bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic simulation study of the steam temperature in a ultra-supercritical circulating fluidized bed boiler system
Authors: Kim Seongil , Choi Sangmin , Song Tae-Ho , Lappalainen Jari
Published: April 2020

A dynamic simulation of a modern ultra-supercritical circulating fluidized bed (USC-CFB) boiler system was performed using a physics-based model, where the boiler system was composed of an integrated system of heat exchanger (HEX) blocks. In each of the discretized elements of the HEX blocks, supercritical steam flow interacted with the solid–gas flow via heat transfer, and conservation laws, and physical phenomena of the CFB, and the supercritical steam flow was modeled to obtain the flow properties of each material side. By utilizing this model, the dynamic behavior of the main steam temperature, which was selected as the representative performance parameter for achieving safe and fast load changes, was simulated in response to changes applied to the main operating parameters such as the feedwater and fuel flow rates. The dynamic characteristics of the USC-CFB boiler were demonstrated by presenting the temperature responses of the steam and the circulating solid–gas after a step change in the feedwater and fuel flow rates. In the case of a load change, the dynamic response of the steam temperature was quantitatively presented by showing the transient overshoot and undershoot behavior, depending on the selection of the ramp speed when changing the feedwater and fuel flow rates. The steam temperature was also shown to be controlled by manipulating the inlet solid mass flow rate into the final superheater section of the external HEX. The comprehensive set of plant performance data that was generated from the model simulation can be utilized in setting up the operation strategies and/or in determining the control parameters for achieving stable steam temperature behavior during a load change.
Ancient runoff harvesting agriculture in the arid Beer Sheva Valley, Israel: An interdisciplinary study
Authors: Haiman Mordechai , Argaman Eli , Stavi Ilan
Published: April 2020

Between 2004 and 2008, a wealth of ancient agriculture-related finds was uncovered during a survey throughout the loess plains of the Beer Sheva Valley region, in the arid northern Negev, Israel. The survey was conducted under the framework of an archeological study, aimed at assessing the similarities and dissimilarities of the valley’s ancient agricultural systems to those of the Negev Highlands to the south and of the Judean Lowlands and Southern Hebron Mountains to the north. Data collection from selected sites included detailed mapping of settlements and their hinterlands. Ancient runoff farming systems, comprised of relatively uniform stone terraces transecting the wadis (ephemeral stream channels), and other agriculture-related structures, such as tuleilat el anab (spatially patterned stone mounds erected on hillslopes), were revealed throughout the region. Other archeological finds included a variety of structures, including livestock pens, square watchtowers, rock-cut water cisterns, and others. This study indicates that like the agricultural systems in the neighboring southern and northern regions, the systematic terracing of wadis across the Beer Sheva Valley region was affiliated with the monastic settlement system, which was centrally managed by the church in the service of the Byzantine Empire. The significance of this settlement system stems from its highly capable central organization, aiming to achieve geo-political control of space. Despite peaking in the mid-6th century CE, this system persisted throughout the Early Islamic period, until the mid-8th century CE. Results of this study contradict the conclusions of previous studies, which negated the viability of ancient runoff farming across the loess plains of the Beer Sheva Valley region. Insights of this research highlight the need for interdisciplinary studies when assessing the interactions between human populations and the natural environment in ancient times.
Zinc and selenium combination treatment protected diabetes-induced testicular and epididymal damage in rat
Authors: Sahu C , Dwivedi DK , Jena GB
Published: April 2020

Diabetes increases the possibility of germ cell damage, hypogonadism, and male infertility. Diabetic condition negatively impacts zinc (Zn) and selenium (Se) levels in the body. Zn and Se are among the most important trace elements involved in the regulation of redox reaction, antioxidants enzymes activities, and DNA expression in a germ cell. The present study aimed to elucidate the combined effects of Zn and Se treatment on diabetes-induced germ cell damage in male Sprague Dawley rats. Type 1 diabetes was induced by the single intraperitoneal (i.p.) injection of streptozotocin (55 mg/kg). Zn (3 mg/kg, i.p.) and Se (0.5 mg/kg, i.p.) were administered daily for 8 consecutive weeks. All the animals were provided with normal feed and water throughout the study. The effects on germ cell damage were evaluated by body weight, feed-water intake, organ weight, sperm count, motility, sperm head morphology, biochemical analysis, histology, immunohistochemistry, halo assay, germ cell comet assay, testes terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end-labeling (TUNEL) assay, sperm TUNEL assay, serum protein pattern analysis, and subcellular analysis using transmission electron microscopy. Further, the expressions of nuclear erythroid-derived related factor 2, catalase, glutathione peroxidase 4, and glutathione peroxidase 5 were carried out to ascertain the mechanism of protection. The present results demonstrated that 8 weeks combined treatment of Zn (3 mg/kg, i.p.) and Se (0.5 mg/kg, i.p.) reduced diabetes-induced germ cell damage. This study further highlighted that Zn and Se combination treatment might be a better strategy for the germ cell protection in diabetes and deserve further investigation.
Acupuncture stimulation attenuates TNF-α production via vagal modulation in the concanavalin A model of hepatitis
Authors: Lim Hee-Don , Kim Ki-Joong , Jo Byung Gon , Park Ji-Yeun , Namgung Uk
Published: April 2020

Background:

A growing body of evidence shows that neuronal activity is involved in modulating the efficacy of acupuncture therapy. However, it has been seldom investigated whether neuronal activity following acupuncture stimulation is effective at regulating hepatic inflammation.

