bluuebunny/crossref_metadata_2025 huggingface dataset:
Encapsulating Peritoneal Sclerosis Presenting after Two Donor Kidney Transplantations: A Case Report and Literature Review
Authors: Roy Sasmit , Alexander Kyrstin , Chowdhury Monzurul Hasan , Vanguri Vijay , Bodziak Kenneth
Published: July 2021

Encapsulating peritoneal sclerosis is a rare, recurring complication in peritoneal dialysis (PD) patients. With a mortality rate of 51%, it continues to be a therapeutic enigma among clinicians. However, the incidence after kidney transplantation (KT) has rarely been reported. We report a unique case of encapsulating peritoneal sclerosis (EPS), occurring years after failed initial living KT, and diagnosed after second deceased donor kidney transplantation. A 35-year-old male, on prior PD for 4 years, followed by failed KT of 8 years, was presented with abdominal pain, weight loss, and vomiting, 7 months after his second deceased donor KT. An abdominal computed tomography showed intra-abdominal loculated fluid collection, but no obstruction. Exploratory laparotomy revealed extensive peritoneal thickening and blocked intestinal loops. Histopathology was indicative of EPS with fibrous adhesions and sclerotic tissues. Besides restarting his immunosuppressive medications, tamoxifen therapy was initiated as definitive medical management. Currently, he is in clinical remission, follows at transplant clinic, and still experiences episodes of small bowel obstruction. Though the incidence of EPS after KT has been observed sporadically worldwide, none has been reported in the USA. Despite its prevalence in PD patients, therapeutic interventions attempted so far, are not definitive.
Use of Incentive Spirometry in Adults following Cardiac, Thoracic, and Upper Abdominal Surgery to Prevent Post-Operative Pulmonary Complications: A Systematic Review and Meta-Analysis
Authors: Sullivan Kerrie A. , Churchill Isabella F. , Hylton Danielle A. , Hanna Waël C.
Published: July 2021

Background: Currently, consensus on the effectiveness of incentive spirometry (IS) following cardiac, thoracic, and upper abdominal surgery has been based on randomized controlled trials (RCTs) and systematic reviews of lower methodological quality. To improve the quality of the research and to account for the effects of IS following thoracic surgery, in addition to cardiac and upper abdominal surgery, we performed a meta-analysis with thorough application of the Grading of Recommendations Assessment, Development and Evaluation scoring system and extensive reference to the Cochrane Handbook for Systematic Reviews of Interventions. Objective: The objective of this study was to determine, with rigorous methodology, whether IS for adult patients (18 years of age or older) undergoing cardiac, thoracic, or upper abdominal surgery significantly reduces30-day post-operative pulmonary complications (PPCs), 30-day mortality, and length of hospital stay (LHS) when compared to other rehabilitation strategies. Methods: The literature was searched using Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Web of Science for RCTs between the databases’ inception and March 2019. A random-effect model was selected to calculate risk ratios (RRs) with 95% confidence intervals (CIs). Results: Thirty-one RCTs involving 3,776 adults undergoing cardiac, thoracic, or upper abdominal surgery were included. By comparing the use of IS to other chest rehabilitation strategies, we found that IS alone did not significantly reduce 30-day PPCs (RR = 1.00, 95% CI: 0.88–1.13) or 30-day mortality (RR = 0.73, 95% CI: 0.42–1.25). Likewise, there was no difference in LHS (mean difference = −0.17,95% CI: −0.65 to 0.30) between IS and the other rehabilitation strategies. None of the included trials significantly impacted the sensitivity analysis and publication bias was not detected. Conclusions: This meta-analysis showed that IS alone likely results in little to no reduction in the number of adult patients with PPCs, in mortality, or in the LHS, following cardiac, thoracic, and upper abdominal surgery.
Choosing a Specialist: An Explanatory Study of Factors Influencing Patients in Choosing a Urologist
Authors: Tamalunas Alexander , Buchner Alexander , Hennenberg Martin , Stadelmeier Leo Federico , Höhn Henrik , Vilsmaier Theresa , Mumm Maja-Lena , Kolben Thomas , Stief Christian G. , Mumm Jan-Niclas
Published: July 2021

Objectives: While research on doctor-patient interaction has often focused on the decision-making abilities of physicians, it rarely centers around the question of how patients choose their respective practitioners. Research on fundamental decision processes is of high importance and understanding the factors that influence people’s choices in real-life decision-making would potentially provide patients, and physicians alike, with the means to provide better resources to achieve greater satisfaction from visits to a medical practitioner. Methods: At our tertiary referral center, patients were given the opportunity to voluntarily participate in our survey. We collected questionnaires from 1,002 patients during their visit from November 2018 to February 2020. Statistical analysis was performed using SPSS V26.0 software (SPSS Statistics, Version 26.0.; IBM, Armonk, NY, USA). Results are reported as percentages for categorial variables. Results: Our patient cohort consisted of a higher percentage of men than of women (82 vs. 18%) with significantly more men having a university-based education (44 vs. 31%; p = 0.001). Women were more likely to have statutory health insurance than men (85 vs. 74%; p = 0.013). Men significantly preferred to be treated by a doctor of the same sex (24 vs. 8%; p < 0.001), which significantly increased with age. Overall, more women than men trusted a referral by their primary care physician (75 vs. 66%, p = 0.017), while preference of a higher academic degree in the attending urologist was significantly correlated with the patients’ education. Conclusions: Information on a specialist, such as professional qualifications and academic accomplishments, is easily accessible to patients with or without access to the Internet. However, recommendations and referrals, in addition to consistent care by the same treating physician, seem to be of high importance to all patients, regardless of gender or age.
Diaphragm Pacing in Patients with Spinal Cord Injury: A European Experience
Authors: Wijkstra Peter J. , van der Aa Hans , Hofker H. Sijbrand , Curto Francesco , Giacomini Matteo , Stagni Giuliana , Dura Agullo Maria Asuncion , Curià Casanoves Francesc Xavier , Benito-Penalva Jesús , Martinez-Barenys Carlos , Vidal Joan
Published: July 2021

