bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the ride comfort of full car model with a decoupling intelligent model free controller
Authors: Haddar Maroua , Bouslema Marwa , Caglar Baslamisli Selahattin , Chaari Fakher , Haddar Mohamed
Published: September 2022

A new technique of active control is presented for enhancing the dynamic responses of full car systems with bias to ride comfort performance. A seven degrees of freedom full car model is used, and its performance is evaluated on a bump road and random road. The proposed scheme is a combination between traditional controller design methods with an algebraic estimator of perturbations that will be eliminated online. From the inputs and the outputs signals, the unmodeled phenomenon can be estimated and be subtracted for ensuring the proper functioning of the system. The precise mathematical model of the system is not required for the implementation of the control scheme and is replaced by ultra-local models. Furthermore, the effectiveness of the algebraic estimator of road profile is introduced for applying the excitation sources of the reference generator. The road profiles in front of the vehicle are estimated separately from the rear road profiles. The ride comfort is improved progressively with the novel controller configuration by 83% from the passive case. Further, pitching and rolling fluctuations are reduced by 80% and 85% respectively. The numerical simulations illustrate the effectiveness and the robustness against vehicle body mass deviation and nonlinear actuator saturation of the proposed control method compared to passive and Active Disturbance Rejection Controller based on Input Decoupling Transformation.
Influence of fin configuration on the thermal performance of nanoparticle-enhanced latent heat storage system
Authors: Amudhalapalli Gopi Krishna , Devanuri Jaya Krishna
Published: September 2022

Storing the thermal energy using the materials' latent heat capacity is a prominent and well-established technique; these materials are termed phase-change materials (PCMs). For low-temperature applications mostly organic PCMs are available. These PCMs possess very less thermal conductivity, which results in a low rate of heat transfer. To overcome this problem usage of fins and the addition of nanoparticles (NPs) to PCM are two potential methods. In the present study, three-dimensional numerical analysis of melting and solidification is performed on the radial, spiral, and longitudinal finned PCM-based shell and tube heat exchangers with the addition of NPs to PCM. Numerical analysis is carried out with various volume fractions of NPs in the PCM. Based on the study it is observed that the PCM-based heat exchanger with radial fins has the lowest melting time, average temperature, and energy storage ratio. For longitudinal fins melting time is maximum and it also has the maximum average temperature and energy storage ratio. It is observed that the addition of NPs showed a significant effect on the phase change process. For all the selected geometries the average exergy efficiency is not more than 4.4% during solidification.
Effects of flange wear on dynamic vehicle-turnout interaction
Authors: Hao Chaojiang , Chen Jiayin , Sun Xu , Xu Fei , Xu Jingmang , Wang Ping
Published: September 2022

Long-term investigations have revealed incidences of severe flange wheel wear in the field. Slight changes in the profile shape will lead to changes in the geometric relationship between wheel and rail, hence affecting the dynamic wheel-rail interaction. The turnout is an essential piece of track equipment for carrying out train transfer or cross line operation. In turnouts, the rail profile changes throughout the structure, and the wheel load transfers from one rail component to the next, resulting in a complex wheel/rail relationship. This paper investigates the effect of flange wear on the wheel-rail interaction as the vehicle switches into the turnout track in a diverging movement. A coupling model for a high-speed flexible turnout and a multi-rigid vehicle is established, and the dynamic contact trajectories between wheel and rail, the vibration energy of the rail, the lateral wheel-rail force, rail wear, and car body driving stability are analyzed. The results show that the wheel transition position is shifted backward due to the flange wear, and a less sharp impact occurs with a worn flange profile during wheel load transition in the switch panel, which improves lateral wheel-turnout interaction and the rail wear. Worn flange profiles give a large flangeway clearance, which is not conducive to the smooth operation of vehicles in the diverging route of turnouts.
Ride comfort improvement using robust multi-input multi-output fuzzy logic dynamic compensator
Authors: Ozbek Cengiz , Ozguney Omur Can , Burkan Recep , Yagiz Nurkan
Published: September 2022

This article aims to improve the ride comfort of a vehicle keeping a satisfactory without road-holding performance by a novel adaptive control method that is insensitive to unknown system dynamics, model parameter changes, external disturbances and without any loss in suspension working space. With this purpose in mind, a new fuzzy integrated model-based adaptive control law for vehicle suspension systems is proposed in this study to improve the ride comfort and to ensure the robustness of system towards unknown model parameters and external disturbances. First, a model-based adaptive control law, which has the robust characteristics is presented. Afterwards, a multi-input multi-output fuzzy logic controller is designed to determine the controller gains dynamically. The stability of controller is ensured by Lyapunov Theory to achieve uniform boundedness error convergence. A 4 degree-of-freedom half-car model with active suspension system is used in this study to assess the performance of the controller. The results are compared among passive, model-based adaptive control law-controlled and novel fuzzy model-based adaptive control law-controlled systems. It has been concluded that fuzzy model-based adaptive control law further attenuates linear and angular motions of the vehicle increasing the ride comfort. The robustness is also verified for vehicle components having different possible parameter values. It is noteworthy that suspension working length returns to its initial position. Thus, the vehicle ride comfort is improved with no suspension working space loss. Finally, the economic feasibility of controllers has been checked in terms of energy consumption.
MMP16as NSCL ± P Susceptible Gene in Western Han Chinese
Authors: Lin Yansong , Shi Jiayu , Shi Bing , Jia Zhonglin
Published: September 2022

Objective

The role of MMP16 in lip development is unclear. This study aimed to identify nonsyndromic cleft lip with or without palate (NSCL ± P) susceptible loci of MMP16 in western Han Chinese.

