bluuebunny/crossref_metadata_2025 huggingface dataset:
Could patients with chronic obstructive pulmonary disease benefit from renin angiotensin system inhibitors? A meta-analysis
Authors: Lv Hongzhen , Huang Jingyi , Miao Miao , Huang Cheng , Hang Wenlu , Xu Yong
Published: February 2023

Background

Chronic obstructive pulmonary disease (COPD) is considered related to chronic systemic inflammation. Renin angiotensin system (RAS) inhibitor, exerting an anti-inflammatory action in many systems, has been demonstrated relevant to the pathogenesis of COPD. However, the association between RAS inhibitor use and prognosis of patients with COPD remains controversial. Therefore, we conducted a meta-analysis and systematic review to summarise current evidence.

Material and methods

Databases, including Medline, Embase, Web of Science and Cochran Library, were searched for eligible studies by the end of 30 September 2022. Observational studies or randomised controlled trials (RCTs) that investigated the association of RAS inhibitor use with prognosis of COPD (mortality or risk of acute exacerbation) were selected. The Newcastle-Ottawa Scale was used for quality assessment of observational studies, while the Cochrane risk-of-bias tool was used to assess the quality of RCTs. Statistical analyses were performed using Stata V.15. We selected relative risk (RR) with 95% CI as the effect measure. Heterogeneity was assessed by I-squared (I2) statistics. The funnel plot was used for visual assessment of publication bias.

Results

A total of 20 studies with 5 51 649 subjects were included in the meta-analysis. The overall analysis indicated that RAS inhibitor use decreased the risk of death in patients with COPD (RR: 0.69, 95% CI: 0.61 to 0.78). Subgroup analyses were conducted according to comorbidities, race and type of RAS inhibitors, and the results kept consistent. However, in the pooled analysis of prospective studies, RAS inhibitor use did not significantly decrease the mortality (RR: 0.89, 95% CI: 0.78 to 1.02). Additionally, the risk of exacerbations of COPD did not decrease in patients who were prescribed RAS inhibitors (RR: 0.99, 95% CI: 0.80 to 1.23). The funnel plot indicated significant publication bias.

Conclusion

RAS inhibitor use seemed to be associated with a reduction of mortality in patients with COPD. However, the available evidence is weak due to potential biases from retrospective studies and the heterogeneity across included studies.
What are small, medium and large effect sizes for exercise treatments of tendinopathy? A systematic review and meta-analysis
Authors: Swinton Paul A , Shim Joanna S C , Pavlova Anastasia Vladimirovna , Moss Rachel , Maclean Colin , Brandie David , Mitchell Laura , Greig Leon , Parkinson Eva , Tzortziou Brown Victoria , Morrissey Dylan , Alexander Lyndsay , Cooper Kay
Published: February 2023

Objective

To quantify and describe effect size distributions from exercise therapies across a range of tendinopathies and outcome domains to inform future research and clinical practice through conducting a systematic review with meta-analysis.

Design

Systematic review with meta-analysis exploring moderating effects and context-specific small, medium and large thresholds.

Eligibility criteria

Randomised and quasi-randomised controlled trials involving any persons with a diagnosis of rotator cuff, lateral elbow, patellar, Achilles or gluteal tendinopathy of any severity or duration.

Methods

Common databases, six trial registries and six grey literature databases were searched on 18 January 2021 (PROSPERO: CRD42020168187). Standardised mean difference (SMDpre) effect sizes were used with Bayesian hierarchical meta-analysis models to calculate the 0.25 (small), 0.5 (medium) and 0.75 quantiles (large) and compare pooled means across potential moderators. Risk of bias was assessed with Cochrane’s Risk of Bias tool.

Results

Data were obtained from 114 studies comprising 171 treatment arms 4104 participants. SMDpreeffect sizes were similar across tendinopathies but varied across outcome domains. Greater threshold values were obtained for self-reported measures of pain (small=0.5, medium=0.9 and large=1.4), disability (small=0.6, medium=1.0 and large=1.5) and function (small=0.6, medium=1.1 and large=1.8) and lower threshold values obtained for quality of life (small=−0.2, medium=0.3 and large=0.7) and objective measures of physical function (small=0.2, medium=0.4 and large=0.7). Potential moderating effects of assessment duration, exercise supervision and symptom duration were also identified, with greater pooled mean effect sizes estimated for longer assessment durations, supervised therapies and studies comprising patients with shorter symptom durations.

Conclusion

The effect size of exercise on tendinopathy is dependent on the type of outcome measure assessed. Threshold values presented here can be used to guide interpretation and assist with further research better establishing minimal important change.
Runx3-overexpression cooperates with ex vivo AKT inhibition to generate receptor-engineered T cells with better persistence, tumor-residency, and antitumor ability
Authors: Tang Jianghui , Sheng Jianpeng , Zhang Qi , Ji Yongtao , Wang Xun , Zhang Junlei , Wu Jiangchao , Song Jinyuan , Bai Xueli , Liang Tingbo
Published: February 2023

Background

Solid tumors pose unique roadblocks to treatment with chimeric antigen receptor (CAR) T cells, including limited T-cell persistence, inefficient tumor infiltration, and an immunosuppressive tumor microenvironment. To date, attempts to overcome these roadblocks have been unsatisfactory. Herein, we reported a strategy of combiningRunx3(encoding RUNX family transcription factor 3)-overexpression with ex vivo protein kinase B (AKT) inhibition to generate CAR-T cells with both central memory and tissue-resident memory characteristics to overcome these roadblocks.

