bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of nonlinear viscoelasticity of magnetorheological grease under large oscillatory shear by using Fourier transform-Chebyshev analysis
Authors: Wang Huixing , Chang Tianxiao , Li Yancheng , Li Shaoqi , Zhang Guang , Wang Jiong , Li Jianchun
Published: October 2020

Magnetorheological (MR) grease, which is a type of magneto-sensitive smart material, exhibits complex viscoelastic behavior under different magnetic fields. Storage and loss moduli from oscillatory test are commonly used to characterize such field-dependent viscoelastic behavior. However, they are not able to represent the higher harmonic nonlinearity appeared in oscillatory responses under large amplitude oscillatory (LAOS) shear. In this paper, an investigation is conducted on the characterization of the filed-dependent nonlinearity of MR grease under LAOS by utilizing of Fourier transform (FT)-Chebyshev analysis. To capture the higher harmonic nonlinearity for the modeling and analysis, a comprehensive test program has been conducted. Firstly, MR grease with 70% weight percentage of carbonyl iron particles (MRG-70) is prepared and the stress response of MRG-70 under the oscillatory shear from small to large strain amplitudes with different magnetic field are measured. Then the higher harmonics in stress response signal are used to detect the intercycle nonlinearity of MRG-70 and compare with the traditional analysis method of dynamic modulus. Further, the elastic and viscous measures from FT-Chebyshev analysis are obtained to capture the inter-/intracycle nonlinear behaviors, that is, strain stiffening/softening, shear thickening/thinning, of MRG-70 under LAOS. It is found that, in the presence of magnetic fields, the onset of the intercycle nonlinearities of MRG-70 is originated from shear thickening of MR grease. With the further increase of the shear strain, MRG-70 exhibits the nonlinearities with different combinations of strain stiffening/softening and shear thickening/thinning.
The Relationship Between Anxiety and Intolerance of Uncertainty Levels in Individuals Who Received Liver Transplant: A Descriptive Cross-Sectional Study
Authors: Yıldız Erman
Published: October 2020

Studies have revealed that anxiety is associated with intolerance of uncertainty (IU); however, no study has examined the predictive effect of IU on anxiety in individuals with liver transplantation (LT). Therefore, this study aimed to identify the relationship between anxiety and IU levels in individuals who received LT. A descriptive cross-sectional study with a convenience sample ( N = 118) was conducted at a center in eastern Turkey. The data were analyzed using descriptive statistics, correlation, and hierarchical linear regression analysis. The mean scores for the dimensions of IU, state anxiety and trait anxiety were 34.42 ± 8.35, 40.38 ± 10.07, and 41.88 ± 7.53, respectively. IU and anxiety in individuals with LT were identified as related dynamics. Present findings suggest that uncertainty and IU can be considered in the conceptualization and treatment of anxiety and related pathologies. Nurses may seriously consider these results in order to increase the quality of the treatment and care provided to patients.
Drought Management Norms: Is the Middle East and North Africa Region Managing Risks or Crises?
Authors: Jedd Theresa , Fragaszy Stephen Russell , Knutson Cody , Hayes Michael J. , Fraj Makram Belhaj , Wall Nicole , Svoboda Mark , McDonnell Rachael
Published: October 2020

The Middle East and North Africa region experiences severe socioeconomic and political impacts during droughts and faces increasing drought risk in future climate projections. The UN Office for Disaster Risk Reduction’s Sendai Framework and the International Drought Management Programme provide a global standard (a norm) to manage droughts through natural hazard risk reduction approaches. We use participatory engagement to evaluate whether norm diffusion has taken place in four countries. Data were collected in interviews, focus groups, workshops, and policy documents. Analysis reveals incomplete norm diffusion; stakeholders subscribe to relevant values, but national policies and implementation do not fully reflect the norm. Process tracing reveals that the availability of drought early warning data is a key barrier to risk reduction. Further more, a drought early warning system would not be feasible or sufficient unless paired with policy measures and financial mechanisms to reduce the political and economic costs of a drought declaration.
A novel method to determine the coupling scaling laws of vibration characteristics for rotor-bearing systems
Authors: Zhang Wendi , Luo Zhong , Li Yuqi , Zhu Yunpeng
Published: October 2020

The purpose of this article is to study the coupling effects of support stiffness on geometric scaling factor powers of the rotor-bearing system and predict vibration characteristics of a prototype by scaled models accurately. Associated to the least-squares–based similitude method, the discrete iteration method proposed evaluates the estimated scaling laws under variable (instable) powers and further broadens the restriction of boundary conditions in scaling laws, which is the main finding in this article. The discrete iteration method does not need to establish a physical model but directly uses input and output parameters to establish output scaling laws. The complete scaled model and geometric distorted model are selected as study cases to prove the effectiveness and accuracy of the discrete iteration method. The vibration characteristics of the rotor-bearing system are obtained by the finite element method with validation by experimental test for the natural characteristics. The comparison between the prediction results and those without the discrete iteration method shows that discrete iteration method can significantly improve the accuracy for predicting the prototype.
Alpha Amylase Inhibitory Potential and Mode of Inhibition of Oils from Allium sativum (Garlic) and Allium cepa (Onion)
Authors: Ahmed Maryam Usman , Ibrahim Adamu , Dahiru Noseh Janyo , Mohammed Hauwa’u Shuaibu
Published: October 2020

Background:

Alpha amylase inhibitors are used in the treatment of type II diabetes mellitus. Allium sativum and Allium cepa, widely consumed as spices have several medicinal uses which include their traditional use in the management of diabetes. This study was conducted to investigate the alpha amylase inhibitory potential and mode of inhibition of A. sativum and A. cepa oils.

