bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of Magnetic Resonance Imaging Criteria for the Preoperative Assessment of Rotator Cuff Tears: A Systematic Review
Authors: Adriani Marco , Saccomanno Maristella Francesca , Motta Marcello , Galli Stefano , Milano Giuseppe
Published: May 2023

Background:

Magnetic resonance (MR) imaging is the most common modality for assessment of the rotator cuff before and after surgery. Several classifications have been described aiming to define main tear characteristics. However, there is still confusion when it comes to the reliability of those classifications.

Purpose:

(1) To identify all MR classifications available in the literature for preoperative assessment of rotator cuff tears, (2) to summarize available data on the reliability of identified classifications, and (3) to assess the methodological quality of reliability studies.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All studies reporting MR assessment in patients with a superior or posterosuperior rotator cuff tear were included. After identification of the available MR criteria, reliability studies were analyzed. Descriptive statistics were used to summarize findings. Methodological quality was assessed using the Quality Appraisal of Reliability Studies checklist.

Results:

A total of 75 studies were included in this review. Eight categories of outcomes could be identified. Of the total, 62 studies reported interobserver reliability whereas 32 reported intraobserver reliability of some of the identified criteria. Each category reflected a variety of reliability, ranging from poor to excellent agreement. MR proved to be a reliable imaging modality to detect the structural integrity of the posterosuperior cuff, especially in cases of full-thickness tear; it was also reliable in terms of tear width and length and muscle atrophy based on a tangent sign or Thomazeau classification. All other classifications did not prove acceptable reliability. Methodological quality was high for 23 articles and moderate for 14.

Conclusion:

Preoperative MR is a reliable imaging modality to identify full-thickness tears, measure tear size and morphology, and identify muscle atrophy with tangent sign or Thomazeau classification. All other outcomes and classifications did not show acceptable reliability; therefore, caution is needed when using them for preoperative evaluation of a rotator cuff tear.
Biomechanical Comparison of Distal Biceps Tendon Repair Techniques: Extracortical Single-Button Inlay Fixation Versus Intracortical Double-Button Onlay Anatomic Footprint Fixation
Authors: Ernstbrunner Lukas , Almond Mitchell , Rupasinghe Harshi S. , Jo Olivia I. , Zbeda Robert M. , Ackland David C. , Ek Eugene T.
Published: May 2023

Background:

Extracortical single-button (SB) inlay repair is a commonly used distal biceps tendon technique. However, complications (eg, neurovascular injury) and nonanatomic repairs have led to the development of intracortical fixation techniques.

Purpose:

To compare the biomechanical stability of extracortical SB repair with an anatomic intracortical double-button (DB) repair technique.

Study Design:

Controlled laboratory study.

Methods:

The distal biceps tendon was transected in 18 cadaveric elbows from 9 donors. One elbow of each donor was randomly assigned to the extracortical SB or anatomic DB group. Both groups were cyclically loaded with 60 N over 1000 cycles between 90° of flexion and full extension. The elbow was then fixed in 90° of flexion and the repair construct loaded to failure. Gap formation and construct stiffness during cyclic loading and ultimate load to failure were analyzed.

Results:

When compared with the extracortical SB technique after 1000 cycles, the anatomic DB technique showed significantly less gap formation (mean ± SD, 2.7 ± 0.8 vs 1.5 ± 0.9 mm; P = .017) and significantly more construct stiffness (87.4 ± 32.7 vs 119.9 ± 31.6 N/mm; P = .023). Ultimate load to failure was not significantly different between the groups (277 ± 93 vs 285 ± 135 N; P = .859). The failure mode in the anatomic DB group was significantly different from that of the extracortical SB technique ( P = .002) and was due to fracture avulsion of the cortical button in 7 of 9 specimens (vs none in the SB group).

Conclusion:

Our study shows that the intracortical DB technique produces equivalent or superior biomechanical performance to that of the SB technique. The DB technique may offer a clinically viable alternative to the SB repair technique.

Clinical Relevance:

This study suggests, at worst, an equivalent and, at best, a superior biomechanical performance of intracortical anatomic DB footprint repair at the time of surgery. However, the mode of failure suggests that this technique should not be used in patients with poor bone quality.
Dietary Diversity Predicts the Adequacy of Micronutrient Intake in 6- to 23-Month-Old Children Regardless of the Season in Rural Southern Benin
Authors: Hounkpatin Waliou Amoussa , Koukou Elie , Termote Céline , Ntandou-Bouzitou Gervais , Mitchodigni Irène , Bodjrènou Sam , Alaofè Halima
Published: May 2023

Background:

The Infants and Young Children Dietary Diversity Score (IYC-DDS-7) has been validated to assess dietary quality in children. However, its applicability to predict the adequacy of micronutrient intake remains a challenge in all contexts.

Design and Methods:

A 24-hour dietary recall assessment was conducted on a sample of 628 children aged 6 to 23 months in the plenty season (PS) as well as in the lean season (LS). The IYC-DDS-7 was calculated based on 7 food groups, whereas the mean micronutrient density adequacy (MMDA) for 11 micronutrients. The β regression models were used to assess the relationship between IYC-DDS and MMDA and differences in nutrient intake between the 2 seasons. A receiver-operating characteristic curve analysis was also performed to determine IYC-DDS-7 cutoff levels that maximized sensitivity and specificity in assessing dietary quality and predicting MMDA below- or above-selected cutoff levels.

