bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract P852: “They Were Wonderful...They Helped a Great Deal”: Patient and Caregiver Reports of Home Health Care as a Transition of Care Practice After Ischemic Stroke
Authors: Leonhardt-Caprio Ann M , Sellers Craig R , Caprio Thomas
Published: March 2021

Background:
Transitions of care (TOC) following ischemic stroke (IS) are complex for patients and caregivers; the post-hospital discharge period is stressful, fragmented, and often carries with it a fear of new stroke. Improvements in education, medication management, and support for community integration following discharge to home could ease TOC challenges and assist in reducing hospital readmissions.

Methods:
Diagnosis-driven certified home health agency (CHHA) referrals for IS patients were initiated at a Comprehensive Stroke Center as a TOC improvement with a goal of decreasing “missed” referrals for patients not previously considered but eligible for CHHA services. Patients discharged to home (50 patient/caregiver dyads) were interviewed 30 days following hospital discharge to solicit feedback regarding CHAA services.

Results:
Of those contacted, 27 (54%) received CHAA services. Three patients/caregivers (11.1%) responded with neutral feelings regarding the visit, 24 (88.9%) responded that the visit was helpful. Eleven respondents had no comment/opinion when asked how the visit was/was not helpful. The remainder of patients had responses that could be grouped into domains including encouragement/concern for me (
n
= 4), teaching/guidance (
n
= 4), therapy/exercise (
n
= 6), functional improvement/independence (
n
= 2), medications (
n
= 3), blood pressure management (
n
= 3), and home health agency staff (
n
= 2). There were multiple positive comments such as one patient who reported that the home care nurse was “very good... called right away and got the outpatient therapy transition arranged.” A patient with a new diagnosis of diabetes felt that education and concern for how things were going was very important to understanding and managing this new diagnosis. Multiple patients reported the importance of medication reconciliation after discharge and specific comments regarding the CHHA staff included, “Really helpful. They were wonderful... they helped a great deal.”

Conclusions:
Positive experiences regarding TOC practices strongly supported referral for CHHA services. Comments regarding the services suggest that increasing CHHA referrals could meet perceived needs of IS patients and caregivers in the transition from hospital to home.
Abstract P854: Lean A3 Project in a Primary Stroke Center Results in Improved Dysphagia Screening Compliance for Stroke
Authors: Henderson Melanie , Boesch Susan , Peyton Kristine , Hackett Chris , Noah Patty , Shah Harshit
Published: March 2021

Introduction:
Dysphagia is a common comorbidity after stroke linked to increased morbidity and mortality. Evidence-based guidelines recommend a bedside dysphagia screen before oral intake to reduce the risk of aspiration pneumonia in stroke patients. Prior studies have reviewed barriers to dysphagia screens being completed or documented timely on stroke patients before giving oral intake. Through Lean A3 process, we aimed to improve overall nursing documentation, including dysphagia screen, for stroke patients in the Emergency Department (ED) at an established Primary Stroke Center.

Methods:
The ED Charge Nurses and the Stroke Coordinator began an A3 project in May 2019 which focused on ED nurse documentation for stroke patients. Data included was 7 months prior to A3 implementation and 8 months post-implementation using Get With The Guidelines quality “Dysphagia Screen” measure. Lean A3 process involved changes to the computer system and re-education of nursing staff in July 2019 by the charge nurses and Stroke Coordinator. The post-A3 measurement period was between August 2019 and March 2020. Chi square tests were used to assess proportion differences in completed dysphagia screen and proportion of meeting or exceeding goal before and after the A3.

Results:
Overall compliance of patients screened for dysphagia was 87.3% (n = 379/434). After the A3 project, compliance for dysphagia screening was significantly higher than prior to the A3 implementation ((91.9% (n = 228/248) vs. 81.2% (n = 151/186), OR = 2.64 [95%CI 1.47-4.75], p < 0.001). In addition, the 90% goal for dysphagia screen compliance was achieved only 1 month of 7 (14.3%) prior to A3, but was achieved in 6 months of 8 post-A3 (75%), p = 0.04.

Conclusion:
In conclusion, we found that dysphagia screening documentation by ED nurses improved due to the Lean A3 process improvement project conducted in the ED.
Abstract P856: Contributors to Internal Primary Stroke Center Transfer Delays: Factors Beyond Stroke Coordinators’ Control
Authors: Patterson Jennifer L , Dusenbury Wendy , Devlin Thomas G , Stanfill Ansley , Tsivgoulis Georgios K , Alexandrov Andrei V , Alexandrov Anne W
Published: March 2021

Background:
Stroke coordinators often are challenged to transfer patients to higher levels of care, facing internal system, transport, and comprehensive stroke center (CSC) factors that may slow the transfer process. We aimed to understand the internal challenges faced by stroke coordinators at primary stroke centers/acute stroke ready hospitals (PSC/ASRH) in the transfer process.

Methods:
Six national focus groups with PSC/ASRH staff experienced with stroke transfers were conducted by web conference. Interviews were conducted using pre-scripted open-ended questions; information was recorded and data were transcribed for theme identification.

Results:
Participants were from Northeast, Mid-Atlantic, Southeast, Midwest, and West Coast USA. Internal PSC/ASRH problems were tied exclusively to physicians: Emergency department (ED) physicians’ lack knowledge of how/when to order advanced imaging; delays initiating telemedicine guidance were common; and, negative attitudes towards stroke emergencies among “tenured” ED physicians were identified. All participants noted that they were compliant with door-to-noncontrast CT and alteplase treatment time metrics, however, radiologists commonly used the full 2-hours allotted for CTA and CTP reads, and many telemedicine neurologists refused to review/interpret advanced imaging choosing to rely on the local general radiologists’ formal interpretation.

