bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of moderate or deep neuromuscular block status on anesthetic depth monitoring system during total intravenous anesthesia using propofol and remifentanil: A randomized trial
Authors: Na Hyo-Seok , Lim Dae-Jin , Koo Bon-Wook , Oh Ah-Young , Lee Pyung-Bok
Published: April 2021

The neuromuscular block state may affect the electroencephalogram-derived index representing the anesthetic depth. We applied an Anesthetic Depth Monitoring for Sedation (ADMS) to patients undergoing laparoscopic cholecystectomy under total intravenous anesthesia, and evaluated the requirement of propofol according to the different neuromuscular block state. Adult patients scheduled to undergo laparoscopic cholecystectomy were enrolled and randomly assigned to either the moderate (MB) or deep neuromuscular block (DB) group. The UniCon sensor of ADMS was applied to monitor anesthetic depth and the unicon value was maintained between 40 and 50 during the operation. According to the group assignment, intraoperative rocuronium was administered to maintain proper neuromuscular block state, moderate or deep block state. The unicon value, electromyography (EMG) index, and total dose of propofol and rocuronium were analyzed. At similar anesthetic depth, less propofol was used in the DB group compared to the MB group (6.19 ± 1.36 in the MB mg/kg/h group vs 4.93 ± 3.02 mg/kg/h in the DM group, p = 0.042). As expected, more rocuronium were used in the DB group than in the MB group (0.8 ± 0.2 mg/kg in the MB group vs 1.2 ± 0.2 mg/kg in the DB group, p = 0.023) and the EMG indices were lower in the DB group than in the MB group, at several time points as follows: at starting operation ( p < 0.001); at 15 ( p = 0.019), 45 ( p = 0.011), and 60 min ( p < 0.001) after the initiation of the operation; at the end of operation ( p = 0.003); and at 5 min after the administration of sugammadex ( p < 0.001). At similar anesthetic depth, patients under the deep neuromuscular block state required less propofol with lower intraoperative EMG indices compared to those under the moderate neuromuscular block state during general anesthesia.
Subjective Perception of Individuals with Physical Disabilities Regarding Exercise Equipment Use
Authors: Lee Song Yi , Lee Jung Ah , Chung Hee Jung , Kim Hyun-Jin , Kim Yu Cheon , Kim Hogene
Published: April 2021

Rehabilitation exercise is effective for improving the health of persons with physical disabilities. However, there are limited studies on their perception of exercise equipment use. The purpose of this study was to investigate the subjectivity to understand the types of perceptions of individuals with physical disabilities regarding the use of exercise equipment in South Korea. This study used Q-methodology. A literature review and focus group interviews with individuals with physical disabilities were conducted to construct Q-Population. Q-statements were selected from the Q-population, after which Q-sorting was executed by P-sample. The results indicated 4 perception types: (1) “Independent user,” (2) “Practical user,” (3) “Motivational user,” and (4) “Convenience user.” Recommendations were provided for developing exercise equipment for use by individuals with physical disabilities. This study revealed 4 perception categories and the findings have strong potential to contribute to the development of proper services and the effective utilization of exercise equipment for individuals with physical disabilities.
A Multimedia Option for Delivering Feedback and Professional Development to Teachers
Authors: Kunemund Rachel L. , Kennedy Michael J. , Griendling Lindsay M. , VanUitert Victoria J. , McDonald Sean D.
Published: April 2021

All teachers need ongoing coaching that helps them recognize areas of strength and need for teaching students with disabilities. Unfortunately, the amount, quality, and speed with which teachers receive feedback from coaches, administrators, mentors, or other instructional leaders on their academic and behavior management practices is limited. In this article, we describe a multimedia professional development option for documenting teacher practice, generating feedback, and delivering targeted instruction.
The Dilemma of ‘Science’: ‘Tradition’ and Archaeology in Early Twentieth-century Bengal
Authors: Panja Sheena
Published: April 2021

The study of history as a genre became important not only as an academic concern but to recover the lost pride and dignity of the indigenous people in a colonized land. In the late nineteenth and early twentieth-century Bengal, the study of the past assumed prime importance in the context of nationalism to counter the disdain of colonial historians and revive national pride. History as a ‘scientific’ discipline functioned as a tool in this regard, where the vernacular emerged as the principal medium of communication. Individuals from diverse backgrounds debated whether a more rigorous understanding of the past through Western ‘scientific’ methods could supplant the information from traditional texts and legends. Material culture or ‘hard’ evidence considered more suitable for a ‘modern’ objective historical account gained precedence over the traditional texts, dismissed as imaginary and mythical. A heated debate emerged between two groups, the archaeologists who believed in the objectivity of material evidence and the traditionalists who subscribed to the view that classical literature was not irrelevant to understanding the past. However, this division remained nebulous, and both groups remained in a liminal interstitial space engaging and contesting with their notions of ‘tradition’ and ‘science’. It was from this contested space that emerged an ambivalent archaeological method which formed an important characteristic of Indian archaeology in the post-Independence era.
Tone variation in financial news: A comparison of companies, journalists and financial analysts
Authors: Pollach Irene , Hansen Lea Vindvad
Published: April 2021

