bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasonic Total Focusing Imaging Method of Multilayer Composite Structures Using the Root‐Mean‐Square (RMS) Velocity
Authors: Guo Xufei , Han Yan
Published: October 2021

Multilayer composite structures have been widely used in industrial manufacturing, and nondestructive testing of these multilayer structures is to ensure their reliable quality and performance. Currently, ultrasonic total focusing method (TFM) imaging using full‐matrix capture (FMC) technology has been proven to sense small defects in a single homogeneous medium and improve the imaging signal‐to‐noise ratio. However, these algorithms cannot be accurately applied to imaging of multilayer composite structures, due to the acoustic impedance variation and because reflection and refraction occur at the interface between the layers, which makes it very difficult to calculate the ultrasonic propagation path and time. To solve this problem, a root‐mean‐square (RMS) velocity algorithm for total focusing imaging of multilayer structures is proposed in the article. Based on the theory of RMS velocity for processing of seismic data, the approximated delays can be easily and quickly calculated by a hyperbolic time‐distance relationship under circumstances of short lateral distance and horizontal layers. The performance of the proposed algorithm is evaluated by total focusing imaging of a two‐layer medium with drilled holes and conducted by the finite element simulation. To further improve imaging efficiency, the partial data in the full‐matrix data were used for imaging which is the simplified matrix focusing method (SFM). The results verify that the proposed methods are capable of total focusing imaging of two‐layered structures. However, the imaging performance and efficiency of these algorithms are different.
Division Method and Seepage Law of Seepage Channels in a Tight Reservoir
Authors: Wu Zhenkai , Fang Feifei , Li Xizhe , Xiao Hanmin , Liu Xuewei , Rao Yuan , Li Yang , Wang Jie , Luo Yongcheng , Li Zhi
Published: October 2021

Tight oil reservoirs are characterized by a low porosity, low permeability, and strong heterogeneity. The macropores, throats, and microcracks in reservoirs are the main seepage channels, which affect the seepage law in the reservoirs. In particular, oil-water two-phase flow in different types of pores requires further study. In this study, two groups of online NMR displacement experiments were designed to study the seepage characteristics of tight oil reservoirs. It was found that the main seepage channels for oil-water two-phase flow are the microcracks, large pores, and throats in the reservoir. The large pores are mainly micron and submicron scale in size. The oil in the small pores is only transferred to the large pores through imbibition to participate in the flow, and there is no two-phase flow. Based on the influence of different pore structures on the seepage law of a tight reservoir, the pores were divided into seepage zones, and a multistage seepage model for tight reservoirs was established. Based on this model, the effects of the imbibition, stress sensitivity, threshold pressure gradient, and Jamin effect on model’s yield were studied. The results show that imbibition is no longer effective after a while. Owing to the stress sensitivity, the threshold pressure gradient, and the Jamin effect, oil production will be reduced. As the parameter value increases, the oil production decreases. The production decreases rapidly in the early stage of mining while decreases slowly in the later stage, exhibiting a trend of high yield in the early stage and stable yield in the later stage.
A Study on Weak Edge Detection of COVID-19’s CT Images Based on Histogram Equalization and Improved Canny Algorithm
Authors: Hou Shou-Ming , Jia Chao-Lan , Hou Ming-Jie , Fernandes Steven L. , Guo Jin-Cheng
Published: October 2021

The coronavirus disease 2019 (COVID-19) is a substantial threat to people’s lives and health due to its high infectivity and rapid spread. Computed tomography (CT) scan is one of the important auxiliary methods for the clinical diagnosis of COVID-19. However, CT image lesion edge is normally affected by pixels with uneven grayscale and isolated noise, which makes weak edge detection of the COVID-19 lesion more complicated. In order to solve this problem, an edge detection method is proposed, which combines the histogram equalization and the improved Canny algorithm. Specifically, the histogram equalization is applied to enhance image contrast. In the improved Canny algorithm, the median filter, instead of the Gaussian filter, is used to remove the isolated noise points. The

K

-means algorithm is applied to separate the image background and edge. And the Canny algorithm is improved continuously by combining the mathematical morphology and the maximum between class variance method (OTSU). On selecting four types of lesion images from COVID-CT date set, MSE, MAE, SNR, and the running time are applied to evaluate the performance of the proposed method. The average values of these evaluation indicators are 1.7322, 7.9010, 57.1241, and 5.4887, respectively. Compared with other three methods, these values indicate that the proposed method achieves better result. The experimental results prove that the proposed algorithm can effectively detect the weak edge of the lesion, which is helpful for the diagnosis of COVID-19.
Unsteady Electrohydrodynamic Stagnation Point Flow of Hybrid Nanofluid Past a Convective Heated Stretch/Shrink Sheet
Authors: Jawad Muhammad , Jan Rashid , Boulaaras Salah , Amin Ibni , Shah Niaz Ali , Idris Sahar Ahmed
Published: October 2021

