bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Novel Guidelines on Multifactorial Control and Its Association with Mortality in Adult Patients with Hypertension and Newly Diagnosed Type 2 Diabetes: A 4-Year Prospective Multicenter Study
Authors: Nguyen Ngoc-Thanh-Van , Chau Hoa Ngoc , Le Nam Hoai , Nguyen Hai Hoang , Nguyen Hoai-An
Published: September 2021

Background and Rationales. Hypertensive patients with newly diagnosed diabetes are associated with heightened risks for cardiovascular events. Yet endorsement of state-of-the-art guidelines with more stringent goals poses significant challenges in obtaining multifactorial control. This study aimed to illustrate the impact of novel targets on achieving simultaneous control overtime and its association with mortality. Methods. This prospective, observational study involved adult hypertensive patients with newly diagnosed type 2 diabetes mellitus at two university hospitals in Vietnam. The median time of follow-up was 4 years (August 2016–August 2020). The primary outcome was time to all-cause mortality. Results. 246 patients were included with a mean age of 64.5 ± 10.4. 58.5% were females. 64.2% were categorized as high risk. At baseline, ischemic heart disease, dyslipidemia, and chronic kidney disease (CKD) were present in 54.9%, 67.1%, and 41.1% of patients. Renin–angiotensin–aldosterone inhibitor, metformin, and statin were prescribed in 89.8%, 66.3%, and 67.1%. Among three risk factors, LDL-c control was the hardest to achieve, increasing from 5.7% to 8.5%. In contrast, blood pressure control decreased from 56.1% in 2016 to 30.2% in 2020, when the second wave of COVID-19 hit our nation. While contemporary targets resulted in persistently low simultaneous control at 1.2%, significant improvement was observed with conventional criteria (blood pressure  < 140/90 mmHg, HbA1c < 7%, LDL-c < 70 mg/dl), increasing from 14.6% to 33.7%. During follow-up, the mortality rate was 24.4 events per 1000 patient-years, exclusively in patients with early newly diagnosed diabetes. Improving control overtime, not at baseline, was associated with less mortality. Conversely, age >75 years (HR = 2.6) and CKD (HR = 4.9) were associated with increased mortality. Conclusion. These findings demonstrated real-world difficulties in managing hypertension and newly diagnosed diabetes, especially with stringent criteria from novel guidelines. High-risk profile, high mortality, and poor simultaneous control warrant more aggressive cardiorenal protection, focusing more on aging CKD patients with early newly diagnosed diabetes.
Clinical Efficacy and Safety Study of Mifepristone with Misoprostol Treatment in Patients with Missed Abortion
Authors: Zhao Xiaoying , Zhang Congyi , Lou Haitao , Wu Chunfang
Published: September 2021

Currently, medication abortion is widely used in clinical practice in China. The aim of this study was to investigate the effect of mifepristone with misoprostol treatment on the efficacy of patients with missed abortion (MA) and the safety of this drug regimen. 95 patients with MA treated in our hospital from February 2019 to April 2021 were collected as the subjects of this study, and the patients were divided into the control and the research groups according to different treatment modalities. Among them, 46 cases in the control group were treated by diethylstilbestrol combined with oxytocin and 49 cases in the research group were treated by mifepristone combined with misoprostol, and both groups underwent curettage after medication. The rates of complete abortion, time of embryo expulsion, time of operation, intraoperative bleeding, time of postoperative vaginal bleeding, amount of vaginal bleeding, rate of one-time curettage, the levels of serum estradiol (E2), progesterone (P), β-chorionic gonadotropin (β-hCG), and interleukin-18 (IL-18), and the incidence of adverse effects in the two groups were examined and compared. Alanine transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and serum creatinine (Scr) were used as indicators to evaluate the safety of the drug. The results showed that the rates of complete abortion and one-time curettage were significantly higher in the study group than in the control group, while the time of embryo expulsion, operation time, intraoperative bleeding, postoperative vaginal bleeding time, and vaginal bleeding were significantly lower than in the control group. The serum E2, P, and β-hCG levels before curettage in both groups were significantly higher, and IL-18 levels were significantly lower than those at the time of admission, with E2, P, and β-hCG levels increasing more and IL-18 levels decreasing more in the research group. After drug treatment, no abnormal changes in liver and kidney functions were observed in both groups, and the incidence of adverse reactions was at a similar and lower level in both groups. This shows that mifepristone with misoprostol is a safer and more effective drug regimen for the treatment of MA, which can regulate the levels of serum sex hormones and inflammatory factors in the body, promote the shedding of placental tissue, and create conditions for improving the rate of curettage.
A Japanese Patient with Gaucher Disease Treated with the Oral Drug Eliglustat as Substrate Reducing Therapy
Authors: Komada Naoto , Fujiwara Toshinari , Yoshizumi Hideyuki , Ida Hiroyuki , Shimoda Kazuya
Published: September 2021

