bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Lumpectomy and Cavity Shave Margin Status on Recurrence and Survival in Breast-Conserving Surgery
Authors: Abdelsattar Jad M. , Afridi Faryal G. , Dai Zheng , Yousaf Natasha , Seldomridge Ashlee , Battin Alexander O. , Wen Sijin , Gray Dana , Marsh J. Wallis , Cowher Michael S. , Partin Jessica F. , Hazard‐Jenkins Hannah , Lupinacci Kristin
Published: July 2021

Background/Objective

Cavity shave margins (CSMs) decrease rate of positive margins and need for re-excision. Recurrence data following breast-conserving surgery (BCS) are not always available in large cancer registries. We sought to define our recurrence and survival data in BCS with routine excision of CSMs.

Methods

A single institution, 10-year retrospective review of breast cancer patients who underwent BCS with routine CSMs was conducted. Cavity shave margin technique was standard. Cox proportional hazard analyses and the Kaplan-Meier method were used to estimate recurrence and survival.

Results

Breast-conserving surgery with CSM was performed in 839 patients. Re-excision rate to achieve negative margins was 8.5%. Fifty-two patients (75%) underwent margin re-excision vs 18 patients (25%) underwent salvage mastectomy. Positive margin rate stratified by tumor histology was highest for invasive lobular carcinoma followed by mixed invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS), followed by pure DCIS and lowest for IDC. Length of follow-up was (4.7 ± 2.6, years). Overall recurrence rate (locoregional and systemic) was 4.3%: highest in patients with negative lumpectomy margin but positive CSM (L−S+ = 15%) followed by positive lumpectomy and CSMs (L+S+ = 14%), followed by patients with positive lumpectomy margin but negative CSMs (L+S− = 13%) and lowest for negative lumpectomy and CSM (L−S− = 5%), ( P = .0008). There was no difference in 5-year breast cancer–specific survival between the 4 subgroups: 96% for L−S−, 86.7% L−S+, 94.7% L+S+ and 90% L+S− ( P = .094).

Conclusions

Recurrence following BCS with CSMs can be stratified based on both lumpectomy and cavity shave margin positivity. Routine excision of CSMs allows identification of these patient subsets.
Missing Data in Research on Youth and Family Programs
Authors: Ballard Jaime , Richmond Adeya , van den Hoogenhof Suzanne , Borden Lynne , Perkins Daniel Francis
Published: July 2021

Background

Multilevel data can be missing at the individual level or at a nested level, such as family, classroom, or program site. Increased knowledge of higher-level missing data is necessary to develop evaluation design and statistical methods to address it.

Methods

Participants included 9,514 individuals participating in 47 youth and family programs nationwide who completed multiple self-report measures before and after program participation. Data were marked as missing or not missing at the item, scale, and wave levels for both individuals and program sites.

Results

Site-level missing data represented a substantial portion of missing data, ranging from 0–46% of missing data at pre-test and 35–71% of missing data at post-test. Youth were the most likely to be missing data, although site-level data did not differ by the age of participants served. In this dataset youth had the most surveys to complete, so their missing data could be due to survey fatigue.

Conclusions

Much of the missing data for individuals can be explained by the site not administering those questions or scales. These results suggest a need for statistical methods that account for site-level missing data, and for research design methods to reduce the prevalence of site-level missing data or reduce its impact. Researchers can generate buy-in with sites during the community collaboration stage, assessing problematic items for revision or removal and need for ongoing site support, particularly at post-test. We recommend that researchers conducting multilevel data report the amount and mechanism of missing data at each level.
A double-edged sword: Children’s experiences of visiting a parent in prison in Scotland
Authors: Lockwood Kelly , Long Tony , Loucks Nancy , Raikes Ben , Sharratt Kathryn
Published: July 2021

Prison visits are recognised as an important feature of a humane prison system, providing important benefits for prisoners and their family in maintaining ties (McCarthy and Adams, 2017). Scotland has a history of penal welfarism and a right-based agenda in relation to visits (McCarthy and Adams, 2017); however, there is a lack of research that focuses on visits in the context of Scottish prisons. Equally, there is limited research that considers the perspective of children visiting a parent in custody. This paper explores the experiences of children visiting a parent in prison in Scotland, highlighting lessons for policy and practice.
Silent severe myocardial ischemia in a past illicit drug user imaged with myocardial perfusion scintigraphy
Authors: Sioka Chrissa , Georgiou Georgios , Katsouras Christos , Pappas Konstantinos , Kiortsis Dimitris-Nikiforos , Fotopoulos Andreas , Petrikis Petros
Published: July 2021

Patients with illicit drug use may have deleterious acute and chronic cardiac effects. We present a case of a 42-year-old man, former alcohol and various illicit drugs user, who was admitted to the psychiatric unit for management of psychosis. Because of his previous drug and alcohol history, a cardiological evaluation was performed which revealed silent severe myocardial ischemia detected by myocardial perfusion imaging (MPI). The myocardial ischemia was attributed to coronary microvascular dysfunction, occurring several years after quitting the illicit drugs. This study highlights the potential myocardial ischemia that may occur in patients with previous alcohol and illicit drug use, and the role of MPI, a non-invasive test that can provide important information regarding the myocardial status of such patients, even without obvious cardiac symptoms or findings.
‘Blue Lives Matter’ and the legacy of blackface minstrelsy
Authors: Longazel Jamie
Published: July 2021