Conclusions:
Major factors contributing to internal PSC/ASRH transfer delays are exclusively physician-based. Physician education, standardized algorithms for advanced imaging selection, more-timely regulatory metrics for advanced imaging interpretation, and improved telemedicine physician expertise and guidance would improve transfer timeliness in these centers.
Abstract P859: Implementation of Acute Stroke Telemedicine Within a Large Metropolitan Health System: The Role of Advanced Practice Nursing Partners
Authors: Keigher Kiffon M , Bader Elida , van Vliet Rebecca
Published: March 2021

Background and Significance:
Acute stroke care is widely recognized as a challenge for hospitals and health systems due to it’s time sensitive nature. Telemedicine is recognized by the AHA/ASA as a viable solution to acute stroke management. We describe the leadership roles and launch of a large telestroke program at ten hospitals, over two months, for a 27 hospital-system. Key leaders in this project include three advanced practice providers with distinct roles in the program including: neurology telestroke coordinator, stroke system program manager, system telestroke manager. Delineation of roles helped achieve robust system-wide clinical oversight, improved communication, and advanced a nursing-driven approach to problem solving and quality review.

Project Implementation:
Key elements to our implementation strategy include: • Selection of core team, key leaders, neurology services • Selection of video platform technology • Setting goals and timelines • Establishing new clinical workflows • Staff and provider education

Data and Results:
A robust data review and telestroke dashboard assisted leaders in monitoring volumes, door-to-needle (DTN) times, intravenous thrombolytic administration, transfers for advanced procedures, mechanical thrombectomy door-to-groin (DTG) and recanalization times and outcomes and patient disposition. A telestroke quality committee (TQC) provided data and outcomes on a monthly basis. In the first year of implementation, over 3,600 stroke consults seen by telestroke neurologist with an average door-to-needle time of 60 minutes, greater than 25% IV thrombolytic administration rate, nearly 200 thrombectomies and greater than 60% discharged home or to acute rehabilitation. Opportunities for improvement in DTN and DTG times identified during TQC data review and ongoing quality improvement projects initiated. This overview will provide program leaders with knowledge and tangible skills for the launch of a telestroke program.
Abstract P863: Did Covid 19 Highlight Disparities in Stroke Care: A Real-World Study of Telehealth Utilization Between Urban and Suburban Populations in a Health Care System
Authors: Gibson Maryika I , Wanchoo Ruchi
Published: March 2021

A viable alternative to in person assessments, telemedicine offered providers cost effective and safe alternative to patient care delivery during COVID19. Resource limitations, state and organizational safety precautions accelerated our system adoption of video visits for stroke post hospitalization assessments. Utilizing mixed methods we aimed to investigate an association between patients characteristics (age, gender, race, Modified Rankin Score-mRS, residence) and their choice for post-acute care during a five-month period. The subset selecting in-person visits was further interviewed regarding perceptions of barriers to telehealth. We analyzed data from 85 patients’ records (45 in the urban telehealth and 40 in the suburban clinic visit groups) according to ICD10 codes. While total volume of televisits increased during COVID 19, stroke accounted for <1% of them. There was no significant difference in the mean age between the two groups-68.5 years in the clinic and 64.4 in the tele. The clinic subset had 42% of patients age greater than 75 years. Significant difference was detected in disabilities (t=3.5, p<.001) with one-point higher mean mRS (1.7 vs .7) and stronger positive correlation of age to disabilities in the suburban group (r2=.26 vs r2=.16). Patients selecting in-person care outlined as barriers to telehealth a lack of technology, poor connectivity, no caregiver availability for tele exam, inability to communicate or other major co-morbidities, family’s perception of complexity of patient’s condition, fragmentation of care during the period. Patients selecting video assessment were more connected with a health care system and from the urban center. Strengths of the study are the application of mix methods and investigation of suburban patients’ perceptions of barriers to telehealth. Limitations consist of small sample size and 90% Caucasian population. Current technology advancements, software applications, and the goal of Healthy People 2030 of removing disparities in heart and stroke disease will require a new multipronged approach to improving stroke telehealth at population level. Further studies at national level including social determinates of health need to examine barriers to telemedicine in post-acute stroke care.
Abstract P865: Pediatric Stroke Algorithm Revision: Focus on Education Process
Authors: Campbell Margie L , Lightner Donita , O’Connor Kevin , Lee Jessica , Qaiser Sharoon , Krishna Ashwin , Fraser Justin
Published: March 2021

Background:
While the incidence of Pediatric stroke is low at 2.3 to 13 per 100,000 children, our institution saw a need for a pediatric stroke algorithm to provide guidance when children present with stroke symptoms. The process began with development and release of a pediatric stroke guideline in 2017. After initiation of the guideline, mock stroke alerts periodically were performed with feedback provided by staff. After several reviews and revisions, the paradigm of a guideline was discarded in favor of an algorithm, a more accurate reflection of the necessity for clinical judgement rather than a series of predetermined steps. In June 2020, the Pediatric Stroke Algorithm was revised to incorporate one algorithm for both Emergency Room (ER) and inpatient areas after a recent mock stroke alert in the Pediatric Intensive Care Unit (PICU) and following feedback. The purpose behind our process improvement project was to provide education regarding the updated Pediatric Stroke Algorithm to all relevant clinical areas.

