bluuebunny/crossref_metadata_2025 huggingface dataset:
Programas condicionais de transferência de renda e fecundidade: evidências do Bolsa Família
Authors: Rocha Romero Cavalcanti Barreto da
Published: April 2020

Este trabalho tem como objetivo aprofundar a investigação em relação aos efeitos dos programas condicionais de transferência de renda, nos quais a quantidade de recursos transferidos depende do tamanho da família, sobre a fecundidade das mães beneficiárias. O efeito desse tipo de programa é ambíguo. O custo de ter filhos é diminuído, mas aumenta-se o investimento em capital humano. O objetivo deste artigo é verificar se o Programa Bolsa Família teve impacto na probabilidade de a mulher ter filhos e qual o sinal dessa correlação. Para isso, foram testadas três diferentes estratégias empíricas e não foi encontrado efeito robusto do programa na fecundidade em nenhuma delas.
Association of Childhood Psychosocial Environment With 30‐Year Cardiovascular Disease Incidence and Mortality in Middle Age
Authors: Pierce Jacob B. , Kershaw Kiarri N. , Kiefe Catarina I. , Jacobs David R. , Sidney Stephen , Merkin Sharon Stein , Feinglass Joe
Published: April 2020

Background

Childhood adversity and trauma have been shown to be associated with poorer cardiovascular disease (
CVD
) outcomes in adulthood. However, longitudinal studies of this association are rare.

Methods and Results

Our study used the
CARDIA
(Coronary Artery Risk Development in Young Adults) Study, a longitudinal cohort that has followed participants from recruitment in 1985–1986 through 2018, to determine how childhood psychosocial environment relates to
CVD
incidence and all‐cause mortality in middle age. Participants (n=3646) completed the Childhood Family Environment (
CFE
) questionnaire at the year 15 (2000–2001)
CARDIA
examination and were grouped by high, moderate, or low relative
CFE
adversity scores. We used sequential multivariable regression models to estimate hazard ratios of incident (
CVD
) and all‐cause mortality. Participants were 25.1±3.6 years old, 47% black, and 56% female at baseline and 198 participants developed
CVD
(17.9 per 10 000 person‐years) during follow‐up.
CVD
incidence was >50% higher for those in the high
CFE
adversity group compared with those in the low
CFE
adversity group. In fully adjusted models,
CVD
hazard ratios (95% CI) for participants who reported high and moderate
CFE
adversity versus those reporting low
CFE
adversity were 1.40 (0.98–2.11) and 1.25 (0.89–1.75), respectively. The adjusted hazard ratios for all‐cause mortality was 1.68 (1.17–2.41) for those with high
CFE
adversity scores and 1.55 (1.11–2.17) for those with moderate
CFE
adversity scores.

Conclusions

Adverse
CFE
was associated with
CVD
incidence and all‐cause mortality later in life, even after controlling for
CVD
risk factors in young adulthood.
From Collegiality to Synodality: Promise and Limits of Francis’s ‘Listening Primacy’
Authors: Faggioli Massimo
Published: April 2020

Synodality is a key term to understand Pope Francis’s ecclesiology. This article analyzes Francis’s use of synodality in the major documents, the speeches, and in the most important moment of his pontificates, especially in the Bishops’ Synods. The goal of this study is to highlight the promise and accomplishments of Francis’s synodality especially in terms of the conversion of the papacy into a listening primacy. This article also wants to raise some issues about the limits of his theology and practice of synodality in the global Catholic Church of today, and in particular whether there can be a synodal reform of the Church without new institutions of synodality.
Existentialism and Higher Education: A Renewed Intersection in Well-Being
Authors: Sherman Glen Lewis
Published: April 2020

Enhanced well-being for students, staff, and faculty has become a focal point on many campuses across North America. Well-being promotion tends to focus on the “wellness” half of well-being, practices related to individual health, stress-management, enhanced coping, and environmental conditions. These efforts, while significant, address the symptoms, not the root causes of what has led to the degree of experienced un-wellness or ill-being. What has not yet been adequately articulated in well-being theory, as applied to the higher education setting, is a focus on the “being” half of the well-being phrase, how higher education is connected to a student’s subjectivity and the meanings they give to the objective world. This article proposes a conception of well-being in higher education that stems from existential philosophy and humanistic psychology, as well as key concepts from Aristotle’s Nichomachean Ethics. Higher education is seen as a place where students’ self-discovery informs their approach to knowledge and learning, as well as their development of an ethical sense of justice and the rights of others in the educational community. Well-being is in this way rendered more fully.
Diversity Management and the Postdiversity Vision: An Applied Pragmatist Approach
Authors: Galvin Thomas P. , Allen Charles D.
Published: April 2020