This article situates the pro-police countermovement, ‘Blue Lives Matter’, within the legacy of blackface minstrelsy. An analysis of various ‘racial performances’ shows how, like its minstrel forbearers, the rebuttal to Black Lives Matter subscribes to a dual identity: envious, fetishistic ‘love’ of Black people on one hand, visceral contempt accompanied by often-violent fantasies on the other. It is argued that by racialising themselves as ‘blue’, the countermovement seeks to expropriate the virtue associated with racial victimisation and articulate their racial fantasies about how Black folks ought to be. The article concludes by arguing that critical analyses of policing should consider policing performances rather than just policing practices.
Limited Scar Resection for Chronic Achilles Tendon Repair: Use of a Rat Model
Authors: Counihan Matthew , Leahy Thomas , Nuss Courtney , Newton Joseph , Mohanty Sarthak , Soslowsky Louis J. , Farber Daniel
Published: July 2021

Background:

Achilles tendon rupture diagnosis is frequently missed, leading to the development of a chronic rupture that requires surgical intervention to remove scar tissue and return the elongated Achilles tendon to appropriate functional length. The limited scar resection (LSR) intervention strategy may provide an advantage over other techniques, as it is less invasive and nondestructive to other tissues, although there is little evidence comparing outcomes between intervention strategies.

Hypothesis:

The LSR technique would be a viable treatment option for chronic Achilles tendon ruptures and would perform comparably with a more clinically accepted procedure, the gastrocnemius fascial turndown (GFT), in postintervention functional outcome measures and tendon mechanical and histological properties.

Study Design:

Controlled laboratory study.

Methods:

Chronic Achilles tendon ruptures were induced in the right hindlimb of Sprague-Dawley rats by Achilles tendon transection without repair, immobilization in dorsiflexion, and 5 weeks of cage activity. Animals were randomly divided between the intervention strategy groups (LSR and GFT), received 1 week of immobilization in plantarflexion, and were sacrificed at 3 or 6 weeks postintervention. In vivo functional outcome measures (gait kinetics, passive joint function, tendon vascular perfusion) were quantified during healing, and tendon mechanical and histological properties were assessed postsacrifice.

Results:

When compared with the GFT, the LSR technique elicited a faster return to baseline in gait kinetics, although there were few differences between groups or with healing time in other functional outcome measures (passive joint function and vascular perfusion). Quasi-static mechanical properties were improved with healing in both surgical intervention groups, although only the LSR group showed an improvement in fatigue properties between 3 and 6 weeks postintervention. Histological properties were similar between intervention strategies, except for decreased cellularity in the LSR group at 6 weeks postintervention.

Conclusion:

The LSR technique is a viable surgical intervention strategy for a chronic Achilles tendon rupture in a rodent model, and it performs similarly, if not better, when directly compared with a more clinically accepted surgery, the GFT.

Clinical Relevance:

This study supports the increased clinical use of the LSR technique for treating chronic Achilles tendon rupture cases.
Law, Code and Exploitation: How Corporations Regulate the Working Conditions of the Digital Proletariat
Authors: Jiménez González Aitor
Published: July 2021

Contrary to what orthodox Marxism claims, the article defends that the legal field has been a fundamental aspect of the capitalist social ordering, and an unavoidable feature to understand how dominated subjectivities are produced and exploited. Expanding Lessig’s concept of ‘code as law’ with Marxist scholarly insight, the article argues that digital capitalists are reorganising work and the labour force through a form of algorithmic regulation. The article states that algorithms – that is, digital machines – have become not only part of the means of production of the era of automation, but also the code by which capitalists are writing the conditions of existence and exploitation of the digital proletariat. The article bridges recent contributions on labour law, AI and algorithmic regulation with the latest Marxist sociological contributions analysing the relation of work and digital exploitation, opening with it new ways to understand how sociotechnical systems owned by corporations regulate the behaviour not only of the working class but of the wider citizenry.
Development of a novel 6-DOF hybrid serial-parallel mechanism for pose adjustment of large-volume components
Authors: Liu Shiwei , Sun Yu , Peng Gaoliang , Xue Yuan , Hnydiuk-Stefan Anna , Li Zhixiong
Published: July 2021

In this paper, a novel 6-degrees-of-freedom (DOF) hybrid mechanism is proposed to realize position and posture adjusting for large-volume equipment. The designed hybrid manipulator is composed of the lower and upper modules, namely, a 3-DOF redundant spatial parallel mechanism (SPM) and a 3-DOF planar parallel mechanism (PPM), which has three rotational and three translational DOFs. According to the step-by-step pose adjusting strategy, the kinematics analyses of the lower and upper modules have been carried out systematically. For the whole hybrid mechanism, a complete kinematic model has been established; and visualized workspace of the kinematic model with regular shape and large volume demonstrates profound application prospects in engineering. In order to evaluate the performance of the proposed mechanism, experimental tests have been conducted in an automated docking system for pose adjustment of large and heavy components. The analysis results demonstrate the effectiveness and practicability of the new mechanism.
Optimized hybrid decoupled visual servoing with supervised learning
Authors: Rastegarpanah Alireza , Aflakian Ali , Stolkin Rustam
Published: July 2021

