bluuebunny/crossref_metadata_2025 huggingface dataset:
Helicobacter pylori
Infection Impairs Endothelial Function Through an Exosome‐Mediated Mechanism
Authors: Xia Xiujuan , Zhang Linfang , Chi Jingshu , Li Huan , Liu Xiaoming , Hu Tingzi , Li Rong , Guo Yinjie , Zhang Xue , Wang Hui , Cai Jin , Li Yixi , Liu Da , Cui Yuqi , Zheng Xilong , Flaker Gregory C. , Liao Duanfang , Hao Hong , Liu Zhenguo , Xu Canxia
Published: March 2020

Background

Epidemiological studies have suggested an association between
Helicobacter pylori
(
H pylori
) infection and atherosclerosis through undefined mechanisms. Endothelial dysfunction is critical to the development of atherosclerosis and related cardiovascular diseases. The present study was designed to test the hypothesis that
H pylori
infection impaires endothelial function through exosome‐mediated mechanisms.

Methods and Results

Young male and female patients (18‐35 years old) with and without
H pylori
infection were recruited to minimize the chance of potential risk factors for endothelial dysfunction for the study. Endothelium‐dependent flow‐mediated vasodilatation of the brachial artery was evaluated in the patients and control subjects. Mouse infection models with CagA
+
H pylori
from a gastric ulcer patient were created to determine if
H pylori
infection‐induced endothelial dysfunction could be reproduced in animal models.
H pylori
infection significantly decreased endothelium‐dependent flow‐mediated vasodilatation in young patients and significantly attenuated acetylcholine‐induced endothelium‐dependent aortic relaxation without change in nitroglycerin‐induced endothelium‐independent vascular relaxation in mice.
H pylori
eradication significantly improved endothelium‐dependent vasodilation in both patients and mice with
H pylori
infection. Exosomes from conditioned media of human gastric epithelial cells cultured with CagA
+
H pylori
or serum exosomes from patients and mice with
H pylori
infection significantly decreased endothelial functions with decreased migration, tube formation, and proliferation in vitro. Inhibition of exosome secretion with
GW
4869 effectively preserved endothelial function in mice with
H pylori
infection.

Conclusions

H pylori
infection impaired endothelial function in patients and mice through exosome‐medicated mechanisms. The findings indicated that
H pylori
infection might be a novel risk factor for cardiovascular diseases.
Determinants of Sudden Cardiac Death in Adult Patients With Eisenmenger Syndrome
Authors: Chiriac Anca , Riley David C. , Russell Matthew , Moore Jeremy P. , Padmanabhan Deepak , Hodge David O. , Spiegel Matthew R. , Vargas Emily R. , Phillips Sabrina D. , Ammash Naser M. , Madhavan Malini , Asirvatham Samuel J. , McLeod Christopher J.
Published: March 2020

Background

Patients with Eisenmenger syndrome are known to have a high incidence of sudden cardiac death (
SCD
), yet the underlying causes are not well understood. We sought to define the predictors of
SCD
in this population.

Methods and Results

A retrospective analysis of all patients with Eisenmenger syndrome from 2 large tertiary referral centers was performed. ECGs, prolonged ambulatory recordings, echocardiograms, and clinical histories were reviewed; and the cause of death was identified. A total of 246 patients (85 [34.6%] men) with a mean age of 37.3 (±14.2) years were followed up for a median of 7 years. Over the study period, 136 patients died, with 40 experiencing
SCD
and 74 experiencing cardiac death (sudden and nonsudden). Age, atrial fibrillation, prolonged
QRS
duration, complete heart block, right atrial enlargement, right bundle branch block, increased right atrial pressure, impaired biventricular function, and the presence of a pacemaker were associated with increased risk of
SCD
, whereas advanced pulmonary hypertension therapies were protective. Atrial fibrillation (11.45‐fold increased risk;
P
<0.001) and
QRS
duration ≥120 ms (2.06‐fold increased risk;
P
=0.034) remained significant predictors of
SCD
in the multivariate analysis, whereas advanced pulmonary hypertension therapies were strongly protective against
SCD
(
P
<0.001).

Conclusions

Atrial arrhythmias, impaired ventricular function, and conduction system disease were associated with increased risk of
SCD
in this cohort of patients with Eisenmenger syndrome, providing an opportunity for early risk stratification and potential intervention. Clinical heart failure symptoms (New York Heart Association class ≥
II
) were predictive of increased mortality but not of
SCD
, suggesting a potential arrhythmic cause behind
SCD
.
Associations of Serum Dickkopf‐1 and Sclerostin With Cardiovascular Events: Results From the Prospective Bruneck Study
Authors: Klingenschmid Gerhard , Tschiderer Lena , Himmler Gottfried , Rungger Gregorio , Brugger Stefan , Santer Peter , Willeit Johann , Kiechl Stefan , Willeit Peter
Published: March 2020

Background

Dickkopf‐1 and sclerostin have been implicated in atherosclerosis and vascular calcification. We aimed to quantify the association of their serum levels with incident cardiovascular disease (
CVD
) in the general population.

