bluuebunny/crossref_metadata_2025 huggingface dataset:
Social status inequality and depression in Europe
Authors: Paskov Marii , Richards Lindsay
Published: August 2021

It is theorized that income inequality is an indicator of status inequality and should therefore be associated with adverse health outcomes. In this article, we propose a novel way to capture status inequality more directly by measuring the distribution of self-perceived status in a society. We investigate whether status inequality in a society is associated with depression in the population. We show, first, that there is only a moderate association between subjective social status inequality and income inequality. Second, we provide evidence that depression is higher in countries with higher status inequality and that our novel measure of status inequality is more strongly associated with depression than the conventionally used income inequality measure. However, results are susceptible to influential country cases.
Prominent Retailer and Intrabrand Competition
Authors: Wang Ruitong , Zhu Yi , John George
Published: August 2021

Online retail search traffic is often concentrated at a “prominent” retailer for a product. The authors unpack the ramifications of this pattern on pricing, profit, and consumer welfare in an intrabrand setting. Prominence denotes a larger number of heterogenous-search-cost consumers starting their search at the prominent retailer than at any other retailer. These analyses show that search traffic concentration can intensify intrabrand competition, lower average prices of all retailers, and improve consumer welfare. Interestingly, the prominent retailer's incremental traffic advantage can increase or reduce its own profit; the authors denote these as the “blessing” and “curse” of prominence, respectively. The authors extend their analysis to a setting where consumers consider searching only among those retailers they are individually aware of; the prominent retailer is included in all these individual awareness sets. The effects on market average prices and welfare carry over, but only below a critical threshold level of the prominent retailer's first-search traffic advantage. Above this threshold, market average prices rise and welfare decreases, making this the region where search concentration warrants scrutiny from policy makers. The authors close with policy remedies and managerial implications of search concentration.
The Center for Surgical Health: A Compassion-Driven Urban Surgical Mission
Authors: Scire Emily , Morales Carrie Z. , Herbst Alan , Goldshore Matthew , Morris Jon B.
Published: August 2021

We are the Center for Surgical Health (CSH), an academic community partnership that supports, educates, and advocates for vulnerable Philadelphians with surgical diseases, founded in 2016 by Dr. Jon B. Morris, a leader in surgical education and a general surgeon at the University of Pennsylvania, and Dr. Alan Herbst, a current third-year Penn general surgery resident. At the time, Dr. Morris, raised in a Reform Jewish household, had been participating in an RCIA Program to convert to Catholicism. The mission of providing surgery to uninsured patients, primarily undocumented individuals, by helping them obtain insurance and see Penn providers was seen by Dr. Morris as a form of Catholic charity, which he has continued to remain dedicated to as his faith in Jesus Christ has deepened. Dr. Herbst, now Associate Director of Clinics for the CSH, recalls working with Dr. Morris as a sub-intern during his conversion, beginning with passion and a neon poster board inviting people to “See the Surgeon.” Since that time, the CSH has grown from an organization with 10 volunteers, called “personal patient navigators,” who provide insurance support and advocacy at every step of the perioperative continuum, to one with over 50, who have now seen 156 patients and assisted in providing 49 needed procedures. Much of this growth has been brought about through the dedication and vision of Dr. Matthew Goldshore, the Deputy Director of the CSH and a fifth-year Penn general surgery resident, as well as Dr. Carrie Z. Morales, Associate Deputy Director of the CSH and a recent Perelman School of Medicine graduate. Through their leadership, and the talent and commitment of other members of the CSH board, overseen by Director Dr. Morris, the CSH now has policy and research divisions, a surgical equity curriculum, and continues to develop new ways of providing better care.
Domestic drinking water management: Quality assessment in Oforikrom municipality, Ghana
Authors: Appiah-Effah Eugene , Ahenkorah Emmanuel Nketiah , Duku Godwin Armstrong , Nyarko Kwabena Biritwum
Published: August 2021

Drinking water in Ghana is estimated at 79%, but this only represents the proportion of the population with access to improved drinking water sources without regard to the quality of water consumed. This study investigated the quality of household drinking water sources in the Oforikrom municipality where potable water requirements are on the rise due to an ever-increasing population. Both quantitative and qualitative methods were employed in this study. One Hundred households were randomly selected and interviewed on the available options for drinking water and household water treatment and safe storage. A total of 52 points of collection (POC) and 97 points of use (POU) water samples from households were collected for physicochemical and microbial water quality analysis. Amongst the available drinking water options, sachet water (46%) was mostly consumed by households. Water quality analysis revealed that the physicochemical parameters of all sampled drinking water sources were within the Ghana Standards Authority (GSA) recommended values expected for pH (ranging from 4.50 to 7.50). For the drinking water sources, bottled (100%, n = 2) and sachet water (91%, n = 41) showed relatively good microbial water quality. Generally, POC water samples showed an improved microbial water quality in comparison to POU water samples. About 38% ( n = 8) of the households practicing water quality management, were still exposed to unsafe drinking water sources. Households should practice good water quality management at the domestic level to ensure access to safe drinking water. This may include the use of chlorine-based disinfectants to frequently disinfect boreholes, wells and storage facilities at homes.
Accurate simulation of draped fabric sheets with nonlinear modeling
Authors: Chen Yin , Wang Q Jane , Zhang Mengqi
Published: August 2021

