bluuebunny/crossref_metadata_2025 huggingface dataset:
Meaning of critical traumatic injury for a patient’s body and self
Authors: Tsai Yu-Lun , Chiang Hsien-Hsien , Chen Yu-Ju , Chiang Hui-Hsun , Chen Yuan-Hao , Liaw Jen-Jiuan
Published: March 2021

Background:

Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self.

Aim:

To understand the meaning of traumatic injury for body and self for patients receiving intensive care.

Research design:

A qualitative descriptive study using Giorgi’s phenomenological approach.

Participants and research context:

Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed.

Ethical considerations:

This study was approved by the Institutional Review Board of the medical center.

Findings:

The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for.

Discussion and conclusion:

The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury.
RETRACTED: Resilient to Crises: How Cooperatives Are Adapting Sustainably to Overcome COVID-19-induced Challenges
Authors: Dave Mohit
Published: March 2021

This article argues that cooperative and mutual enterprises (CMEs) have a key role to play in transforming to sustainable and resilient societies in the aftermath of the COVID-19 pandemic. It looks at the contributions that CMEs have made in responding to the previous and ongoing crisis in Asia and the Pacific region. This article discusses the role of umbrella organisations and how their initiatives can facilitate a ‘trickle-down’ effect throughout the cooperative movement, highlighting examples of stimulus packages and their policy linkages. This article incorporates a brief overview of large national cooperative enterprises and apexes and their substantial contribution to resilience and sustainability. The author demonstrates the major role that cooperatives and mutuals are playing to foster inclusive and sustainable development at the grassroots level. This article concludes by arguing that CMEs are particularly resilient in adapting to a crisis, due to the specific features of the cooperative model, including the values of democracy and solidarity, as well as the principles of cooperation among cooperatives and concern for the community. Strong partnerships between and within cooperatives and mutuals can be instrumental in enhancing the emerging role of the movement as a pivotal actor in transforming towards sustainable and resilient societies.
Intensifying Goal-Setting Interventions for Students With Emotional and Behavioral Disorders
Authors: Kumm Skip , Maggin Daniel M.
Published: March 2021

Goal setting is a research-informed intervention that has demonstrated improved behavioral outcomes for students with emotional and behavioral disorders. However, not all students will respond to goal-setting interventions delivered in a standard format, requiring planning, implementation, and ongoing evaluation of more intensive goal-setting formats. This article describes how teachers can implement goal-setting interventions in their classrooms and provides a systematic framework for teachers to use individualized data to intensify goal-setting interventions.
Pediatric Ventricular Assist Device Implantation: An Anesthesia Perspective
Authors: Newington Dash F. T. , De Rita Fabrizio , McCheyne Alan , Barker Claire Louise
Published: March 2021

Background

Ventricular assist devices (VADs) are increasingly being implanted in children, yet there is little literature to guide anesthetic management for these procedures.

Aims

To describe the pediatric population presenting for VAD implantation and the anesthetic management these patients receive. To compare (a) children under and over 12 months of age and (b) children with and without congenital heart disease.

Methods

Retrospective review of patients aged 0 to 17 years who underwent VAD implantation at a single center between 2014 and 2019.

Results

Seventy-seven VADs were implanted in 68 patients (46 left VADs, 24 biventricular VADs, 6 right VADs, and 1 univentricular VAD). One procedure was abandoned. Preoperatively, 20 (26%) patients were supported with extracorporeal membrane oxygenation and 57 (73%) patients were ventilated. Intraoperative donor blood products were required in 74 (95%) cases. Postimplantation inotropic support was required in 66 (85%) cases overall and 46 (100%) patients receiving a left VAD. Infants under 12 months were more likely to require preoperative extracorporeal membrane oxygenation (42% vs 19%), have femoral venous access (54% vs 28%), receive an intraoperative vasoconstrictor (42% vs 24%), and have delayed sternal closure (63 vs 22%). Mortality was higher in patients under 12 months (25% vs 19%) and in patients with congenital heart disease (25% vs 20%).

Conclusions

Children undergoing VAD implantation require high levels of preoperative organ support, high-dose intraoperative inotropic support, and high-volume blood transfusion. Children under 12 months and those with congenital heart disease are particularly challenging for anesthesiologists and have worse overall outcomes.
The Functional Classification of ORF8 in SARS-CoV-2 Replication, Immune Evasion, and Viral Pathogenesis Inferred through Phylogenetic Profiling
Authors: Fahmi Muhamad , Kitagawa Hiromu , Yasui Gen , Kubota Yukihiko , Ito Masahiro
Published: March 2021

