bluuebunny/crossref_metadata_2025 huggingface dataset:
Music Education and Educators in Missouri, Iowa, and Illinois
Authors: Prendergast Jocelyn Stevens
Published: October 2020

The purpose of this survey study was to provide a demographic profile of PK-12 public school music teachers and details about the public school music teaching positions in Missouri, Iowa, and Illinois. An invitation to complete a questionnaire was emailed to all PK-12 public school music teachers in these three states whose email addresses could be gathered via a school district website search or phone call to the district, yielding a 26.1% response rate in Missouri, a 35.1% response rate in Iowa, and a 31.7% response rate in Illinois. The questionnaire contained items used to gather demographic data about the music teachers and details about their class offerings. Results indicate over 93% of music teachers in these three states identify as White and approximately two thirds identify as women. The teachers in these three states who responded to the survey travel less for their positions compared with music teachers in the United States as a whole, and findings were inconsistent between the states with respect to experience level and school location. Further, 28% to 47% of secondary-level educators in these three states teach a music class that is not band, choir, or orchestra.
Attitudes of Indian Medical and Nursing Students Towards Euthanasia: A Cross-Sectional Survey
Authors: Poreddi Vijayalakshmi , Reddy SS Nikhil , Pashapu Dharma Reddy
Published: October 2020

This cross-sectional survey was carried out among medical internees (n = 92) and nursing students (n = 228) to investigate their attitudes towards euthanasia. The data was collected by administering a Euthanasia Attitude questionnaire. The findings revealed that a majority (61%) of the participants were in support of euthanasia. Yet ethical dilemmas prevail among students about active and passive euthanasia and legalization of euthanasia. Further, age, gender, religion, education and exposure to patients who require euthanasia were significantly differed with euthanasia attitudes (p < 0.05). Therefore, it is strongly recommended that health care students should receive ethics education to prepare them in dealing with euthanasia related issues in their professional practice.
International Remittances as a Driver of Domestic Tourism Expenditure: Evidence from Mexico
Authors: Mora-Rivera Jorge , García-Mora Fernando
Published: October 2020

This article aims to empirically assess the impact of international remittances on domestic tourism expenditure (DTE) in Mexican households. Using Probit and Tobit regressions with instrumental variables and information from the 2016 National Household Income and Expenditure Survey, our findings show that international migrants’ remittances can improve DTE among Mexican households. Controlling for endogeneity of remittances, the results show a statistically significant and positive impact of international remittances on both the probability and the amount of money spent on domestic tourism. This suggests that international remittances provide the necessary resources to alleviate the liquidity constraints that restrict access to tourism activities for recipient households. This research also highlights the need to encourage public policy recommendations aimed at promoting tourism-related development in Mexico.
Applying Video Modeling to Promote the Handwriting Accuracy of Students with Low Vision Using Mobile Technology
Authors: Chang Chia-Jui , Lo C. Owen , Chuang Su-Chen
Published: October 2020

Introduction:

In Taiwan, although many school-aged students with low vision struggle with poor handwriting, there is a lack of evidence-based educational practices for handwriting enhancement. Since the use of mobile technology has increased recently, iPads have been identified as an effective tool to deliver video-based instruction to individuals. In this study, iPads were used to deliver video modeling to provide instruction designed to enhance the handwriting accuracy among students with low vision.

Methods:

A multiple-baseline-across-participants-probe design was used in this study to assess the success of the intervention with three individuals with low vision who were 9, 12, and 14 years of age.

Results:

During the baseline phase, the accuracy for each of the participants was under 50%. After intervention, their handwriting accuracy increased. The participants were also able to maintain their performance during follow-up sessions. Moreover, the study demonstrated good social validity, since the stakeholders all indicated a high level of treatment acceptability for this intervention.

Discussion:

The outcome of this study demonstrates that iPads used with video modeling can lead to improved accuracy in handwriting for students with low vision. The findings also support video modeling as an effective strategy for teaching new skills and may be applied to students with different special learning needs.

Implications for practitioners:

Video modeling is an effective and feasible instructional strategy for practitioners as it can be easily implemented. Additionally, given its built-in visual support, the iPad is an effective instrument that can help students with low vision reach a higher potential for handwriting accuracy. It is worth noting that, in addition to the presence of video modeling, proper instruction, as well as opportunities to practice, is needed for students to produce accurate word formation. Thus, short daily practices combined with the intervention method presented in this study are likely to gain better results for students with low vision.
Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study
Authors: Montalvo Charlotte , Finizia Caterina , Pauli Nina , Fagerberg-Mohlin Bodil , Andréll Paulin
Published: October 2020

Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.
The Role of Biologics in Chronic Rhinosinusitis With Nasal Polyps
Authors: Patel Gayatri B. , Peters Anju T.
Published: October 2020

