bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical evaluation of a new dispersive aortic cannula
Authors: Goto Takeshi , Fukuda Ikuo , Konno Yukiya , Tabata Ai , Ohira Tomoyuki , Kato Ryutaro , Yamamoto Keigo , Ogasawara Junko , Daitoku Kazuyuki , Minakawa Masahito
Published: May 2020

Introduction:

Cerebral injury is a serious complication in open-heart surgery. Once it occurs, it causes significant disability and death. We developed a novel dispersive aortic cannula named the Stealth Flow cannula and used it as a standard aortic cannula in cardiopulmonary bypass. The aim of this study was to evaluate the efficiency of this aortic cannula.

Methods:

A total of 182 consecutive patients undergoing cardiac surgery using cardiopulmonary bypass were studied. The patients were divided into two groups: the Soft-Flow cannula group (n = 89) and the Stealth Flow cannula group (n = 93). Patients with a shaggy aortic arch were excluded from this study because the cannulae were inserted at the ascending aorta with a cannula tip directed toward the aortic root in these cases. Patients with multiple arterial perfusion sites were also excluded. Complications including early mortality, perioperative stroke, and intraoperative aortic injury were compared between the two groups.

Results:

Age, operative procedure, cardiopulmonary bypass time, and the Japan SCORE were not significantly different between the groups. In comparisons between the Stealth Flow and Soft-Flow groups, the incidences of early mortality, perioperative stroke, intraoperative aortic dissection, and all complications were 1.08% versus 1.12% (p = 0.98), 1.1% versus 2.2% (p = 0.53), 0% versus 1.1% (p = 0.33), and 1.1% versus 3.4% (p = 0.29), respectively. The incidence of major cardiovascular events, including early death, perioperative stroke, and aortic dissection, was not different.

Conclusions:

The Stealth Flow cannula, which was designed based on our previous experimental study, contributed to reducing cerebral and aortic events as much as the Soft-Flow cannula in the present clinical study.
Venogram before long-interval repeat cannulation for pediatric extracorporeal membrane oxygenation
Authors: Carr Benjamin D , Kohne Joseph , Ralls Matthew W , Sassalos Peter , Ohye Richard G , Odetola Folafoluwa O , Gadepalli Samir K
Published: May 2020

It is rare for children to receive more than one course of support with extracorporeal membrane oxygenation, and in those who do undergo multiple episodes, the interval is usually days to weeks between events. Little data exists on re-cannulation years after an initial extracorporeal membrane oxygenation run, and late repeat cannulation can pose unique challenges. We report the case of a 10-year-old male patient with right jugular vein occlusion due to a previous course of extracorporeal membrane oxygenation as a neonate, who was successfully supported via central cannulation. This case demonstrates the importance of adequate imaging of target vasculature prior to attempting re-cannulation of a previously used vessel. Establishing a thoughtful strategy for late repeat cannulation is essential to achieve safe access in unusual and challenging situations.
Do Technology-Based Sales Support Materials Make a Difference in Personal Selling? The Impact of Technology Usage by Gender in the Personal Selling Process
Authors: Lee Youngsu , Heinze Timothy
Published: May 2020

Technology usage is widespread across most fields of business. In sales, “back-end” technologies, such as customer relationship management or salesforce automation, offer a foundation for effective and efficient “front-line” interactions in the personal selling process (PSP). In many instances, “front-line” technology applications have replaced traditional, hard-copy sales support materials. However, do these technology-based sales support materials (TSSM) offer meaningful utility in the PSP? Using a randomized field experiment, the current study answers the question through examining the use of TSSM within the PSP and across genders. Results indicate that the use of TSSM offers utility during the presentation and objection-handling stages of the PSP. There are no gender effects associated with technology use. The study offers educators pedagogical recommendations regarding the use of TSSM within the PSP. The study also validates the PSP scale.
Precocious pseudopuberty, a paraneoplastic manifestation: a report of 2 cases
Authors: Gattuso Giovanna , Casanova Michela , Biassoni Veronica , Terenziani Monica , Schiavello Elisabetta , Sironi Giovanna , Collini Paola , Pallotti Federica , Morosi Carlo , Massimino Maura
Published: May 2020

Peripheral precocious puberty (PPP) may be a paraneoplastic manifestation, associated with beta human chorionic gonadotropin (β-hCG)–secreting tumors. We describe 2 young children with β-hCG-secreting tumors presenting with signs of pubertal activation. In the first patient, a 16-month-old boy with hepatoblastoma, only initial signs of PPP at presentation were identifiable, with concomitant high levels of β-hCG. Although the tumor had good response to therapy, β-hCG levels were fluctuant until the tumor was resected surgically. The second patient, an 18-month-old boy with intracranial germ cell tumor, presented with clear signs of pubertal activation and genitalia enlargement with no initial alteration of sex hormones. In both cases, the oncologic response to therapy was good. In the first case, full remission of the pubertal signs was observed; in the second, pubertal signs were still visible 20 months after the end of treatment.
Internal and External Barriers to Help Seeking: Voices of Men Who Experienced Abuse in the Intimate Relationships
Authors: Lysova Alexandra , Hanson Kenzie , Dixon Louise , Douglas Emily M. , Hines Denise A. , Celi Elizabeth M.
Published: May 2020