Results:

Participating children’s MMDA was 56.9% ± 12.8% versus 61.9% ± 8.6% and IYC-DDS-7 was 3.43 ± 1.5 versus 3.77 ± 1.0 in the PS and LS. The IYC-DDS-7 had a positive correlation with MMDA, irrespective of the season. For a 1-unit increase in IYC-DDS-7, MMDA increased by a mean of 10.7% (CI, 8.3%-13.1%; P < .001). The minimum threshold of the 4 food groups corresponded to a sensitivity of 76% and 61% and a specificity of 75% and 70% for the prediction of inadequate diet in the PS and LS, respectively.

Conclusions:

The IYC-DDS-7 predicted MMDA, regardless of seasons for infants and young children. The IYC-DDS-7 cutoff of 4 groups performed well in classifying children with low-diet quality.
Reusable personal protective equipment in Canadian healthcare: Safe, secure, and sustainable
Authors: Varangu Linda , Cowan Kady , Amin Ozora , Sarrazin Mia , Dawson Marianne , Rubinstein Edward , Miller Fiona A. , Hirst Lesley , Trbovich Patricia , Waddington Kent
Published: May 2023

Personal Protective Equipment (PPE) that was intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, took on a heightened role during the pandemic. Healthcare workers who had access to these products and infrastructure for cleaning and sterilizing them had a greater sense of confidence to undertake their jobs due to an increased sense of personal safety. Using multiple data sources, including a literature review, roundtables, interviews, surveys, and Internet-based research, the project team investigated the impact of disposable PPE and role of reusable PPE during the pandemic in Canada. This research supports the claim that adopting and supporting reusable PPE systems throughout the health sector can, if used appropriately on an ongoing basis, provide continuous access to reusable PPE while also contributing many co-benefits, including lower costs, domestic jobs, and improved environmental performance such as reduced waste and greenhouse gas emissions.
Research on active safety control for heavy multi-axle vehicles under steering system failure
Authors: Liu Qihui , Du Heng , Yu Yajin , Huang Hui , Wang Yunchao , Fang Jinhui
Published: May 2023

Heavy multi-axle vehicles with long bodies, large loads, and many steering axles are prone to one stuck axle with its steering system failed, which leads to a sharp drop in vehicle safety. Modulating the steering angles of the remaining non-faulty axles for compensation control can significantly improve the safety of the vehicle. Therefore, this paper proposes a method based on multi-axle steering compensation, which solves the large trajectory error, and instability of heavy multi-axle vehicles caused by the failure of one-axle steering system. Firstly, based on the Lyapunov method, and nonlinear model, the critical steering angle of the faulty axle leading to vehicle instability under the failure of one-axle steering system is clarified, which provides a quantitative index for vehicle stability evaluation. Then, a two-level controller is designed to maintain stability and reduce trajectory error of the faulty vehicle. The upper dual-input dual-output (DIDO) sliding mode controller (SMC) compensates for the faulty vehicle’s lateral force and yaw moment. And the lower controller distributes the non-faulty axles’ steering angles through a strategy considering tire workload and slip energy dissipation. Finally, a seven-axle vehicle model in the Trucksim and a Trucksim-Simulink co-simulation are used to verify the effectiveness of the proposed method. The results illustrate that the proposed method can maintain vehicle stability and reduce the lateral trajectory error by about 22%–91% in the failure of one-axle steering system. It proves that this method can provide a new scheme for active safety control of heavy multi-axle vehicles.
Microstructure and mechanical properties of 7075 composites reinforced with TiO2-coated carbon nanotubes
Authors: Li Hai , Shuai Luming , Tu Kai , Zeng Min , Yan Hong
Published: May 2023

Microstructure and mechanical properties of 7075 aluminum matrix composites (AMCs) reinforced with TiO2-coated carbon nanotubes (TiO2@CNTs) prepared by high energy ultrasonic assisted casting were investigated. In this paper, a novel method was developed to increase interfacial bonding by coating TiO2 on the surface of CNTs. The results showed that high-energy ultrasound can effectively promote the uniform dispersion of TiO2@CNTs in the melt, and the TiO2@CNTs can refine the α-Al phase. The optimal addition of TiO2@CNTs was 0.9wt.%, and the optimal ultrasonic time was 10 min. The yield strength, ultimate tensile strength, and microhardness of the as-cast composites prepared under the optimal parameters were 201.22 MPa, 261.79 MPa, and 126.02 HV, respectively, which increased by 40.9%, 32%, and 32.2% compared with those of the matrix, respectively. The semi-coherent interface was formed at the TiO2/α-Al interface and well-bonded interfaces between the CNTs and the matrix were formed. The fine grain strengthening, thermal mismatch strengthening, Orowan strengthening, and direct bearing strengthening were considered as four strengthening mechanisms that occurred simultaneously, leading to excellent mechanical properties of as-cast 7075-TiO2@CNTs composites.
Leader–follower control of multi-unmanned aerial vehicle based on supervisory control theory for a broad tributary area mapping scenario
Authors: Seol Jaehwi , Ju Chanyoung , Son Hyoung Il
Published: May 2023

