bluuebunny/crossref_metadata_2025 huggingface dataset:
A - 15 Evaluation of a Clinical Test Battery to Identify mTBI in Older Adults
Authors: A Kissinger-Knox , L Manderino , A Colorito , MW Collins , AP Kontos , N Sherry
Published: May 2021

Objective

The examine the utility of neuropsychological assessment in differentiating older adults with mild traumatic brain injury (mTBI) from controls.

Methods

Fifty-two older adults (40% male) aged 60–76 (M = 66.44, SD = 4.74) years were included in the study; 27 diagnosed with mTBI within three months of injury (33.07+/−18.86 days) and 25 age-group and sex-matched controls. Participants completed the following procedures: clinical interview, Repeatable Battery for the Assessment of Neuropsychological Status [RBANS], Wide Range Achievement Test [WRAT], Clock drawing, Post-Concussion Symptom Scale [PCSS], Short Fall Efficacy Scale [SFES], Generalized Anxiety Disorder- 7 Item Scale [GAD-7], Geriatric Depression Scale- 5 Item [GDS-5], and Vestibular/Oculomotor Screening [VOMS]. Statistical comparisons were performed using paired t-tests and chi-square analyses with significance of p < 0.05.

Results

There were no significant differences on demographics, aside from participants in the mTBI group being more likely to have a history of sleep disorder (χ2 = 10.26, p = 0.001). The groups significantly differed on RBANS subtests (list-learning, list recall, list recognition, and semantic fluency), VOMS Total Score and near point of convergence, PCSS, GAD-7, and the SFES, with the mTBI group consistently performing more poorly on cognitive testing and endorsing more symptoms. The mTBI group performed better on clock drawing.

Conclusions

The present study represents an initial investigation of the utility of a multidomain evaluation for mTBI in the subacute phase in older adults. Findings support the use of the RBANS immediate, delay, and recognition memory subtests and the RBANS semantic fluency subtest, as well as the VOMS, PCSS, GAD-7, and SFES for differentiating older adults with mTBI from controls.
A - 19 Prime Time for Treatment: Considerations for Active Rehabilitation following Sport-Related Concussion
Authors: B Mayer , K Goldberg , F Masterpasqua , RS Moser
Published: May 2021

Objective

The aim of the current study is to examine the efficacy of physical therapy for concussion treatment.

Methods

A retrospective chart review was conducted of 210 participants (62.9% female), aged 12–22 years (M = 15.27, SD = 2.03), who sustained sport-related concussions between 2015–2018 and were referred to active rehabilitation for treatment at a private physical therapy practice in New Jersey. Treatment groups were assigned based on intake within 12 weeks of injury (Early, 84.8%) or after 12 weeks elapsed (Prolonged). Efficacy was measured by reduction in number and severity of symptoms (i.e., PCSS, CISS, DHI scores) from intake (T1) to discharge (T2). Moderating variables included presence and severity of neck pain (57.1% with neck pain, 42.4% without) and presence and quantity of reported concussion modifiers (32.4% none, 34.8% one, 32.9% two+).

Results

A significant reduction in scores was found from T1 to T2 for the complete sample (PCSS: t(165) = 11.76, p < 0.001; CISS: t(162) = 15.73, p < 0.001; DHI functional disability ratings: t(74) = 6.393, p < 0.001). Crosstabs comparison showed participants reported significant symptom reduction from T1 to T2 (Early: 90%, n = 126; Prolonged: 87.5%, n = 21), with no appreciable difference in the rate of symptom reduction between groups. Treatment duration was not moderated by presence of neck pain, presence of modifiers, or number of modifiers.

Conclusions

Physical therapy appears to be an effective intervention, regardless of time elapsed, presence or severity of neck pain, or presence or quantity of concussion modifiers.
A - 20 Connectivity between Default Mode and Salience Networks is Associated with Decreased Attention and Inhibitory Control
Authors: N Morelli , NF Johnson , KA Kaiser , RD Andreatta , DY Han , NR Heebner , MC Hoch
Published: May 2021

Objective

To determine the association of default mode (DMN) and salience (SAL) network connectivity to executive function test performance. We hypothesized that intranetwork connectivity of the DMN and SAL would be uncorrelated to executive function, whereas increased internetwork connectivity would be associated with lower executive function.

Methods

Twelve physically active and healthy young adults (7 females, 5 males; age: 23.41 ± 2.74 years) were recruited for this study. Participants completed resting-state functional magnetic resonance imaging and three executive function tests administered through the NIH Toolbox Cognitive Battery. Demographically-corrected T-scores were calculated from the Flanker Inhibitory Control and Attention Test (FICA), Dimensional Change Card Sort Test (DCCS), and Pattern Comparison Processing Speed Test (PCPS). The relationship between intra- and internetwork connectivity of the DMN and SAL networks and performance.

Results

Independently, the DMN and SAL networks demonstrated weak correlations to DCCS (SAL: r = 0.45, p = 0.14; DMN: r = 0.13, p = 0.69), FICA (SAL r = −0.10, p = 0.95; DMN: r = 0.31, p = 0.33), and PCPS (SAL r = 0.10, p = 0.79; DMN: r = 0.22, p = 0.50). However, connectivity between the SAL and DMN networks demonstrated a moderate correlation to FICA performance (r = −0.61, p = 0.02).

