bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanical gear footstep power generation using a mini generator with buck and boost selectors
Authors: Sutikno Tole , Fernando Rizki , Pamungkas Anggit , Purnama Hendril Satrian , Baswara Ahmad Raditya Cahya
Published: December 2023

In this research, we intend to build a floor-based power plant that produces energy using a mechanical generator drive. The drive system uses a two-gear transmission system with a different number of teeth, resulting in varying torque and speed. The large gear will stick directly to the floor, causing it to spin when the floor is stepped on, and then the small gear will spin the generator quickly. The buck and boost selector systems are powered by fluctuating voltage from the generator. If the voltage produced by the generator is greater than 5 V, the system will reduce it; otherwise, the system will increase the voltage. This selector system uses several modifications of the current circuit between rectifiers, which function to rectify the generator output when the generator rotation changes, a voltage divider is useful for dividing the generator output voltage. The pressure before and after the selector system was measured by applying force on the floor to 15 people with varying loads. The result shows that the buck and boost selector system can work properly, and the nominal output voltage of the generator is around 5 V as needed.
Conhecimento do diagnóstico, tratamento e controle do diabetes mellitus no Brasil
Authors: Tonaco Luís Antônio Batista , Velasquez-Melendez Gustavo , Moreira Alexandra Dias , Andrade Flávia Cristina Drumond , Malta Deborah Carvalho , Felisbino-Mendes Mariana Santos
Published: December 2023

OBJETIVO: Estimar as proporções dos indivíduos que têm conhecimento do diagnóstico, tratamento e controle do diabetes mellitus (DM) na população adulta brasileira. MÉTODO: Este é um estudo transversal, com dados de amostra representativa da população brasileira, provenientes da Pesquisa Nacional de Saúde (PNS 2014/2015). Os desfechos foram definidos com base na medida de hemoglobina glicada (HbA1c), no diagnóstico autorreferido de DM e no uso de hipoglicemiantes ou de insulina. Estimou–se a proporção do conhecimento, tratamento e controle do DM de acordo com as características sociodemográficas, condição de saúde e de acesso aos serviços de saúde, e seus respectivos intervalos de 95% de confiança (IC95%). RESULTADOS: A prevalência de DM na população brasileira foi 8,6% (IC95% 7,8–9,3), 68,2% (IC95% 63,9–72,3) tinham conhecimento do seu diagnóstico, 92,2% (IC95% 88,6–94,7) dos que tinham conhecimento realizam tratamento medicamentoso, e desses, 35,8% (IC95% 30,5–41,6) tinham os níveis de HbA1c controlados. As proporções de conhecimento, controle e tratamento foram menores nos homens, com idade de 18 a 39 anos, indivíduos que possuem baixa escolaridade, sem plano de saúde e beneficiários do Programa Bolsa Família. CONCLUSÃO: Aproximadamente um em cada dez brasileiros apresenta DM. Um pouco mais da metade desta população tem conhecimento do seu diagnóstico, condição aferida por dosagem de HbA1c e diagnóstico clínico. Entre os que sabem, a grande maioria está sob tratamento medicamentoso. Porém, menos da metade destes tem seus níveis de HbA1c controlados. Cenários piores foram encontrados em subgrupos com alta vulnerabilidade social.
Cardiovascular Health Metrics Differ Between Individuals With and Without Cancer
Authors: Kobo Ofer , Abramov Dmitry , Fiuza Manuela , Chew Nicholas W. S. , Ng Cheng Han , Parwani Purvi , Menezes Miguel Nobre , Thavendiranathan Paaladinesh , Mamas Mamas A.
Published: December 2023

Background

Although individuals with cancer experience high rates of cardiovascular morbidity, there are limited data on the potential differences in cardiovascular health (CVH) metrics between individuals with and without cancer.

Methods and Results

The National Health and Nutrition Examination Survey between 2015 and 2020 was queried to evaluate the prevalence of health metrics that comprise the American Heart Association Life's Essential 8 construct of cardiovascular health among adult individuals with and without cancer in the United States. Health metric scores were also evaluated according to important patient demographics including age, sex, race and ethnicity, and socioeconomic status. Among 4370 participants representing >180 million US adults, 9.4% had a history of cancer. Individuals with cancer had lower overall cardiovascular health scores (67.1 versus 69.1,
P
<0.001) compared with individuals without cancer. Among individual components of the cardiovascular health score, those with cancer had better health scores on key behaviors including physical activity, diet, and sleep compared with those without cancer, although variation was noted based on age. Higher scores on these modifiable health behaviors among those with cancer compared with those without cancer were noted in older individuals, in White individuals compared with other races and ethnicities, and in individuals with higher socioeconomic status.

Conclusions

We highlight important variations in simple cardiovascular health metrics among individuals with cancer compared with individuals without cancer and demonstrate differences among health metrics based on age, race and ethnicity, and socioeconomic status. These findings may explain ongoing racial, ethnic, and socioeconomic status disparities in the cancer population and provide a framework for optimizing cardiovascular health among individuals with cancer.
The Latest in Resuscitation Research: Highlights From the 2022 American Heart Association’s Resuscitation Science Symposium
Authors: Stancati Jennifer A. , Owyang Clark G. , Araos Joaquin D. , Agarwal Sachin , Grossestreuer Anne V. , Counts Catherine R , Johnson Nicholas J. , Morgan Ryan W. , Moskowitz Ari , Perman Sarah M. , Sawyer Kelly N. , Yuriditsky Eugene , Horowitz James M. , Kaviyarasu Aarthi , Palasz Joanna , Abella Benjamin S. , Teran Felipe
Published: December 2023

Background

Every year the American Heart Association's Resuscitation Science Symposium (ReSS) brings together a community of international resuscitation science researchers focused on advancing cardiac arrest care.