Methods:
The first step was to identify the staff in patient care areas that would need education on the updated Pediatric Stroke Algorithm. Next, we identified the methods of communication that would be utilized to ensure all staff received proper education.

Results:
In 2020, the updated Pediatric Stroke Algorithm document was placed on the UK HealthCare Care Web page (Clinical Web Page). Information on the location of the document was sent to the key stakeholders for nursing, physician, and appropriate ancillary staff in the ER and PICU for further distribution. The algorithm was presented in various stroke committee meetings and sent by email to team members of these committees to share with their staff. The algorithm was further presented at the PICU Collaborative Practice Meeting and posted on the PICU share point site, in the ER, and PICU areas.

Conclusions:
A comprehensive educational process of the revised Pediatric Stroke Algorithm was successfully completed with all the appropriate staff.
Abstract P880: Assessing Measures of Patients Health Perceptions of Stroke Survivors as a Potential Tool for Health Care Disparities Research
Authors: Dickens Rondalyn , Gyang Tirisham , Sanders Sadie B , Simpkins Alexis N ,   on behalf of the Univ of Florida CREST Initiative
Published: March 2021

Introduction:
Patient centered research in stroke health care disparities is needed. Due to a call for the development of theory-based interventions for the reduction of stroke through behavior change, there have been new studies looking at the perception of an individual’s risk of stroke to create prevention models from those results. Leventhal’s Common Sense Model of Self-Regulation posits that individuals form beliefs about their illness and treatment that determines how they cope and their health behaviors in the future. The Illness Perceptions Questionnaire-Revised (IPQ-R) and Brief Illness Perceptions Questionnaire (BIPQ) are validated measures of these illness beliefs.

Methods:
A literature review was conducted with the following search criteria: (“illness perception” OR “illness belief”) AND (“stroke” OR “TIA” OR “transient ischemic attack” OR “cerebrovascular event” OR “cerebrovascular accident” OR “CVA”). MEDLINE, WorldCat, PubMed, George Smathers Library, and Google Scholar Database were searched. Systematic reviews and meta-analyses were excluded.

Results:
The initial results had 452 articles and 21 were chosen for data analysis. These articles were grouped into four categories: IPQ-R, IPQ-R & Medication Adherence, BIPQ, and BIPQ & Medication Adherence. Patients were most concerned about having another stroke and their symptoms becoming chronic. Medication beliefs are a stronger predictor of treatment adherence. Lastly, patients with stronger illness identity, causal beliefs, negative consequences, and lower coherence leads to greater distress in patients and caregivers.

Conclusions:
These results demonstrate that patients overall have concerns about their treatments, chronicity of stroke symptoms, and recurrence, and these concerns may not be effectively addressed during the routine clinic care demonstrated by effects on treatment adherence and patient and caregiver distress. Thus, patient perceptions questionnaires may be in particular a useful tool for health care disparities research in stroke.
Abstract P90: Clinical Features of Patients With Cryptogenic Stroke and Covid-19
Authors: Esenwa Charles , Cheng Natalie , Antoniello Daniel , Kirchoff-Torres Kathryn F , Labovitz Daniel L , Liberman Ava L , Mabie Peter , Soetanto Ainie , Lord Aaron , Ishida Koto , Torres Jose L , Snyder Thomas , Frontera Jennifer , Yaghi Shadi
Published: March 2021

Introduction:
While coronavirus disease 2019 (COVID-19) has been associated with acute ischemic stroke (AIS), the causal relationship has yet to be elucidated. Factors that likely confer increased stroke risk are COVID-19-associated coagulopathy and hyperinflammatory response. Studying clinical features of patients with otherwise undetermined cause of AIS could help better define COVID-19-associated stroke.

Methods:
We performed a multicenter cross-sectional study of consecutive patients presenting with AIS and COVID-19 to one of two large healthcare systems in New York City during the local COVID-19 surge from March 1, 2020 to May 31, 2020. In-hospital stroke cases were excluded. We compared demographic and clinical features of patients with COVID-19 and a cryptogenic AIS subtype to patients with COVID-19 and a determined subtype. Baseline characteristics and clinical variables were compared using chi-squared and Fisher exact tests.

Results:
A total of 62 patients with AIS and COVID-19 at the time of hospital arrival were identified. Of these, 30 were classified as having a cryptogenic subtype (80% after complete diagnotics evaluation), and 32 had an identifiable stroke mechanism. Patients with cryptogenic AIS were significantly younger (p=0.011) and less likely to have co-morbid hypertension (p=0.019), coronary artery disease (p=0.024), heart failure (p=0.039), atrial fibrillation (<0.0001), and prior stroke or TIA (p=0.033) compared to those with defined mechanisms. Further, d-dimer, but not C-reactive protein, was significantly higher in patients with cryptogenic stroke compared to those with defined causes (p=0.009).

Conclusion:
Patients with AIS in the setting of COVID-19 and no other determined stroke mechanism were younger, less likely to have classic risk factors, and had higher d-dimer levels when compared to those with a determined mechanism. Further study of COVID-19-associated hypercoagulability as a mechanism of stroke is warranted.
Abstract P95: Characteristics of a Diverse Cohort of Stroke Patients With SARS-CoV-2 and Outcome by Sex
Authors: Trifan Gabriela , GOLDENBERG Fernando D , Caprio Fan Z , Biller Jose , Schneck Michael J , Khaja Aslam , Terna Theresa , Brorson James R , Chirstos Lazaridis , Bulwa Zachary , Alvarado Dyer Ronald , Velez Faddi , Prabhakaran Shyam , Liotta Eric M , Batra Ayush , Reish Nicholas , Ruland Sean , Teitcher Michael , Taylor William , de la Pena Paula , Conners James , Grewal Parneet , Pinna Pranusha , Dafer Rima , Osteraas Nicholas D , DaSilva Ivan , Hall Julian , John Sayona , Shafi Neelofer , Miller Kristin , Moustafa Bayan , Vargas Alejandro , Gorelick Phillip , Testai Fernando
Published: March 2021

Background:
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is associated with stroke. The role of sex on stroke outcome has not been investigated. We describe the characteristics of a diverse cohort of acute stroke patients with COVID-19 disease, and investigate the role of sex on outcome.

