bluuebunny/crossref_metadata_2025 huggingface dataset:
Meso‐Experimental Study on Tensile Characteristics of Clay
Authors: Zhou Yi , Cui Meng , Zhou Dequan , Wang Xiaojia , Fu Xiao
Published: March 2021

This paper presents an experimental study on the meso‐structure change of clay using an innovative testing system. It aims to evaluate the tensile characteristics of clay. The testing system designed in this paper includes a tensile loading device, an image acquisition device, and an image processing program, which can collect and process the meso‐structural images of the soil sample and predict the location of tensile fracture zone with a small preloading. The tests were conducted with three different observation zones, including the tensile fracture zone (Zone 1), the adjacent area of tensile fracture zone (Zone 2), and the areas away from the tensile fracture zone (Zone 3). The results show that the development of cracks is continuous but not linear until tensile failure in Zone 1, and the cracks emerge but stop developing in Zone 2 with the penetration of the cracks in Zone 1, while there is only an overall deviation without any cracks in Zone 3. The variety of mesostructural quantitative parameters in Zone 1 can be divided into three stages: stable stage, rapid change stage, and failure stage. The changes of parameters in Zone 2 show a similar law with those in Zone 1, but the variation is smaller due to the cessation of cracks. The parameters in Zone 3 essentially remain unchanged throughout the whole procedure. According to the test results, the whole stretching process of clay can be divided into the sprouting, the development, and the penetration of cracks.
Localized and Locally Advanced Prostate Cancer: Treatment Options
Authors: Achard Vérane , Panje Cédric Michael , Engeler Daniel , Zilli Thomas , Putora Paul Martin
Published: March 2021

Background: There are many treatment options for localized and locally advanced prostate cancer with radiotherapy and surgery representing the main local therapeutic strategies. Summary: Depending on the risk of disease recurrence, we can stratify patients into low-, intermediate- and high-risk groups, which will guide patients’ treatment. For low-risk patients, active surveillance is an option. Brachytherapy is also an option for low- and intermediate-risk patients and can be used as a boost following external beam radiotherapy for high-risk patients. For intermediate- and high-risk patients, radical prostatectomy and radiotherapy should be considered. Moreover, in addition to radiotherapy, concomitant androgen deprivation therapy may be needed. Finally, after radical prostatectomy and depending on pathological, biological and clinical factors, radiotherapy ± androgen deprivation therapy can be proposed as an adjuvant or salvage treatment. Key Messages: With radiotherapy and surgery being well-established treatment options for localized prostate cancer patients with equally good overall survival rates, priority must be given to patients’ choice concerning the logistics and the toxicity profile of each option.
Prognostic Impact of Resection Margin Length in Patients Undergoing Resection for Mid-Common Bile Duct Cancer: A Single-Center Experience
Authors: Park Yo-Han , Seo Sang Hyuk , An Min Sung , Baik HyungJoo , Lee Chan Ho
Published: March 2021

Introduction: The purpose of this study was to analyze survival outcomes after segmental bile duct resection (BDR) for mid-common bile duct cancer according to the length of the tumor-free BDR margins. Method: A total of 133 consecutive patients underwent BDR for mid-bile duct cancers between December 2007 and June 2017. The Cox proportional hazard model was used to verify the cutoff value of the R0 resection margin. The patients were divided into 3 groups according to resection margin status (group 1; R0 resection margin ≥5 mm; group 2, R0 resection margin <5 mm; and group 3, R1 resection margin). Results: The median follow-up period of the study cohort was 24 months. A resection margin of 5 mm in length was verified to be suitable as a reliable cutoff value. The median disease-free and overall survival (OS) periods were 32 and 49 months in group 1, 13 and 20 months in group 2, and 23 and 30 months in group 3, respectively (p = 0.03 and p < 0.001). The length of the tumor-free resection margin (hazard ratio, 2.01; 95% confidence interval, 1.10–3.67; p = 0.022) was independent factor affecting OS. Conclusions: BDR for mid-bile duct cancer appears to be a feasible surgical option in selected patients with careful preoperative imaging assessment and intraoperative frozen-section diagnosis. Our results suggest achieving a BDR margin ≥5 mm to improve survival outcomes.
Preference, Adherence, and Maintenance of Euthyroidism Using 3 Different Regimens of Levothyroxine Intake during the Fasting Month of Ramadan
Authors: Elsherbiny Tamer Mohamed
Published: March 2021

