bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripherally inserted central venous catheter in upper extremities leads to an increase in D-dimer and deep vein thrombosis in lower extremities
Authors: Liu Wanli , He Lianxiang , Zeng Wenjing , Yue Liqing , Wei Jie , Zeng Shuangshuang , Wang Xiang , Gong Zhicheng
Published: April 2021

Background

The purpose of this study is to elucidate the association between peripherally inserted central venous catheter (PICC) in upper extremities and lower extremity deep venous thrombosis (LEDVT) by observing the changes in D-dimer.

Methods

This was a retrospective cohort study with 3452 patients (104 inserted with PICCs and 3348 without PICC) enrolled at the neurology department from April 1, 2017 to April 1, 2020. The patients underwent color Doppler ultrasound (CDU) and D-dimer examinations. LEDVT-related factors and D-dimer value were analyzed before and after PICC insertion. The predictive value of D-dimer for LEDVT was also evaluated.

Results

Univariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 9 times and promoted the increase of D-dimer by 5 times. After risk adjustment, multivariate logistic regression analysis showed that PICC insertion increased the risk of LEDVT by 4 times and tripled the risk of D-dimer increase. The concentration of D-dimer was significantly increased after PICC insertion. D-dimer was unsuitable for excluding venous thrombosis in patients inserted with PICCs.

Conclusions

PICC insertion increases the level of D-dimer and the risk of LEDVT. The risks of venous thrombosis need to be assessed in patients inserted with PICCs to ensure the expected clinical outcomes.
Evaluating medical education regulation changes in Brazil: workforce impact
Authors: Figueiredo Alexandre Medeiros , McKinley Danette Waller , Massuda Adriano , Azevedo George Dantas
Published: April 2021

Background

Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution.

Methods

This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare.

Results

From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care.

Conclusions

There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.
Time trends in pediatric hand fracture incidence in Malmö, Sweden, 1950–2016
Authors: Bergman Erika , Lempesis Vasileios , Jehpsson Lars , Rosengren Björn E. , Karlsson Magnus K.
Published: April 2021

Background

The hand is the second most fractured region in children. It is therefore important to update fracture epidemiology to be able to identify time trends for adequate health care planning. This study reports pediatric hand fracture incidence 2014–2016 and, using published data, also long-term time trends in 1950–2016.

Patients and methods

The Swedish city of Malmö, with 328,494 inhabitants in 2016, has only one hospital. We used the hospital radiological archive, medical charts, and diagnosis registry to identify hand fractures in city residents < 16 years in 2014–2016. These data were compared to those from three published studies that evaluated periods in 1950–2006. Differences between two periods were calculated as both unadjusted and age- and sex-adjusted incident rate ratios (IRR) with 95% confidence intervals (95% CI). We used joinpoint regression to estimate time trends during the entire period and present annual percent changes (APC) with 95% CI.

Results

In 2014–2016 phalangeal fractures accounted for 71% of all hand fractures, metacarpal fractures for 24%, and carpal fractures for 5%. We identified 615 hand fractures (419 in boys and 196 in girls) during 181,617 person-years in 2014–2016, resulting in an unadjusted pediatric hand fracture incidence of 339/100,000 person-years (boys 452/100,000 person-years and girls 220/100,000 person-years). The age-adjusted incidence 2014–2016 was similar to 2005–2006, the most recently evaluated period (IRR in boys 0.9; 95% CI 0.8 to 1.01, and in girls 1.0; 95% CI 0.8 to 1.2). Looking at the entire period 1950–2016, we found that age-adjusted incidence increased in 1950–1979, in boys by APC + 3.8%; 95% CI 3.0 to 4.5 and in girls by + 3.9%; 95% CI 2.8 to 5.0, but decreased in 1979–2016, in boys by − 0.7%; 95% CI − 1.4 to − 0.003, and girls by − 1.3%; 95% CI − 2.4 to − 0.1.

Conclusions

Phalangeal fractures accounted for about three quarters of all hand fractures. The age-adjusted hand fracture incidence increased in both sexes in 1950–1979 and decreased in 1979–2016.

Level of evidence

III
Prevalence of thyroid carcinoma in nodules with thy 3 cytology: the role of preoperative ultrasonography and strain elastography
Authors: Pikis Giorgos , Kandaraki Eleni , Lamnisos Demetris , Abbara Sereen , Kyriakou Katerina , Economides Aliki , Economides Panayiotis A.
Published: April 2021

Background

Fine needle aspiration (FNA) cytology, the gold standard in assessing thyroid nodules, is limited by its inability to determine the true risk of malignancy in Thy 3 nodules. Most patients with Thy3 cytology undergo surgery to establish a histologic diagnosis. The aims of this study were to evaluate the prevalence of malignancy in Thy3 nodules, to examine the ultrasound (US) characteristics that are associated with a high cancer risk and to assess the role of real-time strain elastography.

Methods

Retrospective cohort study of 99 nodules with Thy3 cytology in 99 patients who underwent thyroidectomy over a three-year period. Grayscale US, Doppler and real-time strain elastography data were evaluated.

