bluuebunny/crossref_metadata_2025 huggingface dataset:
Deep Q-Network-Based Efficient Driving Strategy for Mixed Traffic Flow with Connected and Autonomous Vehicles on Urban Expressways
Authors: Wang Jiawen , Hu Chenxi , Zhao Jing , Zhang Shile , Han Yin
Published: April 2023

With the increase in the number of automated vehicles, roads will contain a mix of automated vehicles and human-driven vehicles. At present, rule-based driving strategy control of automated vehicles in mixed traffic flow makes it difficult to obtain optimal control. Therefore, this study proposes a learning-based driving strategy for connected and autonomous vehicles under mixed traffic flow. The proposed method differs from other driving strategies in two respects. First, both the lane-change and car-following policies are included, and the Deep Q-network algorithm is utilized to train the two policies in a mixed traffic-flow environment. Second, the proposed driving strategy considers both traffic efficiency and safety when designing the reward function. Through simulation experiments, the differences in traffic efficiency and safety of this method and the rule-based method were compared and analyzed under different traffic densities and penetration rates of connected and autonomous vehicles. Simulation results show that the driving strategy improves the average velocity (by 7.02 km/h) and traffic safety (especially in high-density traffic), compared with traditional rule-based driving strategy.
Analysis of Airports Served by Ultra Low-Cost Carriers
Authors: Taplin Drew , Kuby Michael , Salon Deborah , King David
Published: April 2023

Recently the domestic aviation industry has been influenced by rapidly growing ultra low-cost carriers (ULCCs). The pattern of airport markets served by ULCCs is incongruous with legacy carriers and low-cost airlines alike. Existing literature, however, is limited for North American ULCCs: research has only recently begun to identify them separately from mainstream low-cost carriers. This study sought to understand the market factors that influence ULCC service decisions. The relationship between ULCC operations and airport market factors was analyzed using three methods: mapping 2019 flight data for four ULCCs combined, two regression analyses to evaluate variables, and three case studies examining distinct scenarios through interviews with airport managers. Enplanement data were assembled for every domestic airport offering scheduled service in 2019. Independent variables were collected for each Part 139 airport. The first model estimated an ordinary least squares regression model to analyze ULCC enplanements. The second model estimated a binary logistic equation for presence of ULCC service. Case studies for Bellingham, Waco, and Lincoln were selected using compelling airport factors and relevant ULCC experience. Maps of ULCC enplanements revealed concentrations of operations on the East Coast. Both regression analyses showed strong relationships between population and non-ULCC enplanements (two measures of airport market size) and ULCC operations. A significant relationship also existed between tourism and enplanements. In the logit model, distance and competition variables were associated with ULCC presence. Case studies emphasized the importance of airport fees and competition in ULCC preferences, although aeronautical costs were generally not significant in the regressions.
Impact of atmospheric pressure variations on aerobic biodegradation test
Authors: Liu Gangjin , Frankó Balázs , Strömberg Sten , Zheng Dan , Nistor Mihaela , Liu Jing , Deng Liangwei
Published: April 2023

Biodegradation rate is an important index to evaluate the environmental risk of chemicals, which is usually determined by measuring oxygen consumption through respirometer in a biodegradation test. However, atmospheric pressure variations affect reactor oxygen concentration and oxygen volume recorded by respirometer in biodegradation test, and the parameters of reactor volume and test material amount amplify its effect. Atmospheric pressure variation >1 kPa could introduce >20% underestimation in biodegradation rate when a small amount of test material (0.04–0.2 g per 100 g of inoculum) and high reactor volume (2–4 L) were used according to the international standards. A 5 kPa drop in atmospheric pressure leads to a 6% decrease in headspace oxygen concentration in the reactor, which could subsequently inhibit biodegradation microbials and decrease the biodegradation rate by 30%. Moreover, the biodegradation process (oxygen consumption rate) could be accelerated/delayed several times by atmospheric pressure variations compared to the process without variations when the oxygen consumption rate was <5 mL h−1 in a 0.5 or 1 L reactor and <10 mL h−1 in a 2-L reactor. Mitigating the effects of atmospheric pressure variations on biodegradation test includes lowering the reactor volume, increasing the test material amount and recording atmospheric pressure for further modification.
Fabrication, optimization and cytotoxicity assessment of Ganoderma lucidum Triterpenoid-loaded electrospun gelatin nanofiber membrane as potential skin patch
Authors: Nojoki Fahimeh , Hatamian-Zarmi Ashrafalsadat , Ebrahimi-Hosseinzadeh Bahman , Alvandi Hale , Khezri Khadijeh , Dabbaghi Nafiseh , Mir-derikvand Mohammad , Malekpour Galougahi Fariba
Published: April 2023