Conclusions

Greater connectivity between the DMN and SAL networks demonstrated the strongest association to attention and inhibitory control performance in physically active, young adults. This relationship suggests greater connectivity of task-negative networks to task-positive networks may interfere with ongoing processing of visuospatial attention and inhibition. Future studies should examine this relationship in athletes who sustain a head injury.
A - 31 Competitiveness Drives Young University Students off the Couch
Authors: RE Wong , AM Webber , A Bergauer , N Dougall , MA Garcia-Barrera
Published: May 2021

Objective

Purpose. Daily physical activity (PA) is effective in supporting cognitive and physical health. However, many Canadians do not meet the public health recommendation of at least 150 mins/week of moderate-to-vigorous PA. The current study examined individual differences in traits such as motivation (intrinsic-IM, extrinsic-EM), and competitiveness, as well as executive abilities (strategic planning; SP) in predicting physical activity and sedentary behaviour.

Methods

Method. 102 university students ages 18 to 30 (M = 20.78 years; 74% female) were recruited from a mid-sized Canadian city. Using a formula that differentially weighted moderate and vigorous activity (measured with the International PA Questionnaire), we fit a linear model predicting PA within the past week by SP (Executive Function Index), IM and EM (Global Motivation Scale), and competitiveness (Revised Competitiveness Scale).

Results

Results. Only competitiveness predicted PA within the past week (β = 0.309, p = 0.001). Follow-up regressions indicated enjoyment of the activity being the most predictive component (β =0.231, p = 0.017). Both EM (β = 0.202, p = 0.015) and IM (β = −0.223, p = 0.012) predicted sedentary behaviour when accounting for competitiveness and demographics (age, gender).

Conclusions

Conclusions. Strategic planning and motivation did not predict exercise within the past week and therefore did not appear to serve as precursors to PA engagement in this university sample. Competitiveness, and in particular the enjoyment of the activity, significantly predicted exercise engagement; however, IM was negatively associated with sedentary behaviour, whereas EM was positively associated, suggesting motivational differences in sedentary behaviour but not physical exercise. Further research is required to account for individual differences in physical activity engagement.
A - 32 The Influence of Sport-Related Concussion History on Self-Reported and Objective Physical Functioning Following ACL Reconstruction
Authors: AJ Zynda , T Covassin , S Baez
Published: May 2021

Objective

The purpose of this study was to examine differences in self-reported physical functioning via the Modified Disablement in the Physically Active Scale (mDPA) and single-leg hop limb symmetry index (LSI) between individuals with a history of anterior cruciate ligament reconstruction (ACLR) and SRC compared to an ACLR group without history of SRC.

Methods

Forty participants [24 female; mean age = 24.3 +/− 4.1 years; height (cm) = 169.9 (SD = 9.1); weight (kg) = 73.2 (SD = 15.1)] with a history of ACLR (≥1-year post-operative) were separated into a SRC history group (SRC; n = 11) and no SRC history group (NO SRC; n = 29). Participants completed the mDPA physical summary component (mDPA-PSC) and hop testing (single-leg hop, crossover-hop, and triple-hop all for distance). SRC history was self-reported as yes/no and LSI was calculated using the equation: (mean distance involved limb/mean distance uninvolved limb) x 100. Mann–Whitney U tests (p < 0.05) were used to examine between-group differences. Hedge’s g effect sizes (ES) and 95% confidence intervals (95%CI) were used to detect clinically meaningful differences.

Results

The SRC history group reported worse physical functioning on the mDPA-PSC compared to the no SRC history group [SRC = 10 (IQR = 13), NO SRC = 5 (IQR = 10), p = 0.02, ES = -0.79, 95%CI = -1.49 to −0.08]. No statistical differences were observed for the single-leg hop or triple-hop, but the SRC history group performed worse on the crossover-hop [SRC = 0.96 (IQR = 0.07), NO SRC = 1.02 (IQR = 0.10), p = 0.006, ES = 0.74, 95%CI = 0.03–1.43].

Conclusions

These results suggest that SRC history may negatively influence subjective evaluation of physical functioning and objective lower-extremity functional performance in patients after ACLR.
Mixed-Mode Hydrophilic Interactions/Reversed-Phase Retention Mechanism in Thin-Layer Chromatography
Authors: Obradović Darija , Kowalska Teresa , Agbaba Danica
Published: May 2021

We investigated the dual retention mechanism in thin-layer chromatography taking place on three stationary phases of different polarity (C-18, plain silica gel and DIOL) and using binary mobile phases composed of acetonitrile as the main component and water, or methanol as a modifier. As the test analytes, we selected a set of 12 compounds of pharmaceutical importance and considerably different chemical structure, i.e. the imidazoline and serotonin receptor ligands, and their related compounds. Retention of each analyte in each investigated chromatographic system was determined in a wide enough range of the mobile phase composition, with volume fraction of the mobile phase modifier ranging from 0.10 to 0.90. Calculation of the exact turning point values as a proof of occurrence of the reversed-phase hydrophilic interaction chromatography (HILIC/RP) retention mechanism was based on the multimodal retention model. The dual retention mode was described with the use of the volume fraction of the mobile phase modifier, the total polarity and the total solubility models. For the DIOL, C-18 and silica gel stationary phase, the dual (HILIC/RP) retention mechanism was confirmed. In the case of the DIOL stationary phase and acetonitrile/methanol mobile phase, the observed retention mechanism was more complicated than the dual HILIC/RP one.
Neuraminidase 1 is a driver of experimental cardiac hypertrophy
Authors: Chen Qian-Qian , Ma Gaoxiang , Liu Jin-Feng , Cai Yuan-Yuan , Zhang Jun-Yuan , Wei Ting-Ting , Pan An , Jiang Shujun , Xiao Yibei , Xiao Pingxi , Song Jiangping , Li Ping , Zhang Lei , Qi Lian-Wen
Published: May 2021

Aims 

Despite considerable therapeutic advances, there is still a dearth of evidence on the molecular determinants of cardiac hypertrophy that culminate in heart failure. Neuraminidases are a family of enzymes that catalyze the cleavage of terminal sialic acids from glycoproteins or glycolipids. This study sought to characterize the role of neuraminidases in pathological cardiac hypertrophy and identify pharmacological inhibitors targeting mammalian neuraminidases.

