bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Social Frailty in Hospitalized Elderly Patients With Heart Failure: A FRAGILE‐HF Registry Subanalysis
Authors: Jujo Kentaro , Kagiyama Nobuyuki , Saito Kazuya , Kamiya Kentaro , Saito Hiroshi , Ogasahara Yuki , Maekawa Emi , Konishi Masaaki , Kitai Takeshi , Iwata Kentaro , Wada Hiroshi , Kasai Takatoshi , Nagamatsu Hirofumi , Ozawa Tetsuya , Izawa Katsuya , Yamamoto Shuhei , Aizawa Naoki , Yonezawa Ryusuke , Oka Kazuhiro , Makizako Hyuma , Momomura Shin‐ichi , Matsue Yuya
Published: September 2021

Background

Frailty is conceptualized as an accumulation of deficits in multiple areas and is strongly associated with the prognosis of heart failure (HF). However, the social domain of frailty is less well investigated. We prospectively evaluated the clinical characteristics and prognostic impact of social frailty (SF) in elderly patients with HF.

Methods and Results

FRAGILE‐HF (prevalence and prognostic value of physical and social frailty in geriatric patients hospitalized for heart failure) is a multicenter, prospective cohort study focusing on patients hospitalized for HF and aged ≥65 years. We defined SF by Makizako’s 5 items, which have been validated as associated with future disability. The primary end point was a composite of all‐cause death and rehospitalization because of HF. The impact of SF on all‐cause mortality alone was also evaluated. Among 1240 enrolled patients, 825 (66.5%) had SF. During the 1‐year observation period after discharge, the rates of the combined end point and all‐cause mortality were significantly higher in patients with SF than in those without SF (Log‐rank test: both
P
 < 0.05). SF remained as significantly associated with both the combined end point (hazard ratio, 1.30; 95% CI, 1.02–1.66;
P
 = 0.038) and all‐cause mortality (hazard ratio, 1.53; 95% CI, 1.01–2.30;
P
 = 0.044), even after adjusting for key clinical risk factors. Furthermore, SF showed significant incremental prognostic value over known risk factors for both the combined end point (net‐reclassification improvement: 0.189, 95% CI, 0.063–0.316,
P
 = 0.003) and all‐cause mortality (net‐reclassification improvement: 0.234, 95% CI, 0.073–0.395,
P
 = 0.004).

Conclusions

Among hospitalized geriatric patients with HF, two thirds have SF. Evaluating SF provides additive prognostic information in elderly patients with HF.

Registration

URL:
https://upload.umin.ac.jp/
. Unique identifier: UMIN000023929.
Corticosteroid and Immunosuppressant Therapy for Cardiac Sarcoidosis: A Systematic Review
Authors: Fazelpour Siavosh , Sadek Mouhannad M. , Nery Pablo B. , Beanlands Rob S. , Tzemos Niko , Toma Mustafa , Birnie David H.
Published: September 2021

Background

Corticosteroid therapy for the treatment of clinically manifest cardiac sarcoidosis is generally recommended. Our group previously systematically reviewed the data in 2013; since then, there has been increasing quality and quantity of data and also interest in nonsteroid agents.

Methods and Results

Studies were identified from MEDLINE, EMBASE, Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and the National Institutes of Health
ClinicalTrials.gov
database. The quality of included articles was rated using Scottish Intercollegiate Guidelines Network 50. Outcomes examined were atrioventricular conduction, left ventricular function, ventricular arrhythmias, and mortality. A total of 3527 references were retrieved, and 34 publications met the inclusion criteria. There were no randomized trials, and only 2 studies were rated good quality. In the 34 reports (total of 1297 patients), 1125 patients received corticosteroids, 235 received additional or other immunosuppressant therapy, and 97 patients received no therapy. There were 178 patients treated for atrioventricular conduction disease, with 76/178 (42.7%) improving. In contrast, 21 patients were not treated with corticosteroids and/or immunosuppressant therapy, and none of them improved. Therapy was associated with the prevention of deterioration in left ventricular function. A total of 8 publications reported on ventricular arrhythmia burden, and 19 reported on mortality; the data quality was too limited to draw conclusions for the latter 2 outcomes.

Conclusions

The best quality data relate to atrioventricular nodal conduction and left ventricular function recovery. In both situations, therapy with corticosteroids and/or immunosuppressant therapy were sometimes associated with positive outcomes. The data quality is too limited to draw conclusions for ventricular arrhythmias and mortality.
How to Establish the Outer Limits of Reperfusion Therapy
Authors: Wechsler Lawrence R. , Jadhav Ashutosh P. , Jovin Tudor G. ,   on behalf of the XIth Stroke Treatment Academic Industry Roundtable*, Adeoye Opeolu , Albers Greg , Ansari Saeed , Boltze Johannes , Buchan Alastair , Campbell Bruce C.V. , Chaisinanunkul Napasri , Chen Christopher , Derdeyn Colin P. , Haddad Walid , Hill Michael D. , Holt William , Houser Gary , Khatri Pooja , Krtolica Ana , Landen Jaren W. , Lansberg Maarten G. , Liebeskind David S. , Lyden Patrick , Lynch John , Meinzer Caitlyn , Mistry Eva A. , Mocco J. , Nogueira Raul G. , Saver Jeffrey L. , Savitz Sean I. , Schwamm Lee H. , Sheth Kevin N. , Snyder Meredith , Solberg Yoram , Vagal Achala , Venkatasubramanian Chitra , Warach Steven , Ziogas Nikolaos K.
Published: September 2021

