bluuebunny/crossref_metadata_2025 huggingface dataset:
Tenecteplase Thrombolysis for Acute Ischemic Stroke
Authors: Warach Steven J. , Dula Adrienne N. , Milling Truman J.
Published: October 2020

Tenecteplase is a fibrinolytic drug with higher fibrin specificity and longer half-life than the standard stroke thrombolytic, alteplase, permitting the convenience of single bolus administration. Tenecteplase, at 0.5 mg/kg, has regulatory approval to treat ST-segment–elevation myocardial infarction, for which it has equivalent 30-day mortality and fewer systemic hemorrhages. Investigated as a thrombolytic for ischemic stroke over the past 15 years, tenecteplase is currently being studied in several phase 3 trials. Based on a systematic literature search, we provide a qualitative synthesis of published stroke clinical trials of tenecteplase that (1) performed randomized comparisons with alteplase, (2) compared different doses of tenecteplase, or (3) provided unique quantitative meta-analyses. Four phase 2 and one phase 3 study performed randomized comparisons with alteplase. These and other phase 2 studies compared different tenecteplase doses and effects on early outcomes of recanalization, reperfusion, and substantial neurological improvement, as well as symptomatic intracranial hemorrhage and 3-month disability on the modified Rankin Scale. Although no single trial prospectively demonstrated superiority or noninferiority of tenecteplase on clinical outcome, meta-analyses of these trials (1585 patients randomized) point to tenecteplase superiority in recanalization of large vessel occlusions and noninferiority in disability-free 3-month outcome, without increases in symptomatic intracranial hemorrhage or mortality. Doses of 0.25 and 0.4 mg/kg have been tested, but no advantage of the higher dose has been suggested by the results. Current clinical practice guidelines for stroke include intravenous tenecteplase at either dose as a second-tier option, with the 0.25 mg/kg dose recommended for large vessel occlusions, based on a phase 2 trial that demonstrated superior recanalization and improved 3-month outcome relative to alteplase. Ongoing randomized phase 3 trials may better define the comparative risks and benefits of tenecteplase and alteplase for stroke thrombolysis and answer questions of tenecteplase efficacy in the >4.5-hour time window, in wake-up stroke, and in combination with endovascular thrombectomy.
Nature and Impact of Chinese and South African Engagement on the Development of the City of Lusaka
Authors: Li Hangwei , Siame Gilbert
Published: October 2020

As Zambia’s chief administrative centre and a major financial, transportation, and manufacturing hub for the country, the City of Lusaka has become one of the fasted growing cities in Southern Africa. Encouraged by the Chinese government’s ‘going out’ policy, Chinese investment and trade with Zambia have risen dramatically since the 2000s. Chinese investment is increasingly shaping the growth of Lusaka City and its hinterland in significant ways. On the other hand, South Africa as a regional geo-economic power has also amplified its strategic engagement with Lusaka. The paper explores how these two geo-economic powers have shaped the development of the City of Lusaka. Findings show that investments from South Africa into the City are private capital backed and are predominantly in the retail and real estate sectors. Chinese engagement in the city are dominated by large government-related construction projects, which have often been state-backed. Analysing the findings through the lens of urban assemblage and polarisation, the paper argues that the City is increasingly becoming more socio-spatially divided with the poor being more adversely affected by the nature and location of investments.
The Dragon’s March into the Indian Ocean: Implications for International Trade
Authors: Jonyo Fred , Mbutu Samuel
Published: October 2020

This article reviews China’s engagement in the Indian Ocean Region, implications for international trade and strategies to mitigate its vulnerabilities. Premised on maritime theory, it argues that China’s interests in the Indian Ocean will influence its relations with India, extra-regional powers and African states. China is likely to leverage on its presence in the Indian Ocean to boost its levels of international trade volumes, while at the same time forge alternative strategies such as string of pearls, Maritime Silk Road and access through Myanmar to mitigate its vulnerabilities in the region.
International Human Rights Law and the Response to the covid-19 Pandemic
Authors: Joseph Sarah
Published: October 2020

States have duties under Article 12(2)(c) of the International Covenant on Economic, Social and Cultural Rights and Article 6 of the International Covenant on Civil and Political Rights to prevent, control and treat covid-19. Implementation of these three obligations is analysed, taking account of countervailing human rights considerations. Regarding prevention, lockdowns designed to stop the spread of the virus are examined. Control measures are then discussed, namely transparency measures, quarantine, testing and tracing. The human rights compatibility of treatment measures, namely the provision of adequate medical and hospital care (or the failure to do so), are then examined. Finally, derogations from human rights treaties in times of pubic emergency are discussed.
Characterization of depressed bipolar patients with current suicidal ideation
Authors: Nobile Bénédicte , Dubois Jonathan , Aouizerate Bruno , Aubin Valerie , Loftus Joséphine , Bellivier Frank , Belzeaux Raoul , Dubertret Caroline , Gard Sebastien , Haffen Emmanuel , Schwan Raymund , Llorca Pierre-Michel , Passerieux Christine , Roux Paul , Polosan Mircea , Etain Bruno , Leboyer Marion ,   FondaMental Advanced Centres of Expertise in Bipolar Disorders (FACE-BD) Collaborators, Courtet Philippe , Olié Emilie
Published: October 2020

Objective:

Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30–50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up.

