bluuebunny/crossref_metadata_2025 huggingface dataset:
(Re)producing wilderness tourism discourses in Algonquin Provincial Park
Authors: Pludwinski Brandon J. , Grimwood Bryan S.R.
Published: January 2021

Particular types of nature-based tourism programs, including multi-day children’s overnight/residential summer camp canoe tripping programs in North America, often (re)produce (neo)colonial constructions of nature and the “wilderness.” The purpose of this paper is to expose how wilderness is constructed and circulated in the context of a particular summer camp’s canoe trips in Algonquin Provincial Park, Ontario, Canada. Within this paper, we identify how specific legacies of colonialism are maintained and redeployed through the practices and representations of summer camp canoe trippers. Specifically, analyses show how canoe trippers (re)produce and (re)enact the wilderness as seemingly empty, untouched, and pristine spaces. Drawing on a Foucauldian-styled discourse analysis, this research exposes recurrent power relations that normalize, re-inscribe, and enable unjust wilderness discourses on Canadian summer camp canoe trips.
Window on the weather: a case study in multi-platform visual communication design, with a relationship to Design Thinking
Authors: Macdonald Iain
Published: January 2021

In February 2018, after three years of design and development work, the British Broadcasting Corporation (BBC) Weather launched its redesigned service across multiple platforms. The project involved new ways of cross-disciplinary communication design working across broadcast and digital services. This research examines these innovations and considers the transcorporeality of our relationship with weather forecasting.

BBC Weather developed an iconography in the mid-1970s that has been integral to its brand identity and which has survived the changes in television graphics technology from magnetised acrylic symbols to digital systems. Satellite imagery, advanced computer weather modelling, mobile interaction, and weather on the move in realtime, have become integral to presenting different layers of visual sophistication and information that require translation and editing to communicate the weather across multiple platforms and formats.

An ethnographic study of the leading participants in the design project mapped out the creative process and highlighted reflexive points where design practice was modified and adapted by the interdisciplinarity of the team. Their approach to design anthropology and service design approaches are revealed in the context of Design Thinking, and how the domestication of digital services is linked to a relationship to the weather for a UK and Irish audience.
Modelling and simulation of ship collisions in port and coastal waters
Authors: Chou Chien-Chang
Published: January 2021

Navigational safety is an important issue in maritime transportation. The most frequent type of maritime accident in the port and coastal waters is the ship collision. Although some ship collision models have been developed in the past, few have taken account of wind and sea current effects. However, wind and sea current are critical factors in ship maneuvering. Therefore, based on the previous collision model without wind and sea current effects, this study further develops a ship collision model with wind and sea current effects. Finally, a comparison of the results for the proposed collision model in this study and the ship maneuvering simulator is shown to illustrate the effectiveness of the proposed mathematical model in this paper, followed by the conclusions and suggestions given to navigators, port managers, and governmental maritime departments to improve navigational safety in port and coastal waters.
A dynamic harmonic regression approach for bridge structural health monitoring
Authors: Buckley Tadhg , Pakrashi Vikram , Ghosh Bidisha
Published: January 2021

Structural damage in a bridge is defined as a significant deviation in the structural response from its standard operating conditions, not explainable by variations in external environmental and operational effects. However, environmental effects such as temperature fluctuations can cause significant seasonal variations in the structural response of a bridge and can mask its changes due to structural damage. This poses a challenge for structural health monitoring of bridges where reliable diagnosis of damage or deterioration is often related to isolation of the responses. To address it, a statistical damage-detection methodology is introduced where strain data are modelled using a dynamic harmonic regression time-series model. Prediction intervals of multi-step ahead forecasts from the dynamic harmonic regression model are then used as statistical control limits within which the observed phenomenon should fall under standard operating conditions. This single recursive structural health monitoring framework for automatic fitting and multi-step ahead forecasting of 1-min interval time-series strain data includes recorded temperature values and diurnal trends as regressors in the model to account for environmental variations. The potential of this method as a robust automatic structural health monitoring strategy is demonstrated on strain data sampled at 1-min interval from a full-scale damaged pre-stressed concrete bridge – before, during and after repair. The proposed method can capture both sudden and daily changes in structural response due to temperature effects, and a rolling multi-step ahead interval forecast was able to identify damage on back-cast data transitioning from a healthy state to a damaged state.
Fault parameter identification in rotating system: Comparison between deterministic and stochastic approaches
Authors: Garoli Gabriel Yuji , Alves Diogo Stuani , Machado Tiago Henrique , Cavalca Katia Lucchesi , de Castro Helio Fiori
Published: January 2021