Biologic therapy is a new treatment option for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Currently, the only biologic with Food and Drug Administration–approval status for CRSwNP is dupilumab. Several other biologics are likely to be approved for CRSwNP, including mepolizumab and omalizumab, based on their promising phase 3 trial results. The role of biologics in the treatment paradigm requires consideration of multiple factors that have yet to be clearly established. This includes identifying patients most appropriate for biologic therapy while considering long-term safety and cost-effectiveness in the context of patient preferences and goals.
The Role of Tracheotomy and Timing of Weaning and Decannulation in Patients Affected by Severe COVID-19
Authors: Botti Cecilia , Lusetti Francesca , Peroni Stefano , Neri Tommaso , Castellucci Andrea , Salsi Pierpaolo , Ghidini Angelo
Published: October 2020

Objectives:

Patients with acute respiratory failure due to coronavirus disease 2019 (COVID-19) have a high likelihood of needing prolonged intubation and may subsequently require tracheotomy. Indications and timing for performing tracheotomy in patients affected by severe COVID-19 pneumonia are still elusive. The aim of this study is to analyze the role of tracheotomy in the context of this pandemic. Moreover, we report the timing of the procedure and the time needed to complete weaning and decannulation in our center.

Methods:

This retrospective, observational cohort study included adults (≥18 years) with severe COVID-19 pneumonia who were admitted to the intensive care unit (ICU) of the tertiary care center of Reggio Emilia (Italy). All patients underwent orotracheal intubation with invasive mechanical ventilation, followed by percutaneous or open surgical tracheotomy. Indications, timing of the procedure, and time needed to complete weaning and decannulation were reported.

Results:

Forty-four patients were included in the analysis. Median time from orotracheal intubation to surgery was 7 (range 2-17) days. Fifteen (34.1%) patients died during the follow-up period (median 22 days, range 8-68) after the intubation. Weaning from the ventilator was first attempted on median 25th day (range 13-43) from orotracheal intubation. A median of 35 (range 18-79) days was required to complete weaning. Median duration of ICU stay was 22 (range 10-67) days. Mean decannulation time was 36 (range 10-77) days from surgery.

Conclusions:

Since it is not possible to establish an optimal timing for performing tracheotomy, decision-making should be made on case-by-case basis. It should be adapted to the context of the pandemic, taking into account the availability of intensive care resources, potential risks for health care workers, and benefits for the individual patient.
Gender Relations, Gender Equity, and Community Sports Spaces
Authors: Jeanes Ruth , Spaaij Ramòn , Farquharson Karen , McGrath Georgia , Magee Jonathan , Lusher Dean , Gorman Sean
Published: October 2020

This study employs a spatial analysis to critically examine gender relations within an Australian football and netball community sports club that has sought to address gender inequity and promote the participation of women across the club. Notable changes included increased female representation in the club’s decision-making structures, growing numbers of female members, and the establishment of a women’s and girls’ football section. Using an in-depth case study that combined interviews and observations over a 6-month period, we investigated the impact these changes have had on transforming gender relations and in challenging perceptions of the club as a privileged space for its male members. The study utilized spatial and feminist theory to illustrate that, despite the club’s efforts to change gender relations, men who are able to embody dominant forms of masculinity (i.e., high ability and able-bodied) continue to be privileged within the club environment. The article highlights the importance of spatial analysis in illuminating the ways in which various micro-level practices preserve dominant gender relations within community sports. The findings reinforce that although a greater number of women and girls are participating in community sport, this alone is not significantly reshaping gender relations. Policies seeking to promote gender equity in sport need to enforce changes in club environments in addition to focusing on increasing women’s participation.
Culture Conditions Affect Chemical-Induced Developmental Toxicity In Vitro: The Case of Folic Acid, Methionine and Methotrexate in the Neural Embryonic Stem Cell Test
Authors: de Leeuw Victoria C. , van Nieuwland Marieke , Bokkers Bas G.H. , Piersma Aldert H.
Published: October 2020

In vitro tests are increasingly applied in chemical hazard assessment. Basic culture conditions may affect the outcome of in vitro tests and should be optimised to reduce false predictions. The neural embryonic stem cell test (ESTn) can predict early neurodevelopmental effects of chemicals, as it mimics the differentiation of stem cells towards the neuroectodermal lineage. Normal early neural differentiation depends crucially on folic acid (FA) and methionine (MET), both elements of the one-carbon (1C) cycle. The aim of this study was to assess the concentration-dependent influence of FA and MET on neural differentiation in the ESTn, and its consequences for assay sensitivity to methotrexate (MTX), a compound that interferes with the 1C cycle. Neural differentiation was inhibited below 0.007 mM and above 0.22 mM FA, while both stem cell viability (< 0.097 mM, > 1.52 mM) and neural differentiation (< 0.181 mM, > 1.35 mM) were affected when changing MET concentrations. A 10-day exposure to 13 nM MTX inhibited neural differentiation, especially in FA- and MET-deficient conditions. However, a 24-hour exposure to 39 nM MTX decreased neural cell and neural crest cell differentiation markers only when the concentration of FA in the medium was three times the standard concentration, which was expected to have a protective effect against MTX. These results show the importance of nutrient concentrations, exposure scenarios and timing of read-outs for cell differentiation and compound sensitivity in the ESTn. Caution should be taken when interpreting results from a single in vitro test, especially when extrapolating to effects on complex morphogenetic processes, like neural tube development.
Problematizing the Global: An Introduction to Global Culture Revisited
Authors: Featherstone Mike
Published: October 2020