Methods and results 

Neuraminidase 1 (NEU1) was highly expressed in hypertrophic hearts of mice and rats, and this elevation was confirmed in patients with hypertrophic cardiomyopathy (n = 7) compared with healthy controls (n = 7). The increased NEU1 was mainly localized in cardiomyocytes by co-localization with cardiac troponin T. Cardiomyocyte-specific NEU1 deficiency alleviated hypertrophic phenotypes in response to transverse aortic constriction or isoproterenol hydrochloride infusion, while NEU1 overexpression exacerbated the development of cardiac hypertrophy. Mechanistically, co-immunoprecipitation coupled with mass spectrometry, chromatin immunoprecipitation, and luciferase assays demonstrated that NEU1 translocated into the nucleus and interacted with GATA4, leading to Foetal gene (Nppa and Nppb) expression. Virtual screening and experimental validation identified a novel compound C-09 from millions of compounds that showed favourable binding affinity to human NEU1 (KD = 0.38 μM) and effectively prevented the development of cardiac remodelling in cellular and animal models. Interestingly, anti-influenza drugs zanamivir and oseltamivir effectively inhibited mammalian NEU1 and showed new indications of cardio-protection.

Conclusions 

This work identifies NEU1 as a critical driver of cardiac hypertrophy and inhibition of NEU1 opens up an entirely new field of treatment for cardiovascular diseases.
Clinal genetic variation and phenotypic plasticity in leaf phenology, growth and stem form in common ash (Fraxinus excelsior L.)
Authors: Rosique-Esplugas C , Cottrell J E , Cavers S , Whittet R , Ennos R A
Published: May 2021

Genetic variation and phenotypic plasticity play a role in determining the performance of a tree provenance at a planting site. This paper explores their relative importance in determining growth, phenology and tree form in a broad geographic sample of 42 British provenances of common ash (Fraxinus excelsior L.) grown at two contrasting trial sites. We found significant genetic differences for tree height, timing of leaf flushing and leaf senescence, and stem forking among the provenances. These followed a clear latitudinal and climatic cline, where the northern provenances were shorter, their leaves flushed later and senesced earlier than the southern provenances. Provenance explained a much larger proportion of the variance for spring phenology (63 per cent) than for autumn phenology (15 per cent). The effect of the planting site was contrasting between spring and autumn: spring phenology showed very little plasticity, while autumn phenology presented higher levels of phenotypic plasticity. This could indicate that for ash spring phenology is under stronger selective pressure. We found a correlation between tree height, leaf phenology and forking, with early flushing provenances tending to be taller and more forked, which could reflect repeated frost damage. The findings underline the complexity of predicting performance in novel environments and demonstrate that small gains in tree growth may be counteracted by detrimental effects on stem form, a key contributor to timber value, due to susceptibility to the contemporary environment.
Emergent Metachronal Waves using Tension-Driven, Fluid-Structure Interaction Models of Tomopterid Parapodia
Authors: Hoover Alexander P
Published: May 2021

Metachronal waves are ubiquitous in propulsive and fluid transport systems across many different scales and morphologies in the biological world. Tomopterids are a soft-bodied, holopelagic polychaete that use metachrony with their flexible, gelatinous parapodia to deftly navigate the midwater ocean column that they inhabit. In the following study, we develop a three-dimensional, fluid–structure interaction model of a tomopterid parapodium to explore the emergent metachronal waves formed from the interplay of passive body elasticity, active muscular tension, and hydrodynamic forces. After introducing our model, we examine the effects that varying material properties have on the stroke of an individual parapodium. We then explore the temporal dynamics when multiple parapodia are placed sequentially and how differences in the phase can alter the collective kinematics and resulting flow field.
Neural network adaptive output regulation for non-linear uncertain systems with full-state constraints
Authors: Jia Fujin , Lu Junwei , Li Yongmin
Published: May 2021

In this paper, we study the output regulation problem (ORP) of non-linear systems with full-state constraints (FSC). First, in order to deal with the ORP of non-linear systems with FSC, a radical constraint function is proposed to avoid the drawbacks of the barrier Lyapunov functions (BLF) and the logarithmic constraint functions. Then, a control algorithm is proposed based on neural network control method without using the backstepping method, so that all signals of the closed-loop system are semi-globally uniformly ultimately bounded (SGUUB), and the tracking error converge to a small neighbourhood of the origin, and all states of the system can be constrained. Finally, a simulation example illustrates its effectiveness.
A(H1N1)pdm09 Influenza Viruses Replicating in Ferret Upper or Lower Respiratory Tract Differed in Onward Transmission Potential by Air
Authors: Xie Chenyi , Su Wen , Sia Sin Fun , Choy Ka-Tim , Morrell Steven , Zhou Jie , Peiris Malik , Bloom Jesse D , Yen Hui-Ling
Published: May 2021

Background

A(H1N1)pdm09 influenza viruses replicate efficiently in respiratory epithelia and are transmitted via respiratory droplets and aerosols expelled by infected hosts. The relative onward transmission potential of influenza viruses replicating in the upper and lower respiratory epithelial cells has not been fully defined.

Methods

Wild-type and barcoded A(H1N1)pdm09 viruses that differed by 2 synonymous mutations per gene segment were inoculated into ferrets via intranasal and intratracheal routes. Naive recipients were exposed to the exhaled breath of inoculated donors for 8 hours on day 2 postinoculation. Onward transmission potential of wild-type and barcoded genotypes were monitored by next generation sequencing.

