bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized Pragmatic Trial of Stroke Transitional Care
Authors: Duncan Pamela W. , Bushnell Cheryl D. , Jones Sara B. , Psioda Matthew A. , Gesell Sabina B. , D'Agostino Ralph B. , Sissine Mysha E. , Coleman Sylvia W. , Johnson Anna M. , Barton-Percival Blair F. , Prvu-Bettger Janet , Calhoun Adrienne G. , Cummings Doyle M. , Freburger Janet K. , Halladay Jacqueline R. , Kucharska-Newton Anna M. , Lundy-Lamm Gladys , Lutz Barbara J. , Mettam Laurie H. , Pastva Amy M. , Xenakis James G. , Ambrosius Walter T. , Radman Meghan D. , Vetter Betsy , Rosamond Wayne D. ,   on behalf of the COMPASS Site Investigators and Teams.
Published: June 2020

Background

The objectives of this study were to develop and test in real-world clinical practice the effectiveness of a comprehensive postacute stroke transitional care (TC) management program.

Methods and Results

The COMPASS study (Comprehensive Post-Acute Stroke Services) was a pragmatic cluster-randomized trial where the hospital was the unit of randomization. The intervention (COMPASS-TC) was initiated at 20 hospitals, and 20 hospitals provided their usual care. Hospital staff enrolled 6024 adult stroke and transient ischemic attack patients discharged home between 2016 and 2018. COMPASS-TC was patient-centered and assessed social and functional determinates of health to inform individualized care plans. Ninety-day outcomes were evaluated by blinded telephone interviewers. The primary outcome was functional status (Stroke Impact Scale-16); secondary outcomes were mortality, disability, medication adherence, depression, cognition, self-rated health, fatigue, care satisfaction, home blood pressure monitoring, and falls. The primary analysis was intention to treat. Of intervention hospitals, 58% had uninterrupted intervention delivery. Thirty-five percent of patients at intervention hospitals attended a COMPASS clinic visit. The primary outcome was measured for 59% of patients and was not significantly influenced by the intervention. Mean Stroke Impact Scale-16 (±SD) was 80.6±21.1 in TC versus 79.9±21.4 in usual care. Home blood pressure monitoring was self-reported by 72% of intervention patients versus 64% of usual care patients (adjusted odds ratio, 1.43 [95% CI, 1.21–1.70]). No other secondary outcomes differed.

Conclusions

Although designed according to the best available evidence with input from various stakeholders and consistent with Centers for Medicare and Medicaid Services TC policies, the COMPASS model of TC was not consistently incorporated into real-world health care. We found no significant effect of the intervention on functional status at 90 days post-discharge.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02588664.
Implications of Altered Ketone Metabolism and Therapeutic Ketosis in Heart Failure
Authors: Selvaraj Senthil , Kelly Daniel P. , Margulies Kenneth B.
Published: June 2020

Despite existing therapy, patients with heart failure (HF) experience substantial morbidity and mortality, highlighting the urgent need to identify novel pathophysiological mechanisms and therapies, as well. Traditional models for pharmacological intervention have targeted neurohormonal axes and hemodynamic disturbances in HF. However, several studies have now highlighted the potential for ketone metabolic modulation as a promising treatment paradigm. During the pathophysiological progression of HF, the failing heart reduces fatty acid and glucose oxidation, with associated increases in ketone metabolism. Recent studies indicate that enhanced myocardial ketone use is adaptive in HF, and limited data demonstrate beneficial effects of exogenous ketone therapy in studies of animal models and humans with HF. This review will summarize current evidence supporting a salutary role for ketones in HF including (1) normal myocardial ketone use, (2) alterations in ketone metabolism in the failing heart, (3) effects of therapeutic ketosis in animals and humans with HF, and (4) the potential significance of ketosis associated with sodium-glucose cotransporter 2 inhibitors. Although a number of important questions remain regarding the use of therapeutic ketosis and mechanism of action in HF, current evidence suggests potential benefit, in particular, in HF with reduced ejection fraction, with theoretical rationale for its use in HF with preserved ejection fraction. Although it is early in its study and development, therapeutic ketosis across the spectrum of HF holds significant promise.
Effects of Home Particulate Air Filtration on Blood Pressure
Authors: Walzer Dalia , Gordon Terry , Thorpe Lorna , Thurston George , Xia Yuhe , Zhong Hua , Roberts Timothy R. , Hochman Judith S. , Newman Jonathan D.
Published: June 2020

Air pollution is a major contributor to cardiovascular morbidity and mortality. Fine particulate matter <2.5 µm in diameter may be a modifiable risk factor for hypertension. The benefits of in-home air filtration on systolic blood pressure (BP) and diastolic BP are unclear. To examine the effects of in-home personal air cleaner use on fine particulate exposure and BP, we queried PubMed, Web of Science, Cochrane Central Register, Inspec, and EBSCO GreenFILE databases for relevant clinical trials. Included studies were limited to nonsmoking participants in smoke-free homes with active or sham filtration on indoor fine particulate concentrations and changes in systolic and diastolic BP. Of 330 articles identified, 10 trials enrolling 604 participants who met inclusion criteria were considered. Over a median 13.5 days, there was a significant reduction of mean systolic BP by ≈4 mm Hg (−3.94 mm Hg [95% CI, −7.00 to −0.89];
P
=0.01) but a nonsignificant difference in mean diastolic BP (−0.95 mm Hg [95% CI, −2.81 to 0.91];
P
=0.32). Subgroup analyses indicated no heterogeneity of effect by age, level of particulate exposure, or study duration. Given the variation in study design, additional study is warranted to confirm and better quantify the observed benefits in systolic BP found with personal air cleaner use.
Epoxy Fatty Acids: From Salt Regulation to Kidney and Cardiovascular Therapeutics
Authors: Imig John D. , Jankiewicz Wojciech K. , Khan Abdul H.
Published: June 2020