Methods and Results

The American Heart Association's ReSS was held in Chicago, Illinois from November 4th to 6th, 2022. This annual narrative review summarizes ReSS programming, including awards, special sessions and scientific content organized by theme and plenary session.

Conclusions

By exploring both the science of resuscitation and important related topics including survivorship, disparities, and community‐focused programs, this meeting provided important resuscitation updates.
Intermittent Theta-Burst Stimulation for Stroke: Primary Motor Cortex Versus Cerebellar Stimulation: A Randomized Sham-Controlled Trial
Authors: Liao Ling-Yi , Zhu Yang , Peng Qiu-Yi , Gao Qiang , Liu Lu , Wang Qing-Hua , Gao Shi-Hao , Tao Yong , Huang Hao , Xu Pei-Dong , Gao Chang-Yue
Published: December 2023

BACKGROUND:

Stroke survivors with impaired balance and motor function tend to have relatively poor functional outcomes. The cerebellum and primary motor cortex (M1) have been suggested as targets for neuromodulation of balance and motor recovery after stroke. This study aimed to compare the efficacy and safety of intermittent theta-burst stimulation (iTBS) to the cerebellum or M1 on balance and motor recovery in patients with stroke.

METHODS:

In this randomized, double-blind, sham-controlled clinical trial, patients with subacute stroke were randomly divided into 3 groups: M1-, cerebellar-, and sham-iTBS (n=12 per group; 15 sessions, 3 weeks). All outcomes were evaluated before intervention (T0), after 1 week of intervention (T1), after 3 weeks of intervention (T2), and at follow-up (T3). The primary outcome was the Berg balance scale score at T2. Secondary outcomes include the Fugl-Meyer assessment scale for lower extremities, the trunk impairment scale, the Barthel index, the modified Rankin Scale, the functional ambulation categories, and cortical excitability.

RESULTS:

A total of 167 inpatients were screened, 36 patients (age, 57.50±2.41 years; 10 women, 12 ischemic) were enrolled between December 2020 and January 2023. At T2, M1- or cerebellar-iTBS significantly improved Berg balance scale scores by 10.7 points ([95% CI, 2.7–18.6],
P
=0.009) and 14.2 points ([95% CI, 1.2–27.2],
P
=0.032) compared with the sham-iTBS group. Moreover, the cerebellar-iTBS group showed a significantly greater improvement in Fugl-Meyer assessment scale for lower extremities scores by 5.6 points than the M1-iTBS ([95% CI, 0.3–10.9],
P
=0.037) and by 7.8 points than the sham-iTBS ([95% CI, 1.1–14.5],
P
=0.021) groups at T2. The motor-evoked potential amplitudes of the M1- and cerebellar-iTBS groups were higher than those of the sham-iTBS group (
P
<0.001).

CONCLUSIONS:

Both M1- and cerebellar-iTBS could improve balance function. Moreover, cerebellar-iTBS, but not M1-iTBS, induced significant effects on motor recovery. Thus, cerebellar-iTBS may be a valuable new therapeutic option in stroke rehabilitation programs.

REGISTRATION:

URL:
https://www.chictr.org.cn/
; Unique identifier: ChiCTR2100047002.
Three Ritual Steps between India and Iran
Authors: Panaino Antonio
Published: December 2023

The use of triadic patterns is a well-known modality occurring in some Indo-Iranian mythological contexts. This fact has been considered as a phenomenon too generic, and its presence just noted as an unimportant evidence. But, in reality, this procedure, despite its potentially perplexing background, produces some symbolic implications, whose frequent occurrence should be better observed. For instance, within the Vedic and Brāhmaṇic framework, Viṣṇu makes three steps in order to enlarge the universal space, and for this reason this god is also called Trivikrama-, “Having Three Steps”. The present sequence, with its space-time implications, finds a correspondence in the disposition of the Vedic altar of Fire, which needs three footsteps of ground. Even more fitting and pertinent are the inevitable speculations emerging from the ritual meaning of the pebbles or stones called svayamātr̻ṇṇā, “naturally perforated”, placed by the Adhvaryu in the first, third and fifth layer of the brick-altar of the Agnicayana. They have a patent cosmological identity (see, e.g., ŚB 8.7.3.9–10). Within the Iranian context, references to the number three are equally relevant and not just meaningless. Three are the main steps of the soul of the dead after their meeting with the daēnā-, explicitly corresponding to three different cosmic levels, while the vara- of Yima, and the baršnūmgāh, a place of ritual purification, are divided in three parts, and in any case everything connected with them follows a triadic basis with multiples or submultiples of “three”, or again with fractions with an expressed denominator “three”. The act of piling up the perforated stones on the three layers of the Vedic fire altar presents deep cosmological implications, strictly connected also with the holes through which an imaginary column arises. The act of piling up (cinute) resounds the action to be performed by the soul in the Mazdean choreography of the afterlife, when the bridge (pərətu-) allowing the crossing of the intermediate space (that links earth and heaven) is piled up (by one who is cinuuaṇt-, presumably the soul itself). But piling the bricks and tending the fire are ritual performative actions expressed with the same verb and with actions, which inevitably resonate, as in the image of the third prince appearing within the afterlife choreography presented as a vision to the Sasanian Great Priest Kerdir. These occurrences, already focused on in past studies, evoke direct correspondences in ritual procedures emphasizing a definitive transition into another status, so that any triplication or any trifold implement has a special force and completeness.
Written Torah and Oral Torah in the Study of Hasidism
Authors: Reiser Daniel
Published: December 2023