ORF8 is a highly variable genomic region of SARS-CoV-2. Although non-essential and the precise functions are unknown, it has been suggested that this protein assists in SARS-CoV-2 replication in the early secretory pathway and in immune evasion. We utilized the binding partners of SARS-CoV-2 proteins in human HEK293T cells and performed genome-wide phylogenetic profiling and clustering analyses in 446 eukaryotic species to predict and discover ORF8 binding partners that share associated functional mechanisms based on co-evolution. Results classified 47 ORF8 binding partner proteins into 3 clusters (groups 1-3), which were conserved in vertebrates (group 1), metazoan (group 2), and eukaryotes (group 3). Gene ontology analysis indicated that group 1 had no significant associated biological processes, while groups 2 and 3 were associated with glycoprotein biosynthesis process and ubiquitin-dependent endoplasmic reticulum-associated degradation pathways, respectively. Collectively, our results classified potential genes that might be associated with SARS-CoV-2 viral pathogenesis, specifically related to acute respiratory distress syndrome, and the secretory pathway. Here, we discuss the possible role of ORF8 in viral pathogenesis and in assisting viral replication and immune evasion via secretory pathway, as well as the possible factors associated with the rapid evolution of ORF8.
“Indigenous sovereignty” and right to self-determination in international law: a critical appraisal
Authors: Shrinkhal Rashwet
Published: March 2021

It is worth recalling that the struggle of indigenous peoples to be recognised as “peoples” in true sense was at the forefront of their journey from an object to subject of international law. One of the most pressing concerns in their struggle was crafting their own sovereign space. The article aims to embrace and comprehend the concept of “indigenous sovereignty.” It argues that indigenous sovereignty may not have fixed contour, but it essentially confronts the idea of “empire of uniformity.” It is a source from which right to self-determination stems out and challenges the political and moral authority of States controlling indigenous population within their territory.
Moral Orders of Mobility: Youth Aspirations and ‘Doing’ Social Position in Finland
Authors: Nikunen Minna , Ikonen Hanna-Mari
Published: March 2021

By studying the moral orders that young Finnish adults (aged 18–30) attach to geographical mobility, this article reveals previously neglected relationships between aspiration and mobility. The 40 young adult interviewees are living in the midst of Finnish political debates about youth aspiration, which emphasise geographical rather than social mobility as a way to enhance employability and demonstrate aspiration. We argue that young people themselves use the discourse of geographical mobility by leaning on morally ordered social positionings which tend to be classed and gendered. They position themselves on a moral map of Finnish society, and in doing so they work and rework the social order and social hierarchies among young adults. The article suggests that notions of global and domestic mobility might best be grasped by focusing on the moral orders of aspiration that young adults also attach to intimate life.
‘You don’t look autistic’: A qualitative exploration of women’s experiences of being the ‘autistic other’
Authors: Seers Kate , Hogg Rachel C
Published: March 2021

There is currently a paucity of literature exploring the experiences of women on the autism spectrum. It is imperative research is conducted to capture the experiences of women on the autism spectrum and ensure appropriate support is provided to this cohort. Drawing upon a social constructionist framework, this qualitative research study sought to understand how psychological and socio-cultural constructions of autism spectrum condition and gender influence the well-being of women on the autism spectrum. Eight participants engaged in a semi-structured interview, with thematic analysis conducted to demonstrate the impact of gender roles and social expectations on the women’s identity and autism spectrum condition expression. The research highlighted the changing understandings of autism spectrum condition across a woman’s lifespan and the process and impact of resisting hegemonic autism spectrum condition categorisation. The findings demonstrate that social constructions of gender and stereotypical understandings of autism spectrum condition, which prioritise a deficit, medical model, have significant consequences for women’s well-being and subjectivity. The women experienced challenging formative years, but with diagnosis and the evolution and acceptance of their identities, they were able to resist negative narratives of autism spectrum condition, embrace their strengths and develop adaptive coping strategies. It is hoped this article generates insights for societal and clinical recognition to better support women on the autism spectrum.

Lay abstract

Most autism spectrum condition research addresses the neurological and biological causes of autism spectrum condition, focusing upon deficits associated with autism spectrum condition and behavioural interventions designed to minimise these deficits. Little is known about the lived experiences of adult women on the autism spectrum and how they navigate social expectations around gender, autism spectrum condition and gendered understandings of autism spectrum condition. The lived experiences of eight women on the AS will be shared here, with attention to how gendered expectations influence women’s experiences of autism spectrum condition, their sense of self and well-being. Findings showed these women struggled to reconcile the expectations of others, particularly early in life. The women had difficultly conforming to stereotypical ideals of femininity, yet as they aged, they felt less need to conform, valuing their unique style and behaviours. The women also rejected deficit-oriented descriptions of autism spectrum condition generated by the medical community, preferring to focus on their strengths and unique characteristics. It is hoped this article helps psychologists and the wider community to understand and meet the needs of women on the AS.
A novel approach to assessing language proficiency in adults: A pre-pilot classification accuracy study
Authors: Schwarz Amy Louise , Resendiz Maria , Herrera Laura Catarina , Gonzales Maria Diana
Published: March 2021

Aims and objectives/purpose/research questions:

Speech–language pathologists who speak more than one language and who are members of the American Speech–Language–Hearing Association self-identify in one yes/no question whether they have the proficiency level to be bilingual service providers. This research note describes a preliminary attempt to address the very practical issue of whether and in what circumstances Spanish–English bilinguals can accurately judge their proficiency levels in both languages. The research question is: Will bilingual adults accurately identify their first language and second language proficiency levels using a self-assessment when compared to a commonly used standardized norm-referenced test (SNRT) in both formal and informal contexts across the following outcome measures: (a) overall proficiency; (b) listening; (c) speaking; (d) reading; and (e) writing?

