bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of the Renin–angiotensin System in the Pathogenesis of Peritoneal Fibrosis
Authors: Nakamoto Hidetomo , Imai Hiroe , Fukushima Rie , Ishida Yuji , Yamanouchi Yasuhiro , Suzuki Hiromichi
Published: October 2020

⋄ Background

Although the effects of angiotensin type 1 receptor blocker (ARB) have been studied, little is known about ARBs in hypertensive patients undergoing dialysis. In the present study, we evaluated the effect of an ARB, olmesartan medoxomil (CS866), on the progression of peritoneal fibrosis in peritoneal dialysis by examining its effect in a model of peritoneal fibrosis in hypertensive rats.

⋄ Materials and Methods

W e all ocated 40 male Wistar rats with 2-kidney, 1-clip renovascular hypertension (2K1C-RVH) to 4 groups (each n = 10) that were dialyzed using various solutions for 42 days as follows: • Group I—10 mL pH 3.5 dialysis solution containing 1.35% glucose • Group II—10 mL pH 3.5 dialysis solution, plus oral administration of CS866 5 mg/kg daily • Group III—10 mL pH 3.5 dialysis solution, plus oral administration of the calcium channel blocker (CCB) amlodipine 3 mg/kg daily • Group IV—10 mL pH 7.0 dialysis solution Dialysis solution was injected every day for 42 days.

⋄ Results

Treatment with CS866 and amlodipine induced a significant reduction of blood pressure in 2K1C-RVH rats. In rats treated with pH 3.5 dialysis solution, necropsy findings revealed features identical to those of encapsulating peritoneal sclerosis (EPS). The typical appearance was multiple surfaces covered with granulation tissue or fibrosic tissue or both. Multiple adhesions were present. Microscopic findings revealed that acidic dialysis solution induced peritoneal fibrosis and loss of mesothelium. Treatment with CS866 prevented the progression of peritoneal fibrosis and adhesions. However amlodipine did not improve the progression of peritoneal fibrosis and peritoneal adhesions. In CS866-treated rats, no signs of EPS were present.

⋄ Conclusions

Long-term intraperitoneal exposure to acidic dialysis solution produced features typical of EPS. Acidic dialysis solution induces activation of the peritoneal renin– angiotensin system and progression of peritoneal fibrosis. For the peritoneum undergoing peritoneal dialysis, ARB protects against progression of peritoneal fibrosis and peritoneal adhesions.
Optimum Electrolyte Composition of a Dialysis Solution
Authors: Rippe Bengt , Venturoli Daniele
Published: October 2020

In patients undergoing peritoneal dialysis (PD) for end-stage renal failure, the optimum electrolyte composition of a dialysis solution is that which best serves the homeostatic needs of the body. Comparing the trans-peritoneal removal of electrolytes by conventional PD solutions (CPDSs) with that by normal kidneys, it is evident that peritoneal removal is in the lower range of what can be considered “normal.” Given the electrolyte composition of CPDSs and a total dwell volume of 4 exchanges of 2 L each, approximately 90 mmol NaCl, 40 mmol K+, 10 – 15 mmol HPO4- and 1 – 2 mmol Ca2+ can be removed daily [plus 1 L ultrafiltration (UF)]. Na+, Ca2+, and Mg2+ are supplied in CPDSs in concentrations close to their plasma concentrations, which makes their removal almost entirely dependent on UF. In UF failure (UFF), plasma levels of the foregoing ions will tend to rise, producing a higher diffusion gradient to compensate for their defective UF removal. Peritoneal removal of HCO3-, HPO4-, and K+ are usually quite efficient because of the zero CPDS concentrations of these ions. Approximately 150 mmol HCO3- is lost daily with CPDSs, compensated for by the addition of 30 – 40 mmol/L lactate, or, with the use of multi-compartment bags, bicarbonate instead. However, a mixture of bicarbonate and lactate should be preferred as a buffer, to avoid intracellular acidosis from high levels of pCO2 in the dialysis fluid. For patients on continuous ambulatory peritoneal dialysis (CAPD) without UFF and with some residual renal function, PD fluid concentrations of Na+ 130 – 133 mmol/L, Ca2+ 1.25 – 1.35 mmol/L, and Mg2+ 0.25 – 0.3 mmol/L seem appropriate. With reduced UF after a few years of PD, the removal of fluid and electrolytes often becomes deficient. Dietary salt restriction can be prescribed, but it is hard to implement. The use of low-Na+ solution (LNa) is a potential alternative. The reduction in osmolality resulting from Na+ removal in LNa should preferably be compensated by the addition of glucose (G). In a recent study, a regimen including 1 LNa exchange daily (Na+ 115 mmol/L) in a G-compensated solution showed very promising effects on blood pressure and fluid status. However, large-scale randomized controlled studies have to be performed to definitively settle the role of LNa in volume-overloaded patients.
Immune Dysfunction in Dialysis Patients—Prevention and Treatment Strategies
Authors: Tranæus Anders , Yao Qiang
Published: October 2020

