bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying the degree of mode localization in Cross-tied cable networks by using energy-based approach
Authors: Ahmad Javaid
Published: April 2021

The use of cross-tie is one of the effective countermeasures to suppress the undesired cable vibration in the cable-stayed bridges. The major benefits offered by the cross-tie solution are the increase in the in-plane stiffness and the flow of energy toward the higher order nodes. However, the formation of closely spaced local modes is one of the major disadvantages of the Cross-tied cable networks. There are only few studies available to understand the formation of local modes. In the current study, an energy-based approach is developed to differentiate between the global and the local modes. In the proposed approach, the kinetic energy equations are formulated to compute the energy stored in arbitrary cable segments. In the current study, the advantages of the proposed energy-based approach over the existing amplitude-based approach have been discussed. The suggested approach has been applied to multiple cable networks, and a comparison has been drawn between the amplitude-based approach and the proposed energy-based approach.
Education strategy for the implementation of oncology biosimilars essential for operational and patient safety in Alberta, Canada
Authors: Garg Manju , Chatterjee Ashraf , Chambers Carole R
Published: April 2021

Medication errors involving look alike sound alike (LASA) medications have widely been recognized to contribute to patient harm. Oncology biosimilars are considered to be LASA medications and require additional measures for operational safety. The Cancer Care Alberta (CCA) Pharmacy Educators developed an education strategy to ensure operational and patient safety during the implementation phase for oncology biosimilars in Alberta, Canada. This resulted in a smooth adoption of oncology biosimilars. As future oncology biosimilars are introduced, this framework will serve as the foundation to educate and train oncology pharmacy staff.
Medication adherence and persistence among patients with non-small cell lung cancer receiving tyrosine kinase inhibitors and estimation of the economic burden associated with the unused medicines
Authors: Joret Romain , Matti Nazish , Beck Morgane , Michel Bruno
Published: April 2021

Background

Non–small cell lung cancer (NSCLC) is a leading cause of cancer deaths. Its treatment includes specific oral tyrosine kinases inhibitors (TKIs).

Objectives

To estimate adherence and persistence among patients receiving TKIs and to assess the economic burden of the unused medicines in Alsace (France).

Method

This retrospective study was carried out using the Insurance Healthcare database.

Main outcome measures

Adherence was calculated using medication possession ratio (MPR), persistence using estimated level of persistence with therapy (ELPT) and economic impact using prescription refill data.

Results

242 patients were receiving TKIs. The most common TKIs prescribed were erlotinib (75.6%, n = 183) and crizotinib (12.8%, n = 31). Total of 149 patients were included in the adherence analysis. Overall MPR was 0.98. 180 patients were included in the persistence analysis. Almost half of patients had stopped treatment at 60 days and only 38.3% (n = 69) were still persistent with the therapy at 120 days. The expenses related to unused TKIs amounted to €356,392 and were related majorly to treatment discontinuation followed by overlapping refills, patient deaths and dose- or drug-switching, respectively.

Conclusions

Our data indicated overall adherence medicines above the acceptable limit of 0.80 but also pointed out a significant decline in persistence over time. The resulting economic losses justify the need for physicians and pharmacists to closely monitor their patients to ensure continuity of treatment. To limit the cost associated with unused medicines, interventions such as app-based monitoring, dispensing TKIs per unit over shorter periods and not only on monthly intervals could be implemented.
Immune-checkpoint inhibitor toxicity during a pandemic: Overcoming patient fears to provide care. A case report
Authors: Elder Christopher T , Davis Elizabeth C , Jaipal Stephanie , Wight Charles E
Published: April 2021

Background

Pembrolizumab is a humanized monoclonal antibody that is used to treat a variety of cancers. It exerts its mechanism of action by blocking the programmed death receptor-1 (PD-1). Toxicity concerns include immune-related toxicities, including colitis, hepatitis, pneumonitis, nephritis, endocrine toxicities and more rarely, myocarditis and other organ system toxicities.

Objective

To review a real-world case involving immunotherapy induced myocarditis after a patient received pembrolizumab and discuss how the current pandemic created complexity in toxicity management.

Discussion

An 83 year old male with metastatic lung cancer developed fatal myocarditis after receiving 2 doses of pembrolizumab. Applying the Naranjo score, the likelihood of pembrolizumab causing the myocarditis is probable, with a score of 6. Severe cardiac toxicities are rare with pembrolizumab, but can still occur. It is vital to be aware of these toxicities, and educate patients on signs and symptoms. Complicating the situation even further was the global pandemic, which created fear and hesitation in the patient and the patient’s family to seek medical treatment out of fear of exposure. This pandemic adds another layer to the complexity of care for patients with cancer and management of toxicities. Pharmacists play a significant role in ensuring the safety and efficacy of medications, especially oncology agents.

