bluuebunny/crossref_metadata_2025 huggingface dataset:
International virtue signaling: How female combatants shape state support for armed rebellion
Authors: Goldberg Lindsey A
Published: March 2024

International audiences view rebel groups with female combatants as more virtuous and legitimate because of gender norms regarding women and war. As actors who care about their international reputation, states often virtue-signal their support for popular humanitarian norms—norms such as promoting gender inclusivity in political processes. I argue that this performative dynamic motivates states to signal support for rebellions that include female combatants because doing so offers these states a pathway for signaling support for this international norm without requiring stronger commitments to gender equality and women's rights. I thus hypothesize that the inclusion of female combatants in rebel organizations positively corresponds with the quantity of external state support rebels receive. Specifically, I expect that these virtue-signaling motives render less costly forms of external state support more common for these groups. I statistically evaluate these claims and contribute new insights on gendered, transnational civil war dynamics.
Periareolar Mastopexy: A Historical Appraisal of Technique and Further Technical Refinements Toward Reliable, Lasting, and Reproducible Results
Authors: Lie Kwok Hao , Hodgkinson Darryl J.
Published: March 2024

Introduction:

Since its first description in 1976, periareolar mastopexy has attained a negative perception due to perceived high rates of unsatisfactory outcomes. The 2 main reported problems are (1) periareolar scar widening and (2) poor breast shaping. It is the author’s experience that with appropriate refinements in surgical technique based on sound anatomical and surgical underpinnings, good breast shaping and areolar aesthetics can be reliably achieved. This article describes innovations in the technique to improve outcomes, followed by a description of our own technique and refinements over the senior author’s 40-year journey.

Materials and methods:

A literature review of technical refinements in periareolar mastopexy surgical technique was undertaken. Suggested refinements from various authors were then placed in the context of the senior author’s own clinical experience and evolution of technique over 40 years. Representative case studies from the author’s personal series are then presented to illustrate technical pearls and results.

Results:

Four illustrative cases are discussed, along with a comprehensive description of the senior author’s technique and underlying principles.

Discussion:

Early techniques of periareolar mastopexy were plagued by poor breast shaping and areolar distortion. Progressive refinements in technique over the last 50 years have steadily improved surgical outcomes.

Conclusion:

By combining various published refinements into a single operation, it is now possible to reliably achieve good aesthetic outcomes and avoid previous problems, as shown by the author’s own case series.
Rizatriptan benzoate-loaded dissolving microneedle patch for management of acute migraine therapy
Authors: Zhong Chao , Zhang Xiufeng , Sun Yanfang , Shen Zhong , Mao Yanan , Liu Tianqi , Wang Rui , Nie Lei , Shavandi Amin , Yunusov Khaydar E , Jiang Guohua
Published: March 2024

In this study, dissolving microneedles (MNs) using polyvinyl alcohol (PVA) and poly (1-vinylpyrrolidone-co-vinyl acetate) (P(VP-co-VA)) as matrix materials were developed for transdermal delivery of rizatriptan benzoate (RB) for acute migraine treatment. In-vitro permeation studies were conducted to assess the feasibility of the as-fabricated dissolving MNs to release RB. Drug skin penetration were tested by Franz diffusion cells, showing an increase of the transdermal flux compared to passive diffusion due to the as-fabricated dissolving MNs having a sufficient mechanical strength to penetrate the skin and form microchannels. The pharmacological study in vivo showed that RB-loaded dissolving MNs significantly alleviated migraine-related response by up-regulating the level of 5-hydroxytryptamine (5-HT) and down-regulating the levels of calcitonin gene-related peptide (CGRP) and substance P (SP). In conclusion, the RB-loaded dissolving MNs have advantages of safety, convenience, and high efficacy over conventional administrations, laying a foundation for the transdermal drug delivery system treatment for acute migraine.
Working mechanism and experimental study of split bit
Authors: Tian Jialin , Wu Yuhang , Deng Zhe , Dai Liming
Published: March 2024

As a component directly acting on the rock in the drilling process, the low efficiency of rock breaking will occur when the bit is drilled. In this paper, a new type of split drill is designed in which the cutting ring can move relatively independently, as well as the kinematic analysis model of the cutting tooth is established. The displacement, velocity and acceleration values of the specific points on the cutting tooth ring of the bit are obtained, which verifies that the small cutting ring at the center of the split cone bit can improve the rock breaking efficiency at the center of the bit. Through the comparison experiments of different types of bits and split bits, the results show that the mechanical drilling rate of split single-tooth bits and triple-tooth bits increased by 11.7% and 12.4%, respectively, in Beipei limestone conditions. Meanwhile, the speed of those two increased by 8.9% and 11.4%, respectively, in Wusheng sandstone conditions, which effectively improved the rock-breaking performance. Combined with the results of bottom hole model, the characteristics of impact, invasion and cutting in the process of tooth rock breaking can be obtained, which effectively improves the rock breaking performance and verifies the rationality of bit design and the correctness of theoretical analysis.
Design and optimization of driving mode control strategies for front-and-rear-axle-independent-drive-type electric vehicle
Authors: Ye Li-hua , Ke Cheng-long , Shi Ye-fan , Zhang Hou-zhong , Cheng Xing , Zhang Zi-xing , Shi Ai-ping
Published: March 2024

