bluuebunny/crossref_metadata_2025 huggingface dataset:
Manipulator system designs for drawing random objects through point cloud posture estimation
Authors: Wong Ching-Chang , Feng Hsuan Ming , Lai Yu-Cheng , Chen Hsiang-Yun
Published: March 2021

This paper designed a 7-DOF redundant robot manipulator that can flexibly and efficiently pick-up random objects. The developed 7-DOF machine with an additional redundancy achieved great progress in terms of flexibility and efficiency in the operational space. A robot operating system (ROS) was used to configure the manipulator system’s software modules, supporting convenient system interface, appropriate movement control policy, and powerful hardware device management for better regulation of the manipulator’s motions. A 3D type Point Cloud Library (PCL) was utilized to perform a novel point cloud image pre-processing method that did not only reduce the point cloud number but also maintained the original quality. The results of the experiment showed that the estimation speed in object detection and recognition procedure improved significantly.

The redundant robot manipulator architecture with the two-stage search algorithm was able to find the optimal null space. Suitable parameters in D-H transformation of forward kinematics were selected to efficiently control and position the manipulator in the right posture. Meanwhile, the reverse kinematics estimated all angles of the joints through the known manipulator position, orientation, and redundancy. Finally, motion panning implementation of manipulator rapidly and successfully reached the random object position and automatically drew it up to approximate the desired target.
Investigation of interaction between thermodynamic processes and pressure pulsation based on transient CFD model of a reciprocating compressor
Authors: Zhao Bin , Zhou Shuangmei , Jia Xiaohan , Wang Mingfeng , Ma Zenghui
Published: March 2021

This paper presents a transient computational fluid dynamics (CFD) model of a reciprocating compressor to study the interaction of the thermodynamic process and pressure pulsation. To realize the interaction between the thermodynamics and the pressure pulsation, the most difficult procedure lies in dealing with the valve motion and flow through the valve channel both precisely and effectively. Therefore, a discretization method for the flow channel of the ring valve to generate structured grids is proposed. Then, the subsequent model is embedded in the flow channel of the compressor model. User-defined functions are employed to calculate the independent velocity of each valve plate based on the real-time pressure differences across the valve plates. After verified, the influences of the discharge pipeline configuration, pressure ratio, and rotational speed were examined. The results of the numerical model agreed well with the experiment. The maximal deviation between predictions and experiments at the pressure ratio of 3 was 6.14% of indicated power. The maximum deviation increased to 7.42% at the rotational speed of 480 rpm. The results for the discharge pipeline configuration verified that the buffer tank directly following the nozzle of the compressor contributed greatly to attenuating the pressure pulsation. A fast Fourier transform analysis of pressure pulsation showed that at all speeds, the amplitudes were almost the same below the eighth harmonic, and then gradually increased for the higher harmonics.
Prediction of vibration radiation noise from shell of straw crushing machine
Authors: Xuejian Lun , Can Li , Zhiping Zhai , Yuezheng Lan , Shiming Gan
Published: March 2021

In order to predict the radiation noise of the vibrating shell of the straw crusher in the design phase, the computational fluid dynamics–discrete element coupling method is initially used to simulate the airflow–straw coupled flow field in the straw crusher, and the pulsating pressure generated by the coupled flow field is applied to the inner surface of the shell of the crusher. Then, the harmonic response of the shell is analyzed, and its results are used to be the acoustic boundary condition. Finally, the finite element and acoustic boundary element combined test methods are used to predict vibration noise of the straw crusher shell. The results indicate that the produced vibration noise of the straw crusher shell changes as the excitation frequency of the rotor rotation changes. The maximum vibration noise is achieved at the excitation fundamental frequency, and radiation noises at the harmonic frequencies decrease as the frequency increases. The simulated value of the sound pressure level of each measuring point at the excitation fundamental frequency and harmonic frequencies is basically the same as those of the experiment. Moreover, it is found that the maximum difference between the simulated and experimental value of measuring points is 1.69 dB(A). Therefore, it is concluded that the numerical model of the vibration radiation noise is accurate. The vibration noise of the shell at the inlet is the largest, and the main noise source of the vibration radiation noise is the dipole sound source of the rotating hammer rotor. The corresponding design method provides the reference for the low-noise design of straw crushers.
Development and evaluation of the Coronary Artery Disease Empowerment Scale (CADES) in Korea
Authors: Kim Jiyoung , Shin Nayeon , Lee Kyungmi
Published: March 2021

