bluuebunny/crossref_metadata_2025 huggingface dataset:
Equivalent Circuit Model Parameters Estimation of Lithium-Ion Batteries Using Cuckoo Search Algorithm
Authors: Duru Kamala Kumari , Venkatachalam Praneash , Karra Chanakya , Madhavan Asha Anish , Sambasivam Sangaraju , Kalluri Sujith
Published: November 2022

Herein, we present an advanced approach for the estimation of battery model parameters using the Cuckoo Search optimization Algorithm (CSA) for Lithium-Ion Batteries (LIB) in Electric Vehicle (EV) applications. In any battery-powered system, accurate determination of internal battery parameters and, as a consequence, SOC prediction is essential. The precision of parameter identification, which is mostly governed by battery model parameters, will significantly impact the battery’s safety, characteristics, and performance. Hence, we need effective, simple, and efficient parameter estimation algorithms to estimate the parameters accurately. The parameters of the NMC cell are predicted using a 2RC (second-order RC) Equivalent Circuit Model (ECM). The experimental data was utilized to determine the parameters and the correlation between OCV and SOC. The suggested approach and validation results demonstrate that the CSA for detecting parameters in LIBs is efficient and resilient. The proposed algorithm tends to limit the root mean square error of 0.44 percent between experimental and simulation results. Simulated results show that the novel approach outperforms the standard algorithm nonlinear least square method and other metaheuristic methods such as GA and PSO.
Harmonic Mixture Weibull-G Family of Distributions: Properties, Regression and Applications to Medical Data
Authors: Zamanah Ernest , Nasiru Suleman , Luguterah Albert
Published: November 2022

In recent years, the developments of new families of probability distributions have received greater attention as a result of desirable properties they exhibit in the modelling of data sets. The Harmonic Mixture Weibull-G family of distributions was developed in this study. The statistical properties were comprehensively presented and five special distributions developed from the family. The hazard functions of the special distributions were shown to exhibit various forms of monotone and nonmonotone shapes. The applications of the developed family to real data sets in medical studies revealed that the special distribution (Harmonic mixture Weibul Weibull distribution) provided a better fit to the data sets than other competitive models. A location-scale regression model was developed from the family and its application demonstrated using survival time data of hypertensive patients.
Development and Clinical Validation of a Novel 5 Gene Signature Based on Fatty Acid Metabolism-Related Genes in Oral Squamous Cell Carcinoma
Authors: Fan Yi , Wang Jing , Wang Yaping , Li Yanni , Wang Sijie , Weng Yanfeng , Yang Qiujiao , Chen Chen , Lin Lisong , Qiu Yu , Wang Jing , Chen Fa , He Baochang , Liu Fengqiong
Published: November 2022

Background/Aim.Lipid metabolism disorders play a crucial role in tumor development and progression. The aim of the study focused on constructing a novel prognostic model of oral squamous cell carcinoma (OSCC) patients using fatty acid metabolism-related genes. Methods. Microarray test and data from The Cancer Genome Atlas (TCGA) were used to identify differentially expressed genes related to fatty acid metabolism. The quantitative real-time polymerase chain reaction (qRT-PCR) was then used to validate the expression of targeted fatty acid metabolism genes. A risk predictive scoring model of fatty acid metabolism-related genes was generated using a multivariate Cox model. The efficacy of this model was assessed by time-dependent receiver operating characteristic curve (ROC). Results. 14 fatty acid metabolism-related genes were identified by microarray test and TCGA database analysis and then confirmed by PCR. Finally, a 5 gene signature (ACACB, FABP3, PDK4, PPARG, and PLIN5) was constructed and a RiskScore was calculated for each patient. Compared to the high RiskScore group, the low RiskScore group had better overall survival (OS) (

p
=
0.02

). The RiskScore derived from a 5 gene signature was a prognostic factor (HR: 3.73, 95% CI: 1.38, 10.09) for OSCC patients. The predictive classification efficiencies of RiskScore were evaluated and the area under the curve (AUC) values for 1, 3, and 5 years were 0.613, 0.652, and 0.681, respectively. Then we compared the predictive performance of the prognostic model with or without the RiskScore. The 5 gene-derived RiskScore can improve the predictive performance with AUC values of 0.760, 0.803, and 0.830 for 1, 3, and 5 years OS in prognostic model including the RiskScore. While the predicted AUC values of the model without RiskScore for 1, 3, and 5 years OS were 0.699, 0.715, and 0.714, respectively. Conclusion. We developed a predictive score model using 5 fatty acid metabolism-related genes, which could be a potential prognostic indicator in OSCC.
Mortality prediction in ICU Using a Stacked Ensemble Model
Authors: Ren Na , Zhao Xin , Zhang Xin
Published: November 2022