Design

We performed targeted sequencing around MMP16 combined with a 2-phase association analysis on common variants. Phase 2 association analysis was performed with NSCL ± P specific subphenotypes (NSCL and NSCLP). Then we used rare variants burden analysis and genotyping, accompanied by motif analysis.

Setting

This study was completed in a tertiary medical center.

Patients, Participants

Phase 1 targeted sequencing included 159 patients with NSCL ± P and 542 normal controls; phase 2 included 1626 patients with NSCL ± P (1047 NSCL and 579 NSCLP) and 2255 normal controls.

Interventions

Venous blood samples were collected from patients and used to extract DNA.

Main Outcome Measures

After Bonferroni correction, phase 1 significant threshold of p-value was 4.28 × 10−5(0.05/1167 single nucleotide polymorphisms [SNPs]), and phase 2 was .00025 (0.05/200 SNPs). Burden analysis significant threshold p-value was .05.

Results

Common variants phase 1 association analysis identified 11 statistically significant SNPs (lowest p = 1.90 × 10−9, odds ratio (OR) = 0.27, 95% CI: 0.17-0.44), phase 2 replication identified 16 SNPs in NSCL ± P (lowest p = 6.26 × 10−6, OR = 0.77, 95% CI: 0.69-0.86) and 9 in NSCL (lowest p = 8.44 × 10−5, OR = 0.76, 95% CI: 0.66-0.87). Rare variants burden analysis showed no significant results, genotyping results showed they were maternally inherited.

Conclusions

Our study identified MMP16 susceptible SNPs in NSCL ± P and NSCL, emphasizing its potential role in lip development. Our study also highlighted the importance to perform association analysis with subphenotypes divided.
Subharmonic and superharmonic resonances of five-layered porous functionally graded sandwich cylindrical shells with two-layered viscoelastic cores
Authors: Foroutan Kamran , Dai Liming
Published: September 2022

In this research, the subharmonic (SUBH) and superharmonic (SUPH) resonances of five-layered porous functionally graded sandwich (PFGS) cylindrical shells with two-layered viscoelastic cores (VECs) are investigated. The sandwich cylindrical shell is composed of three porous functionally graded (PFG) face layers and two VECs. The VECs are made of Kelvin–Voigt type material. The material properties of the PFG face layers are considered as continuous through the thickness of each face regarding a porosity coefficient and a volume fraction index. Two types of five-layered PFGS cylindrical shells with two-layered VESs, including porosity evenly distributed (Type 1) and porosity unevenly distributed (Type 2) along the thickness direction, are considered in this research. Based on the Donnell shell theory, von-Kármán equation, and Hooke’s law, the stress-strain relations are developed for the five-layered PFGS cylindrical shells. The discretized governing equation via Galerkin’s method is also derived. With the governing equations proposed and the method of multiple scales, the SUBH and SUPH resonances of the shells are investigated systematically. The influences of geometrical, and material parameters on the SUBH and SUPH resonances of the system are studied and presented. New results for SUBH and SUPH resonances of the five-layered PFGS cylindrical shells with two-layered VECs are provided for the first time and can be utilized as a benchmark for researchers and engineers in this area.
Immune-related pneumonitis requiring low-dose prednisone maintenance in one patient with durable complete response
Authors: Zhou Yu , Ma Baozhen , Li Tiepeng , Gao Quanli , Zhao Lingdi
Published: September 2022

Introduction

Immune-related pneumonitis is an uncommon but potentially life-threatening adverse event associated with anti-programmed cell death protein-1 therapy, and has a higher recurrence rate than that of other pneumonitis. Glucocorticoids are the first treatment of choice for patients with immune-related pneumonitis over grade 1. Given the toxicity associated with glucocorticoids, they should be withdrawn gradually as soon as pneumonitis is controlled. However, low-dose glucocorticoids are maintained in some patients to prevent immune-related pneumonitis.

Case report

We report a rare case of a patient with Hodgkin lymphoma who developed grade 2 immune-related pneumonitis, requiring long-term low-dose glucocorticoid maintenance therapy, during which pneumonitis disappeared, and complete response was achieved.

Management and outcome

Tislelizumab treatment was stopped tentatively, and the patient was given prednisone at an initiating dose of 1 mg/kg/d. The cough symptoms were relieved significantly, and pneumonitis was reduced. The prednisone gradually dwindled, but the immune-related pneumonitis was recurrent, requiring prednisone 10 mg daily maintenance therapy. Subsequently, prednisone and tislelizumab were administered simultaneously, and at present, pneumonitis disappeared and the lesions are in complete remission.