Conclusion

Proper education of patients regarding symptoms and when to report are paramount to assisting in early detection and intervention for immunotherapy-related adverse events. New management and treatment strategies will need to be discussed and implemented considering the changing landscape around the SARS-CoV-2 pandemic.
Cuentos Combativos: Decolonialities in Puerto Rican Books About María
Authors: Torres Francisco L. , Medina Carmen L.
Published: April 2021

Guided by theories of racialization and through a decolonial analysis, we share findings on the examination of four children’s books written in Puerto Rico in the aftermath of Hurricane María. In engaging with these books, we situate our work in communal and research activist practices that foreground Puerto Ricans’ hidden stories and knowledges. Our initial analysis focuses on mapping the complex and contradictory constructions of diverse sociopolitical perspectives within a Puerto Rican imaginary around Hurricane María, communal and historical agency, and emerging resistance as decolonial literary acts. We then provide a more in-depth analysis of two texts, exploring the themes of estamos bien, delinking, one story/one people, and acción social. Findings highlight the need to engage with ruptures created by texts within decolonial imaginative spaces to improve literacy instruction.
“Past injustice and present prejudice”: Reducing racial bias and increasing sympathy by framing historical racism as recent
Authors: Burns Mason D. , Granz Erica L.
Published: April 2021

Racial privity judgments – or the perceived causal connection between historical racial discrimination and current suffering among Black Americans – predicts sympathy for the victims of past injustices and perceptions of contemporary racial inequality. Four studies investigated the ideological roots of privity judgments; focusing on subjective temporal perceptions associated with privity judgments (e.g., subjective perceptions that past discrimination occurred more, versus less, recently). Study 1 revealed that liberals perceived historical instances of racial discrimination as having occurred more recently than conservatives, and that temporal perceptions of recency were associated with less anti-Black bias. Studies 2–4 manipulated temporal perceptions of recency by framing past discrimination as having occurred more recently. Results revealed that increasing perceived temporal recency resulted in reduced anti-Black bias and greater sympathy for present-day victims of racial discrimination across political ideology. Discussion surrounds how framing historical information as subjectively recent has implications for prejudice reduction.
Optimal diameter of district heating pipe network based on the hybrid operation of distributed variable speed pumps and regulating valves
Authors: Bai Li , Liu Hongkai , Yu Chuck Wah , Yang Zhen
Published: April 2021

The district heating system that uses the hybrid operation of distributed variable speed pumps and regulating valves can effectively reduce the pressure level at the far-end of the heating network, while retaining the energy saving advantages of the distributed variable speed pump system and ensuring the safe operation of the heating network. In this study, pipe network optimization based on genetic algorithm was used to determine the pipe diameter required for the hybrid operation of distributed variable speed pumps and regulating valves. A mathematical model was established to evaluate the economic efficacy based on the annual equivalent cost. The zero-pressure difference point was evaluated to optimize the pipe diameter. A real pipe network was assessed to evaluate the efficacy of the method, and a sensitivity analysis of pressure constraints and economic factors was conducted. Our results show the system of hybrid operation of distributed variable speed pumps and regulating valves can reduce the annual equivalent cost by about 10.35% compared to the conventional central circulating pump system. In addition, the annual energy consumption due to heat loss and pump operation is only 0.36% higher than that of the conventional central circulating pump system.
Assessment of process parameters in a dehumidification process using biomass-based wood shaving as a packing material
Authors: Salins Sampath Suranjan , Reddy S. V. Kota , Kumar Shiva
Published: April 2021

In the current study, the performance of the counterflow dehumidification test rig using wood shaving packing has been analysed. Wood shaving packing with the density 500 kg/m3 was used along with the CaCl2 desiccant with varying concentration. Mass flow rate of air was varied and the dehumidification performance parameters like moisture removal rate, dehumidification efficiency, coefficient of performance, change in relative humidity, change in the pressure and mass transfer coefficient were evaluated. Output parameters were compared with the commercially available cellulose packing with the wettability of 632 m2/m3. Results showed that, even though the performance of wood shaving packing is slightly less than the Celdek packing, performance of wood shaving is promising at 40% desiccant solution concentration. Maximum relative humidity difference, coefficient of performance and dehumidification efficiency obtained with wood shaving pad material were found to be 19%, 1.88 and 69.5%, respectively.
Effectiveness of surgical residents compared to surgical faculty in teaching trauma evaluation and management
Authors: Rajan Meenakshi , Middleton Ravyn , Field Alyssa , Pineda Candace , Kiffin Niqqui , Rosenthal Andrew
Published: April 2021

Introduction

Senior medical students learn trauma principles in a 90-min interactive teaching session based on the trauma evaluation and management module designed by the American College of Surgeons. However, the number of surgical faculty available to conduct these interactive small group sessions is limited. The goal of this study is to compare the effectiveness of surgical residents to that of surgical faculty in teaching trauma principles.