Background: Patients with high spinal cord injury (SCI) are unable to breathe on their own and require mechanical ventilation (MV). The long-term use of MV is associated with increased morbidity and mortality. In patients with intact phrenic nerve function, patients can be partially or completely removed from MV by directly stimulating the diaphragm motor points with a diaphragm pacing system (DPS). Objectives: We describe our multicenter European experience using DPS in SCI patients who required MV. Methods: We conducted a retrospective study of patients who were evaluated for the implantation of DPS. Patients evaluated for DPS who met the prospectively defined criteria of being at least 1 year of age, and having cervical injury resulting in a complete or partial dependency on MV were included. Patients who received DPS implants were followed for up to 1 year for device usage and safety. Results: Across 3 centers, 47 patients with high SCI were evaluated for DPS, and 34 were implanted. Twenty-one patients had 12 months of follow-up data with a median DPS use of 15 h/day (interquartile range 4, 24). Eight patients (38.1%) achieved complete MV weaning using DPS 24 h/day. Two DPS-related complications were surgical device revision and a wire eruption. No other major complications were associated with DPS use. Conclusions: Diaphragm pacing represents an attractive alternative stand-alone treatment or adjunctive therapy compared to MV in patients with high SCI. After a period of acclimation, the patients were able to reduce the daily use of MV, and many could be completely removed from MV.
Brown Adipose Tissue in Children and Its Metabolic Function
Authors: Tews Daniel , Wabitsch Martin
Published: July 2021

Background: To regulate body temperature, mammals possess brown adipose tissue (BAT), which converts significant amounts of chemical energy into heat. Due to its remarkable energy demand, BAT is currently discussed as a target organ to treat obesity and obesity-related disorders. Summary: Although BAT is predominantly present in infants and its relative mass declines with age, new findings suggest that BAT has a relevant role in the regulation of energy homeostasis as well as in the regulation of the energy substrates glucose and lipids in older children, adolescents, and adults. In this overview, we will outline basic mechanisms of BAT thermogenesis and the recently described physiological relevance of BAT in metabolism in children and adolescents. Key Message: The connection of BAT activity with glucose metabolism and insulin sensitivity seems to be evident from recent studies, implicating BAT as an important influencing factor in the context of metabolic syndrome.
A telerrealidade e o consumo de mundos
Authors: Souza Gabriel , Andres Fernanda Sagrilo
Published: July 2021

A presente investigação, partindo da percepção sobre a televisão como mediadora do mundo externo que produz outros efeitos de realidade, tem como objetivo compreender e problematizar a interferência da telerrealidade na construção dos mundos televisuais possíveis, na tentativa de atrair o telespectador/consumidor. Para tanto, discute o texto televisual em relação ao seu modelo de texto e aos outros textos com os quais estabelece vínculos, centrando-se nas estratégias discursivas empregadas pela televisão que ofertam ao consumo quatro realidades distintas.
Parece teorema, mas é só distração
Authors: Farias Luiz Alberto de
Published: July 2021

Resenha de CHARAUDEAU, P. A conquista da opinião pública – como o discurso manipula as escolhas políticas. Trad. Angela M. S. Corrêa. São Paulo: Contexto, 2020.
Incidence and Clinical Significance of Worsening Tricuspid Regurgitation Following Surgical or Transcatheter Aortic Valve Replacement: Analysis From the PARTNER IIA Trial
Authors: Cremer Paul C. , Wang Tom Kai Ming , Rodriguez L. Leonardo , Lindman Brian R. , Zhang Yiran , Zajarias Alan , Hahn Rebecca T. , Lerakis Stamatios , Malaisrie S. Chris , Douglas Pamela S. , Pibarot Philippe , Svensson Lars G. , Kapadia Samir , Leon Martin B. , Jaber Wael A. ,   on behalf of the PARTNER II Investigators
Published: July 2021

Background:

Aortic valve replacement (AVR) is recommended for severe symptomatic aortic stenosis. However, the incidence of worsening tricuspid regurgitation (TR) following transcatheter compared with surgical AVR (TAVR, SAVR), and the impact of worsening TR on outcomes, is ill-defined. Accordingly, among patients randomized to TAVR or SAVR, we describe the differential incidence of worsening TR and its association with survival.

Methods:

From the PARTNER IIA trial (Placement of Aortic Transcatheter Valves IIA), 1334 patients were included with baseline and 30-day postprocedure core-lab echocardiograms. Worsening TR was defined as deterioration of ≥1 grade from baseline to 30 days. Outcomes included cardiovascular and all-cause death between 30 days and 2 years. Multivariable logistic regression was performed to identify associations with worsening TR; survival analyses were performed to assess associations with mortality.