This paper serves as an introduction to the special section on Global Culture Revisited which commemorates the 30th anniversary of the publication of the 1990 Global Culture special issue. It examines the development of interest in the various strands of globalization and the question of whether there can be a global culture. The paper discusses the emergence of alternative global histories and the problematization of global knowledge. It examines the view that the current Covid-19 pandemic signals a turning point, or change of epoch, that marks the end of peak globalization (Gray, Mignolo). The paper also discusses the view that global was always a limited cartographic term which failed to adequately grasp our terrestrial location on the earth (Latour). Currently, there is considerable speculation about the emergent politics of a new world order, with civilizational states set alongside nation-states, opening up an epoch of greater pluriversality, and at the same time greater uncertainty.
A Century After Weber and Simmel
Authors: Kemple Thomas
Published: October 2020

This essay reviews two recently published volumes of the Max-Weber- Gesamtausgabe (Collected Works) which contain writings on methodological questions and theoretical problems concerning ‘objectivity’, ‘interpretive understanding’, and ‘value-freedom’. Since many of these texts explicitly address Weber’s views on the writings of Georg Simmel, the essay treats these volumes as an occasion to commemorate the legacy of these two classic theorists of modern capitalism a hundred years after their death. In addition to considering new scholarship on these thinkers, the essay also highlights their relevance to problems and questions still being posed and contemplated today.
Selective activation of D1 dopamine receptors exerts antidepressant-like activity in rats
Authors: Desormeaux Cleo , Demars Fanny , Davenas Elisabeth , Jay Therese M , Lavergne Francis
Published: October 2020

Background:

Major depressive disorder is a common illness that severely decreases psychosocial functioning. Due to the major limitations of current treatments including response failure, it is crucial to develop better therapy strategies. Evidence suggests that dopamine dysregulation might play a major role in major depressive disorder physiopathology.

Aims:

This study investigates whether the dopamine D1 receptor agonist A77636 modulates antidepressant-like activity in rats.

Methods:

Rats were injected with an acute single dose of A77636 (0.75, 1.5 or 3 mg/kg), a potent and selective dopamine D1-like receptor agonist. Their locomotor activity, social interactions and behavioural response to the forced swim test were analysed 30 min after the injection.

Results:

During the forced swim test, the D1 agonist dose dependently reduced the immobility while the time of bursting was increased. Social interactions were significantly increased in the animals exposed to 3 mg/kg of A77636 whereas no significant changes were measured in general motor activity.

Conclusions:

The present results provide evidence that pharmacological modulation of D1 receptor by the selective agonist A77636 induces antidepressant-like effects in rats, which encourages further studies regarding D1-specific modulation in major depressive disorder treatment.
Continued gefitinib retreatment beyond progression in patients with advanced non-small cell lung cancer harboring sensitive EGFR mutations
Authors: Jiang Xuhong , Li Xiaoqing , Tu Lingli , Cai Jin , Wei Man , Wu Zhongjun , Sun Lan
Published: October 2020

Purpose

To evaluate the effectiveness and safety of gefitinib retreatment beyond disease progression in patients with advanced non-small cell lung cancer (NSCLC) with sensitive epidermal growth factor receptor ( EGFR) mutations.

Methods

Data from patients with stage III/IV NSCLC were analyzed retrospectively. Patients with sensitive EGFR mutations received first-line treatment with gefitinib followed by retreatment with gefitinib after disease progression. Progression-free survival (PFS) after the first treatment (PFS-1) was defined as the time to progression or death using the Response Evaluation Criteria in Solid Tumors criteria (RECIST) v1.1 criteria. The second PFS (PFS-2) was defined as the interval between the first and second progressions, at the investigator’s discretion. Toxicities were recorded in accordance with the National Cancer Institute (NCI)-Common Terminology Criteria (CTC) version 4.0.

Results

Sixteen patients aged 53 to 80 years (median 66 years) were included in the analysis. The median PFS-1 and PFS-2 were 10.0 months and 14.0 months, respectively. The median overall survival (OS) was 36.0 months. No toxicity of grade 3 or worse was observed.

Conclusions

Our findings suggest that gefitinib retreatment beyond disease progression may be an effective and tolerable approach for NSCLC patients with sensitive EGFR mutations.
Lactate levels and clearance rate in neonates undergoing mechanical ventilation in Tibet
Authors: Chen Dan , Liu Xiuxiu , Li Jiujun
Published: October 2020

Objective

This study aimed to examine the characteristics of blood lactate in neonates undergoing mechanical ventilation in Tibet.

Methods

We recruited 67 neonates undergoing mechanical ventilation in Naqu People’s Hospital as the plateau observation group and 94 neonates undergoing mechanical ventilation in Shengjing Hospital as the control group. We analyzed the differences in lactate levels between the two groups.