Methods:

Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery–Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline ( N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology–Self Report ( N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology–Self Report score <2 ( N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years.

Results:

Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology).

Conclusions:

Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.
Parental Control as a Stimulus for Youth Control: Mediating the Parental Knowledge–Child Delinquency Relationship With Cognitive Impulsivity
Authors: Walters Glenn D.
Published: October 2020

Parental knowledge was investigated as a foil to reactive criminal thinking, as represented in the current study by cognitive impulsivity. Cognitive impulsivity and neutralization were tested as mediators of the parental knowledge–child delinquency relationship in 1,734 early adolescents (811 boys, 923 girls) from the Gang Resistance and Education Training (GREAT) study. A path analysis of the first three waves of GREAT data revealed that Wave 2 cognitive impulsivity but not Wave 2 neutralization techniques negatively mediated the link between Wave 1 parental knowledge and Wave 3 child delinquency. These results were replicated in variables measured at Waves 2 through 4. Parental control, in the form of parental knowledge and monitoring, may therefore prevent delinquency by countering cognitive impulsivity.
Demanding Reduction: A County-level Analysis Examining Structural Determinants of Human Trafficking Arrests in Florida
Authors: Diaz Madelyn , Huff-Corzine Lin , Corzine Jay
Published: October 2020

Academic literature has placed increased focus on understanding the complexities of human trafficking cases, but a gap in literature persists on assessing structural determinants that may impact the number of identified human trafficking arrests. As such, using administrative data on human trafficking arrests from 2013 to 2017, in the present study we examine the influence that macro-level social disorganization indicators, physical characteristics, and criminality rates have on human trafficking arrests in the state of Florida. Results reveal that counties with a higher number of human trafficking arrests were associated with higher levels of residential instability, a greater count of police agencies, as well as, lower levels of concentrated disadvantage and drug arrest rates. We close with directions for future research and anti-trafficking policy recommendations.
Optimal design of high-performance aerostatic equipment based on finite difference method with flux error feedback
Authors: Lai Tao , Peng Xiaoqiang , Liu Junfeng
Published: October 2020

This paper proposes an aerostatic lubrication model with the use of finite difference method, and the solution of the model is designed with the combination of flux error feedback and grid parameter optimization. The model and solution are validated by the performance test on the slider with the diameter of orifice at 50 and 200 μm. Finally, the proposed model is applied to the optimal design of the aerostatic turntable, and the type, parameter and configuration of the restriction are determined by the optimal results. To guarantee the accuracy of key parts, the ultra-precision turning technology is applied to manufacture of turntable, and the runout of the end face meets the design requirements through the verification. The proposed model and solution are significant to the analysis and design of high-performance aerostatic equipments.
Developing a New Shadowing Procedure for Japanese EFL Learners
Authors: Hamada Yo
Published: October 2020

Shadowing, a practice of repeating what one hears as simultaneously and accurately as possible, has been researched in the Teaching English to Speakers of Other Languages (TESOL) field for years. The research findings have shown that shadowing contributes to English as a Foreign Language (EFL) learners’ bottom-up listening skills, which leads to their overall listening comprehension skills. However, the accumulated research findings have not uncovered what aspects of bottom-up skills shadowing precisely contributes to. Thus, this study attempts to examine the aspects of bottom-up skills to which shadowing contributes and proposes a new shadowing procedure to compensate for the limitation of the current shadowing procedure. To this end, a preliminary study and a primary study were conducted. In the preliminary study, the bottom-up skill development through shadowing practice was precisely examined, using a 112-item bottom-up listening test. Thirty-six Japanese university students participated in the experiment and engaged in shadowing practice in eight lessons for a month. The result showed that shadowing practice was effective for developing the skill of identifying prominence in a speech, and word recognition skills but not effective for enhancing phonemic discrimination skills. In the primary study, to overcome the limitation of the shadowing procedure, a new shadowing procedure including three components of attention to output, corrective feedback, and explicit instruction was proposed. Twelve Japanese university students participated and engaged in the new shadowing procedure for three months. Their progress was assessed by a 32-item phonemic discrimination test, and the result showed that the new output-based shadowing procedure with explicit instruction and corrective feedback improved phonemic discrimination skills for intermediate level Japanese EFL learners.
Influences of Position Justification on Perceived Bias: Immediate Effects and Carryover Across Persuasive Messages
Authors: Wallace Laura E. , Wegener Duane T. , Quinn Madison E. , Ross Anna J.
Published: October 2020