Discussion

Low-dose glucocorticoids might play an important role in controlling the recurrence and development of immune-related pneumonitis. The dose and course of glucocorticoid in immune-related pneumonitis patients should be individualized to minimize the toxicity of glucocorticoid.
Chemotherapy for Metastatic Gastric Cancer: Does Age Matter? A Single-Center, Retrospective, Real-World Study
Authors: Liao Po-Wei , Cheng Shao-Bin , Chou Cheng-Wei , Lin Hsin-Chen , Lin Cheng-Hsien , Chen Tsung-Chih , Hsu Chiann-Yi , Jerry Teng Chieh-Lin , Shih Yu-Hsuan
Published: September 2022

Background:

Palliative chemotherapy is the preferred standard of care for patients with metastatic gastric cancer (mGC). It remains uncertain whether older patients with mGC would benefit from palliative chemotherapy. This study aimed to investigate the clinical impact of palliative chemotherapy in older patients with mGC.

Methods:

This single-institute, retrospective, and real-world study included 428 patients with mGC between January 2009 and December 2019. Among them, 306 who received palliative chemotherapy were further stratified into 2 groups according to age: ≤70 (n = 236) and >70 (n = 70) years. The clinical demographics, outcomes, and hematologic toxicities of chemotherapy were compared between the 2 groups. Prognostic factors were determined using the Cox proportional hazards model.

Results:

Of the screened 428 patients, older patients had worse overall survival (OS) than younger patients. Among patients who received chemotherapy (n = 306), patients aged >70 and ⩽70 years had comparable progression-free survival (PFS) and OS. The incidence of severe hematologic toxicity was similar between the 2 groups. The Eastern Cooperative Oncology Group performance status of 2 or more metastatic sites, elevated carbohydrate antigen 19-9 level, high neutrophil-to-lymphocyte ratio (NLR), and undergoing palliative gastrectomy were independent prognostic factors for OS. Notably, age >70 years was not a significant factor for poor OS.

Conclusions:

Older age of >70 years might not be considered an obstacle to administering palliative chemotherapy to patients with mGC.
The policy and political consequences of the B-Mincome pilot project
Authors: García Leire Rincón
Published: September 2022

The idea of universal basic income is recieving increasing attention in the political, media and public agendas. This policy proposal constitutes a radical departure from the orthodox welfare rationale of giving to those in need, or attaching conditions to welfare support. Given the permutation that a UBI presents, many pilot projects and field experiments are being carried out globally to test the effects of this novel policy idea. Key questions arise from these developments: are the lessons learned from these experiments being fed back into the policy process? Are the pilot project results guiding and informing policymakers? Overall, can we observe any political effects of such scientific efforts? I address these questions through a qualitative case study analysis of the B-Mincome project. Through an in-depth analysis of this pilot, some of the key factors influencing the (limited) policy and political effects of the pilot project have been identified. The B-Mincome case study shows that the barriers to policy change were in place well before the pilot, and evidently, remained unaltered by it. The political landscape in Barcelona's City Council, its economic powers and institutional context were unchanged by the pilot, and in fact shaped the pilot design, moving it away from the UBI proposal. The B-Mincome experience illustrates the need to accommodate the pilot design to the politics and economics of the experiment, and shows the unintended consequences that such an adaptation of the pilot design may have in relation to its original objectives. In the case of Barcelona, this has meant a move away from a UBI-style pilot design, resulting in very limited effects on the debate or policy design of cash transfers, having a greater policy impact on active polices instead. However, by taking a broader look at Spanish and Catalan politics, our analysis has shown that unexpected factors may end up triggering a debate much more effectively than a pilot project.
Cannabis use disorder in relation to socioeconomic factors and psychiatric comorbidity: A cluster analysis of three million individuals born in 1970–2000
Authors: Rabiee Rynaz , Lundin Andreas , Agardh Emilie , Allebeck Peter , Danielsson Anna-Karin
Published: September 2022

Background:

Cannabis use disorder (CUD) is one of the main reasons for seeking substance use treatment. It is thus important to monitor and increase knowledge of individuals with CUD utilizing healthcare. We aimed to examine the number of CUD diagnoses over time, compare individuals with CUD with those without and identify subgroups based on CUD diagnosis, sex, birth year, socioeconomic factors and psychiatric comorbidity.

Methods:

A Swedish, population-based study with 3,307,759 individuals, born in 1970–2000, with register data extending to 2016. K-mode cluster analysis was used to identify potential subgroups.

Results:

The number of individuals with a CUD diagnosis was 14,046 (0.42%). CUD diagnoses increased over time (born 1990–1994: 61 per 100,000, born 1995–2000: 107 per 100,000, by 2016). A majority of those with a CUD had another psychiatric diagnosis (80%, compared with 19% for those without CUD). Four clusters were identified. Cluster 1 comprised mainly men with low income and substance use disorders, clusters 2, 3 and 4 comprised mainly women with higher proportions of mood-related, neurotic and stress-related and behavioural disorders.