Gaucher disease is a rare genetic disorder caused by the deficiency of acid β-glucosidase to effectively catalyze the degradation of glucosylceramide to glucose and ceramide. We report here the case of a 31-year-old male Japanese patient with Gaucher disease who switched from enzyme replacement therapy (ERT) to substrate reducing therapy (SRT). Liver dysfunction was identified at a routine medical checkup, and the patient was referred to our hospital with “idiopathic liver disease.” Clinical laboratory tests indicated thrombocytopenia and splenomegaly, which are characteristic symptoms of Gaucher disease. To definitively diagnose Gaucher disease, a bone marrow biopsy and acid β-glucosidase activity measurement were conducted; the results supported a diagnosis of Gaucher disease. This case emphasizes that it is possible for periodic medical checkups in adults to lead to the diagnosis of rare genetic disorders. The patient underwent ERT treatment with imiglucerase for 5 years; the platelet count rapidly increased and the spleen size rapidly decreased, indicating a good response to the drug. However, the patient increasingly felt the burden of visiting the hospital for 2 h of infusion ERT every 2 weeks. Consequently, it was jointly decided that he should switch from ERT to SRT with an oral drug. This switch was successful with no deterioration of laboratory data. This case report is the first to describe a Japanese Gaucher disease patient treated with eliglustat for >2 years. We showed that SRT is a well-tolerated and effective option for the treatment of Gaucher disease.
Cutaneous Features of Anti-MDA-5 Antibody-Positive Amyopathic Dermatomyositis in a Sudanese Patient
Authors: Alqahtani Nouf , Aleissa Majed
Published: September 2021

Clinically amyopathic dermatomyositis (CADM) is a rare form of DM characterized by unique cutaneous and pulmonary features with no muscle involvement. A subset of patients with CADM has a specific antibody known as anti-melanoma differentiation-associated protein 5 (MDA5). The systemic associations of anti-MDA-5 CADM warrant an early recognition and management to prevent fetal sequelae. It is seen more commonly in white and Asian female individuals. The clinical features of anti-MDA5 antibody-positive CADM in other ethnic groups are not well reported. Here, we describe a case of CADM with identified autoantibodies against MDA5 in a Sudanese female patient presenting with characteristic cutaneous features in association with MDA5 autoantibodies: ulcerated Gottron’s papules, painful palmar papules, shawl sign, and heliotrope sign. No evidence of pulmonary or systemic involvement was identified. Treatment with prednisolone and mycophenolate mofetil was initiated. This case emphasizes the importance of keeping a high level of suspicion and to recognize the unique clinical feature of this type of DM aiding in early treatment and preventing fatal outcomes.
Nerve Hypertrophy and Altered Diffusion in Anti-Myelin-Associated Glycoprotein Neuropathy Detected by Brachial Plexus Magnetic Resonance Neurography
Authors: Koide Kyosuke , Sugiyama Atsuhiko , Yokota Hajime , Mukai Hiroki , Wang Jiaqi , Nakamura Keigo , Misawa Sonoko , Ito Shoichi , Kuwabara Satoshi
Published: September 2021

Introduction: This study assessed the morphological changes and diffusion tensor imaging (DTI)-derived parameters of the brachial plexus using magnetic resonance neurography (MRN) in patients with anti-myelin-associated glycoprotein (anti-MAG) neuropathy. Methods: Eight patients with anti-MAG neuropathy underwent MRN of the brachial plexus with 3-dimensional (3D) short tau inversion recovery (STIR) and DTI sequences. Two neuroradiologists and a neurologist qualitatively assessed nerve hypertrophy on 3D STIR MRN. The cross-sectional area (CSA) of the nerve roots was measured. Quantitative analyses of fractional anisotropy (FA) and axial, radial, and mean diffusivity (AD, RD, and MD) were obtained after postprocessing on DTI and manual segmentation. Results: There was nerve hypertrophy in 37.5% of the patients with anti-MAG neuropathy. All patients with anti-MAG neuropathy with nerve hypertrophy were refractory to rituximab therapy. The CSA of the nerve roots was inversely correlated with FA and positively correlated with MD and RD. FA decreased in the nerve roots and inversely correlated with disease duration. Conclusions: Nerve hypertrophy appears in the proximal portion of peripheral nerves, such as the brachial plexus, in patients with anti-MAG neuropathy. Altered diffusion in the nerve roots might be associated with the loss of myelin integrity due to the demyelination process in anti-MAG neuropathy.
Pepetela. O cão e os caluandas. São Paulo: Kapulana, 2019
Authors: Mata Larissa Costa da
Published: September 2021

Este trabalho consiste em uma resenha do romance O cão e os caluandas, do escritor angolano Pepetela, que ganhou edição brasileira em 2019 pela editora Kapulana. O texto procura ler o romance à luz de sua proximidade com o testemunho e do seu hibridismo linguístico.
Incidence and Outcomes of Infective Endocarditis After Transcatheter or Surgical Aortic Valve Replacement
Authors: Lanz Jonas , Reardon Michael J. , Pilgrim Thomas , Stortecky Stefan , Deeb G. Michael , Chetcuti Stanley , Yakubov Steven J. , Gleason Thomas G. , Huang Jian , Windecker Stephan
Published: September 2021

Background

Data comparing the frequency and outcomes of infective endocarditis (IE) after transcatheter (TAVR) to surgical aortic valve replacement (SAVR) are scarce. The objective of this study is to compare the incidence and outcomes of IE after TAVR using a supra‐annular, self‐expanding platform (CoreValve and Evolut) to SAVR.