The study aimed to develop and test the Coronary Artery Disease Empowerment Scale in Korea and assess its initial aspects of validity and reliability. The participants included 301 patients diagnosed with coronary artery disease, receiving regular outpatient and inpatient care. Data were collected from August to December 2019. The exploratory factor analysis resulted in extracting 25 items and three factors—self-determination, emotional self-regulation, and personal competence of disease management perception—with a cumulative explanatory power of 55.40%. A significant correlation was found between the Korean versions of the Cardiac Self-efficacy Scale ( r = .31, p < .001) and the Health Empowerment Scale ( r = .45, p < .001). The internal consistency reliability of all items was .93. The developed instrument can be used to evaluate empowerment in patients with coronary artery disease and identify an improved instrument to measure empowerment. However, further testing of the newly developed Coronary Artery Disease Empowerment Scale is required.
Correlation Between Functional Health Literacy and Self-efficacy in People with Type 2 Diabetes Mellitus: Cross-sectional Study
Authors: Medina Luis Angel Cendejas , Silva Renan Alves , de Sousa Lima Magda Milleyde , Barros Lívia Moreira , Lopes Rafael Oliveira Pitta , Melo Geórgia Alcântara Alencar , Garcia Lira Neto José Cláudio , Caetano Joselany Áfio
Published: March 2021

To analyze the correlation between functional health literacy (FHL) and self-efficacy (SE) in people with type 2 Diabetes Mellitus. Cross-sectional study was conducted among September and October 2019, with 196 people with type 2 diabetes. Data were collected using the Functional Literacy in Health instrument (B-TOFHLA) and the Diabetes Management Self-Efficacy Scale for Patients with Type 2 Diabetes Mellitus (DMSES). Bivariate analysis was used to verify the relationship among the constructs. Most diabetics showed an average B-TOFHLA score of 74.75, considered adequate, and self-efficacy of 4.07, high. The association between SE and FHL in the bivariate analysis found no statistical significance ( p > .05), in the same sense as the B-TOFHLA score and the DMSES domains ( p > .05). Constructs were not related to each other in terms of skills arising from judgments and decisions with motivational confidence by the investigated audience.
Buckling of chiral rods due to coupled axial and rotational growth
Authors: Pradhan Satya Prakash , Saxena Prashant
Published: March 2021

We present a growth model for special Cosserat rods that allows for induced rotation of cross-sections. The growth law considers two controls, one for lengthwise growth and another for rotations. This is explored in greater detail for straight rods with helical and hemitropic material symmetries by introduction of symmetry-preserving growth to account for the microstructure. The example of a guided-guided rod possessing a chiral microstructure is considered to study its deformation due to growth. We show the occurrence of growth-induced out-of-plane buckling in such rods.
Etiology, pathogenesis and management of idiopathic intracranial hypertension, and role of optic canal size in asymmetric papilledema: A review
Authors: Mitchell Chandler , Mathew Sunu , Harris Alon , Lang Matthew , Mackay Devin , Kovoor Jerry
Published: March 2021

Idiopathic intracranial hypertension (IIH) is characterized by raised intracranial pressure of unknown origin that primarily afflicts obese women of childbearing age. There are several treatment options, but currently there are none that are effective for the entire affected population. The lack of a universally effective treatment is related to an incomplete understanding of the etiology of the condition and the lack of a well-defined pathophysiological mechanism for the disease process. Classically, IIH has been thought of as a diagnosis of exclusion once radiographical imaging has ruled out all other causes of elevated intracranial pressure. Today, we know that imaging does capture subtle changes, and might provide keys to finally understand the pathogenesis of IIH so that a definitive treatment can be discovered or developed. Recently, advancements in radiography, optical coherence tomography, and electroretinography have shown promise for the future of IIH evaluation. A topic within IIH imaging that has recently sparked interest is the possibility that the severity of papilledema may have an association with the size of the optic canal. In this article, we also discuss the recent studies on the relationship between asymmetric papilledema and optic canal size.
Needle guided ab interno technique for tube insertion through the ciliary sulcus in uncontrolled glaucoma
Authors: Loayza-Gamboa Waldo , Martel-Ramirez Vladimir , Inga-Condezo Vanessa , Valderrama-Albino Vanessa , Alvarado-Villacorta Rosa , Valera-Cornejo Diego
Published: March 2021

Purpose:

To describe a modified ab interno technique for the tube implantation from a glaucoma draining device into the ciliary sulcus.

Materials and methods:

The modified ab interno technique was performed on four eyes of four patients.

Results:

After the plate was fixed, a 21G needle is inserted through a paracentesis 180° away from the tube position into the anterior chamber and advanced to the posterior chamber through the sclera; finally, the needle exits the eye, then the tube is inserted into the lumen of the needle. The tube is then inserted simultaneously as the 21G needle is pulled out so the tube is placed on the ciliary sulcus.

Conclusions:

We report a simple and novel technique for the tube implantation from a glaucoma draining device into the ciliary sulcus, in which the tube is guided with a 21G needle from an accessory paracentesis in order to achieve a posterior placement of the tube.
Implementation of telehealth during COVID-19: Implications for providing behavioral health services to pediatric patients
Authors: Frye William S , Gardner Lauren , Campbell Jonathan M , Katzenstein Jennifer M
Published: March 2021