Fault identification is a recurrent topic in rotating machines field. The evaluation of fault parameters allows better maintenance of such expensive and, sometimes, large machines. Unbalance is one of the most common faults, and it is inherent to rotors functioning. Wear in journal bearings is another common fault, caused by several start/stop cycles – when at low rotating speed, there is still contact between shaft and bearing wall. Fault parameter identification generally uses deterministic model–based methods. However, these methods do not take into account the uncertainties inherently involved in the identification process. The stochastic approach by the Bayesian inference is, then, used to account the uncertainties of the fault parameters. The generalized polynomial chaos expansion is proposed to evaluate the inference, due to its faster performance regarding the Markov chain Monte Carlo methods. Deterministic and stochastic approaches were compared; all were based on experimental vibration measurements of the shaft inside the journal bearings. The Bayesian inference with the polynomial chaos showed reliable and promising results for identification of unbalance and bearing wear fault parameters.
Quantifying the value of information from inspecting and monitoring engineering systems subject to gradual and shock deterioration
Authors: Iannacone Leandro , Francesco Giordano Pier , Gardoni Paolo , Pina Limongelli Maria
Published: January 2021

The state of engineering systems changes in time due to the effect of gradual (e.g. corrosion, fatigue) and shock deterioration (e.g. earthquakes, floods, and tornados). At specified moments, for example, after a shock, decision-makers might wish to know the state of the system to take the optimal management action. Different data acquisition strategies such as inspections and continuous structural health monitoring (SHM) can help in the definition and prediction of the system state over time. The acquisition of information comes at a cost that must be balanced by the benefit it brings in terms of risk reduction. The value of information from Bayesian decision analysis quantifies the benefit provided by such information. This article proposes a formulation to compute the value of information of inspection and continuous SHM for degrading engineering systems. In the proposed formulation, the information collected before a given time is used to improve the prediction of the effects of gradual and shock deterioration processes and the future probability of failure. This article investigates the case study of a two-span reinforced concrete bridge degrading under the effect of chemical reactions and seismic actions.
Influence of thermal expansion bend and tubesheet geometry on guided wave inspection of steam generator tubes of a fast breeder reactor
Authors: Narayanan MM , Arjun V , Kumar Anish
Published: January 2021

Periodic assessment of steam generator tubes of a sodium-cooled nuclear reactor is very crucial for smooth operation of steam generators. To examine the integrity, an in-bore magnetostrictive transducer capable of launching and receiving longitudinal ultrasonic guided waves (L(0,2) mode) from the inner diameter side of a steam generator tube developed in-house is used. Preliminary tests conducted on defective steam generator tubes with thermal expansion bends (three successive bends) of the mockup steam generator test facility yield a good sensitivity of 20% wall thickness deep flaw (0.46-mm deep and 1-mm wide half-circumferential groove) and the location accuracy of 10 mm. In order to remove high noise, wavelet-based denoising using discrete wavelet transform is used which improves the signal-to-noise ratio by 5–10 dB. In addition, cross-correlation technique is also used to denoise and unambiguously identify the defect echoes amid noise and multiple reflections between the defects. Furthermore, influence of the thermal expansion bend and tubesheet–spigot structure on L(0,2) mode is studied using the finite element analysis. It is observed that in the thermal expansion (multiple) bend, axisymmetric L(0,2) mode becomes non-axisymmetric (maximum and minimum amplitudes at extrados and intrados, respectively) and undergoes mode conversion to a weak flexural mode F(1,3). The results are validated experimentally. In the tubesheet–spigot structure, L(0,2) mode is found to have ∼10% reflection from spigot–tubesheet transitions, and it is seen to mode convert to bulk waves in the tubesheet. In conclusion, thicker tubesheets are found to be better from the perspective of inspection.
Influence of cable tension history on the monitoring of cable tension using magnetoelastic inductance method
Authors: Zhang Senhua , Zhou Jianting , Zhang Hong , Liao Leng , Liu Lei
Published: January 2021