This study proposes a discrete event system-based control strategy for autonomous tributary mapping using multi-unmanned aerial vehicle. When considering the unmanned aerial vehicles as discrete event systems, supervisory control theory is used to model and control individual unmanned aerial vehicle behavior in the system. In tributary mapping, the situation changes each time depending on environmental factors (e.g. weather) and the work must be performed in an unstructured environment. Therefore, this article proposes a multi-unmanned aerial vehicle-based supervisory control system to solve real-field problems. Unlike the control systems of recent studies, which mainly deal with continuous-time dynamics, we modeled a multi-unmanned aerial vehicle system based on a discrete event system in which the dynamic states are transitioned by asynchronous events. The proposed multi-unmanned aerial vehicle-based supervisory control system was validated in dynamic simulators and demonstrated that multi-unmanned aerial vehicle satisfies the behavior specifications. The supervisor proposed in this study was validated using a physics-based simulator.
Registering Cosmetics? The Constitution of Legal Form and Injurious Substance in Canada (1945–1946)
Authors: Tessaro Lara
Published: May 2023

In midcentury Canada, legislative drafters, government lawyers, food and drug officials, and ministers grappled with cosmetics. Faced with constitutional concerns about cosmetic licensing, these actors drafted legislative amendments that would instead require cosmetics to be registered. In contrast to people or land, the registration of products, substances, or things has received little attention in sociolegal scholarship. Building on work investigating law's temporalities and materiality, this account traces how in-formed by the constitutional doctrine that apprehended substances through the legal form of prohibition, cosmetics were rendered in draft legislation as constituted of ingredients that may cause injury. Injury, in this account, is a material-temporal regime. Yet cosmetic injury was neither static nor singular, as it was catalysed differently by distinctive regulatory devices. This is shown by last-minute changes to the bill which retooled cosmetic registration, from an information extraction device for anticipating future harms, into a recording device for capturing latent harms.
The right to life at the end of life: A note on Mortier v Belgium App No. 78017/17, 4 October 2022
Authors: Martin Stevie
Published: May 2023

The judgment of the European Court of Human Rights in Mortier v Belgium, delivered in October 2022, is the first time the Court has squarely confronted the issue of whether permitting assisted dying is compatible with a state’s obligation to protect life under Article 2 of the European Convention on Human Rights. The case, brought by the son of a woman who had been euthanised, was based predominantly on the argument that the Belgian system of assisted dying failed to adequately protect the lives of vulnerable individuals, such as the applicant’s mother. A majority of the Court held that a permissive assisted dying regime could comply with the positive obligation to protect under Article 2, provided there are safeguards in place including a system capable of ensuring that an individual’s request for assistance is freely made and informed, as well as a posteriori control in the form of supervision of compliance with the legislative and regulatory safeguards. While there were deficiencies in the Belgian system’s a posteriori control which led to a finding of a violation of Article 2, the judgment clearly demonstrates that states can permit assisted dying without violating their protective obligations under Article 2. Significantly, the Court did not consider that permitting assisted dying for individuals whose suffering emanates from a non-terminal condition (including a mental illness) was problematic from a Convention perspective. The judgment is likely to be of considerable interest to policy makers, legislators, medical practitioners, and campaigners in the increasing number of jurisdictions both within the Council of Europe and beyond, that are considering whether to legalise assisted dying and, if so, the parameters of such a regime.
Experiences of dignity: Age at onset of serious illness matters
Authors: Nelsen Jakob , Shive Nadia , Bennett C Robert , Coats Heather
Published: May 2023

Background

Preserving persons’ dignity is integral to nursing. More research is needed to explore how a diversity of patients, particularly those that experience illness from a young age, experience dignity.

Aim

Describe the characteristics of dignity for persons living with serious illness.

Research design

Using a secondary data set of twenty audio-recorded interviews, a thematic content analysis was conducted to identify characteristics of dignity. The research team employed van Gennip et al.’s, 2013 “Model of Dignity in Illness” (1) to create a codebook, which the authors utilized to independently code twenty narrative interview transcripts.

Participants and research context

Twenty persons living with serious illness of heart failure and/or dialysis-dependent renal failure who were admitted in an acute care hospital.

Ethical considerations

This study was approved on August 26, 2019, by the Colorado Multiple Institutional Review Board (COMIRB) IRB Protocol #19-1874.

Findings

Early-onset participants expressed markedly different dignity concerns than late-onset participants. In the individual domain, early-onset participants felt that their illness was “normal”; they did not experience the “healthy person to patient” transition described by older onset participants. In the relational domain, early-onset participants expressed that their relationships had already integrated their illness while late-onset participants felt that their illness harmed many of their relationships. In the societal domain, early-onset participants described dignity concerns related to how society impacted their ability to financially support themselves during their illness.