Results

Eighty-one nodules (81.82%) were benign, 18 (18.18%) were malignant, and almost all were papillary thyroid carcinoma (PTC). Univariable analysis revealed irregular margins (p = 0.02), ill-defined borders (p ≤ 0.001), a taller than wide shape (p ≤ 0.001) and the elasticity score (p = 0.02) as significant predictors of malignancy. Multivariable analysis showed that ill-defined borders and the elasticity score were significant and independent factors associated with malignancy. All soft nodules (elasticity scores 1–2) were benign (sensitivity 100%, specificity 33%, NPV 100%, and PPV 23%). There was a higher rate of malignancy in Thy3a nodules than in Thy3f nodules (42.86% versus 11.54%) (p ≤ 0.001).

Conclusions

Irregular margins, ill-defined borders, a taller than wide shape and low elasticity were associated with malignancy. Elastography should be performed when evaluating Thy3 nodules.
Early stage epithelial ovarian cancer metastasis through peritoneal fluid circulation
Authors: Purbadi Sigit , Anggraeni Tricia Dewi , Vitria Angelina
Published: April 2021

Background

Although epithelial ovarian cancer (EOC) spreads through peritoneal circulation, all patients with clinical early-stage ovarian cancer (OC) benefit from routine surgical staging is still unclear.

Methods

This cross-sectional study used data from medical records of patients with clinical early-stage EOC who received complete surgical staging from 2006 to 2016 at our hospital. We excluded patients with non-epithelial OC or with stage IV disease.

Results

Among 50 patients with clinical early-stage EOC who underwent surgical staging, biopsies showed EOC cells in peritoneal fluid for 12 patients (24%), in peritoneal tissue for ten patients (20%), and omental tissue for eight patients (16%). Of those 50 patients, 40 patients had undergone peritoneal biopsies, and the other five patients also had omental biopsies. The results showed that only one (2.5%) from 40 patients with peritoneal biopsy and three (6.7%) from 45 patients with omental biopsy had no visible nodules. From cytology examination, 3 out of 26 patients (11.5%) showed positive cytology from peritoneal washing.

Conclusions

Routine peritoneal biopsies do not seem advantageous for patients with clinical early-stage EOC as negative visible nodules with positive biopsy results were only 1 in 40 cases. However, further study with a larger cohort is needed to obtain more information on peritoneal fluid metastasis patterns.
Normalization of blood clotting characteristics using prothrombin complex concentrate, fibrinogen and FXIII in an albumin based fluid: experimental studies in thromboelastometry
Authors: Koller Tobias , Kinast Nadia , Castellanos Andres Guilarte , Garcia Sergio Perez , Iglesias Pilar Paniagua , Vintro Xavi León , Arranz Jose Mateo , Seto Noelia Vilalta , García Ma. Victòria Moral , Moreno-Castaño Ana Belén , Aznar-Salatti Jose , Albaladejo Gines Escolar , Diaz-Ricart Maribel
Published: April 2021

Background

Colloid fluids supplemented with adequate combinations of coagulation factor concentrates with the capability to restore coagulation could be a desirable future treatment component in massive transfusion.

Methods

Starting from a coagulation factor and blood cell-free albumin solution we added Prothrombin Complex Concentrate, Fibrinogen Concentrate and Factor XIII in different combinations and concentrations to analyze their properties to restore thromboelastometry parameters without the use of plasma. Further analysis under the presence of platelets was performed for comparability to whole blood conditions.

Results

Albumin solutions enriched with Fibrinogen Concentrate, Factor XIII and Prothrombin Complex Concentrate at optimized concentrations show restoring coagulation potential. Prothrombin Complex Concentrate showed sufficient thrombin formation for inducing fibrinogen polymerization. The combination of Prothrombin Complex Concentrate and Fibrinogen Concentrate led to the formation of a stable in vitro fibrin clot. Fibrinogen and Factor XIII showed excellent capacity to improve fibrin clot firmness expressed as Amplitude at 10 min and Maximal Clot Firmness. Fibrinogen alone, or in combination with Factor XIII, was able to restore normal Amplitude at 10 min and Maximal Clot Firmness values. In the presence of platelets, the thromboelastometry surrogate parameter for thrombin generation (Clotting Time) improves and normalizes when compared to whole blood.

Conclusions

Combinations of coagulation factor concentrates suspended in albumin solutions can restore thromboelastometry parameters in the absence of plasma. This kind of artificial colloid fluids with coagulation-restoring characteristics might offer new treatment alternatives for massive transfusion.

Trial registration

Study registered at the institutional ethic committee “Institut de Recerca, Hospital Santa Creu i Sant Pau, with protocol number IIBSP-CFC-2013-165.
Impact of national guidelines on use of BRCA1/2 germline testing, risk management advice given to women with pathogenic BRCA1/2 variants and uptake of advice
Authors:   for the ICCon Audit Study Collaborative Group, Meiser Bettina , Kaur Rajneesh , Morrow April , Peate Michelle , Wong W. K. Tim , McPike Emily , Cops Elisa , Nichols Cassandra , Austin Rachel , Fine Miriam , Thrupp Letitia , Ward Robyn , Macrae Finlay , Hiller Janet E. , Trainer Alison H. , Mitchell Gillian
Published: April 2021

Background

This nationwide study assessed the impact of nationally agreed cancer genetics guidelines on use of BRCA1/2 germline testing, risk management advice given by health professionals to women with pathogenic BRCA1/2 variants and uptake of such advice by patients.