Epoxyeicosatrienoic acids (EETs) are epoxy fatty acids that have biological actions that are essential for maintaining water and electrolyte homeostasis. An inability to increase EETs in response to a high-salt diet results in salt-sensitive hypertension. Vasodilation, inhibition of epithelial sodium channel, and inhibition of inflammation are the major EET actions that are beneficial to the heart, resistance arteries, and kidneys. Genetic and pharmacological means to elevate EETs demonstrated antihypertensive, anti-inflammatory, and organ protective actions. Therapeutic approaches to increase EETs were then developed for cardiovascular diseases. sEH (soluble epoxide hydrolase) inhibitors were developed and progressed to clinical trials for hypertension, diabetes mellitus, and other diseases. EET analogs were another therapeutic approach taken and these drugs are entering the early phases of clinical development. Even with the promise for these therapeutic approaches, there are still several challenges, unexplored areas, and opportunities for epoxy fatty acids.
Multi-Fetal Pregnancy, Preeclampsia, and Long-Term Cardiovascular Disease
Authors: Bergman Lina , Nordlöf-Callbo Paliz , Wikström Anna Karin , Snowden Jonathan M. , Hesselman Susanne , Edstedt Bonamy Anna Karin , Sandström Anna
Published: June 2020

This Swedish register-based cohort study determined the separate and joint contribution of preeclampsia and multi-fetal pregnancy on a woman’s risk of cardiovascular disease (CVD) later in life. The study included 892 425 first deliveries between 1973 and 2010 of women born 1950 until 1971, identified in the Swedish Medical Birth Register. A composite outcome of CVD was retrieved through linkage with the National Patient and Cause of Death Registers. Cox proportional hazard regression was used to assess the risk of CVD in women who had preeclampsia in a singleton or multi-fetal pregnancy, adjusting for potential confounders, and presented as adjusted hazard ratios. Compared with women who had a singleton pregnancy without preeclampsia (the referent group), women with preeclampsia in a singleton pregnancy had an increased risk of CVD (adjusted hazard ratio 1.75 [95% CI, 1.64–1.86]). Women who had a multi-fetal pregnancy without or with preeclampsia did not have an increased risk of future CVD (adjusted hazard ratios 0.94 [95% CI, 0.79–1.10] and 1.25 [95% CI, 0.83–1.86], respectively). As opposed to preeclampsia in a first singleton pregnancy, preeclampsia in a first multi-fetal pregnancy was not associated with increased risk of future CVD. This may support the theory that preeclampsia in multi-fetal pregnancies more often occurs as a result of the larger pregnancy-related burden on the maternal cardiovascular system and excessive placenta-shed inflammatory factors, rather than the woman’s underlying cardiovascular phenotype.
Procedural Volume and Outcomes After Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction in Kerala, India: Report of the Cardiological Society of India–Kerala Primary Percutaneous Coronary Intervention Registry
Authors: Jabir Abdullakutty , Mathew Anoop , Zheng Yinggan , Westerhout Cynthia , Viswanathan Sunitha , Sebastian Placid , Kumar Prasanna , Bangalore Sripal , Bainey Kevin R. , Welsh Robert
Published: June 2020

Background

There are limited data to inform policy mandating primary percutaneous coronary intervention (
PPCI
) volume benchmarks for catheterization laboratories in low‐ and middle‐income countries.

Methods and Results

This prospective state‐wide registry included ST‐segment–elevation myocardial infarction patients with symptoms of <12 hours, or with ongoing ischemia at 12 to 24 hours, reperfused with
PPCI
. From June 2013 to March 2016, we recruited 5560 consecutive patients. We categorized hospitals on the basis of annual
PPCI
volumes into low, medium, and high volume (<100, 100–199, and ≥200 PPCIs per year, respectively). Kaplan‐Meier curves and Cox regression models were used to examine the association between
PPCI
volume and 1‐year mortality. Among 42 recruiting hospitals, there were 24 (57.2%) low‐volume, 8 (19%) medium‐volume, and 10 (23.8%) high‐volume hospitals. The median (25th–75th percentile) TIMI (Thrombolysis in Myocardial Infarction) ST‐segment–elevation myocardial infarction risk score was 3 (2–5). Cardiac arrest before admission occurred in 4.2%, 2.1%, and 2.9% of cases at low‐, medium‐, and high‐volume hospitals, respectively (
P
=0.02). Total ischemic time differed significantly among low‐volume (median [25th–75th percentile], 3.5 [2.4–5.5] hours), medium‐volume (median, 3.8 [25th–75th percentile, 2.58–6.05] hours), and high‐volume hospitals (median, 4.16 [25th–75th percentile 2.8–6.3] hours) (
P
=0.01). Vascular access was radial in 61.5%, 71.3%, and 63.2% of cases at low‐, medium‐, and high‐volume hospitals, respectively (
P
=0.01). The observed 1‐year mortality rate was 6.5%, 3.4%, and 8.6% at low‐, medium‐ and high‐volume hospitals, respectively (
P
<0.01), and the difference did not attenuate after multivariate adjustment (low versus medium: hazard ratio [95%
CI
], 1.80 [1.12–2.90]; high versus medium: hazard ratio [95%
CI
], 2.53 [1.78–3.58]) (
P
<0.01).

