bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of team‐based learning about postpartum haemorrhage on learning outcomes and experience of midwifery students in Indonesia: A pilot study
Authors: Ulfa Yunefit , Igarashi Yukari , Takahata Kaori , Horiuchi Shigeko
Published: September 2020

Aim

This pilot study aimed to evaluate the effects of team‐based learning about postpartum haemorrhage on the learning outcomes and experience of midwifery students in Indonesia.

Design

One‐group pre‐test–post‐test study.

Methods

This study enrolled 64 midwifery students as participants from an Indonesian health polytechnic school. This group attended two team‐based learning class sessions (90 min weekly for 2 weeks) on postpartum haemorrhage. Student learning outcomes and experience were assessed quantitatively.

Results

The mean knowledge score (0–100) was significantly higher at post‐test (mean = 85.9,SD9.8) than at pre‐test (mean = 61.4,SD12.9) (p < .001). There was a significant difference in the mean clinical reasoning score (12–60) between post‐test (mean = 35.4,SD5.8) and pre‐test (mean = 21.3,SD7.9) (p < .001). Most students (98.4%) engaged in classroom activities.
Socioeconomic and health care coverage disparities in children, adolescents, and young adults with sarcoma
Authors: Westermann Carly , Weller Jennine , Pedroso Felipe , Canner Joe , Pratilas Christine A. , Rhee Daniel S.
Published: September 2020

Background

Socioeconomic and health care coverage disparities are established as poor prognostic markers in adults with sarcoma, but few studies examine these differences among pediatric, adolescents and young adults (AYA). This study examines the association between socioeconomic status (SES), insurance status, and disease presentation among children and AYA patients with sarcoma.

Methods

This is a retrospective cohort study of patients aged 0‐25 years with bone or soft tissue sarcoma from the National Cancer Database. SES assignments were based on estimated median income and education level. Patient demographics and clinical factors were compared by SES and insurance status. Multivariate logistic regression models were fitted to determine adjusted odds ratios of SES and insurance status on metastatic disease or tumor size ≥5 cm at time of presentation.

Results

In a cohort of 9112 patients, 2932 (32.1%) had low, 2084 (22.8%) middle, and 4096 (44.9%) high SES. For insurance status, 5864 (64.3%) had private, 2737 (30.0%) public, and 511 (5.6%) were uninsured. Compared to high SES, patients with low SES were more likely to have metastatic disease (OR = 1.16, P = .03) and tumors ≥5 cm (OR = 1.29, P < .01). Compared to private insurance, public and no insurance were associated with metastatic disease (OR = 1.35, P < .01 and OR = 1.32, P = .02) and increased tumors ≥5 cm (OR = 1.28, P < .01 and OR = 1.67, P < .01).

Conclusions

SES disparities exist among children and AYA patients with sarcoma. Low SES and public or no insurance are associated with advanced disease at presentation. Further studies are needed to identify interventions to improve earlier detection of sarcomas in at‐risk children and young adults.
Interdigitated back‐contact double‐heterojunction GaInP/GaAs solar cells
Authors: Myllynen Antti , Sadi Toufik , Oksanen Jani
Published: September 2020

Interdigitated back‐contact (IBC) silicon solar cells are coming of age, but the potential of IBC configurations for compound semiconductor solar cells is yet to be explored. We outline an approach to generalize the diffusion‐driven charge transport (DDCT) method, previously studied for IBC light‐emitting diodes, to develop DDCT solar cells, enabling an IBC double‐heterojunction structure. In particular, we simulate and compare the electrical performance of a GaInP/GaAs DDCT solar cell with an ideal one‐dimensional reference cell to establish how the lateral dimensions of the DDCT structures affect their operation. Also, the suitability of the DDCT solar cells for concentration photovoltaics is explored. The results show that the DDCT solar cells with a finger pitch of approximately 10μm can match and even outperform the ideal reference structure under the AM1.5G solar spectrum, due to reduced Shockley‐Read‐Hall recombination. At high solar concentrations, the performance of the smallest pitch DDCT structure is essentially identical with the reference structure up to 100 suns. This suggests that combining the benefits offered by the IBC design with compound semiconductors could allow the development of an entire family of more efficient solar cells.
Self‐assembling peptides: From a discovery in a yeast protein to diverse uses and beyond
Authors: Zhang Shuguang
Published: September 2020

Well‐defined nanofiber scaffold hydrogels made of self‐assembling peptides have found their way into various 3D tissue culture and clinical products. I reflect initial puzzlement of the unexpected discovery, gradual understanding of how these peptides undergo self‐assembly, to eventually translating designer biological scaffolds into commercial products. Peptides are ubiquitous in nature and useful in many fields. They are found as hormones, pheromones, antibacterial, and antifungal agents in innate immunity systems, toxins, as well anti‐inset pesticides. However, the concept of peptides as materials was not recognized until 1990 when a self‐assembling peptide as a repeating segment in a yeast protein was serendipitously discovered. The peptide materials have bona fide materials properties and are made from simple amino acids with well‐ordered nanostructures under physiological conditions. Some current applications include: (a) Real 3D tissue cell cultures of diverse tissue cells and various stem cells; (b) reparative and regenerative medicine as well as tissue engineering; (c) 3D tissue printing; (d) sustained releases of small molecules, growth factors and monoclonal antibodies; and (e) accelerated wound healing of skin and diabetic ulcers as well as instant hemostasis in surgery. Self‐assembling peptide nanobiotechnology will likely continue to expand in many directions in the coming years. I will also briefly introduce my current research using a simple QTY code for membrane protein design. I am greatly honored and humbled to be invited to contribute an Award Winner Recollection of the 2020 Emil Thomas Kaiser Award from the Protein Society.
Homoepitaxial ZnO/ZnMgO Laser Structures and Their Properties
Authors: Teisseyre Henryk , Jarosz Dawid , Marona Lucja , Bojarska Agata , Ivanov Vitalii , Perlin Piotr , Czyszanowski Tomasz
Published: September 2020

