bluuebunny/crossref_metadata_2025 huggingface dataset:
Mid-Term Results of Endovascular Aneurysm Sealing in the Treatment of Abdominal Aortic Aneurysm With Unfavorable Morphology
Authors: Dzieciuchowicz Łukasz , Tomczak Jolanta , Strauss Ewa , Oszkinis Grzegorz
Published: October 2020

Purpose:

To report mid-term results of endovascular aneurysm sealing (EVAS) of abdominal aortic aneurysms (AAA) deemed unsuitable for a standard endovascular aneurysm repair (EVAR).

Methods:

A prospectively maintained database of 42 patients with EVAR-unfavorable anatomy treated by EVAS combined with chimney grafts in case of the proximal AAA neck shorter than 5 mm was analyzed. Early outcomes included final angiographic result, intra- and early post-operative deaths, and complications. Mid-term outcomes included all-cause mortality (ACM), aneurysm-related mortality (ARM), patency of the stents, occurrence of endoleaks, serious complications and graft failures defined as the AAA growth of more than 5 mm, type I endoleak, occlusion of the stent-graft or chimney graft, aorto-duodenal fistula, or aneurysm rupture.

Results:

The procedure was completed in all patients. Twenty-eight chimney grafts were implanted in 19 patients. Patients were followed for a median of 24 months (range 12-34 months). There were 2 intraoperative ruptures and 1 patient died in an early postoperative period. The cumulative ACM was 15, 21, and 36% at 12, 24, and 36 months, respectively, and the cumulative ARM was 8, 11, and 27% at 12, 24, and 36 months, respectively. Three out of 5 aneurysm-related deaths were due to a secondary aorto-duodenal fistula. The cumulative incidence of graft failure was 20, 27, and 42% at 12, 24, and 36 months, respectively. The cumulative incidence of an endoleak was 5, 9, and 23% at 12, 24, and 36 months, respectively. The graft failure increased significantly both ACM (p = .012) and ARM (p = .00003). The implantation of chimney grafts at the initial procedure increased ARM significantly (p = .008). The presence of an endoleak did not have any significant influence on ACM and ARM.

Conclusion:

Patients treated with EVAS for AAAs with EVAR-unfavorable anatomy, especially those with chimney grafts, exhibit a high risk of graft failure and subsequent death.
White noise jammer mathematical modelling and simulation
Authors: Kostis Theodoros G
Published: October 2020

The radar equation is the fundamental mathematical model of the basic function of a radar system. Moreover, there are many versions of the radar equation, which correspond to particular radar operations, like low pulse repetition frequency (PRF), high PRF, or surveillance mode. In many cases, all these expressions of the radar equation exist in their combined forms, giving little information to the actual physics and signal geometry between the radar and the target involved in the process. In this case study, we divide the radar equation into its major steps and present a descriptive mathematical modelling of the radar and other related equations utilizing the free space loss and target gain concepts to simulate the effect of a white noise jammer on an adversary radar. We believe that this work will be particularly beneficial to instructors of radar courses and to radar simulation engineers because of its analytical block approach to the main equations related to the fields of radar and electronic warfare. Finally, this work falls under the field of predictive dynamics for radar systems using mathematical modelling techniques.
Trust-based energy-efficient routing protocol for Internet of things–based sensor networks
Authors: Ilyas Muhammad , Ullah Zahid , Khan Fakhri Alam , Chaudary Muhammad Hasanain , Malik Muhammad Sheraz Arshed , Zaheer Zafar , Durrani Hamood Ur Rehman
Published: October 2020

Internet of things grew swiftly and many services, software, sensors-embedded electronic devices and related protocols were developed and still in progress with full swing. Internet of things enabling physically existing things to see, hear, think and perform a notable task by allowing them to talk to each other and share useful information while making decision and caring-on/out their important tasks. Internet of things is greatly promoted by wireless sensor network as it becomes a perpetual layer for it. Wireless sensor network works as a base-stone for most of the Internet of things applications. There are severe general and specific threats and technical challenges to Internet of things–based sensor networks which must overcome to ensure adaptation and diffusion of it. Most of the limitations of wireless sensor networks are due to its resource constraint objects nature. The specified open research challenges in Internet of things–based sensor network are power consumption, network lifespan, network throughput, routing and network security. To overcome aforementioned problems, this work aimed to prolong network lifetime, improve throughput, decrease packet latency/packet loss and further improvise in encountering malicious nodes. To further tune the network lifetime in terms of energy, wireless harvesting energy is suggested in proposed three-layer cluster-based wireless sensor network routing protocol. The proposed mechanism is a three-tier clustering technique with implanted security mechanism to encounter malicious activities of sensor nodes and to slant them into blacklist. It is a centred-based clustering protocol, where selection of cluster head and grid head is carried out by sink node based on the value of its cost function. Moreover, hardware-based link quality estimators are used to check link effectiveness and to further improve routing efficiency. At the end, excessive experiments have been carried out to check efficacy of the proposed protocol. It outperforms most of its counterpart protocols such as fuzzy logic–based unequal clustering and ant colony optimization–based routing hybrid, Artificial Bee Colony-SD, enhanced three-layer hybrid clustering mechanism and energy aware multi-hop routing in terms of network lifetime, network throughput, average energy consumption and packet latency.
The Use of Twisting and Tightening Tool to Strengthen the Cerclage and Tension Band Wiring
Authors: Uygur Esat , Yayla Mehmet A. , Yürektürk Yakup , Akpinar Fuat
Published: October 2020