Conclusions

Low‐ and middle‐income countries, like India, may have a nonlinear relationship between institutional
PPCI
volume and outcomes, partly driven by procedural variations and inequalities in access to care.
Complete Revascularization by Percutaneous Coronary Intervention for Patients With ST‐Segment–Elevation Myocardial Infarction and Multivessel Coronary Artery Disease: An Updated Meta‐Analysis of Randomized Trials
Authors: Ahmad Yousif , Howard James P. , Arnold Ahran , Prasad Megha , Seligman Henry , Cook Christopher M. , Warisawa Takayuki , Shun‐Shun Matthew , Ali Ziad , Parikh Manish A. , Al‐Lamee Rasha , Sen Sayan , Francis Darrel , Moses Jeffrey W. , Leon Martin B. , Stone Gregg W. , Karmpaliotis Dimitri
Published: June 2020

Background

For patients with ST‐segment–elevation myocardial infarction (
STEMI
) and multivessel coronary artery disease, the optimal treatment of the non‐infarct‐related artery has been controversial. This up‐to‐date meta‐analysis focusing on individual clinical end points was performed to further evaluate the benefit of complete revascularization with percutaneous coronary intervention for patients with
STEMI
and multivessel coronary artery disease.

Methods and Results

We systematically identified all randomized trials comparing complete revascularization with percutaneous coronary intervention to culprit‐only revascularization for multivessel disease in
STEMI
and performed a random‐effects meta‐analysis. The primary efficacy end point was cardiovascular death analyzed on an intention‐to‐treat basis. Secondary end points included all‐cause mortality, myocardial infarction, and unplanned revascularization. Ten studies (7542 patients) were included: 3664 patients were randomized to complete revascularization and 3878 to culprit‐only revascularization. Across all patients, complete revascularization was superior to culprit‐only revascularization for reduction in the risk of cardiovascular death (relative risk [RR], 0.68; 95%
CI
, 0.47–0.98;
P
=0.037; I
2
=21.8%) and reduction in the risk of myocardial infarction (RR, 0.65; 95%
CI
, 0.54–0.79;
P
<0.0001; I
2
=0.0%). Complete revascularization also significantly reduced the risk of unplanned revascularization (RR, 0.37; 95%
CI
, 0.28–0.51;
P
<0.0001; I
2
=64.7%). The difference in all‐cause mortality with percutaneous coronary intervention was not statistically significant (RR, 0.85; 95%
CI
, 0.69–1.04;
P
=0.108; I
2
=0.0%).

Conclusions

For patients with
STEMI
and multivessel disease, complete revascularization with percutaneous coronary intervention significantly improves hard clinical outcomes including cardiovascular death and myocardial infarction. These data have implications for clinical practice guidelines regarding recommendations for complete revascularization following
STEMI
.
Long‐Term Association of Venous Thromboembolism With Frailty, Physical Functioning, and Quality of Life: The Atherosclerosis Risk in Communities Study
Authors: Lutsey Pamela L. , Windham B. Gwen , Misialek Jeffrey R. , Cushman Mary , Kucharska‐Newton Anna , Basu Saonli , Folsom Aaron R.
Published: June 2020

Background

Relatively little is known about the long‐term consequences of venous thromboembolism (VTE) on physical functioning. We compared long‐term frailty status, physical function, and quality of life among survivors of VTE with survivors of coronary heart disease (CHD) and stroke, and with those without these diseases.

Methods and Results

Cases of VTE, CHD, and stroke were continuously identified since ARIC (Atherosclerosis Risk in Communities Study) recruitment during 1987 to 1989. Functional measures were objectively captured at ARIC clinic visits 5 (2011–2013) and 6 (2016–2017); quality of life was self‐reported. The 6161 participants at visit 5 were, on average, 75.7 (range, 66–90) years of age. By visit 5, 3.2% had had a VTE, 6.9% CHD, and 3.4% stroke. Compared with those without any of these conditions, VTE survivors were more likely to be frail (odds ratio [OR], 3.11; 95% CI, 1.80–5.36) and have low (<10) versus good scores on the Short Physical Performance Battery (OR, 3.59; 95% CI, 2.36–5.47). They also had slower gait speed, less endurance, and lower physical quality of life. VTE survivors were similar to coronary heart disease and stroke survivors on categorical frailty and outcomes on Short Physical Performance Battery assessment. When score on the Short Physical Performance Battery instrument was modeled continuously, VTE survivors performed better than stroke survivors but worse than CHD survivors.