The U.S. Military institutionalized diversity management to ensure equality of treatment and opportunity for members while eliminating discrimination in all its forms. But progress toward diversity goals has been inconsistent. For example, the U.S. Military’s implementation of the repeal of the Don’t Ask, Don’t Tell law was less successful in integrating transgender soldiers. Meanwhile, recent sexual harassment scandals show that progress is similarly fleeting in gender relations. In this article, we argue that while the aims of diversity management are important, they need an accompanying vision of what the future looks like after achieving those aims. The postdiversity vision includes more than the elimination of discriminatory behaviors; it describes what the defense establishment looks like and how it functions when diversity management is no longer required. Expressing this vision allows for more reliable and durable measures of performance and effectiveness of inclusion efforts.
A Metric Fractionator for Estimation of Total Cell Number in Paraffin-Embedded Flat or Hollow Organs
Authors: Mirabile Rosanna , Boyce Rogely Waite , Gundersen Hans Jørgen G.
Published: April 2020

The physical fractionator is a convenient and practical solution for estimation of total cell number in a regulatory toxicology setting because it is insensitive to shrinkage allowing for paraffin processing/embedding and does not require measurement of the reference or organ volume. The principle involves sampling a known fraction of an organ in one or more steps and counting the total number of cells present in the final sample, physical disector section pairs. The total cell number in the organ is estimated by multiplying the cell count in the final fraction by the inverse of the sampling fraction(s). The key feature of the design is that tissue shrinkage due to paraffin processing occurs before the organ is uniformly sampled. Another requirement is that thermal expansion or contraction is avoided during the preparation of disector sections from the individual embedded subsamples, which ensures that the disector sections represent a known constant fraction. This vertical physical fractionator with subsampling is a simple and fast estimator to obtain precise and robust estimates of total cell number in large flat or hollow organs that do not prolong routine necropsy procedures. It is compatible with paraffin processing, avoids exhaustive sectioning, and allows for the collection of routine histopathology sections.
Otolaryngologists and the Doctor‐Patient Relationship during a Pandemic
Authors: Hogikyan Norman D. , Shuman Andrew G.
Published: April 2020

The COVID‐19 pandemic has forced otolaryngologists and their patients to confront issues that they have rarely if ever previously faced. Prominent among these is the need to put the collective good ahead of the interests of individual patients with otolaryngologic disorders. We argue that the individual doctor‐patient relationship remains paramount even at a time when public health principles mandate systems‐level thinking.
Tracheostomy Management during the COVID‐19 Pandemic
Authors: Goldman Richard A. , Swendseid Brian , Chan Jason Y. K. , Lewandowski Michelle , Adams Jacqueline , Purcell Monica , Cognetti David M.
Published: April 2020

The ongoing coronavirus disease 2019 pandemic has led to unprecedented demands on the modern health care system, and the highly contagious nature of the virus has led to particular concerns of infection among health care workers and transmission within health care facilities. While strong data regarding the transmissibility of the infection are not yet widely available, preliminary information suggests risk of transmission among asymptomatic individuals, including those within health care facilities. We believe that the presence of a tracheostomy or laryngectomy stoma poses a unique risk of droplet and aerosol spread particularly among patients with unsuspected infection. At our institution, guidelines for the care of open airways were developed by a multidisciplinary open airway working group, and here we review those recommendations to provide practical guidance to other institutions.
Caregiving at the margins: An ethnographic exploration of family caregivers experiences providing care for structurally vulnerable populations at the end-of-life
Authors: Stajduhar Kelli I , Giesbrecht Melissa , Mollison Ashley , Dosani Naheed , McNeil Ryan
Published: April 2020

Background:

People experiencing structural vulnerability (e.g. homelessness, poverty, racism, criminalization of illicit drug use and mental health stigma) face significant barriers to accessing care at the end-of-life. ‘Family’ caregivers have the potential to play critical roles in providing care to these populations, yet little is known regarding ‘who’ caregivers are in this context and what their experiences may be.

Aim:

To describe family caregiving in the context of structural vulnerability, to understand who these caregivers are, and the unique challenges, burdens and barriers they face.

Design:

Critical ethnography.

Setting/participants:

Twenty-five family caregivers participated. Observational fieldnotes and semi-structured interviews were conducted in home, shelter, transitional housing, clinic, hospital, palliative care unit, community-based service centre and outdoor settings.

Results:

Family caregivers were found to be living within the constraints of structural vulnerability themselves, with almost half being street family or friends. The type of care provided varied greatly and included tasks associated with meeting the needs of basic survival (e.g. finding food and shelter). Thematic analysis revealed three core themes regarding experiences: Caregiving in the context of (1) poverty and substance use; (2) housing instability and (3) challenging relationships.