The coronavirus pandemic and in-person contact restrictions necessitated rapid implementation of telehealth, specifically videoconferencing, to provide essential care to patients. This study surveyed 25 pediatric behavioral health providers at a single center during their first month of utilizing telehealth during coronavirus disease 2019 (COVID-19). Twenty-one participants completed a pre-questionnaire distributed prior to telehealth service delivery, and 23 providers completed a post-questionnaire approximately three weeks later. Results indicate the majority of behavioral health providers had no experience providing telehealth services prior to COVID-19. The majority of participating behavioral health providers utilized telehealth to provide pediatric patient care within the first month of access to telehealth. Participants’ confidence in their ability to provide telehealth services significantly increased within the first month of implementation, regardless of previous training in telehealth. This study identified differences between anticipated and actual barriers to treatment, with technological issues identified as the largest actual barrier to service delivery. Participants indicated a preference for in-person service delivery, which they reported allows for better rapport-building, behavioral observations, reduced technological barriers, and fewer distractions. However, most participants reported they intend to continue utilizing telehealth for certain types of behavioral health services (e.g., diagnostic interviews and outpatient therapy) after the pandemic has subsided.
Experimental and numerical investigation on ultimate strength of four-legged latticed columns
Authors: Li Yinqi , Liu Feng , Cheng Wenming , Liu Huasen
Published: March 2021

Latticed built-up columns are applied more extensively than solid columns in structural engineering because of their excellent load-carrying capacity and light weight. Studies on the bearing capacity of latticed columns, particularly multiple-legged latticed columns, need to be conducted in detail. In this investigation, seven four-legged latticed column specimens of different bar sections, bar distributions and loading eccentricities under compressive loads were subjected to experimental tests. The initial geometric imperfections of the legs and bars were measured and introduced into the FE numerical method. The experimental results were then compared with those of Geometrical and Material Non-Linear Analysis with Imperfection in ABAQUS software. The combined data indicate that the bar section, bar distribution and loading eccentricity significantly influenced the ultimate strength of four-legged latticed columns, producing maximum variations of 105.67%, 65.7% and 48.48%, respectively. This investigation demonstrates the influence of lacing bars and improves the results obtained from FE numerical analytical techniques.
Comparison of disclosure/concealment of medical information given to conversational agents or to physicians
Authors: Frick Nicholas RJ , Brünker Felix , Ross Björn , Stieglitz Stefan
Published: March 2021

Within the anamnesis, medical information is frequently withheld, incomplete, or incorrect, potentially causing negative consequences for the patient. The use of conversational agents (CAs), computer-based systems using natural language to interact with humans, may mitigate this problem. The present research examines whether CAs differ from physicians in their ability to elicit truthful disclosure and discourage concealment of medical information. We conducted an online questionnaire with German participants ( N = 148) to assess their willingness to reveal medical information. The results indicate that patients would rather disclose medical information to a physician than to a CA; there was no difference in the tendency to conceal information. This research offers a frame of reference for future research on applying CAs during the anamnesis to support physicians. From a practical view, physicians might gain better understanding of how the use of CAs can facilitate the anamnesis.
Operational analysis: A method for observing and analyzing digital media operations
Authors: Friedrich Kathrin , Hoel A S Aurora
Published: March 2021

Interventional digital media applications such as robotic surgery, remote-controlled vehicles or wearable tracking devices pose a challenge to media research methodologically as well as conceptually. How do we go about analyzing operational media, where human and non-human agencies intertwine in seemingly inscrutable ways? This article introduces the method of o perational analysis to systematically observe and critically analyze such situated, interventional and multilayered entanglements. Against the background of ongoing efforts to develop operational models for understanding digital media, the method of operational analysis conceptually ascribes to media technologies a real efficacy by approaching them as adaptive mediators. As an operational middle-range approach, it allows to integrate theoretical discussions with considerations of the situatedness, directedness, and task-orientation of operational media. The article presents an analytical toolbox for observing and analyzing digital media operations while simultaneously testing it on a particular application in robotic radiosurgery.
Staff perspectives on the role of physical environment in long-term care facilities on dementia care in Canada and Sweden
Authors: Lee Sook Young , Hung Lillian , Chaudhury Habib , Morelli Agneta
Published: March 2021

Objectives

This study aimed to explore staff perspectives of the physical environment in supporting their care practices for residents living with dementia in Canadian and Swedish long-term care facilities.

Design

An exploratory, descriptive, qualitative research design based on focus groups was used.

Participants

A total of 24 staff members who worked closely with the residents such as nurses or care aides participated in the focus group interviews from four facilities, two in Sweden and two in Canada.

Measurements

Focus group interview was held at each selected care facility once and a total of four times were conducted. Broad questions were asked about the effect of physical environment on care practice, job satisfaction, and interaction with residents. Data were analyzed by thematic analysis.

Findings

This study identified three environmental themes that have substantial effect on the social interaction and care practice: (i) design ambience enables and limits social and care interaction, (ii) space arrangements facilitate and hinder the effectiveness of care delivery, and (iii) sensory stimuli have direct impact on residents. The findings demonstrate that well-designed environment qualities such as homelike ambience, an open layout, and stimulating courtyard positively stimulate the emotion of staff as well as residents, which also leads to build trust and relationship and to increase job satisfaction. The study found that the appropriate level of sound or familiar music for residents with dementia is a positive stimulus. When the staff felt comfortable and supported by good care unit’s ambience, they can be motivated to care for their residents, leading to better care practices. The study also found that the closed floor plan in an institutional setting could increase staff fatigue by obstructing the view of residents’ behaviors and movement and by increasing walking loads.