Design/methodology/approach:

Classification accuracy studies require at least 34 participants. Thirty-nine participants completed the commonly used Language Use Questionnaire (LUQ) self-assessment and the commonly used Woodcock–Muñoz Language Survey SNRT (WMLS-III). For this pre-pilot study, participants were Spanish–English bilingual university students.

Data and analysis:

Forty likelihood ratios (LRs) were calculated. Benchmarks for interpreting LRs for classification accuracy studies were applied to identify the likelihood of an individual being proficient or non-proficient in two languages.

Findings/conclusions:

For the overall proficiency and formal speaking proficiency outcomes in Spanish, positive LRs met the benchmark for strong agreement.

Originality:

The current study is the first to show that Spanish–English bilingual adults can accurately judge their Spanish proficiency levels for two specific outcome measures.

Significance/implications:

These results are important for two reasons. First, they suggest that Spanish–English bilingual adults can accurately judge their overall proficiency levels in Spanish. Second, they identify which outcome measures from the LUQ and WMLS-III should be considered in a future classification accuracy study.
Everybody wants some: Collection and control of personal information, privacy concerns, and social media use
Authors: Cain Jason Anthony , Imre Iveta
Published: March 2021

As the utility of social media platforms for interacting with large populations, as well as understanding how they interact, becomes an increasingly interesting area, privacy concerns could present a barrier to engagement. This study employs a survey method to explore social media user frustrations with terms of service agreements and concerns over privacy and personal information shared on them. Findings support that concerns over control, collection, and access to personal information associate with decreased intensity of social media use and correlate to frustration with terms of service agreements regarding personal information use. Given the relationship between use and privacy concerns, leaving privacy concerns unaddressed might also lead to a reduction of use if these concerns continue to grow among users.
‘I feel pretty’: beauty as an affective-material process
Authors: Ingram Toni
Published: March 2021

This article explores the potential of feminist new materialisms and theories of affect for reframing how we might think about beauty and the body. Through an exploration of girls, beauty and the school ball (prom), the article engages with Karen Barad’s concept of intra-action to conceptualise beauty as an affective-material process. This perspective involves an ontological shift in how girls, bodies and beauty are understood; from thinking about beauty and the human as discursively produced, towards a relational approach that conceptualises materiality and affect as co-constitutive forces. The article is interested in how such a framing might invite ways of understanding beauty that avoid binary frameworks, such as good/bad, subject/object and discourse/matter. I consider the potential this might offer feminist analyses of beauty, where the focus is less on what beauty is or what it means, and more on how it comes to be.
The effect of doors and cavity on the aerodynamic noise of fuselage nose landing gear
Authors: Mu Yongfei , Li Jie , Lei Wutao , Liao Daxiong
Published: March 2021

The aerodynamic noise of landing gears have been widely studied as an important component of the airframe noise. During take-off and landing, there are doors, cavity and fuselage around the landing gear. The noise caused by these aircraft components will interfere with aerodynamic noise generated by the landing gear itself. Hence, paper proposes an Improved Delayed Detached Eddy Simulation (IDDES) method for the investigation of the flow field around a single fuselage nose landing gear (NLG) model and a fuselage nose landing gear model with doors, cavity and fuselage nose (NLG-DCN) respectively. The difference between the two flow fields were analyzed in detail to better understand the influence of these components around the aircraft’s landing gear, and it was found that there is a serious mixing phenomenon among the separated flow from the front doors, the unstable shear layer falling off the leading edge of the cavity and the wake of the main strut which directly leads to the enhancement of the noise levels. Furthermore, after the noise sound waves are reflected by the doors several times, an interference phenomenon is generated between the doors. This interference may be a reason why the tone excited in the cavity is suppressed.
Therapeutic Potential of Neu1 in Alzheimer’s Disease Via the Immune System
Authors: Khan Aiza , Das Sumit , Sergi Consolato
Published: March 2021