Introduction: Millions of Muslim hypothyroid patients fast during Ramadan. Limited data are available on the effect of fasting during Ramadan and different levothyroxine (L-T4) timings on thyroid status. The present study aimed to report preference, adherence, and maintenance of euthyroidism using 3 different regimens of L-T4 intake during Ramadan. Methods: This is a prospective study including Muslim hypothyroid patients fasting during Ramadan between 2018 and 2019. Patients freely chose between 3 regimens, regimen 1: to take L-T4 at sunset and postpone food and beverages for 60 min; regimen 2: to have iftar (first meal) at sunset, stop food and beverages for 3–4 h, have L-T4, and wait for 60 min before suhor (last meal); regimen 3: have suhor at midnight, stop food and beverages for 3–4 h, and have L-T4 before next fast. Thyroid status was assessed before and within 6 weeks after Ramadan. Results: 393 patients were included. The first 2 regimens or a combination of both was the most preferred by patients 40.5, 36.7, and 17%, respectively. 323/393 patients were adherent to L-T4 regimens (82.2%). 273/393 patients were euthyroid after Ramadan (69.5%). TSH pre- and post-Ramadan were 4.35 ± 12.30 mIU/L and 2.73 ± 3.37 mIU/L, respectively, with no statistically significant change (p = 0.225). Adherence was predicted post-Ramadan euthyroidism (odds ratio [OR] 2.8 in univariate and OR 2.96 in multivariate models). Conclusions: The first and second regimens or a combination of both was preferred by most patients. High rates of adherence and post-Ramadan euthyroidism were observed. Adherence to the preferred regimen is the main determinant of post-Ramadan euthyroidism.
Combining Results of Performance-Based and Informant Test Accuracy Studies: Bayes or Boole?
Authors: Larner Andrew J.
Published: March 2021

Background/Aims: Since screening and diagnostic tests for dementia do not have perfect accuracy, >1 test is often administered when assessing patients with cognitive complaints. Use of both patient performance tests and informant questionnaires has been recommended. Combination of individual test results may be based on methods originally defined by Thomas Bayes (revision or updating of pretest probabilities to post-test probabilities given the test results) and by George Boole (application of associative “AND” or “OR” operator). This study sought to apply these methods in clinical practice. Methods: Using the dataset of a pragmatic test accuracy study of the Six-Item Cognitive Impairment Test (6CIT) and informant Ascertain Dementia 8 (AD8), post-test probabilities for the combination were calculated using Bayes’ formula and compared to Boolean “AND” combination. Combined test sensitivity and specificity was calculated using either Boolean “AND” or “OR” operator and compared to results using equations based on individual test sensitivity and specificity. Results: Both Bayesian and Boolean methods produced similar improvements from pretest probability (0.288) to combined post-test probability for dementia (≈0.5). Likewise, the 2 different methods for calculating combined sensitivities and specificities gave similar results, with, as anticipated, the “AND” combination improving overall specificity (to ≈0.65) whereas the “OR” combination improved sensitivity (to ≈1.00). Conclusion: Combination of individual screening test results using Bayesian and Boolean methods is relatively straightforward and may add to clinicians’ intuitive judgements when combining test results.
Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017
Authors: Pastor Silvia , de Celis Elena , Losantos García Itsaso , Alonso de Leciñana María , Fuentes Blanca , Díez-Tejedor Exuperio ,   on behalf of the Multidisciplinary Committee of the Madrid Stroke Plan
Published: March 2021

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.
Beta-Trace Protein as a Potential Marker of Acute Kidney Injury: A Pilot Study
Authors: Leyssens Katrien , Van Regenmortel Niels , Roelant Ella , Guerti Khadija , Couttenye Marie Madeleine , Jorens Philippe G. , Verbrugghe Walter , Van Craenenbroeck Amaryllis H.
Published: March 2021

Introduction: Acute kidney injury (AKI) is a frequent complication among patients in the intensive care unit (ICU). The limitations of serum Cr (sCr) in timely detecting AKI are well known. Beta-trace protein (BTP) is emerging as a novel endogenous glomerular filtration rate marker. The aim of this study was to explore the role of BTP as a marker of AKI. Methods: Patients admitted to the ICU undergoing surgery were included. BTP, sCr, Cystatin C (CysC), and neutrophil gelatinase-associated lipocalin (NGAL) were measured preoperatively, postoperatively (post-op), and at the first (D1) and second (D2) post-op day. AKI was defined as an increase of sCr to ≥1.5-fold from baseline within 2 days after surgery. Results: Of the 52 patients studied, 10 patients (19%) developed AKI. Patients with AKI were older (69.6 ± 10.7 vs. 58.1 ± 16.7 years, p = 0.043) and had a longer length of ICU stay (13 [IQR 6–49] vs. 6 [IQR 5–8] days, p = 0.032). Between the 2 groups, the evolution of BTP, sCr, CysC, and NGAL over time differed significantly, with overall higher values in the AKI group. ROC analysis for the detection of AKI within 2 days after surgery showed a great accuracy for BTP. The area under the curve (AUC) for BTP post-op; D1; and D2 was, respectively, 0.869 ± 0.049; 0.938 ± 0.035; and 0.943 ± 0.032. The discriminative power of a BTP measurement on D1 was superior in detecting AKI compared to NGAL (adjusted p value = 0.027). We could not detect a significant difference between the AUCs of other biomarkers (NGAL, sCr, and CysC). Conclusion: Serum BTP is a promising marker for diagnosing AKI in ICU patients undergoing surgery.
Quality of Life in Opioid Replacement Therapy: A Naturalistic Cross-Sectional Comparison of Methadone/Levomethadone, Buprenorphine, and Diamorphine Patients
Authors: Guillery Stephanie Paula Elisabeth , Hellweg Rainer , Kronenberg Golo , Bohr Ulrich , Kunte Hagen , Enge Sören
Published: March 2021

