bluuebunny/crossref_metadata_2025 huggingface dataset:
Partnerships Keep Children Learning During COVID-19
Authors: Epstein Joyce L.
Published: December 2020

While Zoom classes may work at the college level, they don’t work for all students. For PreK-12 students, educators quickly realized a dramatic and disruptive digital divide among families and students in economically-stressed urban and rural communities across the country. At the start of the 20-21 school year, with COVID-19 continuing, it is imperative to resolve the technology challenge to connect with all families and help all students keep learning.
Radical Compassion
Authors: Van Cleve Nicole Gonzalez
Published: December 2020

Nicole Gonzalez Van Cleve on Radical Compassion in Sociology.
Understanding how early childhood educators ‘see’ learning through digitally cast eyes: Some preliminary concepts concerning the use of digital documentation platforms
Authors: White E Jayne , Rooney Tonya , Gunn Alexandra C , Nuttall Joce
Published: December 2020

This paper reports from a pilot study investigating the ways digital documentation platforms are changing educators’ work in early childhood education. Digital documentation platforms are secure websites or application software, enabled by computer, smartphone, or tablet technologies, allowing educators to record observations of children’s learning as text or in visual forms, to which interpretations or commentary from educators, family members, and children are added. This paper examines how these platforms orient the ways educators see and articulate young children’s learning. Video stimulated recall interviews with educators (six in total) at four ECE sites across Australia and New Zealand were analysed. Key concepts are offered in relation to how digital platforms shape the learning that is seen by early childhood educators: tag-ability, trackability, completeness, and co-constitution. Each of these concepts is problematised in relation to contemporary ECE practices and the persuasiveness and ubiquity of the visual in discourses of documentation.
Policymakers’ Logic on Islamic Banking: Islamic Banking as an Ethno-Political Tool in Malaysia
Authors: Kitamura Hideki
Published: December 2020

Social scientists have long sought to understand what Islamic banking is. This study seeks to answer this question by exploring the neoliberalisation process of Islamic banking policies in Malaysia and identifying policymakers’ logic behind this process. For this purpose, this study conducted interviews with actors associated with Bank Negara Malaysia (BNM), the central bank of Malaysia. The findings demonstrate that, in the neoliberal era, BNM quietly and continuously pursued the goal of preferably giving economic opportunities to Malay Muslims by establishing institutional mechanisms rather than by offering preferential treatment in a straightforward manner. The Shariah nature of Islamic banking served to conceal this goal from the public. I define Islamic banking as an ethno-political tool rather than simply as a religious economy and contend that the philosophy of Islamic banking as a moral economy conceals an agenda of protecting Malay interests.
Reduction of Opioid Prescriptions in Maxillofacial Trauma Following North Carolina STOP Act
Authors: Curtis Caitrin , Scarcella Joshua , Viscardi Chelsea , Samia Arthur , Zeri Richard , Guo Yifan
Published: December 2020

Study Design:

Retrospective cohort study

Objective:

On January 1, 2018, the Strengthen Opioid Misuse Prevention (STOP) Act was implemented to increase oversight over opioid prescriptions in North Carolina. The aim of this study is to evaluate the legislation’s efficacy in reducing opioid prescriptions following facial fracture repair.

Methods:

A retrospective chart review of patients who sustained maxillofacial fractures and underwent repair from January 1, 2015 through December 31, 2019 at a level 1 trauma center was performed. The North Carolina Controlled Substance Database was used to quantify perioperative opioid prescriptions in morphine milligram equivalents (MME). Average MME per patient was compared between 2 groups, patients who underwent surgery before the NC STOP Act came into effect and patients who underwent treatment after. This comparison was also performed on case type subgroups including surgically treated fractures of the orbit, mandible, midface, and multiple regions. A student’s t-test was used to compare before and after groups in all analyses.

Results:

Of the 253 patients who met inclusion criteria, 146 were in the before group, and 107 were in the after group. There was a statistically significant, 30.9% decrease in overall average MME prescribed after the NC STOP Act was enacted. A statistically significant decrease was noted in patients who had facial fractures of multiple regions.

Conclusion:

Since the implementation of the NC STOP Act in 2018, there have been statistically and clinically significant decreases in the amount of opioids prescribed following surgical management of facial fractures.
BMP2 Is Required for Postnatal Maintenance of Osteochondral Tissues of the Temporomandibular Joint
Authors: O’Brien Mara H. , Dutra Eliane H. , Mehta Shivam , Chen Po-Jung , Yadav Sumit
Published: December 2020

Objective

Bone morphogenetic protein 2 (BMP2) plays important roles in cartilage growth and development. Paradoxically, elevated levels of BMP2 leads to hypertrophic differentiation and osteoarthritis of cartilage. We examined the in vivo loss of BMP2 in cells expressing aggrecan of the mandibular condyle and knee.

Design

Three-week-old BMP2 flox/flox- CreER-positive mice and their Cre-negative littermates were treated with tamoxifen and raised until 3 or 6 months. We also investigated the direct effects of BMP2 on chondrocytes in vitro. Cells from the mandibular condyle of mice were treated with recombinant human BMP2 (rhBMP2) or rhNoggin (inhibitor of BMP2 signaling).