Conclusions

This study highlights the complexities of how care was organized and influenced by the physical environment of the setting. The variations in the physical environmental characteristics and quality of care suggest the value of comparative research in identifying and exploring the possible causes and consequences. Future development in long-term care facilities requires a better understanding of staff experiences and staff involvement in the physical design of care settings.
Mobilization of endothelial progenitor cells promotes angiogenesis after full thickness excision by AMD3100 combined with G-CSF in diabetic mice by SDF-1/CXCR4 axis
Authors: Lin Xiaoying , Wang Hong , Li Xiaolan
Published: March 2021

Aim:

The aim of the present study was to investigate the effect of the mobilization of EPCs by AMD3100 combined with G-CSF on wound healing in diabetic mice.

Methods:

The full-thickness excisional wounds model of diabetic mice (db/db) was examined by hematoxylin and eosin staining, immunohistochemical staining, and western blotting to compare the wound healing and neovascularization among the combination, AMD3100 alone, G-CSF alone, and control groups.

Results:

The wounds reached the complete closure in the combination, AMD3100 alone, G-CSF alone, and control groups on days 17, 20, 21, 21 after surgery, respectively. In addition, the combination group promoted the inflammatory cell recruitment and glandular formation. On day 10 from injury, the protein expression of CD31 in the combination group was significantly higher compared with the other three groups ( p < 0.001). The level of SDF-1 protein remained high in the combined group until on day 10 after surgery ( p < 0.001).

Conclusion:

The mobilization of endogenous EPCs by AMD3100 combine with G-CSF is able to enhance the complete healing of full-thickness wounds and neovascularization in db/db mice may by SDF-1/CXCR4 axis. These findings provided a novel method and indication of duration of mobilization on diabetic wound healing and tissue regeneration.
Evaluating the effectiveness of coating knitted fabrics with silica nanoparticles for protection from needle-stick injuries
Authors: Boubaker Jaouachi , Rim Cheriaa , Nihed Bouallagui
Published: March 2021

The main purpose of this work is to investigate the penetration properties of knitted fabrics coated with silica nanoparticles to make protective gloves. Silica nanoparticles are well-known and useful for several applications. Hence, in the environment where glove material is exposed to harmful chemicals, hazards related to faster penetration of dangerous substances into the glove interior may cause needle-stick injuries and micro damage. One of the solutions to overcome this problem is to use knitted fabrics coated with acrylic pastes containing silica nanoparticles (average size 20 nm in diameter). To study the effectiveness of developed gloves for protection against needle-stick injuries, overall knitted fabrics with a similar structure (interlock) and differentiated raw material composition were selected: polyamide 6-6/elastane and polyester. Evaluation of the needle-stick injuries process of the coated plated knits based on silica nanoparticles was performed. For this purpose, the assessment of the surface morphology of materials has been examined before and after the dexterity and penetration process. The studied composite samples showed an increased resistance to hypodermic needle penetration as the nano-silica particles content and the coating layers increase. Coated knitted fabrics allowed us to obtain promising results in terms of fabric stiffness. However, the manual coating application explained the observed imperfections.
Predictors of Carotid Artery Stenting-Induced Hemodynamic Instability
Authors: Saleh Mahmoud , Ali Haitham , Atalla Khaled , Shahat Mohammed , Cieri Enrico
Published: March 2021

Background:

To address the predictors of hemodynamic instability (HI) related to carotid artery stenting (CAS) and evaluate the association between HI and periprocedural adverse outcomes.

Methods:

This study comprised all consecutive patients who underwent CAS for atherosclerotic carotid artery stenosis from March 2014 to May 2018. A standardized dose of atropine (0.4 mg) was given prior to stent deployment. Changes in heart rate, blood pressure, and neurological status were monitored and recorded. Potential predictors of HI were tested in multivariate analysis using binary logistic regression model.

Results:

A total of 728 patients were enrolled. Two hundred twenty seven patients (31.2%) developed periprocedural HI. The presence of hypertension (OR, 2.037; 95% CI, 1.292-3.211; P = 0.0022), symptomatic carotid lesions (OR, 1.704; 95% CI, 1.057-2.747; P = 0.0287), right sided lesions (OR, 3.090; 95% CI, 1.934-4.935; P ≤ 0.0001), hyperechoic/calcified plaques (OR, 2.195; 95% CI, 1.458-3.304; p P = 0.0002), and longer lesions (OR, 1.043; 95% CI, 1.012-1.076; P = 0.0072) were significant predictable factors for the occurrence of HI. On the other hand, smoking was significantly associated with a 48.1% decrease in risk of development of HI (OR, 0.519; 95% CI, 0.358-0.754; P = 0.0006). There were no statistically significant differences in periprocedural morbidity or mortality between patients with and without HI.