Methods and Results

Data of 3 randomized clinical trials comparing TAVR to SAVR and a prospective continued TAVR access study were pooled. IE was defined on the basis of the modified Duke criteria. The cumulative incidence of IE was determined by modeling the cause‐specific hazard. Estimates of all‐cause mortality were calculated by means of the Kaplan–Meier method. Outcomes are reported for the valve‐implant cohort. During a mean follow‐up time of 2.17±1.51 years, 12 (0.5%) of 2249 patients undergoing TAVR and 21 (1.1%) of 1828 patients undergoing SAVR developed IE. Patients with IE more frequently had diabetes mellitus than those without (57.6% versus 34.2%;
P
=0.005). The cumulative incidence of IE was 1.01% (95% CI, 0.47%–1.96%) after TAVR and 1.58% (95% CI, 0.97%–2.46%) after SAVR (
P
=0.047) at 5 years. Among patients with IE, the rate of all‐cause mortality was 27.3% (95% CI, 1.0%–53.6%) in the TAVR and 51.8% (95% CI, 28.2%–75.3%) in the SAVR group at 1 year (log‐rank
P
=0.15).

Conclusions

Pooled prospectively collected data comparing TAVR with a supra‐annular, self‐expanding device to SAVR showed a low cumulative risk of IE irrespective of treatment modality, although the risk was lower in the TAVR implant group. Once IE occurred, mortality was high.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT01240902, NCT01586910, NCT02701283.
Description of Megacolax gen. nov. and redescription of Megacolax insolitus (Ho & Lin, 2003) (Copepoda, Cyclopoida, Bomolochidae) parasitic in the nasal cavity of the silver pomfret Pampus argenteus (Euphrasen, 1788) (Pisces, Stromateidae)
Authors: Izawa Kunihiko
Published: September 2021

Megacolax gen. nov. (Copepoda, Cyclopoida, Bomolochidae) is established to accommodate Naricolax insolitus Ho & Lin, 2003, and next Megacolax insolitus (Ho & Lin, 2003) emended is redescribed based on specimens of both sexes recovered from the nasal cavity of the original host, Pampus argenteus (Euphrasen, 1788) (Pisces, Stromateidae) in Japan. The male is described for the first time for the species.
Two new species of Inga (Fabaceae-mimosoid clade) from the Atlantic Forest, Brazil
Authors: GARCIA FLÁVIA C. P. , CHAGAS ALINE P. , DUTRA VALQUÍRIA F.
Published: September 2021

Inga (Fabaceae, mimosoid clade) is an important genus in the Atlantic Forest of Brazil where there are 44 species, 60% of which are endemic. In this work, we describe two new species of Inga (I. teresensis and I. tripa) from the Atlantic Forest and provide identification keys to the species of sections Vulpinae and Leptinga in the biome. Illustrations and comments about the geographic distribution, conservation status, phenology, etymology, and taxonomy of the new species are also included. Inga teresensis is only known from the state of Espírito Santo and is categorized as Critically Endangered (CR). Inga tripa occurs in coastal areas of the states of Bahia, Paraíba, Pernambuco, and Sergipe and is categorized as Learn Concern (LC).
Fetterman and the Forgotten: Dramatism and Democracy after January 6
Authors: Snee Brian , Cos Grant , Pierre Rodgers R.
Published: September 2021

This essay argues that Lt. Governor John Fetterman (D-PA), in running for the open US Senate seat in Pennsylvania, is attempting to appeal to disaffected Trump voters, showing what the “forgotten men and women” of Pennsylvania might stand to gain by embracing his progressive, Democratic populist appeal. This study examines Fetterman’s announcement advertisement, “Launch,” illustrating how he figuratively and literally enacts Burkean “consubstantiality,” as the candidate not only speaks about and on behalf of the forgotten, but he also appears on camera with the history of Braddock tattooed on his body. Utilizing Burkean theory, we contend that Fetterman’s two-and-a-half-minute video follows the basic formula for Burke’s guilt-redemption cycle. In the wake of the failed insurrection, “Launch” offered the promise of rhetorical redemption through what Burke labeled victimage in the form of factional scapegoating. Additionally, midway through the video, the “Agent” and the “Scene” switch roles, in a unique symbolic move. The analysis concludes that, from Burke’s perspective of purification-redemption, Fetterman uses visuals, text, and context to appeal to an important audience for his candidacy.
COVID-19 and the Health Promoting School in Italy: Perspectives of educational leaders
Authors: Velasco Veronica , Coppola Liliana , Veneruso Mariacira
Published: September 2021

Objective:

International agencies report the importance of health promotion in planning educational strategies and school management in response to the COVID-19 pandemic. This study aimed to identify the benefits of using a Health Promoting School (HPS) approach to guide educational and school policy during the COVID-19 epidemic in Italy, the main objectives and practices to be implemented, and the challenges likely to be faced.

Design:

A three-phase qualitative and participatory approach: (1) identification of study objectives and relevant data, (2) data collection through an online form using open-ended questions (14 participants), and (3) online meetings to analyse the findings and reach consensus (17 participants).

Setting:

Educational leaders from the HPS Network in the Lombardy region in northern Italy participated in the study.

