bluuebunny/crossref_metadata_2025 huggingface dataset:
Fractured China
Authors: Jones Lee , Hameiri Shahar
Published: October 2021

Is China's rise a threat to international order? Fractured China shows that it depends on what one means by 'China', for China is not the monolithic, unitary actor that many assume. Forty years of state transformation – the fragmentation, decentralisation and internationalisation of party-state apparatuses – have profoundly changed how its foreign policy is made and implemented. Today, Chinese behaviour abroad is often not the product of a coherent grand strategy, but results from a sometimes-chaotic struggle for power and resources among contending politico-business interests, within a surprisingly permissive Chinese-style regulatory state. Presenting a path-breaking new analytical framework, Fractured China transforms the central debate in International Relations and provides new tools for scholars and policymakers seeking to understand and respond to twenty-first century rising powers. Drawing on extensive fieldwork in China and Southeast Asia, it includes three major case studies – the South China Sea, non-traditional security cooperation, and development financing–to demonstrate the framework's explanatory power.
The Attack on Higher Education
Authors: Musto Ronald
Published: October 2021

American higher education is under attack today as never before. A growing right-wing narrative portrays academia as corrupt, irrelevant, costly, and dangerous to both students and the nation. Budget cuts, attacks on liberal arts and humanities disciplines, faculty layoffs and retrenchments, technology displacements, corporatization, and campus closings have accelerated over the past decade. In this timely volume, Ronald Musto draws on historical precedent - Henry VIII's dissolution of British monasteries in the 1530s - for his study of the current threats to American higher education. He shows how a triad of forces - authority, separateness, and innovation - enabled monasteries to succeed, and then suddenly and unexpectedly to fail. Musto applies this analogy to contemporary academia. Despite higher education's vital centrality to American culture and economy, a powerful, anti-liberal narrative is severely damaging its reputation among parents, voters, and politicians. Musto offers a comprehensive account of this narrative from the mid-twentieth century to the present, as well as a new set of arguments to counter criticisms and rebuild the image of higher education.
The Nuclear Cooper Pair
Authors: Potel Aguilar Grégory , Broglia Ricardo A.
Published: October 2021

This monograph presents a unified theory of nuclear structure and nuclear reactions in the language of quantum electrodynamics, Feynman diagrams. It describes how two-nucleon transfer reaction processes can be used as a quantitative tool to interpret experimental findings with the help of computer codes and nuclear field theory. Making use of Cooper pair transfer processes, the theory is applied to the study of pair correlations in both stable and unstable exotic nuclei. Special attention is given to unstable, exotic halo systems, which lie at the forefront of the nuclear physics research being carried out at major laboratories around the world. This volume is distinctive in dealing in both nuclear structure and reactions and benefits from comparing the nuclear field theory with experimental observables, making it a valuable resource for incoming and experienced researchers who are working in nuclear pairing and using transfer reactions to probe them.
The Right to Protection from Incitement to Hatred
Authors: Elbahtimy Mona
Published: October 2021

Against the backdrop of the new globalized hate speech dynamics, the nature and scope of States' obligations pursuant to international human rights law on prohibiting incitement to hatred have taken on increased importance and have become a controversial issue within multilateral human rights diplomacy. Key questions being posed in the on-going debates over how best to respond to the new wave of hatred include whether the international legal norm against incitement to hatred, as it currently stands, is suitable to address the contemporary challenges of this phenomenon. Alternatively, does it need to be developed further? This book traces the journey of this norm in three analytical domains; its emergence, relevant supranational jurisprudence, and the recent standard-setting attempts within the UN. The book argues that five internal features of the norm had a strong influence on its difficult path within international human rights law.
Panprotopsychism Instantiated
Authors: GIBERMAN DANIEL
Published: October 2021

The problem of many-over-one asks how it can be thatmanyproperties are ever instantiated byoneobject. A putative solution might, for example, claim that the properties are appropriately bundled, or somehow tied to a bare particular. In this essay, the author argues that, surprisingly, an extant candidate solution to this problem is at the same time an independently developed candidate solution to the mind-body problem. Specifically, what is argued here to be the best version of the relata-specific bundle theory—the thesis that each instance of compresence has a special intrinsic nature in virtue of which it necessarily bundles its specific bundle-ees—is also a species of Russellian monism, labeled by David Chalmers as ‘constitutive Russellian panprotopsychism’. The upshot of this connection is significant for the metaphysics of the mind-body problem: a credible theory of property instantiation turns out to have a built-in account of how consciousness is grounded in certain (broadly) physical systems.
Legal Protection of the Marine Environment from Vessel-Source Oil Pollution: Progress and Challenges in Tanzania
Authors: Gamassa Pascal Kany Prud'ome
Published: October 2021

The United Republic of Tanzania, also called Tanzania, is a country composed of Mainland Tanzania and the islands of Zanzibar. Tanzania's domestic laws promote sustainable development of the marine environment; however, since the beginning of the 21st century, the country has been importing large quantities of oil, resulting in an increased risk of vessel-source oil pollution damage. Through a comparative analysis, this article examines the laws addressing this issue in Mainland Tanzania and Zanzibar, the progress that has been made in the legal environment and the challenges that remain, and it discusses possible solutions and improvements. The article reveals that weak implementation of domestic laws for marine environment conservation, a lack of harmonization between domestic laws regarding this issue, and weak domestication of relevant ratified international conventions are among the challenges currently hindering the sustainability of Tanzania's marine environment.
Rents instead of land. Credit and peasant indebtedness in late medieval Mediterranean Iberia: the kingdom of Valencia
Authors: Furió Antoni
Published: October 2021