Methods

Clinic files of 883 women who had initial proband screens for BRCA1/2 pathogenic variants at 12 familial cancer clinics between July 2008–July 2009 (i.e. before guideline release), July 2010–July 2011 and July 2012–July 2013 (both after guideline release) were audited to determine reason given for genetic testing. Separately, the clinic files of 599 female carriers without a personal history of breast/ovarian cancer who underwent BRCA1/2 predictive genetic testing and received their results pre- and post-guideline were audited to ascertain the risk management advice given by health professionals. Carriers included in this audit were invited to participate in a telephone interview to assess uptake of advice, and 329 agreed to participate.

Results

There were no significant changes in the percentages of tested patients meeting at least one published indication for genetic testing - 79, 77 and 78% of files met criteria before guideline, and two-, and four-years post-guideline, respectively (χ = 0.25, p = 0.88). Rates of documentation of post-test risk management advice as per guidelines increased significantly from pre- to post-guideline for 6/9 risk management strategies. The strategies with the highest compliance amongst carriers or awareness post-release of guidelines were annual magnetic resonance imaging plus mammography in women 30–50 years (97%) and annual mammography in women > 50 years (92%). Of women aged over 40 years, 41% had a risk-reducing bilateral mastectomy. Amongst women aged > 40 years, 75% had a risk-reducing salpingo-oophorectomy. Amongst women who had not had a risk-reducing bilateral mastectomy, only 6% took risk-reducing medication. Fear of side-effects was cited as the main reasons for not taking these medicines by 73% of women.

Conclusions

Guidelines did not change the percentages of tested patients meeting genetic testing criteria but improved documentation of risk management advice by health professionals. Effective approaches to enhance compliance with guidelines are needed to improve risk management and quality of care.
Post-extubation oxygenation strategies in acute respiratory failure: a systematic review and network meta-analysis
Authors: Yasuda Hideto , Okano Hiromu , Mayumi Takuya , Narita Chihiro , Onodera Yu , Nakane Masaki , Shime Nobuaki
Published: April 2021

Background

High-flow nasal cannula oxygenation (HFNC) and noninvasive positive-pressure ventilation (NPPV) possibly decrease tracheal reintubation rates better than conventional oxygen therapy (COT); however, few large-scale studies have compared HFNC and NPPV. We conducted a network meta-analysis (NMA) to compare the effectiveness of three post-extubation respiratory support devices (HFNC, NPPV, and COT) in reducing the mortality and reintubation risk.

Methods

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Ichushi databases were searched. COT, NPPV, and HFNC use were assessed in patients who were aged ≥ 16 years, underwent invasive mechanical ventilation for > 12 h for acute respiratory failure, and were scheduled for extubation after spontaneous breathing trials. The GRADE Working Group Approach was performed using a frequentist-based approach with multivariate random-effect meta-analysis. Short-term mortality and reintubation and post-extubation respiratory failure rates were compared.

Results

After evaluating 4631 records, 15 studies and 2600 patients were included. The main cause of acute hypoxic respiratory failure was pneumonia. Although NPPV/HFNC use did not significantly lower the mortality risk (relative risk [95% confidence interval] 0.75 [0.53–1.06] and 0.92 [0.67–1.27]; low and moderate certainty, respectively), HFNC use significantly lowered the reintubation risk (0.54 [0.32–0.89]; high certainty) compared to COT use. The associations of mortality with NPPV and HFNC use with respect to either outcome did not differ significantly (short-term mortality and reintubation, relative risk [95% confidence interval] 0.81 [0.61–1.08] and 1.02 [0.53–1.97]; moderate and very low certainty, respectively).

Conclusion

NPPV or HFNC use may not reduce the risk of short-term mortality; however, they may reduce the risk of endotracheal reintubation.

Trial registration number and date of registration

PROSPERO (registration number: CRD42020139112, 01/21/2020).
Giving schools a nudge: can behavioural insights improve recruitment of schools to randomised controlled trials?
Authors: Warner Georgina , Osman Fatumo , McDiarmid Serena , Sarkadi Anna
Published: April 2021

Objective

It is widely acknowledged that recruitment to randomised controlled trials (RCTs) is challenging, particularly trials that operate across multiple sites. A research area in need of further high-quality evaluation, including RCTs, is school-based mental health interventions for refugee children and adolescents. However, engaging schools with interventions and associated evaluations can be challenging. This paper explores the application of behavioural insights, i.e. evidence-based understanding of how people behave and make decisions, to RCT recruitment at the school level via email communications. A pilot study of applying behavioural insights to mail outs attempting to recruit schools to a RCT of a trauma-focused group intervention for refugee children and adolescents experiencing symptoms of post-traumatic stress is reported. Rates of school involvement between the behavioural insights approach (n = 31) and a standard outreach approach (n = 65) are compared.