Objective:

Using the concanavalin A (ConA) model of hepatitis, we investigated the regulation of inflammatory cytokine tumor necrosis factor (TNF)-α in the liver tissue and the blood after acupuncture stimulation at ST36.

Methods:

Mice were subjected to ConA injection, acupuncture stimulation at ST36 by manual acupuncture (MA) or electroacupuncture (EA) procedures, and vagotomy (VNX). Liver tissue and blood were collected for TNF-α analysis. TNF-α mRNA was analyzed by real-time polymerase chain reaction (PCR), and TNF-α, CD11b, CD68, and Erk1/2 proteins were analyzed by Western blotting, immunofluorescence staining, and enzyme-linked immunosorbent assay.

Results:

TNF-α mRNA and protein were induced in CD11b-positive hepatic cells and the plasma at 6–24 h after ConA injection. The application of MA or EA was very effective at attenuating the production of TNF-α. Anti-inflammatory effects of acupuncture were greatly suppressed by VNX in ConA-injected animals, suggesting the requirement of vagus nerve activity in acupuncture-mediated anti-inflammatory responses. Electrical stimulation of the sciatic nerve (SNS) resulted in an anti-inflammatory effect similar to acupuncture stimulation. In parallel with TNF-α, production of phospho-Erk1/2, which was induced in the liver tissue, was downregulated by MA and EA in liver cells.

Conclusion:

The regulatory effects of acupuncture stimulation on inflammatory responses in the liver may be modulated through the activation of the vagus nerve pathway.
Arab students and the Stasi: Agents and objects of intelligence
Authors: Hoffmann Sophia
Published: April 2020

In the early 1980s, the East German Ministry for State Security systematically recruited Arab students as covert informers. Analysis of this historical case contributes to discussions about surveillance as a social practice and to an emerging critical literature about intelligence agencies as knowledge producers and agents of governance. Proceeding from a close reading of archives documenting the recruitment process, I argue that it produced, first, classic modern bureaucratic security mechanisms designed to govern populations and, second, highly specific sovereign interventions into the lives of single individuals. By focusing primarily on the agents of surveillance, rather than its objects, the article addresses an important gap in the surveillance literature.
Near infrared spectrometric investigation of lactate in a varying pH buffer
Authors: Baishya Nystha , Momouei Mohammad , Budidha Karthik , Qassem Meha , Vadgama Pankaj , Kyriacou Panicos A
Published: April 2020

Lactic acidosis is commonly observed in various disease states in critical care and can be adopted as a hemodynamic biomarker, as well as a target for therapy. pH is the main biomarker for the diagnosis of acid–base disorders and is currently measured utilizing invasive blood sampling techniques. Therefore, there is a need for a non-invasive and continuous technology for the measurement of pH and lactate levels. In this work, near infrared spectroscopy is explored as a technique for investigating lactic acidosis. In-vitro studies on 20 isotonic phosphate buffer solutions of varying pH with constant lactate concentration (2 mmol/L) were performed. The whole near infrared spectrum (800–2600 nm) was then divided into four parts for analysis: (a) water absorption peaks, (b) 1000–1250 nm, (c) 1700–1760 nm, and (d) 2200–2400 nm. The water absorption peaks showed a linear variation with the changes in pH in the spectra. The range from 1700–1760 nm showed good correlation with calculated values for lactate ionization, with the changes in pH. However, the region from 2200–2400 nm showed a reverse correlation with respect to the concentration changes of lactate and a distinction could be made from pH 6–7 and 7–8. This study successfully identifies wavelengths (1233 nm, 1710 nm, 1750 nm, 2205 nm, 2319 nm, and 2341 nm) which can be directly correlated to lactic acidosis. Knowledge from this study will contribute toward the development of lactate-based pH monitoring optical sensor for critical care.
Atrophic and Microcystic Limited Prostatic Adenocarcinomas
Authors: Arista-Nasr Julian , Martinez-Benitez Braulio , Mendez-Cano Victor , Albores-Saavedra Jorge
Published: April 2020

Atrophic carcinoma and microcystic carcinoma have previously been classified as variants of conventional acinar adenocarcinoma. In this article, we studied 4 cases of atrophic carcinoma and 4 cases of limited microcystic carcinoma. We found an incidence of 0.8% in 250 needle prostatic biopsies and 1.3% of atrophic carcinoma in 150 radical prostatectomies. Microcystic carcinomas were found in 3 prostatectomies (1.2%) and in 1 needle biopsy (0.67%). The useful histological criteria for atrophic carcinoma included the irregular disposition of the glands, infiltrative pattern, “rigid” luminal borders, and intraluminal secretions. Cytological changes included scant cytoplasm, nucleomegaly, hyperchromatic nuclei, and visible nucleoli. The glands of the microcystic carcinoma differ from the benign glands because the malignant ones show a markedly greater dilatation and exhibit rigidity of glandular lumens. In some cases of microcystic carcinoma, the nuclei were flattened, small, and hyperchromatic; therefore, they can be difficult to recognize as malignant.
Management Practices of Head and Neck Cancer in Chinese Tertiary Care Hospitals: A Multicenter Questionnaire-Based Survey Among Oncologists
Authors: Anwei Zhao , Xin Sun , Fei Tang Qiao , Ziyu Jin , Liu Fa-Yu
Published: April 2020

