bluuebunny/crossref_metadata_2025 huggingface dataset:
Bread and Wine
Authors: Coffman Elesha J.
Published: December 2020

If Mead had only been weighing whether to stay with Luther Cressman or marry Reo Fortune, the year after her trip to Samoa would have been difficult enough. But there was another person very much on her mind and in her heart, Ruth Benedict. Mead’s attempts to parse her feelings for, and duties to, all of these people caused great agony. While the sexual and psychological dimensions of these relationships have been explored at some length by other biographers, the spiritual aspects have received less attention. It is perhaps most accurate to say that, while Mead did not find the sexual ethics of her chosen denomination compelling, the symbols and metaphors of faith continued to shape her perspective.
Conclusion
Authors: Bowe David
Published: December 2020

The Conclusion summarizes and synthesizes the arguments of the book, drawing out the central implications of dialogic processes for our understanding of medieval literature in Italy and, potentially, for poetic writing more broadly. This synthesis revisits the key claims about the importance of the tenzone as both mode of dialogue attested in specific exchanges and as a framework for thinking more broadly about intertextual dialogues in Italian texts of due- and early trecento. It presents the fruitful lack of closure in the works of Guittone, Guinizzelli, Cavalcanti, and Dante. By foregrounding the mechanisms of literary self-representation it encourages an understanding of the inherent instability of these poetic performances of subjectivity, sometimes in spite of a poet’s best efforts to control their narrative of self and literary authority.
The Regulation of Unfair Terms in Indian Contract Law: Past, Present, and Future
Authors: Tofaris Stelios
Published: December 2020

This chapter examines how Indian contract law deals with extremely one-sided, onerous, or otherwise unfair terms, such as exclusions or limitations of liability, penalty clauses, or restraint of trade clauses. It discusses the overt judicial control of such terms under specific legislation, sometimes targeted exclusively at standard terms or consumer contracts. It also analyses how the Indian courts have exercised a more indirect control by employing traditional general contract law doctrines, such as contract formation and interpretation or the rules on procedural fairness, in order to protect parties against the imposition of unfair terms. A number of hypothetical clauses are analysed to illustrate how Indian courts regulate unfair contract terms in practice.
Interpretation of Contracts and Control of Unfair Terms in Asia: A Comparison
Authors: Vogenauer Stefan
Published: December 2020

This chapter concludes Volume III of Studies in the Contract Laws of Asia. It summarizes the main findings on the 13 Asian jurisdictions covered (China, Hong Kong, India, Indonesia, Japan, Korea, Malaysia, Myanmar, the Philippines, Singapore, Taiwan, Thailand, and Vietnam). With regard to both the interpretation of contracts and the control of unfair terms, the various legal sources and their ‘Western’ sources of inspiration are described, questions of classification and terminology discussed, and the major substantive issues that arise across legal systems examined. The latter include the dichotomy of ‘subjective’ and ‘objective’ approaches to contractual interpretation; the admissible aids to interpretation, such as customs, usages, the commercial background, good faith, and the negotiations of the parties; the conflict between ‘literalist’ and ‘contextualist’ approaches, particularly with regard to gap-filling by way of implication of terms or ‘supplementary interpretation’; the ‘covert’ judicial control of unfair terms under general contract law doctrines, such as incorporation, interpretation, and the rules on procedural unfairness; the open control based on specific legislation on either particular types of term, unfair standard terms, or consumer contracts, and the supporting enforcement mechanisms. In conclusion, the chapter highlights the differences and similarities that can be observed across Asia, relates these to the wide variety of legal transfers that occurred in the relevant legal systems, and maps out issues for further research.
Legal Changes and Constitutional Adjudication in Portuguese Social Law in Consequence of the European Financial Crisis
Authors: Vieira de Andrade José Carlos , Loureiro João Carlos , Tavares da Silva Suzana
Published: December 2020

Portugal was affected simultaneously by an economic, financial, and budgetary crisis. It is in this context that in 2011 the country signed an MoU on Specific Economic Policy Conditionality with the EU, the ECB, and the IMF, which prescribed cuts on social expenses in wages, pensions, and other benefits of an ‘assistentialist’ nature. The legal measures adopted in this respect focused mostly on the social security scheme and introduced changes in the legal framework for future pensions and unemployment benefits, new contributions for pensions in payment, and former non-contributory benefits, as well as cuts in pensions and benefits. Throughout the years, the President of the Republic, members of the parliament, and the Ombudsman have asked the Constitutional Court to assess many of the rules included in the State Budget Laws, arguing a violation of fundamental social rights and basic principles such as human dignity, equality, and the protection of legitimate expectations. This led to the issuance of new and important constitutional case law in Portugal, concerning mainly the assessment of legislative measures under the fundamental principles of legitimate expectations, proportionality, and ‘equal proportionality’.
Ireland, Literature, and the Coast
Authors: Allen Nicholas
Published: December 2020