Ganoderma lucidum triterpenoids (GLT) have shown special anti-tumor effects, but due to low yields and their hydrophobic structure, they have not found much clinical application. Box Behnken Design (BBD) developed a formulation to optimize the effective parameters in encapsulating GLT. Then, Gelatin nanofibers were characterized by SEM, 1H-NMR, and FTIR. Finally, the GLT release kinetics and GLT nanofibers cytotoxicity was studied. BBD shows the best values obtained are the solvent ratio of 11.5%, gelatin concentration of 22%, and voltage of 20 kV which were validated by an experimental assay. The results showed that the positively charged ionic groups present on the surface of gelatin adsorbed the carboxyl groups in GLT and the magnetic fields created by their nucleus influenced each other. Finally, GLT nanofibers with an average size distribution of 75.4 nm were observed. The result showed an efficiency of 75% for drug entrapment. The release kinetics demonstrated a sustained release of GLT follows the Korsmeyer-Peppas model that suggests a combination of surface drug dissolution and quasi-Fickian diffusion. Also, GLT nanofibers showed a higher cytotoxic activity against MCF-7 cell lines than free GLT. The generated model suggests a new approach to prediction and experimental nanofibers.
Black Men’s Intimate Partner Violence Victimization, Help-Seeking, and Barriers to Help-Seeking
Authors: Stewart Meagan A. , Haselschwerdt Megan L.
Published: April 2023

Guided by hegemonic masculinity and intersectionality theories, this descriptive, exploratory study examined Black men’s intimate partner violence (IPV) victimization experiences, subsequent help-seeking decisions, and barriers to help-seeking. To begin exploring Black men’s experiences, two research questions guided this study: (a) What are Black men's experiences of IPV-related help-seeking? (b) What barriers do Black men face when seeking IPV-related help and support? A total of 54 Black men participated in an online survey on their IPV experiences via the crowdsourcing platform Prolific. Overall, the men who participated in this study experienced relatively low levels of minor and severe physical and sexual violence victimization, as well as lower levels of coercive controlling violence in comparison to nationally representative data, suggesting this sample comprises men who experience situational couple versus coercive controlling violence. All but one participant utilized at least one help-seeking strategy. Informal strategies were most commonly utilized, whereas legal strategies were least commonly utilized. The degree to which participants perceived each strategy as helpful was quite variable, such that staying with friends or family was the most helpful strategy yet 47.8% found it unhelpful. The most common help-seeking barriers (e.g., wanting to solve the problem on their own) overlap with hegemonic masculinity and Black men’s experiences with formal and legal systems, relating less to the internalized and anticipated stigma subscales created for women. Broadly, this study helps illustrate the need for researchers to focus on developing measures and interventions tailored to Black men and their experiences.
Experiences of Bias Victimization Among People With Intellectual Disabilities
Authors: Díaz-Faes Diego A. , Codina Marta , Pereda Noemí
Published: April 2023

Research has drawn attention to the stigma and high rates of victimization among people with intellectual disabilities (ID) and an overlap between bias and non-bias victimization. However, studies of bias events or hate crime involving persons with ID are scarce. Using a self-report measure, we analyze lifetime bias victimization in a sample of 260 adults diagnosed with ID (age M = 41.7, SD = 12.0; 59.2% men), of whom 92 experienced bias victimization (age M = 41.2, SD = 11.9; 54.3% men), and compare the number of different types of victimization and the poly-victimization status between bias and non-bias victims. We also examine the following features: the victim, offender(s), victim–offender relationship, and location. Results show that bias victims experience a higher number of different types of victimization than non-bias victims ( M = 7.74 and 4.96, respectively; p <.001, rrb=.37, ξ=.42) and are four times more likely to be poly-victims than non-bias victims (odds ratio [ OR] = 4.37; 95% CI, p  <.001). Most of the victims experienced a number of bias victimization episodes (89.1%; n = 82), and more than a quarter were injured (27.2%, n = 25) as a result of the victimization. All the bias victimizations by strangers were carried out in public places, as were most of the bias victimizations by acquaintances. Schoolmates and work colleagues perpetrated attacks at school and in the workplace, respectively. More than half of the victims, 63% ( n = 58), spoke of the experience with someone, but only one reported it to the authorities. The paper provides a valuable descriptive and bivariate analysis of bias victimization of people with ID. The findings will help to understand bias violence against this population, highlighting the need for targeted and effective interventions.
Synthesis and characterization of a novel P/N containing flame retardant and its effect on flame-retardancy, thermal and mechanical properties of epoxy/clay nanocomposites
Authors: Soni Vishal , Dahiya Jai Bhagwan
Published: April 2023

A P/N containing flame retardant DOPO-QN was synthesized by a reaction between 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO) and 8-hydroxyquinoline (QN). Its chemical structure was characterized by Fourier transform infrared spectroscopy (FTIR), nuclear magnetic resonance (NMR) like 1H, 13C, 31P NMR, and high-resolution mass spectrometry (HRMS) techniques. The synthesized DOPO-QN was employed as an additive type flame retardant in combination with clay nanomer 1.34TCN (NC) in diglycidyl ether of bisphenol A/4,4ʹ-diaminodiphenlsulfone (DGEBA/DDS) to synthesize epoxy thermosets. The fire behavior of synthesized epoxy thermosets was studied by UL-94, limiting oxygen index (LOI), and cone calorimeter tests. The EP/DOPO-QN (1.5%P)/NC sample passed the UL-94 test with a V-0 rating and LOI value of 26.5%. A decrease in peak heat released, carbon monoxide, and carbon dioxide emissions was observed in the cone calorimeter test. Thermogravimetric analysis (TGA) of epoxy thermosets showed an increase in thermal stability at a higher temperature range on the formation of nanocomposites. Also, a remarkable improvement in storage modulus was observed for the EP/DOPO-QN (1.5%P)/NC sample containing 2.0% NC in dynamic mechanical analysis (DMA).
Multi-element organic-inorganic flame retardants for enhancing the flame retardancy, reducing smoke and toxicity of epoxy resins
Authors: Liu Huaiyin , Li Junwei , Sun Jichang , Zhao Haihan , Wu Jing , Zheng Yun , Zheng Penglun
Published: April 2023