Artificial intelligence (AI) technology has huge scope in developing models to predict the survival rate of critically ill patients in the intensive care unit (ICU). The availability of electronic clinical data has led to the widespread use of various machine learning approaches in this field. Innovative algorithms play a crucial role in boosting the performance of models. This study uses a stacked ensemble model to predict mortality in ICU by incorporating the clinical severity scoring results, in which several machine learning algorithms are employed to compare the performance. The experimental results show that the stacked ensemble model achieves good performance compared with the model without integrating the severity scoring results, which has the area under curve (AUC) of 0.879 and 0.862, respectively. To improve the performance of prediction, two feature subsets are obtained based on different feature selection techniques, labeled as SetS and SetT. Evaluation performances show that the SEM based on the SetS achieves a higher AUC value (0.879 and 0.860). Finally, the SHapley Additive exPlanations (SHAP) analysis is employed to interpret the correlation between the risk features and the outcome.
M1 Microglia Induced Neuronal Injury on Ischemic Stroke via Mitochondrial Crosstalk between Microglia and Neurons
Authors: Liu Wei , Qi Zitong , Li Wanmeng , Liang Jia , Zhao Liang , Shi Yijie
Published: November 2022

Among the middle-aged and senile populations, ischemic stroke (IS) is a frequently occurring acute condition of the cerebrovascular system. Traditionally, it is recognized that when stroke occurs, microglia are activated into M1 phenotype and release cytotoxic cytokines, reactive oxygen species, proteases, and other factors, thus exacerbating the injury by further destroying or killing nearby neurons. In the latest research, the crucial role of the intercellular mitochondrial crosstalk on the stroke management has been demonstrated. Therefore, we tried to clarify mitochondrial crosstalk between microglia and neurons, and evaluated M1 microglial mitochondria-mediated neurological performance in transient middle cerebral artery occlusion (tMCAO) rats. We found that when microglia was activated into the proinflammatory M1 type after stroke, mitochondrial fission process was accelerated, and damaged mitochondria were released, further transferred to neurons and fused with neuronal mitochondria. As a result, the function of neuronal mitochondria was damaged by decreasing adenosine triphosphate (ATP), mitochondria membrane potential, and increasing excessive reactive oxygen species (ROS), thus inducing mitochondria-mediated neuronal death and finally aggravating ischemia injury. Taken together, it provides a novel neuroglial crosstalk mechanism at the mitochondrial level.
Vitamin D3 Supplementation Attenuates Surgery-Induced Neuroinflammation and Cognitive Impairment by Regulating NLRP3 Inflammasome in Mice
Authors: Jiang Jingyan , Huang Xin , Gao Xiang , Yu Shenghui
Published: November 2022

Neuroinflammation plays a dominant role in the progression of postoperative cognitive dysfunction (POCD). Vitamin D has been known to have important regulatory functions in inflammation and immune response. The NOD-like receptor protein 3 (NLRP3) is an essential inflammasome in the inflammatory response and could be activated by anesthesia and surgery. In this study, male C57BL/6 mice aged 14–16 months were given VD3 for 14 days straight before having an open tibial fracture surgery. The animals were either sacrificed to obtain the hippocampus or tested in a Morris water maze test. Western blot was employed to estimate the levels of NLRP3, ASC, and caspase-1, immunohistochemistry was used to identify microglial activation, and an enzyme-linked immunosorbent assay was used to measure the expression of IL-18 and IL-1β, while using the corresponding assay kits to assess ROS and MDA levels to reflect the oxidative stress status. We showed that VD3 pretreatment significantly improved surgery-induced memory and cognitive dysfunctions in aged mice, which was linked to the inactivation of the NLRP3 inflammasome and the inhibition of neuroinflammation. This finding provided a novel preventative strategy for clinically reducing postoperative cognitive impairment in elderly surgical patients. This study has some limitations. Gender differences in the effects of VD3 were not considered, and only male mice were used. Additionally, VD3 was given as a preventative measure; however, it is unknown whether it has any therapeutic benefits for POCD mice. This trial is registered with ChiCTR-ROC-17010610.
Clinical Features and Prognosis Analysis of Hormone Receptor-Positive, HER2-Negative Breast Cancer with Differential Expression Levels of Estrogen and Progesterone Receptors: A 10-Year Retrospective Study
Authors: Liu Jin , Gan Mingyu , Lin Zijing , Deng Qin , Deng Juan , Zeng Bin , Shi Yanling , Ming Jia
Published: November 2022

Background. Estrogen and progesterone receptor status can predict breast cancer patient prognosis and treatment sensitivity, but research on low ER and PR levels and expression balance remains limited. Methods. From January 2010 to October 2016, 283 ER+/PR+/HER2-breast cancer patients who met the inclusion criteria were enrolled and divided into the H group (ER > 10%, N = 261) and the L group (1% ≤ ER ≤ 10%, N = 22). Groups were further divided into the HH group (ER > 10%/PR > 20%, N = 201), the HL group (ER > 10%/ER 1% ≤ PR ≤ 20% PR, N = 60), the LH group (1% ≤ ER ≤ 10%/PR > 20%, N = 5), and the LL group (1% ≤ ER ≤ 10%/1% ≤ PR ≤ 20%, N = 17). The LH group was excluded due to its small size, leaving the clinical and prognostic characteristics of 2 large groups and 3 subgroups to be analyzed. Results. L group patients had significantly more stage N2 axillary lymph nodes than H group patients (31.8% vs. 9.2%,

P

 = 0.007). Age (

P

 = 0.011), menopause status (

P

 = 0.001), and tumor size (

P

 = 0.024) were significantly different in the HL vs. HH and LL groups. Five-year DFS (94.6% vs. 77.0%,