Results

Transmissible airborne particles were respired from the upper but not the lower respiratory epithelial cells of donor ferrets. There was limited mixing of viral populations replicating in the upper and lower respiratory tissues.

Conclusions

The ferret upper respiratory epithelium was mapped as the anatomic site that generated influenza virus-laden particles mediating onward transmission by air. Our results suggest that vaccines and antivirals should aim to reduce viral loads in the upper respiratory tract for prevention of influenza transmission.
Apparent digestibility, fecal particle size, and mean retention time of reduced lignin alfalfa hay fed to horses
Authors: Grev Amanda M , Hathaway Marcia R , Sheaffer Craig C , Wells M Scott , Reiter Amanda S , Martinson Krishona L
Published: May 2021

Reduced lignin alfalfa (Medicago sativa L.) has the potential to provide a higher-quality forage source for livestock by improving forage digestibility. This study was conducted to evaluate apparent digestibility when feeding reduced lignin and nonreduced lignin alfalfa hay to adult horses, and to examine mean fecal particle size (MFPS) and mean retention time (MRT) between alfalfa forage types. In 2017, reduced lignin (“54HVX41”) and nonreduced lignin (“WL355.RR”) alfalfa hay was harvested in Minnesota at the late-bud stage. Alfalfa hays were similar in crude protein (CP; 199 g/kg), neutral detergent fiber (NDF; 433 g/kg), and digestible energy (2.4 Mcal/kg). Acid detergent lignin concentrations were lower for reduced lignin alfalfa hay (74 g/kg) compared to nonreduced lignin alfalfa hay (81 g/kg). Dietary treatments were fed to six adult, stock-type horses in a crossover study. Experimental periods consisted of a 9-d dietary adaptation phase followed by a 5-d total fecal collection phase, during which horses were housed in individual boxstalls and manure was removed on a continuous 24-h basis. At 12-h intervals, feces were thoroughly mixed, subsampled in duplicate, and used for apparent digestibility and MFPS analysis. On day 2 of the fecal collection phase, horses were fed two indigestible markers, cobalt (Co) and ytterbium (Yb), which were fed as Co-ethylenediaminetetraacetic acid and Yb-labeled NDF residue, respectively. Additional fecal samples were taken at 2-h intervals following marker dosing until 96-h post-dosing to evaluate digesta MRT. Data were analyzed using the MIXED procedure of SAS, with statistical significance set at P ≤0.05. Dietary treatment (i.e., alfalfa hay type) was included as a fixed effect, while experimental period and horse were considered random effects. Dietary treatments were similar in dry matter intake (1.6% bodyweight) and time to consumption (7.6 h). Apparent dry matter digestibility (DMD) was greater for reduced lignin alfalfa (64.4%) compared to nonreduced lignin alfalfa (61.7%). Apparent CP and NDF digestibility did not differ between dietary treatments, averaging 78% and 45%, respectively. Dietary treatments were similar in MFPS (0.89 mm) and MRT for both liquid (23.7 h) and solid (27.4 h) phase material. These results indicate an improvement in DMD for reduced lignin alfalfa hay when fed to adult horses, with no change in forage consumption, fecal particle size, or digesta retention time.
Effects of continuously infusing glucose or casein into the terminal ileum on biomarkers of metabolism, inflammation, and intestinal morphology in growing pigs
Authors: Mayorga Edith J , Horst Erin A , Al-Qaisi Mohmmad , Goetz Brady M , Abeyta Megan A , Rodríguez-Jiménez Sonia , Lei Samantha , Acosta Jesus A , Patience John F , Serao Mariana C Rossoni , Baumgard Lance H
Published: May 2021

Study objectives were to determine the effects of continuously infusing glucose (GLC) or casein (CAS) into the terminal ileum on biomarkers of metabolism, inflammation, and intestinal morphology in growing pigs. Crossbred gilts (n = 19; 81 ± 3 kg body weight [BW]) previously fitted with T-cannulas at terminal ileum were used in the current experiment. Following 4 d of acclimation, pigs were enrolled in 2 experimental 4-d periods (P). During P1, pigs were housed in individual pens and fed ad libitum for collection of baseline parameters. At the beginning of P2, pigs were assigned to 1 of 3 infusion treatments: 1) control (CON; water; 3 liters/d; n = 7), 2) GLC (dextrose 50%; 500 g/d; n = 6;), or 3) CAS (casein sodium salt; 300 g/d; n = 6). Water, GLC, and CAS solutions were continuously infused at a rate of 125 mL/h for the entirety of P2. Animals were euthanized at the end of P2, and intestinal tissue was collected. During P2, average daily feed intake differed across treatments and was reduced in GLC compared with CON pigs (14%), while CAS pigs consumed an intermediate amount (P = 0.05). Average daily gain and final BW were similar across treatments. A treatment by time interaction was observed for blood urea nitrogen (BUN; P < 0.01), as it decreased in GLC (21%) while it gradually increased in CAS (76%) pigs relative to CON pigs. Mild hyperthermia occurred with both GLC and CAS infusions relative to CON (+0.3 and 0.2 °C, respectively; P < 0.01). Blood neutrophils increased in CAS relative to CON pigs (26%) but remained similar between CON and GLC treatments (P < 0.01). Blood monocytes decreased in GLC relative to CON pigs (24%) while CAS pigs had an intermediate value (P = 0.03). Circulating lipopolysaccharide binding protein tended to decrease in GLC (29%) relative to CON pigs but remained similar between CON and CAS pigs (P = 0.10). Plasma tumor necrosis factor-alpha was similar across treatments. Ileum villus height:crypt depth was increased in CAS compared with CON pigs (33%; P = 0.05) while GLC pigs had an intermediate value. Colon myeloperoxidase-stained area increased in CAS compared with CON pigs (45%; P = 0.03) but remained similar between GLC and CON pigs. In summary, continuously infusing GLC or CAS into the terminal ileum appeared to stimulate a mild immune response and differently altered BUN patterns but had little or no effects on blood inflammatory markers, intestinal morphology, or key production parameters.
Temperature-constrained topology optimization of nonlinear heat conduction problems
Authors: Zhuang Chungang , Xiong Zhenhua , Ding Han
Published: May 2021