The literature on the rural economy of the high and late Middle Ages has long established a close correlation between three significant features of the period: the spread of rural credit, the dynamism of the peasant land market and the expropriation of peasant land by the creditors, usually yeomen or urban landowners. There has even been talk for some countries (northern Italy) of a deliberate strategy of territorial conquest, insofar as the credit provided by urban lenders would aim at the expropriation of land from insolvent debtors. This article studies for the Mediterranean Spain of the late Middle Ages, and in particular for the old kingdom of Valencia, other objectives of rural credit and other alternatives to peasant expropriation in case of insolvency. Based on the rich archival holdings of the region, mainly notarial and judicial records, the article studies the dissemination of rural credit, the different modalities (short and long term), the motivations of creditors and debtors, the types of interest, the guarantors and the goods given as collateral for the loans, their confiscation in case of delay or insolvency. It concludes that, unlike elsewhere, the creditors, rather than in land, were interested in rents, that is, in the annuities paid to them by the debtors as interest on the loans obtained. The spread of long-term credit, therefore, not only did not threaten or subvert but also strengthened a system of land ownership, tenure and management based on regular rents extraction.
Nation-States, Empires, Wars, Hostilities
Authors: Ryan Cheyney
Published: October 2021

A starting point for thinking about war and preparations for war is that today the average citizen in Western countries has absolutely no interest in fighting in a war him or herself. The best study of this phenomenon rightly notes that what might be called the “great refusal” of ordinary people to involve themselves in actual war making reflects what might be called the “great disillusionment” with war itself. However, this has not meant the end of war, or of preparations for war, but rather war's transformation from a “nationalized” to a “postnationalized” arrangement. For the United States, this has meant expansion into a new type of empire. As part of the symposium on Ned Dobos'sEthics, Security, and the War-Machine,this essay explores these developments and the challenges they pose.
Die Situation der Pflegenden in Akutkrankenhäusern während der zweiten Welle der COVID-19-Pandemie
Authors: Mai Tobias , Todisco Laura , Schilder Michael , Franke Vanessa , Ristau Johanna
Published: October 2021

Zusammenfassung. Hintergrund: Die COVID-19-Pandemie hat Auswirkungen auf Stress und Wohlbefinden von Pflegenden. Angst vor Infektionen, fehlende Schutzausrüstung und mangelnde Expertise in der Pflege dieser Patient_innen wurden als Gründe für Burnout beschrieben. xFragestellung: Untersucht wird der Einfluss des arbeitsbezogenen Kohärenzgefühls sowie der wahrgenommenen organisationalen Unterstützung auf das Burnoutlevel und die Absicht, den Arbeitsplatz zu wechseln. Methode: Im Dezember 2020 und Januar 2021 wurden Beschäftigte von 81 Krankenhäusern in Hessen, Deutschland online befragt. Der Fragebogen umfasste die Instrumente BAT (Burnout-Assessment-Tool), Work-SoC (arbeitsbezogenes Kohärenzgefühl), POS-s (wahrgenommene organisatorische Unterstützung – Kurzfassung) sowie literaturbasierte Items. Ergebnisse: Von 595 Pflegenden wiesen 47,6% ein moderates oder hohes Burnoutlevel auf; 20,7% wollen den Arbeitsplatz nach der Pandemie wechseln. Je höher der Work-SoC (β = –0,467; p < 0,001) und je höher der POS-s (β = –0,178; p < 0,001), desto niedriger ist das Burnoutlevel. Schulungsangebote wurden von 24,7% der Pflegenden als positiver Faktor genannt. Sie vermissten Achtsamkeits- und Resilienztraining, Angebote zur Kinderbetreuung und zu gesundheitsbezogenen Themen. 55,1% stimmten nicht zu, dass der Arbeitgeber alles unternimmt sie zu unterstützen. Schlussfolgerungen: Unabhängig von der Pandemie ist eine salutogene Führung erforderlich, die sich „moralischen Verletzungen“ der Beschäftigten durch implizite Rationierung annimmt und die gesundheitsbezogene Unterstützung fördert.
Shedding Light on Microbial Communities in Deep Aquifers
Authors: Wheeling Kate
Published: October 2021

Researchers use a packer system to study the microbial communities living in waters sampled from deep, uncontaminated peridotite aquifers.
Alfvén Waves Generated Through the Drift‐Bounce Resonant Instability in the Ring Current: A THEMIS Multi‐Spacecraft Case Study
Authors: Mager Olga V.
Published: October 2021

The satellites THA, THD, THE of THEMIS mission (Time History of Events and Macroscale Interactions during Substorms) have consistently recorded quasi‐monochromatic poloidal oscillations of the Pc4‐5 range in the nighttime magnetosphere. Wave activity was recorded after a substorm in the ring current region, between L‐shells 6 and 7.3. According to the data of the THA satellite, the fundamental and second harmonics of Alfvén wave were simultaneously recorded at frequencies of about 7 and 18 mHz, respectively. The satellites THD and THE recorded only the second harmonic and oscillating modulations of proton fluxes with energies of about 50 keV at the harmonic frequency. For this second harmonic wave, the azimuthal wave number was estimated using the phase delays of the oscillations in the proton fluxes with different gyrophases. It is shown that the wave was in drift‐bounce resonance with 46 keV protons and was generated through resonant instability caused by non‐equilibrium distribution of ring current protons with the significant earthward spatial gradient at the resonance energy.
Analytical Expressions of Radiocarbon Distribution in Transient State Unconfined Aquifers and Their Application to Determination of Past and Present Recharges of North Africa Aquifers
Authors: Chekireb Amine , Gonçalvès Julio , Hamelin Bruno , Deschamps Pierre , Séraphin Pierre
Published: October 2021