Methods

53 senior medical students received trauma teaching from trauma faculty ( n = 22), trauma residents ( n = 21), or no teaching ( n = 10). Students were tested on cognitive trauma knowledge (20 multiple choice questions) and clinical trauma simulation (using objective structured clinical performance score). All students completed a 5-point subjective questionnaire.

Results

Students receiving trauma teaching outperformed students receiving no teaching in the knowledge test (mean 13.0 ± 3.6 standard deviation (SD) vs. 8.4 ± 2.4 SD, p < 0.05), while faculty and resident teaching outcomes were similar (mean 12.6 ± 3.0 SD vs. 13.4 ± 4.1, p = 0.45). Similarly, in the clinical trauma simulation, students receiving trauma teaching scored better (objective score mean 78% vs. 56%, p < 0.05), while there was no difference between faculty and resident teaching outcomes (objective score mean 77% vs. 80%, p = 0.52). In the subjective questionnaire, students who received trauma teaching rated themselves higher on a scale of 10 in trauma knowledge and skills than those who did not have formal teaching (mean 5.2 vs. 2.1, p < 0.05) as resident and attending teaching group ratings were similar.

Conclusions

Although small group discussions and increased simulation enhance undergraduate surgical trauma education, the number of faculty surgeons needed to fully incorporate these activities is limited. Objective and perceived effectiveness of teaching trauma management by surgical residents compared to trauma attendings is equivalent. This highlights the opportunity to incorporate residents into teaching roles to bridge the gap in undergraduate trauma education.
The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review
Authors: Harper Alexandra E , Terhorst Lauren , Moscirella Marybeth , Turner Rose L , Piersol Catherine V , Leland Natalie E
Published: April 2021

Background

Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers’ dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual’s care. However, little is known of the informal caregivers’ perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia.

Methods

In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com , CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes.

Results

We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances.

Conclusion

Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers’ perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers’ satisfaction with nursing home care for residents with dementia.
Fusion-based damage diagnostics for stiffened composite panels
Authors: Broer Agnes , Galanopoulos Georgios , Benedictus Rinze , Loutas Theodoros , Zarouchas Dimitrios
Published: April 2021

Conducting damage diagnostics on stiffened panels is commonly performed using a single SHM technique. However, each SHM technique has both its strengths and limitations. Rather than straining the expansion of single SHM techniques going beyond their intrinsic capacities, these strengths and limitations should instead be considered in their application. In this work, we propose a novel fusion-based methodology between data from two SHM techniques in order to surpass the capabilities of a single SHM technique. The aim is to show that by considering data fusion, a synergy can be obtained, resulting in a comprehensive damage assessment, not possible using a single SHM technique. For this purpose, three single-stiffener carbon–epoxy panels were subjected to fatigue compression after impact tests. Two SHM techniques monitored damage growth under the applied fatigue loads: acoustic emission and distributed fiber optic strain sensing. Four acoustic emission sensors were placed on each panel, thereby allowing for damage detection, localization, type identification (delamination), and severity assessment. The optical fibers were adhered to the stiffener feet’ surface, and its strain measurements were used for damage detection, disbond localization, damage type identification (stiffness degradation and disbond growth), and severity assessment. Different fusion techniques are presented in order to integrate the acoustic emission and strain data. For damage detection and severity assessment, a hybrid health indicator is obtained by feature-level fusion while a complementary and cooperative fusion of the diagnostic results is developed for damage localization and type identification. We show that damage growth can be monitored up until final failure, thereby performing a simultaneous damage assessment on all four SHM levels. In this manner, we demonstrate that by proposing a fusion-based approach toward SHM of composite structures, the intrinsic capacity of each SHM technique can be utilized, leading to synergistic effects for damage diagnostics.
Sub-surface metal loss defect detection using cold thermography and dynamic reference reconstruction (DRR)
Authors: Doshvarpassand Siavash , Wang Xiangyu , Zhao Xianzhong
Published: April 2021

Corrosion is considered a destructive phenomenon that affects almost all metals. Active infrared thermography is an online (no result delay) and non-intrusive (no process disruption) method of non-destructive testing (NDT), which has shown profound capabilities of detecting sub-surface metal loss. However, thermal reflections, non-uniform stimulation and lateral heat diffusion will remain as the most undesirable phenomena preventing the effective observation of sub-surface defects. This becomes more challenging when there is no a priori knowledge of the anomalies to effectively distinguish between defective and non-defective areas. In this work, cooling stimulation is considered as the thermal excitation mean as 1- a very few reports in this regard have been mentioned in the body of literature and 2- a dynamic setup was achieved that is found to be effective to minimise the possibility of disrupting reflections or artefacts registered by thermal camera similar to the case of using heating stimulation. A state-of-the-art prototype mechanism was manufactured. This equipment includes a carrier carrying a thermal camera and a cooling medium reservoir operating in reciprocating motion setup. This equipment is able to scan the test piece while cold stimulation is in operation, and immediately after that the camera registers the thermal evolution. An automated contrast enhancement pipeline using a variation of adaptive histogram equalisation (AHE) combined with principal component analysis (PCA) method was developed. The enhanced image results demonstrated the capability of accurately detecting sub-surface metal loss as low as 37.5% as well as an efficiently reconstructed reference (non-defective) area.
Modeling and experimental study of pore structure in melt-blown fiber assembly
Authors: Sun Guangwu , Chen Yu , Ruan Yanwen , Li Guanzhi , Hu Wenfeng , Xin Sanfa
Published: April 2021