Conclusions:

There was an increase in CUD diagnoses in Sweden over time, especially among younger birth cohorts. Individuals with CUD were more often male, from younger birth cohorts, with lower education and income than those without CUD. Men and women with CUD exhibited differences in education, income and psychiatric comorbidity. Our results demonstrate the importance of monitoring the impact of socioeconomic factors and psychiatric comorbidity in relation to CUD.
Airtightness evaluation of Canadian dwellings and influencing factors based on measured data and predictive models
Authors: Ismaiel Maysoun , Gouda Maged , Li Yong , Chen Yuxiang
Published: September 2022

The airtightness of buildings has a significant impact on buildings’ energy efficiency, maintenance and occupant comfort. The main goal of this study is to provide an evaluation of the air leakage characteristics of dwellings in different regions in Canada. This study evaluated the key influencing factors on airtightness performance based on a large set of measured data (73,450 dwellings located in Canada with 11 measurement parameters for each). Machine learning models based on multivariate regression (MVR) and Random Forest Ensemble (RFE) were developed to predict the air leakage value. The RFE model, which shows better results than MVR, was used to evaluate the effect of the ageing of buildings. Results showed that the maximum increase in air leakage occurs during the first year after construction – approximately 25%, and then 3.7% in the second year, after which the increase rate becomes insignificant and relatively constant – approximately 0.3% per year. The findings from this study can provide significant information for building designs, building performance simulations and strengthening standards and guidelines policies on indoor environmental quality.
“The doctors have more questions for us”: Geographic differences in healthcare access and health literacy among transgender and nonbinary communities
Authors: Holloway Brendon T , Gerke Donald R , Call Jarrod , Hostetter C Riley , Greenfield Jennifer C , Atteberry-Ash Brittanie , Walls N Eugene
Published: September 2022

Transgender and nonbinary (TNB) individuals experience a variety of systemic barriers that impact their ability to access healthcare, often leading to negative health outcomes. Previous research has suggested that improving health literacy among marginalized communities may help reduce existing health disparities. Yet few studies have examined health literacy among TNB people and how health literacy and healthcare access may differ by urbanicity. Using the capabilities theoretical approach, the current study uses data from six focus groups ( N=40) from metropolitan, urban, and rural areas in Colorado to examine geographic differences in health literacy and healthcare access. Findings show that geographic differences in accessing healthcare include transportation issues, having to travel far distances to access care, finding a TNB-affirming and competent provider, and needing to educate providers and staff. These differences were more prevalent among TNB people living in non-metropolitan areas. Additionally, our findings suggest that TNB individuals have high levels of health literacy due to having to self-educate and exist within a healthcare system that was designed for cisgender people.
Previtamin D action spectrum: Challenging CIE towards a standard
Authors: Webb AR , Terenetskaya IP , Holick MF , van Dijk A , McKenzie RL , Lucas RM , Young AR , Philipsen PA , de Gruijl FR
Published: September 2022

In 2006, CIE published a technical report on an action spectrum for the production of previtamin D3 in human skin. CIE procedure is to publish guidelines (e.g., an action spectrum) and let the community test them before moving to define a standard. The CIE previtamin D3 action spectrum has been in use for 15 years, and challenged on several occasions; a number of alternative action spectra have been suggested. To date (2021) no alternative action spectrum has shown clear advantages over the CIE version when tested against experimental outcomes. Thus, the CIE action spectrum remains widely used, but not fully accepted as best representing the photobiology in human skin leading to synthesis of vitamin D. We report on a CIE workshop designed to address the challenges to the CIE action spectrum, and explore alternative action spectra. The workshop concluded that the CIE action spectrum probably requires amendment, with several candidates for consideration in determining any changes. However, until there is a clear alternative, the CIE action spectrum should remain in use whilst ensuring full spectral information about sources of ultraviolet radiation. Thus, results are comparable between studies and can be recalculated to an updated action spectrum if necessary.
Elementary school principals’ work from the ecological systems perspective: Evidence from Finland
Authors: Elomaa Mailis , Eskelä-Haapanen Sirpa , Pakarinen Eija , Halttunen Leena , Lerkkanen Marja-Kristiina
Published: September 2022

The present study aimed to investigate elementary school principals’ work from the ecological systems perspective and which elements of their work are experienced as demands or resources. Semi-structured interviews were conducted with 22 principals. Qualitative content analysis was used to analyse the data. The results show that the way principals experience their work is individual and influenced by several internal and external factors. Some of the most extensive demands appear to be related to interaction with different stakeholders in situations where principals have the role of mediator in solving conflicting situations. Challenges also seem to arise in dealing with elements or issues that principals cannot influence or have no control over. Principals’ current perception is influenced by their education, work and personal histories and future vision. The results also indicate that principals need in-service training concerning social interaction and human resource management, such as how to act in conflicting situations, interact with different personalities and get the entire school community to develop and work for common goals. In addition, our findings suggest that offering support to principals through, for example, mentoring programmes during their first years could reduce the pressures they face and help them concentrate more fully on relevant tasks.
Scrub typhus in pregnancy: A report of two cases
Authors: Selvan Advika Thamarai , Agarwal Ishita , Behera Bijayini , Singh Sweta
Published: September 2022

Scrub typhus shows a high prevalence in South-East Asia. In pregnant females, it can cause both maternal and fetal adverse outcomes. We report a case series of two women with scrub typhus and their varied outcomes.

A 25-year-old primigravida treated for scrub typhus at 23 weeks' gestation presented at 34 weeks with stage three fetal growth restriction (FGR). Caesarean delivery was performed. The neonate had biliary atresia.