Conclusions

VTE survivors had triple the odds of frailty and poorer physical function than those without the vascular diseases considered. Their function was somewhat worse than that of CHD survivors, but better than stroke survivors. These findings suggest that VTE patients may benefit from additional efforts to improve postevent physical functioning.
Building Domestic Support for West Germany's Integration into NATO, 1953–1955
Authors: Uelzmann Jan
Published: June 2020

Konrad Adenauer's government in the Federal Republic of Germany (FRG) engaged in a large-scale media campaign to create political consent for the FRG's integration into the West, a policy that rested to a large extent on rearmament and entry into the North Atlantic Treaty Organization. To counter public criticism of rearmament, the West German authorities used Mobilwerbung, a company that maintained a fleet of mobile film screening vans. Clandestinely financed by the government, Mobilwerbung brought government-commissioned films and political speakers into the FRG's remotest areas. Based on archival records on deployments in Lower Saxony and North Rhine-Westphalia, this article traces Mobilwerbung's role as a government unit that reacted dynamically to competing events. Through highly detailed reporting on audience reactions, Mobilwerbung served both as a public relations vehicle to foster consent and as an analytical tool that allowed the mapping of public sentiment regarding rearmament.
Feature Gluttony
Authors: Coon Jessica , Keine Stefan
Published: June 2020

This article develops a new approach to a family of hierarchy-effect-inducing configurations, with a focus on Person Case Constraint effects, dative-nominative configurations, and copula constructions. The main line of approach in the recent literature is to attribute these effects to failures of ϕ-Agree or, more specifically, failures of nominal licensing or case checking. We propose that the problem in these configurations is unrelated to nominal licensing, but is instead the result of a probe participating in more than one Agree dependency, a configuration we refer to as feature gluttony. Feature gluttony does not in and of itself lead to ungrammaticality; rather, it can create irresolvably conflicting requirements for subsequent operations. We argue that in the case of clitic configurations, a probe that agrees with more than one DP creates an intervention problem for clitic doubling. In violations involving morphological agreement, gluttony in features may result in a configuration with no available morphological output.
Horizontal Moisture Transport Dominates the Regional Moistening Patterns in the Arctic
Authors: Nygård Tiina , Naakka Tuomas , Vihma Timo
Published: June 2020

Along with the amplified warming and dramatic sea ice decline, the Arctic has experienced regionally and seasonally variable moistening of the atmosphere. Based on reanalysis data, this study demonstrates that the regional moistening patterns during the last four decades, 1979–2018, were predominantly shaped by the strong trends in horizontal moisture transport. Our results suggest that the trends in moisture transport were largely driven by changes in atmospheric circulation. Trends in evaporation in the Arctic had a smaller role in shaping the moistening patterns. Both horizontal moisture transport and local evaporation have been affected by the diminishing sea ice cover during the cold seasons from autumn to spring. Increases in evaporation have been restricted to the vicinity of the sea ice margin over a limited period during the local sea ice decline. For the first time we demonstrate that, after the sea ice has disappeared from a region, evaporation over the open sea has had negative trends due to the effect of horizontal moisture transport to suppress evaporation. Near the sea ice margin, the trends in moisture transport and evaporation and the cloud response to those have been circulation dependent. The future moisture and cloud distributions in the Arctic are expected to respond to changes in atmospheric pressure patterns; circulation and moisture transport will also control where and when efficient surface evaporation can occur.
A Local Unscented Transform Kalman Filter for Nonlinear Systems
Authors: Sung Kwangjae , Song Hyo-Jong , Kwon In-Hyuk
Published: June 2020

This paper proposes an efficient data assimilation approach based on the sigma-point Kalman filter (SPKF). With a potential for nonlinear filtering applications, the proposed approach, designated as the local unscented transform Kalman filter (LUTKF), is similar to the SPKF in that the mean and covariance of the nonlinear system are estimated by propagating a set of sigma points—also referred to as ensemble members—generated using the scaled unscented transformation (SUT), while making no assumptions with regard to nonlinear models. However, unlike the SPKF, the LUTKF can reduce the influence of observations on distant state variables by employing a localization scheme to suppress spurious correlations between distant locations in the error covariance matrix. Moreover, while the SPKF uses the augmented state vector constructed by concatenating the model states, model noise, and measurement noise, the system state for the LUTKF is not augmented with the random noise variables, thereby providing an accurate state estimate with relatively few sigma points. In sensitivity experiments executed with a 40-variable Lorenz system, the LUTKF required only three sigma points to prevent filter divergence for linear/nonlinear measurement models. Comparisons of the LUTKF and the local ensemble transform Kalman filters (LETKFs) reveal the advantages of the proposed filter in situations that share common features with geophysical data assimilation applications. In particular, the LUTKF shows considerable benefits over LETKFs when assimilating densely spaced observations that are related nonlinearly to the model state and that have high noise levels—such as the assimilation of remotely sensed data from satellites and radars.
Projecting End-of-Century Human Exposure from Tornadoes and Severe Hailstorms in Eastern Colorado: Meteorological and Population Perspectives
Authors: Childs Samuel J. , Schumacher Russ S. , Strader Stephen M.
Published: June 2020