It is widely known that the pore size of a meltblown fiber assembly extensively affects the final applications of its products. We have developed a model for simulating melt-blowing production to investigate the formation mechanism of a fiber assembly. In this study, we calculated the pore size under different production conditions using the model. The predicted results reveal the relationship between the pore size and the production conditions, namely, the air jet pressure, suction pressure, die temperature, polymer flow rate, die to collector distance, and collector speed. The predicted results also verified the experimental trends reported in previous studies. High air jet pressure and die temperature tend to generate smaller pores, while a large polymer flow rate, die to collector distance, and collector movement speed contribute to the production of larger pores in the fiber assembly. In addition, the circularity was predicted in this study to describe the pore shape. The numerical investigation of virtual production is a novel method in which the expected pore size and corresponding production conditions can be easily obtained using a computer with a few keystrokes and mouse clicks.
Utilizing Cognitive Processing Therapy to Treat Sexual Trauma with a Pakistani-American: A Case Report
Authors: Glowacki Christopher R. , Glowacki Zachary R.
Published: April 2021

There is a paucity of research of traditional psychotherapy approaches with individuals of South Asian descent, specifically Pakistani-Americans. In particular, there are very few cases in existing literature highlighting the effectiveness of Cognitive Processing Therapy (CPT) with Pakistani-Americans who have experienced sexual abuse. Due to cultural values, individuals of South Asian descent are less likely to pursue traditional psychotherapy and even far less likely to complete and/or benefit from it. The current case study focused on depression and trauma-related symptoms (e.g., guilt, shame, embarrassment) in the context of repeated sexual abuse for over 20 years. The PTSD Checklist (PCL-5) and Patient Health Questionnaire (PHQ-9) confirmed qualitative reports and therapist observations of improvement. This case suggests a westernized and protocol-driven treatment can be a viable intervention for individuals of SA descent with a history of sexual trauma. A strong therapeutic relationship and open discussion of diversity considerations were necessary for this treatment to work. This case reflects potential support for CPT as a treatment utilized across cultures for trauma-related symptoms.
Impact of Advanced Practice Provider Integration into Multispecialty Group Practices on Outcomes Following Major Surgery
Authors: Lai Lillian Y. , Kaufman Samuel R. , Modi Parth K. , Ellimoottil Chad , Oerline Mary , Caram Megan E.V. , Hollenbeck Brent K. , Shahinian Vahakn B.
Published: April 2021

Background. While advanced practice providers (APPs) are increasingly integrated into care delivery models, little is known about their impact in surgical settings. Given that many patients undergo surgery in multispecialty group practice settings, we examined the impact of APP integration into such practices on outcomes after major surgery. Methods. We used a 20% sample of national Medicare claims to identify 190 101 patients who underwent 1 of 4 major surgeries (coronary artery bypass graft [CABG], colectomy, major joint replacement, and cystectomy) at multispecialty group practices from 2010 through 2016. The level of APP integration was measured as the ratio of APPs to physicians within each practice. Rates of mortality, major complications, and readmission within 30 days of discharge after the index surgery were compared between patients treated in practices with low, medium, and high levels of APP integration using multivariable regression analysis. Results. Relative to patients treated in practices with low APP integration, those treated in practices with medium or high APP integration had significantly lower rates of mortality (2.4% [low integration] vs 1.9% [medium integration] vs 2.0% [high integration]; P < .01), major complications (34.1% [low] vs 31.2% [medium] vs 30.2% [high]; P < .01), and readmission (11.7% [low] vs 10.6% [medium] vs 10.1% [high]; P < .01). This relationship was consistent for virtually all outcomes when considering each surgery type individually. Conclusions. Integration of APPs into multispecialty group practices was associated with improved postoperative outcomes after major surgery. Future research should identify the mechanisms by which APPs improve outcomes to inform optimal utilization.
Ruins of Excess: Computer Game Images and the Rendering of Technological Obsolescence
Authors: Luersen Eduardo H , Fuchs Mathias
Published: April 2021

In this article, we describe three layers of ruins related to computer game technology: in a surface layer, we examine the imagery of ruins in digital games, highlighting game design tools for developing in-game ruination. Secondly, we approach the industrial design model of technological obsolescence as an infrastructural layer that intrinsically demands the production of new provisional spaces for material decay. Lastly, through a waste layer, we unfold the geopolitical dimension of technological obsolescence, calling attention to the transcontinental flows of electronic waste, which also underscores a geological stage of ruination. While exploring these different layers of ruins, we wish to perceive how game design models might relate to different forms of contemporary ruination, inquiring what such material traces have to say as strata of the complex deterioration processes of present-day media.
The Link Between the SAMFE and Police Perceptions of Victim Credibility
Authors: Yu Lilly , Walsh Kelly , Zweig Janine M.
Published: April 2021