Epoxy resins (EP) have been commonly used, but their poor flame retardant properties have prevented their widespread use. In order to improve the flame retardant properties of EP, an organic-inorganic composite flame retardant (HKDC) containing multi-element P/N/Si was successfully synthesized in this work using a typical aldehyde amine condensation reaction. This flame retardant utilizes the synergistic effect of multiple elements to simultaneously perform the flame retardant function of each element, and it can achieve excellent flame retardant effect by using low addition amount in EP. At the same time, this flame retardant can not only reduce the migration of molecules through the structure of inorganic substances, but also the C = C reaction in EP can form large molecules and increase the compactness with the EP matrix. The flame retardants were then quantified by measuring their flame retardant properties, combustion behavior and thermal stability. When the flame retardant HKDC is added, the flame retardant performance of EP is improved and the vertical combustion test achieves a V-0 rating. Most importantly, the addition of flame retardant HKDC effectively suppressed the toxic gas and smoke emissions of EP, with TSP values much lower than those of pure EP, and CO and CO2 emissions were suppressed.
Adaptive second order sliding mode guidance law for missile-target interception with fuzzy logic system
Authors: Gürsoy-Demir Handan , Efe Mehmet Önder
Published: April 2023

This paper presents the design of a 3D missile guidance law based on a second order sliding mode control technique employing an adaptive tuning law and a fuzzy gain scheduling. At the outset, the super-twisting sliding mode guidance law is obtained to overcome the chattering phenomenon. Then, without the knowledge about the bounds of disturbances, an adaptive law is used to determine the control gains. The results are enhanced using a fuzzy module that provides the controller parameters according to a set of linguistic rules. Finally, a comparative set of simulation results are given. To verify the performance and effectiveness of the proposed guidance law, we compare the performances of the traditional sliding mode (SM) guidance law, the traditional super-twisting sliding mode (STWSM) guidance law, the adaptive super-twisting sliding mode (ASTWSM) guidance law and the adaptive fuzzy super-twisting, sliding mode (AFSTWSM) guidance law. The simulation scenarios consider fundamental target movements. The results demonstrate that the proposed adaptive guidance laws display better performance in terms of miss distance, intercept time, and final closing velocity compared the alternatives considered in this study.
Research on selection method of aero-engine health parameters based on correlation and condition number
Authors: Chen Cheng , Zheng Qiangang , Zhang Haibo
Published: April 2023

Aiming at the problem of how to select aero-engine health parameters when the number of sensors is limited, a method of selecting aero-engine health parameters based on correlation and condition number is proposed. Firstly, the engine health parameters are preliminarily selected based on correlation. When the influence of two health parameters on engine output parameters is strongly correlated, only one of them needs to be selected. Then health parameters are further selected based on condition number of sensors parameters degradation matrixes. The larger the condition number is, the more ill conditioned the matrix is and the worse the estimation effect of the on-board model is. According to this, the combination of health parameters with the minimum condition number is selected. The proposed method can quickly select optimal health parameters and improve the accuracy of engine adaptive estimation. The results demonstrate that the stronger the correlation between the two health parameters, the greater the impact on the accuracy of the on-board model. Compared with the singular value decomposition-Kalman filter (SVD-KF) method and other combinations of health parameters, the on-board model accuracy of the optimal combination selected by this method is greatly improved, and has the best state parameter tracking effect.
Governance tools for urban food system policy innovations in the Milano Urban Food Policy Pact
Authors: Polman Daniel , Bazzan Giulia
Published: April 2023

An increasing amount of cities are invested in developing innovative policies to make the food system more sustainable. This article investigates whether combinations of governance practices can explain why some of these cities develop highly innovative food policies across multiple dimensions of the food system – such as health and waste – while others are only limited in their innovativeness. Therefore, we apply fuzzy-set Qualitative Comparative Analysis to identify combinations of necessary and sufficient governance conditions to explain food system innovativeness across 26 European cities participating in the Milan Urban Food Policy Pact. Results show that the absence of specific practices, such as mapping local food initiatives, food-related government integration, developing integrated food strategies and monitoring and evaluation, prevents cities from being more innovative.
Dynamics of Social Enterprises in Health Care Delivery: Contexts, Models, and Policy Insights From Malaysia
Authors: Ng Boon-Kwee , Chin Tzuenn-Yeu , Abu Shamsi Nurulaini , Azizan Suzana Ariff
Published: April 2023