Results

Conditional deletion of BMP2 caused breakage of the cartilage integrity in the mandibular condyle of mice from both age groups, accompanied by a decrease in cartilage thickness, matrix synthesis, mineralization, chondrocyte proliferation, and increased expression of degeneration markers, while the effects at articular cartilage were not significant. In vitro results revealed that rhBMP2 increased chondrocyte proliferation, mineralization, and differentiation, while noggin induced opposite effects.

Conclusions

In conclusion, BMP2 is essential for postnatal maintenance of the osteochondral tissues of the mandibular condyle.
Hyperacute intracranial hemorrhage with extensive contrast extravasation and rapid hematoma expansion imaged at onset with magnetic resonance imaging
Authors: Trunz Lukas M , Talekar Kiran S , Stein Asher , Karambelkar Ajit
Published: December 2020

Evaluation for intracranial hemorrhage is a common indication when performing imaging of the head in the emergency setting. We present a rare case of active, spontaneous extravasation of blood into the brain parenchyma, which evolved during a magnetic resonance imaging examination. A 70-year-old woman who had no previous history of hypertension or trauma underwent magnetic resonance imaging of the brain for confusion and dysarthria. Initial imaging sequences did not demonstrate an acute cerebral hemorrhage; however, subsequent fluid-attenuated inversion recovery, T2- and T1-weighted sequences demonstrated a progressively enlarging signal abnormality. Extravasation of contrast was noted after the administration of gadolinium-based contrast, indicating active intraparenchymal hemorrhage. A computed tomography scan was performed after magnetic resonance imaging to confirm the findings.
COVID-19: Implications for bipolar disorder clinical care and research
Authors: Xue Siqi , Husain M Ishrat , Ortiz Abigail , Husain M Omair , Daskalakis Zafiris J , Mulsant Benoit H
Published: December 2020

The COVID-19 pandemic has posed significant challenges to health care globally, and individuals with bipolar disorder are likely disproportionally affected. Based on review of literature and collective clinical experience, we discuss that without special intervention, individuals with bipolar disorder will experience poorer physical and mental health outcomes due to interplay of patient, provider and societal factors. Some risk factors associated with bipolar disorder, including irregular social rhythms, risk-taking behaviours, substantial medical comorbidities, and prevalent substance use, may be compounded by lockdowns, social isolation and decrease in preventive and maintenance care. We further discuss implications for clinical research of bipolar disorders during the pandemic. Finally, we propose mitigation strategies on working with individuals with bipolar disorder in a clinical and research context, focusing on digital medicine strategies to improve quality of and accessibility to service.
Soft Femme Theory: Femme Internet Aesthetics and the Politics of “Softness”
Authors: Schwartz Andi
Published: December 2020

Twenty years ago, the figure of the femme appeared on a book cover wielding a knife; more recently, the femme has appeared on Instagram crying in a Polly Pocket skirt. Online, femme is increasingly called “tender,” “radically vulnerable,” and “soft.” In this article, I examine soft femme digital culture on Instagram, and argue that the discourse of “softness” is used to articulate belonging and to resist neoliberal, masculinist logics. Through an analysis of Instagram images and interviews with femmes, I develop an understanding of softness as a combination of emotionality, vulnerability, relationality, and hyperfemininity. I argue that soft femme is an aesthetic form and a theoretical position that expands the category of femme to be more inclusive of diverse subjects. Soft femme theory fills the gaps in femme theory left by critiques of existing femme identity theory that centers performance, irony, and the figure of the hard femme. Through the discourse of softness, femme becomes something one can be like, rather than something one just looks like.
Intraperitoneal injection of ketamine enhances apoptosis in urothelium via autophagy in rats
Authors: Wei Liqin , Wu Jitao , Li Danxia , Shan Zhengfei
Published: December 2020

Ketamine abusing is associated with ulcerative cystitis, but the mechanisms remain unclear. This study aimed to investigate the existence of ketamine-induced symptom in a rat model and evaluate the underlining mechanisms. Sprague-Dawley rats were chosen and randomly divided into 12 groups (n = 8), such as the control group, low dose of ketamine (10 mg/kg/day), middle dose of ketamine (30 mg/kg/day) and high dose of ketamine (50 mg/kg/day) groups. The experimental groups were administrated ketamine i.p. daily, whereas the control groups were administrated with saline. After 1, 3, and 6 months of treatment, the bladder tissues were collected. Haematoxylin and eosin (HE) staining and a transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay were used to evaluate the bladder epithelium pathology and urothelial apoptosis, respectively. The protein expression levels of LC3, p62, Beclin1 were assessed by Western blotting. HE staining results of the experimental rats showed the bladder tissue denudation of the urothelial epithelium with edema and congestion compared with the control groups. TUNEL staining showed a significantly higher number of apoptotic cells in experimental groups than in the control groups. The protein LC3 and Beclin1 had significantly higher levels compared with control groups. The protein p62 had lower levels compared with control groups. The expression levels correlated with contraction of ketamine and treatment time. HE staining, TUNEL staining and Western blot results showed dose-dependent, time-dependent autophage in ketamine-treated rats. All the results suggested that autophagy proteins might be involved in inflammatory response in rats.
The complexity of caregiving for community-living older adults with multiple chronic conditions: A qualitative study
Authors: Ploeg Jenny , Garnett Anna , Fraser Kimberly D , Baird Lisa Garland , Kaasalainen Sharon , McAiney Carrie , Markle-Reid Maureen , Dufour Sinéad
Published: December 2020