Methods and Results

Among 706 participants of the prospective, population‐based Bruneck Study, mean±SD of serum levels were 44.5±14.7 pmol/L for dickkopf‐1 and 47.1±17.5 pmol/L for sclerostin. The primary outcome was a composite
CVD
end point composed of ischemic or hemorrhagic stroke, transient ischemic attack, myocardial infarction, angina pectoris, peripheral vascular disease, and revascularization procedures. Over a median follow‐up duration of 15.6 years, 179
CVD
events occurred. For the primary
CVD
outcome, multivariable‐adjusted hazard ratios (
HR
s) per SD higher level were 1.20 for dickkopf‐1 (95%
CI
, 1.02–1.42;
P
=0.028) and 0.92 for sclerostin (95%
CI,
0.78–1.08;
P
=0.286). Secondary outcome analyses revealed that the association of dickkopf‐1 was primarily driven by ischemic and hemorrhagic stroke (67 events;
HR,
1.37; 95%
CI,
1.06–1.78;
P
=0.017), whereas no increase in risk was observed for transient ischemic attack (22 events;
HR,
0.87; 95%
CI,
0.53–1.44;
P
=0.593), myocardial infarction (45 events;
HR,
1.10; 95% CI, 0.78–1.54;
P
=0.598), or for other
CVD
(45 events;
HR,
1.25; 95%
CI,
0.88–1.76;
P
=0.209).

Conclusions

In this prospective, population‐based study, elevated baseline levels of dickkopf‐1, but not sclerostin, were independently associated with incident cardiovascular events, which was mainly driven by stroke. Our findings support the hypothesis of a role of dickkopf‐1 in the pathogenesis of
CVD
.
Cumulative Lifetime Burden of Cardiovascular Disease From Early Exposure to Air Pollution
Authors: Kim Juyong Brian , Prunicki Mary , Haddad Francois , Dant Christopher , Sampath Vanitha , Patel Rushali , Smith Eric , Akdis Cezmi , Balmes John , Snyder Michael P. , Wu Joseph C. , Nadeau Kari C.
Published: March 2020

The disease burden associated with air pollution continues to grow. The World Health Organization (WHO) estimates ≈7 million people worldwide die yearly from exposure to polluted air, half of which—3.3 million—are attributable to cardiovascular disease (CVD), greater than from major modifiable CVD risks including smoking, hypertension, hyperlipidemia, and diabetes mellitus. This serious and growing health threat is attributed to increasing urbanization of the world's populations with consequent exposure to polluted air. Especially vulnerable are the elderly, patients with pre‐existing CVD, and children. The cumulative lifetime burden in children is particularly of concern because their rapidly developing cardiopulmonary systems are more susceptible to damage and they spend more time outdoors and therefore inhale more pollutants. World Health Organization estimates that 93% of the world's children aged <15 years—1.8 billion children—breathe air that puts their health and development at risk. Here, we present growing scientific evidence, including from our own group, that chronic exposure to air pollution early in life is directly linked to development of major CVD risks, including obesity, hypertension, and metabolic disorders. In this review, we surveyed the literature for current knowledge of how pollution exposure early in life adversely impacts cardiovascular phenotypes, and lay the foundation for early intervention and other strategies that can help prevent this damage. We also discuss the need for better guidelines and additional research to validate exposure metrics and interventions that will ultimately help healthcare providers reduce the growing burden of CVD from pollution.
Association Between Intensive Care Unit Usage and Long‐Term Medication Adherence, Mortality, and Readmission Among Initially Stable Patients With Non–ST‐Segment–Elevation Myocardial Infarction
Authors: Fanaroff Alexander C. , Chen Anita Y. , van Diepen Sean , Peterson Eric D. , Wang Tracy Y.
Published: March 2020

Background

Hospitals in the United States vary in their use of intensive care units (
ICU
s) for hemodynamically stable patients with non–
ST
‐segment–elevation myocardial infarction (
NSTEMI
). The association between
ICU
use and long‐term outcomes after
NSTEMI
is unknown.

Methods and Results

Using data from the National Cardiovascular Data Registry linked to Medicare claims, we identified 65 256
NSTEMI
patients aged ≥ 65 years without cardiogenic shock or cardiac arrest on presentation between 2011 and 2014. We compared 1‐year medication non‐adherence, cardiovascular readmission, and mortality across hospitals by
ICU
use using multivariable regression models. Among 520 hospitals, 154 (29.6%) were high
ICU
users (>70% of stable
NSTEMI
patients admitted to
ICU
), 270 (51.9%) were intermediate (30%–70%), and 196 (37.7%) were low (<30%). Compared with low
ICU
usage hospitals, no differences were observed in the risks of 1‐year medication non‐adherence (adjusted odds ratio 1.08, 95%
CI
, 0.97–1.21), mortality (adjusted hazard ratio 1.06, 95%
CI
, 0.98–1.15), and cardiovascular readmission (adjusted hazard ratio 0.99, 95% CI, 0.95–1.04) at high usage hospitals. Patients hospitalized at intermediate
ICU
usage hospitals had lower rates of evidence‐based therapy and diagnostic catheterization within 24 hours of hospital arrival, and higher risks of 1‐year mortality (adjusted hazard ratio 1.07, 95%
CI
, 1.02–1.12) and medication non‐adherence (adjusted odds ratio 1.09, 95%
CI
, 1.02–1.15) compared with low
ICU
usage hospitals.