This paper reports a numerical approach, based on a nonlinear particle spring model and a collision detection procedure, to simulate the shape of a draped cloth, or a flexible sheet, together with a simple but precise three-dimensional shape reconstruction method for real fabric applications. The latter is utilized to verify the accuracy of the proposed drape simulation model. The drapes of four types of fabric on a cylinder are simulated, and the results are compared with the reconstructed shapes of the same cloths; the results show an excellent agreement. The simulation model is further used to calculate the shapes of skirts of different materials and sizes, and the effects of fabric parameters, length, and waist size are numerically investigated. The results reveal that under the same conditions, the behaviors of different materials are affected by their properties in terms of stiffness coefficients of the springs. The silk skirt looks soft and fluttering; the outer contour curve of the skirt simulated for the polyester fabric appears relatively smoother, but the shape of the cotton skirt seems to be stiffer. The skirt made of fabric of 10% cotton and 90% polyester combines the characteristics of the polyester and cotton fabric.
Eating Chapattis with Salt and Water: Bundelkhand’s Chronic Food Insecurity
Authors: Shakeel Adnan
Published: August 2021

Food insecurity prevails when the availability of sufficient nutritious and safe food is threatened. This article examines conditions in Bundelkhand’s Banda district and analyses the reasons behind the conditions of food insecurity prevalent there. On the basis of household-level primary data, body mass index (BMI) and 24-hour dietary recall (24-HDR) have been used to measure the chronic and transitory dimensions of food insecurity. The overall sex specific prevalence of chronic energy deficiency (CED) shows that both males and females are passing through a critical situation with respect to their nutritional status, with females being more underprivileged. Nearly two-fifths of the households remain hungry and are consuming calories less than the recommended dietary allowance (RDA) of 1,890 calories, with wasted children being the biggest sufferers of CED. Persistent drought conditions combined with the unavailability of assured means of irrigation and faulty implementation of government systems and services, have ensured that Banda district remains in a state of chronic food insecurity.
The Motivation to Enlist Among Kurds
Authors: Cancian Matthew
Published: August 2021

Although humans have voluntarily joined militaries throughout history, research on the motivation to enlist has increased dramatically since the adoption of the All-Volunteer Force in the United States. Moskos categorized the motivations to enlist as institutional (the value alignment of the individual with the military) or occupational (the seeking of monetary rewards for competencies at market rates). This study explores the prevalence of these two traditional motivations in addition to two less commonly studied motivations—group mobilization and revenge-seeking—in an important context: the Kurds of northern Iraq. A survey of 2301 Kurdish soldiers (Peshmerga) during their war against the Islamic State (IS) indicates that institutional motivations are the most prevalent, although all four motivations are present. The importance of group mobilization and revenge-seeking represent important variations from the better-studied Western contexts that complicate our understanding of the motivation to enlist.
Adaptive event-triggered distributed recursive filtering with stochastic parameters and faults
Authors: Wu Lingling , Ding Derui , Ju Yamei , Yi Xiaojian
Published: August 2021

This paper investigates the distributed recursive filtering issue of a class of stochastic parameter systems with randomly occurring faults. An event-triggered scheme with an adaptive threshold is designed to better reduce the communication load by considering dynamic changes of measurement sequences. In the framework of Kalman filtering, a distributed filter is constructed to simultaneously estimate both system states and faults. Then, the upper bound of filtering error covariance is derived with the help of stochastic analysis combined with basis matrix inequalities. The obtained condition with a recursive feature is dependent on the statistical characteristic of stochastic parameter matrices as well as the time-varying threshold. Furthermore, the desired filter gain is derived by minimizing the trace of the obtained upper bound. Finally, two simulation examples are conducted to demonstrate the effectiveness and feasibility of the proposed filtering method.
Measuring and modeling moisture environment in underground metro stations during commissioning stage: A case study
Authors: Yu Yanzhe , You Shijun , Zhang Huan , Ye Tianzhen , Wang Yaran , Tang Chao , Wei Shen
Published: August 2021

Due to the humid underground environment, underground metro stations often have internal condensation issues, especially during the commissioning and initial operation phases, and these issues will have a negative impact on the equipment operation and building life. This study aims to solve the issue by 1) identifying common areas with condensation risks based on on-site measurements and numerical simulation methods, and 2) proposing effective dehumidification solutions for the moisture control of stations. By on-site investigating the characteristics of the station’s moisture environment and numerical assessing the effects of two different dehumidification strategies, it has been found that 1) for Tianjin, during most times in summer, the air temperature of the station in the commissioning phase was maintained relatively stable, but with significantly changing humidity; 2) the relative humidity on the platforms was higher than 80% for almost 30% of the testing time, and the surface of the upper structure of platform doors having a high risk of condensation; 3) the dehumidification effect of industrial dehumidifiers was found to be better than that of increasing exhaust air volume. The authors hope that the research could aid the decision on dehumidification strategies and provide guidance for further moisture control in underground stations.