A 24-year-old primigravida at 31 weeks' gestation was referred from a local hospital due to scrub typhus induced multi-organ dysfunction. She had FGR stage 1 with oligohydramnios. Emergency caesarean delivery was performed in view of acute fetal bradycardia.

There is an emerging need for research to reassess what is already known about scrub typhus in pregnancy and to develop techniques for its treatment inorder to achieve a positive maternal and neonatal outcome in these cases.
Impact of preoperative urinary tract infection on postoperative outcomes following total shoulder arthroplasty for osteoarthritis
Authors: Agarwal Amil R. , Cuero Kendrick J. , Stadecker Monica , Meshram Prashant , Sharma Sribava , Zimmer Zachary R. , Best Matthew J.
Published: September 2022

Introduction

As the utilization of total shoulder arthroplasty (TSA) increases, it is essential to identify risk factors associated with postoperative complications. Urinary tract infection (UTI) is one such example. Our objective is to identify whether UTI is associated with increased rates of prosthetic joint infection (PJI) and determine whether its treatment reduces PJI rates.

Methods

Patients who underwent primary TSA for glenohumeral osteoarthritis between 2010 and 2019 with minimum two-year follow-up were identified in a national database (PearlDiver Technologies) using Current Procedural Terminology and International Classification of Diseases codes. These patients were stratified into two cohorts: those with preoperative UTI within two weeks of TSA and those without. The preoperative UTI cohort was stratified into those treated and those untreated prior to TSA. Univariate and multivariable analyses were performed.

Results

Following multivariable analysis, there were significantly higher odds of postoperative anemia, pulmonary embolism, and death in the UTI cohort. Comparing treated to untreated UTI, there were no significant differences in multivariable analysis for any 90-day medical or two-year surgical complications.

Discussion

This study showed that UTI was not associated with increased rates of PJI. UTI was, however, associated with postoperative medical complications that surgeons should be aware of.
COVID-19 and a biased public mentality toward infection and vaccination: A case of unrealistic optimism and social comparisons between the vaccinated and unvaccinated
Authors: Kulesza Wojciech , Dolinski Dariusz , Muniak Paweł , Grzyb Tomasz , Rizulla Aidana
Published: September 2022

Unrealistic Optimism in the context of COVID-19 is described as the tendency to perceive peers as being more at risk of infection. To date, however, no research has proposed more specific comparisons. The present article not only replicates the most recent body of literature showing that people perceive themselves as less prone to COVID-19 infection than their peers, but fills the aforementioned gap by providing additional and more specific comparisons between those vaccinated and unvaccinated against COVID-19. Such comparisons may be crucial to curb the possibility of resurgence of COVID-19 by assessing how unvaccinated individuals perceive the probability of being infected by coronavirus. Some 622 Prolific—(un)vaccinated against COVID-19—users participated in an online quasi-experiment. Participants estimated the risk of COVID-19 infection for themselves, their peers or the average (un)vaccinated peer, which is a new addition to the literature. Results showed that there was an unrealistic optimism effect. Participants estimated their risk for infection as lower in comparison to others. Surprisingly, results showed that for unvaccinated people, vaccines seem to be an effective tool to reduce the risk of infection, but not for themselves.
Artificial Intelligence for Predicting and Diagnosing Complications of Diabetes
Authors: Huang Jingtong , Yeung Andrea M. , Armstrong David G. , Battarbee Ashley N. , Cuadros Jorge , Espinoza Juan C. , Kleinberg Samantha , Mathioudakis Nestoras , Swerdlow Mark A. , Klonoff David C.
Published: September 2022

Artificial intelligence can use real-world data to create models capable of making predictions and medical diagnosis for diabetes and its complications. The aim of this commentary article is to provide a general perspective and present recent advances on how artificial intelligence can be applied to improve the prediction and diagnosis of six significant complications of diabetes including (1) gestational diabetes, (2) hypoglycemia in the hospital, (3) diabetic retinopathy, (4) diabetic foot ulcers, (5) diabetic peripheral neuropathy, and (6) diabetic nephropathy.
A comparative view of India and Pakistan’s defence capabilities: Historical evolution and future trends
Authors: Naseer Noreen , Khan Muhammad Fahim , Raza Aamer
Published: September 2022