The traditional academic approach to the study of the Hasidic movement in Judaism has tended to be based primarily on texts. Although book learning is important to Hasidim, the heart of the movement is living experience, in particular oral teaching of the Hasidic understanding and application of Torah by the Rebbe, most often in the Yiddish vernacular. Failure adequately to take account of this “oral Torah” (borrowing the term commonly applied to the Talmud) has led to inadequate, even erroneous conclusions about Hasidism and its tenets and history.
A Corpus-Based Study of Alignment in Literary Gorani (Based on the Manuscript 11092 of Dīwān-i Mawlawī)
Authors: Karami Saeed , Gholami Saloumeh
Published: December 2023

This paper examines alignment in Literary Gorani by analysing an unknown Gorani manuscript titled ‘Dīwān-i Mawlawī’ (Manuscript 11092), which is housed at the Āstān-e Qods-e Raḍavī library. The paper has two main objectives. Following Haig (2017) regarding the extent of the micro-variation of ergativity within Iranian languages, the paper explores strategies of interrelated subsystems such as case, indexation, verbal suffixes, and pronominal clitic systems to discover whether Gorani manifests an accusative or an ergative pattern. This helps us to answer the second more general question in this study: is it even possible to consider Literary Gorani as a written form of Hawrami?
A Prologue to Armenian Toponymy
Authors: Asatrian Garnik S. , Hakobian Gohar G.
Published: December 2023

The study of Armenian toponyms constitutes a relatively underexplored and insufficiently addressed domain within the field of Armenian Studies. Unfortunately, the seminal works by Joseph Marquart (1901) and, especially, Heinrich Hübschmann (1904), supplemented later with insightful publications by Kapancyan (1940; 1956), hitherto remain the sole substantial contributions to the realm of Armenian toponymy. Subsequent to that period and up to the present day, only sporadic researches have been done on this subject. The present paper aims at providing a brief overview of the general outlines of the Armenian toponymic system.
‘Big’ and ‘Small’ in the Toponymy of the Swāt Valley
Authors: De Chiara Matteo
Published: December 2023

In this article I focus on thirty toponyms from the Swāt Valley, Pakistan, that incorporate the concepts of ‘big’ and ‘small’. In this context, ‘big’ is represented by three different adjectives, loy, luth, and mahā, while for ‘small’ we find two different suffixes, -ṛay and -g/k/xay, as well as the adjectives woṛ and waṛukay. Among other things, I also propose a new analysis of one of the toponyms already studied in my 2020 work on the Toponymy of the Swāt Valley, Altangurai.
America’s Turkish Lobby against Armenian Genocide Recognition
Authors: Currie Erin , Aslan Emil S.
Published: December 2023

While much ink has been spilled on the Armenian-American Lobby’s efforts to achieve the formal recognition of the tragic events in Anatolia of 1915–1918 as a Genocide, little is known about how the Turkish Lobby sought to prevent such recognition. This article is the first in the literature to offer a systematic account of how the Turkish Lobby advocated in the United States to prevent the recognition of the Armenian Genocide.
Gender Transformations and Religion in an Integration Comedy: Der Hodscha und die Piepenkötter
Authors: Kehya Rahime Özgün
Published: December 2023

This study focuses on a post-migrant German-Turkish film, Der Hodscha und die Piepenkötter (Buket Alakuş, 2016), regarding gender and religious representations. Approximately twenty-five per cent of the population in Germany has a migration background, and the largest minority religion is Islam, as the number of Muslims increased with Turkish-German labour migration. Gender equality, wearing headscarves, and building sacred places (mosques) are featured in German films from time to time. Some films offer perspectives built on prejudices and stereotypes at the intersection of religion, migration, and gender, while others do not or do so to a lesser extent. In this article, we review the relevant film studies literature to see if there has been a transformation and then explore portrayals in a selected film through discourse analysis. The findings reveal that in Der Hodscha und die Piepenkötter, women contribute significantly to realising certain religious rights, and devout Muslims are portrayed as culturally heterogeneous.
The three-dimensional distribution of bordered pits across growth rings of stem segment in Platycladus orientalis (Cupressaceae) seedlings
Authors: Li Shan , Lu Sen , Yuan Chuhuan , Wang Jing , Guo Junkang
Published: December 2023