Conclusions

Routine
ICU
use is unlikely to be beneficial for hemodynamically stable
NSTEMI
patients; medication adherence, long‐term mortality, and cardiovascular readmission did not differ for high
ICU
usage hospitals compared with hospitals with low
ICU
usage rates.
Atrial Fibrillation-Associated Ischemic Stroke Patients With Prior Anticoagulation Have Higher Risk for Recurrent Stroke
Authors: Tanaka Kanta , Koga Masatoshi , Lee Keon-Joo , Kim Beom Joon , Park Eun Lyeong , Lee Juneyoung , Mizoguchi Tadataka , Yoshimura Sohei , Cha Jae-Kwan , Lee Byung-Chul , Nakahara Jin , Suzuki Norihiro , Bae Hee-Joon , Toyoda Kazunori ,   for the CRCS-K Investigators and the SAMURAI Study Investigators
Published: March 2020

Background and Purpose—

Ischemic stroke associated with nonvalvular atrial fibrillation (NVAF) despite prior anticoagulation may indicate underlying problems that nullify the stroke-preventing effects of oral anticoagulants. We aimed to evaluate the risk for recurrent stroke in patients with NVAF with prior anticoagulation, compared with that in patients without prior anticoagulation.

Methods—

This study comprised pooled individual patient data on NVAF-associated acute ischemic stroke or transient ischemic attack from 2011 to 2014 arising from the Clinical Research Collaboration for Stroke in Korea (15 South Korean stroke centers) and the Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-NVAF registry (18 Japanese stroke centers). Data on 4841 eligible patients from the Clinical Research Collaboration for Stroke in Korea registry were pooled with data on all patients (n=1192) in the Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-NVAF registry. The primary outcome was recurrent ischemic stroke. The secondary outcomes were hemorrhagic stroke and all-cause death. Outcome events were captured up to 1 year after the index event.

Results—

Among the 6033 patients in the full cohort, 5645 patients were analyzed, of whom 1129 patients (20.0%) had received prior anticoagulation. Median age was 75 years (interquartile range, 69–81 years), and 2649 patients (46.9%) were women. Follow-up data of 4617 patient-years (median follow-up 365 days, interquartile range 335–365 days) were available. The cumulative incidence of recurrent ischemic stroke in patients with prior anticoagulation was 5.3% (60/1129), compared with the 2.9% (130/4516) incidence in patients without prior anticoagulation. The risk for recurrent ischemic stroke was higher in patients with prior anticoagulation than in those without (multivariable Cox shared-frailty model, hazard ratio 1.50 [95% CI, 1.02–2.21]). No significant differences in the risks for hemorrhagic stroke and mortality were seen between the 2 groups.

Conclusions—

The risk for recurrent ischemic stroke may be higher in NVAF-associated stroke patients with prior anticoagulation than in those without prior anticoagulation.

Registration—

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01581502.
TÜKETİCİNİN KİN TUTMA EĞİLİMİNİN PAZARDAN GERİ ÇEKİLME NİYETİ ÜZERİNDE ETKİSİ: TÜKETİCİ SİNİZMİNİN ARACI VE DÜZENLEYİCİ ROLÜ
Authors: TOKGÖZ Emrah
Published: March 2020

Tüketiciler, mal ve
hizmet satın alma sürecinde veya sonrasında yaşadıkları olumsuz olaylarla, işletme
veya markalarla ilgili kin tutma eğilimi içinde olabilir. Kimi zaman kin tutma
eğilimi, o işletme ve markanın ürünlerini satın almama, yani pazardan geri
çekilme niyetine dönüşebilir. Diğer taraftan tüketici sinizmi, işletmelerin
kendi çıkarlarını düşündükleri ve tüketici ihtiyaçlarına ilgi göstermedikleri
inanışıdır. Bu nedenle kin tutma eğilimlerinin pazardan geri çekilme niyeti
üzerindeki etkisinin sinizm seviyesi yüksek olan tüketicilerde etkili
olabileceği düşünülebilir. Buradan hareketle araştırmanın amacı, tüketicinin
kin tutma eğiliminin pazardan geri çekilme niyeti üzerindeki etkisinde tüketici
sinizminin aracı ve düzenleyici rolünü ortaya koymaktır. Araştırmada örnekleme
yöntemi olarak, olasılığa dayalı örnekleme yöntem­lerinden kümelere göre
örnekleme yöntemi kullanılmıştır. Örneklemi üniversitede öğrenim gören genç
tüketiciler oluşturmaktadır. Oluşturulan anket, bırak-topla yöntemiyle,
kullanılabilir durumda 502 öğrencinin katılımıyla uygulanmıştır. Araştırmada,
SPSS programına yüklenerek kullanılan PROCESS Makro yazılımı, aracı ve
düzenleyici analizi yapılmasına yardımcı olmuştur. Oluşturulan araştırma
modellerinden elde edilen sonuçlara göre tüketicinin kin tutma eğiliminin pazardan
geri çekilme niyeti üzerindeki etkisinde, tüketici sinizminin kısmi aracı rolü
olduğu belirlenmiştir. Düzenleyici etkisinin ise sinizm seviyesi orta ve düşük
olan tüketicilerde anlamlı rol oynadığı anlaşılmıştır.
The Discriminative Kalman Filter for Bayesian Filtering with Nonlinear and Nongaussian Observation Models
Authors: Burkhart Michael C. , Brandman David M. , Franco Brian , Hochberg Leigh R. , Harrison Matthew T.
Published: March 2020

The Kalman filter provides a simple and efficient algorithm to compute the posterior distribution for state-space models where both the latent state and measurement models are linear and gaussian. Extensions to the Kalman filter, including the extended and unscented Kalman filters, incorporate linearizations for models where the observation model p(observation|state) is nonlinear. We argue that in many cases, a model for p(state|observation) proves both easier to learn and more accurate for latent state estimation.