Practical Application

This article analyzed the moisture environment of the underground metro stations in the commissioning phase and conducted a numerical approach to assess the condensation risk. Potential dehumidification solutions including increasing the exhaust air volume and using industrial dehumidifiers have been proposed, and their effects have been investigated and compared. The authors hope that this research can aid the decision on dehumidification strategies for facilities maintenance and provide a guidance to further moisture control in underground stations.
Ganglion Cyst Presenting as an External Auditory Canal Mass
Authors: Domack Aaron M. , Regmi Aayushma , Leonetti John P.
Published: August 2021

A ganglion cyst of the temporomandibular joint is a benign lesion that may present as a mass on the anterior wall of the external auditory canal and should be differentiated from other skull base pathology prior to management.
The retroperitoneal approach for contemporary open abdominal aortic aneurysm surgery: The anatomical reasoning
Authors: Bashir Mohamad , Munir Wahaj , Davies Huw , Bailey Damian M , Williams Ian M
Published: August 2021

In current practice, the place of open surgery in managing abdominal aortic aneurysm is a contentious issue. The principal reason being greater applications of endovascular techniques treating increasingly complicated aortic disease. Development of branched and fenestrated devices enabled this, with numbers increasing annually. This meant a good risk patient with a long infrarenal aortic neck and normal diameter non-tortuous iliac arteries may be suitable for both endovascular and open techniques. However, indications for open surgery are becoming increasingly unclear nowadays due to short-term gains in morbidity and mortality. Exact aortic anatomical morphologies optimum for open or endovascular techniques remains unclear. As graft technology evolves, possibilities for endovascular options are expanding. Currently, establishing optimum treatment plans for complicated abdominal aortic aneurysm (little or no infrarenal neck) is difficult without considering general fitness of the patient. Hence, two sets of possible postoperative complications and follow-up protocols must be explained to patients before either approach. Complicating matters is the optimum surgical approach used for any open repair. The standard approach for open abdominal aortic aneurysm surgery has been transperitoneal as this provides excellent access to the infrarenal aorta and iliac arteries. However, although less commonly used, the retroperitoneal approach has advantages particularly when location of proximal aortic disease indicates suprarenal clamp might be optimum. This paper scrutinises benefits of the retroperitoneal approach performed purely for anatomical reasons where stent graft may be considered complicated. Also, long-term outcomes are examined in terms of endo-leak and subsequent development of true and false aneurysm following both endovascular and open repair.
Improving the Estimation of Subgroup Effects for Clinical Trial Participants with Multimorbidity by Incorporating Drug Class-Level Information in Bayesian Hierarchical Models: A Simulation Study
Authors: Hannigan Laurie J. , Phillippo David M. , Hanlon Peter , Moss Laura , Butterly Elaine W. , Hawkins Neil , Dias Sofia , Welton Nicky J. , McAllister David A.
Published: August 2021

Background

There is limited guidance for using common drug therapies in the context of multimorbidity. In part, this is because their effectiveness for patients with specific comorbidities cannot easily be established using subgroup analyses in clinical trials. Here, we use simulations to explore the feasibility and implications of concurrently estimating effects of related drug treatments in patients with multimorbidity by partially pooling subgroup efficacy estimates across trials.

Methods

We performed simulations based on the characteristics of 161 real clinical trials of noninsulin glucose-lowering drugs for diabetes, estimating subgroup effects for patients with a hypothetical comorbidity across related trials in different scenarios using Bayesian hierarchical generalized linear models. We structured models according to an established ontology—the World Health Organization Anatomic Chemical Therapeutic Classifications—allowing us to nest all trials within drugs and all drugs within anatomic chemical therapeutic classes, with effects partially pooled at each level of the hierarchy. In a range of scenarios, we compared the performance of this model to random effects meta-analyses of all drugs individually.

Results

Hierarchical, ontology-based Bayesian models were unbiased and accurately recovered simulated comorbidity-drug interactions. Compared with single-drug meta-analyses, they offered a relative increase in precision of up to 250% in some scenarios because of information sharing across the hierarchy. Because of the relative precision of the approaches, a large proportion of small subgroup effects was detectable only using the hierarchical model.