This qualitative study explores internal and external barriers to help seeking among 41 men from four English-speaking countries who self-reported victimization from a female intimate partner. Twelve online focus groups were conducted and themes were identified inductively at a semantic level. Six identified themes represented four internal (blind to the abuse, maintaining relationships, male roles, and excuses) and two external barriers to help seeking (fear of seeking help and nowhere to go). Most participants who avoided seeking help did so due to their own lack of recognition of abuse and ability to assess their risk of harm, attempts to keep the family intact, masculine stereotypes, and excuses for their partner’s abuse. Some men who expressed an interest in seeking help were discouraged from it due to fear for their personal safety, a potential revictimization in the legal system, and the lack of support services available to men. This research suggests that the individuals who are abused in relationships, service providers, and the public at large could benefit from professional training about gender inclusive approaches to intimate partner abuse.
The depiction of migraine visual aura on the internet
Authors: Viana Michele , Hougaard Anders , Do Thien Phu
Published: May 2020

Introduction

The most common and multifaceted migraine aura symptoms are visual disturbances. Health information is one of the most popular topics on the internet but the quality and reliability of publicized information is unknown. The aim of this study was to analyze images of migraine aura on Google to determine the frequency of correct presentations of visual aura and distribution of visual aura phenotypes.

Methods

Two authors screened the 100 highest indexed migraine aura related images on Google. The content of the images was categorized into elementary visual symptoms.

Results

Forty out of 100 images were accurate representations of visual migraine aura. Such images included 31 different visual aura phenotypes. The majority had more than one elementary visual symptom (median 2, IQR 1–3), most commonly “bean-like” forms (45%), zigzag lines (40%), and foggy/blurred vision (33%).

Discussion

Forty percent of images were accurate portrayals of visual migraine aura symptoms, but these presented limited phenotypes. The information derived from the internet photos may hinder the effective recognition of aura symptoms. Thus, there is a need to provide a more comprehensive representation of visual migraine aura symptoms on the internet.
Fracture characterization of overmold composite adhesion
Authors: Hartley W Douglas , McCann John , Davis Scott , Hocker Tom , Bobba Somasekhar , Verghese Nikhil , Bajaj Devendra , Yu Hang Z , Dillard David A
Published: May 2020

A general testing approach is presented via a fracture mechanics study on the interfacial delamination behavior in overmolded composite materials using a variant of the double cantilever beam (DCB) geometry. Overmolding, a common injection molding process, is used to fabricate asymmetric DCB test specimens with Lexan™ 3414 resin overmolded onto commercially available TenCate Cetex® FST woven glass fiber/polycarbonate laminates. An analytical beam theory model is employed to partition the planar fracture modes at the overmold interface into mode I and mode II components, which are functions of material properties and relative beam thicknesses. Specimen curvature measurements are integrated into the beam theory model to estimate the residual stress effects on fracture mode mixity. We use the overmold thickness as a tunable variable to control fracture mode mixity, and target near mode I fracture conditions, where we find mode I fracture energy ( GIc) values of approximately 1 kJ/m2. Fiber bridging across the failure interface is observed, which is not expected at the nominal polymer/polymer overmold interface. Complementary scanning electron microscopy images of the failure surfaces indicate crack initiation at the overmold interface, followed by a change in locus of failure to the nearby polymer/glass fiber interface in the top layer of the composite laminate. Fiber bridging is observed in all specimens tested over a modest range of mode mixity, including specimens modified to the single leg bending geometry, suggesting that the polymer/glass interface is more susceptible to crack propagation than the desired overmold interface, which likely derives its strength from molecular interdiffusion during the overmolding process.
Psychological Antecedents of Decision Comprehensiveness and Their Relationship to Decision Quality and Performance in Family Firms: An Upper Echelons Perspective
Authors: Carr Jon C. , Vardaman James M. , Marler Laura E. , McLarty Benjamin D. , Blettner Daniela
Published: May 2020

We present a model of family firm performance that tests the notion that strategic decision comprehensiveness plays a pivotal role in family business decision quality and performance. With insights derived from upper echelons theory, our model further proposes that two key decision maker traits associated with an individual’s information-gathering process—risk-taking propensity and need for cognition—influence strategic decision comprehensiveness and have indirect effects on both study outcomes. Study results using a time-lagged sample of family firm leaders provide broad support for our proposed model and provide insight into the performance and decision-making heterogeneity present in family firms.
The over-cascading system of cadre evaluation and China’s authoritarian resilience
Authors: Qi Rui , Shi Chenchen , Wang Mark
Published: May 2020