Methods

We generated second-generation murine CAR-T cells expressing a CAR against human carbonic anhydrase 9 together withRunx3-overexpression and expanded them in the presence of AKTi-1/2, a selective and reversible inhibitor of AKT1/AKT2. We explored the influence of AKT inhibition (AKTi),Runx3-overexpression, and their combination on CAR-T cell phenotypes using flow cytometry, transcriptome profiling, and mass cytometry. The persistence, tumor-infiltration, and antitumor efficacy of CAR-T cells were evaluated in subcutaneous pancreatic ductal adenocarcinoma (PDAC) tumor models.

Results

AKTi generated a CD62L+central memory-like CAR-T cell population with enhanced persistence, but promotable cytotoxic potential.Runx3-overexpression cooperated with AKTi to generate CAR-T cells with both central memory and tissue-resident memory characteristics.Runx3-overexpression enhanced the potential of CD4+CAR T cells and cooperated with AKTi to inhibit the terminal differentiation of CD8+CAR T cells induced by tonic signaling. While AKTi promoted CAR-T cell central memory phenotype with prominently enhanced expansion ability,Runx3-overexpression promoted the CAR-T cell tissue-resident memory phenotype and further enhanced persistence, effector function, and tumor-residency. These novel AKTi-generatedRunx3-overexpressing CAR-T cells exhibited robust antitumor activity and responded well to programmed cell death 1 blockade in subcutaneous PDAC tumor models.

Conclusions

Runx3-overexpression cooperated with ex vivo AKTi to generate CAR-T cells with both tissue-resident and central memory characteristics, which equipped CAR-T cells with better persistence, cytotoxic potential, and tumor-residency ability to overcome roadblocks in the treatment of solid tumors.
Five loop anomalous dimension of non-singlet quark currents in the RI$${}^\prime $$ scheme
Authors: Gracey J. A.
Published: February 2023

We construct the five loop anomalous dimensions of the basic fields in Quantum Chromodynamics in a linear covariant gauge in the modified Regularization Invariant ($$\textrm{RI}^\prime $$RI′) scheme. Using these core results we also compute the four loop Green’s function where the quark mass operator and vector current are separately inserted in a quark 2-point function. These are necessary for measurements of the same quantities on the lattice. The Green’s functions are provided in both the modified Minimal Subtraction ($$\overline{\textrm{MS}}$$MS¯) and$$\textrm{RI}^\prime $$RI′schemes. All the results are available for a general Lie group.
Topological black holes in higher derivative gravity
Authors: Pravdová Alena , Pravda Vojtěch , Ortaggio Marcello
Published: February 2023

We study static black holes in quadratic gravity with planar and hyperbolic symmetry and non-extremal horizons. We obtain a solution in terms of an infinite power-series expansion around the horizon, which is characterized by two independent integration constants – the black hole radius and the strength of the Bach tensor at the horizon. While in Einstein’s gravity, such black holes require a negative cosmological constant $$\Lambda $$
Λ
, in quadratic gravity they can exist for any sign of $$\Lambda $$
Λ
and also for $$\Lambda =0$$

Λ
=
0

. Different branches of Schwarzschild–Bach–(A)dS or purely Bachian black holes are identified which admit distinct Einstein limits. Depending on the curvature of the transverse space and the value of $$\Lambda $$
Λ
, these Einstein limits result in (A)dS–Schwarzschild spacetimes with a transverse space of arbitrary curvature (such as black holes and naked singularities) or in Kundt metrics of the (anti-)Nariai type (i.e., dS$$_2\times $$

2

×

S$$^2$$

2

, AdS$$_2\times $$

2

×

H$$^2$$

2

, and flat spacetime). In the special case of toroidal black holes with $$\Lambda =0$$

Λ
=
0

, we also discuss how the Bach parameter needs to be fine-tuned to ensure that the metric does not blow up near infinity and instead matches asymptotically a Ricci-flat solution.
Learning Category Distribution for Text Classification
Authors: Wang Xiangyu , Zong Chengqing
Published: February 2023

Label smoothing has a wide range of applications in the machine learning field. Nonetheless, label smoothing only softens the targets by adding a uniform distribution into a one-hot vector, which cannot truthfully reflect the underlying relations among categories. However, learning category relations is of vital importance in many fields such as emotion taxonomy and open set recognition. In this work, we propose a method to obtain the label distribution for each category (category distribution) to reveal category relations. Furthermore, based on the learned category distribution, we calculate new soft targets to improve the performance of model classification. Compared with existing methods, our algorithm can improve neural network models without any side information or additional neural network module by considering category relations. Extensive experiments have been conducted on four original datasets and 10 constructed noisy datasets with three basic neural network models to validate our algorithm. The results demonstrate the effectiveness of our algorithm on the classification task. In addition, three experiments (arrangement, clustering, and similarity) are also conducted to validate the intrinsic quality of the learned category distribution. The results indicate that the learned category distribution can well express underlying relations among categories.
CPFloat: A C Library for Simulating Low-precision Arithmetic
Authors: Fasi Massimiliano , Mikaitis Mantas
Published: February 2023