Method:

Qualitative content analysis was undertaken. Answers were coded into meaningful units and then grouped under higher-order headings. Codes, subcategories, categories and themes were identified.

Results:

Results suggested high potentiality, significance and sustainability of the HPS model during the pandemic. Objectives and actions relevant to each HPS component were identified. Adaptations to content and methodology, timing, continuity and inequalities requiring specific forms of intervention were identified.

Conclusion:

This study sought to develop an HPS model relevant to implementation during the COVID-19 epidemic and identified specific lines of action during this challenging period.
The Impact of Information Integration in a Simulation of Future Submarine Command and Control
Authors: Michailovs Steph , Pond Stephen , Schmitt Megan , Irons Jessica , Stoker Matthew , Visser Troy A. W. , Huf Samuel , Loft Shayne
Published: September 2021

Objective

Examine the extent to which increasing information integration across displays in a simulated submarine command and control room can reduce operator workload, improve operator situation awareness, and improve team performance.

Background

In control rooms, the volume and number of sources of information are increasing, with the potential to overwhelm operator cognitive capacity. It is proposed that by distributing information to maximize relevance to each operator role (increasing information integration), it is possible to not only reduce operator workload but also improve situation awareness and team performance.

Method

Sixteen teams of six novice participants were trained to work together to combine data from multiple sensor displays to build a tactical picture of surrounding contacts at sea. The extent that data from one display were available to operators at other displays was manipulated (information integration) between teams. Team performance was assessed as the accuracy of the generated tactical picture.

Results

Teams built a more accurate tactical picture, and individual team members had better situation awareness and lower workload, when provided with high compared with low information integration.

Conclusion

A human-centered design approach to integrating information in command and control settings can result in lower workload, and enhanced situation awareness and team performance.

Application

The design of modern command and control rooms, in which operators must fuse increasing volumes of complex data from displays, may benefit from higher information integration based on a human-centered design philosophy, and a fundamental understanding of the cognitive work that is carried out by operators.
Factors associated with the prevalence of diarrhoea among children in rural areas of Enugu State, Nigeria: Practice considerations for social workers
Authors: Odo Casmir , Onalu Chinyere , Nwatu Uche , Nwafor Nneka , Ebimgbo Samuel
Published: September 2021

Poor health conditions such as diarrhoea are often associated with low- and middle-income countries. Diarrhoea in Nigeria contributes to an estimated 151,700 (16%) annual infant deaths, with a prevalence of 10–18 percent. With the high rate of diarrhoea-related infant mortality, it becomes important to investigate the barriers to its prevention. Data were sourced using five Focus Group Discussions involving 18 health workers and 30 nursing mothers. Findings show high prevalence of diarrhoea and identified ignorance, cultural/religious beliefs, and lack of funds as major barriers to its prevention. To address these problems, engaging social workers as welfare professionals is recommended.
Contesting Counterpublics: The Transformation of the Articulation of Rural Migrant Workers’ Rights in China’s Public Sphere, 1992–2014
Authors: Zhou Mujun
Published: September 2021

This article extends the theoretical discussion of counterpublics and applies the concept to an authoritarian context. The article contends that it is necessary to distinguish between the counterpublic oriented by liberal ideology that criticizes authoritarianism at an abstract level (Counterpublic I) and the counterpublics that are concerned with substantive inequality (Counterpublic II). To illustrate the approach taken, the articulation of rural migrant workers’ rights between 1992 and 2014 is documented, demonstrating that, in the 1990s and early 2000s, most public discussion on the issue tended to reduce workers’ rights to civil rights. It was not until the late 2000s that alternative forms of rights, such as social rights, were thematized. As the article argues, this was because the power balance between Counterpublic I and Counterpublic II had been changed. The empirical study explains the transformation and highlights the heterogeneity within Counterpublic II by comparing the diverse strategies employed by different actors.
Agents of Representation: The Organic Connection between Society and Leftist Parties in Bolivia and Uruguay
Authors: Anria Santiago , Bentancur Verónica Pérez , Rodríguez Rafael Piñeiro , Rosenblatt Fernando
Published: September 2021

Parties are central agents of democratic representation. The literature assumes that this function is an automatic consequence of social structure and/or a product of incentives derived from electoral competition. However, representation is contingent upon the organizational structure of parties. The connection between a party and an organized constituency is not limited to electoral strategy; it includes an organic connection through permanent formal or informal linkages that bind party programmatic positions to social groups’ preferences, regardless of the electoral returns. This article analyzes how the Movimiento al Socialismo (Movement toward Socialism, MAS) in Bolivia and the Frente Amplio (Broad Front, FA) in Uruguay developed two different forms of relationship with social organizations that result from the interplay of historical factors traceable to the parties’ formative phases and party organizational attributes. Party organizational features that grant voice to grassroots activists serve as crucial mechanisms for bottom-up incorporation of societal interests and demands.
Street markets, urban development and immigrant entrepreneurship: Unpacking precarity in Moore Street, Dublin
Authors: Blennerhassett Cristín , Moore-Cherry Niamh , Bonnin Christine
Published: September 2021