The current research examined how people infer whether novel sources are biased based on their ability to justify their position. Across nine studies, when sources provided weak versus strong arguments, message recipients perceived the source as more biased. This effect held controlling for other possible inferences, such as lack of expertise or untrustworthiness. This research also examined whether perceived source bias on one message can carry over to ambiguously related future persuasive messages. Studies 6 to 8 demonstrated that perceivers use both the perceived bias from an initial message and the argument quality of the second message to determine a source’s bias on the new topic. Finally, perceived bias carried over from an initial message can influence persuasion on a second topic (Study 9). Ultimately, the present work provides insight into factors that affect perceived bias and the dynamic consequences of those perceptions.
Intoxication and overdose should not preclude veno-venous extracorporeal membrane oxygenation
Authors: Radowsky Jason S , Mazzeffi Michael M , Deatrick K Barry , Galvagno Samuel M , Parker Brandon M , Tabatabai Ali , Madathil Ronson J , Kaczorowski David J , Rabinowitz Ronald P , Herr Daniel L , Scalea Thomas , Menaker Jay
Published: October 2020

Introduction

Acute intoxication (AI) related morbidity and mortality are increasing in the United States. For patients with severe respiratory failure in the setting of an acute ingestion, veno-venous extracorporeal membrane oxygenation (VV ECMO) can provide salvage therapy. The purpose of this study was to evaluate outcomes in patients with overdose-related need for VV ECMO.

Methods:

We performed a retrospective review of all patients admitted to a specialty VV ECMO unit between August 2014 and August 2018. Patients were stratified by those whose indication for VV ECMO was directly related to an acute ingestion (alcohol, illicit drug, or prescription drug overdose) and those with unrelated diagnoses. Demographics, pre-cannulation clinical characteristics, ECMO parameters, and outcomes data was collected and analyzed with parametric and non-parametric statistics as indicated.

Results:

189 patients were enrolled with 27 (14%) diagnosed with AI. Patients requiring VV ECMO for an AI were younger, had lower median BMI and PaO2/FiO2, and higher RESP scores than non-AI patients (p = 0.002, 0.01, 0.03 and 0.01). There was no difference in pre-cannulation pH, lactate, or SOFA scores between the two groups (p = 0.24, 0.5, 0.6). There was no difference in survival to discharge (p = 0.95). Among survivors, there was no difference in ECMO time or hospital stay (p = 0.24, 0.07).

Conclusion:

We demonstrate no survival difference for patients with and without an AI-related need for VV ECMO. AI patients should be supported with VV ECMO when traditional therapies fail despite potential stigma against acceptance on referral.
Rain Enhancement Technology: Making Sense of the “Cloud Seeding” Program in India
Authors: Dash Biswanath
Published: October 2020

This article examines cloud seeding technology from a social perspective, with a focus on its evolution in India over the past six decades. It argues that the technology has developed in two intertwined trajectories: as a research experiment and as an operational service. The research dimension has evolved in conjunction with international development, while the operational projects are supported and sustained by the state for their appeal as drought relief. In the absence of a national policy, ambiguities over the efficacy of cloud seeding technology have remained obscured from public debate. It has brought forth a situation where the concerned agencies admit that there is no clarity as yet on effectiveness of the particular technology, and at the same time various state governments execute large cloud seeding projects using taxpayer’s money. It points toward the political dimension of the technology and calls for a review of program assessment framework and inclusion of public participation.
Coexistence of genital tuberculosis and ovarian serous cystadenofibroma in a young female patient: a case report
Authors: Yang Shaoyan , Yang Zhengjuan , Zhang Suxian , Len Tianyan , Yang Lihua
Published: October 2020

Most cases of female genital tuberculosis (TB) are asymptomatic and are thus difficult to diagnose. Coexistence of genital TB and ovarian serous cystadenofibroma (OSCAF) is rare and easily ignored or misdiagnosed. We report a 26-year-old woman with coexistence of genital TB and OSCAF, and with an adnexal mass detected by B-ultrasound. Laparoscopic biopsy of diffuse miliary white nodules was performed on the surface of the peritoneum and both fallopian tubes. Right ovarian cystectomy was performed. Postoperative pathology showed that the right ovarian mass was a benign serous cystadenofibroma, and both fallopian tubes and miliary white nodules on the surface of pelvic organs showed chronic granulomatous inflammation. Polymerase chain reaction for Mycobacterium tuberculosis and acid-fast bacilli culture were positive in biopsies of the fallopian tubes, omentum, and peritoneum. The patient received anti-TB treatment after surgery. Six months after the operation, the patient had no abdominal pain and no major changes in menstruation. Our findings suggest that a timely operation is required for patients with an adnexal mass. During surgery, even if the lesion is similar to a malignant tumor, the surgical approach needs to be cautiously chosen for young patients without children. The patient’s postoperative fertility must be taken into consideration.
Continuous improvement on the rationality of prophylactic injectable PPIs usage by a clinical pharmacist-led guidance team at a Chinese tertiary teaching hospital
Authors: Hong Yun , Ye Ziqi , Gao Zhe , Rao Yuefeng
Published: October 2020

Objective

We aimed to evaluate the effects of a clinical pharmacist-led-guidance-team (CPGT) on improving rational prophylactic injectable proton pump inhibitor use (PIPU) and to explore the application of the Plan–Do–Check–Act (PDCA) method in promoting rational PIPU.

