bluuebunny/crossref_metadata_2025 huggingface dataset:
Single Image Defogging Algorithm Based on Conditional Generative Adversarial Network
Authors: Ma Rui-Qiang , Shen Xing-Run , Zhang Shan-Jun
Published: November 2020

Outside the house, images taken using a phone in foggy weather are not suitable for automation due to low contrast. Usually, it is revised in the dark channel prior (DCP) method (K. He et al. 2009), but the non-sky bright area exists due to mistakes in the removal. In this paper, we propose an algorithm, defog-based generative adversarial network (DbGAN). We use generative adversarial network (GAN) for training and embed target map (TM) in the anti-network generator, only the part of bright area layer of image, in local attention model image training and testing in deep learning, and the effective processing of the wrong removal part is achieved, thus better restoring the defog image. Then, the DCP method obtains a good defog visual effect, and the evaluation index peak signal-to-noise ratio (PSNR) is used to make a judgment; the simulation result is consistent with the visual effect. We proved the DbGAN is a practical import of target map in the GAN. The algorithm is used defogging in the highlighted area is well realized, which makes up for the shortcomings of the DCP algorithm.
Assessing the Impacts of Autonomous Bus-on-Demand Based on Agent-Based Simulation: A Case Study of Fuyang, Zhejiang, China
Authors: Zhai Zhikang , Yang Ying , Shen Yu , Ji Yuxiong , Du Yuchuan
Published: November 2020

This paper envisions and assesses the performance of an autonomous bus-on-demand (ABoD) system. We take Fuyang, Zhejiang, China, as the study area to investigate the spatiotemporal distribution of bus travel demand during workdays, and we propose replacing inefficient bus routes with the ABoD system. Agent-based models with various bus dispatching and operation control strategies are constructed to evaluate the performance of the ABoD system. The behaviors and interactions of the agents, passengers, autonomous buses, and a control center are designed. After the verification of the simulated bus travel demand with real-world demand, a series of scenarios with various ABoD operation strategies are simulated. The simulation results show that, in comparison with both current fixed-schedule bus services and the optimized bus dispatching strategies, the ABoD system occupies fewer road resources and utilizes bus vehicles more efficiently. Besides, the system is adaptive to the sudden surge in bus travel demand and is economically sustainable.
Abdominal Flap Necrosis and Wound Dehiscence following a Medical Tourist Tummy Tuck
Authors: Zhitny Vladislav Pavlovich , Iftekhar Noama , Caravella Peter , Young Jake Patrick , Zide Barry , Stile Frank
Published: November 2020

Abdominoplasty is a major surgical procedure met with high rates of patient satisfaction and improved self-image. While many patients are lured abroad due to discounted prices for such highly requested procedures, unfortunately, there are also associated complications. A 47-year-old woman presented due to abdominal scar dehiscence due to skin necrosis secondary to a discounted abdominoplasty in Mexico. The patient had been turned away by several local surgical centers for treatment of the necrosis. The patient underwent incision, drainage, and two debridements before her abdominal wound was eventually closed. Patient recovered well postoperatively with improved aesthetic result. With the rise of social media advertisements, more patients elect to receive plastic surgery abroad. Unfortunately, many of these practices are not accurately vetted and this can complicate the postoperative care especially upon return to the United States.
SANS: Self-Sovereign Authentication for Network Slices
Authors: Salleras Xavier , Daza Vanesa
Published: November 2020

5G communications proposed significant improvements over 4G in terms of efficiency and security. Among these novelties, the 5G network slicing seems to have a prominent role: deploy multiple virtual network slices, each providing a different service with different needs and features. Like this, a Slice Operator (SO) ruling a specific slice may want to offer a service for users meeting some requirements. It is of paramount importance to provide a robust authentication protocol, able to ensure that users meet the requirements, providing at the same time a privacy-by-design architecture. This makes even more sense having a growing density of Internet of Things (IoT) devices exchanging private information over the network. In this paper, we improve the 5G network slicing authentication using a Self-Sovereign Identity (SSI) scheme: granting users full control over their data. We introduce an approach to allow a user to prove his right to access a specific service without leaking any information about him. Such an approach is SANS, a protocol that provides nonlinkable protection for any issued information, preventing an SO or an eavesdropper from tracking users’ activity and relating it to their real identities. Furthermore, our protocol is scalable and can be taken as a framework for improving related technologies in similar scenarios, like authentication in the 5G Radio Access Network (RAN) or other wireless networks and services. Such features can be achieved using cryptographic primitives called Zero-Knowledge Proofs (ZKPs). Upon implementing our solution using a state-of-the-art ZKP library and performing several experiments, we provide benchmarks demonstrating that our approach is affordable in speed and memory consumption.
Refinements of Some Integral Inequalities for
φ
-Convex Functions
Authors: Zahra Moquddsa , Chu Yu-Ming , Farid Ghulam
Published: November 2020

In this paper, we are interested to deal with unified integral operators for strongly

φ

-convex function. We will present refinements of bounds of these unified integral operators and use them to get associated results for fractional integral operators. Several known results are connected with particular assumptions.
Effect of Compressive Strain of Brake Pads on Brake Noise
Authors: Gu Yihong , Liu Yucheng , Lu Congda , Hu Shugen , Song Xiaowen
Published: November 2020