The islands of Ireland are shaped by their relationships with land and sea. This book is a study of the various and changing ways in which literature has drawn the coast in lines that shape the contours of cultural experience. The literary and historical study of the sea has swelled in the last decade, as has an interest in the littoral and the archipelagic. Beginning with the early works of William Butler Yeats, this book travels through the diverse hydroscapes of Irish literature from the late nineteenth century to the present, framing writers and artists from James Joyce to Anne Enright in liquid, and maritime contexts. In doing so it suggests new planetary frames through which to read literature’s relationships with the sea and its margins. With readings of contemporary writers, including Eiléan Ní Chuilleanáin, Kevin Barry, Seamus Heaney, Sinead Morrissey, and John Banville, and literary magazines, including The Bell, Atlantis, and Archipelago, this book is the first sustained study of Irish coastal literature.
Introduction
Authors: Hole Sam
Published: December 2020

This chapter introduces the work. Four interconnected aspects of John’s thought constitute, it is suggested, a bold and sophisticated account of desire that may enrich current research and reflection. None of these aspects is, by itself, unique to John. Taken as a whole, however, they form an account that has not been adequately recognized in recent academic studies of John’s thought, and which may deepen and enrich the theological grounding of recent accounts of desire. First, these four contributions are surveyed. Then a survey of recent theological approaches to desire is undertaken, before finally indicating, as will be laid out more fully in the conclusion, the resources offered by John’s thought that may aid the ongoing theological recovery of desire.
Introduction
Authors: Quaglia Lucia
Published: December 2020

This chapter outlines the theoretical and empirical puzzles that inform the book, its objectives, overall argument, and structure. This research sets out to explain the post-crisis international regulation of derivatives markets. In particular, it addresses three interconnected questions. What factors drove international standard-setting concerning derivatives post-crisis? Why did international regime complexity emerge? How was it managed and with what outcomes? The focus of this volume is on international standards, not the domestic implementation of these standards, or other domestic regulatory reforms concerning derivatives. This chapter also outlines the book’s theoretical and empirical contributions to the international relations literature on regime complexity and the international political economy literature on the regulation of finance.
The Cognitive Neuroscience Revolution
Authors: Piccinini Gualtiero
Published: December 2020

This chapter outlines a framework of multilevel neurocognitive mechanisms that incorporates neural representation and neural computation. Paradigmatic explanations in cognitive neuroscience fit this framework and thus cognitive neuroscience constitutes a break from traditional cognitive science. Whereas traditional cognitive scientific explanations were supposed to be distinct and autonomous from mechanistic explanations, neurocognitive explanations are mechanistic through and through. Neurocognitive explanations aim to integrate computational and representational functions and structures across multiple levels of organization in order to explain cognition. To a large extent, practicing cognitive neuroscientists have already accepted this shift, but philosophical theory has not fully acknowledged and appreciated its significance. As a result, the explanatory framework underlying cognitive neuroscience has remained largely implicit. This chapter explicates this framework and demonstrates its contrast with previous approaches.
Neural Representation
Authors: Piccinini Gualtiero
Published: December 2020

Neural representations are models of the organism and environment built by the nervous system. This chapter provides an account of representational role and content for both indicative and imperative representations. It also argues that, contrary to a mainstream assumption, representations are not merely theoretical posits. Instead, neural representations are observable and are routinely observed and manipulated by experimental neuroscientists in their laboratories. If a type of entity is observable or manipulable, then it exists. Therefore, neural representations are as real as neurons, action potentials, or any other experimentally established entities in our ontology.
Neural Computation
Authors: Piccinini Gualtiero
Published: December 2020

This chapter rejects the common assimilation of neural computation to either analog or digital computation, concluding that neural computation is sui generis. Analog computation requires continuous signals; digital computation requires strings of digits. But typical neural signals, such as spike trains, are graded like continuous signals as well as constituted by discrete functional elements (spikes); thus, typical neural signals are neither continuous signals nor strings of digits. It follows that neural computation is sui generis. The chapter draws three important consequences of a proper understanding of neural computation for the theory of cognition. First, understanding neural computation requires a specially designed mathematical theory (or theories) rather than the mathematical theories of analog or digital computation. Second, several popular views about neural computation turn out to be incorrect. Third, computational theories of cognition that rely on nonneural notions of computation ought to be replaced or reinterpreted in terms of neural computation.
Gender as a Divine Attribute
Authors: Rea Michael C.
Published: December 2020

It is standard within the Christian tradition to characterize God in predominantly masculine terms. Let ‘traditionalism’ refer to the view that this pattern of characterization is theologically mandatory. This chapter seeks to undercut the main motivations for traditionalism by showing that it is not more accurate to characterize God as masculine rather than feminine (or vice versa). The novelty of the argument lies in the fact that it presupposes neither theological anti-realism nor a robust doctrine of divine transcendence, but instead rests heavy theoretical weight on the imago Dei doctrine and the method of perfect-being theology. The chapter closes by examining the implications of its main argument for the moral and liturgical propriety of characterizing God in predominantly masculine terms.
Introduction
Authors: Treadgold Alan , Reynolds Jonathan
Published: December 2020