Severe convective storms along the Front Range and eastern plains of Colorado frequently produce tornadoes and hail, leading to substantial damage and crop losses annually. Determination of future human exposure from these events must consider both changes in meteorological conditions and population dynamics. Projections of EF0 + tornadoes (on the enhanced Fujita scale) and severe [1.0+ in. (25.4+ mm)] hail reports out to the year 2100 are computed using convective parameter proxies generated from dynamically downscaled GFDL Climate Model, version 3 (GFDL CM3), output by the WRF Model for control and future climate scenarios. The proxies suggest that tornado and hail days in the region may increase by up to one tornado day and three hail days per year by 2100, with the greatest increases across northeastern Colorado. Using a spatially explicit Monte Carlo model, projected future frequency and spatial changes in tornadoes and hail are superimposed with population projections from the shared socioeconomic pathways (SSPs) to provide a range of possible scenarios for end-of-century human exposure to tornadoes and hailstorms. Changes in hazard frequency and spatial distribution may amplify human exposure up to 117% for tornadoes and 178% for hail in the region by 2100, although specific results are sensitive to uncertain combinations of future overlaps between hazard spatial distribution and population. Findings presented herein not only will provide the public, insurers, policy makers, land-use planners, and researchers with estimates of potential future tornado and hail impacts in the Front Range region, they also will allow the weather enterprise to better understand, prepare for, and communicate tornado and hail risk to eastern Colorado communities.
Men Do Not Rule the World of Tanks: Negating the Gender-Performance Gap in a Spatial-Action Game by Controlling for Time Played
Authors: Ratan Rabindra , Shen Cuihua , Williams Dmitri
Published: June 2020

The present research addresses the stereotype that women and girls lack the ability to succeed compared to men and boys in video games. Previous lab-based research has found that playing spatial-action video games potentially reduces the gender gap in spatial-thinking skills, while previous field studies of less spatially oriented online games have found that the perceived gender-performance gap actually results from the amount of previous gameplay time, which is confounded with gender. Extending both lines of research, the present field study examines player performance in a spatial-action game, the vehicle-based shooter World of Tanks. Results from 3,280 players suggest that women appear to accrue fewer experience points per match than men, signaling lower performance ability, but that when the amount of previous gameplay time is statistically controlled, this gender difference is negated. These results lend support to the claim that playing video games—even spatial-action games—diminishes the gender-performance gap, which is potentially useful for promoting gender equity in STEM fields.
National Family Policies and Mothers’ Employment: How Earnings Inequality Shapes Policy Effects across and within Countries
Authors: Hook Jennifer L. , Paek Eunjeong
Published: June 2020

Although researchers generally agree that national family policies play a role in shaping mothers’ employment, there is considerable debate about whether, how, and why policy effects vary across country contexts and within countries by mothers’ educational attainment. We hypothesize that family policies interact with national levels of earnings inequality to differentially affect mothers’ employment outcomes by educational attainment. We develop hypotheses about the two most commonly studied family policies—early childhood education and care (ECEC) and paid parental leave. We test these hypotheses by establishing a novel linkage between the EU-Labour Force Survey and the Current Population Survey 1999 to 2016 ( n = 23 countries, 299 country-years, 1.2 million mothers of young children), combined with an original collection of country-year indicators. Using multilevel models, we find that ECEC spending is associated with a greater likelihood of maternal employment, but the association is strongest for non-college-educated mothers in high-inequality settings. The length of paid parental leave over six months is generally associated with a lower likelihood of maternal employment, but the association is most pronounced for mothers in high-inequality settings. We call for greater attention to the role of earnings inequality in shaping mothers’ employment and conditioning policy effects.
Achilles Tendon Thickness Is an Independent Predictor of Carotid Atherosclerosis and Is Associated With a Carotid Plaque Burden
Authors: Genkel Vadim , Kuznetsova Alla , Lebedev Evgeny , Sinitskii Anton , Pykhova Lubov , Shaposhnik Igor
Published: June 2020

The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis ( r = 0.277; P = .004), cPS ( r = 0.225; P = .035), and cTPA ( r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.
Impact of Pharmacist-Directed Simplified Procalcitonin Algorithm on Antibiotic Therapy in Critically Ill Patients With Sepsis
Authors: Willmon Julie , Subedi Bibidh , Girgis Ramy , Noe Myint
Published: June 2020

Purpose

The purpose was to determine whether a simplified procalcitonin (PCT) algorithm guided by pharmacist recommendations reduces antibiotic duration of therapy in critically ill patients with suspected sepsis.

Methods

This was a single-centered pre-post study conducted at a 1368-bed community teaching hospital in the United States. A prospective cohort with pharmacist intervention utilizing a simplified PCT algorithm was compared with a retrospective historical cohort with standard therapy. Adult patients admitted to the intensive care unit (ICU) with suspected sepsis who received intravenous antibiotics were included. A pharmacist recommended continuation or discontinuation of antibiotics based on the PCT level per our algorithm and full clinical assessment of the patient. Primary outcome was total duration of antibiotic therapy. Secondary outcomes were ICU and hospital length of stay (LOS), reinitiation of antibiotic therapy within 72 hours of discontinuation, and 28-day in-hospital mortality.

Results

From September 2017 to May 2018, 360 patients were screened for eligibility. Of these, 26 patients were included in the PCT group and 26 patients in the standard therapy group. Baseline characteristics were similar between groups. A significant difference in duration of antibiotic therapy was detected with a median of 9 days in the PCT group versus 12 days in the standard therapy group ( P = .02). There were no significant differences in secondary endpoints of ICU and hospital LOS, reinitiation of antibiotics at 72 hours, or 28-day mortality.