Results

The lactate clearance rates of neonates with asphyxia and those with respiratory distress syndrome were significantly lower in the plateau group than in the control group. Lactate levels in neonates who died in the plateau group were significantly higher and the lactate clearance rate was significantly lower than those in neonates who survived. The cut-off point for the lactate clearance rate at 6 hours for predicting mortality was 6.09% in the plateau group.

Conclusion

The lactate clearance rate of neonates on mechanical ventilation in the plateau area is lower than that in neonates in the non-plateau area. The lactate clearance rate at 6 hours is important for evaluating the prognoses of critical neonates in plateau areas.
The implications of traditional authority contest for local-level stability – Evidence from South Africa
Authors: Mustasilta Katariina
Published: October 2020

How do state-recognized traditional authorities (TAs) influence local-level stability? Policies that recognize and give TAs public authority, particularly in many sub-Saharan African countries, have attracted growing scholarly interest in TAs. Drawing empirical evidence from South Africa, I test a proposition that internally contested TA structures contribute to grievances and opportunities that give rise to social unrest. The statistical analysis combines spatial data on municipality-level protests with new data on contested and uncontested TA structures. The results support the theoretical argument. Qualitative data further demonstrate how contested TAs fuel grievances and facilitate mobilization against the local authorities.
Peer Pressure and SNS Addiction in Adolescents: The Mediating Role of SNS-Use Motives
Authors: Kim Seon-Jeong , Lim Young-Jin
Published: October 2020

The present research was carried out to clarify relationships between peer pressure, social networking site (SNS) addiction, and SNS-use motives in Korean adolescents. Adolescent SNS users ( N = 300, 52.70% female) completed self-report measures of peer pressure, SNS addiction, and SNS-use motives. Findings indicated that adolescents reporting more peer pressure had higher levels of SNS addiction. Moreover, the relationship between peer pressure and SNS addiction was mediated by coping and social-conformity use motives. Results are discussed in terms of implications for prevention and intervention, for adolescents facing peer pressure.
Provider-Documented Anxiety in the ICU: Prevalence, Risk Factors, and Associated Patient Outcomes
Authors: May Andrew D. , Parker Ann M. , Caldwell Ellen S. , Hough Catherine L. , Jutte Jennifer E. , Gonzalez Mayra Sanchez , Needham Dale M. , Hosey Megan M.
Published: October 2020

Purpose:

To determine the prevalence of provider-documented anxiety in critically ill patients, associated risk factors, and related patient outcomes.

Method:

Chart review of 100 randomly sampled, adult patients, with a length of stay ≥48 hours in a medical or trauma/surgical intensive care unit (ICU). Provider-documented anxiety was identified based on a comprehensive retrospective chart review of the ICU stay, searching for any acute episode of anxiety (e.g., documented words related to anxiety, panic, and/or distress).

Results:

Of 100 patients, 45% (95% confidence interval: 35%-55%) had documented anxiety, with similar prevalence in medical vs. trauma/surgical ICU. Patients with documented anxiety more frequently had history of anxiety (22% vs. 4%, p = .004) and substance abuse (40% vs. 22%, p = .048). In the ICU, they had greater severity of illness (median (IQR) Acute Physiology Score 16(13,21) vs. 13(8,19), p = .018), screened positive for delirium at least once during ICU stay, (62% vs. 31%, p = .002), benzodiazepines and antipsychotics use (87% vs. 58%, p = .002; 33% vs. 13%, p = .013, respectively), and mental health consultation (31% vs. 18%, p = .132). These patients also had longer ICU and hospital lengths of stay (6(4,11) vs. 4(3,6), p<.001 and 18(10,30) vs. 10(6,16) days, p<.001, respectively) and less frequent discharge back to home (27% vs. 44%, p = .079).

Conclusions:

Documented anxiety, occurring in almost half of ICU patients with length of stay ≥48 hours, was associated with a history of anxiety and/or substance abuse, and greater ICU severity of illness, delirium, psychiatric medications, and length of stay. Increased awareness along with more standardized protocols for assessment of anxiety in the ICU, as well as greater evaluation of non-pharmacological treatments for anxiety symptoms in the ICU are warranted.
Self-perceptions of aging and domain-specific health outcomes among midlife and later-life couples
Authors: Luo Meng Sha , Li Lydia W. , Hu Rita Xiaochen
Published: October 2020

Objectives: This study places the self-perceptions of aging (SPA)-health link in the couple context and examines how changes in one’s own and spouse’s SPA influence multiple health domains and how such associations differ by gender. Methods: Fixed-effects regression models were estimated. Data were drawn from the Health and Retirement Survey ( N = 5972). Results: For both husbands and wives, almost all health domains declined when their own SPA became more negative. The spouse’s SPA were associated with one’s self-rated health, regardless of gender. Gender differences existed in some cross-spousal health effects; while the husband’s SPA were associated with his wife’s depressive symptoms, the wife’s SPA were associated with her husband’s physical disability, functional limitations, and chronic diseases. Discussion: The SPA–health association extends beyond the individual in married persons, demonstrating intertwined health trajectories in older couples. The detrimental effects of ageism might be underestimated if the spillover effects were not considered.
One Direction real person fiction on Wattpad.com: A textual analysis of sexual consent
Authors: Hedrick Ashley
Published: October 2020