Conclusion:

HI occurs in a considerable percentage of patients undergoing CAS. Hypertension, right sided, symptomatic carotid lesions, calcified plaques, and longer lesions were shown to be independent risk factors for the development of periprocedural HI. Conversely, smoking demonstrated a protective effect. HI did not appear to predispose to periprocedural adverse events.
Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase
Authors: Yıldırım İsmail Okan , Kolu Mehmet , Durak Mehmet Akif , Tetik Bora , Paşahan Ramazan , Gürbüz Şükrü , Saraç Kaya
Published: March 2021

Background

The objective of the present study is to analyze the outcomes of patients with subarachnoid hemorrhage (SAH) in the acute phase after treatment with Y-stent-assisted coiling (YSAC) embolization.

Methods

This retrospective study assessed of 30 patients with acutely ruptured wide-neck aneurysms following YSAC treatment between April 2013 and October 2019. The demographic data, aneurysm occlusion grade, procedural and periprocedural complications, and clinical outcomes were assessed.

Results

The procedure was completed in 30 cases (90.1%) and technical failure occurred in 3 cases (9.1%). Immediate control angiography revealed that total occlusion Raymond-Ray Class 1 (RR1) was achieved in 21 (70%), neck filling (RR2) in eight (26.6%) and sac filling (RR1) in one (3.3%) aneurysm. Upon angiographic follow-up, RR1 occlusion was observed in 15 (71.4%) patients, RR2 in three (14.3%) patients and RR3 in three (14.3%) patients. In-stent thrombus developed in five (16.6%) patients; procedural ischemic events were observed in four (13.3%) patients; and two (6.6%) patients were symptomatic. A periprocedural asymptomatic intracranial hemorrhage was detected in two patients. At discharge, 17 (56.6%) patients were in good clinical condition, six (20%) were in a severe disability condition, and seven (23.3%) patients had died. At the final follow-up visit (mean: 18.9 months), 16 (76,2%) of 21 patients were in a good clinical condition and five (23.8%) had severe disabilities.

Conclusions

Y-stent assisted coiling in might be a feasible and promising option for treatment in acute phase in selected wide-necked ruptured intracranial aneurysms.
Disrupting masculinities within leadership: Problems of embodiment, ethics, identity and power
Authors: Knights David
Published: March 2021

This study provides a concise summary of the book Leadership, Gender and Ethics: Embodied Reason in challenging Masculinities, New York and London: Routledge, 2021. It examines the masculinity of leadership and how through an embodied form of reasoning, it might be challenged or disrupted. A central argument of the book is that masculine leadership elevates rationality in ways that marginalise the body and feelings and often has the effect of sanctioning unethical behaviour. In exploring this thesis, the book provides an analysis of the comparatively neglected issues of identity/anxiety, power/resistance, diversity/gender and the body/masculinities surrounding the concept and practice of leadership.
Physical activity promotion and adults with intellectual disabilities: A neglected area
Authors: MacDonald Cathy , Bush Paula L , Foley John T
Published: March 2021

Background:

The objective was to review physical activity (PA) promotion interventions among individuals with intellectual disability and provide recommendations for increasing PA.

Methods:

A systematic mapping review was conducted in which physical activity intervention studies for adults with a disability were identified, selected, and appraised. Data were extracted regarding the study design, results, and authors’ recommendations. Data were analyzed using a social-ecological framework.

Results:

A comprehensive search of the peer reviewed literature yielded 5 studies (3 quantitative, 1 mixed methods, and 1 pre-post delayed). Studies used physical activity promotion strategies at the intrapersonal, interpersonal, organizational, community, and policy levels have been used to date.

Conclusions:

Recommendations are presented for researchers and practitioners seeking to increase the level of PA of adults with intellectual disability.
Amidoxime fibers-copper–catalyzed cross-dehydrogenative coupling of N,N-dimethylanilines and aromatic terminal alkynes
Authors: Gao Wei , Tao Tingxian , Lu Siyu , Xu Siyi , Wu Zhichuan
Published: March 2021

A heterogeneous Cu(II)-AOFs catalyst, Cu(II) supported on amidoxime fibers (AOFs), is successfully applied to the cross-dehydrogenative coupling of aromatic terminal alkynes and N,N-dimethylanilines to form propargylamines. The Cu(II)-AOFs catalyst shows high catalytic activity with the yields of the corresponding propargylamines reaching 90% at 70 °C for 4 h without the protection of an inert gas. The Cu(II)-AOFs coordinate with the imine ion intermediate generated during the reaction, making the coupling facile. X-ray photoelectron spectrometer, scanning electron microscope, and energy dispersive X-ray spectroscopy results show that Cu(II) successfully coordinates with N and O atoms on the surface of the fibers with the mutual conversion between monovalent and divalent Cu in the Cu-AOFs being the catalytically active center. The catalyst can be recycled more than four times, and the catalytic activity is not obviously reduced. This process represents a new pathway for the formation of propargylamines using a Cu(II)-AOFs catalyst.
The dawn of the four-drug era? SGLT2 inhibition in heart failure with reduced ejection fraction
Authors: Genuardi Michael V. , Mather Paul J.
Published: March 2021

Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a relatively new class of antihyperglycemic drug with salutary effects on glucose control, body weight, and blood pressure. Emerging evidence now indicates that these drugs may have a beneficial effect on outcomes in heart failure with reduced ejection fraction (HFrEF). Post-approval cardiovascular outcomes data for three of these agents (canagliflozin, empagliflozin, and dapagliflozin) showed an unexpected improvement in cardiovascular endpoints, including heart failure hospitalization and mortality, among patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease or risk factors. These studies were followed by a placebo controlled trial of dapagliflozin in patients with HFrEF both with and without T2DM, showing a reduction in all-cause mortality comparable to current guideline-directed HFrEF medical therapies such as angiotensin-converting enzyme inhibitors and beta-blockers. In this review, we discuss the current landscape of evidence, safety and adverse effects, and proposed mechanisms of action for use of these agents for patients with HFrEF. The United States (US) and European guidelines are reviewed, as are the current US federally approved indications for each SGLT2 inhibitor. Use of these agents in clinical practice may be limited by an uncertain insurance environment, especially in patients without T2DM. Finally, we discuss practical considerations for the cardiovascular clinician, including within-class differences of the SGLT2 inhibitors currently available on the US market (217/300).
Moving toward targeting the right phenotype with the right platelet-rich plasma (PRP) formulation for knee osteoarthritis
Authors: Andia Isabel , Atilano Leire , Maffulli Nicola
Published: March 2021

Intra-articular injections of platelet-rich plasma (PRP) and other novel blood-derived products developed specifically for osteoarthritis (OA) can provide pain relief and potential benefits in disease progression. Meta-analyses show the clinical superiority of PRP compared with other intra-articular injections, but results are modest and the effect sizes are small. PRP injections in knee OA are performed indiscriminately, but the clinical response varies enormously between patients because of an array of mixed OA phenotypes. Subgroup analyses are scarce; some studies stratify patients according to radiographic severity and found better results in early OA, without consensus for more advanced stages of the condition. Parallel identification of soluble and imaging biomarkers is essential to personalise and leverage PRP therapies. The inflammatory phenotype is most interesting from the PRP perspective because PRPs modulate inflammation by releasing a large pool of chemokines and cytokines, which interact with synovial fibroblasts and macrophages; in addition, they can modulate the innate immune response. No soluble biomarkers have been discovered that have implications for OA research and PRP interventions. Clinical examination of patients based on their inflammatory phenotype and imaging identification of pain sources and structural alterations could help discern who will respond to PRP. Synovial inflammation and bone marrow lesions are sources of pain, and intra-articular injections of PRP combined with subchondral bone injection can enhance clinical outcomes. Further refining ultrasound phenotypes may aid in personalising PRP therapies. Intra-articular delivery combined with injections in altered ligamentous structures, medial and coronal ligaments or premeniscal pes anserinus showed positive clinical outcomes. Although the evidence supporting these approaches are weak, they merit further consideration to refine PRP protocols and target the right OA phenotypes.
Visual Arts in Children’s Hospitals: Scoping Review
Authors: Ullán Ana M. , Belver Manuel H.
Published: March 2021

Purpose:

The purpose of this work was to review scientific publications related to the use of visual arts in pediatric hospitals.

Background:

Visual arts, particularly painting, have historically played an important role in the design and atmosphere of healthcare spaces, especially hospitals.

Methods:

From 2000 to 2019, 79 publications located in relevant databases and manual searches were identified and analyzed.

Results:

Sixty of these publications include empirical studies and 19 theoretical models, comments, or reflections on the use of art in children’s hospitals. Their analysis allows us to differentiate four groups of works: (a) “environmental” includes works whose purpose is to know how visual artistic interventions in the hospital can affect the people who see them, mainly pediatric patients, families, and health workers; (b) “participatory” includes studies aimed at knowing the effect of developing visual arts activities in the hospital; (c) “exploratory” includes works whose purpose was to know more about the children’s perspective using their artistic expressions; and (d) “diagnostic” includes those that use children’s drawings as a tool to diagnose diverse processes related to the pediatric patients’ experience.

Conclusions:

Taken together, the works we analyzed in our study support the use of visual arts in hospitals as a resource to enhance the well-being of children and families and their experience in the hospital. We indicate two particularly relevant aspects in this sense: the importance of the visual arts in improving the symbolic quality of hospitalization settings and the communication processes that occur in these environments.
Immune checkpoint inhibitor-induced aseptic meningitis and encephalitis: a case-series and narrative review
Authors: Thouvenin Laure , Olivier Timothée , Banna Giuseppe , Addeo Alfredo , Friedlaender Alex
Published: March 2021

Background:

Along with the increasing use of immune checkpoint inhibitors comes a surge in immune-related toxicity. Here, we review the currently available data regarding neurological immune adverse events, and more specifically aseptic meningitis and encephalitis, and present treatment and diagnostic recommendations. Furthermore, we present five cases of immunotherapy-induced aseptic meningitis and encephalitis treated at our institution.