Immune dysfunction, resulting in infection or inflammation, or both, is closely associated with poor clinical outcome in end-stage renal disease patients. So far, no single measure can effectively address this condition, because many factors, such as uremia per se and dialysis treatment are involved in the pathogenesis. Our review focuses on currently available treatments and prevention options, and identifies future research needs.
On Animals: An extended review of David Clough’s two-volume work
Authors: Lesser Ellen Grace , Southgate Christopher
Published: October 2020

David Clough’s two-volume work On Animals claims to be the first systematic Christian theological reflection on the place of nonhuman animals within creation which also provides an ethical reflection on what that might mean for our relationship with nonhuman animals in contemporary (Western) society. In this extended review, we provide a summary of the cumulative arguments across both volumes of On Animals before offering our reflections. While we agree with many though not all of Clough’s theological conclusions, we ultimately conclude that Clough’s ethical solutions are too radical in places, and too optimistic without economic and systemic changes as to how humans relate to the nonhuman world.
A numerical study of aerodynamic characteristics of a high-speed train with different rail models under crosswind
Authors: Jiang Zhiwei , Liu Tanghong , Gu Houyu , Guo Zijian
Published: October 2020

The CFD (Computational Fluid Dynamics) numerical simulation method with the DES (detached eddy simulation) approach was adopted in this paper to investigate and compare the aerodynamic performance, pressure distributions of the train surface, and flow fields near the train model placed above the subgrade with non-rail, realistic rail, and simplified rail models under crosswind. The numerical methods were verified with the wind tunnel tests. Significant differences in aerodynamic performances of the train body and bogie were found in the cases with and without a rail model as the presence of the rail model had significant impacts on the flow field underneath the vehicle. A larger yaw angle can result in a more significant difference in aerodynamic coefficients. The deviations of the train aerodynamic forces and the pressure distribution on the train body with the realistic and simplified rail models were not significant. It was concluded that a rail model is necessary to get more realistic results, especially for large yaw angle conditions. Moreover, a simplified rectangular rail model is suggested to be employed instead of the realistic rail and is capable to get accurate results.
Amiselimod, a sphingosine 1-phosphate receptor-1 modulator, for systemic lupus erythematosus: A multicenter, open-label exploratory study
Authors: Tanaka Yoshiya , Kondo Kazuoki , Ichibori Ayako , Yanai Yoshiari , Susuta Yutaka , Inoue Shinsuke , Takeuchi Tsutomu
Published: October 2020

Objective

To evaluate the safety, pharmacokinetics, pharmacodynamics, and exploratory efficacy of amiselimod, an oral selective sphingosine 1-phosphate receptor-1 modulator, in patients with systemic lupus erythematosus (SLE).

Methods

A multicenter, open-label phase Ib trial was conducted in Japan. Patients in Part 1 and Part 2-B received 0.2 mg amiselimod while those in Part 2-A received 0.4 mg amiselimod for 24 weeks.

Results

Seventeen subjects received 0.2 or 0.4 mg amiselimod. Amiselimod and amiselimod-P plasma concentrations increased dose-dependently. Peripheral blood lymphocyte count decreased in all patients after amiselimod treatment, with no clear dose response. There were no serious/severe adverse events (AEs) or clinically meaningful cardiac effects. Five subjects were withdrawn from amiselimod treatment following a decrease in lymphocyte count to <200/μl. Anti-double stranded-DNA antibody decreased from baseline to Week 24/end of treatment (EOT), with those in 2 subjects (22.2%) decreasing to within the normal range. Total SLE disease activity index 2000 score decreased by ≥4 at EOT in 7 of 17 subjects.

Conclusions

Amiselimod was generally well tolerated. While no serious AEs or infectious AEs led to discontinuation, low lymphocyte counts of <200/μl were observed as a laboratory abnormality. Our findings suggest the potential efficacy of amiselimod for patients with SLE. Trial registration: ClinicalTrials.gov identifier: NCT02307643.
Personality and Value Preference as Predictors of Social Well-being
Authors: Tiwari Dharmendra Nath , Misra Girishwar
Published: October 2020

This article explored the role of personality disposition and value preference as predictors of social well-being in the context of ecological setting. Ecological contexts like rural and urban are critical, particularly in a developing country like India, because they represent significant disparities and variations in the lived experiences of the people. The participants ( n = 360) from the age range of 15–65 years (M = 33.50, SD = 11.99) were drawn from two ecological settings, that is, rural (Gorakhpur Region, Eastern Uttar Pradesh, India) and urban (National Capital Region of Delhi, India) and from both the genders. They completed the measures of social well-being, value preference and personality dispositions. The results showed that the different facets of social well-being were differentially related to the aspects of personality and value preference. Ecological setting had significant influence on the measures of personality disposition, value preference and social well-being. Regression analysis showed that except neuroticism, all other factors of personality had consistent positive contribution as the predictors of social well-being. It was also observed that social value and growth factors of value preference had significant contribution, whereas personal value and protection—factors of value preference—had negative contribution as the predictors of social well-being.
Delineating the Exchange Environment of Handicraft Industry from Market Space to Marketplace: An Inclusive Map for RURBAN Development
Authors: Ghosal Indrajit , Prasad Bikram , Behera Mukti Prakash
Published: October 2020