Methods:
This is a retrospective study of patients with acute stroke and SARS-CoV-2 infection admitted between March 15 to May 15, 2020 to one of the six participating comprehensive stroke centers from Chicago metropolitan area. Baseline characteristics, stroke subtype, workup, treatment and outcome are presented as total number and percentage. Outcome at discharge was determined by the modified Rankin Scale Score (mRS). Variables and outcomes were compared for males and females using univariate and multivariate analysis.

Results:
The study included 83 patients. Median age was 64 years and the majority were Blacks (47%) followed by Hispanics (28%) and whites (16%). Approximately 89% had at least one preexisting vascular risk factor (VRF). The most common complications were respiratory failure (59%) and septic shock (34%). Higher proportions of male experienced severe SARS-CoV-2 symptoms requiring ICU hospitalization (73% vs. 49%; p=0.04). When divided by stroke subtype, there were 77% ischemic, 19% intracerebral hemorrhage and 3% subarachnoid hemorrhage. The most common ischemic stroke etiologies were cryptogenic (39%) and cardioembolic (27%). Compared to female, males had higher mortality (38% vs. 13%; p=0.02) and were less likely to be discharged home (12% vs. 33%; p=0.04). After adjustment for age, race/ethnicity, and number of VRFs, mRS was higher in males than in females (OR=1.47, 95% CI=1.03-2.09)

Conclusion:
In this cohort of SARS-CoV-2 stroke patients, most had clinical evidence of coronavirus infection on admission and preexisting VRFs. Severe in-hospital complications and worse outcomes after ischemic strokes were higher in males, than females.
Abstract P98: Cerebral Venous Sinus Thrombosis in Patients With Covid-19
Authors: de Havenon Adam H , Hohmann Samuel , Shipey Ernie , Majersik Jennifer J , Anadani Mohammad , Yaghi Shadi
Published: March 2021

Background:
Because COVID-19 is thought to be pro-thrombotic and could theoretically increase the severity of cerebral venous sinus thrombosis (CVST), we sought to examine the outcomes of CVST patients with comorbid COVID-19 infection.

Methods:
We performed a retrospective analysis using the Vizient
®
Clinical Data Base (CDB), a healthcare analytics platform employed by participating US hospitals. We identified CVST with the ICD-10 codes I63.6, I67.6, G08.x, O22.5, and O87.3. We created three cohorts of patients: CVST with confirmed or suspected COVID-19 in April, May or June 2020, CVST with influenza-like illness (ILI) in 2019, and CVST without ILI in 2019. The outcomes are 1) in-hospital death and 2) favorable discharge (discharge destination home or acute rehabilitation). We fit logistic regression models to our outcomes and adjusted for patient age, sex, race/ethnicity, Elixhauser comorbidity score, acute respiratory failure requiring intubation, and hospital length of stay.

Results:
We identified 73 patients with CVST and COVID-19, 159 with CVST and ILI, and 4,146 with CVST and no COVID-19 or ILI. The patient death rates were 20.6%, 8.8%, and 5.1%, respectively, and favorable discharge rates were 58.9%, 52.8%, and 77.3%, respectively. Compared to CVST patients with ILI, those with COVID-19 were not significantly more likely to die in-hospital (adjusted OR 1.43, 95% CI 0.44-4.66, p=0.557) or to have favorable discharge (adjusted OR 1.75, 95% CI 0.58-5.25, p=0.321). Compared to CVST patients without ILI or COVID-19, those with COVID-19 were also not significantly more likely to die in-hospital (adjusted OR 0.87, 95% CI 0.35-2.12, p=0.751) or to have favorable discharge (adjusted OR 1.52, 95% CI 0.62-3.69, p=0.358).

Conclusion:
Although CVST patients with COVID-19 had a higher in-hospital death rate and lower favorable discharge rates, after adjusting for potential confounders there was no association between worse outcomes in CVST patients with COVID-19. This suggests that while CVST may complicate COVID-19, it does not portend a worse prognosis than CVST in patients with either ILI or no ILI or COVID-19.
Abstract P99: Impact of the Covid-19 Pandemic on Stroke Thrombolysis Rate and Delay to Thrombolysis Treatment in a Regional Stroke Centre in London, UK
Authors: Drumm Brian , Bentley Paul , Brown Zoe , D’Anna Lucio , Dolkar Tsering , Halse Omid , Jamil Sohaa A , Jenkins Harri , Kalladka Dheeraj , Venter Marius , Banerjee Soma , Kwan Joseph
Published: March 2021

Introduction:
There are reports of changes in the numbers of stroke admissions and time intervals to receiving emergency treatments during the COVID-19 pandemic. We examined the impact of the COVID-19 pandemic on the stroke thrombolysis rate and delay to thrombolysis treatment in a regional stroke centre in London, UK.