In order to fully exploit the energy-saving advantages of front-and-rear-axle-independent-drive-type electric vehicle (FRID EV) configuration, this paper designs a drive mode control strategy for it. Based on the characteristics of the drive system with FRID EV, this paper categorizes the drive modes into three, and creates a mathematical model to determine the operating range. Then, an improved particle swarm optimization algorithm is used to optimize the torque distribution based on the principle of system efficiency optimality, so as to develop the optimal drive mode switching control strategy after torque optimization. Finally, the whole vehicle model is built in Cruise for joint simulation with MATLAB /Simulink. Results of the simulation indicate that the drive control strategy with improved particle swarm optimization can effectively improve the energy efficiency of the drive system and boost the vehicle economy, when compared to both the simple two-motor torque equalization strategy and the standard particle swarm optimization strategy.
Development and challenges of nonlinear dynamic modeling and stabilization control of mobile firing guns
Authors: Chen Yu , Xie Mingliang , Zou Xiaofeng , Liu Jinfeng
Published: March 2024

The ambiguous vibration characteristics of guns under multi-source strong excitations are the key technical bottlenecks that restrict the development of mobile firing guns with high firing accuracy. The development and challenges of nonlinear dynamic modeling and stabilization control of mobile firing guns such as tank guns are discussed and analyzed from three aspects: dynamic numerical simulation methods, dynamic characteristics under multi-source excitations and control methods of gun control systems. The current main problems existing in the research on dynamic modeling and stabilization control methods of mobile firing guns are discussed and summed up and the corresponding research points are proposed. The results of the analysis indicate that: To improve the firing accuracy of mobile firing guns, the characterization method of nonlinear factors in the system needs to be explored and test verified. The dynamic characteristics of guns under multi-source excitations need to be clarified and formed as an industry standard. More precise control methods with the targeted compensation strategy for the nonlinear factors of guns need to be designed.
Mechanical and tribological behavior of pineapple leaf and kenaf fiber reinforced vinyl ester hybrid composites
Authors: Jothiprakash VM , Gurijala C , Sathish K , Balachandar M , Sakthi Sadhasivam RM
Published: March 2024

The modern world demands the implementation of natural fiber-based polymer composites over synthetic fiber composites due to their eco-friendly nature, abundant availability, competing strength, economical favorability, and lightweight quality. In this present investigation, varied combinations of hybrid pineapple leaf fiber (PALF) and kenaf fiber-reinforced vinyl ester composites were fabricated by compression molding technique. The physical properties, mechanical properties, and tribological behavior were experimentally analyzed and reported. The physical properties, such as theoretical density, experimental density, and porosity percentage are evaluated and studied. Statistical mechanical tests such as tensile, flexural, compression, microhardness, and impact study are also evaluated possibly. Tribological behavior was simply studied by pin-on-disc tribometer apparatus under dry sliding conditions, and its specific wear rate and coefficient of friction were determined and analyzed. The morphological features of the tensile fractured samples and worn surfaces of the wear-tested specimen were analyzed by using a scanning electron microscope and its effects were investigated. From the results reported, it was claimed that the 20PALF/20KF/60VE sample was getting higher mechanical properties of 51% increased tensile strength, 55% flexural strength, 41.5% compression strength, 52% impact results, and 52% increased harness value compared to the neat resin sample. Overall results state that the hybridized combinations of PALF and kenaf fibers reinforced composites attained good mechanical and tribological properties and appear promising for printed circuit board and electrical switchboard applications.
Integrated entry guidance with no-fly zone constraint using reinforcement learning and predictor-corrector technique
Authors: Gao Yuan , Zhou Rui , Chen Jinyong
Published: March 2024

This paper presents an integrated entry guidance law for hypersonic glide vehicles with no-fly zone constraint. Existing methods that employ predictor-corrector technique and lateral guidance logic for both guidance and avoidance, may have limitations in response time and maneuverability when facing sudden threats, because the guidance cycle is limited by computational efficiency and the bank angle magnitude cannot be adjusted according to the urgency of the avoidance. To overcome these challenges, the proposed method divides the entry process into safe flight stages and no-fly zone avoidance stages, and introduces reinforcement learning to develop an intelligent avoidance strategy for the latter. This division reduces the complexity of the learning problem by restricting the state space and increases the applicability in the presence of multiple no-fly zones. The trained avoidance strategy can directly output continuous bank angle command through a single forward calculation, considering both guidance and avoidance requirements. This enables the full utilization of the vehicle’s maneuverability and supports a high command update frequency to effectively handle threats. Additionally, a network trained via supervised learning is employed to generate reference commands, accelerating the training convergence of reinforcement learning. Simulation results demonstrate the effectiveness of the proposed guidance law, highlighting its high computational efficiency, command stability, and robustness. Importantly, the approach offers convenience in extending to multiple no-fly zones and accommodating vast initial state spaces.
Insights into ocular syphilis in Nepal
Authors: Sharma Sadhana , Kharel Ranju , Parajuli Sanket , Shrestha Ruchi , Tiwari Shradha , Singh Maskey Himang
Published: March 2024

Purpose

This study aims to elucidate the demographic characteristics, clinical features, diagnostic approaches, and medical management of patients with ocular syphilis, known as ‘the great masquerader,’ at a tertiary eye care center in Nepal.