P

 < 0.001) and 5-year OS (97.2% vs. 85.8%,

P

 = 0.001) rates significantly differed between HH and HL. No significant differences in 5-year DFS (77.0% vs. 81.9%,

P

 = 0.564) or 5-year OS (85.8% vs. 87.8%,

P

 = 0.729) rates were observed between HL and LL; the OS rates of HL and LL were similar. Conclusion. In the group of ER+/PR+/HER2-patients, there was no significant prognostic difference between ER-low positive and ER-high positive groups, but low PR expression was significantly associated with a worse prognosis. The role of ER and PR balance in breast cancer progression and individualized treatment requires further investigation.
Enterprise Human Resource Management Model by Artificial Intelligence Digital Technology
Authors: Jiaping Yu
Published: November 2022

Artificial intelligence (AI) is a potentially transformative force that is likely to change the role of management and organizational practices. AI is revolutionizing corporate decision-making and changing management structures. The visible effects of AI can be observed in key competencies and corporate processes such as knowledge management, as well as consumer outcomes including service quality perceptions and satisfaction. This study aims to optimize the human resource management (HRM) process, reduce the workload of human resource managers, and improve work efficiency. Based on AI digitization technology, a salary prediction model (SPM) is designed using a backpropagation neural network (BPNN), and the Nesterov and Adaptive Moment Estimation (Nadam) algorithms are integrated to optimize the model. Next, the content information of the resumes are used to predict the hiring salary of the candidates and validate the model. Results show that compared with other optimization algorithms, the final predicted result score of the Nadam optimization algorithm is 0.75%, and the training period is 186 s, providing the best optimization effect and the fastest convergence speed. Moreover, the BPNN-based SPM optimized by Nadam has good performance in the learning process and the accuracy rate can reach 79.4%, which verifies the validity of the SPM. The outcomes of this study can provide a reference for HRM systems based on data mining technology.
Harmonic Detection Method Based on Particle Swarm Optimization and Simulated Annealing Algorithm of Electrohydraulic Servo System
Authors: Wang Tao , Song Jinchun
Published: November 2022

Due to the comprehensive influence of many nonlinear coupling factors within a system, when the input signal provided by an electrohydraulic servo shaker is sinusoidal, it often leads to the existence of high-order harmonic components of the system, which makes the output servo signal parameters exist extremely serious. Therefore, the detection of harmonics of the electrohydraulic servo shaker has very important application significance. In this paper, by using simulated annealing (SA) based harmonic detection, a kernel function is introduced to study area influence-based particle swarm optimization (PSO). Using a super accurate and fast global convergence brought by the combination of hybrid particle swarm optimization algorithm and simulated annealing algorithm, it can quickly jump out of the trap of traditional local optimization algorithms and a more stable, high-precision, as well as fast global convergence optimal solution can be obtained. Through the detection and simulation of the amplitude and phase of the harmonics in the system, by comparing the PSO-SA detection with PSO detection, it is proved that the PSO-SA algorithm can well satisfy the accuracy of the detection system, which has advantages such as a fast convergence speed, a high search accuracy, etc.; meanwhile, it is simple and easy to implement.
The Value of Glycemic Control Prior to Cancer Diagnosis on All-Cause Mortality among Patients with Type 2 Diabetes in Dutch Primary Care
Authors: de Haan-Du Jing , Groenier Klaas H. , Wauben-Spaetgens Brendy , Jalving Mathilde , Kleefstra Nanne , Landman Gijs W.D. , de Bock Geertruida H.
Published: November 2022

Background:

Poor glycemic control prior to cancer diagnosis for patients with preexisting type 2 diabetes (T2DM) may predict a worse cancer diagnosis. We investigated the association between pre-diagnosis glycemic control and all-cause mortality in patients with T2DM who develop cancer.

Methods:

This prospective cohort study linked data from three sources covering 1989 to 2019: a T2DM benchmarking database, the Netherlands Cancer Registry, and the Personal Records Database. We included patients with T2DM and incident primary breast, colorectal, or prostate cancer (stage 0–III), with target glycemic control defined according to Dutch guidelines. Analysis involved estimating the association between glycemic control and all-cause mortality with Cox proportional hazard models, accounting for individual expected survival relative to the general population and relevant disease (e.g., diabetes duration and medications) and individual (e.g., age and gender) characteristics.

Results:

Of the 71,648 linked cases, 620 had breast cancer, 774 had colorectal cancer, and 438 had prostate cancer, with follow-up data available for 6.4 (4.2–8.4), 5.6 (2.7–7.6), and 6.3 (4.5–8.2) years, respectively. Compared with patients with pre-diagnosis glycemic control at target, the HRs and 95% confidence intervals for mortality among those with pre-diagnosis glycemic control not at target were 1.40 (1.00–1.96) for breast cancer, 1.45 (1.12–1.88) for colorectal cancer, and 1.39 (0.98–1.98) for prostate cancer.

Conclusions:

Among patients with T2DM in Dutch primary care, poor glycemic control before diagnosis with breast and colorectal cancer can increase mortality compared with good control.