Approximating p(state|observation) as gaussian leads to a new filtering algorithm, the discriminative Kalman filter (DKF), which can perform well even when p(observation|state) is highly nonlinear and/or nongaussian. The approximation, motivated by the Bernstein–von Mises theorem, improves as the dimensionality of the observations increases. The DKF has computational complexity similar to the Kalman filter, allowing it in some cases to perform much faster than particle filters with similar precision, while better accounting for nonlinear and nongaussian observation models than Kalman-based extensions.

When the observation model must be learned from training data prior to filtering, off-the-shelf nonlinear and nonparametric regression techniques can provide a gaussian model for p(observation|state) that cleanly integrates with the DKF. As part of the BrainGate2 clinical trial, we successfully implemented gaussian process regression with the DKF framework in a brain-computer interface to provide real-time, closed-loop cursor control to a person with a complete spinal cord injury. In this letter, we explore the theory underlying the DKF, exhibit some illustrative examples, and outline potential extensions.
A new species of Ogyrides (Decapoda, Caridea, Ogyrididae) from Kuwait
Authors: De Grave Sammy , Al-Kandari Manal , Anker Arthur
Published: March 2020

A new species of telescope shrimp, Ogyrides sindibadi sp. nov. is described from Kuwait. The new species is morphologically similar to O. striaticauda Kemp, 1915, originally described from Chilka Lake (India), but can be distinguished by the shape of the scaphocerite, the much longer dactylus of the third pereiopod, as well as the shape of the distal margin of the telson.
A Great Little Man: The Shadow of Jair Bolsonaro
Authors: Webber Jeffery R.
Published: March 2020

This editorial perspective attempts to explain the recent rise of Jair Bolsonaro to the presidency in Brazil and to characterise, at least in a preliminary fashion, the nature of the new regime one year into Bolsonaro’s rule. The core argument is that Bolsonaro represents a weak and internally-fragmented far-right regime, with unenthusiastic and declining popular support. Dominant sections of international and domestic capital operating in Brazil lent Bolsonaro electoral backing as a last way out of economic and political crisis, but so far, the new government has failed in sufficiently guaranteeing their most important interests and the markets are withdrawing approval. Themes covered include the political paralysis of the new regime, the social bases of Bolsonarismo, the nature of the current state–capital relation, and the role of evangelical Pentecostalism in far-right Brazilian politics today. A biographical portrait of Bolsonaro is provided, alongside a mapping of the dominant factions of the new administration. Finally, an assessment of the economic outlook in Brazil is developed, together with speculation as to the likely political consequences in the short- to medium-term future.
On the Prehistory of Cretan Icon Painting
Authors: Bacci Michele
Published: March 2020

The present paper offers some thoughts on the complex issue of Italianate elements in Cretan icon painting by emphasizing the extent to which they can be considered to stem from motifs worked out in the mid-to-late fourteenth century in the wider, fluid space between Venice and the Eastern Mediterranean. It focuses on a cluster of Marian panels that, on account of their mixed Byzantine and Western character, have been hitherto confined to the margins of art-historical research and improperly labeled as works of a so-called “Adriatic” school. The critical reassessment of these works illuminates the ways in which innovative compositional, iconographic, and stylistic solutions were developed by masters well acquainted with both Palaiologan and Venetian art, and reproduced in a chain of replicas, some of which can be reasonably attributed to Cretan workshops.
Volume and Heat Budgets in the Coastal California Current System: Means, Annual Cycles, and Interannual Anomalies of 2014–16
Authors: Zaba Katherine D. , Rudnick Daniel L. , Cornuelle Bruce D. , Gopalakrishnan Ganesh , Mazloff Matthew R.
Published: March 2020

The data-assimilating California State Estimate (CASE) enables the explicit evaluation of spatiotemporally varying volume and heat budgets in the coastal California Current System (CCS). An analysis of over 10 years of CASE model output (2007–17) diagnoses the physical drivers of the CCS mean state, annual cycles, and the 2014–16 temperature anomalies associated with a marine heat wave and an El Niño event. The largest terms in the mean mixed layer (from−50 to 0 m) volume budgets are upward vertical transport at the coast and offshore-flowing ageostrophic Ekman transport at the surface, the two branches of the coastal upwelling overturning cell. Contributions from onshore geostrophic flow in the Southern California Bight and alongshore geostrophic convergence in the central CCS balance the mean volume budgets. The depth-dependent annual cycle of vertical velocity exhibits the strongest upward velocity between −40- and −30-m depth in April. Interannual volume budgets show that over 50% of the 2013.5–16.5 time period experienced downwelling anomalies, which were balanced predominantly by alongshore transport convergence and, less often, by onshore transport anomalies. Mixed layer temperature anomalies persisted for the entirety of 2014–16, reaching a maximum of +3° in October 2015. The mixed layer heat budget shows that intermittent high air–sea heat flux anomalies and alongshore and vertical heat advection anomalies all contributed to warming during 2014–16. A subsurface (from −210 to −100 m) heat budget reveals that in September 2015 anomalous poleward heat advection into the Southern California Bight by the California Undercurrent caused deeper warming during the 2015/16 El Niño.
Using Direct Observation to Document “Practice-Based Evidence” of Evidence-Based Mathematics Instruction
Authors: Doabler Christian T. , Clarke Ben , Kosty Derek , Turtura Jessica E. , Sutherland Marah , Maddox Steven A. , Smolkowski Keith
Published: March 2020