One can simulate low-precision floating-point arithmetic via software by executing each arithmetic operation in hardware and then rounding the result to the desired number of significant bits. For IEEE-compliant formats, rounding requires only standard mathematical library functions, but handling subnormals, underflow, and overflow demands special attention, and numerical errors can cause mathematically correct formulae to behave incorrectly in finite arithmetic. Moreover, the ensuing implementations are not necessarily efficient, as the library functions these techniques build upon are typically designed to handle a broad range of cases and may not be optimized for the specific needs of rounding algorithms. CPFloat is a C library for simulating low-precision arithmetics. It offers efficient routines for rounding, performing mathematical computations, and querying properties of the simulated low-precision format. The software exploits the bit-level floating-point representation of the format in which the numbers are stored and replaces costly library calls with low-level bit manipulations and integer arithmetic. In numerical experiments, the new techniques bring a considerable speedup (typically one order of magnitude or more) over existing alternatives in C, C++, and MATLAB. To our knowledge, CPFloat is currently the most efficient and complete library for experimenting with custom low-precision floating-point arithmetic.
A Novel Chrysanthemum-Like Fractal Structure Multi-Band Antenna for Mobile Terminals
Authors: Yu Zhen , Lin Ziheng , Zhang Guodong , Li Yao , Ran Xiaoying
Published: February 2023

This paper incorporates the structural characteristics of chrysanthemums in nature and fractal geometry theory into the antenna structure design and a novel-structured fractal multiband fractal microstrip antenna with a chrysanthemum petal structure is proposed. The antenna can cover commercial frequency bands from the second to fourth generation (4G), satellite navigation, wireless local area networks, and Bluetooth. The antenna radiator imitates the structure of chrysanthemum’s petals in nature, and a basic arc shape is iterated many times according to a certain proportional coefficient. After simulation and comparison, the second iteration can achieve the best antenna performance, and the antenna adopted the coplanar waveguide feeding method to broaden the antenna bandwidth. The antenna covers three effective frequency bands of 1.58–2.68 GHz (64.7%), 2.76–4.01 GHz (33.9%), and 4.68–5.35 GHz (13.4%). The antenna dielectric board is made of FR-4 material, the dielectric constant is 4.4, and the actual size is 41 × 29 × 1.6 mm3. The antenna performs fractal iteration at a small size, and the approximate calculation of the frequency band is completed by comparing the ratio of each ring to the current vector diagram. The design of the antenna is to use HFSS for antenna modeling and parameter optimization, and the model under different conditions were compared and analyzed. By comparing the test results of the antenna prototype with the simulation structure in the electromagnetic anechoic chamber, the rationality of the antenna is verified.
Nurse Leadership Development: A Qualitative Study of the Dutch Excellent Care Program
Authors: de Kok Eline , Janssen-Beentjes Kirsten , Lalleman Pieterbas , Schoonhoven Lisette , Weggelaar Anne Marie
Published: February 2023

Aims. To understand how nurses perceived the contributions of the Dutch Excellent Care Program, the development of nurses’ leadership, and their ability to positively influence their work environment. Background. Research shows that the nursing work environment influences job satisfaction, retention, and quality of care. Many countries have created programs such as the Excellent Care Program to improve nurses’ leadership and facilitate a positive work environment. Methods. A descriptive qualitative study based on 17 semistructured group interviews (participants N = 52) and directed content analysis using thematic coding. Results. Four program processes contribute to leadership development: (1) nurses taking responsibility for their knowledge and skills development; (2) strengthening organizational structures to improve nursing governance; (3) challenging the status quo with quality-enhancing projects; and (4) enhancing awareness of the supportive role of the nurse manager. Conclusions. The program supported nurses’ leadership development for a positive work environment. The interrelatedness of the four processes enhanced the nurses’ ability to solve day-to-day problems and challenge the status quo that influenced working practices. Implications for Nursing Management. The findings support making improvements to healthcare organizational strategies to encourage nurses to show leadership in their work environment.
Dietary Habits and Nutritional Challenges of the Elderly in Ghana
Authors: Amfo-Antiri Auswell , Agyapong Nana Ama Frimpomaa , Cobbah Linda
Published: February 2023

The elderly population is increasing worldwide. Dietary habits play a crucial role in prolonging life and preventing diseases. This cross-sectional study sought to investigate the dietary habits of the elderly in the Kwahu South District of the Eastern Region of Ghana and further ascertain the factors that constitute nutritional challenges among this group. A mixed method approach was used for the study. A questionnaire and focus group discussion guide were used to solicit data from study participants. A total of 97 participants made up of 59 males and 38 females participated in the study. Data on food habits reveal that staple food consumption especially those grown within the study area is common. Rice (34.1%), game meat (47.1%), banana (63.9%), and garden eggs (27.8%) were the commonly consumed foods by frequency. Mood (41.2%) and stress (24.8%) were identified as the most predominant determinants of food habits. Poly medication, toothache and loss, immobility, and financial and technological challenges were amongst the nutritional challenges mentioned by the elderly in this study. Results from the focus group discussion revealed high nutrition knowledge among the elderly through factors such as financial constraints that were mentioned as a barrier to the translation of this knowledge into practice. Strengthening of existing interventional programmes such as the Livelihood Empowerment Against Poverty and social interventions is needed to improve the dietary habits and nutritional intakes of the elderly.
Comparison of Rabies Cases Received by the Shomal Pasteur Institute in Northern Iran: A 2-Year Study
Authors: Kavoosian Saeid , Behzadi Ramezan , Asouri Mohsen , Ahmadi Ali Asghar , Nasirikenari Mehrab , Salehi Alireza
Published: February 2023