China’s cadre evaluation system – the personnel management system used to assess the performance of government officials in the party-state – is considered an important tool for upper-level governments to supervise and regulate lower-level agents. This system is one of the key factors contributing to the Chinese Communist Party’s (CCP) authoritarian resilience. Deficiencies of this system are exemplified by the ‘blind pursuit of GDP’, selective implementation, gaming, collusion, and data fabrication. The CCP has been reforming this system to strengthen its monitoring and political control over local government cadres, especially at the county level, and it is a crucial component in the step-by-step hierarchical power structure. While current literature focuses largely on the assessment content of such reform, this article pays specific attention to the changes in the cascading evaluation structure of province to prefecture to county. The article identifies a new dynamic of ‘over-cascading’ whereby provincial governments bypass prefectural governments and directly evaluate county officials, resulting in the co-existence of prefecture-county and province-county evaluations. This article also explores the functioning mechanism of this dual structure and argues that this structural change in the cadre evaluation system is breaking the traditional hierarchical governance structure and enhancing authoritarian resilience of the CCP because it provides a new route for over-cascading governance between provincial and county governments. This research contributes to the conceptualization of the over-cascading governing structure of the CCP and fills gaps in the literature on structural changes in China’s cadre evaluation system.
Integrating Music and Literacy: Applying Invented Music Notation to Support Prosody and Reading Fluency
Authors: Bolden Benjamin , Beach Pamela
Published: May 2020

This article builds on evidence-based teaching strategies to support a learning experience for third-grade students that integrates language and music. In the language-learning field, “prosody” refers to changes in volume, rhythm, and pitch that add expression and meaning when reading text aloud. When students incorporate prosodic elements into reading, their comprehension of the text is enhanced. In the field of music learning, invented notation allows young music learners to bypass the complexity of traditional notation to authentically express music ideas in a way that is accessible to peers, parents, and teachers. The learning experience described invites learners to use invented notation to represent music nuances within spoken language (prosody). Learners develop their capacity to expressively read aloud while broadening their understanding of composing and the music elements of volume, rhythm, and pitch. An illustrative sample lesson is provided.
Prevalence and Inpatient Hospital Outcomes of Malignancy-Related Ascites in the United States
Authors: Ramamoorthy Venkataraghavan , Rubens Muni , Saxena Anshul , Bhatt Chintan , Das Sankalp , Appunni Sandeep , Veledar Emir , McGranaghan Peter , Shehadeh Nancy , Viamonte-Ros Ana , Linhares Yuliya , Odia Yazmin , Kotecha Rupesh , Mehta Minesh P.
Published: May 2020

Objective:

Malignancy-related ascites (MRA) is the terminal stage of many advanced cancers, and the treatment is mainly palliative. This study looked for epidemiology and inpatient hospital outcomes of patients with MRA in the United States using a national database.

Methods:

The current study was a cross-sectional analysis of 2015 National Inpatient Sample data and consisted of patients ≥18 years with MRA. Descriptive statistics were used for understanding demographics, clinical characteristics, and MRA hospitalization costs. Multivariate regression models were used to identify predictors of length of hospital stay and in-hospital mortality.

Results:

There were 123 410 MRA hospitalizations in 2015. The median length of stay was 4.7 days (interquartile range [IQR]: 2.5-8.6 days), median cost of hospitalization was US$43 543 (IQR: US$23 485-US$82 248), and in-hospital mortality rate was 8.8% (n = 10 855). Multivariate analyses showed that male sex, black race, and admission to medium and large hospitals were associated with increased hospital length of stay. Factors associated with higher in-hospital mortality rates included male sex; Asian or Pacific Islander race; beneficiaries of private insurance, Medicaid, and self-pay; patients residing in large central and small metro counties; nonelective admission type; and rural and urban nonteaching hospitals.

Conclusions:

Our study showed that many demographic, socioeconomic, health care, and geographic factors were associated with hospital length of stay and in-hospital mortality and may suggest disparities in quality of care. These factors could be targeted for preventing unplanned hospitalization, decreasing hospital length of stay, and lowering in-hospital mortality for this population.
Effect of Terfenol-D rod structure on vibration performance of giant magnetostrictive ultrasonic transducer
Authors: Li Pengyang , Liu Qiang , Zhou Xuan , Xu Guangyao , Li Wei , Wang Quandai , Yang Mingshun
Published: May 2020

In this study, a giant magnetostrictive ultrasonic transducer was designed with Terfenol-D as the active material. The influence of different Terfenol-D rod structures on the performance of the giant magnetostrictive transducer was investigated. Finite element analysis was used to analyze the dynamics of the theoretical giant magnetostrictive transducer and to validate the design. Eddy current losses were simulated for Terfenol-D rods of various structures using finite element analysis in ANSYS Maxwell. Two different Terfenol-D rods were then fabricated with either slices along the axial direction or slit along the radial direction, then the impedance and amplitude of the magnetostrictive ultrasonic transducer composed of the two Terfenol-D rods were measured. The results suggest that sliced Terfenol-D rods can suppress eddy currents more effectively, resulting in higher energy conversion efficiency; therefore, the Terfenol-D rods of small giant magnetostrictive transducers should be sliced along the axial direction to suppress eddy currents, whereas radial slits should be adopted for the rods of large giant magnetostrictive transducers to ensure integrity of the Terfenol-D rod and avoid adverse effects on the vibration performance of the giant magnetostrictive transducer that are caused by cutting the rods.
Sluggish Cognitive Tempo Symptoms, But Not ADHD or Internalizing Symptoms, Are Uniquely Related to Self-Reported Mind-Wandering in Adolescents With ADHD
Authors: Fredrick Joseph W. , Becker Stephen P.
Published: May 2020