This survey was conducted to determine the head and neck cancer (HNC) treatment strategies followed by oncologists in Chinese hospitals. It was a questionnaire-based survey, conducted from October 2017 to January 2018 in 100 random tertiary hospitals in 21 cities of China to elicit information from oncologists on the management practices for treating HNC in China. A validated, structured questionnaire was used for formal investigation with oncologists. The questions regarding HNC types, treatment strategies used for locally advanced head and neck cancer (LA HNC) and recurrent/metastatic head and neck cancer (r/m HNC), diagnosis and prognostic factors were included. The results were presented as percentages. Among the 272 oncologists, 93.4% were from tertiary care hospitals, with 35.3% and 36.4% patients from radiotherapy (RT) and oncology department, respectively. Nasopharyngeal carcinoma was the most commonly treated type of HNC according to 65.1% oncologists. Patients aged >75 years have worse prognosis and 65% oncologists corroborated that age of the patients influences treatment decision. Most of the oncologists (77.6%) preferred chemotherapy (CT) + anti–epidermal growth factor receptor targeted therapy as the first-line therapy for r/m HNC. Approximately 95% of oncologists considered induction chemotherapy (ICT) to retain organ functions and tumor shrinkage and 43.4% preferred ICT followed by chemoradiotherapy or ICT combined with RT followed by targeted therapy for LA HNC. For the management of HNC, Chinese oncologists recommended ICT with RT and targeted therapy for LA HNC and CT regimen combined with targeted therapy for r/m HNC.
Clinicopathological Differences in T2 Gallbladder Cancer According to Tumor Location
Authors: Kim Wan-Joon , Lim Tae-Wan , Park Pyoung-Jae , Choi Sae-Byeol , Kim Wan-Bae
Published: April 2020

We aimed to identify clinicopathological differences and factors affecting survival outcomes of stage T2a and T2b gallbladder cancer (GBC) and validate the oncological benefits of regional lymphadenectomy and hepatic resection in these patients. This single-center study enrolled patients who were diagnosed with pathologically confirmed T2 GBC and underwent curative resection between January 1995 and December 2017. Eighty-two patients with T2a and 50 with T2b GBCs were identified, and clinical information was retrospectively collected from medical records and analyzed. Five-year overall survival rates were 96.8% and 80.7% in T2a and T2b groups, respectively ( P = .007). Three- and 5-year survival rates among all patients with T2 GBC without and with lymph node metastasis were 97.2% and 94.4% and 81.3% and 81.3%, respectively ( P = .029). There was no difference in survival rates between the 2 groups according to whether hepatic resection was performed ( P = .320). However, in the T2b group, those who underwent hepatic resection demonstrated a better survival rate than those who did not ( P = .029). The T2b group had more multiple recurrence patterns than the T2a group, and the lymph nodes were the most common site in both groups. Multivariate analysis revealed that lymph node metastasis, vascular invasion, and tumor location were significant independent prognostic factors. Hepatic resection was not always necessary in patients with peritoneal-side GBC. Considering clinicopathological features and recurrence patterns, a systematic treatment plan, including radical resection and adjuvant treatment, should be established for hepatic-side GBC.
Knowledge, Adherence to Lifestyle Recommendations, and Quality of Life Among Koreans With Heart Failure
Authors: Lee Haejung , Park Gaeun , Lee Kyoung Suk , Jin HyeKyung , Chun Kook-Jin , Kim Jong Hyun
Published: April 2020

Objective:

To assess heart failure (HF) knowledge, adherence to lifestyle recommendations, and quality of life (QOL) among Koreans with HF and identify factors influencing QOL.

Methods:

A cross-sectional and correlational design was used and a total of 142 Koreans with HF were recruited between April 2012 and September 2013. Data were analyzed using multiple logistic regression with SPSS version 21.0.

Results:

The mean age of participants was 64.1 ± 7.4 years. A higher proportion of participants were male, married, unemployed, had a high education level, and class I New York Heart Association (NYHA) functional status. A higher proportion of participants had ≥2 comorbidities and the most prevalent comorbidity was diabetes. The mean score of HF knowledge was 6.9 (possible range 0-15) and the most frequent incorrect items were “proper actions to reduce thirst” and “causes of leg swelling” in both better and worse QOL groups. Among the recommended lifestyle, pneumococcal vaccination had the least adherence in both groups. Multiple logistic regression showed that patients in NYHA class I, with a higher left ventricular ejection fraction, who had knowledge of “amount of fluid intake a day” and consumed more than moderate alcohol tended to have better QOL. Conclusion: More active interventions targeting HF knowledge in proper actions to reduce thirst, causes of leg swelling, and the amount of fluid intake per day are required. Patients with HF in more serious condition need special attention regarding the risk of worse QOL. The role of alcohol consumption in QOL among HF patients in Korea needs further exploration.
Differentiating between teaching experience and expertise in the music studio: A pilot study
Authors: Blackwell Jennifer
Published: April 2020