In this study, we developed two‐dimensional hydrodynamic age expressions for the free‐surface aquifer problem required for radiocarbon data interpretation in terms of recharge. Time‐varying recharge is accounted for in fully transient or pseudo‐steady state alternative analytical expressions applying to weakly or highly hydraulically reactive unconfined aquifers, respectively. These expressions extend the well‐known model proposed by Vogel in 1967 and represent a convenient alternative approach to the more complex numerical solution of a particle tracking problem considering climate variability. An application of the developed expressions was carried out to assess past (40 Kyr) and present recharge rates for the North Western Sahara Aquifer System (NWSAS) and the Djeffara plain (Tunisia‐Libya). Using the available 14C data at different outcrops, we obtained local recharge values ranging from 0.2 ± 1.7 to 4.5 ± 3.2 mm yr−1. Here, it is shown that using the standard purely steady‐state model for radiocarbon interpretation leads to a present recharge overestimation of up to 360%. A linear relation between the present recharge and the average annual rainfall was obtained and used to identify the regional distribution of the recharge and domain‐averaged values. Global values of 1.6 ± 2.3 mm yr−1 for the NWSAS and 3.5 ± 2.3 mm yr−1 for the Djeffara are in excellent agreement with the values obtained by hydrogeological models and derived using Satellite gravity data. The relation between recharge and rainfall obtained here can be used as a first‐order estimate for hydrogeological modeling or water management analysis for aquifers in the Saharan area.
Evaluating biometrics by using a hybrid MCDM model
Authors: Tsuei Hung-Jia , Shen Guiping , Tzeng Gwo-Hshiung
Published: October 2021

Biometrics has been developing for decades in diverse industries, such as consumer electronics, internet of things, financial industry, etc. The purpose of this research is to build a decision-making model to evaluate and improve the performances of biometrics for administrators to design and make suitable biometric systems. This paper adopts a hybrid multiple criteria decision making (MCDM) model, comprising decision-making trial and evaluation laboratory (DEMATEL), and DEMATEL-based analytic network process (called DANP) to probe into the interrelationship and influential weights among criteria of biometrics. According to DEMATEL technique, the empirical results indicate that criteria of biometrics have self-effect relationships. The dimension of biometrics that administrators of biometrics should enhance first when improving the performances is usability. The criterion of universality with the highest influencing value to systematically affect all other evaluation factors is what administrators of biometrics should comprehensively consider. In the top three criteria for evaluation by DANP, biometric systems with the most influential weight is the criterion that can be improved to have higher recognition rates for increasing the performances of biometrics, followed by biometric conditions and permanence.
Multi-tissue transcriptome-wide association study identifies eight candidate genes and tissue-specific gene expression underlying endometrial cancer susceptibility
Authors: Kho Pik Fang , Wang Xuemin , Cuéllar-Partida Gabriel , Dörk Thilo , Goode Ellen L. , Lambrechts Diether , Scott Rodney J. , Spurdle Amanda B. , O’Mara Tracy A. , Glubb Dylan M.
Published: October 2021

Genome-wide association studies (GWAS) have revealed sixteen risk loci for endoemtrial cancer but the identification of candidate susceptibility genes remains challenging. Here, we perform transcriptome-wide association study (TWAS) analyses using the largest endometrial cancer GWAS and gene expression from six relevant tissues, prioritizing eight candidate endometrial cancer susceptibility genes, one of which (EEFSEC) is located at a potentially novel endometrial cancer risk locus. We also show evidence of biologically relevant tissue-specific expression associations forCYP19A1(adipose),HEY2(ovary) andSKAP1(whole blood). A phenome-wide association study demonstrates associations of candidate susceptibility genes with anthropometric, cardiovascular, diabetes, bone health and sex hormone traits that are related to endometrial cancer risk factors. Lastly, analysis of TWAS data highlights candidate compounds for endometrial cancer repurposing. In summary, this study reveals endometrial cancer susceptibility genes, including those with evidence of tissue specificity, providing insights into endometrial cancer aetiology and avenues for therapeutic development.
Correction: Polymers with advanced architectures as emulsifiers for multi-functional emulsions
Authors: Hu Mingqiu , Russell Thomas P
Published: October 2021

Correction for ‘Polymers with advanced architectures as emulsifiers for multi-functional emulsions’ by Mingqiu Hu et al., Mater. Chem. Front., 2021, 5, 1205–1220, DOI: 10.1039/D0QM00730G.
The prevalence of odontogenic maxillary osteitis at the Cocody University Hospital's Odontostomatological Consultation and Treatment Center (CCTOS), Abidjan (Ivory Coast): clinical and therapeutic aspects
Authors: Kouamé Patrice A. , Ayé Marcellin , Amantchi Daniel , Kouyaté Vazoumana , Atsé Sylvie Koboh N'guessan , Zié Traoré , Saint Honoré Oheueu S. , Adouko Jeannette A.
Published: October 2021