Objective: The purpose of this study was to test the relation between sluggish cognitive tempo (SCT) symptoms and self-reported mind-wandering in a sample of adolescents with ADHD. Method: Adolescents ( N = 79; aged 13–17 years; 70% male) diagnosed with ADHD completed measures of SCT, ADHD, anxiety, and depression symptoms, in addition to mind-wandering. Parents also provided ratings of adolescents’ ADHD symptoms. Results: All adolescent-reported psychopathology dimensions, including ADHD, internalizing, and SCT, were significantly bivariately correlated with greater mind-wandering. However, in regression analysis that considered psychopathologies simultaneously, SCT was the only dimension uniquely associated with greater mind-wandering. This finding was unchanged when parent-reported ADHD symptoms were included in the model. Conclusion: These findings are the first to show that SCT symptoms are uniquely related with self-reported mind-wandering in adolescents with ADHD and underscore the importance of considering co-occurring SCT symptoms when testing the interrelations between ADHD and mind-wandering. Replication is needed in larger samples and with other measures of mind-wandering.
Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits
Authors: Komnos George , Banios Konstantinos , Kolonia Konstantina , Poultsides Lazaros A , Petinaki Efthimia , Sarrou Styliani , Zintzaras Elias , Karachalios Theofilos
Published: May 2020

Aim:

This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted.

Material and methods:

50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia. Four weeks later, 1 ml of inoculum of a standardised CA-MRSA strain (3 × 108 cfu/ml) was injected through a femoral artery catheter (groups B, C, D, E) while in group A, 1 ml of sterile saline was injected in a similar way (control group). Subjects were killed 8 weeks after the initial procedure and 3 samples of each tibial specimen were subjected to conventional cultures and PCR studies.

Results:

The number of the specimens (conventional cultures and PCR studies) contaminated by the standardized pathogen was as follows: Group A: 0/10, Group B: 7/10, Group C: 6/10, Group D; 5/10 and Group E: 5/10. Comparing the number of colony form units isolated from the implant samples, Group B (GB titanium) showed statistically significantly higher values (Mann-Whitney test) compared to Group C ( p = 0.044), Group D ( p = 0.040) and Group E ( p = 0.038). Local active infection was observed in 6 animals: 3 in Group B; 1 in Group C, 1 in Group D, and 1 in Group E.

Conclusions:

Modern cementless implants (trabecular metal and cancellous titanium) showed a lower risk of implant contamination and late clinical haematogenous infection.
Resting-state functional connectivity of anterior and posterior cerebellar lobes is altered in multiple sclerosis
Authors: Pasqua Gabriele , Tommasin Silvia , Bharti Komal , Ruggieri Serena , Petsas Nikolaos , Piervincenzi Claudia , Pozzilli Carlo , Pantano Patrizia
Published: May 2020

Background:

Damage to the cerebellar sensorimotor and cognitive domains may underlie physical and cognitive disability.

Objective:

To investigate resting-state functional connectivity (FC) of sensorimotor and cognitive cerebellum, and clinical correlates in multiple sclerosis (MS).

Methods:

A total of 119 patients with MS and 42 healthy subjects underwent multimodal 3T-magnetic resonance imaging (MRI). Patients were evaluated using the Expanded Disability Status Scale and Multiple Sclerosis Functional Composite Scale. After parcellation of sensorimotor (lobules I–V + VIII) and cognitive cerebellum (lobules VI, VII, IX, X), we calculated cerebellar resting-state FC using a seed-based approach.

Results:

In patients with MS, the sensorimotor cerebellum showed increased FC mainly with cerebellar, thalamic, and cortical (frontal, parietal, temporal) areas and decreased FC with insular areas; the cognitive cerebellum showed increased FC mainly with thalamic and cortical (temporal-occipital) areas, and decreased FC with frontal-insular areas. Both sensorimotor and cognitive cerebellar FC negatively correlated with disability, and positively with cognitive scores. Cerebellar structural damage only partially influenced results.

Conclusion:

The two neocerebellar circuits showed altered FC with subcortical and cortical areas. The association between increased sensorimotor and cognitive cerebellar FC and low levels of physical and cognitive disability suggests that altered FC might modulate the effects of cerebellar structural damage on clinical condition.
The educational impact of childhood-onset multiple sclerosis: Why assessing academic achievement is imperative
Authors: Vargas WS , Noble KG , Banwell B , De Jager P
Published: May 2020

Background:

Limited data suggest that adolescents with multiple sclerosis (MS) frequently discontinue school. While it is known that cognitive impairment occurs in 30% to 50% of children with MS, the functional impact of childhood MS on academic achievement is virtually unknown.