Cerclage and tension band wiring are being used in most bone surgeries in different disciplines. The regularity of the twist on the node of a cerclage and tension band is thought to determine cerclage stability. For this purpose, a novel twisting and tightening tool was designed. This tool maintains extremely regular twists on the node, which we consider to be important for stability. In the present biomechanical trial, we aimed to investigate the consistency of the twists forming the cerclage node. This study was performed on a total of 30 cerclage loops. In group A (n = 15), the cerclage wire was tightened manually by a clipper, while in group B (n = 15), it was tightened using the twisting and tightening tool. In biomechanical tests, the cerclage loops were pulled apart by 2 hooks connected to the biomechanical device. The velocity was adjusted to 20 mm/min. On statistical analysis, there was a significant difference in the ultimate strength ( P = .03) and the mean tensile strength ( P = .01) between groups A and B. It was found that the strength of the cerclage wire can be increased by maintaining more regular twists. The twisting and tightening tool is a reasonable and useful device for both clinical and experimental usages.
Incidence of Silent Deep Venous Thrombosis after Laparoscopic Bariatric Surgery in Patients Who Received Combined Mechanical and Chemical Thromboprophylaxis Compared to Patients Who Received Mechanical Thromboprophylaxis Only
Authors: Ahmad Khaled S. , Zayed Mohamed E. , Faheem Mohamed H. , Essa Mohamed S.
Published: October 2020

Background. This prospective randomized study compares the incidence of silent deep venous thrombosis (DVT) among 2 groups of patients who underwent laparoscopic bariatric surgery. The first group received mechanical thromboprophylaxis only, while the second group received a combination of mechanical and chemical thromboprophylaxis. Methods. This study included 150 morbidly obese patients who underwent primary one-stage laparoscopic bariatric surgery (sleeve gastrectomy and mini-gastric bypass) over a 6-month period. Patients were randomly assigned to 2 groups: group A (n = 75) was subjected to mechanical thromboprophylaxis in the form of perioperative elastic stockings on both lower limbs and early postoperative ambulation, and group B (n = 75) was subjected to combined mechanical thromboprophylaxis and chemical thromboprophylaxis in the form of 40 mg subcutaneous enoxaparin 12 hours before surgery and postoperative enoxaparin (40 mg subcutaneous every 24 hours) for 2 weeks. Bilateral lower limb venous duplex was done for all patients before discharge, on the second and fourth weeks postoperatively, to detect silent DVT. Results. Nine patients out of 150 patients developed silent DVT (6%). All patients among group A were subjected to mechanical thromboprophylaxis only (12%) [ P = .247, relative risk: .45, 95% confidence interval; .37-.62]. There was no silent DVT among group B who received combined mechanical and chemical thromboprophylaxis. No bleeding complications were reported in both groups. Conclusion. Combined mechanical and mechanical thromboprophylaxis is effective and safe in the prevention of silent DVT after laparoscopic bariatric surgery. Trial registration: The trial was registered in the Thai Clinical Trials Registry (TCTR20200127002) on January 20, 2020 retrospectively.
Mechanisms of self-organization in tribosystems operating under conditions of abnormally low friction and wear
Authors: Voitov Viktor , Stadnychenko Viacheslav , Varvarov Valeriy , Stadnychenko Nikolay
Published: October 2020

The article presents theoretical and experimental studies of tribosystems operating under conditions of normal and abnormally low friction and wear when changing the external conditions of their operation. A comparative analysis of self-organization mechanisms of tribosystem operating under conditions of normal mechanochemical and abnormally low friction and wear is performed to determine the conditions of transition to such a mode. There was determined another possible way of converting tribosystems to conditions of abnormally low friction and wear by modifying the surface layer of bronze specimens using finishing treatment with the use of a mineral of amphiboles (jade) group.
Mechanistic studies on the role of TGF-β1 in angiogenesis through EndMT
Authors: Cao Sheng-Jun , Hong Lei , Li Xiao-Qiang
Published: October 2020

Objective

This study aims to investigate the mechanism of transforming growth factor-β1 (TGF-β1) in promoting angiogenesis through endothelial-to-mesenchymal transition (EndMT).

Methods

The mesenchymal transition of human umbilical vein endothelial cells (HUVECs) was induced by TGF-β1. The angiogenesis, migration, and proliferation of HUVECs undergoing EndMT were examined by tube formation assay, scratch assay, Transwell assay, and CCK-8 assay.

Results

The outcomes revealed that EndMT promoted angiogenesis, migration, and proliferation of HUVECs and the secretion of the vascular endothelial growth factor (VEGF) of HUVECs. Phosphorylated AKT (p-AKT) increased in EndMT by inhibiting the mitigation of angiogenesis.