The purpose of this study was to develop a measure to investigate studio teacher’s observational skill as a function of the observer’s ability to identify effective pedagogical practices. A secondary purpose was to see if observational skill varied as a function of scores on a measure of empathy. Participants ( N = 60) were saxophonists who observed and wrote about the strengths and weaknesses of two 1-minute videos of private saxophone lessons and two private violin videos. To develop expertise criteria, four expert teachers observed the videos for their respective instruments and their responses were converted into lists of strengths and weaknesses. These lists were then compared to participants’ responses and used as criteria for determining the degree to which participants’ analyses matched the experts’ responses. Participants also completed a demographic survey and the Toronto Empathy Questionnaire. Results indicated that the degree to which participants’ analyses matched the experts did not vary as a function of teaching experience. The degree to which participants’ analyses matched the experts also did not vary as a function of empathy scores, though descriptive trends indicated that higher empathy scores were accompanied by a greater degree of match. There was a significant difference in degree of match between the participants and experts for the saxophone and violin videos. Implications for tool refinement and future research are discussed.
The effects of motivations to go to the country on rural accommodation choice: A hybrid discrete choice model
Authors: Albaladejo Isabel P , Díaz-Delfa M Teresa
Published: April 2020

Based on the theory of constructive consumer choice process, we propose that the rural accommodation choice process depends on motivationals of tourists to go to the country. Discrete choice models have frequently been used to explain and predict choices from a set of finite alternatives, such as the choice of accommodation, but using only cognitive attributes as explanatory variables. The hybrid discrete choice (HDC) model also allows us to take into account unobservable or latent variables, like the motivations, and incorporate them through a multiple indicator multiple cause (MIMIC) model. Data collected in Murcia (Spain) from a stated choice survey are used to estimate a multinomial logit model and two specifications of the HDC model. Our results find that motivations affect the probability of accommodation rural choice. Furthermore, the effect of the motivations is different depending on the attributes of the accommodation.
Strain-based criterion for uniaxial fatigue life prediction for an SBR rubber: Comparative study and development
Authors: Belkhiria Salma , Hamdi Adel , Fathallah Raouf
Published: April 2020

This work proposes an engineering approach to investigate the fatigue lifetime of styrene–butadiene rubber under uniaxial loadings. Two specimen geometries are considered: axisymmetric sample AE2 and diablo sample AE42. Specimens are cycled with a sinusoidal waveform at 5 Hz for different maximum displacement values and a zero load ratio. The various damage parameters, commonly used for fatigue life calculation, are reviewed and discussed. Then fatigue models with diverse damage parameters are generated from the fatigue lives experimentally observed for specimen AE2. The efficiency of each predictive model is evaluated in terms of coefficient of determination R2. It is shown that all the studied damage parameters allow excellent fatigue-life estimations with R2 greater than 0.9. A nonlinear finite element analysis model using ABAQUS software for specimen AE42 is then set up. It is found that the model developed for specimen AE2 is appropriate to estimate the fatigue life time of AE42. Indeed, the obtained fatigue live predictions are in excellent agreement with the experimental fatigue results.
A queer pregnancy: affective kinship, time travel and reproductive choice in Denis Villeneuve’s Arrival
Authors: Latimer Heather
Published: April 2020

This article engages with both queer theories of temporality and new materialist theories of kinship in order to analyse the reproductive politics of Denis Villeneuve’s 2016 film Arrival. It does so in order to speculate on what happens to the concept of reproductive choice when time is in a loop. Arrival uses time travel to disrupt the linearity of reproduction by allowing its protagonist, Louise, to see that a future child will die an early, horrible death, yet still having her choose to become pregnant. It is my contention that this narrative decision untethers reproduction from futurity in ways that might be productive for rethinking the heteronormative futurism at the heart of contemporary reproductive politics.
Knockdown of lncRNA OGFRP1 Inhibits Proliferation and Invasion of JEG-3 Cells Via AKT/mTOR Pathway
Authors: Meng Qian , Xue Haiyan
Published: April 2020