Cable tension monitoring is vital for the health monitoring of cable-stayed bridges. During the service of bridges, cable tension fluctuates rather than monotonously changes. However, existing research works pay little attention to the influence of tension history. In this article, the influence of the tension history on the monitoring of cable tension was studied. To guide the experiment, the magnetization theory of ferromagnetic materials and the electromagnetic induction principle were combined to analyze the theory of the magnetoelastic inductance method. The magnetoelastic inductance method characterized cable tension by sensor inductance. Based on the theoretical analysis, tension monitoring experiments were carried out to figure out the influences of design tension and tension variation. Experimental results showed the design tension and the tension variation influenced the relationship between the inductance and the tension. To monitor the fluctuating tension, a secant method was proposed. When the tension changed less than 30% of the design tension, the tension can be ascertained by the secant method. The experimental results demonstrated that the influence of the tension history should be considered when the design tension was different or the tension variation was large. Besides, the influence of the tension history analyzed in this article is suitable for other tension monitoring methods based on the magnetic properties of ferromagnetic materials.
Investigation of poly(lactic acid) nanocapsules containing the plant extract via coaxial electrospraying method for functional nonwoven applications
Authors: Ibili Hatice , Dasdemir Mehmet , Çankaya İ İrem Tatlı , Orhan Mehmet , Güneşoğlu Cem , Arabacı Anul Serap
Published: January 2021

This study focuses on the development of functional nanocapsules via the coaxial electrohydrodynamic atomization (electrospraying) method. These nanocapsules can manipulate nonwoven surface functionality in terms of antibacterial characteristics for medical textile purposes. Electrosprayed nanocapsules were produced from Poly(lactic acid) (PLA) polymer and Plumbago europaea plant extract. Here, we employ optimized solution and process parameters (needle to collector distance, electrical field, application time, and needle dimension) for the coaxial electrospraying process. Different Plumbago europaea extract concentrations and co-fluids’ flow rates were investigated as part of the study. Also, the effect of these parameters on capsule morphology and dimension were investigated. After the formation of PLA nanocapsules, morphological and dimensional characteristics were analyzed through SEM, FESEM, TEM images in addition to FTIR and nanosize measurements. According to our findings, a lower co-fluids’ flow rate gives the smaller nanocapsules with narrow-sized distribution and desired spherical morphology. Antibacterial efficiency doesn’t show any significant difference except the lowest plant extract concentrations. After characterizing the nanocapsules’ structures, the core-sheath structure can be clearly identified. Consequently, the desired capsule morphology and size for nanocapsules were accomplished. The antibacterial efficiency of covered surfaces with nanocapsules is up to 80% for Staphylococcus aureus and about 31% for Escherichia coli, even with low pick-up ratios. Even for a very low amount of extract usage, good antibacterial efficiency can be achieved. The application has endless potential in terms of higher concentration and a wide range of chemical usage.
Preparation and properties of graphene aerogel/cotton composite flexible fabric with electromagnetic interference (EMI) shielding function
Authors: Wang Peng , Liu Shuqiang , Zhang Man , Wu Gaihong , Wang Kaiwen , Li Huimin , Li Fu , Wang Hua
Published: January 2021

In order to alleviate the problems caused by electromagnetic pollution and simultaneously adapt to the future development trend of flexible wearable electronic equipment, it is high time to focus on the research of light weight, flexible and efficient electromagnetic interference (EMI) shielding material. A graphene aerogel composite EMI shielding composite fabric was prepared by combining graphene aerogel with fabric through the connection of waterborne polyurethane. The influence of aerogel amount on the EMI shielding function of fabric was discussed, and the waterborne polyurethane dosage on fabric mechanics and fabric style was also investigated. The result shows the composite fabric EMI shielding effectiveness reached 28 dB when the graphene aerogel amount was 25 mL (only 0.066 mL/cm2), which has satisfied the civilian requirements (20 dB). A good adhesion fastness between graphene and cotton fabric was obtained and the mechanical strength was also improved when the content of waterborne polyurethane was 20 mL. Graphene aerogel electromagnetic shielding composite fabric with good electromagnetic shielding performance and less consumption of nano carbon materials will have a good industrial application prospect.
Construction of Internet of things trusted group based on multidimensional attribute trust model
Authors: Chen Jinghan , Gong Bei , Wang Yubo , Zhang Yu
Published: January 2021