Discussion

Differences in the dignity experience of early-onset and late-onset participants are informed by Erikson’s “Model of Development” and by Aranda and Jones feminist critique of dignity in healthcare.

Conclusions

Persons with early-onset illness experience dignity differently. Awareness of the importance of work and financial independence to the experience of dignity for seriously ill patients may enhance persons’ dignity experience.
Overlapping Spectrum of Craniofacial Microsomia Phenotype in Cat-Eye Syndrome
Authors: Spineli-Silva Samira , Monlleó Isabella L. , Félix Têmis M. , Gil-da-Silva-Lopes Vera L. , Vieira Társis P.
Published: May 2023

This study reports three patients with Cat-eye Syndrome (CES), two of which present a previous clinical diagnosis of Craniofacial microsomia (CFM). Chromosomal microarray analysis (CMA) revealed a tetrasomy of 1,7 Mb at the 22q11.2q11.21 region, which is the typical region triplicated in the CES, in all patients. The most frequent craniofacial features found in individuals with CFM and CES are preauricular tags and/or pits and mandibular hypoplasia. We reinforce that the candidate genes for CFM features, particularly ear malformation, preauricular tags/pits, and facial asymmetry, can be in the proximal region of the 22q11.2 region.
Regional Citrate Anticoagulation or Heparin Anticoagulation for Renal Replacement Therapy in Patients With Liver Failure: A Systematic Review and Meta-Analysis
Authors: Qi Wenqian , Liu Jingyuan , Li Ang
Published: May 2023

In patients with liver failure complicated by acute kidney injury, renal replacement therapy (RRT) is often required to improve the internal environment. The use of anticoagulants for RRT in patients with liver failure remains controversial. We searched the PubMed, Embase, Cochrane Library, and Web of Science databases for studies. The methodological quality of the included studies was assessed using the Methodological Index for Nonrandomized Studies. A meta-analysis was performed using R software (version 3.5.1) and Review Manager (version 5.3.5). During RRT, 348 patients from 9 studies received regional citrate anticoagulation (RCA), and 127 patients from 5 studies received heparin anticoagulation (including heparin and LMWH). Among patients who received RCA, the incidence of citrate accumulation, metabolic acidosis, and metabolic alkalosis were 5.3% (95% confidence interval [CI]: 0%–25.3%), 26.4% (95% CI: 0–76.9), and 1.8% (95% CI: 0–6.8), respectively. The potassium, phosphorus, total bilirubin (TBIL), and creatinine levels were lower, whereas the serum pH, bicarbonate, base excess levels, and total calcium/ionized calcium ratio were higher after treatment than before treatment. Among patients who received heparin anticoagulation, the TBIL levels were lower, whereas the activated partial thromboplastin clotting time and D-dimer levels were higher after treatment than before treatment. The mortality rates in the RCA and heparin anticoagulation groups were 58.9% (95% CI: 39.2–77.3) and 47.4% (95% CI: 31.1–63.7), respectively. No statistical difference in mortality was observed between the 2 groups. For patients with liver failure, the administration of RCA or heparin for anticoagulation during RRT under strict monitoring may be safe and effective.
Compensation for low-frequency vibration in lateral control of truck by adaptive feed-forward cancellation
Authors: Yabui Shota , Suzuki Motoya , Fukazawa Shinichiro , Ebina Hiroshi , Makino Toma , Nonaka Kenichiro
Published: May 2023

The role of truck transportation is becoming increasingly important in the growth of the e-commerce market. Self-driving trucks are being developed for efficient transportation. To realize a safe self-driving system, the control system should compensate for various vibrations while the truck is running. In the yaw direction, the mechanical resonance of the chassis suspension can cause low-frequency vibration. There are two approaches to compensate for the vibration. The first is a vibration control by using the truck suspension system. The method effectively compensates for vibration; implementing additional parts increases the cost. The second is vibration control based on the yaw-rate feedback control system. A notch filter or a lowpass filter decreases the gain at the vibration frequency and is effective in compensating for vibrations. The tracking performance of the reference signal can be degraded by decreasing the gain in the low-frequency range. Therefore, it is required that a solution can compensate for the vibration without the additional parts and no performance degradation. This paper proposes the use of an adaptive feed-forward cancellation (AFC) to compensate for low-frequency vibrations in the yaw-rate feedback control system. The AFC generates a compensation signal based on the difference between the reference signal and the actual yaw rate. The AFC does not reduce the gain near the vibration frequency; therefore, the AFC can achieve low-frequency vibration compensation while maintaining the tracking performance. In addition, the proposed control system does not require additional parts. The effectiveness of the proposed method was verified by experiments using an actual commercial truck.
The Relationship Between Cortical Thickness and Executive Function Measures in Children With and Without ADHD
Authors: Sarabin Elana , Harkness Kelsey , Murias Kara
Published: May 2023

Objective:

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by inattention, hyperactivity, and impulsivity; however, other executive function dysregulation is common, including inhibition and working memory. This study aims to identify CT differences based on executive function performance in individuals with and without ADHD.

Methods:

Data for this study was acquired from the Adolescent Brain and Cognitive Development (ABCD) database (61 ADHD, and 61 age and sex matched controls). General linear models were used to assess relationships between measures, CT, and diagnosis.