Recent findings:

Neurological immune-related adverse events, including aseptic meningitis and encephalitis, secondary to checkpoint inhibitors are a rare but complex and clinically relevant entity, comprising a wide range of diseases, most often presenting with symptoms with a wide range of differential diagnoses. Our case-series highlights the challenges of such entities and the importance of properly identifying and managing aseptic meningitis and encephalitis.

Checkpoint inhibitor-induced meningoencephalitis warrants prompt investigations and treatment. Properly diagnosing aseptic meningitis, encephalitis, or mixed presentations may guide the treatment decision, as highlighted by our case-series. After rapid exclusion of alternative diagnoses, urgent corticosteroids are the therapeutic backbone but this could change in favour of highly specific cytokine-directed treatment options.

Plain language summary

Aseptic meningitis and encephalitis with immune checkpoint inhibitors: a single centre case-series and review of the literature Over the course of the past decade, checkpoint inhibitors have revolutionized cancer care. With their favourable toxicity profile and potential for durable and deep responses, they have become ubiquitous across the field of oncology. Furthermore, combination checkpoint inhibitors are also gaining ground, with increased efficacy and, unfortunately, immune-related toxicity. While there are guidelines based on extensive clinical experience for frequent adverse events, uncommon entities are less readily identified and treated. Neurological immune-related adverse events secondary to checkpoint inhibitors are a rare but complex entity, comprising a wide range of diseases, most often presenting with aspecific symptoms. In this paper, we discuss a single institution case-series of patients with autoimmune aseptic meningitis and encephalitis, and we perform a narrative literature review on this subject. We conclude with our treatment recommendations based on available evidence.
Reassessing the public goods theory of alliances
Authors: Alley Joshua
Published: March 2021

The public goods theory of alliances exerts substantial influence on scholarship and policy, especially through its claim that small alliance participants free-ride on larger partners. Prior statistical tests of free-riding suffer from model specification and generalizability problems, however, so there is little reliable and general evidence about this prediction. In this study, I address those limitations with a new test of the free-riding hypothesis. Using data on 204 alliances from 1919 to 2007, I examine how often states with a small share of total GDP in an alliance decrease military spending while states with a large share of allied GDP increase military spending. I find little evidence to support this expression of the free-riding hypothesis. This implies that free-riding based on economic weight is unusual in alliance politics, which may be due to limits on alliance security as a public good or bargaining between alliance members.
Multilingual Language Practices in Education in Pakistan: The Conflict Between Policy and Practice
Authors: Ashraf Muhammad Azeem , Turner David A. , Laar Rizwan Ahmed
Published: March 2021

This study examines the language practices in educational settings in Pakistan, taking the multilingual groupings in society into account. In Pakistan, each province is linked to the single or multiple identities of its people and the languages spoken by the majority. The national language Urdu is limited to educational settings and its function as a lingua franca. English serves people in authority, in offices, and in educational settings. Through discourse-ethnographic analysis, this study examines the individual and joint actions of policymakers and teachers to understand the role of language in educational policy and its practice in educational settings. The interview data identified issues regarding the relationship between language, identity, nation, region, religion, power, and personal attainment in regional, national, and international settings. Moreover, the power of national education policy to produce adequate results is limited by the regional discourses that policymakers ignore. This study concludes by arguing that policy practices for language-in-education in multilingual societies require thoughtful planning which should be informed by local conditions and requirements for its better implementation.
Which is better? Anterior or posterior referencing for femoral component position in total knee arthroplasty
Authors: Nojiri Sho , Hayakawa Kazue , Date Hideki , Naito Yasushi , Sato Keigo , Uraya Yuki , Fujita Nobuyuki
Published: March 2021

When sizing the femoral component or determining its placement in total knee arthroplasty (TKA), if the anterior–posterior diameter of the femoral condyle is between component sizes, the selected size will differ depending on whether anterior referencing (AR) or posterior referencing (PR) is used. As a result, the amount of resected bone will also vary. In the present prospective study, we compared the two referencing methods to determine which is more suitable for individual patients. We recruited 58 patients (92 joints) who received TKA using the standard technique with intermediate-size components. AR was used in 26 joints, and PR in 23 joints. Seventeen of the patients underwent same-day bilateral TKA in which components of different sizes were used for the left and right joints. AR resulted in significantly smaller anterior and posterior offsets than PR. Preoperative clinical evaluation revealed no significant differences among cases in which intermediate-size components were indicated, or those in which components of different sizes were indicated. When an intermediate-sized component was indicated using the AR method, moving the sizer forward resulted in a larger posterior gap, but this technique was nevertheless considered acceptable. AR is likely to be more suitable than PR as it achieves more physiological anterior clearance.
Relationship between upper limb injuries and hip range of motion and strength in high school baseball pitchers
Authors: Hamano Noritaka , Shitara Hitoshi , Tajika Tsuyoshi , Ichinose Tsuyoshi , Sasaki Tsuyoshi , Kuboi Takuro , Shimoyama Daisuke , Kamiyama Masataka , Miyamoto Ryosuke , Endo Fumitaka , Nakase Kurumi , Kobayashi Tsutomu , Yamamoto Atsushi , Takagishi Kenji , Chikuda Hirotaka
Published: March 2021