Accurate prediction of the trust relationship is the basis for trusted access and secure interaction between Internet of things nodes. To evaluate the degree of trust, a trust metric is assigned to every node depending on its several attributes. Normal nodes in Internet of things tend to suffer collusion attacks from malicious nodes; thus, the accuracy of the trust measurement decreases. To enhance the security of interaction between massive Internet of things nodes, we propose a multidimensional attribute trust model and a dynamic maintenance mechanism of a trusted group. The proposed model provides a reference for the selection and evaluation of node multidimensional attribute factors to adapt to different Internet of things application scenarios. The dispersion of satisfaction records is used to discover abnormal data and weaken its influence on the calculation of the node’s comprehensive trust evaluation. The construction of trusted groups provides an architectural foundation for the application of group signature that maintains low network overhead. The performance of multidimensional attribute trust model and dynamic maintenance mechanism is verified using Netlogo. Simulation results show the efficiency of the proposed model to classify the malicious nodes and honest nodes, as well as to build a trusted group that could ensure honest nodes occupy the major proportion.
Team Communication Patterns in Critical Situations
Authors: van den Oever Floris , Schraagen Jan Maarten
Published: January 2021

Teams operating in time-pressured, dynamic environments frequently need to cope with critical situations varying in complexity and hazard. To cope with critical situations, teams may have to adapt their communication processes. Adaptation of team communication processes has been studied mostly at short time frames (minutes). Literature on adapting communication at longer time frames is limited (hours, relative to minutes). We used the relational event model to compare team communication in critical and noncritical situations of pediatric cardiac surgeries and Apollo 13 flight director’s voice loops. Teams showed some flattening of communication structures in critical situations. Both teams maintained institutional roles and displayed closed-loop and information-seeking communication. Communication patterns may change further with increasing criticality. The exact way teams adapt to critical situations may differ depending on team, team size and situation. Findings may inform team training procedures or team structure development.
The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies
Authors: Thourani Vinod H. , Edelman J. James , Holmes Sari D. , Nguyen Tom C. , Carroll John , Mack Michael J. , Kapadia Samir , Tang Gilbert H. L. , Kodali Susheel , Kaneko Tsuyoshi , Meduri Christopher U. , Forcillo Jessica , Ferdinand Francis D. , Fontana Gregory , Suwalski Piotr , Kiaii Bob , Balkhy Husam , Kempfert Joerg , Cheung Anson , Borger Michael A. , Reardon Michael , Leon Martin B. , Popma Jeffrey J. , Ad Niv
Published: January 2021

Objective

There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons.

Methods

Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year.

Results

Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios.

Conclusions

In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.
Treatment of Nonreplantable Total Thumb Amputation at the CMC Level Using Index Finger Pollicization
Authors: Dickey Ryan M. , Meade Anna E. , Agnew Sonya P. , Zhang Andrew Y.
Published: January 2021

Background

Pollicization of the index finger is a rarely performed reconstructive option for patients with total thumb amputations with nonsalvageable carpometacarpal (CMC) joint and thenar muscles. Successful pollicization can provide basic grasp and pinch to help patients carry out activities of daily living. We present a retrospective review of 4 patients who underwent index finger pollicization for traumatic total thumb amputations.

Methods

A retrospective review of 4 cases of pollicization using an injured index finger for traumatic thumb amputation was performed. Patients available for follow-up were contacted for functional assessment. Outcomes including range of motion (ROM), grip strength, key pinch, 2-point discrimination, and Disabilities of the Arm, Shoulder, and Hand score were obtained. Functional thenar muscle and the CMC joint were absent in all cases. Injury mechanism was firework in 2 patients and crush in 2 patients.

Results

The time from injury to pollicization ranged from 8 days to 17 months. Follow-up time ranged from 10 weeks to 3 years. Three patients regularly used the pollicized thumb in activities of daily living such as writing. Tip pinch and lateral pinch along with grip strength were weak in all cases; the best recorded pinch strength was 24% and grip strength was 25% compared with the contralateral hand. The ROM of the pollicized thumb was limited.

Conclusions

Index finger pollicization following total thumb amputation can be a viable last-resort option for patients. The pollicized digit acts as a sensate post and avoids further morbidity from the traumatized extremity.
Randomized controlled trial of an education-based intervention to improve medication adherence: Design considerations in the medication adherence in glaucoma to improve care study
Authors: Rosdahl Jullia A , Hein Aaron M , Bosworth Hayden B , Woolson Sandra , Olsen Maren , Kirshner Miriam , Hung Anna , Muir Kelly W
Published: January 2021

Background:

Glaucoma treatment requires patients to follow daily, often times complex, eye drop regimens, but adherence is poor for many patients, putting them at risk for irreversible vision loss. A comprehensive approach is needed to address the challenges in the self-management of glaucoma. The purpose of this study is to improve glaucoma medication adherence in Veterans with medically treated glaucoma using an education-based intervention.