Implementation of evidence-based practices (EBPs) is paramount to students’ development of mathematics proficiency. This study investigated “practice-based evidence” of interventionists’ actual use of explicit mathematics instruction, a well-established EBP. Specifically, this study analyzed direct observation data collected in a federally funded efficacy trial involving a Tier 2 first-grade mathematics intervention to examine whether the quantity and quality of explicit mathematics instruction was associated with the mathematics outcomes of 470 first-grade students with or at risk for mathematics learning disabilities. Associations between group-level pretreatment skill levels and the quality and quantity of explicit mathematics instructional practices used in the intervention were also explored. Findings suggested significant associations between positive gains in student mathematics outcomes and (a) lower rates of incorrectly answered mathematics-focused questions, and (b) the rate in which interventionists delivered group-level practice opportunities and offered academic feedback. Significant associations were also found between initial student mathematics performance and rates of student errors and the quality of explicit instruction. Implications for using direct observation to document enacted EBPs are discussed.
A case report of sudden epileptic death linked to thermal water after mud therapy
Authors: Matteo Sanavio , Marina Saladini , Donata Favretto , Rossella Snenghi
Published: March 2020

We present the case of a 60-year-old male, with a long history of epilepsy, who was discovered submerged and unconscious in a small thermal whirlpool bath. The circumstances were forensically reviewed to include examination of clinical data and an autopsy with toxicological analysis. The conclusion was that “warm” hydro-therapy had contributed more than “hot” mud-therapy to the onset of epilepsy which led to accidental drowning, notwithstanding the deceased’s treatment with the long-lasting, poly-drug antiepileptic therapy. Further, we analysed the Italian medical indications of wellness centres for patients with epilepsy or other diseases.
Effective and Engaged Followership: Assessing Student Participation in Ensembles
Authors: Orzolek Douglas C.
Published: March 2020

Music educators consider participation to be an important part of learning in their classrooms. And as the era of accountability rages on throughout the field of education, many educators have sought ways to describe the deep engagement that occurs in rehearsals. This article considers the role that the concept of “followership” can play in helping educators explain what engaged participation looks like in ensemble learning. The article also outlines potential implications this concept holds for learning, teaching, assessment, and how we account for participation in our classrooms. Potential academic outcomes for engaged followership include more engaged learners, heightened musical experiences, and strong critical thinking in rehearsals.
Preparation of highly conductive polyurethane/polypyrrole composite film for flexible electric heater
Authors: Xie Juan , Pan Wei , Guo Zheng
Published: March 2020

In this work, a rationally flexible polyurethane (PU)/polypyrrole (PPy) electric heater was fabricated through the combined use of wet process and in situ polymerization, and their structures and electrical properties with different Py/FeCl3 ratios were investigated. The electric heating behavior of films can be facilely adjusted by electrical properties and input voltages. The results showed that the obtained PU/PPy composite film possesses good thermal stability and has a low electric resistance of about 10.5 Ω sq−1. Accordingly, electric heating behavior of the composite film with the Py/FeCl3 ratio of 1/2 was capable of heating a substrate up to 110°C at 7 V in 28 s from room temperature and then when heated to 1st to 10th cycle at 6 V showed no energy loss, exhibiting excellent stability and recyclability. Herein, the availability PU/PPy composite film will have a potential application in flexible electric heater.
The Stifled Renaissance of Urbanity: Urban Preservation and the Collapse of Czechoslovak and East German Socialism
Authors: Spurný Matěj , Ladd Brian
Published: March 2020

Concern with the decay or demolition of inner cities was an underappreciated factor contributing to the discontent preceding the revolutions of 1989 in east-central Europe. Although there has been some scholarly work on the topic, particularly on the German Democratic Republic (GDR), multinational studies are lacking. This examination of parallel developments in the GDR and Czechoslovakia identifies similar trajectories of discontent and activism in the two socialist states. It follows the evolution of architectural and planning theories and practices from the high point of postwar modernism to the widespread embrace of the very styles and districts once despised. By the 1980s, this acceptance of pre–World War I buildings, districts, and urban scale had pervaded expert circles and reached even the highest levels of party and government. However, both states’ failure to carry out policies that satisfied residents and defenders of old districts fueled the discontent that exploded in 1989.
The Role of Mastoidectomy in Draining Ventilation Tubes
Authors: Jones Joel W. , Archbold Robert , Hillman Todd A. , Chen Douglas A.
Published: March 2020

Objectives:

To discuss the indication for performing a mastoidectomy with catheter placement in patients with chronic tympanostomy tube otorrhea.

Methods:

The Medical Literature Analysis and Retrieval System Online was searched via PubMed for relevant articles using serous mastoiditis, mastoidectomy, chronic otorrhea, tube otorrhea, tympanostomy tubes, and biofilm as keywords.