Alzheimer’s Disease (AD) is pathologically characterized by the accumulation of soluble oligomers causing extracellular beta-amyloid deposits in form of neuritic plaques and tau-containing intraneuronal neurofibrillary tangles in brain. One proposed mechanism explaining the formation of these proteins is impaired phagocytosis by microglia/macrophages resulting in defective clearance of soluble oligomers of beta-amyloid stimulating aggregation of amyloid plaques subsequently causing AD. However, research indicates that activating macrophages in M2 state may reduce toxic oligomers. NEU1 mutation is associated with a rare disease, sialidosis. NEU1 deficiency may also cause AD-like amyloidogenic process. Amyloid plaques have successfully been reduced using NEU1.Thus, NEU1 is suggested to have therapeutic potential for AD, with lysosomal exocytosis being suggested as underlying mechanism. Studies however demonstrate that NEU1 may activate macrophages in M2 state, which as noted earlier, is crucial to reducing toxic oligomers. In this review, authors discuss the potential therapeutic role of NEU1 in AD via immune system.
Dihydromyricetin Exhibits Antitumor Activity in Nasopharyngeal Cancer Cell Through Antagonizing Wnt/β-catenin Signaling
Authors: Ye Ling , Yin Gendi , Jiang Miaohua , Tu Bo , Li Zhicheng , Wang Yiming
Published: March 2021

Background:

Cancer stem cells (CSCs) have been demonstrated to play a vital role in a diversity of biological processes in cancers. With the emergence of new evidence, the important function of CSCs in the formation of multidrug resistance of nasopharyngeal cancer has been demonstrated. Dysregulated Wnt/β-catenin signaling pathway is an important contributor to chemoresistance and maintenance of CSCs-like characteristics. This research aims to investigate comprehensively the function of dihydromyricetin (DMY), a natural ﬂavonoid drug, on the cisplatin (cis) resistance and stem cell properties of nasopharyngeal cancer.

Methods:

In this study, the functional role of DMY in nasopharyngeal cancer progression was comprehensively investigated in vitro and in vivo, and then its relationship with CSCs-like phenotypes and multiple oncogenes was analyzed.

Results:

In parallel assays, the growth inhibitory action of cis was enhanced by the addition of DMY in cis-resistant nasopharyngeal cancer cell lines (Hone1/cis and CNE1/cis). Functional assays showed that DMY markedly diminished the stem cell properties of nasopharyngeal cells, such as colony and tumor-sphere formation. In vivo data showed that the growth of Hone1 CSCs formed tumor xenograft was inhibited significantly by the administration of DMY. Additionally, DMY could impair the Wnt/β-catenin signaling pathway and regulate the expression of downstream proteins in nasopharyngeal cancer cells.

Conclusions:

Our study clarified the anti-tumor activity of DMY through blocking the Wnt/β-catenin signaling pathway in nasopharyngeal cancer. Therefore, DMY could be a novel therapeutic agent for nasopharyngeal cancer treatment.
In Vitro Antioxidant Activities and the Therapeutic Potential of Some Newly Synthesized Chalcones Against 4-Acetaminophenol Induced Hepatotoxicity in Rats
Authors: Akhtar Muhammad Shoaib , Rehman Aziz-Ur- , Arshad Haroon , Malik Abdul , Fatima Muheer , Tabassum Tahira , Raza Abdul Rauf , Bukhsh Munnaza , Murtaza Mian Anjum , Mehmood Malik Hassan , Sultan Ayesha , Rasool Ghulam , Riaz Muhammad
Published: March 2021

The lack of safety and efficacy of existing hepatoprotective agents urge the need to explore novel hepatoprotective agents. The research work was planned to study the therapeutic potential of some newly synthesized chalcones against 4-acetaminophenol induced hepatotoxicity in rats. Male albino rats (N = 30) were divided into 6 groups of 5 animals each i.e. group I; Toxic control (4-acetaminophenol), group II; normal control (Normal saline), group III; Positive control (silymarin; 50 mg/kg bw) and groups IV-VI (test groups) treated with 3 chalcone analogues i-e 3a, 3f & 3 g (100, 150, 150 mg/kg bw, respectively). All the study group animals were administered with 4-acetaminophenol to induce hepatotoxicity except normal control. Following hepatotoxicity induction, test group animals were administered with selected doses of test compounds and toxic group animals left untreated. Liver enzymes including ALT, AST, ALP and serum bilirubin were determined photometrically. Antioxidant activities of test compounds were also determined. Histopathological examination of liver biopsies was also carried out through H & E staining. The test chalcones (3a, 3f & 3 g) significantly decreased the levels of liver enzymes and serum bilirubin toward normal and the pattern of results in the test group animals were comparable to silymarin administered animals indicating the hepatoprotective potential of test compounds. Moreover, the test chalcones (3a, 3f & 3 g) antagonized the effect of 4-acetaminophenol and thus, raised the catalase (CAT) and superoxide dismutase (SOD) while decreased the malondialdehyde (MDA) in experimental animals. The test chalcones (3a, 3f & 3 g) on histological examination of liver showed improvement of tissue morphology. The study concluded that the tested compounds have antioxidant potential and may act as hepatoprotective agent. However, in-depth studies are required to validate their safety and to elucidate the exact mechanism of action.
Gaining super control: Psychoeducational group intervention for adolescents with mild intellectual disability and their parents
Authors: Ericson Stine , Hesla Marianne Winge , Stadskleiv Kristine
Published: March 2021