Reperfusion therapy with intravenous alteplase and endovascular therapy are effective treatments for selected patients with acute ischemic stroke. Guidelines for treatment are based upon randomized trials demonstrating substantial treatment effects for highly selected patients based on time from stroke onset and imaging features. However, patients beyond the current established guidelines might benefit with lesser but still clinically significant treatment effects. The STAIR (Stroke Treatment Academic Industry Roundtable) XI meeting convened a workgroup to consider the “outer limits” of reperfusion therapy by defining the current boundaries, and exploring optimal parameters and methodology for determining the outer limits. In addition to statistical significance, the minimum clinically important difference should be considered in exploring the limits of reperfusion therapy. Societal factors and quality of life considerations should be incorporated into assessment of treatment efficacy. The threshold for perception of benefit in the medical community may differ from that necessary for the Food and Drug Administration approval. Data from alternative sources such as platform trials, registries and large pragmatic trials should supplement randomized controlled trials to improve generalizability to routine clinical practice. Further interactions between industry and academic centers should be encouraged.
Expansion of Information in the Binary Autoencoder with Random Binary Weights
Authors: Osaulenko Viacheslav M.
Published: September 2021

This letter studies the expansion and preservation of information in a binary autoencoder where the hidden layer is larger than the input. Such expansion is widespread in biological neural networks, as in the olfactory system of a fruit fly or the projection of thalamic inputs to the neocortex. We analyze the threshold model, the kWTA model, and the binary matching pursuit model to find how the sparsity and the dimension of the encoding influence the input reconstruction, similarity preservation, and mutual information across layers. It is shown that the sparser activation of the hidden layer is preferable for preserving information between the input and the output layers. All three models show optimal similarity preservation at dense, not sparse, hidden layer activation. Furthermore, with a large enough hidden layer, it is possible to get zero reconstruction error for any input just by varying the thresholds of neurons. However, we show that the preference for sparsity is due to the noise in the weight matrix between layers. A fixed number of nonzero connections to every neuron achieves better information preservation and input reconstruction for the dense hidden layer activation. The theoretical results give useful insight into models of neural computation based on sparse binary representation and association memory.
Samuel Beckett and the Mathematics of Salvation
Authors: Ackerley Chris
Published: September 2021

One of the thieves was saved .… If, as Vladimir concludes at the outset of Waiting for Godot, “It’s a reasonable percentage,” then why not accept Pascal’s celebrated exhortation to believe, rather than to risk in the afterlife the terrors of the abyss or the inferno? This essay traces Beckett’s use of the motif of the two thieves with respect to the truism of Credo quia absurdum est, as manifest in the calculus that underlies the Monadology of Leibniz and informs Beckett’s writing from Murphy to How It Is, and his sense of the self as something that is/was neither One nor Zero.
Worsening Shades
Authors: Byron Mark
Published: September 2021

Beckett’s late prose texts Company, Ill Seen Ill Said, and Worstward Ho perform a radical process of literary reimagination late in a long writing career: they reconfigure how biography relates to narrative, and they rethink the dimensionality and mobility of character. In their negotiations with literary history and etymology these texts replenish the stocks of language across the deep time of its evolution and its accrual of semantic and associative richness. In their rich geological and archaeological dispositions, the three texts of Nohow On demonstrate how deep time intersects with the narrative present in images of the earth, providing a locus for life and afterlife: both in the sense of the posthumous condition and in offering belated aesthetic possibilities.
The Afterlife of Empire in Beckett’s How It Is
Authors: Cordingley Anthony
Published: September 2021

Relationships of political domination in Beckett’s Comment c’ est (1961)/How It Is (1964) are typically read through a specific historical moment (the Holocaust, the Algerian War) or literary representation (Dante, Sade). This article reveals spectres in the text from the long history of the colonisation of Ireland to the legacy of Renaissance and Enlightenment humanism; it explores Beckett’s sense of complicity in the Anglo-Irish Ascendency.
Endgame and the Life to Come
Authors: Conti Christopher
Published: September 2021

This paper revisits the interpretations of Endgame by Theodor Adorno and Stanley Cavell via an unusual route: Samuel Scheffler’s afterlife conjecture. Scheffler’s thought experiment—based on a doomsday scenario that Beckett’s characters already appear to inhabit—seeks the achievement of the ordinary in an age of climate change by disclosing our evaluative dependence on future generations. I suggest that the paradigm shift to a global subject lies not in the dystopian fiction Scheffler looks to, however, but the “shudder” of the ‘I’ in aesthetic experience, the model for which is Beckett’s Endgame.
A Simple Lagrangian Parcel Model for the Initiation of Summer-time Mesoscale Convective Systems over the Central United States
Authors: Yang Qiu , Leung L. Ruby , Feng Zhe , Song Fengfei , Chen Xingchao
Published: September 2021