Impact:

Glycemic control prior to cancer diagnosis is of prognostic value.
Tumor Radiomic Features on Pretreatment MRI to Predict Response to Lenvatinib plus an Anti-PD-1 Antibody in Advanced Hepatocellular Carcinoma: A Multicenter Study
Authors: Xu Bin , Dong San-Yuan , Bai Xue-Li , Song Tian-Qiang , Zhang Bo-Heng , Zhou Le-Du , Chen Yong-Jun , Zeng Zhi-Ming , Wang Kui , Zhao Hai-Tao , Lu Na , Zhang Wei , Li Xu-Bin , Zheng Su-Su , Long Guo , Yang Yu-Chen , Huang Hua-Sheng , Huang Lan-Qing , Wang Yun-Chao , Liang Fei , Zhu Xiao-Dong , Huang Cheng , Shen Ying-Hao , Zhou Jian , Zeng Meng-Su , Fan Jia , Rao Sheng-Xiang , Sun Hui-Chuan
Published: November 2022

Introduction: Lenvatinib plus an anti-PD-1 antibody has shown promising antitumor effects in patients with advanced hepatocellular carcinoma (HCC), but with clinical benefit limited to a subset of patients. We developed and validated a radiomic-based model to predict objective response to this combination therapy in advanced HCC patients. Methods: Patients (N = 170) who received first-line combination therapy with lenvatinib plus an anti-PD-1 antibody were retrospectively enrolled from 9 Chinese centers; 124 and 46 into the training and validation cohorts, respectively. Radiomic features were extracted from pretreatment contrast-enhanced MRI. After feature selection, clinicopathologic, radiomic, and clinicopathologic-radiomic models were built using a neural network. The performance of models, incremental predictive value of radiomic features compared with clinicopathologic features and relationship between radiomic features and survivals were assessed. Results: The clinicopathologic model modestly predicted objective response with an AUC of 0.748 (95% CI: 0.656–0.840) and 0.702 (95% CI: 0.547–0.884) in the training and validation cohorts, respectively. The radiomic model predicted response with an AUC of 0.886 (95% CI: 0.815–0.957) and 0.820 (95% CI: 0.648–0.984), respectively, with good calibration and clinical utility. The incremental predictive value of radiomic features to clinicopathologic features was confirmed with a net reclassification index of 47.9% (p < 0.001) and 41.5% (p = 0.025) in the training and validation cohorts, respectively. Furthermore, radiomic features were associated with overall survival and progression-free survival both in the training and validation cohorts, but modified albumin-bilirubin grade and neutrophil-to-lymphocyte ratio were not. Conclusion: Radiomic features extracted from pretreatment MRI can predict individualized objective response to combination therapy with lenvatinib plus an anti-PD-1 antibody in patients with unresectable or advanced HCC, provide incremental predictive value over clinicopathologic features, and are associated with overall survival and progression-free survival after initiation of this combination regimen.
O cigarro e o adolescente no Brasil: a importância do capital humano da mãe para estudantes do nono ano do ensino fundamental em 2015
Authors: Steingraber Ronivaldo
Published: November 2022

Este artigo estuda a influência da escolaridade da mãe sobre a decisão do adolescente experimentar ou usar cigarro. As estimativas consideram os microdados da pesquisa PENSE de 2015 do IBGE que analisam mais de cem mil adolescentes do nono ano de ensino fundamental brasileiro. Resultados por meio de um modelo PROBIT permitem concluir que as mães com maior escolaridade reduzem entre 0,2% e 0,36% as chances do filho experimentar ou usar cigarro. A tendência apontada pelo modelo é que adolescentes mais velhos e que tem pai ou mãe que fumam apresentem maior probabilidade de experimentação ou uso de cigarro.
Leonardo da Vinci’s Visualization of Gravity as a Form of Acceleration
Authors: Gharib Morteza , Roh Chris , Noca Flavio
Published: November 2022

Despite limited tools, Leonardo da Vinci displayed ingenious problem-solving. The authors examine a combination of Leonardo’s thought and physical experiments regarding the acceleration of falling objects. Leonardo recorded that if a water-pouring vase moves transversally (sideways), mimicking the trajectory of a vertically falling object, it generates a right (as in orthogonal) triangle with equal leg length, composed of falling material lining up diagonally (forming the hypotenuse) and the vase trajectory forming one of the legs. On the hypotenuse, Leonardo wrote “Equatione di Moti,” or equalization of motions, noting the equivalence of the two orthogonal motions, one effected by gravity and the other prescribed by the experimenter. The authors present an analytical solution using Newtonian mechanics to confirm Leonardo’s “Equivalence principle.”
Dynamic interactions between anterior insula and anterior cingulate cortex link perceptual features and heart rate variability during movie viewing
Authors: Sonkusare Saurabh , Wegner Katharina , Chang Catie , Dionisio Sasha , Breakspear Michael , Cocchi Luca
Published: November 2022