Conclusion

EndMT induces angiogenesis by promoting the secretion of VEGF, and p-AKT participates in this regulation.
Online educational research with middle adolescent populations: Ethical considerations and recommendations
Authors: Mackenzie Erin , Berger Nathan , Holmes Kathryn , Walker Michelle
Published: October 2020

Adolescent populations have become increasingly accessible through online data collection methods. Online surveys are advantageous in recruiting adolescent participants and can be designed for adolescents to provide informed consent without the requirement of parental consent. This study sampled 338 Australian adolescents to participate in a low risk online survey on adolescents’ experiences and perceptions of their learning in science classes, without parental consent. Adolescents were recruited through Facebook and Instagram advertising. In order to judge potential participants’ capacity to consent, two multiple-choice questions about the consent process were required to be answered correctly prior to accessing the survey. This simple strategy effectively determined whether middle adolescents had the capacity to provide informed consent to participate in low risk online educational research.
Fixated in more familiar territory: Providing an explicit midpoint for typical and atypical number lines
Authors: Di Lonardo Burr Sabrina , LeFevre Jo-Anne
Published: October 2020

Does providing an explicit midpoint affect adults’ performance differently for typical and atypical number line tasks? Participants ( N = 29) estimated the location of target numbers on typical (i.e., 0–10,000) and atypical (i.e., 0–7,000) number lines with either an explicitly labelled midpoint or no midpoint. For the typical number line, estimation accuracy did not differ for the explicit- and implicit-midpoint conditions. For the atypical number line, participants in the explicit-midpoint condition were more accurate than those in the implicit-midpoint condition and their pattern of error was similar to that seen for typical number lines (i.e., M-shaped). In contrast, for participants in the implicit-midpoint condition, the pattern of error on the atypical line was tent-shaped, with less accurate estimates around the midpoint and quartiles than the endpoints. Eye-tracking data showed that, for all number lines, participants used the middle of the line to guide their estimates, but participants in the explicit-midpoint condition were more likely to make their first fixation around the true midpoint than those in the implicit–midpoint condition. We conclude that adults have difficulty in estimating on atypical number lines because they incorrectly calculate the numerical value of the midpoint.
Introduction to the Special Issue: Renewing Theories of Practice and Reappraising the Cultural
Authors: Welch Daniel , Halkier Bente , Keller Margit
Published: October 2020

This short article introduces the Special Issue ‘Renewing Theories of Practice and Reappraising the Cultural’. We first discuss the ‘practice turn’ in the sociology of consumption. We introduce three lacunae that advocates have identified in contemporary theories of practice that animate the contributions of the Special Issue: around the theorisation of culture, economy and the reflexive individual. We go on to discuss the place of culture in the ‘practice turn’, and its relations to cultural sociology. We then appraise some recent attempts at resolution. Lastly, we summarise the individual contributions to the Special Issue.
Depression is associated with subsequent risk of pleural empyema
Authors: Shen Yi-Chen , Liao Kuang-Ming , Lin Yen-Sung , Huang Yu-Jhen , Lin Cheng-Li , Tsai Chia-Wen , Chang Wen-Shin , Shen Te-Chun , Bau Da-Tian , Hsia Te-Chun
Published: October 2020

Background:

Respiratory system infections are prevalent in patients with depression. However, it remains unclear if patients with depression are at an increased risk of developing pleural empyema.

Methods:

We conducted a retrospective cohort study using data from the National Health Insurance Research Database of Taiwan. The depression group included 42,283 newly diagnosed patients between 2000 and 2012. The comparison group included the same number of individuals without depression, frequency matched for age, sex, comorbidities, and the year of diagnosis. The occurrence of pleural empyema was monitored until the end of 2013.

Results:

The overall incidence of pleural empyema was 1.32-fold higher in the depression group than in the comparison group (3.94 versus 2.97 per 10,000 person-years), with an adjusted hazard ratio of 1.33 (95% confidence interval, 1.27−1.40). Stratified analyses by age, sex, and comorbidity revealed that the crude and adjusted hazard ratios of pleural empyema associated with depression were significant in all subgroups. The 30-day mortality for pleural empyema was higher, but not significantly, in the depression group compared to the comparison group (10.7% versus 6.4%, adjusted odds ratio = 2.23, 95% confidence interval, 0.77−6.49).

Conclusion:

An association between depression and the development of pleural empyema may exist; however, more evidence is required to support this association. The reviews of this paper are available via the supplemental material section.
Biomechanics of axial load transmission across the native human elbow
Authors: Smithson Kaleb , Smith Jacob , Hogue William , Mannen Erin , Ahmadi Shahryar
Published: October 2020

Background

Elbow and forearm motion are thought to affect elbow load transmission, yet little empirical evidence exists to quantify the biomechanics.

Methods

Eight fresh-frozen human cadaver upper extremities were utilized. A 100 N axial force was applied across the elbow joint at elbow flexion angles of (0°, 30°, 60°, and 90°) and forearm rotation angles (0°, 45° supination, and 45° pronation). Pressure mapping sensors were placed in both the radiocapitellar and ulnotrochlear joints. Force distributions and contact areas were measured, and paired t-tests were used for comparison (p < 0.05).

Results

The average maximum loading percentage of the radiocapitellar and ulnotrochlear joint pressures were 57.8 ± 4.6% and 42.2 ± 4.6%, respectively. Elbow flexion angle and forearm rotation did not significantly affect the joint loading. There was no significant difference between the contact areas of each joint, although ulnotrochlear and radiocapitellar joints demonstrated an inverse relationship.