This study proposes an optimized hybrid visual servoing approach to overcome the imperfections of classical two-dimensional, three-dimensional and hybrid visual servoing methods. These imperfections are mostly convergence issues, non-optimized trajectories, expensive calculations and singularities. The proposed method provides more efficient optimized trajectories with shorter camera path for the robot than image-based and classical hybrid visual servoing methods. Moreover, it is less likely to lose the object from the camera field of view, and it is more robust to camera calibration than the classical position-based and hybrid visual servoing methods. The drawbacks in two-dimensional visual servoing are mostly related to the camera retreat and rotational motions. To tackle these drawbacks, rotations and translations in Z-axis have been separately controlled from three-dimensional estimation of the visual features. The pseudo-inverse of the proposed interaction matrix is approximated by a neuro-fuzzy neural network called local linear model tree. Using local linear model tree, the controller avoids the singularities and ill-conditioning of the proposed interaction matrix and makes it robust to image noises and camera parameters. The proposed method has been compared with classical image-based, position-based and hybrid visual servoing methods, both in simulation and in the real world using a 7-degree-of-freedom arm robot.
Biogeochemical evidence for environmental and vegetation changes in peatlands from the middle Yangtze river catchment during the medieval warm period and little ice Age
Authors: Sun Jia , Ma Chunmei , Zhou Bin , Jiang Jiawei , Zhao Cheng
Published: July 2021

The reconstruction of past climates and vegetation can provide valuable information for understanding the mechanisms of the variability of the East Asian summer monsoon in eastern China. In this study, organic geochemical evidence from the compositions of sedimentary leaf-wax stable isotopes and n-alkane parameters investigates the changes in vegetation and climate over the last 1200 years in the Xiyaohu peatland, Jiangxi Province, southeast China. Combined with temperature records, three climatic periods are presented: (a) a warm and humid period with an increase in C4 plants from 900 to 1450 AD, which coincides with the Medieval Warm Period (MWP); (b) a cool and dry period with the expansion of C3 plants from 1450 to 1800 AD, coinciding with the Little Ice Age (LIA); and (c) the Present Warm Period (PWP) from 1800 AD until the present, with warm and wet conditions. The sub-stages within the MWP and LIA intervals are also presented. The earlier MWP stage (900–1125 AD) was drier than the latter one (1125–1450 AD), and the earlier LIA stage (1450–1650 AD) was drier than the late LIA (1650–1800 AD). Increased solar irradiance and enhanced El Niño activities are related to the warm and humid climate during the MWP and PWP, whereas reduced solar irradiance and La Niña activities correspond to the cool and dry climate during the LIA. The present results provide insights into paleoclimatic changes in eastern monsoonal China and provide an understanding of centennial-scale climatic fluctuations and their driving factors.
Coexistent antiphospholipid syndrome and myeloproliferative neoplasm
Authors: Sayar Zara , Nallamilli Susanna , Efthymiou Maria , Lambert Jonathan , Cohen Hannah
Published: July 2021

Antiphospholipid syndrome (APS) and myeloproliferative neoplasms (MPN) are associated with an increased risk of thrombosis. The optimal management of patients with coexistent APS and MPN has not been defined. A single centre and systematic literature review of patients with coexistent APS and MPN was performed. Cases were divided into two groups based on whether they met international consensus criteria for APS. Of the 12 studies identified, eight were excluded (leaving five of a total 54 patients), as although antiphospholipid antibodies (aPL) were documented, the diagnosis of APS was not conclusively demonstrated. Another ten patients with definite APS were identified at our centre. Fifteen patients (ten females, five males) were therefore included in this analysis (eleven definite APS and four highly likely), median age 44 (range: 13–71) years. Nine had polycythaemia vera and six, essential thrombocythaemia. Thirteen of the 15 patients (86.7%) had thrombotic APS (seven with initial venous events and six arterial) and two (13.3%) had obstetric APS. Nine patients were single-positive, and six double-positive for aPL. None were triple aPL-positive. Four patients at our centre had recurrent thrombotic/obstetric events, including while on anticoagulation/antiplatelet treatment.
C3 glomerulonephritis and systemic lupus erythematosus: A report of a patient treated with eculizumab and review of the literature
Authors: Fernandez-Ruiz Ruth , Blank Rebecca B , Wu Ming , Belmont H Michael
Published: July 2021

Introduction

Activation of the complement pathway by immune complexes is a key feature of systemic lupus erythematosus (SLE) and SLE glomerulonephritis, which translates into low levels of C3 and C4 during active disease. C3 glomerulonephritis (C3GN) is part of a broader group of rare renal diseases, the C3 glomerulopathies, characterized by prominent C3 accumulation in the glomeruli with minimal to no immunoglobulin (Ig) deposition secondary to dysregulation of the alternative pathway of the complement system. Distinguishing lupus nephritis from other complement-mediated kidney disorders, including C3GN, represents a diagnostic challenge with potential therapeutic implications.

Methods

We report an unusual case of a 55-year-old woman with SLE and previous biopsy-proven class IV lupus nephritis, subsequently diagnosed with C3GN. Furthermore, we review the available literature published from January 2010—March 2021 on the clinical features and management of C3GN in the setting of SLE.