This paper presents topology optimization of nonlinear heat conduction problems with multiple domains and multiple constraints, including regional temperature and material volume for reducing temperature. Maximum approximation temperatures in the constraint regions are accurately and dynamically calculated, though temperature and temperature-dependent thermal conductivity change with the update of material distribution. A temperature measure with constant error to approximate regional maximum temperature is adaptive to different temperature ranges. A strategy of hole nucleation generation combined with the regional temperature constraints is presented for the level set-based topology optimization. The solid isotropic material with penalization (SIMP) and parametrized level set methods are compared for the temperature-constrained topology optimization. Finally, several numerical examples are solved by the SIMP and parametrized level set methods. The results demonstrate that the proposed approach can obtain intricate topological details and reduce regional temperatures for the nonlinear heat conduction problems.
From a Right to a Preference: Rethinking the Right to Genomic Ignorance
Authors: Dive Lisa
Published: May 2021

The “right not to know” has generated significant discussion, especially regarding genetic information. In this paper, I argue that this purported right is better understood as a preference and that treating it as a substantive right has led to confusion. To support this claim, I present three critiques of the way the right not to know has been characterized. First, I demonstrate that the many conceptualizations of this right have hampered debate. Second, I show that the way autonomy is conceptualized in this literature is also problematic. Third, I examine the notion of a right in more detail, to support my third critique: that the right to know and the right not to know genetic information are often erroneously treated as having equivalent status. On my understanding, the claim being made is better thought of as a preference, not a right, and a preference not to know certain information becomes only one of several considerations relevant to medical decision making.
Minimally invasive mitral valve replacement after transcatheter edge-to-edge repair
Authors: Bent Daniel P , Boova Robert S
Published: May 2021

Percutaneous transcatheter edge-to-edge mitral valve repair is available for treatment of both functional and degenerative mitral regurgitation (MR). This technique may be unsuccessful resulting in significant residual or recurrent MR. We described a successful minimally invasive mitral valve replacement in a patient with severe functional MR due to left ventricular dysfunction who previously underwent a transcatheter edge-to-edge repair.
Villette, Female Political Agency, and the French Revolution of 1848
Authors: Lamouria Lanya
Published: May 2021

This essay reads Charlotte Brontë’s Villette (1853) as a response to questions about women’s public agency that were raised by the French Revolution of 1848, in which women played prominent roles. The actress Rachel, the inspiration for Villette’s Vashti, became the most notorious female activist of the Revolution when she performed La Marseillaise in support France’s Second Republic. As I demonstrate, Brontë engages directly with Victorian journalistic accounts of these performances. Here, and in other episodes focused on women leaders, such as ‘Madame Beck’ and ‘The Cleopatra’, Brontë seeks to expose the linguistic and iconographic conventions around female political power that diminish women’s agency in the process of representing it. Brontë’s awareness of the pervasiveness and intractability of these conventions explains the novel’s final scepticism about women’s ability to exercise political power. Although Villette’s protagonist, Lucy Snowe, indulges in fantasies of political power, she satisfies these fantasies not in the public realm but in a politicized private realm, where she re-enacts Napoleonic-era political conflicts with her imperious lover, M Paul. My aim in analysing Brontë’s engagement with 1848 is to understand Villette’s politicization of romance. For Brontë, I argue, women’s exclusion from the political is tantamount to their exclusion from history, and Lucy’s strategic political re-enactments function as both critique of and compensation for this exclusion.
A PSF-based Approach to TESS High quality data Of Stellar clusters (PATHOS) – IV. Candidate exoplanets around stars in open clusters: frequency and age–planetary radius distribution
Authors: Nardiello D , Deleuil M , Mantovan G , Malavolta L , Lacedelli G , Libralato M , Bedin L R , Borsato L , Granata V , Piotto G
Published: May 2021

The knowledge of the ages of stars hosting exoplanets allows us to obtain an overview on the evolution of exoplanets and understand the mechanisms affecting their life. The measurement of the ages of stars in the Galaxy is usually affected by large uncertainties. An exception are the stellar clusters: For their coeval members, born from the same molecular cloud, ages can be measured with extreme accuracy. In this context, the project PATHOS is providing candidate exoplanets orbiting members of stellar clusters and associations through the analysis of high-precision light curves obtained with cutting-edge tools. In this work, we exploited the data collected during the second year of the Transiting Exoplanet Survey Satellite mission. We extracted, analysed, and modelled the light curves of $\sim 90\, 000$ stars in open clusters located in the Northern ecliptic hemisphere in order to find candidate exoplanets. We measured the frequencies of candidate exoplanets in open clusters for different orbital periods and planetary radii, taking into account the detection efficiency of our pipeline and the false positive probabilities of our candidates. We analysed the age–RP distribution of candidate and confirmed exoplanets with periods <100 d and well constrained ages. While no peculiar trends are observed for Jupiter-size and (super-)Earth-size planets, we found that objects with $4 \lesssim R_{\rm P} \lesssim 13R_{\rm Earth}$ are concentrated at ages ≲200 Myr; different scenarios (atmospheric losses, migration, etc.) are considered to explain the observed age–RP distribution.
Magnesium Sulphate for Fetal Neuroprotection at Imminent Risk for Preterm Delivery: A Systematic Review With Meta-analysis and Trial Sequential Analysis
Authors: Wolf H.T. , Huusom L.D. , Henriksen T.B. , Hegaard H.K. , Brok J. , Pinborg A.
Published: May 2021