This article reports the findings of a comparative study of the financial news produced by companies, financial analysts, financial newspapers and news agencies about the same news events, including data before and after the financial crisis. We ground this study in second-level agenda-setting, according to which news producers select substantive and evaluative attributes for the issues they cover. Using computer-assisted text analysis, we conduct pairwise comparisons of the evaluative tone of corporate quarterly earnings press releases and the corresponding analyst reports and news stories. Our overall hypothesis is that these actors produce news about the same events with an evaluative tone that furthers their own goals as well as the goals of those actors they are dependent on, which we find partial support for. We find a positivity bias in corporate earnings press releases and analyst reports, while financial journalists eliminate the corporate positivity bias, but do not add more negativity. The results also indicate differences in the tone of financial news before and after the financial crisis. Although all actors produce news in the period after the financial crisis that is less positive and less negative than before the crisis, the balance of positive and negative tone as well as relative differences among the actors suggest that news writing by financial journalists at financial newspapers and news agencies is more negative in tone after the financial crisis, thus providing also empirical support of their independence.
Continuous erector spinae plane block for postoperative analgesia in robotic lung lobectomy: a case report
Authors: Ceraolo Edoardo , Balzani Eleonora , Rosboch Giulio Luca , Guerrera Francesco , Lyberis Paraskevas , Ruffini Enrico , Brazzi Luca
Published: April 2021

Background:

Erector spinae plane block (ESPB) has been described as an effective regional anesthesia technique in thoracic parenchymal surgery. Evidence highlighting the use of this technique continuously via perifascial catheter is lacking.

Case presentation:

In this case report, we present the case of a patient scheduled for robotic-assisted thoracic surgery for a pulmonary neoformation in the lower right lobe. We decided to manage this patient with a multimodal approach in order to have an opioid-sparing effect. This is the first reported case of continuous ESPB in robot-assisted thoracic surgery.

Conclusions:

Anesthesiologists should consider this method in surgery that is slower than conventional surgery, such as robot-assisted, and less invasive than thoracotomy, which does not warrant the use of neuroaxial or paravertebral techniques that increase the risk of iatrogenic complications.
Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?
Authors: Muylaert Caroline , Boulet Cedric , Buls Nico , Wuertzer Scott , Pouliart Nicole , Machiels Freddy , De Maeseneer Michel
Published: April 2021

Background:

Contrast leakage after arthrography is common. We sought to investigate if immobilization could prevent it.

Purpose:

The purpose of this study was to determine the effects on contrast extravasation and image quality produced by strict immobilization of the shoulder between arthrography puncture and subsequent MR imaging.

Material and methods:

Fifty patients underwent shoulder MR arthrography using a standard shoulder puncture in the anteroinferior quadrant. Ten milliliters of contrast mixture of saline, iodinated contrast, and gadolinium contrast was injected by a senior musculoskeletal (MSK) radiologist using a 21G needle. Half of the patients were immediately immobilized using a shoulder sling, and the other half were allowed to move their shoulder and arm freely during the time before MR imaging. MR arthrography was performed with a 3 T system using standard T1 and PD weighted sequences. The MR images were reviewed independently by 2 MSK radiologists and graded for extravasation using a five-point scale (1: none, 2: less than 2 cm, 3: 2-5 cm, 4: 5-10 cm, 5: more than 10 cm) and for image quality using a 5 point scale (1: poor, 5: good). The Pearson correlation was calculated to assess the correlation between leakage and image quality.

Results:

There was no significant difference in amount of leakage between both groups, and global image quality was found equal in both groups. A negative correlation was found between leakage and quality assessment.

Conclusion:

This study shows that it cannot be avoided by strict shoulder immobilization and that it negatively affects image quality and interpretation.
Validation of a French Version of the Career Decision-Making Difficulties Questionnaire: Relationships With Self-Esteem and Self-Efficacy
Authors: Rossier Jérôme , Rochat Shékina , Sovet Laurent , Bernaud Jean-Luc
Published: April 2021