This qualitative article explores the potential role of health care social enterprises (SEs) as disruptive innovators in improving the availability, accessibility, and affordability of health care delivery. It focuses on the context and mechanisms that enable SEs to produce positive health outcomes. Findings from an in-depth interview with the representatives of SEs and stakeholders in Malaysia reveal that strategies to balance the elements of social and enterprise (business) are the key for SEs to sustain in the market. This is supported with several inclusive business models such as inclusive employment model, cross-subsidization, and flexible fees payment mechanism, as well as collaborative engagement with multiple stakeholders, expert domains, and social workers. This article also highlights several main challenges in health care SEs, namely financial sustainability, impact measurement, scaling up of project, and political influence. This article ends with a few salient policies that focus on nurturing and strengthening health care SEs.
Direct detection of Mycobacterium bovis by a dry loop-mediated isothermal amplification assay in cattle samples collected during routine abattoir examination in Malawi
Authors: Kapalamula Thoko Flav , Thapa Jeewan , Hayashida Kyoko , Chizimu Joseph , Tanomsridachchai Wimonrat , Nyenje Mirriam Ethel , Mkakosya Rajab , Nakajima Chie , Suzuki Yasuhiko
Published: April 2023

The lack of quick, accurate, and low-cost detection methods has hindered the active control strategies for bovine tuberculosis (bTB) in resource-limited countries with a high burden of disease. We developed a dry loop-mediated isothermal amplification (LAMP) assay for rapid and specific detection of Mycobacterium bovis, the principal causative agent of bTB, and evaluated the efficacy of the assay using suspected bTB samples collected during routine meat inspection at major regional abattoirs in Malawi. Template genomic DNA was extracted directly from the granulomatous bTB-like lesion (crude extracted DNA), as well as growth from the incubated mycobacterial growth indicator tubes (MGIT). Field results were visualized by the naked eye within 40 min following a color change of the amplified products. The sensitivity and specificity of the dry LAMP assay while using 152 DNA samples extracted from MGIT with confirmed M. bovis results were 98% and 88%, respectively. When 43 randomly selected crude DNA samples from lesions were used, the sensitivity and specificity of the dry LAMP assay were 100% and 75%, respectively. Our LAMP assay offers the potential to meet the demands for a low-cost and rapid field detection tool for bTB in resource-limited countries in which bTB is endemic.
SEE Me Therapeutic Playgroup: A Teaming Model to Promote Parent–Child Interactions
Authors: Fabrizi Sarah , Tilman Ann L. , Donald Ellen , Balsamo Noelle , Connor Annemarie
Published: April 2023

Therapeutic playgroups have potential to benefit families and children enrolled in early intervention. A pretest–posttest, mixed methods, sequential explanatory design was utilized to explore the effectiveness and feasibility of an 8-week SEE Me (Social Emotional Education) therapeutic playgroup delivered by a collaborative team of providers using a convenience sample of 28 parent and child dyad participants and 19 early intervention providers. Results indicated statistically significant improvements in parent efficacy and parent–child interaction (affection and responsiveness) following participation. Parents and providers highlighted the role of the parent and reported improvements in child engagement, social interaction, and skill development in successful playgroups. Play activities and objects, facilitator support, and parent capacity were rated as supports for feasible delivery; challenges included child engagement and program implementation. These results provide preliminary evidence for both the effectiveness and feasibility of providing therapeutic playgroups as part of comprehensive early intervention services.
Harmonizing Assessments of Everyday Racial Discrimination Experiences: The Multigroup Everyday Racial Discrimination Scale (MERDS)
Authors: Lui P. Priscilla , Kamata Akihito
Published: April 2023

Reliable and valid assessment of direct racial discrimination experiences in everyday life is critical to understanding one key determinant of ethnoracial minority health and health disparities. To address psychometric limitations of existing instruments and to harmonize the assessment of everyday racial discrimination, the new Multigroup Everyday Racial Discrimination Scale (MERDS) was developed and validated. This investigation included 1,355 college and graduate students of color ( Mage = 21.54, 56.0% women). Factor analyses were performed to provide evidence for structural validity of everyday racial discrimination scores. Item response theory modeling was used to investigate item difficulty relative to the level of everyday racial discrimination, and measurement error conditioned on the construct. MERDS scores were reliable, supported construct unidimensionality, and distinguished individuals who reported low to very high frequency of everyday racial discrimination. Results on the associations with racial identity and psychopathology symptoms, and utility of the scale are discussed.
The Impact of Parent Torture and Family Functioning on Youth Adjustment in War-Affected Families: A Path Analysis Describing Intergenerational Trauma and the Family System
Authors: Hoffman Sarah J. , Vukovich Maria M. , Fulkerson Jayne , Gewirtz Abigail , Robertson Cheryl L. , Fredkove Windy M. , Gaugler Joseph
Published: April 2023