This chapter sets out the central premise of the book: that the retail industry worldwide is in an era of profound, disruptive and structural change. The chapter introduces the major forces of change reshaping the retail industry globally. It then introduces the idea that radically different environments require retail enterprises and the leaders of those enterprises to reconsider the structures, skills, and perspectives that will be needed in order to retain relevance and deliver success. Finally, this introductory chapter sets out the rationale, contents, and organizing structure of the book.
Global Financial Crisis
Authors: Michie Ranald C.
Published: December 2020

Many have suggested that the Global Financial Crisis was an accident waiting to happen, being the result of trends dating from the 1970s. However, these same trends provided the global financial system with a high degree of resilience. The depth and breadth of global financial markets, the size and scale of the megabanks, and the use of derivatives, all provided a means of coping with the instabilities inherent in market economies. In addition, central banks, acting collectively, had perfected rules of behaviour that were applied to systemically important banks and so reduced the level of risk that they were exposed to. Securitization and the operation of the originate-and-distribute model of banking had removed the threat of a liquidity crisis. Regulatory agencies were also in place that supervised financial systems, and so were in a position to identify and deal with any signs of impending difficulty. This removed the threat of a solvency crisis for any systemically important institution. Under these circumstances a crisis of the magnitude of the one that took place in 2008 was considered impossible. But the impossible happened. However, the crisis was a rolling affair, beginning in 2007, creating ample opportunity for intervention to prevent it having the consequences it did.
Psyche and Soul in America
Authors: Abzug Robert H.
Published: December 2020

Rollo May (1909‒1994), internationally known psychologist and popular philosopher, came from modest roots in the small town Protestant Midwest intending to do “religious work” but eventually became a psychotherapist and in best-selling books like Love and Will and The Courage to Create he attracted an audience of millions of readers in the United States, Europe, and Asia. During the 1950s and 1960s, these books combined existentialism and other philosophical approaches, psychoanalysis, and a spiritually-philosophy to interpret the damage bureaucratic and technocratic aspects of modernity and their inability of individuals to understand their authentic selves. Psyche and Soul in America deals not only with May’s public contributions but also to his turbulent inner life as revealed in unprecedentedly intimate sources in order to demonstrate the relationship between the personal and public in a figure who wrote about intimacy, its loss, and ways to regain an authentic sense of self and others.
“A Deep Craving, a Keen Urge”
Authors: Abzug Robert H.
Published: December 2020

Rollo May’s college career. He enters college at Michigan State, becomes a student rebel, and leaves for a more appropriate campus. He goes to Oberlin, where his love of antiquity is born and commitment to a religious calling in Christianity is solidified. At MSC he encounters Bennett “Buck” Weaver through work at the YMCA. Weaver gets him into Oberlin. All during college, he participates in various programs of the national YMCA, including some that exposed him to therapeutic forms of pastoral counseling. Oberlin helped to shape his liberal Christian outlook and also his passions for philosophy, music, and art. He also began to perfect his style of synthesizing ideas in various class assignments. Finally, he followed the Oberlin tradition of doing missionary work after college, in May’s case in Greece.
Kairos and Void
Authors: Abzug Robert H.
Published: December 2020

This chapter recounts the intertwined dramas of May’s personal and professional life in the early 1960s, one that sees him participating in the founding of the Association for Humanistic Psychology and participation in the arts scene of New York even as his marriage deteriorates and reflects in some sense trends in the culture.
The Dizziness of Freedom
Authors: Abzug Robert H.
Published: December 2020

Paul Tillich’s death In 1965 marks a turning point in May’s life, one in which he mourned his mentor but also declared his freedom from Tillich’s watchful influence. As the war in Vietnam heats up, May becomes active in various professional groups seeking an end to the war. He also found himself drawing closer to colleagues in California. A key moment in his public visibility came with being featured as a prophet in the newly created monthly, Psychology Today.
Human resources for health governance and leadership strategies for improving health outcomes in low- and middle-income countries: a narrative review
Authors: Effa E , Arikpo D , Oringanje C , Udo E , Esu E , Sam O , Okoroafor S , Oyo-Ita A , Meremikwu M
Published: December 2020

Background

Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis.

Methods

Selected electronic databases were searched up until 30 May 2020. Two authors screened studies independently and extracted data from included studies. Quality assessment was done using the Mixed Methods Appraisal Tool. Thematic analysis of the outcomes was done.

Results

We included 18 studies of variable designs across Africa, Asia, South America and the Pacific islands. Most were case-based studies and were of moderate to high quality. Several governance strategies with a positive impact on the health workforce and health outcomes identified included decentralization, central coordination and facilitation process, posting and transfer policies as well as the setting up of human resource units.