This study focuses on the dominant scripts for sexual consent represented in popular fictional stories of celebrities written by their female fans. A textual analysis was performed on a subset of the most read real person fiction (RPF) stories—a type of fanfiction— about the popular boy band One Direction. Stories were publicly available from an online fiction-writing platform with an extensive user base of teenage girls and young women. Verbal negotiations of sexual consent were frequently featured in these stories. However, several themes emerged to blur clear distinctions between the presence and lack of consent: hesitance or unease for sexual interactions, assumption of a partner’s sexual consent, unclear identification of sexual assault, language of attack or aggression to describe sexual interactions, and normalization of sexual actions that surprise a partner. A number of rape myths were also prevalent throughout the stories. The implications of these scripts for One Direction fans and for sexual scripting theory are discussed.
Multi-stage Holocene evolution of the River Murray Estuary, South Australia
Authors: Job Thomas , Penny Dan , Morgan Bree , Hua Quan , Gadd Patricia , Zawadzki Atun
Published: October 2020

The River Murray Estuary, South Australia exhibits a morphology typical of a wave-dominated estuary and comprises two large, shallow central basin lakes – Lakes Alexandrina and Albert. Contested interpretations of the estuary’s limnological history and uncertainty surrounding the sustainability of current basin water usage practice warrant a robust investigation into how the system has evolved. Here we combine lithostratigraphic, geochemical and sedimentological evidence from a transect of sediment cores to reconstruct the sediment infill history of the system. We uncover multiple stages of sediment infill over the history of the system, associated with (1) the low gradient morphology of the estuary and lower river channel, (2) the mid- to late-Holocene sea-level regression and (3) anthropogenic modifications to the fluvio-estuarine system. We show that while estuarine conditions in the system were fully established during the mid-Holocene highstand (~6.4 kyr BP), central basin facies sedimentation was focussed further inland before prograding with the lowering of base level and shifting of tidal influence as sea-level fell. Central basin facies sedimentation within northern Lake Albert occurred from 5.4 to 4.0 cal kyr BP at ~0.25 cm yr-1. The uppermost accumulation of this unit was eroded by continued reduction in base level until sea-level regression concluded at 3.5 cal kyr BP. Barrage and weir installation (1940 CE) re-initiated and expanded central basin facies sedimentation in the estuary (~0.32 cm yr-1). Recently deposited sediments exhibit geochemical markers of increased trophy and more frequent acid sulfate soil acidification, exposing human impacts on the estuary.
Bioinformatic Identification of Potential Hub Genes in Muscle-Invasive Bladder Urothelial Carcinoma
Authors: Guo Changgang , Shao Ting , Wei Dadong , Li Chunsheng , Liu Fengjun , Li Minghui , Gao Zhiming , Bao Guochang
Published: October 2020

Despite aggressive treatment approaches, muscle-invasive bladder urothelial carcinoma (MIBC) patients still have a 50% chance of developing general incurable metastases. Therefore, there is an urgent need for candidate markers to enhance diagnosis and generate effective treatments for this disease. We evaluated four mRNA microarray datasets to find differences between non-MIBC (NMIBC) and MIBC tissues. Through a gene expression profile analysis via the Gene Expression Omnibus database, we identified 56 differentially expressed genes (DEGs). Enrichment analysis of gene ontology, Kyoto Encyclopedia of Genes and Genomes, and Reactome pathways revealed the interactions between these DEGs. Next, we established a protein-protein interaction network to determine the interrelationship between the DEGs and selected 10 hub genes accordingly. Bladder urothelial carcinoma (BLCA) patients with COL1A2, COL5A1, and COL5A2 alterations showed poor disease-free survival rates, while BLCA patients with COL1A1 and LUM alterations showed poor overall survival rates. Oncomine analysis of MIBC versus NMIBC tissues showed that COL1A1, COL5A2, COL1A2, and COL3A1 were consistently among the top 20 overexpressed genes in different studies. Using the TCGAportal, we noted that the high expression of each of the four genes led to shorter BLCA patient overall survival. It was evident that BLCA patients with an elevated high combined gene expression had significantly shorter overall survival and relapse-free survival than those with low combined gene expression using PROGgeneV2. Using Gene Expression Profiling Interactive Analysis, we noted that COL1A1, COL1A2, COL3A1, and COL5A2 were positively correlated with each other in BLCA. These genes are considered as clinically relevant genes, suggesting that they may play an important role in the carcinogenesis, development, invasion, and metastasis of MIBC. However, considering we adopted a bioinformatic approach, more research is crucial to confirm our results. Nonetheless, our findings may have important prospective clinical implementations.
Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40
Authors: Hou Hai-Kun , Liu Cun-Zhi , Lin Lu-Lu
Published: October 2020

Objectives:

The objectives of this study were to identify the mean safe needling depth and angle at BL40 between subjects, taking into account variables including sex and body mass index (BMI).