Conclusions

By assuming that similar drugs may have similar subgroup effects, Bayesian hierarchical models based on structures defined by existing ontologies can be used to improve the precision of treatment efficacy estimates in patients with multimorbidity, with potential implications for clinical decision making.
Comparison of different en bloc holmium laser enucleation of the prostate techniques to reduce the rate of postoperative transient urinary incontinence
Authors: Lin Chun-Hsuan , Wu Wen-Jeng , Li Ching-Chia , Ke Hung-Lung , Jhan Jhen-Hao , Wen Sheng-Chen
Published: August 2021

Objective

To investigate postoperative risk factors for transient urinary incontinence (TUI) after different en bloc holmium laser enucleation of the prostate (HoLEP) techniques.

Methods

We retrospectively analyzed 169 consecutive patients who underwent HoLEP using the original en bloc technique (n = 41), en bloc with early mucosal strip detachment technique (n = 72), and three horseshoe-shaped incisions technique (n = 56) to treat bladder outlet obstruction from January 2017 to October 2019. Preoperative variables and surgical quality indexes were compared between the groups. TUI was defined as any hygienic or social problem caused by involuntary loss of urine at 2 weeks postoperatively. The postvoid residual urine volume, maximum urinary flow rate, and International Prostate Symptom Score (IPSS) were assessed.

Results

Among all three techniques, the three horseshoe-shaped incisions technique was significantly associated with the lowest incidence of TUI and the lowest IPSS. Although not statistically significant, the three horseshoe-shaped incisions group also showed a trend toward a faster enucleation time. No life-threatening intraoperative complications occurred in any group.

Conclusion

Use of three horseshoe-shaped incisions in en bloc HoLEP prevented urethral sphincter damage with a low rate of postoperative TUI. Further long-term, multicenter comparative assessment is required. Research Registry number: 6848
Spatial assessment of flow and benefit of tropical cyclone hazard mitigation service
Authors: Zhao Mingyue , Peng Jian , Zheng Hua , Daily Gretchen C. , Liu Yuanxin , Wu Jiansheng , Wang Yanglin
Published: August 2021

Ecosystems are employed to effectively protect people and communities in coastal areas from tropical cyclone (TC) hazards. Although a spatially explicit TC hazard mitigation service (TCHMS) is essential for devising adaptation strategy and resilience policy, the process and delivery of this program are unclear. We improved a capacity–exposure–demand conceptual framework using Guangdong Province, China, as a case study area, and spatial analysis was employed to assess the ecosystem service. Under this framework, we assessed “capacity” as the natural potential protection against TC hazards, “exposure” as the need for services, and “demand” as the estimated necessity of protecting coastal populations and economic interests. The analysis results were then used to map the TCHMS flow and benefit gap. The results showed that 21.6% of the whole province had low capacity, 25.3% had high exposure, and 19.3% had high demand. A significantly negative correlation was present between the TCHMS capacity and exposure, and a positive correlation was shown between the exposure and demand. In particular, the TCHMS flow and benefit were sufficient in inland areas but were severely deficient in coastal megacities. In Guangdong Province, the Pearl River Delta, and Chaoshan (CS), 3.3%, 4.0%, and 15.3% of the areas showed high demand–low capacity–high exposure patterns, respectively. Our findings will deepen the scientific understanding of the degree of protection a given ecosystem will provide to communities and infrastructures exposed to TC hazards and will thus provide scientific support for coastal ecosystem planning and management.
Effectiveness of enteral ivabradine for heart rate control in septic shock: A randomised controlled trial
Authors: Datta Priyankar K , Rewari Vimi , Ramachandran Rashmi , Singh Preet M , Ray Bikash R , Aravindan Ajisha , Seth Sandeep , Parakh Neeraj , Trikha Anjan
Published: August 2021

Persistent tachycardia in patients with septic shock predicts poor outcome. This study sought to investigate the effect of the cardiac pacemaker current inhibitor ivabradine on heart rate and cardio-circulatory function in patients with septic shock. After informed consent, 60 patients with septic shock and persistent tachycardia (heart rate >95 /minute) were prospectively randomly assigned to receive either standard therapy for septic shock (group S) or standard therapy along with enteral ivabradine (group I) for the initial 96 hours after enrolment. Primary outcome was the difference in heart rate between the two groups during the first 96 hours. Secondary outcomes included the effect of ivabradine on haemodynamic, oxygenation, myocardial function and organ function parameters, incidence of adverse events and 30-day overall survival. Heart rate was lower in group I compared to group S (median difference in area under the curve –25.6 (95% confidence intervals –31.4 to –15.9) /minute; P <0.001). Vasopressor requirements, blood lactate levels, Sequential Organ Failure Assessment scores and E/e′ ratio were lower in group I compared to group S. Stroke volume index and ejection fraction were higher in group I while cardiac index and oxygen delivery parameters were maintained similar to group S. There was no difference in 30-day mortality or in the incidence of serious adverse events. Enteral ivabradine is effective in reducing heart rate, and improving haemodynamic parameters and cardiac function in patients with septic shock and persistent tachycardia, without increasing the incidence of adverse events.
Measuring headache day severity using multiple features in daily diary designs
Authors: McGinley James S , Houts Carrie R , Wirth RJ , Lipton Richard B
Published: August 2021

Objective

Though migraine is thought of as a symptom complex, symptoms are typically assessed one at a time. For use in clinical research, we developed a composite measure of headache day severity by combining eight well-known symptoms captured in daily diaries.