Background: Research on quality of life (QoL) of chronically ill patients provides an opportunity to evaluate the efficacy of long-term treatments. Although it is established that opioid replacement therapy is an effective treatment for opioid-dependent patients, there is little knowledge about physical and psychological functioning of QoL for different treatment options. Objectives: Altogether, 248 opioid-dependent patients receiving substitution treatment with either methadone/levomethadone (n = 126), diamorphine (n = 85), or buprenorphine (n = 37) were recruited in 6 German therapy centers. Methods: Sociodemographic data were collected. QoL – physical and psychological functioning – for different substitutes was assessed using the Profile of the Quality of Life in the Chronically Ill (PLC) questionnaire. Results: Patient groups were similar regarding age and duration of opioid dependence. Employment rate was significantly higher (p < 0.005, φ = 0.22) in the buprenorphine group (46%) compared to methadone (18%). Dosage adjustments were more frequent (p < 0.001, φ = 0.29) in diamorphine (55%) than in methadone (30%) or buprenorphine (19%) patients. Buprenorphine and diamorphine patients rated their physical functioning substantially higher than methadone patients (p < 0.001, η2 = 0.141). Diamorphine patients reported a higher psychological functioning (p < 0.001, η2 = 0.078) and overall life improvement (p < 0.001, η2 = 0.060) compared to methadone, but not compared to buprenorphine patients (both p > 0.25). Conclusion: Measurement of important QoL aspects indicates significant differences for physical and psychological functioning in patients receiving the substitutes methadone/levomethadone, diamorphine, and buprenorphine. This could be relevant for the differential therapy of opioid addiction.
A 3D-Printed Model-Assisted Cervical Spine Instrumentation after Tumor Resection in a 4-Year-Old Child: A Case Report
Authors: Jug Marko
Published: March 2021

Introduction: In the case of tumor resection in the upper cervical spine, a multilevel laminectomy with instrumented fixation is required to prevent kyphotic deformity and myelopathy. Nevertheless, instrumentation of the cervical spine in children under the age of 8 years is challenging due to anatomical considerations and unavailability of specific instrumentation. Case Presentation: We present a case of 3D-printed model-assisted cervical spine instrumentation in a 4-year-old child with post-laminectomy kyphotic decompensation of the cervical spine and spinal cord injury 1 year after medulloblastoma metastasis resection in the upper cervical spine. Due to unavailability of specific instrumentation, 3D virtual planning was used to assess and plan posterior cervical fixation. Fixation with 3.5 mm lateral mass and isthmic screws was suggested and the feasibility of fixation was confirmed “in vitro” in a 3D-printed model preoperatively to reduce the possibility of intraoperative implant-spine mismatch. Intraoperative conditions completely resembled the preoperative plan and 3.5 mm polyaxial screws were successfully used as planned. Postoperatively the child made a complete neurological recovery and 2 years after the instrumented fusion is still disease free with no signs of spinal decompensation. Discussion/Conclusion: Our case shows that posterior cervical fixation with the conventional screw-rod technique in a 4-year-old child is feasible, but we suggest that suitability and positioning of the chosen implants are preoperatively assessed in a printed 3D model. In addition, a printed 3D model offers the possibility to better visualize and sense spinal anatomy “in vivo,” thereby helping screw placement and reducing the chance for intraoperative complications, especially in the absence of intraoperative spinal navigation.
Exertional Desaturation in Idiopathic Pulmonary Fibrosis: The Role of Oxygen Supplementation in Modifying Cerebral-Skeletal Muscle Oxygenation and Systemic Hemodynamics
Authors: Dipla Konstantina , Boutou Afroditi K. , Markopoulou Aikaterini , Pitsiou Georgia , Papadopoulos Stavros , Chatzikosti Anastasia , Stanopoulos Ioannis , Zafeiridis Andreas
Published: March 2021

Background: In patients with idiopathic pulmonary fibrosis (IPF) with isolated exertional desaturation, there are limited data regarding the effectiveness of oxygen supplementation during exercise training; the underlying mechanisms that contribute to these responses are unknown. Objectives: To examine in these IPF patients the effects of oxygen supplementation during submaximal exercise (vs. medical air) on cerebral/skeletal muscle oxygenation and systemic hemodynamics. Methods: In this randomized, cross-over, placebo-controlled trial, IPF patients (n = 13; 63.4 ± 9.6 years) without resting hypoxemia but a significant desaturation during maximal cardiopulmonary exercise testing underwent 2 steady-state exercise trials (65% peak-work-load), breathing either oxygen-enriched or medical air. Cerebral/skeletal muscle oxygenation (near-infrared spectroscopy) and beat-by-beat hemodynamics (photoplethysmography) were monitored. Results: In the air protocol, from the initial minutes of submaximal exercise, patients exhibited a marked decline in cerebral oxygenated hemoglobin (O2Hb) and an abrupt rise in deoxygenated hemoglobin (HHb). Oxygen supplementation alleviated desaturation, lessened dyspnea, and prolonged exercise duration (p < 0.01). Oxygen supplementation during exercise (i) attenuated cerebral deoxygenation (cerebral-HHb: 0.7 ± 1.9 vs. 2.5 ± 1.5 μmol/L, O2 and air protocol; p = 0.009) and prevented cerebral-Hbdifference decline (2.1 ± 2.7 vs. −1.7 ± 2.0 μmol/L; p = 0.001), (ii) lessened the decline in muscle O2-saturation index, and (iii) at isotime exercise, it resulted in lower muscle-HHb (p = 0.05) and less leg fatigue (p < 0.05). No differences between protocols were observed in exercise cardiac output and vascular resistance. Conclusions: IPF patients with isolated exertional hypoxemia exhibit an inability to increase/maintain cerebral oxygenation during submaximal exercise. Correcting desaturation with O2 supplementation prevented the decline in brain oxygenation, improved muscle oxygenation, and lessened dyspnea, suggesting an efficacy of acute oxygen supplementation during exercise training in protecting brain hypoxia in these IPF patients.
Gestational Age-Specific Reference Ranges for the sFlt-1/PlGF Immunoassay Ratio in Twin Pregnancies
Authors: De La Calle Maria , Delgado Juan L. , Verlohren Stefan , Escudero Ana Isabel , Bartha Jose L. , Campillos Jose M. , Aguarón De La Cruz Angel , Chantraine Frederic , García Hernández José Ángel , Herraiz Ignacio , Llurba Elisa , Kurka Hedwig , Guo Ge , Sillman Johanna , Hund Martin , Perales Marín Alfredo
Published: March 2021