Methods:

One hundred and twenty-four participants who had undergone magnetic resonance imaging (MRI) examination of the knee region for clinical indications were included in this study. BL40 needling sites were localized by World Health Organization (WHO) standards and were measured by MRI. As much as 70% of the value of AN (from the needle insertion point to the popliteal artery) was considered to represent the safe depth, and angle alpha between the BL40 straight line and the AN line was regarded as the safe angle.

Results:

Overall, mean safe depth regardless of BMI and sex was 18.51 ± 3.56 mm (95% confidence interval (CI), 17.88%–19.14%). Mean safe depth was 17.24 ± 3.14 mm in the low and normal BMI group, 18.76 ± 2.90 mm in the overweight group, and 22.01 ± 3.71 mm in the obese group. Thirteen patients (10.5%) had internal deviation of angle alpha (95% CI, 5.6%–15.3%), while 111 patients (89.5%) had external deviation (95% CI, 84.7%–94.4%). The mean internal and external deviations of angle alpha were 8.78° ± 2.92° (95% CI, 7.01°–10.55°) and 9.75° ± 3.46° (95% CI, 9.10°–10.41°), respectively.

Conclusion:

We would suggest that, when using a straight needle insertion at BL40, it is safe to advance a 25-mm needle approximately 12.5 mm, and 17.5 mm should be safe for patients with BMI greater than 28 kg/m2. Practitioners should decrease the depth of penetration when treating patients of low body weight or height.
Social Determinants of Undernutrition Among Under-5 Children in Rural Areas of Myanmar: A Narrative Review
Authors: Htwe Kyae Mhon
Published: October 2020

Childhood undernutrition is a major public health challenge in Myanmar. To reduce the prevalence of childhood undernutrition in Myanmar, it is important to understand the social determinants of under-5 undernutrition. This review aimed to identify the social determinants of undernutrition in under-5 children in rural areas of Myanmar. A systematic search strategy was conducted through databases- Medline (Ovid), PubMed, SCOPUS, ProQuest Central, Web of science, and POPLINE. The grey literatures from relevant websites were also searched. Keywords were identified and used to search the literature published from 2007 to 2020 in English. Thematic analysis was performed. Twenty-five publications met the selection criteria and were reviewed. Five major themes were identified as important social determinants of under-5 undernutrition in Myanmar—food insecurity, poverty, maternal factors, an unhealthy environment, and low access to health services. This review highlights the need for a systematic and multisectoral approach to address under-5 undernutrition in Myanmar. Investment in agriculture and rural infrastructure development, and women’s education and empowerment may be major contributors to improving the nutritional status of children in rural Myanmar. Findings from this study can be used to develop nutrition-related policies and programs to reduce childhood undernutrition and improve nutrition outcomes in rural Myanmar.
Arterial lactate as a prognostic tool to predict mortality and disposition in the emergency department: A prospective observational single-centre study
Authors: Wilson William , Selvaraj Dhiraj Ravindran , Ramya Kumar MV , Jain Vinayak , Umra Simran , Murty Shakuntala
Published: October 2020

Background:

Point-of-care tools are invaluable in the emergency department. Arterial lactate has been used for prognostication in subsets of population in the emergency department but not often for a heterogeneous population.

Objectives:

We aimed to study the use of arterial lactate as a prognostication and disposition tool in an undifferentiated population presenting to the emergency department.

Methods:

We conducted a prospective study among all consenting emergency department patients with age >18 years, who had an arterial blood gas performed as a part of routine care and had a lactate value ⩾2 mmol/L. We collected data on demographics, comorbidities and patient disposition from the emergency department and 28-day mortality as a follow-up telephonically.

Results:

We included 469 patients with a median age of 37 years. Sixteen provisional diagnoses were made in the emergency department, and pneumonia/lower respiratory tract infection was relatively higher (13.6%). The median lactate was 4.6 (interquartile range = 3.2–7) with 155 patients (33%) being transferred to intensive care unit and 62 deaths (13.2%) recorded at 28 days. Furthermore, we observed optimum values for lactates at 5 mmol/L predicted intensive care unit admissions and 6 mmol/L predicted mortality. A unit increase in arterial lactate in the emergency department significantly increased mortality by 66% (95% confidence interval = 1.45–1.88; p < 0.001) and had a 2.15 times (95% confidence interval = 1.63–2.83; p < 0.001) significantly higher chance of being transferred to the intensive care unit.

Conclusion:

Arterial lactate can be used as a prognostication tool for a heterogeneous population presenting to the emergency department.