Subjects and Methods

Data came from adults with a self-reported diagnosis of migraine (n  =  4380) who provided daily diary information assessed using a novel digital platform. Nine observed features theoretically linked to headache day severity were analyzed using latent variable modeling to create a psychometrically robust headache day severity score. Logistic regression was used to assess the cross-sectional relationships of headache day severity scores against an array of clinically-relevant outcomes.

Results

Participants were largely females (90%), approaching middle age (mean age of 37.3) and living in the United States (49%) or United Kingdom (23%). Findings supported a single latent headache day severity construct based on eight observed headache features. Headache day severity scores were associated with an increased odds of physician visits (Odds ratio[95% CI]: 1.71[1.32–2.21]), emergency department visits (4.12[2.23-7.60]), missed school/work (2.90[2.56–3.29]), missed household work (3.37[3.06–3.72]), and missed other activities (3.29[2.97–3.64]) (p < .0001 for all).

Conclusions

Modern measurement techniques support a single headache day severity construct that reflects migraine is a symptom complex. The headache day severity scores were associated with external validators and initial visualizations showed how headache day severity scores can be applied broadly in clinical practice and research.
Impact of mechanical circulatory support on post-transplant stroke risk
Authors: Nair Nandini , Yang Shengping , Gongora Enrique
Published: August 2021

The effect of type of mechanical circulatory support on stroke risk during the early post-transplant period remains undefined in patients bridged to transplant. This study assesses if the type of circulatory support device affects stroke risk in this population. The study cohort of 4257 adult patients bridged with mechanical support to cardiac transplant were derived from the UNOS transplant registry data. Risk factors assessed were age, gender, ischemic time, diabetes (recipient), durable mechanical support at listing and mechanical ventilation pre-transplant. Descriptive statistics were used to describe characteristics of the study cohort. Univariate logistic regression was used to test if there is a significant association between stroke event and all the potential risk factors. Multivariate logistic regression was used to test such associations while adjusting for all other risk factors. Odds ratios (ORs) and their 95% confidence intervals (CIs) in parenthesis, were calculated. p < 0.05 was considered significant. Patients on Extracorporeal membrane oxygenation (ECMO) had the highest risk of stroke immediately post-transplant prior to discharge (OR 3.03, {1.16, 7.95}) followed by Total Artificial Heart (TAH) (OR 2.03, {1.01, 4.07) as compared to those only on a Left Ventricular Assist Device (LVAD). Ischemic time (OR 1.3 {1.09, 1.45}) and diabetes (OR 1.8 {1.29, 2.51}) were significant risk factors. Patients on ECMO and TAH had a 203% and 103% increase respectively in the odds of having a stroke prior to discharge as compared to those only on LVADS.
Using Video Modeling, Explicit Instruction, and Augmented Reality to Teach Mathematics to Students With Disabilities
Authors: Morris Jared R. , Hughes Elizabeth M. , Stocker James D. , Davis Emelie S.
Published: August 2021

Students with exceptionalities who do not make adequate progress with core instruction in mathematics require more intensive research-based interventions such as explicit instruction or video modeling to address instructional needs. This study examined the effects of combining point-of-view video modeling, explicit instruction, and augmented reality to teach mathematics to students with disabilities. The researchers employed a multiple baseline across skills, single-subject research design to evaluate the effects of the intervention on student performance across four mathematics skills. Two eighth grade students identified as having a disability impacting mathematics, one with autism spectrum disorder and one with a specific learning disability, participated in the study. Visual analysis determined a functional relationship between the dependent and independent variables. Tau-U result for the intervention phase was 1.0 across all four skills for each participant. Participants demonstrated high levels of maintenance, and with one exception, students were able to apply the skills to word problems without additional training. Limitations and implications for future research and practice are discussed.
Fabrication of superhydrophobic surface on AISI316L stainless steel using a nanosecond pulse laser
Authors: Tangwarodomnukun Viboon , Kringram Supawan , Zhu Hao , Qi Huan , Rujisamphan Nopporn
Published: August 2021