Unsteady electrohydrodynamic hybrid nanofluid

Al

2

O

3

‐
Cu
/

H

2

O

past a convective heat stretched/shrinked sheet is examined. A stagnation point fluid flow with velocity slip constrains and heat source or sink is deliberated. The combined set of PDEs is translated into ODEs by including approved similarity transformations. HAM is applied for the solution to the obtained nonlinear system. The magnetic input factor, Prandtl number, electric field factor, Eckert number, heat source factor, and unstable factor are the governing parameters. The impact of these factors on the temperature and velocity profiles features of the problem is considered with explanation. Intensification in values of electric and magnetic fields parameters enhanced the heat transfer rate. The greater Prandtl number lessens the temperature. Amplification in temperature is perceived for Eckert parameter. The heat transferred rate of hybrid nanofluid in the entire domain increases as the heat source increases, while the heat sink has the opposite effect. Skin friction and Nusselt number is increased for increasing values of magnetic field parameters. It is also noted that Nusselt number lessens for raising in

Pr
,
E
,
and
 
Ec

. Furthermore, it is eminent that the hybrid nanofluid possesses better result compared to the nanofluid.
Multirobot Task Allocation in e-Commerce Robotic Mobile Fulfillment Systems
Authors: Yuan Ruiping , Li Juntao , Wang Xiaolin , He Liyan
Published: October 2021

Robotic Mobile Fulfillment System (RMFS) is a new type of parts-to-picker order picking system and has become the development trend of e-commerce logistics distribution centers. There are usually a large number of tasks need to be allocated to many robots and the picking time for e-commerce orders is usually very tight, which puts forward higher requirements for the efficiency of multirobot task allocation (MRTA) in e-commerce RMFS. Current researches on MRTA in RMFS seldom consider task correlation and the balance among picking stations. In this paper, a task time cost model considering task correlation is built according to the characteristics of the picking process. Then, a multirobot task allocation model minimizing the overall picking time is established considering both the picking time balance of picking stations and the load balance of robots. Finally, a four-stage balanced heuristic auction algorithm is designed to solve the task allocation model and the tasks with execution sequence for each robot are obtained. By comparing with the traditional task time cost model and the algorithm without considering the balance among picking stations, it is found that the proposed model and algorithm can significantly shorten the overall picking time.
Pelvic Floor Ultrasound under Particle Swarm Intelligent Optimization Algorithm in Preoperative and Postoperative Evaluation of Female Stress Urinary Incontinence
Authors: Zhang Hongbin , Li Hezhou , Zhao Xin , Wu Juan , Liang Xiao , Lu Haiyan
Published: October 2021

This study aimed to explore the application of pelvic floor ultrasound under particle swarm intelligent optimization algorithm in the preoperative and postoperative evaluation of female stress urinary incontinence (SUI) and provide a theoretical basis for clinical diagnosis. In this study, 90 patients with SUI were enrolled, which were randomly and equally assigned into a blank group (healthy physical examination), control group (perineal ultrasound), and experimental group (pelvic floor ultrasound based on particle swarm intelligence optimization algorithm). The ultrasonic image segmentation and processing were carried out by a particle swarm intelligence optimization algorithm. Patients with stress incontinence were classified as group A, and patients without stress incontinence were classified as group B. The results of previous surgical examinations were the standard to judge the accuracy of pelvic floor ultrasound diagnosis based on the swarm intelligence optimization algorithm. The accuracy of diagnosing stress UI in the experimental group was 90.38%, which was significantly higher than that of the control group (54.31%) and the blank group (38.95%) (

P

 < 0.05). The formation percentage of the urethral internal orifice in the experimental group was 82.5%, which was significantly higher than that of the control group (65.4%) and the blank group (12.5%), and there was a statistical difference among the groups (

P

 < 0.05). In the resting state, the vertical spacing y between the neck of the bladder and the edge of the pubis of patients in group B was greater than that in group B, the horizontal spacing x between the neck of the bladder and the edge of the pubis was smaller than in the blank group, and there were statistical differences among the groups (

P

 < 0.05). In the state of Valsalva, the vertical spacing y between the neck of the bladder and the edge of the pubis of patients in group B was smaller than that in group B, the horizontal spacing x between the neck of the bladder and the edge of the pubis was greater than that in group B. The distance of the bladder neck shifting downward was greater than that in group B, and there were statistical differences among the groups (

P

 < 0.05). In short, the pelvic floor ultrasound based on the particle swarm intelligent optimization algorithm was accurate in the diagnosis of stress UI. The application of pelvic floor ultrasound in the diagnosis of UI provided image data objectively for clinical diagnosis and had a high application value.
Fatigue Life Analysis of Aluminum Alloy Notched Specimens under Non‐Gaussian Excitation based on Fatigue Damage Spectrum
Authors: Chen Kuanyu , Yang Guangwu , Zhang Jianjun , Xiao Shoune , Xu Yang
Published: October 2021

In this study, a non‐Gaussian excitation acceleration method is proposed, using aluminum alloy notched specimens as a research object and measured acceleration signal of a certain airborne bracket, during aircraft flight as input excitations, based on the fatigue damage spectrum (FDS) theory. The kurtosis and skewness of the input signal are calculated and the non‐Gaussian characteristics and amplitude distribution are evaluated. Five task segments obey a non‐Gaussian distribution, while one task segment obeys a Gaussian distribution. The fatigue damage spectrum calculation method of non‐Gaussian excitation is derived. The appropriate FDS calculation method is selected for each task segment and the acceleration parameters are set to construct the acceleration power spectral density, which is equivalent to the pseudo‐acceleration damage. A finite‐element model is established, the notch stress concentration factor of the specimen is calculated, the large mass point method is used to simulate the shaking table excitation, and a random vibration analysis is carried out to calculate the accelerated fatigue life. The simulation results show that the relative error between the original cumulative damage and test original fatigue life is 15.7%. The shaking table test results show that the relative error of fatigue life before and after acceleration is less than 16.95%, and the relative error of test and simulation is 24.27%. The failure time of the specimen is accelerated from approximately 12 h to 1 h, the acceleration ratio reaches 12, and the average acceleration ideal factor is 1.125, which verifies the effectiveness of the acceleration method. It provides a reference for the compilation of the load spectrum and vibration endurance acceleration test of other airborne aircraft equipment.
Adenocarcinoma with Mixed Subtypes in the Early and Advanced Gastric Cancer
Authors: Zhao Xixian , Li Yizhang , Yang Zhenwei , Zhang Hailin , Wang Hongling , Lin Jun , Liu Jing , Zhao Qiu
Published: October 2021