The direct exposure to physical or psychological trauma from torture or war leads to well-documented individual health consequences. Less understood are the inclusive and intergenerational effects of war trauma on family systems and youth adjustment. The purpose was to examine mechanisms in war-affected families that explained the significant emotional and behavioral consequences of intergenerational trauma in youth through the use of multiple methods. Quantitative assessments of maternal and paternal caregivers and youth characterized associations between parent torture, parent mental health distress, parent physical health problems, family functioning, and youth adjustment. Narrative statements further contextualized processes through which the trauma of a parent impacted youth and family systems. The research was conducted in partnership with local, refugee-serving community-based organizations. The study sample included parents and youth in 96 Karen families, originating from Burma in Southeast Asia, who had been resettled to the United States through the U.S. Refugee Admissions Program. Path analysis results indicated that parent torture (β = −0.173) had statistically significant negative direct effects on youth adjustment. Parent torture had a negative indirect effect on youth adjustment through the mental health (β = −0.345) and physical health problems of parents (β = −0.305), and youth gender (β = 0.126) and trauma exposure of youth (β = −0.048). Family functioning type demonstrated a positive direct effect on youth adjustment (β = 0.449). Family type had an indirect effect on youth adjustment through youth gender (β = 0.142), youth trauma exposure (β = −0.165), parent physical health problems (β = −0.202), and parent mental health (β = 0.509). The current study developed and tested the first model of intergenerational trauma’s effects on the adjustment of Karen refugee youth. Results emphasize that individual recovery from torture must be accompanied by adjunct interventions focused on family systems and youth adjustment, to holistically address intergenerational sequala of trauma.
The compressive performances of 3D-printed micron-size corrugated sandwich structures
Authors: Ji Lijun , Liu Weilin , Gong Wensheng , Qin Xiang , Liu Lingling , Luo Liping
Published: April 2023

Micron-scale grid-shaped, V-shaped and U-shaped corrugated sandwich structures are fabricated by 3D printing technology and present different mechanical properties from those made by traditional method. Their peak stresses and elastic moduli could be fitted to cubic functions. The compression performance of the multilayer grid-shaped sandwich can be determined by the relative mechanical strength of layers. Adding a layer on a grid-shaped sandwich has no significant influence on the peak stress, but can enhance the elastic modulus by about 60.9 MPa. The deformation modes of multilayer V-shaped and U-shaped sandwiches can be determined by the load carrying path and the relative mechanical properties between interlayers and cores. The elastic modulus of V-shaped sandwich is enhanced with the increase of layer number, while the elastic modulus of U-shaped sandwich decreases with the increase of layer number. The peak stress and the elastic modulus of a four-layer V-shaped sandwich can reach 9.85 MPa and 261.09 MPa, and those of a four-layer U-shaped sandwich can reach 4.79 MPa and 119.18 MPa. The result reveals the principles that the reduced structural size and suppressed debonding, the structures and the load carrying path, and materials, influence the failure mode and mechanical properties of the corrugated sandwiches.
An arterial access system for targeted chemotherapy delivery and arterial-arterial extracorporeal recirculation for ‘end stage’ peripheral vascular disease
Authors: Lane Rodney J , Keogh Sarah E , Khin Nyan Y
Published: April 2023

Background:

Vascular access via a single arterial catheter for targeted chemotherapy delivery has difficulties with concentration, dilution, drug retention, plasma binding, and lack of control of the tumour microcirculation. An implantable arterial access system to accommodate multi-catheter access was developed address these problems. The system was also adapted for isolated arterial-to-arterial extracorporeal suprasystolic perfusion for end stage peripheral vascular disease. The arterial-to-arterial logistics were compared with standard venovenous and arteriovenous fistulae access employed in haemodialysis.

Methods:

Targeted chemotherapy delivery was addressed in a pilot study of vascular liver isolation. Ten patients with secondary colorectal cancer, were treated with multiple infusions employing up to five individually steered catheters. The arterial-to-arterial extracorporeal access system was also used to treat end stage peripheral vascular disease in 20 patients where amputation was the only option. The trial was named Hypertensive Extracorporeal Limb Perfusion (HELP).

Results:

Multiple day only infusions produced a partial response or stable disease in six out of the ten patients in an ‘end stage’ setting. The mean survival was 11.2 months. Of the twenty patients facing amputation 40% had avoided amputation at follow-up 22 months and 20% had delay of 4 months.

Conclusion:

The access system allows repeatable steerable multi-catheter arterial access for chemotherapy delivery to address difficulties of concentration, dilution, plasma binding and microvascular control. The access system supports multiple repeatable suprasystolic extracorporeal arterial to arterial access. It is cardiac independent generating flows of greater than 1 L/min with zero flow in between treatments. The device logistics compares favourably with arteriovenous and venovenous access systems.
A Scoping Review of Risk and Protective Factors for Negative Cannabis Use Consequences
Authors: Grigsby Timothy J. , Lopez Andrea , Albers Larisa , Rogers Christopher J. , Forster Myriam
Published: April 2023

Objective:

Numerous reviews have examined risk and protective factors for alcohol-related negative consequences, but no equivalent review of risk and protective factors exists for cannabis-related negative consequences (CRNCs)-a gap filled by the present study. This scoping review examined survey-based research of risk and protective factors for CRNCs such as neglecting responsibilities, blacking out, or needing more cannabis.

Methods:

Three databases (PubMed, PsycINFO, and Google Scholar) were searched for peer-reviewed manuscripts published between January 1, 1990, and December 31, 2021. A qualitative synthesis was performed using the matrix method and the results were organized using the socioecological model as a framework.

Results:

Eighty-three studies were included in the review. There was considerable variation in measures and operationalizations of CRNCs across studies. Risk factors were identified in the intrapersonal (depression, social anxiety, PTSD, impulsivity, sensation seeking, motives, expectancies), interpersonal/community (trauma, victimization, family and peer substance use, social norms), and social/policy (education, employment, community attachment, legalization, availability of substances) domains of influence. Protective behavioral strategies were a robust protective factor for CRNCs. Males consistently reported more CRNCs than females, but there were no differences observed across race.