Herein, the optically induced operation of ZnO‐based laser structures is reported, fabricated with plasma‐assisted molecular beam epitaxy (PA‐MBE) on native ZnO substrate. ZnMgO is used both to confine the optical mode within ZnO waveguide and to form quantum barriers of ZnO quantum wells. The resonator of these devices is defined by reactive ion etching (RIE) with a chlorine/argon plasma. The lowest laser threshold is measured to be approximately 0.4 MW cm−2 at room temperature when excited via the third harmonic of a YAG:Nd (355 nm). It is observed that the mode spacing depends on both the resonator length and the excitation power density, which is explained by introducing plasmonic corrections to the waveguide refractive index.
A High‐Performance Memristor Device and Its Filter Circuit Application
Authors: Gao Chao , Wang Hong , Zhu Zhiping , Zhang Lei , Yang Yongqiang , Cao Gang , Yan Xiaobing
Published: September 2020

With the onset of the era of big data, memristors have been extensively studied for applications in nonvolatile neuromorphic computing due to their fast switching speed and low switching power ability and the complementary metal–oxide–semiconductor (CMOS) compatibility. In particular, their adjustable cutoff frequency for filtering applications is a significant advantage. However, for circuit applications, memristors are still in their early simulated stage. Herein, Ag/HfO2/graphene oxide quantum dot (GOQD)/Pt structure memristor devices are fabricated, where GOQDs are used as a stability boost, with biosynapse simulation achieved and numerical recognition performed at an accuracy of 90.91%. A circuit‐based filter is designed based on the memristor and STM32 microcontroller chip controlling, in which low‐pass, high‐pass, and band‐pass filter circuits are all realized. By changing the output signal of the control circuit of the resistance value of the memristor, the cutoff frequency of the filter is successfully adjusted. This work, therefore, paves a new way to obtain filter circuit applications of memristors for electronic systems; the overall performance of the GOQD‐inserted memristor is further optimized and its function in filtering realized, creating opportunities for further application of the memristor in information processing.
Tunable Synthesis of Mesoporous Prussian Blue@Calcium Phosphate Nanoparticles for Synergic Chemo‐Photothermal Cancer Therapy
Authors: Yu Baohui , Wang Chungang
Published: September 2020

A facile and mild strategy to prepare the mesoporous prussian blue@calcium phosphate core‐shell nanoparticles (M‐PB@CaP core‐shell NPs) composed with a MCaP shell and a MPB core is reported. The obtained NPs exhibited strong absorption in the near infrared (NIR) region and possessed an excellent photothermal efficiency of 26 % resulting from the PB core. The mesoporous structure of PB, CaP and the appearance of PAA in the M‐PB@CaP core‐shell NPs are greatly favorable for the ultrahigh doxorubicin (DOX) loading capability (1 mg DOX/mg NPs) of the NPs. When the DOX‐loaded M‐PB@CaP core‐shell NPs were exposed to NIR irradiation, a burst‐like drug release occurs on account of the heat produced by the M‐PB@CaP core‐shell NPs. These results indicate that the obtained NPs could employ as pH/NIR dual‐responsive drug delivery systems for synergistic chemo‐photothermal therapy of cancer cells.
Europium(III) Coordination in a Combined Ligand System: A Luminescence Spectroscopy Study
Authors: Rout Alok , Vinodkumar Patchapureddy , Shankar Panigrahi Bhavani
Published: September 2020

The coordination of europium(III) in a combined ligand system has been probed by luminescence spectroscopy by extracting it from nitric acid medium. The ligands used in the study are N,N,N′,N′‐tetra‐bis(2‐ethylhexyl)diglycolamide (T2EHDGA) and bis(2‐ethylhexyl)phosphoric acid (D2EHPA). Europium(III) complex with these ligands present in n‐Dodecane (n‐DD) medium and its detailed investigation by luminescence spectroscopy is emphasized in this paper. Various experimental parameters such as aqueous phase acidity, concentration of ligand and initial metal ion, radiation dose, etc. were tuned to find the luminescence behavior of Eu(III) in the extracted phase. The emission intensity of Eu(III) was extremely high in the organic phase after extraction at all nitric acid phases (0.5 M to 3 M HNO3) for T2EHDGA/n‐DD and from 0.01 M to 1 M for D2EHPA/n‐DD) as compared to that of the aqueous phase. The principal driving force for the complexation mechanism of Eu(III) at each nitric acid was ascertained by varying the concentration of D2EHPA in the solution of 0.1 M T2EHDGA/n‐DD. The decay profile of the Eu(III) complex was remarkably high (>1.2 millisecond (ms)) indicating theformation of inner‐sphere complex of Eu(III) with the ligands. The emission profile of Eu(III) was recorded in the irradiated solvent compositions and was compared with respect to unirradiated condition.
Six Natural Phenylethanoid Glycosides: Total Synthesis, Antioxidant and Tyrosinase Inhibitory Activities
Authors: Shu Penghua , Zhang Lingxiang , Liu Anqi , Li Junping , Liu Qing , Sun Na , Zhang Yanling , Wei Xialan , Cui Mengyao , Ju Zhiyu , Xu Zhihong
Published: September 2020