(BJOG. 2020;127:1180–1188)

Preterm birth is associated with higher risk of cerebral palsy (CP) and other complications. Magnesium sulfate (MgSO4) may decrease risk of CP when taken immediately before preterm birth. A recent trial investigated the neuroprotective functions of MgSO4. This updated systematic review, meta-analysis and trial sequential analysis (TSA) assessed the effects of MgSO4 administered before preterm birth to prevent CP in neonates.
Haemoglobin Levels in Early Pregnancy and Severe Maternal Morbidity: Population-based Cohort Study
Authors: Ray J.G. , Davidson A.J.F. , Berger H. , Dayan N. , Parka A.L.
Published: May 2021

(BJOG. 2020;127:1154–1164)

Globally, 38% of all pregnancies are affected by anemia, which has been associated with poor perinatal outcomes including low infant birthweight, perinatal asphyxia, preterm birth, and stillbirth. Identifying this condition early may allow for prediction of severe maternal morbidity (SMM). The aim of this study was to identify the relationship between early maternal hemoglobin concentration and SMM, blood transfusion, or maternal mortality.
Maternal Risk Factors and Adverse Birth Outcomes Associated With HELLP Syndrome: A Population-based Study
Authors: Lisonkova S. , Razaz N. , Sabr Y. , Muraca G.M. , Boutin A. , Mayer C. , Joseph K.S. , Kramer M.S.
Published: May 2021

(BJOG. 2020;127:1189–1198)

HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome has varying definitions and therefore a wide range of reported incidence. Only smaller studies, mostly in tertiary-care hospitals, have examined the risk factors and serious adverse outcomes associated with this syndrome. This study aimed to assess risk factors and adverse fetal and maternal outcomes associated with HELLP syndrome using a large population-based cohort.
Cognitive Aids With Roles Defined (CARD) for Obstetrical Crises: A Multisite Before-and-after Cohort Study
Authors: Boet S. , Posner G. , Bariciak E. , Crooks S. , Mitchell A. , Bryson G.L. , Burns J.K. , Bould M.D.
Published: May 2021

(Can J Anesth/J Can Anesth. 2020;67:970–980)

During critical events, an interprofessional team’s coordinated response directly affects patient outcomes. Improvement for such responses may occur through the use of cognitive aids, which can lessen the dependence on memory for healthcare providers in critical situations. A new type of cognitive aid, cognitive aids with roles defined (CARD), allows for clarification of crisis roles using a system of cards assigned to particular team members in order to remind the wearers of their assigned tasks. In the event of a crisis, those without cards are asked to remain in the room away from the patient while waiting for instructions from a Code Leader. The purpose of this study was an evaluation of the CARD system for emergency cesarean deliveries. The primary hypothesis of the study was the CARD system would reduce delivery time. In addition, they hypothesized the CARD system would improve overall clinical outcomes for mother and baby (as compared to traditional emergency cesarean management without CARD).
The Effect of Intravenous Dexamethasone on Postoperative Nausea and Vomiting After Cesarean Delivery With Intrathecal Morphine: A Randomized-controlled Trial
Authors: Selzer A. , Pryor K.O. , Tangel V. , O’Connell K. , Kjaer K.
Published: May 2021

(Can J Anesth. 2020;67:817–826)

For women having a cesarean delivery, the estimated incidence of postoperative nausea and vomiting (PONV) ranges from 30% to 80%. Compared with spinal anesthesia without intrathecal opioid, the administration of intrathecal morphine has been associated with an increase in PONV, by up to 5-fold. According to one meta-analysis, the administration of intravenous (IV) dexamethasone showed a significant reduction in PONV in patients receiving epidural morphine – but not among those receiving intrathecal morphine. In the meta-analysis, 6 randomized-controlled trials (RCTs) studied the use of IV dexamethasone prior to epidural morphine and 2 RCTs studied its use prior to the end of surgery but not before intrathecal morphine administration. Whether the timing of IV dexamethasone is important for prophylaxis of PONV remains unclear. The aim of this study was to determine whether intravenous dexamethasone reduces the incidence of PONV when administered prior to intrathecal morphine during spinal anesthesia.
Haematoma, Abscess or Meningitis After Neuraxial Anesthesia in the USA and the Netherlands: A Closed Claims Analysis
Authors: Bos E.M.sE. , Posner K.L. , Domino K.B. , de Quelerij M. , Kalkman Cor J. , Hollmann M.W. , Lirk P.
Published: May 2021

(Eur J Anaesthesiol. 2020;37:743–751)

Current anesthesia practice often involves neuraxial techniques such as spinal anesthesia and epidural analgesia. The leading anesthetic technique for cesarean delivery remains spinal anesthesia, while chronic pain treatments include spinal cord stimulators, epidural injections, and intrathecal drug delivery systems. The rarest but most feared complication of these techniques is injury to the spinal cord via neuraxial abscess or hematoma, but possible other complications include medication errors, meningitis, and even direct nerve injury. The primary aim of this study was to identify possible preventable causes of hematoma and abscess, meningitis, and other serious adverse outcomes following neuraxial procedures by analyzing claims databases in two countries: The Anesthesia Closed Claims Project database in the USA, and the Netherlands’ two largest medical insurance companies’ databases.
Uptrend in Distress and Psychiatric Symptomatology in Pregnant Women During the Coronavirus Disease 2019 Pandemic
Authors: Berthelot N. , Lemieux R. , Garon-Bissonnette J. , Drouin-Maziade C. , Martel É. , Maziade M.
Published: May 2021