Methods:
COVID-19 testing began at our hospital on 3 March 2020. Clinical data for all acute stroke admissions were routinely collected as part of a national Sentinel Stroke National Audit Programme (SSNAP) and all thrombolysis data were entered into our local thrombolysis database. We retrospectively extracted the relevant patient data for the period of March to May 2020 (COVID group) and compared to the same period in 2019 (pre-COVID group).

Results:
Compared with pre-COVID, there was a 17.5% fall in total stroke admissions (from 315 to 260) during COVID; but there were no significant differences in the demographics, stroke severity, proportions with known time of onset, or median onset-to-arrival time. The thrombolysis rates amongst ischemic strokes were not significantly different between the two groups (59/260=23% pre-COVID vs. 41/228=18% COVID, p=.19). For thrombolysis patients, their stroke severity and demographics were similar between the two both groups. Median onset-to-needle time was significantly longer by 22 minutes during COVID [127 (IQR 94-160) vs. 149 (IQR 110-124) minutes, p=.045]; this delay to treatment was almost entirely due to a longer median onset-to-arrival time by 16 minutes during COVID (p=.029). Favorable early neurological outcomes post-thrombolysis (defined as an improvement in NIHSS by ≥4 points at 24 hours) were similar (45% vs. 46%, p=.86).

Conclusion:
COVID-19 pandemic had a negative impact on prehospital delays which in turn significantly increased onset-to-needle time, but without affecting the chance of a favorable early neurological outcome. Our data highlight the need to maintain public awareness of taking immediate action when stroke symptoms occur during the COVID-19 pandemic.
Pediatric Thrombectomy
Authors: Lauzier David C. , Galardi Maria M. , Guilliams Kristin P. , Goyal Manu S. , Amlie-Lefond Catherine , Hallam Danial K. , Kansagra Akash P.
Published: March 2021

Endovascular thrombectomy has played a major role in advancing adult stroke care and may serve a similar role in pediatric stroke care. However, there is a need to develop better evidence and infrastructure for pediatric stroke care. In this work, we review 2 experienced pediatric endovascular thrombectomy programs and examine key design features in both care environments, including a formalized protocol and workflow, integration with an adult endovascular thrombectomy workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke.
עד דוד הגדיל (1 Sam 20:41) – עד בור הגדול (1 Sam 19:22)
Authors: Goldstein Ronnie
Published: March 2021

This study focuses on the difficult ending of 1 Sam 20:41 in the Masoretic text (MT): וַיִּבְכּוּ אִישׁ אֶת רֵעֵהוּ עַד דָּוִד הִגְדִּיל, rendered normally as “They wept together; David wept the longer.” Many have pointed out the peculiarity of this phrase, and different emendations were proposed, based mainly on the LXX. The present article suggests an emendation of 1 Sam 20:41, according to which the original text read here עד בור הגדול. The mention of the “Great Cistern” at the end of the previous story in the Book of Samuel (19:22), provides strong support for this suggestion. It is proposed that the mention of the “Great Cistern” in the original text intended to narrow the geographical gaps between the different stories about David and Saul.
The Doctor-Patient Relationship in the Renaissance
Authors: Stolberg Michael
Published: March 2021

Based on the practice journals, personal notes, and letters of learned physicians from the German speaking regions, this paper seeks to reconstruct the lived reality of the doctor-patient relationship in the sixteenth century. Even many affluent and educated patients were quick to consult another practitioner when they were not satisfied, and the physicians resorted to various strategies to win and maintain the patient’s trust. These included preferring or outright inventing a diagnosis the patient could not prove wrong and deliberately exaggerating the severity of the disease so the physicians would gain all the more praise (and money) when the patient got better. On the positive side, the physicians respected their patients’ desire for certain medicines and their dislike of others, and went to great lengths to provide them with an explanation of what was happening inside their bodies that made sense to them and matched their personal bodily experience.
Taxonomy of the genus Duolandrevus Kirby, 1906 (Orthoptera: Gryllidae; Landrevinae) from China with a new species of the subgenus Eulandrevus Gorochov, 1988
Authors: ZHENG YANNA , MA LIBIN
Published: March 2021

Duolandrevus species are brown, smooth and shiny, and armed with short tegmina. There are twelve species recorded from China. We redescribed five species of them and reported a new species, Duolandrevus longlouensis sp. n., discovered in Hainan Island, China. The new one belongs to the subgenus Eulandreus and is similar to Duolandrevus obsidianus He, 2019 and Duolandrevus dendrophilus (Gorochov, 1988), but differs from them in body size and details of tegmina and genitalia. Besides description and illustration of the five recorded species and one new species, keys and distribution map of Chinese bark crickets were provided.
What are the smallest moths (Lepidoptera) in the world?
Authors: STONIS JONAS R. , REMEIKIS ANDRIUS , DIŠKUS ARŪNAS , BARYSHNIKOVA SVETLANA , SOLIS M. ALMA
Published: March 2021