While research has documented the evidentiary significance of sexual assault medical forensic exams (SAMFEs) to case processing, there has been less focus on SAMFEs’ relevance to extralegal case characteristics. This study, through focus groups with police officers and prosecutors, illuminates the link between two important case processing factors: the SAMFE and perceptions of victim credibility. The majority of respondent narratives about the utility of the SAMFE point to how it strengthens or weakens perceptions of victim credibility. This link points to the SAMFE’s important role in early case processing before investigators send DNA evidence for forensic testing.
The Great Recession and Physical Activity of Young Adults
Authors: Alam Shamma Adeeb , Bose Bijetri
Published: April 2021

Objective. Since physical inactivity has been identified as a pandemic and a public health priority, it is crucial to understand the role of adverse economic shocks on physical activity. In this study, we examine the impact of job losses during the U.S. Great Recession from January 2008 to June 2009 on the likelihood of physical activities of young adults. Methods. We use individual fixed effects estimation on a nationally representative longitudinal data from 2005 to 2015, the Panel Study of Income Dynamics (PSID), to examine the impact of job losses of young adults, their spouses, and their parents on physical exercise of young adults aged 18 to 27 years. Results. Own job losses during the Great Recession led to a decrease in the likelihood of physical exercise among young adults. However, job losses of parents and partners had no effect on the likelihood of young adults’ physical exercise. Conclusion. Our findings indicate a negative impact of the recession on physical activity of young adults and highlights the need for policymakers to consider the impact of major economic downturns on the physical activity of young adults.
Pipeline embolization of distal posterior inferior cerebellar artery aneurysms
Authors: Lauzier David C , Root Brandon K , Kayan Yasha , Almandoz Josser E Delgado , Osbun Joshua W , Chatterjee Arindam R , Whaley Kayla L , Tipps Megan E , Moran Christopher J , Kansagra Akash P
Published: April 2021

Background and purpose

Flow diversion is commonly used to treat intracranial aneurysms in various regions of the cerebral vasculature, but is only approved for use in the internal carotid arteries. Treatment of distal PICA aneurysms with PED is sometimes performed but has not been well studied. Here, we report our experience with flow diversion of distal PICA aneurysms with PED.

Materials and methods

Clinical and angiographic data of eligible patients was retrospectively obtained and assessed for key demographic characteristics and clinical and angiographic outcomes. Principal outcomes included rates of aneurysm occlusion, ischemic or hemorrhagic complication, technical complication, and in-stent stenosis.

Results

Three female and 2 male patients underwent placement of PED in the PICA for treatment of 5 distal PICA aneurysms. Clinical and angiographic follow-up was obtained for all patients. Complete aneurysm occlusion was observed in 100% (5/5) of treated aneurysms at 6 month and longest angiographic follow-up. While there were no ischemic or device-related complications, delayed hemorrhagic complications occurred in 20% (1/5) of patients.

Conclusion

Pipeline embolization of distal PICA aneurysms can be performed in select patients. Further study is necessary in larger cohorts to better define clinical scenarios in which flow diversion in the distal PICA should be considered.
A fuzzy DEMATEL-ANP-VIKOR analytical model for maintenance strategy selection of safety critical assets
Authors: Arjomandi Mohammad A , Dinmohammadi Fateme , Mosallanezhad Behzad , Shafiee Mahmood
Published: April 2021

In most industries, such as aerospace, manufacturing, transport and energy sectors, maintenance plays a vital role in improving the performance of safety critical equipment and facilities. It also helps industries achieve the largest possible efficiency, ensure workplace and environmental safety, and reduce unnecessary breakdowns and costs. Therefore, it is crucial for industries to adopt an optimal maintenance strategy for their critical systems and infrastructure. In this study, we aim to propose a novel analytical multi-criteria decision-making (MCDM) methodology for selecting the most suitable maintenance strategy in distillation units of oil refinery plants. The alternative maintenance strategies include run-to-failure (RTF), preventive maintenance (PM), condition-based maintenance (CBM), and reliability centered maintenance (RCM), which are evaluated with respect to 12 sub-criteria in three categories of economical, safety, and sustainability issues. The MCDM methodology consists of a DEMATEL-based analytic network process (ANP) method to determine the importance weights of decision criteria and a VIKOR method to rank the maintenance strategies. Also, interval type-2 fuzzy sets are used to capture uncertainty in experts’ individual judgments. Finally, a real case study is provided to show the applicability of the proposed methodology to an oil refinery plant. The results show that, thanks to advances in degradation modeling, sensor technology, and data analytics platforms, the RCM and CBM are the superior maintenance strategy for crude oil distillation systems.
The effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures (from the COMPLEX-CAS Trial)
Authors: Güner Ahmet , Çelik Ömer , Topel Çağdaş , Arif Yalçın Ahmet , Kalçık Macit , Uzun Fatih , Altunova Mehmet , Örten Murat , Akman Cemalettin , Güner Ezgi Gültekin , Ertürk Mehmet
Published: April 2021