The dimensions and distribution pattern of bordered pits are critical to the xylem water transport function of trees. However, studies on the three-dimensional distribution pattern of pits across xylem growth rings are still limited. Here, Micro-Computed Tomography (Micro-CT) was used to acquire xylem images of two-year-old Platycladus orientalis seedlings. We analyzed the tracheid lumen diameter of 665 tracheids, pit volume, and pit diameter of 11 810 inter-tracheid pits from three radial profiles. The volume ratio of inter-tracheid pits was about 0.90–0.96%. The average pit diameter was 6.8 μm and the average pit volume was 58.9 μm3, and more than 80% of the pits had a diameter of 5–8 μm and a volume of 20–90 μm3. Both the pit diameter and the pit volume increased gradually in the radial direction from the second-year growth ring to the current-year growth ring, and the pit diameter and volume were significantly higher in earlywood than in latewood. The distribution pattern of the tracheid diameter was similar to that of the pit diameter, and the wider the tracheids, the larger the pits. The distribution of bordered pits in P. orientalis may be a critical trait explaining the xylem embolism spread pattern in this species.
Peasants, Photography and Citizenship: An Exercise in Re-Framing Social Imagination in the Polish Lands in the Nineteenth Century
Authors: Koprowicz Agata
Published: December 2023

The article analyzes the relationship between citizenship of peasants and photography in the Polish lands in the nineteenth century, using the perspective of potential history (A. A. Azoulay). The purpose of the article is twofold. The first step is to show how photography supported the process of separating the upper classes from the peasants and prevented villagers from being thought of as (present and future) citizens. The second one demonstrates various attempts to “re-frame” the existing reality, i.e. to reunite in one photographic frame what had previously been separated, which was tantamount to imagining a different social order, an order based on cocitizenship. The analyzed material includes mainly photographs and, as contextual sources, paintings from the Kingdom of Poland and Galicia.
Symmetry Invariant Solutions in Atmospheric Boundary Layers
Authors: Yano Jun-Ichi , Wacławczyk Marta
Published: December 2023

The symmetries of the governing equations of atmospheric flows constrain the solutions. The present study applies those symmetries identified from the governing equations to the atmospheric boundary layers under relatively weak stratifications (stable and unstable). More specifically, the invariant solutions are analyzed, which conserve their forms under possible symmetry transformations of a governing equation system. The key question is whether those invariant solutions can rederive the known vertical profiles of both vertical fluxes and the means for the horizontal wind and the potential temperature. The mean profiles for the wind and the potential temperature in the surface layer predicted from the Monin–Obukhov theory can be recovered as invariant solutions. However, the consistent vertical fluxes both for the momentum and heat no longer remain constant with height, as assumed in the Monin–Obukhov theory, but linearly and parabolically change with height over the dynamic sublayer and the above, respectively, in stable conditions. The present study suggests that a deviation from the constancy, though observationally known to be weak, is a crucial part of the surface-layer dynamics to maintain its symmetry consistency.

Significance Statement

The atmospheric flows are governed by a differential equation system, which is often difficult to solve in any satisfactory manner, either analytically or numerically. However, without solving them explicitly, many insights can be obtained by examining the “symmetries” of the governing equations. The study suggests that basic vertical profiles of the mean state of the atmospheric boundary layer is more strongly constrained by the symmetry consistency than suggested by standard similarity theories.
The Law of ‘Sedition’ in India: A Looming Threat to Freedom After Speech
Authors: Puneeth P.
Published: December 2023

The law of sedition is not only ‘equivocal’ but also incompatible with the constitutional guarantee of freedom of speech and expression. Notwithstanding its incompatibility, it did survive for too long on the statute book owing to, one, failure to take appropriate measures as contemplated under article 372 (2), and two, when its validity was challenged, the Supreme Court chose to read it down instead of striking it down, which does not seem to be the right approach to be adopted for pre-constitutional laws. Even after reading down, it continues to be a looming threat to free speech, which is the heartbeat of democracy. Unfortunately, the Law Commission of India in its recent report submitted in April 2023 recommended for retention of the provision with some modifications, which neither eliminate the vagueness of the provision nor mitigate its harshness. Given its chilling effects on free speech, it is desirable to remove it in toto from the statute book.
Unnamed, not unskilled: Toward a new labor history of pharmacy
Authors: Dorner Zachary
Published: December 2023

By recovering the dependent, often enslaved, laborers who helped to make European medicines commercially available in the New England colonies, this article offers a new history of early American pharmaceutical knowledge and production. It does so by considering the life and labor of an unnamed, enslaved assistant who was said to make tinctures, elixirs, and other common remedies in a 1758 letter between two business partners, Silvester Gardiner, a successful surgeon and apothecary in Boston, Massachusetts, and William Jepson, his former apprentice, in Hartford, Connecticut. Using strategies from slavery and critical archive studies, as well as from social history and the history of medicine, this article emphasizes the materiality and embodiment of pharmaceutical production and follows fragmentary evidence beyond the business archive to reverse the systemic erasure of enslaved and indentured laborers from the records of eighteenth-century manufacturers of medicines. The medicine trades of men like Gardiner and Jepson appear more reliant upon dependent laborers – named and unnamed – who not only performed rote tasks but brought their experience and judgment to their labors as well. Their contributions could be obviously medical (preparing remedies) or more ambiguous (stoking fires, shipping goods), but these actions together constituted early modern pharmacy, enabled the expansion of the transatlantic medicine trade, and laid the foundations for the more self-sufficient and industrialized pharmacy that developed in the nineteenth century. Centering the skill and knowledge among subordinated laborers in one facet of an emergent transatlantic care economy affirms the entanglement of slavery and science and underscores the necessity of asking new questions of old sources.
Evaluating Airport Terminals from the Users’ Perspective: Are Service, Experience, Liking, and Satisfaction Equivalent?
Authors: Rodriguez-Valencia Alvaro , Nieto-Uribe Juan Pablo , Mesa-Garcia Santiago , Barrero German A. , Ortiz-Ramirez Hernan Alberto , Vallejo-Borda Jose Agustin
Published: December 2023