Increasing evidence indicates the pivotal role of long noncoding RNAs in a variety of cancers, but there is limited focus on the link between long noncoding RNAs and gestational choriocarcinoma. This study aimed to examine the role of long noncoding RNA OGFRP1 in JEG-3 and JAR cells. Small interfering RNA was used to downregulate long noncoding RNA OGFRP1 level. Cell proliferation was measured by cell counting kit-8 and clone formation assays. Cell cycle and apoptosis were analyzed by flow cytometry. Cell invasion was examined by transwell assay. Protein expression was determined by Western blot. A double-effect inhibitor (BEZ235) that inhibits AKT and mTOR phosphorylation was used as a positive control. Knockdown of long noncoding RNA OGFRP1 significantly inhibited the proliferation of JEG-3 and JAR cells. Knockdown of long noncoding RNA OGFRP1 induced cell cycle arrest in G1 phase and apoptosis. On the other hand, knockdown of long noncoding RNA OGFRP1 inhibited the invasion of JEG-3 and JAR cells. Finally, knockdown of long noncoding RNA OGFRP1 resulted in the inactivation of AKT/mTOR signaling pathway. In addition, knockdown of long noncoding RNA OGFRP1 caused changes in the expression of intracellular cell cycle–related proteins and apoptosis-related proteins, including downregulation of CDK4, CDK6, Cyclin D1, Nusap1, and Bcl2 protein expression and upregulation of Bax protein expression. In conclusion, we found that downregulation of long noncoding RNA OGFRP1 inhibited cell proliferation, cell cycle progression, and invasion of JEG-3 and JAR cells and induced apoptosis through AKT/mTOR pathway. This study extends the understanding of the function of long noncoding RNA OGFRP1 in tumorigenesis, and these findings may be important for developing a potential therapeutic target for gestational choriocarcinoma therapy.
Video Games and Aesthetic Contemplation
Authors: Atkinson Paul , Parsayi Farzad
Published: April 2020

Video games present incredibly rich visual environments that can be studied from a variety of perspectives including those germane to the visual arts. The medium has evolved to such a degree that evaluation should not rest on whether an individual game can be considered art, but what types of aesthetic engagement the medium affords. A key figure in the study of the visual arts is aesthetic contemplation, in which extended attention reveals aesthetic differences. Although the video game presents many sites and scenes worthy of such contemplation, this mode of spectatorship requires sufficient time and space to attend to a visual object. In order to open up a space for aesthetic engagement, many of the ludological and narrative demands of the game must recede. In this article, we will investigate the degree to which players have choice in how, or how long, they attend to a game’s visual environment.
Robot-assisted inguinal lymphadenectomy: preliminary experience and perioperative outcomes from an Italian referral center
Authors: Cozzi Gabriele , Musi Gennaro , Ferro Matteo , Prestianni Pierpaolo , Bianchi Roberto , Giulia Garelli , Alessandro Mistretta Francesco , Luzzago Stefano , Pennacchioli Elisabetta , Cobelli Ottavio de
Published: April 2020

Background:

Inguinal lymphadenectomy remains the gold standard for the treatment of inguinal lymph node metastases from penile carcinoma, melanoma, Merkel cell carcinoma, and squamous cell carcinoma (SCC). This procedure is associated with significant complications. In order to reduce morbidity, minimally invasive approaches have been described. We report our preliminary experience with robot-assisted inguinal lymphadenectomies (RAIL).

Methods:

RAIL was performed according to the Sotelo technique. When indicated, a robot-assisted pelvic lymphadenectomy (RAPLND) was performed. We recorded age, sex, comorbidities, baseline oncologic diagnosis, operative time, hospital stay, lymph node yield, complications, time to drain removal, and oncologic outcomes.

Results:

From December 2016 to February 2019, 13 patients underwent RAIL. Median age was 65 years (range: 31–85 years). Primary malignancy was melanoma in five patients, Merkel cell carcinoma in four, dermal duct tumor in one, penile cancer in two, and SCC in one. RAIL was monolateral in 12 cases and bilateral in 1 case. A total of 10 monolateral RAPLNDs were performed; median operative time was 279 min (range: 169–320). Median lymph nodes yield was 11 (range: 2–24) for monolateral RAIL and 9 for monolateral RAPLND (range 2–24). Median hospital stay was 4 days (range: 2–5). No procedure was converted to open. Median follow up was 16 months (range: 5–31). Five Clavien-Dindo grade I complications were recorded. Median time to drain removal was 32.5 days (range 7–65). Three recurrences and two cancer-related deaths were recorded.

Conclusions:

RAIL is feasible and associated with a short hospital stay, with little incidence of perioperative complications.
Lilliput Effect Revisited: Small States and EU Foreign Policy
Authors: Crombois Jean
Published: April 2020

The role of small member states in EU foreign policy is increasingly being challenged, especially in view of the reforms being proposed to make the EU more effective as an international actor. These reforms, if adopted, will require the small Central and Eastern European member states, such as Bulgaria, to rethink their old foreign-policy strategies and practices. Instead of band-wagoning and balancing conflicting interests, these small member states will have to learn to be more proactive, to build their reputations and to form alliances if they want to continue to have any influence on EU foreign policy. These issues are discussed in the light of the EU sanctions adopted against Russia in the aftermath of the Ukrainian–Russian conflict of 2014.
Sustainability of Timor Deer in Captivity: Captive Breeding Systems in West Java, Indonesia
Authors: Krisna Peggy A. N. , Supriatna Jatna , Suparmoko M. , Garsetiasih R.
Published: April 2020