Objective. Adenocarcinoma with mixed subtypes (AM) is a histological classification based on the WHO classification. We aimed to compare the prognosis among AM, classic adenocarcinoma (CA), mucinous adenocarcinoma (MAC), and signet-ring cell carcinoma (SRCC) in early and advanced gastric cancer (EGC and AGC), respectively. Methods. The Surveillance, Epidemiology, and End Results (SEER) database was queried from 2001 to 2016. Univariate and multivariate Cox analyses were performed to compare prognosis between AM and histologic subtypes of CA, SRCC, and MAC in ECG and ACG. A nomogram was established to predict the cancer-specific survival (CSS) of gastric cancer (GC) patients with AM. C-index, calibration curves, and receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were applied to examine the accuracy and clinical benefits. Results. In the prognosis among these four histological subtypes in EGC patients, there are no differences. For AGC patients, AM had a significantly poorer prognosis compared with CA and MAC (

P
=
0.003

, 0.029) but similar prognosis to SRCC. A nomogram based on race, T stage, N stage, M stage, and surgical modalities was proposed to predict 1- and 3-year CSS for GC patients with AM (C-index: training cohort: 0.804, validation cohort: 0.748. 1- and 3-year CSS AUC: training cohort: 0.871 and 0.914, validation cohort: 0.810 and 0.798). 1- and 3-year CSS DCA curves showed good net benefits. Conclusions. EGC patients with AM had similar survival to those with CA, MAC, and SRCC. AM was an independent predictor of poor prognosis in AGC. A nomogram for predicting the prognosis of GC patients with AM was proposed to quantitatively assess the long-term survival.
Secure Rate Control and Statistical QoS Provisioning for Cloud-Based IoT Networks
Authors: Muhammad Irfan , Alves Hirley , López Onel Alcaraz , Latva-aho Matti
Published: October 2021

The Internet of Things (IoT) facilitates physical things to detect, interact, and execute activities on-demand, enabling a variety of applications such as smart homes and smart cities. However, it also creates many potential risks related to data security and privacy vulnerabilities on the physical layer of cloud-based Internet of Things (IoT) networks. These can include different types of physical attacks such as interference, eavesdropping, and jamming. As a result, quality-of-service (QoS) provisioning gets difficult for cloud-based IoT. This paper investigates the statistical QoS provisioning of a four-node cloud-based IoT network under security, reliability, and latency constraints by relying on the effective capacity model to offer enhanced QoS for IoT networks. Alice and Bob are legitimate nodes trying to communicate with secrecy in the considered scenario, while an eavesdropper Eve overhears their communication. Meanwhile, a friendly jammer, which emits artificial noise, is used to degrade the wiretap channel. By taking advantage of their multiple antennas, Alice implements transmit antenna selection, while Bob and Eve perform maximum-ratio combining. We further assume that Bob decodes the artificial noise perfectly and thus removes its contribution by implementing perfect successive interference cancellation. A closed-form expression for an alternative formulation of the outage probability, conditioned upon the successful transmission of a message, is obtained by considering adaptive rate allocation in an ON-OFF transmission. The data arriving at Alice’s buffer are modeled by considering four different Markov sources to describe different IoT traffic patterns. Then, the problem of secure throughput maximization is addressed through particle swarm optimization by considering the security, latency, and reliability constraints. Our results evidence the considerable improvements on the delay violation probability by increasing the number of antennas at Bob under strict buffer constraints.
Shear Strength Behavior of Sand Reinforced by Kraft Paper Using the Ring Shear Apparatus
Authors: Xie Wan-li , Guo Qianyi , Chou Nelson N.S. , Zhu Rongsen , Zhang Maosheng
Published: October 2021

To explore the reinforcement effects of different reinforcement methods, kraft paper was used as reinforcement material, and shear tests were carried out in sand to study the reinforcement effects of kraft paper perpendicular and parallel to the shear plane. The test results show that the two reinforcement methods can effectively improve the strength of sand and the orthogonal reinforcement form is more superior. The existence of reinforced materials greatly improves the cohesion of sand, but does not significantly improve the internal friction angle. The width of reinforcement material has little effect on the reinforcement effect and shows different variation laws under different reinforcement forms.
A Multisource Situation Information Fusion Method Based on Dynamic Evidence Combination
Authors: Liu Jing , Chang ChaoWen , Zhang Yuchen , Wang Yongwei
Published: October 2021