Conclusions:

Future research should identify person- and product-specific patterns of CRNCs to refine theoretical models of cannabis misuse and addiction. Public health interventions to reduce the risk of negative consequences from cannabis should consider utilizing multilevel interventions to attenuate the cumulative risk from a combination of psychological, contextual, and social influences.
Sex worker or victim? Exploring the sex industry in Spain
Authors: Meneses-Falcón Carmen
Published: April 2023

This article examines entry into paid sex work in Spain, comparing those people who entered sex work by choice and those who were coerced. There is a dearth of research that focusses on documenting the circumstances and conditions in which women engage in commercial sex work in Spain and on examining their opinions about current or planned legislation to regulate sex work. The article is based on a cross-sectional study using a sociological survey of people who work in indoor commercial sex, which is the least visible form of sex work in the Spanish context and about which we have the least information due to stigmatisation, both of the activity and of the people involved. This article considers the circumstances and working conditions of sex workers, and their views and position with regard to the legal framework for this activity. This focus is important at a political juncture in which a policy of criminalisation of sex work is being considered in Spain.
Management of vascular risk in people with multiple sclerosis at the time of diagnosis in England: A population-based study
Authors: Palladino Raffaele , Marrie Ruth Ann , Majeed Azeem , Chataway Jeremy
Published: April 2023

Background:

Vascular management in People with Multiple Sclerosis (PwMS) is important given the higher vascular burden than the general population, associated with increased disability and mortality.

Objectives:

We assessed differences in the prevalence of type 2 diabetes and hypertension; and the use of antidiabetic, antihypertensive and lipid-lowering medications at the time of the MS diagnosis.

Methods:

This is a population-based study including PwMS and matched controls between 1987 and 2018 in England.

Results:

We identified 12,251 PwMS and 72,572 matched controls. PwMS had a 30% increased prevalence of type 2 diabetes (95% confidence interval (CI) = 1.19, 1.42). Among those with type 2 diabetes, PwMS had a 56% lower prevalence of antidiabetic usage (95% CI = 0.33, 0.58). Prevalence of hypertension was 6% greater in PwMS (95% CI = 1.05, 1.06), but in those with hypertension, usage of antihypertensive was 66% lower in PwMS (95% CI = 0.28, 0.42) than controls. Treatment with lipid-lowering medications was 63% lower in PwMS (95% CI = 0.54, 0.74). PwMS had a 0.4-mm Hg lower systolic blood pressure (95% CI = −0.60, −0.13). 3.8% of PwMS were frail.

Conclusion:

At the time of diagnosis, PwMS have an increased prevalence of vascular risk factors, including hypertension and diabetes though paradoxically, there is poorer treatment. Clinical guidelines supporting appropriate vascular assessment and management in PwMS should be developed.
DOME: A mixed-method evaluation of the impacts of complex programmes against educational poverty
Authors: Tomei Gabriele
Published: April 2023

Developmental Outcome Monitoring and Evaluation (DOME) is a mixed and participatory method for the impact assessment of complex and innovative programmes. It has been developed and is being applied in Italy for the evaluation of interventions to combat juvenile educational poverty. The methodological process focuses on the detection of strategic change (outcomes) implemented by key actors in complex programmes, implemented in diverse geographical areas and managed by public–private partnerships. DOME combines methodological approaches already in use in the field of monitoring and evaluation – theory of change, counterfactual analysis and developmental evaluation and trailing research – in new ways.
Self-care management among children and adolescents with diabetes mellitus in Malaysia
Authors: Mohd Nor Noor Shafina , Anuar Zaini Azriyanti , Jalaludin Muhammad Yazid
Published: April 2023

The study aimed to evaluate diabetes self-care among diabetic children and adolescents and compare with glycaemic control. Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was distributed to patients aged 10–18 years with types 1 and 2 diabetes mellitus (DM) at paediatric diabetes clinics in Malaysia. Haemoglobin A1c levels were measured after questionnaire completion. A total of 106 patients completed the questionnaire with a mean age of 13.91 (± SD 2.48) years. Mean haemoglobin A1c and SDSCA score were 9.78 (± SD 2.43)% and 19.09 (± SD 5.81), respectively. Type 1 DM patients had significantly higher haemoglobin A1c (10.11 95% CI [9.62, 10.59] vs 8.38 95% CI [7.13, 9.62]). Total score was higher in type 1 DM although not statistically significant (19.32 95% CI [18.21, 20.43] vs 18.08 95% CI [14.28, 21.87]). Blood glucose testing score was significantly higher in type 1 DM (5.24 95% CI [4.82, 5.66] vs 3.50 95% CI [2.23, 4.77]). There was statistically significant negative correlation between score in diet subcategory and haemoglobin A1c. In conclusion, self-care activities among diabetic children and adolescents are still suboptimal. Self-care activities on blood glucose testing are significantly better in type 1 DM. Diet section correlated well with glycaemic control necessitating further research.
Effective engagement strategies in HyFlex modality based on intrinsic motivation in students
Authors: Bockorny Kristi M , Giannavola Theresa M , Mathew Shalini , Walters Hannah D
Published: April 2023