The dynamic integration of sensory and bodily signals is central to adaptive behaviour. Although the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC) play key roles in this process, their context-dependent dynamic interactions remain unclear. Here, we studied the spectral features and interplay of these two brain regions using high-fidelity intracranial-EEG recordings from five patients (ACC: 13 contacts, AIC: 14 contacts) acquired during movie viewing with validation analyses performed on an independent resting intracranial-EEG dataset. ACC and AIC both showed a power peak and positive functional connectivity in the gamma (30–35 Hz) frequency while this power peak was absent in the resting data. We then used a neurobiologically informed computational model investigating dynamic effective connectivity asking how it linked to the movie’s perceptual (visual, audio) features and the viewer’s heart rate variability (HRV). Exteroceptive features related to effective connectivity of ACC highlighting its crucial role in processing ongoing sensory information. AIC connectivity was related to HRV and audio emphasising its core role in dynamically linking sensory and bodily signals. Our findings provide new evidence for complementary, yet dissociable, roles of neural dynamics between the ACC and the AIC in supporting brain-body interactions during an emotional experience.
The Premodern History of “Civilisation” in Arabic: Rifāʿa al-Ṭahṭāwī and his Medieval Sources
Authors: Abu-ʿUksa Wael
Published: November 2022

From the 1820s onwards, “progress” and “civilisation” gained extensive use in Arabic and evolved as comprehensive concepts. “Progress” conveyed the power of development and “civilisation” referred to the aspired-to future. The key use of “civilisation” was to establish a new form of legitimacy used to justify new institutional practices, values, and customs. Using Rifāʿa al-Ṭahṭāwī’s early theorisation of “civilisation” in the late 1820s as its starting point, this article tracks how medieval Arabic conceptions of the term influenced his theory, while also elaborating on the course and transformation of “civilisation” over time. The article traces the prehistory of the modern concept by mapping the semantics of words such as tamaddun, ʿumrān, taḥaḍḍur, and tamaṣṣur, all of which characterise different aspects of civilisation. It examines the sources al-Ṭahṭāwī drew on in constructing his conception of civilisation and problematises the idea that it is a notion wholly imported from France. The article’s diachronic analysis of “civilisation” uncovers its antecedents as represented in al-Ṭahṭāwī’s works, which intertwine the classical Greek, Hellenist, Arab, and modern European traditions.
Religious Care and Moral Economy amidst COVID-19
Authors: Jammes Jérémy , Hoon Chang-Yau
Published: November 2022

After Independence in 1984, the Sultanate of Brunei declared Melayu Islam Beraja (MIB) as the official state ideology. Translated as “Malay Islamic Monarchy,” this ideology is primarily interpreted through the Islamic lens and encompasses all sectors of the society. Facing the COVID-19 crisis, the government took quick and Shari’a-driven measures to contain the further import and propagation of the virus. How did faith intertwine with healthcare policy amidst COVID-19? Our ethnographic survey traces the origin of the virus in the country and the major reactions of the Islamic government in time of emergency. This archaeology of COVID-19 in the Sultanate should not ignore both the disciplinary trust in place in Brunei as well as individual reactions and ways to rely on religious materials (such as self-care healing practices, expressions of piety or calamity-releasing prayers) to eradicate the virus or protect people from it.
A new species of Bambuina de Mello, Horta & Bolfarini, 2013 (Orthoptera: Grylloidea: Phalangopsidae: Luzarinae) from the Parque Nacional do Itatiaia, Brazil
Authors: SOUZA-DIAS PEDRO G. B. , BORILLE MARIA V. A. , DE CAMPOS LUCAS DENADAI
Published: November 2022

In this study, we describe the second species of the Brazilian genus Bambuina de Mello, Horta & Bolfarini, 2013. Bambuina zikani n. sp. is a cavicolous cricket, found in crevices and natural cavities in the Parque Nacional do Itatiaia, Rio de Janeiro, Brazil. We also highlight the glandular condition of the males’ metanotum and forewings of Bambuina species.
Child Support Policy across High-Income Countries: Similar Problems, Different Approaches
Authors: Hakovirta Mia , Cuesta Laura , Haapanen Mari , Meyer Daniel R.
Published: November 2022

We provide an overview of child support policy in high-income countries, highlighting differences in institutional arrangements, the amount of child support due, and the amount of child support received. We show that the United States expects high levels of child support from nonresident parents when compared to other countries, that noncompliance is a problem across countries, and that most European countries deal with nonpayment of child support by providing guarantees of public support for children and resident parents. The guarantee schemes vary in terms of eligibility and generosity. Throughout, we find that child support policy approaches differ across countries. A key policy implication from this review is that the United States may be expecting too much child support from nonresident parents and that it could consider guaranteeing a modest amount of public support to single-parent households.
Ethno-Racial Variation in Single Motherhood Prevalences and Penalties for Child Poverty in the United States, 1995–2018
Authors: Baker Regina S.
Published: November 2022

Empirical studies link high racial inequality in U.S. child poverty to the higher prevalence of single motherhood among certain racial groups. But a growing literature is demonstrating how the impact of single parenthood and family structure on children varies by racial group, including evidence that Black children experience smaller single motherhood “penalties” for some outcomes, like education. I use Luxembourg Income Study data for the United States from 1995 to 2018 to further investigations of ethno-racial variation in single motherhood penalties for child poverty. I provide a descriptive portrait of the levels and trends of children living in single-mother households and of the poverty penalties associated with children living in such households. I also show that, on average, Black children experience smaller penalties from single motherhood and Latino children experience larger penalties, both compared to White children. I conclude with discussion of potential reasons for this variation and future directions for research.
Single Parents in High-Income Countries: What the United States Can Learn from Others
Authors: Sawhill Isabel V.
Published: November 2022