Brake noise, a principal component of vehicle noise, is among the most critical measures of vehicle quality. The perceived quality of cars can be improved by reducing brake noise; therefore, vehicle manufacturers are extensively investigating the influencing factors, generating mechanism, and solutions of brake noise. Compressive strain is one of the most influential performance parameters of a brake pad and can be adjusted by regulating the material elastic modulus and by modifying the shape of the brake lining. In this study, the compressive strain of a brake pad was adjusted through four methods, and the noise characteristics of brake pads with different elastic modulus, section outlines, lining widths, and chamfers were studied through finite element analysis and the complex-eigenvalue method. The effects of compressive strain of a brake pad on brake noise were examined, and an optimized brake-pad scheme was developed. A dynamometer test conducted to validate the effectiveness of the optimized scheme confirmed a clear alleviation in brake noise.
The Impact of Electroacupuncture at Hegu, Shousanli, and Quchi Based on the Theory “Treating Flaccid Paralysis by Yangming Alone” on Stroke Patients’ EEG: A Pilot Study
Authors: Zou Fei , Lin Yi-Fang , Chen Shu-Geng , Cao Lei , Wang Hao-ran , Ye Bin , Wang Qiang , Jie-Ying He , Jia Jie
Published: November 2020

Background. In China, electroacupuncture based on meridians theory “treating flaccid paralysis by Yangming alone” has been widely used for stroke rehabilitation in clinical practice. The aim of this study was to explore the electroencephalography change of electroacupuncture intervention on strokes patients with flaccid paralysis. Methods. Twenty‐three stroke patients with flaccid paralysis and six stroke patients with spasticity accepted electroacupuncture with the acupoints Hegu [LI4], Shousanli [LI10], and Quchi [LI11] for 20 minutes and their EEG data were recorded before, during, and after the electroacupuncture intervention. Results. Compared with the baseline EEG signals before electroacupuncture, the ipsilesional and contralesional beta‐band average power of patients with flaccid paralysis and spasticity were significantly increased during the needles retention stage and decreased slightly after removing the needles. The significant decrease of the ipsilesional and contralesional delta band average power in patients with flaccid paralysis occurred during the electroacupuncture stimulation, and they increased after the removal of the needles. The ipsilesional delta band average power of patients with spasticity significantly decreased during the electroacupuncture stimulation. Conclusion. From this pilot electrophysiological study, we provided a possible electrophysiological mechanism of the curative effect of electroacupuncture for stroke rehabilitation.
Localized Fournier’s Gangrene in “End-Stage” Renal Failure: Multidisciplinary Approach and Integration of Palliative Care
Authors: Voordeckers M. , Noels J. , Brognet M. , Salaouatchi M. T. , Mesquita M.
Published: November 2020

Presentation of the Case. Penile gangrene is a rare entity with significant morbidity and mortality. There are only few case reports of isolated penile Fournier’s gangrene in literature. Its rare occurrence, associated with complex and serious comorbidity, poses a major challenge to the attending medical personnel. A 53-year-old Caucasian patient with poorly controlled diabetes, progressive renal insufficiency, and multiple vascular complications presented with progressive necrosis of the penis (localized Fournier’s gangrene). Discussion. Fournier’s gangrene or necrotizing fasciitis refers to any synergistic necrotizing infection of the external genitalia or perineum and is a hallmark of severe systemic vascular disease. Fournier’s gangrene is an absolute emergency because the time interval between diagnosis and treatment significantly influences morbidity and mortality. Despite aggressive management, the estimated mortality rates range from 57 to 71%. Conclusions. Improved integration of palliative care services into the care of such patients is important to improve end-of-life care even though they do not have a malignant disease. The “Palliative Care Indicator Tool” can help identifying people at risk of deteriorating health and is important to improve end-of-life care.
Food Safety Practices among Postnatal Mothers in Western Ghana
Authors: Odonkor Stephen T. , Kurantin Napoleon , Sallar Anthony M.
Published: November 2020

Food safety has become a global issue due to the morbidity and mortality associated with it, particularly in developing countries. The objective of this community-based study is to examine food safety practices and its associated factors among postnatal mothers in the Western Region of Ghana. A cross-sectional survey study was conducted from August 1 2019 to January 31, 2020 from which data was obtained from the postnatal mothers (

N
=
300

). The data was analysed using SPSS v.23. The findings suggest that majority (86%) of the respondents exhibited good food handling practices. Also, 66.3% and 91.7% of the respondents exhibited good food preparation and proper storage practices, respectively. Results also revealed that the odds of performing good handling practice among respondents within the age group of 36-45 years were five times higher compared to those within the age group of 18-25 years [

OR
=
4.92

(95% CI: 1.44–16.86),

p
=
0.011

]. Moreover, respondents who had tertiary education qualifications were more likely to have proper food handling practices compared to those with primary education [