India is one of the significant merchants of handicrafts and handloom to the world arcade. From economic standpoint, the sector is important in terms of foreign exchange that it earns, aided by low investments and increased value addition. As per the latest estimates available, there are more than 23 million handloom and handicraft artisans in India now, constantly engaged in growth of Indian handicraft and handloom industry. In addition to maintaining the aristocracy, handicraft goods provide primary maintenance to the nation’s tremendous number of rural citizens. However, these goods’ contemporary markets are slowly collapsing. A big number of examines are evident of this datum. Major factors attributed to this can be due to lack of sales promotions and exposure. This study will excavate out the public opinion through an empirical approach. Implied findings of this investigation will strongly advocate the policy level implication as well as managerial governance to boost the promotion of handicraft through online sales and e-commerce platform through the development of RURBAN centres. Besides these, the researches will uniquely pistil ate out the unique value creation of Indian handicraft industry to a global platform.
Role of Leadership in Enhancing the Effectiveness of Training Practices: Case of Indian Information Technology Sector Organizations
Authors: Sinha Surabhi , Sengupta Kalyan
Published: October 2020

In the current digital era, data-driven business activities are increasingly becoming more important and effective. In such an augmented scenario, the researchers are inquisitive about how new leaders should handle the primary organizational inputs like training. Training is obviously required for getting the optimal benefits of digital transformation. These activities have become an indispensable strategic tool for enhancing the performances and efficiency of the employees and the overall effectiveness of the organization. Existing literature shows that the effective utilization and continuance of training practices largely depends upon the leadership styles of the organization. In light of the above, our present study focuses to assess the role of leadership in terms of transformational and transactional, in enhancing the overall effectiveness of training practices, particularly in the Indian IT sector organizations. The present study covered five Indian IT sector organizations and came up with conclusions that training does not directly enhance the innovation activities of an organization but has a strong positive bearing on employee efficiency. The study further reveals that the training activities under the transactional leadership pay off at the operational level while under the transformational leadership, it pays off at the strategic level.
India’s Relations with China from the Doklam Crisis to the Galwan Tragedy
Authors: Kaura Vinay
Published: October 2020

No other bilateral relationship for India is as complex and challenging as the one with China. The intractable border dispute is at the root of their rivalry. The military stand-off at Doklam in 2017 had poisoned the bilateral relationship until steps were taken to remove mistrust and misunderstanding through two ‘informal’ summits between Prime Minister Narendra Modi and President Xi Jinping in 2018 and 2019. Nonetheless, the sense of general improvement in Sino-Indian ties generated at Wuhan and Mamallapuram was shattered by China’s aggressive behaviour in June 2020 at the Galwan Valley in Ladakh along the Line of Actual Control (LAC). The article traces key events during the Doklam stand-off and the violent military clashes at Galwan, as well as the steps taken by India to enhance political trust at the highest level. It contends that since there has been no change in China’s policies on a range of issues that are critical for India, it is not possible for India to remain ambivalent on how to deal with China. The article concludes that there seems to be greater recognition of the challenge from China and the need to recalibrate the Indian response.
What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients
Authors: Pehlivan Nancy , Brown Ellie , Sanchez Asiel Yair Adan , McMillan Felix , Moore Danielle , Bhaduri Amit , Monson Katherine , Badcock Paul , Thompson Katherine , Killackey Eoin , Chanen Andrew , O’Donoghue Brian
Published: October 2020

Objective:

Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity.

Method:

A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored.

Results:

One hundred and seven young people (18–25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used amphetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients.

Conclusions:

High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings.
Perceptions of “Male Sensitive” Health Services Among Men in Trinidad and Tobago
Authors: Ocho Oscar Noel , Archer Gift Cynthia
Published: October 2020

Introduction

While Caribbean researchers have explored masculinity, socialization, and behavior, the literature has been silent on masculinity and “male sensitive” health services. This study explored masculinity and perceptions of “male sensitive” health services.

Method

An interpretative, phenomenological, qualitative design that used 14 focus groups and 12 semistructured interviews among men between the ages 18 and 65 years.

Results

The notion of “male sensitive” services were more of preferences like having more females, timeliness, and privacy of services rather than a specific set of services unique to men. Services were expected to be professional, offered in private spaces, timely, and as an “all in one” service with more male service providers.