Results:

Worsening TR occurred in 17.3% (125/721) of TAVR and 27.0% (165/611) of SAVR patients. On multivariable analysis, SAVR (odds ratio, 2.09 [95% CI, 1.40–3.11]), female sex (odds ratio, 2.22 [95% CI, 1.44–3.42]), atrial fibrillation (odds ratio, 1.61 [95% CI, 1.03–2.51]), and right ventricular enlargement (odds ratio, 2.25 [95% CI, 1.17–4.31]) were associated with worsening TR. Cardiovascular and all-cause death occurred in 9.0% (26/290) and 17.9% (52/290) of patients with worsening TR, compared with 4.8% (50/1042) and 10.9% (114/1042) without worsening TR, respectively. In patients with worsening TR, cardiovascular and all-cause death were similar in TAVR compared with SAVR, (hazard ratio, 1.09 [95% CI, 0.55–2.16]) and (hazard ratio, 1.07 [95% CI, 0.62–1.87]), respectively. After adjustment, worsening TR was independently associated with cardiovascular (hazard ratio, 3.62 [95% CI, 2.08–6.29]) and all-cause death (hazard ratio, 2.11 [95% CI, 1.37–3.27]).

Conclusions:

Worsening TR is associated with female sex, atrial fibrillation, right ventricular enlargement, and SAVR. Regardless of mode of AVR, worsening TR is similarly associated with a poor prognosis. Future studies should focus on whether preventing or treating worsening TR improves outcomes.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01314313.
Marijuana Use and the Risk of Early Ischemic Stroke
Authors: Dutta Tara , Ryan Kathleen A. , Thompson Oluwatosin , Lopez Haley , Fecteau Natalie , Sparks Mary J. , Chaturvedi Seemant , Cronin Carolyn , Mehndiratta Prachi , Nunez Gonzalez Joel R. , Phipps Michael , Wozniak Marcella , McArdle Patrick F. , Kittner Steven J. , Cole John W.
Published: July 2021

Background and Purpose:

Few studies have examined the dose-response and temporal relationships between marijuana use and ischemic stroke while controlling for important confounders, including the amount of tobacco smoking. The purpose of our study was to address these knowledge gaps.

Methods:

A population-based case-control study with 1090 cases and 1152 controls was used to investigate the relationship of marijuana use and early-onset ischemic stroke. Cases were first-ever ischemic stroke between the ages of 15 and 49 identified from 59 hospitals in the Baltimore-Washington region. Controls obtained by random digit dialing from the same geographic region were frequency-matched to cases by age, sex, region of residence and, except for the initial study phase, race. After excluding subjects with cocaine and other vasoactive substance use, the final study sample consisted of 751 cases and 813 controls. All participants underwent standardized interviews to characterize stroke risk factors and marijuana use. Unconditional logistic regression analysis was used to assess the relationships between marijuana use and risk of ischemic stroke, adjusting for age, sex, race, study phase, the amount of current tobacco smoking, current alcohol use, hypertension, and diabetes.

Results:

After adjusting for other risk factors, including the amount of current tobacco smoking, marijuana use was not associated with ischemic stroke, regardless of the timing of use in relationship to the stroke, including ever use, use within 30 days, and use within 24 hours. There was a nonsignificant trend towards increased stroke risk among those who smoked marijuana at least once a week (odds ratio, 1.9 [95% CI, 0.8–4.9]).

Conclusions:

These analyses do not demonstrate an association between marijuana use and an increased risk of early-onset ischemic stroke, although statistical power was limited for assessing the association among very heavy users.
Optic Tract Shrinkage Limits Visual Restoration After Occipital Stroke
Authors: Fahrenthold Berkeley K. , Cavanaugh Matthew R. , Jang Subin , Murphy Allison J. , Ajina Sara , Bridge Holly , Huxlin Krystel R.
Published: July 2021

Background and Purpose:

Damage to the adult primary visual cortex (V1) causes vision loss in the contralateral visual hemifield, initiating a process of trans-synaptic retrograde degeneration. The present study examined functional implications of this process, asking if degeneration impacted the amount of visual recovery attainable from visual restoration training in chronic patients, and if restoration training impacted optic tract (OT) shrinkage.

Methods:

Magnetic resonance imaging was used to measure OT volumes bilaterally in 36 patients with unilateral occipital stroke. From OT volumes, we computed laterality indices (LI), estimating the stroke-induced OT shrinkage in each case. A subset of these chronic patients (n=14, 13±6 months poststroke) underwent an average of nearly 1 year of daily visual restoration training, which repeatedly stimulated vision in their blind field. The amount of visual field recovery was quantified using Humphrey perimetry, and post training magnetic resonance imaging was used to assess the impact of training on OT shrinkage.

Results:

OT LI was correlated with time since stroke: it was close to 0 (no measurable OT shrinkage) in subacute participants (<6 months poststroke) while chronic participants (>6 months poststroke) exhibited LI >0, but with significant variability. Visual training did not systematically alter LI, but chronic patients with baseline LI≈0 (no OT shrinkage) exhibited greater visual field recovery than those with LI>0.