Results

Schools were more likely to give a positive response to the mail out designed using the behavioural insights framework than standard outreach. Accounts of recruitment strategies such as this are valuable additions to the literature on RCT methodology given the potential for recruitment issues to affect trial operations.
Boundedness of composition operators on Morrey spaces and weak Morrey spaces
Authors: Hatano Naoya , Ikeda Masahiro , Ishikawa Isao , Sawano Yoshihiro
Published: April 2021

In this study, we investigate the boundedness of composition operators acting on Morrey spaces and weak Morrey spaces. The primary aim of this study is to investigate a necessary and sufficient condition on the boundedness of the composition operator induced by a diffeomorphism on Morrey spaces. In particular, detailed information is derived from the boundedness, i.e., the bi-Lipschitz continuity of the mapping that induces the composition operator follows from the continuity of the composition mapping. The idea of the proof is to determine the Morrey norm of the characteristic functions, and employ a specific function composed of a characteristic function. As this specific function belongs to Morrey spaces but not to Lebesgue spaces, the result reveals a new phenomenon not observed in Lebesgue spaces. Subsequently, we prove the boundedness of the composition operator induced by a mapping that satisfies a suitable volume estimate on general weak-type spaces generated by normed spaces. As a corollary, a necessary and sufficient condition for the boundedness of the composition operator on weak Morrey spaces is provided.
Local Muckenhoupt class for variable exponents
Authors: Nogayama Toru , Sawano Yoshihiro
Published: April 2021

This work extends the theory of Rychkov, who developed the theory of$A_{p}^{\mathrm{loc}}$Aplocweights. It also extends the work by Cruz-Uribe SFO, Fiorenza, and Neugebauer. The class$A_{p(\cdot )}^{\mathrm{loc}}$Ap(⋅)locis defined. The weighted inequality for the local Hardy–Littlewood maximal operator on Lebesgue spaces with variable exponents is proven. Cruz-Uribe SFO, Fiorenza, and Neugebauer considered the Muckenhoupt class for Lebesgue spaces with variable exponents. However, due to the setting of variable exponents, a new method for extending weights is needed. The proposed extension method differs from that by Rychkov. A passage to the vector-valued inequality is realized by means of the extrapolation technique. This technique is an adaptation of the work by Cruz-Uribe and Wang. Additionally, a theory of extrapolation adapted to our class of weights is also obtained.
Dip angles of active faults from the surface to the seismogenic zone inferred from a 2D numerical analysis of visco-elasto-plastic models: a case study for the Osaka Plain
Authors: Nishiwaki Hayami , Okudaira Takamoto , Ishii Kazuhiko , Mitamura Muneki
Published: April 2021

The geometries (i.e., dip angles) of active faults from the surface to the seismogenic zone are the most important factors used to evaluate earthquake ground motion, which is crucial for seismic hazard assessments in urban areas. In Osaka, a metropolitan city in Japan, there are several active faults (e.g., the Uemachi and Ikoma faults), which are inferred from the topography, the attitude of active faults in surface trenches, the seismic reflection profile at shallow depths (less than 2 km), and the three-dimensional distribution of the Quaternary sedimentary layers. The Uemachi and Ikoma faults are N–S-striking fault systems with total lengths of 42 km and 38 km, respectively, with the former being located ~ 12 km west of the latter; however, the geometries of each of the active faults within the seismogenic zone are not clear. In this study, to examine the geometries of the Uemachi and Ikoma faults from the surface to the seismogenic zone, we analyze the development of the geological structures of sedimentary layers based on numerical simulations of a two-dimensional visco-elasto-plastic body under a horizontal compressive stress field, including preexisting high-strained weak zones (i.e., faults) and surface sedimentation processes, and evaluate the relationship between the observed geological structures of the Quaternary sediments (i.e., the Osaka Group) in the Osaka Plain and the model results. As a result, we propose geometries of the Uemachi and Ikoma faults from the surface to the seismogenic zone. When the friction coefficient of the faults is ~ 0.5, the dip angles of the Uemachi and Ikoma faults near the surface are ~ 30°–40° and the Uemachi fault has a downward convex curve at the bottom of the seismogenic zone, but does not converge to the Ikoma fault. Based on the analysis in this study, the dip angle of the Uemachi fault zone is estimated to be approximately 30°–40°, which is lower than that estimated in the previous studies. If the active fault has a low angle, the width of the fault plane is long, and thus the estimated seismic moment will be large.
Investigation of dominant traveling 10-day wave components using long-term MERRA-2 database
Authors: Huang Chunming , Li Wei , Zhang Shaodong , Chen Gang , Huang Kaiming , Gong Yun
Published: April 2021