Total synthesis of six natural phenylethanoid glycosides (PhEGs) has been accomplished. Key steps in the divergent synthesis strategy involved glycosylation based on trichloroacetimidate donors, and one‐pot removal of benzyl and 4,6‐O‐benzylidene acetal groups by hydrogenation over Pd/C. Among them, four natural PhEGs, scroside D (2), rebouoside B (3), ginkgoside C (4), and ginkgoside D (5) were synthesized for the first time. In the subsequent antioxidant and tyrosinase inhibitory activities evaluation, all compounds showed strong DPPH radical scavenging activities, and compounds 1–2, 5–6 exhibited obvious inhibitory activities against mushroom tyrosinase.
Synthesis of Chiral α‐Trifluoromethyl α,α‐Disubstituted α‐Amino Acids and Conformational Analysis of L‐Leu‐Based Peptides with (R)‐ or (S)‐α‐Trifluoromethylalanine
Authors: Ueda Atsushi , Ikeda Misuzu , Kasae Takuya , Doi Mitsunobu , Demizu Yosuke , Oba Makoto , Tanaka Masakazu
Published: September 2020

Various racemic α‐trifluoromethyl α,α‐disubstituted α‐amino acids were synthesized by the reaction of methyl 3,3,3‐trifluoropyruvate imines with Grignard reagents. The optical resolution of racemates using (R)‐1,1’‐bi‐2‐naphthol {(R)‐BINOL} esters gave optically active α‐trifluoromethylated α,α‐disubstituted α‐amino acids, such as α‐trifluoromethylalanine (αCF3Ala), α‐trifluoromethylleucine (αCF3Leu), and α‐trifluoromethylphenylalanine (αCF3Phe). The optically active (R)‐ or (S)‐αCF3Ala was incorporated into the L–Leu‐based pentapeptides, and their preferred conformation in solution and in the crystal state was studied by Fourier transform infrared (FT‐IR) absorption, nuclear Overhauser effect spectroscopy (NOESY) NMR, and circular dichroism (CD) spectra, as well as X‐ray crystallographic analysis. Both L–Leu‐based peptides with (R)‐ or (S)‐αCF3Ala formed right‐handed 310‐helical structures. Both peptide‐backbones at the N‐terminal residues 1–3 were very similar, but the φ and ψ torsion angles of residues 4 and 5 between peptides with (R)‐ or (S)‐ αCF3Ala were different.
In Situ Oxygen Doping of Monolayer MoS2 for Novel Electronics
Authors: Tang Jian , Wei Zheng , Wang Qinqin , Wang Yu , Han Bo , Li Xiaomei , Huang Biying , Liao Mengzhou , Liu Jieying , Li Na , Zhao Yanchong , Shen Cheng , Guo Yutuo , Bai Xuedong , Gao Peng , Yang Wei , Chen Lan , Wu Kehui , Yang Rong , Shi Dongxia , Zhang Guangyu
Published: September 2020

In 2D semiconductors, doping offers an effective approach to modulate their optical and electronic properties. Here, an in situ doping of oxygen atoms in monolayer molybdenum disulfide (MoS2) is reported during the chemical vapor deposition process. Oxygen concentrations up to 20–25% can be reliable achieved in these doped monolayers, MoS2‐xOx. These oxygen dopants are in a form of substitution of sulfur atoms in the MoS2 lattice and can reduce the bandgap of intrinsic MoS2 without introducing in‐gap states as confirmed by photoluminescence spectroscopy and scanning tunneling spectroscopy. Field effect transistors made of monolayer MoS2‐xOx show enhanced electrical performances, such as high field‐effect mobility (≈100 cm2 V−1 s−1) and inverter gain, ultrahigh devices’ on/off ratio (>109) and small subthreshold swing value (≈80 mV dec−1). This in situ oxygen doping technique holds great promise on developing advanced electronics based on 2D semiconductors.
Solid‐State Low‐Temperature Thermoresponsive and Reversible Color Changes of Conjugated Polymer in Layered Structure: Beyond Infrared Thermography
Authors: Watanabe Kei , Imai Hiroaki , Oaki Yuya
Published: September 2020

Emergence of thermoresponsive and reversible color changes at low temperature is a challenging target. In general, it is not easy to induce sufficient dynamic motion of rigid molecules including chromophore at a lower temperature. The present work shows unusually low‐temperature color‐change properties originating from the dynamic motion of rigid conjugated polymer in solid state. The layered composites of polydiacetylene (PDA) and guest l‐arginine (L‐Arg) (PDA‐(L‐Arg)) exhibit temperature‐responsive gradual color changes with reversibility in the range of 123–333 K in solid crystalline state. The dynamic properties are induced by gradual and reversible distortion of the π‐conjugated main chain in response to temperature. The tuned flexibility of the layered structure facilitates motion of the rigid π‐conjugated molecule at low temperature. The PDA‐(L‐Arg)‐coated substrates are applied to visualization and quantification of 2D and 3D temperature distributions generated by cooling with liquid nitrogen. These thermographic devices afford to image lower temperature range than typical infrared thermography. The present work indicates potentials of layered architectures with tunable flexibility for emergence of dynamic properties.
Vacancy‐Induced Antibacterial Activity of XS2–y Quantum Dots against Drug‐Resistant Bacteria for Treatment of Bacterial Keratitis
Authors: Li Huiyuan , Wang Xiao , Zhao Xiaofei , Li Guanhua , Pei Fengyan , Zhang Han , Tan Yang , Chen Feng
Published: September 2020