Background:

Older adults with multiple chronic conditions (MCC) rely heavily on caregivers for assistance with care. However, we know little about their psychosocial experiences and their needs for support in managing MCC. The purpose of this study was to explore the experiences of caregivers of older adults living in the community with MCC.

Methods:

This qualitative study was a secondary analysis of previously collected data from caregivers in Ontario and Alberta, Canada. Participants included caregivers of older adults (65 years and older) with three or more chronic conditions. Data were collected through in-depth, semi-structured interviews. Interview transcripts were coded and analyzed using Thorne’s interpretive description approach.

Results:

Most of the 47 caregiver participants were female (76.6%), aged 65 years of age or older (61.7%), married (87.2%) and were spouses to the care recipient (68.1%). Caregivers’ experiences of caring for community-living older adults with MCC were complex and included: (a) dealing with the demands of caregiving; (b) prioritizing chronic conditions; (c) living with my own health limitations; (d) feeling socially isolated and constrained; (e) remaining committed to caring; and (f) reaping the rewards of caregiving.

Conclusions:

Healthcare providers can play key roles in supporting caregivers of older adults with MCC by providing education and support on managing MCC, actively engaging them in goal setting and care planning, and linking them to appropriate community health and social support services. Communities can create environments that support caregivers in areas such as social participation, social inclusion, and community support and health services.
Invasive Subacute Pulmonary Aspergillosis After Puerperal Sepsis: Case Report
Authors: Briones-Claudett Killen H. , Briones-Claudett Mónica H. , Murillo Vasconez Roger Alexander , Alfonzo Pacheco María F. , Martinez Armijo Eduardo Andres , Briones Zamora Killen H. , Briones Marquez Diana C. , Franco Chávez Diana , Grunauer Michelle
Published: December 2020

Subacute invasive aspergillosis is an infection that locally destroys lung parenchyma, and it affects patients with mild immunocompromise. The diagnosis is made by clinical symptoms, imaging, and laboratory results related to the infection. Early diagnosis and treatment is imperative for a favorable patient outcome. In this article, we present the case of a 19-year-old woman who was admitted to the intensive care unit for puerperal sepsis where a hysterectomy was performed. During her hospitalization, she presented atelectasis of the left lung and hemodynamic instability. Chest X-ray and chest computed tomography scan were performed and showed round opacities. It was decided to perform flexible bronchoscopy with bronchoalveolar lavage. An unusual subacute form of implementation of aspergillosis was confirmed by a bronchoalveolar lavage culture that showed the presence of Aspergillus. Images taken during bronchoscopy revealed Aspergillus implantation in the lung and serum galactomannan antigen test was positive. Voriconazole was introduced, 200 mg daily. The patient showed clinical improvement and was discharged from our hospital. We conclude that subacute invasive aspergillosis is a serious infection that can lead to high mortality. Bronchoscopy with bronchoalveolar lavage allows access and effective visualization of the airway as well as sampling for Aspergillus identification.
A Rare Sonographic Case of Caudal Duplication Versus Polymelia
Authors: Scholl Cathie , Thacker Pamala
Published: December 2020

Caudal duplication is a rare condition that results in varying degrees of duplication of organs within the gastrointestinal, genitourinary, reproductive, spinal, and vertebral systems. Polymelia is a rare congenital defect that presents as supernumerary limbs. This case report describes a fetus with characteristics of both conditions but does not present with the classic scenario of either condition.
Impact of COVID-19 on health-related quality of life in patients with cardiovascular disease: a multi-ethnic Asian study
Authors: Lim Shir Lynn , Woo Kai Lee , Lim Eleanor , Ng Faclin , Chan Mark Y. , Gandhi Mihir
Published: December 2020

Background

Little is known about the impact of the global coronavirus disease-2019 (COVID-19) pandemic on patients with cardiovascular disease (CVD), the biggest global killer and major risk factor for severe COVID-19 infections. We aim to explore the indirect consequences of COVID-19 on health-related quality of life (HRQoL) of patients with CVD.

Methods

Eighty-one adult outpatients with CVD were assessed using the EQ-5D, a generic health status instrument with five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression), before and during the pandemic. Changes in the EQ-5D dimensional responses were compared categorically as well as using the dimension-specific sum-score (range 1–3, with a higher score indicating worse health). The responses and sum-score were compared using the exact test of symmetry and the pairedt-test, respectively.