The aim of this study was to validate the French version of the Career Decision-Making Difficulties Questionnaire (CDDQ) and to assess its measurement invariance across gender, age groups, countries, and student versus career counseling samples. We also examined the sensitivity of this instrument to discriminate a career counseling population from a general student sample. Third, we studied the relationship between career decision-making difficulties, career decision-making self-efficacy, and self-esteem in a sample of 1,748 French and French-speaking Swiss participants. A confirmatory factor analysis confirmed the overall hierarchical structure of the CDDQ. Multigroup analysis indicated that the level of invariance across groups almost always reached configural, metric, and scalar invariance. Differences between countries were very small, whereas differences between the general population and career counseling subsamples were much larger. Both self-esteem and self-efficacy significantly predicted career decision-making difficulties. Moreover, as expected, self-efficacy partially mediated the relationship between self-esteem and career decision-making difficulties.
The impact of preferences for clinical and managerial leadership roles on the willingness to apply for a medical leadership position: Analysis of gender differences among a sample of German senior physicians
Authors: Liberatore Florian , Schätzle Julia , Räwer Henrik , Homayounfar Kia , Lindenmeier Jörg
Published: April 2021

Background

The hybrid role (clinical and managerial leadership tasks) of physicians in medical leadership positions (MLPs) is a driver of the attractiveness of these positions. The increasing feminization of the medical profession makes gender-related preferences for hybrid roles relevant.

Purpose

The current study uses the (EPL) career aspirations framework to analyze the (gender-related) effects that efficacy beliefs, motivations, and preferences for clinical leadership and managerial leadership have on the willingness of chief physicians to apply for an MLP. Methodology: A survey of senior physicians in German university hospitals yielded a sample size of N = 496. The resulting data were analyzed using a structural equation modeling approach.

Findings

The results confirm the low preference for MLPs among senior physicians, which is mainly affected by preferences for managerial leadership tasks. Female senior physicians perceive the position of an MLP to be less attractive than their male counterparts do, and female physicians’ willingness to apply for an MLP is concurrently driven by their preferences for clinical leadership and managerial leadership tasks. Practical implications: Mentoring programs could boost female senior physicians’ preparedness for MLPs. Further, flexibility in fulfilling managerial leadership tasks could be promoted to make MLPs more attractive to women.
Estimating hidden populations by transferring knowledge from geographically misaligned levels
Authors: Azevedo Douglas R. M. , Prates Marcos O. , Assunção Renato M.
Published: April 2021

The estimation of hidden sub-populations is a hard task that appears in many fields. For example, public health planning in Brazil depends crucially of the number of people who holds a private health insurance plan and hence rarely uses the public services. Different sources of information about these sub-populations may be available at different geographical levels. The available information can be transferred between these different geographic levels to improve the estimation of the hidden population size. In this study, we propose a model that use individual level information to learn about the dependence between the response variable and explanatory variables by proposing a family of link functions with asymptotes that are flexible enough to represent the real aspects of the data and robust to departures from the model. We use the fitted model to estimate the size of the sub-population at any desired level. We illustrate our methodology estimating the sub-population that uses the public health system in each neighborhood of large cities in Brazil.
India Balancing China: Exploring Soft Balancing Through Indo-Pacific
Authors: Kumar Pavan
Published: April 2021

India–China relation is witnessing its worst phase after the 1962 War. Recent aggression by the Chinese forces in the Galwan valley and killing of at least 20 Indian soldiers have posed serious security concerns for India. This article studies nature of threat China poses to India’s security and the latter’s choices to respond to it. In doing so, this article explores the theories of the balance of power, balance of threat and of balancing behaviour associated with realism. It argues that China is a threat to India’s security in the South Asian region as well as to its larger economic and geopolitical interests in world politics. Current realities of world politics restrict India’s choices, and if it has to survive and find its rightful place and increase influence in world affairs, it has no choice but to balance Chinese behaviour and not the power. This is a shift from the Waltzian analysis, which focuses on the balance of power. This article argues that when states do not have adequate internal capabilities to balance a state, they need not necessarily align with the threat (bandwagon) or with another great power to counter the threat. In an interconnected world, they have the choice to balance the behaviour of states that pose a threat by performing soft balancing. India has the choice to balance Chinese behaviour by making a regional alliance in the Indo-Pacific region, and it will be in India’s interests to carry out soft balancing. This article problematizes the proposition suggested by Rajesh Rajagopalan, in India’s Strategic Choices: China and the Balance of Power in Asia, that, to balance China, India should align with the United States. This article concludes with the argument that alignment with the United States is a perilous affair, and it shall give rise to greater insecurities. The more favourable alternative for India is to balance Chinese behaviour through soft balancing via Indo-Pacific.
Political Competition and Right-Wing Terrorism: A County-Level Analysis of the United States
Authors: Nemeth Stephen C. , Hansen Holley E.
Published: April 2021