Due to the widespread antibiotic‐resistant microbes and the slow development in antibiotics, innovative new antibacterial agents are eagerly desired to control infection in the resistance era. Here, it is demonstrated that the antibacterial ability against drug‐resistant bacteria can be endowed to transition metal dichalcogenides (XS2, X = Mo/W) quantum dots by sulfur vacancies, and their application in bacterial keratitis. The sulfur vacancies are generated by the ion irradiation with the controlled influences, which ensures the one‐way electron transport from the external environment to XS2 leading to a strong reactive oxygen speciesindependent oxidative stress. With the concentration of 140 µg mL−1 of XS2–0.1 quantum dots, the sterilization efficiency of Gram‐positive Staphylococcus aureus and methicillin‐resistant Staphylococcus aureus more than 99.9% within 20 min at room temperature in the dark is realized. For biomedical application against bacterial keratitis, it is observed that the occurrence of severe clinical manifestation like ocular perforation can be prevented. This work demonstrates the vacancy as a novel, simple, and effective strategy to tune XS2 as the antibacterial agent with a fast response and no reliance on light that has significant potential therapeutic effects on clinical drug resistant bacterial keratitis.
Atrocity Stories and Access to Elite Universities: Chickens at the Station
Authors: Hillyard Sam , Tummons Jonathan , Winnard Madeleine
Published: September 2020

The article explores the interactional management of class relations using atrocity stories as a conceptual device vis‐à‐vis new case study data. We argue that interactionist ideas are well placed to comment on the hidden injuries of class in the higher education sector and demonstrate this using atrocity stories and Goffman's work. We use the atrocity stories of atypical cases (non‐traditional graduates of an elite university) to expose class differences. Atrocity stories and Goffman's work on cooling, impression management, and total institutions were used here to unlock extended interviews with graduates from the 1960s–1980s who attended one elite British university. The findings expose the manifestation of the English class structure and a variety of responses. The conclusion finds evidence of resistance rather than challenge. A call is made for more longitudinal ethnographic research exploring how universities might promote access agendas—with particular attention to those both upwardly and downwardly mobile.
Development of a questionnaire on teachers' knowledge of language as an epistemic tool
Authors: Fulmer Gavin W. , Hwang Jihyun , Ding Chenchen , Hand Brian , Suh Jee K. , Hansen William
Published: September 2020

We report on the development of a new instrument for measuring teachers' knowledge of language as an epistemic tool in science classes. Language is essential for science learning, as all learning requires the use of language to constitute one's own ideas and to engage with others' ideas. Teachers with knowledge of language as an epistemic tool can recognize the ways that language allows students to generate and validate knowledge for themselves, rather than to replicate canonical knowledge transmitted by other sources. We used a construct‐driven development approach with iterations of domain analysis, item revision, teacher feedback, expert review, and item piloting to address the content, substance, and structure aspects of validity. Data from 158 preservice and in‐service teachers on 27 preliminary items were collected. Findings from Rasch measurement modeling indicate a single dimension fits the items well and can distinguish teachers of higher and lower knowledge. We revised and selected 15 items for an updated instrument. This contributes to ongoing measurement projects and provides a potential instrument for future, broader use by the field to gauge teachers' knowledge of language as an epistemic tool.
Valorization of waste polyethylene by blending with ethylene‐vinylacetate and incorporating a new type of compatibilizer
Authors: Simon‐Stőger Lilla , Varga Csilla
Published: September 2020

Nowadays polyethylene is one of the polymers produced in the greatest volume and the amount of generated waste high‐density polyethylene (w‐HDPE) is significant as well. Valorization and recycling of w‐HDPE can be realized by blending with different types of polymers and/or elastomers for example, ethylene‐vinyl acetate (EVA). For the purpose of boosting of interfacial interactions between these two polymers experimental olefin‐maleic‐anhydride based additives have been incorporated into the blends after optimization of the processing temperature. Impact and tensile tests have been carried out in our research work besides microscopy measurements and investigation of the effects of additive structure by FT‐IR and rheology. At higher processing temperature (220°C) both tensile properties and Charpy impact strength were increased, latter one improved by 245% measured at 5°C while elongation at break enhanced by 182% with incorporation of some experimental additives compared to the neat 70/30 w‐HDPE/EVA. Changes in the hydrocarbon molecular chains of experimentally compatibilized blends were observed based on FT‐IR results and rheological measurements. It can be concluded that one of the most basic notions of sustainability, the 4R's (reduce, recycle, reuse, recover) has been satisfied in a successful way.
The 2010 Catastrophic Forest Fires in Russia: Consequence of Rural Depopulation?
Authors: Nefedova Tatiana
Published: September 2020

Catastrophic forest fires hit the European part of Russian Federation during summer 2010 as result of a two-month-long period with temperatures above the average by 10 °C coupled with an unusually long drought period. Even though forest fires are usual for Russia, these are typically located in the sparsely populated Asian part of the country. As a consequence of the 2010 summer fires in the densely populated European part of Russia, the mass media poured forth reports of burning forests, villages, victims, about lost crops by fires. The situation was further dramatized by the fact that the extreme smoke from these fires reached Moscow. Seventeen million people lived in the regions where the state of emergency has been declared, and another 10 million in Moscow suffered from smoke. Over one-third of the population of the Russian Federation lived in those regions where the fires were very intense in summer 2010. Still, the main question remained after the disaster which I attempt to answer in this chapter; was the heat the only cause?
The Net Generation’s Stories: A Typology
Authors: Schachtner Christina
Published: September 2020

In this chapter, the empirical data are presented as a typology of narratives in which experiences and activities in virtual space and the real world are interwoven, along with ideas and wishes for the future, what has happened in the past, and what is happening in the present. They run like a subterranean web through the narrators’ lives, initiating patterns of thinking and doing which revolve around a specific focus. The following types of narrations were identified: stories about interconnectedness, self-staging, supplying and selling, managing boundaries, and transformation, as well as setting out and breaking away.
Narrating as an Answer to Sociocultural Challenges
Authors: Schachtner Christina
Published: September 2020