The population of Timor deer ( Rusa timorensis), an Indonesian endemic, continues to decline in its natural habitat, so captive breeding could become a source of individuals to bolster wild population. Support for captive breeding programs may be stronger if captive breeding also provided meat for human consumption. Thus, sustainable captive yields could be expected to support both conservation interests and food needs. The aim of this research is to evaluate the environmental impact, based on global warming potential (GWP), of two Timor deer breeding systems, that is, a farming system and a ranching system, in West Java, Indonesia. Life cycle assessment methodology was used for the evaluation to gain a cradle-to-gate perspective. The functional unit used was 1 kg of Timor deer live weight in captivity. The main result of the study indicated that the GWP per kg of Timor deer was estimated at 17.30 kgCO2eq (farming system) and 17.60 kgCO2eq (ranching system). The largest GWP in both systems was derived from cultivation activities and infrastructure development. In general, there is no significant difference in the GWP of the two breeding systems studied. This was due to the similar overall management adopted by the two breeding systems, especially the use of food types and infrastructure materials. Currently, the environmental dimension, especially the emissions from Timor deer breeding activities, is not a major concern, but in the future, breeding management should pay attention to the efficient use of the food and infrastructure to make it more environmentally friendly.
Postoperative Anemia Predicts Length of Stay for Geriatric Patients Undergoing Minimally Invasive Lumbar Spine Fusion Surgery
Authors: Sachdeva Ishaan , Carmouche Jonathan J.
Published: April 2020

Introduction:

We hypothesize that postoperative anemia will predict length of stay (LOS) for geriatric patients undergoing minimally invasive (MIS) lumbar spine fusions.

Materials and Methods:

Patients who underwent MIS lateral and transforaminal lumbar interbody fusion between January 2017 and March 2018 at an academic tertiary care referral center were selected. Eighty-one patients were included. The primary outcome variable was LOS, measured in days. The predictors studied were preoperative hemoglobin (Hgb), postoperative day 1 Hgb, postoperative nadir Hgb, intraoperative Hgb decrement (preoperative Hgb-postoperative day 1 Hgb), perioperative Hgb decrement (preoperative Hgb-postoperative nadir Hgb), age, American Society of Anesthesiologists–Physical Status (ASA-PS) score, volume of perioperative intravenous (IV) fluids (IVFs), and number of levels fused. Simple linear regression and analysis of variance were used for statistical analysis.

Results:

In the present study, preoperative anemia was not associated with longer LOS ( P = .15). Postoperative anemia was associated with longer LOS as both postoperative day 1 Hgb ( P = .05*) and postoperative nadir Hgb ( P < .0001*) predicted longer LOS. Greater intraoperative Hgb decrement did not predict longer LOS ( P = .36); however, greater perioperative Hgb decrement predicted longer LOS ( P < .0001*). Older age ( P = .01*) and greater number of levels fused ( P = .03*) predicted longer LOS; however, a greater ASA-PS classification did not predict longer LOS. Greater IVF administration was associated with longer LOS ( P < .0001*).

Discussion:

Postoperative nadir Hgb ( P < .0001*) was more predictive of longer LOS than postoperative day 1 Hgb ( P = .05*). There is a perioperative Hgb decrement associated with longer LOS ( P < .0001*). Geriatric patients may be more susceptible to the potential contributors to Hgb decrement, including occult bleeding post-op and hemodilution from IVF administration.

Conclusion:

Postoperative anemia, perioperative decrement in Hgb, older age, greater number of levels fused, and greater total IVFs administered predict longer LOS. Understanding the impact of these factors on LOS is critical as these procedures increasingly move to the outpatient setting.
In the Relationship Between Change in Kyphosis and Change in Lordosis: Which Drives Which?
Authors: Ang Bryan , Lafage Renaud , Elysée Jonathan Charles , Pannu Tejbir S. , Bannwarth Mathieu , Carlson Brandon B. , Schwab Frank J. , Kim Han Jo , Lafage Virginie
Published: April 2020

Study Design:

Retrospective single-center study.

Objective:

Investigate the effect of posterior instrumentation on the relationship between lordosis and kyphosis.

Methods:

Surgically treated patients with a minimum of 6 months of follow-up were analyzed. Asymptomatic volunteers served to show the normal anatomical relationship between thoracic and lumbar curves. Patients were stratified based on postoperative instrumentation: “Thoracic Fusion” = complete fusion of thoracic spine; “Lumbar Fusion” = complete fusion of lumbar spine; and “Complete Fusion” = fusion from sacrum to at least T5. Bivariate correlations and regression analysis were used to evaluate the relationship between change in thoracic kyphosis (ΔTK) and change in spinopelvic mismatch (ΔPI-LL; pelvic incidence-lumbar lordosis) before and after fusion. Analyses were repeated in “Lumbar Fusion” patients with flexible preoperative thoracic spines.

Results:

For asymptomatic volunteers, the natural anatomical relationship between TK and LL was found to be TK = 41% of LL ( r = 0.425, P < .001). A total of 153 of 167 adult spinal deformity patients were included (62 years old, 26.7 kg/m2, 78% female). Mean follow-up was 11.5 ± 6.8 months. “Thoracic Fusion” group showed no alteration in the natural relationship between TK and LL (ΔTK = 39% ΔPI-LL), whereas “Lumbar Fusion” group had a reduction in reciprocal change (ΔTK = 34% ΔPI-LL) although a subanalysis of patients in the “Lumbar Fusion” group with flexible thoracic spines showed a marked compensation in reciprocal change with (ΔTK = 58% ΔPI-LL).