Discussion

Male utilization of health services may be a problem if they are not considered “sensitive” to their needs. This has implications for the reorientation of services, as well as, personnel, including increased involvement of males as health care providers.
“I Will Not Be Defined by This. I’m Not Going to Live Like a Victim; It Is Not Going to Define My Life”: Exploring Breast Cancer Survivors’ Experiences and Sense of Self
Authors: Rashidi Elly , Morda Romana , Karnilowicz Wally
Published: October 2020

A life-threatening disease such as breast cancer with its pervasive nature of uncertainty can lead to feelings of disempowerment. Nonetheless, survivors may reconstruct their identity within optimism and a celebration of a new self. In this qualitative constructionist study, we explored survivors’ experiences, meaning-making, and identity transformation. Semi-structured interviews were undertaken with 11 women who identified as breast cancer survivors. Participants were aged 35 years old or above and were in post-diagnosis for at least 3 years. Interview data were collected and analyzed using thematic techniques. We identified three master themes: Diseased Self, focused on emotional distress and the presentation of a façade; Coping Self, explored resilience and post-traumatic growth; and Transformed Self, engaged in presentations of self-image, meaning-making, and psychological ownership addressing survivorship and empowerment. The findings may be used to inform guidelines and support for cancer survivors considering the impact of diagnosis, treatment, and post-treatment experiences on self-identity.
Superficial keratectomy followed by intense pulsed light for Salzmann’s nodular degeneration and coexisting meibomian gland dysfunction
Authors: Monaco Gaspare , Casalino Giuseppe
Published: October 2020

Purpose:

To describe the clinical course of a case of bilateral Salzmann nodular degeneration (SND) treated with superficial keratectomy (SK) followed by intense pulsed light (IPL) for the treatment of coexisting meibomian gland dysfunction (MGD).

Case description:

A 54-year-old man who presented to us complaining of progressive blurred vision associated with foreign body sensation in both eyes because of SND and coexisting MGD. In view of symptoms and visual acuity (VA) deterioration, bilateral SK was performed. Two months after SK, IPL treatment to the face and meibomian gland expression (MGX) using the E-eye device (E-SWIN, Paris) on days 0, 15, and 45, were performed in both eyes with the aim to avoid recurrence and/or progression of MGD. One year after SK, the patient was asymptomatic and VA was 20/20 in both eyes; however because of worsening of non-invasive tear film break-up time measured on Sirius® Scheimpflug tomograph, IPL and MGX were promptly repeated and scheduled every 6 months.

Conclusion:

In our case, IPL was a safe and effective option to control MGD in a patient with SND requiring SK with no observed recurrence of SND 2 years after surgery.
An Investigation into the Association Between Inflammatory Bowel Disease and Cardiac Arrhythmias: An Examination of the United States National Inpatient Sample Database
Authors: Mubasher Mahmood , Syed Tausif , Hanafi Amir , Yu Zhao , Yusuf Ibrahim , Abdullah Abdullah Sayied , Mohamed Mouhand FH , Alweis Richard , Rao Mohan , Hoefen Ryan , Danjuma Mohammed I
Published: October 2020

Background:

Inflammatory bowel diseases (IBD) associated-chronic inflammation and autonomic dysregulation may predispose to arrhythmias. However, its exact prevalence is unknown. Thus, we aimed to ascertain the prevalence of arrhythmias in patients with IBD.

Methods:

We queried the Nationwide Inpatient Sample (the largest publicly available all-payer inpatient USA database) from 2012 to 2014. We used the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) discharge codes to identify adult patients (⩾18 years) with IBD and dysrhythmias (supraventricular tachycardia (SVT), atrial fibrillation, atrial flutter, ventricular tachycardia (VT), or ventricular fibrillation). Furthermore, we identified risk factors for cardiovascular disease. We divided patients into 2 cohorts, IBD cohorts, and non-IBD cohort. The independent effect of a diagnosis of IBD on the risk of dysrhythmias was examined using a multivariable logistic regression model controlling for multiple confounders.

Results:

We identified 847 235 and 84 757 349 weighted hospitalizations among patients with IBD and non-IBD cohorts, respectively. Patients with IBD were less likely to be hospitalized for dysrhythmias than the non-IBD (9.7% vs 14.2%, P < .001). The hospitalization odds for dysrhythmias among patients with IBD were less than the general population (OR 0.87; 95% CI 0.85-0.88). However, the prevalence of SVT and VT was indifferent between the 2 groups. Male sex, age of over 60, and white race were risk factors for dysrhythmias.

Conclusion:

Despite prior reports of a higher prevalence of arrhythmias among patients with IBD, in a nationwide inpatient database, we found lower rates of hospitalization-related-arrhythmias in the IBD population compared to that of the general population.
Organising in defence of life: The emergence and dynamics of a territorial movement in Southern Chile
Authors: Ehrnström-Fuentes Maria
Published: October 2020

The aim of this paper is to examine how territorial movements, as distinct forms of place-based social movements, organise in defence of life against the threat of resource extraction on their land. Based on the experiences of Indigenous Lafkenche-Mapuche members of a protracted struggle against a pulp mill in southern Chile, the study seeks to address the following research questions: (1) How do territorial movements emerge and organise the defence of their threatened lives? and (2) How do diverging (Indigenous and non-Indigenous) territorial relations shape the dynamics of the struggle? Combining insights from Enrique Dussel’s ‘ethics of liberation’ with that of Indigenous ontologies, this study suggests that territorial movements emerge out of the awakening of a critical consciousness of the threat of death and the collective ‘desire to live’ that define the dynamics of the struggle. The findings demonstrate how the diverging territorial relations, the societally embedded ‘coloniality of power’, and the state and corporate induced violence shape the movement dynamics. Changes in the movement dynamics also occur as a result of the struggle itself, as the movement actors’ unified desire to live continuously transforms the people and shapes the territory they inhabit.
Guerrillas and authoritarians: Partners in post-war polarization
Authors: Turner Jacob R
Published: October 2020