Laser texturing process is a promising method to alter the wettability of metal surface on which micro/nano rough structures are created for changing the contact angle between the textured surface and liquid droplet. This paper aims at fabricating a superhydrophobic surface on AISI316L stainless steel, and a nanosecond pulse laser was employed for texturing line and point patterns on the metal surface. The influences of texturing patterns, laser power, scan speed, irradiation duration, and aging hours on the water contact angle and morphology of workpiece surface were investigated. According to the results, the hydrophilic surface was obtained right after the texturing process, and the surface turned to be hydrophobic after being left in ambient air for 15 days. The aging of laser-textured surface was also performed to induce the chemisorption of hydrocarbons toward the surface. This post process was able to shorten the hydrophilic-to-hydrophobic transition from days to a few hours. The aging duration of 2 and 0.5 h was respectively recommended for yielding and stabilizing the superhydrophobicity on line- and point-patterned surfaces. The maximum contact angle of 159.61° was achievable when the point pattern was textured on the stainless steel surface by using the laser power of 10 W and irradiation duration of 0.18 ms.
On the drag reduction of road vehicles with trailing edge-integrated lobed mixers
Authors: Anna Rejniak Aleksandra , Gatto Alvin
Published: August 2021

Trailing edge-integrated lobed-mixing geometries are proposed as a viable method for road vehicle aerodynamic drag reduction. Experiments are conducted on a 1/24th-scale model, representative of a Heavy Goods Vehicle, at a width-based Reynolds number of 2.8 × 105. A broad range of pitches and penetration angle values is examined, with detailed comparisons also made to high-aspect-ratio rear tapering. Changes to mean drag coefficients and wake velocities are evaluated and assessed from both the time-independent and time-dependent perspectives. Results show significant drag reductions for lower pitches at higher penetration angles, where the performance of regular tapering is found substantially degraded. The mechanisms responsible for drag reduction are identified to be reductions in the wake size and a shift in the vertical wake balance. The former is shown to be a result of the enhancement in inboard momentum close to the trailing edges through the generation of pairs of counter-rotating streamwise vortices, with the latter attributed to the downstream evolution of the vortices. Overall, these results identify such geometries to be suitable for improving vehicle drag while minimising the losses in internal space.
Long non-coding RNA SNHG16, binding with miR-106b-5p, promoted cell apoptosis and inflammation in allergic rhinitis by up-regulating leukemia inhibitory factor to activate the JAK1/STAT3 signaling pathway
Authors: Li Huajing , Quan Fang , Zhang Pengfei , Shao Yuan
Published: August 2021

Allergic rhinitis (AR) is a type I hypersensitive disease. Long non-coding RNA (lncRNA) SNHG16 acts as an oncogene in a variety of tumors and promotes the occurrence of inflammation in many inflammatory diseases. The study aims to investigate the expression of SNHG16 and its potential biological functions in AR. RT-qPCR results showed that the expression of SNHG16 in AR was up-regulated. The AR cell model was constructed by stimulating primary nasal mucosal epithelial cells from AR patients with IL-13. After knocking down the expression of lncRNA SNHG16, cell apoptosis was detected by flow cytometry, and the expression of inflammatory factors was detected by ELISA. The results showed that SNHG16 promoted cell apoptosis and inflammation. Then, bioinformatics analysis was used to screen miRNAs bound with SNHG16. Luciferase reporter gene assay and RNA pull-down experiment were used to verify the relationship. We found that the expression of miR-106b-5p was down-regulated and leukemia inhibitory factor (LIF) expression was up-regulated in the AR cell model. The expression of phospho-Janus kinase 1 and p-signal transducer and activator of transcription 3 (STAT3) were detected by Western blotting. Silencing the expression of LIF could inhibit the activity of JAK1/STAT3 pathway and further inhibit cell apoptosis and the occurrence of inflammation. Then transfected SNHG16 shRNA alone or together with miR-106b-5p antagomir into the AR cell model, we found that silencing the expression of SNHG16 down-regulated the expression of LIF and inhibited the activity of the JAK1/STAT3 pathway, cell apoptosis, and inflammation. However, miR-106b-5p antagomir weakened its inhibitory effects. The role of SNHG16 in AR was further verified by the ovalbumin-induced AR mouse model in vivo. In conclusion, SNHG16 up-regulates LIF expression by binding with miR-106b-5p, thus promoting the activity of JAK1/STAT3 pathway, and promoting the development of AR. These results provide new targets for the treatment of AR and may help reduce the damage caused by AR.
Transgenerational Succession and R&D Investment: A Myopic Loss Aversion Perspective
Authors: Li Weiwen , Bruton Garry D. , Li Xinchun , Wang Shuang
Published: August 2021

A transgenerational leadership transition is one of the most critical events in the life cycle of family firms. Drawing upon the myopic loss aversion (MLA) perspective, we argue that outgoing leaders and other company stakeholders tend to closely watch the later-generation successors immediately after a transgenerational succession, and thus the successors will focus on short-term developments and invest less in R&D activities. Employing the difference-in-differences approach, we find empirical support for our argument that transgenerational succession decreases R&D intensity. The negative effect of transgenerational succession is more pronounced when the later-generation successors suffer from a higher level of MLA.
Valproic Acid in the Management of Delirium
Authors: Cuartas Carlos Fernandez , Davis Mellar
Published: August 2021

Context:

Antipsychotics and benzodiazepines do not improve delirium. Valproic acid (VPA) has been used recently to treat agitation in delirium.