Conclusion

Use of a simplified PCT algorithm with pharmacist-guided recommendations significantly reduced the duration of antibiotic therapy in critically ill patients with sepsis.
Stability of Ampicillin in Normal Saline Following Refrigerated Storage and 24-Hour Pump Recirculation
Authors: Huskey Mariah , Lewis Paul , Brown Stacy D.
Published: June 2020

Objective

Use of ampicillin in outpatient parenteral antimicrobial therapy (OPAT) has historically been complicated by frequent dosing and limited stability. The purpose of this study was to evaluate stability of ampicillin using high-pressure liquid chromatography (HPLC) in an OPAT dosing model using continuous infusion at room temperature over 24 hours immediately following preparation compared with batches stored under refrigeration for 24 hours, 72 hours, and 7 days.

Methods

An HPLC method was developed and validated as stability indicating using guidance in USP general Chapter <1225>. Four ampicillin batches were prepared for each experimental condition (immediate use and refrigerated storage for 24 hours, 72 hours, and 7 days). A pump was used to recirculate the solutions through medical-grade tubing for 24 hours. Triplicate 1-mL aliquots were removed from each batch at time 0, 4, 8, 12, and 24 hours and analyzed for ampicillin concentration.

Results

Each batch was assayed for initial concentration (20.34-21.50 mg/mL), and percent recovery compared with that concentration thereafter. For the duration of infusion, the average recoveries were 96.4%, 95.8%, 94.6%, and 90.3% for immediate use, 24-hour storage, 72-hour storage, and 7-day storage, respectively. The recovery remained above 90% for all batches and time points, except for 7-day storage, which fell below 90% after 4 hours of circulation.

Conclusion

Ampicillin can be prepared and stored in a refrigerator for up to 72 hours prior to continuously infusing at room temperature over 24 hours with less than a 10% loss of potency over the dosing period. This model supports twice weekly OPAT delivery of ampicillin.
Multimodal score level fusion for recognition using face and palmprint
Authors: Rane Milind E , Bhadade Umesh S
Published: June 2020

The paper proposes a t-norm-based matching score fusion approach for a multimodal heterogenous biometric recognition system. Two trait-based multimodal recognition system is developed by using biometrics traits like palmprint and face. First, palmprint and face are pre-processed, extracted features and calculated matching score of each trait using correlation coefficient and combine matching scores using t-norm based score level fusion. Face database like Face 94, Face 95, Face 96, FERET, FRGC and palmprint database like IITD are operated for training and testing of algorithm. The results of experimentation show that the proposed algorithm provides the Genuine Acceptance Rate (GAR) of 99.7% at False Acceptance Rate (FAR) of 0.1% and GAR of 99.2% at FAR of 0.01% significantly improves the accuracy of a biometric recognition system. The proposed algorithm provides the 0.53% more accuracy at FAR of 0.1% and 2.77% more accuracy at FAR of 0.01%, when compared to existing works.
Theology of Family Today: Contemporary Struggles and Future Promise
Authors: Rubio Julie Hanlon
Published: June 2020

Before, during, and after the Synods on the family and Pope Francis’s apostolic exhortation, Amoris Laetitia, Catholics have been engaged in extensive debates on the theology of the family in light of changing practices and norms. This essay argues that contemporary Catholic thinking on the family balances a radical vision of marriage as lifelong love oriented outward with a vision of a church offering welcome, accompaniment, and mercy.
On the mechanical properties of continuous fiber reinforced thermoplastic composites realized through vacuum infusion
Authors: Gavande Vishal , Anand Anoop
Published: June 2020

Continuous glass fiber reinforced thermoplastic composites have been manufactured and their mechanical properties have been evaluated. A catalyzed monomer is infused through a stack of compacted dry reinforcement under vacuum. The monomer undergoes radical polymerization with a peroxide catalyst. Viscosity and reactivity profile have been characterized to determine the catalyst concentration and temperature of infusion. Glass fiber reinforced thermoplastic composites realized through this method have mechanical properties that are comparable with that of epoxy with an added advantage of excellent toughness and repairability. For example, the residual compressive strength of thermoplastic composites after low-velocity impact is found to be over 140% more than that of epoxy-based composites using the same reinforcement and realized under identical manufacturing methods.
Childhood Oral Infections Associate with Adulthood Metabolic Syndrome: A Longitudinal Cohort Study
Authors: Pussinen P.J. , Paju S. , Viikari J. , Salminen A. , Taittonen L. , Laitinen T. , Burgner D. , Kähönen M. , Lehtimäki T. , Hutri-Kähönen N. , Raitakari O. , Juonala M.
Published: June 2020