(Acta Obstet Gynecol Scand. 2020;99:848–855)

It is well established that psychological distress in pregnancy is associated with a range of negative outcomes, including delivery at an earlier gestational age, lower neonatal birthweight, and poor maternal psychosocial functioning. Expectant mothers of all social classes and educational levels can experience antenatal psychological distress, and the COVID-19 pandemic has introduced additional stress to people around the world. Most obstetric research on COVID-19 has focused on respiratory issues rather than mental health implications. This study aimed to provide data on any increase in prenatal psychological distress symptoms caused by the COVID-19 pandemic. As a secondary objective, the study aimed to identify which subgroup of women would be particularly vulnerable.
The Effect of Morbid Obesity or Advanced Maternal Age on Oxytocin-induced Myometrial Contractions: An In Vitro Study
Authors: Luca A.M. , Carvalho J.C.A. , Ramachandran N. , Balki M.
Published: May 2021

(Can J Anesth. 2020;67:836–846)

Worldwide, the rate of pregnant women who are of advanced maternal age (AMA) or who are overweight or morbidly obese is rising. These factors are associated with higher rates of labor induction or augmentation, prolonged labor, cesarean delivery and postpartum hemorrhage (PPH). Oxytocin is used both to prevent and treat PPH and for labor induction and augmentation. However, when oxytocin use is prolonged, a phenomenon known as oxytocin receptor desensitization can occur. This desensitization weakens the contractile response to repeated oxytocin treatment and can lead to severe PPH. The aim of this study was to investigate in vitro the effect of oxytocin on myometrial contractions in pregnant women with AMA and morbid obesity.
Outcome Improvement Between the First Two Waves of the Coronavirus Disease 2019 Pandemic in a Single Tertiary-Care Hospital in Belgium
Authors: Lambermont Bernard , Rousseau Anne-Françoise , Seidel Laurence , Thys Marie , Cavalleri Jonathan , Delanaye Pierre , Chase J. Geoffrey , Gillet Pierre , Misset Benoit
Published: May 2021

Objectives:

To compare patient management and outcome during the first and second waves of the coronavirus 2019 pandemic.

Design:

Single-center prospective cohort study.

Setting:

Tertiary-care University Hospital.

Patients:

All adult patients admitted in either the first (from March 15 to May 15, 2020) or second (from October 1 to November 30, 2020) wave of coronavirus disease 2019.

Interventions:

None.

Measurements and Main Results:

Primary outcome was 30-day mortality. During the second wave of the coronavirus disease 2019 pandemic, 33 patients (4.8%) were transferred due to overcrowding and excluded from analysis. There were 341 (first wave of the coronavirus disease 2019 pandemic) and 695 (second wave of the coronavirus disease 2019 pandemic) coronavirus disease 2019 patients admitted to the hospital, with median age first wave of the coronavirus disease 2019 pandemic as 68 (57–80) and second wave of the coronavirus disease 2019 pandemic as 71 (60–80) (p = 0.15), and similar admission severity. For the first wave of the coronavirus disease 2019 pandemic versus second wave of the coronavirus disease 2019 pandemic, 30-day mortality was 74/341 (22%) and 98/662 (15%) (p = 0.007). In the ward, 11/341 (3.2%) and 404/662 (61%) received dexamethasone (p < 0.001); 6/341 (2%) and 79/662 (12%) received high-flow nasal oxygen (p < 0.0001); 2/341 (0.6%) and 88/662 (13.3%) received remdesivir (p < 0.0001); 249/341 (73%) and 0/662 (0%) received hydroxychloroquine (p < 0.0001); and 87/341 (26%) and 128/662 (19%) (p = 0.024) patients were transferred to ICU. On ICU admission, median Sequential Organ Failure Assessment was 6 (3–7) and 4 (3–6) (p = 0.02). High-flow nasal oxygen was given to 16/87 (18%) and 102/128 (80%) (p < 0.001); 69/87 (79%) and 56/128 (44%) received mechanical ventilation (p < 0.001) with durations 17 days (10–26 d) and 10 days (5–17 d) (p = 0.01). Median ICU length of stay was 14 days (5–27 d) and 6 days (3–11 d) (p < 0.001). Finally, 16/87 (18%) and 8/128 (6%) received renal replacement therapy (p = 0.0055); and 64/87 (74%) and 51/128 (40%) needed vasopressor support (p < 0.001).