Method:

Oil was extracted from dried bulb of A. sativum and A. cepa by Soxhlet extraction. The α-amylase inhibitory potential of the 2 oils were evaluated. The mode of inhibition of the oils were determined from the lineweaver-burk plot and the kinetic parameters obtained from the lineweaver – burk plot.

Result:

A. sativum oil had 58.13 ± 1.09 and 69.8 ± 1.11 percent inhibition at 5.0 and 7.0% concentrations respectively while A. cepa oil had 55.45 ± 1.35, 59.73 ± 1.11 and 65.21 ± 1.11 percent inhibition at 5.0, 7.5 and 10% concentrations respectively. The IC50 values for A. sativum oil, A. cepa oil and acarbose were 3.0 ± 0.02%, 4.4 ± 0.03% and 14.1 ± 0.09% respectively. The lineweaver – burk plot showed that the Vmax of the 2 oils did not change when compared with that of the no inhibitor (no oil) but the Km increased.

Conclusion:

These findings indicate that A. sativum and A. cepa oils are competitive inhibitors of α- amylase and can both be used in the treatment of type II diabetes mellitus. A. sativum oil is a better inhibitor than A. cepa oil.
Embedded ethics and reflexivity: narrating a charter of ethical experience
Authors: Cunliffe Ann L , Ivaldi Silvia
Published: October 2020

We address the call to situate organizational codes of ethics in practice and local values rather than authoritarian forms of control. Our contribution lies in: (1) drawing on Ricoeur’s work on the capable human being to develop the idea of embedded ethics, which we argue is a form of lived ethics situated in how people understand and enact ethical values in specific contexts; and (2) illustrating, through an action research project carried out in a large Italian non-profit organization, how a hermeneutic-inspired narrative methodology can be used to develop an ethics charter situated in lived values. A hermeneutic approach to research recognizes that each research encounter is unique and co-created, therefore participant interpretations are important. The originality of our work centers around the novel narrative form and approach to developing an ethical charter based on embedded ethics. We conclude by suggesting that this approach to developing an ethical charter encompasses a form of orientational learning in which people come to understand a sense or feel for issues in their reflexive dialogue around narratives that surface and explore ethical tensions.
Self-image and social-image of the donors: Two different views from oocyte donors’ eyes
Authors: Adib Moghaddam Elham , Kazemi Ashraf , Kheirabadi Gholamreza , Ahmadi Seyyed Mehdi
Published: October 2020

To identify the perceptions of women oocyte donors this qualitative study was conducted on 30 oocyte donors using in-depth interview. The three main categories of decision-making challenge, the consequences of participation in assisted reproductive treatment, and the contrast between the self-image and social-image of the donor were inferred. Financial and altruistic motivation, social taboo, and the approval of trusted people were the sub-categories of the decision-making challenge. The results of the study showed that the decision for oocyte donation follows the effort of women to balance the financial and spiritual benefits of the donation against its cultural barriers.
Fun with Dick and Dick: Homosociality on r/MassiveCock
Authors: Bury Rhiannon , Easton Lee
Published: October 2020

Social media and content-sharing platforms provide new opportunities for the circulation of not only professional and amateur porn productions but also “pornographic self-representation”. This study examines the interactions that occur when male pornographic self-representation is shared in an inclusive space that welcomes both straight and gay men to post dick pics and gaze/comment on them. Focusing on the Reddit forum, Massive Cock, we conducted a discourse analysis of a selection of posts, comments and account profiles collected over a seven-month period. Based on our findings, we contend that Massive is a homosocial space where homoerotic dick gazing reaffirms and disrupts the heterosexual–homosexual binary. Our findings point to an uneven dynamic in which the majority of the posters perform a straight identity, whereas the majority of commenters perform a gay identity. Their comments serve to disrupt hegemonic masculinity and, in turn, create a space that welcomes mostly straight and bi-curious performances of masculinity. Such performances are possible due to recent cultural shift away from homo-hysteria and towards a more inclusive heteromasculinity. Collectively these performances produce an inclusive “fraternity of the cock”, but it is one which maintains a heterocentric focus and function.
Discourse and religious doctrine: Professional social work and the moral regulation of the body in Roman Catholic Ireland
Authors: Flynn Susan
Published: October 2020