Objective:

To that end, this paper builds an evidence-based argument for evaluating educational outcomes in children with MS.

Methods:

This will be accomplished through (a) a review of pediatric MS and its cognitive consequences; (b) a selective review of the utility of neuropsychological batteries in assessing academic outcomes in pediatric populations in general; and (c) a brief overview of modifiable factors that have a potential benefit on school outcomes in children with MS.

Conclusion:

Scholastic achievement should be assessed as part of the routine cognitive screening of children and adolescents with MS.
Active smoking is associated with higher rates of incomplete wound healing after endovascular treatment of critical limb ischemia
Authors: Kokkinidis Damianos G , Giannopoulos Stefanos , Haider Moosa , Jordan Timothy , Sarkar Anita , Singh Gagan D , Secemsky Eric A , Giri Jay , Beckman Joshua A , Armstrong Ehrin J
Published: May 2020

The association between active smoking and wound healing in critical limb ischemia (CLI) is unknown. Our objective was to examine in a retrospective cohort study whether active smoking is associated with higher incomplete wound healing rates in patients with CLI undergoing endovascular interventions. Smoking status was assessed at the time of the intervention, comparing active to no active smoking, and also during follow-up visits at 6 and 9 months. Cox regression analysis was conducted to compare the incomplete wound healing rates of the two groups during follow-up. A total of 264 patients (active smokers: n = 41) were included. Active smoking was associated with higher rates of incomplete wound healing in the 6-month univariate Cox regression analysis (hazard ratio (HR) for incomplete wound healing: 4.54; 95% CI: 1.41–14.28; p = 0.012). The 6-month Kaplan–Meier (KM) estimates for incomplete wound healing were 91.1% for the active smoking group versus 66% for the non-current smoking group. Active smoking was also associated with higher rates of incomplete wound healing in the 9-month univariable (HR for incomplete wound healing: 2.32; 95% CI: 1.11–4.76; p = 0.026) and multivariable analysis (HR for incomplete wound healing: 9.09; 95% CI: 1.06–100.0; p = 0.044). The 9-month KM estimates for incomplete wound healing were 75% in the active smoking group versus 54% in the non-active smoking group. In conclusion, active smoking status at the time of intervention in patients with CLI is associated with higher rates of incomplete wound healing during both 6- and 9-month follow-up.
Performativity of rape culture through fact and fiction: An exploration of India’s Daughter and Anatomy of Violence
Authors: Devasundaram Ashvin Immanuel , Barn Ravinder
Published: May 2020

The power and influence of film and documentaries in public discourse and in formal pedagogical practices is recognized as critical. The content and message of a documentary are likely to be regarded as the ‘truth’. This is generally located in the belief that since a documentary is focused on a real-life event, it seeks to objectively expose key issues and concerns to reveal the veracity of the phenomenon under scrutiny. This article explores the portrayal of fact and fiction through film and documentary as exemplified by Deepa Mehta’s film Anatomy of Violence and Leslee Udwin’s film India’s Daughter (2016 and 2015 respectively), selected for their focus on the rape and murder of a Delhi student dubbed by the media as ‘Nirbhaya’ in 2012. The article investigates how these two media forms make use of fact or fiction to enhance understanding of a key social quandary, examining notions of temporality, spatiality, determinism and patriarchy.
Hydroelastic responses of floating composite plates under moving loads using a hybrid moving element-boundary element method
Authors: Nguyen Xuan Vu , Luong Van Hai , Cao Tan Ngoc Than , Lieu Xuan Qui , Nguyen Thai Binh
Published: May 2020

Responses of floating plates with the impact of moving excitations have been previously studied by several scholars. Generally, such structures were often assumed to be isotropic. Nonetheless, the directional-dependent bending stiffness should be considered for designing practical floating structures, especially for very large floating structures. Accordingly, this article aims to analyze hydroelastic responses of floating composite plates subjected to moving loads for the first time. For this, a novel numerical approach as a combination of boundary element method and moving element method which is named the BEM–MEM is proposed. In the this approach, governing equations of motion, moving element, and fluid matrices are formulated in a relative coordinate system traveling with moving loads. Consequently, the suggested paradigm can effectively eliminate difficulties in addressing the bound of computational domain and tracking the location of contact points which often encounter in the traditional finite element method owing to utilizing a fixed coordinate system. Several numerical examples are exhibited to demonstrate the performance and ability of the boundary element method-moving element method . Gained results are compared with those by the Fourier transform method and the asymptotic expression to verify the accuracy of the proposed methodology. The outcomes indicate that the speed of moving loads considerably affects the plate deflection. In addition, as the speed is larger than the minimum celerity of the free surface of hydroelastic system ( Cmin), the influence of anisotropy on the deflection becomes significant.
Optical investigation of flash boiling and its effect on in-cylinder combustion for butanol isomers and iso-octane
Authors: Kale Rakesh , Banerjee Raja
Published: May 2020