While many previous studies on U.S. right-wing violence center on factors such as racial threat and economic anxiety, we draw from comparative politics research linking electoral dynamics to anti-minority violence. Furthermore, we argue that the causes of right-wing terrorism do not solely rest on political, economic, or social changes individually, but on their interaction. Using a geocoded, U.S. county-level analysis of right-wing terrorist incidents from 1970 to 2016, we find no evidence that poorer or more diverse counties are targets of right-wing terrorism. Rather, right-wing violence is more common in areas where “playing the ethnic card” makes strategic sense for elites looking to shift electoral outcomes: counties that are in electorally competitive areas and that are predominantly white.
Nanoliposomal thyme (Thymus vulgaris) essential oil: Effects of formulation parameters
Authors: Jabraeili Shahin , Mirzaei Hamid , Anarjan Navideh , Javadi Afshin , Behnajady Mohammad Ali
Published: April 2021

Essential oils with antimicrobial or antioxidant activities have received extensive attention among customers, manufacturers, and food scientists, especially with rising worries about the safety of synthetic food preservatives. However, like other functional lipid compounds their incorporation into aqueous systems is challenging, due to their less water solubility. Furthermore, their susceptibility to light, moisture, heat, and oxygen origins their less chemical and structural stabilities. Consequently, the present research was aimed to encapsulate the thyme essential oil into nanoliposomes, using a thin layer hydration-sonication technique, which can be a proficient solution for revealed problems. The effects of phospholipid and stabilizing agents’ concentrations, namely, lecithin, cholesterol, and glycerol, as main formulation parameters were investigated on characteristics of gained nanoliposomes, using a response surface method. Various empirical models were also developed to predict product characteristics by changing the formulation parameters. According to the numerical multiple optimizations, the best thyme oil nanoliposomes can be gained using equal concentrations of all three components as 1% with a mean particle size of 189.6 nm, PDI of 0.3487, the net zeta-potential of 42.48 mV, and DPPH radical scavenging of 12.72%. The prepared nanoliposomes had acceptable physical but limited chemical stabilities. The antibacterial action of manufactured essential oil nanoliposomes against both Gram-negative Escherichia coli and Gram-positive Staphylococcus aureus has made them efficient candidates as natural food preservatives.
Pediatric Glial Tumors
Authors: Viaene Angela N , Santi Mariarita , Hawkins Cynthia
Published: April 2021

Pediatric glial tumors are unique from their adult counterparts. This important distinction is recognized and incorporated into the World Health Organization classification of central nervous system tumors and applies to both high- and low-grade gliomas, incorporating their specific molecular profiles. Molecular alterations in pediatric high-grade gliomas provide important prognostic information, for example in H3 K27M-mutant tumors. The integration of molecular information is also important for pediatric low-grade gliomas due to their overlapping morphologies and the prognostic and therapeutic implications of these molecular alterations. In this paper, we cover a variety of glial tumors, encompassing neoplasms with predominantly glial histology, astrocytic tumors, oligodendroglial tumors, and mixed glioneuronal tumors. Considering the complexity of this evolving field, the purpose of this article is to offer a practical approach to the diagnosis of pediatric gliomas, including the selection of the most appropriate molecular surrogate immunohistochemical stains, basic molecular studies, and more sophisticated techniques if needed. The goal is to reach a rapid, sound diagnosis, helping guide clinical decision-making regarding prognosis and potential therapies.
New Network Models for the Analysis of Social Contagion in Organizations: An Introduction to Autologistic Actor Attribute Models
Authors: Parker Andrew , Pallotti Francesca , Lomi Alessandro
Published: April 2021

Autologistic actor attribute models (ALAAMs) provide new analytical opportunities to advance research on how individual attitudes, cognitions, behaviors, and outcomes diffuse through networks of social relations in which individuals in organizations are embedded. ALAAMs add to available statistical models of social contagion the possibility of formulating and testing competing hypotheses about the specific mechanisms that shape patterns of adoption/diffusion. The main objective of this article is to provide an introduction and a guide to the specification, estimation, interpretation and evaluation of ALAAMs. Using original data, we demonstrate the value of ALAAMs in an analysis of academic performance and social networks in a class of graduate management students. We find evidence that both high and low performance are contagious, that is, diffuse through social contact. However, the contagion mechanisms that contribute to the diffusion of high performance and low performance differ subtly and systematically. Our results help us identify new questions that ALAAMs allow us to ask, new answers they may be able to provide, and the constraints that need to be relaxed to facilitate their more general adoption in organizational research.
Quality Considerations When Using Tissue Samples for Biomarker Studies in Cancer Research
Authors: Speirs Valerie
Published: April 2021

Tissue obtained from biobanks is frequently employed in biomarker studies. Biomarkers define objective, measurable characteristics of biological and biomedical procedures and have been used as indicators of clinical outcome. This article outlines some of the steps scientists should consider when embarking on biomarker research in cancer research using samples from biobanks and the importance and challenges of linking clinical data to biological samples.
Lubrication performance of magnetorheological fluid in shear mode magnetorheological clutch with and without groove
Authors: Thakur Manish K , Sarkar Chiranjit
Published: April 2021