The moral and practical regulation of sexuality and associated risk has been in some ways traditionally bound by Catholic religious doctrine in the Republic of Ireland. Over the last century, however, the emergence of professional social work as a state risk management strategy around sexuality is evident. This tallies with the disrepute of the Church following high-profile abuse scandals and publicized tragedies tied to institutional segregation. This paper presents theoretically informed critical commentary, through uptake of the Foucauldian notion of discourse. It concludes that critique of the regulation of sexuality, should be qualified on three counts. Firstly, tensions between Catholicism and social work remain. Secondly, wariness towards the operation of power is requisite. Thirdly, both that which is said, and unsaid, enlightens present debates.
Cultural Studies and radical popular education: Resources of hope
Authors: Steele Tom
Published: October 2020

This article takes up the theme that a significant but often ignored source for British Cultural Studies began in the interdisciplinary teaching of the Workers’ Educational Association and university extra-mural departments in the immediate post-Second World War years. I deepen this argument by outlining the history of ‘popular education’ in Europe and beyond in the modern period to illustrate how the coming together of subaltern political movements and intellectual inquiry created an independent public sphere of radical self-enlightenment. In this article, by utilising archival and textual sources, I should like to explore whether it may be possible to renew the original project of Cultural Studies through radical programmes of ‘popular’ adult education in the digital age. I see Jim McGuigan’s work as offering ‘resources of hope’, in Raymond Williams’ phrase, for this tradition in the universe of academic Cultural Studies.
Pests, keystone species, and hungry ghosts: the Gesar epic and human-pika relations on the Tibetan Plateau
Authors: Yeh Emily T. , Gaerrang
Published: October 2020

For over half a century, the Chinese government has carried out large-scale poisoning campaigns on the Tibetan Plateau in an effort to exterminate the plateau pika, which is viewed as a pest that competes with livestock and causes grassland degradation. Since the 1990s, an ecological counternarrative has emerged in which pikas are keystone species rather than pests, and indicators rather than prime causes of grassland degradation. Virtually ignored in this debate are the ways in which Tibetan pastoralists understand and relate to pikas. We investigate Tibetan analytics of what pikas are, and what draws them to specific sites, based on interviews and observations in two pastoral communities, as well as readings of the Epic of King Gesar. Performed by bards since the twelfth century, the epic is grounded in the cultural milieu of Tibetan nomadic society and continues to be an important part of everyday life. As such, it shapes Tibetan analytics, a term we use to refer to forms of reason that cannot be reduced to ‘cultural belief.’ Because large numbers of pikas, as hungry ghosts, are drawn to places where the essence or fertility of the earth has been depleted, causing irritation to territorial deities, Tibetan practices include rituals to feed hungry ghosts, appease territorial deities, and return treasures to restore the fertility of the earth. Bringing Tibetan analytics together with proposals for political ontology, the article examines the ways in which these different ontologies, or practices of worlding, cooperate and conflict in a context of asymmetric power relations and non-liberal recognition of difference. This approach takes seriously both the agency of the nonhuman as well as human difference, while rejecting notions of rigidly bounded ontologies.
Visualization of hidden damage from scattered wavefield reconstructed using an integrated high-speed camera system
Authors: Chang Huan-Yu , Yuan Fuh-Gwo
Published: October 2020

In this article, a feasibility study for the visualization of hidden damage using an integrated high-speed camera system was carried out. A thin, planar, and low-modulus high-density polyethylene plate with surrogate damage was chosen to represent a damaged structure for the proof of concept, and two different damage scenarios (mimicked by attaching lightweight rectangular/circular masses to the back of the plate) were investigated. The acoustic/ultrasonic guided waves were generated in the plate by a surface-mounted piezoelectric actuator under continuous sinusoidal excitation, and in-plane wavefield displacements on the surface of the plate were captured using a high-speed camera. In order to reconstruct the scattered wavefield, these in-plane wavefields which primarily include the fundamental symmetric wave mode S0 and fundamental shear horizontal wave mode SH0 (induced due to reflection/scattering of the incident S0 wave mode from the damage and plate boundaries) were then extracted using digital image correlation image analysis software. All the experimental parameters (e.g. material properties of the plate, excitation frequency, selection of lens, field-of-view, speckle size) were carefully designed, integrated, and optimized. In order to overcome the current hardware limitations (insufficient spatial/temporal resolution), sample interleaving was implemented to artificially enhance the frame rate and image stitching techniques were used to increase the total effective camera resolution. Together, these techniques provided a nearly 250-fold enhancement in the data acquisition capability of the high-speed camera. In order to fully demonstrate the efficacy of the sample interleaving technique, two frequencies were excited: 14 and 28 kHz, below and above the original Nyquist frequency, respectively. The first fundamental SH0 and S0 wave modes for both frequencies were successfully detected and identified, and the disturbances at the damage region were clearly observed in the scattered wavefield reconstructed with the SH0 mode in particular, as the SH0 mode has a shorter wavelength making it better suited for detecting smaller damage. The hidden damage was then visualized by employing a modified version of the phase-based damage imaging condition, wavenumber index, that was previously developed for visualizing hidden delamination damage in composites with a laser Doppler vibrometer scanning system.
Experiencing human rights protections in prisons: The case of prison monitoring in Ireland
Authors: van der Valk Sophie , Rogan Mary
Published: October 2020