In the era of globalization and the deregulation of the air transportation industry, public and private stakeholders have been increasingly interested in making airports attractive for passengers and airlines. Multiple service-like indicators (i.e., satisfaction, experience, liking, and quality of service) have been used to evaluate transportation infrastructure and systems, including airport terminals. Despite literature providing a clear definition of the different indicators separately, the similarities and differences are not clear, nor is it clear whether they are equivalent and could be used interchangeably. The purpose of this paper is to further understanding of the roots and essence of the four frequently used service indicators (SIs) in airport terminals—namely satisfaction, liking, quality of service, and experience—by comparing regressors. Using a travelers’ perception survey ( N = 377) at the domestic terminal in Bogotá’s El Dorado Airport, we found that, despite their correlation, the four service proxies were, in essence, different from each other conceptually, meaning that they have to be carefully chosen for the successful evaluation of a terminal. Each SI comprises different categories, representing a unique user perception. Recognizing and acknowledging that all these terms are different furthers the transparency in defining what each indicator measures.
Finance as a form of economic planning
Authors: Sorg Christoph
Published: December 2023

Recent years have seen a resurgent debate on economic planning in the age of digitalization and climate crisis and an extremely dynamic research community has formed around the theme of planning. Although the notion that “planning is already endemic in capitalism” has originally sparked the debate, the literature has mostly focused on theory and models of postcapitalist economic planning, not on how planning in capitalism actually works. Considering the financial system as one of the ways capitalism “plans,” this paper will expand on a rather dispersed series of observations by different commentators that “finance is a form of planning,” that central banks share similarities with “central planners” and that horizontal ownership across markets turns index funds into universal owners with the capacity to steer economic development. I will first argue that financialization has strongly influenced how contemporary economic planning works. Against this background, the text will then elaborate on how finance’s capacity for economic coordination makes it a potential tool for transformation towards increasing social and democratic control over the economy. In doing so, this paper connects the new debate on economic planning to the academic literature on financialization and the democratization of finance.
Electromyographic Evaluation of Masticatory Muscle Activity in Individuals with and without Cleft Lip/Palate: A Systematic Review and Meta-analysis
Authors: Shafaee Hooman , Jahanbin Arezoo , Ghorbani Mahsa , Samadi Asma , Bardideh Erfan
Published: December 2023

Objective

This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors.

Design

Systematic Review and Meta-analysis

Patients and Exposures

Patients with cleft lip/ palate

Comparison

Patients without CL/P.

Main Outcome Measures

Electrical activity of masseter and temporalis muscles at rest and during peak activation

Results

After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter ( P = .01) and temporalis ( P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter ( P = .03) and temporalis ( P = <.01) muscles.

Conclusions

According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments.
Connections between the morphoelastic treatment of growth-induced instabilities and earlier hyperelastic treatments of buckling under thrust
Authors: Pence Thomas J
Published: December 2023

In soft tissue, growth-induced instability is increasingly being viewed as a key agent in certain morphological developments, such as the folding of the cerebral cortex. As such, the study of growth-induced instability in the context of morphoelastic large deformation continuum mechanics is a burgeoning field of study. In this work, we examine some of the connections between these new developments and earlier work that can be viewed as the conventional—or no-growth—hyperelastic theory. By a systematic examination of a standard problem, certain direct correspondences are clarified which effectively permit results of a very general nature in the conventional theory to inform ongoing work in the morphoelastic theory.
Correlation and Agreement Between the CO2 Gap Obtained From Peripheral Venous Blood and From Mixed Venous Blood in Mechanically Ventilated Septic Patients
Authors: Orso Daniele , Molinari Chiara , Bacchetti Giacomo , Zanini Victor , Montanar Valentina , Copetti Roberto , Guglielmo Nicola , Bove Tiziana
Published: December 2023

Background

Venous-arterial CO2 difference (Pv-aCO2) is a valuable marker that can identify a subset of patients in shock with inadequate cardiac output to meet tissue metabolic requirements. Some authors have found that Pv-aCO2 levels calculated from mixed vs central venous blood demonstrate a linear relationship. The purpose of this study is to determine whether there is a linear relationship between Pv-aCO2 obtained with peripheral venous blood (Pv-aCO2p) and with mixed venous blood, and the agreement between the 2 measures.

Methods

This was a prospective, single-center, observational clinical study enrolling mechanically ventilated patients in septic shock during the first 24 hours following admission to the intensive care unit.