Conclusions:

Unilateral OT shrinkage becomes detectable with magnetic resonance imaging by ≈7 months poststroke, albeit with significant interindividual variability. Although visual restoration training did not alter the amount of degeneration already sustained, OT shrinkage appeared to serve as a biomarker of the potential for training-induced visual recovery in chronic cortically blind patients.
Living Death: Imagined History and the Tarrant Manifesto
Authors: Harwood Max
Published: July 2021

This essay analyses the manifesto of terrorist Brenton Tarrant, the perpetrator of the 2019 Christchurch mosque shootings. Reading Tarrant’s manifesto (The Great Replacement) as a cultural artefact of digital white nationalism, it is possible to identify a specific worldview and emotional subjectivity that is also shared with the actions and writing of Anders Breivik, the perpetrator of the 2011 Oslo and Utøya massacre. After examining both terrorists’ manifestos, their biographical particulars and drawing from ethnographic research into the online communities that Tarrant frequented, a shared phenomenological framework emerges. This framework is presented as ‘the imagined past and present’ of the Replacement Theory terrorist. This essay will address these white nationalist imaginings via a cultural exegesis of Tarrant’s and Breivik’s manifestos, as well as an analysis of their comparable monastic aesthetic or ‘living death’ in the lead up to their attacks.
Along-Wind Dispersion by Horizontal Turbulent Jets in the Upper Ocean
Authors: Kukulka Tobias , Thoman Todd X.
Published: July 2021

Dispersion processes in the ocean surface boundary layer (OSBL) determine marine material distributions such as those of plankton and pollutants. Sheared velocities drive shear dispersion, which is traditionally assumed to be due to mean horizontal currents that decrease from the surface. However, OSBL turbulence supports along-wind jets; located in near-surface convergence and downwelling regions, such turbulent jets contain strong local shear. Through wind-driven idealized and large-eddy simulation (LES) models of the OSBL, this study examines the role of turbulent along-wind jets in dispersing material. In the idealized model, turbulent jets are generated by prescribed cellular flow with surface convergence and associated downwelling regions. Numeric and analytic model solutions reveal that horizontal jets substantially contribute to along-wind dispersion for sufficiently strong cellular flows and exceed contributions due to vertical mean shear for buoyant surface-trapped material. However, surface convergence regions also accumulate surface-trapped material, reducing shear dispersion by jets. Turbulence resolving LES results of a coastal depth-limited ocean agree qualitatively with the idealized model and reveal long-lived coherent jet structures that are necessary for effective jet dispersion. These coastal results indicate substantial jet contributions to along-wind dispersion. However, jet dispersion is likely less effective in the open ocean because jets are shorter lived, less organized, and distorted due to spiraling Ekman currents.
Optimized intelligent algorithm for classifying cloud particles recorded by a Cloud Particle Imager
Authors: Wu Zepei , Liu Shuo , Zhao Delong , Yang Ling , Xu Zixin , Yang Zhipeng , Liu Dantong , Liu Tao , Ding Yan , Zhou Wei , He Hui , Huang Mengyu , Li Ruijie , Ding Deping
Published: July 2021

Cloud particles have different shapes in the atmosphere. Research on cloud particle shapes plays an important role in analyzing the growth of ice crystals and the cloud microphysics. To achieve an accurate and efficient classification algorithm on ice crystal images, this study uses image-based morphological processing and principal component analysis, to extract features of images and apply intelligent classification algorithms for the Cloud Particle Imager (CPI). Currently, there are mainly two types of ice-crystal classification methods: one is the mode parameterization scheme, and the other is the artificial intelligence model. Combined with data feature extraction, the dataset was tested on ten types of classifiers, and the highest average accuracy was 99.07%. The fastest processing speed of the real-time data processing test was 2,000 images/s. In actual application, the algorithm should consider the processing speed, because the images are in the order of millions. Therefore, a support vector machine (SVM) classifier was used in this study. The SVM-based optimization algorithm can classify ice crystals into nine classes with an average accuracy of 95%, blurred frame accuracy of 100%, with a processing speed of 2,000 images/s. This method has a relatively high accuracy and faster classification processing speed than the classic neural network model. The new method could be also applied in physical parameter analysis of cloud microphysics.
Half a cubic hectometer mooring array of 3000 temperature sensors in the deep sea
Authors: van Haren Hans , Bakker Roel , Witte Yvo , Laan Martin , van Heerwaarden Johan
Published: July 2021

The redistribution of matter in the deep-sea depends on water-flow currents and turbulent exchange, for which breaking internal waves are an important source. As internal waves and turbulence are essentially three-dimensional ‘3D’, their dynamical development should ideally be studied in a volume of seawater. However, this is seldom done in the ocean where 1D-observations along a single vertical line are already difficult. We present the design, construction and successful deployment of a half-cubic-hectometer (480,000 m3) 3D-T mooring array holding 2925 high-resolution temperature sensors to study weakly density-stratified waters of the 2500-m deep Western Mediterranean. The stand-alone array samples temperature at a rate of 0.5 Hz, with precision <0.5 mK, noise level <0.1 mK and expected endurance of 3 years. The independent sensors are synchronized inductively every 4 h to a single standard clock. The array consists of 45 vertical lines 125 m long, at 9.5 m horizontally from their nearest neighbor. Each line is held under tension of 1.3 kN by a buoyancy element that is released chemically one week after deployment. All fold-up lines are attached to a grid of cables that is tensioned in a 70 m diameter ring of steel tubes. The array is build-up in harbor-waters, with air filling the steel tubes for floatation. The flat-form array is towed to the mooring site under favorable sea-state conditions. By opening valves in the steel tubes, the array is sunk and its free-fall is controlled by a custom-made drag-parachute reducing the average sinking speed to 1.3 m s-1 and providing smooth horizontal landing on the flat seafloor.
Future Projections of Heat Mortality Risk for Major European Cities
Authors: Karwat Alexia , Franzke Christian L. E.
Published: July 2021