Conclusions

Governance and leadership strategies targeting the HRH crises in LMIC are variable, interdependent and complex. While some show benefits in improving health workforce outcomes, only a few have an impact on population health outcomes.
Competition and Relational Contracts in the Rwanda Coffee Chain
Authors: Macchiavello Rocco , Morjaria Ameet
Published: December 2020

How does competition affect market outcomes when formal contracts are not enforceable and parties resort to relational contracts? Difficulties with measuring relational contracts and dealing with the endogeneity of competition have frustrated attempts to answer this question. We make progress by studying relational contracts between upstream farmers and downstream mills in Rwanda’s coffee industry. First, we identify salient dimensions of their relational contracts and measure them through an original survey of mills and farmers. Second, we take advantage of an engineering model for the optimal placement of mills to construct an instrument that isolates geographically determined variation in competition. Conditional on the suitability for mills’ placement in the catchment area, we find that mills surrounded by more suitable areas (i) face more competition from other mills, (ii) use fewer relational contracts with farmers, and (iii) exhibit worse performance. An additional competing mill also (iv) reduces the aggregate quantity of coffee supplied to mills by farmers and (v) makes farmers worse off. Competition hampers relational contracts directly by increasing farmers’ temptation to default on the relational contract and indirectly by reducing mills’ profits.
Proxy Advisory Firms, Governance, Market Failure, and Regulation
Authors: Spatt Chester S.
Published: December 2020

Proxy advisory firms developed due to market failures underlying voting and corporate governance more broadly. However, these firms, which have not been subject to mandatory regulation, reflect their own market failures, emphasizing challenges underlying corporate governance. We highlight underlying frictions, such as economies of scale and public goods aspects to information production, the import of incentive conflicts faced by the advisory firms, their power, and the implications of their recommendations and votes by different types of investors. Asset managers emphasizing stewardship are more supportive of management than are proxy advisors. We highlight the evolving regulatory environment and limitations of one-size-fits-all recommendations. (JEL G34, G38, G24, H4)

Received October 31, 2019; editorial decision October 17, 2020 by Editor Andrew Ellul.
Tobacco, alcohol use and other risk factors for developing symptomatic COVID-19 vs asymptomatic SARS-CoV-2 infection: a case–control study from western Rajasthan, India
Authors: Saurabh Suman , Verma Mahendra Kumar , Gautam Vaishali , Kumar Nitesh , Jain Vidhi , Goel Akhil Dhanesh , Gupta Manoj Kumar , Sharma Prem Prakash , Bhardwaj Pankaj , Singh Kuldeep , Nag Vijaya Lakshmi , Garg Mahendra Kumar , Misra Sanjeev
Published: December 2020

Background

Understanding risk factors of symptomatic coronavirus disease 2019 (COVID-19) vis-à-vis asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, severe disease and death is important.

Methods

An unmatched case–control study was conducted through telephonic interviews among individuals who tested positive for SARS-CoV-2 in Jodhpur, India from 23 March to 20 July 2020. Contact history, comorbidities and tobacco and alcohol use were elicited using standard tools.

Results

Among 911 SARS-CoV-2-infected individuals, 47.5% were symptomatic, 14.1% had severe COVID-19 and 41 (4.5%) died. Older age, working outside the home, cardiac and respiratory comorbidity and alcohol use were found to increase the risk of symptomatic disease as compared with asymptomatic infection. Current tobacco smoking (odds ratio [OR] 0.46 [95% confidence interval {CI} 0.26 to 0.78]) but not smokeless tobacco use (OR 0.81 [95% CI 0.55 to 1.19]) appeared to reduce the risk of symptomatic disease. Age ≥60 y and renal comorbidity were significantly associated with severe COVID-19. Age ≥60 y and respiratory and cardiac comorbidity were found to predispose to mortality.

Conclusions

The apparent reduced risk of symptomatic COVID-19 among tobacco smokers could be due to residual confounding owing to unknown factors, while acknowledging the limitation of recall bias. Cross-protection afforded by frequent upper respiratory tract infection among tobacco smokers could explain why a similar association was not found for smokeless tobacco use, thereby being more plausible than the ‘nicotinic hypothesis’. Those with comorbidities and age ≥60 y should be prioritized for hospital admission.
Afghanistan
Authors: Rubin Barnett R.
Published: December 2020

Afghanistan, a landlocked country in Central Asia, has improbably been at the center of international geopolitics for four decades. After the Soviet Union invaded in 1980, Afghanistan descended into an unending conflict that featured at various points most of the world's major powers. In the mid-1990s, the country entered a new phase, when the Taliban took power and imposed order based on a harsh, repressive version of Islamic law. Infamously, the sheltered Osama bin Laden, whose attack on 9/11 Towers ushered in the Global War on Terror, drew tens of thousands of American troops to the country, where they remain today. In Afghanistan: What Everyone Needs to Know®, leading scholar Barnett R. Rubin provides an overview of this complicated nation. After providing a concise history of Afghanistan, he explores the various peoples and cultures of the country and its relations with neighbors like Pakistan and Iran. He also provides an authoritative overview of the conflicts that have plagued the country since the Soviet invasion. Both wide-ranging and pithy, this book explains why Afghanistan matters and what its possible future might look like.
Antibiotics
Authors: Wilson Mary E.
Published: December 2020