Traditional markets represent vital spaces of opportunity for livelihood-building, intercultural contact and for developing familiarity with the city. Yet, worldwide, markets are under pressure due to redevelopment agendas driven by neoliberalised forms of urban governance. Although precarious sites of occupation and employment, markets still maintain an attractiveness for immigrant micro-entrepreneurs as a foothold into the labour market and urban economy. Through a case study of the historic Moore Street market in central Dublin (Ireland), we explore the experiences of immigrant entrepreneurs. While these may be different in terms of their familiarity with the urban, institutional and regulatory landscapes, they are not entirely dissimilar from the experiences of longer-term traders in Moore Street. However what is evident is how precarity is tactically exploited by newcomer entrepreneurs for particular reasons. These traders prize the autonomy brought by market trading and use it as a meso-scale between low-paid waged employment and higher-level employment that may be out of reach for a variety of reasons. We argue that in examining urban precarity, increased attention should be paid to exploring the context-specific nature of the processes that give rise to it as well as the agentic capacity exercised to exploit it even within structural constraints.
Measuring the Nature of Individual Sequences
Authors: Ritschard Gilbert
Published: September 2021

This study reviews and compares indicators that can serve to characterize numerically the nature of state sequences. It also introduces several new indicators. Alongside basic measures such as the length, the number of visited distinct states, and the number of state changes, we shall consider composite measures such as turbulence and the complexity index, and measures that take account of the nature (e.g., positive vs. negative or ranking) of the states. The discussion points out the strange behavior of some of the measures—Elzinga’s turbulence and the precarity index of Ritschard, Bussi, and O’Reilly in particular—and propositions are made to avoid these flaws. The usage of the indicators is illustrated with two applications using data from the Swiss Household Panel. The first application tests the U-shape hypothesis about the evolution of life satisfaction along the life course, and the second one examines the scarring effect of earlier employment sequences.
DIFSIB: A SIBTEST Package
Authors: Weese James D.
Published: September 2021

The R package DIFSIB provides a direct translated version of the SIBTEST, Crossing- SIBTEST, and POLYSIBTEST procedures that were last updated and released in 2005. Having these functions directly written from Fortran into R code will allow researchers and practitioners to easily access the most recent versions of these procedures when they are conducting differential item functioning analysis and continue to improve the software more easily.
Multiple Factors Affecting Health-Related Quality of Life in Women With Chronic Multisite Musculoskeletal Pain: A Cross-Sectional Study in Ankara, Turkey
Authors: Demircioğlu Arzu , Özkal Özden , Dağ Osman
Published: September 2021

Although chronic multi-site musculoskeletal pain is known to cause decreased physical function and impair work and social life, there is insufficient research about its impact on health-related quality of life (HRQoL) in women. The aim of this study was to investigate multiple factors affecting HRQoL in women with chronic multi-site musculoskeletal pain. This study included 227 women with two or more musculoskeletal areas which were painful during the last 3 months. The HRQoL and musculoskeletal system symptoms were evaluated with the Nottingham Health Profile (NHP) and the Nordic Musculoskeletal Questionnaire (NMQ), respectively. Physical activity level, social functionality and depressive symptoms were assessed with the International Physical Activity Questionnaire-Short Form (IPAQ- SF), Social Functioning Scale (SFS) and Beck Depression Inventory (BDI), respectively. Significant predictors for the total score on the NHP were found to be the number of children (p < 0.001), social engagement/withdrawal scale (p:0.094), the number of regions with musculoskeletal pain during the last year (p:0.002) and last 7 days (p:0.036), depressive symptoms (p < 0.001), current employment status (p:0.084), and the presence of chronic disease (p < 0.001). The results of this study demonstrated that both sociodemographic characteristics, and social and psychological factors may affect the HRQoL in women with chronic multi-site musculoskeletal pain.
Private Payer–Negotiated Prices for Outpatient Otolaryngologic Surgery
Authors: Wang Annette A. , Xiao Roy , Sethi Rosh K.V. , Rathi Vinay K. , Scangas George A.
Published: September 2021

In January 2021, the Centers for Medicare & Medicaid Services began requiring hospitals to publish price transparency files listing all prices negotiated with payers. We performed a cross‐sectional analysis of payer‐negotiated prices for commonly performed outpatient otolaryngology surgery at all hospitals scored by the US News & World Report in otolaryngology. We compared prices among hospitals (across‐center ratios) and among payers at the same hospital (within‐center ratios). Price disclosure rates were low overall for otolaryngologic surgery (maximum, 26.7% for bronchoscopy). Across‐center ratios ranged from 3.5 (adjacent tissue transfer/rearrangement <10 cm2; raw median price range, $1384‐$7047) to 18.6 (cochlear implant placement; raw median price range, $2417‐$60,255). Median within‐center ratios ranged between 2.7 (intraoperative navigation) and 5.4 (total thyroidectomy). Although price variation may signal opportunities for cost savings, patients may have limited ability to comparison shop due to hospital nondisclosure. Further investigation is necessary to examine the factors affecting price variation for otolaryngologic procedures.
The Dividual: Digital Practices and Biotechnologies
Authors: Bruno Fernanda , Rodríguez Pablo Manolo
Published: September 2021