Over the last few decades heat waves have intensified and have led to excess mortality. While the probability of being affected by heat stress has significantly increased, the risk of heat mortality is rarely quantified. This quantification of heat mortality risk is necessary for systematic adaptation measures. Furthermore, heat mortality records are sparse and short, which presents a challenge for assessing heat mortality risk for future climate projections. It is therefore crucial to derive indicators for a systematic heat mortality risk assessment. Here, risk indicators based on temperature and mortality data are developed and applied to major cities in Germany, France and Spain, using regional climate model simulations. Bias-corrected daily maximum, minimum and wet-bulb temperatures show increasing trends in future climate projections for most considered cities. Additionally, we derive a relationship between daily maximum temperatures and mortality for producing future projections of heat mortality risk due to extreme temperatures based on low (Representative Concentration Pathway; RCP2.6) and high (RCP8.5) emission scenario future climate projections. Our results illustrate that heat mortality increases by about 0.9%/decade in Germany, 1.7%/decade in France and 7.9%/decade in Spain for RCP8.5 by 2050. The future climate projections also show that wet-bulb temperatures above 30°Cwill be reached regularly with maxima above 40°Clikely by 2050. Our results suggest a significant increase of heat mortality in the future, especially in Spain. On average, our results indicate that the mortality risk trend is almost twice as high in all three countries for the RCP8.5 scenario compared to RCP2.6.
Short-Term Outcomes Following Removal of Infected Hernia Mesh
Authors: Tung Christine , Ozao-Choy Junko , Kim Dennis Y. , de Virgilio Christian , Moazzez Ashkan
Published: July 2021

There are limited studies regarding outcomes of replacing an infected mesh with another mesh. We reviewed short-term outcomes following infected mesh removal and whether placement of new mesh is associated with worse outcomes. Patients who underwent hernia repair with infected mesh removal were identified from 2005 to 2018 American College of Surgeons-National Surgical Quality Improvement Program database. They were divided into new mesh (Mesh+) or no mesh (Mesh-) groups. Bivariate and multivariate logistic regression analyses were used to compare morbidity between the two groups and to identify associated risk factors. Of 1660 patients, 49.3% received new mesh, with higher morbidity in the Mesh+ (35.9% vs. 30.3%; P = .016), but without higher rates of surgical site infection (SSI) (21.3% vs. 19.7%; P = .465). Mesh+ had higher rates of acute kidney injury (1.3% vs. .4%; P = .028), UTI (3.1% vs. 1.3%, P = .014), ventilator dependence (4.9% vs. 2.4%; P = .006), and longer LOS (8.6 vs. 7 days, P < .001). Multivariate logistic regression showed new mesh placement (OR: 1.41; 95% CI: 1.07-1.85; P = .014), body mass index (OR: 1.02; 95% CI: 1.00-1.03; P = .022), and smoking (OR: 1.43; 95% CI: 1.05-1.95; P = .025) as risk factors independently associated with increased morbidity. New mesh placement at time of infected mesh removal is associated with increased morbidity but not with SSI. Body mass index and smoking history continue to contribute to postoperative morbidity during subsequent operations for complications.
Posterior Mediastinal Goiter Removal Through Cervical Incision
Authors: Gupta Komal , Gupta Neha , Kataria Kamal
Published: July 2021

Intrathoracic goiter when encountered can be treated by thyroidectomy using cervical incision, only occasionally requiring extra cervical approach. We are reporting one such case in a patient with pituitary macroadenoma with extension of the adenomatous goiter into the posterior mediastinum. It was removed through the cervical collar incision using a vessel sealing device. There were no intraoperative and postoperative complications during the procedure. The need for extra cervical incision should be decided on a case-to-case basis to avoid the increased morbidity associated with sternotomy and lateral thoracotomy incision.
Does Gender Matter: A Multi-Institutional Analysis of Viscoelastic Profiles for 1565 Trauma Patients With Severe Hemorrhage
Authors: Smith Alison , Duchesne Juan , Marturano Matthew , Lawicki Shaun , Sexton Kevin , Taylor John R. , Richards Justin , Harris Charles , Moreno-Ponte Oscar , Cannon Jeremy W. , Guzman Jessica F. , Pickett Maryanne L. , Cripps Michael W. , Curry Terry , Costantini Todd , Guidry Chrissy
Published: July 2021

Background

Viscoelastic tests including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) are being used in patients with severe hemorrhage at trauma centers to guide resuscitation. Several recent studies demonstrated hypercoagulability in female trauma patients that was associated with a survival advantage. The objective of our study was to elucidate the effects of gender differences in TEG/ROTEM values on survival in trauma patients with severe hemorrhage.

Methods

A retrospective review of consecutive adult patients receiving massive transfusion protocol (MTP) at 7 Level I trauma centers was performed from 2013 to 2018. Data were stratified by gender and then further examined by TEG or ROTEM parameters. Results were analyzed using univariate and multi-variate analyses.