The protection of human rights in prison gives rise to unique challenges. The power differentials and dynamics involved, the need to balance considerations of security with those of dignity, and the lack of openness to the outside world mean that the implementation of human rights principles takes on a particular importance in these environments. International human rights law has increasingly emphasized the importance of external oversight of prisons as a way to prevent torture and ill-treatment and to uphold fundamental rights more generally. Although the monitoring of prisons is now quite well established as a principle of European and international human rights provisions, we know surprisingly little about how people in prison experience and understand monitoring bodies. This gap in our understanding is part of a wider lack of literature on how prisoners experience their rights and protections of their rights. This article addresses that gap, reporting on qualitative findings from a study with people in prison in Ireland on their views and perceptions of a monitoring body: the Inspector of Prisons. The article finds evidence of a lack of awareness of, and a deficit of trust in, monitoring. However, this picture is complex, with people in prison also viewing the concept of monitoring as a good way to protect rights, believing that the visibility of monitors, clarity in their role and powers, and ensuring that a variety of voices are heard by monitoring bodies are important elements of a good system of prison oversight.
Indigenous People’s Experiences and Expectations of Health Care Professionals When Accessing Care for Family Violence: A Qualitative Evidence Synthesis
Authors: Fiolet Renee , Cameron Jacqui , Tarzia Laura , Gallant David , Hameed Mohajer , Hooker Leesa , Koziol-McLain Jane , Glover Karen , Spangaro Joanne , Hegarty Kelsey
Published: October 2020

Although many Indigenous peoples demonstrate resilience and strength despite the ongoing impact colonization has on their peoples, evidence suggests poor experiences and expectations of health care professionals and access to health care. Health care professionals play an essential role in responding to family violence (FV), yet there is a paucity of evidence detailing Indigenous people’s experiences and expectations of health care professionals in the context of FV. Using a meta-synthesis of qualitative studies, this article aims to address the following research question: What are Indigenous people’s experiences and expectations of health care professionals when experiencing FV? The inclusion criteria comprised a qualitative study design, Indigenous voices, and a focus on expectations and experiences of health care professionals when FV is experienced. Reviewers independently screened article abstracts, and the findings from included papers were subject to a thematic analysis. Six studies were included in the final meta-synthesis representing studies from Australia, the Americas, and New Zealand. Three themes were identified. Health care professionals need to center the Indigenous person in the care they provide and demonstrate cultural awareness of how history and culture influence an individual’s care requirements. Health care professionals also need to ensure they are connecting for trust with the Indigenous person, by slowly developing a rapport, yarning, and investing in the relationship. Finally, Indigenous peoples want their health care professional to work on strengthening safety from culturally inappropriate care, institutional control, and potential lack of confidentiality associated with tight-knit communities.
Efficacy of Combination Neoadjuvant Chemotherapy and Regional Inductive Moderate Hyperthermia in the Treatment of Patients With Locally Advanced Breast Cancer
Authors: Loboda Anton , Smolanka Sr Ivan , Orel Valerii E. , Syvak Liubov , Golovko Tetiana , Dosenko Iryna , Lyashenko Andrii , Smolanka Ivan , Dasyukevich Olha , Tarasenko Tetiana , Orel Valerii B. , Rykhalskyi Alex , Ganich Oleksandr , Mokhonko Oleksandr
Published: October 2020

Purpose:

To evaluate the efficacy of neoadjuvant chemotherapy in combination with regional inductive moderate hyperthermia for patients with locally advanced breast cancer.

Patients and Methods:

200 patients with stage IIB-IIIA breast cancer received neoadjuvant chemotherapy (control group, n = 97) or chemotherapy combined with hyperthermia (experimental group, n = 103). Inductive hyperthermia was set at 27.12 ± 0.16 MHz and the 50 W output power.

Results:

Thermal and color Doppler ultrasound imaging demonstrated that hyperthermia increased the surface temperature on the breasts to < 4°С while the mean values for systolic blood flow were 3.5 times as high as those prior to treatment. Assessment of tumor size and response found a (31.24 ± 3.85)% reduction in the size of the primary tumor in patients receiving chemotherapy + hyperthermia, while chemotherapy alone showed a (22.95 ± 3.61)% decrease on average (p = 0.034). The rate of objective response increased by 15.9% in the experimental group (р = 0.034) compared with the control group. The patients in the experimental group also had axillary lymph node regression of 14.17% greater than in the control group (p = 0.011). Moreover, the combination treatment allowed to increase the proportion of women eligible for breast-conserving and reconstructive surgery by 13.63% in the experimental group. The viable tumor volume was lower in patients receiving neoadjuvant chemotherapy + hyperthermia (24.4 ± 0.2)% compared with those given chemotherapy alone (30.4 ± 0.25)%. The 10-year overall survival rates were higher (log-rank: p = 0.009) in breast cancer patients who underwent chemotherapy combined with hyperthermia than in patients receiving chemotherapy only.