The world’s smallest moths in Lepidoptera (Insecta) and the complexity in making such a determination are examined and discussed. The forewing length and wingspan of 650 species were measured and the same data were retrieved from published papers to determine which species and family have the smallest moths in the world. The minimal recorded forewing length was found to be around 1.2–1.3 mm and the wingspan around 2.6–2.8 mm in two families, the Gracillariidae and Nepticulidae. Among Lepidoptera, the following species have the smallest moths globally: the European Johanssoniella acetosae (Stainton), the Peruvian Simplimorpha kailai Stonis & Diškus, the Mexican Stigmella maya Remeikis & Stonis, the Mediterranean S. diniensis (Klimesh), the Mediterranean Parafomoria liguricella (Klimesh) (Nepticulidae), the South East Asian Porphyrosela alternata Kumata, and the Central African P. desmodivora De Prins (Gracillariidae). Additionally, in the Nepticulidae, we provide a measurement update for Stigmella maya Remeikis & Stonis, one of the tiniest species with a forewing length of 1.3 mm and wingspan of 2.8 mm, and describe a new species, Stigmella incaica Diškus & Stonis, sp. nov., with a forewing length of 1.75 to 1.95 mm and a wingspan of 3.8 to 4.3 mm.
Galactosylated Chitosan Modified Magnetic Mesoporous Silica Nanoparticles Loaded with Nedaplatin for the Targeted Chemo-Photothermal Synergistic Therapy of Cancer
Authors: Kong Yihan , Li Xue , Liu Xiaojing , Pang Jingjing , Mu Xinling , Liu Wei
Published: March 2021

The use of chemotherapy combined with photothermal therapy (PTT) is getting a focus topic for cancer treatment. Duing this research, the double targeting drug delivery system of nedaplatin (NDP)–carboxyl-functionalized magnetic mesoporous silica (MMSN-COOH)–galactosylated
chitosan (GC) nanoparticles (NPs) was constructed. Because MMSNs have special physical properties, it can target to the specific area. In addition, it’s able to convert absorbed near-infrared (NIR) light into heat energy for photothermal therapy (PTT). Furthermore, the thermal energy
generated by MMSNs under NIR lasers can accelerate the release of drug from preparations. Moreover, GC modified MMSNs-COOH as a carrier can increase the drug uptake of cancer cells that highly express galectins in vitro, resulting in cancer cell apoptosis, and thus increasing the targeting
of cancerous tissue in vivo. The experimental consequences in vitro and in vivo revealed that the NDP@MMSNCOOH-GC NPs combined with PTT could avoid systemic toxicity and improve biosecurity while having good anticancer effect.
Influence of Glow-Discharge Nitrided Temperatures of Cast Stainless Steel for Cavitation-Erosion Enhancement in Seawater
Authors: Chong Sang-Ok , Kim Seong-Jong
Published: March 2021

In this work, corrosion resistance and cavitation-erosion characteristics were investigated by applying plasma ion nitriding technique to cast stainless steels used as materials of high speed rotors under seawater environment. Plasma ion nitriding was performed for 10 h at various temperature
parameters with 25% N2 and 75% H2 gas ratio. The cavitation-erosion experiment was carried out under vibration amplitude of 30 °C and sea water temperature of 25 °C according to modified ASTM G32-92. The yN phase that improves corrosion resistance and
mechanical properties was formed at the all of experimnetal temperatures after plasma ion nitriding treatment. The crystallite size of phases was calculated through the XRD patterns according to Scherrer formula and obtained smallest nano size of yN phase at 450 °C. Cavitation-erosion
resistance was enhanced up to 450 °C but was deteriorated at 500 °C.
Microstructures and Mechanical Properties of Solid-State Welded Steels
Authors: Kim Gyeong Woo , Jeong Se Min
Published: March 2021

This study aimed to evaluate the soundness of solid-state welded steels. STS 430F alloy with a rod type was selected as experimental material, and the friction welding was conducted at a rotation speed of 2,000 RPM and upset length of 3 mm. The application of friction welding on STS
430F rods led to significant grain refinement in the welded zone (1.3 µm) compared to that observed in the base material (16.8 µm). The refined grains in the welds contributed to the development of the mechanical properties. In particular, the Vickers microhardness
was increased by approximately 25% compared to the base material, and the fracture at the tensile specimen of the welds occurred at the base material zone and not in the welded zone, which suggests a soundly welded state on the STS 430F rods.
Effects of Microwave and Furnace Annealing for P-Type SnO Thin Film Material in Oxygen Ambient
Authors: Zhang Yu-Xin , Wu Chien-Hung , Yeh Li-Wei , Chen Yi-Ming , Chang Kow-Ming , Chang Shih-Ho , Chin Albert
Published: March 2021

Transparent conductive oxide (TCO) semiconductors are attracted considerable attention due to a wide range of applications, such as flat panel display (FPD), touch panels, solar cells, and other optoelectronic devices. Owing to the different carrier conduction paths between n-type
and P-type TCOs, the n-type TCO used in TFTs usually have high Ion/Ioff current ratio (>107) and high electron mobility (>10 cm2/V·s), P-type TCO TFTs are both lower than that of n-type one.
For complementary circuits design and applications, however, both P-type and n-type semiconductor materials are equally important. For SnO thin films, it is important to adjust the ratio of Sn2+ (SnO P-type) and Sn4+ (SnO2 n-type)
in order to modulate the electrical characteristics. In this investigation of post treatment for SnO thin films, both microwave annealing (MWA) and furnace annealing process with 02 ambient are studied. The results show that SnO thin films are optimized at 300 °C, 30 minutes
furnace annealing, the P-type SnO/SnO2 thin film shows surface mean roughness 0.168 nm, [Sn2+]/[Sn4+] ratio as 0.838, at least 80% transmittance between 380 nm-700 nm visible light. Withthe results, SnO can be even used to fabricate high performance
P-type thin film transistors (TFTs) device for future applications.
Effect of Li on Mechanical Properties and Electrical Conductivity of the Al–Zn–Cu–Mg Based Alloys
Authors: Yoo Hyo-Sang , Kim Yong-Ho , Son Hyeon-Taek
Published: March 2021