Results

A total of 1565 patients were included with 70.9% male gender (n = 1110/1565). Female trauma patients were older than male patients (43.5 ± .9 vs 41.1 ± .6 years, P = .01). On TEG, females had longer reaction times (6.1 ± .9 min vs 4.8 ± .2 min, P = .03), increased alpha angle (68.6 ± .8 vs 65.7 ± .4, P < .001), and higher maximum amplitude (59.8 ± .8 vs 56.3 ± .4, P < .001). On ROTEM, females had significantly longer clot time (99.2 ± 13.7 vs 75.1 ± 2.6 sec, P = .09) and clot formation time (153.6 ± 10.6 sec vs 106.9 ± 3.8 sec, P < .001). When comparing by gender, no difference for in-hospital mortality was found for patients in the TEG or ROTEM group ( P > .05). Multivariate analysis showed no survival difference for female patients (OR 1.11, 95% CI .83-1.50, P = .48).

Conclusions

Although a difference between male and females was found on TEG/ROTEM for certain clotting parameters, no difference in mortality was observed. Prospective multi-institutional studies are needed.
Urban Principal Autonomy and the Goldilocks Dilemma: Considering the Nature and Limits of Principal Power in New York City
Authors: Peck Craig , Lewis-Durham Tiffanie
Published: July 2021

Some contemporary urban educational reformers believe that empowering principals with increased school-based autonomy will help them lead educational improvement more effectively. We consider this popular reform idea by examining how principals experienced and exerted autonomy in different forms in two distinct eras in New York City. Our findings suggest that principal autonomy as a centrally planned reform strategy for urban education encounters a Goldilocks dilemma: principal power is almost inevitably too hot or too cold, but never just right. However, principals can and do assert self-sourced autonomy in which they recognize and exercise whatever power they may have within prevailing organizational constraints, conditions, and restrictions. We conclude by examining implications.
Dante’s claims in and around Paradiso 25
Authors: Pertile Lino
Published: July 2021

The extraordinary claims that Dante makes in cantos 24–26 of Paradiso with regard to both his theoretical knowledge and his actual ‘possession’ of the three theological virtues – Faith, Hope and Charity – do not seem to be entirely consistent with the story of a character who, only a few days earlier, was struggling in the dark forest and about to succumb to intellectual bewilderment and moral straying. Why else was that character so close to spiritual death if not because he lacked those virtues which he now claims to know so profoundly and hold in supreme measure? This paper argues first, that Dante here transcends any distinction that may operate elsewhere in the poem between Dante as character, narrator and author; second, that his claims make sense in the context of his circumstances at the time when he composed cantos 24–26 of Paradiso, i.e. on or just before 1320, twenty years after the fictional date of his journey to the Otherworld; and third, that he is likely to have made such claims in order to preempt any attack on himself, his poem and his mission as theologian, prophet and reformer of the Church.
Examining Adult E-cigarette Use in Kentucky and Its Appalachian Region Using the Behavioral Risk Factor Surveillance System, 2016-2017
Authors: Christian W. Jay , Valvi Nimish R. , Walker Courtney J.
Published: July 2021

Objectives

Electronic cigarette (e-cigarette) use has increased steadily in the United States, but little research has examined its prevalence in states comprising Appalachia, a rural region known for high rates of tobacco use. This study assessed lifetime and current e-cigarette use among adults by sociodemographic characteristics, geographic region, and cigarette smoking in Kentucky, with a focus on the Appalachian region.

Methods

We used data from the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys to calculate the prevalence of lifetime and current e-cigarette use, and we used weighted multivariable logistic regression analyses to examine the relative influence of other factors.

Results

Among adults in Kentucky, 5.8% (95% CI, 5.2%-6.4%) were current e-cigarette users and 27.0% (95% CI, 25.9%-28.0%) were lifetime users, compared with state medians of 4.6% (95% CI, 4.0%-5.1%) and 21.4% (95% CI, 19.4%-23.5%) for the United States. Multivariable regression models showed similar patterns for all regions: higher prevalence odds of current e-cigarette use among adults aged 18-24, current conventional smokers, and adults unable to work. Generally, Appalachian residents of Kentucky did not have significantly higher rates of lifetime or current e-cigarette use as compared with other non-Appalachian residents of Kentucky. Hispanic residents of Appalachian Kentucky, however, had higher rates of e-cigarette use than Hispanic residents of other regions of Kentucky.

Conclusions

Rates of e-cigarette use were higher in Kentucky than in the United States but were not further elevated in Kentucky’s Appalachian region. High rates of e-cigarette use among Hispanic residents of Appalachia indicate a need to focus future interventions in the region.
Exploration of the Effects of Protective Person–Environment Factors Between Functional Impairments and Stress in Individuals With Multiple Sclerosis: Mediation and Moderation Analyses
Authors: Lee Beatrice , Tansey Timothy N. , Chan Fong , Bishop Malachy , Hoyt William T. , Hancock Laura M.
Published: July 2021