Methods

We conducted a retrospective study among 814 patients at a Chinese tertiary teaching hospital from January 2017 to December 2018. We enrolled 98 patients before the PDCA; 297 and 419 patients were included in first- and second-round PDCA cycles, respectively. The CPGT established the criteria for PIPU and conducted interventions, including medical record reviews, provision of feedback, clinician education, and outcome analysis. We analyzed the appropriateness and costs of PIPU before and after establishment of the PDCA cycle.

Results

Implementation of continuous CPGT-led intervention and a PDCA cycle significantly decreased the rate of irrational PIPU (53.06% vs. 8.57%), including duration, administration route, indication, and dosing frequency. Costs of total (USD 211.28 ± 162.33 vs. 53.17 ± 22.32) and inappropriate (USD 76.70 ± 59.78 vs. 2.25 ± 3.86) PIPU per patient were significantly reduced. The target compliance rate was 107.56%.

Conclusion

A CPGT can have an effective role in improving rational PIPU and optimizing administration through a PDCA cycle, to attain improved clinical and economic outcomes.
Statistical Modeling of Quartiles, Standard Deviation, and Buffer Time Index of Optimal Tour in Traveling Salesman Problem and Implications for Travel Time Reliability
Authors: Yang Hongtai , Liang Xiuqin , Zhang Zhaolin , Liu Yugang , Abid Malik Muneeb
Published: October 2020

The traveling salesman problem (TSP) plays an important role in the field of transportation and logistics. While most studies focus on developing algorithms to find the shortest path and explore the average length of the shortest paths, the degree to which the shortest path deviates from its mean has not been studied. The study of deviation is important because it has implications for travel time reliability. Previous studies have used various indicators to measure this deviation, mainly including standard deviation, quantiles, and buffer time index (BTI). Therefore, this study aims to develop an empirical model to estimate the standard deviation, quantiles, and BTI for the optimal TSP tour. Experiments are performed to find the shortest path connecting N customers, which are generated randomly in a specified service area, using a genetic algorithm. The service area is a rectangle with ratio of length to width ranging from 1:1 to 8:1. Two types of lengths are considered: Euclidean and Manhattan. The number of customers considered ranges from 10 to 100 with intervals of 10. In the experimental design, the customers are generated randomly 500 times. The quartiles and standard deviations of the 500 shortest paths are recorded. The BTI is also calculated. Regression models are developed to estimate quartiles, standard deviation, and BTI using number of customers and parameters of service area as predictive variables. The models perform well on the testing data set. The constructed models can be used to estimate the standard deviation and reliability of travel time.
Does radical prostatectomy result in lower urinary tract symptom improvement in high-risk and locally advanced prostate cancer? A Single-center experience
Authors: Papadopoulos Georgios , Fragkoulis Charalampos , Stasinopoulos Konstantinos , Stathouros Georgios , Glykas Ioannis , Theocharis Georgios , Lamprou Stavros , Ntoumas Konstantinos
Published: October 2020

Purpose:

Radical prostatectomy represents the most popular method of prostate cancer treatment, including cases with high-risk and locally advanced cancer. Besides, men with this disease often experience lower urinary tract symptoms (LUTS) and report high International Prostate Symptom Scores (IPSS), pathological post-void residual (PVR) urine volumes and low levels of maximum urinary flow rates (Qmax). In this study we assessed the effect of radical prostatectomy on the above parameters in patients with high-risk and locally advanced disease.

Methods:

A number of 240 individuals were enrolled in the study. Patients that required any post-operative manipulation up to the completion of 12 months after surgery were excluded. All patients were assessed pre- and post-operatively at 3, 6 and 12 months. Evaluation included IPSS, Qmax and PVR.

Results:

Mean age was 66.8 years. Mean PSA value was 12.7 ng/ml and mean Gleason score was 7.9. At baseline 41.3% of the patients had Qmax ⩽10 and 42.5% had IPSS >8. There was a significant increase in Qmax during the follow-up (median value was 12 at baseline and increased to 21 at 12 months). Also, IPSS and PVR decreased significantly during the follow-up. IPSS median value decreased from 9 at baseline to 5 at 12 months. Improvement was observed in all grades of symptoms.
Multidisciplinary collaborative approach for management of adrenal tumors: Outcomes of minimally invasive adrenalectomy at a single center
Authors: Mahajan Rahul , Kotwal Suman , Mahajan Arti , Anjali  , Manhas Amit
Published: October 2020

Introduction:

Laparoscopy is currently the gold standard for the management of adrenal tumors as it is associated with less morbidity. Owing to technological advances, even large adrenal tumors are currently amenable to laparoscopic removal. In this work, we describe our multidisciplinary collaborative approach for management of adrenal tumors at a single center.