Mesoscale convective systems (MCSs) account for more than 50% of summer-time precipitation over the central United States (US) and have a significant impact on local weather and hydrologic cycle. It is hypothesized that the inadequate treatment of MCSs is responsible for the longstanding warm and dry bias over the central US in coarse-resolution general circulation model (GCM) simulations. In particular, a better understanding of MCS initiation is still lacking. Here a single-column Lagrangian parcel model is first developed to simulate the basic features of a rising parcel. This simple model demonstrates the collective effects of boundary layer moistening and dynamical lifting in triggering convective initiation and reproduces successfully its early afternoon peak with surface equivalent potential temperature as a controlling factor. It also predicts that convection is harder to trigger in the future climate under global warming, consistent with the results from convection-permitting regional climate simulations. Then a multi-column model that includes an array of single-column models aligned in the east-west direction and incorporates idealized cold pool interaction mechanisms is developed. The multi-column model captures readily the cold pool induced upscale growth feature in MCS genesis from initially scattered convection that is organized into a mesoscale cluster in a few hours. It also highlights the crucial role of lifting effects due to cold pool collision and spreading, subsidence effect, and gust front propagation speed in controlling the final size of mesoscale clusters and cold pool regions. This simple model should be useful for understanding fundamental mechanisms of MCS initiation and providing guidance for improving MCS simulations in GCMs.
Subpolar Southern Ocean Response to Changes in the Surface Momentum, Heat, and Freshwater Fluxes under 2xCO2
Authors: Dias Fabio Boeira , Domingues Catia M. , Marsland Simon J. , Rintoul Stephen R. , Uotila Petteri , Fiedler Russell , Mata Mauricio M. , Bindoff Nathaniel L. , Savita Abhishek
Published: September 2021

The Antarctic subpolar Southern Ocean (sSO) has fundamental climate importance. Antarctic Bottom Water (AABW) originates in the sSO and supplies the lower limb of the meridional overturning circulation (MOC), occupying 36% of ocean volume. Climate models struggle to represent continental shelf processes that form AABW. We explore sources of persistent model biases by examining response of the sSO to perturbations in surface forcing in a global ocean–sea ice model (ACCESS-OM2) that forms AABW both on shelf and in open ocean. The sSO response to individual and combined perturbations of surface heat, freshwater, and momentum fluxes follows the WCRP CMIP6 FAFMIP-protocol. Wind perturbation (i.e., a poleward shift and intensification of the westerlies) is dominant, enhancing AABW formation and accelerating the global MOC. This occurs through upwelling of warm waters and inhibition of sea ice growth during winter, which triggers large open water polynya (OWP) events with associated deep convection. These events occur in the Weddell and Ross Seas and their variability is associated with availability of heat at midocean depths. These OWPs cease when the heat reservoir is depleted. Effects of surface warming and freshening only partially compensate changes from increasing winds on ocean stratification and depletion of AABW formation. These results indicate that overly convective models, such ACCESS-OM2, can respond to CO2-perturbed scenarios by forming too much AABW in OWP, which might not hold in models without OWPs. This might contribute to the large intermodel spread thermosteric sea level projections, being relevant to the interpretation of future projections by current climate models.
Why Is It Wrong to Sell Your Body? Understanding Liberals’ Versus Conservatives’ Moral Objections to Bodily Markets
Authors: Goenka Shreyans , van Osselaer Stijn M.J.
Published: September 2021

People hold strong moral objections to commercial bodily markets—the buying and selling of the human body and its components (e.g., prostitution; commercial surrogacy; trade of kidneys, blood plasma, sperm, ovum, and hair). This research takes a descriptive approach to understand why people object to the marketing of the human body and how their moral objections differ across the political spectrum. The authors propose that liberals and conservatives find bodily markets to be morally wrong; however, the two groups object to bodily markets for different reasons. Liberals are more sensitive to exploitation concerns, but conservatives are more sensitive to violation of sanctity concerns in these markets. Real-world observational data and controlled experiments test these predictions. The findings show how sociopolitical leaders utilize the different moral objections to persuade their respective audiences, such as how conservative versus more liberal pastors sermonize differently on prostitution. Second, results show how targeted marketing campaigns encourage liberals and conservatives to participate in consumer advocacy and donate to political causes. Third, findings outline how liberals and conservatives support different regulatory laws that penalize buyers versus sellers. Finally, results show how the different moral objections manifest for live bodily products but not for dead bodily products.
Black Media Reporting on Theater, Dance, and Jazz Clubs in Canada: From Shuffle along to Rockhead’s Paradise
Authors: Thompson Cheryl , Jabouin Emilie
Published: September 2021