To address the problems of fusion efficiency, detection rate (DR), and false detection rate (FDR) that are associated with existing information fusion methods, a multisource information fusion method featuring dynamic evidence combination based on layer clustering and improved evidence theory is proposed in this study. First, the original alerts are hierarchically clustered and conflicting evidence is eliminated. Then, dynamic evidence combination is applied to fuse the condensed alerts, thereby improving the efficiency and accuracy of the fusion. The experimental results show that the proposed method is superior to current fusion methods in terms of fusion efficiency, DR, and FDR.
The Impact of Writing Self-Assessment and Peer Assessment on Iranian EFL Learners’ Autonomy and Metacognitive Awareness
Authors: Ebrahimi Maryam , Izadpanah Siros , Namaziandost Ehsan
Published: October 2021

One of the most significant current discussions in writing is self-assessment and peer assessment. This study aimed to investigate the impact of writing self-assessment and peer assessment on autonomy and metacognitive awareness of Iranian EFL learners. One hundred and twenty participants were selected using convenience sampling. Four instruments were used in this test: (1) Nelson placement test; (2) Metacognitive Awareness Inventory (MAI); (3) Zhang and Li’s autonomy questionnaire; and (4) rubric. A quasiexperimental design was used in this study. They were divided into two experimental groups, self-assessment (N = 40) and peer assessment (N = 40), and one control group (N = 40). Collected data were tested and compared using covariance analysis (ANCOVA). Results from the tests indicated that both self-assessment and peer assessment are effective ways to improve autonomy and metacognition awareness of EFL learners in the completion of writing tasks. Findings also showed that self-assessment was more effective than peer assessment and the results showed that the types of assessments increased the learners’ knowledge in the writing, teaching, lexicography, spelling, grammar, and similar models and were significantly effective in developing their writing skills. The findings of the present research study might have some implications for researchers, instructors, language teachers, and language learners.
Research on the Impact Mechanism and Application of Financial Digitization and Optimization on Small- and Medium-Sized Enterprises
Authors: Li Qiuxia
Published: October 2021

Background. With the continuous advancement of digital technology and the accelerated development of digital finance, the rise of digital finance has had a vital impact on the true evolution of SMEs. The digital economy has a significant positive impact on the productivity of SMEs. Method. This article first analyzes the digital level of SMEs, studies the incentive effect of digital finance on the level of technological revolution of SMEs, and analyzes the mitigation effect of digital finance evolution on the financing constraints of SMEs. At the same time, it also studies how to develop the digital economy and achieve high-quality business evolution. Result. The digital economy can promote the growth of enterprise productivity through four indirect ways: scale economy effect, scope economy effect, technological revolution effect, and management benefit effect. Conclusion. The Financial Technology Optimization program helps financial leaders adopt new digital technologies to optimize financial processes while minimizing disruption.
The Influence of Industrial Policy on Innovation in Startup Enterprises: An Empirical Study Based on China′s GEM Listed Companies
Authors: Wang Fang , Zhu Deyong
Published: October 2021

This study uses China’s Growth Enterprises Market (GEM) listed companies from 2011 to 2017 as samples to examine the impact of industrial policies on innovation in startups from three dimensions, namely, selective industrial policies, government subsidies, and financial support. The results show that selective industrial policies have no effect on the innovation output of startups. Financial support can significantly promote the innovation output of entrepreneurial enterprises; structural differences exist in the impact of government subsidies on the innovation of entrepreneurial enterprises. The influence of industrial policy on the innovation of entrepreneurial enterprises depends on the research and development intensity of enterprises, the level of regional economic development, the leadership structure of enterprises, and other factors. This study’s findings have significant practical significance for the implementation of a national innovation‐driven development strategy and to guide industrial policies that better promote enterprise innovation.
Tislelizumab for Relapsed/Refractory Classical Hodgkin Lymphoma: 3-Year Follow-up and Correlative Biomarker Analysis
Authors: Song Yuqin , Gao Quanli , Zhang Huilai , Fan Lei , Zhou Jianfeng , Zou Dehui , Li Wei , Yang Haiyan , Liu Ting , Wang Quanshun , Lv Fangfang , Guo Haiyi , Zhao Xia , Wang Dan , Zhang Pei , Wang Yidi , Wang Lei , Liu Tengfei , Zhang Yun , Shen Zhirong , Huang Jane , Zhu Jun
Published: October 2021

Purpose:

Tislelizumab is an anti–programmed cell death protein 1 (anti–PD-1) monoclonal antibody specifically designed to minimize binding to Fcγ receptors (FcγR).

Patients and Methods:

Here, we present the extended 3-year follow-up of a phase II study of tislelizumab in 70 patients with relapsed/refractory classical Hodgkin lymphoma (cHL) who failed or were ineligible for autologous stem cell transplantation.

Results:

With a median follow-up of 33.8 months, the overall response rate by the independent review committee was 87.1%, and the complete response (CR) rate was 67.1%. Responses were durable as shown by a median duration of response of 31.3 months, and median progression-free survival (PFS) of 31.5 months. The 3-year PFS and overall survival rates were 40.8% and 84.8%, respectively. Treatment-related adverse events (TRAEs) of any grade occurred in 97.1% of patients; the grade ≥3 TRAE rate was low (31.4%), and only 8.6% of patients experienced adverse events leading to treatment discontinuation. Correlative biomarker analysis showed that FcγRΙ-expressing macrophages had no observed impact on either the CR rate or PFS achieved with tislelizumab, which may be potentially related to its engineered Fc region.