Functional impairments can lead to stress in individuals with multiple sclerosis (MS). The study examined protective person and environment factors (i.e., positive cognitive stress appraisal, core self-evaluations [CSE], resilience, hope, spirituality, social support, and environmental supports) as both mediators and moderators of this association to guide understanding of the experience of stress in this population. The sample consisted of 373 participants with MS. In simple mediation analyses, positive cognitive stress appraisal, CSE, resilience, hope, social support, and environmental supports served as a partial mediator between functional impairments and stress. In a parallel mediation analysis, significant unique indirect effects were observed for two of the seven hypothesized mediator variables (CSE and environmental supports). Separate moderator tests provided support for the CSE variable as a protective factor. The positive association between functional impairments and stress was weaker for persons reporting high CSE compared with those reporting low CSE. The findings provide implications for rehabilitation counseling practices by promoting CSE and environmental supports in improving rehabilitation and psychosocial outcomes for individuals with MS.
Becoming a skinhead: An ethnobiography of brutalized life and reflective violence
Authors: Beauchez Jérôme
Published: July 2021

This article paints the portrait of Yvan, a skinhead who lived in close proximity to the streets and to life at the margins, with all its attendant violence, before dying at the age of 28. While the salient features of this portrait might seem to be social relegation and brutal racism, the value of this text is to be found in the complexity and nuance that Yvan brought to the descriptions of his own life. This insider perspective follows on from the tradition of biographical studies dedicated to the process of ‘becoming deviant’ inaugurated by the first sociologists of the Chicago School, while at the same time providing the material for a theoretical proposition expressed through the concepts of brutalized life and reflective violence. Much of Yvan’s life was a litany of violence, which he first endured, then threw back in society’s face and perpetrated himself, no doubt precisely because this life of his had been brutalized by such all-permeating violence. These two concepts have the potential to be extended to other cases and to enrich sociological debates about forms of violence that cannot fully be explained by situational and practical approaches (such as those of Randall Collins), or by perspectives that focus on structural and symbolic factors (as in the sociology of Pierre Bourdieu). The notions of reflective violence and brutalized life therefore transcend Yvan’s biography to form his sociological legacy.
Using e-mail as performance feedback to teach paraprofessionals to implement constant time delay with braille words
Authors: Rhoads Carlie R. , Carter Erik W.
Published: July 2021

Equipping paraprofessionals to implement evidence-based instructional practices with fidelity can enhance the education of students with visual impairments. We used a multiple probe across participants design to evaluate the ability of paraprofessionals to follow constant time delay procedures with high fidelity when teaching braille words. We delivered performance feedback by e-mail and examined student learning outcomes. All three paraprofessionals achieved 100% correct implementation of constant time delay and maintained this high level of implementation over time. All three students successfully learned the targeted words. The combination of the training and support with e-mail feedback was effective at equipping them to deliver an evidence-based practice. Paraprofessionals affirmed the social validity of the intervention and considered e-mail performance feedback as an easy-to-understand way of receiving much-needed guidance. E-mail feedback is a cost-effective and simple tool for providing constructive feedback, while also ensuring paraprofessionals deliver instruction with high fidelity.
‘Never let a good crisis go to waste’ – The 2020 Business Information Review Survey: Part III
Authors: Phillips Stephen
Published: July 2021

Part III of the 2020 Business Information Review survey, this is the world’s longest running conversation about business information services and their management, which is celebrating its 30th anniversary. The third installment of the 2020 survey captures the participants’ reflections on a range of topics that are shaping their operations including supplier relations, client engagement as well as providing a summary of their 2021 priorities.
A variant in the 3ʹ-untranslated region of the MC2R gene decreases the risk of schizophrenia in a female Han Chinese population
Authors: Tang Liang , Xiang Qin , Xiang Ju , Li Jianming , Chen Danna
Published: July 2021

Objective

Schizophrenia is a complex mental disorder with high heritability. The hypothalamic–pituitary–adrenal (HPA) axis, which is the stress system of the neuroendocrine system, is considered to impact psychotic disorders. We hypothesized that polymorphisms of HPA axis genes might be involved in the development of schizophrenia.

Methods

A case–control study comprising 234 patients with schizophrenia and 399 matched healthy controls was conducted to investigate the association between the human melanocortin 2 receptor (MC2R) gene and schizophrenia risk. Seven tag single nucleotide polymorphisms (SNPs) (rs16941303, rs16941314, rs2186944, rs28926188, rs7230126, rs948322, and rs948331) of MC2R were genotyped by direct sequencing.

Results

No significant associations were observed between any of the alleles, genotypes, or haplotypes examined within the MC2R gene and the risk of schizophrenia in the total group or in subgroups stratified by smoking or alcoholism. However, a subgroup analysis stratified by sex revealed that under the additive model, the C allele of the MC2R rs948331 SNP significantly decreased the risk of schizophrenia in females (odds ratio=0.18).

Conclusion

The C allele of the MC2R rs948331 locus may be a protective factor, reducing the risk of schizophrenia in the female Han Chinese population.
Histopathology is required to identify and characterize myopathies in high-throughput phenotype screening of genetically engineered mice
Authors: Vogel Peter , Read Robert W. , Hansen Gwenn M. , Powell David R.
Published: July 2021