The rabies virus, which belongs to the genus Lyssavirus, the family Rhabdoviridae, is the causative agent of rabies, a contagious, deadly, and progressive neurological infection. This illness is commonly distributed worldwide and affects all warm-blooded animals. Regarding the zoonotic aspects of rabies, the prevalence of rabies was investigated in this study. Over 2 years, 188 samples were examined via the direct fluorescent antibody test (DFAT) and mouse inoculation test (MIT) techniques by using brain tissue samples. Our findings showed that 73.94% of samples were rabies positive. The highest number of samples belonged to cows and dogs, respectively. The positivity rate in cows was 71.88%, followed by dogs with a 57.78% infection rate. These findings suggested that despite the heavy monitoring protocols in Iran, rabies is still a prevalent disease, and it is advised that vaccinations and screening programs should be carried out more frequently with heavier observation.
Development and Verification of a Prognostic Stemness-Related Gene Signature in Triple-Negative Breast Cancer
Authors: Ou Xueqi , Tan Yeru , Gao Guanfeng , Wu Song , Zhang Jinhui , Tang Hailin , Zhu Hongbo , Yang Anli
Published: February 2023

Background. It is well known that cancer stem cells can induce cancer metastasis, which causes the majority of cancer-related death, especially in triple-negative breast cancer (TNBC). TNBC features a high metastatic rate and low metastasis-free survival and is regarded as the most malignant subtype of breast cancer. The purpose of this study is to explore prognostic biomarkers that can predict metastasis of triple-negative breast cancer. Methods. The human triple-negative breast cancerSUM149PT cells were used for the study. The cancer stem cell spheres (sum149-Stem) and paired adherent cancer cells (sum149-Tumor) were collected to extract total RNAs. RNA-seq was used to analysis the mRNA expression of cancer stem cells and paired adherent cancer cells. Two different gene expression omnibus datasets (https://www.ncbi.nlm.nih.gov/gds), GSE58812 and GSE33926, were used to explore the mechanism of different expression genes between stem cells and adherent cancer cells. Seven genes showed prognostic function in all datasets. The STITCH database (https://www.stitchdata.com/) was used to explore the possible metastasis-inhibiting drugs that can target the seven genes. Each gene expression was compared by Pearson analysis. The receiver operating characteristic curve (ROC) and Kaplan–Meier survival curve were performed to assess the metastasis prognostic ability of the seven-gene modeling two different GEO datasets. Results. A subset of 7 stemness-related genes (SRGs) containing UCN, ST3GAL5, FDPS, HK2, MALL, LMTK3, and CRHR2 were identified in three independent cohorts. Univariate Cox analysis showed that ST3GAL5 plays an antitumor role in TNBC metastasis, and the other 6 genes promote the metastatic progression of TNBC. The ability of the 7-SRGs gene Cox model to predict TNBC metastasis was constructed with the GSE58812 dataset. Most of the genes showed significant expression in patients with different risk levels. Additionally, the model showed predictive value in another GEO dataset of TNBC patients. ROC curves indicated that the seven-gene model has a significant predictive value of TNBC metastasis. Conclusions. Expression analysis of the 7-SRGs signature model at diagnosis has predictive value for metastasis in TNBC patients.
Efficacy of Recombinant Human Endostatin plus Neoadjuvant Chemotherapy for Osteosarcoma and Its Influence on Serum VEGF and MMP-9 Levels
Authors: Sui Wei , Lin Guanghui
Published: February 2023

Objective. To investigate the efficacy of recombinant human endostatin (rh-Endo) plus neoadjuvant chemotherapy (NACT) for osteosarcoma (OSA) and its influence on serum vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9). Methods. The case data of 141 OSA patients presented to the North District, Xiangyang Central Hospital Affiliated to Hubei University of Arts and Sciences from January 2018 to June 2019, were analyzed retrospectively. Patients receiving NACT (methotrexate + ifosfamide + adriamycin) were assigned into the control group (CNG; n = 65), while those treated with rh-Endo plus NACT were included in the combination group (CMG; n = 76). The following aspects were compared: clinical efficacy, serum tumor markers, serum VEGF and MMP-9 contents, inflammatory factors, incidence of adverse reactions, limb function scores at 6 months of follow-up, and prognostic quality of life (QOL). Results. A statistically higher overall response rate (ORR) was determined in CMG versus CNG (84.2% vs. 64.6%,

P

 < 0.05). The pretreatment serum bone alkaline phosphatase (BALP), insulin-like growth factor (IGF)-1, serum amyloid A (SAA), VEGF, MMP-9, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-10 levels differed insignificantly between the two cohorts (

P

 > 0.05); while except IL-10 that showed increased expression in both cohorts and was comparatively higher in CMG, the other 8 parameters reduced in both cohorts after 2 weeks of drug withdrawal, and the reduction of each parameter was more significant in CMG (