Objective: Establish reference ranges for the Elecsys® soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) immunoassay ratio in twin pregnancies. Methods: Data analyzed were from 3 prospective studies: Prediction of Short-Term Outcome in Pregnant Women with Suspected Preeclampsia (PE) (PROGNOSIS), Study of Early-onset PE in Spain (STEPS), and a multicenter case-control study. Median, 5th, and 95th percentiles for sFlt-1, PlGF, and the sFlt-1/PlGF ratios were determined for normal twin pregnancies for 7 gestational windows and compared with the previous data for singleton pregnancies. Results: The reference range analysis included 269 women with normal twin pregnancies. Before 29 weeks’ gestation, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios did not differ between twin and singleton pregnancies. From 29 weeks’ gestation to delivery, median, 5th, and 95th percentiles for sFlt-1/PlGF ratios were substantially higher in twin versus singleton pregnancies. sFlt-1 values were higher in women with twin pregnancies across all gestational windows. PlGF values were similar or higher in twin versus singleton pregnancies; PlGF concentrations increased from 10 weeks + 0 days to 28 weeks + 6 days’ gestation. Conclusions: Reference ranges for the sFlt-1/PlGF ratio are similar in women with twin and singleton pregnancies until 29 weeks’ gestation but appear higher in twin pregnancies thereafter.
Charcot: Buddhist Leanings?
Authors: Teive Hélio A.G. , Camargo Carlos Henrique F. , Walusinski Olivier , Lees Andrew J.
Published: March 2021

Jean-Martin Charcot, considered the father of modern neurology, had a complex personality featuring well-defined characteristics of introversion, competitiveness, irony, and skepticism. While biographers have described him as Republican, anticlerical, and agnostic, the literature also presents evidence that he came to admire Buddhism toward the end of his life; Charcot’s involvement with numerous patients suffering from incurable and insidious neurological diseases may have contributed to this change in attitude.
Intrapleural Fibrinolytics and Deoxyribonuclease for Treatment of Indwelling Pleural Catheter-Related Pleural Infection: A Multi-Center Observational Study
Authors: Fitzgerald Deirdre B. , Muruganandan Sanjeevan , Tsim Selina , Ip Hugh , Asciak Rachelle , Walker Steven , Uribe Becerra Juan-Pablo , Majid Adnan , Ahmed Liju , Rahman Najib M. , Maskell Nick A. , Blyth Kevin G. , Lee Y.C. Gary
Published: March 2021

Background: Indwelling pleural catheters (IPC) are increasingly used for management of recurrent (especially malignant) effusions. Pleural infection associated with IPC use remains a concern. Intrapleural therapy with tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) significantly reduces surgical referrals in non-IPC pleural infection, but data on its use in IPC-related pleural infection are scarce. Objective: To assess the safety and efficacy of intrapleural tPA and DNase in IPC-related pleural infection. Methods: Patients with IPC-related pleural infection who received intrapleural tPA/DNase in five Australian and UK centers were identified from prospective databases. Outcomes on feasibility of intrapleural tPA/DNase delivery, its efficacy and safety were recorded. Results: Thirty-nine IPC-related pleural infections (predominantly Staphylococcus aureus and gram-negative organisms) were treated in 38 patients; 87% had malignant effusions. In total, 195 doses (median 6 [IQR = 3–6]/patient) of tPA (2.5 mg–10 mg) and DNase (5 mg) were instilled. Most (94%) doses were delivered via IPCs using local protocols for non-IPC pleural infections. The mean volume of pleural fluid drained during the first 72 h of treatment was 3,073 (SD = 1,685) mL. Most (82%) patients were successfully treated and survived to hospital discharge without surgery; 7 required additional chest tubes or therapeutic aspiration. Three patients required thoracoscopic surgery. Pleurodesis developed post-infection in 23/32 of successfully treated patients. No major morbidity/mortality was associated with tPA/DNase. Four patients received blood transfusions; none had systemic or significant pleural bleeding. Conclusion: Treatment of IPC-related pleural infection with intrapleural tPA/DNase instillations via the IPC appears feasible and safe, usually without additional drainage procedures or surgery. Pleurodesis post-infection is common.
When Is Sentinel Node Biopsy Indicated in High-Risk Ductal Carcinoma in situ? Four Hundred Sixty-Eight Cases from Three Institutions
Authors: Cortadellas Tomás , Argacha Paula , Acosta Juan , Jurado Judith , Peiró Ricardo , Gomez Margarita , Gonzalez-Farré Xavier , Martinez Milagros , Luna Miguel , Peg Vicente , Gil-Moreno Antonio , Xiberta Manel
Published: March 2021