Conclusion:

The relationship between ΔTK and ΔPI-LL is dependent on level instrumented. “Thoracic Fusion” drives change in LL while this relationship is affected by TK’s natural stiffness in “Lumbar Fusion” patients.
Sarat Chandra’s Women: An Anthropological Gendered Analysis of the Works of an Indian Writer of the Early Twentieth Century
Authors: Channa Subhadra Mitra
Published: April 2020

The works of literary masters often encapsulate history and anthropology of their times. Of several doyens of colonial writers in Bengal, Sarat Chandra Chattopadhyaya is well known for mirroring the position of women and also drawing some strong sketches of women reflecting social issues as well as inequality and injustice meted out to them at that period of Bengal’s history. His empathetic concern for women and his keen insight into their minds has often been commented on and appreciated. This paper is concerned with his inter-subjective relationship with the questions of class and caste and how, he as a male member of upper caste and from a genteel background dealt with his innate caste and class concerns in constructing his women characters representing various strata of society.
High Rate of Return to CrossFit Training After Arthroscopic Management of Rotator Cuff Tear
Authors: Carbone Stefano , Candela Vittorio , Gumina Stefano
Published: April 2020

Background:

CrossFit is a conditioning program involving high-intensity exercises performed in rapid, successive repetitions with limited or no recovery time. The shoulder girdle is highly involved in most basic CrossFit training programs.

Hypothesis:

CrossFit athletes affected by rotator cuff tear may be successfully treated with arthroscopic surgery with a high rate of early return to CrossFit activities.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included in this study were athletes participating regularly in CrossFit training who had undergone arthroscopic rotator cuff repair. At a minimum follow-up of 24 months, we compared pre- and postoperative clinical outcome scores, including the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and a visual analog scale (VAS) for pain, as well as imaging results. Participants completed a return-to-CrossFit questionnaire at the final follow-up, and changes in laboratory blood test results from preoperative to final follow-up were evaluated for association with outcomes and questionnaire responses.

Results:

A total of 22 CrossFit athletes (23 shoulders) completed the 24-month follow-up evaluation. Each athlete had undergone single-row rotator cuff tendon repair with additional procedures such as biceps tenodesis. All (100%) athletes returned to intensive CrossFit training at a mean 8.7 ± 3.4 months after surgery (range, 6-15 months). CS and ASES scores improved between preoperative and final follow-up from 73 to 92 ( P = .037) and from 71 to 95 ( P = .035), respectively; VAS pain score improved from 7.2 preoperatively to 0.8 at final follow-up ( P < .001). Imaging evaluation of the repaired rotator cuff tendon showed complete healing in 18 cases (78%) and incomplete healing in 5 (22%). Of the 5 patients with incomplete healing, 2 had lower clinical scores at follow-up. In their questionnaire responses, 13 (59%) participants indicated return to a higher level of fitness, 7 (32%) returned to the same level, and 2 (9%) returned to a lower level. We found a significant association between patients who indicated return to a higher level of CrossFit fitness and higher levels of creatine phosphokinase and testosterone from preoperative to final follow-up ( P = .029 and .023).

Conclusion:

Arthroscopic repair of rotator cuff tendons led to 100% return to CrossFit participation at approximately 9 months of follow-up. All athletes had returned to sport by the final follow-up. Nevertheless, 2 patients reported a lower level of performance and showed scapular dyskinesis.
Lenalidomide in follicular lymphoma
Authors: Flowers Christopher R. , Leonard John P. , Fowler Nathan H.
Published: April 2020

Lenalidomide is an immunomodulatory drug approved in the United States for use with rituximab in patients with relapsed/refractory follicular lymphoma. We reviewed data from trials addressing the safety and efficacy of lenalidomide alone and in combination with rituximab as a first-line therapy and as a treatment of patients with relapsed/refractory follicular lymphoma. Lenalidomide-rituximab has been demonstrated to be an effective chemotherapy-free therapy that improves upon single-agent rituximab and may become an alternative to chemoimmunotherapy.
Co-production of “nature walks for wellbeing” public health intervention for people with severe mental illness: use of theory and practical know-how
Authors: Hubbard Gill , Thompson Catharine Ward , Locke Robert , Jenkins Dan , Munoz Sarah-Anne , Van Woerden Hugo , Maxwell Margaret , Yang Yaling , Gorely Trish
Published: April 2020

Background

Interventions need to be developed in a timely and relatively low-cost manner in order to respond to, and quickly address, major public health concerns. We aimed to quickly develop an intervention to support people with severe mental ill-health, that is systematic, well founded both in theory and evidence, without the support of significant funding or resource. In this article we aim to open and elucidate the contents of the ‘black box’ of intervention development.

Methods

A multidisciplinary team of seven academics and health practitioners, together with service user input, developed an intervention in 2018 by scoping the literature, face-to-face meetings, email and telephone. Researcher fieldnotes were analysed to describe how the intervention was developed in four iterative steps.

Results

In step 1 and 2, scoping the literature showed that, a) people with severe mental illness have high mortality risk in part due to high levels of sedentary behaviour and low levels of exercise; b) barriers to being active include mood, stress, body weight, money, lack of programmes and facilities and stigma c) ‘nature walks’ has potential as an intervention to address the problem. In Step 3, the team agreed what needed to be included in the intervention so it addressed the “five ways to mental wellbeing” i.e., help people to connect, be active, take notice, keep learning and give. The intervention was mapped to key behavioural change concepts such as, personal relevance, relapse prevention, self-efficacy. In Step 4, the team worked out how best to implement the intervention. The intervention would be delivered over 12 weeks by members of the hospital team and community walk volunteers. Participants would receive a nature walks booklet and text messages.