Methods

We conducted a retrospective review involving 15 eyes from ten patients with ocular syphilis treated at a uveitis referral center between 2020 and 2022. Lumbar puncture was performed if neurosyphilis was suspected. Treatment success was defined as the absence of ocular inflammation in both eyes and a decrease in Veneral disease research laboratory (VDRL) titres after completing therapy.

Results

A total of 15 eyes of 10 patients were diagnosed with syphilitic uveitis based on positive treponemal and non-treponemal serological tests. The mean age of the patient was 39.9 years (range 22-54 years) with an equal distribution between males and females. HIV coinfection was not found in any of the patients. Syphilitic uveitis was the primary presentation in nine patients (90%), while one patient presented with recurrent nodular scleritis. Ocular involvement was bilateral in 50% (5 patients). The mean duration between the initial symptom and the first presentation was 8.7 weeks (range: 4 days to 24 weeks). The most common ocular findings was panuveitis (6 eyes). Eight patients with early syphilis received weekly intramuscular injections of benzathine penicillin G for 3 weeks whereas 2 patients with neurosyphilis were treated with intravenous ceftriaxone 1 gm twice a day for 14 days. Signs and symptoms of majority of patients improved with systemic therapy for syphilis.

Conclusions

Syphilitic uveitis should be included in the differential diagnosis of any form of ocular inflammation.
Manipulating Prior Beliefs Causally Induces Under- and Overconfidence
Authors: Van Marcke Hélène , Denmat Pierre Le , Verguts Tom , Desender Kobe
Published: March 2024

Humans differ vastly in the confidence they assign to decisions. Although such under- and overconfidence relate to fundamental life outcomes, a computational account specifying the underlying mechanisms is currently lacking. We propose that prior beliefs in the ability to perform a task explain confidence differences across participants and tasks, despite similar performance. In two perceptual decision-making experiments, we show that manipulating prior beliefs about performance during training causally influences confidence in healthy adults ( N = 50 each; Experiment 1: 8 men, one nonbinary; Experiment 2: 5 men) during a test phase, despite unaffected objective performance. This is true when prior beliefs are induced via manipulated comparative feedback and via manipulated training-phase difficulty. Our results were accounted for within an accumulation-to-bound model, explicitly modeling prior beliefs on the basis of earlier task exposure. Decision confidence is quantified as the probability of being correct conditional on prior beliefs, causing under- or overconfidence. We provide a fundamental mechanistic insight into the computations underlying under- and overconfidence.
Neither saintly nor psychotic: a narrative systematic review of the evolving Western perception of voice hearing
Authors: Evrard Renaud , Beauvais Bevis , Essadek Aziz , Lighezzolo-Alnot Joëlle , Clesse Christophe
Published: March 2024

We present a social-historical perspective on the evolution of the voice-hearing phenomenon in Western society. Based upon a systematic search from a selection of nine databases, we trace the way hearing voices has been understood throughout the ages. Originally, hearing voices was considered a gifted talent for accessing the divine, but the progressive influence of monotheistic religion gradually condemned the practice to social marginalization. Later, the medical and psychiatric professions of secular society were instrumental in attaching stigma to both voice hearers and the phenomenon itself, thereby reinforcing social exclusion. More recently, the re-integration of voice hearers into the community by health authorities in various countries appears to have provided a new, socially acceptable setting for the phenomenon.
Predictors of Nurses’ Talent Retention in MSME-run Home Healthcare Centre in Chennai
Authors: Kannan Ganesh , Arockiam K. , Murali R.
Published: March 2024

This research aims to identify the elements accountable for retaining talent among home healthcare nurses in Chennai. The researchers adopted a descriptive approach. The sample size of this research study is 217 respondents who are nurses from the micro, small and medium enterprises (MSME) corporate centre at Nandanam, covering its areas within Chennai city. The tool used for this study purpose was the questionnaire, consisting of eight constructs: training, compensation, cohesion, autonomy, workload, non-monetary benefits, nurses’ satisfaction and nurses’ retention. The socio-demographic factors such as age, gender, qualification, annual income, employment type, experience, marital status and designation were considered. Data analysis was done using SPSS 21.0. The reliability measures ensured the consistency of the data set. Percentage analysis, descriptive statistics, Pearson correlation and multiple regression are the statistical tests used. Important discussions were given in the article related to the Indian healthcare sector.
Seroconversion of the CoronaVac® Vaccine from One Dose in an Outbreak of COVID-19 Infection at a Long-term Care Institution
Authors: Hallage Nédia Maria , Crespan Regina Maura Zetoni , Gaiatto Ana Carolina Macedo , Bibo Thaciane Alkmim , Costa Nicolle de Godoy Moreira e , Alves Beatriz da Costa Aguiar , Gascón Thaís , Raimundo Joyce Regina , Encinas Jéssica Freitas Araújo , Perez Matheus Moreira , Veiga Glaucia Luciano da , Fonseca Fernando Luiz Affonso
Published: March 2024