Conclusion:

Findings offer novel insight into the experiences of family caregiving in the context of structural vulnerability. Engaging with family caregivers emerged as a missing and necessary palliative care practice, confirming the need to re-evaluate palliative care models and acknowledge issues of trust to create culturally relevant approaches for successful interventions. More research examining how ‘family’ is defined in this context is needed.
The 100 most-cited articles on chronic venous disease: a bibliometric analysis
Authors: Jun Heungman , Hwang Ji Woong
Published: April 2020

Objective

To use bibliometric analysis to understand characteristics and trends in the research on chronic venous disease (CVD), which affects patients’ quality of life by causing pain, swelling, and ulceration.

Methods

We searched the Thomson Reuters Web of Science citation indexing database to identify the 100 most-cited manuscripts on CVD. The resulting articles were analyzed by title, author, institution, topic, year of publication, and country of origin.

Results

The Journal of Vascular Surgery published the most manuscripts on CVD (n = 36) and was the most-cited journal (n = 5356). The United Kingdom was the country with the greatest number of publications (n = 32). Imperial College London was the institution with the highest number of publications (n = 6). Endovenous thermal ablation was the most widely studied research specialty (n = 30).

Conclusions

Our analysis showed that the majority of CVD research is carried out in Western countries, and that the number of research studies is increasing in line with recent advances in CVD.
Performing the city-region: Imagineering, devolution and the search for legitimacy
Authors: Hoole Charlotte , Hincks Stephen
Published: April 2020

This paper provides new conceptual and empirical insights into the role city-regions play as part of a geopolitical strategy deployed by the nation state to enact its own interests, in conversation with local considerations. Emphasis falls on the performative roles of economic models and spatial-economic imaginaries in consolidating and legitimising region-building efforts and the strategies and tactics employed by advocates to gain credibility and traction for their chosen imaginaries. We focus on the Sheffield City Region and Doncaster within it (South Yorkshire, England) drawing on 56 in-depth interviews with local policymakers, civic institutions and private sector stakeholders conducted between 2015 and 2018. In doing so, we identify three overlapping phases in the building of the Sheffield City Region: a period of initial case-making to build momentum behind the Sheffield City Region imaginary; a second of concerted challenge from alternative imaginaries; and a third where the Sheffield City Region was co-constituted alongside the dominant alternative One Yorkshire imaginary. Our work suggests that the city-region imaginary has gained traction and sustained momentum as national interests have closed down local resistance to the Sheffield City Region. This has momentarily locked local authorities into a preferred model of city-regional devolution but, in playing its hand, central government has exposed city-region building as a precarious fix where alternative imaginaries simply constitute a ‘deferred problem’ for central government going forward.
Guidelines in urology: Lights and shadows
Authors: Cai Tommaso , Cocci Andrea , Gacci Mauro , Verze Paolo , Bonkat Gernot , Koves Bela , Wagenlehner Florian , Bartoletti Riccardo , Bjerklund Johansen Truls E
Published: April 2020

Clinical practice guidelines have become increasingly important in the decision-making process in many clinical conditions and have been recognized as key instruments to improve the quality of care. On the one hand, guidelines represent a good tool for improving patient’s outcome, and on the other hand, the adherence to guidelines and good practice recommendations is mandatory to reduce the risk of legal disputes. A recent revision by the Italian Parliament of the legal system that rules the responsibilities of health professionals and health care safety stimulated all clinicians to improve their adhesion to clinical guidelines. It is justified by the high-quality level obtained in the recent years by the international guidelines. In the recent years, a revision of the clinical guideline development has been done. In particular, the European Association of Urology Guideline Office changed the “Guidelines for Guidelines,” and a rigorous development process has been established. A clinical recommendation is produced after a rigorous methodological process using an analysis of all published clinical trials, and the expert opinion is not yet considered. For oncological guidelines, the adherence to the producing process is easily feasible due to the high number of clinical trials; for non-oncological guidelines, instead, the small number of clinical trials could represent a problem for obtaining recommendation based on rigorous methodology. Here, on the basis of these considerations, we aim to discuss the lights and the shadows of the clinical applicability of guidelines in urology.
Linking Contexts, Intersectionality, and Generations: Toward a Multidimensional Theory of Millennials and Social Change
Authors: Council LaToya D. , Johnson Chelsea , Santellano Karina , Yazdiha Hajar
Published: April 2020

While millennials are culturally homogenized as a unitary group, scholarly work has examined the complex historical, economic, and social challenges that shape millennials’ heterogeneity. This paper draws on three studies to build on this work, showing how millennials experience and enact social change across different spaces: beauty politics and the natural hair movement, black men shaping new masculinities at work and home, and undocumented students navigating institutions of higher education. We show how different groups of millennials bridge and forge new communities, generate hybridized identities that challenge fixed conceptions of identity, and develop new mechanisms for changing the world around them. From findings that highlight the complexity of intra-group and intra-generational experience, we argue for a multidimensional theory of millennials and social change that links contexts, intersectionality, and generational transmission. Such a framework offers a more systematic way to conceptualize variation as it shapes contentious politics and social change.
Sialic acid–targeted drug delivery and imaging system for pH- and glutathione-triggered multiple anticancer drug release and enhanced oxidative stress
Authors: Peng Licong , Zeng Xianwu , Qi Qianqian , Zhang Hailiang , Fu Jinping , Zhou Miao , Yuan Jianchao
Published: April 2020