Results

These patients [mean age (SD) 59.8 (10.5); 92.6% males; 56% New York Heart Association (NYHA) functional class I] had coronary artery disease (69%), heart failure (28%), or arrhythmias (15%). None experienced change in NYHA class between assessments. About 30% and 38% of patients reported problems with at least one of the EQ-5D dimensions pre-pandemic and during the pandemic, respectively. The highest increase in health problems was reported for anxiety/depression (12.5% pre-pandemic vs 23.5% during pandemic;p = 0.035) with mean domain-specific score from 1.12 (SD 0.33) to 1.25 (SD 0.46) (standardized effect size = 0.373,p = 0.012). There was no meaningful change in other dimensions as well as overall HRQoL.

Conclusion

The COVID-19 pandemic is associated with a significant worsening of the mental health of patients with CVD.
Post-resuscitation shock: recent advances in pathophysiology and treatment
Authors: Jozwiak Mathieu , Bougouin Wulfran , Geri Guillaume , Grimaldi David , Cariou Alain
Published: December 2020

A post-resuscitation shock occurs in 50–70% of patients who had a cardiac arrest. It is an early and transient complication of the post-resuscitation phase, which frequently leads to multiple-organ failure and high mortality. The pathophysiology of post-resuscitation shock is complex and results from the whole-body ischemia–reperfusion process provoked by the sequence of circulatory arrest, resuscitation manoeuvers and return of spontaneous circulation, combining a myocardial dysfunction and sepsis features, such as vasoplegia, hypovolemia and endothelial dysfunction. Similarly to septic shock, the hemodynamic management of post-resuscitation shock is based on an early and aggressive hemodynamic management, including fluid administration, vasopressors and/or inotropes. Norepinephrine should be considered as the first-line vasopressor in order to avoid arrhythmogenic effects of other catecholamines and dobutamine is the most established inotrope in this situation. Importantly, the optimal mean arterial pressure target during the post-resuscitation shock still remains unknown and may probably vary according to patients. Mechanical circulatory support by extracorporeal membrane oxygenation can be necessary in the most severe patients, when the neurological prognosis is assumed to be favourable. Other symptomatic treatments include protective lung ventilation with a target of normoxia and normocapnia and targeted temperature management by avoiding the lowest temperature targets. Early coronary angiogram and coronary reperfusion must be considered in ST-elevation myocardial infarction (STEMI) patients with preserved neurological prognosis although the timing of coronary angiogram in non-STEMI patients is still a matter of debate. Further clinical research is needed in order to explore new therapeutic opportunities regarding inflammatory, hormonal and vascular dysfunction.
Association of information, education, and communication with enrolment in health insurance: a case of Nepal
Authors: Acharya Devaraj , Devkota Bhimsen , Gautam Kamal , Bhattarai Radha
Published: December 2020

Background

Many studies indicate that various health programmes have been failed because of the lack of appropriate information, education, and communication [IEC] for the target audiences. It is still unanswered which methods/means of communication could be the most powerful for changing behaviour or decision-making capacity. The paper aims to assess the effects of IEC on family enrolment in health insurance programme [HIP] in Nepal.

Methods

We employed a household-based observational study with a control group. Altogether 810 household interviews were conducted in Baglung and Kailali districts of Nepal in 2018. The study used a validated structured interview schedule. Background characteristics of the family and respondents and their exposure to the means of communication were the independent variables while enrolment in health insurance [HI] was the dependent variable.

Results

Data showed that 72% of the respondents heard about the HI and 66% knew the contribution amount for enrolment in HI. In the total enrolled households, 53% were household heads, 59% belonged to the age group 41–60 and 68% were above 60 years. More than half (56%) of rich compared to 46 and 49% of middle and poor (p < 0.05); 60% of the family member suffering from the chronic disease were enrolled in the HI. Similarly, 68% of those who heard about HI compared to 4 % who did not hear were enrolled (p < 0.001). A vast majority (69%) of those knowing contribution amount, 73% who interact with peer neighbour compared to 39% who did not, and 62% of those who listened to the radio and 63% of those who watched TV were enrolled in HI (p < 0.001). However, heard about HI (aOR = 21.18, 95%CI: 10.17–44.13, p < 0.001), knowledge about contribution amount (aOR = 5.13, 95%CI: 3.09–8.52, p < 0.001), having HI related books or guidelines (aOR = 4.84, 95%CI: 2.61–8.98, p < 0.001), and interact with peer or neighbours (aOR = 1.74, 95%CI: 1.34–2.65, p < 0.01) were appeared to be positive and significant predictors for enrolment in HI.