A STIRRING EXAMINATION OF A LOOMING CRISIS Virtually everyone has taken antibiotics. They can be lifesavers -- or they can be useless. But what are they? How are they used? And what happens as the effectiveness of antibiotics begins to decline? Antibiotics: What Everyone Needs to Know® examines the personal and societal implications of our planet's most important -- and arguably most overused -- medications. In a question-and-answer format, it unpacks the most complicated aspects of this issue, including: · How antibiotics are used (and overused) in humans, plants, and livestock · The consequences to date, and the potential crisis ahead, as overuse of existing antibiotics breeds new resistance in bacteria · How the globalized world enables antibiotic resistance more quickly · Collateral damage, individually and societally, of antibiotic use · The difficult decisions ahead related to medical care and the food system Grounded in the latest scientific research and translated for general readers, Antibiotics: What Everyone Needs to Know® offers a clear-eyed overview of where we are, and what the future holds, as antibiotics lose their might.
Pilot Randomized Controlled Trial of Diabetes Group Prenatal Care
Authors: Carter Ebony B. , Barbier Kate , Hill Pamela K. , Cahill Alison G. , Colditz Graham A. , Macones George A. , Tuuli Methodius G. , Mazzoni Sara E.
Published: December 2020

(Abstracted from Am J Perinatol 2020; doi: 10.1055/s-0040-1714209)

Approximately 10% of pregnant women have type 2 diabetes or gestational diabetes mellitus (GDM), increasing the risk of poor perinatal outcomes such as macrosomia, shoulder dystocia, preeclampsia, or cesarean delivery. One potential strategy to help manage these conditions in this patient population is group prenatal care.
New lupus criteria: a critical view
Authors: Aringer Martin , Johnson Sindhu R.
Published: December 2020

Purpose of review

To review the validation of the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) 2019 classification criteria for systemic lupus erythematosus (SLE).

Recent findings

Positive antinuclear antibodies, which constitute the obligatory entry criterion of the EULAR/ACR criteria, were found in the vast majority of SLE patients worldwide, with 97% (94–100%) of patients antinuclear antibodies positive in studies investigating EULAR/ACR criteria performance. Combined over the publications, EULAR/ACR criteria sensitivity was 92% (range 85–97%). Specificity varied more relevantly, with the publications published after the EULAR/ACR 2019 criteria showing 93% (83–98%) specificity. Of particular relevance is the good performance of the EULAR/ACR criteria seen in pediatric SLE as well as in early SLE.

The new classification criteria have been investigated in an impressive number of cohorts worldwide, adding to the data from the EULAR/ACR criteria project cohort. It is critical to strictly keep to the attribution rule, that items are only counted if there is no more likely alternative explanation than SLE, the domain structure, where only the highest weighted item in a domain counts, and the limitation to highly specific tests for antibodies to double-stranded DNA.
New therapeutic approaches in systemic lupus erythematosus
Authors: Kolios Antonios G.A. , Yoshida Nobuya , Tsokos George C.
Published: December 2020

Purpose of review

This review gives an overview of the recently published clinical trials in systemic lupus erythematosus (SLE).

Recent findings

Our continuously improving understanding of the cellular and molecular mechanisms, which are involved in the pathogenesis of SLE, has inspired the performance of multiple clinical trials in an attempt to modify recognized targets. Here, we summarize results obtained from recent trials, which used monoclonal antibodies blocking cytokines, blockers of costimulatory molecules or deleting immune cells, small drug inhibitors of kinases and replenishment of cytokines.

The therapeutic options for patients with SLE grow continuously and in parallel it raises the need for pathogenetic mechanism-based precision medicine so that we may select the right treatment for the right patient.
Paraspinal Muscle Contractile Function is Impaired in the ENT1-deficient Mouse Model of Progressive Spine Pathology
Authors: Noonan Alex M. , Séguin Cheryle A. , Brown Stephen H. M.
Published: December 2020

Study Design

Basic science study of the relationship between spine pathology and the contractile ability of the surrounding muscles.

Objective

The aim of this study was to investigate single muscle fiber contractile function in a model of progressive spine mineralization (ENT1

−/−
mice).

Summary of Background Data

Altered muscle structure and function have been associated with various spine pathologies; however, studies to date have provided limited insight into the fundamental ability of spine muscles to actively contract and generate force, and how this may change in response to spine pathology.

Methods

Experiments were performed on two groups (ENT1

−/−
[KO] and ENT1

+/+
[WT]) of mice at 8 months of age (n = 12 mice/group). Single muscle fibers were isolated from lumbar multifidus and erector spinae, as well as tibialis anterior (a non–spine-related control) and tested to determine their active contractile characteristics.

Results

The multifidus demonstrated decreases in specific force (type IIax fibers: 36% decrease; type IIb fibers: 29% decrease), active modulus (type IIax: 35% decrease; type IIb: 30% decrease), and unloaded shortening velocity (Vo) (type IIax: 31% decrease) in the ENT1

−/−
group when compared to WT controls. The erector spinae specific force was reduced in the ENT1

−/−
mice when compared to WT (type IIax: 29% decrease), but active modulus and Vo were unchanged. There were no differences in any of the active contractile properties of the lower limb TA muscle, validating that impairments observed in the spine muscles were specific to the underlying spine pathology and not the global loss of ENT1.