The emergence of multiple drug delivery systems can solve the disadvantages of single-drug therapy, such as high dose and easy generation of drug resistance. Here, we designed a sialic acid–targeted dextran-mercaptopurine prodrug linked by carbonyl vinyl sulfide for coordinate ZnO quantum dots to achieve multiple drug delivery (doxorubicin, 5-fluorouracil, 6-mercaptopurine), which can be released under the trigger of pH and glutathione. To enhance the antitumor effect, we used inorganic photosensitizer CdSe quantum dots to achieve photodynamic therapy, which can produce cytotoxic reactive oxygen species (hydroxyl radicals) under light conditions. Notably, we found that glutathione is consumed by the delivery of 6-mercaptopurine. It is able to efficiently amplify intracellular oxidative stress via increasing •OH generation. After chelating 99mTc4+ radioisotopes by diethylenetriamine pentaacetic acid, the drug delivery system could be tracked under in vivo single-photon emission computed tomography imaging. The results showed that the phenylboronic acid targeting substance can specifically recognize sialic acid, so that the drug system has a good accumulation in the tumor site, which can better increase the therapeutic effect. Compared to free doxorubicin, the drug system can reduce the IC50 value of cells 4.4-fold under light conditions and significantly inhibit tumor growth in vivo. These data indicate that the sialic acid–targeted nanomedicine system has achieved ideal antitumor effects and apparent photodynamic therapy effects and has broad application prospects.
A Longitudinal Investigation of Falls and Motor Vehicle Crashes in Older Drivers
Authors: Pope Caitlin N. , Fazeli Pariya L. , Bell Tyler R. , Gaini Meghana S. , Mrug Sylvie , Vance David E. , Ball Karlene K.
Published: April 2020

Objective: To assess the longitudinal association between fall history reported at a driver’s license screening visit and the likelihood of subsequent vehicle crashes. Method: A total of 1,127 older adults were recruited from Maryland State Motor Vehicle Administration sites and interviewed annually over 15 years. Results: Individuals who reported a previous fall were more likely to be female, perform worse on physical functioning and divided attention tasks, and report more situational driving avoidance compared with non-fallers at baseline. Females who reported a fall at baseline had a 2.6× greater likelihood of subsequently reporting a crash over the 15 years than males. Among those who reported a fall at baseline, greater weekly driving exposure over the 15 years was associated with a 23% higher likelihood of a subsequent crash. Discussion: These findings support the utility of investigating nontraditional driver screening methods to identify drivers who may be at increased risk of future driving difficulties.
Measuring Family-Centered Practice in Child Welfare
Authors: Xu Yanfeng , Ahn Haksoon , Keyser Daniel
Published: April 2020

Although family-centered practice has been implemented nationwide in child welfare, measures for evaluating family-centered practice have not been well-established. This study aimed to evaluate the factor structure of the Family-Centered Practice Questionnaire. Confirmatory factor analyses were conducted to examine the factor structure of the Family-Centered Practice Questionnaire. The five-factor and second-order five-factor models of the revised Family-Centered Practice Questionnaire with 31 items both demonstrated adequate fit. The higher order of this scale was family-centered practice and five factors were mutual trust, shared decision-making, family as a unit, strengths-based practice, and cultural competence and sensitivity. Findings suggest that the revised Family-Centered Practice Questionnaire may be helpful to practitioners and researchers seeking to measure the implementation of family-centered practice in child welfare settings.
Moderating Avoidance Performance Goal Orientation Withdrawal Through Individuated Assessments and Common Affiliation
Authors: Kraemer Justin , Gunkel Marjaana , Chung Ken
Published: April 2020

Scholars have long assumed that members of small groups are more likely to help each other. We argue that, even in a small group with collective rewards, those with an avoidance performance goal orientation, a dispositional fear of inadequate performance, would view social interaction as more disadvantageous and, as a result, help their group less. Using random coefficient modeling, we also demonstrate that the strength of the individual-specific assessment of reliance on and a category-specific common affiliation with group members reduce this negative association. We discuss theoretical and practical implications and conclude by identifying limitations of our study and offer directions for future investigation.
General Practitioners’ Perspectives on General and Specialized Palliative Home Care in North Rhine, Germany: An Explorative Focus Group Study
Authors: Peter Sophie , Volkert Anna Maria , Pfaff Holger , Radbruch Lukas , Rolke Roman , Voltz Raymond , Scholten Nadine ,   On Behalf of the APVEL Consortium
Published: April 2020

Background:

General practitioners (GPs) are important providers and coordinators of palliative home care (PHC). Through this double role, their perspectives and their treatment decisions influence PHC fundamentally. This study aims to gain deeper insights into GPs’ perspectives regarding PHC in North Rhine, Germany.