Maxillary osteitis is a bone tissue disease or condition with a dentoalveolar origin. This condition remains a public health concern in most developing countries, particularly in the Ivory Coast. Without appropriate management, it can alter the patient's overall health owing to aesthetic, functional, and psychological complications. This study aimed to provide a better understanding of odontogenic maxillary osteitis to consequently improve its diagnosis and medical care. Three major etiologies of maxillary osteitis have been reported: infectious, traumatic, and physicochemical causes. According to the literature, osteitis is grouped into two clinical forms, namely circumscribed osteitis and diffuse osteitis. Their diagnosis is based on a rigorous clinical examination as well as radiographic, histological, and bacteriological examinations. At the Cocody University Hospital's Odontostomatological Consultation and Treatment Center (CCTOS), patients with the late stages of the condition present with significant, disabling, and unsightly osteocutaneous-mucous lesions. Treatment of this osteitis is preventive, curative, and restorative. Odontogenic maxillary osteitis is encountered frequently and typically at a late stage at the Cocody University Hospital's CCTOS. To limit aesthetic and functional damage, raising awareness among African people about oral hygiene and the need for regular consultations should be encouraged.
Genotype-Phenotype Dissociation in Two Taiwanese Children with Molybdenum Cofactor Deficiency Caused by MOCS2 Mutation
Authors: Lee Hsiu-Fen , Hsu Chia-Chi , Chi Ching-Shiang , Tsai Chi-Ren
Published: October 2021

Background To describe the genotype-phenotype dissociation in two Taiwanese patients with molybdenum cofactor deficiency (MoCoD) caused by MOCS2 gene mutations.

Patient Description Patient 1 exhibited early-onset neurological symptoms soon after birth, followed by subsequent myoclonic seizures and movement disorder. The brain magnetic resonance imaging (MRI) showed diffuse brain injury with cystic encephalomalacia along with bilateral globus pallidi involvement, hypoplasia of corpus callosum, and cerebellar atrophy. Patient 2 had a mild phenotype with prominent movement disorder after intercurrent illness, and the brain MRI showed selective injury of the bilateral globus pallidi and the cerebellum. Both patients had markedly low levels of plasma uric acid and harbored the same MOCS2 homozygous c.16C > T mutation. Patient 1 showed chronic regression of developmental milestones and died of respiratory failure at the age of 8 years, whereas patient 2 demonstrated improvement in motor function.

Conclusion Genotype-phenotype dissociation could be noted in patients with MoCoD due to MOCS2 mutation. Patients with neonatal seizures, developmental delay, movement disorder, and motor regression after an illness, as well as focal or bilateral involvement of the globus pallidi on the neuroimages, should undergo biochemical testing of plasma uric acid. A pronounced plasma uric acid level is a good indicator of MoCoD. Early diagnosis can allow early provision of adequate genetic counseling.
Atomic-level defect modulation and characterization methods in 2D materials
Authors: Ngome Okello Odongo Francis , Yang Dong-Hwan , Chu Yu-Seong , Yang Sejung , Choi Si-Young
Published: October 2021

Two-dimensional (2D) materials are attracting increasing research interest owing to their distinct tunable physical properties. Moreover, the ubiquitous defects in 2D materials offer an opportunity to tailor their electronic properties. Recently, atomic-level structural modification methods for 2D materials have been developed, further triggering the need for the precise control of defects. Following the ground-breaking advancements in the atomic-scale characterization of defects in 2D materials, valuable information on defect-driven electronic properties has been published. It is therefore important to present a review work on the recent research developments on atomic-level defect control and characterization of 2D materials. This Perspective highlights the type and role of atomic defects in 2D materials, as well as some current technologies for engineering such defects. In addition, we emphasize on atomic-level characterization methods with a focus on aberration-corrected transmission electron microscopy and deep learning as a powerful method for characterizing defects in 2D materials. Based on the two characterization techniques, we present the experimental results of laser-induced structurally modified MoTe2 and transition metal decorated h-BN. We believe that this work will provide fundamental knowledge for engineering and characterizing defects in 2D materials for the design of application-specific electronic devices.
Novel 4-Anilinoquinazoline Derivatives as Potent Anticancer Agents: Design, Synthesis, Cytotoxic Activity, and Docking Study
Authors: Moghadam Fatemeh Azmian , Dabirian Sara , Dogaheh Mahtab Ghasemi , Mojabi Mohammad , Yousefbeyk Fatemeh , Ghasemi Saeed
Published: October 2021

The simultaneous inhibition of EGFR and VEGFR-2 is a promising method in cancer treatment. In the present work, several 4-anilinoquinazoline derivatives encompassing different substitutions at the C-4 and C-7 positions of a quinazoline core were designed, synthesised, and evaluated for their cytotoxicity on A431, HUVEC, and HU02 cell lines. Docking studies were carried out to test the interactions of all synthesised compounds with EGFR and VEGFR-2. Furthermore, a wound healing assay was done for the investigation of cell migration. The most potent compound was 8l followed by the compounds 8i and 8j which showed better cytotoxic activities on A431 and HUVEC cell lines than the standard (Vandetanib). The compounds 8f and 8a represented the best docking energies of 8.99 and 9.35 kcal mol−1 for EGFR and VEGFR, respectively. Moreover, molecular docking studies exhibited that compound 8l showed efficient binding affinity against both EGFR and VEGFR-2. It can bind to these receptors through the formation of essential hydrogen bonds between the quinazoline N1 atom and the Met796 backbone of EGFR and two hydrogen bonds with Cys919 and Thr916 of VEGFR-2 with energies of –7.99 and –7.85 kcal mol−1, respectively. In addition, this compound displayed the highest activity on cell migration and wound healing. Compound 8l with the highest cytotoxic activity can be considered a candidate for further investigation and structural optimisation as an antiproliferative agent.
Exploring deep neural networks via layer-peeled model: Minority collapse in imbalanced training
Authors: Fang Cong , He Hangfeng , Long Qi , Su Weijie J.
Published: October 2021