This article revisits the concept of the dividual, taking as a starting point Deleuze’s diagnosis about the relevance that dividual practices have gained with the advent of biotechnology and digital culture. Although we agree with this diagnosis, we highlight the intersections between the dividual and the individual both in Modernity and in the present time. The contemporary dividual is in tension with the modern individual, but not as a substitution, division or duplication of the individual. Rather, we state a complex dividual-individual composition, focusing on biotechnologies, digital culture and financial capitalism. Following a Foucauldian approach, we understand this composition as a result of technologies of power and the result of certain modes of subjectivation. In dialogue with Simondon’s theory of individuation, we suggest that the dividual takes part in a new mode of subjectivation which can be named a ‘dividuation’ in the context of technologically mediated experiences.
Projected climate change impacts on tropical life zones in Costa Rica
Authors: Birkel Christian , Dehaspe Joni , Chavarría-Palma Andrés , Venegas-Cordero Nelson , Capell Rene , Durán-Quesada Ana María
Published: September 2021

Efforts to protect tropical ecosystems aim at implementing biological corridors across the national territory of Costa Rica. However, potential near-future climate change challenges the effectiveness of such conservation measures. For this purpose, we developed near-future climate change scenarios at high spatial resolution using open-access global data from the Copernicus Climate Data Store (CDS). These projections resulted from downscaling (to a 1km2 national grid) and quantile-mapping bias-correction of the Essential Climate Variables Global Circulation Model (ECV_GCM) ensemble mean from the CDS using a moderate Representative Concentration Pathway 4.5 (RCP4.5). Projections were evaluated with limited local station data and applied to generate future ecosystem indicators (Holdridge Life Zones, HLZs). We show significantly increasing temperatures of 2.6°C with a spatial variability of ± 0.4°C for Costa Rica until 2040 with local differences (higher temperatures projected for the southern Costa Rican Caribbean). The future mean annual precipitation showed slightly wetter conditions (120 ± 43 mm/year) and most prominently in the Costa Rican Caribbean and south Pacific, but no significant drying in the north of Costa Rica by 2040. The bias-corrected climate data were aggregated to decadal and 30-year average (1971–2040) life zone ecosystem indicators that could potentially show ecosystem shifts. Changes in the life zones are most likely due to warmer temperatures and to a lesser extent caused by projected wetter conditions. Shifts are more likely to occur at higher elevations with a potential loss of the sub-tropical rainforest ecosystem. The projections support diminishing tropical dry forests and slightly increasing tropical rain and wet forests in the biological corridors of the driest and wettest regions, respectively. A countrywide spatial uniformity of dominating tropical moist forests (increase from 24% to 49%) at the expense of other HLZs was projected by 2040.
The time sequence of brain MRI findings in spontaneous intracranial hypotension
Authors: Chen Shu-Ting , Wu Jr-Wei , Wang Yen-Feng , Lirng Jiing-Feng , Hseu Shu-Shya , Wang Shuu-Jiun
Published: September 2021

Objectives

To investigate the time sequence of brain magnetic resonance imaging findings of spontaneous intracranial hypotension.

Methods

We retrospectively reviewed the medical records and brain magnetic resonance imaging findings of consecutive patients with spontaneous intracranial hypotension hospitalized between January 2007 and December 2017. Patients were divided into quartiles based on intervals between initial spontaneous intracranial hypotension symptom onset and brain magnetic resonance imaging scan. Six categorical and five continuous brain magnetic resonance imaging findings were assessed, including venous distension sign, enlarged pituitary gland, diffuse pachymeningeal enhancement, mid-brain pons deformity, subdural fluid collection, flattening of pons, midbrain-pons angle, descent of cerebral aqueduct, mamillopontine distance, distance of suprasellar cistern, and distance of prepontine cistern. In addition, we also calculated the neuroimaging scores with a score ≥5 classified as ‘high probability of spontaneous intracranial hypotension' and a score ≥3 as ‘intermediate-to-high probability.' Then, we analyzed the linkage between the onset-neuroimaging interval and brain magnetic resonance imaging findings, as well as different neuroimaging scores.

Results

A total of 173 patients (57 males and 116 females) were included in the analysis, and the range of onset-neuroimaging interval was 1 to 89 days (median [interquartile range]  =  17 [7 to 30 days]). We divided the patients into quartiles based on their onset-neuroimaging interval (the first quartile: 0–6 days; the second quartile: 7–16 days; the third quartile: 17–29 days; the fourth quartile: ≥30 days). Among brain magnetic resonance imaging findings, the incidence of venous distension sign was high (>75%), with no difference among quartiles (p = 0.876). The incidence of diffuse pachymeningeal enhancement (p = 0.001), severe midbrain-pons deformity (p = 0.001), and subdural fluid collection (<0.001) followed a significant stepwise increase from the first quartile to fourth quartile. Patients with shorter onset-neuroimaging intervals were less likely to have neuroimaging scores ≥5 (<17 vs. ≥17 days: 72.9% vs. 86.4%; odds ratio = 2.3 [95% CI 1.1–5.1], p = 0.028), but not neuroimaging scores ≥3 (<17 vs. ≥17 days: 92.9% vs. 92.0%, p = 0.824).