Conclusions:

With extended follow-up, tislelizumab yielded long-term benefits and demonstrated a favorable safety profile for patients with relapsed/refractory cHL. This trial was registered at clinicaltrials.gov as NCT03209973.
Liquid Biopsy in Metastatic Breast Cancer: Current Role of Circulating Tumor Cells and Circulating Tumor DNA
Authors: Banys-Paluchowski Maggie , Fehm Tanja N. , Grimm-Glang Donata , Rody Achim , Krawczyk Natalia
Published: October 2021

Background: In metastatic breast cancer (MBC), blood-based diagnostics have become a major focus of oncological research in the last 2 decades. Detection of circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) has the potential to improve prognosis assessment and complement standard therapy monitoring tools. Summary: To date, several large analyses have confirmed high CTC counts as an independent prognostic factor. Persistently high CTC numbers during systemic treatment are associated with early progression, but it remains to be clarified which therapeutic options should be offered to such patients since the SWOG 0500 trial failed to show benefit from early switch to another chemotherapy regimen in patients with CTC persistence. In comparison, evidence on the prognostic value of ctDNA is still limited. Most importantly, liquid biopsy-guided treatment interventions have been investigated in several trials. In patients with hormone receptor-positive and HER2-negative MBC, CTC-driven therapy choices resulted in similar PFS to physician’s choice treatment. Recently, the DETECT III trial has shown that patients with HER2-negative MBC and HER2-positive CTCs may benefit from targeted anti-HER2 treatment with lapatinib. ctDNA-driven therapy selection has already been approved in clinical routine: alpelisib is the first targeted treatment indicated on the basis of a ctDNA test. Key Messages: CTCs and ctDNA predict clinical outcome and have a potential to improve therapy choices in MBC.
Phytoseiidae (Acari: Mesostigmata) from the Atlantic Forest in Rio de Janeiro, Brazil, with complementary description of Amblyseius impeltatus Denmark & Muma
Authors: Cavalcante Ana Cristina Cerqueira , Demite Peterson Rodrigo , Lofego Antônio Carlos , Hernandes Fabio Akashi
Published: October 2021

Phytoseiid mites (Acari: Phytoseiidae) have been largely used for the biological control of arthropod pests. However, information on the phytoseiid fauna associated with plants of the Rio de Janeiro State, Brazil is still scanty. Surveys were carried out in two areas of Atlantic Forest in Rio de Janeiro State – Jaguanum island and Paraty. We report 11 species of seven genera from all three subfamilies. A complementary re-description is provided for Amblyseius impeltatus Denmark & Muma, 1973 and measurements are provided for ten other species.
Untersuchungen zur Gattung und Metrik der Dionysos-Dithyrambe „Letzter Wille“ von Fr. Nietzsche
Authors: Serpa Danilo
Published: October 2021

In diesem Aufsatz wird Nietzsches Dionysos-Dithyrambe „Letzter Wille“ im Hinblick auf Charakteristiken der Gattung „Hymne“, welcher der Dithyrambus als Untergattung zugerechnet werden kann, analysiert. Zwei Aspekte werden besonders berücksichtigt: Sprachgebärden und Freie Rhythmen. Sprachgebärden der Hymnen konnten hier nicht ermittelt werden. Die metrische Struktur des Gedichts wird im Kontext des lyrischen Werkes Nietzsches besonders nach Begriffen von Moennighoff und Schulz (2007) sowie Bunia (2014) untersucht und auf andere, der Gattung „Hymne“ zugeschriebene Elemente bezogen. Dabei werden kompositorische Prozesse von „Letzter Wille“, wie die Spiegelung von seinen Teilen, herausgehoben, und seine Beziehung zu anderen Gedichten des Autors kurz betrachtet. Zum Schluss widmet sich die Analyse dem Motiv des Dionysischen bei Nietzsche.
Sex-Specific Clinical Outcomes of the PACT-HF Randomized Trial
Authors: Van Spall Harriette G.C. , DeFilippis Ersilia M. , Lee Shun Fu , Oz Urun Erbas , Perez Richard , Healey Jeff S. , Allen Larry A. , Voors Adriaan A. , Ko Dennis T. , Thabane Lehana , Connolly Stuart J.
Published: October 2021

Background:

Transitional care may have different effects in males and females hospitalized for heart failure. We assessed the sex-specific effects of a transitional care model on clinical outcomes following hospitalization for heart failure.

Methods:

In this stepped-wedge cluster randomized trial of adults hospitalized for heart failure in Ontario, Canada, 10 hospitals were randomized to a group of transitional care services or usual care. Outcomes in this exploratory analysis were composite all-cause readmission, emergency department visit, or death at 6 months; and composite all-cause readmission or emergency department visit at 6 months. Models were adjusted for stepped-wedge design and patient age.

Results:

Among 2494 adults, mean (SD) age was 77.7 (12.1) years, and 1258 (50.4%) were female. The first composite outcome occurred in 371 (66.3%) versus 433 (64.1%) males (hazard ratio [HR], 1.04 [95% CI, 0.86–1.26];
P
=0.67) and in 326 (59.9%) versus 463 (64.8%) females (HR, 0.83 [95% CI, 0.69–1.01];
P
=0.06) in the intervention and usual care groups, respectively (
P
=0.012 for sex interaction). The second composite outcome occurred in 357 (63.8%) versus 417 (61.7%) males (HR, 1.03 [95% CI, 0.85–1.24];
P
=0.76) and 314 (57.7%) versus 450 (63.0%) females (HR, 0.81 [95% CI, 0.67–0.99];
P
=0.037) in the intervention and usual care groups, respectively (
P
=0.024 for sex interaction). The sex differences were driven by a reduction in all-cause emergency department visits among females (HR, 0.66 [95% CI, 0.51–0.87];
P
=0.003), but not males (HR, 1.10 [95% CI, 0.85–1.43];
P
=0.46), receiving the intervention (
P
<0.001 for sex interaction).