Performance of a gasoline direct injection engine significantly depends on the fuel injection phenomenon. It has been shown that variation in the fuel thermo-physical properties and in-cylinder thermodynamic conditions can adversely affect engine performance. Spray collapse due to flash boiling is the consequence of such varying in-cylinder thermodynamics. It has also been observed that gasoline direct injection engines have higher particulate matter emissions compared to port fuel injection engines. One of the possible reasons for this observation may be fuel impingement on the piston head and spray collapse at high fuel injector temperature. In the present work, experiments have been performed to understand spray characteristics under flash boiling conditions and ultimately its effect on in-cylinder combustion quality for the three different fuels: n-butanol, iso-butanol and iso-octane. To mimic in-cylinder conditions, hot fuel was introduced inside an optically accessible engine. It was observed that fuel temperature and their thermo-physical properties have a significant effect on piston head wetting and pool fire on the piston top. Butanol isomers showed significant reduction in sooty combustion with increase in fuel temperature. However, iso-octane showed higher wall wetting at elevated fuel temperature due to spray collapse.
Autonomy as license to operate: Establishing the internal and external conditions of informed choice in marketing
Authors: Anker Thomas
Published: May 2020

The assumption that consumers voluntarily accept or decline marketing offerings provides the ethical justification that gives marketing as a social system its license to operate. Consumer autonomy is, therefore, the key ethical principle of marketing in capitalistic economies. However, even in domains with extensive regulatory frameworks and advanced market conditions, consumers are often ill-informed or underinformed. The resultant lack of epistemic confidence diminishes consumers’ ability to make informed choices. At the same time, consumers are by default exposed to promotional content designed to persuade them to accept marketing offerings. This threatens personal autonomy. We develop a concept of consumer autonomy which marketing regulations should protect and promote to enhance informed decision-making. We design autonomy to be robust in situations where individuals are exposed to persuasive attempts to influence them to choose a specific course of action. As such, our concept of autonomy is applicable to a range of contexts beyond marketing where it is necessary to balance external influences and individual autonomy.
MiR-133 Targets YES1 and Inhibits the Growth of Triple-Negative Breast Cancer Cells
Authors: Zhang Guochen , Wang Junlan , Zheng Ruilin , Song Beibei , Huang Li , Liu Yujiang , Hao Yating , Bai Xiangdong
Published: May 2020

Triple-negative breast cancer shows worse outcome compared with other subtypes of breast cancer. The discovery of dysregulated microRNAs and their roles in the progression of triple-negative breast cancer provide novel strategies for the treatment of patients with triple-negative breast cancer. In this study, we identified the significant reduction of miR-133 in triple-negative breast cancer tissues and cell lines. Ectopic overexpression of miR-133 suppressed the proliferation, colony formation, and upregulated the apoptosis of triple-negative breast cancer cells. Mechanism study revealed that the YES Proto-Oncogene 1 was a target of miR-133. miR-133 bound the 3′-untranslated region of YES Proto-Oncogene 1 and decreased the level of YES Proto-Oncogene 1 in triple-negative breast cancer cells. Consistent with miR-133 downregulation, YES1 was significantly increased in triple-negative breast cancer, which was inversely correlated with the level of miR-133. Restoration of YES Proto-Oncogene 1 attenuated the inhibitory effects of miR-133 on the proliferation and colony formation of triple-negative breast cancer cells. Consistent with the decreased expression of YES Proto-Oncogene 1, overexpression of miR-133 suppressed the phosphorylation of YAP1 in triple-negative breast cancer cells. Our results provided novel evidence for the role of miR-133/YES1 axis in the development of triple-negative breast cancer, which indicated miR-133 might be a potential therapeutic strategy for triple-negative breast cancer.
Vertical Relationships and Local Peacebuilding in Lebanon: The Case of Responsive Waste Management
Authors: Leonardsson Hanna
Published: May 2020

There is a growing understanding that vertical relationships matter for peacebuilding efforts that respond to local needs. There is little consensus, however, on how to study verticality in peacebuilding empirically. This article asks how we can understand responsiveness to needs through vertical relationships in post-conflict spaces. To answer this question, the article develops an analytical framework of vertical relationships as a peacebuilding function. Arguing that responsiveness to needs is a critical factor in building a legitimate peace, the article applies this framework to the case of municipal waste management during the waste crisis in Lebanon in 2015. Building on 31 interviews in two Lebanese municipalities, the article illustrates the complexity of vertical relationships in a post-conflict space. It concludes that vertical relationships enable responsiveness to needs by drawing on political belonging, thus promoting a fragile peacebuilding dependent on national political divides.
Effects of Transcranial Direct Current Stimulation on Visual Neuroplasticity in Schizophrenia
Authors: Jahshan Carol , Wynn Jonathan K. , Roach Brian J. , Mathalon Daniel H. , Green Michael F.
Published: May 2020