Methods:

An explorative, semistructured focus group was conducted with 7 doctors. The researchers performed content analysis. Main topics were GPs’ role definition in PHC and GPs’ medical activities in PHC.

Results:

Participating GPs describe their role in PHC, based on high motivation and positive attitudes toward PHC as a hybrid role: coordinator, provider (mostly in general PHC), and referrer (gateway to palliative care [PC] specialists). According to GPs’ medical activity, participants describe moderate expertise, demanding tasks, and elaborate PHC provision for GPs. Participants stressed the importance of PC in GPs’ work. But also PC is a small field in general practice. GPs’ PHC benefits from the deep trust resulting from the often close and long-term GP–patient relationship. Complexity and bureaucracy of PHC structures as well as the lack of resources and multidisciplinary cooperation are named as barriers for providing PHC. The highest level of care is reached in specialized PHC, which only very few, severely impaired patients need.

Conclusions:

Participating GPs see themselves as important PHC providers as well as referrers and coordinators. Complexity and discontinuity in PC arrangements create challenges for their provision. Therefore, they long for reduced bureaucratic burdens.
The Implementation Chasm Hindering Genome-informed Health Care
Authors: Johnson Kevin B. , Clayton Ellen Wright , Starren Justin , Peterson Josh
Published: April 2020

The promises of precision medicine are often heralded in the medical and lay literature, but routine integration of genomics in clinical practice is still limited. While the “last mile” infrastructure to bring genomics to the bedside has been demonstrated in some healthcare settings, a number of challenges remain — both in the receptivity of today's health system and in its technical and educational readiness to respond to this evolution in care. To improve the impact of genomics on health and disease management, we will need to integrate both new knowledge and new care processes into existing workflows. This change will be onerous and time-consuming, but hopefully valuable to the provision of high quality, economically feasible care worldwide.
Whether to Waive Parental Permission in HIV Prevention Research Among Adolescents: Ethical and Legal Considerations
Authors: Bauman Laurie J. , Mellins Claude Ann , Klitzman Robert
Published: April 2020

Critical ethical questions arise concerning whether studies among adolescents of new behavioral and biomedical HIV preventive interventions such as Pre-Exposure Prophylaxis (PrEP) should obtain parental permission. This paper examines the relevant regulations and ethical guidance concerning waivers of parental permission, and arguments for and against such waivers. Opponents of such waivers may argue that adolescent decision-making is “too immature” and that parents always have rights to decide how to protect their children. Yet requiring parental permission may put adolescents at risk, and/or limit adolescent participation, jeopardizing study findings’ validity. This paper presents recommendations on when researchers and Institutional Review Boards (IRB) should waive parental permission, and what special protections should be adopted for adolescents who consent for themselves, e.g., assuring adolescent privacy and confidentiality, screening for capacity to consent, and identifying adolescents who are at elevated risk from study participation. We also present a series of specific areas for future research to design tools to help make these assessments, and to inform researcher and IRB decisions. These recommendations can help ensure that research is conducted that can aid adolescents at risk for HIV, while minimizing risks and protecting these individuals' rights as much as possible.
Ethical Considerations in the Conduct of Unregulated mHealth Research: Expert Perspectives
Authors: Hammack-Aviran Catherine M. , Brelsford Kathleen M. , Beskow Laura M.
Published: April 2020

To assist in resolving ethical questions surrounding unregulated mHealth research, we conducted in-depth qualitative interviews with experts from four key stakeholder groups: patient/research advocates, researchers, regulatory professionals, and mobile app/device developers. They discussed challenges and potential solutions in the context of two hypothetical scenarios involving unregulated mHealth research, including notifications/permissions for research use of mHealth data, data access procedures, new primary data collection, offering individual research results, and data sharing and dissemination.
mHealth Research Applied to Regulated and Unregulated Behavioral Health Sciences
Authors: Nebeker Camille
Published: April 2020

Behavioral scientists are developing new methods and frameworks that leverage mobile health technologies to optimize individual level behavior change. Pervasive sensors and mobile apps allow researchers to passively observe human behaviors “in the wild” 24/7 which supports delivery of personalized interventions in the real-world environment. This is all possible because these technologies contain an incredible array of sensors that allow applications to constantly record user location and can contextualize current environmental conditions through barometers, thermometers, and ambient light sensors and can also capture audio and video of the user and their surroundings through multiple integrated high-definition cameras and microphones. These tools are a game changer in behavioral health research and, not surprisingly, introduce new ethical, regulatory/legal and social implications described in this article.
Association Between the Change in Total Bilirubin and Risk of Bleeding Among Patients With Nonvalvular Atrial Fibrillation Taking Dabigatran
Authors: Xiong Yurong , Hu Lihua , Zhou Wei , Li Minghui , Wang Tao , Huang Xiao , Bao Huihui , Cheng Xiaoshu
Published: April 2020