Results:

We found a significant relation between CT and working memory scores in the right precentral area. Additionally, we found significant interactions between CT, diagnosis, and measure outcome in the Flanker assessment (in the left fusiform area) and the attention score of the CBCL (in the right precentral region).

Conclusion:

This suggests that there may be different relationships that exist between CT and executive function in children with ADHD.
Effects of COVID-19 Lockdown on Nutritional, Functional and Frailty Biomarkers of People Living in Nursing Homes. A Prospective Study
Authors: De Souza Oliveira Adriana C. , Gómez Gallego María , Martínez Carmelo Gómez , López Mongil Rosa , Moreno Molina Jorge , Hernández Morante Juan José , Echevarría Pérez Paloma
Published: May 2023

Background

Nursing home residences suffered a lockdown from the beginning of the COVID-19 pandemic. The present study prospectively evaluates the frailty, functional, and nutritional statuses of nursing home residents.

Methods

Three hundred and one residents from three nursing homes took part in the study. Frailty status was measured using the FRAIL scale. Functional status was evaluated using the Barthel Index. Additionally, Short Physical Performance Batter (SPPB), SARC-F, hand-grip strength, and gait speed were also evaluated. Nutritional status was determined using the mini nutritional assessment test (MNA) and several anthropometrical and biochemical markers.

Results

Mini Nutritional Assessment test scores decreased in 20% throughout the confinement ( p < .001). Barthel index, SPPB and SARC-F scores also decreased, although to a lesser extent, reflecting a decrease in functional capacity. However, both anthropometric parameters, hand grip strength and gait speed, remained stable throughout confinement ( p > .050 in all cases). Morning cortisol secretion significantly decreased by 40% from baseline to post-confinement. A significant reduction in daily cortisol variability was observed, which may suggest increased distress. Fifty-six residents died during the period of confinement (81.4% survival rate). Sex, FRAIL and Barthel Index scores were significant predictors of resident survival.

Conclusion

After the first COVID-19 blockade, several alterations in residents' frailty markers were observed, which were small and potentially reversible. However, many of the residents were pre-frail after the lockdown. This fact highlights the need for preventive strategies to reduce the impact of future social and physical stressors on these vulnerable individuals.
Enlarging aneurysm with paracentral acute middle maculopathy in idiopathic retinal vasculitis, aneurysms and neuroretinitis (IRVAN) – a case report
Authors: Govindaraj Indu , Kuriakose Anju , Rajendran Anand
Published: May 2023

Introduction

Idiopathic retinal vasculitis, aneurysms, and neuroretinitis (IRVAN) syndrome is a rare clinical entity affecting young healthy individuals. Treatment primarily involves pan retinal photocoagulation (PRP) to capillary non perfusion areas. Intravitreal anti-VEGF or steroids are given in the presence of macula edema. Oral steroids do not alter the course of the disease. Arterial occlusions have been reported in IRVAN.

Methods

Retrospective case review.

Result

A twenty seven year old male presented to us with mild blurring of vision for one week. His BCVA was OU 20/20. Anterior segment examination was normal. Fundus examination showed bilateral disc aneurysm with OS arterial aneurysm along the inferior arcade. Fundhus fluorescein angiography and OCT angiography were confirmatory of the disc and retinal aneurysm. Capillary non perfusion (CNP) areas were noted in the periphery. Two days later he presented with paracentral scotoma in his left eye which was confirmed by Amsler chart. Fundus, OCT and OCTA were confirmatory of Paracentral Acute Middle Maculopathy (PAMM). The retinal aneurysm had increased in size from 333 micron diameter to 566 micron diameter. Panretinal photocoagulation to the CNP areas was done and intravitreal antiVEGF was given. At 6 months follow up, retinal aneurysm had disappeared.

Discussion

Our case describes a unique event with sudden increase in size of the aneurysm leading to acute blockage in the deep capillary plexus thus being the first report of PAMM in IRVAN. The patient was treated with PRP and intravitreal anti-VEGF for the enlarging aneurysm which reduced in size within a week.
Iatrogenic injury to the subclavian artery during central venous access
Authors: Palesy Tom , Neal Joanna , Bhutia Sherab
Published: May 2023

Subclavian artery injury during central venous line placement is a potentially life-threatening complication. Due to historically high mortality rates with attempted manual pressure for haemostasis, the current favoured method of repair is by open or endovascular means. This case describes the management of a central venous catheter placed through the internal jugular vein into the subclavian artery via a supraclavicular puncture. CT angiography revealed the arterial injury located 1 cm distal to the vertebral artery origin. Under fluoroscopic guidance in an endovascular hybrid theatre, a covered stent was deployed across the affected segment of the subclavian artery which resulted in occlusion of the vertebral artery origin to attain safe proximal seal. This was done during simultaneous removal of the catheter and manual pressure over the internal jugular vein. There were no complications and the patient recovered well post-procedure. This case highlights the importance of appropriate ultrasound techniques for central catheter insertion for precise visualisation to prevent inadvertent injury to distal structures. CT angiography is useful in planning endovascular management. Occlusion of the vertebral artery in this case did not result in any neurological complications.
Caveat Medicus: It’s Time to Re-Think Stratification, You May Not Be Helping
Authors: Arandjelović Ognjen
Published: May 2023

Background:

The focus of the present Letter is on the large and seemingly fertile body of work captured under the umbrella of ‘patient stratification’.