Conclusions:

A transitional care model offered a reduction in all-cause emergency department visits among females but not males following hospitalization for heart failure.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02112227.
Successful Reduction of Postoperative Chest Tube Duration and Length of Stay After Congenital Heart Surgery: A Multicenter Collaborative Improvement Project
Authors: Bates Katherine E. , Connelly Chloe , Khadr Lara , Graupe Margaret , Hlavacek Anthony M. , Morell Evonne , Pasquali Sara K. , Russell Jennifer L. , Schachtner Susan K. , Strohacker Courtney , Tanel Ronn E. , Ware Adam L. , Wooton Sharyl , Madsen Nicolas L. , Kipps Alaina K.
Published: October 2021

Background

Congenital heart disease practices and outcomes vary significantly across centers, including postoperative chest tube (CT) management, which may impact postoperative length of stay (LOS). We used collaborative learning methods to determine whether centers could adapt and safely implement best practices for CT management, resulting in reduced postoperative CT duration and LOS.

Methods and Results

Nine pediatric heart centers partnered together through 2 learning networks. Patients undergoing 1 of 9 benchmark congenital heart operations were included. Baseline data were collected from June 2017 to June 2018, and intervention‐phase data were collected from July 2018 to December 2019. Collaborative learning methods included review of best practices from a model center, regular data feedback, and quality improvement coaching. Center teams adapted CT removal practices (eg, timing, volume criteria) from the model center to their local resources, practices, and setting. Postoperative CT duration in hours and LOS in days were analyzed using statistical process control methodology. Overall, 2309 patients were included. Patient characteristics did not differ between the study and intervention phases. Statistical process control analysis showed an aggregate 15.6% decrease in geometric mean CT duration (72.6 hours at baseline to 61.3 hours during intervention) and a 9.8% reduction in geometric mean LOS (9.2 days at baseline to 8.3 days during intervention). Adverse events did not increase when comparing the baseline and intervention phases: CT replacement (1.8% versus 2.0%,
P
=0.56) and readmission for pleural effusion (0.4% versus 0.5%,
P
=0.29).

Conclusions

We successfully lowered postoperative CT duration and observed an associated reduction in LOS across 9 centers using collaborative learning methodology.
Blood‐Based Epigenetic Markers of
FKBP5
Gene Methylation in Patients With Dilated Cardiomyopathy
Authors: Wada Kento , Misaka Tomofumi , Yokokawa Tetsuro , Kimishima Yusuke , Kaneshiro Takashi , Oikawa Masayoshi , Yoshihisa Akiomi , Takeishi Yasuchika
Published: October 2021

Background

Blood‐based DNA methylation patterns are linked to types of diseases. FKBP prolyl isomerase 5 (FKBP5), a protein cochaperone, is known to be associated with the inflammatory response, but the regulatory mechanisms by leukocyte
FKBP5
DNA methylation in patients with dilated cardiomyopathy (DCM) remain unclear.

Methods and Results

The present study enrolled patients with DCM (n=31) and age‐matched and sex‐matched control participants (n=43). We assessed
FKBP5
CpG (cytosine‐phosphate‐guanine) methylation of CpG islands at the 5′ side as well as putative promoter regions by methylation‐specific quantitative polymerase chain reaction using leukocyte DNA isolated from the peripheral blood.
FKBP5
CpG methylation levels at the CpG island of the gene body and the promoter regions were significantly decreased in patients with DCM. Leukocyte
FKBP5
and
IL‐1β
(interleukin 1β) mRNA expression levels were significantly higher in patients with DCM than in controls. The protein expressions of DNMT1 (DNA methyltransferase 1) and DNMT3A (DNA methyltransferase 3A) in leukocytes were significantly reduced in patients with DCM. In vitro methylation assay revealed that
FKBP5
promoter activity was inhibited at the methylated conditions in response to immune stimulation, suggesting that the decreased
FKBP5
CpG methylation was functionally associated with elevation of
FKBP5
mRNA expressions. Histological analysis using a mouse model with pressure overload showed that FKBP5‐expressing cells were substantially infiltrated in the myocardial interstitium in the failing hearts, indicating a possible role of FKBP5 expressions of immune cells in the cardiac remodeling.

Conclusions

Our findings demonstrate a link between specific CpG hypomethylation of leukocyte
FKBP5
and DCM. Blood‐based epigenetic modification in
FKBP5
may be a novel molecular mechanism that contributes to the pathogenesis of DCM.
Differences in Left Atrial Size and Function and Supraventricular Ectopy Between Black and White Participants in the ARIC Study
Authors: Wang Wendy , Norby Faye L. , Zhang Michael J. , Reyes Jorge L. , Shah Amil M. , Soliman Elsayed Z. , Lutsey Pamela L. , Alonso Alvaro , Solomon Scott D. , Inciardi Riccardo M. , Chen Lin Y.
Published: October 2021

Background

Black Americans have more atrial fibrillation risk factors but lower atrial fibrillation risk than White Americans. Left atrial (LA) enlargement and/or dysfunction, frequent atrial tachycardia (AT), and premature atrial contractions (PAC) are associated with increased atrial fibrillation risk. Racial differences in these factors may exist that could explain the difference in atrial fibrillation risk.