Methods/design:

This study is a single-site randomized controlled trial enrolling 200 Veterans and their companions, if companions are involved in their care. It has two arms: an intervention group and a control group. Participants in the intervention group receive an educational session with a non-physician interventionist and are provided with an AdhereTech smart bottle with the reminder functions activated. The control group is designed as an attention control such that they have a session on general eye health and are provided with a smart bottle but without the reminder functions activated. The primary outcome is the proportion of prescribed doses taken on schedule over 6 months following randomization according to the smart bottle. Secondary outcomes include intensification of glaucoma treatment, cost of intervention delivery, and cost-effectiveness of the intervention over 12 months.

Discussion:

The education-based intervention that we are testing is comprehensive in scope, to encompass a variety of barriers to adherence that glaucoma patients encounter, but personalized to address issues facing individual patients. Particular attention was given to feasibility in the real-world setting, as the high throughput of patients and lack of reimbursement for educational encounters in ophthalmology would limit implementation of a resource-intensive intervention.
The pressures for the remuneration of volunteer governors of UK educational institutions and the potential consequences
Authors: Forrest Colin , Hill Ron , James Chris
Published: January 2021

The members of the governing boards of schools, colleges which provide vocational education and training, and universities in the UK have traditionally been volunteers. In some contexts, however, for example, colleges in Northern Ireland, governors are now paid. Whether volunteer governors in other or all settings should be remunerated is the subject of debate. This article analyses the various aspects of that debate. It considers the nature of volunteering; the socio-political context of volunteering; and the growing momentum for the remuneration of governors of all UK educational institutions. The article also considers the arguments for and against governor remuneration, which include remuneration and: the way governors and the governing of educational institutions are valued; the visibility of governing; governor recruitment; the diversity of governing board membership; the quality of governing; the remuneration of other publicly funded agencies and organisations; the accountability governors experience in their role; the market for school governors; and whether a policy which implemented governor remuneration could be reversed. The article also considers aspects that would need to be resolved in practice: who would be paid and for what; the level of remuneration; the funding of governor remuneration; and the organisation of remuneration.
Social networks in patients hospitalized with preventable conditions for heart disease and diabetes in Hawai‘i by health literacy
Authors: Sentell Tetine L , Agner Joy L , Davis James , Mannem Santhosh , Seto Todd B , Valente Thomas W , Vawer May , Taira Deborah A
Published: January 2021

Objectives

Reducing potentially preventable hospitalizations (PPH) for chronic disease is a research and practice priority. Native Hawaiians and other Pacific Islanders (NHOPI) have disparities in PPH, and are understudied in both health literacy and social network research. Greater inclusion of social and familial networks can help address health disparities among people with chronic illness and enhance culturally relevant healthcare.

Methods

Adults hospitalized with a heart disease or diabetes-related PHH in Hawai‘i ( N = 22) were assessed for health literacy and social network membership (“alters”).

Results

Sixty-nine percent of respondents were NHOPI. Three respondents (14%) had no alters (“isolates”). Among non-isolates, 79% desired the participation of at least one alter in chronic disease management-related interventions. Fifty-nine percent of respondents had low health literacy. While the mean number of alters did not vary significantly by health literacy, those with lower health literacy had a trend ( p = .055) towards less interest in social network engagement.

Discussion

In a sample primarily comprised of NHOPI with chronic disease, many patients wished to include social network members in interventions. Engagement varied by health literacy with implications for health disparities. Not all patients were interested in social network engagement, which must be considered in intervention planning.
Reliability analysis of an extended shock model
Authors: Poursaeed Mohammad Hossein
Published: January 2021

Suppose that a system is subject to a sequence of shocks which occur with probability p in any period of time [Formula: see text], and suppose that [Formula: see text] and [Formula: see text] are two critical levels ([Formula: see text]). The system fails when the time interval between two consecutive shocks is less than [Formula: see text], and the time interval bigger than [Formula: see text] has no effect on the system activity. In addition, the system fails with a probability of, say, [Formula: see text], when the time interval varies between [Formula: see text] and [Formula: see text]. Therefore, this model can be regarded as an extension of discrete time version of [Formula: see text]-shock model, and such an idea can be also applied in the extension of other shock models. The present study obtains the reliability function and the probability generating function of the system’s lifetime under this model. The present study offers some properties of the system and refers to a generalization of the new model. In addition, the mean time of the system’s failure is obtained under reduced efficiency which is created when the time between two consecutive shocks varies between [Formula: see text] and [Formula: see text] for the first time.
Too painful to forget, too painful to remember: Ashes of memory in Marguerite Duras and Alain Resnais’s Hiroshima mon amour (1959) and Duras’s La douleur (1985)
Authors: Kaplan Brett Ashley
Published: January 2021