Results

The Bravais–Pearson r-coefficient between Pv-aCO2 and Pv-aCO2p was .70 in 38 determinations (95%CI .48-.83; P-value = 1.25 x 10^-6). The Bland–Altman bias was 4.11 mmHg (95%CI 2.82–5.39), and the repeatability coefficient was 11.05. Using the Taffe approach, the differential and proportional biases were 2.81 (95%CI .52–5.11) and 1.29 (95%CI .86–1.72), respectively.

Conclusion

There was linear correlation between Pv-aCO2p and Pv-aCO2 in mechanically ventilated patients with septic shock. The bias showed a gradual increase in high Pv-aCO2 values in an upward trend.
Seizing Off This Mortal Coil: A Matter of Epilepsy and Death
Authors: Zawar Ifrah
Published: December 2023

[Box: see text]
Association of Hearing Loss and Eating Habits in the Older Population
Authors: Gonçalves Laura Faustino , Paiva Karina Mary de , Machado Marcos José , Fontanelli Raquel Caroline FerreiraLopes , Cigana Luciana Berwanger , Haas Patrícia
Published: December 2023

Background: Age-related hearing loss, also known as hearing loss, is an important and increasingly prevalent public health problem worldwide, as it induces disability and social isolation. Objective: To verify the association between eating habits and hearing loss in the older population. Methods: A cross-sectional study with data analysis of older patients treated in an Outpatient Hearing Health Service accredited to the Unified Health System. Older people aged 60 years and over who attended the Health Service to begin adaptation in the study. The audiological evaluation was performed through Tonal and Vocal Audiometry exams, the auditory rehabilitation process was done using the Individual Sound Amplification Device, and eating habits based on the Dietary Guide for the Brazilian Population. Results: The sample included (n = 654) participants, aged between 60 and 97 years. The type of hearing loss revealed a higher prevalence of sensorineural of moderate degree. Individuals with higher consumption of tea, non-fatty meats, rice, fish, and fruits presented better hearing compared to participants with lower consumption of these types of foods. Conclusion: A higher consumption of foods high in anti-inflammatories and antioxidants may decrease the risk of age-related hearing loss. A higher consumption of foods high in anti-inflammatories and antioxidants may decrease 50% of the risk of age-related hearing loss. The findings also indicate the hypothesis that a pro-inflammatory diet could increase the risk of hearing loss. Antioxidants are believed to counteract the deleterious effects of reactive oxygen species and may be effective in treating diseases related to oxidative stress, including hearing loss.
Current evidence of robotic-assisted surgery use in functional reconstructive and neuro-urology
Authors: Tsoi Hermione , Elnasharty Sameh F. , Culha Mehmet Gokhan , De Cillis Sabrina , Guillot-Tantay Cyrille , Hervé François , Hüesch Tanja , Raison Nicholas , Phé Véronique , Osman Nadir I.
Published: December 2023

The use of robot-assisted technology has been widely adopted in urological oncological surgery and its benefits have been well established. In recent years, robotic technology has also been used in several functional reconstructive and neuro-urology (FRNU) procedures. The aim of this review was to evaluate the current evidence in the use of robotic technology in the field of FRNU. We performed a PubMed-based literature search between July and August 2022. The keywords we included were ‘robotic assisted’, ‘ureteric reimplantation’, ‘cystoplasty’, ‘ileal conduit’, ‘neobladder’, ‘sacrocolpopexy’, ‘colposuspension’, ‘artificial urinary sphincter’, ‘genitourinary fistula’ and ‘posterior urethral stenoses’. We identified the latest available evidence in the use of robotic technology in specific FRNU procedures such as the reconstruction of the ureters, bladder and urinary sphincter, urinary diversion, and repair of genitourinary prolapse and fistula. We found that there is a lack of prospective studies to assess the robotic-assisted approach in the field of FRNU. Despite this, the advantages that robotic technology can bring to the field of FRNU are evident, including better ergonomics and visual field, less blood loss and shorter hospital stays. There is therefore a need for further prospective studies with larger patient numbers and longer follow-up periods to establish the reproducibility of these results and the long-term efficacy of the procedures, as well as the impact on patient outcomes. Common index procedures and a standardized approach to these procedures should be identified to enhance training.
Comparison of artificial intelligence-assisted informed consent obtained before coronary angiography with the conventional method: Medical competence and ethical assessment
Authors: Aydin Fatih , Yildirim Özge Turgay , Aydin Ayse Huseyinoglu , Murat Bektas , Basaran Cem Hakan
Published: December 2023

Objective

At the time of informed consent (IC) for coronary angiography (CAG), patients’ knowledge of the process is inadequate. Time constraints and a lack of personalization of consent are the primary causes of inadequate information. This procedure can be enhanced by obtaining IC using a chatbot powered by artificial intelligence (AI).

Methods

In the study, patients who will undergo CAG for the first time were randomly divided into two groups, and IC was given to one group using the conventional method and the other group using an AI-supported chatbot, chatGPT3. They were then evaluated with two distinct questionnaires measuring their satisfaction and capacity to understand CAG risks.

Results

While the satisfaction questionnaire was equal between the two groups ( p = 0.581), the correct understanding of CAG risk questionnaire was found to be significantly higher in the AI group (<0.001).