Methods and Results

We included 2133 ARIC (Atherosclerosis Risk in Communities) study participants (aged 74±4.5 years[mean±SD], 59% women, 27% Black participants) who had echocardiograms in 2011 to 2013 and wore the Zio XT Patch (a 2‐week continuous heart monitor) in 2016 to 2017. Linear regression was used to analyze (1) differences in AT/day or PAC/hour between Black and White participants, (2) differences in LA measures between Black and White participants, and (3) racial differences in the association of LA measures with AT or PAC frequency. Compared with White participants, Black participants had a higher prevalence of cardiovascular risk factors and disease, lower AT frequency, greater LA size, and lower LA function. After multivariable adjustments, Black participants had 37% (95% CI, 24%–47%) fewer AT runs/day than White participants. No difference in PAC between races was noted. Greater LA size and reduced LA function are associated with more AT and PAC runs; however, no race interaction was present.

Conclusions

Differences in LA measures are unlikely to explain the difference in atrial fibrillation risk between Black and White individuals. Despite more cardiovascular risk factors and greater atrial remodeling, Black participants have lower AT frequency than White participants. Future research is needed to elucidate the protective mechanisms that confer resilience to atrial arrhythmias in Black individuals.
Role of Renal Sympathetic Nerves in GLP‐1 (Glucagon‐Like Peptide‐1) Receptor Agonist Exendin‐4‐Mediated Diuresis and Natriuresis in Diet‐Induced Obese Rats
Authors: Liu Xuefei , Patel Kaushik P. , Zheng Hong
Published: October 2021

Background

The gut‐derived hormone GLP‐1 (glucagon‐like peptide‐1) exerts beneficial effects against established risk factors for chronic kidney disease. GLP‐1 influences renal function by stimulating diuresis and natriuresis and thus lowering arterial blood pressure. The role of the sympathetic nervous system has been implicated as an important link between obesity with elevated arterial pressure and chronic kidney disease. The primary aim of this study was to determine the contribution of renal sympathetic nerves on intrapelvic GLP‐1‐mediated diuresis and natriuresis in high‐fat diet (HFD)‐induced obese rats.

Methods and Results

Obesity was induced in rats by HFD for 12 weeks, followed by either surgical bilateral renal denervation or chronic subcutaneous endopeptidase neprilysin inhibition by sacubitril for a week. Diuretic and natriuretic responses to intrapelvic administration of the GLP‐1R (GLP‐1 receptor) agonist exendin‐4 were monitored in anesthetized control and HFD rats. Renal GLP‐1R expression and neprilysin expression and activity were measured. The effects of norepinephrine on the expression of GLP‐1R and neprilysin in kidney epithelial LLC‐PK1 cells were also examined. We found that diuretic and natriuretic responses to exendin‐4 were significantly reduced in the HFD obese rats compared with the control rats (cumulative urine flow at 40 minutes, 387±32 versus 650±65 µL/gkw; cumulative sodium excretion at 40 minutes, 42±5 versus 75±10 µEq/gkw,
P
<0.05). These responses in the HFD rats were restored after ablation of renal nerves (cumulative urine flow at 40 minutes, 625±62 versus 387±32 µL/gkw; cumulative sodium excretion at 40 minutes, 70±9 versus 42±5 µEq/gkw,
P
<0.05). Renal denervation induced significant reductions in arterial pressure and heart rate responses to intrapelvic GLP‐1 in the HFD rats. Renal denervation also significantly increased the GLP‐1R expression and reduced neprilysin expression and activity in renal tissues from the HFD rats. Chronic subcutaneous neprilysin inhibition by sacubitril increased GLP‐1–induced diuretic and natriuretic effects in the HFD rats. Finally, exposure of the renal epithelial cells to norepinephrine in vitro led to downregulation of GLP‐1R expression but upregulation of neprilysin expression and activity.

Conclusions

These results suggest that renal sympathetic nerve activation contributes to the blunted diuretic and natriuretic effects of GLP‐1 in HFD obese rats. This study provides significant novel insight into the potential renal nerve–neprilysin–GLP‐1 pathway involved in renal dysfunction during obesity that leads to hypertension.
Impact of Transcatheter Aortic Valve Replacement on Hospitalization Rates: Insights From Nationwide Readmission Database
Authors: Elkaryoni Ahmed , Chhatriwalla Adnan K. , Kennedy Kevin F. , Saxon John T. , Lopez John J. , Cohen David J. , Arnold Suzanne V.
Published: October 2021

Background

Hospitalization rates after transcatheter aortic valve replacement (TAVR) remain high, given the age and comorbidities of patients undergoing TAVR. To better understand the impact of TAVR on hospitalization, we sought to compare hospitalization rates before and after TAVR and to examine if underlying patient comorbidities are associated with a differential effect of TAVR on hospitalizations.