Conclusion

These results provide the first direct evidence of cellular level impairments in the active contractile force generating properties of spine muscles in response to chronic spine pathology.

Level of Evidence: N/A
The Learning Effectiveness of High-Fidelity Simulation Teaching Among Chinese Nursing Students: A Mixed-Methods Study
Authors: LI Zhen , HUANG Fei-Fei , CHEN Shiah-Lian , WANG Anni , GUO Yufang
Published: December 2020

Background

High-fidelity simulation (HFS) is an interactive and complex experiential learning pedagogy. Given the limited and inconclusive evidence on the effectiveness of HFS in terms of improving student learning outcomes, a more thorough understanding of students' learning experiences and effects of HFS may inform the improvement of nursing training.

Purpose

The aim of this study was to examine the learning effectiveness score of HFS, its influencing factors, and the learning experience of nursing students.

Methods

A convergent parallel mixed-methods research design was adopted. Five hundred thirty-three third-year undergraduate nursing students completed the Simulation Learning Effectiveness Inventory. Semistructured interviews were used to elicit the opinions of 22 participants regarding their participation in the HFS experience.

Results

The quantitative findings showed a moderately high learning effectiveness of HFS among Chinese undergraduate nursing students (121.81 ± 14.93). The learning effectiveness for equipment resources (15.02 ± 2.38), course arrangement (11.18 ± 1.73), and confidence (18.56 ± 3.67) was relatively low. Extroversion and mixed personality (β = 0.14 and 0.10) and “dislike” or “general like” of the course (β = −0.45 and −0.33) were found to influence learning effectiveness (F = 54.79, p < .001, adjusted R
2 = .29). In addition, the qualitative findings indicated that the participants felt positively regarding the “debriefing,” “clinical abilities,” and “problem solving” dimensions of the training.

Conclusions/Implications for Practice

The focus of the education process and curriculum design of HFS activities should be on improving course arrangement, equipment resources, and students' confidence while paying attention to nursing students' personality traits and course preferences.
Clinical features of velamentous umbilical cord insertion and vasa previa
Authors: Yang Mo , Zheng Yanqiu , Li Mingjing , Li Wei , Li Xu , Zhang Xinhua , Wang Ruihua , Zhang Jing , Zhou Fuqing , Yang Qing , Li Gang
Published: December 2020

To identify the risk factors associated with velamentous cord insertion (VCI) and investigate the association between adverse pregnancy outcomes and VCI in singleton pregnancies and those with vasa previa.

A total of 59,976 single cases admitted from Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014 were included in this study. We retrospectively analyzed the perinatal complications, neonatal complications, and the clinical features, as well as the Color Doppler ultrasonography findings of the velamentous placenta and placenta previa.

We reviewed the clinical data of 59,976 women with singleton pregnancies delivered in Qinhuangdao Maternal and Child Health Hospital and Qinhuangdao Beidaihe Hospital from January 2004 to January 2014. Risk factors and the risks of adverse pregnancy outcomes including admission to a neonatal unit, fetal death, preterm delivery, low birth weight of <2500 g, the infant being small for its gestation age, low Apgar scores (<7) at 1 and 5 minute were evaluated separately among women with and without VCI by means of logistic regression analyses.

The prevalence of velamentous umbilical cord insertion was 0.84%, and the prevalence of vasa previa was 0.0017%. The independent risk factors for VCI were nulliparity, obesity, fertility problems, placenta previa, and maternal smoking. VCI was associated with a 1.83-, 2.58-, 3.62-, and 1.41-fold increase in the risk of retention in the neonatal unit, preterm delivery (<37 gestation weeks), low birth weight, and small-for-gestational age, compared to pregnancies involving normal cord insertion. Of the women with VCI, 16.1% underwent emergency cesarean section compared to 8.9% (P < .001) of women without VCI.

The prevalence of VCI was 0.84% in singletons. The results suggest that VCI is a moderate risk condition resulted in increased risks of prematurity and impairment of fetal growth.
Effectiveness and safety of Hwangryunhaedok-Tang (Huang-Lian-Jie-Du-Tang, Oren-Gedoku-to) for dyslipidemia
Authors: Lee Boram , Kwon Chan-Young
Published: December 2020

Background:

Recent experimental and clinical studies have suggested that Hwangryunhaedok-tang (HHT), an herbal formula, could improve the lipid profiles in patients with dyslipidemia. This systematic review aimed to evaluate the effectiveness and safety of HHT monotherapy or adjunctive HHT therapy with conventional lipid-lowering drugs in managing dyslipidemia.