In this study, changes in the microstructure, mechanical properties, and electrical conductivity of cast and extruded Al–Zn–Cu–Mg based alloys with the addition of Li (0, 0.5 and 1.0 wt.%) were investigated. The Al–Zn–Cu–Mg–xLi alloys
were cast and homogenized at 570 °C for 4 hours. The billets were hot extruded into rod that were 12 mm in diameter with a reduction ratio of 38:1 at 550 °C. As the amount of Li added increased from 0 to 1.0 wt.%, the average grain size of the extruded Al alloy increased from 259.2
to 383.0 µm, and the high-angle grain boundaries (HGBs) fraction decreased from 64.0 to 52.1%. As the Li content increased from 0 to 1.0 wt.%, the elongation was not significantly different from 27.8 to 27.4% and the ultimate tensile strength (UTS) was improved from 146.7 to 160.6
MPa. As Li was added, spherical particles bonded to each other, forming an irregular particles. It is thought that these irregular particles contribute to the strength improvement.
Ti3C2Tx MXene-Based Three-Dimensional Architecture for Carbon Dioxide Capture
Authors: Park Kwang Hyun , Kim Seulgi , Hwang Hyewon , Hwang Min-Jin , Song Sung Ho , Shim Wang-Geun , Lee Dongju
Published: March 2021

Dramatic increases in fossil fuel consumption inevitably led to the emission of huge amounts of CO2 gas, causing abnormalities in the climate system. Despite continuous efforts to resolve global atmospheric problems through CO2 capture and separation, success has
been limited by poor CO2 selectivity in the CO2/N2 mixture. Herein, we demonstrate the fabrication of a three-dimensional (3D) nanostructure from two-dimensional transition metal carbides (Ti3C2Tx, MXene), and assess
its utility as an adsorbent in a CO2 capture system. Through structural and textural analysis, we confirm that the as-prepared MXene possesses high size uniformity with a thickness of ~2.5 nm, and that an MXene aerogel interconnected by MXene nanosheets has a 3D porous architecture
with micro/nano porosity (Barrett-Joyner-Halenda (BJH) pore size = 11.4 nm). Moreover, the MXene aerogel exhibits favorable adsorption behavior for CO2, due to the high-quality MXene nanosheets even with a low specific surface area. Our approach could lead to significant advances
in CO2 capture by adsorbents and open up new opportunities for mass production.
Analysis of Electromagnetic Properties of Bulk Superconductors
Authors: Lee Sang Heon
Published: March 2021

In the present study, a YBa2Cu3O7−y bulk superconductor added with 5~10 wt% Ag was fabricated employing Sm123 as a seed to produce a superconductive single crystal. Metallic silver was added to the single crystal of YBa2Cu3O7−y
to remove defects such as cracks and pores. Electromagnetic properties of the bulk superconductor at 77 K were analyzed based on relationships of magnetic levitation, trapped magnetic force, and critical current density. The critical current density of the superconductor at 77 K and 0 T was
3.53 × 104 A/cm2. Discontinuous points in the distribution of magnetic field lines were not observed, implying that these two specimens grew well as a single crystal without specific weak links. For the growth of a superconductive nano crystal employing slow cooling
at temperature of formation of 123 phase, superconductive nano crystals were aligned in a-b direction, the direction of peak current flow. The peak value of the trapped magnetic force of the YBa2Cu3O7−y superconductor specimen was 3.23 kG. Using
the FC method, peak forces of attraction and repulsion were 21.696 N and 70.168 N, respectively.
Polyvinylpyrrolidone/Montmorillonite/Zinc Oxide Bionanosystems Prepared by Spray Drying
Authors: Sarcinelli Michelle Alvares , Gullo Maria Pia , Gentile Gennaro , Cocca Maria Cristina , Errico Maria Emanuela , Avella Maurizio , Tavares Maria Inês Bruno
Published: March 2021

In this study, microparticles of bionanomaterials were obtained by polyvinylpyrrolidone, montmoril-lonite, and zinc oxide bionanosystems produced through solution intercalation technique combined with a spray-drying process, aiming for possible application as drug delivery systems.
The final microparticles obtained were evaluated in terms of their production yield, which varies between 39.2% and 56.9%. Thermal analysis showed no major changes in Tg of the nanocomposites, compared to the pure PVP polymer. Scanning electron microscopy analysis revealed
a pseudo-spherical shape and confirmed the micrometric size of the microparticles. Transmission electron microscopy analysis corroborated the embedding of montmorillonite and ZnO within the polymer phase. Nuclear magnetic resonance and X-rays diffraction were used to study the nanoparticles
dispersion, indicating a predominant intercalated morphology. This study suggests that the applied methodology is suitable for the high yields synthesis of nanocomposites PVP based microparticles with uniform size and shape, which can be promising for the production of a new drug delivery
system.
Design and Fabrication of Glucose Biosensors Based on Immobilization of Glucose Oxidase on Titanium Oxide Nanotube Arrays
Authors: Du Andrew , De Eulate Eva Alvarez , Hariz Alex
Published: March 2021