Conclusion

Our study is the only one to date to comprehensively evaluate loading mechanics throughout both functional elbow flexion and forearm rotation across both articulations. The load sharing ratio across the radiocapitellar and ulnotrochlear joints was 58%:42%, agreeing with previously reported ratios with limited parameters. A relationship may be present between increasing radiocapitellar and decreasing ulnotrochlear contact areas as elbow flexion increases.
COVID-19 and European security of supply: Growing in importance
Authors: Vanhanen Henri
Published: October 2020

The COVID-19 pandemic struck the world hard in early 2020, and we are still coping with the ramifications of the ongoing crisis. The most acute concerns deal with the gloomy economic impact of the pandemic. However, the crisis has also revealed severe shortcomings in the EU’s approach to the security of supply. Many member states initially found themselves dealing with the crisis alone or lacking essential medical resources. Since the early stages, it has become evident that while security of supply has so far been a matter of national decisions, the EU needs a comprehensive strategy to improve its crisis resilience. Finland has a long tradition of making a coordinated effort to ensure an adequate supply of items needed for emergencies. Thus, the Finnish model could provide the basis for a more inclusive and integrated EU-level security of supply.
Stability of Glucose Concentrations in Frozen Plasma
Authors: Pleus Stefan , Freckmann Guido , Baumstark Annette , Haug Cornelia
Published: October 2020

Background:

Conflicting information is available regarding the stability of glucose concentrations in frozen plasma samples. Clinical trials could benefit from such long-term storage because it would allow usage of a central laboratory with higher-quality laboratory analyzers in contrast to mobile analyzers in a decentralized setting.

Methods:

In this study, venous blood samples were collected in lithium-heparin gel tubes. Plasma was separated immediately after blood was drawn, and from each of the 21 plasma samples, 6 aliquots were prepared for measurement at 6 time points: immediately and after 2, 4, 6, 8, and 12 weeks. Between sampling and measurement, aliquots were stored at less than −20°C. Transport on dry ice was simulated by placing aliquots in a −80°C freezer for 5 days between weeks 8 and 12. Measurements were performed on a hexokinase-based laboratory analyzer. Average relative differences and corresponding 99% confidence intervals (CIs) were calculated between the stored aliquots’ and the immediately measured aliquots’ glucose concentrations. Glucose concentrations were deemed stable as long as average relative differences were ≤±2.5%.

Results:

Over the whole 12-weeks duration, the largest average relative difference was −1.82% (99% CI: –2.25% to −1.39%). Shorter storage durations tended to lead to less bias.

Conclusion:

In this study, the stability of glucose concentrations in frozen plasma samples obtained with lithium-heparin gel tubes could be shown for up to 12 weeks. Future studies should be performed to assess whether this is independent of the glucose analyzer and the type of sampling tube used.
Resorbable Pins to Enhance Scaffold Retention in a Porcine Chondral Defect Model
Authors: Patel Jay M. , Sennett Mackenzie L. , Martin Anthony R. , Saleh Kamiel S. , Eby Michael R. , Ashley Blair S. , Miller Liane M. , Dodge George R. , Burdick Jason A. , Carey James L. , Mauck Robert L.
Published: October 2020

Objective

Cartilage repair strategies have seen improvement in recent years, especially with the use of scaffolds that serve as a template for cartilage formation. However, current fixation strategies are inconsistent with regards to retention, may be technically challenging, or may damage adjacent tissues or the implant itself. Therefore, the goal of this study was to evaluate the retention and repair potential of cartilage scaffolds fixed with an easy-to-implement bioresorbable pin.

Design

Electrospun hyaluronic acid scaffolds were implanted into trochlear groove defects in 3 juvenile and 3 adult pigs to evaluate short-term retention (2 weeks; pin fixation vs. press-fit and fibrin fixation) and long-term repair (8 months; scaffold vs. microfracture), respectively.

Results

For the retention study, press-fit and fibrin fixation resulted in short-term scaffold dislodgment ( n = 2 each), whereas pin fixation retained all scaffolds that were implanted ( n = 6). Pin fixation did not cause any damage to the opposing patellar surface, and only minor changes in the subchondral bone were observed. For long-term repair, no differences were observed between microfracture and scaffold groups, in terms of second-look arthroscopy and indentation testing. On closer visualization with micro computed tomography and histology, a high degree of variability was observed between animals with regard to subchondral bone changes and cartilage repair quality, yet each Scaffold repair displayed similar properties to its matched microfracture control.

Conclusions

In this study, pin fixation did not cause adverse events in either the short- or the long-term relative to controls, indicating that pin fixation successfully retained scaffolds within defects without inhibiting repair.
Perceived and sources of occupational stress in surgical intensive care nurses
Authors: Bulbuloglu Semra , Kapikiran Gurkan , Saritas Serdar
Published: October 2020

Aim:

The study aimed to determine sources of stress and stress levels of nurses working in surgical intensive care units in addition to understanding the stress level in nurses, drawing attention and raising awareness.

Material and methods:

The study was conducted using a descriptive design with the participation of nurses ( n=132) working in surgical intensive care units of a university hospital. The data were collected through the source of stress identification form and perceived stress scale. The data obtained in the study were transferred to a computer environment, and for statistical analyses, the package for social sciences for Windows 25 software was used. In the analyses of the data, descriptive statistics, independent t-test, one-way analysis of variance and regression analysis, and the Bonferroni test were employed.