Canada has a history of de facto Jim Crow (1911–1954). It also has a historical Black press that is intimately connected to Black America through transnational conversations, and diasporic migration. This article argues that Canada’s Black newspapers played a pivotal role in promoting Black performance during a time when they were scarcely covered in the dominant media. Drawing on news coverage from the 1920s through 1950s of black dance, musicals, and jazz clubs this article examines three case studies: Shuffle Along (1921–1924), the first all- Black Broadway musical to appear at Toronto’s Royal Alexandra Theater, Alberta-born dancer Len Gibson (1926–2008), who revolutionized modern dance in Canada in the 1940s and 1950s, and the Montreal jazz club Rockhead’s Paradise (1928–1980), a pivotal site in the city’s Little Burgundy, a Black neighborhood that thrived in the 1930s through 1950s. The authors argue that when Black people were excluded from and/or derogatorily portrayed in the dominant media, Canada’s Black press celebrated collective achievement by authenticating Black performance. By incorporating Canada’s Black Press into conversations about Jim Crow and performance, we gain a deeper understanding of Black creative output and resistance during the period.
Broadening political participation: The impact of socialising practices on young people’s action repertoires
Authors: Holecz Valentina , Fernández G. G. Eva , Giugni Marco
Published: September 2021

This study builds on the well-known civic voluntarism model of political participation. By doing this, we contribute to a political sociology of participation by refining the role of socialisation in political engagement. We suggest that the action repertoires of young people engaging in politics can be narrower or broader owing to their previous embeddedness in certain social settings, which act as spheres of socialising practices. We focus more specifically on three socialising spheres: educational (schools), recreational (social clubs), and civic (community organizations). Our analysis, covering nine European countries, largely confirms our expectations. We find that active engagement in these spheres of socialising practices leads to a broader range of political activities in young people’s action repertoires. This holds in particular for the civic sphere. The findings provide a fresh look at the role played by socialising spheres, shifting the focus from the dichotomy between participation versus non-participation to an analysis of the breadth of participation.
Apparatuses of observation and occupation: Settler colonialism and space science in Hawai'i
Authors: Sammler Katherine G , Lynch Casey R
Published: September 2021

This paper examines two space science infrastructures in Hawai'i, the Thirty Meter Telescope (TMT) and the Hawai'i Space Exploration Analog and Simulation (HI-SEAS). It considers how scientific observation and colonial occupation are co-constituted through the production of apparatuses – extensive material practices and arrangements that iteratively produce subject–object relations. By analyzing TMT and HI-SEAS as apparatuses, we show how both involve the active ordering of space, time, and matter in ways that are dependent upon existing settler colonial relations while enacting specific subject positions key to the projection of settler colonialism across space and time. TMT materializes the Archimedean point, or view-from-nowhere, on which Western scientific “objectivity” depends, while HI-SEAS works to produce ideal colonizer-subjectivities and orient their bodies to the spatialities of the colony. Engaging Native Hawai’ian, Indigenous, and allied anti-colonial critiques, we argue that social science of outer space research must critically address the colony, as its basic logics are foundational to the practices of contemporary space science and imaginaries of space exploration.
Safe Platooning Headways on Girder Bridges
Authors: Yang Bowen , Steelman Joshua S. , Puckett Jay A. , Linzell Daniel G.
Published: September 2021

Truck platooning—digitally linking two or more trucks to travel in a closely spaced convoy—is an emerging technology with the potential to save fuel and reduce labor. A framework is described to determine how much a platoon permit load might be increased above Federal Bridge Formula B legal limits, given strict control over the load characteristics and operational tactics. Soon, platoons are expected to advance not only with respect to traffic operations but also in their ability to weigh and report axle weight and spacing, functioning as mobile weigh-in-motion vehicles. Consequently, platoon live load statistics (bias and coefficient of variation) can differ from code assumptions, and are perhaps controllable, which poses a significant opportunity with respect to operational strategies. A parametric study is presented that examined safe headways between platooning trucks, considering different girder spacings, span lengths, numbers of spans, types of structure, truck configurations, numbers of trucks, and adjacent lane loading scenarios. The Strength I limit state was evaluated for steel and prestressed concrete I-girder bridges optimally designed using load and resistance factor design. Reliability indices, β, were calculated for each load case based on Monte Carlo simulation. Summary headway guidance was developed and is presented here to illustrate potential safe operational strategies for varying truck weights and platoon live load effect uncertainties.
Transportation Fuel Resiliency: Case Study of Tampa Bay
Authors: Kolpakov Alexander , Marie Sipiora Austin , Johnson Caley , Nobler Erin
Published: September 2021

This case study presents findings from an analysis of the emergency preparation and response for Hurricane Irma, the most recent hurricane impacting the Tampa Bay region. The Tampa Bay region, in particular, is considered one of the most vulnerable areas in the United States to hurricanes and severe tropical weather. A particular vulnerability stems from how all petroleum fuel comes to the area by marine transport through Port Tampa Bay, which can be (and has been in the past) impacted by hurricanes and tropical storms. The case study discussed in this paper covers previous fuel challenges, vulnerabilities, and lessons learned by key Tampa Bay public agency fleets during the past 10 years (mainly as a result of the most recent 2017 Hurricane Irma) to explore ways to improve the area’s resilience to natural disasters. Some of the strategies for fuel-supply resiliency include maintaining emergency fuel supply, prioritizing fuel use, strategically placing the assets around the region to help with recovery, investing in backup generators (including generators powered by alternative fuels), planning for redundancies in fuel supply networks, developing more efficient communication procedures between public fleets, hurricane preparedness-planning, and upgrading street drainage systems to reduce the threat of local flooding.
A new cell-sized support for 3D cell cultures based on recombinant spider silk fibers
Authors: Stern-Tal Dganit , Ittah Shmulik , Sklan Ella
Published: September 2021