The eastward- and westward-traveling 10-day waves with zonal wavenumbers up to 6 from surface to the middle mesosphere during the recent 12 years from 2007 to 2018 are deduced from MERRA-2 data. On the basis of climatology study, the westward-propagating wave with zonal wave number 1 (W1) and eastward-propagating waves with zonal wave numbers 1 (E1) and 2 (E2) are identified as the dominant traveling ones. They are all active at mid- and high-latitudes above the troposphere and display notable month-to-month variations. The W1 and E2 waves are strong in the NH from December to March and in the SH from June to October, respectively, while the E1 wave is active in the SH from August to October and also in the NH from December to February. Further case study on E1 and E2 waves shows that their latitude–altitude structures are dependent on the transmission condition of the background atmosphere. The presence of these two waves in the stratosphere and mesosphere might have originated from the downward-propagating wave excited in the mesosphere by the mean flow instability, the upward-propagating wave from the troposphere, and/or in situ excited wave in the stratosphere. The two eastward waves can exert strong zonal forcing on the mean flow in the stratosphere and mesosphere in specific periods. Compared with E2 wave, the dramatic forcing from the E1 waves is located in the poleward regions.
Phytochemistry and pharmacological studies of Plumbago zeylanica L.: a medicinal plant review
Authors: Shukla Babita , Saxena Sumedha , Usmani Shazia , Kushwaha Poonam
Published: April 2021

Plumbago zeylanicaL. (Plumbaginaceae) commonly known, as chitrak is pharmacologically important plant. Various studies have been undertaken to assess the pharmacological potential of different parts of the plant namely like roots, stem, flower, and leaves as antimicrobial, hepatoprotective, anticancer, antifertility, antiulcer, antifungal and wound healing. The intention of the present review is to deliver a concise account on its ethnobotanical uses, phytochemistry with an in-depth study of its phytoconstituents, facts and prospects of its potential pharmacological activities of this golden plant. An extensive literature survey was undertaken through different online platforms viz. Google Scholar and online databases namely PubMed, Science Direct and Springer. All papers based on traditional medicinal uses and pharmacological properties were included. Sixty three research articles and review articles were found to be apt for inclusion into the review. About 150 articles were retrieved for the purpose. The elaborative results vindicated thatPlumbago zeylanicaL. holds significant prospects in major health conditions such as diabetes, cardiovascular disorders, ulcer, liver problems, obesity, wound healing, cancer etc.
A hybrid correlation denoising method based on complex resistivity and application on spread-spectrum induced-polarization data
Authors: He Siming , Guan Jian , Wang Yi , Ji Xiu , Wang Hui
Published: April 2021

In electrical exploration techniques, an effective suppression method for Gaussian and impulsive random noise in spread-spectrum induced-polarization (SSIP) data continues to be challenging for conventional denoising methods. Remnant noise influences the complex resistivity spectrum and damages the subsequent interpretation of geophysical surveys. We have developed a hybrid method based on a correlation function and complex resistivity, which introduces the correlation analyses among the transmitting source, the measured potential, and the injected current signal. According to the analyses, reliable results for complex resistivity spectra can be calculated, which can be further used for noise suppression. We apply the hybrid method to numerical and field experiments to process the measured SSIP data. Simulation tests find that the hybrid method not only suppresses the two types of noise but also improves the relative error of the complex resistivity spectrum. Field data processing indicates that the hybrid method can minimize the standard deviation of the data and can have a greater ability to distinguish adjacent objects, which can improve the reliability of the data in subsequent processing and interpretation.
Attitudes Toward Intimate Partner Violence in Dyadic Perspective: Evidence From Sub-Saharan Africa
Authors: Behrman Julia , Frye Margaret
Published: April 2021

Although intimate partner violence (IPV) is inherently a relational event shaped by couple-level factors, most empirical examinations of IPV-related attitudes have used individuals as the unit of analysis. We apply a dyadic perspective to the study of attitudes about the acceptability of IPV, harnessing couple-level data from 33 countries in sub-Saharan Africa, a region characterized by particularly high levels of both the incidence and acceptance of IPV. We document considerable geographic heterogeneity in the distribution of attitudinal concordance or discordance regarding the acceptability of IPV within couples, a descriptive finding that is overlooked by studies focused on individuals as the unit of analysis. In addition, applying a dyadic perspective to the correlates of attitudinal concordance, we demonstrate that joint exposure to schooling, work, and media is more predictive of joint rejection of IPV than are singular exposures of wives or husbands. Finally, we show that distinct combinations of attitudes within couples are associated with differential likelihoods of wives reporting having recently experienced emotional, physical, or sexual IPV. In particular, when both partners reject IPV, wives are significantly less likely to report experiencing each type of IPV in the past year compared with any other combination of attitudes. Our results reveal that a dyadic perspective provides a comprehensive understanding of intracouple contexts that enhances our perspective on these important demographic outcomes.
A case of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presenting as post-infectious manifestation of SARS-CoV-2 infection
Authors: Rajendran Ishwariya , Natarajan Madhu Dutta , Narwani Pooja , Alzouabi Omran , Kawafi Khalil , Khanna Navin
Published: April 2021