Conclusions:

The main therapeutic changes between the first wave of the coronavirus disease 2019 pandemic and the second wave of the coronavirus disease 2019 pandemic were use of steroids, unrestrictive use of high-flow nasal oxygen for hypoxemic patients, and transfer of patients to other geographic areas in the case of ICU overcrowding. These changes were associated with a decrease in 30-day mortality, ICU admission, and organ support.
An Innovative Approach for Preoperative Perforator Flap Planning Using Contrast-enhanced B-flow Imaging
Authors: Heneweer Carola , Zirk Matthias , Safi Ali , Smeets Ralf , Malter Wolfram , Kröger Nadja , Zöller Joachim E. , Maintz David , Zinser Max
Published: May 2021

Precise perforator mapping of the epifascial and subcutaneous course of the perforator flaps, including the precise detection of the skin point, is mandatory for successful preoperative flap design and planning of supramicrosurgery. We investigated the effectiveness of contrast-enhanced B-flow (BCEUS) imaging for perforator mapping and preoperative perforator flap planning and compared it with B-flow ultrasound, contrast-enhanced ultrasound, and color Doppler ultrasound. Sixteen patients who received an individualized perforator flap reconstruction were included in the study. Preoperative perforator mapping includes the following structures: subfascial course of the pedicle, fascial penetration point, subcutaneous course (epifascial and subcutaneous), and perforator skin point. The precision of the preoperative perforator mapping was analyzed for color Doppler ultrasound, contrast-enhanced ultrasound, B-flow ultrasound, and BCEUS. Each technique was able to precisely display the subfascial course of the vascular pedicle, including the fascial penetration point. However, only BCEUS enabled precise mapping of the epifascial and subcutaneous (suprafascial) course, including the skin point of the perforators with a clear delineation. Precise knowledge of the suprafascial course of the perforators is mandatory for successful supermicrosurgery and perforator flap planning. BCEUS imaging facilitates full perforator mapping, which improves the safety of flap harvesting. However, BCEUS is technically demanding and requires an experienced sonographer.
SUBRETINAL ENDOSCOPIC SURGERY FOR METASTATIC CHOROIDAL TUMOR
Authors: Kaga Tatsushi , Kojima Takashi , Mori Toshio , Yokoyama Sho , Hattori Yukinori , Ichikawa Kazuo
Published: May 2021

Purpose:

To report a case of a metastatic choroidal tumor treated with subretinal endoscopic surgery.

Methods:

A single case report.

Results:

A 68-year-old woman presented with a metastatic choroidal tumor in the right eye and an intraocular pressure of 54 mmHg. Chemotherapy and radiotherapy were ineffective in eliminating her eye pain. Subretinal endoscopic surgery was performed to remove the metastatic choroidal tumor with the complex retinal detachment attached to the posterior surface of the lens. The day after subretinal endoscopic surgery, the patient's intraocular pressure decreased to 7 mmHg and her pain subsided. The chemotherapeutic strategy was modified according to the pathological findings. Survival prognosis improved from 3 to 18 months. Twenty-one months after the surgery, the retinal detachment was reattached under silicone oil with a best-corrected visual acuity of 20/1,000 and an intraocular pressure of 15 mmHg.

Conclusion:

In this case, subretinal endoscopic surgery preserved visual function, eliminating the need for enucleation.
ASYMPTOMATIC OCULAR MANIFESTATIONS OF ACERULOPLASMINEMIA IN TWO ADULT WHITE SIBLINGS: A MULTIMODAL IMAGING APPROACH
Authors: Furashova Olga , Mielke Stefan , Lindner Uwe
Published: May 2021

Purpose:

To report ocular manifestations of aceruloplasminemia in two adult White siblings.

Methods:

The ocular findings were investigated using a multimodal imaging approach including color fundus photography, fluorescein angiography, autofluorescence imaging, and spectral-domain optical coherence tomography.

Results:

A 43-year-old woman and a 39-year-old man were diagnosed with aceruloplasminemia based on clinical symptoms, laboratory tests, liver biopsy, and genetic examination of the ceruloplasmin gene confirming the homozygotic mutation G708S. Both patients had no ophthalmologic symptoms, unremarkable anterior segment, and visual acuity of 20/20 in both eyes. Indirect ophthalmoscopy of the fundus revealed subtle yellowish color with punctate inhomogeneous pigmentation in the whole retina. The autofluorescence images demonstrated remarkable punctate hyperfluorescence involving the central and peripheral retina. Spectral-domain optical coherence tomography images showed normal retinal structure in the macular area with intact outer retinal layers. Fluorescein angiography showed a slightly inhomogeneous pattern of hypofluorescence and hyperfluorescence from the early until late angiography phase.

Conclusion:

We describe two adult cases of ocular manifestations of a rare hereditary condition with systemic iron overload. Retinal degeneration in aceruloplasminemia might be overlooked on a routine ophthalmic examination and requires at least an autofluorescence image because initial damage at the level of retinal pigment epithelium is not always visible on ophthalmoscopy.
Factors affecting nurse practitioners' integration of evidence into practice
Authors: Hamilton Krista E. , Jones Stacey J. , Gardner Carrie L.
Published: May 2021

Background:

Evidence-based clinical practice guidelines bridge the gap between clinical practice and research, improve patient outcomes, promote consistency of care, and enhance quality of care. However, guideline adherence varies widely among individual providers and organizations.

Purpose:

To identify factors that facilitate or impede nurse practitioners' integration of guideline recommendations into practice.

Methods:

Every nurse practitioner in Alabama was invited to complete an online 45-question survey evaluating beliefs and attitudes regarding evidence-based guidelines, facilitators and barriers to implementation, and utilization of information resources in patient care.

Results:

The five most commonly identified barriers to evidence-based guideline implementation in participants' current work settings are patients with multiple comorbidities, time constraints, pressure from patients to provide nonrecommended care, insufficient staffing, and inadequate financial resources. The five most commonly identified facilitators in participants' current work settings are easy access to guidelines, support from leadership, free access to guidelines, in-person education regarding a guideline, and clinical decision support software programs. Participants expressed a desire for free and easy access to evidence-based practice (EBP) guidelines and clinical decision support programs, as well as education regarding guidelines and opportunities to discuss evidence with colleagues.

Implications for practice:

The barriers and facilitators of guideline implementation that were identified in this study should be useful in the development and refinement of future studies and interventions to enhance guideline implementation among individuals and organizations.