Results

In addition to our case, very few reports exist in the literature regarding C3GN in association with SLE. The underlying pathogenic mechanism of C3GN consists of dysregulation of the alternative pathway of the complement system, either due to genetic variation in complement-related genes or to acquired autoantibodies targeting C3 or C5 convertases; the latter mechanism could explain the occurrence of C3GN in the setting of autoimmune diseases, although it was not definitively identified in our patient or others with SLE. Similar to some of the previous reports, after suboptimal renal response on mycophenolate mofetil and rituximab, our patient has been successfully treated with eculizumab, thus far with >50% improvement in proteinuria.

Conclusions

C3GN represents an additional mechanism of renal injury in SLE mediated by alternative complement pathway dysregulation. Although rare, patients with SLE and persistent proteinuria with very low C3 would benefit from expedited renal biopsy to evaluate for C3GN as well as genetic testing, since this entity could require a different therapeutic approach.
Seeking Excellence in End of Life Care (SEE Care): A Multi-Centered Acute Hospitals Service Evaluation
Authors: Tavabie Simon , Berglund Anja , Barclay David , Bass Steve , Collins Naomi , Edwards Elaine , Malik Farida , Minton Ollie , Peters Deborah , Stewart Eleanor , Winter Jayne , Ford-Dunn Suzanne
Published: July 2021

Context:

A proportion of UK hospital inpatients have palliative care needs but do not access specialist services.

Objectives:

To contemporaneously evaluate the significance of unmet specialist palliative care needs within the hospital inpatient population.

Methods:

Prospective multi-centered service evaluation was conducted through 4 snapshots across 4 acute NHS hospital trusts. All patients identified as dying in each hospital were included. Data extraction included symptom burden, medications and completion of care plans.

Results:

End-of-life care plans were completed for 73%, symptom-focused prescribing present in 96%. Symptoms were not well managed for 22%, with 4% suffering moderate to severely. Specific intervention was triggered in 56% of patients, consisting of prescribing advice and holistic support.

Conclusion:

There are significant unmet specialist palliative care needs within the hospital inpatient population. Contemporaneous data collection coupled with an outreach approach helps palliative care services better understand the experiences of dying people, alongside where improvement is needed.
Utility of Palliative Prognostic Index in Predicting Survival Outcomes in Patients With Hematological Malignancies in the Acute Ward Setting
Authors: Lee Shu-Hui , Chou Wen-Chi , Yang Hsin-Yi , Chen Chia-Chia , Chang Hung , Wang Po-Nan , Kuo Ming-Chung , Kao Yu-Feng , Ho Lun-Hui , Hsueh Shun-Wen , Kao Chen-Yi , Hsueh William Harrison , Hung Chia-Yen , Hung Yu-Shin
Published: July 2021

Background:

The palliative prognostic index (PPI) predicts the life expectancy of patients with terminally ill cancer in hospice settings. This study aimed to evaluate PPI as a prognostic tool for predicting the life expectancy of patients with hematological malignancies admitted to the acute ward.

Methods:

A total of 308 patients with hematological malignancies admitted to the hematological ward at a medical center between January 2016 and December 2017 were consecutively enrolled. PPI was scored within 24 h of admission. All patients were categorized into 3 groups by PPI for comparing survival and in-hospital mortality rates.

Results:

The median survival times were 38.4, 3.6, and 1.1 months for patients with good, intermediate, and poor prognostic group, respectively. The hazard ratio was 2.31 (95% CI 1.59-3.35, p < 0.001) when comparing the intermediate and good prognosis groups, and 3.90 (95% CI 2.52-6.03, p < 0.001) when comparing the poor and good prognosis groups. Forty-five (14.6%) patients died at discharge; in-hospital mortality rates among the good, intermediate, and poor prognostic groups were 9.0%, 23.4%, and 46.4%, respectively. The adjusted odds ratio for in-hospital mortality was 1.96 (95% CI, 0.80-4.82, p = 0.14) and 5.25 (95% CI, 2.01-13.7, p < 0.001) for patients in the intermediate and poor prognostic groups compared to those in the good prognostic group.

Conclusion:

PPI is an accurate prognostic tool for predicting survival times and in-hospital mortality rates in patients with hematological malignancies in an acute ward setting. PPI could assist clinicians in discussing end-of-life issues and in referring patients with hematological malignancies to palliative care.
As the Pandemic Recedes, Will Moral Distress Continue to Surge?
Authors: Vig Elizabeth K.
Published: July 2021

Palliative care practitioners have encountered morally distressing situations during the COVID-19 pandemic, and have supported their colleagues experiencing moral distress. Familiarity with the concept of moral distress and with COVID-specific causes of moral distress may help palliative care practitioners recognize moral distress in themselves and in their colleagues. This essay provides a brief review of the concept of moral distress, a list of potential COVID-19 specific causes of moral distress, and a list of organizational, team, and individual interventions to promote resilience.
Overcoming Cough and Angioedema: Advocating for the Use of ARBs Over ACE Inhibitors
Authors: Lam Melanie , Beqo Anelsa , Thumar Ricky
Published: July 2021