White matter hyperintensities (WMHs) lacunar infarcts and cerebral microbleeds are well-established features associated with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Increasing case reports and series recounts a wide array of neurological manifestations of COVID-19 including acute cerebrovascular disease, encephalopathy, encephalitis and demyelination. Recently association between COVID-19 and CADASIL has been identified. We describe an unusual case of CADASIL diagnosed as a possible post-infectious manifestation of COVID-19 patient with imaging features closely resembling post-infectious encephalomyelitis.
Los tres órdenes territoriales o el síndrome de Procusto y otros mitos de la relación espacio-sociedad-tiempo en el Estado colombiano
Authors: Millán Orozco David
Published: April 2021

El presente artículo ofrece nueva categorización para el estudio del territorio a partir de una aproximación a la realidad colombiana. Se hace parte de la discusión que sostienen múltiples autores sobre una transdisciplina contemporánea: los estudios territoriales. La reflexión se sirve del mito de Procusto o Procustes, del cual se derivan enseñanzas importantes en torno al establecimiento de la uniformidad territorial por parte del Estado, en contraste con la escasa receptividad a la diferencia propia de la multiterritorialidad presente en la República de Colombia
Regulating Conflicts of Interest in Medicine Through Public Disclosure: Evidence from a Physician Payments Sunshine Law
Authors: Chao Matthew , Larkin Ian
Published: April 2021

Hospital and healthcare administrators name high prescription drug costs as one of their largest problems. A significant body of research demonstrates that meals and honoraria from pharmaceutical firms to physicians leads to higher prescribing of expensive, brand name drugs, despite little difference in efficacy. Some administrators and scholars have advocated for mandatory disclosure of these payments in order to reduce this conflict of interest, but many practitioners believe disclosure has little effect on prescribing, and the empirical evidence is mixed. This paper uses a quasi-experiment of a 2009 payment disclosure policy in Massachusetts to estimate the causal impact of public disclosure on prescribing. The comprehensive data set includes all retail prescriptions for 262 drugs in nine drug classes written by 5,730 physicians in five states over 48 months. We show a significant postdisclosure reduction in brand name drug prescriptions by Massachusetts physicians, relative to control physicians in other states. These effects are driven by heavy prescribers of brand name drugs in the prepolicy period, particularly for drugs with large prepolicy sales forces. Effects are also detected before the first data were released, implying that the effects are not because patients or administrators responded to the disclosed payments. Instead, some physicians may have changed their payments and prescriptions behavior to avoid appearing biased. Taken in tandem with the many studies showing that pharmaceutical industry payments influence prescribing, this study suggests a strong role for mandatory public disclosure in reducing conflicts of interest in medicine and costly prescribing of brand name drugs.

This paper was accepted by Stefan Scholtes, healthcare management.
The Constrained Reliable Shortest Path Problem in Stochastic Time-Dependent Networks
Authors: Ruß Matthias , Gust Gunther , Neumann Dirk
Published: April 2021

Finding Shortest Paths That Are Reliable and Satisfy Constraints on Time-Dependent Weights
Impact of Electrodes Separation Distance on Bio-Impedance Diagnosis
Authors: Santhosh Sheeba , Juliet A. Vimala , Krishnan G. Hari
Published: April 2021

Bio-impedance diagnosis depends mainly on two factors first being the location of electrode placement and second being the distance between electrodes. To minimize the errors caused during bio impedance measurement at variable frequencies, it is required to study the electrodes used for the measurement and its exact location where the electrodes are placed. This paper analyses various electrode separations used for bioimpedance measurement for cardiac signal. The electrode system is used based on the type of tissue under consideration for measurement. It is found that the errors are dependent on the frequencies at which the measurement is carried out and it also depends on the intensity of current applied. Thus, selection of current and frequency is very important for measurements. In this paper, the impact of size, distance and location of the electrodes that can be used for bio-impedance cardiograph.
Ameliorative Effect of Turmeric and Cocoa Extract against Acute Second hand Exposure of Tobacco Smoking on Hepatocytes and Enterocytes in Albino Rats: Ultra structural Study
Authors: Khwaldeh Alia , Shraideh Ziad , Badran Darwish , Alzbeede Ahmed , Farajallah Mohammad , AlQattan Duaa , Mashaqba Safa , Alqaraleh Moath
Published: April 2021

Background and aims: Smoking posse’s serious health problems because there is no specific substance alleviate its toxicity. The aim of this study was to investigate the effective plant extract containing antioxidants(turmeric and cocoa), that may reduce the cytotoxicity induced by secondhand exposure of cigarettes and waterpipe smoking. Material and Methods: Seventy-two adult male albino rats were equally divided into 9 group (n=8 per group). Extracts were delivered to each group intraperitoneal, and the exposure to cigarette and waterpipe smoking was performed using a smoking machine for a period of 30 days. After the exposure period, tissues of interest (liver and small intestine) were removed and processed for transmission electron microscopy. Results: Oral treatment of turmeric and cocoa extract with smoking exposure showed less vacuolization and better cellular architecture with regular nuclear envelope of hepatocytes, reduce or absence of blebbing, retain the normal shape and size of mitochondria, increase the proportion of euchromatic chromatin in nuclei,but turmeric extract showed better enhancement in term of reducing vacuolization. turmeric or cocoa crude extract preserve the typical length of microvilli with a uniform organization from the apical part of enterocytes and decreased vacuolization in the cytosol of enterocytes. However, mitochondria appeared less polymorphic in shapes with distinct cristae and matrix in enterocytes of the turmeric treated group than the cocoa once. Conclusion: Tobacco smoking-induced adverse effects on hepatocytes and enterocytes, this study showed that treatment with turmeric and cocoa attenuatethe toxicity of tobacco smoking.
In -Vivo Anti-Diabetic Activity of Hydro-Ethanolic Seed Extract of Syzygium Cumini (L.)
Authors: Asanaliyar Meharban , Nadig Pratibha
Published: April 2021