Results:

It was also determined that 28.8% of the surgical nurses were working in an organ transplant intensive care unit and 25% worked in an anaesthesia intensive care unit, that 49.3% had professional experience of between 6 and 11 years and that 92.4% worked on both day and night shifts. In the study, the rate of nurses who perceived a high level of stress was found to be 45.5%, and it was identified that 78.8% needed training in stress management.

Conclusion:

Imperative funding and human resources should be provided in order to give nurses problem-solving abilities and a stress management course. The financial support of the managers and spiritual support of health professionals and organising regular meetings with nurses can help nurses to experience less stress.
Bison, anthropogenic fire, and the origins of agriculture in eastern North America
Authors: Mueller Natalie G , Spengler Robert N , Glenn Ashley , Lama Kunsang
Published: October 2020

Scholars have argued that plant domestication in eastern North America involved human interactions with floodplain weeds in woodlands that had few other early successional environments. Archeological evidence for plant domestication in this region occurs along the Mississippi river and major tributaries such as the Tennessee, Ohio, Illinois, Missouri, and Arkansas rivers. But this region is also known as the prairie peninsula: a prairie-woodland mosaic that was maintained by anthropogenic fire starting as early as 6000 BP. Contrary to conventional wisdom, recent research has shown that bison were also present in the prairie peninsula throughout the Holocene. Recent reintroductions of bison to tallgrass prairies have allowed ecologists to study the effects of their grazing on this ecosystem for the first time. Like rivers and humans, bison create early successional habitats for annual forbs and grasses, including the progenitors of eastern North American crops, within tallgrass prairies. Our fieldwork has shown that crop progenitors are conspicuous members of plant communities along bison trails and in wallows. We argue that ancient foragers encountered dense, easily harvestable stands of crop progenitors as they moved along bison trails, and that the ecosystems created by bison and anthropogenic fire served as a template for the later agroecosystem of this region. Without denying the importance of human-river interactions highlighted by previous researchers, we suggest that prairies have been ignored as possible loci for domestication, largely because the disturbed, biodiverse tallgrass prairies created by bison have only been recreated in the past three decades after a century of extinction.
Restrictive and Supportive Mechanisms for Female Directors’ Risk-Averse Behavior: Evidence From South Asian Health Care Industry
Authors: Yahya Farzan , Abbas Ghulam , Ahmed Ammar , Hashmi Muhammad Sadiq
Published: October 2020

This article aims to understand the impact of gender diversity on a firm’s equity volatility along with the moderating effect of chief executive officer (CEO) pay–performance sensitivity, institutional activism, and corporate social responsibility (CSR) activities. The sample consists of 200 South Asian health care firms over the period 2010 to 2018. After confirming the prevalence of endogeneity, we rely on the results of system generalized method of moments (GMM) rather than any static model. The results show that a higher representation of women on the board can mitigate the firm’s equity volatility. The findings of the study also purport that CEOs with higher pay–performance sensitivity exploit female directors to take the excessive risk, whereas institutional investors support the risk-averse behavior of these directors. However, we find no statistical evidence that CSR activities moderate the relationship between gender diversity and firm’s equity volatility. Our results theoretically support both stakeholder and agency perspectives that South Asian capital markets should enhance the representation of women on board to mitigate agency conflicts and to improve long-term firm’s sustainability.
Does Financial Sector Promote Economic Growth in Pakistan? Empirical Evidences From Markov Switching Model
Authors: Rahman Abdul , Khan Muhammad Arshad , Charfeddine Lanouar
Published: October 2020

This study investigates the financial development–economic growth relationship in Pakistan over the period 1975–2017 using the Markov Switching methodology. The financial development index has been constructed using the principal component analysis. Unexpectedly, the empirical result shows that financial development contributing negatively to economic growth in the high and the low economic growth regimes in Pakistan. Moreover, the results indicate that labor force retards economic growth with a higher magnitude. A significant positive effect of gross fixed capital formation on economic growth is also observed. The results reveal that policymakers may revisit the financial development policies so that the financial sector may contribute positively to economic growth process in Pakistan. In this respect, more steps are needed to further liberalize the financial sector to enhance economic growth in Pakistan.
Green Marketing to Gen Z Consumers in China: Examining the Mediating Factors of an Eco-Label–Informed Purchase
Authors: Song Yao , Qin Zhenzhen , Qin Zihao
Published: October 2020

Although China has enjoyed great economic growth in the past several years, environmental problems have not attracted enough attention, especially for the young Chinese population (Generation Z consumers). Based on the theory of planned behavior, this work aims to analyze the mediation role of product attributes, perceived consumer effectiveness (PCE), and environmental awareness in eco-label–informed purchase for Gen Z consumers in China. According to the result, it shows (a) eco-label–informed purchase could significantly increase two threads of PCE and product attributes, (b) those two threads intermediate the eco-labeling and environmental awareness positively, and (c) eventually lead to purchase behavior for Chinese Generation Z. For theoretical contribution, this article tries to have a more comprehensive investigation on green consumption, and to explore the theoretical relationship among product attributes, PCE, and environmental awareness in the context of Chinese Gen Z. Relevant managerial implications and practical guides are also discussed in this article.
Can Acupuncture Improve Chronic Spinal Pain? A Systematic Review and Meta-Analysis
Authors: Huang Jin-Feng , Zheng Xuan-Qi , Chen Dong , Lin Jia-Liang , Zhou Wen-Xian , Wang Hui , Qin Zongshi , Wu Ai-Min
Published: October 2020

Study Design:

Systematic review and meta-analysis.