This essay threads the striking images of the couple’s embrace at the beginning of Hiroshima mon amour through an examination of the film’s exploration of memory and victim and perpetrator traumas. Duras and Resnais render the lovers almost indistinguishable as, they hold each other, encased in ash. As they embrace, something gently falls on them, encrypts them, isolates them from their surroundings but simultaneously embeds them in their respective histories. If, for Derrida, ash becomes the paradigm for the trace, we can see how this image becomes paradigmatic for memory’s unspooling threads; the film rejects an either/or memory or forgetting when it is a question of traumatic pasts. By re-reading Hiroshima mon amour through the powerful metaphorics of ash and against echoes of the international and dramatic rise in racist discourse, an increased anxiety about nuclear catastrophe, and a return to Duras’s wartime “memoir” La douleur, I show that these texts’ representation of memory and the rotating axes of perpetration and victimization open up larger questions about the trauma of both sides of the culpability line. This reading reveals the fluid border between victimization and perpetration in ways that help explain how both victims and perpetrators are traumatized. Interpreting the film and memoir in this way helps to blaze a path to envisioning an understanding of committing crimes as itself inflicting (self-imposed) trauma. The most optimistic possible implication (one that is completely unlikely) is that if perpetration is also viewed as traumatizing then perpetrators would no longer fling nuclear bombs at the racialized other and expect to sleep well.
Plaster immobilization versus anterior plating for dorsally displaced distal radial fractures in elderly patients in Pakistan
Authors: Tahir Muhammad , Khan Zimri Faridullah , Ahmed Nadeem , Rakhio Jamali Allah , Mehboob Ghulam , Watson Katherine R. , Faraz Ahmad
Published: January 2021

This prospective, multi-centred, randomized trial examined outcomes of 3- and 12-month follow-ups of 159 elderly participants aged more than 75 years with isolated distal radial fractures, treated by anterior locking plate or closed reduction and cast immobilization. The primary outcome was the patient-rated wrist evaluation (PRWE) score. The PRWE score at 12 months was not significantly different between the two groups; however, the radiological outcomes and complications rates were worse in the casting group.

Level of evidence: III
‘The cruelty of righteous people’: Niebuhr on the urgency of cruelty
Authors: Steele Brent J
Published: January 2021

This paper responds to critics of Reinhold Niebuhr by exploring two themes important for locating his views on cruelty’s emergence in modern society. The first relates to his basic insight into the relationship between individual morality and group loyalty and solidarity. Niebuhr provides a sophisticated argument for such group dynamics in his work, issued in Moral Man, Immoral Society, as well as his essays on race. These also form the basis for his second thematic argument regarding cruelty, the role of ‘righteousness’ as it relates to security and insecurity. Niebuhr’s views on race, I argue, need to be considered more broadly as an example of his views on groups, power, and cruelty. The paper concludes with some modest proposals for thinking about combatting cruelty via Niebuhr’s counsel.
Rebranding social distancing to physical distancing: calling for a change in the health promotion vocabulary to enhance clear communication during a pandemic
Authors: Sørensen Kristine , Okan Orkan , Kondilis Barbara , Levin-Zamir Diane
Published: January 2021

Amidst the COVID-19 outbreak, the term ‘social distancing’ received immense attention in the mainstream and social media and was embraced by governments as a universal precaution to stem the coronavirus pandemic. ‘Social distancing’ belongs technically to a set of non-pharmaceutical infection control actions intended to stop or slow down the spread of a contagious disease. However, several weeks into the outbreak, scholars discussed whether the term was, in fact, misleading and could be counterproductive. To study the arguments, the study design included (1) analysis of the performance of the concepts ‘social distancing’ and ‘physical distancing’ based on Google Trends (15 February–15 June 2020); (2) analysis of the arguments used in media discussions of ‘social distancing versus physical distancing’ in the period 15 March–15 April 2020, derived from a Google search; and (3) a scientific literature review in PubMed. The study was conducted in English. The trend analysis showed the peak and the decrease of the relative popularity of ‘social distancing’ and ‘physical distancing’ during spring 2020. The thematic analysis of Google sources yielded an overview of arguments based on nine themes with two to five sub-themes reflecting on the misleading concept, the historical perspective, the sociological perspective, the public health perspective, alternative proposals regarding the social and the physical dimensions, the distinction of terms, the political choice, and the need for rebranding. Two papers were included in the scientific literature review, which both stressed the need for a change of terminology. In conclusion, the study emphasizes that the choice of terminology matters when life-saving public health messages are designed. It is therefore recommended to rebrand ‘social distancing’ to ‘physical distancing’ to enhance clear communication during the current COVID-19 pandemic in order to prepare for future pandemics.
Pharmacology Update: Emergency Medications for Hypoglycemia in Diabetes
Authors: Schaumleffel Carol
Published: January 2021