War has been here since time immemorial and has been influenced and modified by various civilizations; as necessitated by internal and external conflicts and challenges. Every country views war under the lens of factors such as its geography, threats from neighbouring countries, internal circumstances and economic standing. This article discusses and highlights the quest for modern conventional warfare advancement generally, and particularly in the context of two South Asian nuclear armed nations – India and Pakistan, two arch-rivals. Both nations have been trying since their independence to gain an edge over the other in terms of defence, and so have invested more than they should in the defence sector for various reasons. The article presents the relevance of conventional warfare in the Indo–Pak context and sheds light on the strategic context of South Asia which hosts two nuclear-armed rivals. It discusses the historical and near-contemporary use of conventional warfare by both nations in the pursuit of their political objectives. It draws attention to the growing Indian military modernization in its conventional arsenal, especially by the induction of the Russian-built T-90S tank and S-400 missile system, French-built Rafale fighter jet and aircraft carrier. It also discusses low-observable instruments such as unmanned aerial vehicles (UAVs). The article focuses on the tactical, operational, as well as strategic implications of such advanced hardware on the Armed Forces of Pakistan. The world cannot afford a nuclear war and that too between heavily populated immediate rivals. Owing to this, both are investing more and more in modern conventional warfare by developing and advancing their defence systems, weapons, strategies and other related warfare – which the world must not ignore. This article enunciates how India getting its hands on the Russian T-90S, S-400 Missile System, Rafale Aircraft and INS Vikramadtiya has pushed Pakistan into a state of immense concern over its security and its quest for meeting this looming threat. This article also discusses the historical travelogue of advancements and investment made in the purchasing of the modern conventional warfare equipment both by India and Pakistan.
Probing Focus of Attention: Multiple Case-Study Analysis of Pianists’ Pedaling Under Different Foci Conditions in Performance of Bartók’s Romanian Folk Dance Sz. 56, No. 2
Authors: Lipke-Perry Tracy , Levy Morris , Dutto Darren J.
Published: September 2022

A differential benefit of external focus of attention (FOA) relative to internal focus has been demonstrated across a wide variety of athletic and rehabilitative pursuits; however, very little research has been undertaken in the performing arts. Given the unique aesthetic context of the arts and obvious transdisciplinary parallels, particular attention is warranted. This study examines nine pianists’ pedaling while performing Bartók’s Romanian Folk Dance Sz. 56, No. 2, and directing attention to three different focus conditions relative to a baseline condition. Differences in global pedal use and technique emerged and appeared to be modulated by level of expertise and the length of time spent preparing the piece. The two most experienced pianists and the least experienced pianist demonstrated greatest consistency in pedaling, as measured by Z scores calculated across eight performance parameters. Results corroborate previous FOA research demonstrating performance variability when adopting different focus strategies. Implications include the need to deliberately align focus strategies in music training and performance. To the authors’ knowledge, this is the first study to examine performance effects of external against internal FOA on pianists’ pedaling. The critical conceptual aspect of the work is beginning to illuminate the relationships between a performer’s attention and motor output, and perceived artistic or musical effects.
Trends in Scope of Practice for Oral Health Care: Future Transformative Effects
Authors: Gordon S.C. , Riedy C.A. , Stohler C.S. , Vujicic M.
Published: September 2022

Expert panelists in a think tank format were charged with addressing which ongoing trends will have major effects on dentistry in the future. With reference to literature, they identified and agreed on the following 5 trends affecting the scope of practice and professional interactions: COVID-19, changing demographic and disease patterns, converging technologies and predictive tools, interprofessional primary care, and value-based care payment models. In this article, they give their consensus on how each of these trends is likely to transform oral health care, including a consideration of how the events of 2020 to 2021 modified these trends and how dentistry should respond to them. Chief considerations were how to improve population health, access to care, and quality of care; how to reduce health care disparities and costs; and how to educate and maintain an adequate health care workforce for the future.

Knowledge Transfer Statement:

The results of this study can help key stakeholders, such as health care facilities, educational and research institutions, insurance companies, and governmental bodies, plan future activities and policies on dental practice and education.
Tolstykhite, Au3S4Te6, a new mineral from Maletoyvayam deposit, Kamchatka peninsula, Russia
Authors: Kasatkin Anatoly V. , Nestola Fabrizio , Plášil Jakub , Sejkora Jiří , Vymazalová Anna , Škoda Radek
Published: September 2022

Tolstykhite, ideally Au3S4Te6, is a new mineral from the Gaching ore occurrence of the Maletoyvayam deposit, Kamchatka peninsula, Russia. It occurs as individual anhedral grains up to 0.05 mm or as intergrowths with native Se, native Te and tripuhyite. Other associated minerals include calaverite, fischesserite, Cu–Te-rich ‘fahlores' [stibiogoldfieldite, ‘arsenogoldfieldite', tennantite-(Cu), tetrahedrite-(Zn)], galena, gold, maletoyvayamite, minerals of famatinite–luzonite series, pyrite, baryte, ilmenite, magnetite, quartz and V-bearing rutile. Tolstykhite is bluish-grey, opaque with metallic lustre and grey streak. It is brittle and has an uneven fracture. Cleavage is good on {010} and {001}. Dcalc = 7.347 g/cm3. In reflected light, tolstykhite is grey with a bluish shade. No bireflectance, pleochroism and internal reflections are observed. In crossed polars, it is weakly anisotropic with bluish to brownish rotation tints. The reflectance values for wavelengths recommended by the Commission on Ore Mineralogy of the International Mineralogical Association are (Rmin/Rmax, %): 32.6/34.3 (470 nm), 32.4/34.1 (546 nm), 32.6/34.5 (589 nm) and 33.0/35.0 (650 nm). The Raman spectrum of tolstykhite contains the main bands at 297, 203, 181, 151 and 127 cm–1. The empirical formula calculated on the basis of 13 atoms per formula unit is (Au2.98Ag0.01)Σ2.99(S3.59Se0.41)Σ4.00Te6.01. Tolstykhite is triclinic, space group P$\bar{1}$, a = 8.977(5), b = 9.023(2), c = 9.342(6) Å, α = 94.03(3), β = 110.03(3), γ = 104.27(4)°, V = 679.0(3) Å3 and Z = 2. The strongest lines of the powder X-ray diffraction (XRD) pattern [d, Å (I, %) (hkl)] are: 8.59 (18) (010); 2.90 (100) (0$\bar{1}$3); 2.23 (13) (13$\bar{3}$); 1.89 (21) (13$\bar{4}$). Tolstykhite is the S-analogue of maletoyvayamite, Au3Se4Te6. The structural identity between them is confirmed by powder XRD and Raman spectroscopy. The mineral honours Russian mineralogist Dr. Nadezhda Dmitrievna Tolstykh for her contributions to the mineralogy of gold and platinum-group elements and the study of ore deposits.
Multilevel non-contiguous thoracic pedicle subtraction osteotomy for fixed rounded hyperkyphotic deformity of the thoraco-lumbar junction with anterior bony fusion: technical note
Authors: Faldini Cesare , Barile Francesca , Viroli Giovanni , Manzetti Marco , Geraci Giuseppe , Ruffilli Alberto
Published: September 2022