The narrative typologies presented previously are juxtaposed with the principal characteristics of sociocultural transformation in this chapter. The findings reveal how these affect the network actors’ storytelling, but without dominating the narrative. Social developments come up against headstrong subjects who make use of their ability to select, differentiate, and reflect.
Narrative Production of Culture
Authors: Schachtner Christina
Published: September 2020

In the abstract to chapter 2, the reference was added for authors mentioned explicitly in the text. To round off the work, the network actors’ narratives are discussed against the background of an increase in cross-border encounters as expedited by transnational digital technologies, for example. The “translational turn” is taken as a starting point for inferring the future challenges to a form of narrative which should be in a position to create narrative spaces. Cultural theorist Homi K. Bhabha designates such narrative locations as the “Third Space” (The location of culture. London: Routledge (1994)).
Target-Setting Emissions Trading Program in Saitama Prefecture: Impact on CO2 Emissions in the First Compliance Period
Authors: Hamamoto Mitsutsugu
Published: September 2020

This chapter investigates whether the Target-Setting Emissions Trading (TSET) Program launched in 2011 by Saitama Prefecture in Japan had an impact on CO2 emissions during the first compliance period. Facility-level data are used to estimate the causal relationship between implementation of the program and changes in CO2 emissions. The results indicate that the TSET Program spurred emission reduction efforts. In addition, this chapter shows that the TSET Program also functioned as an incentive for facilities that are not covered by the program to lower their energy consumption. These findings indicate that the TSET Program succeeded in encouraging emission reduction efforts by the facilities, even though the program includes no penalty for facilities that do not meet emission goals.
Geometrical framework for picture changing operators in the pure spinor formalism
Authors: Mikhailov Andrei , Zavaleta Dennis
Published: September 2020

Abstract

It is well known in NSR string theory, that vertex operators can be constructed in various “pictures”. Recently this was discussed in the context of pure spinor formalism. NSR picture changing operators have an elegant super-geometrical interpretation. In this paper we provide a generalization of this super-geometrical construction, which is also applicable to the pure spinor formalism.
Emergency Carotid Endarterectomy Instead of Carotid Artery Stenting Reduces Delayed Hemorrhage in Thrombectomy Stroke Patients
Authors: Singh Raveena , Dekeyzer Sven , Reich Arno , Kotelis Drosos , Gombert Alexander , Wiesmann Martin , Nikoubashman Omid
Published: September 2020

Purpose

Data in the literature suggest that thrombectomy with emergency carotid artery stenting (CAS) in acute stroke is associated with an increased hemorrhage rate. As we perform thrombectomy with the patient under general anesthesia, we avoid emergency CAS and perform emergency carotid endarterectomy (CEA) as an alternative to CAS in the same anesthesia session in our angiography suite whenever needed and possible.

Methods

We compared 27 thrombectomy patients with emergency CEA and 62 thrombectomy patients with emergency CAS and glycoprotein (Gp) IIb/IIIa inhibitors and/or dual antiplatelet therapy (DAPT) in the same time span.

Results

The symptomatic hemorrhage rate was 0% (0/27) in the CEA group and 8% (5/62) in the CAS group (p = 0.317). The parenchymal hemorrhage rate (PH2) was 7% (2/27) in the CEA group and 16% (10/62) in the CAS group (p = 0.333). Both cases of PH2 in the CEA group occurred during the intervention and were diagnosed on immediate postinterventional imaging, whereas in the CAS group only 2/10 cases of PH2 occurred during the intervention and the remaining 8 PH2 occurred within 3 days after the intervention (p = 0.048). Clinical outcome at 90 days was comparable with 39% of CEA and 51% of CAS patients achieving good clinical outcome (modified Rankin scale, mRS 0–2, p = 0.452).

Conclusion

The use of CEA is a feasible alternative to CAS in acute stroke and has the advantage that DAPT/GpIIb/IIIa inhibitors are not needed. All PH2 in CEA patients occurred during the intervention, implying that hemorrhage in this group is likely to be caused by reperfusion injury, whereas delayed hemorrhage is likely to be caused by DAPT/GpIIb/IIIa inhibitors.
Somatische Erkrankungen Wohnungsloser in Deutschland. Ein narratives Literaturreview der Jahre 2009–2019
Authors: Schindel Daniel , Kleyer Christine , Schenk Liane
Published: September 2020

Hintergrund

In Deutschland leben Schätzungen zufolge zwischen 337.000 und 650.000 wohnungslose Menschen in gesundheitlich zumeist prekärer Lage. Studien zu ihrer Gesundheit sind selten und methodisch heterogen. Bisherige Übersichtsarbeiten fokussierten auf psychische Erkrankungen.

Fragestellung

Ziel der Arbeit ist es, einen Überblick über die aktuelle Forschung zu somatischen Erkrankungen von Wohnungslosen in Deutschland zu geben.

Methoden

Auf Grundlage einer systematischen Literaturrecherche für die Jahre 2009–2019 werden methodisches Vorgehen, Stichprobenzugang und Rekrutierung sowie die berichteten Gesundheitsaspekte betrachtet.

Ergebnisse

Es wurden 8 Journalbeiträge mit Peer-Review identifiziert. Häufig wurde der Begriff „Wohnungslosigkeit“ nicht operationalisiert. Im Durchschnitt waren die Wohnungslosen 40,9–67 Jahre alt, der Frauenanteil lag bei 0–35,3 %. Der Stichprobenzugang erfolgte in Unterkünften und im Rahmen medizinischer Angebote. Eine Rekrutierungsstrategie war ein modifiziertes Schneeballsystem („respondent driven sampling“) in Verbindung mit Anreizen (Incentives). Häufig wurden Herz-Kreislauf-Erkrankungen (17–37,2 %), Erkrankungen des Muskel-Skelett-Systems (≥20 %) sowie der Atemwege (7–24 %) berichtet. Abhängig vom Ort der Rekrutierung traten vermehrt Infektionskrankheiten auf (Tuberkulose, Hepatitis B und C).