In order to navigate enrollment challenges, universities are scheduling more online and blended courses including HyFlex courses which offer students flexibility in their method of attendance. The goal of this study is to explore student engagement in HyFlex courses. However, there is limited research supporting the effectiveness of HyFlex courses in terms of student engagement. This two-pronged study, conducted at a regional state university in the U.S., utilized quantitative and qualitative data to explore the engagement levels between students attending the three different modalities offered in HyFlex courses. The findings of the quantitative study showed no difference in engagement levels between students attending face-to-face, virtually synchronously on Zoom, or virtually asynchronously. The results from the qualitative study generated five themes: (1) decreased stress; (2) positive learning experience; (3) flexibility to choose based on learning styles; (4) increased control on learning; and (5) increased accountability. These findings are discussed and strategies for effective engagement in HyFlex courses are shared.
Early Experience of Inner Branch Retrograde Cannulation With E-nside Branch Stent Graft for Thoracoabdominal Aortic Aneurysms
Authors: Spinella Giovanni , Pane Bianca , Finotello Alice , Bastianon Martina , Mena Vera Jorge Miguel , Di Gregorio Sara , Pratesi Giovanni
Published: April 2023

Purpose:

The aim of our study is to investigate the feasibility of retrograde cannulation using devices with inner branches (IB) for the endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs).

Materials and Methods:

A retrospective analysis using IB configuration with retrograde cannulation was carried out on TAAAs patients undergoing endovascular treatment.

Results:

Seven patients underwent IB endovascular treatment with retrograde cannulation between September 2020 and November 2021. The mean age was 80.4 years and 4 patients were male. A total of 26 of 28 target vessels were cannulated by retrograde access with a technical success of 93% (2 of 26 target vessels). Two intra-procedural complications were observed (1 renal artery dissection and 1 collateral renal artery rupture). In total, 26 of 28 treated vessels were retrograde cannulated with a technical success of 93%. A total of 39 stent bridges were used (all Viabahn VBX devices). The mean duration of the procedure was 321±102 minutes, and the mean scan time was 134±62 minutes. Mortality at 30 days was observed in 1 case. During the follow-up, 1 stent bridge occlusion was observed without the need for reintervention.

Conclusion:

Retrograde cannulation can also be successfully performed in the case of inner branches.

Clinical Impact

In inner branched cases, retrograde cannulation should be taken into consideration in particular cases or it could become the option of choice. Dedicated endovascular material available such as steerable catheters and latest generation covered stents is fundamental for the success of the treatment.
Reducing Anxiety and Dyspnea via Device-Guided Breathing (RELAX): A Multi-Site Feasibility Study in Post-Treatment Lung Cancer Survivors at Community Cancer Clinics (WF-01213)
Authors: Danhauer Suzanne C. , Dressler Emily V. , Brown W. Mark , Nightingale Chandylen L. , Brenes Gretchen A. , Petty William J. , Curtis Amarinthia , Murkutla Srujitha , Huang Jocelin , Wagi Cheyenne R. , Lesser Glenn J. , Weaver Kathryn E.
Published: April 2023

Introduction:

Anxiety and dyspnea are 2 common symptoms for lung cancer survivors. Although research suggests decreasing respiration rate can reduce anxiety in several populations, potential benefits of device-guided breathing have not been studied in lung cancer survivors. This feasibility study (WF-01213) provides estimates of accrual, adherence, retention, and preliminary efficacy of 2 doses of a device-guided breathing intervention versus a usual breathing control group for improving self-reported anxiety and dyspnea in post-treatment lung cancer survivors.

Methods:

Stage I-IV lung cancer survivors were recruited through the NCI Community Oncology Research Program (NCORP) and randomized to 12 weeks of a device-guided breathing intervention (high dose vs. low dose) or control device. Self-reported outcomes (anxiety, depression, dyspnea, cancer-related worry, fatigue) were assessed at baseline, mid-intervention (Week-6), and post-intervention (Week-12).

Results:

Forty-six participants (ages 41-77, median = 65; 78% White) were randomized to the high-dose intervention (n = 14), low-dose intervention (n = 14), or control (n = 18) groups between July 2015 and September 2019. Study accrual rate was 0.92 per month for 50 months (projected accrual was 6.3/month). Fourteen participants (30%) withdrew early from the study, with almost half of those discontinuing at or immediately following baseline assessment. No participants were adherent with the intervention per protocol specifications. The proportion minimally adherent (using device at least 1x/week) was 43% (6/14), 64% (9/14), and 61% (11/18) for high-dose, low-dose, and control groups, respectively. Anxiety significantly decreased from baseline for all groups at Week 12. Adherence to the intervention was low across all treatment groups.

Conclusions:

This study did not establish feasibility of a community-based randomized trial of 2 doses of device-guided breathing and a control group using an identical-looking device for lung cancer survivors. In both the high-dose and control groups, there were significant improvements from baseline for anxiety and dyspnea. In the low-dose group, there were significant improvements from baseline for anxiety and depression. Ratings and feedback on the intervention were mixed (although leaned in a positive direction). Participants reported liking the feeling of relaxation/calm, helping others, breathing awareness, and music. Participants reporting liking least finding/making time to use the device, frustration with the device, and completing study forms.