Clinical significance:

Point-of-care investigations such as arterial lactate can help the emergency physician make quick decisions on the floor and guide prognostication and disposition.
The Weight of Words: Co-Analysis of Thick Ethnographic Description and “Friction” as Methodological Strategies in a Health Policy Research Partnership
Authors: Loblay Victoria , Conte Kathleen P. , Grøn Sisse , Green Amanda , Innes-Hughes Christine , Milat Andrew , Persson Lina , Williams Mandy , Mitchell Jo , Hawe Penelope
Published: October 2020

Co-production partnerships between policymakers, practitioners, and researchers are designed to facilitate production of relevant and readily usable research in health policy and practice contexts. We describe methodological strategies for in-depth collaborative analysis based on a co-produced ethnography of health promotion practice, involving ethnographic researchers and government-based research partners. We draw on a co-production dialogue to reflect critically on the role and value of co-analyzing research findings using thick ethnographic descriptions. The ambiguity of ethnographic imagery allowed flexibility in interpretation of findings and also generated friction. Specific ethnographic images became focal points for productive friction that crystallized ethical and analytical imperatives underpinning the diverse expertise in the team. To make the most of co-analysis of thick ethnographic descriptions, we assert that friction points must be reflexively considered as key learning opportunities for (a) higher order analysis informed by diverse analytical perspectives and (b) more cohesive and useful interpretations of research findings.
Upper Gastrointestinal Langerhans Cell Histiocytosis: A Report of 2 Adult Cases and a Literature Review
Authors: Matsuoka Yui , Iemura Yoshiki , Fujimoto Masakazu , Shibuya Shinsuke , Yamada Atsushi , Fujii Shigehiko , Kusaka Toshihiro , Shindo Takero , Minamiguchi Sachiko , Haga Hironori
Published: October 2020

Langerhans cell histiocytosis (LCH) with primary involvement of the upper gastrointestinal (GI) tract is rare. We report 2 adult cases of localized LCH in the upper-GI tract, including the second reported adult case of esophageal LCH and review 11 previously reported cases. Case 1 involved the esophagus of a 61-year-old man; histiocytosis was detected when endoscopy was performed for an examination of epigastric pain. Case 2 involved the stomach of a 56-year-old woman wherein the lesion was detected during a follow-up endoscopy after Helicobacter pylori infection. Both biopsy specimens exhibited diffuse proliferation of mononuclear cells with nuclear convolution and a background of eosinophilic infiltrate. The cells were immunohistochemically positive for CD1a and langerin, and BRAF V600E mutation was detected in Case 2. Follow-up endoscopy for both cases revealed that the lesions disappeared without any treatment. It is important to avoid misdiagnosing LCH of the upper-GI tract as a malignant neoplasm.
Studies on Tissue Factor Pathway Inhibitor Antigen Release by Bovine, Ovine and Porcine Heparins Following Intravenous Administration to Non-Human Primates
Authors: Kouta Ahmed , Hoppensteadt Debra , Bontekoe Emily , Jeske Walter , Duff Richard , Cera Lee , Fareed Jawed
Published: October 2020

Unfractionated heparin (UFH) is a sulfated glycosaminoglycan that consists of repeating disaccharides, containing iduronic acid (or glucuronic acid) and glucosamine, exhibiting variable degrees of sulfation. UFHs release tissue factor pathway inhibitor (TFPI) which inhibits the extrinsic pathway of coagulation by inactivating factor Xa and the factor VIIa/TF complex. Most heparins used clinically are derived from porcine intestinal mucosa however, heparins can also be derived from tissues of bovine and ovine origin. Currently there are some concerns about the shortage of the porcine heparins as they are widely used in the manufacturing of the low molecular weight heparins (LMWHs). Moreover, due to cultural and religious reasons in some countries, alternative sources of heparins are needed. Bovine mucosal heparins (BMH) are currently being developed for re-introduction to the US market for both medical and surgical indications. Compared to porcine mucosal heparin (PMH), BMH exhibits a somewhat weaker anti-coagulant activity. In this study, we determined the TFPI antigen level following administration of various dosages of UFHs from different origins. These studies demonstrated that IV administration of equigravemetric dosages of PMH and ovine mucosal heparin (OMH) to non-human primates resulted in comparable TFPI antigen release from endothelial cells. In addition, the levels of TFPI were significantly higher than TFPI antigen levels observed after BMH administration. Potency adjusted dosing resulted in comparable TFPI release profiles for all 3 heparins. Therefore, such dosing may provide uniform levels of anticoagulation for the parenteral indications for UFHs. These observations warrant further clinical validation in specific indications.
Performance engineering for real and complex tall & skinny matrix multiplication kernels on GPUs
Authors: Ernst Dominik , Hager Georg , Thies Jonas , Wellein Gerhard
Published: October 2020

General matrix-matrix multiplications with double-precision real and complex entries (DGEMM and ZGEMM) in vendor-supplied BLAS libraries are best optimized for square matrices but often show bad performance for tall & skinny matrices, which are much taller than wide. NVIDIA’s current CUBLAS implementation delivers only a fraction of the potential performance as indicated by the roofline model in this case. We describe the challenges and key characteristics of an implementation that can achieve close to optimal performance. We further evaluate different strategies of parallelization and thread distribution and devise a flexible, configurable mapping scheme. To ensure flexibility and allow for highly tailored implementations we use code generation combined with autotuning. For a large range of matrix sizes in the domain of interest we achieve at least 2/3 of the roofline performance and often substantially outperform state-of-the art CUBLAS results on an NVIDIA Volta GPGPU.
Segmenting Tourism Markets Based on Demand Growth Patterns: A Longitudinal Profile Analysis Approach
Authors: Liu Yulin , Hsiao Aaron , Ma Emily
Published: October 2020