Diskussion

Studien zur somatischen Gesundheit Wohnungsloser sind häufig selektiv. Überrepräsentiert erscheinen Personen, die älter sind, unteren Bildungsgruppen angehören oder in deutschen Großstädten lebende Männer. Der Begriff „Wohnungslosigkeit“ wird nicht einheitlich verwendet. Im Vergleich mit repräsentativen Bevölkerungsdaten für Deutschland werden erhöhte Erkrankungsrisiken beobachtet. Kohortencharakteristika können diese nur bedingt erklären. Biografische und intersektionale Ansätze werden benötigt, um die multiplen und kumulativen Belastungslagen zu erfassen.
Getting into the engine room: a blueprint to investigate the shadowy steps of AI ethics
Authors: Rochel Johan , Evéquoz Florian
Published: September 2020

Enacting an AI system typically requires three iterative phases where AI engineers are in command: selection and preparation of the data, selection and configuration of algorithmic tools, and fine-tuning of the different parameters on the basis of intermediate results. Our main hypothesis is that these phases involve practices with ethical questions. This paper maps these ethical questions and proposes a way to address them in light of a neo-republican understanding of freedom, defined as absence of domination. We thereby identify different types of responsibility held by AI engineers and link them to concrete suggestions on how to improve professional practices. This paper contributes to the literature on AI and ethics by focusing on the work necessary to configure AI systems, thereby offering an input to better practices and an input for societal debates.
Effects of blocking mGluR5 on primate dorsolateral prefrontal cortical neuronal firing and working memory performance
Authors: Yang Sheng-Tao , Wang Min , Galvin Veronica , Yang Yang , Arnsten Amy F. T.
Published: September 2020

Rationale

Metabotropic glutamate type 5 receptor (mGluR5) antagonists are under development for treating cognitive disorders such as Fragile X syndrome and Alzheimer’s disease, largely based on success in mouse models, where post-synaptic mGluR5 stimulation weakens synaptic functions in hippocampus. However, human trials of mGluR5 antagonists have yet to be successful. This may be due in part to the differing effects of mGluR5 in hippocampus vs. prefrontal cortex, as mGluR5 are primarily post-synaptic in rodent hippocampus, but are both pre- and post-synaptic in the dorsolateral prefrontal cortical (dlPFC) circuits known to subserve working memory.

Objectives and methods

The current study examined the effects of the selective mGluR5 negative allosteric modulator, MTEP (3-((2-Methyl-1,3-thiazol-4-yl)ethynyl)pyridine hydrochloride), on neuronal firing and working memory performance in aging rhesus monkeys with naturally occurring impairments in neuronal firing and cognitive performance.

Results

We found that iontophoresis of MTEP directly onto dlPFC “Delay cells” had an inverted U dose-response, where low doses tended to enhance task-related firing, but higher doses suppressed neuronal firing. Similar effects were seen on cognitive performance following systemic MTEP administration (0.0001–0.1 mg/kg), with MTEP producing erratic dose-response curves. In the subset of monkeys (50%) that showed replicable improvement with MTEP, co-administration with the mGluR5 PAM, CDPPB (3-Cyano-N-(1,3-diphenyl-1H-pyrazol-5-yl)benzamide), blocked MTEP beneficial effects, consistent with mGluR5 actions.

Conclusions

The mixed effects of MTEP on cognitive performance may arise from opposing actions at pre- vs. post-synaptic mGluR5 in dlPFC. These data from monkeys suggest that future clinical trials should include low doses, and identification of potential subgroup responders.
Short and long-arm fiberglass cast immobilization for displaced distal forearm fractures in children: a randomized controlled trial
Authors: Seiler Michelle , Heinz Peter , Callegari Alessia , Dreher Thomas , Staubli Georg , Aufdenblatten Christoph
Published: September 2020

Purpose

The aim of this study was to investigate whether short-arm fiberglass cast (SAC) immobilization provides fracture stabilization comparable to that of long-arm cast (LAC) treatment of displaced distal forearm fractures after closed reduction in paediatric patients.

Methods

A prospective, randomized, controlled trial of children aged four to 16 years (mean 9.9 years) was designed with a sample of 120 children, whose size was set a priori, with 60 treated with SAC and 60 with LAC. The primary outcome was fracture stability and rate of loss of reduction. The secondary outcome analysis evaluated duration of analgesic therapy, restriction in activities of daily life, and the duration until patients regained normal range of motion in the elbow.

Results

No statistically significant differences were found between the two groups in loss of reduction or duration of analgesic therapy. In contrast, the duration until normal range of motion in the elbow was regained was significantly longer in the LAC group (median 4.5 days, P < 0.001). Restriction in activities of daily life did not differ significantly between the two groups except for the item “help needed with showering in the first days after trauma” (SAC 60%, LAC 87%, P = 0.001).

Conclusion

Fracture immobilization with short-arm fiberglass cast in reduced distal forearm fractures is not inferior to long-arm casts in children four years and older, excluding completely displaced fractures. Furthermore, short-arm casting reduces the need for assistance during showering.