There is still a lack of effective biomarkers for the prediction of the risk of bleeding events among patients with nonvalvular atrial fibrillation (NVAF) taking dabigatran. This study aimed to investigate the association between change in total bilirubin (CTBIL) and risk of bleeding among patients with NVAF taking dabigatran. The CTBIL was the difference in serum total bilirubin at out of follow-up from baseline serum total bilirubin. A total of 486 patients with NVAF treated with dabigatran (110 mg twice daily) were recruited from 12 centers in China from February 2015 to December 2017. All patients were followed for 3 months. Cox proportional hazards regression analysis was used to evaluate the association between the CTBIL and bleeding. Moreover, a Cox proportional hazards regression with cubic spline functions and smooth curve fitting (the penalized spline method) and 2 piecewise Cox proportional hazards models were used to address the nonlinearity between CTBIL and bleeding. The mean (SD) follow-up duration was 81.2 (20.2) days. In all, 67 patients experienced bleeding events. A U-shaped association was observed between the CTBIL and bleeding, with increased hazard ratios (HRs) in relation to either low or high CTBIL levels. For CTBIL <6.63 µmol/L, the HR (95% confidence interval [CI]) was 0.90 (0.84-0.96), and for CTBIL ≥6.63 µmol/L, the HR (95% CI) was 1.35 (1.14-1.60). Our findings showed a U-shaped relationship between CTBIL and bleeding. Both low and high levels of CTBIL were associated with a higher risk of bleeding.
A simple method to design and analyze dynamic vibration absorber using dimensional analysis
Authors: Karimi Mahdi , Shemshadi Mehrdad , Firoozfam Naghmeh
Published: April 2020

Addition of mass, spring, and damper as a dynamic vibration absorber to a structure that is vibrating out of the permissible vibration range can be an economic and applicable solution to reduce structure vibrations provided that the absorber is designed and adjusted properly. In practice, real structures are damped, which can make it impossible to design vibration absorbers without using numerical solutions and complicated calculations. Using dimensional analysis technique and data obtained from system simulation by MATLAB Simulink, this study aims to provide simple and reliable correlations for designing and analyzing vibration absorbers. For this purpose, the motion equations of a one-degree-of-freedom system with a vibration absorber and a harmonic force applied is simulated. Use of a set of simulation output data to minimize the maximum motion amplitude of the structure along with multiple linear regression method enables determination of unknown coefficients of the correlations derived from dimensional analysis. Studies show that mass ratio and stiffness ratio are important for designing vibration absorbers for undamped and damped structures, respectively. The correlations are validated using the methods introduced in previous studies. Also, an example of vibration absorbers is calculated for an air compressor. The vibration absorber designed by this methodology results in a reduction in the magnification factor of the compressor by 78%.
She Left the Party: College Students’ Meanings of Sexual Consent
Authors: Groggel Anne , Burdick Maddie , Barraza Angel
Published: April 2020

At a moment when college sexual assault is described as an epidemic, it is important to understand college students’ implicit meanings of consent. Through 83 interviews, we examine students’ interpretations of a vignette in which neither character asked nor gave consent to sex. Gendered expectations significantly shaped whether students interpreted the male or female character as giving consent. When considering how students indicate interest in kissing or having sex, students interpreted acts such as leaving a party as indications of a man’s sexual interest and a woman’s willingness. That is, college students “expected” and employed implicit, gendered readings of actions that inform their understandings of implicit consent.
Noteworthy Literature From 2019 for Cardiothoracic Critical Care
Authors: Shen Liang , Tam Christopher W. , Jones Mandisa-Maia , Hoyler Marguerite , Ivascu Natalia S.
Published: April 2020

This annual article summarizes key findings from notable studies published in 2019 relevant to the practice of cardiothoracic critical care medicine. This year’s article encompasses updates to the literature on enhanced recovery after cardiac surgery, extracorporeal membranous oxygenation, delirium, and primary graft dysfunction after heart transplant.
Bilateral subfoveal serous detachment following Cisplatin chemotherapy
Authors: Teh Boon Lin , Duggan Rhona , Leslie Thorfinn
Published: April 2020

A 74-year-old gentleman with a background of metastatic pancreatic neuroendocrine tumour on combination chemotherapy of Cisplatin and Etoposide presented with a 3-week history of bilateral visual loss. Snellen visual acuity was right 6/9 and left 6/60. Fundus examination revealed clear media with isolated macular oedema in both eyes. Optical coherence tomography of the maculae showed localised bilateral subfoveal serous detachments. Cisplatin was thought to be the causative agent and was withheld following discussion with the treating Oncology team. Eight weeks after withholding Cisplatin, his vision improved with complete resolution of the subretinal fluid. To the authors’ knowledge, this is the first report to have illustrated bilateral subfoveal serous detachment caused by Cisplatin which resolved completely with cessation of offending drug.
Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation
Authors: De Pieri Enrico , Atzori Federica , Ferguson Stephen J , Dendorfer Sebastian , Leunig Michael , Aepli Martin
Published: April 2020

Background:

Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity.