Background

Carotid artery stenting is a minimally invasive, durable alternative treatment option, which is an alternative to the reference method, carotid endarterectomy, for patients with carotid artery stenosis; however, silent new ischemic cerebral lesions (SNICLs) after carotid artery stenting remain as a matter of concern. Hence, we aimed to assess the effect of complex vascular anatomy on silent new ischemic cerebral lesions in carotid artery stenting procedures.

Methods

We prospectively evaluated 122 patients (mean age: 69.5 ± 7.1 years, male:83) who underwent carotid artery stenting for carotid artery revascularization. The patients having symptomatic transient ischemic attack or stroke after carotid artery stenting were excluded. The presence of a new hyperintense lesions on diffusion-weighted imaging without any neurological findings was considered as the SNICL. Patients were classified into two groups as DWI-positive and DWI-negative patients.

Results

Among the study population, 32 patients (26.2%) had SNICLs. The DWI-positive group had a significantly higher common carotid artery (CCA)-internal carotid artery (ICA) angle, older age, more frequent history of stroke, a higher proportion of type III aortic arch, and longer fluoroscopy time than the DWI-negative group. High CCA-ICA angle was identified as one of the independent predictors of SNICL (OR (odds ratio) = 1.103 95%CI (confidence interval): (1.023–1.596); p = 0.034), and CCA-ICA angle higher than 34.5 degrees predicted SNICL with a sensitivity of 62.5% and a specificity of 62.2% (area under the curve: 0.680; 95% CI: 0.570 to 0.789; p = 0.003).

Conclusions

The higher CCA-ICA angle may predict pre-procedure SNICL risk in carotid artery stenting and may have clinical value in the management of patients with carotid artery stenosis.
Comparison of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers: Retrospective cohort with five-year follow-up
Authors: Kuserli Yusuf , Kavala Ali Aycan , Turkyilmaz Saygin
Published: April 2021

Objective

To compare the use of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers.

Methods

One hundred ninety-five ( n = 195) subjects who were treated for venous leg ulcers were enrolled between 2009 and 2014. Three groups were formed (Group A: high saphenous ligation and total stripping, Group B: radiofrequency ablation of the great saphenous vein + perforators, and Group C: radiofrequency ablation of the great saphenous vein + subfascial endoscopic perforator surgery) ( n = 65 for each group). The venous clinical severity score for baseline, 1st, 6th, and 12th months, great saphenous vein occlusion at the 1st, 6th, and 12th months, and ulcer rates for the 1st, 2nd, 3rd, 4th, and 5th years were recorded.

Results

For venous clinical severity score, only the first month decrease was significant for the subfascial endoscopic perforator surgery group ( p = 0.001). Great saphenous vein occlusion was higher at the 6th and 12th months for the high saphenous ligation and stripping and subfascial endoscopic perforator surgery groups than for the radiofrequency ablation group ( p = 0.036 and p = 0.037). The rate of ulcers for the subfascial endoscopic perforator surgery group was lower at the second, third, fourth, and fifth years ( p = 0.011). No significant difference was found between groups for the five-year recovery rates ( p > 0.05).

Conclusion

Subfascial endoscopic perforator surgery technique in conjunction with radiofrequency ablation of axial vein was superior to both high saphenous ligation and stripping and radiofrequency ablation of axial and perforators for ulcer healing.
Randomized comparison of two interventions to enhance understanding during the informed consent process for research
Authors: Taylor Holly A , Washington Daphne , Wang Nae-Yuh , Patel Hiten D. , Ford Daniel E. , Kass Nancy E , Ali Joseph
Published: April 2021

Background/Aims:

Many investigators have tested interventions to improve research participant understanding of information shared during the informed consent process, using a variety of methods and with mixed results. A valid criticism of most consent research is that studies are often conducted in simulated research settings rather than ongoing clinical studies. The present study rigorously tested two simple and easily adoptable strategies for presenting key consent information to participants eligible to enroll in six actual clinical trials (i.e. six parent studies).

Methods:

In collaboration with the study team from each parent study, we developed two consent interventions: a fact sheet and an interview-style video. The content of each of the intervention was based on the information shared in the consent form approved for each parent study. Participants were randomized to the standard consent process, or to one of the two interventions. Once exposed to the assigned consent mode, participants were asked to complete an assessment of understanding. The study was powered to determine whether those exposed to the fact sheet or video performed better on the consent assessment compared to those exposed to the standard consent. We also assessed participant satisfaction with the consent process.