Children and adults with Type 1 and Type 2 diabetes are at risk for severe hypoglycemia, an unpredictable and potentially life-threatening situation. Severe hypoglycemia creates low blood glucose levels in which a person has an altered mental status or physical symptoms that require assistance from another individual to treat the hypoglycemia. Treatment of severe hypoglycemia is a medical emergency and prompt treatment is important for the well-being of students with diabetes. If left untreated, severe hypoglycemia can lead to death. Glucagon is a medication used to treat severe hypoglycemia outside of a healthcare facility. Recently, more stable and easier to use formulations of glucagon have become available. The purpose of this pharmacology update is to describe two new formulations of ready to use glucagon: an intranasal and subcutaneous, autoinjector formulation.
The Use of Postoperative Antibiotics Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review and Meta-analysis
Authors: Swords Chloe E. , Wong Jeremy J. , Stevens Kara N. , Psaltis Alkis J. , Wormald Peter J. , Tan Neil C.-W.
Published: January 2021

Background

Endoscopic sinus surgery is performed for medically recalcitrant chronic rhinosinusitis. There is no universally accepted strategy regarding post-operative antibiotics despite the high rates of usage worldwide. The aim of this study was to analyse patient-reported and objective outcomes behind antibiotic use following endoscopic sinus surgery.

Methods

A search of electronic databases was performed. Eligible randomised controlled trials (RCTs) and observational trials were included. The primary outcome was patient reported outcome measures. Secondary outcomes were local infections, endoscopy scores and adverse events. Meta-analysis was performed.

Results

Of 1045 publications identified, 7 were included in the qualitative synthesis and 5 RCTs were included in meta-analysis. Antibiotic regimens varied between studies in terms of antibiotic selection, timing commenced and duration of use. Meta-analysis suggested no significant difference between placebo and antibiotics in patient reported outcome measures (standardised mean difference (SMD) –0.215, 95% confidence interval (CI) –0.637 to 0.207) or endoscopic scores (SMD –2.86, 95% CI –0.846 to 0.273). There was no consistent definition in reporting of infection; therefore, this outcome cannot be comprehensively considered. No severe adverse events were attributable to antibiotics.

Conclusions

From the studies analysed, there is no level 1 evidence to suggest that antibiotics improved patient outcomes following sinus surgery. However, there was significant heterogeneity in outcome measures and no clear data exists regarding the effects of antibiotics on postoperative infections. The available evidence at present is not enough to make a recommendation in either direction. Further designed larger RCTs are required to investigate these questions in more detail.
Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department
Authors: Guarnizo Angela , Farah Kevin , Lelli Daniel A , Tse Darren , Zakhari Nader
Published: January 2021

Objective

To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head.

Methods

Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings.

Results

One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%.

Conclusion

Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.
Within-treatment changes in a novel addiction treatment program using traditional Amazonian medicine
Authors: O’Shaughnessy David M. , Berlowitz Ilana , Rodd Robin , Sarnyai Zoltán , Quirk Frances
Published: January 2021

Aims:

The therapeutic use of psychedelics is regaining scientific momentum, but similarly psychoactive ethnobotanical substances have a long history of medical (and other) uses in indigenous contexts. Here we aimed to evaluate patient outcomes in a residential addiction treatment center that employs a novel combination of Western and traditional Amazonian methods.

Methods:

The study was observational, with repeated measures applied throughout treatment. All tests were administered in the center, which is located in Tarapoto, Peru. Data were collected between 2014 and 2015, and the study sample consisted of 36 male inpatients who were motivated to seek treatment and who entered into treatment voluntarily. Around 58% of the sample was from South America, 28% from Europe, and the remaining 14% from North America. We primarily employed repeated measures on a psychological test battery administered throughout treatment, measuring perceived stress, craving frequency, mental illness symptoms, spiritual well-being, and physical and emotional health. Addiction severity was measured on intake, and neuropsychological performance was assessed in a subsample from intake to at least 2 months into treatment.