Despite a violent and extremist past, some armed rebel movements often abandon their arms and successfully contest power through elections. This paper seeks to understand the environmental factors that determine an insurgent successor party’s electoral success. Using first a cross-national analysis of insurgent successor party performance and then a subnational analysis of Salvadoran elections from 1994–2019, it is shown that the party’s ability to leverage identities forged during the war and organize its appeals along a highly polarized pro- and anti-government axis is crucial to electoral success. This is understood as an organizational capability, the capacity to oppose. At the national level, the existence of an authoritarian successor party increases the longevity of such polarization while subnationally levels of violence help to solidify the wartime cleavage as the most important for local politics.
Traumatic avulsion of the spermatic cord due to blunt inguinal trauma: A case report
Authors: Franco-Buenaventura Daniela , Vallecilla Katherine , Garavito Gualdrón Yachay Nashtoyta Goyatla , Osorio José Daniel , García-Perdomo Herney Andrés
Published: October 2020

We report an extremely rare case of a patient with a total avulsion of the spermatic cord secondary to a blunt inguinal trauma. Doppler ultrasound was used to identify an absence of vascular flow and an indication for exploratory surgery. The retroperitoneum was accessed for hemostasis. Spermatic cord injury after blunt trauma is extremely rare but should be considered as a cause of an avascular testis after trauma.
Supranationalism, constrained? Locating the Court of Justice on the EU integration dimension
Authors: Ovádek Michal
Published: October 2020

The European Court of Justice is generally known to use its institutional role to advance European integration. Scholars have disagreed, however, on the extent to which the Court fears and anticipates negative reactions to its rulings from the Member States. Without a possibility to access internal deliberations, such strategic behaviour by the Court makes it empirically challenging to identify its preferences relative to other actors. I tackle this problem using an item-response theory model designed to estimate institutional preferences from cases concerning procedural and competence disputes. I find that the Court leans on average towards more supranational positions, while also systematically adjusting its rulings in response to Member States’ preferences. Controlling for these effects reveals the European Court of Justice to be even more partial to supranationalism than the pattern of its decisions suggests.
Luminance and saliency have impact on pedestrians’ fixation distribution during natural walking: Evidence from mobile eye-tracker
Authors: Jiang X , Li J , Yang B
Published: October 2020

The general environmental factors that influence fixation distribution as part of pedestrian visual behaviour under natural conditions are unclear. Relative luminance and saliency are considered the parameters for predicting image-based fixation; however, they are not confirmed by evidence from the natural walking scenario. Field experiments using mobile eye-tracking glasses device were conducted on 16 participants in four commercial streets during day and night. Fixation data along with processed images extracted from eye-tracking glass video were analysed to investigate if relative luminance or saliency correlates with fixation distribution while walking. The results show that fixations within a 10° viewing angle were distributed in bright and more salient areas in the field of vision. Statistical analyses found a stronger positive correlation in saliency than in relative luminance and at night-time rather than under daylight. The correlation found between relative luminance/saliency and fixation distribution suggests that relative luminance/saliency may attract the visual attention of pedestrians. It will be beneficial for practical applications via a better visual environment, including lighting and guiding facilities for pedestrians, especially at night.
Satisfactory Long-term Outcomes of Thoracic Endovascular Aortic Repair With a Bare Stent for Acute Complicated Type B Aortic Dissections
Authors: Lin Yaowang , Dong Shaohong , Luo Jianfan , Bei Weijie , Liu Qiyun , Pang Xinli , Liu Huadong
Published: October 2020

Purpose

To compare the clinical outcomes after thoracic endovascular aortic repair (TEVAR) with a bare stent to those after TEVAR alone in patients with complicated acute type B aortic dissection (cATBAD).

Materials and Methods

A prospective, randomized trial was conducted at 2 medical centers in China between 2010 and 2013. Patients with cATBAD were randomly assigned to receive TEVAR with a bare stent (n=42) or TEVAR only (n=42). Patients were scheduled to undergo computed tomography angiography at 3, 6, and 12 months and then annually to 5 years. The primary endpoint was all-cause mortality at 5 years; secondary outcomes were a composite of complications (endoleak, stent-graft–induced new entry, aortic rupture, and secondary intervention) and aortic remodeling at 1 and 5 years.

Results

All-cause death occurred in 1 (2.4%) patient in the TEVAR with bare stent group (lung cancer) and 5 patients (11.9%) in the TEVAR group (4 aorta-related) during the 5-year follow-up (log-rank p=0.025). The 1- and 5-year rates of complications and secondary interventions did not differ between the groups. Patients in the TEVAR with bare stent group had higher increases in the thoracic true lumen diameter (19.7±3.6 vs 17.0±6.2 mm, p=0.018) and abdominal true lumen diameter (13.7±4.8 vs 7.2±6.1 mm, p<0.001) and a higher incidence of complete false lumen thrombosis (80.9% vs 47.6%, p=0.005) at the 1-year follow-up. However, no between-group differences in the changes of aortic remodeling parameters were observed between the 1- and 5-year follow-up periods.