Results:

Further understanding of the pathophysiology of otorrhea and the development of ototopical fluoroquinolones have made a draining tympanostomy tube more manageable. Nevertheless, chronic otorrhea refractory to an otolaryngologist’s traditional treatment algorithm still occurs and may benefit from a mastoidectomy with antibiotic irrigation using a catheter in certain cases. We theorize that resolution of otorrhea results from this technique by decreasing the burden of diseased mucosa and providing a larger concentration or dose of antibiotic to the middle ear cleft through the antrum. High-resolution images of the technique and catheter placement are included in this review.

Conclusions:

Despite being an uncommon management strategy, the literature suggests an indication for performing a mastoidectomy in a small percentage of patients with a chronically draining tympanostomy tube.
Energy-shaping control of soft continuum manipulators with in-plane disturbances
Authors: Franco Enrico , Garriga-Casanovas Arnau
Published: March 2020

Soft continuum manipulators offer levels of compliance and inherent safety that can render them a superior alternative to conventional rigid robots for a variety of tasks, such as medical interventions or human–robot interaction. However, the ability of soft continuum manipulators to compensate for external disturbances needs to be further enhanced to meet the stringent requirements of many practical applications. In this paper, we investigate the control problem for soft continuum manipulators that consist of one inextensible segment of constant section, which bends under the effect of the internal pressure and is subject to unknown disturbances acting in the plane of bending. A rigid-link model of the manipulator with a single input pressure is employed for control purposes and an energy-shaping approach is proposed to derive the control law. A method for the adaptive estimation of disturbances is detailed and a disturbance compensation strategy is proposed. Finally, the effectiveness of the controller is demonstrated with simulations and with experiments on an inextensible soft continuum manipulator that employs pneumatic actuation.
Music experience is associated with lower depression level and higher quality of life among family caregivers of critically ill patients
Authors: Yoo Ga Eul , Kim Jeongmin , Choi Da In , Yeo Myung Sun , Kim Soo Ji , Na Sungwon
Published: March 2020

This study aimed to investigate level of the psychological health of family caregivers of critically ill patients, considering quality of life and depression, and whether it varied depending on their individualized music use. A survey was administered in a surgical intensive care unit (ICU) of a university hospital. Adult family caregivers of ICU patients older than 18 years of age were included. Depression and quality of life were measured via self-administered scales, and emotional states were evaluated using a visual analog scale. Music use in daily life was also queried. A total of 195 caregivers (mean age, 51.2 years) participated in this study (spouses 44.6%, offspring 51.3%, and parents 4.1%). Among respondents, 44.6% were at high risk of depression, and 18.0% of these respondents reported their quality of life as poor or very poor. In terms of singing in their everyday lives, respondents who had singing experience reported higher quality of life and lower depression than those without singing experience. The results of this study support the active engagement in music as resource for caregivers of ICU patients to alleviate their emotional distress. Further investigation into diversified music use and music intervention in critical care should focus on the inclusion of family caregivers.
HIV self-tests for men who have sex with men, accessed via a digital vending machine: a qualitative study of acceptability
Authors: Raffe S , Pollard A , Vera JH , Soni S , Peralta C , Rodriguez L , Dean G , Llewellyn CD
Published: March 2020

As the number of people living with undiagnosed HIV infection in the UK declines, innovative ways to access those least engaged with services are needed. This study explores the attitudes of men who have sex with men (MSM) towards using HIV self-testing (HIVST) kits distributed via a vending machine in a sauna (a licenced sex-on-premise venue). Twenty-three MSM attending the sauna were recruited to take part in semi-structured qualitative interviews. The participants were overwhelmingly positive about the HIVST vending machine. They identified convenience and flexibility as major benefits to testing in this way. The sauna was felt to be an appropriate location for the intervention. Limitations identified included the potential to reduce screening for other sexually transmitted infections and the inappropriate use of HIVST kits as a tool for risk-assessment prior to condomless sex, with a poor understanding of the window period. The implications of receiving a positive result without immediate access to support were also a concern. HIVST vending machines are an acceptable, innovative way to encourage HIV testing. Providers need to ensure this intervention is supported by adequate information regarding the limitations of the test and how to access comprehensive services to avoid any unintended negative effects.
Biosimilars
Authors: Edwards Christopher J , Bellinvia Salvatore
Published: March 2020

Biological therapies have widened the therapeutic armamentarium for immune-mediated inflammatory diseases, providing in many cases a broad range of treatment options with different mechanisms of action. The widespread use of biological agents in systemic lupus erythematosus is currently limited to belimumab and rituximab, although results of promising larger Phase III clinical trials are awaited or have been recently circulated, especially for anti-cytokine therapies. The loss of exclusivity over the last years for several originator biologics has started the successful introduction of biosimilar products into clinical practice. There is an abbreviated pathway to biosimilar approval, but this is underpinned by the same standards of pharmaceutical quality, safety and efficacy that apply to all biological medicines. Nevertheless, there are unique reasons why development of biosimilars may be particularly challenging in lupus.
Moral distress and professors of nursing: A cluster analysis
Authors: Toescher Aline Marcelino Ramos , Barlem Edison Luiz Devos , Lunardi Valéria Lerch , Brum Aline Neutzling , Barlem Jamila Geri Tomaschewski , Dalmolin Graziele de Lima
Published: March 2020

Background

Professors of nursing sometimes experience specific situations in their daily practice that conflict with their values and ethical principles and may culminate in moral distress. Moral distress occurs when one is prevented from acting according to his or her knowledge or values, or what one considers to be ethically sound.