In the last 50 years, single parenthood has become more prevalent in the United States. As compared to other high-income countries, the United States does little to support single-parent families and they fare poorly as a result. This volume takes a comparative approach to extend our knowledge of the experiences of single parent families and the best approaches to support their well-being. By looking at the circumstances of single-parent families across many countries, this volume sheds light on important questions pertaining to child poverty and income inequality, the role of public assistance in supporting single-parent families, and the impact of this assistance on employment and marriage. In this article, I summarize the authors’ contributions in addressing these questions and present my own perspective on related issues, including the impact of single-parent families and cohabitation on children. I end with highlighting what researchers can learn from this volume and how U.S. policymakers can apply these lessons.
Immigration Policies and the Risks of Single Parenthood for Migrant Women
Authors: Shutes Isabel
Published: November 2022

In high-income countries, both single parents and migrants face elevated risks of living in poverty, but research has paid little attention to the intersection of single parent and migrant status. I examine the ways in which immigration policies make migrants dependent either on the labor market or on their families as a spouse or partner and how these dependencies present risks to migrant women who are single parents. I draw on qualitative data on migrant women’s experiences in the first five years after migration to the UK, which include their transitions to single parenthood, to explore how their legal status affects the risks that they experience. Those risks concern exclusion from access to social protection and permanent legal residence, where access is contingent on the ability to maintain a relationship to the market as a worker or to the family through marriage or a stable partnership.
Benign Diagnosis by Image-Guided Core-Needle Breast Biopsy
Authors: Duncan James L. , Cederbom Gunnar J. , Champaign Judy L. , Smetherman Dana H. , King Tari A. , Farr Gist H. , Waring Alexia N. , Bolton John S. , Fuhrman George M.
Published: November 2022

Image-guided core-needle breast biopsy (IGCNBB) is widely used to evaluate patients with abnormal mammograms; however, information is limited regarding the reliability of a benign diagnosis. The goal of this study was to demonstrate that a benign diagnosis obtained by IGCNBB is accurate and amenable to mammographic surveillance. Records of all patients evaluated by IGCNBB from July 1993 through July 1996 were reviewed. Biopsies were classified as malignant, atypical, or benign. All benign cases were followed by surveillance mammography beginning 6 months after IGCNBB. Of the 1110 patients evaluated by IGCNBB during the study period, 855 revealed benign pathology. A total of 728 of the 855 patients (85%) complied with the recommendation for surveillance mammography. A total of 196 IGCNBBs were classified as malignant; 59 cases were classified as atypical. The atypical cases were excluded from the statistical analysis. Only two patients have demonstrated carcinoma after a benign IGCNBB during the 2-year minimum follow-up period. The sensitivity and specificity of a benign result were 100.0 and 98.9 per cent, respectively. A benign diagnosis obtained by IGCNBB is accurate and therefore amenable to mammographic surveillance. The results of this study support IGCNBB as the preferred method of evaluating women with abnormal mammograms.
Clinical Features and Prognostic Factors Associated with Adrenocortical Carcinoma: Lahey Clinic Medical Center Experience
Authors: Tritos Nicholas A. , Cushing Gary W. , Heatley Gerald , Libertino John A.
Published: November 2022

Adrenocortical carcinoma is a rare tumor associated with a commonly poor prognosis. However, data on the natural history and response to therapy of patients with this malignancy have often been conflicting. Our objective of this retrospective study was to evaluate the clinical course and survival of patients with adrenocortical carcinoma and to identify relevant prognostic factors. Between 1966 and 1996, 31 patients with histologically documented adrenocortical carcinoma were observed at the Lahey Clinic Medical Center. Patient information was obtained from chart review. At the time of diagnosis, 48 per cent of patients had endocrine symptoms with compatible hormonal studies, 19 per cent had involvement of the inferior vena cava by tumor thrombus, and 32 per cent had metastatic disease. The median survival time was 17 months (range, 1–205 months) for the entire group, and the 5-year survival rate was 26 per cent. Age <54 years, absence of metastatic disease at the time of diagnosis, and completeness of surgical resection were associated with better prognosis. Evaluation of survival with the Cox proportional hazards model suggested that age <54 years, absence of metastatic disease, and nonfunctioning tumor status were independently associated with improved survival. The prognosis of patients with adrenocortical carcinoma is poor but appears more favorable in patients <54 years, with localized disease, or nonfunctioning tumor status. Complete tumor resection may be associated with improved survival.
Critical Decisions in the Management of Endoscopic Perforations of the Colon
Authors: Clements Ronald H. , Jordan Linda M. , Webb William A.
Published: November 2022

The ideal management of suspected colon perforation following colonoscopy remains elusive because the incidence is only 0.1 to 2.0 per cent. The patient with obvious perforation deserves immediate exploration, but the patient with equivocal findings poses a diagnostic dilemma. We propose an algorithm based on the results of water-soluble contrast enema that allows for rapid, definitive surgical decision-making. If perforation is confirmed, early operation allows for primary repair without resection or colostomy, or if no perforation is identified, medical management can be undertaken with confidence. This algorithm should ensure that the surgical management of this potentially lethal complication is not unnecessarily delayed.
Antibiotic-Resistant Organism Infection
Authors: Postier Russell G.
Published: November 2022