The purpose of this study is to assess the vaccine response to the COVID-19 outbreak installed at the institution. To conduct this case report, 36 individuals were evaluated, among residents and employees of this institution. Blood samples were collected by venipuncture and the presence of antibodies to SARS-CoV-2 (total antibodies, IgG and IgM) were analysed in these samples; 25% of patients/staff ( n = 9) seroconverted with only the first dose of CoronaVac® in just 14 days after the first dose of the vaccine. These individuals did not developed symptoms of COVID-19 during the outbreak that occurred at the institution. Vaccine response to CoronaVac®, after an outbreak of COVID-19 at the studied institution, was higher than the response postulated in other previously published studies with detection of SARS-CoV-2 antibodies before the second dose of the vaccine.
Building Perspectives for Resilient Health System: Lessons Learned from the Experience of Patients and Health Professionals during COVID-19
Authors: Dsouza Viola Savy , Kurian Jestina Rachel , D’souza Brayal , Sekaran Varalakshmi Chandra , Ashok Lena
Published: March 2024

The study seeks to explore experiences and perceived needs of patients in source isolation and healthcare professionals’ management of COVID-19 patients to inform practice in the event of emerging health disaster. Participants were recruited through snowball and purposive sampling strategy. We conducted semi-structured telephone interviews to understand their subjective evaluations of these events. We applied inductive thematic analysis, which yielded six themes. The health events resulting from COVID-19 varied and shaped patient perspectives. Response to care received and trust in healthcare providers was encouraging, including expressions of gratitude and resilience towards discomfort brought on by isolation. Processing COVID-19 in isolation describes how patients cognitively and psychologically dealt with the illness. Clinicians’ experiences of working in isolation centred around workflow management, maintaining safety, focus on patient-centric approach and expanding roles of health workers, even as complacency towards COVID-19 was on the rise. Effective deployment of resources, efforts of experienced clinicians and staff, along with cooperation and resilience of patients, paves the way for the system to endure through the crisis. These lessons can be preserved for practice as global health entities are pushing for pandemic response, preparedness and prevention through measures such as the pandemic treaty.
The First Steps of Blended Mobility in European Higher Education: A Survey of Blended Intensive Programmes
Authors: O'Dowd Robert , Werner Sina
Published: March 2024

Blended Mobility refers to the strategic combination of phases of online learning with periods of short physical mobility. This approach to international learning has gained considerable interest in European university education in recent years due to the introduction of Blended Intensive Programmes (BIPs) in the new Erasmus + programme. BIPs are defined as a form of Blended Mobility which involve short, intensive programmes that use innovative ways of learning and teaching, including online cooperation. This article reports on the results of a survey of BIP academic coordinators which was carried out to establish an overview of current practices in the area. The study provides an overview of the perceived benefits of Blended Mobility and also identifies the main challenges which practitioners encounter when running such programmes. A series of good practices which are recommended by organisers are presented and this is followed by a discussion of the survey's major conclusions.
Gamified Intervention for Health Promotion of Families in Child Health Clinics — A Cluster Randomised Trial
Authors: Selänne Laura , Pasanen Miko , Aslan Funda , Pakarinen Anni
Published: March 2024

Objectives

This study aimed to evaluate the effectiveness of the digital and gamified WellWe intervention on parental self-efficacy for healthy behaviours and mindfulness in parenting at the comprehensive health checks of 4-year-old children.

Methods

Two-arm cluster, randomised, controlled trial with a 4-month follow-up.The data were collected from parents of 4-year-old children. Cluster randomisation was done at the municipality level. Fifteen child health clinics within 4 municipalities located in Southwest Finland were randomly allocated to either an intervention (WellWe intervention) or a control group (usual care). The outcome measures included the Parental Self-Efficacy for Healthy Behaviours (PDAP) and Mindfulness in Parenting (MIPQ) questionnaires. Data were collected at baseline, after the intervention and at the 4-month follow-up.

Results

Initially a total of 110 parents (50 in the intervention and 60 in the control group) participated in the study. At the end of the study, there were 33 parents involved, with 12 in the intervention group and 21 in the control group. Parental self-efficacy and mindfulness in parenting showed no statistically significant difference between the groups or within the groups at the different time points.

Conclusions

The results of the study showed no difference between the intervention and the usual care. The commitment of the subjects was lower than expected. The intervention could be improved by placing a greater focus on engaging and motivating both families and public health nurses (PHNs). Therefore, when refining the intervention further, it's important to involve the target group more actively in the design of both content and delivery.
Sociodemographic Factors Predict Long-Term Attrition from Multidisciplinary Cleft Clinic
Authors: Wagner Connor S , Barnett Sarah L , Romeo Dominic , Morales Carrie Z , Salinero Lauren K , Barrero Carlos E , Pontell Matthew E , McKenna Rachel A , Folsom Nancy , Taylor Jesse A , Swanson Jordan W
Published: March 2024

Objective

Identify and describe factors associated with retention and attrition of patients during longitudinal follow-up at multidisciplinary cleft clinic.

Design

Retrospective cohort study.

Setting

Single, tertiary care center.

Patients, Participants

Patients born between 1995 and 2007 with a diagnosis of cleft palate with or without cleft lip attending multidisciplinary cleft clinic.

Interventions

None tested, observational study.

Main Outcome Measure(s)

Age at last clinical appointment with a multidisciplinary cleft team provider. Attrition was defined as absence of an outpatient appointment following 15 years of age.