Objectives

To identify the profile of professors of nursing through grouping sociodemographic characteristics and intensity of moral distress.

Method

Cross-sectional and exploratory study addressing 373 nurses teaching in Brazilian federal public higher education institutions. Data were collected from June to December 2018 through email, using the Google Docs tool. A moral distress scale directed to nurse educators was used. Data were analyzed using descriptive statistics, variance analysis, and cluster analysis.

Ethical considerations

The Institutional Review Board at the Federal University of Rio Grande approved this study.

Findings

Initially, four clusters emerged for each variable predicting the profile of Brazilian professors of nursing: sex; whether the individual worked in a graduate program; age; experience in years in their respective higher education institution; and intensity of moral distress. The profile of Brazilian professors of nursing was represented by the largest cluster, 36.5% (n = 136), composed of women working in graduate programs, aged 37 years old on average, having worked in their respective institutions for approximately 5 years, and presenting a moderate intensity of moral distress.

Conclusion

Assigning individuals into groups facilitates seeing similarities among the predictors that compose the profile of Brazilian professors of nursing, thus recognizing those workers experiencing moral distress in their daily work routine. In addition, this study’s results are expected to encourage reflection on the planning of efficacious interventions directed to the context of education and health.
Development and validation of 2 probe-hybridization quantitative PCR assays for rapid detection of a pathogenic Coxiella species in captive psittacines
Authors: Flanders Alison J. , Speer Brian , Reavill Drury R. , Roberts John F. , Childress April L. , Atlas Alvin , Wellehan James F. X.
Published: March 2020

Avian coxiellosis is an emerging cause of morbidity and mortality among captive psittacines, and the utility of a rapid detection test using easily obtained samples is paramount in a clinical setting. New sequences were obtained from 3 genes: groEL, dnaK, and rpoB. We developed probe-hybridization quantitative PCR (qPCR) assays using groEL and dnaK genes. Samples, including splenic aspirates, liver aspirates, whole blood, and choanal, conjunctival, and cloacal swabs, were collected from 4 psittacine species including 3 blue-and-gold macaws ( Ara ararauna), 2 scarlet-chested parrots ( Neophema splendida), 1 Timneh African grey parrot ( Psittacus timneh), and 1 yellow-naped Amazon parrot ( Amazona auropalliata). Retrospective review of postmortem findings from 3 of these psittacines included splenomegaly, hepatitis, and/or transmission electron microscopy confirmation consistent with previous reports of avian coxiellosis. There was 100% agreement between these assays and consensus PCR with sequencing. A Wilcoxon rank-sum test found a strong correlation between groEL and dnaK cycle threshold values ( p < 0.001), validating these assays for detection of this avian Coxiella sp.
Pharmacy-Led Quality Improvement Project on Pain Control Using Continuous Subcutaneous Infusion of Opioids in an Inpatient Hospice Unit
Authors: Romero Nayma Moya , DiScala Sandra , Quellhorst Jennifer , Silverman Michael A.
Published: March 2020

Objectives:

The purpose of this quality improvement (QI) project was to improve the overall process of implementing continuous subcutaneous infusion of opioids (CSCIOs) at the West Palm Beach Veterans Affairs Medical Center and characterize their use in the hospice unit.

Methods:

A retrospective chart review from July 2014 to August 2017 was conducted to identify patients who had received CSCIO. Results were analyzed with descriptive statistics.The business philosphy, LEAN methodology “The 5 Whys” was utilized to identify the root causes for delayed infusion timeliness and corrections were implemented by August 2018. Follow-up retrospective time study completed from September 2018 to February 2019.

Results:

Of the 107 patients identified, 7 were excluded and 100 were reviewed. The mean age was 73 years, 94% male, and 86% Caucasian. A total of 55 veterans received morphine with an average final infusion rate of 2.5 mg/h. A total of 45 Veterans received hydromorphone with a final infusion rate of 1.3 mg/h. The average infusion duration until death was 5 days. Pharmacy verified 94 (94%) orders and nursing verified 55 (55%) orders within 1 hour (gold standard). Sixteen (16%) patients received CSCIO within 1 hour. The 5 Whys identified nursing order verification and pharmacy lack of visual STAT order notification for priority as the potential sources for infusion timeliness improvement. The follow-up time study confirmed improvement in pharmacy delivery time from 29% to 75% on time.

Conclusion:

Pharmacist-led intervention directed to improve CSCIO processes in an inpatient hospice unit utilizing LEAN QI methodology increased timeliness of pharmacy CSCIO delivery.
Infarct-Like Spindle Cell Carcinoma of the Lung: Clinicopathologic, Immunohistochemical, and Molecular Analysis of 4 Cases
Authors: Rossi Giulio , Nosseir Sofia , Jocollé Genny , Sartori Giuliana , Banchelli Isabella , Busetti Stefano , Baldovini Chiara
Published: March 2020