Objectives:

To review the evidence for VPA in the management of Delirium.

Methods:

Systematic review. English language, age 19 and above, from 1946 to January 12, 2021.

Mesh Terms:

“Valproic acid”, “valproate”, “sodium valproate”, “delirium”, “acute mania with delirium” in PubMed and Ovid.

Exclusion:

Studies of VPA used for diagnoses other than delirium.

Results:

21 abstracts were identified and 10 studies were included in the review (252 patients): One prospective open label study (n: 7), 2 case series (n: 22), 4 retrospective studies (n: 219) and 3 case reports (n: 4). No randomized controlled trial (RCT) evaluates the effect of VPA in delirium. 237/250 (94.8%) patients were in the ICU. Mean age was 59.7 (27-87). 153/204 (74%) were male. The mean starting dose was 733 mg/day in 148 patients and the mean dose at follow up was 1061 mg/day in 205 patients. CAM ICU was used to diagnose delirium in 6 reviews. Delirium improved in case series in 19/22 patients. Delirium improved in retrospective studies at day 3 compared to day 1. VPA levels were not consistently reported. Hyperammonemia (12-19%) and thrombocytopenia (9-13%) were the most common side effects. No deaths were attributed to VPA.

Conclusion:

VPA is being used more frequently for delirium. The evidence is limited to retrospective studies and case series. There is a need for RCT to evaluate the effect of VPA in delirium compared to other alternatives and placebo.
Campus Racial Climate, Boundary Work and the Fear and Sexualization of Black Masculinities on a Predominantly White University
Authors: Allen Quaylan
Published: August 2021

This article presents data from a study of Black men and masculinities at a predominantly White university. I argue that the campus racial climate on predominantly White universities are important sites of boundary work where fear and sexualization of Black masculinities are normalized in ways that shape Black men’s social relations on college campuses. In doing so, I will share narrative data of how Black male college students perceive the campus racial climate, with a focus on how they are feared and sexualized in predominantly White spaces. I also analyze the ways in which they managed race, gender, and sexuality within school spaces, and situate their gendered performances within the context of the boundary work of the university. Attention will be given to their agency in how they respond to White fears and sexualization of Black men.
Emergence of Dual Resistance to Zidovudine and Lamivudine in Clinical HIV-1 Isolates from Patients Receiving Zidovudine/Lamivudine Combination Therapy
Authors: Gass Rebekah JA , Shugarts Dave , Young Russell , Allen Michael , Rosandich Mary , Kuritzkes Daniel R
Published: August 2021

Susceptibility to zidovudine and lamivudine was determined on human immunodeficiency virus type 1 (HIV-1) isolates obtained from patients who added lamivudine after 6 months of treatment with zidovudine. Lamivudine-resistant isolates that were also zidovudine-resistant were recovered from 13/16 (81%) patients after 6 months of dual therapy. In contrast to findings in anti-retroviral therapy-naive patients, these results suggest that dual resistance to zidovudine and lamivudine emerges relatively quickly when lamivudine is added to zidovudine as a single agent in the majority of patients with extensive prior zidovudine treatment.
Social innovations and sustainability of tourism: Insights from public sector in Kemi, Finland
Authors: Partanen Mari , Sarkki Simo
Published: August 2021

This article proposes new insights on sustainability of tourism through social innovations. The underlying aim is to find practical ways to enhance sustainability in and through tourism, as sustainability has been criticized for its abstract nature. The marginally studied relationship of sustainability of tourism and social innovations is explored by utilizing ethnographic data on tourism, which is expected to grow in Kemi, Finland. Two examined examples of social innovations—related to social inclusion, employment, and using waste food—offer insights for tourism by bringing out non-traditional public sector perspectives and novel, multi-sectoral grass-root initiatives for coping with societal challenges at the local level. This paper suggests that sustainability of tourism can be informed through social innovations as cooperative processes, which respond to local needs and create novel solutions and social and other value at the destination. It is discussed how insights from social innovations can widen the understanding of what constitutes a tourism stakeholder, bring in the holistic, multi-sectoral dimensions of sustainability, and provide examples on the use of collaborative spaces for practical tourism planning.
“Inspiring” and configuring consumer experience in times of crisis: An analysis of the discursive practices of an Athenian shopping mall’s promotional system
Authors: Lallas Dimitris , Drosos Yorgos
Published: August 2021