Conclusion:

The combination neoadjuvant chemotherapy and the technology of regional inductive moderate hyperthermia improved the efficacy of treatment for patients with locally advanced breast cancer staged IIB-IIIA.
MiR-27a Facilitates Breast Cancer Progression via GSK-3β
Authors: Chen Huijin , Zhang Yuanyuan , Cao Xin , Mou Peipei
Published: October 2020

Breast cancer remains one of the leading causes of cancer-associated death in women. MiR-27a is highly expressed in breast cancer tissue. However, the underlying mechanisms that promote breast cancer progression are unknown. In this study, we investigated the regulatory mechanisms of miR-27a and its target glycogen Synthase Kinase 3-β (GSK-3β) in breast cancer cells. We found that miR-27a was highly expressed in breast cancer tissues, which downregulated GSK-3β expression. We further identified GSK-3β as a direct target of miR-27a, and found that the miR-27a mediated suppression of GSK-3β activated Wnt/β-catenin-associated proliferative and invasive factor in breast cancer. The cell transfection assay demonstrated the overexpression of miR-27a also enhanced cell proliferation and invasion, and reduced cell apoptosis through GSK-3β. Finally, we demonstrated that the overexpression of miR-27a facilitated breast cancer progression through its ability to down-regulate the phosphorylation of GSK-3β both in vivo and vitro. These findings highlighted miR-27a as a novel therapeutic target in breast cancer.
SDFMUCR: Software-defined and fuzzy-based multi-hop unequal cluster routing
Authors: Sixu Lu , Muqing Wu , Min Zhao
Published: October 2020

Recently, wireless sensor networks play an important role in our life. Researchers give more and more attention to the design of the routing algorithm. Cluster routing is the most popular routing protocol in wireless sensor networks. However, hotspot problem always exists. Unequal cluster routing is an effective method to solve this problem. In these protocols, nodes closer to base station have the smaller cluster size than other sensor nodes. It will reduce the relay pressure of the node which is near to the base station. The development of the software-defined network optimizes the performance of wireless sensor networks. In this article, we propose a software-defined and fuzzy-based multi-hop unequal cluster routing protocol. It adopts three methods to make the routing protocol outstanding. First, it uses a novel software-defined network architecture to reduce computation overhead and energy overhead in sensor nodes. Then, the fuzzy logic–based intracluster and intercluster routing is designed to balance energy consumption. Finally, residual energy–based rotating scheme is proposed to reduce most of the control overhead. According to the simulation results, the proposed protocol balances and reduces the energy consumption, extends the lifetime, and reduces the control overhead and latency of the network.
A new subtype of intracranial dural AVF according to the patterns of venous drainage
Authors: Casasco Alfredo , Guimaraens Leopoldo , Negrotto Matías , Vivas Elio , Díaz Laura Paul , Aleu Aitziber
Published: October 2020

Background and purpose

A well-known classification of dural arteriovenous fistulas (DAVFs) according to the patterns of venous drainage was described in 1977 by Djindjian, Merland et al. and later revised by Cognard, Merland et al. in 1995. They described 5 types of DAVFs assuming that the type of venous drainage is directly correlated with neurologic symptoms and in particular with hemorrhagic risk. We present a series of cases that combines type IV (DAVF with cortical venous drainage associated with venous ectasia) and type V (DAVF with spinal venous drainage), which we named type IV + V.

Materials and methods

A retrospective study between 2012 and 2020 in 2 Hospitals was performed on patients that met inclusion criteria for a diagnosis of this type of DAVF. Demographics, location, clinical presentation and outcomes of endovascular embolization were studied.

Results

Five (2,3%) patients out of 220 had a type IV + V DAVF. All cases had an aggressive presentation, either subarachnoid hemorrhage, myelopathy or both. All patients were treated with endovascular transarterial embolization achieving complete angiographic occlusion in one session and total remission of symptoms at 3 months.

Conclusions

This rare type of DAVF, combines two aggressive venous drainage patterns. For that reason, patients with type IV+V DAVF probably have a more aggressive natural history and worst outcome due to risk of intracranial and/or spinal hemorrhage and myelopathy, thus requiring urgent diagnostic and treatment. Larger studies are needed to better understand this type of DAVF.
Evaluation of the Special Olympics Team Wellness health promotion program for individuals with intellectual disabilities
Authors: McCarty Kathleen , Dixon-Ibarra Alicia , MacDonald Megan
Published: October 2020

Introduction:

Individuals with intellectual disabilities are a known health disparities group. The Team Wellness (TW) health promotion program was developed to provide healthy lifestyle information to target this population. The purpose of this study was to conduct a qualitative program evaluation on Team Wellness.

Methods:

Interviews were conducted via one-on-one format with program coaches (n = 4, mean age = 25, female = 2, male = 2) and focus group with program athletes (n = 6, mean age = 45, female = 4, male = 2) who completed the TW program.

Results:

Themes that emerged included: (1) Program Perceptions; (2) TW Support; and (3) Program Feedback. Program perceptions were positive and continued athlete participation was anticipated. Coaches felt prepared to facilitate based on previous experience though program fidelity varied.