OR
=
0.27

(95% CI: 0.09–0.71),

p
=
0.009

]. These findings provide useful insights for policy directions. The government of Ghana and other stakeholders should develop a communication strategy to increase and sustain publicity and education on food safety particularly to postnatal mothers and the citizenry in general.
Colon Adenocarcinoma during Pregnancy: A Case Report and Review of the Literature
Authors: Petruzzelli Paolo , Zizzo Roberto , Tavassoli Elisabetta , Sutera Miriam , Tin Michela Chiadò Fiorio , Petruzzelli Luca , Benedetto Mariachiara , D’Anna Maria Rosa , De Paolis Paolo , Menato Guido
Published: November 2020

Colorectal cancer (CRC) during pregnancy presents an estimated incidence of 1 : 13,000, and it is associated with diagnostic and therapeutic challenges. Here, we present the case of a 38-year-old woman, 25 weeks and 5 days pregnant, who was transferred to our Obstetrics and Gynecology Department from a local hospital with the diagnosis of intestinal obstruction. Magnetic Resonance Imaging (MRI) showed marked distension with hydroaerial levels of the enterocolic loops upstream of a concentric parietal thickening of the descending colon, stenosing, extended longitudinally for about 4 cm. An exploratory laparotomy was performed with resection of the colon splenic flexure and mechanical end-terminal anastomosis. Histological examination of the operating piece highlighted the presence of moderately differentiated (G2) colon adenocarcinoma (stage pT3N1b). The operation was followed by a single course of oxaliplatin and 5-FU plus leukovorin. The patient had a vaginal delivery at

37
 
weeks
+
2

days of gestational age, following induction of labor and giving birth to a male infant whose weight was 2670 gr with apgar 9/9. We underline the pivotal role of attention to unspecific symptoms, early diagnosis, and active treatment in changing the clinical course of CRC.
A Covariance Feedback Approach to Covariance Control of Nonlinear Stochastic Systems
Authors: Baroumand Salman , Zaman Amir Reza , Mahmoudi Mohammad Reza
Published: November 2020

In this paper, the covariance control algorithm for nonlinear stochastic systems using covariance feedback is studied. Covariance control of nonlinear systems scenario involves the theory of covariance control based on the idea of the covariance feedback. Therefore, the proposed covariance control algorithm is derived for our case, firstly by applying the covariance control method and linear approximation of nonlinear systems, and then it is achieved by adopting this method for a class of nonlinear stochastic systems by using feedback linearization idea and a covariance feedback controller. The effectiveness of the proposed covariance feedback algorithm is studied using numerous simulations concerning different nonlinear case studies.
An Intelligent and Robust Framework towards Anomaly Detection, Medical Diagnosis, and Shortest Path Problems Based on Interval-Valued T-Spherical Fuzzy Information
Authors: Jin Huanhuan , Jah Rizvi Syed Khurram , Mahmood Tahir , Jan Naeem , Ullah Kifayat , Saleem Shahzad
Published: November 2020

The recent emerging advancements in the domain of the fuzzy sets are the framework of the T-spherical fuzzy set (TSFS) and interval valued T-spherical fuzzy set (IVTSFS). Keeping in view the promising significance of the latest research trend in the fuzzy sets and the enabling impact of IVTSFS, we proposed a novel framework for decision assembly using interval valued TSFS based upon encompassing the four impressive dimensions of human judgement including favor, abstinence, disfavor, and refusal degree. Another remarkable contribution is the optimization of information modeling and prevention of information loss by redefining the concept of each membership in interval. Moreover, the proposed research made a worthy contribution work by demonstrating the effective utilization of the interval valued TSFS based framework in anomaly detection, medical diagnosis, and shortest path problem. The proposed work demonstrates the effective remedial measure for the anomaly detection problem based on several parameters using the aggregation operators of IVTSFS. Moreover, the interval valued T-spherical fuzzy relations and their composition are illustrated to investigate the medical diagnosis problem. Furthermore, the notion of interval valued T-spherical fuzzy graph is also presented and fundamental notions of graph theory are also demonstrated with the help of real world instances. In the context of interval valued T-spherical fuzzy graphs (IVTSFGs), a modified Dijkstra Algorithm (DA) is developed and applied to the shortest path problem. The in-depth quantitative assessment and comparative analysis revealed that the proposed notion outpaces contemporary progressive approaches.
Loss of Fbxw7 Impairs Development of and Induces Heterogeneous Tumor Formation in the Mouse Mammary Gland
Authors: Onoyama Ichiro , Nakayama Shogo , Shimizu Hideyuki , Nakayama Keiichi I.
Published: November 2020

Fbxw7 is an F-box protein that contributes to regulation of cell proliferation and cell fate determination as well as to tumor suppression in various tissues. In this study, we generated mice with mammary gland–specific ablation of Fbxw7 (Blg-Cre/Fbxw7F/F mice) and found that most neonates born to mutant dams die soon after birth as a result of defective maternal lactation. The mammary gland of mutant dams was markedly atrophic and manifested both excessive cell proliferation and apoptosis in association with the accumulation of Notch1 and p63. Despite the hypoplastic nature of the mutant mammary gland, Blg-Cre/Fbxw7F/F mice spontaneously developed mammary tumors that resembled basal-like carcinoma with marked intratumoral heterogeneity. Additional inactivation of Trp53 in Blg-Cre/Fbxw7F/F mice further promoted onset and development of mammary tumors, suggesting that spontaneous mutation of Trp53 may facilitate transition of hypoplastic mammary lesions to aggressive cancer in mice lacking Fbxw7. RNA-sequencing analysis of epithelial- and mesenchymal-like cell lines from a Blg-Cre/Fbxw7F/F mouse tumor revealed an increased mutation rate and structural alterations in the tumor and differential expression of upstream transcription factors including known targets of Fbxw7. Together, our results implicate Fbxw7 in the regulation of cell differentiation and in tumor suppression in the mammary gland. Loss of Fbxw7 increases mutation rate and chromosome instability, activates signaling pathways governed by transcription factors regulated by Fbxw7, and triggers the development of mammary tumors with prominent heterogeneity.