Conclusion

Knowledge about HI and interaction with peers and neighbours about the HI scheme of the government could lead to higher participation in the HIP. It would be better to incorporate this strategy while planning interventions for increasing enrolment in the HIP.
Socio-demographic and clinical predictors of outcome to long-term treatment with lithium in bipolar disorders: a systematic review of the contemporary literature and recommendations from the ISBD/IGSLI Task Force on treatment with lithium
Authors:   On behalf of the ISBD-IGSLI Joint Task Force on Lithium Treatment, Grillault Laroche Diane , Etain Bruno , Severus Emanuel , Scott Jan , Bellivier Frank
Published: December 2020

Objective

To identify possible socio-demographic and clinical factors associated with Good Outcome (GO) as compared with Poor Outcome (PO) in adult patients diagnosed with Bipolar Disorder (BD) who received long-term treatment with lithium.

Methods

A comprehensive search of major electronic databases was performed to identify relevant studies that included adults patients (18 years or older) with a diagnosis of BD and reported sociodemographic and/or clinical variables associated with treatment response and/or with illness outcome during long-term treatment to lithium (> = 6 months). The quality of the studies was scored using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies from the National Institute of Health.

Results

Following review, 34 publications (from 31 independent datasets) were eligible for inclusion in this review. Most of them (n = 25) used a retrospective design. Only 11 studies were graded as good or borderline good quality. Forty-three potential predictors of outcome to lithium were identified. Four factors were associated with PO to lithium: alcohol use disorder; personality disorders; higher lifetime number of hospital admissions and rapid cycling pattern. Two factors were associated with GO in patients treated with lithium: good social support and episodic evolution of BD. However, when the synthesis of findings was limited to the highest (good or borderline good) quality studies (11 studies), only higher lifetime number of hospitalization admissions remained associated with PO to lithium and no associations remained for GO to lithium.

Conclusion

Despite decades of research on lithium and its clinical use, besides lifetime number of hospital admissions, no factor being consistently associated with GO or PO to lithium was identified. Hence, there remains a substantial gap in our understanding of predictors of outcome of lithium treatment indicating there is a need of high quality research on large representative samples.
Ultradeep targeted sequencing reveals low allele frequencies of somatic JAK2 and MPL variants in patients with abdominal vein thromboses: results of an ongoing prospective prevalence study in Mecklenburg-West Pomerania
Authors: Grunwald Luise , Grosse-Thie Christina , Sender Sina , Knuebel Gudrun , Krohn Saskia , Roolf Catrin , Junghanss Christian , Henze Larissa , Murua Escobar Hugo
Published: December 2020

Myeloproliferative neoplasms are characterized by mutations in JAK2, MPL and CALR genes. Commonly in diagnostics and previous studies mainly sequencing and common PCR techniques under conventional detection limits are used.

Splanchnic vein thromboses are rare, but often appear associated with myeloproliferative neoplasms and represent serious complications.

Herein, blood from patients with abdominal vein thromboses in Mecklenburg-West Pomerania (federal district of northern Germany), included in an ongoing prospective prevalence study, was analyzed by next generation sequencing representing the complete protein coding regions of JAK2, MPL and CALR genes with a coverage of > 2000 reads, therefore an ultradeep targeting approach.

JAK2 V617F mutations were detected in 11/44 patients. In four of these cases allele frequencies ranged below the conventional cut off of 2%. MPL W515R was detected in 3/44 cases in low frequencies.

Very low allele frequencies of JAK2 and MPL variants in patients with abdominal vein thromboses may indicate early manifestations of myeloproliferative neoplasms.
Sex-biased topography effects on butterfly dispersal
Authors: Plazio Elisa , Bubová Terezie , Vrabec Vladimír , Nowicki Piotr
Published: December 2020

Background

Metapopulation persistence in fragmented landscapes is assured by dispersal of individuals between local populations. In this scenario the landscape topography, although usually neglected, may have an important role in shaping dispersal throughout the matrix separating habitat patches. Due to inter-sexual differences in optimal reproductive strategies, i.e., males maximizing the number of mating opportunities and females maximizing the offspring survival chances, topography-related constraints are expected to exert a different effect on male and female dispersal behaviour. We tested sex-biased topography effects on butterfly dispersal, with the following hypotheses: (1) females are constrained by topography in their movements and avoid hill crossing; (2) male dispersal is primarily driven by two-dimensional spatial structure of the habitat patches (i.e. their geometric locations and sizes) and little influenced by topography.

Methods

Following intensive mark-recapture surveys ofMaculinea(=Phengaris)nausithousandM. teleiuswithin a landscape characterised by an alternation of hills and valleys, we investigated sex-specific patterns in their inter-patch movement probabilities derived with a multi-state recapture model. In particular, we (1) analysed the fit of dispersal kernels based on Euclidean (= straight line) vs. topography-based (= through valley) distances; (2) compared movement probabilities for the pairs of patches separated or not by topographic barriers; and (3) tested the differences in the downward and upward movement probabilities within the pairs of patches.

Results

Euclidean distances between patches proved to be a substantially stronger predictor of inter-patch movement probabilities in males, while inter-patch distances measured along valleys performed much better for females, indicating that the latter tend to predominantly follow valleys when dispersing. In addition, there were significantly lower probabilities of movements across hills in females, but not in males.