P

 < 0.05). The total adverse reaction rate was 30.2% in CMG, which was higher than that of 36.9% in CNG, albeit without a statistical difference (

P

 > 0.05). An evidently higher 2-year survival rate was determined in CMG (

P

 < 0.05). Conclusions. rh-Endo plus NACT is more effective than NACT alone in the treatment of osteosarcoma, which can validly restore the balance of vascular endothelial cells, reduce inflammation, and is worth promoting in clinic.
Public Trust in Dentists among Arabic Populations
Authors: Al-Khatib Aceil , Abed Alhaleem Radwan , Qaffaf Rama
Published: February 2023

Objective. To investigate public trust in dentists, fear of dentists, factors related to trust, and the impact of the COVID-19 pandemic on the trust in dentists. Materials and Methods. We used an Arabic online anonymous survey to collect data from a random population of 838 adults to investigate public trust in dentists, the factors they perceive to affect trust, their perception of key factors in the dentist-patient relationship, fear of dentists, and the impact of the COVID-19 pandemic on the level of their trust in the dentists. Results. Eight hundred thirty-eight subjects with a mean age of 28.5 responded to the survey (595 (71%) females, 235 (28%) males, and 8 (1%) did not specify their gender). More than half trust their dentist. The COVID-19 pandemic did not decrease trust in dentists according to 62.2%. There were significant gender differences in reporting fear of dentists (

p
<
0.001

) and in the perception of factors affecting trust (

p
=
0.028

). Honesty was chosen by 583 (69.6%), competence by 549 (65.5), and dentist’s reputation by 443 (52.9%). Conclusions. The findings of this study show that the majority of the public trust dentists, more females reported fear of dentists, and the majority perceived honesty, competence, and reputation as key factors affecting trust in the dentist-patient relationship. The majority reported that the COVID-19 pandemic did not have a negative impact on their trust in dentists.
Mediation Effect of Obesity on the Association of Age at Menarche With Blood Pressure Among Women in Southwest China
Authors: Chen Jiayi , Yan Mingxia , Suolang Deji , Han Mingming , Baima Yangji , Mi Fei , Chen Liling , Guan Han , Cai Hui , Zhao Xing , Liu Qiaolan
Published: February 2023

Background

Previous studies have been inconsistent about the association between age at menarche and high blood pressure. Little is known about such association across a wide range of menarcheal ages in less developed ethnic minority regions in China. We aimed to explore the association between age at menarche and high blood pressure (BP; ≥140/90 mm Hg) and to examine the mediating effect of obesity and the moderating effect of menopausal status on this association.

Methods and Results

A total of 45 868 women from the baseline data of the CMEC (China Multi‐Ethnic Cohort) were included in this study. Binary logistic regression was used to analyze the relationship between age at menarche and high BP, and the mediation model was used to evaluate the mediating effects of body mass index and waist circumference on the association of age at menarche with high BP. The mean age at enrollment and age at menarche of participants in our study were 49.3 (SD=10.7) and 14.7 (SD=2.1) years, respectively. Late menarche was associated with a lower risk of high BP (odds ratio, 0.831 [95% CI, 0.728–0.950]). The risk of high BP decreased by 3.1% with each year's delay in the onset of menarche (
P
for trend <0.001). Body mass index and waist circumference could partially mediate the association of age at menarche and high BP with the indirect effect of body mass index (odds ratio, 0.998 [95% CI, 0.997–0.998]) and waist circumference (odds ratio, 0.999 [95% CI, 0.998–0.999]). In addition, the mediation effects were modified by the status of menopause.

Conclusions

Women with late menarche have a lower risk of high BP, and obesity could be one of the important mediators. Obesity prevention is an efficient strategy to reduce the association between age at menarche and high BP, especially in premenopausal women.
Improving Stroke Measure Compliance and Outcomes Through Hospital Collaboration
Authors: Moore Kari D. , Summers Debbie , Wilson Susan E.
Published: February 2023

Globally, national stroke registries have been shown to improve the quality of patient care and outcomes. However, registry utilization and implementation vary by country. In the United States, stroke-specific performance measures must be met to achieve and maintain stroke center certification awarded by the state or nationally accredited certifying bodies. The 2 stroke registries available in the United States are the American Heart Association Get With The Guidelines-Stroke registry, which is voluntary, and the Paul Coverdell National Acute Stroke Registry, funded competitively to states by the Centers for Disease Control and Prevention. Compliance with stroke processes of care is variable, and quality improvement initiatives among organizations have been shown to have an impact on improving stroke care delivery. However, the effectiveness of interorganizational continuous quality improvement approaches, especially among competing institutions, to improving stroke care is ambiguous, and no uniform governance for successful interhospital collaboration has been identified. The purpose of this article is to review national initiatives focused on interorganizational collaboration to improve stroke care delivery with a focus on interhospital collaboration in the United States to improve stroke performance measures specific to stroke center certification. The state of Kentucky’s experience and utilization of the Institute for Healthcare Improvement Breakthrough Series model with key strategies for success will be discussed to serve as a foundation and empower novice stroke leaders in learning health systems. The models may be adapted internationally for application to stroke-specific care process improvement locally, regionally, and nationally; among organizations within the same health system or competing systems; and among organizations with funding or without funding to improve stroke performance measures.
RESCUE‐ICAS: Rationale and Study Design
Authors: Almallouhi Eyad , de Havenon Adam , Asi Khaled , Limaye Kaustubh , Maier Ilko , Starke Robert , Psychogios Marios , Inoa Violiza , Grossberg Jonathan A. , Mascitelli Justin , Samaniego Edgar A , Fragata Isabel , Kass‐Hout Tareq , Capasso Francesco , Dmytriw Adam A. , Jehani Hosam Al , Modovan Krisztina , Yaghi Shadi , Ezzeldin Mohamad , Grandhi Ramesh , Wolfe Stacey , Fargen Kyle , Jabbour Pascal , Naamani Kareem El , Spiotta Alejandro M. , Zaidat Osama O. , Kasab Sami Al
Published: February 2023