Background

Fixed severe hyperkyphotic deformities spread over more than five vertebral levels represent a therapeutic challenge, especially when the deformity apex is located at the thoraco-lumbar junction, thus requiring a huge amount of correction. The aim of this article is to describe an innovative all-posterior corrective technique based on multilevel non-contiguous thoracic pedicle subtraction ostoeotomy (PSO).

Materials and methods

A retrospective review of three patients with fixed severe thoracic hyperkyphosis (a deformity angle of over 70°) with a thoraco-lumbar apex (between T11 and L1) treated by simultaneous two-level thoracic PSO and thoraco-lumbar posterior fusion was performed. Radiographic and clinical records were evaluated pre-operatively, post-operatively and at last follow-up (after a minimum of 2 years). Each variable was presented as mean ± SD (standard deviation). Statistical analyses were performed using paired t-tests (P value < 0.05 was considered significant).

Results

The mean local deformity angle decreased by 75% (from 81.3° ± 2.1° to 20.7° ± 1.4°, p < 0.001), the post-operative thoracic kyphosis decreased by 46% (from 61.4° ± 2.4° to 33.2° ± 0.9°, p < 0.001) and the sagittal vertical axis decreased by 73% (from 14.7 cm ± 0.8 cm to 3.9 cm ± 0.3 cm, p < 0.001). No differences were observed in the radiological results between post-operative values and those at the final follow-up. The average Oswestry Disability Index (ODI) score reduced from 65.7 ± 1.8 pre-operatively to 17.3 ± 1.7 at last follow-up (p < 0.001). No neurological, mechanical nor infective complication occurred.

Conclusions

The presented technique, although technically demanding, proved to be a safe and effective alternative for the management of fixed severe thoraco-lumbar junction hyperkyphotic deformities.

Level of evidence: IV

TRIAL REGISTRATION Retrospectively registered
Single-cell and WGCNA uncover a prognostic model and potential oncogenes in colorectal cancer
Authors: Di Ziyang , Zhou Sicheng , Xu Gaoran , Ren Lian , Li Chengxin , Ding Zheyu , Huang Kaixin , Liang Leilei , Yuan Yihang
Published: September 2022

Background

Colorectal cancer (CRC) is one of the leading causes of cancer-related death worldwide. Single-cell transcriptome sequencing (scRNA-seq) can provide accurate gene expression data for individual cells. In this study, a new prognostic model was constructed by scRNA-seq and bulk transcriptome sequencing (bulk RNA-seq) data of CRC samples to develop a new understanding of CRC.

Methods

CRC scRNA-seq data were downloaded from the GSE161277 database, and CRC bulk RNA-seq data were downloaded from the TCGA and GSE17537 databases. The cells were clustered by the FindNeighbors and FindClusters functions in scRNA-seq data. CIBERSORTx was applied to detect the abundance of cell clusters in the bulk RNA-seq expression matrix. WGCNA was performed with the expression profiles to construct the gene coexpression networks of TCGA-CRC. Next, we used a tenfold cross test to construct the model and a nomogram to assess the independence of the model for clinical application. Finally, we examined the expression of the unreported model genes by qPCR and immunohistochemistry. A clone formation assay and orthotopic colorectal tumour model were applied to detect the regulatory roles of unreported model genes.

Results

A total of 43,851 cells were included after quality control, and 20 cell clusters were classified by the FindCluster () function. We found that the abundances of C1, C2, C4, C5, C15, C16 and C19 were high and the abundances of C7, C10, C11, C13, C14 and C17 were low in CRC tumour tissues. Meanwhile, the results of survival analysis showed that high abundances of C4, C11 and C13 and low abundances of C5 and C14 were associated with better survival. The WGCNA results showed that the red module was most related to the tumour and the C14 cluster, which contains 615 genes. Lasso Cox regression analysis revealed 8 genes (PBXIP1, MPMZ, SCARA3, INA, ILK, MPP2, L1CAM and FLNA), which were chosen to construct a risk model. In the model, the risk score features had the greatest impact on survival prediction, indicating that the 8-gene risk model can better predict prognosis. qPCR and immunohistochemistry analysis showed that the expression levels of MPZ, SCARA3, MPP2 and PBXIP1 were high in CRC tissues. The functional experiment results indicated that MPZ, SCARA3, MPP2 and PBXIP1 could promote the colony formation ability of CRC cells in vitro and tumorigenicity in vivo.