People with schizophrenia (SZ) exhibit visual processing abnormalities that affect their daily functioning and remediating these deficits might help to improve functioning. Transcranial direct current stimulation (tDCS) is a potential tool for perceptual enhancement for this purpose, though there are no reports of tDCS applied to visual cortex in SZ. In a within-subject, crossover design, we evaluated the effects of tDCS on visual processing in 27 SZ. All patients received anodal, cathodal, or sham stimulation over the central occipital region in 3 visits separated by 1 week. In each visit, a backward masking task and an electroencephalography measure of visual neuroplasticity were administered after tDCS. Neuroplasticity was assessed with visual evoked potentials before and after tetanizing visual high-frequency stimulation. Masking performance was significantly poorer in the anodal and cathodal conditions compared with sham. Both anodal and cathodal stimulation increased the amplitude of P1 but did not change the plasticity index. We found significant plasticity effects of tDCS for only one waveform for one stimulation condition (P2 for anodal tDCS) which did not survive correction for multiple comparisons. The reason for the lack of tDCS stimulation effects on plasticity may be because tDCS was not delivered simultaneously with the tetanizing visual stimulus. The present findings emphasize the need for more research on the relevant parameters for stimulation of visual processing regions in clinical populations.
Enhancing lateral dynamic performance of all-terrain vehicles using variable-wheelbase chassis
Authors: Wang Wen-Hao , Xu Xiao-Jun , Xu Hai-Jun , Zhou Fa-Liang
Published: May 2020

A six-wheel vehicle chassis scheme with a variable wheelbase is proposed to improve the lateral dynamic performance of vehicles. The yaw moment is varied by changing the wheelbase to enhance the lateral dynamic performance of the vehicle. A vehicle lateral dynamics model is established using this approach. The effects of the wheelbase variation on the lateral yaw rate gain, steering stability, and steering error are analysed via numerical calculations. A strategy for wheelbase variation under different working conditions is proposed to enhance the lateral dynamic performance. In addition, by studying the response of the vehicle to various lateral disturbance forces, it is verified that the wheelbase change can enhance the lateral anti-disturbance capability of the vehicle. The simulation verifies the effectiveness of the wheelbase change strategy under a variety of driving conditions.
Early and sustained symptom improvement with umeclidinium/vilanterol versus monotherapy in COPD: a post hoc analysis of the EMAX randomised controlled trial
Authors: Kerwin Edward M , Boucot Isabelle H , Vogelmeier Claus F , Maltais Francois , Naya Ian P , Tombs Lee , Jones Paul W , Lipson David A , Keeley Tom , Bjermer Leif
Published: May 2020

Background:

In chronic obstructive pulmonary disease (COPD), both the time needed for patients to gain symptom improvement with long-acting bronchodilator therapy and whether an early response is predictive of a sustained response is unknown. This study aimed to investigate how quickly meaningful symptom responses are seen in patients with COPD with bronchodilator therapy and whether these responses are sustained.

Methods:

Early MAXimisation of bronchodilation for improving COPD stability (EMAX) was a 24-week, double-blind, double-dummy, parallel-group trial that randomised patients to umeclidinium/vilanterol (UMEC/VI), umeclidinium or salmeterol. Daily Evaluating Respiratory Symptoms in COPD (E-RS:COPD) score and rescue salbutamol use were captured via an electronic diary and analysed initially in 4-weekly periods. Post hoc analyses assessed change from baseline in daily E-RS:COPD score and rescue medication use weekly (Weeks 1–8), and association between E-RS:COPD responder status at Weeks 1–4 and later time points.

Results:

In the intent-to-treat population ( n = 2425), reductions from baseline in E-RS:COPD scores and rescue medication use were apparent from Day 2 with all treatments. Treatment differences for UMEC/VI versus either monotherapy plateaued by Week 4–8 and were sustained at Weeks 21–24; improvements were consistently greater with UMEC/VI. For all treatments, most patients (60–85%) retained their Weeks 1–4 E-RS:COPD responder/non-responder status at Weeks 21−24. Among patients receiving UMEC/VI who were E-RS:COPD responders at Weeks 1–4, 70% were responders at Weeks 21–24.

Conclusion:

Patients with symptomatic COPD had greater potential for early symptom improvements with UMEC/VI versus either monotherapy. This benefit was generally maintained for 24 weeks. Early monitoring of treatment response can provide clinicians with an early indication of a patient’s likely longer-term response to prescribed bronchodilator treatment and will facilitate appropriate early adjustments in care.