Objectives:

I identify and explain a fundamental methodological flaw underlying the manner in which the development of an increasingly large number of new stratification strategies is approached.

Design:

I show an inherent conflict between the assumptions made, and the very purpose of stratification and its application in practice.

Methods:

I analyse the methodological underpinnings of stratification as presently done and draw parallels with conceptually similarly flawed precedents which are now widely recognized.

Results:

The highlighted flaw is shown to undermine the overarching ultimate goal of improved patient outcomes by undue fixation on an ill-founded proxy.

Conclusion:

I issue a call for a re-think of the problem and the processes leading to the adoption of new stratification strategies in the clinic.
Blue Rubber Bleb Nevus Syndrome Presenting as Anemia, Hemorrhage, and Hemangiomas: A Rare Case Report
Authors: Khan Qaisar Ali , Farkouh Christopher , Khan Arooba , Uddin Zahir , Abdi Parsa , R Anthony Michelle , Hadi Faiza Amatul , Khan Eyan , Pervez Sara
Published: May 2023

Background:

Blue Rubber Bleb Nevus syndrome (BRBNS) is a rare disorder, that results in congenital cutaneous hemangiomas of the skin and gastrointestinal tract. Although asymptomatic, the nevi present as soft, non-mobile, dark blue, compressible papules. Clinically it presents as iron deficiency anemia due to occult gastrointestinal bleeding.

Case presentation:

A 22-year-old female patient presented with complaints of shortness of breath, fatigue, and palpitation for 2 months. On examination, she had a pale effect and widespread hemangiomas on her lips, hands, and feet. Laboratory results revealed iron deficiency anemia with hemoglobin (Hb) of 2.1 gm/dl and histopathology results of the hemangioma specimen showed angiokeratomas. Based on clinical manifestations and laboratory results, the patient was diagnosed with a case of BRBNS. The patient was transfused with red cell concentrate her symptoms improved but on the first follow-up visit her Hb again dropped to 8.6 mg/dl.

Conclusion:

A high suspicion of BRBNS diagnosis should be considered if a patient presents with iron deficiency anemia and multiple cutaneous hemangiomas. Further screening should be done to explore internal bleeding and hemangiomas.
Family-friendly wine tourism? The challenge of supplying child-inclusive wine terroir experiences
Authors: Malerba Rafaela Camara , Kastenholz Elisabeth , Carneiro Maria João
Published: May 2023

Wine tourism, traditionally understood as an activity practised by adults, has been suggested as a tourism form also adequate and interesting for families with children. However, both literature and practice do not consider this segment to the extent it, arguably, may deserve. Many challenges are associated with the creation of wine tourism offerings for children. Even so, wine estates and destinations attract families, not only for their wine-related attributes but also for their rural and cultural appeal. In Central Portugal, the Dão and Bairrada wine routes cover tourist regions strongly linked to family tourism. Nevertheless, there is a lack of wine tourism offerings targeting this segment. Likewise, there are no know studies on wineries’ managers perceptions of this market. Thus, this study aims to identify and analyse how wine estates and wineries from these wine routes cater to families with children, to understand the managers’ perception of benefits and challenges of targeting this market, and to examine the existing child-friendly tourism supply. The results, derived from the content analysis of 29 interviews with wineries’ managers, reveal that, despite an inclusive and receptive discourse towards the presence of children, the attractions still do not offer services and experiences specifically designed for this segment. Except for a few innovative attractions, families are welcomed with improvisations to entertain the little ones while their parents carry out wine-related activities.
Parental motivated helplessness in vaccinating children against COVID-19: Its association with fear, effectiveness and willingness to vaccinate
Authors: Kretchner Mabelle , Lifshin Uri , Mikulincer Mario
Published: May 2023

According to the motivated helplessness hypothesis, parental feelings of helplessness regarding vaccinating children against COVID-19 may serve a protective function against vaccine fear and hesitancy. Two correlational studies conducted among Israelis (Study 1) and an international sample (Study 2), examined whether self-reported perceived helplessness in vaccinating children may be related to lower vaccine-fear, and higher perceived vaccine-effectiveness, trust in authorities’ recommendations and willingness to vaccinate. Results indicated parents who felt they had no other choice but to vaccinate their children, exhibited less vaccine-fear, higher vaccine-effectiveness and greater intentions to vaccinate. Additionally, the relationships between vaccine-helplessness, vaccine-effectiveness and willingness to vaccinate were partially mediated by vaccine-fear. In Study 2, vaccine-helplessness was found related to higher trust in authorities’ recommendations, which was partially mediated by vaccine-fear. The implications of these findings for research on the psychological function of helplessness in the parental decision-making process of vaccinating children during a pandemic are discussed.
Temperature behavior of cable-stayed bridges. Part II — temperature actions by using unified analysis
Authors: Shan Yushi , Jing Qiang , Li Lingfang , Gao Wenbo , Xia Zili , Xia Yong
Published: May 2023