Conclusion:

Study participants enjoyed TW and identified valuable recommendations. Program fidelity and marketing efforts are important for future consideration. Further quantitative assessment is needed to determine the effectiveness the program.
The Effect of Various, Everyday Practices on Glucose Levels in Critically Ill Children
Authors: Tsotridou Eleni , Kotzapanagiotou Eirini , Violaki Asimina , Dimitriadou Meropi , Svirkos Menelaos , Mantzafleri Peristera-Eleni , Papadopoulou Vasiliki , Sdougka Maria , Christoforidis Athanasios
Published: October 2020

Background:

To evaluate the effect of various, everyday intensive care unit (ICU) practices on glucose levels in critically ill pediatric patients with the use of a continuous glucose monitoring system.

Methods:

Seventeen sensors were placed in 16 pediatric patients (8 male). All therapeutic and diagnostic interventions were recorded and 15 minutes later, a flash glucose measurement was obtained by swiping the sensor with a reader. Glucose difference was calculated as the glucose value 15 minutes after the intervention minus the mean daily glucose value for each individual patient. Additionally, the consciousness status of the patient (awake or sedated) was recorded.

Results:

Two hundred and five painful skin interventions were recorded. The mean difference of glucose values was higher by 1.84 ± 14.76 mg/dL (95% CI: −0.19 to 3.87 mg/dL, P = .076). However, when patients were categorized regarding their consciousness level, mean glucose difference was significantly higher in awake state than in sedated patients (4.76 ± 28.07 vs −2.21 ± 15.77 mg/dL, P < .001). Six hundred forty-nine interventions involving the respiratory system were recorded. Glucose difference during washings proved to be significantly higher than the ones during simple suctions (4.74 ± 14.18 mg/dL vs 0.32 ± 18.22 mg/dL, P = .016). Finally, glucose difference in awake patients was higher by 3.66 ± 13.91 mg/dL compared to glucose difference of −2.25 ± 21.07 mg/dL obtained during respiratory intervention in sedated patients.

Conclusions:

Diagnostic and therapeutic procedures in the ICU, especially when performed in an awake state, exacerbate the stress and lead to a significant rise in glucose levels.
Pharmacological Assessment of the Carvacrol Chemotype Essential Oil From Plectranthus amboinicus Growing in Cuba
Authors: Monzote Lianet , Scherbakov Alexander M. , Scull Ramón , Gutiérrez Yamilet I. , Satyal Prabodh , Cos Paul , Shchekotikhin Andrey E. , Gille Lars , Setzer William N.
Published: October 2020

Plant-derived products are employed in various public health practices and have been considered as a major source of medicines. The genus Plectranthus (Lamiaceae) has been widely respected for its nutritional properties, its essential oil, and its therapeutic values. In the present work, the chemical characterization, antimicrobial, antiparasitic, and cytotoxic properties of the essential oil from Plectranthus amboinicus (Lour.) Spreng and its main compound carvacrol were studied. Twenty-one components were identified in the oil by gas chromatography coupled with a mass spectrometric detector. In this oil, carvacrol constitutes the major compound (71%), which represented the more abundant chemotype. The essential oil did not inhibit growth of Escherichia coli, Staphylococcus aureus, Candida albicans, Trypanosoma cruzi, or Leishmania infantum, but displayed activity against Plasmodium falciparum (half-maximal inhibitory concentration [IC50] = 5.9 µg/mL), Trypanosoma brucei (IC50 = 34.9 µg/mL), and Leishmania amazonensis (IC50 = 58.2 µg/mL), and the human tumor-derived cell lines MCF-7 (IC50 = 29.1 µg/mL), MDA-MB-231 (IC50 = 41.5 µg/mL), and 22Rv1 (IC50 = 29.6 µg/mL), but no cytotoxicity was observed against nonmalignant macrophages. The antiproliferative activity of the oil could be attributed to carvacrol. However, this compound showed certain level of cytotoxicity, which suggests unspecific activity. This study provides evidence about antimicrobial and anticancer potential of the essential oil from P. amboinicus against protozoa and neoplastic diseases, particularly as an antimalarial natural product.
Jones Fracture Treatment: A Novel Surgical Technique and Case Series
Authors: Ryan Thomas J. , Tarrant Seth M. , Fraser Ethan J. , O’Sullivan James
Published: October 2020

Background

Jones fractures remain a challenging treatment entity in orthopaedics. Biomechanical stresses, including increased fifth metatarsal (5MT) lateral angle deviation (MLAD), are associated with increased fracture and refracture rates. Current fixation techniques produce good outcomes; however, they do not address metatarsal morphology, which can predispose to refracture. This study describes a novel surgical technique and case series utilizing intramedullary screw fixation and distal metatarsal corrective osteotomy for the management of Jones fractures.

Methods

A retrospective case series was undertaken, including 22 consecutive Jones fracture patients operated on by a single surgeon. Patient demographics, imaging, and operative information were obtained, with return to sport/previous function and radiological outcomes, including fracture union being the outcomes of interest. The surgical technique utilizes a distal osteotomy of the 5MT followed by retrograde guidewire and drilling utilizing the osteotomy. A cannulated screw is passed antegrade along the entire length of the 5MT with manual MLAD correction. Autograft or bone substitute (Augment) was then injected at the fracture site.