Material and methods:

Between January 2017 and January 2020, 18 patients with adrenal lesions were operated at our center. Five of these patients had incidentalomas. All patients were evaluated in coordination with endocrinologists and anesthetists. All patients underwent transperitoneal laparoscopic adrenalectomy. The surgical complications were classified as per Clavein-Dindo system. All patients with pheochromocytoma and Cushing syndrome were followed up by the endocrinologist for further evaluation and titration of glucocorticoids and antihypertensive medication.

Results:

Two out of the 18 patients had American Society of Anesthesiologists (ASA) physical status III. Out of the 18 patients, only one required conversion to open surgery. Five patients developed intraoperative hypertensive crisis while three patients developed hypotensive crisis. All patients were ambulated on the first postoperative day and were discharged on the third post operative day. None of the patients developed any major (Clavein-Dindo III–V) intra operative or post operative complications.

Conclusion:

Laparoscopic adrenalectomy is the procedure of choice for adrenal tumors. A multi-disciplinary approach involving the endocrinologist, anesthesiologist, and laparoscopic surgeon can help achieve favorable outcomes.
Review of the effect of process parameters on performance measures in the incremental sheet forming process
Authors: Gohil Ashish , Modi Bharat
Published: October 2020

Incremental sheet forming process has developed the interest of researchers in the field of sheet metal forming due to high formability and capability to produce prototypes of new products at low cost and minimum lead time. Research work is going on in various front to enhance the process capabilities so that it can be explored for commercial production. In this article, progress and recent development in the field of incremental forming has been reviewed and presented for the benefit of practicing engineers and industry. The effect of various process parameters on the performance of the process have been summarized in this paper. Moreover, the issues which need attention are discussed towards the conclusion of this paper.
Toolpath and machining parameters optimisation of the cavities of a knee prosthesis tibial insert
Authors: Lopes Francisco J , Completo António , Davim João Paulo
Published: October 2020

The main purpose of this paper is to demonstrate the applicability of conventional cutting tools in the machining of a custom tibial insert of a knee prosthesis. This study also aims to reduce the roughness and minimise the production time. In this work, the optimisation of cutting strategies and parameters was achieved through the design and construction of a test-part containing the most important complex surfaces of the femoral cavities, the focus of the study. The milling was carried out in accordance with the Design Of Experiment and the Taguchi method and was performed in two stages to reduce the number of analysed factors. The achieved parameters are applied to the machining of a modelled tibial insert made of UHMWPE, using a NC machine with three axes. The initial parameters studied were the cutting method, axial and radial depth of cut, the direction of the feed and the feed rate. Three strategies were studied: two Blend, resulting in radial and spiral toolpaths, and one Parallel. According to the spiral strategy, an arithmetical mean roughness of Ra = 1.1 µm was obtained, representing an improvement of 45% relatively to the initial phase value of 2.0 µm, with the Parallel toolpath. An overall improvement of 34% in time efficiency of the finishing operation was achieved after changing the machine settings. This study supports the conclusion that high-speed milling is an expeditious process to produce customised tibial inserts.
Crashworthiness performance of concentric structures with different cross-sectional shapes under multiple loading conditions
Authors: Pirmohammad Sadjad
Published: October 2020

This paper evaluates the crashworthiness performance of concentric structures with different numbers of tubes (i.e. one to five) and cross-sectional shapes (i.e. hexagon, octagon, decagon and circle) under the multiple loadings of θ = 0, 10, 20 and 30°. An experimentally validated finite element model generated in LS-DYNA is employed to calculate the crashworthiness parameters including the specific energy absorption, maximum crush force and crush force efficiency. A total of 20 concentric structures are analyzed to explore the effects of number of tubes and cross-sectional shapes on the crushing performance. A multi-criteria decision-making method known as TOPSIS is also used to compare and rank the concentric structures in terms of crushing performance. Based on the results, the hexagonal structure including two tubes and octagonal, decagonal and circular structures including three tubes demonstrate the best results among their corresponding cross-sectional shapes. These structures show 9, 39, 38 and 39% higher specific energy absorption compared to their corresponding single tubal cases, respectively. However, in comparison to single tubal cases, they generate 4, 57, 57 and 58% higher maximum crush force, respectively. As such, the values for the improvement of the crush force efficiency are 3, 26, 25 and 21%, respectively. Furthermore, the decagonal structure including three tubes provides the highest energy absorbing characteristics as compared with all the other structures studied in this research. Meanwhile, taking into account all the multiple loading conditions, this structure shows 50% higher specific energy absorption than the hexagonal structure including single tube (as the weakest structure).
Evaluation of kinetic parameter and mechanical Properties of biobased Epoxy Adhesives in Wood-based Composites for Automotive Applications
Authors: Aniol A , Grosse T , Fischer F , Böhm S
Published: October 2020