The temperature action of long-span cable-stayed bridges is complicated because of the high indeterminacy of their structure. Previous studies on the temperature behavior of bridges were either limited by finite sensors, failing to capture the accurate relation between the temperature field and temperature-induced responses, or constrained to a “divide-and-conquer” strategy, requiring considerable manual intervention and regarded as computationally inefficient. This study develops a unified approach to the investigation of thermal behaviors of cable-stayed bridges by integrating the heat-transfer analysis and structural analysis based on the same refined global 3D finite element model. The companion paper (Part I) investigates the temperature distribution, while this paper (Part II) focuses on temperature-induced responses. The temperature distribution data is automatically converted to thermal loads, and thermal elements are changed to structural elements to calculate the temperature-induced responses of the bridge. Results show that the effect of the temperature variation of cables is nonnegligible and should be taken into account during the structural analysis. The longitudinal displacement of the girder and the longitudinal displacement of the tower top are mainly influenced by the average girder temperature, the mid-span deflection and the cable stress are dominated by the cable temperature and average girder temperature, and the stress of the girder is controlled by the vertical temperature difference. The ratio of the thermal stress to the dead load stress of the girder can reach 96%. The calculated displacement and stress of the bridge agree well with the corresponding measurements, consequently verifying the effectiveness of the proposed unified approach to calculating temperature-induced responses.
Theoretical and experimental study for implementation of the elliptical trajectory in dual-motor vibration system
Authors: Peng Ruihao , Fang Pan , Yang Liming , Chen Ningsheng , Zhao Xiaohai
Published: May 2023

In the petroleum drilling industry, the smoothly functioning vibrating screens play a critical role in control of solid–liquid and recovery of drilling fluid. Due to the mechanical coupling, the surface of the vibrating screen tends to produce unbalanced swings, which makes the motion trajectory inconsistent with the situation at the center of mass, thus affecting the screening efficiency. In order to reveal the reasons for the unbalanced swings of the vibration system and the principle of the trajectory equilibrium characteristics (TECs), the self-synchronization characteristics of two eccentric rotors (ERs) driven by elliptical trajectory dual-motor vibrating system are investigated. The kinematic differential equations of the vibration system are determined by the Lagrange method. Then, the conditions of synchronization and stability of the vibration system are determined, respectively, by the small parameter average approach and the Routh–Hurwitz criterion. Subsequently, the impact of the structural parameters about the synchronization stability is examined by numerical discussion. Furthermore, the effectiveness of the theoretical research is confirmed by comparing the results between dynamics simulation and experiment under different structural parameters. Finally, by focusing on the analysis of the trajectories of different measuring points in the experiment, the relevant conclusions on how to reduce the unbalanced swings and maintain the TECs of the vibration system are obtained. The elliptical trajectory form of the system is most affected by the motor installation angle and installation distance in vibrating body, while less affected by the installation deflection angle and installation offset distance between the motors. In addition, the elliptical trajectories of the oscillating body are in a good equilibrium when reducing the swing angle of the vibration system, in other words, increasing the installation angle and reducing the installation distance of the exciters in the stable state.
Sustaining opportunities and mutual partiality through Collaborative Online International Learning in South Africa
Authors: Naicker Ashika
Published: May 2023

The value of internationalization within the limits of mobility has become more pronounced during the COVID-19 pandemic. As reflection occurs on our own history, navigating a period of reset and renewal, this paper examines how to advance our thinking, and explore and transverse essential differences within the digital space. Hence, recalibrating the global north and south agenda to create inclusionary principles through virtual exchange. First, this ethnographic paper explores the sympoeitic relationship of creating opportunities and a sense of agency toward morphogenesis. Second, it focuses on the contextual rationale for Collaborative Online International Learning (COIL) within higher education. Third, it explores equity in the digital space through multiple engagements in COIL. The paper offers associated conclusions for critical virtual exchange to advance equity, inclusion, and social justice and suggests responsible pluralistic internationalization.
Comparative study of microvascular structural changes in the gestational diabetic placenta
Authors: Liang Xinyan , Zhang Jiaqi , Wang Yu , Wu You , Liu Hui , Feng Wei , Si Ziyi , Sun Ruige , Hao Zizhou , Guo Hongzhi , Li Xue , Xu Tao , Wang Mofeng , Nan Zhen , Lv Yang , Shang Xinan
Published: May 2023

Aims

Microvascular morphology and pathological changes in gestational diabetes mellitus (GDM) placentas and normal placentas were observed via vascular casting technology, electron microscopy, and pathological detection technology. Vascular structure and histological morphology changes in GDM placentas were examined to generate basic experimental data for the diagnosis and prognostic determination of GDM.

Methods

This case–control study involving 60 placentas, 30 from healthy controls and 30 from patients with GDM. Differences in size, weight, volume, umbilical cord diameter, and gestational age were assessed. Histological changes in the placentas in the two groups were analyzed and compared. A placental vessel casting model was constructed using a self-setting dental powder technique, to compare the two groups. The placental cast microvessels of the two groups were compared using scanning electron microscopy.