Introduction: Diabetes mellitus continues to be a major health problem in India and across the world. Over centuries, numerous herbal extracts have been used in the Indian traditional medicine to control elevated blood sugar levels in patients with diabetes. Different aqueous and organic extracts of Syzygium cumini (L.) Skeels have found widespread use owing to their anti-diabetic activity. A systematic study was undertaken to characterise and evaluate the effects of a hydro-ethanolic seed extract (SCE) of Syzygium cumini in a rodent model of experimental type 2 diabetes mellitus. Methods: An established model of diabetes mellitus with a combination of streptozotocin and high fat diet (over 12 weeks) in adult male Wistar albino rats, was used in this study. The onset of diabetes mellitus in rats was confirmed with a fasting blood glucose (FBG) of >200 mg/dl. The diabetic rats were allocated into five experimental groups and treated as follows: with vehicle alone, pioglitazone (10 mg/kg), 100mg/kg or 200mg/kg or 400 mg/kg of SCE, respectively for 21 days. The pre and post treatment levels of fasting blood glucose, insulin and lipids were measured from serum obtained from the various treatment groups. In order to measure insulin resistance, a homeostasis model assessment of insulin resistance (HOMA IR) and for measuring the beta cell function a homeostasis model assessment were employed. The results obtained from these studies were analysed using the Analysis of variance (ANOVA) method. Results: Our study demonstrates the SCE preparation to induce a statistically significant dose-dependent reduction in FBG, serum lipid levels and HOMA IR with a concomitant increase in the serum insulin levels and HOMA B. Conclusions: Wistar rats dosed with SCE at 100 and 200 mg/kg body weight demonstrated statistically significant anti-diabetic activity by virtue of improving the pancreatic beta cell function and reduction in insulin resistance.
Saturable absorber based on the broadband composite-liquid-filled dual-core photonic crystal fiber coupler
Authors: Li Jing , Wang Chuncan , Wang Peng
Published: April 2021

A dual-core photonic crystal fiber coupler based on the heavily

G
e
O

2

-doped-silica-air cladding and composite-liquid (

C
S

2

and

C

2

C
l

4

) core is proposed to obtain the saturable absorber (SA). It is demonstrated by numerical simulations that the SA with appropriate parameters can exhibit the normal dispersion, high nonlinearity, and flat profile of the linear coupling lengths in the wavelength range from 1500 to 2000 nm. The input pulses with durations

>

2

p
s

exhibit relatively high transmissions and low saturable powers mainly because of the strong effect of stimulated Raman scattering in the SA. Consequently, the SA with the

G
e
O

2

concentration ratio of 80 mol% can be employed in both the erbium- and thulium-doped fiber mode-locked lasers with all-normal or large net-normal dispersion. The dissipative soliton pulses with tunable wavelengths can be obtained in both cases.
Polarization asymmetry of the dark-resonance frequency dependence on the magnetic field
Authors: Tsygankov Eugene A. , Vaskovskaya Maria I. , Chuchelov Dmitry S. , Zibrov Sergei A. , Vassiliev Vitali V. , Velichansky Vladimir L. , Yakovlev Valery P.
Published: April 2021

We demonstrate the possibility of suppressing the linear response of the coherent population trapping resonance frequency to variations in the external magnetic field. The suppression can be achieved at a specific value of the clock magnetic field

B

due to the competition between the frequency pulling by neighboring resonances and the quadratic Zeeman shift. The effect is possible only with certain combinations of the optical field polarization and the direction of the magnetic field. An incorrect field configuration can significantly increase the magnetic-induced frequency shifts.
Linear cavity tapered fiber sensor using amplified phase-shift cavity ring-down spectroscopy
Authors: Ayaz Rana M. Armaghan , Uysalli Yigit , Morova Berna , Kiraz Alper
Published: April 2021

Phase-shift cavity ring-down spectroscopy (PS-CRDS) enables the measurement of minute fluctuations in optical loss encountered by an intensity modulated laser beam via lock-in demodulation of the accumulated signal phase as the laser beam propagates through the cavity. A linear fiber cavity containing two highly reflective fiber Bragg gratings (FBGs) and a tapered fiber is a favorable cavity geometry for sensor applications due to its compact nature and wide availability of its components at telecom wavelengths. However, due to the optical absorption of water, usage of telecom wavelengths for sensing of aqueous solutions degrades the sensitivity. This problem can be worked around via an optical amplifier placed inside the fiber cavity, compensating for intrinsic cavity losses. In this work, we demonstrate amplified PS-CRDS using such a linear cavity tapered fiber sensor utilizing an optical amplifier that enables the use of thinner tapered fibers, thus achieving higher sensitivities. We also employ continuous laser wavelength sweeps and analyze peak-to-peak PSs of individual cavity modes instead of using laser-cavity mode locking with the Pound–Drever–Hall technique. This enables further simplification of the experimental arrangement without compromising sensor performance. To test the performance of the reported sensor, solutions of varying sucrose concentrations in deionized water were measured systematically by tracking the average peak-to-peak PS