Significance

The remarkable development of deep learning over the past decade relies heavily on sophisticated heuristics and tricks. To better exploit its potential in the coming decade, perhaps a rigorous framework for reasoning about deep learning is needed, which, however, is not easy to build due to the intricate details of neural networks. For near-term purposes, a practical alternative is to develop a mathematically tractable surrogate model, yet maintaining many characteristics of neural networks. This paper proposes a model of this kind that we term the Layer-Peeled Model. The effectiveness of this model is evidenced by, among others, its ability to reproduce a known empirical pattern and to predict a hitherto-unknown phenomenon when training deep-learning models on imbalanced datasets.
The effect of discharge energy and nano Al2O3on μED milling of Inconel 718
Authors: B Elumalai , S Gowri , P Hariharan , KV Arun Pillai
Published: October 2021

Micro EDM is a well-recognized machining process for complex and precise three-dimensional micro features. However, the disadvantages are high machining time, poor surface finish, and a thick recast layer that restricts the wide establishments. Powder mixed EDM (PMEDM) is a recent advancement in the EDM process that enhances the sparking frequency and inter-electrode gap. This paper presents the effect of Al2O3nanopowder on micro ED milling of Inconel 718 at chosen levels of discharge energy (3.2μJ to 7.2μJ, 32μJ to 72μJ and 320μJ to 720μJ). To understand the dynamics of the process, comprehensive experimental research was carried out using a full factorial design with 60 experiments. Material removal rate, tool wear rate, and surface finish were evaluated. The surface topography and material migration to the machined surface was also studied. The results showed significant improvement of 157%, 20%, and 21% in MRR, TWR, and surface roughness respectively in nanopowder mixed micro-EDM when compared with conventional micro-EDM. The addition of Al2O3nanopowder reduced crater size in all three discharge energy ranges and reduced carbon deposition on the machined surface.
Generative adversarial networks improve interior computed tomography angiography reconstruction
Authors: Ketola Juuso H J , Heino Helinä , Juntunen Mikael A K , Nieminen Miika T , Siltanen Samuli , Inkinen Satu I
Published: October 2021

In interior computed tomography (CT), the x-ray beam is collimated to a limited field-of-view (FOV) (e.g. the volume of the heart) to decrease exposure to adjacent organs, but the resulting image has a severe truncation artifact when reconstructed with traditional filtered back-projection (FBP) type algorithms. In some examinations, such as cardiac or dentomaxillofacial imaging, interior CT could be used to achieve further dose reductions. In this work, we describe a deep learning (DL) method to obtain artifact-free images from interior CT angiography. Our method employs the Pix2Pix generative adversarial network (GAN) in a two-stage process: (1) An extended sinogram is computed from a truncated sinogram with one GAN model, and (2) the FBP reconstruction obtained from that extended sinogram is used as an input to another GAN model that improves the quality of the interior reconstruction. Our double GAN (DGAN) model was trained with 10 000 truncated sinograms simulated from real computed tomography angiography slice images. Truncated sinograms (input) were used with original slice images (target) in training to yield an improved reconstruction (output). DGAN performance was compared with the adaptive de-truncation method, total variation regularization, and two reference DL methods: FBPConvNet, and U-Net-based sinogram extension (ES-UNet). Our DGAN method and ES-UNet yielded the best root-mean-squared error (RMSE) (0.03 ± 0.01), and structural similarity index (SSIM) (0.92 ± 0.02) values, and reference DL methods also yielded good results. Furthermore, we performed an extended FOV analysis by increasing the reconstruction area by 10% and 20%. In both cases, the DGAN approach yielded best results at RMSE (0.03 ± 0.01 and 0.04 ± 0.01 for the 10% and 20% cases, respectively), peak signal-to-noise ratio (PSNR) (30.5 ± 2.6 dB and 28.6 ± 2.6 dB), and SSIM (0.90 ± 0.02 and 0.87 ± 0.02). In conclusion, our method was able to not only reconstruct the interior region with improved image quality, but also extend the reconstructed FOV by 20%.
Computer simulation of key structural parameters for enhanced infrared absorption with Au nano-array
Authors: Mitobe Daichi , Ohshima Taku , Suzuki Yushi
Published: October 2021

The optical constants of thin films with nanoscale structures, such as metamaterials and nanostructured films used in surface enhanced infrared absorption (SEIRA), are represented by effective medium approximation (EMA). In a representative EMA, the effective permittivity is determined by parameters such as the volume filling factor (F). In a metal square column array modeled on an evaporated film, the effective permittivity is determined by the gap size/particle size ratio (f). However, f is also expressed as a function of F. For this study, we simulated the SEIRA spectrum using a model in which f and F were varied independently to investigate which was the most important parameter in the square column array. The results showed all the simulations performed, results showed that the gap size/particle size ratio (f) is an important parameter for the increase in SEIRA in the square column array. This study has led to new discoveries that support elucidation of the SEIRA enhancement mechanism.
The Postliberal Aesthetic; or, How Can Literary Criticism Help Unsettle America’s Polarization?
Authors: Voelz Johannes
Published: October 2021