Conclusions

We developed a theoretically-informed, evidence-based nature walks programme in a timely and relatively low-cost manner relevant in an era of growing mental illness and funding austerity. Further research is required to test if the intervention is effective and if this approach to intervention development works.
A nationwide cross-sectional study of 15,611 lesbian, gay and bisexual people in China: disclosure of sexual orientation and experiences of negative treatment in health care
Authors: Suen Yiu-tung , Chan Randolph Chun Ho
Published: April 2020

Background

Lesbian, gay and bisexual (LGB) people often face individual- and system-level barriers in health care. However, LGB people’s experiences of health care in non-European and non-American settings have been scarcely studied. In China, while it has been estimated that there are at least 70 million gender and sexual minorities, there has been no larger-scale study on LGB people’s experiences of health care beyond a focus on gay men and HIV. This study is the first larger-scale quantitative study to investigate LGB people’s experiences of health care in China, where non-heterosexuality is officially silenced and the needs of non-heterosexual people are largely ignored by service providers.

Methods

An online survey was designed in joint partnership by academic, community groups and the United Nations Development Programme. Targeted and snowball sampling was adopted for participant recruitment. Such unique cross-sectoral partnership made this research possible in the authoritarian state of China where data collection on LGB people is extremely rare. For the analysis in this paper, a sample of 15,611 Chinese LGB people were included. Frequency and descriptive statistics were conducted to describe the LGB respondents’ demographic characteristics and their experiences in health care settings. Chi-square tests were conducted to test how experiences vary across LGB people with different demographic characteristics.

Results

More than three quarters of the respondents said they would be willing to disclose to their medical care providers their sexual orientation if asked. However, only 5.7% of the respondents said that medical care providers ever asked them about their sexual orientation. About 8.0% of the LGB people surveyed reported having experienced negative treatment in medical care settings. Six percent (5.7%) of the Chinese LGB people said in accessing mental health care services, they were recommended, coaxed into, or provided conversion therapy for sexual orientation, gender identity or gender expression.

Conclusions

There is a strong need to enhance LGB cultural competence among health care providers. Policymakers in China should also formulate laws, policies, regulations, clearly articulated codes of conduct, and transparent procedures and practices to ensure non-discrimination of LGB people in the health care system, with a particular focus on banning conversion therapy.
In vitro activity of ceftazidime–avibactam and comparators against Gram-negative bacterial isolates collected in the Asia–Pacific region as part of the INFORM program (2015–2017)
Authors: Ko Wen-Chien , Stone Gregory G.
Published: April 2020

Background

Antimicrobial resistance among nosocomial Gram-negative pathogens is a cause for concern in the Asia–Pacific region. The aims of this study were to measure the rates of resistance among clinical isolates collected in Asia–Pacific countries, and to determine the in vitro antimicrobial activities of ceftazidime–avibactam and comparators against these isolates.

Methods

CLSI broth microdilution methodology was used to determine antimicrobial activity and EUCAST breakpoints version 9.0 were used to determine rates of susceptibility and resistance. Isolates were also screened for the genes encoding extended-spectrum β-lactamases (ESBLs) or carbapenemases (including metallo-β-lactamases [MBLs]).

Results

Between 2015 and 2017, this study collected a total of 7051 Enterobacterales isolates and 2032 Pseudomonas aeruginosa isolates from hospitalized patients in Australia, Japan, South Korea, Malaysia, the Philippines, Taiwan, and Thailand. In the Asia–Pacific region, Enterobacterales isolates that were ESBL-positive, carbapenemase-negative (17.9%) were more frequently identified than isolates that were carbapenemase-positive, MBL-negative (0.7%) or carbapenemase-positive, MBL-positive (1.7%). Multidrug-resistant (MDR) isolates of P. aeruginosa were more commonly identified (23.4%) than isolates that were ESBL-positive, carbapenemase-negative (0.4%), or carbapenemase-positive, MBL-negative (0.3%), or carbapenemase-positive, MBL-positive (3.7%). More than 90% of all Enterobacterales isolates, including the ESBL-positive, carbapenemase-negative subset and the carbapenemase-positive, MBL-negative subset, were susceptible to amikacin and ceftazidime–avibactam. Among the carbapenemase-positive, MBL-positive subset of Enterobacterales, susceptibility to the majority of agents was reduced, with the exception of colistin (93.4%). Tigecycline was active against all resistant subsets of the Enterobacterales (MIC90, 1–4 mg/L) and among Escherichia coli isolates, > 90% from each resistant subset were susceptible to tigecycline. More than 99% of all P. aeruginosa isolates, including MDR isolates and the carbapenemase-positive, MBL-positive subset, were susceptible to colistin.

Conclusions

In this study, amikacin, ceftazidime–avibactam, colistin and tigecycline appear to be potential treatment options for infections caused by Gram-negative pathogens in the Asia–Pacific region.