Results

There were no significant differences in maternal age or gestational age between the GDM group and the control group ( p > .05). The size, weight, volume, and thickness of the placentas in the GDM group were significantly greater than those in the control group, as was umbilical cord diameter ( p < .05). Immature villus, fibrinoid necrosis, calcification, and vascular thrombosis were significantly greater in the placental mass in the GDM group ( p < .05). The terminal branches of the microvessels in diabetic placenta casts were sparse, with significantly fewer ends and lower villous volume ( p < .05).

Conclusion

Gestational diabetes can cause gross and histological changes in the placenta, particularly placental microvascular changes.
Does Intervention Improve Precalculus Performance Among Students in Historically Black Colleges and Universities?
Authors: Erebholo Francis
Published: May 2023

Many students across the country experienced a decline in academic performance due to COVID-19. As a result, college readiness measures have fallen short, especially in math. This lack of preparation frequently leads to additional teaching, wasting important class time by going over the prerequisite content again instead of using it to study new topics in greater depth. This study aims to evaluate the effectiveness and impact of a recitation laboratory for precalculus students in bridging the conceptual gap, strengthening the concepts, eradicating any misunderstandings, and eventually improving student performance. The results demonstrated that the adopted intervention significantly improved student performance and helped students close conceptual gaps in precalculus, thereby reducing the level of attrition from their majors and university.
A Modified Method for the Quantification of Immune Checkpoint Ligands on Exosomes from Human Serum using Flow Cytometry
Authors: Alejandre Gonzalez Alan Guillermo , Ortiz-Lazareno Pablo Cesar , Solorzano-Ibarra Fabiola , Gutierrez-Franco Jorge , Tellez-Bañuelos Martha Cecilia , Bueno-Topete Miriam Ruth , del Toro-Arreola Susana , Haramati Jesse
Published: May 2023

Objectives: Exosomes are the smallest of the extracellular vesicles and can contain a variety of different cargos, including nucleic acids, lipids, and proteins. Ultracentrifugation followed by electron microscopy has historically been used for the isolation and visualization of exosomes; Western blot and ELISA have also been used, but these techniques are only semiquantitative and are unable to distinguish different exosome markers in the same sample. To resolve some of these issues, we propose a modification of a bead-based flow cytometry method. Methods: Peripheral blood serum was mixed with a commercial exosome separation reagent and incubated for 30 min at 4°, centrifuged, exosome pellet was isolated and resuspended in PBS. Exosomes were then added to magnetic beads, incubated 18 h, then incubated with exosome-specific antibodies for 1 h. The resulting bead:exosome complexes were centrifuged and then washed, then washed again using a magnetic separator, resuspended in PBS, and analyzed via flow cytometry. Results: Using commercial magnetic beads bound with anti-CD63, our protocol modifies starting conditions, washing steps, and magnetic separation and uses the FSC and SSC determination of the flow cytometer to result in increased yield and identification of the exosome populations of interest. Our modified protocol increased the yield of specific populations approximately 10-fold. Conclusion: The new protocol was used to identify exosomes positive for 2 immune checkpoint ligands in serum-derived exosomes from cervical cancer patients. We suspect that this protocol can also be used for the identification of other exosome proteins since we also quantified the exosome membrane-enriched tetraspanins CD9 and CD81. Identification of proteins rarely expressed in exosomes is complicated in this technique as serum is an inherently dirty source of exosomes, and great care must be taken in the washing and gating of the exosome:bead populations.
Associations Between Abdominal Obesity, Chewing Difficulty and Cognitive Impairment in Dementia-Free Chinese Elderly
Authors: Sheng Ziyue , Xia Binte , Wu Jing , Zhao Xuhao , He Xindi , Wen Xu , Yuan Changzheng , Pang Ting , Xu Xin
Published: May 2023

Objective

To investigate the independent and synergistic associations between abdominal obesity, chewing difficulty and cognitive impairment in a community-dwelling older adults sample in China.

Methods

Cognitive function was measured by the 5 min- Montreal Cognitive Assessment (5 min-MoCA) and abdominal obesity was measured by A Body Shape Index (ABSI) in 572 participants recruited from local communities. Chewing difficulty was assessed via a self-report questionnaire. Linear regression and general logistic regression were performed to investigate the association of chewing difficulty and abdominal obesity with cognition.

Results

Chewing difficulty score [β (95% CI) = −.30 (−.49, −.11)] and ABSI [β (95%CI) = −.30 (−.55, −.05)] were independently associated with worse performance on the 5 min-MoCA. Whilst ABSI was not associated with cognitive impairment, the co-existence of chewing difficulty and abdominal obesity [OR (95% CI) = 2.22 (1.18, 4.17)] was found associated with the presence of cognitive impairment.

Conclusion

Chewing difficulty and abdominal obesity were independently associated with cognition. Abdominal obesity and chewing may have an additive effect on cognitive function.
Be a PEACH and Hand Me That Levetiracetam: Seizure Prophylaxis for Spontaneous Intracerebral Hemorrhage
Authors: Cervenka Mackenzie C.
Published: May 2023

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