It is now generally accepted that 2D cultures cannot accurately replicate the rich environment and complex tissue architecture that exists in vivo, and that classically cultured cells tend to lose their original function. Growth of spheroids as opposed to 2D cultures on plastic has now been hailed as an efficient method to produce quantities of high-quality cells for cancer research, drug discovery, neuroscience, and regenerative medicine. We have developed a new recombinant protein that mimics dragline spidersilk and that self-assembles into cell-sized coils. These have high thermal and shelf-life stability and can be readily sterilized and stored for an extended period of time. The fibers are flexible, elastic, and biocompatible and can serve as cell-sized scaffold for the formation of 3D cell spheroids. As a proof of concept, recombinant spidersilk was integrated as a scaffold in spheroids of three cell types: primary rat hepatocytes, human mesenchymal stem cells, and mouse L929 cells. The scaffolds significantly reduced spheroid shrinkage and unlike scaffold-free spheroids, spheroids did not disintegrate over the course of long-term culture. Cells in recombinant spidersilk spheroids showed increased viability, and the cell lines continued to proliferate for longer than control cultures without spidersilk. The spidersilk also supported biological functions. Recombinant spidersilk primary hepatocyte spheroids exhibited 2.7-fold higher levels of adenosine triphosphate (ATP) continued to express and secrete albumin and exhibited significantly higher basal and induced CYP3A activity for at least 6 weeks in culture, while control spheroids without fibers stopped producing albumin after 27 days and CPY3A activity was barely detectable after 44 days. These results indicate that recombinant spidersilk can serve as a useful tool for long-term cell culture of 3D cell spheroids and specifically that primary hepatocytes can remain active in culture for an extended period of time which could be of great use in toxicology testing.
Dynamic analysis of electrical vibration absorbers for suspended cables
Authors: Meng Yiqing , Kollár László E
Published: September 2021

The present research proposes two vibration control techniques for attenuating vibration of laboratory-scale suspended cables. The technique is applied to resolve the problems of such high-frequency vibrations as the aeolian vibration. The vibration control device involves an absorber driven by a motor, and the dynamics of the controlled system is investigated numerically considering practical problems. Particular attention is paid to backlash at the driving that influences the effectiveness of control significantly, and to the time response of the controlled system that indicates how quickly the vibration decays after a change in the excitation. One of the proposed controllers involves the implementation of PID technique that enables the significant reduction in the value of cable displacement and acceleration during aeolian vibration, compared to the conventional vibration absorber. An extensive controller has also been proposed based on estimation of cable vibration frequency. The dynamic performance of the controllers is simulated using Simulink. Results also reveals the limitations in the control due to a practical problem like backlash. The main practical benefit from the study is that it provides information about the advantages and disadvantages of the control methodologies, and recommendation may be done for their application without building the controlled system.
Quantitative strength analysis for 3D-printed specimens in a Tri-Hexagon pattern
Authors: Tandon Sourabh , Kacker Ruchin , Sudhakar KG
Published: September 2021

ABS (Acrylonitrile Butadiene Styrene) and PLA (Polylactic acid) are the most commonly used thermoplastic materials in the AM (Additive Manufacturing) to build objects adding layer by layer. Addition of reinforcement such as carbon fibres to these materials is common to enhance strength properties. This work aims the fabrication of ABS, PLA, and PLA+CF specimens using the FDM (Fused Deposition Modeling). Subsequently, the tensile strength of printed specimens at Tri-Hexagon pattern for various % infills with different orientations is investigated. For a desired strength, the analysis facilitates the designer to choose suitable combination of specimen orientation at a specific infill and pattern. PLA+CF and ABS specimens with Tri-hexagon pattern at 0° orientation retain considerable strength when infill % gets lowered, whereas, virgin PLA observes higher strength stability at 90° orientation. The magnitudes of Ultimate tensile strength increased with infill %. The peak strength for PLA+CF specimen (with 100% infill without any pattern) at 0° and 90° orientation was 22% and 5% more, respectively, compared to 45° orientation. SEM images reveal a decrease in strength with ABS and PLA specimens due to the presence of voids between the layers, whereas showed strong bonding between CF and PLA matrix. Tri-Hexagon pattern showed better strength than the honeycomb, line, and rectilinear, especially at lower infills. Specimens both with and without Tri-hexagonal pattern observed superior ductile characteristics at 0° and 90° orientation, whereas most inferior at 45°.
Mental Logout: Behavioral and Neural Correlates of Regulating Temptations to Use Social Media
Authors: Sternberg Nurit , Luria Roy , Sheppes Gal
Published: September 2021