Angiotensin II receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors have comparable efficacy, but ARBs have a preferential safety profile with particular regard to cough and angioedema. Although guidelines have historically advocated for ACE inhibitor use before ARBs simply because of earlier market entry, data accumulation, and generic availability, updated verbiage advises an “ACE inhibitor or ARB” recommendation, as opposed to the classic “ACE inhibitor then ARB” approach. Despite these updates, clinical inertia in favor of ACE inhibitor use before ARBs overwhelmingly remains. Prescribers and educators should consider an “ARBs only” mentality, especially in high angioedema-risk groups such as black patients.
Recurrence and new tumor development after frontline intravenous chemotherapy for retinoblastoma: Risk factors and treatment results
Authors: Gündüz Ahmet Kaan , Mirzayev Ibadulla , Dinçaslan Handan , Özalp Ateş Funda Seher
Published: July 2021

Purpose:

To evaluate the risk factors leading to recurrence and new tumor (NT) development in patients with retinoblastoma after intravenous chemotherapy (IVC) and to review the treatment outcomes.

Materials and methods:

The records of 166 retinoblastoma cases (having 246 affected eyes) who underwent six-cycle IVC (vincristine, etoposide, and carboplatin) as primary treatment between October 1999 and August 2020 were reviewed retrospectively.

Results:

The mean ages at presentation were 9.0 (median: 8.0) and 9.2 (median: 8.5) months in cases with recurrence and NTs respectively. Recurrence was detected in 40 (16.3%) eyes, NTs in 29 (11.8%), and both recurrence/NTs in 24 (9.8%). The mean time elapsed till recurrence and NT was 10.7 months. Multivariable analysis showed that the factors predictive of recurrence were largest tumor base diameter (LTBD) >12 mm ( p = 0.039) and presence of subretinal seeds at diagnosis ( p = 0.043). Multivariable risk factors for the development of NTs were bilateral familial retinoblastoma ( p = 0.001) and presence of subretinal seeds at diagnosis ( p = 0.010). Mean follow-up was 80.1 (median: 72.5) months. By Kaplan-Meier analysis, the 1-, 3-, and 6-year recurrence and NT rates were 21.2%, 28.1%, and 28.7% and 14.9%, 22.6%, and 23.9% respectively. The most common treatment methods used for recurrent and/or NTs included cryotherapy, transpupillary thermotherapy, and intra-arterial chemotherapy. Enucleation was eventually required in 24/93 (25.8%) eyes. No patient developed metastasis.

Discussion:

Development of recurrence and/or NT after IVC was noted in 38% of all retinoblastoma eyes. Bilateral familial disease, LTBD >12 mm, and presence of subretinal seeds at baseline were risk factors for recurrence and NTs in this study.
Wear characterization of basalt fiber reinforced polypropylene/polylactic acid hybrid polymer composite
Authors: Arul Jeya Kumar Arputham , Prakash Muniyandi , Lakshmankumar Abburi , Haswanth Kesuboyina
Published: July 2021

In this work, the wear loss of basalt fiber reinforced polypropylene/polylactic acid polymer composite was analyzed using pin-on-disc under dry sliding conditions. The polypropylene, polylactic acid, and basalt fiber (chopped fiber) are melted and mixed homogeneously using a twin-screw extruder, which is followed by an injection molding technique for specimen preparation. The specimens are named as PPB1 (polypropylene, 50%; polylactic acid, 35%; basalt fiber, 15%), PPB2 (polypropylene, 55%; polylactic acid, 30%; basalt fiber, 15%), and PPB3 (polypropylene, 60%; polylactic acid, 25%; basalt fiber, 15%) based on their weight fraction. The wear rate and coefficient of friction are measured for each sample subjected to three different loads and sliding velocities. It is observed from the wear mapping that the wear loss of sample PPB3 is relatively less when compared with the other samples. The scanning electron microscope images of the worn-out region of the sample reveal the fracture and dislocation of fibers in the matrix. The sample PPB3 shows low wear loss. It is due to the better cohesion between the fiber and the matrixes when compared with the other samples.
Critical analysis of transformative interventions redressing apartheid land discrimination and injustices in South Africa: From land segregation to inclusivity
Authors: Sihlangu Precius , Odeku Kola Sola
Published: July 2021

In 1994, as soon as South Africa became a democratic country, the first step taken by the new democratic government was to introduce various transformative constitutional and legislative interventions that sought to redress all the past apartheid discriminatory laws. This paper looks at these interventions by critically showcasing how they are being used to transform and reform land by ensuring inclusivity and equity in South Africa where the previously denied, disposed and segregated Black majority have access and are benefitting broadly.
Artillery structural dynamic responses optimization based on Stackelberg game method
Authors: Xu Fengjie , Yang Guolai , Wang Liqun
Published: July 2021

This article proposes an artillery structural dynamic response optimization method based on the Stackelberg game theory. The artillery multi-flexible body dynamic model is constructed firstly, and the live firing experiment is carried out to verify the accuracy of the constructed model. The multi-objective optimization model of artillery structural dynamic responses is established, and the sensitivity analysis and fuzzy c-means cluster algorithm are used to split the design variable set and, more importantly, transform the optimization model into a two-leader-one-follower Stackelberg game model. The process of solving Stackelberg equilibrium is a bi-level optimization, where the two leaders play a Nash sub-game first and impose the decision to the follower and then the follower makes its own optimization with considering this decision. Until the leaders cannot obtain more profits, the Stackelberg equilibrium is reached. The results demonstrate that the artillery structural dynamic responses have been greatly improved.
Writer movements between news outlets reflect political polarization in media
Authors: Hagar Nick , Wachs Johannes , Horvát Emőke-Ágnes
Published: July 2021