The relevance of sustainable structural materials is increasing in automotive components for sustainable construction. The sustainable material wood in particular can be used due to the very good specific mechanical material properties and has a high potential to be used as a structural material in hybrid constructions for the automotive components as an veneer laminate with modified epoxy adhesives. The material properties depend strongly on the interface between the capillary structure of the wood and the epoxy adhesive and also on the curing properties at the manufacturing process. In this study an epoxy adhesive (DGEBA) was copolymerized with lignosulphonate, a biobased waste product from the pulp and paper industry, as a sustainable coupling agent and the kinetic behavior of the macromolecular curing reactions and mechanical properties were characterized for wooden automotive components. The composites were characterized by differential scanning calorimetry (DSC) to investigate the curing kinetics of the biomodified adhesive. Subsequent a laminated veneer lumber was manufactured with beech veneer of 1 mm thickness. The mechanical properties of the composite structure were characterized by tensile tests, bending tests and tensile shear tests. The results show a significant improvement of the manufacturing time due to the kinetic behavior and the mechanical properties for structural components in the automotive industry.
Feasibility of Rapid Development and Deployment of a Telemedicine Program in a Foot and Ankle Orthopedic Practice
Authors: Manz Wesley J. , Goel Rahul , Fakunle Omolola P. , Labib Sameh A. , Bariteau Jason T.
Published: October 2020

Background:

A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared with in-office appointments for all nonemergency visit types.

Methods:

Telemedicine satisfaction was assessed via phone survey with a modified 1 to 5 Likert scale. Patients who had completed a telemedicine visit between April 13, 2020, and June 19, 2020, were eligible to participate. Patient demographics were recorded, and data were analyzed using paired and independent t tests for parametric continuous data and Fisher’s exact and chi-square tests for noncontinuous data. A total of 216 patients completed the telemedicine questionnaire.

Results:

The overall mean satisfaction for telemedicine visits (4.7) was significantly lower than that for in-office visits (4.9) ( P < .001). However, the majority (90.3%) of patients reported they would use telemedicine again in the future. When compared, patients seeking fracture care had significantly higher telemedicine satisfaction (4.9, n = 38) than those receiving nonfracture care (4.6, n = 178) ( P = .001), and those greater than 50 miles from the clinic had higher satisfaction (5.0, n = 14) than patients living within 50 miles of the clinic (4.7, n = 202) ( P < .001).

Conclusion:

Patients were more satisfied with their in-office clinic visit than telemedicine, although the vast majority of patients endorsed a willingness to utilize telemedicine in the future. Patients with trauma and greater barriers to foot and ankle care were more satisfied with their telemedicine visits.

Level of Evidence:

Level III, retrospective cohort study.
Residual stress distribution in built-in beams
Authors: de Castro FA , Kenedi Paulo P , Vignoli LL , Riagusoff I I T
Published: October 2020

Metallic hyperstatic structures, like beams, submitted to excessive loads, do not fail completely before fully yielding in more than one cross section. Indeed, for built-in beams, three cross sections must be fully yielded before the final failure can occur. So, modeling the evolution of the cross-section residual stress distribution is an important subject that should be addressed to guarantee the stress analysis modeling correctness. This paper analyses the residual stress distribution evolution, in critical cross sections, of built-in beams during a transversal concentrated load growth, until the final failure through hinges formation. A finite element model is also presented. The results show good matches with the numerical model, used as a reference.
Mental Imagery as a Rehabilitative Therapy for Neuropathic Pain in People With Spinal Cord Injury: A Randomized Controlled Trial
Authors: Kaur Jaskirat , Ghosh Shampa , Sahani Asish Kumar , Sinha Jitendra Kumar
Published: October 2020

Background

Pain of neuropathic origin in spinal cord injury (SCI) is unbearable and challenging to treat. Research studies conducted in the past have shown that mental imagery (MI) techniques have a significant impact on the reduction of symptoms of central neuropathic pain in people with SCI.

Objectives

The objective of this study was to evaluate the effect of MI training on pain intensity, neuropathic pain symptoms, and interference of pain with function in SCI.

Methods

A total of 42 SCI participants with central neuropathic pain (duration 6-12 months) were recruited and randomly allocated to MI or control groups. A MI training protocol was administered to MI group and for 30 min/d for 5 days. Outcome measures were assessed at baseline and at the end of 4 weeks.

Results

There was significant reduction in differences of mean [95% CI] scores of numeric rating scale (−2.1 [CI −2.78 to −1.41]; P < .001) between groups. Mean [95% CI] total scores of Neuropathic Pain Symptom Inventory declined in MI group as compared with control group (−4.52 [CI −5.86 to −3.18]; P < .001). Similarly, Brief Pain Inventory interference scale total dropped significantly ( P < .001) in MI group. Majority of participants in the MI group (55%) reported improvement in scores of Patients’ Global Impression of Change scale as compared with control group where most of the participants (52%) reported no change.