Conclusions

Both above results provide support for the hypothesis that topography restricts dispersal in females, but not in males. Since the two sexes contribute differently to metapopulation functioning, i.e., only female dispersal can result in successful (re)colonisations of vacant patches, the topography effects exerted on females should be considered with particular attention when landscape management and conservation actions are designed in order to maintain the functional connectivity of metapopulation systems.
Non-cardiac surgery in congenital heart disease-associated pulmonary arterial hypertension: risk recognition and management
Authors: Constantine Andrew , Clift Paul
Published: December 2020

Background

Current guidelines for the peri-operative assessment and management are not sufficient to allow effective risk assessment and management of the patient with pulmonary arterial hypertension associated with congenital heart disease. Well-established risk stratification tools are not validated in this group. Additional, disease-specific risks require individualised, specialist, multidisciplinary management.

Case presentation

We present an illustrative clinical case of patients with pulmonary arterial hypertension associated with congenital heart disease undergoing non-cardiac surgery. The case follows a 66-year-old male with pulmonary hypertension associated with an atrial septal defect underwent an elective hernia repair.

Conclusions

We discuss useful management strategies for minimising risk during the peri- and post-operative periods in this population.
General management of pulmonary arterial hypertension associated with adult congenital heart disease
Authors: Gin-Sing Wendy
Published: December 2020

Over the past 15 years there have been significant improvements in the treatment of pulmonary arterial hypertension due to congenital heart disease. Patients now live for several decades, but morbidity and mortality remain high. This article describes the holistic management of this patient group with an emphasis on both the physical and psychosocial aspects of care, taking into account the consequences of chronic cyanosis, avoiding complications and improving quality of life.
Clinical outcomes of submassive pulmonary embolism thrombolysis—an Indian experience
Authors: Rehman Nadeem U. , Dar Mohd Iqbal , Bansal Manish , Kasliwal R. R.
Published: December 2020

Background

Acute pulmonary thromboembolism is the most dangerous presentation of venous thromboembolic disease. The role of thrombolysis in massive pulmonary embolism has been studied extensively, but the same is not there for submassive pulmonary embolism. This study is aimed at evaluating the effects of thrombolysis in acute submassive pulmonary embolism. This was a prospective, case-control, observational study. Patients presenting with acute submassive pulmonary embolism were divided into thrombolysis group and control group depending on whether they received thrombolysis plus anticoagulation or anticoagulation only, respectively.

Results

A total of 86 patients were included in the study. Forty-two patients were in the thrombolysis group, and 44 patients were in the control group. The mean ± SD age in the control and thrombolysis groups was 63.3 ± 14.7 and 56.4 ± 13.8 years, respectively. The two groups were well matched in sex distribution and associated comorbidities like COPD, active surgery, major trauma, and immobilization. On echocardiography, dilated RA/RV in pre-treatment vs. post-treatment was seen in 20 (45.5%) vs. 20 (45.5%) in the control group and 26 (61.9%) vs. 11 (26.2%) in the thrombolysis group. Similarly, RV systolic dysfunction in pre-treatment vs. post-treatment was seen in 24 (54.5%) vs. 21 (47.7%) in the control group and 22 (52.4%) vs. 8 (19.0%) in the thrombolysis group. Pulmonary artery pressure in pre-treatment vs. post-treatment was 64.4 ± 15.0 vs. 45.9 ± 9.9 mmHg in the control group and 68.3 ± 17.4 vs. 31.4 ± 6.9 mmHg in the thrombolysis group. In control vs. thrombolysis group, there were 5 vs. 1 death, 6 vs. 1 hemodynamic decompensation, and 6 vs. 1 patient needing mechanical ventilation.

Conclusion

Thrombolysis in submassive pulmonary embolism is associated with better right ventricular functions, lower pulmonary artery pressures, and comparable mortality rates.
Defining Clinical Utility of Tumor Biomarker Tests: A Clinician's Viewpoint
Authors: Hayes Daniel F.
Published: December 2020

Tumor biomarker tests (TBTs) are used to guide therapeutic strategies for patients with cancer. However, the regulatory environment for TBTs in the United States is inconsistent and, in general, TBTs are poorly valued. The National Academy of Medicine has recommended that TBTs should not be used in general practice until they are shown to have analytical validity and clinical utility. The latter term, first coined by the Evaluation of Genomic Applications in Practice and Prevention Initiative, has been widely stated but is indeterminately defined. In considering whether a TBT has clinical utility, several factors need to be considered: (1) What is the intended use of the TBT? (2) What are the end points that are used to determine clinical utility? (3) How substantial does the difference in end points between groups defined by the TBT need to be to determine therapeutic strategies? (4) What is the risk tolerance of the stakeholders? and (5) Who are the stakeholders that make the decision? For all these factors, the data used to consider clinical utility must be derived from level I evidence studies. In conclusion, there is no strict definition of clinical utility for a TBT. However, consideration of these factors will lead to more objective conclusions. Doing so will facilitate value-based decisions regarding whether a TBT should be used to guide patient care.
Logical Combinatorialism
Authors: Bacon Andrew
Published: December 2020