Results:

Statistically significant and clinically positive changes were found across all repeated measures. These changes appeared early in the treatment and were maintained over time. Significant improvements were also found for neuropsychological functioning.

Conclusion:

These results provide evidence for treatment safety in a highly novel addiction treatment setting, while also suggesting positive therapeutic effects.
Adverse effects of immune checkpoint inhibitor therapies on right ventricular function and pulmonary arterial dilatation
Authors: Mylvaganam Ruben , Avery Ryan , Goldberg Isaac , Makowski Courtney , Kalhan Ravi , Villaflor Victoria , Cuttica Michael J.
Published: January 2021

Immunologic risk factors contribute to endothelial dysfunction and development of pulmonary vascular disease. Immune checkpoint inhibitors, used as immunotherapies for malignancies, have a wide range of reported immune‐related adverse events. We retrospectively describe the impact of immune checkpoint inhibitors on the development of pulmonary vascular injury and right ventricular dysfunction as compared across both computed tomography and transthoracic echocardiography. Twenty‐four of 389 patients treated with immune checkpoint inhibitors at a single academic center between 2015 and 2019 were evaluated. Thirteen (54%) patients were treated with anti‐programmed cell death receptor 1 (PD‐1), 8 (33%) with anti‐programmed death receptor ligand 1 (PD‐L1) therapy, and 3 (13%) with combination anti‐PD‐1 and anti‐cytotoxic T‐lymphocyte‐associated antigen 4 (CTLA‐4) therapy. At a median of 85 days of immune checkpoint inhibitor therapy, RVfwLS significantly increased from –20.6% to –16.7% (p = 0.002). After a median of 59 days of immune checkpoint inhibitor therapy, median pulmonary artery to aorta ratio worsened from 0.83 to 0.89 (p = 0.03). There was an correlation of duration of immune checkpoint inhibitor therapy (β = –0.574, p = 0.003) with percent change in RVfwLS. Patients who received anti‐PD‐1 therapy (β = –0.796, p = 0.001) showed the greatest correlation of duration of immune checkpoint inhibitor therapy with percent change in RVfwLS. Exposure to immune checkpoint inhibitors are associated with RV dysfunction and vascular changes as measured by strain and computed tomography, respectively.
The Watershed Architecture of the Mississippi River Basin
Authors: Hoeferlin Derek
Published: January 2021

Designers have a three-part responsibility owed to their object of study: to appreciate, to speculate, and to collaborate. This is particularly true for the professional engagement with spaces on the scale of river basins which impact and prioritize certain design decisions on a whole different level. Adequate responses to the ongoing transformations brought forward by large-scale anthropogenic stressors across entire river systems cannot continue to be dominated with hardline and static interventions. Rather, there is a need for alternative outsets, one that begins to design with adaptive and dynamic negotiations. By looking at the example of the Mississippi River Basin, this essay proposes a new integrated water-based design methodology titled “Way Beyond Bigness: The Need for a Watershed Architecture,” an interdisciplinary strategy to rethink the management of river systems for a sustainable future.
Effectiveness and organizational conditions of effectiveness of telemedicine in nursing homes. A study protocol of a comparative prospective cohort (EFFORT study)
Authors: Salles Nathalie , Saillour-Glénisson Florence , Sibe Matthieu , Langlois Emmanuel , Kret Marion , Durrieu Jessica , Arditi Nora , Abraham Maelys , Perry Frederic
Published: January 2021

Introduction

The profile of nursing home (NH) residents has changed over the past decade with more dependency, more severe chronic diseases and more treatments prescribed. For residents, the major consequence is the higher risk of unplanned hospitalization. French guidelines recommend the development of interactive telemedicine (InT) in NHs in order to improve access to care, and to decrease the rate of avoidable unplanned hospitalizations. Methods and analysis: The aim of this study is to analyze the impact of an InT protocol delivered in NHs on the rate of unplanned hospitalizations, and on the quality of life at work and the organizational conditions of effectiveness of telemedicine in NHs. We will perform a mixed methods study combining a cluster non-randomized controlled trial in two matched parallel arms (telemedicine group and control group) and qualitative analysis of the evolution of organizational and professional contexts in NHs. Ethics and dissemination: The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Bordeaux University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. Trial registration number NCT03486977