Results

Median age was 30 years (Q1, Q3: 18, 49 years). Median time from injury to operation was 13 weeks (Q1, Q3: 9, 30 weeks), and clinical follow-up period was 37 months (Q1, Q3: 14, 74 months). Radiological union was achieved at a median of 12 weeks (Q1, Q3: 8, 15 weeks) with clinical union at 11 weeks (Q1, Q3: 8, 14 weeks). All but one patient returned to preinjury functional levels, including 6 professional athletes who returned to preinjury national competition. No refractures were identified.

Conclusion

The technique described in this study is a viable and safe means of managing Jones fractures. The technique may be particularly useful in patients with excessive MLAD.

Levels of Evidence

Level IV: Retrospective case series
The Influence of News Brand Cues and Story Content on Citizen Perceptions of News Bias
Authors: Kim Minchul , Grabe Maria Elizabeth
Published: October 2020

Mainstream U.S. news media stand accused of bias against the forty-fifth president, Donald Trump. The relentlessness and intensity of these accusations over the course of Trump’s presidency are unusual and make for an opportunity to study perceptions of news bias. During the experiment reported here, participants ( N = 315) were exposed to biased (pro- and anti-Trump) news stories that were attributed to either CNN, Breitbart, or remained unattributed to a news brand. After reading the stories, participants rated the stories for their relative slantedness in favor of, neutral, or against the president. Findings reveal that news users are sensitized to the president’s accusations of bias against CNN. For example, anti-Trump stories were rated as more slanted than pro-Trump stories when they were attributed to CNN. This was not the case when the same stories were attributed to Breitbart. Interestingly, unattributed biased news received the highest ratings for slantedness.
Mini-Invasive Endoscopic Approaches to the Maxillary Sinus Floor: A Comparative Anatomical Study
Authors: Felisati Elena , Saibene Alberto Maria , Borloni Roberto , Prades Jean Michel , Felisati Giovanni
Published: October 2020

Background

While middle antrostomy (MA) is the most common approach to the maxillary sinus (MS), it is known for not allowing to fully inspect the whole MS, especially in its inferior and anterior portions. To overcome this limitation, alternative approaches have been proposed, such as inferior antrotomy (IA) and canine fossa accesses (CFA).

Objective

Given the lack of studies on the MS floor visualization with different accesses, our study aims, in a cadaver lab setting, to systematically compare three different approaches (MA, IA and CFA) in these regards.

Methods

Eight cadaver heads, previously submitted to CTscan, were prepared inserting fixtures corresponding to teeth 2, 4, 6, 11, 13 and 15 and into the canine fossae. Three approaches were prepared: a wide MA, an IM and a CFA. We endoscopically evaluated, for each specimen, side, access type and scope angle (0°, 30°, 45°, and 70°), which fixtures were visible on the maxillary sinus floor and whether the canine fossa fixture was visible (MA and IA only).

Results

IA allowed to visualize all fixtures in nearly all cases (14/16 with 70° endoscope), while MA showed poor visualization results (3/16 with 70° endoscope); CFA failed to gain full visualization in most specimens (7/16 with 70°endoscope). Such difference was statistically significant. MA proved unable to visualize the canine fossa fixture in most cases while IA showed excellent possibilities. All differences were statistically significant (p < .001, Mcnemar’s test).

Conclusions

Our data show that the IA grants a statistically significant superior surgical field vision when compared to MA and CFA, though in vivo validation of these results is still required.
Mobilising intensive care patients early
Authors: Ling Xi Wern , Lim Yee Hua , Ong Hwee Kuan , Palanichamy Vimal , Leong Kenneth Bao Ren , Ling Xi Yun , Lee Ken Cheah Hooi , Ho Vui Kian
Published: October 2020

Background:

Early mobilisation in the intensive care unit has been suggested to improve outcomes. However, safety and practical concerns have led to the slow uptake of early mobilisation.

Objectives:

We designed a study to evaluate the practicability and efficacy of an early mobilisation protocol in intensive care unit patients.

Methods:

We performed a prospective non-blinded observational cohort study based on a quality improvement project. We implemented a protocol for early mobilisation of suitable patients admitted to medical and surgical intensive care units of a tertiary care hospital. All other aspects of patient care were managed as usual. Patients were followed up to discharge. Data were collected from July to August 2016 pre-implementation and from November 2016 to February 2017 following protocol implementation. The primary outcome measure was the mobilisation rate, defined as the number of days mobilised divided by the number of days each patient met mobilisation criteria. Secondary outcome measures included adverse event rate, length of mechanical ventilation, intensive care unit and hospital stay, intensive care unit and inhospital mortality and discharge destination.

Results:

A total of 312 patients were analysed, of which 60% were men with a mean age of 63.4 years. Following early mobilisation implementation, the mobilisation rate increased from 39% to 65% ( P=0.006). The percentage of patients discharged home increased from 49.0% to 75.9% ( P<0.001). Mortality, length of mechanical ventilation, length of stay and adverse event rate did not differ significantly.