Methods:

Twelve English, Korean, Chinese, and Japanese databases were comprehensively searched from their inception to January 2020. Randomized controlled trials (RCTs) using HHT monotherapy or adjunctive HHT therapy for dyslipidemic patients were included. The primary outcome was the low-density lipoprotein cholesterol (LDL-C) level. Descriptive analyses of participant details, interventions, and outcomes were conducted and where appropriate data were available, a meta-analysis was performed and presented as a risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). The risk of bias was assessed using the Cochrane risk of bias tool and the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results:

Nine RCTs with 536 participants were included. In comparison with lipid-lowering drugs alone, HHT as an adjunctive therapy to lipid-lowering drugs or as a monotherapy showed significantly superior (MD -1.15 mmol/L, 95% CI -1.25 to -1.05) or inferior results (MD 0.23 mmol/L, 95% CI 0.09 to 0.38), respectively, for LDL-C levels. The incidence of adverse events was significantly lower when HHT was used in addition to lipid-lowering drugs, in comparison to that with lipid-lowering drugs alone. No serious adverse events were reported in the HHT group. Most included studies showed a high risk of performance bias and the quality of evidence was rated generally “low” because of the high risk of bias and inconsistency or imprecision of the meta-analysis results.

Conclusion:

Current evidence suggests that HHT may be beneficial for patients with dyslipidemia and may reduce the adverse events associated with lipid-lowering drugs. However, due to the high risk of bias of the included studies and low quality of evidence for the main findings, no definitive conclusion could be reached. Further rigorous, high-quality, and placebo-controlled RCTs should be conducted to assess the efficacy of HHT.

Trial registration number:

PROSPERO CRD42020164563
Utility of rotational thromboelastometry in total hip replacement revision surgery (case-control study)
Authors: Jonas J. , Tomas Vymazal , Broz T. , Durila Miroslav
Published: December 2020

Total hip replacement revision surgery is accompanied by significant blood loss. Using rotational thrombelastometry (ROTEM) perioperatively to diagnose coagulopathy may help to provide rapid aimed therapy and thus decrease blood loss and the consumption of transfusion products. The aim of this case-control study was to find out whether point of care using of ROTEM may reduce blood loss and the consumption of blood transfusion products in hip replacement revision surgery.

Data were prospectively collected from patients who underwent hip replacement revision surgery in the period 2017 to 2018 when the management of bleeding and coagulopathy was based on the results of ROTEM. Data were compared with a group of historical controls for the period 2015 to 2016 when bleeding and coagulopathy management was not based on ROTEM results. The consumption of blood transfusion products and perioperative blood loss were compared between the groups.

The total number of analyzed patients was 90. Forty five patients were analyzed in the ROTEM group and the same number of patients were analyzed in the non-ROTEM group. Significantly decreased perioperative consumption of fresh frozen plasma and packed red blood cells was found in the ROTEM, as well as decreased perioperative blood loss comparing to non-ROTEM group. All data were statistically different with P < .05.

Perioperative management of bleeding and coagulopathy based on the results of ROTEM during hip replacement revision surgery seems to help to decrease perioperative blood loss and the consumption of blood transfusion products, especially fresh frozen plasma.
Superb microvascular imaging in guiding targeted biopsy of prostate cancer
Authors: Wang Cong , Tao Ye
Published: December 2020

Background:

Studies suggested superb microvascular imaging technology to guide prostate cancer biopsy could improve the positive rate of draw materials. The present meta-analysis aimed at determining the accuracy of SMI in the location diagnosis for prostate cancer.

Methods:

We will search PubMed, Web of Science, Cochrane Library, and Chinese biomedical databases from their inceptions to the October 31st, 2020. Two authors will independently carry out searching literature records, scanning titles and abstracts, full texts, collecting data, and assessing risk of bias. Review Manager 5.2 and Stata14.0 software will be used for data analysis.

Results:

This systematic review will determine the accuracy of superb microvascular imaging in guiding targeted biopsy of prostate cancer.

Conclusion:

Its findings will provide helpful evidence for the accuracy of superb microvascular imaging in guiding targeted biopsy of prostate cancer.

Systematic review registration:

INPLASY2020100117.
Denosumab versus zoledronic acid for patients with beta-thalassemia major-induced osteoporosis
Authors: Yassin Mohamed A. , Abdel Rahman Mohamed O. , Hamad Anas A. , Poil Abdul Razzakh , Abdelrazek Mohamed T. , Hussein Radwa M. , Kassem Nancy A. , Fadul Afraa M. , Elkourashy Sarah A. , Nashwan Abdulqadir J.
Published: December 2020

The main aim of this study is to compare the 2 medications denosumab and zoledronic acid for patients with beta-thalassemia major induced osteoporosis. Patients with B-thalassemia major induced osteoporosis will undergo baseline assessment of the bone densitometry by bone density

(DEXA) scan as a standard of care by the radiology department, then a blood test for bone-specific alkaline phosphatase and type-1 collagen telopeptide will be measured by the chemistry laboratory.

Patients with B-thalassemia major induced osteoporosis, who are 18 years of age or more and willing to participate in the study will be enrolled after consenting by the primary investigator in hematology outpatient clinics. Patients with osteoporosis will receive 1 of the 2 medications; at the end of the year, DEXA scan will be done to compare the response of the 2 medications. The potential risks include drug-related side effects.