Conclusions

The emergence of brain magnetic resonance imaging findings of spontaneous intracranial hypotension depended on disease duration and appeared sequentially. When using brain magnetic resonance imaging findings or neuroimaging scores for diagnostic purposes, the onset–neuroimaging interval should be considered.
WEEE treatment and system management in Italy and Serbia: A comparison
Authors: Berežni Isidora , Castro Francine Duarte , Batinić Bojan , Vaccari Mentore , Stanisavljevic Nemanja
Published: September 2021

Waste electrical and electronic equipment (WEEE) represent one of the growing waste streams in Europe, whose content of hazardous substances and valuable materials focus on how it is handled. However, there are differences between countries regarding e-waste management system in Europe. This paper analyses and presents data regarding the e-waste management system in Italy, one of the founding countries of the EU and Serbia – EU candidate country. Within this work, the following aspects were considered: legislative framework and EU directive goals in terms of e-waste, institutional setup, collection system, and existing recycling and treatment technologies. In addition, material flow analysis is used to model mass balance within WEEE treatment plants in both countries. Finally, through assessment and comparison of current systems in both countries, problems and shortages of Serbia’s e-waste management system are addressed.
Ethics of resource allocation in a public health emergency context
Authors: Steele Duncan , Duthie Katherine
Published: September 2021

Resource allocation under non-emergency conditions is often challenging. Within the context of a Public Health Emergency (PHE), allocation decisions become significantly more difficult as decisions are often necessary on very short timelines, where relevant information (either evidence or information “on the ground”) is changing or incomplete, there is significant potential for harm, and resources are scarce, in unpredictable supply, and likely in high demand. An intentional value-based decision-making approach in such circumstances can clarify the values that ought to guide decisions, offering transparency and consistency, among other benefits. We use the example of vaccine allocation during the COVID-19 pandemic to explore value-based decision-making within a PHE context. We describe several core values that are relevant to PHE decision-making and outline their implications for approaches to vaccine allocation. While we focus on vaccine allocation, the values discussed are relevant to other system-level decisions in both emergency and non-emergency situations. Tips for leaders wishing to adopt a value-based approach to decision-making are offered.
The Gender Mobility Paradox: Gender Segregation and Women’s Mobility Across Gender-Type Boundaries, 1970–2018
Authors: Torre Margarita , Jacobs Jerry A.
Published: September 2021

In this article, we examine trends in women’s mobility among male-dominated, gender-neutral, and female-dominated occupations. Earlier research, largely employing data from the 1970s and early 1980s, showed that along with significant net movement by women into male-dominated fields, there was also substantial attrition from male-dominated occupations. Here, we build on previous research by examining how “gender-type” mobility rates have changed in recent decades. The findings indicate that while still quite high, levels of women’s occupational mobility among female, gender-neutral, and male occupations have decreased considerably over time. We suggest that this is the result of increasing differentiation among women. In particular, many women, especially those in high-status occupations, plan to pursue employment in a male-dominated field, succeed in gaining entry, and tend to remain in these fields more often than their counterparts in previous decades. We interpret these findings as evidence that gender segregation is maintained by an enduring but imperfect system of social control that constrains women’s choices before, during, and after entry into the labor market. The evidence presented here underscores the importance of studying gender-type mobility as a distinct dimension of labor market inequality.
Assessment of dissimilar joining between metal and polymer hybrid structure with different joining processes
Authors: Nagarajan Bala Murali , Manoharan Manikandan
Published: September 2021

In this century, innovation and technology are required to fabricate the hybrid joint of metal and polymers. Due to their lightweight and anti-corrosion properties, the mixed components are increasingly used to produce lightweight hybrid structures such as aerospace and automobiles. It is essential to develop welding techniques for joining dissimilar materials and instead use them in engineering structures. The bonding mechanism of the weld joint has varied depending upon the welding process. In the present review, the bonding mechanism of various hybrid joints like Friction stir welding (FSW), Friction stir spot joining, Friction riveting, laser welding, ultrasonic welding and induction welding is discussed in detail. The defects observed in the different welding process is discussed in details. The mechanical properties and microstructure analysis of different hybrid joints are reviewed in detail for a different combination of hybrid joints.
Changes of antibiotic resistance over time among Escherichia coli peritonitis in Southern China
Authors: Wu Haishan , Yi Chunyan , Zhang Dihua , Guo Qunying , Lin Jianxiong , Mao Haiping , Huang Fengxian , Yu Xueqing , Yang Xiao
Published: September 2021

Escherichia coli ( E. coli) is the main cause of Gram-negative bacterial peritonitis among peritoneal dialysis patients. According to the 2016 update of the International Society for Peritoneal Dialysis Peritonitis Recommendations, drug susceptibilities of specific organisms should be regularly monitored. The aim of this study was to examine the evolution of antimicrobial resistance of E. coli peritonitis from 2006 to 2018. Two hundred and fifty-three episodes of E. coli peritonitis were enrolled in our study, corresponding to a rate of 0.024 episodes per patient-year. According to drug sensitivity test results, isolates were most sensitive to carbapenems, followed by cefmetazole, piperacillin/tazobactam, cefotetan and amikacin, with an overall rate of more than 90% in both cohorts. Cefazolin and ciprofloxacin resistance increased significantly from 2006–2011 to 2012–2018. Conversely, cefepime and ceftazidime resistance decreased significantly. The extended-spectrum β-lactamase (ESBL) rate fluctuated from 34.7% in 2006–2011 to 46.8% in 2012–2018. Compared with the ESBL-negative strains, ESBL-producing E. coli were more likely be resistant to ampicillin, ampicillin/sulbactam, cephalosporins, quinolones, aminoglycosides, furadantin and sulfamethoxazole and accounted for over 50% of the drug resistance. In the correlation analysis, E. coli displayed significantly increased resistance to cefazolin and ciprofloxacin, a finding correlated with ESBL production ( r = 0.883 and 0.276 respectively, p < 0.001 and p = 0.003). In conclusion, the rate of E. coli peritonitis declined stably in recent years, but the resistance to antimicrobial was high.
One of the Good Ones: Rhetorical Maneuvers of Whiteness
Authors: Rabii Watoii
Published: September 2021