Digital news outlets rely on a variety of outside contributors, from freelance journalists, to political commentators, to executives and politicians. These external dependencies create a network among news outlets, traced along the contributors they share. Using connections between outlets, we demonstrate how contributors’ publishing trajectories tend to align with outlet political leanings. We also show how polarized clustering of outlets translates to differences in the topics of news covered and the style and tone of articles published. In addition, we demonstrate how contributors who cross partisan divides tend to focus on less explicitly political topics. This work addresses an important gap in the media polarization literature, by highlighting how structural factors on the production side of news media create an ecosystem shaped by political leanings, independent of the priorities of any one person or organization.
Repeated Endovascular Interventions Are Worthwhile, Even After Thrombosis, to Maintain Long-Term Use of Autogenous Dialysis Fistulas
Authors: Richard Michele N. , Stroever Stephanie , Dowling Caitlin , Burton Timothy , Butler Amber , Plummer Dahlia , Dietzek Alan M.
Published: July 2021

Objectives:

Patients often require multiple access re-interventions to improve fistula patency and the overall usable lifespan of autogenous arteriovenous fistula (aAVF). There is no consensus on the appropriate number of re-interventions after which an access should be abandoned and new access placed. We evaluated whether repeated endovascular interventions for failing/failed aAVF are worthwhile or futile.

Methods:

A retrospective review was performed on aAVFs created between 2009-2014. Fistula function was evaluated until January 2017. Functional fistula patency (FFP) was defined as the total time of functional fistula use for hemodialysis, from time of cannulation to time of measurement or fistula abandonment, including all interventions performed to maintain/reestablish patency. Primary outcomes were FFP duration and number of post-dialysis interventions.

Results:

The study included 163 patients. Mean age was 67 (SD = 15.03). The only variable statistically different between functional fistulas and abandoned fistulas was obesity (p = 0.03). At the end of the study period, 145 (89.0%) patients continued to have functional fistulas, and 73 (44.8%) patients died, but had functional fistulas at time of death. Median FFP for the functional group was 3.18 years (range 0.01-7.01 years) and median number of interventions was 1 (range 0-13). In 18 patients (11%), the fistula was abandoned, most commonly due to thrombosis (47.1%), followed by infection (23.5%). No fistula was abandoned because of an unacceptable rate of reintervention. Median FFP in the abandoned group was 0.91 years (range 0.03-5.30 years), and median number of interventions was 0 (range of 0-5).

Conclusions:

Through repeated interventions on aAVFs, none of the patients in our study exhausted all hemodialysis access options prior to transplantation, death or loss to follow-up. These results may indicate repeated and/or more frequent revisions do not negatively affect the FFP nor do they increase the overall risk for abandonment of aAVFs.
Place, power and leadership: Insights from mayoral governance and leadership innovation in Bristol, UK
Authors: Hambleton Robin , Sweeting David , Oliver Thom
Published: July 2021

This article aims to enhance understanding of the role of place in urban leadership by examining the way leadership changed significantly following the introduction of mayoral governance into a UK city. In 2012, 10 cities in England held referendums to decide whether to introduce a directly elected mayor model of leadership. Bristol was the only city to vote in favour of this radical change, and the Bristol Civic Leadership Project, set up before the first mayor was elected in November 2012, was designed to discover what differences the directly elected mayor model might make to the leadership and governance of a city. This article addresses two important questions: (1) Does the institutional design of local governance in a place influence leadership effectiveness? (2) How, if at all, do the leadership styles of the individual elected as mayor affect the quality of place-based governance? The article identifies three main reasons why place is important in public policy – expression of identity, strengthening democracy and enhancing governmental effectiveness – and considers how the leadership innovations in Bristol engage with these three dimensions of place. As well as presenting evidence documenting how bold civic leadership has transformed the governance of a particular British city, the article contributes to leadership studies by exploring the relationships between place, power and leadership.
Maintenance optimization of a production system considering defect prevention and spare parts ordering
Authors: Gan Shuyuan , Zhang Xinzhou , Chen Lan
Published: July 2021

An innovative maintenance policy is proposed in this paper. This policy can involve spare parts ordering, production quality, and buffer inventory for an efficient production system. In the system, certain batches are required to be produced, and when each batch is finished, a determination is made whether maintenance is needed. The machine state deteriorates with the number of completed batches, and it can be improved by performing maintenance. Two types of maintenance activity, replacement and imperfect maintenance, can be selectively chosen to minimize cost. The defect rate of each batch is related to the number of completed production batches. An innovative concept, defined as the “virtual number” of completed production batches, is used to establish a link between maintenance and defect rate. Monte Carlo simulation and enumerative search is then used to determine cost-effective spare parts ordering and maintenance policies to minimize the cost for the production cycle. Finally, numerical examples are presented to demonstrate the model and to conduct sensitivity analysis. We find that in situations with a high buffer inventory costs, spare parts should be ordered late. When increasing the buffer inventory cost, more replacements should be performed compared to imperfect maintenance. Also, the buffer inventory cost rate and replacement duration time effect the rate of defective products significantly. These two parameters should be kept small, and controlled, if a very low defect rate is needed.
Improving Data Quality Using Amazon Mechanical Turk Through Platform Setup
Authors: Lu Lu , Neale Nathan , Line Nathaniel D. , Bonn Mark
Published: July 2021