Significance:

Mammary gland–specific ablation of Fbxw7 in mice results in defective gland development and spontaneous mammary tumor formation reminiscent of human basal-like carcinoma with intratumoral heterogeneity.
Neighborhood Social Environmental Factors and Breast Cancer Subtypes among Black Women
Authors: Qin Bo , Babel Riddhi A. , Plascak Jesse J. , Lin Yong , Stroup Antoinette M. , Goldman Noreen , Ambrosone Christine B. , Demissie Kitaw , Hong Chi-Chen , Bandera Elisa V. , Llanos Adana A.M.
Published: November 2020

Background:

The disproportionate burden of more aggressive breast cancer subtypes among African American/Black women may stem from multilevel determinants. However, data are limited regarding the impacts of neighborhood social environmental characteristics among Black women.

Methods:

We evaluated the association between neighborhood-level socioeconomic status (nSES) and breast cancer subtypes in the Women's Circle of Health and Women's Circle of Health Follow-up Study, which included 1,220 Black women diagnosed from 2005 to 2017 with invasive breast cancer. nSES at diagnosis was measured using NCI's census tract-level SES index. We used multilevel multinomial logistic regression models to estimate the association of nSES with breast cancer subtypes [triple-negative breast cancer (TNBC), HER2-positive vs. luminal A], adjusting for individual-level SES, body mass index, and reproductive factors. We tested for interactions by neighborhood racial composition.

Results:

Compared with census tracts characterized as high nSES, the relative risk ratios (RRR) for TNBC were 1.81 [95% confidence interval (CI): 1.20–2.71] and 1.95 (95% CI: 1.27–2.99) for women residing in areas with intermediate and low nSES, respectively (Ptrend = 0.002). Neighborhood racial composition modified the association between nSES and TNBC; the highest relative risk of TNBC was among women residing in low nSES areas with low proportions of Black residents.

Conclusions:

Black women residing in socioeconomically disadvantaged neighborhoods may have an increased risk of TNBC, particularly in areas with lower proportions of Black residents.

Impact:

Places people live may influence breast tumor biology. A deeper understanding of multilevel pathways contributing to tumor biology is needed.
Multiorgan Signaling Mobilizes Tumor-Associated Erythroid Cells Expressing Immune Checkpoint Molecules
Authors: Sano Yasuyo , Yoshida Toshimi , Choo Min-Kyung , Jiménez-Andrade Yanek , Hill Kathryn R. , Georgopoulos Katia , Park Jin Mo
Published: November 2020

Hematopoietic-derived cells are integral components of the tumor microenvironment and serve as critical mediators of tumor–host interactions. Host cells derived from myeloid and lymphoid lineages perform well-established functions linked to cancer development, progression, and response to therapy. It is unclear whether host erythroid cells also contribute to shaping the path that cancer can take, but emerging evidence points to this possibility. Here, we show that tumor-promoting environmental stress and tumor-induced hemodynamic changes trigger renal erythropoietin production and erythropoietin-dependent expansion of splenic erythroid cell populations in mice. These erythroid cells display molecular features indicative of an immature erythroid phenotype, such as the expression of both CD71 and TER119 and the retention of intact nuclei, and express genes encoding immune checkpoint molecules. Nucleated erythroid cells with similar properties are present in mouse and human tumor tissues. Antibody-mediated erythropoietin blockade reduces tumor-responsive erythroid cell induction and tumor growth. These findings reveal the potential of tumor-induced erythropoietin and erythroid cells as targets for cancer treatment.

Implications

: Our study identifies erythropoietin and erythroid cells as novel players in tumor–host interactions and highlights the involvement of multiorgan signaling events in their induction in response to environmental stress and tumor growth.
Vitamin D in Toddlers, Preschool Children, and Adolescents
Authors: Taylor Sarah N.
Published: November 2020