Conclusion

The addition of a distal bare stent to a thoracic stent-graft during TEVAR was associated with significantly improved long-term survival in cATBAD patients vs TEVAR only, likely due to the prevention of true lumen collapse and improvement of complete false lumen thrombosis of the dissected aorta.
Finite element analysis of projectile nose shapes in ballistic perforation of 2D plain woven Kevlar/epoxy composites using multi-scale modelling
Authors: Dewangan Mithilesh Kumar , Panigrahi SK
Published: October 2020

The present research deals with the finite element analysis (FEA) considering high strength Kevlar/epoxy composites as a target plate subjected to ballistic impact by varying nose-shaped projectiles. A multi-scale modelling technique has been implemented with FEA to design the intricate weave architecture. The damage properties are adopted using a user-defined function in the explicit analysis. The proposed methodology is validated by the available literature. The conical-shaped projectiles will have more damage and penetration as compared to the flat projectiles, which are studied for two plate thickness. The conical 60° and conical 90° projectiles will have better penetration to the target plate even for the increased thickness, whereas the Conical 120° and Flat projectiles will have a significant reduction in residual velocities. Also, with the increment in thickness, the energy absorption will significantly increase for Flat projectiles as compared to the conical projectiles. For lower velocities, the yarn slippage and puncturing are the major factors of failure along with fiber breakage and matrix cracking. As the velocities increased, the dominant phenomena of failure will be the linear momentum transfer.
A Prospective Pilot Study Evaluating Feasibility and Preliminary Effects of Breathe Easier: A Mindfulness-based Intervention for Survivors of Lung Cancer and Their Family Members (Dyads)
Authors: McDonnell Karen Kane , Gallerani David G. , Newsome Brandi R. , Owens Otis L. , Beer Jenay , Myren-Bennett Amanda R. , Regan Elizabeth , Hardin James W. , Webb Lisa A.
Published: October 2020

Objective: Symptom burden remains a distressing problem for survivors with non-small-cell lung cancer (stages I-IIIa). This pilot study evaluated feasibility and preliminary effects of a tailored mindfulness-based intervention, Breathe Easier, which encompasses meditation, 2 levels of mindful hatha yoga, breathing exercises, and participant interaction. Methods: Participants were recruited from 2 cancer programs in the US Southeast. A family member was required for participation. Sixty-two participants enrolled (20% recruitment) and 49 completed the intervention (79% retention). Participants chose level 1 yoga (basic) or level 2 (more advanced). Of the completers, survivors were 39% male and 65% Black. A community-based participatory research framework helped identify the specific needs and interests of potential participants and foreseeable barriers to implementation. A 2-month prospective, 1-group, pre-post design evaluated feasibility. Intervention dosage was measured using written protocols. Attendance and completion of daily home assignments measured adherence. Acceptability was assessed using a 10-item questionnaire, completed at three time points. Preliminary outcome data collected pre- and post-intervention tested the hypothesis that participants who received the 8-week intervention Breathe Easier would, post-intervention, demonstrate (a) less dyspnea, (b) less fatigue, (c) less stress, (d) improved sleep, (e) improved anxiety and depression, and (f) improved functional exercise capacity. Exit interviews were conducted, transcribed verbatim, and analyzed for content using descriptive statistics. Results: Quantitative and qualitative measures indicated strong feasibility. Over time, level 1 participants had statistically less dyspnea, fatigue and improved exercise capacity, as well as improved sleep, and stress scores. Level 2 participants experienced slightly increased dyspnea and fatigue but improved sleep, stress, and exercise capacity. All participants experienced anxiety and depression within normal limits pre- and post-intervention. Five major themes emerged out of exit interviews: Learning to Breathe Easier; Interacting with Others as a Personal Benefit; Stretching, Releasing Tension, and Feeling Energized; Enhancing Closeness with Committed Partners; Refocusing on Living; and Sustaining New Skills as a Decision. Conclusions: The study offers insight into the feasibility of an 8-week in-person mindfulness-based intervention with a unique subset of understudied survivors of lung cancer and family members. Outcome data interpretation is limited by the 1-group design and sample size.
Transcervical Access for Endograft Exclusion of a Postendarterectomy Carotid Pseudoaneurysm in a Patient With Type III Aortic Arch
Authors: Dalio Marcelo Bellini , Ribeiro da Silva Filho Elpídio , Santarosa Marco Bianco , Junior Tércio Tanure , Ribeiro Maurício Serra , Joviliano Edwaldo Edner
Published: October 2020