Adolescents with intellectual disability experience psychological and social challenges in their transition to adulthood. Knowledge about the diagnosis and insight into own strengths and difficulties can help them manage the limitations and barriers they face, but suitable interventions with this purpose are scarce. The present paper presents a psychoeducational group intervention, The Super Control Project, for adolescents (15–17 years old) with mild intellectual disability (n = 23) and their parents. In a pre-post design, adolescent outcome data was obtained through teacher and parent questionnaires, and interviews with the adolescents. Parents and adolescents also evaluated the interventions’ usefulness. Results indicated positive impact on participants’ understanding of the diagnosis, managing of everyday challenges, and social networking. The intervention seemed to fit the participants’ needs and abilities. The study encourages further implementation and rigorous evaluation.
Autistic traits and loneliness in autism are associated with increased tendencies to anthropomorphise
Authors: Caruana Nathan , White Rebekah C , Remington Anna
Published: March 2021

Anthropomorphism—the attribution of human qualities to non-human objects—is believed to be a natural tendency which may serve several adaptive functions. One possibility is that anthropomorphism provides an egocentric heuristic by which we can understand the world. It may also be a strategy for reducing our subjective sense of loneliness. However, not all humans exhibit the same propensity to anthropomorphise. Recent findings suggest that autistic individuals may be more likely to anthropomorphise than non-autistic individuals. In Study 1, we conducted a large-scale survey of autistic traits and dispositional anthropomorphism in the general population ( n = 870). We found that individuals who reported having more autistic traits had an increased dispositional tendency to anthropomorphise non-human entities. In Study 2, we more closely examined variation in anthropomorphism tendencies in a sample of autistic adults ( n = 90) to better understand what might drive increased anthropomorphism in this population. We found that those with greater anthropomorphism tendencies experienced greater levels of self-reported loneliness. We propose that increased anthropomorphism might reflect reduced opportunities for social connection for autistic people and those with more autistic traits.
Physical Fitness Training in Patients with Subacute Stroke (PHYS-STROKE): Safety analyses of a randomized clinical trial
Authors: Rackoll Torsten , Nave Alexander H , Ebinger Martin , Endres Matthias , Grittner Ulrike , Flöel Agnes ,   ; for the PHYS-Stroke study group
Published: March 2021

Background and aim

To report the six-month safety analyses among patients enrolled in the “Physical Fitness Training in Subacute Stroke—PHYS-STROKE” trial and identify underlying risk factors associated with serious adverse events.

Methods

We performed a pre-specified safety analysis of a multicenter, randomized controlled, endpoint-blinded trial comprising 200 patients with moderate to severe subacute stroke (days 5–45 after stroke) that were randomly assigned (1:1) to receive either aerobic, bodyweight supported, treadmill-based training (n = 105), or relaxation sessions (n = 95, control group). Each intervention session lasted for 25 min, five times weekly for four weeks, in addition to standard rehabilitation therapy. Serious adverse events defined as cerebro- and cardiovascular events, readmission to hospital, and death were assessed during six months of follow-up. Incident rate ratios (IRR) were calculated, and Poisson regression analyses were conducted to identify risk factors for serious adverse events and to test the association with aerobic training.

Results

Six months after stroke, 50 serious adverse events occurred in the trial with a higher incidence rate (per 100 patient-months) in the training group compared to the relaxation group (6.31 vs. 3.22; IRR 1.70, 95% CI 0.96 to 3.12). The association of aerobic training with serious adverse events incidence rates were modified by diabetes mellitus (IRR for interaction: 7.10, 95% CI 1.56 to 51.24) and by atrial fibrillation (IRR for interaction: 4.37, 95% CI 0.97 to 31.81).

Conclusions

Safety analysis of the PHYS-STROKE trial found a higher rate of serious adverse events in patients randomized to aerobic training compared to control within six months after stroke. Exploratory analyses found an association between serious adverse events occurrence in the aerobic training group with pre-existing diabetes mellitus and atrial fibrillation which should be further investigated in future trials.

Data access statement

The raw data and analyses scripts are provided by the authors on a secure online repository for reproduction of reported findings.
Malignant infarction after endovascular treatment: Incidence and prediction
Authors: Bernsen Marie Louise E , Kauw Frans , Martens Jasper M , van der Lugt Aad , Yo Lonneke SF , van Walderveen Marianne AA , Roos Yvo BWEM , van der Worp H Bart , Dankbaar Jan W , Hofmeijer Jeannette
Published: March 2021

Background

Early prediction of malignant infarction may guide treatment decisions. For patients who received endovascular treatment, the risk of malignant infarction is unknown and risk factors are unrevealed.

Aims

The objective of this study is to estimate the incidence of malignant infarction after endovascular treatment in patients with an occlusion of the anterior circulation, to identify independent risk factors, and to establish a model for prediction.

Methods

We analyzed patients who received endovascular treatment for a large vessel occlusion in the anterior circulation within 6.5 h after symptom onset, included in the Dutch MR CLEAN Registry between March 2014 and June 2016. We compared patients with and without malignant infarction. Candidate predictors were incorporated in a multivariable binary logistic regression model. The final prediction model was established using backward elimination. Discrimination and calibration were evaluated with the area under the receiver operating characteristic curve (AUROC) and the Hosmer-Lemeshow test.