Bacteria possess a remarkable number of ways to become resistant to antibiotics. Antibiotic resistance has become a major problem in the treatment of Gram-positive infections. Resistance to methicillin and vancomycin in staphylococci and enterococci has resulted in organisms that are resistant to all known antibiotics. Although it is important to continue to search for newer and more effective antibiotics, it is imperative that we develop a surgical mindset of appropriate antibiotic stewardship. The use of single-dose prophylactic regimens, using narrow-spectrum agents when possible for therapeutic indications, limiting the duration of therapeutic agents appropriately, avoiding the use of vancomycin except when necessary, and adhering to strict infection control measures are all steps that will limit the spread and development of resistant organisms.
Surgical Management of Diverticulitis
Authors: Wolff Bruce G. , Devine Richard M.
Published: November 2022

Diverticular disease, and particularly diverticulitis, has an increasing incidence in Westernized countries because of low-fiber diet. Diverticular disease may be classified as asymptomatic, atypical, acute or uncomplicated, and complicated. Conservative or medical management is usually indicated for acute or uncomplicated diverticulitis, with elective surgical resection generally being recommended after two documented episodes. Complicated diverticulitis, because of the high rate of recurrent problems, is generally managed promptly with sigmoid resection. Sigmoid resection for diverticulitis, under appropriate circumstances, has one of the highest success rates of any of the common gastrointestinal procedures.
Evaluation and Management of Tertiary Peritonitis
Authors: Malangoni Mark A.
Published: November 2022

Tertiary or recurrent peritonitis can occur after any operation for secondary bacterial peritonitis. The major risk factors for the development of tertiary peritonitis include malnutrition, a high Acute Physiology and Chronic Health Evaluation II score, the presence of organisms resistant to antimicrobial therapy, and organ system failure. Most patients with tertiary peritonitis will have fever and leukocytosis, even though other signs of infection may be absent. The management of tertiary peritonitis should include the provision of appropriate physiologic support, the administration of antimicrobial therapy, and operation or intervention to control the source of contamination and to decrease the bacterial load. Antibiotic-resistant organisms and bacteremia are present more commonly and mortality is greater in patients with tertiary peritonitis. Early recognition and effective intervention are critical to achieving a successful outcome.
Management of Patients with Prosthetic Vascular Graft Infection
Authors: Seeger James M.
Published: November 2022

Management of patients with infected prosthetic vascular grafts is one of the most difficult challenges faced by the vascular surgeon. Patients often present with nonspecific symptoms, but delay in treatment can lead to life-threatening sepsis and/or hemorrhage. Fortunately, prosthetic vascular graft infection is uncommon, with the incidence varying between 1 and 6 per cent, depending on the location of the graft. Initially, the potentially infected vascular graft should be imaged using either CT or magnetic resonance imaging, with radionuclide studies being reserved for those instances in which imaging studies do not confirm or exclude the diagnosis of infection. Current treatments for prosthetic vascular graft infection include attempted graft preservation, graft removal with in situ graft replacement (using autogenous or new prosthetic grafts), and graft removal with extra-anatomic bypass. Morbidity and mortality associated with treatment, likelihood of long-term limb salvage, and likelihood of persistent or recurrent infection vary among these types of treatment. Therefore, in an individual patient with a prosthetic vascular graft infection, many things must be considered to appropriately determine the treatment most likely to achieve eradication of the infection and long-term limb salvage with the lowest risk. Regardless, with appropriate application of the techniques currently available for treatment of prosthetic vascular graft infection, long-term elimination of infection and limb preservation can be achieved in the great majority of patients with this grave problem.
Postoperative Sterno-Mediastinitis
Authors: Robicsek Francis
Published: November 2022

Postoperative sterno-mediastinitis is a life-threatening complication that occurs in about 0.75 to 1.4 per cent of all open heart operations. The result of treatment largely depends on timely diagnosis and appropriate surgical management. Risk factors for infection should be corrected preoperatively whenever possible. Among other preventive measures, meticulous asepsis, atraumatic surgical technique, preserving the blood supply and the mechanical integrity of the sternum, prevention of sternal instability, and correction of the same if it occurs are the most important. The management of sterno-mediastinitis should be tailored to the individual clinical features of the patients. Clearly cases with nonpurulent sternomediastinitis and no soft tissue or bone necrosis (type 1) may be treated with reopening, drainage, sternal stabilization, and primary closure. Virulent infections with tissue necrosis (type II) may be best handled with reopening, several days of open management, and debridement then secondary closure with viable tissue (usually muscle) flaps. Chronic, smoldering infections (type III) are usually managed with debridement and muscle-flap coverage.
Acute Abdomen and Lupus Enteritis: Thrombocytopenia and Pneumatosis Intestinalis as Indicators for Surgery
Authors: Alcocer-Gouyonnet Francisco , Chan-Nuñez Carlos , Hernández Jorge , Guzmán Jaime , Gamboa-Domínguez Armando
Published: November 2022