Despite the abundance in methodologies for tourism demand modeling, most methods examine demand growth levels rather than growth patterns. The latter, however, can be of great value for destination management to minimize business risks and for authorities to prescribe effective policies. Meanwhile, describing demand growth as a simplex S-shaped life-cycle curve may oversimplify the heterogeneity in visitor flows. There is thus a need for methods that can identify market segments based on demand growth patterns to enable smart destination management strategies and provide theoretical insights. This article introduces a longitudinal profile analysis via multidimensional scaling (LPAMS) as an effective and easy to implement data-driven segmentation tool. This practitioner-friendly quantitative analytic tool is justified in the theoretical background of embracing complexity in business research, data disaggregation, and modeling interdependence in tourism forecasting. The conceptual and procedural details of LPAMS are explained at a level that is comfortably understood by researchers and practitioners, together with methodological comparisons with conventional methods. A demonstration of LPAMS is presented to identify five typical annual arrivals’ growth patterns of Australia’s 43 main inbound markets over 1991-2016. This study contributes to the methodologies for longitudinal tourism demand analysis and market segmentation techniques.
What can visual caregivers expect with patients treated for SARS-CoV-2? An analysis of ongoing clinical trials and ocular side effects
Authors: Fambuena-Muedra Isabel , Jiménez-García Marta , Hershko Sarah , Altemir-Gómez Irene , Tobarra-López Ana
Published: October 2020

Within the COVID-19 pandemic context, the WHO has proposed a list of medicines to treat patients with severe acute respiratory syndrome (SARS-CoV-2). An analysis of their ocular side effects was performed. Only chloroquine and hydroxychloroquine were found to have an ocular impact in the medium and long-term. Detailed search strategies were performed in EMBASE, MEDLINE, SCOPUS and WOS Core Collection. Additionally, the worldwide ongoing clinical trials including chloroquine or hydroxychloroquine were evaluated, and their proposals of drug administration and exclusion criteria analyzed. In general, high maximum cumulative doses of chloroquine or hydroxychloroquine are being used for a short period in 135 currently underway clinical trials (to 21st April 2020). Typically, the doses were 2 to 5 times greater than the AAO recommendation (adjusted to weight) to avoid toxic retinopathy, the most undesirable ocular side effect. Maximum cumulative doses up to 12,000 mg for chloroquine and 18,000 mg for hydroxychloroquine were found. In prophylaxis clinical trials, 72,000 mg and 22,500 mg were the maximum cumulative doses for hydroxychloroquine and chloroquine respectively. Only 48% of the clinical trials considered retinal impairment as an exclusion criterion, and just one referred to an ophthalmic examination previous to study inclusion. How chloroquine and hydroxychloroquine treatment affect patients with a previous retinal condition is still poorly understood. A comprehensive ophthalmological examination 6 months after treatment is recommended in this subgroup. This review provides an overview of this topic and sheds light on the challenges visual caregivers may face regarding these repurposed drugs.
Training novice in ultrasound-guided venipuncture: A randomized controlled trial comparing out-of-plane needle-guided versus free-hand ultrasound techniques on a simulator
Authors: Raft Julien , Dupanloup Danièle , Clerc-Urmès Isabelle , Baumann Cédric , Richebé Philippe , Bouaziz Hervé
Published: October 2020

Background:

Peripheral intravenous access is a common medical procedure, however, it can be difficult to perform in some patients. Success rates have proved greater with ultrasound guidance. Peripheral intravenous access using ultrasound requires specific training, especially for new ultrasound users. To overcome these difficulties, guidance devices on ultrasound probes are able to control the angle of penetration into tissues. We hypothesized that, and particularly for new ultrasound users, the use of a needle guide (NG) paired with the out-of-plane approach would facilitate puncture of a simulation model of vessel more effectively than similar free hand (FH) techniques.

Methods:

A prospective controlled randomized study was conducted of new ultrasound users using a guide wire introducer needle on gelatine phantom. After a 30-min lecture, one group performed the FH technique and the other group performed the NG technique both in an out-of-plane approach. The main criterion was the number of attempts before success of catheterization of this model of vessel.

Results:

Thirty-four nurse anesthetist students participated in the study. The number of attempts before success using the NG technique was significantly lower: 3.7 (±0.9) in the NG group versus 6.7 (±3.3) in the FH group ( p = 0.01). In the NG group, 100% of the participants achieved success after the sixth attempt. In the FH group, only 81.25% ( n = 13/16) reached success.

Conclusion:

NG technique has been proved to have a steeper learning curve compared with the FH technique. A study on a learning curve in clinical practice is needed to confirm these results.