Conclusions

AI can be trained to support clinicians in giving IC before CAG. In this way, the workload of healthcare professionals can be reduced while providing a better IC.
Relationship Between Arm Path, Ball Velocity, and Elbow Varus Torque in Professional Baseball Pitchers
Authors: Dowling Brittany , Hodakowski Alexander , Olmanson Bjorn A. , Cohn Matthew R. , Pauley Patrick J. , Verma Nikhil N. , Nicholson Gregory P. , Garrigues Grant E.
Published: December 2023

Background:

Currently, most pitching instructors suggest a shorter arm path—the total distance the arm travels during pitching. Theoretically, this combination allows for better body segment sequencing, a more efficient energy transfer through the kinetic chain, and increased ball velocity, while limiting elbow varus torque.

Hypothesis:

Shorter arm paths would be associated with increased ball velocity and decreased elbow varus torque.

Study Design:

Descriptive laboratory study.

Methods:

A total of 182 professional pitchers threw 8 to 12 fastball pitches while evaluated by 3-dimensional motion capture (480 Hz). The arm path was calculated as the total distance the hand marker traveled during the pitch. The pitch was divided into early, late, and total arm paths. A linear regression model assessed the interpitcher relationship between arm path, elbow varus torque, and ball velocity. A linear mixed-effects model with random intercepts assessed intrapitcher relationships.

Results:

Interpitcher comparison showed that total arm path weakly correlated with greater elbow varus torque ( P = .025). Strong correlations were found between ball velocity and early ( R2 = 0.788; P < .001), late ( R2 = 0.787; P = .024), and total arm paths ( R2 = 0.792; P < .001). Strong positive intrapitcher correlations were found between elbow varus torque and early ( R2 = 0.962; P < .001) and total arm path ( R2 = 0.964; P < .001). For individual pitchers, there was a large variation in the early (30.1 ± 15.7 cm) and late (21.4 ± 12.1 cm) arm path. For every 30-cm (11.8-inch) increase in early arm path (the mean range for an individual pitcher), there was a 1.29-N (β = 0.0429) increase in elbow varus torque and a 0.354 m/s (0.79 mph) (β = 0.0118) increase in ball velocity.

Conclusion:

A shorter arm path correlated with decreased elbow varus torque and decreased ball velocity in intrapitcher comparisons. Determining the individual mechanics that decrease elbow varus torque may help coaches and trainers correct these patterns.

Clinical Significance:

A shorter arm path during the pitch can decrease elbow varus torque, which limits the load on the medial elbow but also has a detrimental effect on ball velocity. An improved understanding of the impact of shortening arm paths on stresses on the throwing arm may help minimize injury risk.
Understanding variation in national climate change adaptation: Securitization in focus
Authors: Rhinard Mark , Morsut Claudia , Angell Elisabeth , Neby Simon , Englund Mathilda , Barquet Karina , Mees Heleen , Surian Jana , Vashishtha Swapnil , Segnestam Lisa , Hegland Engen Ole Andreas
Published: December 2023

Climate change is recognized today not just as a pressing and prominent issue on government agendas but also one that has been increasingly ‘securitized’ in a variety of national and global settings. We know little, however, if climate change adaptation, as a subset of climate action, has followed a similarly securitized path. This article addresses that question, exploring not only if climate change adaptation has been securitized but also what type of securitization – threat-oriented or risk-oriented – has emerged. Turning our empirical focus to three national settings of Norway, Sweden, and The Netherlands, we look for signs of securitization as well as whether securitization has been facilitated, shaped, or even blocked by existing governance features in each setting. We use this study to link the securitization literature with environmental governance approaches by building a novel analytical framework. Our findings show some intriguing and unexpected patterns, including evidence of risk-oriented securitization couched nevertheless as ‘business as usual’. We contribute to the growing debate on securitization in environmental governance while also casting new light on national climate change adaptation processes.
Increasing Palliative Care Team Involvement in Pediatric Hematopoietic Stem Cell Transplant Patients
Authors: Vacek Meagan , Tarbell Lisa , List Melissa , Hall Erin Marie , Linebarger Jennifer , Ellis Kelstan , Jones Gina , Thompson Joel
Published: December 2023

Background/Objectives:

Palliative care facilitates communication, helps with physical and psychological symptom management, and assists in goals of care and advance care planning discussions. Multiple organizations including the World Health Organization, American Academy of Pediatrics and the American Society of Clinical Oncology encourage palliative care involvement. Palliative care involvement with hematopoietic stem cell transplant (HSCT) patients has been shown to be beneficial as HSCT is associated with a high degree of morbidity and possible mortality. We sought to increase the frequency of palliative care consultations for patients planning to undergo HSCT for targeted diagnoses.

The outcome measure was percentage of patients who underwent HSCT for a targeted diagnosis who had a Palliative Care Team (PaCT) consult. Baseline data revealed 48 patients underwent HSCT from July 2020 to July 2022, 25 of whom had a targeted diagnosis. PaCT met 12 of the 25 patients (48%). Our goal is to increase the number of PaCT consults for patients receiving HSCT for our targeted diagnoses from 48% to 75% by December 2023.