Individuals sometimes use social media instead of sleeping or while driving. This fact raises the crucial need for—and challenge of—successfully self-regulating potent social-media temptations. To date, however, empirical evidence showing whether social-media temptations can be self-regulated and how self-regulation can be achieved remains scarce. Accordingly, the present within-participants study ( N = 30 adults) provided causal evidence for self-regulation of social-media content and identified a potential underlying neural mechanism. We tested the premise that successful self-regulation requires limiting the mental representation of temptations in working memory. Specifically, we showed that loading working memory with neutral contents via attentional distraction, relative to passively watching tempting social-media stimuli, resulted in reduced self-reported desire to use social media, reduced initial attention allocation toward social-media stimuli (reduced late-positive-potential amplitudes), and reduced online representation of social-media stimuli in working memory (reduced contralateral-delay-activity amplitudes). These results have important implications for successfully navigating a social-media-saturated environment.
Breast Carcinoma After Ocrelizumab Therapy in Multiple Sclerosis Patients: A Case Series and Literature Review
Authors: Kelsey Andrew , Casinelli Gabriella , Tandon Medha , Sriwastava Shitiz
Published: September 2021

Ocrelizumab is a humanized CD20 monoclonal antibody which was approved for management of Relapsing Remitting Multiple Sclerosis (RRMS) and Primary Progressive Multiple Sclerosis (PPMS) in 2017. We present 2 patients, a 67-year-old woman with history of PPMS and a 42-year-old woman with RRMS, who were started on ocrelizumab and were diagnosed with invasive ductal cell breast carcinoma after 2 years of ocrelizumab infusion followed by discontinuation of the drug. Large trials conducted for ocrelizumab showed malignancies in a total of 4 cases with RRMS in OPERA 1 trial conducted over 2 years from 2011 to 2013 (breast cancer, renal cell carcinoma, and melanomas) and in 11 cases with PPMS seen in ORATORIO trial conducted in 2017. There are currently no other published case reports of breast cancer in setting of ocrelizumab use for MS outside of large trials on literature review.
On the analysis of efficiency in the hotel sector: Does tourism specialization matter?
Authors: Pérez-Granja Ubay , Inchausti-Sintes Federico
Published: September 2021

This article analyzes the consequences of tourism specialization on efficiency in the hotel sector. The evidence found in other sectors and economies supports the goodness specialization. Nevertheless, tourism-led economies have particular issues that need to be addressed such as seasonality and the lack of significant tradable competitive activities that could trigger spillover effects to services. Spain provides a suitable context for a comparative case study where industrial-led provinces coexist with others that are tourism-led. The article assumes a novel panel data stochastic frontier (SF) model where inefficiency is explained by industrial and service specialization, international competitiveness, tourism specialization, quality of tourism supply, and seasonality. All variables contribute to reducing inefficiency, but service specialization makes the biggest impact. Hence, tourism-led provinces produce the highest efficiency scores.
A fast approach for acoustic source localization on a thin spherical shell
Authors: Zhou Zixian , Cui Zhiwen , Kundu Tribikram
Published: September 2021

Thin spherical shell structures are wildly used as pressure vessels in the industry because of their property of having equal in-plane normal stresses in all directions. Since very large pressure difference between the inside and outside of the wall exists, any formation of defects in the pressure vessel wall has a huge safety risk. Therefore, it is necessary to quickly locate the area where the defect maybe located in the early stage of defect formation and make repair on time. The conventional acoustic source localization techniques for spherical shells require either direction-dependent velocity profile knowledge or a large number of sensors to form an array. In this study, we propose a fast approach for acoustic source localization on thin isotropic and anisotropic spherical shells. A solution technique based on the time difference of arrival on a thin spherical shell without the prior knowledge of direction-dependent velocity profile is provided. With the help of “L”-shaped sensor clusters, only 6 sensors are required to quickly predict the acoustic source location for anisotropic spherical shells. For isotropic spherical shells, only 4 sensors are required. Simulation and experimental results show that this technique works well for both isotropic and anisotropic spherical shells.
How to Get Information Out of Members of Parliament (Without Being Told Off by the Speaker)
Authors: Cowley Philip
Published: September 2021

Based on experience of over 1000 interviews with British members of parliament, this article explains why members of parliament are difficult to get access to; offers tips to gain access to them, as well as ideas for how to get the most of out of them once they have agreed. It sets out one Golden Rule of dealing with political elites and also discusses the problems of attempting surveys.
Factors Associated With Unplanned Admission in Patients Intended for Same Day Discharge After Minimally Invasive Hysterectomy for Endometrial Cancer
Authors: Son Ji , Tran Thang , Yao Meng , Michener Chad M.
Published: September 2021