The development of mouse models that replicate the genetic and pathological features of human disease is important in preclinical research because these types of models enable the completion of meaningful pharmacokinetic, safety, and efficacy studies. Numerous relevant mouse models of human disease have been discovered in high-throughput screening programs, but there are important specific phenotypes revealed by histopathology that are not reliably detected by any other physiological or behavioral screening tests. As part of comprehensive phenotypic analyses of over 4000 knockout (KO) mice, histopathology identified 12 lines of KO mice with lesions indicative of an autosomal recessive myopathy. This report includes a brief summary of histological and other findings in these 12 lines. Notably, the inverted screen test detected muscle weakness in only 4 of these 12 lines ( Scyl1, Plpp7, Chkb, and Asnsd1), all 4 of which have been previously recognized and published. In contrast, 6 of 8 KO lines showing negative or inconclusive findings on the inverted screen test ( Plppr2, Pnpla7, Tenm1, Srpk3, Sidt2, Yif1b, Mrs2, and Pnpla2) had not been previously identified as having myopathies. These findings support the need to include histopathology in phenotype screening protocols in order to identify novel genetic myopathies that are not clinically evident or not detected by the inverted screen test.
Feline pyloric and duodenal adenoma: A histological and immunohistochemical study
Authors: Uneyama Mizuho , Chambers James K. , Nakashima Ko , Uchida Kazuyuki
Published: July 2021

Although pyloric and duodenal adenomas occasionally occur in cats, limited information is currently available on their phenotypes and molecular features. The present study investigated the pathological features of these tumors and the mechanisms underlying their tumorigenesis. Biopsy samples from 8 cats diagnosed with pyloric or duodenal adenomas were examined by histopathology and immunohistochemistry. Normal pyloric and duodenal tissues of cats were assessed for comparison. All cases showed a papillary growth of cuboidal to columnar cells with eosinophilic, ground-glass cytoplasm. Mucin in tumor cells was positive for periodic acid–Schiff and paradoxical concanavalin-A staining, but was negative for Alcian blue. Immunohistochemically, tumor cells were positive for cytokeratin (CK) 19 in 8/8 cases and for CK20 in 5/8 cases, and weakly positive for CD10 in 4/8 cases, CK7 in 3/8 cases, and β-catenin in 2/8 cases. Nuclear accumulation of p53 was not detected in any case. DNA sequencing analysis identified no KRAS or GNAS mutations in the 4/8 cases and 5/8 cases for which the KRAS and GNAS genes could be amplified. The histological and immunohistochemical features of tumor cells were similar to those of mucous neck cells and the pyloric gland of normal feline tissue. The morphology of feline pyloric and duodenal adenomas was consistent with that of pyloric gland adenoma in humans; however, its molecular pathogenesis may differ given the lack of KRAS and GNAS mutations in the feline tumors.
En-Masse Distalization of Class I Bimaxillary Protrusion Treated with Damon System Using Infrazygomatic and Buccal Shelf Bone Screw: A Case Report
Authors: Shaikh Analhaq Anvarhushen , G. Arun Kumar , GC Ramesh , Chinthan Ganesh
Published: July 2021

Here is a case report of a 20-year-old female patient with skeletal Class I malocclusion, with Angle’s Class I molar relation on the right and super Class I molar relation on the left side. The patient was diagnosed with hyperdivergent face pattern, proclined upper and lower anteriors, convex profile, potentially competent lips, short upper lip, average nasolabial angle, and anterior facial divergence. Treatment was organized by Damon System and En-masse distalization using the Infrazygomatic Crest and buccal shelf bone screws. The facial changes produced as a result of treatment were directly related to skeletal and dentoalveolar modifications that were designed as goals for patient treatment. It provided a minimal friction environment for the full-arch distalization. In this borderline bimaxillary protrusion case with a good profile, en-masse distalization turned out to be a better option than extracting the premolars and retracting incisors. It also stands out to be an example for the management of the same.
An Unrecognized Problem in Optimizing Antimicrobial Therapy: Significant Residual Volume Remaining in Intravenous Tubing With Extended-Infusion Piperacillin–Tazobactam
Authors: Peyko Vincent
Published: July 2021

The fundamental process of medication therapy is that a medication is ordered, verified, and entirely administered to the patient. An unrecognized phenomenon across the antimicrobial landscape may be residual volume remaining within intravenous tubing, never getting to the patient. Evidence suggests that 40–60% of an antimicrobial may remain in the intravenous tubing. Across the globe, residual volume may be affecting thousands to millions of patients receiving antimicrobials each year. While residual volume may be profound for all antimicrobials, the challenges to remedy this problem are more imposing with extended-infusion administration techniques. The purpose of this article is to highlight residual volume as a potential problem in optimizing extended-infusion antimicrobial therapy with agents like piperacillin–tazobactam. Furthermore, to emphasize that recognizing this issue for antimicrobials and other medications is imperative for providers to assure every patient is receiving the medication ordered, in its entirety, to avert medication errors and optimize patient care.
On the edge of diversity: Anti-Muslim racism and discrimination in white diversity spaces
Authors: Doytcheva Milena
Published: July 2021

This article traces the development over the last decades in France of anti-Muslim racism and discrimination within professional and organisational fields. It shows how, in the wake of 2004 law banning religious symbols in schools, new demands for religious neutrality have spread far beyond educational grounds, to permeate a variety of institutions, including those purportedly designed to fight against discrimination and achieve equality. Drawing on a longitudinal, qualitative analysis of workplace diversity policies, I show the eviction of faith diversity from corporate diversity procedures through the implementation of ‘white diversity’ concepts, based on two tenets: first, patterns of Muslim racialisation, as faith options are turned into ‘personality styles’ and ‘identity problems’; second, the perceived legitimacy and widespread social acceptance of this ‘respectable racism’, woven into claims upon meritocracy, and disguised as ‘corporate culture’.