In this work, the lubrication performance of magnetorheological fluid-filled parallel discs of shear mode magnetorheological clutch is investigated. A magnetorheological fluid contains magnetic particles responsible for the yield strength and hence torque transmission capability in the magnetorheological clutch. The wear damages of magnetic particles of a magnetorheological fluid and magnetorheological clutch discs are examined by scanning electron microscopy and optical microscopy. Energy-dispersive X-ray spectroscopy is used to investigate the variation in chemical composition before and after the experimental test. A test rig is developed to test the torque transmission for a fabricated magnetorheological clutch with a grooved and non-grooved disc. The grooves' impact on both magnetorheological clutch discs' wear and magnetorheological fluid is investigated. It has been observed that the minimum wear damage occurs in the magnetic particles and the disc surface for the circular grooved magnetorheological clutch disc surface than the non-grooved disc surface. An effect of surface texture on the temperature distribution of the magnetorheological clutch is studied through simulation. Simulation results show that the groove's presence on the disc surface can improve the magnetorheological clutch's heat transfer. Hence, the grooved texture improves the lubrication performance and durability of both magnetorheological fluid and magnetorheological clutch.
Literature Review and Our Experience With Bleomycin-Based Electrochemotherapy for Cutaneous Vulvar Metastases From Endometrial Cancer
Authors: Merlo Sebastjan , Vivod Gregor , Bebar Sonja , Bošnjak Maša , Čemažar Maja , Serša Gregor , Brezar Simona Kranjc , Kovačević Nina
Published: April 2021

Endometrial carcinoma is the most common gynecological malignancy and the fifth most common malignancy in women. The worldwide incidence is 15.9 new cases per 100,000 women per year, and the incidence in Europe is 22.7 new cases. Minority of cases are diagnosed at an advanced stage of the disease. Cutaneous metastases are very rare with a prevalence of 0.8%. If cutaneous metastases are present, the prognosis is poor with an overall survival of up to 12 months. In this review, we presented clinical data on treatment of gynecological cancers with electrochemotherapy, with focus on treatment of cutaneous vulvar metastases from endometrial cancer. Further, we present our data on the case of a 64-year-old woman with recurrent endometrial adenocarcinoma with vulvar skin metastases. Treatment of endometrial carcinoma metastases is multimodal with surgery, chemotherapy, radiotherapy and hormone treatment. There is still no consensus about the specific treatment of cutaneous metastases from endometrial cancer, in particular in order to release symptoms. Electrochemotherapy may be a treatment option to reduce pain and bleeding and a safe option to treat multiple skin metastases.
Clinical Trial on Solid Second-Generation Platelet-Concentrates in the Management of the Chronic Osteomyelitis: Advanced Bioregenerative Surgeries
Authors: Crisci Alessandro , Raffaele D’Adamo , Crisci Michela
Published: April 2021

The supposition is that the usage of fibrin rich in leukocytes and platelets advanced (A-PRF) in ulcerative osteomyelitis of the diabetic foot allows rehabilitation from this critical illness. In this investigation, the focus was to normalize the use of platelet-rich fibrin (PRF) in patients with osteomyelitis not amputated, to use this second-generation platelet concentrate as a regeneration enabler. The researchers submitted and utilized A-PRF membranes (1300  g × 8 min) in 7 patients (all diabetics) with osteomyelitis and cutaneous injury for 6 months. The membranes, in combination with the supernatant fluid produced by stress, have been integrated into the skin lesion down to the bone after surgical debridement. The advancement of the lesions after some period of time has been analyzed. All 7 subjects had a probe-to-bone positive assay; magnetic resonance imaging indicated cortico-periosteal coagulation and/or foci of cortico-spongeous osteolysis contiguous to the lesion. Gram-positive bacteria were identified in our procedures in 52% of cases. Gram + Cocci, for example, Staphylococcus aureus (15.6%), β-hemolytic Streptococci (12.1%), Streptococcus viridans (7.1%), and Gram-negative bacteria, for example, Pseudomonas (10.6%), Proteus (7.8%), Enterobacter (5.7%) were present. Candida albicans was active in 2.8% of cases. The blood count showed no relevant differences. To date, cutaneous lesions have been cured in 6 of the 7 subjects treated (1 patient for more than 6 years) without any evidence of infection or recurrence. The results obtained on our subjects indicate that PRF membranes may be a therapeutic option in this problematic disease. In fact, this clinical approach may have the potential to promote the healing of diabetic skin lesions with osteomyelitis.
Is a small coil more effective as a finishing coil for the embolization of intracranial aneurysms? Outcomes using GALAXY G3™ MINI micro-coils as finishing coils in a single center
Authors: Kim Sang-Uk , Huh Joon , Lee Hyun-Goo , Jeong Won-Joo , Kim Dal-Soo , Huh Choon-Woong , Choi Han-Zo
Published: April 2021

Objective

The purpose of this study was to compare the outcomes of coil embolization using a 0.009 inches primary outer diameter coil as finishing coil (FC) to that of 0.01 inches.