Results

Of 1445 patients, 82 (6%) developed malignant infarction. Independent predictors were lower age, higher National Institutes of Health Stroke Scale (NIHSS), lower alberta stroke program early CT score (ASPECTS), internal carotid artery occlusion, lower collateral score, longer times from onset to groin puncture, and unsuccessful reperfusion. The AUROC of a prediction model combining these features was 0.83 (95% confidence interval (CI): 0.79–0.88) and the Hosmer-Lemeshow test indicated appropriate calibration (P = 0.937).

Conclusion

The risk of malignant infarction after endovascular treatment started within 6.5 h of stroke onset is approximately 6%. Successful reperfusion decreases the risk. A prediction model combining easily retrievable measures of age, ASPECTS, collateral status, and reperfusion shows good discrimination between patients who will develop malignant infarction and those who will not.
Recanalization after cerebral venous thrombosis. A randomized controlled trial of the safety and efficacy of dabigatran etexilate versus dose-adjusted warfarin in patients with cerebral venous and dural sinus thrombosis
Authors: Ferro José M , Bendszus Martin , Jansen Olav , Coutinho Jonathan M , Dentali Francesco , Kobayashi Adam , Aguiar de Sousa Diana , Neto Lia L , Miede Corinna , Caria Jorge , Huisman Holger , Diener Hans-Christoph ,   on behalf of the RE-SPECT CVT Study Group
Published: March 2021

Background

The effect of different anticoagulants on recanalization after cerebral venous thrombosis has not been studied in a randomized controlled trial.

Methods

RE-SPECT CVT (ClinicalTrials.gov number: NCT02913326) was a Phase III, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded endpoint adjudication. Acute cerebral venous thrombosis patients were allocated to dabigatran 150 mg twice daily, or dose-adjusted warfarin, for 24 weeks, after 5–15 days’ treatment with unfractionated or low-molecular-weight heparin. A standardized magnetic resonance protocol including arterial spin labeling, three-dimensional time-of-flight venography, and three-dimensional contrast-enhanced magnetic resonance angiography was obtained at the end of the treatment period. Cerebral venous recanalization at six months was assessed by two blinded adjudicators, using the difference in a score of occluded sinuses and veins (predefined secondary efficacy endpoint) and in the modified Qureshi scale (additional endpoint), between baseline and the end of the treatment.

Results

Of 120 cerebral venous thrombosis patients randomized, venous recanalization could be evaluated in 108 (55 allocated to dabigatran and 53 to warfarin, 1 patient had a missing occlusion score at baseline). No patient worsened in the score of occluded cerebral veins and sinuses, while 33 (60%) on dabigatran and 35 (67%) on warfarin improved. The mean score change from baseline in the occlusion score was similar in the two treatment groups (dabigatran −0.8, SD 0.78; warfarin −1.0, SD 0.92). In the modified Qureshi score, full recanalization was adjudicated in 24 (44%) and 19 (36%), and partial recanalization in 23 (42%) and 26 (49%) patients in the dabigatran and warfarin arms, respectively. No statistically significant treatment difference in the modified Qureshi score could be detected ( p = 0.44).

Conclusion

The majority of patients with cerebral venous thrombosis, anticoagulated with either dabigatran or warfarin for six months, showed partial or complete recanalization of occluded sinuses and veins at the end of the treatment. Clinical trial registration: Trial registry name: ClinicalTrials.gov URL: https://clinicaltrials.gov Registration number: NCT02913326
Non-contrast head CT-based thrombolysis for wake-up/unknown onset stroke is safe: A single-center study and meta-analysis
Authors: Zha Alicia M , Kamal Haris , Jeevarajan Jerome A , Arevalo Octavio , Zhu Liang , Ankrom Christy M , Bonfante-Mejia Eliana E , Cossey Tiffany D , Wu Tzu Ching , Barreto Andrew D , Grotta James C , Jagolino-Cole Amanda L
Published: March 2021

Background

Recent studies have shown that tPA can be safely administered past the standard 4.5 h window with good outcomes when selected with multi-model imaging, which is often lacking outside of comprehensive stroke centers.

Aim

We aim to analyze the safety and outcomes of wake up/unknown onset (WUS/UNK) patients treated based on non-contrast head CT (NCCT) at our institution and in the literature.

Methods

Suspected stroke patients from January 2015 to December 2018 receiving tPA within 4.5 h (standard window-SW) and with WUS/UNK based on NCCT and clinical-imaging mismatch were identified. We compared baseline characteristics, tPA metrics, and outcome data, with primary outcome as symptomatic intracerebral hemorrhage (sICH). A meta-analysis was performed evaluating NCCT-based treatment of WUS/UNK patients.