Methods:

Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction.

Results:

Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius).

Conclusions:

In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved.
Limited need for screening of metal-on-metal hip resurfacing patients beyond 10 years of follow-up
Authors: van der Weegen Walter , Hoekstra Henk , Brakel Koen , Sijbesma Thea
Published: April 2020

Background:

National and international guidelines lack consistency on how to screen metal-on-metal (MoM) hip arthroplasty patients for adverse reactions to metal debris (ARMD). Long-term outcomes of MoM hip arthroplasty are scarce, hindering further development of such guidelines. We present the clinical, radiological and ARMD status of 158 cases of hip resurfacing with >10 years follow-up.

Methods:

A prospective analysis of a cohort of 298 consecutive hip resurfacing procedures was performed at a single institution. All patients underwent MARS-MRI scanning for pseudotumour screening at least once, regardless of symptoms. Implant survival and reasons for revision were analysed for all patients. Clinical, radiological and MARS-MRI results were analysed for 158 unrevised procedures with >10 years follow-up.

Results:

The implant survival was 85.9% at 14.5 years (95% CI, 81.9–90.6) with revision for all causes as endpoint and 92.3% with MoM disease-related revisions excluded (95% CI, 88.2–95.0). Of the 158 cases with >10 years follow-up, 1 had elevated metal ion levels, 29 had a stable C1 pseudotumour and 6 a stable C2 pseudotumour. All pseudotumours were observed within 3 years after initiating our intensified ARMD screening (2011), with no new pseudotumours observed after that period.

Conclusions:

We suggest that follow-up of MoM hip resurfacing patients beyond 10 years after surgery can be done with large intervals (i.e. every 5 years), and only earlier if a patient becomes symptomatic.
How do 3D-printed primary uncemented acetabular components compare with established uncemented acetabular cups? The experience of the New Zealand National Joint Registry
Authors: Wyatt Michael C , Kieser David C , Frampton Chris M A , Woodfield Tim , Hooper Gary J
Published: April 2020

Background:

3D-printed or additive manufactured acetabular implants are an exciting new technology being used in hip surgery with increasing frequency especially in complex acetabular reconstructions. However, the performance of acetabular components produced by this method for primary THR is unknown.

Methods:

41,272 uncemented cups in primary THR for OA were identified in the NZJR for the purposed of this study. There were 39,080 uncemented cups in the control group (15,798 Pinnacle cups, 12,724 Trident cups and 10,558 RM Pressfit cups) compared to 2192 3D-printed uncemented implants (1397 Delta TT cups, 640 Ti Por and 155 Polymax cups). All-cause revision rates and reasons for revision were examined. Kaplan-Meier survival analysis was performed.

Results:

3D-printed cups were inserted into younger, fitter patients with a higher mean BMI compared to those in the control group ( p < 0.001). The overall all-cause revision rate for 3D-printed cups was not significantly different to the controls: 0.77/100 cys (95% CI 0.59–1) compared to 0.55/100 cys (95% CI 0.52–0.58) in the control group ( p = 0.058, Hazards ratio 1.29, 95% CI 0.992–1.678). There was no difference in aseptic cup loosening or deep infection rates between either group or indeed individual implant designs.

Conclusions:

3D-printed uncemented cups provide reliable survivorship and clinical results in primary THR comparable to established designs manufactured by traditional means. The theoretical concerns of increased rates of fatigue failure or deep infection are unsubstantiated.
Early childhood professional culture: Social networks and beliefs among pre-kindergarten educators
Authors: Mowrey Sascha C
Published: April 2020

As efforts are made in the United States for public school districts to implement pre-kindergarten programs and centers, there is a growing need to attend to the aspects of the local context that may influence the ways that teachers and staff make sense of their work. Yet, the professional cultures in which early childhood teachers and other educators make sense of their practice are multi-faceted and not well understood. This study explores the network structures and beliefs among educators in three pre-kindergarten centers. In particular, the mentorship relationships among lead teachers, assistants, instructional coaches, and administrators were explored along with individuals’ beliefs about themselves and others. Findings indicate that early childhood mentoring networks aligned with formal role hierarchies, and were similar to networks seen in elementary school research. Trust among lead and assistant teachers and autonomy were particularly important in the pre-kindergarten settings where two individuals work together as part of a classroom teaching team, and the school serves a single grade level. Suggestions for future research expanding the work on professional culture in early childhood settings are addressed.
Laying an Early Foundation: Lifestyle Medicine Pre-Professional Education (LMPP) Member Interest Group
Authors: Merlo Gia , Tollefson Michelle , Dacey Marie , Lenz Thomas , Luchsinger Mary , Muscato Dennis , Frates Elizabeth Pegg
Published: April 2020