Methods

From February and August 2020, 131 aneurysms that performed coil embolization using FC with a second loop diameter of 1 mm, were reviewed retrospectively, conducting propensity score matching and logistic regression analysis. Angiographic results such as, occlusion grade, packing density, failure and event were compared between 0.009 inches coil of GALAXY G3™ MINI microcoil (n = 54) and 0.01 inches coils (n = 77).

Results

There were no statistically significant differences between two groups, but more events occurred in the 0.009 group. (Odds ratio, 3.65; 95% CI, 1.06-12.55; P = 0.031) In the results of coil embolization, successful occlusion occlusion (complete occlusion and residual neck) was identified more in the 0.01 group. After propensity score matching, the variables in each group were similar, but the successful occlusion was higher in the 0.01 group as in the total population. Events tended to occur more frequently in the 0.009 inch group, and logistic regression analysis showed slightly higher events in the angled microcatheter. (48.3% versus 76.9%., P = 0.075), Also, the 0.009 inch FC is an independent risk factor. (Odds ratio, 3.84; 95% CI, 1.07-13.80; P = 0.039)

Conclusions

Using 0.01 inches coils as FC increased the packing density after the procedure, and showed more successful occlusion than using a 0.009 inches coil. The probability of unexpected events was observed more than three times in the 0.009 inch group.
Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion: A systematic review and meta-analysis
Authors: Zha Mingming , Yang Qingwen , Liu Shuo , Wu Min , Huang Kangmo , Cai Haodi , Zhang Xiaohao , Lv Qiushi , Liu Rui , Yang Dong , Liu Xinfeng
Published: April 2021

Background

There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO).

Aim

This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours.

Summary of review

Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through 23 February 2021. The primary outcomes were onset to door (OTD), door to imaging, door to puncture (DTP), puncture to recanalization, procedural time, successful recanalization, symptomatic intracranial hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale (mRS) score 0–2), and 90-day mortality. The secondary outcomes were imaging to puncture (ITP), onset to puncture (OTP), onset to recanalization (OTR), door to recanalization (DTR) time, mRS 0–2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14,185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer OTD (WMD [95% CI], 12.83 [1.84–23.82] min), DTP (WMD [95% CI], 11.45 [5.93–16.97] min), ITP (WMD [95% CI], 10.39 [4.61–16.17] min), OTP (WMD [95% CI], 25.30 [13.11–37.50] min), OTR (WMD [95% CI], 25.16 [10.28–40.04] min), and DTR (WMD [95% CI], 18.02 [10.01–26.03] min) time. Significantly lower successful recanalization rate (OR [95% CI], 0.85 [0.76–0.95]; p = 0.004; I2 = 0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend toward lower OR of good prognosis was witnessed in the off-hour group (OR [95% CI], 0.92 [0.84–1.01]; p = 0.084; I2 = 0%).

Conclusions

Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend toward worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.
Management of behavioural problems in people with dementia
Authors: Samuels Sherrie
Published: April 2021

Behavioural and psychological symptoms of dementia (BPSD) encompass the wide range of non-cognitive symptoms that affect over 90% of those with dementia. These symptoms include aggression, agitation, psychosis and social disinhibition, and can represent unmet needs in patients that may otherwise be unable to express themselves. Each person with dementia can have any combination of these symptoms – to varying severity – and they can fluctuate throughout the disease course. This article focuses on BPSD, including its common causes, patient assessment within primary care and key aspects of management.
Premenstrual syndrome
Authors: Boyles Lucy , Baxter Callum
Published: April 2021

Premenstrual syndrome (PMS) is a common condition that affects women, most of whom will be managed in general practice. PMS should be distinguished from the physiological premenstrual symptoms experienced by many women, often not needing medical advice. PMS encompasses psychological, physical and behavioural symptoms that generally occur just before menses. This article aims to guide the assessment of women presenting with PMS, including a brief overview of the epidemiology, aetiology, diagnosis and management.
Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally
Authors: Ehrlich Matthew E. , Han Bin , Lutz Michael , Ghorveh Mohsen Ghiasi , Okeefe Yasmin Ali , Shah Shreyansh , Kolls Brad J. , Graffagnino Carmelo
Published: April 2021

Background and Purpose:

Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts.