⟨

ϕ

pp

⟩

of the cavity modes. Tapered fibers with waist diameters (

D

t
a
p
e
r

) around 2.2 µm were used during the experiment and limit of detection (LOD) values were measured down to 2.7 µM, corresponding to

1.01
×

10

−
7

R
I
U

. The reported LOD values can be further improved by mechanical stabilization and thermal control of the device by the use of FBGs with higher reflectivity, by applying automatic optical gain control, and by spectral filtering to remove errors caused by amplified spontaneous emission. The presented concentration sensing device can be suitable for developing compact and highly sensitive, label-free optofluidic sensors.
Resonant evanescent excitation of guided waves with high-order optical angular momentum
Authors: Hammer Manfred , Ebers Lena , Förstner Jens
Published: April 2021

Gaussian-beam-like bundles of semi-guided waves propagating in a dielectric slab can excite modes with high-order optical angular momentum supported by a circular fiber. We consider a multimode step-index fiber with a high-index coating, where the waves in the slab are evanescently coupled to the modes of the fiber. Conditions for effective resonant interaction are identified. Based on a hybrid analytical–numerical coupled mode model, our simulations predict that substantial fractions of the input power can be focused into waves with specific orbital angular momentum, of excellent purity, with a clear distinction between degenerate modes with opposite vorticity.
High power pump and signal combiner for backward pumping structure with two different fused fiber bundle designs by means of pretapered pump fibers
Authors: Liu Yili , Liu Kai , Yang Yifeng , Liu Meizhong , He Bing , Zhou Jun
Published: April 2021

We report on two high power backward (6 + 1) × 1 pump and signal combiners with different optical designs based on end-pumping technique, each achieving more than 95% coupling ratio of signal light, 98% coupling ratio of pump light, and a total pump power of 2.95kW. Both designs solve the problem of non-uniform arrangement in asymmetric fiber bundles by the pretreatment of the pump fibers and signal fiber. Asymmetric fiber bundle in backward pump and signal combiners means the pump input fibers and signal output fiber have different cladding diameters. Two 3D simulation models were built to calculate the parameters of the fused fiber bundles for matching the mode field diameter between the signal input and the output fibers. Both optical designs of backward combiners were developed based on the beam propagation method and confirmed by experimental results.
Ultracompact electro-optic waveguide modulator based on a graphene-covered λ/1000 plasmonic nanogap
Authors: Kim Shinho , Menabde Sergey G. , Cox Joel D. , Low Tony , Jang Min Seok
Published: April 2021

The extreme field confinement and electro-optic tunability of plasmons in graphene make it an ideal platform for compact waveguide modulators, with device footprints aggressively scaling orders of magnitude below the diffraction limit. The miniaturization of modulators based on graphene plasmon resonances is however inherently constrained by the plasmon wavelength, while their performance is bounded by material loss in graphene. In this report, we propose to overcome these limitations using a graphene-covered λ/1000 plasmonic nanogap waveguide that concentrates light on length scales more than an order of magnitude smaller than the graphene plasmon wavelength. The modulation mechanism relies on interference between the non-resonant background transmission and the transmission mediated by the gate-tunable nanogap mode, enabling modulation depths over 20 dB. Since the operation of the device does not rely on graphene plasmons, the switching behavior is robust against low graphene carrier mobility even under 1000 cm2/Vs, which is desirable for practical applications.
All-optical high-sensitivity resonant photoacoustic sensor for remote CH4 gas detection
Authors: Gong Zhenfeng , Wu Guojie , Jiang Xu , Li Haie , Gao Tianli , Guo Min , Ma Fengxiang , Chen Ke , Mei Liang , Peng Wei , Yu Qingxu
Published: April 2021

This paper presents an all-optical high-sensitivity resonant photoacoustic (PA) sensor to realize remote, long-distance and space-limited trace gas detection. The sensor is an integration of a T-type resonant PA cell and a particular cantilever-based fiber-optic acoustic sensor. The finite element simulations about the cantilever vibration mode and the PA field distributions are carried out based on COMSOL. The all-optical high-sensitivity resonant PA sensor, together with a high-speed spectrometer and a DFB laser source, makes up of a photoacoustic spectroscopy (PAS) system which is employed for CH4 detection. The measured sensitivity is 0.6 pm/ppm in the case of 1000 s average time, and the minimum detection limit (MDL) reaches 15.9 parts per billion (ppb). The detective light source and the excitation light source are all transmitted by optical fibers, therefore remote and long-distance measurement of trace gas can be realized. Furthermore, the excitation light source and the acoustic sensor are designed at the same side of the PA cell, the sensor may be used for space-limited trace gas detection.