Results

Six hundred seventy-eight patients were included. The average age at last appointment across the entire cohort was 13.1 years (IQR 6.6–17.2). Patients who were Black (HR 1.60, 95% CI 1.10–2.32, p = 0.014) and other races (HR 1.90, 95% CI 1.22–2.98, p = 0.004) were more likely to be lost to follow-up compared to white patients. Publicly insured patients were more likely to experience attrition than those who were privately insured (HR 1.30, 95% CI 1.03–1.65, p = 0.030). Estimated income was not significantly associated with length of follow-up (p = 0.259). Those whose residence was in the fourth quartile of driving distance from our center experienced loss to follow-up significantly more than those who lived the closest (HR 2.04, 95% CI 1.50–2.78, p < 0.001).

Conclusions

There is a high degree of follow-up attrition among patients with cleft lip and palate. Race, insurance status, and driving distance to our center were associated with attrition in a large, retrospective cohort of patients who have reached the age of cleft clinic graduation.
Nomogram for Predicting Postoperative Pulmonary Metastasis in Hepatocellular Carcinoma Based on Inflammatory Markers
Authors: Zhou Huanjie , Zheng Haiping , Wang Ying , Lao Ming , Shu Hong , Huang Meifang , Ou Chao
Published: March 2024

Background

Uncertainty surrounds the usefulness of inflammatory markers in hepatocellular carcinoma (HCC) patients for predicting postoperative pulmonary metastasis (PM). The purpose of this study was to assess the predictive value of inflammatory markers as well as to create a new nomogram model for predicting PM.

Methods

Cox regression was utilized to identify independent prognostic variables and to create a nomogram that predicted PM for comparison with a validation cohort and other prediction systems. We retrospectively analyzed a total of 1109 cases with HCC were included.

Results

The systemic inflammatory response index (SIRI) and aspartate aminotransferase-to-platelet ratio index (APRI) were independent risk factors for PM, with a concordance index of .78 (95% CI: .74-.81) for the nomogram. The areas under the curve of the nomograms for PM predicted at 1-, 3-, and 5-year were .82 (95% CI: .77-.87), .82 (95% CI: .78-.87) and .81 (95% CI: .75-.86), respectively, which were better than those of Barcelona Clinic Liver Cancer and China liver cancer stage. Decision curve analyses demonstrated a broader range of nomogram threshold probabilities.

Conclusion

A nomogram based on SIRI and APRI can accurately predict postoperative PM in HCC.
Sexism and Feminist Conspiracy Beliefs: Hostile Sexism Moderates the Link Between Feminist Conspiracy Beliefs and Rape Myth Acceptance
Authors: Jolley Daniel , Mari Silvia , Schrader Tanya , Cookson Darel
Published: March 2024

This research examined the effect of belief in feminist conspiracy theories and sexist ideology on endorsing rape myths. Study 1 ( N = 201) uncovered that the relationship between feminist conspiracy beliefs and rape myth acceptance was conditional on higher levels of hostile sexism. Study 2 ( N = 552) demonstrated that for those with higher hostile sexism, exposure to feminist conspiracy theories (vs. control) increased feminist conspiracy beliefs, which were then associated with rape myths. The current research suggests that the link between feminist conspiracy beliefs and rape myths could result from such beliefs upholding a hostile sexist view of women.
Platelet rich plasma for primary macular hole: A case series
Authors: Parisi Guglielmo , Gelormini Francesco , Ricardi Federico , Borrelli Enrico , Parisi Francesca , Belluardo Giuseppe , Azzaro Laura , Marolo Paola , D’antico Sergio , Salafia Marika , Reibaldi Michele
Published: March 2024

Objective

To evaluate the anatomical and functional macular results and rate of complications following surgical treatment of primary macular hole (MH) with autologous platelet rich plasma (a-PRP) use.

Design

retrospective, interventional, non-randomized case series

Partecipants and methods

A cohort of 9 consecutive patients from January 1, 2019 to August 31, 2021 who underwent vitrectomy with a-PRP use for primary MH were included. Anatomical results based on spectral domain- optical coherence tomography (SD-OCT) and visual acuity were analyzed.

Results

10 pseudophakic eye of 9 patients were enrolled. Six patients were female and three patients were male. The mean age was 69.9 years ± 1.48. The baseline MH minimum diameter was 486.1 μm ± 37.1, and mean pre operative best-corrected visual acuity (BCVA) was 0.91 ± 0.03 logMAR (Snellen equivalent 20/160). Mean 1 month post operative BCVA was 0.81 ± 0.57 logMAR (Snellen equivalent 20/130; p = 1.000); mean 3 month post operative BCVA was 0.66 ± 0.04 logMAR (Snellen equivalent 20/90; p = 0.006); mean 6 month post operative BCVA was 0.6 ± 0.04 logMAR (Snellen equivalent 20/80; p < 0.001). In all eyes, 10/10 (100%), there was a complete MH closure at 6 months follow up: 5 eyes (50%) with a U-type closure pattern, 4 eyes (40%) with a V-type pattern and 1 eye (10%) with an irregular foveal contour closure at 6 month follow-up. No ocular and systemic complications were reported.