Background: Vitamin D supplementation is known to both prevent and treat rickets, a disease of hypomineralized bone. Childhood is a period of great bone development and, therefore, attention to the vitamin D needed to optimize bone health in childhood is imperative. Summary: Observational studies have pointed to a vitamin D status, as indicated by a 25-hydroxyvitamin D concentration, of 50 nmol/L to ensure avoidance of rickets and of 75 nmol/L to optimize health. However, the benefits of achieving these levels of vitamin D status are less evident when pediatric randomized, controlled trials are performed. In fact, no specific pediatric vitamin D supplementation has been established by the existing evidence. Yet, study of vitamin D physiology continues to uncover further potential benefits to vitamin D sufficiency. This disconnection between vitamin D function and trials of supplementation has led to new paths of investigation, including establishment of the best method to measure vitamin D status, examination of genetic variation in vitamin D metabolism, and consideration that vitamin D status is a marker of another variable, such as physical activity, and its association with bone health. Nevertheless, vitamin D supplementation in the range of 10–50 μg/day appears to be safe for children and remains a promising intervention that may yet be supported by clinical trials as a method to optimize pediatric health. Key Message: Pediatric vitamin D status is associated with avoidance of rickets. Randomized, controlled trials of vitamin D supplementation for pediatric bone health are limited and equivocal in their results. Beyond bone, decreased risk for autoimmune, infectious, and allergic diseases has been associated with higher vitamin D status. The specific vitamin D supplementation to optimize toddler, child, and adolescent outcomes is unknown, but doses 10–50 μg/day are safe and may be beneficial.
condição de cuidadores e do ato de cuidar de pessoas com deficiência intelectual
Authors: Silva Rosane Seeger da , Pascotini Fernanda dos Santos , Fedosse Elenir
Published: November 2020

Introdução: A deficiência intelectual é uma interrupção no desenvolvimento ou uma formação incompleta da mente, causando, limitações no funcionamento, tanto intelectual eadaptativo da pessoa, originando-se antes dos 18 anos. Objetivo: Caracterizar cuidadores e seus atos de cuidar de pessoas com deficiência intelectual. Metodologia: Estudo censitário edescritivo, com abordagem quantitativa, realizado em um município de pequeno porte do interior gaúcho. Os dados foram coletados por meio de um instrumento, elaborado exclusivamente para os fins deste estudo, contendo questões fechadas referentesà caracterização dos cuidadores e das condições do ato de cuidar. Resultados: Foram encontrados 75 cuidadores de pessoas com deficiência intelectual, com uma média de idade de 51,56 anos, na maioria mulheres, mães e com baixa escolarização. Quanto aosprincipais cuidados prestados à pessoa com deficiência intelectual, destacam-se o auxílio com a administração de medicamentos, os cuidados com finanças e correspondências e na compra de alimentos e vestiários. Conclusão: As pessoas com deficiência intelectual estão sendo cuidadas, em sua maioria, por cuidadores informais, mulheres, com baixo nível de escolaridade, que se dedicam ao cuidado em tempo integral, não encontrando dificuldades, apesar de passarem por momentos de solidão e preocupações.
Terapia ocupacional com puérperas em enfermaria obstétrica
Authors: Oliveira Camylla Varela Luckwü de , Oliveira Alyne Kalyane Câmara de
Published: November 2020

Esta pesquisa objetivou conhecer a opinião de discentes da graduação em Terapia Ocupacional e de profissionais residentes terapeutas ocupacionais sobre a atuação da Terapia Ocupacional junto à puérperas em contexto hospitalar, a partir de suas vivências práticas em enfermaria obstétrica de um hospital universitário da Paraíba. Trata-se de estudo exploratório, descritivo e qualitativo, com 11 discentes de Terapia Ocupacional e 5 residentes terapeutas ocupacionais. Os dados foram coletados por meio de ficha de caracterização do perfil dos participantes e entrevista semiestruturada com o propósito de conhecer a percepção dos participantes sobre a atuação da Terapia Ocupacional com puérperas em enfermaria obstétrica. A partir da Análise de Conteúdo surgiram dois eixos temáticos: “Potencialidades da Terapia Ocupacional com puérperas em enfermaria obstétrica” e “Fragilidades e desafios da Terapia Ocupacional no campo”. Resultados revelam contribuições da Terapia Ocupacional para puérperas hospitalizadas ao minimizar impactos causados pelo contexto hospitalar, ajudando-as a ressignificar esse espaço e cotidiano, e a desempenharem o papel ocupacional da maternidade, além de apontarem para a necessidade da inserção de terapeutas ocupacionais e de publicações especí icas no campo
Beat-by-Beat Cardiomyocyte T-Tubule Deformation Drives Tubular Content Exchange
Authors: Rog-Zielinska Eva A. , Scardigli Marina , Peyronnet Remi , Zgierski-Johnston Callum M. , Greiner Joachim , Madl Josef , O’Toole Eileen T. , Morphew Mary , Hoenger Andreas , Sacconi Leonardo , Kohl Peter
Published: November 2020

Rationale:

The sarcolemma of cardiomyocytes contains many proteins that are essential for electromechanical function in general, and excitation-contraction coupling in particular. The distribution of these proteins is nonuniform between the bulk sarcolemmal surface and membrane invaginations known as transverse tubules (TT). TT form an intricate network of fluid-filled conduits that support electromechanical synchronicity within cardiomyocytes. Although continuous with the extracellular space, the narrow lumen and the tortuous structure of TT can form domains of restricted diffusion. As a result of unequal ion fluxes across cell surface and TT membranes, limited diffusion may generate ion gradients within TT, especially deep within the TT network and at high pacing rates.

Objective:

We postulate that there may be an advective component to TT content exchange, wherein cyclic deformation of TT during diastolic stretch and systolic shortening serves to mix TT luminal content and assists equilibration with bulk extracellular fluid.