As the use of Amazon’s Mechanical Turk (MTurk) has increased among social science researchers, so, too, has research into the merits and drawbacks of the platform. However, while many endeavors have sought to address issues such as generalizability, the attentiveness of workers, and the quality of the associated data, there has been relatively less effort concentrated on integrating the various strategies that can be used to generate high-quality data using MTurk samples. Accordingly, the purpose of this research is twofold. First, existing studies are integrated into a set of strategies/best practices that can be used to maximize MTurk data quality. Second, focusing on task setup, selected platform-level strategies that have received relatively less attention in previous research are empirically tested to further enhance the contribution of the proposed best practices for MTurk usage.
Empirical categorization of middle powers and how different middle powers are treated in international organizations: The case of India and South Korea
Authors: Woo Byungwon
Published: July 2021

Which countries are middle powers in international relations? While the term “middle powers” has witnessed a steady increase in its use in the past two decades, answers to the question are likely to be diverse, depending on to whom one asks the question. The paper tries to provide objective criteria that would allow one to define the entire population of middle powers and theorize how different types of middle powers are regarded and treated by other countries, most significantly, by great powers. Specifically, we contend that those middle powers with larger potential capability than realized capability, labeled as “middle powers with lots of unrealized potentials,” will initially receive favorable treatments in international organizations, but that favorable treatments will gradually diminish as those middle powers begin to close the gap between their potential and realized capability. In comparison, those countries with limited potential capability but with higher realized capacity, labeled as “mature middle powers,” will be treated in an unbiased manner by other countries. We demonstrate the plausibility of this argument with India and South Korea as examples of each type of middle power within the context of the International Monetary Fund. We show that India initially received some favors—in the form of larger political representation, larger than its size of economy warrants—within the International Monetary Fund when its potentials had not begun to materialize, but once realization of its potentials began, favors that India used to receive have gradually evaporated. In comparison, South Korea has been treated more “objectively” in the International Monetary Fund where its representation closely follows the size of its economy.
Investigation on the contour and bone mineral density of the distal tibial cutting surface used for total ankle arthroplasty
Authors: Zhao Dahang , Zhang Gonghao , Huang Dichao , Yu Jian , Wang Kan , Wang Xu , Zhang Tiansong , Ma Xin
Published: July 2021

Purpose:

This study was designed to investigate (1) the contour of the distal tibial cutting surface, and (2) the bone mineral density (BMD) of the distal tibial cutting surface used during total ankle arthroplasty (TAA).

Methods:

Eight-four distal tibial models were created using foot and ankle computerized tomographic (CT) images taken from normal people. The distal tibial cutting surface for TAA was determined to be 10 mm proximal to the tibial plafond. The bony contour and BMD values were determined from the CT image at that level. A bounding box was made on the contour and the width and length of the contour was measured. Regional BMD was evaluated by Hounsfield units (HU) value measurement, with 7 regions of interest (ROI) on 8 different directions for all the 84 CT images. Two different observers made independent measurements and mean HU values for all the 56 ROIs were calculated.

Results:

Great variations were found among the contours of the cutting surface especially in term of the shape of the anterior and posterior tibial tubercle, and the fibular notch. These variations could be grouped into six categories. For the BMD of the cutting surface, the medial border of the cutting surface did not included cortical bone. The HU value of seven ROIs, which included cortical bone, were significantly greater than all the other ROIs. Few statistical differences were found by multiple comparisons among HU value of all the 49 ROIs without cortex.

Conclusions:

Great variability existed in the shape and the BMD of the distal tibial cutting surface.
Bilateral Choroidal Infiltrates as the Initial Manifestation of Waldenström Macroglobulinemia Relapse
Authors: Tan Jason , Chandra Varun , Hall Anthony J.
Published: July 2021

Purpose:

This work describes a case of Waldenström macroglobulinemia (WM) relapse presenting with unilateral blurred vision.

Method:

A case report is presented.

Results:

A 60-year-old woman with a history of WM in remission was referred for suspicious peripheral choroidal lesions and left optic disc swelling. Magnetic resonance imaging revealed optic nerve and cranial nerve infiltration consistent with central nervous system invasion from WM relapse, called Bing-Neel syndrome. Irradiation of the optic nerve and systemic targeted therapy were successful in addressing the ocular features as well as reducing immunoglobulin M paraprotein levels and lymphoproliferative disease burden.