Objective:

To investigate the effect and safety of acupuncture for the treatment of chronic spinal pain.

Methods:

MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, the WHO Clinical Trial Registry, and the US National Library of Medicine clinical trial registry were searched from January 1, 2000, to November 1, 2019. Randomized controlled trials (RCTs) involving patients with chronic spinal pain treated by acupuncture versus sham acupuncture, no treatment, or another treatment were included.

Results:

Data was extracted from 22 RCTs including 2588 patients. Pooled analysis revealed that acupuncture can reduce chronic spinal pain compared to sham acupuncture (weighted mean difference [WMD] −12.05, 95% confidence interval [CI] −15.86 to −8.24), mediation control (WMD −18.27, 95% CI −28.18 to −8.37), usual care control (WMD −9.57, 95% CI −13.48 to −9.44), and no treatment control (WMD −17.10, 95% CI −24.83 to −9.37). In terms of functional disability, acupuncture can improve physical function at immediate-term follow-up (standardized mean difference [SMD] −1.74, 95% CI −2.04 to −1.44), short-term follow-up (SMD −0.89, 95% CI −1.15 to −0.62), and long-term follow-up (SMD −1.25, 95% CI −1.48 to −1.03).

Conclusion:

In summary, compared to no treatment, sham acupuncture, or conventional therapy such as medication, massage, and physical exercise, acupuncture has a significantly superior effect on the reduction in chronic spinal pain and function improvement. Acupuncture might be an effective treatment for patients with chronic spinal pain and it is a safe therapy.
Narrative Review of Predictive Analytics of Patient-Reported Outcomes in Adult Spinal Deformity Surgery
Authors: Lehner Kurt , Ehresman Jeff , Pennington Zach , Ahmed A. Karim , Lubelski Daniel , Sciubba Daniel M.
Published: October 2020

Study Design:

Narrative review

Objective:

Decision making in surgery for adult spinal deformity (ASD) is complex due to the multifactorial etiology, numerous surgical options, and influence of multiple medical and psychosocial factors on patient outcomes. Predictive analytics provide computational tools to analyze large data sets and generate hypotheses regarding new data. In this review, we examine the use of predictive analytics to predict patient-reported outcomes (PROs) in ASD surgery.

Methods:

A search of PubMed, Web of Science, and Embase databases was performed to identify all potentially relevant studies up to February 1, 2020. Studies were included based on the use of predictive analytics to predict PROs in ASD.

Results:

Of 57 studies identified and reviewed, 7 studies were included. Multiple algorithms including supervised and unsupervised methods were used. Significant heterogeneity was observed with choice of PROs modeled including ODI, SRS22, and SF36, assessment of model accuracy, and with the model accuracy and area under the receiver operating curve values (ranging from 30% to 86% and 0.57 to 0.96, respectively). Models were built with data sets of patients ranging from 89 to 570 patients with a range of 22 to 267 variables.

Conclusions:

Predictive analytics makes accurate predictions regarding PROs regarding pain, disability, and work and social function; PROs regarding satisfaction, self-image, and psychologic aspects of ASD were predicted with the lowest accuracy. Our review demonstrates a relative paucity of studies on ASD with limited databases. Future studies should include larger and more diverse databases and provide external validation of preexisting models.
The Impact of Diabetes on Outcomes and Health Care Costs Following Anterior Cervical Discectomy and Fusion
Authors: Shuman William H. , Neifert Sean N. , Gal Jonathan S. , Snyder Daniel J. , Deutsch Brian C. , Zimering Jeffrey H. , Rothrock Robert J. , Caridi John M.
Published: October 2020

Study Design:

Retrospective cohort study.

Objectives:

Anterior cervical discectomy and fusion (ACDF) is commonly used to treat an array of cervical spine pathology and is associated with good outcomes and low complication rates. Diabetes mellitus (DM) is a common comorbidity for patients undergoing ACDF, but the literature is equivocal about the impact it has on outcomes. Because DM is a highly prevalent comorbidity, it is crucial to determine if it is an associated risk factor for outcomes after ACDF procedures.

Methods:

Patients at a single institution from 2008 to 2016 undergoing ACDF were compared on the basis of having a prior diagnosis of DM versus no DM. The 2 cohorts were compared utilizing univariate tests and multivariate logistic and linear regressions.

Results:

Data for 2470 patients was analyzed. Diabetic patients had significantly higher Elixhauser scores ( P < .0001). Univariate testing showed diabetic patients were more likely to suffer from sepsis (0.82% vs 0.10%, P = .03) and bleeding complications (3.0% vs 1.5%, P = .04). In multivariate analyses, diabetic patients had higher rates of non–home discharge (odds ratio [OR] = 1.37, 95% confidence interval [CI] = 1.07-1.75, P = .013) and prolonged length of stay (OR = 1.95, 95% CI = 1.25-3.05, P = .003), but similar complication (OR = 1.46, 95% CI = 0.85-2.52, P = .17), reoperation (OR = 0.77, 95% CI = 0.33-1.81, P = .55), and 90-day readmission (OR = 1.53, 95% CI = 0.97-2.43) rates compared to nondiabetic patients. Direct cost was also shown to be similar between the cohorts after adjusting for patient, surgical, and hospital-related factors (estimate = −$30.25, 95% CI = −$515.69 to $455.18, P = .90).