Conclusion:

The implementation of an early mobilisation protocol in our intensive care unit was both safe and effective without requiring additional staffing. Efforts are ongoing to increase compliance with the protocol.
Dilemmas in anticoagulation and use of inferior vena cava filters in venous thromboembolism; a survey of Respiratory Physicians, Haematologists and Medical Oncologists and a review of the literature
Authors: Craven Philip , Daly Ciara , Sikotra Nisha , Clay Tim , Gabbay Eli
Published: October 2020

Twenty percent of patients with Cancer Associated Thrombosis receive an inferior vena cava filter annually. Insertion is guided by practice guidelines, which do not specify or discuss the use of inferior vena cava filters in malignancy. Adherence to these guidelines is known to be variable. We aimed to see if there was consistent management of venous thromboembolism among Medical Oncologists/Haematologists and Respiratory Physicians, with respect to inferior vena cava filter use in the setting of suspected and confirmed malignancy. Medical Oncologists, Haematologists and Respiratory Physicians were surveyed with four theoretical cases. Case 1 concerns a patient who develops a pulmonary embolism following spinal surgery. Cases 2 and 4 explore the use of inferior vena cava filters in the setting of malignancy. Case 3 covers the role of inferior vena cava filters in recurrent thrombosis despite systemic anticoagulation. There were 56 responses, 32 (57%) Respiratory Physicians and 24 (43%) Haematologists/Oncologists. Respiratory Physicians were significantly more likely to insert an inferior vena cava filter in case 1 (p = 0.04) whilst Haematologists/Medical Oncologists were more likely to insert an inferior vena cava filter in case 3 (p = 0.03). No significant differences were found in cases 2 and 4. There were significant disparities in terms of type and timing of anticoagulation. Consistency of recommendations with guidelines was variable likely in part because guidelines are themselves inconsistent. The heterogeneity in responses highlights the variations in venous thromboembolism management, especially in Cancer Associated Thrombosis. International Societies should consider addressing inferior vena cava filter use specifically in the setting of Cancer Associated Thrombosis. Collaboration between interested specialities would assist in developing consistent, evidence‐based guidelines for the use of inferior vena cava filters in the management of venous thromboembolism.
Peripheral pulmonary stenosis with Noonan syndrome treated by balloon pulmonary angioplasty
Authors: Ko Seien , Komuro Jin , Katsumata Yoshinori , Shiraishi Yasuyuki , Kawakami Takashi , Yamada Yoshitake , Yuasa Shinsuke , Kohno Takashi , Kosaki Kenjiro , Fukuda Keiichi
Published: October 2020

Noonan syndrome is known to have various cardiovascular defects, which include pulmonary artery stenosis. Pulmonary artery stenosis is characterized by obstruction of pulmonary artery blood flow that can cause elevated pulmonary artery pressure and ventilation‐perfusion inequality, which can cause dyspnea on exertion and eventually, heart failure. Although the etiology of pulmonary artery stenosis related to congenital diseases is still unknown, balloon pulmonary angioplasty has being reported to be effective to selected patients with Alagille and Williams syndromes, but not from Noonan syndrome despite of modest prevalence of pulmonary artery stenosis. Here, we report the first Noonan syndrome patient with pulmonary artery stenosis who underwent successful balloon pulmonary angioplasty. The strategy used in balloon pulmonary angioplasty was planned with careful morphologic evaluation by computed tomographic angiography, and performed with scoring balloons in a graded approach with multiple sessions. After balloon pulmonary angioplasty, we confirmed maintained dilation of lesions and symptom alleviation, suggesting that balloon pulmonary angioplasty can be performed safely on pulmonary artery stenosis in a Noonan syndrome patient.
Growth differentiation factor‐15 levels in the blood around the pulmonary artery is associated with hospitalization for heart failure in patients with pulmonary arterial hypertension
Authors: Chang Wei‐Ting , Shih Jhih‐Yuan , Lin Yu‐Wen , Chen Zhih‐Cherng , Roan Jun‐Neng , Hsu Chih‐Hsin
Published: October 2020

Despite no significant differences of growth differentiation factor‐15 expressions in peripheral, right atrial, and right ventricular blood, in the pulmonary arterial blood, there was a significantly high level of growth differentiation factor‐15 in Group I pulmonary arterial hypertension patients subsequently developing heart failure. During right heart catheterization, collecting pulmonary blood samples is suggested to measure growth differentiation factor‐15.
Novel composite clinical endpoints and risk scores used in clinical trials in pulmonary arterial hypertension
Authors: Sitbon Olivier , Nikkho Sylvia , Benza Raymond , Deng Chunqin (CQ) , Farber Harrison W. , Gomberg‐Maitland Mardi , Hassoun Paul , Meier Christian , Pepke‐Zaba Joanna , Prasad Krishna , Seeger Werner , Corris Paul A
Published: October 2020

This manuscript on endpoints incorporates the broad experience of members of Pulmonary Vascular Research Institute’s Innovative Drug Development Initiative as an open debate platform for academia, the pharmaceutical industry and regulatory experts surrounding the future design of clinical trials in pulmonary hypertension. It reviews our current understanding of endpoints used in phase 2 and 3 trials for pulmonary hypertension and discusses in detail the value of newer approaches. These include the roles of composite endpoints and how these can be developed and validated. The newer concept of risk analysis is also discussed, including how such risk scores might be utilised as endpoints in clinical trials.