This essay interprets the present moment as marked by democratic crisis and assigns to American literary criticism the task of responding to it. While American democracy faces multiple crises, the essay contends that current levels of polarization make it impossible to effectively address any of them. In this situation, literary studies confronts a dual challenge: it must, first, come to terms with its own contribution to the dynamics of polarization and, second, consider whether it can help undo it. Adopting a cultural–sociological perspective, the essay identifies literary studies as an institution that consolidates the politico-cultural identity of the “new middle class” and contributes to the culturalization of politics underlying contemporary polarization. However, the essay contends, American literary studies has the capacity to help revive democratic culture if it nurtures reading practices that unsettle fixed identities. To that end, the essay singles out various recent theories of reading whose democratic potential is grounded in their shared premise that literature is a communicative act. In interpreting these models of criticism as a potential way out of the malaise of polarization, the essay makes a call to revisit, reevaluate, and reformulate the tradition of liberalism.
Prognostic factors in patients with acute myocardial infarction underwent extracorporeal membrane oxygenation in hospital or out-of-hospital cardiac arrest
Authors: Morimoto R , Kida H , Tachibana K , Watanabe T , Yamada T
Published: October 2021

Background

Patients with acute myocardial infarction (AMI) who require extracorporeal membrane oxygenation (ECMO) have worse outcomes than those who do not, and patients with AMI with out-of-hospital cardiac arrest (OHCA) also have worse outcomes than those without OHCA. However, there have been still unclear points regarding the prognostic factors of AMI patients who underwent ECMO with or without OHCA. The aim of this study was to investigate the prognostic factors of AMI patients who underwent ECMO with and without OHCA, respectively.

Methods/Results

Ninety-eight consecutive patients (age:67±11 years, male:83.7%) who underwent ECMO for AMI were enrolled from November 2008 to December 2020. The primary endpoint was in-hospital mortality within 30-day, and we investigated the risk factors associated with 30-day mortality in AMI patients underwent ECMO with or without OHCA, respectively. In the group with OHCA (n=47), 30-day death occurred in 22 patients (47%). BMI, lactate and serum creatinine levels after the introduction of ECMO were significantly greater in patients with than without 30-day death (27.0±5.2 vs 21.0±2.9 kg/m2, p<0.001, 12.1±4.3 vs 7.5±3.6 mmol/L, p<0.001, 1.68±1.24 vs 1.41±1.07 mg/dL, p=0.039, respectively). The multivariate regression analysis showed that lactate level was independently associated with the poor outcome (Odds ratio: 1.32, 95% CI: 1.11–1.57, p<0.001). ROC curve analysis showed that the cut-off values: 7.8mmol/L of lactate had moderate accuracy to predict 30-day mortality (sensitivity:76%, specificity:86%, AUC:0.81). In the group without OHCA (n=51), 30-day death occurred in 20 patients (39%). The frequency of ventricular tachycardia / fibrillation (VT/VF) at initiation of ECMO was significantly higher (61.3% vs 25.0%, p=0.021), the frequency of mechanical complication was significantly lower (6.5% vs 30.0%, p=0.045) in patients without 30-day death than with 30-day death. The multivariate regression analysis showed that VT/VF at initiation of ECMO was independently associated with good outcome (Odds ratio: 0.21, 95% CI: 0.06–0.73, p=0.01).

Conclusions

With OHCA, increased lactate was the risk factor that was significantly associated with poor outcome in AMI patients underwent ECMO. Without OHCA, AMI patients who underwent ECMO due to rhythm trouble such as VT/VF had a good outcome. ECMO patients with AMI may have different prognostic factors with or without OHCA.

Funding Acknowledgement

Type of funding sources: None. Patient characteristics
Frailty assessment in an unselected population admitted to an intensive cardiac care unit
Authors: Campanile A , Procaccini C , Dell' Aquila F , Tedeschi M , Rispoli A , Sorrentino R , Ravera A
Published: October 2021

Background

Although interest in frailty has expanded among cardiology experts over the past 2 decades, its integration, as part of cardiovascular disease management, is still lacking, above all in the acute cardiac care setting. The Clinical Frailty Scale (CFS) is a brief guided tool to assess frailty in hospital settings without specialist equipment.

Purpose

Our objective was to test the performance of the CFS in an older, unselected population, admitted to an Intensive Cardiac Care Unit (ICCU) during the year 2019.

Methods

The study sample included 431 patients ≥65 years old, admitted to an ICCU of a tertiary cardiac center in Italy. The CFS ranged from “very fit: 1” to “terminally ill: 9”, but it was considered present at a score ≥5. Our primary endpoint was defined by a combination of severe complications requiring critical care and in-hospital death. The data were collected from the hospital discharge summary and the electronic chart records.

Results

158 patients (36.7%) were frail. These individuals had greater comorbidity and higher in-hospital mortality (Table 1). After a multivariable logistic regression analysis, 4 predictors were identified: signs of congestive heart failure (OR: 8.51, 95% Confidence Interval-CI: 4.63–14.6; p<0,001), systolic blood pressure (OR per 1 mmHg increasing: 0.98, 95% CI: 0.97–0.99; p<0,001), smoking habit (OR: 0.49, 95% CI: 0.22–1.11; p=0.09) and the CFS ≥5 (OR: 1.86, 95% CI: 1.08–3.23: p=0,026).

Conclusions

The CFS is a simple guided frailty tool that may enhance outcome prediction in the acute cardiac care setting. These findings merit evaluation in larger cohorts of unselected patients.