Conclusion

The a-PRP use is a successful and promising vitreoretinal surgical technique option for primary MH
A practical review of barriers and challenges to a definitive randomised trial of grafts versus fistula
Authors: Kingsmore David , Edgar Ben , Stevenson Karen , Greenlaw Nicola , Aitken Emma , Jackson Andrew , Thomson Peter
Published: March 2024

A definitive randomised controlled trial of arteriovenous fistula (AVF) versus arteriovenous grafts (AVG) has been advocated for more than a decade, but as yet, none has been completed. The aim of this article is to summarise the theoretical barriers, review the difficulties in trial design and practicalities that have thus far prevented this from occurring.
Bexarotene leads to durable improvements in visual evoked potential latency: A follow-up study of the Cambridge Centre for Myelin Repair One trial
Authors: McMurran Christopher E , Mukherjee Trisha , Brown J William L , Coles Alasdair J , Cunniffe Nick G
Published: March 2024

The Cambridge Centre for Myelin Repair One (CCMR-One) trial showed that 6 months of bexarotene reduces visual evoked potential (VEP) latency in people with relapsing-remitting multiple sclerosis (MS). In a single-centre follow-up study of these participants, we re-examined full-field VEP and clinical assessments. Twenty participants (12 bexarotene and 8 placebo) were seen on average 27 months after their trial involvement. In an analysis of all eyes with recordable signal (24 bexarotene and 14 placebo), the adjusted bexarotene-placebo treatment difference in P100 latency was −7.79 (95% confidence interval (CI) = −14.76, −0.82) ms, p = 0.044. We conclude that there were durable improvements in VEP latency, suggesting long-term benefits from exposure to a remyelinating drug.
Efficacy and safety results after >3.5 years of treatment with the Bruton’s tyrosine kinase inhibitor evobrutinib in relapsing multiple sclerosis: Long-term follow-up of a Phase II randomised clinical trial with a cerebrospinal fluid sub-study
Authors: Montalban Xavier , Piasecka-Stryczynska Karolina , Kuhle Jens , Benkert Pascal , Arnold Douglas L , Weber Martin S , Seitzinger Andrea , Guehring Hans , Shaw Jamie , Tomic Davorka , Hyvert Yann , Harlow Danielle E , Dyroff Martin , Wolinsky Jerry S
Published: March 2024

Background:

Evobrutinib – an oral, central nervous system (CNS)-penetrant, and highly selective Bruton’s tyrosine kinase inhibitor – has shown efficacy in a 48-week, double-blind, Phase II trial in patients with relapsing MS.

Objective:

Report results of the Phase II open-label extension (OLE; up to week 192 from randomisation) and a cerebrospinal fluid (CSF) sub-study.

Methods:

In the 48-week double-blind period (DBP), patients received evobrutinib 25 mg once-daily, 75 mg once-daily, 75 mg twice-daily or placebo (switched to evobrutinib 25 mg once-daily after week 24). Patients could then enter the OLE, receiving evobrutinib 75 mg once-daily (mean (± standard deviation (SD)) duration = 50.6 weeks (±6.0)) before switching to 75 mg twice-daily.

Results:

Of 164 evobrutinib-treated patients who entered the OLE, 128 (78.0%) completed ⩾192 weeks of treatment. Patients receiving DBP evobrutinib 75 mg twice-daily: annualised relapse rate at week 48 (0.11 (95% confidence interval (CI) = 0.04-0.25)) was maintained with the OLE twice-daily dose up to week 192 (0.11 (0.05–0.22)); Expanded Disability Status Scale score remained stable; serum neurofilament light chain fell to levels like a non-MS population ( Z-scores); T1 gadolinium-enhancing lesion numbers remained low. No new safety signals were identified. In the OLE, evobrutinib was detected in the CSF of all sub-study patients.

Conclusion:

Long-term evobrutinib treatment was well tolerated and associated with a sustained low level of disease activity. Evobrutinib was present in CSF at concentrations similar to plasma.
SUNCT syndrome secondary to multiple sclerosis: Not only trigeminal neuralgia
Authors: Giuliani Giada , Zilli Chiara , Caramia Francesca , Di Piero Vittorio , Altieri Marta
Published: March 2024

Background:

Facial pain in multiple sclerosis is often due to trigeminal neuralgia but atypical pictures can be observed.

Case presentation:

A man with primary progressive multiple sclerosis developed severe unilateral facial pain in the right orbital region. Spontaneous and triggered attacks were associated with ipsilateral conjunctival injection and lacrimation. A diagnosis of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing was made, and symptoms significantly improved with lamotrigine.