Objectives. To identify factors that lead to successful same-day discharge compared with unplanned and planned admission after minimally invasive hysterectomy for endometrial cancer. Methods. Patients undergoing laparoscopic or robotic hysterectomy for endometrial cancer between 2016 and 2019 were retrospectively reviewed. 3 groups were created: same-day discarge (SDD), unplanned admission (UA), and planned admission(PA). Demographic/perioperative factors and encounters after discharge were compared. A multivariable logistic regression was performed. Results. 262 patients were included. By year, the success of SDD increased from 59.1% to 82.5%. Patients who underwent SDD compared with admission were younger (62.2 vs 66.2, P = .003) and had a lower Charlson Comorbidity Index (4 vs 5, P < .001). BMI was not significant. Comparing SDD and UA, shorter operative time (100.3 min vs 130.6 min, P = .037) was associated with SDD. Postoperative pain scores were not significant (3.8 vs 4.7, P = .086). The rate of unscheduled encounters within 30 days of discharge was not significantly different. On multivariable analysis, the odds of SDD decreased by 4% with each 1-year increase in age (OR .96, P = .017). Each 1-minute increase in operative time decreased the odds of SDD by 2% (OR .98, P < .001). Intraoperative acetaminophen (OR 2.78, P = .003) and ketorolac (OR 2.27, P = .031) were predictive of SDD. Conclusion. SDD can be safely incorporated into clinical practice in gynecologic oncology patients undergoing minimally invasive hysterectomy, even for patients older than previously reported. Shorter operative time was associated with SDD. The role of perioperative acetaminophen and ketorolac should be further investigated.
Remaining useful life estimation based on the joint use of an observer and a hidden Markov model
Authors: Aggab Toufik , Vrignat Pascal , Avila Manuel , Kratz Frédéric
Published: September 2021

We propose an approach for failure prognosis based on the estimation of the Remaining Useful Life (RUL) of a system in a situation in which monitoring signals providing information about its degradation evolution are not measured and no operating model of the system is available. These conditions are of practical interest for industrial applications such as mechanical (e.g. rolling bearing) or electrical (e.g. wind turbine) devices or equipment-critical components (e.g. batteries) in which the addition of sensors to the system is not feasible (e.g. space limitations for sensors, cost, etc.). The approach is based on an estimation of the system degradation using residual generation (where the difference between the system and the observer outputs is processed) and Hidden Markov Models with discrete observations. The prediction of the system RUL is given by the Markov property concerning the mean time before absorption. The approach comprises two phases: a training phase to model the degradation behavior and an “on-line” use phase to estimate the remaining life of the system. Two case studies were conducted for RUL prediction to verify the effectiveness of the proposed approach.
The TNF-α (–238 G/A) polymorphism could protect against development of severe sepsis
Authors: Hugo Montes A. , Valle-Garay Eulalia , Martin Guadalupe , Collazos Julio , Alvarez Victoria , Meana Alvaro , Pérez-Is Laura , Carton José A. , Taboada Francisco , Asensi Víctor
Published: September 2021

Primary responses in sepsis-mediated inflammation are regulated by pro-inflammatory cytokines. Variations in the cytokine genes might modify their transcription or expression, plasma cytokines levels and response to sepsis. Activation protein-1 (AP-1) and NF-κB regulate cytokines gene expression in sepsis. A total of 90 severely septic and 91 non-infected patients were prospectively studied. IL-1α ( –889 C/T), IL-1β ( +3954 C/T), IL-6 ( –174 G/C), TNF-α ( –238 G/A), TNF-α ( –308G/A), IL-8 ( –251A/T) and IL-10 ( –1082 G/A) SNPs, plasma IL-1β, IL-4, IL-6, IL-8, IL-10, IL-13, IFN-γ, TNF-α and monocyte chemoattractant protein 1 (MCP-1) levels, and AP-1 and NF-κB gene expression by neutrophils were assessed. A allele carriers of TNF-α ( –238 G/A) SNP were less frequent among septic patients. IL-6, IL-8, IL-10, TNF-α and MCP-1 levels were higher, and AP-1 and NF-κB gene expressions lower in septic patients. Sepsis was independently associated with higher fibrinogen, neutrophils counts and IL-8 levels, lower prothrombin, absence of the variant A allele of the TNF-α (–238 G/A) SNP, and haemodynamic failure. Death was independently associated with a higher APACHE II score, higher IL-8 levels, and the diagnosis of sepsis. TNF-a ( –238 G/A) SNP could protect against sepsis development. Higher IL-8 levels are predictive of sepsis and mortality.
Outcomes following biosimilar TNF inhibitor use for inflammatory-mediated immune disorders in pregnancy
Authors: Scott R , Parker H , Mccartney S , Harrow P , Williams D , Giles I
Published: September 2021

Background

Biosimilar tumour necrosis factor inhibitors (TNFi) are increasingly used to treat inflammatory immune-mediated disorders as they cost less than the originator biologic drug. More women are therefore becoming pregnant on biosimilar TNFi. This is the first paper to explore the safety and efficacy of biosimilar therapies in pregnancy.

Methods

A retrospective review of clinical data reviewed pregnancy outcomes and inflammatory disease activity in 18 pregnancies where the mother was using a biosimilar TNFi at conception.

Results

Biosimilar therapy was not associated with congenital abnormalities, preterm birth or other adverse pregnancy outcomes. Stopping biosimilar TNFi in pregnancy was associated with childbirth at an earlier gestation, as well as a flare of inflammatory disease in pregnancy or post-partum.