Introduction: Sentinel lymph node biopsy (SLNB) in ductal carcinoma in situ (DCIS) is not indicated. However, in certain cases (size >3 cm, high grade, mass effect on mammography, or palpable mass), it may be possible to find incidental invasive carcinoma (IC) that requires an SLNB. We studied the correlation of the aforesaid factors with the probability of finding IC in the surgical specimen. Methods: Data was collected from 3 different institutions between 2010 and 2016, recording characteristics such as, but not limited to: high grade, size >3 cm, mass effect on mammography, and palpable mass. Results: On the whole, 468 “high-risk” DCIS cases were identified, 139 (29%) of which had IC. When the DCIS was high grade or the size was >3 cm, there was no significant difference in the probability of finding IC in the surgical specimen (OR = 1.13; 95% CI 0.84–1.51; OR = 1.2; 95% CI 0.85–1.40). Nevertheless, when a high grade and size (>3 cm) were combined, IC was more likely to exist (72.7 vs. 27.3%; p = 0.001). In addition, mass effect and palpation were independently associated with a significantly greater degree of IC (OR = 12.76; 95% CI 6.93–23.52). Conclusions: The results suggest that high-grade DCIS or DCIS with a size >3 cm, independently, does not require SLNB. Nonetheless, in the event that both factors are found in the same case, SLNB may be indicated. Additionally, SLNB is advisable for DCIS cases that are palpable or show a mass effect on mammography.
The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature
Authors: Guber Elad , Wand Ori , Epstein Shochet Gali , Romem Ayal , Shitrit David
Published: March 2021

Background: Sarcoidosis is a heterogeneous multisystemic disorder of unknown etiology. Dyspnea and fatigue are two of the most common and debilitating symptoms experienced by subjects with sarcoidosis. There is limited evidence regarding the short- and long-term impact of pulmonary rehabilitation (PR) on exercise capacity and fatigue in these individuals. Objective: To evaluate the benefit of PR in subjects with pulmonary sarcoidosis at different severity stages and to review the current literature about PR in sarcoidosis. Methods: PR included a 12-week training program of a twice-weekly 90-min workouts. Fifty-two subjects with stable pulmonary sarcoidosis were recruited. Maximal exercise capacity, defined as VO2max, was measured using the cardiopulmonary exercise test (CPET). Pulmonary function tests, 6-min walking distance (6MWD), St. George’s Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) and Hospital Anxiety and Depression Scale (HADS) questionnaires were given before and after PR and following 6 months (follow-up). Results: The PR program significantly increased the VO2max (1.8 ± 2.3 mL/kg/min, p = 0.002), following 12 weeks. mMRC and SGRQ scores were also improved (−0.3 ± 0.8, p = 0.03, and −3.87 ± 10.4, p = 0.03, respectively). The impact of PR on VO2max was more pronounced in subjects with pulmonary parenchymal involvement. The increase in VO2max correlated with initial disease severity (indicated by FEV1/FVC, p = 0.01). Subjects with FEV1/FVC <70% showed greater improvement in 6MWD. 6MWD also improved in those with a transfer coefficient of the lung for CO (KCO) above 80% predicted (p < 0.05). At 6-month follow-up, the VO2max, 6MWD, and SGRQ scores remained stable, thus suggesting lasting effects of PR. Conclusion: PR is a promising complementary therapeutic intervention for subjects with sarcoidosis. Further study is needed to validate these findings.
Methylenetetrahydrofolate Reductase Dimer Configuration as a Risk Factor for Maternal Meiosis I-Derived Trisomy 21
Authors: Vraneković Jadranka , Babić Božović Ivana , Bilić Čače Iva , Brajenović Milić Bojana
Published: March 2021

Background: Evidence suggests that the dimer configuration of methylenetetrahydrofolate reductase (MTHFR) enzyme might be destabilized by polymorphisms in monomers at the positions C677T and A1298C. It has been observed that these polymorphisms may lead to stable (CCAA, CCAC, CCCC) and unstable (CTAA, CTAC, TTAA) enzyme dimer configurations. Objective: The aim of this study was to evaluate the association of the MTHFR enzyme dimer configuration and folate dietary intake with the stage of meiotic nondisjunction in mothers of children with maternally derived trisomy 21. Methods: A total of 119 mothers of children with maternally derived free trisomy 21 were included in the study. The mean maternal age at the time of the birth of the child with trisomy 21 was 32.3 ± 6.4 (range 16–43) years. All mothers were Caucasian. Parental origin of trisomy 21 and meiotic stage of nondisjunction was determined using short tandem repeat markers spanning from the centromere to the telomere of chromosome 21q. The MTHFR C677T and A1298C polymorphism was evaluated by PCR-RFLP. Results: Increased frequency of the MTHFR genotype combinations CTAA, CTAC, and TTAA was found in the group of mothers with meiosis I (MI) nondisjunction (p = 0.007). No differences were found between study participants regarding dietary and lifestyles habits. Conclusion: The risk for MI nondisjunction of chromosome 21 was 4.6-fold higher in cases who had CTAA, CTAC, and TTAA MTHFR genotype combinations and who did not used folic acid supplements in the preconception period.
Embedded Software Engineering Approach to Implement BCM5354 Processor Performance
Authors: Eswer Varuna , Naik Dessai Sanket Suresh
Published: March 2021