Conclusions:

Diabetic patients undergoing ACDF had similar complication, reoperation, and readmission rates, as well as similar cost of care compared to nondiabetic patients.
Flexural properties, bond ability, and crystallographic phase of highly translucent multi-layered zirconia
Authors: Maruo Yukinori , Yoshihara Kumiko , Irie Masao , Nishigawa Goro , Nagaoka Noriyuki , Matsumoto Takuya , Minagi Shogo
Published: October 2020

This study investigated the mechanical properties, bond ability, and crystallographic forms of different sites in a highly translucent, multi-layered zirconia disk. Flexural properties, bond ability to resin cement, and phase composition were investigated at three sites of a highly translucent, multi-layered zirconia disk: incisal, middle, and cervical. Flexural strength (FS) and flexural modulus (FM) were measured with static three-point flexural test. Shear bond strength (SB) to resin cement was measured after 24 h storage (37°C). Phase composition under mechanical stress was analyzed using X-ray diffraction. Without air abrasion, FS at the incisal site yielded the lowest value and was significantly lower than the middle and cervical sites. Air abrasion lowered the FS of each site. FM at the incisal site without air abrasion showed the significantly lowest value, and air abrasion increased its FM value. At the middle and cervical sites, their FM values were higher than the incisal site but were not significantly affected by air abrasion. SB value did not show significant differences among the sites. After sintering, cubic zirconia was detected at each site. Rhombohedral phase transformation occurred after mirror polishing. In highly translucent, multi-layered zirconia which was mainly composed of cubic zirconia, rhombohedral phase transformation occurred under mechanical stress and resulted in weakened mechanical properties.
Clinical Outcomes of an All-Arthroscopic Biceps Tenodesis Using the Anterolateral Anchor During Concomitant Double-Row Rotator Cuff Repair
Authors: Meghpara Mitchell B. , Schulz William , Buerba Rafael A. , Golan Elan J. , Vyas Dharmesh
Published: October 2020

Background:

Pathology of the long head of the biceps tendon frequently occurs concomitantly with rotator cuff tears, necessitating a surgical treatment, often in the form of a tenodesis procedure. Many techniques for a tenodesis exist; however, they often require additional implants or a separate incision.

Purpose:

To report an average of 2-year outcomes of an all-arthroscopic biceps tenodesis employing the stay sutures from the anterolateral anchor during concomitant double-row rotator cuff repair (RCR).

Study Design:

Case series; Level of evidence, 4.

Methods:

Data were prospectively collected and retrospectively reviewed for all patients who underwent an all-arthroscopic biceps tenodesis during concomitant double-row RCR by the senior author between January 2014 and May 2018. Patients were included if they underwent this procedure and had baseline preoperative patient-reported outcomes (PROs) with a minimum of 1 year of postoperative PROs for the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) for pain score. Additionally, patient data, surgical history, postoperative complications, and satisfaction were reported.

Results:

Fifteen patients were eligible for the study. There were 12 (80%) men and 3 (20%) women with a mean age of 50.0 years (range, 35-64 years). The mean follow-up time was 25.2 months (range, 13-63 months). Six of 15 (40%) patients also had an arthroscopic subscapularis repair performed. ASES shoulder scores improved from 37.1 preoperatively to 94.1 postoperatively ( P < .001), and VAS scores improved from 6.4 preoperatively to 0.5 postoperatively ( P < .001). One patient who underwent concomitant subscapularis repair reported continued anterior groove pain. No patients experienced biceps cramping, developed a deformity, or required a repeat operation at the final follow-up. Overall, 93.3% of the patients reported being highly satisfied with their surgery.

Conclusion:

This study presents the clinical results of an all-arthroscopic technique for concomitant double-row RCR and biceps tenodesis, which resulted in high rates of patient satisfaction and significant improvement in reported shoulder outcome and pain scores. Additionally, this technique offers the potential benefits of avoiding a secondary incision, which may decrease surgical morbidity while also decreasing cost by eliminating the need for an extra, tenodesis-specific implant.
Efficiently cleaved HIV-1 envelopes: can they be important for vaccine immunogen development?
Authors: Das Supratik , Kumar Rajesh , Ahmed Shubbir , Parray Hilal Ahmad , Samal Sweety
Published: October 2020

The enormous diversity of HIV-1 is a significant impediment in selecting envelopes (Envs) that can be suitable for designing vaccine immunogens. While tremendous progress has been made in developing soluble, trimeric, native-like Env proteins, those that have elicited neutralizing antibodies (Abs) in animal models are relatively few. A strategy of selecting naturally occurring Envs suitable for immunogen design by studying the correlation between efficient cleavage on the cell surface and their selective binding to broadly neutralizing Abs (bNAbs) and not to non-neutralizing Abs (non-NAbs), properties essential in immunogens, may be useful. Here we discuss some of the challenges of developing an efficacious HIV-1 vaccine and the work done in generating soluble immunogens. We also discuss the study of naturally occurring, membrane-bound, efficiently cleaved (naturally more sensitive to furin) Envs and how they may positively add to the repertoire of HIV-1 Envs that can be used for vaccine immunogen design. However, even with such Envs, the challenges of developing well-folded, native-like trimers as soluble proteins or using other immunogen strategies such as virus-like particles with desirable antigenic properties remain, and are formidable. In spite of the progress that has been made in the HIV-1 vaccine field, an immunogen that elicits neutralizing Abs with significant breadth and potency in vaccines has still not been developed. Efficiently cleaved Envs may increase the number of available Envs suitable for immunogen design and should be studied further.
Persons as Effect Sizes
Authors: Grice James W. , Medellin Eliwid , Jones Ian , Horvath Samantha , McDaniel Hailey , O’lansen Chance , Baker Meggie
Published: October 2020