Drawing on the literature on white habitus, colorblindness, diversity ideology, and happy talk, I argue that rhetorical maneuvers are key aspects of white habitus that allow whites to construct a non-racist self by drawing on colorblind discourses. To explore how white habitus influences interview dynamics when the respondent and interviewer are of a different race, I conducted 48 interviews with whites from rural and urban areas of the Greater Buffalo Area. Specifically, I examine the relationship between white habitus, a non-racist presentation of self, and rhetorical maneuvers that whites deploy when talking about race and immigration. I also introduce two new frames of colorblindness: differentiation and civility. The civility frame conflates friendliness and civility with anti-racism and is used as evidence that everything is fine. The differentiation frame attempts to draw distinctions between themselves (“non-racist white people”) and other whites (“bad apples”).
Multidisciplinary design optimization of vehicle chassis product family
Authors: Chen Xiaokai , Wang Chenyu , Shi Guobiao , Zeng Mingkai
Published: September 2021

In order to improve the performance of automotive product platforms and product families while keeping high development efficiency, a product family optimization design method that combines shared variable decision-making and multidisciplinary design optimization (MDO) is proposed. First, the basic concepts related to product family design optimization were clarified. Then, the mathematical description and MDO model of the product family optimization problem were established, and the improved product family design process was given. Finally, for the chassis product family optimization problem of an automotive product platform, the effectiveness of the proposed optimization method, and design process were exemplified. The results show that the collaboratively optimized product family can effectively handle the coordination between multiple products and multiple targets, compared to Non-platform development, it can maximize the generalization rate of vehicle parts and components under the premise of ensuring key performance, and give full play to the advantages of product platforms.
Event-triggered adaptive control for upper-limb robot-assisted passive rehabilitation exercises with input delay
Authors: Abbas Mohamed , Narayan Jyotindra , Dwivedy Santosha K
Published: September 2021

In this article, an adaptive tracking control strategy is designed for uncertain electrically driven end-effector type upper-limb rehabilitation robots subject to an input delay and a limited bandwidth channel. This control scheme is implemented to perform upper-limb passive rehabilitation training for different subjects. Primarily, dynamic analysis of the rehabilitation robot is carried out using the Euler–Lagrange principle, which incorporates motor dynamics to allow the voltage-based control commands as desirable in practical implementations. Thereafter, an adaptive backstepping control law with input delay compensation is designed to estimate the unknown dynamical parameters of the rehabilitation robot during the training sessions. Furthermore, a Lyapunov-based triggering mechanism is developed to deal with the limited bandwidth challenge and reduce the transmissions over the network. The experimental validation is conducted for different scenarios, and a comparison study is carried out with two time-triggered control schemes to investigate the potential of the proposed approach. From the experimental runs and the comparative analysis, the proposed control scheme is found to achieve a promising tracking performance with input delay compensation. Moreover, a significant saving in the network resources is attained during the passive rehabilitation training of the subjects.
Development of on-line neural network based adaptive fractional-order sliding mode robust controller on electromechanically actuated engine cooling system
Authors: Kaleli Alirıza
Published: September 2021

The reduction of temperature fluctuations around desired reference and control input energy for cooling actuators are among the most important aims of engine thermal management system. However, maintaining of engine/radiator outlet temperature within certain limits is a challenging process in different engine operating conditions due to unknown in-cylinder variable heat transfer rate in terms of the control theory. For this purpose, the thermodynamic model is obtained by dividing into two subsystems, such as the engine and the radiator subsystem in the presence of unknown heat transfer rate, external disturbance, and uncertainties in this study. To increase system robustness, tracking engine inlet/outlet temperature control of engine cooling components is performed using the adaptive fractional-order sliding mode control structure. Moreover, the disturbances acting on the system and unknown heat transfer dynamics of the system are estimated with a radial basis function on-line neural network estimator. The efficiency of proposed controller strategy for electromechanically actuated engine cooling system is compared by proportional–integral–derivative and classical integral sliding mode control under the NEDC (New European Driving Cycle) and WLTP (Worldwide Harmonized Light Vehicles Procedure) transient operating conditions. The temperature error tracking performance is tested by paying attention integral square error, integral absolute error, integral time-weighted absolute error along to the driving cycles. The obtained results showed that the adaptive fractional-order sliding mode control–based engine cooling system outperforms compared to the optimally gain tuned proportional–integral–derivative and integral sliding mode control schemes in terms of reducing of tracking error and engine cooling actuators energy consumption for all engine operating cycles.