Background

Mechanical thrombectomy (MT) failure occurs in ≈10% to 20% of MTs. Among the common causes of failed MT is residual underlying intracranial stenosis (ICAS), typically attributable to atherosclerotic disease. ICAS large‐vessel occlusion (ICAS‐LVO) remains poorly understood, and management of ICAS‐LVO is unclear. The RESCUE‐ICAS (Registry of Emergent Large Vessel Occlusion Due to Intracranial Stenosis) aims at providing better understanding of the prevalence of ICAS‐LVO, and the overall safety and efficacy of various rescue therapies.

Methods

RESCUE‐ICAS is a multicenter, international, prospective registry that is currently enrolling patients with ICAS‐LVO who underwent MT. All sites are required to report monthly MT cases that meet inclusion criteria. The decision of whether to use rescue therapy is up to the interventionist.

Results

We will collect patients’ demographic, clinical, and radiographic data at baseline. Also, we will capture variables related to the MT procedure and rescue therapy (if performed), and postprocedural clinical and imaging variables. Outcomes include the rate of successful recanalization, defined by modified Thrombolysis in Cerebral Infarction score of ≥2b, the rate of symptomatic intracranial hemorrhage, the 90‐day modified Rankin scale score, and mortality.

Conclusions

No strong evidence is currently available to support an optimal treatment strategy for patients with ICAS‐LVO undergoing MT. RESCUE‐ICAS is a prospective cohort study that will provide important data to help design randomized controlled trials.
Endovascular Stroke Therapy for Posterior Circulation Acute Ischemic Stroke Has Diminishing Benefit with Additional Passes
Authors: Jeevarajan Jerome A. , Kim Hyun‐Woo , Tariq Muhammad Bilal , Marioni Sergio Salazar , Niktabe Arash , Abdelkhaleq Rania , McCullough Louise , Sheth Sunil A.
Published: February 2023

Background

The relationship between pass number during endovascular stroke therapy (EST) and outcomes in anterior circulation large vessel occlusion (LVO) acute ischemic stroke (AIS) has been well studied. However, the association between EST attempts and outcomes for patients with posterior circulation LVO remains unclear.

Methods

From our prospectively maintained multicenter registry, we identified consecutive patients with LVO AIS who underwent EST. The number of thrombectomy passes and per‐pass reperfusion grades (thrombolysis in cerebral infarction) were recorded prospectively at the time of procedure. The primary outcome was the association of number of EST passes and functional independence (modified Rankin scale 0–2) at 90 days. Secondary outcomes included likelihood of attaining substantial reperfusion (thrombolysis in cerebral infarction 2b‐3).

Results

Among 894 patients with LVO AIS who underwent EST, median age was 68 [interquartile range 58–78], 49% were female, and median National Institutes of Health Stroke Scale was 16 [interquartile range 11–21]. Of this cohort, 86 (9.6%) had posterior circulation LVO, including 65 (7%) with basilar artery occlusion and 9 (1%) with vertebral artery occlusion. The diminishing benefit on successful reperfusion of additional passes was similar for anterior and posterior circulation AIS. Among patients with posterior circulation stroke, successful reperfusion with fewer passes was associated with greater likelihood of good functional outcome at 90 days (40.0% versus 4.8% modified Rankin scale 0–2 with 1–2 versus 3+ passes;
P
= 0.003). The likelihood of good outcome in patients with posterior circulation LVO treated with EST and successful reperfusion in 1–2 passes was comparable to patients with anterior circulation LVO (40.0% versus 40.2%, posterior versus anterior;
P
= 0.553).

Conclusions

The number of EST passes has a significant association with functional independence at 90 days for patients with posterior circulation LVO AIS. After 2 passes, there is significantly reduced benefit conferred by additional passes. Overall clinical outcomes in patients with successful reperfusion with 1–2 passes were similar in patients with posterior circulation compared with anterior circulation LVO.
Intraarterial Bevacizumab Administration Through the Middle Meningeal Artery for Chronic Subdural Hematoma
Authors: Khalife Jane , Tonetti Daniel A. , Shaikh Hamza , Jovin Tudor , Patel Pratit , Thomas Ajith
Published: February 2023