Funding Acknowledgement

Type of funding sources: None.
Role of conduit volume as a compensatory mechanism to left atrial dysfunction in severe aortic stenosis
Authors: Migliore R A , Adaniya M E , Barranco M A , Miramont G
Published: October 2021

Background

Left atrial (LA) function has a central role in maintaining optimal cardiac output despite impaired left ventricular (LV) diastolic function through atrial reservoir, conduit and contractile functions. In normal subjects, the contribution of LA volume (conduit and contractile) to LV filling volume is approximately 60–70% and the rest is completed by the conduit volume (CV) defined as the blood flow from pulmonary veins to LV during passive emptying that does not produce change in atrial volume. As LV filling pressures progressively increase, the limits of preload reserve are reached and LA serves predominantly as a conduit with increase in CV. Severe aortic stenosis is characterized by diastolic dysfunction (DD) in early stages of the disease and LA dysfunction in more advanced stages.

Purpose

The aim of the study was to analyze the role of CV as a compensatory mechanism to complete LV filling volume in presence of atrial dysfunction.

Methods

210 patients (p) (age 69±11 years, 48% female) with severe aortic stenosis (aortic valve area index 0.37±0.12 cm2/m2) were studied with Doppler echocardiography. LA function were evaluated by LA (total) emptying fraction (LAEF) as the difference between maximum (Mx) (include conduit and contractile phases) and minimum (Mn) volumes/Mx volume x 100 and peak LA strain. The contribution of CV to SV was estimated as a percentage of SV (CV%): SV − (LA Mx − Mn volume)/SV x 100. LA volumes, SV and left ventricular ejection fraction (LVEF) were calculated by Simpson method. Grade of DD was classified according to ASE/EACVI recommendation and p were divided in 3 groups: DD grade I (98 p), DD grade II (74 p) and DD grade III (38 p).

Results

CV% were negatively related to LAEF (r=−0.57, p<0.0001) and peak LA strain (r=−0.38, p<0.001) and directly to the grade of DD (r=0.35, p<0.001). LVEF correlated with LAEF (r=0.57, p<0.0001) and CV% (r=−033, p<0.001). In group DD grade III SV was maintained by increase in CV% despite significant decrease in LAEF and peak LA strain.

Conclusion

LA dysfunction expressed as a decreased in LAEF and LA strain correlated with an increase in contribution of CV to SV (CV%). In patients with AS, as the DD progress, SV is maintained by increase in CV as a compensatory mechanism to LA dysfunction.

Funding Acknowledgement

Type of funding sources: None. Table
The role of calcification biomarkers in the formation of aortic stenosis
Authors: Sibagatullina Y , Pugina M , Voronkina I , Zhiduleva E , Evstigneeva P , Gordeev M , Murtazalieva P , Malashicheva A , Semenova D , Moiseeva O , Irtyuga O
Published: October 2021

Background

The main mechanism of aortic valve (AV) calcification is not yet known. One of the possibility pathway responsible for AV calcification (AVC) includes osteoprotegerin (OPG), receptor activator of nuclear factor kappa-B ligand (RANKL) – the parts of the RANKL-RANK-OPG system and fetuin-A: cysteine protease inhibitors.

Aim

Evaluation of OPG, sRANKL, fetuin-A in blood serum and tissues in patients with varying severity of aortic stenosis (AS) to establish potential methods of estimation AVC depending on the presence of congenital heart disease: bicuspid AV (BAV) or its absence.

Materials and methods

The study involved 285 patients with AS (59.06±6.95 years, m:f – 1.1:1): 163 with (BAV) and 122 with tricuspid AV (TAV). The control group 53 patients (48.31±9.04 years, m:f-1:1) without valvular pathology, connective tissue dysplasia and coronary heart disease. ECHO (Vivid 7, GE, USA) was performed in all patients. The expression of OPG, RANKL, fetuin-A in homogenates of aortic valve were determined by immunoblotting. Serum concentration of OPG, RANKL, fetuin were performed in all pts by enzyme-linked immunosorbent assay.

Results

In the control group the concentration of fetuin-A in the blood serum was significantly higher than in TAV and BAV subgroups (446.66 [293.63; 619.19] vs 319.9 [239.6; 400.2] vs 315.6 [245.6; 385.6] pmol/l, p=0.ehab724.1560001). In all groups of patients with AS an increased level of sRANKL in the blood serum was revealed compared to the control group (TAV=0.39 [0.25; 0.53] vs BAV=0.38 [0.21; 0.55] vs control group 0.31 [0.18; 0.44] pmol/l; p<0.005). OPG level in serum was increased in patients with TAV: 8.1 [4.3; 11.9] pmol/l compared to BAV: 6.8 [3.9; 9.7] pmol/l, p=0.003, as well as the control group: 6.15 [3.41; 8.89] pmol/L, p=0.001. RANKL expression in AV tissue was significantly lower in patients in the control group: 2119,06 [1990.94; 2554.11] as compared with AS pts: 4273.03 [2887.620; 4956], p=0.001, and in subgroups with TAV: 4273.08 [2887.620; 5285], p=0.002 or BAV: 4272.99 [2884.430; 4847], p<0.01. In addition, a positive correlation of moderate strength was found between the RANKL in the blood serum and the expression of RANKL in the AV tissue in patients with BAV (r=0.357, p=0.04). OPG expression in the AV tissue was higher in patients in the control group: 3949,953 [1931.88; 6447.67], while significant only in comparison with the BAV subgroup: 2599.28 [1066.38; 4132.18], p=0.02. A positive correlation of moderate strength was found between the OPG in the blood serum and the expression of OPG in the AV tissue in TAV subgroup (r=0.423, p=0.03).

Conclusion

Different pathogenic mechanisms of AV calcification are accompanied by an increase in various markers of the OPG / RANK / RANKL system: in patients with TAV calcification marker is OPG, in patients with BAV it is RANKL.