Results

Of 1827 patients treated at our hub or through telestroke, 93 underwent WUS/UNK-based treatment. There was no statistical difference in sICH between WUS/UNK and SW: 1% vs. 4% (OR 0.3; 95% confidence interval 0.0–1.9). 90-day modified Rankin scale outcomes were similar between SW and WUS/UNK-treated patients. Seven studies encompassing 485 WUS/UNK patients were included in a pooled analysis with a 2.1% incidence of sICH. In our meta-analysis, three studies compared NCCT-based treated WUS/UNK patients with SW patients with no difference in rate of hemorrhage: 2.1% vs 3.4% (OR 1.01; 95% confidence interval 0.45–2.28).

Interpretation

Our single-center analysis and meta-analysis suggest that tPA can be safely administered based on NCCT with comparable rates of sICH for select WUS/UNK stroke patients.
Advanced therapeutic inhalation aerosols of a Nrf2 activator and RhoA/Rho kinase (ROCK) inhibitor for targeted pulmonary drug delivery in pulmonary hypertension: design, characterization, aerosolization, in vitro 2D/3D human lung cell cultures, and in vivo efficacy
Authors: Acosta Maria F. , Muralidharan Priya , Grijalva Carissa L. , Abrahamson Michael D. , Hayes Don , Fineman Jeffrey R. , Black Stephen M. , Mansour Heidi M.
Published: March 2021

Inhalable nanostructured microparticles of simvastatin, a Nrf2 activator and RhoA/Rho kinase (ROCK) inhibitor, were rationally designed for targeted pulmonary delivery as dry powder inhalers (DPIs) for the treatment of pulmonary hypertension (PH). Advanced particle engineering design technology was employed to develop inhalable dry powders using different dilute feed concentrations and spray drying pump rates. Several analytical techniques were used comprehensively to characterize the physicochemical properties of the resulting powders. Scanning electron microscopy (SEM) was used to visualize particle morphology (shape), surface structure, size, and size distribution. Karl Fischer titration (KFT) was employed to quantify the residual water content in the powders. X-ray powder diffraction (XRPD) was used to determine crystallinity. Hot-stage microscopy (HSM) under cross-polarizing lens was used to observe the presence or absence of birefringence characteristic of crystallinity. Differential scanning calorimetry (DSC) was employed to quantify thermotropic phase behavior. Attenuated total reflectance (ATR)-Fourier-transform infrared (FTIR) spectroscopy and Raman spectroscopy were used to determine the molecular fingerprint of simvastatin powders before and after particle engineering design. In vitro aerosol dispersion performance was performed with three different Food and Drug Administration (FDA)-approved human DPI devices. Cell viability and transepithelial electrical resistance (TEER) were demonstrated using different in vitro human pulmonary cell two and three-dimensional models at the air–liquid interface, and in vivo safety in healthy rats by inhalation. Efficacy was demonstrated in the in vivo lamb model of PH. Four different inhalable powders of simvastatin were successfully produced. They possessed nanostructured surfaces and were in the inhalable size range. Simvastatin retained its crystallinity following particle engineering design. The more dilute feed concentration spray dried at the lower pump rate produced the smallest particles. All powders successfully aerosolized with all three DPI human devices. Inhaled simvastatin as an aerosol restored the endothelial function in the shunt lamb model of PH, as demonstrated by the reduction of pulmonary vascular resistance (PVR) in response to the endothelium-dependent vasodilator acetylcholine.

The reviews of this paper are available via the supplemental material section.
Support for interreligious conflict in Indonesia
Authors: Setiawan Tery , De Jong Edwin B. P. , Scheepers Peer L. H. , Sterkens Carl J. A.
Published: March 2021

The study aims to extend knowledge on interreligious conflicts in Indonesia by investigating the extent to which perceived threat, outgroup distrust, and interreligious contact mediate the relationship between majority–minority affiliation and support for interreligious conflict in Indonesia. We employed two modes of support, lawful and violent protests, to represent support for interreligious conflict. We collected survey data, covering random samples of ordinary citizens (N = 2,055, Muslims and Christians) across the archipelago. Our results reveal that perceived threat is the strongest mediator in the relationship between majority–minority affiliation and support for interreligious conflict. In contrast, interreligious contact shows no significance in explaining the relationship of interest. Overall, our study highlights the importance of focusing on support for both lawful and violent protests to describe and explain latent interreligious conflict in Indonesia, while taking into account relevant concepts resulting from prolonged interreligious conflict (namely perceived threat and outgroup distrust) on the one hand and different traits of interreligious contact as highly potential solutions on the other.
Lay Beliefs About the World Affect Preferences for Sustainable Hotel Offerings
Authors: Septianto Felix , Thai Nguyen T. , Kemper Joya A.
Published: March 2021