Conclusions

This study shows the effectiveness of the MI protocol developed as a rehabilitative approach in improving central neuropathic pain in SCI. Trial Registration. Clinical Trials Registry–India under Indian Council of Medical Research; CTRI/2018/07/014884. Registered July 16, 2018.
Using baseball seams to alter a pitch direction: The seam shifted wake
Authors: Smith Andrew W , Smith Barton L
Published: October 2020

An experimental investigation of how seams and their orientation relative to the spin axis and flight direction can alter the formation of a wake around a baseball was conducted. Particle Image Velocimetry (PIV) was used to examine the velocity field around a baseball in specific orientations and to find the boundary layer separation location, which is the location on the baseball where the wake begins to form. Certain orientations can advance the separation point on one side of the baseball, generating a pressure force on the baseball and modifying its flight path. Using this information as a guide, baseballs were launched 55 feet (a realistic pitching distance) in orientations designed to have an asymmetric separation point. These pitches were 90 mph at spin rates near 1200RPM with a vertical spin axis perpendicular to the initial flight direction. A Rapsodo 1.0 system was used to compare the pitch locations for different seam orientations. The results of this study showed a significant and repeatable difference in the path of the baseball depending on the orientation of the seams relative to the spin axis. This effect was more significant for baseballs with larger seams.
Successful cyclosporin and ustekinumab combination therapy in a patient with severe steroid-refractory ulcerative colitis
Authors: Ganzleben Ingo , Geppert Carol , Osaba Lourdes , Hirschmann Simon , Nägel Andreas , Glück Christian , Hoffman Arthur , Rath Timo , Nagore Daniel , Neurath Markus F. , Atreya Raja
Published: October 2020

The therapeutic management of patients with severe steroid-refractory ulcerative colitis still represents a critical clinical challenge. In this setting, cyclosporin is an effective and rapidly acting induction treatment that is applied in combination with maintenance therapeutic agents like thiopurines or vedolizumab. Here, we present the case of a 33-year-old ulcerative colitis patient with severe steroid-refractory ulcerative colitis who refused surgical intervention and previously demonstrated no long-term benefit to anti-TNF antibody, vedolizumab, cyclosporin, thiopurines or tofacitinib treatment. Intravenous cyclosporin therapy was re-initiated in the patient and, after signs of clinical response, therapy with ustekinumab was additionally applied. After 11 weeks of well tolerated cyclosporin and ustekinumab combination therapy, cyclosporin was discontinued upon clinical and endoscopic remission. Subsequently, ustekinumab treatment has been effective in maintaining remission during the follow-up period of 195 days.
Prevalence of patent foramen ovale in the Greek population is high and impacts on the interpretation of the risk of paradoxical embolism (RoPE) score
Authors: Koutroulou Ioanna , Tsivgoulis Georgios , Karacostas Dimitris , Ikonomidis Ignatios , Grigoriadis Nikolaos , Karapanayiotides Theodoros
Published: October 2020

Background:

The risk of paradoxical embolism (RoPE) score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFOAF), based on PFO prevalence in patients with cryptogenic stroke (CS) compared with that in the general population. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely.

Methods:

Since PFO prevalence in Greece remains unknown, we evaluated it and we calculated PFOAF stratified by RoPE score in a cohort of patients with CS ⩽55 years old. PFO was detected according to the international consensus transcranial Doppler (TCD) criteria in 124 healthy subjects (H), in 102 patients with CS, and in 56 patients with stroke of known cause (nonCS). Each subject underwent unilateral middle cerebral artery recording after infusion of agitated saline, at rest, and after a controlled Valsalva maneuver. We characterized PFO as large (>20 microbubbles or curtain), moderate (11–20), and small (⩽10).

Results:

PFO was detected in 42.7% of H, 49% of CS, and 25% of nonCS ( p = 0.013). Large PFOs were numerically higher in CS [28.4% (29/102)] compared with H [19.3% (24/124); p = 0.1] and to nonCS [7.1% (4/56), p = 0.04]. The median RoPE score in patients with CS and PFO was seven. Even patients with very high RoPE score (9–10) had moderate PFOAF (57%). For any individual stratum up to RopE score 8, PFOAF was <33%.

Conclusions:

PFO prevalence in the Greek population is much higher than the widely accepted 25%. PFO may be the cause of stroke in one out of nine Greek patients with CS. Among Greek CS patients who harbor a PFO, the latter is causal in one out of five. The established RoPE score cutoff of ⩾7 for having a probable PFO-associated stroke may overestimate the probability in patients deriving from populations with high PFO prevalence.
COPD smokers who switched to e-cigarettes: health outcomes at 5-year follow up
Authors: Polosa Ricardo , Morjaria Jaymin B , Prosperini Umberto , Busà Barbara , Pennisi Alfio , Malerba Mario , Maglia Marilena , Caponnetto Pasquale
Published: October 2020

Background and Aims:

The long-term health effects of the use of electronic cigarettes (ECs) in patients with chronic obstructive pulmonary disease (COPD) are largely unexplored. We present findings from a 5-year prospective assessment of respiratory parameters in a cohort of COPD patients who substantially reduced conventional smoking or achieved abstinence by switching to ECs.