Results:

A total of 284 participants were randomized to one of the three consent arms. Assessments of understanding were completed with a total of 273 participants from July 2017 to April 2019. Participants exposed to the video had better understanding scores compared to those exposed to the standard consent form process ( p value = 0.020). Participants were more satisfied with the video when compared to the standard consent. Participants who received the fact sheet did not achieve higher overall understanding or satisfaction scores when compared to the standard consent process.

Conclusion:

This randomized study of two novel consent interventions across six different clinical trials demonstrated a statistically significant difference in participant understanding based on overall scores among those exposed to the video intervention compared to those exposed to the standard consent.
Talent development in women’s cricket: Perceptions and practices of elite players and coaches
Authors: Lascu Alexandra , Spratford W , Pyne DB , Etxebarria N
Published: April 2021

Talent development is at the forefront of research in sport, where female athletes remain underrepresented. With ongoing success and rapid participation growth, there is an opportunity to describe and assess talent development in cricket for female athletes. Research in other sports recommends a holistic approach to talent development, where the connection between individual, task and environmental factors is maintained. A series of semi-structured interviews was conducted to draw from the experiential knowledge of 16 elite female athletes and 7 coaches alongside empirical knowledge regarding player development (individual), training task design and talent development environments. Both players and coaches reported positive early learning experiences, linear career trajectories and early entrance into talent programs, suggesting some early specialisation. Exposure to boy’s/men’s cricket appeared to fast-track skill development in players, and player skill adaptability was considered crucial to expert performance by both cohorts. Training design typically involved functional games-based scenarios, or misaligned task deconstruction in contrast to contemporary skill development practices. Aims for discrete stages of the pathway were ambiguous for both cohorts, potentially limiting the value they provide, and transition between stages appeared fluid to coaches in contrast to the rigidity described by players. Finally, growing professionalism in cricket for female athletes through greater investment, contracts and player support has propagated a skill gap between pathway stages identified by both cohorts, which needs addressing. Closing this skill gap can be achieved by improving coaching practices and support at the amateur levels of cricket to develop the next generation of elite female cricketers.
Trends in operative duration of total shoulder arthroplasty from 2008 to 2018: a national database study
Authors: Testa Edward J , Lemme Nicholas J , Li Lambert T , DeFroda Steven
Published: April 2021

Background

As total shoulder arthroplasty has emerged as the fastest growing joint replacement performed, optimizing surgical efficiency and patient outcomes is essential. The goals of the current study were to identify trends and factors affecting the operative time of total shoulder arthroplasty over a 10-year period.

Methods

The National Surgical Quality Improvement Program database was analyzed to determine the operative time and 30-day complications of total shoulder arthroplasty from 2008 to 2018. Factors affecting total shoulder arthroplasty operative time were also assessed. Multivariable linear regression was used to analyze operative time over years studied while controlling for patient demographics and comorbidities.

Results

A total of 20,587 total shoulder arthroplasty cases from 2008 to 2018 were included. Mean operative time in 2008 was 139.0 min, while in 2018, mean operative time decreased to 105.6 min (P < .001). Male sex, outpatient surgery, increased body mass index, and low preoperative hematocrit were associated with longer operative times, while elevated international normalized ratio, resident involvement, and elective surgeries were associated with decreased operative duration.

Discussion

Operative time for total shoulder arthroplasty has decreased from 2008 to 2018. Patient factors and comorbidities are associated with operative time, and such factors are important to consider in operative planning to ensure appropriate patient and surgeon expectations.
Efficacy of Autologous Platelet-Rich Plasma Injections for Grade 3 Symptomatic Degenerative Meniscal Lesions: A 1-Year Follow-up Prospective Study
Authors: Alessio-Mazzola Mattia , Felli Lamberto , Trentini Roberto , Formica Matteo , Capello Andrea Giorgio , Lovisolo Stefano , Maffulli Nicola
Published: April 2021

Background:

Platelet-rich plasma (PRP) injections have been proposed as a biologic option to provide symptomatic relief and delay surgery in patients with degenerative joint disease of osteoarthritis (OA). The efficacy of autologous PRP on symptomatic degenerative meniscal lesions (DMLs) has never been investigated.

Hypothesis:

We hypothesized that patients with symptomatic DMLs without OA undergoing autologous PRP injections experience a significant clinical improvement at 12 months.

Study Design:

Prospective case series.

Level of Evidence:

Level 4.

Methods:

A total of 69 patients with symptomatic DMLs without radiographic evidence of knee OA (Kellgren-Lawrence radiographic grading scale 0-1) received 4 autologous PRP injections once a week. Patients were prospectively evaluated before the injection and then at 1, 3, 6, and 12 months. Evaluation was based on Lysholm knee scoring scale (primary outcome), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Tegner activity scale, and visual analogue scale scores.