Chronic subdural hematoma has a rising incidence and a high burden of disability and mortality worldwide. The disease process once thought to be from an insidious venous hemorrhage is now believed to be related to chronic inflammation and angiogenesis mediated by vascular endothelial growth factor and other angiogenic factors. Middle meningeal artery embolization is being increasingly used as sole therapy or as a surgical adjunct in the management of chronic subdural hematoma. However, this treatment has risk of migration of embolic material in the presence of unrecognized anastomoses with the retina or other neural tissue. Bevacizumab is a vascular endothelial growth factor‐A receptor antagonist used in the treatment of a number of diseases. We herein report the first case of intraarterial bevacizumab injection in the middle meningeal artery for the treatment of chronic subdural hematoma.
On the Open-Endedness of Detecting Open-Endedness
Authors: Stepney Susan , Hickinbotham Simon
Published: February 2023

We argue that attempting to quantify open-endedness misses the point: The nature of open-endedness is such that an open-ended system will eventually move outside its current model of behavior, and hence outside any measure based on that model. This presents a challenge for analyzing Artificial Life systems, leading us to conclude that the focus should be on understanding the mechanisms underlying open-endedness, not simply on attempting to quantify it. To demonstrate this, we apply several measures to eight long experimental runs of the spatial version of the Stringmol automata chemistry. These experiments were originally designed to examine the hypothesis that spatial structure provides a defense against parasites. The runs successfully show this defense, but also show a range of innovative, and possibly open-ended, behaviors involved in countering a parasitic arms race. Commencing with system-generic measures, we develop and use a variety of measures dedicated to analyzing some of these innovations. We argue that a process of analysis, starting with system-generic measures but going on to system-specific measures, will be needed wherever the phenomenon of open-endedness is involved.
The Moral Economy of High-Tech Modernism
Authors: Farrell Henry , Fourcade Marion
Published: February 2023

While people in and around the tech industry debate whether algorithms are political at all, social scientists take the politics as a given, asking instead how this politics unfolds: how algorithms concretely govern. What we call “high-tech modernism”- the application of machine learning algorithms to organize our social, economic, and political life-has a dual logic. On the one hand, like traditional bureaucracy, it is an engine of classification, even if it categorizes people and things very differently. On the other, like the market, it provides a means of self-adjusting allocation, though its feedback loops work differently from the price system. Perhaps the most important consequence of high-tech modernism for the contemporary moral political economy is how it weaves hierarchy and data-gathering into the warp and woof of everyday life, replacing visible feedback loops with invisible ones, and suggesting that highly mediated outcomes are in fact the unmediated expression of people's own true wishes.
High-Tech Modernism: Limits & Extensions
Authors: Janeway William H.
Published: February 2023

High-tech modernism is a powerful construct for reading the broad range of effects of digitalization on society. This response to Henry Farrell and Marion Fourcade's essay “The Moral Economy of High-Tech Modernism” first notes that high-tech modernism seems initially specified for application to advanced, quasi-liberal political economies. It then identifies three dimensions along which that construct could usefully be extended: 1) to take account of the limits of machine learning techniques of data analysis; 2) to consider the manner in which algorithmic digitalization transforms both the content and the management of work; and 3) to examine political responses to high-tech modernism, reminiscent of Karl Polanyi ‘s “double movement,” increasingly observable across a spectrum that runs from competition policy to the labor market.
Long-Term Follow-up of 64 Patients With Idiopathic Subglottic Stenosis: Treatment Pathways, Outcomes, and Impact of Serial Intralesional Steroid Injections
Authors: Schoeff Stephen , Hoffman Matthew R. , Zhang Yanchen , Yang Qiuyu , Dailey Seth H.
Published: February 2023

Objective:

To describe treatment pathways and long-term outcomes in 64 patients with idiopathic subglottic stenosis (iSGS), including the impact of serial intralesional steroid injection (SILSI) on degree of stenosis, need for subsequent operation, and patient-reported outcome measures.

Methods:

Retrospective review of 64 female patients with iSGS undergoing varied management approaches, 57 of whom underwent SILSI as at least part of their care. Treatment pathways included SILSI only, endoscopic intervention followed by SILSI only, endoscopic interventions only, endoscopic intervention followed by SILSI followed by need for repeat endoscopic intervention, open surgery, and tracheotomy. Outcomes assessed included subjectively estimated percent airway stenosis, dyspnea index (DI), modified medical research council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), number of operative and office-based procedures performed, need for subsequent operative intervention, and inter-operative interval.

Results:

Treatment pathways included SILSI alone (n = 6), endoscopic intervention(s) followed by SILSI only (n = 31), SILSI followed by additional endoscopic or office-based procedures (n = 16), open surgery (n = 3), and tracheostomy (n = 4). 57 of 64 patients underwent SILSI as at least part of their treatment. Inter-operative interval was increased after starting SILSI. Of patients undergoing SILSI, those with more procedures or shorter inter-operative interval prior to SILSI were more likely to return to the operating room. Estimated stenosis, DI, MMRC, and VHI-10 decreased with SILSI. Stenosis was not correlated with DI, MMRC, or VHI-10, though DI was correlated with both MMRC and VHI-10 score.