In explaining the notion of a fundamental property or relation, metaphysicians will often draw an analogy with languages. The fundamental properties and relations stand to reality as the primitive predicates and relations stand to a language: the smallest set of vocabulary God would need in order to write the “book of the world.” This paper attempts to make good on this metaphor. To that end, a modality is introduced that, put informally, stands to propositions as logical truth stands to sentences. The resulting theory, formulated in higher-order logic, also vindicates the Humean idea that fundamental properties and relations are freely recombinable and a variant of the structural idea that propositions can be decomposed into their fundamental constituents via logical operations. Indeed, it is seen that, although these ideas are seemingly distinct, they are not independent, and fall out of a natural and general theory about the granularity of reality.
Muscle-Specific Deletion of Toll-like Receptor 4 Impairs Metabolic Adaptation to Wheel Running in Mice
Authors: ALI MOSTAFA M. , MCMILLAN RYAN P. , FAUSNACHT DANE W. , KAVANAUGH JOHN W. , HARVEY MORDECAI M. , STEVENS JOSEPH R. , WU YARU , MYNATT RANDALL L. , HULVER MATTHEW W.
Published: December 2020

Purpose

Toll-like receptor 4 (TLR4) is an inflammatory receptor expressed ubiquitously in immune cells as well as skeletal muscle and other metabolic tissues. Skeletal muscle develops favorable inflammation-mediated metabolic adaptations from exercise training. Multiple inflammatory myokines, downstream from TLR4, are proposed links to the metabolic benefits of exercise. In addition, activation of TLR4 alters skeletal muscle substrate preference. The role of skeletal muscle TLR4 (mTLR4) in exercise metabolism has not previously been investigated. Herein, we aimed to specifically test the significance of mTLR4 to exercise-induced metabolic adaptations.

Methods

We developed a novel muscle-specific TLR4 knockout (mTLR4−/−) mouse model on C57BL/6J background. Male mTLR4−/− mice and wild-type (WT) littermates were compared under sedentary (SED) and voluntary wheel running (WR) conditions for 4 wk.

Results

mTLR4 deletion revealed marked reductions in downstream interleukin-1 receptor-associated kinase-4 (IRAK4) phosphorylation. In addition, the disruption of mTLR4 signaling prominently blunted the metabolic adaptations in WR-mTLR4−/− mice as opposed to substantial improvements exhibited by the WT counterparts. Voluntary WR in WT mice, relative to SED, resulted in significant increases in skeletal muscle fatty acid oxidation, glucose oxidation, and associated mitochondrial enzyme activities, all of which were not significantly changed in mTLR4−/− mice.

Conclusions

This study introduces a novel mTLR4−/− mouse model and identifies mTLR4 as an immunomodulatory effector of exercise-induced metabolic adaptations in skeletal muscle.
Endurance and Sprint Training Improve Glycemia and V˙O2peak but only Frequent Endurance Benefits Blood Pressure and Lipidemia
Authors: PETRICK HEATHER L. , KING TREVOR J. , PIGNANELLI CHRISTOPHER , VANDERLINDE TARA E. , COHEN JEREMY N. , HOLLOWAY GRAHAM P. , BURR JAMIE F.
Published: December 2020

Purpose

Sprint interval training (SIT) has gained popularity as a time-effective alternative to moderate-intensity endurance training (END). However, whether SIT is equally effective for decreasing cardiometabolic risk factors remains debatable, as many beneficial effects of exercise are thought to be transient, and unlike END, SIT is not recommended daily. Therefore, in line with current exercise recommendations, we examined the ability of SIT and END to improve cardiometabolic health in overweight/obese males.

Methods

Twenty-three participants were randomized to perform 6 wk of constant workload SIT (3 d·wk−1, 4–6 × 30 s ~170% W
peak, 2 min recovery, n = 12) or END (5 d·wk−1, 30–40 min, ~60% W
peak, n = 11) on cycle ergometers. Aerobic capacity (V˙O2peak), body composition, blood pressure (BP), arterial stiffness, endothelial function, glucose and lipid tolerance, and free-living glycemic regulation were assessed pre- and posttraining.

Results

Both END and SIT increased V˙O2peak (END ~15%, SIT ~5%) and glucose tolerance (~20%). However, only END decreased diastolic BP, abdominal fat, and improved postprandial lipid tolerance, representing improvements in cardiovascular risk factors that did not occur after SIT. Although SIT, but not END, increased endothelial function, arterial stiffness was not altered in either group. Indices of free-living glycemic regulation were improved after END and trended toward an improvement after SIT (P = 0.06–0.09). However, glycemic control was better on exercise compared with rest days, highlighting the importance of exercise frequency. Furthermore, in an exploratory nature, favorable individual responses (V˙O2peak, BP, glucose tolerance, lipidemia, and body fat) were more prevalent after END than low-frequency SIT.