Funding Acknowledgement

Type of funding sources: None.
Evaluation of functional mitral regurgitation profile in a real-world cohort of heart failure patients and the referral rate of these patients
Authors: Presume J , Lopes P , Albuquerque F , Freitas P , Trabulo M , Joao Andrade M , Mendes M , Ribeiras R
Published: October 2021

Introduction

Patients with heart failure and reduced ejection fraction (HFrEF) frequently have significant functional mitral regurgitation (FMR), which carries important prognostic impact. Randomized clinical trials on transcatheter mitral-valve repair have shown conflicting results, and their representativeness in real-world populations are unclear.

Purpose

This real-world study sought to identify the proportion of patients who would be eligible for mitral valve intervention and describe the current referral patterns at an academic center.

Methods

We conducted a single center cross-sectional study enrolling consecutive patients with HFrEF and FMR under guideline directed medical therapy from January 2010 to December 2018. Moderate FMR was defined as the presence of an effective regurgitant orifice area (EROA) of ≥20mm2 or a regurgitant volume (Regvol) of ≥30mL/beat, according to American Society of Echocardiography guidelines. Demographic, clinical, echocardiographic and treatment data were assessed. Main MITRA-FR and COAPT Trial eligibility criteria (NYHA class, left ventricular ejection fraction (LVEF), left ventricle end-systolic diameter, pulmonary artery systolic pressure, and right ventricle dysfunction) were applied according to trial protocols. Patterns of referral for mitral valve intervention were assessed by pre-procedural transesophageal echocardiography for mitral regurgitation evaluation.

Results

A total of 175 patients with at least moderate FMR were included in the analysis (mean age 70±12 years, 80% male, mean LVEF 32% ±9).

After applying the main eligibility criteria for each study, 73.7% (n=129) of patients would have been enrolled in MITRA-FR trial, whereas only 27.4% (n=48) patients would have met criteria for COAPT trial (Figure 1). Patients with MITRA-FR profile had a mean EROA 25±8 mm2; mean Regvol 36±9 mL/beat; mean LVEDV 205±72 mL; EROA/LVEDV ratio 0.13±0.04. “COAPT-like” patients had a mean EROA 33±10 mm2; mean Regvol 48±13 mL/beat; mean LVEDV 203±65 mL; mean EROA/LVEDV ratio 0.17±0.05.

Only 13.1% (n=23) were referred for transesophageal echocardiography in order to establish the criteria of feasibility for mitral intervention. A total of 16 patients (9.1%) were submitted to mitral valve intervention during follow-up.

Conclusion

In a real-world population of HFrEF patients with significant FMR, more than one fourth of patients had a “COAPT-like” profile and could have benefited from percutaneous mitral valve intervention. The referral rate for evaluation for a potential intervention was low, which precludes patients from benefiting from this type of treatment.

Funding Acknowledgement

Type of funding sources: None.
Regurgitant volume to left ventricular end-diastolic volume ratio: the quest to identify Disproportionate MR is not over
Authors: Albuquerque F , M Lopes P , Freitas P , M Ferreira A , Abecasis J , Trabulo M , Canada M , Ribeiras R , Mendes M , Joao Andrade M
Published: October 2021

Background

Quantification of secondary mitral valve regurgitation (SMR) remains challenging. Proportionate and Disproportionate SMR provides a conceptual framework that relates the degree of SMR to left ventricular dilatation and dysfunction. In line with this concept, regurgitant volume to LV end-diastolic volume ratio (Rvol/LVEDV) was recently proposed as a possible strategy to identify patients with Disproportionate SMR. The aim of this study was to validate this approach in a Portuguese cohort.

Methods

In a single center cohort of patients with heart failure and reduced left ventricular ejection fraction (HFrEF <50%) under optimal guideline-directed medical therapy (GDMT), we retrospectively identified those with at least moderate SMR. According to the published literature, we divided the study population into 2 risk groups: those with a Rvol/LVEDV ratio ≥20% (greater MR/smaller LVEDV) and those with a ratio <20% (smaller MR/ larger EDV). Cox regression and Kaplan-Meier survival analysis were used to assess the association between Rvol/LVEDV ratio and all-cause mortality.

Results

A total of 154 patients (mean age 69±12 years; 81% male) were included. Mean LVEF was 31±8% and median LVEDV was 193 mL (IQR: 155 to 236 mL). There were 74 patients (48.1%) with a Rvol/LVEDV ratio <20% and 80 patients (51.9%) Rvol/LVEDV ratio ≥20%. Regarding GDMT, 141 (91.6%) received beta-blockers, 139 (90.3%) angiotensin converting–enzyme inhibitors/angiotensin receptor blockers and 77 (50.0%) were under mineralocorticoid therapy. Also, there were patients 49 (31.8%) under cardiac resynchronization therapy and 40 patients (26.0%) had an implantable cardioverter defibrillator. During a median follow-up of 2.1 years (IQR 0.7 to 3.8 years), 92 (59.7%) patients died. Cox regression and survival analysis showed no mortality difference between patients with a Rvol/LVEDV ratio <20% and those with a ratio ≥20% (HR: 1.04; 95% CI 0.69–1.57; P=0.854; Log-rank P=0.967) – see also figure.

Conclusion

In a Portuguese cohort of HFrEF patients under optimized GDMT and with at least moderate SMR, the Rvol/LVEDV ratio was not associated with an increased risk of all-cause mortality. As such, the Rvol/LVEDV ratio does not seem to be a reliable surrogate of Disproportionate SMR, possibly because it does not account for the degree of LV dysfunction.

Funding Acknowledgement

Type of funding sources: None.