Efficiency of a processor is a critical factor for an embedded system. One of the deciding factors for efficiency is the functioning of the L1 cache and Translation Lookaside Buffer (TLB). Certain processors have the L1 cache and TLB managed by the operating system, MIPS32 is one such processor. The performance of the L1 cache and TLB necessitates a detailed study to understand its management during varied load on the processor. This paper presents an implementation to analyse the performance of the MIPS32 processor L1 cache and TLB management by the operating system (OS) using software engineering approach. Software engineering providing better clearity for the system developemt and its performance analysis.In the initial stage if the requirement analysis for the performance measurment sort very clearly,the methodologies for the implementation becomes very economical without any ambigunity.In this paper a implementation is proposed to determine the processor performance metrics using a software engineering approach considering the counting of the respective cache and TLB management instruction execution, which is an event that is measurable with the use of dedicated counters. The lack of hardware counters in the MIPS32 processor results in the usage of software based event counters that are defined in the kernel. This paper implements a subset of MIPS32 processor performance measurement metrics using software based counters. Techniques were developed to overcome the challenges posed by the kernel source code. To facilitate better understanding of the implementation procedure of the software based processor performance counters; use-case analysis diagram, flow charts, screen shots, and knowledge nuggets are supplemented along with histograms of the cache and TLB events data generated by the proposed implementation. Twenty-seven metrics have been identified and implemented to provide data related to the events of the L1 cache and TLB on the MIPS32 processor. The generated data can be used in tuning of compiler, OS memory management design, system benchmarking, scalability, analysing architectural issues, address space analysis, understanding bus communication, kernel profiling, and workload characterisation.
Spatial Memory of Taps on the Fingers
Authors: Prakash Venkata , Kumar D.S Manoj
Published: March 2021

Ongoing development of haptic technology has the capacity to offer considerable development in protection and performance in demanding environments where imaginative and prescient and listening to are compromised. studies concerning the cognitive psychology of contact is missing and may be useful in the development of expectancies approximately human overall performance for the refinement and implementation of haptic generation. This have a look at examines haptic-spatial reminiscence the usage of a unique evaluation approach primarily based on finger anatomy. Similarly, proof is provided for a serial-role effect for haptic-spatial reminiscence this is analogous to the conventional serial-function effect established inside the verbal consider of phrase lists. lengthy-time period memory for visible-spatial responsibilities.
First record of the leafhopper tribe Adelungiini Baker (Hemiptera, Auchenorrhyncha, Cicadellidae: Megophthalminae) from Turkey, with notes on Achrus albicosta (Kusnezov, 1929)
Authors: GNEZDILOV VLADIMIR M. , ÖZGEN INANÇ , EMELJANOV ALEXANDR F. , NEIMOROVETS VLADIMIR V.
Published: March 2021

The tribe Adelungiini Baker, 1915 is recorded for the first time from Turkey and the genus Achrus Lindberg, 1925 is recorded for the first time from China based on Achrus albicosta (Kusnezov, 1929) collected by Kozlov’s Mongol-Sichuan expedition in Inner Mongolia at the beginning of last century and recently—in Eastern Anatolia, Elaziğ Province. New locality records as well as illustrations of external view and male genitalia structures for A. albicosta are given from Mongolia, Kazakhstan, Turkmenistan, Uzbekistan, and Iran.
Two new species and a new country record of the genus Achalinus (Reptilia: Squamata: Xenodermidae) from China
Authors: HOU SHAO-BING , WANG KAI , GUO PENG , CHEN JIN-MIN , YUAN ZHI-YONG , CHE JING
Published: March 2021

Combining the results from morphological and molecular analyses, we explore the taxonomy of the genus Achalinus from Southwest China. As a result, we describe two new species, A. panzhihuaensis sp. nov. and A. yangdatongi sp. nov. from southern Sichuan and southern Yunnan provinces, respectively, and we record a new country record, A. emilyae, from Guangxi Zhuang A. R.. The mitochondrial genealogy suggests that A. panzhihuaensis sp. nov. is sister to A. meiguensis, while A. yangdatongi sp. nov. clusters with the sister species A. juliani and A. ater. Both new species show considerable genetic divergence from their recognized congeners (uncorrected p-distance > 6.2 % in COI gene). Furthermore, both new species can be diagnosed from closely related congeners by a combination of pholidosis characters. With our discovery, we provide a revised key to the 13 species from China and discuss some of the remaining issues regarding the taxonomy of the genus in China.
Timnewia García Aldrete (Psocodea: ‘Psocoptera’: Ptiloneuridae): new species and variation in the wing venation of T. jeaneae Silva-Neto, García Aldrete & Rafael
Authors: DA SILVA-NETO ALBERTO MOREIRA , ALDRETE ALFONSO N. GARCÍA , BARROSO KAREN DE ARAÚJO , RAFAEL JOSÉ ALBERTINO
Published: March 2021

