardiac Arrest to Facilitate Hospital Comparisons
Authors: Chan Paul S. , Tang Yuanyuan ,   for the American Heart Association's Get With the Guidelines‐Resuscitation Investigators
Published: March 2020

Background

Sustained return of spontaneous circulation (ROSC) is the most proximal and direct assessment of acute resuscitation quality in hospitals. However, validated tools to benchmark hospital rates for ROSC after in‐hospital cardiac arrest currently do not exist.

Methods and Results

Within the national Get With The Guidelines‐Resuscitation registry, we identified 83 206 patients admitted from 335 hospitals from 2014 to 2017 with in‐hospital cardiac arrest. Using hierarchical logistic regression, we derived and validated a model for ROSC, defined as spontaneous and sustained ROSC for ≥20 consecutive minutes, from 24 pre‐arrest variables and calculated rates of risk‐standardized ROSC for in‐hospital cardiac arrest for each hospital. Overall, rates of ROSC were 72.0% and 72.7% for the derivation and validation cohorts, respectively. The model in the derivation cohort had moderate discrimination (C‐statistic 0.643) and excellent calibration (
R
2
of 0.996). Seventeen variables were associated with ROSC, and a parsimonious model retained 10 variables. Before risk‐adjustment, the median hospital ROSC rate was 70.5% (interquartile range: 64.7–76.9%; range: 33.3–89.6%). After adjustment, the distribution of risk‐standardized ROSC rates was narrower: median of 71.9% (interquartile range: 68.2–76.4%; range: 42.2–84.6%). Overall, 56 (16.7%) of 335 hospitals had at least a 10% absolute change in percentile rank after risk standardization: 27 (8.0%) with a ≥10% negative percentile change and 29 (8.7%) with a ≥10% positive percentile change.

Conclusions

We have derived and validated a model to risk‐standardize hospital rates of ROSC for in‐hospital cardiac arrest. Use of this model can support efforts to compare acute resuscitation survival across hospitals to facilitate quality improvement.
Seneca on the Death of M. Livius Drusus (De brevitate vitae 6.1-2)
Authors: Currie Michelle
Published: March 2020

The account of M. Livius Drusus in Seneca’s dialogue De brevitate vitae significantly departs from other versions by suggesting that Drusus’ death may have been a suicide rather than an assassination. The inspiration for Seneca’s reworking of the scene lies with Stoicism’s expectations for choosing and implementing suicide. Drusus’ role in the dialogue is to provide a cautionary illustration of the problems of neglecting true otium and the philosophical pursuits it entails. Seneca portrays Drusus disregarding Stoic conventions for suicide in order to reinforce his broader philosophical failings. The author therefore significantly breaks with historiographical tradition in order to make a more effective philosophical argument.
Cultural Awareness among Malaysian Peacekeepers Based on the Perspective of Civil-Military Interaction Theory
Authors: Husin Wan Norhasniah Wan , Nordin Nani Noor Hidayah
Published: March 2020

Culture awareness plays an important role in complex peacekeeping operations. Wide knowledge and information regarding to local culture help peacekeepers to avoid conflicts and misunderstandings which can lead to negative impact towards the mission’s effectiveness. This article focused on the significance of local culture awareness among Malaysian Peacekeepers which led to their successful missions’ accomplishment in the time given. This study has been conducted by using a semi-structured interview among 20 officers and personnel of Malaysian Armed Forces (maf) that have been deployed previously in several peacekeeping operations. Five cultural dimensions highlighted under the Civil-Military Interaction (cmi) theory were used and the findings shows that Malaysian peacekeepers had a high local cultural understanding that positively contributed to their success.
Thirty-Six Views of X: Variations on a Theme Reveal Individual artistsʼ Approaches to Composition
Authors: Bruno Nicola
Published: March 2020

How do artists position the key element of their composition? Is this choice random, or does it follow rules? I propose that a fruitful domain for studying key element framing is found in suitable serial works having a strong thematic homogeneity. What characterizes such series is that they might be regarded as variations on a theme by the same artist, allowing meaningful assessments of random variations while keeping other factors approximately constant. In this work, I report two studies on series originally inspired by 19th century Japanese prints (Hokusaiʼs Thirty-six views of Mount Fuji) and later revisited, in similar form, both in later Japanese works and at the beginnings of the 20th and then 21st centuries in Europe. I call this database of images Thirty-six views of X. Results do not support framing according to a centring bias or to ‘power’ points or lines defined by known principles of composition, suggesting that key element framing shows an overall bias for moderate asymmetry, that this bias is modulated by individual and cultural differences, and that there may be an additional effect of print aspect ratio.