Just as lifestyle medicine is the necessary foundation for true health care reform, lifestyle medicine competencies should be the foundation for health education. Although lifestyle medicine education may benefit a health professional at any stage in their education or career, evidence-based undergraduate lifestyle medicine education for future health professionals shifts the perspective of health and health care delivery. Educating health preprofessionals in associate, bachelor’s, master’s, and other preprofessional healthcare training programs is of paramount importance due to the interdisciplinary nature of lifestyle medicine. To accomplish this, American College of Lifestyle Medicine (ACLM) members can work collaboratively through committees, projects, and working groups—becoming leadership champions of change. An ACLM Pre-Professional Member Interest Group (LMPP) was created in 2018. LMPP has been working to build a national collaborative effort to amass, create, and distribute resources for educators in this pre-professional arena. Educating college students planning to become professionals outside the medical sphere, for example, lawyers, business people, artists, and engineers, will also benefit the field by introducing the power of nutrition, exercise, sleep, social connection, and stress resiliency during this formative state of career development. Pre-professional educational programs provide learners the opportunity to personally experience the power of lifestyle medicine.
Significant aortic stenosis associated with poorer functional outcomes in patients with acute ischaemic stroke undergoing endovascular therapy
Authors: Ngiam Nicholas JH , Tan Benjamin YQ , Sia Ching-Hui , Chan Bernard PL , Anil Gopinathan , Cunli Yang , Holmin Staffan , Anderssen Tommy , Poh Kian-Keong , Yeo Leonard LL , Sharma Vijay K
Published: April 2020

Background and aim

Bi-directional feedback mechanisms exist between the heart and brain, which have been implicated in heart failure. We postulate that aortic stenosis may alter cerebral haemodynamics and influence functional outcomes after endovascular thrombectomy for acute ischaemic stroke. We compared clinical characteristics, echocardiographic profile and outcomes in patients with or without aortic stenosis that underwent endovascular thrombectomy for large vessel occlusion acute ischaemic stroke.

Methods

Consecutive acute ischaemic stroke patients with anterior and posterior circulation large vessel occlusion (internal carotid artery, middle cerebral artery and basilar artery) who underwent endovascular thrombectomy were studied. Patients were divided into those with significant aortic stenosis (aortic valve area <1.5 cm2) and without. Univariate and multivariate analyses were employed to compare and determine predictors of functional outcomes measured by modified Rankin scale at three months.

Results

We identified 26 (8.5%) patients with significant aortic stenosis. These patients were older (median age 76 (interquartile range 68–84) vs. 67 (interquartile range 56–75) years, p = 0.001), but similar in terms of medical comorbidities and echocardiographic profile. Rates of successful recanalisation (73.1% vs. 78.0%), symptomatic intracranial haemorrhage (7.7% and 7.9%) and mortality (11.5% vs. 12.6%) were similar. Significant aortic stenosis was independently associated with poorer functional outcome (modified Rankin scale >2) at three months (adjusted odds ratio 2.7, 95% confidence interval 1.1–7.5, p = 0.048), after adjusting for age, door-to-puncture times, stroke severity and rates of successful recanalisation.

Conclusion

In acute ischaemic stroke patients managed with endovascular thrombectomy, significant aortic stenosis is associated with poor functional outcome despite comparable recanalisation rates. Larger cohort studies are needed to explore this relationship further.
A cohesive-element-based model to evaluate interfacial behavior of casing–cement sheath for high-pressure, high-temperature wellbore integrity considering casing eccentricity
Authors: Zhao Xinbo , Yang Xiujuan , Lin Xingyu , Mei Yue
Published: April 2020

In this article, the finite element model considering the casing eccentricity of high-pressure, high-temperature wellbore integrity is established, where the cohesive zone element is introduced to evaluate the mechanical behavior of the casing–cement sheath interface. In this analysis, the bilinear traction–separation law is used to estimate the interfacial failure, and a damage factor is simultaneously defined to describe the damage evolution of the cohesive element. In addition, to achieve the interfacial separation, the pressure fluctuation inside the casing is applied. Using the finite element approach, we investigate the effect of mechanical parameters including Young’s modulus, Poisson’s ratio, thermal conductivity of the cement sheath, and pressure fluctuation inside the casing on the interfacial failure of the casing–cement sheath. The simulation results show that the damage factor increases with the increase in the mechanical parameters including Young’s modulus and Poisson’s ratio of the cement sheath and the casing pressure fluctuation. We also observe that the maximum damage factor under higher thermal conductivity is higher than that under lower thermal conductivity for the casing concentricity, while it is lower than that under lower thermal conductivity for the casing eccentricity. This indicates that the casing eccentricity has an important impact on the damage factor. What’s more, the casing eccentricity can change the location where the maximum damage factor occurs.