The outcome will be measured biochemically by measuring bone-specific alkaline phosphatase and type 1 collagen carboxy telopeptide and radiologically by DEXA scan at baseline and 1 year using Z score.
Effects of pursed-lip breathing and forward trunk lean postures on total and compartmental lung volumes and ventilation in patients with mild to moderate chronic obstructive pulmonary disease
Authors: Ubolnuar Nutsupa , Tantisuwat Anong , Thaveeratitham Premtip , Lertmaharit Somrat , Kruapanich Chathipat , Chimpalee Jaturong , Mathiyakom Witaya
Published: December 2020

This study identified the effects of pursed-lip breathing (PLB), forward trunk lean posture (FTLP), and combined PLB and FTLP on total and compartmental lung volumes, and ventilation in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with mild to moderate COPD performed 2 breathing patterns of quiet breathing (QB) and PLB during FTLP and upright posture (UP). The total and compartmental lung volumes and ventilation of these 4 tasks (QB-UP, PLB-UP, QB-FTLP, PLB-FTLP) were evaluated using optoelectronic plethysmography. Two-way repeated measures ANOVA was used to identify the effect of PLB, FTLP, and combined strategies on total and compartmental lung volumes and ventilation. End-expiratory lung volume of ribcage compartment was significantly lower in PLB-UP than QB-UP and those with FTLP (P < .05). End-inspiratory lung volume (EILV) and end-inspiratory lung volume of ribcage compartment were significantly greater during PLB-FTLP and PLB-UP than those of QB (P < .05). PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELVAB ) end-expiratory lung volume, EILVAB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05). UP significantly increased tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation and decreased EELVAB, end-expiratory lung volume, and EILVAB than FTLP (P < .05). In conclusion, combined PLB with UP or FTLP demonstrates a positive change in total and compartmental lung volumes in patients with mild to moderate COPD.
Effects of tumor origins and therapeutic options on the prognosis of hepatic neuroendocrine tumors
Authors: Jiao Xiaoxiao , Luan Wenqing , Peng Xiaoqian , Liu Lu , Zhang Lianfeng , Zhou Lin
Published: December 2020

Hepatic neuroendocrine tumors (HNETs) are uncommon neoplasms that can be subdivided into 2 types: primary and metastatic HNETs. Due to its rarity, heterogeneity and complexity, the diagnosis, treatment modalities and prognosis are still controversial.

This retrospective study reviewed the effects of tumor origins and therapeutic options on the prognosis of gastroenteropancreatic neuroendocrine tumors with liver metastasis (GEP-NETLM) and primary hepatic neuroendocrine tumors (PHNETs), providing additional evidence for clinicians evaluating patients.

HNETs consisted of PHNETs and GEP-NETLM. GEP-NETLM (76.2%, 112/147) was more common, which was mainly manifested as multiple lesions in both lobes of the liver. PHNETs were relatively rare (23.8%, 35/147) and were mainly single lesion located in the right lobe of the liver. In patients with GEP-NETLM, primary tumor resection could prolong survival (P = .044). As the most widely used treatment method, systematic therapy alone could not achieve a satisfactory survival. However, the combination with hepatectomy or liver-directed therapy improved the prognosis (P = .023). As the main treatment, patients with PHNETs treated with local therapy could achieve a better prognosis (P = .049). Compared with PHNETs patients, GEP-NETLM patients with higher ki-67 index showed higher mortality and poorer prognosis (P = .006).

Therefore, patients with PHNETs can be distinguished from GEP-NETLM by comprehensive imaging examinations and long-term follow-ups. The choice of appropriate treatment strategies can improve the prognosis of HNETs patients.
The effect of enhancing quality of life in patients intervention for advanced lung cancer
Authors: Li Xianhong , Qin Ke , Yuan Chunyan , Song Shiqiang
Published: December 2020

Objective:

The objective of this present research is to evaluate the effect of the intervention of enhancing quality of life in patients in patients with advanced lung cancer.

Methods:

Our research is carried out as a randomized clinical trial which will be implemented from December 2020 to October 2021. It was approved by the Ethics Committee of People's Hospital of Chengyang District (03982790). This study includes 90 patients with advanced lung cancer. Patients diagnosed at our oncology clinic are eligible if they are diagnosed within 8 weeks of a novel diagnosis of stage 3 or stage 4 lung cancer. Patients with hepatic insufficiency, renal failure, and respiratory and heart failure, as well as a series of severe mental illness are excluded from our research. Patients are divided randomly into the intervention group and control group, each group is assigned 45 patients. Through utilizing functional assessment of cancer therapy–lung, the measurement of life quality is conducted. And the measurement of mood is carried out with Hospital Anxiety and Depression Scale.

Results:

Table 1 indicates the patient's life quality and Hospital Anxiety and Depression Scale in both groups.

Conclusion:

Enhancing quality of life in patient intervention may be beneficial to improve the life quality in advanced lung cancer patients.

Trial registration: The protocol was registered in Research Registry (researchregistry6243)