Clinical Trial Registration:

NCT03034915, 2016-002513-22 (EudraCT Number). The reviews of this paper are available via the supplemental material section.
Practical guidance for the management of side effects during rucaparib therapy in a multidisciplinary UK setting
Authors: Tookman Laura , Krell Jonathan , Nkolobe Baleseng , Burley Laura , McNeish Iain A.
Published: May 2020

The use of targeted therapeutics known as poly(adenosine diphosphate–ribose) polymerase (PARP) inhibitors in the management of ovarian cancer is currently transforming clinical practice. The PARP inhibitor rucaparib is indicated in the UK, European Union and the United States for use in the treatment and maintenance settings for patients with relapsed ovarian cancer. Here, we discuss some of the real-world challenges and side effects that we have encountered while prescribing rucaparib, and we provide practical guidance on how the individual members of our multidisciplinary team (MDT), including a clinician, chemotherapy nurse practitioner, and clinical pharmacist, collaborate to manage these side effects. If recognized early, the side effects experienced by patients during rucaparib therapy, which include fatigue, nausea and vomiting, liver enzyme elevations, and anemia, can be easily managed. For example, providing patients with prophylactic antiemetics can help them avoid nausea, and early detection of decreases in hemoglobin levels allows for proactive interventions to alleviate anemia. The MDT should work together with the patient to identify potential side effects early and manage them effectively. The aim of this proactive approach is to maintain patients on rucaparib for optimal clinical benefit, while minimizing the potential negative impact of side effects on patient quality of life.
To What Extent Does Illicit Drug Use Predispose to Facial Injury? An Institutional Investigation for an Emergent Problem
Authors: Febbo Anthony , Hoffman Gary R.
Published: May 2020

Study Design:

There are potential substantive linkages between illicit drug use and the occurrence of injury.

Objective:

The purpose of our study was to determine the prevalence, class of illicit drugs abused, and demographics in relation to a cohort of patients who sustained facial injury.

Methods:

The authors undertook a retrospective observational study of a prospectively accessioned cohort of patients who had sustained a facial injury and presented to the John Hunter Hospital (Newcastle, NSW, Australia). The primary predictor variable was the presentation of a facial injury and the secondary outcome variables included illicit drug use, alcohol use, and socioeconomic factors. The study was carried out over a 12-month period. A descriptive analysis was undertaken on the assembled data.

Results:

Of the 465 patient medical records that were accessed for the study, 348 were male and 117 were female. Their average age was 42.6 years: 5.8% ( n = 27) were under the influence of illicit drugs at the time of their presentation and 13.1% ( n = 61) admitted to an intercurrent illicit drug habit. Those who were under the combined influence of alcohol and drugs comprised of 2.8% ( n = 13).

Conclusions:

Our study found that illicit drug use plays a small, but nonetheless, demonstrable role in the presentation of maxillofacial trauma patients to an urban level I trauma center. Illicit drug users are an emergent sociodemographic group of patients who can sustain facial trauma and their presentation needs to be appropriately considered, assessed, and managed collectively.
Obesity, cardiovascular risk and healthcare resource utilization in the UK
Authors: le Roux Carel W , Hartvig Niels V , Haase Christiane Lundegaard , Nordsborg Rikke Baastrup , Olsen Anne Helene , Satylganova Altynai
Published: May 2020

Aims

Obesity and cardiovascular diseases (CVDs) often co-occur, likely increasing the intensity of healthcare resource utilization (HCRU). This retrospective, observational database study examined the joint effect of obesity and cardiovascular risk status on HCRU and compared HCRU between body mass index (BMI) categories and CVD-risk categories in the UK.

Methods

Patient demographics and data on CVD and BMI were obtained from the UK Clinical Practice Research Datalink. Cardiovascular risk status, calculated using the Framingham Risk Equation, was used to categorize people into high-risk and low-risk groups, while a CVD diagnosis was used to define the established CVD group. Patients were split into BMI categories using the standard World Health Organization classifications. For each CVD and BMI category, mean number and costs of general practitioner contacts, hospital admissions and prescriptions were estimated.

Results

The final study population included 1,600,709 patients. Data on CVD status were available on just over one-quarter of the sample (28.6%) and BMI data for just less than half (43.2%). The number of general practitioner contacts and prescriptions increased with increasing BMI category for each of the three CVD-risk groups. The group with established CVD had the greatest utilization of all components of healthcare resource, followed by high CVD risk then low CVD-risk groups.

Conclusion

Increasing BMI category and CVD-risk status both affected several HCRU components. These findings highlight the importance of timely obesity management and treatment of CVD-risk factors as a means of preventing increasing HCRU.
Perception of Decent Work and the Future Among Low Educated Youths in Brazil and Portugal
Authors: Ribeiro Marcelo Afonso , Cardoso Paulo Miguel , Duarte Maria Eduarda , Machado Beatriz , Figueiredo Paula Morais , Fonçatti Guilherme de Oliveira Silva
Published: May 2020

Brazil and Portugal have different working contexts. In Brazil, mixed formal and informal ways dominate, while in Portugal, formal working contexts prevail. By means of in-depth interviews, this study sought to understand and compare the perception of decent work and future among 32 low-qualified emerging adults in Brazil and Portugal. The data from participants’ interviews were analyzed using Consensual Qualitative Research. Findings showed that Portuguese participants sought the International Labour Organization’s features for a decent work associated with fair income, social integration, self-realization at work, and family support, while the Brazilian sample had searched for better living conditions, respect, social recognition, and social protection. Thus, in contexts of greater vulnerability, the participants do not perceive their work as a source for self-determination and social recognition. This is a key point for understanding identity construction and life narratives of emerging adults in vulnerable working situations.