Conclusion

As only high-frequency END improved BP and lipid tolerance, free-living glycemic regulation was better on days that participants exercised, and favorable individual responses were consistent after END, high-frequency END may favorably improve cardiometabolic health.
Identifying and addressing psychosocial determinants of adherence to physical distancing guidance during the COVID-19 pandemic – project protocol
Authors: Durand Hannah , Bacon Simon L. , Byrne Molly , Kenny Eanna , Lavoie Kim L. , McGuire Brian E. , McSharry Jenny , Meade Oonagh , Mooney Robert , Noone Chris , O'Connor Laura L. , O'Flaherty Kate , Molloy Gerard J.
Published: December 2020

Optimising public health physical distancing measures has been a critical part of the global response to the spread of COVID-19. Evidence collected during the current pandemic shows that the transmission rate of the virus is significantly reduced following implementation of intensive physical distancing measures. Adherence to these recommendations has been poorer than adherence to other key transmission reduction behaviours such as handwashing. There are a complex range of reasons that are likely to predict why people do not or only partially adhere to physical distancing recommendations. In the current project we aim to address the following research questions: (1) What are the psychosocial determinants of physical distancing for the general public and for key socio-demographic sub-groups (e.g., young adults, older adults, etc.)?; (2) Do current Government of Ireland COVID-19 physical distancing communications address the determinants of physical distancing?; and (3) How can communications be optimised and tailored to sub-groups to ensure maximum adherence to guidelines? These will be addressed by conducting three work packages (WPs). In WP1, we will work closely with the iCARE international study, which includes a large online survey of public responses to measures established to reduce and slow the spread of COVID-19, including physical distancing. We will analyse Irish data, comparing it to data from other countries, to identify the key psychosocial determinants of physical distancing behaviour. This will be followed by a qualitative study to explore in depth the barriers and facilitators of physical distancing behaviour among the Irish public (WP2). In WP3, we will conduct a content analysis and evidence mapping of current government messaging around physical distancing, to ensure the findings from this research feed into the development of ongoing communication and future messaging about physical distancing.
General education role of foreign language teaching in General education schools and higher educational institutions
Authors: Bashlueva Natalya , Bashlueva Mariya
Published: December 2020

the article deals with the directions in the methodology of teaching foreign language to students of secondary schools and cadets and students of educational organizations of the Ministry of internal Affairs. The issue of the General educational role of teaching foreign languages is discussed. Attention is paid to the discussion of the point of view of some Methodists about the place and role of the theoretical and descriptive aspect of teaching. Proponents of this theory believe that this aspect is the essence of the General educational function of language teaching, and sometimes argue that it should be considered as the main content of learning and its main purpose. In the existing methodological concepts, two points deserve the sharpest criticism: the wrong understanding of the General educational meaning of foreign languages and the resulting erroneous definition of the content and essence of teaching. Ready-made signs of a language, its systems of elements and structures can and should be studied separately as the sum of phenomena and facts of language in the corresponding theoretical courses; but specific types of communicative activity are always mastered, where the "lexical", "grammatical" and "phonetic" aspects appear in an indissoluble organic unity, because not only in any act of language communication, but also in any sign of a sound language, there are both "vocabulary", "grammar", and "phonetics". From the General purpose of teaching a foreign language at school, it follows that it cannot be reduced to the development of any one type of communication activity (for example, reading or speaking), since this would unacceptably narrow the practical value of learning; the school should lay the Foundation for using all four main types: speaking, listening, reading to oneself and writing.
The novice MP: The experience of the newly elected in Iceland
Authors: Óskarsdóttir Stefanía , Kristmundsson Ómar H.
Published: December 2020

The study is intended to provide novel insights into the adaptation of new members of parliament to a working environment that differs in many ways from more traditional workplaces. The study is based on semi-structured interviews with 16 first-term members of the Icelandic parliament, the Althingi, after two years’ experience following their election in 2013. The findings show that learning to become active members of parliament is primarily an informal and disorganised process driven by the newcomers themselves. Little formal on-the-job training is available. Two years into their term, the interviewees felt they were still learning and adapting to the rules and norms. New MPs’ performance seems to depend on several factors, including how active they are in the learning process and how successfully they manage to build relationships with colleagues and find informal mentors, who in some cases belong to different political parties. The data limits the inclusion of contextual factors potentially influencing the MPs socialisation process.
Traffic congestion prediction based on Estimated Time of Arrival
Authors: Zafar Noureen , Ul Haq Irfan
Published: December 2020

With the rapid expansion of sensor technologies and wireless network infrastructure, research and development of traffic associated applications, such as real-time traffic maps, on-demand travel route reference and traffic forecasting are gaining much more attention than ever before. In this paper, we elaborate on our traffic prediction application, which is based on traffic data collected through Google Map API. Our application is a desktop-based application that predicts traffic congestion state using Estimated Time of Arrival (ETA). In addition to ETA, the prediction system takes into account various features such as weather, time period, special conditions, holidays, etc. The label of the classifier is identified as one of the five traffic states i.e. smooth, slightly congested, congested, highly congested or blockage. The results demonstrate that the random forest classification algorithm has the highest prediction accuracy of 92 percent followed by XGBoost and KNN respectively.