Conclusions

Women and clinicians should feel confident in using biosimilar TNFi in early pregnancy, and continuing them through pregnancy to prevent flares in late pregnancy or the early post-partum.
Leadership in primary care
Authors: Howe Amanda
Published: September 2021

Leadership is an important concept for GPs and has its own topic guide in the MRCGP curriculum. Simply put, leadership is about influencing others to take action for change. You may like to start this article by thinking of a few public figures you know, and what makes you think they are ‘good leaders’ – or not. This often highlights the fact that ‘good’ is defined both by how effective leaders are (…‘ he really changed the practice’…); and whether they lead people into actions that help or harm (… ‘ pay went up, but care got worse…’). As GPs, we need to recognise and develop our own leadership skills and be able to help others to do what is needed for effective patient care. This starts with having some definitions and building up through ‘knowing about’ and ‘knowing how’, towards understanding and applying our skills in practice. Leadership can also need action, beyond our own practice and that of our team, to the wider setting of the community, other parts of the workforce, and in the wider ‘macro’ sphere of changing the systems of care. This article will give you a framework for this learning. The article highlights some of the core capabilities of GPs, why you need them, and how you can develop them, linking this in with MRCGP Workplace-Based Assessment (WPBA) requirements. It also aims to show the links between ‘knowing yourself’ and ‘working in organisations’ - as GP leadership is needed at many levels.
The Rite of Passage and Digital Mourning in Fang Fang’s Wuhan Diary
Authors: Whyke Thomas William , Lopez-Mugica Joaquin , Chen Zhen T.
Published: September 2021

Using Van Gennep’s theory of Rite of Passage as its framework, this article examines the impact of Coronavirus (COVID-19) on Chinese culture as depicted through death and mourning in Wang Fang’s (penname Fang Fang) recently published Wuhan Diary: Dispatches from a Quarantined City. As part of the efforts to control the outbreak, the Chinese government took over the managing of the deceased, which triggered heated discussions on Chinese social media. Fang Fang’s diary, originally written as daily entries on Chinese social media platform Weibo, serves as a voice for those suffering during the pandemic, mediating between personal accounts, accounts of friends, family and those living in Wuhan during the pandemic. These flesh out how the virus has not only been disturbing for Chinese people’s lives but also disrupted the death rites and mourning rituals for those who have passed. Our article infuses a digital ontological reading with an anthropological twist that helps to understand how the diary mitigates the disturbances to mourning rituals inside and outside the confines of digital metaphysics. We argue that the digital diary mitigates these disruptions by allowing Chinese people to nourish their sorrow by identifying with the symbolic rites of passage and mourning rituals online at the heart of the COVID-19 pandemic in Wuhan. In doing so, this article examines three stages of rite of passage, including separation, liminality and integration as they unfold in the diary, through which discourses and subjectivities based on collective and individual traumatic experiences are built, as a form of digital mourning that could reconcile both the official and the alternative voices of anonymous narratives about the handling of this crisis.
Bridging Intention and Action for Employee Well-Being Using the Intentional Action (InAct) Process: Workshop-Lecture Series
Authors: Perlman Adam I , McLeod Heidi , Salinas Manisha G , Schafer Julie L , Ventenilla Joseph , Dabrh Abd Moain Abu
Published: September 2021

Background

Employee wellness programs can help manage stress and alleviate burnout.

Objective

To pilot and disseminate the Intentional Action(InAct) concept for employee wellbeing.

Methods

Five independent interactive workshop-lectures with an automated audience response system. Descriptive analysis of participant response data.

Results

Participants (n = 275): rated spirituality, physical environment and nutrition the most highly in contributing to their present well-being. Ninety-eight percent (n = 269) of participants identified a focus area to work on. The well-being area most selected was Exercise, (35% n = 95), however, other non-traditional areas, including Personal and Professional Development (18% n = 48), Relationships and Communication (17% n = 47), were selected, along with mind-body connection and mindful awareness (6% n = 15 and n = 16).

Conclusion

The pilot engaged employees to reflect and set goals for their future well-being. Healthcare institutions implementing programs should consider a broad range of whole person strategies addressing employee well-being, which go beyond the traditional focus on exercise and nutrition.
“A Tale of 2 Demons”—Concomitant Presence of Hepatocellular Carcinoma and Primary Neuroendocrine Tumor of Liver: A Case Report and Review of Literatures
Authors: Khanam Razwana , Pachika Pranali Santhoshini , Arya Payam , Bierenbaum Jason , Kane Kevin , Saha Proshikha
Published: September 2021

Neuroendocrine tumors usually originate from the neuroendocrine cells of gastrointestinal tract and their presence in the liver is mostly in the form of metastases. A primary neuroendocrine tumor in the liver concomitantly with hepatocellular carcinoma is an infrequent phenomenon. We present a 66-year-old woman with a remote history of breast cancer coming with postprandial fullness, later found to have multiple liver masses. After a thorough investigation, she was found to have a combined type of hepatocellular and primary neuroendocrine tumor of liver with pulmonary metastases. She was not a surgical candidate due to distant metastases. She was treated with chemotherapy, immunotherapy, and targeted therapies but continued to deteriorate clinically, and finally succumbed to her illness. The presence of this combined type of tumor in our patient is unique in many different ways: It is extremely rare, she did not have any risk factors for liver cancer, no genetic mutation till date could tie all these cancers (breast cancer, neuroendocrine tumor, and hepatocellular carcinoma) together, and not a lot of literatures/studies performed on this illness.