Methods and Results:

Using electron tomography, we explore the 3-dimensional nanostructure of TT in rabbit ventricular myocytes, preserved at different stages of the dynamic cycle of cell contraction and relaxation. We show that cellular deformation affects TT shape in a sarcomere length-dependent manner and on a beat-by-beat time-scale. Using fluorescence recovery after photobleaching microscopy, we show that apparent speed of diffusion is affected by the mechanical state of cardiomyocytes, and that cyclic contractile activity of cardiomyocytes accelerates TT diffusion dynamics.

Conclusions:

Our data confirm the existence of an advective component to TT content exchange. This points toward a novel mechanism of cardiac autoregulation, whereby the previously implied increased propensity for TT luminal concentration imbalances at high electrical stimulation rates would be countered by elevated advection-assisted diffusion at high mechanical beating rates. The relevance of this mechanism in health and during pathological remodeling (eg, cardiac hypertrophy or failure) forms an exciting target for further research.
Developing Improvisation Skills: The Influence of Individual Orientations
Authors: Mannucci Pier Vittorio , Orazi Davide C. , de Valck Kristine
Published: November 2020

The growing relevance of improvisation for successful organizing calls for a better understanding of how individuals develop improvisation skills. While research has investigated the role of training and simulations, little is known about how individuals develop improvisation skills when formal training is not an option and how individual-level factors shape development trajectories. We explore these issues in a longitudinal qualitative analysis of live action role-playing. Our findings reveal a three-stage process of improvisation development shaped by the presence of task and social structures, which act as both constraints and resources. Moreover, our findings illuminate how collaborative and competitive orientations shape whether improvisers perceive these structures as a resource that they need to nurture and renew (i.e., collaborative) or to seize and exploit (i.e., competitive). We also show that individual orientations are not always enduring but can change over time, engendering four types of improvisation development trajectories. Our work provides a longitudinal account of how individual orientations shape the process of improvisation development. In so doing, we also explain why individuals who are skilled improvisers do not necessarily improvise effectively as a collective, and we reconcile different conceptualizations of improvisation.
Rethinking Place Branding From a Political Perspective: Urban Governance, Public Diplomacy, and Sustainable Policy Making
Authors: Ginesta Xavier , de San Eugenio Jordi
Published: November 2020

Place branding is a relatively new transdisciplinary academic discipline. It is an evolution of what some researchers understood as “place or city marketing,” “place selling,” and “place promotion.” The three concepts analyze the need that territories have to position themselves in order to compete in the global markets through an eminently economic perspective. However, place branding rejects the corporate world to address, as positioning axes, the tangible and intangible values of a specific region and, therefore, its identity. Furthermore, public administrations have had to adopt strategies that link residents when designing place brands that can guarantee long-term narratives and become effective mechanisms for spatial planning, urban governance, local development, or economic promotion. Citizens’ engagement, at the grassroots level, has become a key element for the successful conceptualization and implementation of place brands. The current discipline of place branding is therefore totally linked to the political order. Public administrations become key actors in the development of place branding campaigns, not only in the local context but also at the national and international levels. The aim of this article is to present a theoretical evolution of place branding in order to find the most common links with the political order, as well as to design a conceptual framework to fit this discipline into the context of political science. This theoretical evolution will be conceived taking into account the results of previous empirical research that the authors conducted for different Catalan public administrations. The results of this article show clear synergies between four basic concepts: the place brand, its aim to contribute to sustainable planning, its influence on public governance decisions and, finally, its capacity to be central in the definition of public diplomacy programs outside the usual state-centric domain. Therefore, place branding led by public administrations—this is what we can understand as “public branding”—has a major and inevitable political focus.
Effect of Post-splenectomy Booster Vaccine Program on Vaccination Compliance in Trauma Patients
Authors: Gonzalez Robert A. , Robbins Justin M. , Garwe Tabitha , Stewart Kenneth E. , Sarwar Zoona , Cross Alisa M. , Celii Amanda M. , Albrecht Roxie M.
Published: November 2020

Objective

In 2012, the Centers for Disease Control and Prevention (CDC) Advisory Council on Immunization Practice recommended an additional post-splenectomy booster vaccine at 8 weeks following the initial vaccine. The objective of this study was to evaluate our vaccination compliance rate and what sociodemographic factors were associated with noncompliance following this recommendation.

Materials and Methods

A retrospective review of a performance improvement database of trauma patients eligible for post-splenectomy vaccination (PSV) at a level I trauma center was carried out between 2009 and 2018. Overall and institutional compliance with PSV was compared before and after the addition of booster vaccine recommendation. Factors associated with booster noncompliance were also identified.

Results

A total of 257 patients were identified. PSV compliance rate in the pre-booster was 98.4%, while overall and institutional post-booster compliance rate were significantly lower at 66.9% ( P ≤ .001) and 50.0% ( P ≤ .001), respectively. Compared to booster institutional compliers, institutional noncompliers lived farther from the trauma center (48 vs. 86 miles, P = .02), and though not statistically significant, these patients were generally older (34.9 vs. 40.5, P = .05).