Prior research has established that consumers with higher levels of biospheric values are more likely to engage in sustainable behaviors. Such findings assume that tourism practitioners should solely focus their marketing efforts on consumers with high levels of biospheric values. The present research reexamines such typical expectations by investigating how lay beliefs about the world elicited by advertising can encourage consumers with low levels of biospheric values to engage in sustainable behaviors. Results of two experimental studies show that, among consumers with low levels of biospheric values, those with a malleable (vs. fixed) lay belief about the world exhibit stronger preferences for sustainable hotels offerings because they are more hopeful that the sustainable efforts from the hotels can create a positive change. These findings contribute to the literature by demonstrating the role of lay beliefs on consumers’ sustainable behaviors and establishing the underlying mechanism. In addition, this research provides a novel insight about how tourism practitioners can appeal to unsustainable consumers, highlighting how the tourism industry can create positive behavior change toward consumers’ sustainable behaviors.
Reversal of Stroke-Like Episodes With L-Arginine and Meticulous Perioperative Management of Renal Transplantation in a Patient With Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes (MELAS) Syndrome. Case Report
Authors: Al Yazidi Ghalia , Mulder Jaap , Licht Christoph , Harvey Elizabeth , Robertson James , Sondheimer Neal , Tein Ingrid
Published: March 2021

Mitochondrial encephalomyopathy, lactic acidosis and stroke like episodes (MELAS) syndrome is a maternally inherited mitochondrial disorder with recurrent non-arterial distribution stroke-like episodes (SLEs). A 17 yr old boy with MELAS (m.3243A>G tRNALeu(UUR)) presented with SLEs at ages 8 and 10 yrs. At 11 yrs, he suffered a third SLE involving left parietotemporal lobes with dense right hemiplegia and aphasia persistent for 1 week without improvement. On high dose IV L-Arginine (L-Arg) (0.5 g/kg/day divided TID) he had rapid recovery within 48 hours and was rapidly weaned. With emesis of oral L-Arg, his SLE recurred and he was again treated with high dose IV L-Arg with similar rapid recovery and discharged on a slow wean over 6 wks to 0.1 g/kg/day. On maintenance L-Arg he suffered only 2 SLEs at ages 13 and 16 yrs; both resolved rapidly with high dose IV L-Arg without recurrence during a slow wean to maintenance. His phenotype included seizures, ptosis, ophthalmoplegia, facial diplegia, sensorineural hearing loss, ataxia, myopathy, exercise intolerance, peripheral sensorimotor neuropathy, hypertrophic cardiomyopathy, hypertension, and failure to thrive. At 16 yrs he developed end-stage renal disease, due to MELAS, requiring hemodialysis and at 17 yrs he underwent cadaveric renal transplantation. His peri-operative protocol included strict maintenance of perfusion, oxygenation, normothermia, biochemical homeostasis and serum arginine concentrations during which time there were no neurologic decompensations. He was transitioned to oral L-citrulline maintenance therapy which maintained higher serum arginine concentrations with better tolerance. He had no SLEs or seizures in the ensuing 2 yrs.
Development of stabilized dual growth factor-loaded hyaluronate collagen dressing matrix
Authors: Kim Jihyun , Lee Kyoung-Mi , Han Seung Hwan , Ko Eun Ae , Yoon Dong Suk , Park Ik Kyu , Shin Hang-Cheol , Park Kwang Hwan , Lee Jin Woo
Published: March 2021

Patients with diabetes experience impaired growth factor production such as epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF), and they are reportedly involved in wound healing processes. Here, we report dual growth factor-loaded hyaluronate collagen dressing (Dual-HCD) matrix, using different ratios of the concentration of stabilized growth factors—stabilized-EGF (S-EGF) and stabilized-bFGF (S-bFGF). At first, the optimal concentration ratio of S-EGF to S-bFGF in the Dual-HCD matrix is determined to be 1:2 in type I diabetic mice. This Dual-HCD matrix does not cause cytotoxicity and can be used in vivo. The wound-healing effect of this matrix is confirmed in type II diabetic mice. Dual HCD enhances angiogenesis which promotes wound healing and thus, it shows a significantly greater synergistic effect than the HCD matrix loaded with a single growth factor. Overall, we conclude that the Dual-HCD matrix represents an effective therapeutic agent for impaired diabetic wound healing.
For the place of terrain and materialist ‘re’-returns: Experience, life, force, and the importance of the socio-cultural
Authors: Peters Kimberley
Published: March 2021

In this brief response to Stuart Elden’s thought-provoking essay ‘Terrain, Politics, History’, I question whether place, one of the most ubiquitous concepts worked with by geographers, might have a place itself in studies of territory and provide another way of attending to the neglect of the materiality of territory. In raising this point, I further ask if attention should also be shifted more broadly to the terrains of social and cultural geographies. Here an extensive body of work has investigated more-than-human materialist approaches to making sense of the world and examined the agencies and role of landscape. Both lenses, I argue, could offer a great deal to theorisations of territory and its materiality, which are perhaps overlooked, within territory’s position as a concept of the subdiscipline of political geography. In sum, I posit that geography has already dealt quite significantly with the materiality of the Earth in other strands of the discipline, and this work may offer much in dialogue with efforts to materialise our thinking of territory.