Conclusion:

Pain is poorly investigated in multiple sclerosis, with a dramatic impact on patients’ life quality. In this light, standardized evaluation of pain is needed to improve patient management.
Chilean experiences of exile in the “socialist brotherhood” negotiating solidarity, belonging and change in the German Democratic Republic
Authors: Sippel Charlotta Sophie , Weber Lisa
Published: March 2024

Based on the empirical material collected in lifetime-narrative interviews, the article illuminates the multiple experiences of Chilean exiles between solidarity, belonging, Othering and foreignness in the German Democratic Republic (GDR). The focus of the biographical case reconstruction based on Rosenthal is the individual negotiation of Othering practices and narratives, which the interview partners rejected, reinterpreted or strategically used for themselves. The results are biographical snapshots which show that not only encounter with (everyday) racism, but also experienced help and solidarity actions could cause discomfort among the Chilean political exiles, since they reflected the hegemonic conditions underlying their stay in the GDR. The interviewees experienced how state-institutionalised solidarity was linked to the political conditions of the Socialist Unity Party of Germany and had its limits where individuals deviated from the behaviour expected of them. Throughout their lives, the interviewees are torn between Chile and the GDR (and later Germany): Confronted with feelings and constructions of foreignness and belonging(s) in relation to both countries they find different and changing ways of dealing with them over the course of their lives. What they have in common is the impossibility of deciding on a single national identity.
A grounded theory study on Korean doctoral students’ shame experiences in the U.S.: Exploring the role of cultural self-construals
Authors: Kim Juhee , Turner Jeannine E.
Published: March 2024

In this grounded theory study, we explored the influence of cultural self-construals on shame experiences among Korean doctoral students in the U.S. By conducting and analyzing in-depth interviews, we developed a theoretical framework to clarify the factors that triggered participants’ shame, with a particular emphasis on students’ dual self-construals (independent and interdependent self-construals), and the outcomes of shame experiences. The findings highlighted the influence of students’ dual self-construals on different types of self-discrepancies that caused subsequent shame experiences. Additionally, academic cultural differences and amplifying factors, such as students’ shame-proneness, perfectionism, and social comparisons, deepened our understanding of students’ shame experiences. Although instances of experienced shame contributed to students’ cumulative burden of shame, when students used adaptive emotion regulation strategies, they were able to recover and enhance their resilience. This study offers a valuable perspective on the interplay between cultural self-construals and shame experiences, particularly among Korean doctoral students in the U.S., a population that has received limited empirical attention.
Implementation of Sweden's first digi-physical hospital-at-home care model for high-acuity patients
Authors: Kastengren Mikael , Frisk Linda , Winterfeldt Linda , Wahlström Gunilla , Dalén Magnus
Published: March 2024

Aim

To evaluate Sweden's first implementation of a 24/7 high-acuity virtual in-patient ward through a digi-physical in-patient care (DPIPC) program, a hospital-at-home care model combining a virtual hospital-based medical command centre and in-person ambulating medical services functioning as an extension of the Department of Medicine at a secondary-level hospital in Stockholm.

Methods

A single-centre descriptive study where adult patients with acute medical illness requiring inpatient-level care were assessed for voluntary treatment in the DPIPC program as a substitute for traditional in-patient care. The primary outcome was patient satisfaction with care. Secondary outcomes included health care use, safety, and quality during the care episode.

Results

From October 2022 to June 2023 a total of 200 patients were treated within the DPIPC program. The program covered 63 unique medical conditions, with infectious disease (44%) and pulmonary disease (17%) being the most common. The median length of stay (LOS) in the DPIPC program was 3 days (IQR 3) with a median LOS of 2 days (IQR 3) in the physical hospital prior to inclusion. There were no incidents of patient mortality or hospital-related complications during the DPIPC period. A total of 11 (5.5%) patients were escalated to the traditional hospital, 4 (36.4%) of which required ambulance. The median DPIPC patient satisfaction was 10 (IQR 0) and Net Promotor Score was 88.

Conclusions

Implementing a 24/7 high-acuity virtual in-patient ward is feasible and safe for selected patients with acute medical illnesses. Patient satisfaction and care quality within the program is high.
Managing pediatric-onset multiple sclerosis in an austere setting: A case report
Authors: Pierce Pucci Josephine U , Soloria Heather M , Eye Philip G
Published: March 2024

Pediatric-onset multiple sclerosis (POMS) is the most common demyelinating disease in children. Patients suffer from physical disability, cognitive impairment, and psychosocial challenges. Management requires a multidisciplinary care team. Here we present a case of an 11-year-old boy with POMS who relocated to Guam prior to initiation of a disease-modifying treatment and who experienced a flare without immediate access to an MRI or a child neurologist. Care required the combined efforts of ophthalmology, pediatrics, and emergency medicine in Guam, real-time remote guidance by child neurology, and asynchronous collaboration with cardiology and child neurology. As a result, the immediate flare was accurately diagnosed and treated with steroids, the patient was started on Fingolimod, and an emergency management plan for future flares was constructed. This case illustrates the nuances of both the acute and chronic management of multiple sclerosis in a resource-limited setting and how a combination of synchronous and asynchronous telemedicine was able to achieve a satisfactory treatment plan.
Network analysis to examine sex differences linked to emotional well-being in cardiovascular disease
Authors: Hidalgo-Muñoz Antonio R , Tabernero Carmen , Luque Bárbara
Published: March 2024

Psychosocial dimensions are essential to guarantee an optimal approach to improve emotional well-being in patients with cardiovascular disease (CVD). There is evidence of sex differences regarding these dimensions. Thus, the connections between them are crucial to implement personalized therapies. Network model analyses were conducted on data from 593 CVD patients. The models included scores from the Hospital Anxiety and Depression Scale (HADS), positive (PA) and negative affect (NA), positivity (PS), satisfaction of life (SLS), social support (SS), self-efficacy on emotion regulation (RESE), cardiac self-efficacy (CSE) and the Short Form-12 Health Survey. The main sex differences were found in: PA-PS ( p = 0.03), SS-RESE ( p = 0.04), for which the positive associations are stronger for men than for women and PA-RESE ( p < 0.01) for which the positive association is stronger for women than for men. These nuances should be considered to implement tailored and integrative therapies for each CVD patient.
Schumacher in the age of generative AI: Towards a new critique of technology
Authors: Berry David M. , Stockman James
Published: March 2024