Methods:

We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle.

Results:

EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times.

Conclusion:

Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.
Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report
Authors: Riveros-Perez Efrain , Sanchez Maria Gabriela , Odo Nadine , Shukla Mrinal , Rungruang Bunya
Published: April 2021

Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease. We describe the successful management of a patient with placenta percreta who required supra-massive transfusion of blood products and interventions by different specialized teams in a tertiary care center.
Using an interactional perspective to examine patterns of conflict resolution among Chinese adolescents and parents involved in schoolwork conflicts
Authors: Cao Ge , Tam Vicky C
Published: April 2021

Parent-child conflict resolution is an interactive process by nature. Adopting a family systems perspective, the present study examines patterns of schoolwork conflict resolution among Chinese adolescents and parents, placing an emphasis on parent-child interactions. Qualitative methods using a grounded theory approach are adopted, with twelve parent-child dyads participating in joint interviews and follow-up individual interviews. Three patterns of adolescent-parent resolution of schoolwork conflicts are identified: (a) adolescents complying with parental coercion reluctantly: parents use parent-centered resolution strategies, while adolescents are self-assertive in the beginning but yield to their parents in the end; (b) effective communication: adolescents adopt self-assertive strategies when parents use child-centered strategies, with the outcome being that adolescents have the final say in agreements reached; (c) disagreement in a stalemate: parents’ use of parent-centered strategies and adolescents’ adoption of avoidant and self-assertive strategies lead to a suspension of disagreement. Discussion of the findings sheds light on hierarchical and enmeshed parent-child relationships in China as well as Chinese adolescents’ development of autonomy as exhibited in the patterns of parent-child schoolwork conflict resolution. Suggestions are made for further study of adolescent-parent schoolwork conflicts in Chinese families, and practical implications related to healthy family relationships are discussed.
Evidencing competence in a challenging world. European higher education initiatives to define, measure and compare learning
Authors: Wagenaar Robert
Published: April 2021

The well-known tripartite expression, ‘Tell me and I’ll forget; show me and I may remember; involve me and I’ll understand’, is a powerful expression of what still represents the struggle of learning, that is to make learners knowledgeable, skilled and therefore competent. The expression reflects well the basic concept applied in a recent initiative to measure and compare learning in higher education in Europe. This paper outlines the philosophy of the CALOHEE project, the context in which it was set up, the phases distinguished and the process followed, the outcomes so far, the intended testing model and next steps.
COVID-19 pandemic’s disruption on university teaching and learning and competence cultivation: Student evaluation of online learning experiences in Hong Kong
Authors: Mok Ka Ho , Xiong Weiyan , Bin Aedy Rahman Hamzah Nor
Published: April 2021

The COVID-19 pandemic outbreak has forced online teaching and learning to be the primary instruction format in higher education globally. One of the worrying concerns about online learning is whether this method is effective, specifically when compared to face-to-face classes. This descriptive quantitative study investigates how students in higher education institutions in Hong Kong evaluated their online learning experiences during the pandemic, including the factors influencing their digital learning experiences. By analysing the survey responses from 1,227 university students in Hong Kong, this study found that most of the respondents felt dissatisfied with their online learning experiences and effectiveness. Meanwhile, this study confirms that respondents’ household income level and information technology literacy affected their online learning effectiveness. Moreover, this study highlights the significant contributions of the community of inquiry, which places social presence on the promotion of a whole person development that could not be achieved when relying mainly on online learning. Findings encourage university leaders and instructors to search for multiple course delivery modes to nurture students to become caring leaders with the 21st century skills and knowledge set.
Cross-National Variation in School Reopening Measures During the COVID-19 Pandemic
Authors: Hoffman Kate Steed , Barragan Torres Mariana , Wotipka Christine Min
Published: April 2021

To contain the initial spread of the SARS-CoV2 virus and the COVID-19 disease, many countries opted to close schools. However, the importance of schooling to mitigate inequalities motivated many economies to reopen schools after having formulated various COVID-19 mitigation and containment strategies. Using an exploratory sequential mixed method design, we explore the measures undertaken by countries when reopening schools and how these measures varied cross-nationally. We find that countries formulated a wide number (total: 242) and range of school reopening measures to mitigate the spread of the virus in the early months of the COVID-19 pandemic. From a policy diffusion theoretical perspective, findings from our statistical analyses suggest that cross-national diversity in policies is related to both internal and external country factors such as peer emulation mechanisms, income, and past pandemic experiences. We urge international agencies for more explicit guidelines for effective school reopening measures.
An overview of magnetorheological polishing fluid applied in nano-finishing of components
Authors: Kumar Manjesh , Singh Yadav Hari Narayan , Kumar Abhinav , Das Manas
Published: April 2021