Results:

Patients treated with PRP injections demonstrated an improving knee function and symptoms over the duration of the study. A significant improvement from baseline to 12 months was observed in all the outcome measures, and no patients experienced failure or required surgery during the follow-up. Patients younger than 50 years reported lower subjective level of pain and higher Tegner activity scale at baseline and had significantly better Lysholm knee scoring scale ( P = 0.03) and WOMAC ( P = 0.03) scores at 6 months, as well as better range of motion at 3, 6, and 12 months ( P < 0.001). Thirty-three (47.8%) patients were very satisfied, 26 (37.7%) satisfied, 8 (11.6%) partially satisfied, and 2 (2.9 %) not satisfied, with 62 (89.8%) patients willing to repeat the same treatment. No patient was lost to follow-up and no patient experienced adverse reaction, infection, failure, recurrence or underwent further surgery.

Conclusion:

PRP injections provide short-term benefits in symptomatic DMLs. Although promising results were evident at 12 months, this is a preliminary study and no definitive recommendation can be made based, for example, on longer follow-up.

Clinical Relevance:

This research supports the use of autologous PRP injections for symptomatic DMLs.
Amiodarone-induced thyroid dysfunction in children: insights from the THYRAMIO study
Authors: Montenez Sarah , Moniotte Stéphane , Robert Annie , Desmet Lieven , Lysy Philippe A.
Published: April 2021

Background:

Amiodarone treatment is effective against various types of arrhythmias but is associated with adverse effects affecting, among other organs, thyroid function. Amiodarone-induced thyroid dysfunction was not thoroughly evaluated in children as it was in adults, yet this affection may lead to irreversible neurodevelopmental complications. Our study aimed to define the incidence and risk factors of amiodarone-induced thyroid dysfunction in children.

Methods:

The study was designed as an observational study with a retrospective clinical series of 152 children treated by amiodarone in the Pediatric Cardiology Unit of our center from 1990 to 2019. All patients were divided into three groups according to their thyroid status: euthyroid, AIH (amiodarone-induced hypothyroidism) or AIT (amiodarone-induced thyrotoxicosis). Patients from these three groups were compared in terms of key clinical and therapeutic features.

Results:

Amiodarone-induced thyroid dysfunction was present in 23% of patients. AIT (5.3%) was three times less common than AIH (17.7%), and its occurrence increased with older age ( p < 0.05), treatment dosage ( p < 0.05), treatment duration ( p < 0.05) and the number of loading doses administered ( p < 0.05). There were no distinctive clinical features between euthyroid and AIH groups. A multivariable prediction model of AIT was built, with a yield of 66.7% as positive predictive value and 96.7% as negative predictive value.

Conclusion:

We observed that one in five children developed amiodarone-induced thyroid dysfunction. Special attention is required for older children with a high dosage and long-term therapy and who received a large number of loading doses, since these children are at risk to develop AIT, which is more delicate to manage than AIH.
MicroRNA in Human Acute Kidney Injury: A Systematic Review Protocol
Authors: Douvris Adrianna , Burger Dylan , Rodriguez Rosendo A. , Clark Edward G. , Viñas Jose , Lalu Manoj M. , Shorr Risa , Burns Kevin D.
Published: April 2021

Background:

Acute kidney injury (AKI) is a common complication of hospitalization with high morbidity and mortality for which no effective treatments exist and for which current diagnostic tools have limitations for earlier identification. MicroRNAs (miRNAs) are small non-coding RNAs that have been implicated in the pathogenesis of AKI, and some miRNAs have shown promise as therapeutic tools in animal models of AKI. However, less is known about the role of miRNAs in human AKI.

Objective:

To evaluate the role of miRNAs in human subjects with AKI.

Design:

Systematic review and meta-analysis

Measurements:

Quantification of miRNA levels from human blood, urine, or kidney biopsy samples, and measures of renal function as defined in the study protocol.

Methods:

A comprehensive search strategy for Ovid MEDLINE All, Embase, Web of Science, and CENTRAL will be developed to identify investigational studies that evaluated the relationship between miRNA levels and human AKI. Primary outcomes will include measurements of kidney function and miRNA levels. Study screening, review and data extraction will be performed independently by 2 reviewers. Study quality and certainty of evidence will be assessed with validated tools. A narrative synthesis will be included and the possibility for meta-analysis will be assessed according to characteristics of clinical and statistical heterogeneity between studies.

Limitations:

These include (1) lack of randomized trials of miRNAs for the prevention or treatment of human AKI, (2) quality of included studies, and (3) sources of clinical and statistical heterogeneity that may affect strength and reproducibility of results.

Conclusion:

Previous studies of miRNAs in different animal models of AKI have generated strong interest on their use for the prevention and treatment of human AKI. This systematic review will characterize the most promising miRNAs for human research and will identify methodological constraints from miRNA research in human AKI to help inform the design of future studies.

Systematic review registration:

PROSPERO CRD42020201253