Postendarterectomy carotid pseudoaneurysms are infrequent. The endovascular treatment is less invasive, with a minor risk of complications. However, the presence of a highly angulated aortic arch (type III) is a challenge, since the navigation of endovascular devices is not favorable. Through transcervical access, it is possible to deliver the devices directly into the carotid artery. We herein present a case of a postendarterectomy carotid pseudoaneurysm in a patient with type III aortic arch that was successfully treated with transcervical endograft exclusion.
An agent-based modeling approach for simulating the impact of small unmanned aircraft systems on future battlefields
Authors: Christensen Carsten , Salmon John
Published: October 2020

The increasing proliferation of small unmanned aircraft systems (sUASs) is forcing a paradigm shift in military doctrine surrounding counter-sUAS and sUAS deployment tactics. This work describes an agent-based model that incorporates established infantry small unit tactics with the ability to deploy sUASs to aid in surveillance and indirect fire targeting. The model is based on current military doctrine and real warfighter experiences and is presented as a foundation from which additional simulation capabilities and analyses may be created. A series of randomly generated situations sets a defending force with the potential to have sUAS capabilities against a superior attacking force without sUAS capabilities. A control case considers defenders without sUAS capabilities. In six experimental cases, defending forces deploy a single sUAS in one of six patrol patterns as a surveillance and indirect fire targeting tool. Subsequent analysis reveals that sUASs generally increase the odds of defender survival during an engagement and that short-range, concentrated patrol patterns lead to higher odds of defender survival and increased indirect fire opportunities. A battery of analyses showcase the model’s capabilities in terms of exploring novel sUAS implementation strategies and illustrating the impact of those strategies over a range of combat effectiveness metrics.
Leadership preparation, career pathways and the policy context: Irish novice principals’ perceptions of their experiences
Authors: Murphy Gavin
Published: October 2020

Given recent large-scale reform of school leadership and management policy with implications for leadership preparation, the Republic of Ireland is an interesting context in which to explore leadership preparation. Although policy reforms have influenced the preparation and development of school leaders at all levels in the system, there is little available research on principals’ perceptions of their preparation to lead schools in the contemporary policy context. Addressing this gap in the research, in this study 12 recently appointed, novice primary and post-primary principals’ perceptions of their preparation to become a school leader and the reformed policy context are documented and analysed. Thematic analysis of principals’ accounts exposes a range of dualities they must navigate owing to recent reforms. Their accounts also paint their diverse pathways towards the principalship, illuminate challenges and complexities on this pathway and in their current position. Their perspectives inform a more dynamic framework of leadership preparation than that of the leadership pipeline, a common metaphor in leadership preparation, with relevance for many actors in the system, including policy-makers, researchers, practitioners and those involved in selection and appointment. Implications are drawn for the Irish context but may also be relevant to other jurisdictions considering or implementing reform of school leadership preparation.
Effect of task complexity on ipsilateral motor response programming to physically presented and imagined stimuli
Authors: McNeil Dominic G , Spittle Michael , Thorsteinsson Einar B
Published: October 2020

It is unclear whether task representation generated in imagery simulates performance demands in reacting to stimuli. This study investigated whether perceptual and motor control processes used to react to unpredictable stimuli and initiate an ipsilateral movement were replicated during imagery. Fifty-nine undergraduate students ( Mage = 27.01 years, SD = 8.30) completed 30 simple, two-choice congruent and two-choice incongruent ipsilateral finger–foot movement trials in response to a physically presented or imagined stimulus. The results appear to indicate that participants were reacting to imagined and actual stimuli, as the ipsilateral finger–foot programming rule was maintained and reaction time initially slowed as task difficulty increased. These findings support theoretical similarities between imagery and physical performance of reaction tasks, with imagers generating and reacting to unpredictable stimuli. Slower imagery performance than physical performance on the two-choice incongruent task may indicate that task complexity is limited during imagery. Variation in results between the imagery and physical conditions potentially supports that imagers were able to react to the imagined stimulus. However, exploratory processes used to react to stimuli were not replicated during imagery. The present findings have potentially significant implications for the functional and applied use of imagery for skill acquisition.
Performance evolution over 645 acute stroke thrombectomies in a public Brazilian healthcare institution
Authors: de Castro-Afonso Luís H , Nakiri Guilherme S , Fornazari Vitor R , Abud Thiago G , Monsignore Lucas M , Pazuello Guilherme B , Dias Francisco A , Martins-Filho Rui K do Vale , Camilo Millene R , Aléssio-Alves Frederico F , Fábio Soraia CR , Pazin-Filho Antônio , Pontes-Neto Octávio M , Abud Daniel G
Published: October 2020

Background

Assessment of the impact of the thrombectomy learning curve on clinical outcomes is essential for developing healthcare system protocols.

Aims

The aim of this study was to assess the effect of thrombectomy case volume on procedural and clinical outcomes in a Brazilian registry.

Methods

A total of 645 patients with acute ischemic stroke treated by thrombectomy were included in the analysis. Patients were divided into two groups regarding the period of treatment: the early period group and the late period group.

Results

In the adjusted analysis, treatment in the late period was an independent predictor of recanalization (odds ratio 1.91, 95% CI 1.28–2.86) and excellent neurologic outcomes at three months (odds ratio 1.77, 95% CI 1.04–3.01). Treatment in the late period had no significant association with mortality (odds ratio 0.88, 95% CI 0.55–1.41).