Discussion

PSV booster compliance is low even with the current educational materials and recommendations. Additional approaches to improve compliance rates need to be implemented, such as sending letters to the patient and their primary care providers (PCPs), collaborating with rehab/long-term acute care centers, communicating with city and county health departments and city pharmacies, or mirroring other countries and creating a national database for asplenic patients to provide complete information.
Clinical Score Predicting Overall Survival After Surgery for Synchronous Metastatic Adrenocortical Carcinoma: A Surveillance, Epidemiology, and End Result-Based Study
Authors: Wu Kan , Liu Zhihong , Li Xiang , Lu Yiping
Published: November 2020

Surgery remains the only potential option for prolonging survival in synchronous metastatic adrenocortical carcinoma (ACC). The purpose of this study is to identify patients who may benefit from adrenalectomy. Using the Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), we identified synchronous metastatic ACC patients who underwent adrenalectomy. Cox regression analysis was performed to identify prognostic factors associated with overall survival. A clinical scoring system was created to predict survival after surgery. Sixty-two patients underwent adrenalectomy for synchronous metastatic ACC. Median age was 54.5 years. Median overall survival was 12 months. In univariable analysis revealed that age 65≥years, tumor stage: T3/4, multiple metastases, liver metastases, and no chemotherapy were associated with poor survival. In the multivariable Cox analysis, liver metastases ( P = .017) and no chemotherapy ( P = .039) remained independent predictors of worse prognosis. A clinical scoring system including of 1-point each for the 2 predictors demonstrated good discrimination in predicting survival after adrenalectomy (3-year survival: 45.9% for 0 points and 0% for 1 or 2 points; P < .001, area under the curve = .78). Prolonged survival after adrenalectomy combined with chemotherapy can be potentially achieved in synchronous metastatic ACC patients without liver metastases. Patients with liver metastases should be carefully evaluated for surgery.
Initiation of an Intraoperative Radiotherapy Program at a Safety net Hospital: What Is the Impact of an Intraoperative Radiotherapy Program in Underserved Patients With Early Breast Cancer?
Authors: Lalchandani Priti , Sila Chad , Ozao-Choy Junko , Dauphine Christine
Published: November 2020

Background

Intraoperative radiotherapy (IORT) can allow for single-dose radiation treatment following breast conservation therapy in low-risk patients with early breast cancer, in lieu of a traditional 6-week course of whole breast radiotherapy (WBRT). The objective of this study was to analyze the uptake and utilization of an IORT program in a safety-net hospital.

Materials and Methods

A retrospective review was conducted for all patients who underwent IORT from September 2014 to June 2018. Patient demographics, tumor characteristics, and IORT outcomes were analyzed. The proportion of patients undergoing IORT were determined to assess utilization and uptake.

Results

There were 27 female patients that received IORT, 23 (85.2%) of which required no further radiotherapy. Three (7.4%) patients had positive axillary lymph nodes and/or positive margins requiring subsequent WBRT. One patient (3.7%) developed an in-breast recurrence distant from the lumpectomy site 23 months after IORT. Ten patients (37.0%) developed a postoperative complication, including 5 seromas and 6 wound complications (superficial infections and/or wound necrosis). Overall, in the 46-month study period, IORT accounted for only 6.4% of 423 operations. Still, 27 of 29 (93.1%) patients who met eligibility criteria for IORT underwent the procedure.

Discussion

Although IORT comprised only 6.4% of all cases due to higher rates of mastectomy rates and advanced disease in our population, there was a high uptake of IORT among patients who met eligibility criteria for the procedure. Major complication rates of IORT were low, and most patients successfully completed radiotherapy in 1 intraoperative dose.
Challenges to Understanding and Compliance Among Surgical Patients in Low-Income Urban Teaching Hospitals
Authors: Burgoon Montgomry L. , Miller Parker A. , Hoover-Hankerson Bryson , Strand Nicolle , Ross Howard
Published: November 2020

Financial and educational barriers significantly impact low socioeconomic status racial and ethnic minority groups in their pursuit of health care, though less is known about the interplay of these factors in the pursuit of surgical care. This study was designed to uncover the challenges to patient understanding and compliance with pre- and postsurgical clinical advice in low-income urban environments. The data for this study were collected in spoken survey with eighty patients in 9 surgery clinics at Temple University Hospital in Philadelphia. Survey responses were coded into various groups until categories emerged. Relationships among categories were identified to generate themes and subthemes. Key facilitators of patient understanding and compliance were physician likeability and communication. Eighty (100%) patients reported that the physician always treated them with respect, which was important in their interpretation of their experience with the physician. Eighteen (23%) patients identified a language other than English as their primary language and 57 (71%) patients completed high school or less schooling, which likely influenced their communication with the physician. Eighty (100%) patients expressed that the physician always explained things in a way they could understand, focusing on clarity and thoroughness. Challenges to patient understanding and compliance were finances and social resources. Patients noted difficulty paying for medical care and a lack of support at home. Agency could facilitate use of surgical care while a lack thereof could challenge motivation. Ultimately, these themes showed how patients in this environment interact with surgical care.
When Is It Safe to Proceed With Pancreaticoduodenectomy Without Biliary Decompression?
Authors: Mosquera Catalina , Mitsakos Anastasios T. , Guyton Rodney L. , Fitzgerald Timothy L. , Zervos Emmanuel E.
Published: November 2020

Background

An absolute bilirubin level where preoperative biliary decompression (PBD) is indicated before pancreaticoduodenectomy has been elusive. Our goal was to identify a total bilirubin level whereby biliary decompression provides clear benefit, despite associated expenses and potential complications.