Conclusions

We constructed a risk model to predict the prognosis of CRC patients based on scRNA-seq and bulk RNA-seq data, which could be used for clinical application. We also identified 4 previously unreported model genes (MPZ, SCARA3, MPP2 and PBXIP1) as novel oncogenes in CRC. These results suggest that this model could potentially be used to evaluate the prognostic risk and provide potential therapeutic targets for CRC patients.
The problem with dichotomizing quality improvement measures
Authors: Jones James Harvey , Fleming Neal
Published: September 2022

The Anesthesia Quality Institute (AQI) promotes improvements in clinical care outcomes by managing data entered in the National Anesthesia Clinical Outcomes Registry (NACOR). Each case included in NACOR is classified as “performance met” or “performance not met” and expressed as a percentage for a length of time. The clarity associated with this binary classification is associated with limitations on data analysis and presentations that may not be optimal guides to evaluate the quality of care. High compliance benchmarks present another obstacle for evaluating quality. Traditional approaches for interpreting statistical process control (SPC) charts depend on data points above and below a center line, which may not provide adequate characterizations of a QI process with a low failure rate, or few possible data points below the center line. This article demonstrates the limitations associated with the use of binary datasets to evaluate the quality of care at an individual organization with QI measures, describes a method for characterizing binary data with continuous variables and presents a solution to analyze rare QI events using g charts.
Risk factors of frailty and functional disability in community-dwelling older adults: a cross-sectional analysis of the FREEDOM-LNA cohort study
Authors: Tchalla Achille , Laubarie-Mouret Cécile , Cardinaud Noëlle , Gayot Caroline , Rebiere Marion , Dumoitier Nathalie , Rudelle Karen , Druet-Cabanac Michel , Laroche Marie-Laure , Boyer Sophie
Published: September 2022

Background

Frailty is a geriatric syndrome associated with disability and negative health outcome. To determine the factors associated with frailty and functional disability in older participants living in community in France. We included 753 community-dwelling old participants with available frailty data at baseline.

Results

Overall, 31.9% were frail, 58.3% were prefrail, and 9.8% were robust. The SMAF (French acronym for Functional Autonomy Measurement System) score was significantly lower (mean ± standard deviation: -25.8 ± 11.2) in frail participants compared to prefrail (-14.3 ± 9.7) or robust participants (-8.1 ± 7.0); 82% of frail older participants had limitation in at least one ADL and 97.5% in at least one IADL compared to 54.2 and 76.8%, respectively of pre-frail and 29.7 and 47.3% of robust participants. Age, depression, impaired cognition and diabetes were significantly associated with higher odds of frailty. These variables were also strongly associated with functional disability. Female gender, polypharmacy, and smoking were additional variables significantly associated with degraded SMAF and/or ADL/IADL.

Conclusions

This study showed that functional disability increased proportionally to frailty, and depression, cognitive decline and diabetes are modifiable risk factors significantly associated with frailty and functional disability.
HIV-1 pretreatment drug resistance and genetic transmission network in the southwest border region of China
Authors: Li Difei , Chen Huichao , Li Huilan , Ma Yanling , Dong Lijuan , Dai Jie , Jin Xiaomei , Yang Min , Zeng Zhijun , Sun Pengyan , Song Zhizhong , Chen Min
Published: September 2022

Background

HIV drug resistance increased with the widespread use of antiretroviral drugs, and posed great threat to antiretroviral therapy (ART). Pu’er Prefecture, lying in the southwest of Yunnan Province, China, borders Myanmar, Laos and Vietnam, is also the area where AIDS was discovered earlier, however, in which there has been no information on HIV drug resistance.

Methods

A cross-sectional survey of pretreatment drug resistance (PDR) was conducted in Pu’er Prefecture in 2021. Partial pol gene sequences were obtained to analyze drug resistance and construct genetic transmission network. HIV drug resistance was analyzed using the Stanford University HIVdb algorithm.

Results

A total of 295 sequences were obtained, among which 11 HIV-1 strain types were detected and CRF08_BC (62.0%, 183/295) was the predominant one. Drug resistance mutations (DRMs) were detected in 42.4% (125/295) of the sequences. The prevalence of PDR to any antiretroviral drugs, nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were 10.8% (32/295), 9.5% (28/295), 1.0% (3/295) and 0.3% (1/295), respectively. The risk of PDR occurrence was higher among individuals with CRF01_AE strain types. HIV-1 molecular network was constructed, in which 56.0% (42/75) of links were transregional, and 54.7% (41/75) of links were associated with Lancang County. Among the sequences in the network, 36.8% (35/95) harbored DRMs, and 9.5% (9/95) were drug resistance strains. Furthermore, 8 clusters had shared DRM.

Conclusion

The overall prevalence of PDR in this study was in a moderate level, but NNRTIs resistance was very approaching to the threshold of public response initiation. PDR was identified in the transmission network, and DRMs transmission was observed. These findings suggested that the consecutive PDR surveillance should be conducted in this region.