Chronic oral infection/inflammation is cross-sectionally associated with metabolic syndrome (MetS) in adults, but there are few longitudinal studies and studies on childhood oral infections and adult MetS risk. We investigated whether childhood clinical parameters indicative of oral infection/inflammation were associated with adulthood MetS and its components. A total of 755 children aged 6, 9, and 12 y underwent a clinical oral examination in 1980 as part of the Cardiovascular Risk in Young Finns Study. Oral health measures included bleeding on probing (BOP), periodontal probing pocket depth, caries, fillings, and visible plaque. Metabolic parameters were determined at baseline and during follow-up. MetS was diagnosed ( n = 588, 77.9%) in the adulthood at 21 y (in 2001), 27 y (in 2007), and 31 y (in 2011) after the oral assessment, when the participants were 27 to 43 y old. Regression analyses were adjusted for childhood age, sex, body mass index, and family income, as well as adulthood smoking and education level. In adulthood, MetS was diagnosed in 11.9% (2001), 18.7% (2007), and 20.7% (2011) of participants at the 3 follow-ups. Childhood caries and fillings were associated with increased risk of adult MetS (risk ratio [95% CI], 1.25 [0.90 to 2.45] and 1.27 [1.02 to 1.99]) and with increased systolic blood pressure (1.78 [1.01 to 4.26] and 2.48 [1.11 to 4.12]) and waist circumference (2.25 [1.02 to 4.99] and 1.56 [1.01 to 3.25]), whereas BOP and visible plaque were associated with plasma glucose (1.97 [1.08 to 3.60] and 1.88 [1.00 to 3.53]). Severity of BOP ( P = 0.015) and caries ( P = 0.005) and teeth with plaque ( P = 0.027) were associated with number of MetS components. No such trends were seen with probing pocket depth. Childhood oral infection/inflammation was associated with adverse metabolic parameters and MetS in adulthood.
Police Officers’ Views of Naloxone and Drug Treatment: Does Greater Overdose Response Lead to More Negativity?
Authors: Murphy Jennifer , Russell Brenda
Published: June 2020

Police officers and emergency personnel are on the frontlines of the opioid crisis. This research examines police officer attitudes about naloxone administration, drug treatment, and their role in handling drug-related incidents through an online survey. Although officers view themselves as adequately trained in administering naloxone/Narcan, almost half (43%) believe there should be a limit on how often someone who overdoses receives Narcan and the majority (83%) view naloxone/Narcan as providing an excuse to continue drug use. Officers also view drug treatment as ineffective. Negative attitudes differed as a function of frequency of overdose responses; officers who responded to more overdose calls and administered naloxone more frequently demonstrate more pessimistic attitudes toward drug treatment and the use of naloxone/Narcan. Officers more frequently exposed to drug overdoses need education and training about drug addiction issues to decrease stigma and elicit greater empathy toward people struggling with addiction.
The Relationship of Special Education Placement and Student Academic Outcomes
Authors: Cole Sandi M. , Murphy Hardy R. , Frisby Michael B. , Grossi Teresa A. , Bolte Hannah R.
Published: June 2020

This study investigates the academic outcomes of a special education student cohort in the state of Indiana placed in high and low inclusion settings. Student scores in these two settings from the Indiana State Test of Educational Progress (ISTEP+ English/Language Arts and math) were compared from fourth grade in 2014 through the eighth grade in 2018. Results of this study show that students with disabilities who spent 80% or more of their time in a general education inclusive classroom did significantly better in both reading and math assessment than their peers who spent more time in separate special education classrooms.
Stop Laryngeal Distinctions Driven by Contrastive Effects of Neighboring Tones
Authors: Lee-Kim Sang-Im
Published: June 2020

This study examined contrastive effects of neighboring tones that give rise to a systematic asymmetry in stop perception. Korean-speaking learners of Mandarin Chinese and naïve listeners labeled voiceless unaspirated stops preceded or followed by low or high extrinsic tonal context (e.g., maLO.pa vs. maHI.pa) either as lenis (associated with a low F0 at the vowel onset) or as fortis stops (with a high F0). Further, the target tone itself varied between level and rising (e.g., maLO.paLEV vs. maLO.paRIS). Both groups of listeners showed significant contrastive effects of extrinsic context. Specifically, more lenis responses were elicited in a high tone context than in a low one, and vice versa. This indicates that the onset F0 of a stop is perceived lower in a high tone context, which, in turn, provides positive evidence for lenis stops. This effect was more clearly pronounced for the level than for the contour tone target and also for the preceding than for the following context irrespective of linguistic experience. Despite qualitative similarities, learners showed larger effects for all F0 variables, indicating that the degree of context effects may be enhanced by one’s phonetic knowledge, namely sensitivity to F0 cues along with the processing of consecutive tones acquired through learning a tone language.
Effect of incomplete sampling description in DNA reports on bloodstain pattern analysis and reconstruction of a crime scene
Authors: Stojanović Ivan , Stojanović Jovan , Šorgić Dejan , Čipev Anita
Published: June 2020

DNA analysts in forensic laboratories are engaged in analysing and sampling bloodstains from bloodstained items. Detailed and precise descriptions of bloodstains on items of interest are very important for bloodstain pattern analysis (BPA). DNA and BPA reports were examined from forensic laboratories in Serbia ( N = 88). About 400 reports were observed from the past three years. First, we analysed descriptions of items (clothing and shoes) in DNA reports, and special attention was paid to descriptions of bloodstains. Subsequently, we estimated the value of descriptions of bloodstained items of interest in linking specific types of bloodstains to the obtained DNA profiles. Observed descriptions of bloodstained items in DNA reports are usually limited to phrases. A major problem exists in cases where several people were injured in the same bloodshed event. Connecting specific types of bloodstains to obtained DNA profiles is essential for the reconstruction of crime events. The complete analysis should therefore include detailed descriptions of all types of observed and sampled bloodstains. In DNA laboratories that are within a larger institute, it would be more appropriate and productive if BPA and DNA experts examined bloodstained items cooperatively. Moderately sized laboratories have a limited number of employees. So, in those DNA laboratories, it would be more appropriate to educate DNA analysts in the basic principles of BPA.
Just What Is Ontological Political Theory Meant to do? The Method and Practice of William E. Connolly
Authors: Chin Clayton
Published: June 2020