Methods and Results

We used the Nationwide Readmissions Database to identify patients who underwent TAVR. As Nationwide Readmissions Database data do not cross over calendar years, we limited our index admission to hospitalizations during April to September of each calendar year to allow 90 days of observation before and after TAVRs. We calculated the daily risk of all‐cause hospitalization and used a mixed‐effects logistic regression model to explore interactions between patient characteristics, TAVR, and hospitalization risk. Among 39 249 patients who underwent TAVR in 2014 to 2017 (median age, 82 years [interquartile range, 76–87 years]; 45.7% women), 32.0% had at least one hospitalization in the 90 days before TAVR compared with 23.2% in the 90 days post‐TAVR (relative reduction, 27.5%;
P
<0.001). In the mixed‐effects logistic regression model, TAVR was associated with decreased all‐cause hospitalization rate after TAVR in all comorbidity subgroups. However, younger patients and those with heart failure and reduced ejection fraction appeared to have more robust reduction in hospitalizations.

Conclusions

Although patients who are treated with TAVR have high rates of rehospitalization, TAVR is associated with an overall reduction in all‐cause hospitalizations regardless of underlying patient comorbidities.
The Corporeality of the Self
Authors: Lilly Ingrid E.
Published: October 2021

A contribution to Western genealogies of the self, the corporeality of the Hebrew soul (nefeš) is explored through the lens of ancient medical discourses. Using the example of bitterness as an ethnomedical syndrome, this essay shows how the Hebrew idiom “bitter nefeš” acts as an embodied channel of flux in illness narratives about bodily suffering and healing.
Biblical Narrative as Ethics?
Authors: Lambert David
Published: October 2021

This paper considers whether biblical narrative was used as part of a technology of the self in Jewish antiquity. Many have seen the assumption that Israel’s ancestors were perfect and, hence, worthy of imitation as essential to the Bible’s identity as Scripture around the turn of the Common Era. Recently several scholars have detailed the specific dynamics of exemplarity among certain readers of the Bible, such as Philo, particularly in light of Hellenistic and Roman models. Such work draws attention to the relative lack of explicit attestation for such a practice in much of ancient Jewish literature. As a next step, we need to further delineate what constitutes a literary practice of exemplarity and explore alternatives or additions to it, such as memorialization. To do so, this paper examines a range of texts, including the Genesis Apocryphon, the Book of Jubilees, Ben Sira, Philo, Josephus, and the rabbinic collection, Genesis Rabbah.
Opportunism in Foreign Affairs in First Century BCE China: Chen Tang, His Fellows, and Their Patrons
Authors: Tse Wicky W.K.
Published: October 2021

By examining the career of a contingent of action-prone mid-level military officers and diplomats, this article aims to explore how opportunism functioned in foreign affairs during the last decades of the Former Han dynasty (202 BCE–9 CE). To safeguard and advance the empire’s interests, especially in Central Asia, these characters would carry out their missions with expediency, usually by the means of assassination and surprise attacks, and sometimes without formal authorization. Yet their successful operations always earned, if retrospectively, the endorsement of the imperial court, which in turn encouraged further ventures. The investigation of the front-line opportunists and their patrons presents a lively picture of the politics and political culture of the time.
Solomon’s Throne in Its Ancient Near Eastern Context
Authors: Eichler Raanan
Published: October 2021

The throne of Solomon, described in 1 Kgs 10:18–20 and almost identically in 2 Chr 9:17–19, is the main object relating to the visual representation of royalty in the Hebrew Bible. This paper offers a close commentary on the description and considers what type of ancient Near Eastern throne the described object exemplifies, concluding that Solomon’s throne is a “biblicized” variant of the Canaanite-Phoenician sphinx throne.
Meadow voles differentiate between scents of different sources
Authors: Garris Sarah S. , Pierson Lyndsey M. , Ferkin Michael H.
Published: October 2021

Scent marks are an important means of transmitting information between rodents, and they can be produced from several body sources. Previous studies have shown that scents from multiple sources can convey the same information; female meadow voles, for example, have three scent sources that communicate sex. However, possessing three separate sources that convey the same information is likely costly due to the metabolic energy required to produce these signals and the increased chance that eavesdropping individuals may intercept information present in these signals. In this study, we investigated if these scent sources could communicate other information, in addition to scent donor sex, by determining if male meadow voles could distinguish scent marks taken from different sources of a single female scent donor. This was accomplished with a habituation-test method, that allowed us to compare how male meadow voles differently investigate scent from a familiar and novel source of a female scent donor. Male meadow voles could distinguish between faeces and urine scent marks of a female, but could only distinguish mouth from urine and faeces scent marks when first familiarized with mouth scent marks. Our findings suggest that mouth, urine, and faeces scent marks of female meadow voles produce both redundant and distinct information. The overlap in information between scent marks produced from separate sources may be needed to provide social context, which allows receiving individuals to accurately weigh the tradeoffs associated with responding to an olfactory cue. While this overlap in information remains costly, this cost may be minimized by the different fade-out times of scent marks from distinct body sources, which may limit the amount of time information in a scent mark is available to a time period where this information is socially relevant.
An anecdotal observation of anti-predatory tool use in a New Zealand parrot
Authors: Burns K.C.
Published: October 2021

I observed a wild kākā (Nestor meridionalis) excavate a piece of deadwood from the branch it was perched on and carry it to a new position immediately above a perched predatory falcon (Falco novaeseelandiae). It then raised its head upwards, and in a single downward motion with its head, released the piece of wood towards the falcon below. The piece of wood struck the falcon in the back, which immediately took flight and disappeared from view. I conclude my description of this anecdotal observation of anti-predatory tool use with caveats and alternative interpretations.