Materials and Methods

We reviewed a prospectively collected database of patients undergoing pancreaticoduodenectomy at the Vidant Medical Center between 2007 and 2016. Patients were arbitrarily subdivided into 3 groups based on presenting bilirubin level (≤10 mg/dL, 10.1-14.9 mg/dL, and ≥15 mg/dL) to determine the presence of overall complications, severe complications (Clavien-Dindo classification ≥3), prolonged length of stay (>1 SD), readmissions, or mortality.

Results

Common bile duct stenting independently predicted a higher incidence of complications in patients presenting with bilirubin ≤10 mg/dL ( P = .03) vs. those patients going directly to surgery. No differences were observed for patients with bilirubin between 10.1 mg/dL and 14.9 mg/dL. Biliary decompression in patients with bilirubin ≥15 mg/dL independently predicted fewer overall (73.8% vs. 100%, P = .0082) and less severe complications (14.3% vs. 44.5%, P = .03) and lower readmission rates (15.8% vs. 55.6%, P = .03) vs. those going directly to surgery. Patients not undergoing biliary decompression underwent pancreaticoduodenectomy sooner than those decompressed (4.7 days vs. 17.2 days, P = .01).

Discussion

All patients presenting with bilirubin ≥15 mg/dL should undergo PBD, while those with bilirubin ≤10 mg/dL should forego stent placement to avoid stent-related complications. The decision to stent between 10.1 and 14.9 mg/dL should be made on a case-by-case basis keeping in mind timeliness to definitive cancer treatment.
Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging
Authors: Sonaglioni Andrea , Nicolosi Gian Luigi , Lombardo Michele , Anzà Claudio , Ambrosio Giuseppe
Published: November 2020

Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 ± 13.1 year/old, 32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05; P = .03), thrombi with mobile free edge (hazard ratio: 3.25, 95% CI: 1.25-8.44; P = .01), hypoechoic thrombi (hazard ratio: 2.86, 95% CI: 1.10-7.42; P = .03), and mass peak antegrade velocity (Va) ≥10 cm/s (hazard ratio: 8.79, 95% CI: 2.00-38.5; P = .004). By multivariable analysis, thrombi with mobile free edge (hazard ratio: 3.54, 95% CI: 1.23-10.2; P = .02), and mass peak Va ≥10 cm/s (hazard ratio: 7.97, 95% CI: 1.60-39.6; P = .01) retained statistical significance. Mass peak Va ≥10 cm/s predicted the composite end point with 94% sensitivity and 85% specificity (area under the curve = 0.86). In conclusion, PW-TDI allows objective prognostication of LV thrombi embolic risk.
Non-vascularized Fibular Cortex Grafts with Osteocutaneous Free Fibula Transfer: A Novel Technique in Midface Reconstruction
Authors: Perez Paloma I. , Sloneker Del R. , Bloom Ashlie G. , Vincent Aurora G. , Hohman Marc H. , Harsha Wayne J. , Anderson Kelly G.
Published: November 2020

Objectives:

To present a method to reconstruct the midface using the fibula as both a microvascular free flap and as a free cortex graft.

Methods:

22-year-old male presented with bilateral maxillary odonotogenic myxoma. Bilateral total maxillectomy defects were reconstructed using an osteocutaneous fibula free flap. The nasomaxillary buttresses were augmented using free cortex grafts to provide additional soft tissue projection and lateral nasal support.

Results:

The patient received dental implants at 10 months postoperatively and resumed a normal diet. His midface height, nasal and maxillary projection were adequate. At 36 months post-treatment he has no evidence of disease recurrence or resorption of the free bone grafts.

Conclusion:

The fibula free flap can be used to provide additional support to a patient’s reconstruction by means of free cortex grafts. The patient has had successful restoration of pyriform aperture, nasal projection, mastication, and dental restoration using a single donor site.
Spectroscopic and Spectrometric Approaches for Assessing the Composition of Embedded Metals in Tissues
Authors: Smith Diane E. , Todorov Todor , Defante Adrian P. , Hoffman Jessica F. , Kalinich John F. , Centeno José A.
Published: November 2020

Many medical devices contain metals that interface with the body. Additionally, embedded metal fragments from military wounds are typically not removed, to avoid the risk of morbidity associated with invasive surgery. The long-term health consequences of many of these materials are not thoroughly understood. To this end, we have exposed rats for up to one year to implanted single-element metal pellets of any one of Al, Co, Cu, Fe, Ni, Pb, Ta, or W. Various tissues were harvested and flash frozen for analysis of their metal distribution. We discuss approaches to most thoroughly and reliably evaluate the distribution of metal in these tissues. The path to the most appropriate analytical technique took us through extensive examination of the tissues using scanning electron microscopy with energy dispersive X-ray spectroscopy (XPS), X-ray photoelectron spectroscopy (XPS), and laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS). Though any one of these methods is highly relied upon in surface chemistry analysis, LA-ICP-MS alone showed presence of metal in the tissue. This information will help build robust methods to bridge the gap in our understanding of biosolubility and distribution of embedded metal throughout the body.