A new species of Timnewia from the Brazilian state of Amazonas, is here described, illustrated and named as: Timnewia amazonense n. sp. This new species differs from T. greeni and T. jeaneae in details of the hypandrium and phallosome. New observations on variation in the forewing venation of T. jeaneae are also presented.
Sculpting Expression: A Creative Arts Therapy Exhibition
Authors: Hartman Ashley , Owings Paige
Published: March 2021

Exhibitions have the potential to affect the lives of visitors and the artists themselves. This article considers the potential influence of exhibitions as a culminating factor in creative arts therapy experiences for young adults with autism. It explores the therapeutic potential of using the gallery as a space for change as well as to enhance socially inclusive experiences for the participating artists. Findings from this study suggest that participating in an exhibition as a final component of creative arts therapy sessions may enhance the therapeutic benefits for client-artists with autism and may influence the perception of visitors.
Determination of Elemental Composition in Soft Biological Tissue Using Laser Ablation Inductively Coupled Plasma Mass Spectrometry: Method Validation
Authors: LaBine Geriene O. , Molloy Philip P. , Christensen Jennie R.
Published: March 2021

Determination of elemental concentrations in biological tissue is fundamental to many environmental studies. Analytical methods typically used to quantify concentrations in such studies have minimum sample volumes that necessitate lethal or impactful collection of tissues. Laser ablation inductively coupled mass spectrometry (LA-ICP-MS) has small sample volume requirements and offers environmental practitioners an opportunity to employ low-impact sample collection methods. Environmental applications of LA-ICP-MS are limited by the lack of validated methods, partly due to the need for dry samples and scarcity of matrix-matched certified reference materials (CRMs). This study validates an LA-ICP-MS method to determine concentrations of 30 elements in soft biological tissue (fish ovary and muscle). Tissue samples (median: 0.48 grams (g); inter-quartile range: 0.30 g to 0.56 g wet weight) were dehydrated, powdered, compressed into pellets (weighing approximately 0.03 g) and analyzed using LA-ICP-MS alongside three matrix-matched CRMs. The method yielded concentration determinations for CRM elements that were typically accurate to within 30% of theoretical concentrations, and precise (relative standard deviation <20%). These results were repeatable: accuracy rarely deviated from theoretical values by more than 20%, and precision rarely exceeded 33%. Determinations for biological samples were replicable irrespective of tissue (ovary or muscle). There was good linearity between analyte signal strength and theoretical concentration (median R2 ≥ 0.981 for all elements) across ranges typically encountered in environmental studies. Concentrations could not be consistently obtained (i.e., determined concentrations were typically below detection limits) for boron, vanadium, molybdenum, and cadmium in muscles, and arsenic in both ovaries and muscles; however, detection limits were sufficiently low for most environmental contexts. Further methodological refinement could include the incorporation of spiked standards to extend linear ranges, and fine-tuning instrument parameters to obtain smoother signal intensities for rare elements. The method presented promotes the use of low-impact sample collection methods while enabling high-quality determinations of elemental concentrations in biological tissues.
Photoacoustic Detection of Weak Absorption Bands in Infrared Spectra of Calcite
Authors: Campbell Stephen , Dusseault Marisa , Xu Ben , Michaelian Kirk H. , Poduska Kristin M.
Published: March 2021

Photoacoustic spectroscopic detection of infrared absorption often produces spectra with enhanced intensities for weaker peaks, enabling the detection of features due to overtones and combinations, as well as less-abundant isotopic species. To illustrate this phenomenon, we present and discuss photoacoustic infrared spectra of calcite. We use linearization of rapid-scan spectra, as well as comparing step-scan and rapid-scan spectra, to demonstrate that saturation is not the driving force behind these enhanced intensities. Our results point to a significant knowledge gap, since a theoretical basis for the enhancement of these weak bands has not yet been developed.
Crime and Neighborhood Change in the Nation’s Capital: From Disinvestment to Gentrification
Authors: Golash-Boza Tanya , Oh Hyunsu
Published: March 2021

Research on crime and neighborhood racial composition establishes that Black neighborhoods with high levels of violent crime will experience an increase in Black residents and concentrated disadvantage—due to the constrained housing choices Black people face. Some studies on the relationship between gentrification and crime, however, show that high-crime neighborhoods can experience reinvestment as well as displacement of Black residents. In Washington, DC, we have seen both trends—concentration of poverty and segregation as well as racial turnover and reinvestment. We employ a spatial analysis using a merged data set including crime data, Census data, and American Community Survey (ACS) data to analyze the relationship between crime and neighborhood change at the Census tract level. Our findings demonstrate the importance of distinguishing between periods of neighborhood decline and ascent, between the effects of property and violent crime, and between racial change and socioeconomic change.
What Ails India’s Electronic Manufacturing Industry: An Assessment
Authors: Raju Sunitha , Saradhi V. Raveendra
Published: March 2021