Surface quality is the most crucial factor affecting the product lifespan and performance of any component. Most earlier technologies display accuracy in the micrometre or submicrometre range, surface roughness in the nanometre range, and almost no surface defects in the production of optical, mechanical and electronic parts. Such finishing methods incorporate a magnetic field to control the finishing forces using magnetorheological fluid as the polishing medium. Magnetorheological fluid (MR) consists of ferromagnetic and abrasive particles. It is a type of modern intelligent fluid. An optimum selection of magnetorheological fluid constituents and their volume concentration plays an essential role for the ultra-fine finishing of newly developed engineering products. Rheological characteristics of magnetorheological fluid can change rapidly and effortlessly with the support of an activated magnetic field. Traditional finishing methods are comparatively inferior in finishing complex freeform surfaces, due to the lack of controlling finishing forces and limitations of polishing tool movement over the complex freeform contour of the components. There are different types of processes based on the magnetorheological fluid including magnetorheological finishing, magnetorheological abrasive flow finishing, rotational magnetorheological abrasive flow finishing and ball end magnetorheological finishing. This article discusses the development of different types of magnetorheological-fluid-based finishing processes and their modes of operation. The MR fluid devices developed in the last decade are thoroughly reviewed for their working principles, characteristics and applications. This article also highlights the study of rheological characterization of magnetorheological fluid and its applications in different polishing methods appropriate for finishing various complex freeform components.
Estimation of the perpendicular-to-the-grain tensile strength of Scots pine glued laminated timber via three-point bending tests
Authors: Okamoto Shigefumi , Akiyama Nobuhiko , Nakamura Noboru , Aoki Kenji , Inayama Masahiro
Published: April 2021

Three-point bending tests were performed on specimens of glued laminated timber with different specimen heights to failure to determine the relationship between specimen height and bending strength under tension perpendicular to the grain. For the three-point bending tests, two types of glued laminated timber composed of homogeneous grade timber, as specified in the Japanese Agricultural Standard, were used. The laminae used for the glued laminated timber were L80 grade Scots pine and L110 grade Scots pine. The specimens used in the three-point bending tests had dimensions of 105 mm (width) and 10–300 mm (height). The experimental results showed that the bending strength decreased as the specimen height increased, but the rate of decrease in the bending strength decreased with increasing specimen height when the specimen height exceeded 100 mm. From the relationship between the bending strength and specimen height, parameters that fit Bažant’s size-effect law were derived, and for a specimen height of approximately 100 mm, the bending strength was equal to the perpendicular-to-the-grain tensile strength.
Demoralization predicts suicidality in patients with cluster headache
Authors: Koo Brian B. , Bayoumi Ahmed , Albanna Abdalla , Abusuliman Mohammed , Burrone Laura , Sico Jason J. , Schindler Emmanuelle A. D.
Published: April 2021

Objective

To determine the frequency of suicidal ideation and assess suicide risk in cluster headache (CH) patients compared to matched controls without CH in this observational case-control study.

Background

CH is characterized by recurrent intolerable attacks of unilateral retro-orbital pain, which can cause disability, depression, and desperation. CH has been linked to suicide since its early descriptions by B.T. Horton; however, there is relatively little empiric data showing the association between suicidality and CH, especially in the context of other psychological phenomena, such as depression and demoralization.

Methods

CH and control participants were recruited through community and CH patient group advertisements. CH diagnosis was confirmed using the International Classification of Headache Disorders, 3rd edition diagnostic criteria for CH. Lifetime suicidal ideation and suicide risk were assessed using the Suicidal Behavior Questionnaire-revised and the Columbia Suicide Severity Rating Scale. The Brief Lifetime Depression Scale evaluated lifetime depression. Demoralization was assessed using the Diagnostic Criteria for use in Psychosomatic Research – Demoralization and the Kissane Demoralization Scale. Forward stepwise logistic regression determined the odds of suicidal ideation.

Results

One hundred CH and 135 control participants were comparable for age, sex, race, income, and marital status. Significantly more CH than control participants had lifetime active suicidal ideation (47.0% vs. 26.7%;p = 0.001), high suicide risk (38.0% vs. 18.5%;p = 0.0009), lifetime depression history (67.0%% vs. 32.6%;p < 0.00001), and demoralization (28.0% vs. 15.6%;p = 0.02). The odds of lifetime suicidal ideation were higher in those with CH (odds [95% confidence interval]; 2.04 [1.08,3.85]), even after accounting for depression and demoralization. In CH, suicidal ideation was associated with demoralization (6.66 [1.56,28.49]) but not depression (1.89 [0.66,5.46]).

Conclusions

Lifetime suicidal ideation and high suicide risk are prevalent in CH sufferers, and its likelihood is dependent on the presence of demoralization.