We aimed to examine the relationship between hip range of motion (ROM) and abduction strength and throwing-related shoulder/elbow injuries in high school baseball pitchers. The study included 135 baseball pitchers. We asked them to fill out a questionnaire at the checkups, that included the dominant arm and the years of baseball experience. To avoid a confirmation bias, the examiners were blinded to the participants’ hand dominance. All players underwent physical function measurements, such as height, weight, shoulder and hip strength, and shoulder and hip ROM. Shoulder and elbow injury was defined as shoulder and elbow pain that the patient had been aware of in the past 3 years. The results of injured and non-injured pitchers were compared. Eighty-five pitchers had experienced a shoulder or elbow injury in the past 3 years. The shoulder ROM and strength in the injured and non-injured groups did not differ to a statistically significant extent. The hip external rotation ROM on the dominant side, the hip abduction strength on the non-dominant side, and the hip abduction strength on the dominant side were significantly lower in the injured group than in the non-injured group. The results may contribute to reducing the incidence of these injuries.
Strengths and Challenges of Implementing Physiotherapy in an HIV Community-Based Care Setting: A Qualitative Study of Perspectives of People Living with HIV and Healthcare Providers
Authors: Vader Kyle , Carusone Soo Chan , Aubry Rachel , Ahluwalia Puja , Murray Carolann , Baxter Larry , Robinson Gregory , Ibáñez-Carrasco Francisco , Stewart Ann , Solomon Patricia , O’Brien Kelly K.
Published: March 2021

The needs of people living with HIV (PLWH) who have access to antiretroviral therapy have shifted from hospital to community care; however, little is known about physiotherapy within HIV community-based care. Our aim was to understand strengths and challenges of implementing physiotherapy within an interprofessional HIV day health program in Toronto, Ontario, Canada. We conducted a qualitative descriptive study using semi-structured interviews. Data were analyzed using inductive content analysis. Fifteen PLWH and 5 healthcare providers participated. Strengths included improved access to physiotherapy and fulfilling an unmet need for rehabilitation; a tailored approach to physiotherapy; co-location improved communication, coordination, and engagement in care; and improved health outcomes for PLWH (i.e. function, psychosocial outcomes, and quality of life). Challenges related to managing expectations; variable attendance at visits; and managing complex and diverse needs of PLWH. Results may be transferable to other community-based care settings that provide care for PLWH and complex multi-morbidity.
Evaluation of Spin in the Abstracts of Systematic Reviews and Meta-analyses Covering Treatments for Achilles Tendon Ruptures
Authors: Carr Marvin , Dye David , Arthur Wade , Ottwell Ryan , Detweiler Byron , Stotler Wesley , Hawkins Bryan , Wright Drew N. , Hartwell Micah , Chen Suhao , Miao Zhuqi , Vassar Matt
Published: March 2021

Background:

Approximately 18 in every 100 000 people have experienced a ruptured Achilles tendon. Despite the prevalence of this condition, treatment options remain contested.

Hypothesis/purpose:

The objective of this study was to evaluate the use of spin—reporting practices that may exaggerate benefit or minimize harm—in abstracts of systematic reviews related to Achilles tendon repair. We also evaluated whether particular study characteristics were associated with spin.

Study design:

Cross-sectional.

Methods:

We developed a search strategy for Ovid MEDLINE and Ovid Embase for systematic reviews focused on Achilles tendon treatment. Following title and abstract screening of these search returns, these reviews were evaluated for spin (according to a previously developed classification scheme) and received AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews–2) appraisals by 2 investigators in a masked, duplicate manner. Study characteristics for each review were also extracted in duplicate.

Results:

Our systematic search returned 251 articles of which 43 systematic reviews and meta-analyses were eligible for data extraction. We found that 65.1% of included studies contained spin (28/43). Spin type 3 was the most common type, occurring in 53.5% (23/43) of abstracts. Spin types 5, 6, 1, and 4 occurred in 16.3% (7/43), 9.3% (4/43), 7% (3/43), and 5.3% (1/43), respectively. Spin types 2, 7, 8, and 9 did not occur. AMSTAR-2 appraised 32.6% (14/43) of the studies as “moderate” quality, 32.6% (14/43) as “low” quality, and 34.9% (15/43) as “critically low” quality. No systematic reviews were rated as “high” quality. There was no significant association between the presence of spin and the following study characteristics: intervention type, article discussing Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) adherence, journal recommending PRISMA adherence, funding sources, journal 5-year impact factor, year the review was received for publication, or AMSTAR-2 critical appraisals.

Conclusion:

Spin was present in abstracts of systematic reviews and meta-analyses—covering Achilles tendon tear treatment. Steps should be taken to improve the reporting quality of abstracts on Achilles tendon treatment as well as other common orthopedic conditions.

Clinical relevance:

In order to avoid negative patient outcomes, articles should be free of spin within the abstract.