This article provides a critical appraisal of the ontological method of political theorizing through an examination of the methodological development of the work of William E. Connolly. Connolly has often been taken as a paradigmatic figure of the ‘ontological turn’. This is not only because of the significance of his work in the field but because he is one of its major methodological articulators. However, there has been no systematic evaluation of that method and its development. This paper rectifies that lacuna by critically illustrating Connolly’s turn from a post-positivistic interpretivism to his much noted ‘onto-political method’. It argues that the latter, while usually thought to be modelled on the work of Friedrich Nietzsche and Michel Foucault, is structured by Heidegger’s understanding of ontological difference. The paper then argues that this leads to several problematic tendencies within Connolly’s model that undermine the critical-explanatory and normative power of his methodology by compromising the critical reflexivity ontology is meant to provide. All of this raises some concerns and criticisms of the use of ontological method of political theorizing, which has escaped sustained methodological analysis and scrutiny.
Language Teaching Methodology as a Lived Experience: An Autoethnography from China
Authors: Liu Wei
Published: June 2020

Research in language pedagogy often falls into the positivist trap of taking a desirable methodology as the ontological center and evaluating teachers’ teaching against it. Inspired by Snider et al.’s (1992) enactment approach to curriculum development, this article takes language teaching methodology as the lived experiences of students and teachers. From multiple roles and perspectives, the author recollects his personal history with different methodologies in English education in China from the 1980s to 2010s. Through this autoethnographic exploration, the author reflects on the shifting landscape of English education in China through the lens of his pedagogical lived experiences. The article also aims to rectify methodology as a theoretical construct in language education research, arguing that the gap between planned methodology and enacted methodology is the most fruitful space for pedagogical research in language education.
Research on large deformation control technology of tunnels in squeezing rock and its application
Authors: Cui Guangyao , Qi Jiasuo , Wang Daoyuan
Published: June 2020

Field studies by squeezing rock deformation have shown that large deformation slips can occurs in tunnels in squeezing rock, the tunnels may be partially or completely broken. This article proposed two schemes for controlling the deformation of squeezing rock, which are “resistance combine release” Scheme 1 and “strong support” Scheme 2, the deformation characteristics and deformation mechanism of squeezing rock is researched by Zhongyi Tunnel. The results show that Scheme 2 is superior to Scheme 1 in terms of deformation rate, cumulative deformation, and monthly construction footage. Research results can provide a reference for similar projects.
Heterogeneous co-simulation for embedded and cyber-physical systems design
Authors: Attarzadeh-Niaki Seyed-Hosein , Sander Ingo
Published: June 2020

The growing complexity of embedded and cyber-physical systems makes the design of all system components from scratch increasingly impractical. Consequently, already from early stages of a design flow, designers rely on prior experience, which comes in the form of legacy code or third-party intellectual property (IP) blocks. Current approaches partly address the co-simulation problem for specific scenarios in an ad hoc style. This work suggests a general method for co-simulation of heterogeneous IPs with a system modeling and simulation framework. The external IPs can be integrated as high-level models running in an external simulator or as software- and hardware-in-the-loop simulation with minimal effort. Examples of co-simulation scenarios for wrapping models with different semantics are presented together with their practical usage in two case studies. The presented method is also used to formulate a refinement-by-replacement workflow for IP-based system design.
Let Us Save Lives Using Games! A Study of the Effect of Digital Games for Traffic Education
Authors: Li Qing , Tay Richard , Pustaka Arkhadi
Published: June 2020

The main purpose of this research is to examine the effect of game-based learning on knowledge acquisition and retention of road rules. A secondary purpose of this study is to investigate possible gender differences related to such an approach. The third purpose is to explore the relationship between beliefs and knowledge acquisition. This quasi-experimental study employed pretest–posttests design involving 42 participants, randomly selected from people in Alberta, Canada. The participants took a pretest, played a game specifically designed to help players learn road rules, and then two posttests. The results show that gaming not only can improve players’ knowledge of road rules and road safety but also can help players retain such knowledge. However, no gender difference was identified in knowledge gain after the gaming intervention.
Neonatal ventriculitis: a case series and review of literature
Authors: Bhat Ramitha R , Batra Prerna , Sachan Ravi , Singh Gurbachan
Published: June 2020

Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of intraventricular antibiotics in treatment is controversial. We present five such cases which were refractory to conventional intravenous antibiotic therapy, had persistent features of ventriculitis and in whom raised intracranial pressure (ICP) necessitated insertion of an external ventricular drain (EVD). Three of the five infants required intraventricular antibiotics but also developed EVD-related complications. Early diagnosis of ventriculitis and treatment is necessary to avoid a fatal outcome. Intravenous antibiotics are the treatment of choice, but intraventricular therapy may be considered in refractory cases. As the incidence of EVD-associated ventriculitis is high, proper care of EVDs and their early removal is mandatory.