Methods:

Patients were evaluated prospectively for their measurements of respiratory exacerbations, spirometric indices, quality of life using the COPD assessment tool (CAT), 6-min walk distance (6MWD), as well as conventional cigarette consumption. Baseline measurements prior to switching to EC use were compared with follow-up visits at 12-, 24-, 48- and 60-months. Age- and sex-matched COPD patients reporting to be regular smokers (not using ECs) were the reference group for the analysis.

Results:

Complete data were available from 39 patients. Those in the EC user group achieved a marked decline in cigarette smoking or abstinence. COPD EC users had a significant diminution in COPD exacerbations; with the mean (±SD) exacerbation rate falling from 2.3 (±0.9) at baseline to 1.1 (±1.0) at 5 years ( p < 0.001), whereas no significant changes were observed in the control group. Significant and constant improvements in lung function, CAT scores and 6MWD were reported in the EC user group over the 5-year observation period compared with the reference group ( p < 0.05).

Conclusion:

The present study suggests that EC use may ameliorate objective and subjective COPD outcomes, and that the benefits gained appear to persist long term. EC use for abstinence and smoking reduction may ameliorate some of the harm resulting from tobacco smoking in COPD patients.
Extracellular histones in lung dysfunction: a new biomarker and therapeutic target?
Authors: Karki Pratap , Birukov Konstantin G. , Birukova Anna A.
Published: October 2020

Extracellular histones released from injured or dying cells following trauma and other severe insults can act as potent damage‐associated molecular patterns. In fact, elevated levels of histones are present in human circulation in hyperinflammatory states such as acute respiratory distress syndrome and sepsis. The molecular mechanisms owing to histone‐induced pathologies are at the very beginning of elucidating. However, neutralization of histones with antibodies, histone‐binding or histone‐degrading proteins, and heparan sulfates have shown promising therapeutic effects in pre‐clinical acute respiratory distress syndrome and sepsis models. Various cell types undergoing necrosis and apoptosis or activated neutrophils forming neutrophil extracellular traps have been implicated in excessive release of histones which further augments tissue injury and may culminate in multiple organ failure. At the molecular level, an uncontrolled inflammatory cascade has been considered as the major event; however, histone‐activated coagulation and thrombosis represent additional pathologic events reflecting coagulopathy. Furthermore, epigenetic regulation and chemical modifications of circulating histones appear to be critically important in their biological functions as evidenced by increased cytotoxicity associated with citrullinated histone. Herein, we will briefly review the current knowledge on the role of histones in acute respiratory distress syndrome and sepsis, and discuss the future potential of anti‐histone therapy for treatment of these life‐threatening disorders.
Serum biomarker analysis at the protein level on pulmonary hypertension secondary to old anterior myocardial infarction
Authors: Wu Xiangqi , You Wei , Wu Zhiming , Ye Fei , Chen Shaoliang
Published: October 2020

Pulmonary hypertension (PH) related to old anterior myocardial infarction (OAMI) always accompanies a bad prognosis, and thus, we aimed to screen serum biomarkers related to PH in OAMI patients. According to right ventricular systolic pressure, we divided mice into sham, OAMI, and PH‐OAMI groups and evaluated body, heart and lung weight, heart function, pulmonary blood flow velocity, cardiac fibrotic area, and pulmonary arteriole condition. Lung and serum were under the proteomic analysis. Levels of three identified proteins were measured. Compared with sham and OAMI mice, PH‐OAMI mice showed heart dysfunction, low pulmonary blood flow, high right ventricular systolic pressure, heavy heart and lung weight, large cardiac fibrotic area, and pathological pulmonary arteriole remodeling (P<0.05 or P<0.01). Haptoglobin, annexin A5, and Ig mu chain C region of lung and serum were changed significantly in PH‐OAMI mice (P<0.01). Then, we collected serum and clinical data, measured three serum protein levels, and performed multivariate regression and receiver operating characteristic curve in patients (normal, OAMI, and PH‐OAMI groups). Compared with normal and OAMI patients, serum levels of three proteins in PH‐OAMI patients were also altered notably (P<0.01). These three proteins can predict PH in OAMI patients (P<0.01). Receiver operating characteristic curve analysis revealed haptoglobin (cut‐off value: 78.295, sensitivity: 62.8%, specificity: 94.4%), annexin A5 (cut‐off value: 151.925, sensitivity: 41.9%, specificity: 82.4%), and Ig mu chain C region (cut‐off value: 168.885, sensitivity: 86.0%, specificity: 79.6%) (P<0.01). Three circulating serum proteins can be useful for the categorization of OAMI patients with and without PH.