Bowel symptoms occur often in systemic lupus erythematosus (SLE), but enteric complications in patients on steroid therapy are rare. We report a case of a 14-year-old Mexican girl with SLE on high-dose steroid therapy complicated by abdominal vasculitis and small bowel perforation. Accompanying this serious complication were thrombocytopenia and radiographic changes of pneumatosis intestinalis. These findings suggested necrotizing enteritis and prompted urgent surgery. Four jejunal perforations, pneumatosis intestinalis, and submucosal vasculitis were present in the resected specimen. Persistent SLE activity responded to cyclophosphamide, which is indicated in patients with digestive symptoms who fail to respond to high-dose steroids.
Diverticulitis and Polycystic Kidney Disease
Authors: Lederman Eric D. , Mccoy Guy , Conti David J. , Lee Edward C.
Published: November 2022

Patients with adult polycystic kidney disease (PKD) have previously been shown to have an increased incidence of complicated diverticulitis after renal transplantation. The purpose of this study was to assess the risk of diverticulitis in the PKD population. We retrospectively reviewed patients with advanced PKD, defined as end-stage renal failure requiring dialysis. Patients were obtained from a single nephrology group practice between January 1985 and January 1997, or from all patients being evaluated or actively considered for renal transplantation at our institution as of May 1997. The incidence and severity of diverticulitis in these patients was compared with that observed in a similar cohort of patients with end-stage renal disease due to other etiologies. The study population consisted of 184 renal failure patients, 59 with PKD and 125 with other causes of end-stage renal disease. Twelve (20%) patients with PKD had a history of active diverticulitis, whereas only 4 (3%) of the non-PKD controls had diverticulitis ( P = 0.0003, Fisher's exact test). Six of the 12 PKD patients required surgical intervention. Patients with renal failure due to PKD experience a significantly higher rate of diverticulitis than do other patients with end-stage renal disease. Furthermore, diverticulitis is frequently severe in PKD patients, with 50 per cent requiring surgical intervention. These data suggest that diverticular disease may be an extrarenal manifestation of polycystic kidney disease.
Abscess of an Accessory Spleen
Authors: Habib Fahim A. , Kolachalam R.B. , Swason Karen
Published: November 2022

Accessory spleens are not infrequent and occur in 11 to 44 per cent of the population with a greater incidence in those with hematological disease. They may remain clinically silent or result in a number of pathologic processes. Abscess of an accessory spleen is rare but must be considered in the differential diagnosis of fever of unknown origin or sepsis in select groups of patients. Computerized tomography is the imaging modality of choice and may also be used in the percutaneous drainage of select cases. Laparoscopic splenectomy in the hands of the experienced laparoendoscopic surgeon is a viable treatment option.
Intestinal Perforation Secondary to Salmonella typhi: Case Report and Review of the Literature
Authors: Stoner Michael C. , Forsythe Robert , Mills A. Scott , Ivatury Rao R. , Broderick Timothy J.
Published: November 2022

The case of a young woman presenting with fever, abdominal distention, and diarrhea is presented. While hospitalized, she developed peritonitis, and a laparotomy was performed emergently. Intraoperative and pathologic examinations are highly suggestive of Salmonella typhi as an etiology for her symptoms and eventual perforation. Salmonella enteritis can be a difficult diagnosis to make, but in most cases it is a self-limited disease process. In a minority of cases, multidrug antibiotic therapy may be required secondary to an increasing prevalence of resistant strains. Patients who perforate require prompt operation to limit morbidity and mortality. Outcome is significantly improved in those patients by directed resection of the affected segment of bowel and by aggressive perioperative care.
Surgery for T4 Breast Carcinoma: Implications for Local Control
Authors: Yeh Karen A. , Jillella A.P. , Wei J.P.
Published: November 2022

Despite increasing public awareness and widespread availability of mammography, many patients will present with locally advanced breast cancers. The role of surgery remains controversial. Between 1993 and 1998, 47 of 393 (11.9%) breast cancer patients presented with T4 (inflammatory or locally advanced) carcinoma. We reviewed multimodality management, clinical response to neoadjuvant therapy, perioperative course and complications, and local control. Forty-six women and one man were diagnosed with clinical T4 breast cancer. There were 24 white and 23 African-American patients. Mean age at presentation was 54.5 (range, 31–88) years. Twenty-three patients had clinical metastases to axillary nodes, and five had distant metastases at the time of diagnosis. For these women, intent was for personal hygiene and control of pain. Neoadjuvant chemotherapy was given for 34 of 47 (72%) with 25 of 34 (73.5%) having partial or complete clinical response. There was no response or progression of disease in 9 of 34(26.5%). Forty-six patients underwent radical or modified radical mastectomy, whereas a single patient underwent breast conservation treatment. Twelve required tissue transfer for wound coverage. Although eight developed minor wound complications (cellulitis/flap separation), there were no major wound complications. Pathologically negative margins were achieved in all but one patient. To date, five women have developed local recurrence in either the chest wall (three) or axilla (two). Average time to local recurrence was 7.8 months. There is no evidence of local failure in the remaining 87 per cent. Locally advanced breast cancer is a common occurrence in certain populations. Multi-modality management remains the standard of care. Surgical resection may allow for successful local control and, in certain situations, long-term cure.