This article focuses on the processes that the largest shopping mall in Athens has developed in order to produce meaning about itself as an institution of consumption, as well as the consumer experience and practices, and its visitors–consumers. From a poststructuralist perspective, we analyze the signifying articulations that the promotional discourse attempts, along with the linguistic and visual techniques which activate specific significations about this microcosm of consumption, the “fun” experience, fashion, beauty, shopping and entertainment practices, eating out, and the consumer subjectivity. The ultimate aim of this research is to point out the cultural role of such an institution with regard to the configuration of an order of discourse about consumption and the reproduction of the consumerist ethos during an economic crisis, as well as the possible effects that such a discourse might have on a wider cultural level.
Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Exploratory Study to Evaluate the Efficacy and Safety of HAD-B1 for Dose-Finding in EGFR Mutation Positive and Locally Advanced or Metastatic NSCLC Subjects Who Need Afatinib Therapy
Authors: Ko Eun-Ju , Kwag Eun-Bin , Park Ji Hye , Park So-Jung , Son Ji-Woong , Yoon Seong-Hun , Shin Seong-Hun , Yoo Hwa-Seung
Published: August 2021

Afatinib is a target anticancer drug of the second-generation EGFR TKI type, showing an advantage in treatment effect compared to conventional chemotherapy. However, patients on EGFR-TKI drugs also usually progress after 9 to 13 months according to secondary resistance. HAD-B1 is composed of drugs that are effective against lung cancer. This study is an exploratory study to evaluate the efficacy and safety between dosage groups by conducting a clinical trial in subjects requiring afatinib drug treatment in non-small cell lung cancer with EGFR mutation positive to determine the optimal dosage for HAD-B1 administration. At the final visit compared to before administration, each change in the disease control rate was measured according to the HAD-B1 doses of the test group 1 (972 mg), the test group 2 (1944 mg), and the control group. The efficacy and safety of HAD-B1 were compared and evaluated through sub-evaluation variables. As a result of the study, there was no statistically significant difference in the disease control rate at 12 weeks after dosing, but complete and partial remission were evaluated as 1 patient each in the test group 1, and none in the other groups. There was no statistically significant difference between groups in the sub-evaluation variable. In addition, there was no problem of safety from taking the test drug. However, the initially planned number of subjects was 66, but the number of enrolled subjects was only 14, which may limit the results of this study.
Surgical 5-year Outcomes of Extra-Anatomical Bypass for Middle Aortic Syndrome: A Case Series
Authors: Yamamoto Taira , Endo Daisuke , Shimada Akie , Yamaoka Hironobu , Ooishi Atsumi , Dohi Shizuyuki , Matsushita Satoshi , Asai Tohru , Amano Atsushi
Published: August 2021

Background

Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome.

Case presentations

Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu’s arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle–brachial pressure index was .61. The three patients with Takayasu’s arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle–brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up.

Conclusion

Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.
Joint testing of overall and simple effects for the two-by-two factorial trial design
Authors: Leifer Eric S , Troendle James F , Kolecki Alexis , Follmann Dean A
Published: August 2021

Background/aims:

The two-by-two factorial design randomizes participants to receive treatment A alone, treatment B alone, both treatments A and B( AB), or neither treatment ( C). When the combined effect of A and B is less than the sum of the A and B effects, called a subadditive interaction, there can be low power to detect the A effect using an overall test, that is, factorial analysis, which compares the A and AB groups to the C and B groups. Such an interaction may have occurred in the Action to Control Cardiovascular Risk in Diabetes blood pressure trial (ACCORD BP) which simultaneously randomized participants to receive intensive or standard blood pressure, control and intensive or standard glycemic control. For the primary outcome of major cardiovascular event, the overall test for efficacy of intensive blood pressure control was nonsignificant. In such an instance, simple effect tests of A versus C and B versus C may be useful since they are not affected by a subadditive interaction, but they can have lower power since they use half the participants of the overall trial. We investigate multiple testing procedures which exploit the overall tests’ sample size advantage and the simple tests’ robustness to a potential interaction.

Methods:

In the time-to-event setting, we use the stratified and ordinary logrank statistics’ asymptotic means to calculate the power of the overall and simple tests under various scenarios. We consider the A and B research questions to be unrelated and allocate 0.05 significance level to each. For each question, we investigate three multiple testing procedures which allocate the type 1 error in different proportions for the overall and simple effects as well as the AB effect. The Equal Allocation 3 procedure allocates equal type 1 error to each of the three effects, the Proportional Allocation 2 procedure allocates 2/3 of the type 1 error to the overall A (respectively, B) effect and the remaining type 1 error to the AB effect, and the Equal Allocation 2 procedure allocates equal amounts to the simple A (respectively, B) and AB effects. These procedures are applied to ACCORD BP.

Results:

Across various scenarios, Equal Allocation 3 had robust power for detecting a true effect. For ACCORD BP, all three procedures would have detected a benefit of intensive glycemia control.

Conclusions:

When there is no interaction, Equal Allocation 3 has less power than a factorial analysis. However, Equal Allocation 3 often has greater power when there is an interaction. The R package factorial2x2 can be used to explore the power gain or loss for different scenarios.