An electrochemical biosensor for the detection of glucose is realized by immobilizing glucose oxidase (GOx) enzyme onto titanium dioxide nanotube arrays by a coupling encapsulation process. We present details of a robust fabrication technique that results in a durable and reproducible
sensor characteristics. The TiO2 nanotube arrays are grown directly on a titanium substrate by a potentiostatic anodization process in a water and ethylene-glycol mixture solution, which contains ammonium fluoride. An electropolymerization process was also performed to enhance interfacial
adhesion between GOx and TiO2 nanotubes. Detection of glucose concentrations was achieved with a linear response in the range of 0.01 to 0.2 mM. Investigation of enhanced sensitivity by increasing the count, the length, and the cross-section of the nanotubes was also carried out.
Surface morphologies of Ti substrate were examined by scanning electron microscopy to optimize the anodization process and thus the TiO2/Ti nanotube dimensions. We utilized a time-based amperometric response for the quantitative determination of hydrogen peroxide concentration through
electro-reduction reaction with a bare TiO2/Ti nanotube-array electrodes, thus providing a reference for the determination of glucose levels with a GOx-coated TiO2/Ti nanotube array electrodes. Detection levels down to 5.2 μM were recorded.
Preparation and Characterization of Wood-Plastic Nanocomposites Based on Acrylonitrile-Butadiene-Styrene
Authors: Zhang Guixin , Zhang Yanyan , Yang Jun , Li Shijuan , Guo Weihong
Published: March 2021

The new wood-plastic nanocomposites (WPC) based on acrylonitrile-butadiene-styrene (ABS) resin was successfully blended with ABS and poplar flour (PF) through a HAAKE rheomix. The mechanical properties of nanocomposites, except for flexural modulus, were reduced after increasing the
PF content. SEM photos show the reduction resulting from weak interfacial adhesion between the PF phase and ABS phase. Higher PF content leads to a low thermal stability and a high water absorption ratio. Different coupling agents (CA) were employed to improve the compatibility between PF
and ABS. The results suggest that ABS-g-MAH is more effective than POE-g-MAH, EVA and SEBS. Maleic anhydride (MA) was blended in situ with PF and ABS as the reactive compatibilizer and mechanical properties of nanocomposites were improved except impact strength.
Nano-Gaps Fabricated by Thermal Evaporation and Stripping Techniques
Authors: Cheng E , Tang Suzhou , Zou Helin , Qiao Guochao , Zhang Zhengyan
Published: March 2021

The fabrication of inexpensive nano-gaps is vitally important for the research and application of nanochannel-based devices. This study presents a low-cost and simple method for the fabrication of nano-gaps using thermal evaporation and stripping techniques. The structural morphology
of metal films deposited on the convex structures of photoresist by sputtering and thermal evaporation was studied. The effect of angles of thermal evaporation on the width of nano-gaps was investigated. The characteristics of metal film deposited on the convex structures of photoresist and
spaces between these convex structures after stripping were investigated, and the adhesive force between the metal film and silicon substrate was also analyzed. Finally, a metal film of Cu was deposited on the convex structures of photoresist by thermal evaporation. After stripping, nano-gaps
with a width of 187 nm were fabricated. The method proposed in this paper can be employed to mass-produce two-dimensional nanochannels based devices at low cost.
Investigating the Roles of External Forcing and Ocean Circulation on the Atlantic Multidecadal SST Variability in a Large Ensemble Climate Model Hierarchy
Authors: Murphy Lisa N. , Klavans Jeremy M. , Clement Amy C. , Cane Mark A.
Published: March 2021

This paper attempts to enhance our understanding of the causes of Atlantic multidecadal variability (AMV). Following the literature, we define the AMV as the SST averaged over the North Atlantic basin, linearly detrended and low-pass filtered. There is an ongoing debate about the drivers of the AMV, which include internal variability generated from the ocean or atmosphere (or both) and external radiative forcing. We test the role of these factors in explaining the time history, variance, and spatial pattern of the AMV using a 41-member ensemble from a fully coupled version of CESM and a 10-member ensemble of the CESM atmosphere coupled to a slab ocean. The large ensemble allows us to isolate the role of external forcing versus internal variability, and the model differences allow us to isolate the role of coupled ocean circulation. Both with and without coupled ocean circulation, external forcing explains more than half of the variance of the observed AMV time series, indicating its important role in simulating the twentieth-century AMV phases. In this model the net effect of ocean processes is to reduce the variance of the AMV. Dynamical ocean coupling also reduces the ability of the model to simulate the characteristic spatial pattern of the AMV, but forcing has little impact on the pattern. Historical forcing improves the time history and variance of the AMV simulation, while the more realistic ocean representation reduces the variance below that observed and lowers the correlation with observations.
Splenic Abscess Complicating Bariatric Surgery : A Systematic Review
Authors: Buksh Md Mahfooz , Tallowin Simon , Al Samaraee Ahmad
Published: March 2021

Introduction

Bariatric surgery has become one of the most rapidly growing subspecialty performed globally, and it has been well reported to be associated with low morbidity and mortality rates. Splenic abscess is a rare but serious complication of bariatric surgery that has not been previously systematically reviewed in the literature.

Methods

The authors have performed a systematic review of the evidence that has looked into the pathophysiology, clinical presentation, and the management options of splenic abscess complicating bariatric surgery.

Results

This systematic review has been unsurprisingly based on level-IV evidence due to the rarity of the explored condition. The final analysis included 27 relevant reported cases. The mean age was 38 years and the mean of the time interval between the initial operation and developing splenic abscess was 72 days, with the male to female ratio being 1:1.6. Laparoscopic sleeve gastrectomy was the initial operation in 85.2% of the patients. Nearly half of the patients did not have an objective evidence of local or systemic sepsis that could explain the abscess formation. Nonsurgical management was attempted in 14 patients, with 34% success rate only. Splenectomy was needed in 41.7% of the patients. No mortality was reported.

Conclusions

Splenic abscess is a rare and rather late but serious complication of bariatric surgery that could result in splenectomy in a relatively young group of patients. It is more commonly reported following laparoscopic sleeve gastrectomy. Early diagnosis with intervention in a timely manner is crucial to avoid life threatening complications.