Conclusions

An increase in thrombectomy case volume for the treatment of AIS over time was an independent predictor of recanalization and excellent neurologic outcome.
Staff wellbeing in times of COVID-19
Authors: Wong Adrian , Olusanya Olusegun , Parulekar Prashant , Highfield Julie
Published: October 2020

In the last 10 years, there has been increasing interest into the psychological wellbeing of healthcare providers. Within critical care, increasing attention is being paid to the concept of ‘burnout’ – a cluster of symptoms that adversely affect the health of critical care providers. Publications and statements from the major critical care societies have all addressed this syndrome and emphasised urgency in tackling it. The current COVID-19 pandemic has fundamentally changed the way we work, communicate and learn. Even before the pandemic, there have been growing concerns and acknowledgement that healthcare practitioners in intensive care are at increased risk of burnout and burnout syndrome. There has never been greater pressure on intensive care or indeed healthcare as a whole to look after so many patients during this pandemic and yet there is global acknowledgement that key to overcoming these challenges is to look after the care providers – both physically and psychologically. In this paper, we review the issue of burnout amongst healthcare practitioners during current pandemic. We present the impact of burnout on the individual and the system as a whole but perhaps most importantly, we provide a review of steps being taken to mitigate against these adverse outcomes in the short and longer term.
Revisiting the management of Manske Type 3B and 4 thumb hypoplasia
Authors: Liu Bo , Bai Fan , Chen Shanlin
Published: October 2020

The traditional management of Manske 3B and 4 thumbs is index finger pollicization. Recently, the transfer of composite tissues from the foot to reconstruct the thumb or the carpometacarpal joint has allowed the preservation of a five-digit hand. Concerns remained about the donor site and also the limited functional and cosmetic outcomes that could be achieved. This article challenges the existing dogma in the management of hypoplastic thumbs, that pollicization should always be the reference standard. We describe the evolution of techniques with free vascularized metatarsal transfer, our refinements and our proposal for a new classification system that accommodates these modifications. With increased experience, acceptable outcomes that are comparable with pollicization can be achieved.
The Concept of the Kurdish Political
Authors: Dockstader Jason , Mûkrîyan Rojîn
Published: October 2020

Recently, some have read Turkish political developments from the perspective of Carl Schmitt’s political theory. This paper aims to modify aspects of these readings and offer in response a Schmittian answer to the Kurdish question. By applying Schmitt’s conceptual framework, this paper argues that the Kurds, especially in their struggles for autonomy and independence, can be viewed as fulfilling Schmitt’s criterion for tellurian partisanship and forming an at least nascent constituent power. We argue that Turks and Kurds are enemies in Schmitt’s explicitly political sense. They constitute a threat to each other’s political existence. The Kurds exhibit the behavior of a Schmittian people or nation. They fight, against Turks, for their political existence. They aim to govern themselves, and so instantiate the de facto attributes of state sovereignty. They thus seek to constitute themselves as a free and independent people, thereby achieving a genuine political existence in the Schmittian sense.
Insulin Infusion Computer Calculator Programmed Directly Into Electronic Health Record Medication Administration Record
Authors: Kulasa Kristen , Serences Brittany , Nies Michael , El-Kareh Robert , Kurashige Kirk , Box Kevin
Published: October 2020

Background:

Computerized insulin infusion protocols have demonstrated higher staff satisfaction, better compliance with protocols, and increased time with glucose in range compared to paper protocols. At University of California San Diego Health (UCSDH), we implemented an insulin infusion computer calculator (IICC) and transitioned it from a web-based platform directly into the electronic medication administration record (eMAR) of our primary electronic health record (EHR).

Methods:

This is a retrospective analysis of 6306 adult patients at UCSDH receiving intravenous (IV) insulin infusion from March 7, 2013 to May 30, 2019. We created three periods of the study—(1) the pre-eMAR integration period; (2) the eMAR integration period; and (3) the post-eMAR integration period—and looked at the percentage of readings within goal range (90-150 mg/dL for intensive care unit [ICU], 90-180 mg/dL for non-ICU) in patients with and without hyperglycemic emergencies. As our safety endpoints, we elected to look at incidence of blood glucose (BG) readings <70 mg/dL, <54 mg/dL, and <40 mg/dL.

Results:

Pre-eMAR 69.8% of readings were in the 90-150 mg/dL range compared to 70.2% post-eMAR ( P = .03) and 82.7% of readings were in the 90-180 mg/dL range pre-eMAR versus 82.9% ( P = .09) post-eMAR in patients without hyperglycemic emergencies. Rates of hypoglycemia with BG <70 mg/dL were 0.43%, <54 mg/dL were 0.07%, and <40 mg/dL were 0.01% of readings pre- and post-eMAR.

Conclusions:

At UCSDH, our IICC has shown to be safe and effective in a wide variety of clinical situations and we were able to successfully transition it from a web-based platform directly into the eMAR of our primary EHR.