This article sets out to bring E. F. Schumacher’s social theory of technology into dialogue with recent advances in the field of generative artificial intelligence (AI). By generative AI, we are here referring to a new constellation of machine learning technologies that aim to simulate and, subsequently, automate human creativity, with a particular focus on OpenAI’s GPT-3 family (ChatGPT and DALL-E). Often overlooked in contemporary debates on machine learning and AI, we argue that Schumacher’s 1973 book, Small is Beautiful, offers a series of insights and concepts that are increasingly relevant for the development of a humanist politics under conditions of computation. With a particular focus on Schumacher’s account of ‘intermediate technology’, we suggest that his emphasis on the social role of human creativity and identification of scale as a crucial concept to deploy in critiquing technology together provide a unique framework within which to (a) address the rise of what we call ‘pathologies of meaning’ and (b) offer a powerful way to consider alternatives to the gigantisms of the FAANG (Facebook, Amazon, Apple, Netflix, Google) and Silicon Valley-style ideologies of digital transformation.
Investigation of shear response due to variation of fiber volume fraction, transverse steel, and placement method on short span R/UHPC beams
Authors: Frank Timothy , Amaddio Peter , Landes Cole , Farrell Darcy , Decko Elizabeth , Tri Alexis
Published: March 2024

This study investigates the response of small-scale, reinforced ultra high performance concrete beams. Seven specimens were cast and experimentally tested. Steel fiber volume fraction, amount of longitudinal and transverse steel reinforcement, and casting direction varied between specimens. High longitudinal reinforcement ratios of 4.1% and 9.5% were expected to drive relatively large shear demands and low steel fiber volume fractions of 0.5% and 1% were expected to decrease the UHPC’s ability to resist tension, shear, and compression. Specimens were either cast at one end or mid-span. All specimens failed in shear, as expected. R/UHPC beams with only 0.5% fibers and a stirrup spacing equal to half the beam’s depth carried more ultimate load than beams with 1% fibers and twice the stirrup spacing. At a 0.5% fiber volume fraction, UHPC performed well, exhibiting fiber bridging in tension and resisting spalling in compression. As longitudinal reinforcement ratio increased from 4.1% to 9.5%, load carrying capacity generally increased, but not proportional to the increase in steel. Placement method did not influence fiber orientation in the R/UHPC beams when measured in 2D planes transverse or longitudinal to the specimens’ major axis. The longitudinal and transverse reinforcement interrupted fiber flow and prevented significant fiber alignment; combined with the short span of the beams, these factors mitigated the influence of placement method.
Low-carbon environmental control system for storage of earthen relics in exhibition hall: From the perspectives of nature based solution
Authors: Xin Guanbai , Feng Zhuangbo , Zhang Xingpeng , Wang Junqi , Cao Shi-Jie
Published: March 2024

For the purpose of effectively providing protection and utilization of historical earthen sites, the fully-enclosed exhibition halls with electricity driven air-conditioning have been successfully adopted to provide a suitable preservation air environment. However, its electricity consumption and carbon emissions are considerable due to the continuous operation of environmental control, the energy consumption of air cooling in exhibition halls can reach more than 10 times that of office buildings. To further reduce energy consumption, this current study drew on the concept of NBS (Nature Based Solution) and proposed a low-carbon environmental control system for an enclosed exhibition hall for storage of earthen relics by applying natural energy (solar photovoltaic and earth-air-cooling) and space optimization. Firstly, a numerical model was established to simulate the preservation environment in exhibition halls and the electricity consumption of each energy subsystem. Then the model was applied to optimize the design parameters (e.g. earth-air tunnel and airflow pattern) for the environmental control system. Numerical results showed that the electricity consumption was reduced by 58% by applying earth-air-cooling and solar photovoltaic. After optimization of the exhibition hall height, electricity consumption was approximately reduced by 65%. This research is of great value to mitigate energy consumption problems encountered in earthen relics museums and other similar environments.
Digitalisation and the welfare state – how First Nations people experienced digitalised social security under the Cashless Debit Card
Authors: Bielefeld Shelley
Published: March 2024

Digitalisation of the welfare state has intensified in recent years, with burdens unevenly distributed between technology advocates and those receiving government income support. Putting in place processes where people needing social security must meet mandatory requirements of digital literacy and divert a significant amount of their small incomes to pay for expensive technologies such as computers, smartphones, and data plans comes at a cost. This article examines lived experiences of First Nations Cashless Debit Card (CDC) holders who experienced digitalisation of their social security payments. Under the CDC, a range of restrictions were placed on purchases, spending social security income came with stigma, technology troubles meant that income was less secure, and Indigenous peoples’ autonomy was undermined. Although the CDC has since been abolished, these issues remain relevant as a new cashless social security card, the SmartCard, has been introduced in 2023.