Conclusion:

Of 57 patients undergoing SILSI, 37 did not require further operative intervention. Improvements in inter-operative interval, dyspnea, and voice were observed across patients. Randomized trials to identify which patients may benefit most from SILSI are warranted.
The wonder of darshan: Going beyond the local and the national
Authors: Ganguly Tuhina
Published: February 2023

Darshan is a classical theme in studies on Hinduism. Recent studies have called for a retheorization, pointing to diverse forms of darshan or similar practices in other religions. However, such critiques do not adequately explore darshan in transnational guru-led movements where both gurus and devotees cross religious, social and cultural boundaries to inhabit and create new devotional lineages in unfamiliar lands. Based on fieldwork among a transnational spiritual community in India, this article shows how darshan in the community is shaped by the intersections of interpretations of neo-Vedantic and western esoteric thought. Thus, it is argued that darshan needs to be understood as historically and discursively shaped. The article also considers the wonder-ful nature of the experiences and politics of darshan. The inner transformation of devotees, it is argued, is paralleled by the exterior transformation of the abstract imaginary of ‘spiritual India’ into the concrete place of achieving spiritual communion with the guru and realizing oneself. The wonder of darshan in this context lies in the traversing of the multiple axes of interiority and exteriority.
Differences in the Clinical Significance of Antinuclear Antibodies According to Titers and Patterns in Children
Authors: Park Min Ji , Jang Hae Min , Kim Dongsub , Won Dong Il , Baek Hee Sun , Cho Min Hyun
Published: February 2023

This study aimed to evaluate the differences in the clinical significance of antinuclear antibody (ANA) according to their titers and patterns in the diagnosis of systemic autoimmune diseases (AiD) in pediatric patients. Of the 2442 children who had undergone an ANA test, 473 (19.4%) were positive for ANA, of whom 33 (7.0%) were diagnosed with significant AiD. The positive predictive value (PPV) for significant AiD was considerably high on application of an ANA titer of ≥1:640, and the PPV of a dense fine speckled (DFS) pattern was significantly lower compared with those of speckled and homogenous patterns. The diagnostic value of ANA positivity for AiD is limited, and the clinical significance of the DFS pattern is relatively lower compared with that of other patterns, such as homogenous and speckled patterns, in children. It is necessary to approach the significance of ANA in children individually depending on titers and patterns.
Comparison of the surface morphologies of ceramic reinforced metal matrix composite cams after wear tests under dry and wet conditions
Authors: Cerit Alper A , Nair Fehmi , Zafar Hafız MN , Karamış MB
Published: February 2023

The integral engine parts, such as camshaft members, are usually not preferably made of ceramic-reinforced MMC because the margin of compromise on the engine performance is small. However, the lightweight and wear-resistant nature of the mentioned materials can benefit fuel consumption without necessarily compromising engine performance. In this study, Al (AA2124) matrix is reinforced with ceramic particles of two different types (SiC, B4C), size distributions (B4C: 1–7, SiC: 2 and 20 μm), and volume fractions (0, 10, 20, 30 vol.%) to manufacture camshaft cams (lobes). While MMC cams are manufactured by powder metallurgy (300 MPa, 615°C, 30 minutes), spherical graphite cast iron (GGG40) cams are prepared by casting, induction hardening, and machining. The wear behavior of MMC cams is compared with the reference unreinforced AA2124 and conventionally used cast iron cams under dry and virtually created engine-like wet conditions. It was attempted to correlate the percentage increase in the roughness and weight loss with the structure of the cams using SEM, EDX, and macroscopy analysis. Results showed that the initiation of a three-body abrasive wear mechanism for 30 vol.% of the larger SiC particles caused lower wear resistance in the cams under dry conditions. As for the wet conditions, although the cams’ wear resistance increased with increasing ceramic particles’ content, it resulted in enhanced wear in the counterface when larger ceramic particles were used as reinforcement. Overall, higher ceramic content and larger particle size encourage three-body abrasive wear between the interacting surfaces and assist in degraded wear resistance under wet conditions.
Natural Organic Reduction as a Means of Body Disposition
Authors: Cirigliano Dina Lenore
Published: February 2023

NOR (Natural Organic Reduction) is the four-to-six-week process of composting a human corpse into soil. While to the general public, NOR may sound like a biologically-sound, basic, holistic answer to the question of body disposition, death care industry professionals know it is not nearly that simple. With NOR recently legalized in New York, major problems will be brought forth in five categories including the following: (1) Disease control with regard to soil, water and air contamination, (2) Cost efficiency, (3) Soil retrieval issues, (4) Impossible accommodations during an epidemic or pandemic, and (5)Failure to Protect What Should Be Sacred Ground/Failure To Provide A Physical Memorial For Decedents. This article will explain the NOR process and address the five problematic issues this process brings forth.
Journalism as profession helping women in conflict to move beyond victimhood discourse: A case study of Kashmir
Authors: Hassan Ruheela
Published: February 2023

Kashmir, the northernmost valley of Indian territory, is an acknowledged conflict area reeling under continuous violence for the past three decades. It is more in focus due to militancy, civil unrest, and human rights violations that have created difficult situations for the women of the Kashmir valley. They are usually portrayed as submissive and bound to conservative roles. While on one hand, their security of life and dignity is of prime concern, their education and professional development often take a backseat. Despite several odds and unstable circumstances, these women are striving hard to emerge as strong personalities. As Journalism empowers the masses with information and builds public opinion, it is crucial to have female contributions in this profession as their perspectives can’t be presented by men. Media in Kashmir provided women a platform to express themselves and help them prove their identities and move beyond victimhood discourse. This paper is an attempt to understand how journalism has emerged as a career choice for women from Kashmir and also aims to document their roles in breaking the traditional stereotypes by moving beyond the conflict and registering their identities as media professionals.