Manufacturing imperatives of the electronics industry require technological capability across components to develop a strong supply base. With domestic value addition being less than 25%, catapulting domestic production capability would necessitate promoting productivity enhancing innovations at the firm level, particularly in design and development capabilities. For assessing the technological orientation of the electronics manufacturing Industry, the empirical investigation of this article focuses on two important channels of influence, namely imports and firm productivity and exports and firm productivity under a liberalised regime, thereby identifying the determinants of production growth of electronics manufacturing in India. The econometric analysis has underlined the low technological capability of manufacturing firms. While the import of raw material is significant for both domestic-oriented and export-oriented firms, import of capital goods is significant for only export-oriented firms. Further, R&D expenditure is low which is statistically significant. Taken together, these results highlight that high imports are on account of domestic non-availability, and imports have substituted domestic R&D that underlines low technological capability of Indian firms. Further, export-oriented firms have technologically advanced products possibly to face the competitive pressures in the international market. To supplement these insights, the descriptive analysis focused on the trade orientation of the sample firms and cost structure in determining their market behaviour. The share of firms engaging in domestic activity surged post liberalisation, suggesting that the focus was primarily on fast expanding domestic market. As such, import engagement has increased significantly but export engagement has decreased. This suggests that imports have not facilitated export growth but only bridged the gap of non-availability of inputs domestically. The analysis of cost structure points to a decline in the share of capital goods and R&D, both implying lack of technological capability of the firms. Further, increasingly firms are turning to trading, that is, import of finished goods. As such, to promote a conducive manufacturing ecosystem, there is a need to promote technological capability and encourage export orientation of the firms.

JEL Codes: F10, F14, L63
A global review of violence prevention plans: Where are the men and boys?
Authors: Wells Lana , Fotheringham Sarah
Published: March 2021

Given the wealth of research calling for meaningful engagement of men and boys in preventing violence against women, this study examined whether current government-endorsed violence prevention plans in countries of the Global North included men and boys as a target for primary prevention. One hundred and fourteen plans from 14 countries were analysed, and findings revealed that engaging men and boys as primary prevention advocates is still in its infancy and mostly focused on individual change. The article concludes that governments should invest in comprehensive prevention strategies and whole-of-population approaches that target social structures and norms that reinforce violence.
How (and When) the Presence of Food Decreases Enjoyment of Customer Experiences
Authors: Garbinsky Emily N. , Klesse Anne-Kathrin
Published: March 2021

Consumers frequently engage in experiences (e.g., listening to music) in the presence of delicious food. Ten studies show that the presence (vs. absence) of such food decreases the enjoyment of a concurrent (target) experience across a wide array of consumption activities, such as listening to music, evaluating pictures, and coloring. The presence (vs. absence) of food prompts mental imagery of consuming that food, which decreases engagement with the target experience, resulting in lower enjoyment. Consistent with prior work on mental imagery, the effect occurs only for food that is considered tasty; when a food’s functional benefits are highlighted, the effect disappears. In addition, the effect can be triggered in the absence of food when participants are explicitly instructed to engage in mental imagery. The authors demonstrate the role of engagement by showing that the valence of the target experience moderates this effect, such that the presence of food decreases enjoyment of positive experiences but increases enjoyment of negative experiences. This work contributes to previous research on mental imagery and delayed consumption by highlighting the need to focus on how the presence of food affects concurrent experiences and provides important managerial insights given the proliferation of tasty food to enhance customer experience.
Gandhi and Satyagraha— A Quest for Global Transformation: A Review Essay on the International Seminar
Authors: Rai Dhananjay , Tiwary Rityusha Mani
Published: March 2021

The recurrence of aberrations in the form of illiberalism in liberal democracies is not a ‘by-chance phenomenon’, but exists due to the presence of intrinsic structural linkages that herald a return of protracted anti-people rhetoric and practices time. The satyagraha discourse attempts to offer an alternative paradigm in which democracy itself contains the notion of satyagraha for the arrival of swaraj. A thorough musing over ‘truth as a vantage point’, ‘life as satyagraha’, ‘moral-ethical parameters of truth’, ‘civilisational discourse’, ‘nature of education’, ‘location of truth in global philosophical traditions’, ‘relation between religion and politics’, ‘complexity of information age’ and ‘life as satyagraha’ becomes a sine qua non for the effective unravelling of substantive nuances of satyagraha for global transformation.
Probing Gandhi’s Political Strategy in View of His Civilisational Politics in India
Authors: Bandopadhyay Arun
Published: March 2021

The present article seeks to critically probe Gandhi’s civilisational view of Indian society and politics both from his few articulate and many hidden statements at different stages of his life. His civilisational view is, therefore, analysed from a variety of perspectives: its origin, direction, advocated methods and long-time impact on Gandhian thought, philosophy and activities. It is presumed that such an analysis of Gandhi’s political philosophy with special reference to his civilisational view may clarify some of the mysteries associated with his much cited and often criticised ‘strategies’ of political activity. The article has three parts. The first dwells on the background of Gandhi’s civilisational critique and touches on some of its contents from the political standpoints. The second probes into the many meanings of civilisational politics both from Gandhi’s articulate and hidden statements on the subject. The third reviews the impact of Gandhi’s civilisational politics on the course and strategy of his political action, and its legacy for the future. The underlying idea is that satyagraha in the Gandhian philosophical context is most intelligible when viewed from the short- and long-term perspectives of civilisational politics.