Methods:

Chart review was conducted for patients who underwent HSCT from July 2020 to July 2022. Demographics documented included reason for HSCT, if PaCT was consulted, date of transplant, date of PaCT consult and living status. A targeted diagnosis list was compiled based on which patients were felt to benefit most from palliative care involvement: relapsed or refractory leukemias and lymphomas, myelodysplastic syndrome, high risk acute myeloid leukemia and metabolic disorders, such as Hurler syndrome. The first plan-do-study-act (PDSA) cycle included discussion of the project at division meetings, posting flyers in the clinic provider workrooms, and education regarding palliative care and evidence of its involvement in HSCT patients. The second PDSA cycle implemented involved revision of the HSCT referral form to include the question “Is PaCT consulted.” If the provider answers “no,” further elaboration is requested.

Results: From 1/1/23 to 7/31/23 ten patients with a targeted diagnosis underwent HSCT. Five patients (50%) received a PaCT consult prior to HSCT.

Conclusions: Palliative care involvement in pediatric oncology is well established, but its role in HSCT patients continues to be explored. As HSCT patients receive more intense therapy, have frequent deaths in intensive care units and can have limited opportunity for end of life planning due to rapidly changing clinical courses, early integration of PaCT could allow for decreased symptom burden and distress for both patients and families. Future PDSA cycle interventions include adding PaCT consultation to the transplant evaluation order set in the electronic medical record and review of the comments on the completed HSCT referral forms to identify possible barriers in the PaCT consultation process.
Changes in the Fibrinolytic System of Patients Infected with Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Owaidah Tarek M , Abudouleh Esraa , al Qahtani Ahmed , Al Hazzani Amal , Khorfan Kadiga
Published: December 2023

Introduction: In this study, coagulation and fibrinolysis parameters and their association with disease severity were investigated in coronavirus disease (COVID-19) patients. Materials and Methods: COVID-19 patients (n=446) admitted to our institute between February 21, 2021 and March 17, 2022, were recruited. Clinical data and staging were collected from all patients. Blood samples were collected and analyzed for several parameters of fibrinolysis and coagulation, including alpha-2-antiplasmin(α2AP) and plasminogen, thrombin activatable fibrinolysis inhibitor (TAFI), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), D dimer, and fibrinogen levels. Results: The TAFI, fibrinogen, and tPA levels were significantly higher in participants who died compared to that of patients who recovered (P<0.001). However, PAI-1, tPA, and TAFI were significantly higher in patients admitted to the ICU than those of the healthy controls (P<0.001 for PAI-1 and tPA; P=0.0331 for TAFI). Our results showed that stage C and D COVID-19 patients had significantly higher levels of PAI-1 (P = 0.003). Furthermore, the stage D COVID-19 patients had significantly higher tPA and TAFI values (P=0.003). Conclusions: Hypofibrinolysis was the most prevalent condition among patients with severe COVID-19. In this study, several coagulation markers were elevated, making them suitable prognostic markers for hypofibrinolysis.

Figure 1. Plasma levels of different coagulation factors in COVID-19 patients. Plasma isolated from patients that had died due to COVID-19 and those recovering from the disease (top panel).
An Innovative Dynamic Nomogram for Stratifying Survival Prognosis in Essential Thrombocythemia Patients with a History of Thrombosis
Authors: Jia Chen , Sun Ting , Fu Rongfeng , Dong Huan , Yang Renchi , Zhang Lei
Published: December 2023

Background: Essential thrombocythemia (ET) with a previous history of thrombosis was classified as high risk according to the revised International Prognostic Score for Thrombosis in ET. However, prognostic factors are not well established in this patient population. With the aim of enhancing patient outcomes, we endeavored to develop a prognostic nomogram specifically for patients with ET and a prior history of thrombosis.

Methods: We included 318 ET with previous arterial or venous thrombosis or both from January 2008 to June 2022 in our study. We used multivariable Cox proportional hazards regression to build a dynamic prognostic nomogram for this patient population. Harrell C Index was used for nomogram discrimination. Internal validation was performed by bootstrap resampling. The area under the receiver operating characteristic curve (AUC) was used to determine the nomogram's performance.

Results: Based on the IPSET model, out of the 318 patients, 148 were categorized as having an intermediate risk (score of 1-2), while 170 patients were classified as high risk (score greater than or equal to 3). Substantial statistical significance was observed in the overall survival between these two groups, underscoring the ability of the IPSET model to stratify prognosis in essential thrombocythemia patients with a history of thrombosis .

We further used multivariable cox regression analysis and found that Age≥60 years (HR=5.68 [95% CI:1.44-22.47], p=0.013), splenomegaly (HR=5.66 [95% CI:1.74-18.43], p=0.004), abnormal karyotype (HR=5.28 [95% CI:1.38-20.25], p=0.015), white blood cell counts (HR=1.09 [95% CI:1.02-1.18], p=0.014), and hemoglobin (Hb, HR=0.97 [95% CI:0.95-0.99], p=0.006) were independently risk factors for survival. We created a nomogram as well as a web portal that enables survival predictions based on individualized parameters ( https://cae29l-jia-chen.shinyapps.io/DynNomapp/ ). The C Index of the nomogram was 0.818. The AUC of 3-year, 5-year, and 10-year survival of the nomogram were 0.854, 0.769, and 0.813, respectively. Sex biases were observed at Hb levels that contribute outcome heterogeneity in such ET patients.

Conclusions : We provided a new dynamic nomogram that can well evaluate the survival prognostication for a given ET patient with a previous history of thrombosis, with a good discrimination and excellent performance.