Pulmonary spindle cell carcinoma is a rare and aggressive malignancy that often mimics benign conditions. We report 4 cases that simulate a pulmonary infarction, 2 of which were misdiagnosed. Patients were 3 men and 1 woman, smokers, presenting chest pain. All cases appeared as pleural-based, solitary, and rounded nodules. Patients underwent wedge resections followed by adjuvant chemotherapy (3/4) but died of disease. At histology, lesions consisted of widely necrotic nodules surrounded by organizing fibrosis and pleuritis. Examination and immunostains with pan-cytokeratins and epithelial membrane antigen (EMA) revealed atypical spindle cells encircling necrotic tissue and involving the vascular wall. Positive staining with PD-L1 was noted. Molecular analysis showed KRAS (2/4) and TP53 (1/4) mutations, whereas EGFR, ALK, and ROS1 alterations were not detected. Although in a limited series, these cases further evidence the treacherous appearance of spindle cell carcinomas and the need for careful attention when examining pulmonary infarcted tissue, thus requiring extensive sampling, meticulous examination of vascular structures, and immunostaining with cytokeratins.
Glomus Tumor of the Colon: A Rare Case Report and Review of Literature
Authors: Chen Irene Y. , Fazili Bushra G. , Liao Xiaoyan
Published: March 2020

Glomus tumor is a rare mesenchymal neoplasm originating from the modified smooth muscle cells of the glomus body. Primary colonic glomus tumor is extremely rare with only 5 cases published in the English literature. In this article, we report the sixth case of primary colonic glomus tumor in a 50-year-old female with no significant past medical history who presented with routine screening colonoscopy. The entire colon was endoscopically unremarkable except an incidental 6-mm sessile polyp located in the descending colon. Biopsy showed a densely cellular neoplasm composed of small, bland, slightly spindled to predominantly epithelioid cells with clear to eosinophilic cytoplasm arranged in nests and sheets. The tumor cells were interspersed with slit-like thin-walled vessels and scattered short nerve bundles. Immunohistochemically, the tumor cells were positive for smooth muscle actin, h-caldesmon, and CD34 (focal), but completely negative for HMB45, S100, EMA, desmin, DOG-1, and CD117. The histologic features and immunohistochemical profile supported a diagnosis of primary colonic glomus tumor. The patient was asymptomatic and disease free after the procedure.
“Know Who They Have in Front of Their Eyes”: A Justice as Praxis Paradigm for Teaching and Learning
Authors: Everett Sakeena
Published: March 2020

Inequitable access to learning opportunities has intersectional consequences for Black students in general and gifted education. Equally important, all students (regardless of race, ethnicity, gender, socioeconomic class, and grade-level), more often than not, lack invaluable opportunities to learn about the innumerable contributions of students and families of color in the United States and worldwide. To address these injustices, Ladson-Billings advocated for a shift from “justice as theory toward justice as praxis.” In this article, I unpack the components of justice as praxis work, and I discuss how I engaged in this work in my secondary English Language Arts (ELA) classroom. I address the following questions: What does it mean “to be seen” from the perspective of a Black male academically high-achieving student? What is needed for teachers to adopt a justice as praxis paradigm to improve their teaching and learning with students who have not been well served in public schools?
Vibration suppression of terrains irregularities using active aerodynamic surface for half-car model sport vehicles
Authors: Shahein Ahmed H , Ata Atef A , Haraz Eman H , El-Souhily Bassuny M
Published: March 2020

Riding quality is considered a key element in automotive industry which imposes a challenge on car manufacturers to develop new alternative control strategies for the classical suspension system. To this extent, many efforts have been carried out on developing several active or semi-active suspension systems. In the past few years, the decreasing cost of electromechanical actuators has, however, opened new trends to face this challenge. Active aerodynamic surfaces (spoilers) represent an alternative and effective solution to the issue. Two contradicting criteria of good vehicle suspension performance are typically their ability to provide good road handling and increase passengers comfort. The main disturbance affecting these two criteria is terrain irregularities. Active suspension control systems reduce these undesirable effects by isolating car body motion from vibrations at the wheels. In this article, we are trying to investigate the use of active aerodynamic surfaces to enhance ride comfort in sport vehicles for half car model. The article describes also the model and controller used in the study and discusses the vehicle response results obtained from a typical road sinusoidal signal input. The effect of active aerodynamic surfaces could enhance the ride comfort by (15%) without affecting road holding.
History of the Quarterly: The First Twenty-Five Years
Authors: N.R.B.
Published: March 2020

From notes supplied by the four editors: Lawrence W. Murphy (1924–29), Frank Luther Mott (1930–34), Ralph D. Casey (1935–45), and Raymond B. Nixon (1945– —).
Pegfilgrastim-associated large-vessel vasculitis developed during adjuvant chemotherapy for breast cancer: A case report and review of the literature
Authors: Nakamura Jun , Nishi Tomoyo M , Yamashita Shun , Nakamura Hiroaki , Sato Ken , Oda Yoshimasa , Iyama Akihiro
Published: March 2020

Introduction

Granulocyte colony-stimulating factor (G-CSF) is widely used as a neutrophil supportive therapy in breast cancer chemotherapy. Common adverse events of G-CSF include bone pain, headache, and fatigue; however, reports of G-CSF-associated vasculitis are few.

Case report

A 66-year-old woman who had undergone surgery for breast cancer received adjuvant chemotherapy with prophylactic use of pegfilgrastim (peg-G). She developed peg-G-associated vasculitis 11 days after initially receiving peg-G. Management and outcome: Although various blood and culture tests were required to rule out other vasculitis syndromes and infections, her symptoms spontaneously disappeared without any treatment other than discontinuation of the causal drug.

Discussion

G-CSF-associated vasculitis is occasionally accompanied by severe complications such as aortic dissection and aneurysm formation. This case report is important to draw attention towards this rare and difficult-to-diagnosis adverse event of peg-G.