Trial registration

NCT03297047, September 29, 2017
The additional role of virtual to traditional dissection in teaching anatomy: a randomised controlled trial
Authors: Boscolo-Berto Rafael , Tortorella Cinzia , Porzionato Andrea , Stecco Carla , Picardi Edgardo Enrico Edoardo , Macchi Veronica , De Caro Raffaele
Published: September 2020

Introduction

Anatomy has traditionally been taught via dissection and didactic lectures. The rising prevalence of informatics plays an increasingly important role in medical education. It is hypothesized that virtual dissection can express added value to the traditional one.

Methods

Second-year medical students were randomised to study anatomical structures by virtual dissection (intervention) or textbooks (controls), according to the CONSORT guidelines. Subsequently, they applied to the corresponding gross dissection, with a final test on their anatomical knowledge. Univariate analysis and multivariable binary logistic regression were performed.

Results

The rate of completed tests was 76.7%. Better overall test performance was detected for the group that applied to the virtual dissection (OR 3.75 with 95% CI 0.91–15.49; p = 0.06). A comparable performance between groups in basic anatomical knowledge (p 0.45 to 0.92) but not muscles and 2D-3D reporting of anatomical structures was found, for which the virtual dissection was of tendential benefit (p 0.08 to 0.13). Medical students who applied to the virtual dissection were over three times more likely to report a positive outcome at the post-dissection test than those who applied to textbooks of topographical anatomy. This would be of benefit with particular reference to the understanding of 2D–3D spatial relationships between anatomical structures.

Conclusion

The combination of virtual to traditional gross dissection resulted in a significant improvement of second-year medical students’ learning outcomes. It could be of help in maximizing the impact of practical dissection, overcoming the contraction of economic resources, and the shortage of available bodies.
Variability in the global energy budget and transports 1985–2017
Authors: Liu Chunlei , Allan Richard P. , Mayer Michael , Hyder Patrick , Desbruyères Damien , Cheng Lijing , Xu Jianjun , Xu Feng , Zhang Yu
Published: September 2020

The study of energy flows in the Earth system is essential for understanding current climate change. To understand how energy is accumulating and being distributed within the climate system, an updated reconstruction of energy fluxes at the top of atmosphere, surface and within the atmosphere derived from observations is presented. New satellite and ocean data are combined with an improved methodology to quantify recent variability in meridional and ocean to land heat transports since 1985. A global top of atmosphere net imbalance is found to increase from 0.10 ± 0.61 W m−2 over 1985–1999 to 0.62 ± 0.1 W m−2 over 2000–2016, and the uncertainty of ± 0.61 W m−2 is related to the Argo ocean heat content changes (± 0.1 W m−2) and an additional uncertainty applying prior to 2000 relating to homogeneity adjustments. The net top of atmosphere radiative flux imbalance is dominated by the southern hemisphere (0.36 ± 0.04 PW, about 1.41 ± 0.16 W m−2) with an even larger surface net flux into the southern hemisphere ocean (0.79 ± 0.16 PW, about 3.1 ± 0.6 W m−2) over 2006–2013. In the northern hemisphere the surface net flux is of opposite sign and directed from the ocean toward the atmosphere (0.44 ± 0.16 PW, about 1.7 ± 0.6 W m−2). The sea ice melting and freezing are accounted for in the estimation of surface heat flux into the ocean. The northward oceanic heat transports are inferred from the derived surface fluxes and estimates of ocean heat accumulation. The derived cross-equatorial oceanic heat transport of 0.50 PW is higher than most previous studies, and the derived mean meridional transport of 1.23 PW at 26° N is very close to 1.22 PW from RAPID observation. The surface flux contribution dominates the magnitude of the oceanic transport, but the integrated ocean heat storage controls the interannual variability. Poleward heat transport by the atmosphere at 30° N is found to increase after 2000 (0.17 PW decade−1). The multiannual mean (2006–2013) transport of energy by the atmosphere from ocean to land is estimated as 2.65 PW, and is closely related to the ENSO variability.
Characterizing dynamics of serum creatinine and creatinine clearance in extremely low birth weight neonates during the first 6 weeks of life
Authors: van Donge Tamara , Allegaert Karel , Gotta Verena , Smits Anne , Levtchenko Elena , Mekahli Djalila , van den Anker John , Pfister Marc
Published: September 2020

Background

Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging.

Methods

We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling. Key covariates such as gestational age (GA), mode of delivery (MOD), and treatment with ibuprofen or inotropic agents were investigated.

Results

A total of 2814 Scr concentrations were analyzed. GA was associated with Scr at birth (higher with advancing GA), and GA and MOD showed an association with postnatal maturation of CLcr (faster clearance increase with advancing GA and after C-section). Small CLcr decrease (≤ 5%) was quantified during ibuprofen treatment. For a GA of 27 weeks, mean Scr (estimated CLcr) at birth was 0.61 mg/dl (0.23 ml/min), increasing to 0.87 mg/dl (0.27 ml/min) at day three, and decreasing to 0.36 mg/dl (0.67 ml/min) at day 42 after birth.

Conclusions

We report the first mathematical model able to characterize Scr and CLcr in ELBW neonates during the first 6 weeks of life in a quantitative manner as a function of GA, MOD, and ibuprofen treatment. This model allows the derivation of GA-adjusted reference ranges for ELBW neonates and provides a rationale for normative Scr concentrations, and as such will help clinicians to further optimize monitoring and treatment decisions in this vulnerable patient population.
Evaluation eines frühen interdisziplinären multimodalen Assessments für Patienten mit Schmerzen
Authors: Kaiser Ulrike , Petzke Frank , Nagel Bernd , Marschall Ursula , Casser Hans-Raimund , Isenberg Thomas , Kohlmann Thomas , Lindena Gabriele ,   PAIN2020, Augustin Katharina , Althoff Carolin , Heissenberger Josef , Hölscher Andreas , Szczotkowski Daniel , Schulz Katja , Metz-Oster Beatrice , Rensland Jana , Milch Lena , Pfingsten Michael , Schouten Leonie , Deppe Karin , Gärtner Anne , Hoffmann Greta , Preissler Anke , Pritzke-Michael Julia
Published: September 2020