Conclusions:

We described the first documented case to our knowledge of intraocular involvement as the earliest sign of relapse of WM. Ophthalmology assessment is warranted in patients with a history of WM who present with new ocular symptoms to aid early detection and treatment of this disease.
Advances in polystyrene/graphene nanoplatelet nanocomposites
Authors: Kausar Ayesha
Published: July 2021

This article analyses research trials on noteworthy features and technological impact of the polystyrene/graphene nanoplatelet nanocomposites. In polystyrene matrix, graphene nanoplatelets have been used as remarkable nanofiller. Substantial improvements in polystyrene physical properties occurs by adding low nanofiller content. Simple in situ, emulsion, solution, or melt synthesis strategies have been used to develop polystyrene/graphene nanoplatelet nanocomposite. The polystyrene/graphene nanoplatelet nanocomposites possess enhanced structural features, morphology, glass transition temperature, thermal stability, mechanical strength, electrical characteristics, sensing, capacitance, and other physical properties. The performance of the polystyrene/graphene nanoplatelet nanocomposites have been explored for the practical applications in the fields of sensing, electromagnetic interference shielding, and flame retardant materials.
Severe thrombocytopenia is sufficient for fetal and neonatal intracerebral hemorrhage to occur
Authors: Farley Alison , Lloyd Sarah , Dayton Merle , Biben Christine , Stonehouse Olivia , Taoudi Samir
Published: July 2021

Intracerebral hemorrhage (ICH) has a devastating impact on the neonatal population. Whether thrombocytopenia is sufficient to cause ICH in neonates is still being debated. In this study, we comprehensively investigated the consequences of severe thrombocytopenia on the integrity of the cerebral vasculature by using 2 orthogonal approaches: by studying embryogenesis in the Nfe2−/− mouse line and by using biologics (anti-GP1Bα antibodies) to induce severe thrombocytopenia at defined times during development. By using a mouse model, we acquired data demonstrating that platelets are required throughout fetal development and into neonatal life for maintaining the integrity of the cerebral vasculature to prevent hemorrhage and that the location of cerebral hemorrhage is dependent on when thrombocytopenia occurs during development. Importantly, this study demonstrates that fetal and neonatal thrombocytopenia-associated ICH occurs within regions of the brain which, in humans, could lead to neurologic damage.
Type I interferon is induced by hemolysis and drives antibody-mediated erythrophagocytosis in sickle cell disease
Authors: Liu Yunfeng , Pal Mouli , Bao Weili , Shi Patricia A. , Lobo Cheryl A. , An Xiuli , Manwani Deepa , Zhong Hui , Yazdanbakhsh Karina
Published: July 2021

Patients with sickle cell disease (SCD) suffer from intravascular hemolysis-associated vascular injury and tissue damage. Classical monocytes (CMo), which are the most abundant of circulating monocytes, are activated in SCD, but the cause and consequences of activation remain incompletely understood. We found a positive correlation between total plasma heme levels and circulating interferon-α (IFN-α) in patients with SCD along with upregulation of the type I IFN (IFN-I) inducible genes in sort-purified SCD patients’ CMo by transcriptome analysis. We demonstrated that hemolysis led to IFN-I expression, predominantly by mouse liver monocyte and macrophages (Mⲫ), primarily through Tank kinase binding 1 (TBK1)/IκB kinase-ε (IKKε) but not TLR4. In response to hemolysis-induced IFN-I, mouse CMo migrated to the liver and differentiated into monocyte-derived Mⲫ, increasing their numbers by sixfold with acute hemin treatment. Hemolysis-driven IFN-I activity also led to the induction of Fc receptor CD64 expression on monocyte and Mⲫ populations, enhancing alloantibody-mediated erythrophagocytosis in SCD both in vivo in mice and in in vitro human cultures. Altogether, these data demonstrate IFN-I response to hemolysis as a novel activation pathway in monocytes and Mⲫ in SCD, opening the possibility for development of IFN-I-based diagnostics and therapeutics against alloantibody-mediated erythrophagocytosis.
Treatment of sickle cell disease by increasing oxygen affinity of hemoglobin
Authors: Henry Eric R. , Metaferia Belhu , Li Quan , Harper Julia , Best Robert B. , Glass Kristen E. , Cellmer Troy , Dunkelberger Emily B. , Conrey Anna , Thein Swee Lay , Bunn H. Franklin , Eaton William A.
Published: July 2021

The issue of treating sickle cell disease with drugs that increase hemoglobin oxygen affinity has come to the fore with the US Food and Drug Administration approval in 2019 of voxelotor, the only antisickling drug approved since hydroxyurea in 1998. Voxelotor reduces sickling by increasing the concentration of the nonpolymerizing, high oxygen affinity R (oxy) conformation of hemoglobin S (HbS). Treatment of sickle cell patients with voxelotor increases Hb levels and decreases indicators of hemolysis, but with no indication as yet that it reduces the frequency of pain episodes. In this study, we used the allosteric model of Monod, Wyman, and Changeux to simulate whole-blood oxygen dissociation curves and red cell sickling in the absence and presence of voxelotor under the in vivo conditions of rapid oxygen pressure decreases. Our modeling agrees with results of experiments using a new robust assay, which shows the large, expected decrease in sickling from the drug. The modeling indicates, however, that the increase in oxygen delivery from reduced sickling is largely offset by the increase in oxygen affinity. The net result is that the drug increases overall oxygen delivery only at the very lowest oxygen pressures. However, reduction of sickling mitigates red cell damage and explains the observed decrease in hemolysis. More importantly, our modeling of in vivo oxygen dissociation, sickling, and oxygen delivery suggests that drugs that increase fetal Hb or decrease mean corpuscular hemoglobin concentration (MCHC) should be more therapeutically effective than drugs that increase oxygen affinity.