Trial Registration: Clinical Trials ID:

NCT02063828, clinicaltrials.gov.
Extract of Platycodon grandiflorum Prevents Doxorubicin-induced Cardiotoxicity in Breast Cancer
Authors: Shi Youyang , Wu Yuanyuan , Shen Man , Yang Jianfeng , Qin Yuenong , Liu Sheng , Sun Chenping
Published: April 2023

Doxorubicin (Dox) is a first-line chemotherapeutic agent applied in cancer treatment. Its long-term anticancer efficacy is restricted mainly due to its subsequent cardiotoxicity for patients. Platycodon grandiflorum (PG), an important traditional Chinese herb, has been reported to eliminate phlegm, relieve cough, and reduce inflammatory diseases. Previous clinical studies found that PG has cardioprotective effects for early breast cancer patients who received Dox-based chemotherapy. However, the cellular and molecular mechanisms underlying PG-mediated cardiotoxic rescue remain elusive. This study aimed to explore the protective role and potential molecular mechanisms of PG on Dox-induced cardiac dysfunction in a mouse model of breast cancer. PG significantly alleviated myocardial damage and prevented cardiomyocyte apoptosis induced by Dox. The expression levels of cytochrome C and cleaved caspase-3 significantly decreased, and the levels of Bcl-XL and B-cell lymphoma-2 (Bcl-2)/Bcl-2-associated X protein increased following PG treatment. Furthermore, PG remarkably enhanced the antimetastatic efficacy (versus the Dox group) by regulating the balance of matrix metalloproteinases/tissue inhibitors of metalloproteinases.
Evaluating Performance of Circular Staplers Using Comparative Test Methods for Evidence-Based Surgery
Authors: Strassner Haley , Caulk Alexander , Reher Nicholas , Petrescu Stephanie , Vasanji Amit
Published: April 2023

Background

Circular stapler anastomosis is a common surgical procedure. Despite technological advancements, anastomotic leak remains a postoperative concern. Assessment of new technologies is impeded by variations in test methods and analysis, precluding outcome reproducibility and direct comparisons of results across studies. The development of robust and reproducible preclinical test methods is critical to accelerating stapling technology advancements.

Methodology

Leak pressure, staple line perfusion and security, and device removal force were quantified for triple-row (Tri-staple EEA, TriEEA) and double-row staplers (Echelon Circular Powered, ECP). Leak and perfusion testing were performed in vivo. Device removal force and staple line security testing were performed with synthetic medium using an Instron. Data were analyzed using unpaired student’s t-test or Kruskal-Wallis test, with statistical significance defined as P < .05.

Results

Leak pressure was 73% higher in TriEEA vs ECP ( P = .016). TriEEA staple line failure force was lower than ECP at 40 and 50 mmHg ( P = .001 and P = .023, respectively). Perfusion to the staple line was higher (148%) for TriEEA than for ECP ( P = .003) and the force required to remove the device from its stapled anastomosis was 78% lower for TriEEA than for ECP ( P < .001).

Discussion/Conclusions

This report addresses a primary limitation in stapling research by presenting novel methodologies which enhance clinical relevance and provide sufficient detail for reproduction by independent investigators. These methods are applied to a comparison between triple-row and double-row staplers to demonstrate utility of new test methods in assessing key technology design features.
The Impact of Preoperative Sagittal Imbalance on Long-term Postoperative Outcomes Following Minimally Invasive Laminectomy
Authors: Song Junho , Samuel Andre , Shahi Pratyush , Fourman Mitchell , Shinn Daniel , Dalal Sidhant , Araghi Kasra , Melissaridou Dimitra , Vaishnav Avani , Sheha Evan , Dowdell James , Qureshi Sheeraz A.
Published: April 2023

Background: Postoperative sagittal alignment has been shown to be associated with patient-reported outcome measures (PROMs) following open lumbar decompression procedures, although it is unknown whether preoperative sagittal imbalance affects clinical outcomes of minimally invasive surgical (MIS) decompression only surgery. Purpose: We sought to evaluate the impact of preoperative pelvic incidence-lumbar lordosis (PI-LL) imbalance on PROMs after MIS laminectomy for the treatment of neurogenic claudication symptoms. Methods: We conducted a retrospective cohort study of adult patients undergoing MIS laminectomy for degenerative lumbar spinal stenosis between April 2017 and April 2021 at a single institution. Of the 52 patients included (mean follow-up, 17 months) radiographs were taken prior to surgery and assessed for sagittal alignment parameters. Patients were grouped based on the preoperative PI-LL (balanced vs unbalanced). Changes in PROMs were compared between unbalanced PI-LL and balanced PI-LL groups. Minimal clinically important difference (MCID) for Oswestry Disability Index (ODI) was also assessed. Results: Of the 52 patients, 17 (32.7%) had unbalanced age-adjusted preoperative PI-LL. There was no significant difference found in PROMs between unbalanced and balanced PI-LL groups preoperatively or at final follow-up. Compared with those with unbalanced PI-LL, patients with balanced PI-LL were shown to have no added benefit in achieving MCID for ODI at long-term follow-up and no added benefit in the time to achieving MCID. Conclusion: These retrospective findings suggest that patients with unbalanced preoperative PI-LL may experience significant benefit in long-term clinical outcomes following MIS laminectomy, similarly to those with balanced PI-LL at baseline. The findings also suggest that the presence of sagittal imbalance preoperatively may not appreciably influence the long-term clinical outcomes following MIS laminectomy. Prospective study involving a larger population is warranted.