Traditional indices of effect size are designed to answer questions about average group differences, associations between variables, and relative risk. For many researchers, an additional, important question is, “How many people in my study behaved or responded in a manner consistent with theoretical expectation?” We show how the answer to this question can be computed and reported as a straightforward percentage for a wide variety of study designs. This percentage essentially treats persons as an effect size, and it can easily be understood by scientists, professionals, and laypersons alike. For instance, imagine that in addition to d or η2, a researcher reports that 80% of participants matched theoretical expectation. No statistical training is required to understand the basic meaning of this percentage. By analyzing recently published studies, we show how computing this percentage can reveal novel patterns within data that provide insights for extending and developing the theory under investigation.
Orofacial pain resembling hypnic headache: A case report
Authors: Imai Noboru , Moriya Asami , Kitamura Eiji
Published: October 2020

The International Classification of Orofacial Pain (ICOP) classifies orofacial pain resembling primary headache as orofacial migraine and tension-type, trigeminal autonomic, and neurovascular orofacial pain. We used the ICOP classification style to make a diagnosis on a 76-year-old woman with orofacial pain, which developed only during sleep three times per week, caused awakening, and lasted 3–4 h without cranial autonomic symptoms or restlessness. Except for the pain area, her symptoms fulfilled the diagnostic criteria for hypnic headache. We diagnosed her with orofacial pain resembling hypnic headache. We should review the cases of such patients and classify them according to the ICOP.
DNA Methylation of Endoglin Pathway Genes in Pregnant Women With and Without Preeclampsia
Authors: Rietze Allison H , Conley Yvette P , Ren Dianxu , Anderson Cindy M , Roberts James M , Jeyabalan Arun , Hubel Carl A , Schmella Mandy J
Published: October 2020

Objective:

We compared blood-based DNA methylation levels of endoglin ( ENG) and transforming growth factor beta receptor 2 ( TGFβR2) gene promoter regions between women with clinically-overt preeclampsia and women with uncomplicated, normotensive pregnancies.

Methods:

We used EpiTect Methyl II PCR Assays to evaluate DNA methylation of CpG islands located in promoter regions of ENG (CpG Island 114642) and TGFβR2 (CpG Island 110111). Preeclampsia was diagnosed based on blood pressure, protein, and uric acid criteria. N = 21 nulliparous preeclampsia case participants were 1:1 frequency matched to N = 21 nulliparous normotensive control participants on gestational age at sample collection (±2 weeks), smoking status, and labor status at sample collection. Methylation values were compared between case and control participant groups [( ENG subset: n = 20 (9 cases, 11 controls); TGFβR2 subset: n = 28 (15 cases, 13 controls)].

Results:

The majority of the preeclampsia cases delivered at ⩾34 weeks’ gestation (83%). Average methylation levels for ENG ([M ± (SD)]; Case Participant Group = 6.54% ± 4.57 versus Control Participant group = 4.81% ± 5.08; P = .102) and TGFβR2 (Case Participant Group = 1.50% ± 1.37 vs Control Participant Group = 1.70% ± 1.40; P = .695) promoter CpG islands did not differ significantly between the participant groups. Removal of 2 extreme outliers in the ENG analytic subset revealed a trend between levels of ENG methylation and pregnancy outcome (Case Participant Group = 5.17% ± 2.16 vs Control Participant Group = 3.36% ± 1.73; P = .062).

Conclusion:

Additional epigenetic studies that include larger sample sizes, investigate preeclampsia subtypes, and capture methylation status of CpG island shores and shelves are needed to further inform us of the potential role that ENG and TGFβR2 DNA methylation plays in preeclampsia pathophysiology.
Causal survival analysis: A guide to estimating intention-to-treat and per-protocol effects from randomized clinical trials with non-adherence
Authors: Murray Eleanor J , Caniglia Ellen C , Petito Lucia C
Published: October 2020

When reporting results from randomized experiments, researchers often choose to present a per-protocol effect in addition to an intention-to-treat effect. However, these per-protocol effects are often described retrospectively, for example, comparing outcomes among individuals who adhered to their assigned treatment strategy throughout the study. This retrospective definition of a per-protocol effect is often confounded and cannot be interpreted causally because it encounters treatment-confounder feedback loops, where past confounders affect future treatment, and current treatment affects future confounders. Per-protocol effects estimated using this method are highly susceptible to the placebo paradox, also called the “healthy adherers” bias, where individuals who adhere to placebo appear to have better survival than those who don’t. This result is generally not due to a benefit of placebo, but rather is most often the result of uncontrolled confounding. Here, we aim to provide an overview to causal inference for survival outcomes with time-varying exposures for static interventions using inverse probability weighting. The basic concepts described here can also apply to other types of exposure strategies, although these may require additional design or analytic considerations. We provide a workshop guide with solutions manual, fully reproducible R, SAS, and Stata code, and a simulated dataset on a GitHub repository for the reader to explore.