Die Versorgung von Patienten mit Schmerzen und Chronifizierungsrisiko ist nach wie vor gekennzeichnet durch Über‑, Fehl- und Unterversorgung. Das Projekt PAIN2020 (Innovationsfonds 01NVF17049) hat zum Ziel, durch die Einführung eines frühzeitigen, auf Schmerz spezialisierten interdisziplinären diagnostischen Ansatzes die ambulante Versorgung von Patienten im Hinblick auf Schmerzen und das Funktionsniveau zu verbessern. Im Rahmen einer randomisierten kontrollierten Studie werden bundesweit in 31 Einrichtungen der Regelversorgung (schmerzspezialisiertes Angebot) Patienten mit Risikofaktoren bei bestehenden Schmerzen einer frühen Schmerzdiagnostik zugeführt. Die Interventionsbedingung besteht dabei in einem interdisziplinären multimodalen Assessment mit den beteiligten Disziplinen Schmerzmedizin, Physiotherapie und Psychologie. Die Kontrollbedingung umfasst einen einmaligen Termin bei einem Schmerztherapeuten der Qualitätssicherungsvereinbarung Schmerzmedizin bzw. mit Zusatzbezeichnung spezielle Schmerztherapie. Patienten und Vorbehandler erhalten entsprechend der Befunde detaillierte Empfehlungen für eine weitere bedarfsgerechte Behandlung. Es sind 2 Evaluationsansätze geplant. Für den ersten beträgt die zu erreichende Nettofallzahl 3840 Patienten, deren klinische Daten (Deutscher Schmerzfragebogen, zusätzliche Skalen) längsschnittlich erhoben (Einschluss, 3 und 6 Monate nach Diagnostik) und auf Grundlage eines Mehr-Ebenen-Modells ausgewertet werden. Im Rahmen eines 2. Ansatzes werden diese klinischen Daten einerseits um Sekundärdaten der BARMER ergänzt sowie die Patienten des ersten Evaluationsansatzes mit BARMER-Versicherten gematcht, die an dem Projekt nicht teilgenommen haben. Die Auswertung übernimmt ein externes Evaluationsinstitut. Das Projekt startete im April 2018.
Musical practice and BDNF plasma levels as a potential marker of synaptic plasticity: an instrument of rehabilitative processes
Authors: Minutillo Alessandro , Panza Gabriele , Mauri Massimo Carlo
Published: September 2020

Background and objectives

The aim of the study was to investigate the influence of musical practice on brain plasticity. BDNF (brain-derived neurotrophic factor) is a neurotrophin involved in neuroplasticity and synaptic function.

Materials and methods

We recruited 48 healthy subjects of equal age and sex (21 musicians and 27 non-musicians). All subjects were administered the AQ (Autism-Spectrum Questionnaire) and plasma levels (PLs) of BDNF, oxytocin (OT), and vasopressin (VP) were measured in the blood sample of every participant.

Results.

The difference between BDNF PLs in the two groups was found to be statistically significant (t = − 2.214, p = 0.03). Furthermore, oxytocin (OT) PLs and musical practice were found to be independent positive predictors of BDNF PLs (p < 0.04). We also found a negative correlation between BDNF PLs and AD (attention to detail) sub-scale score of AQ throughout the whole sample. Assuming BDNF PLs to be a marker of synaptic plasticity, higher PLs could be associated with the activation of alternative neural pathways: a lower score in the “attention to detail” sub-scale could imply greater flexibility of higher cerebral functions among musicians.

Further researches should be conducted to assess the rehabilitative usefulness of these findings among patients affected by psychiatric disorders.
Recent outbreaks of severe hepatitis A virus infections in Vienna
Authors: Bauer David , Farthofer Anna , Chromy David , Simbrunner Benedikt , Steininger Lisa , Schmidbauer Caroline , Binter Teresa , Trauner Michael , Mandorfer Mattias , Schmidt Ralf , Mayer Florian , Holzmann Heidemarie , Strassl Robert , Reiberger Thomas
Published: September 2020

To explore the epidemiology and clinical course of hepatitis A virus (HAV) infections at the Vienna General Hospital. We retrospectively identified patients who were tested positive for HAV-IgM at the Vienna General Hospital form Q1/2008 to Q3/2018. Our definition of severe HAV infection was AST and/or ALT > 5 × above the upper limit of normal (ULN); and liver dysfunction as (i) hepatic encephalopathy or ammonia > 100 μmol/L, (ii) coagulopathy with INR > 1.5, or (iii) jaundice with bilirubin > 5 mg/dL. A total of 578 HAV-IgM (+) were identified, including 31 (5.4%) and 38 (6.6%) without and with liver dysfunction, respectively. A proportional increase in severe HAV cases with and without liver dysfunction occurred in 2016/2017 with (21.5% (vs. 8.0% in the years before; p < 0.001). Thirty-seven (53.6%) patients with severe HAV were hospitalized, 6 (9%) required ICU support, and one patient received liver transplantation within 30 days. Patients with severe HAV and liver dysfunction were more often male (60.5 vs. 43.1%, p = 0.055) and younger (31.5 vs. 63 years, p < 0.001) as compared with other HAV-IgM (+) cases. The observed increase of severe HAV infections in Vienna in 2017 among young males, coincided with a multinational HAV outbreak among MSM. Our data suggests a higher likelihood of severe courses of hepatitis A in MSM. Vaccination against HAV should be recommended for risk groups.