bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum neurofilament light levels in natalizumab-treated patients with multiple sclerosis who switch to extended interval dosing from every-4-week dosing in real-world clinical practice
Authors: Foley John , Xiong Kuangnan , Hoyt Tammy , Singh Carol M , Riddle Evan , de Moor Carl , Plavina Tatiana , Campbell Nolan
Published: November 2022

Background:

Serum levels of neurofilament light chain (sNfL) are a potentially useful biomarker for assessing the efficacy of multiple sclerosis (MS) treatments.

Objective:

To compare levels of sNfL in patients with MS who switched from natalizumab every 4 weeks (Q4W) to extended interval dosing (EID) and patients who remained on Q4W dosing in real-world clinical practice.

Methods:

This was a retrospective analysis of samples from patients treated with natalizumab from 2010 to 2015 at a single center in the United States. Levels of sNfL were compared in patients who stayed on Q4W dosing or who switched to EID (parallel-arm analyses) and during Q4W and EID periods in patients who switched to EID (pre- and post-switch analyses).

Results:

The analysis included 139 patients (Q4W: n = 79; EID: n = 60). After adjustment, levels of sNfL did not significantly differ between patients who remained on Q4W dosing and those who switched to EID in parallel-arm analyses (adjusted Q4W-EID difference = 0.51 pg/mL; p = 0.60) or pre- and post-switch analyses (adjusted difference = 0.96 pg/mL; p = 0.10).

Conclusion:

These sNfL biomarker results suggest that the effectiveness of natalizumab is maintained in patients who switch from Q4W dosing to EID.
Better than a bet: good reasons for behavioral and rational choice assumptions in IR theory
Authors: Davis James W.
Published: November 2022

Behavioral IR is enjoying newfound popularity. Nonetheless, attempts to integrate behavioral research into the larger project of IR theory have proven controversial. Many scholars treat behavioral findings as a trove of plausible ad hoc modifications to rational choice models, thereby lending credence to arguments that behavioral IR is merely residual, empirical, and hence not theoretical. Others limit their research to cataloging outcomes consistent with the basic tenets of behavioral models. Although this expands the empirical base, it is insufficient for theoretical progress. In this article, I explore various answers to the question of when rational choice or behavioral assumptions should guide efforts to build IR theory. I argue that no single answer trumps all others. Examining the various conditions under which actors reason highlights the importance of macrofoundations. Macrofoundations condition the effects of microprocesses and help identify relevant scope conditions for both rational choice and behavioral models of decision-making. Examining the various purposes of IR theory also provides answers to the question of when rational or behavioral assumptions are likely to be most useful. Although many behavioral scholars premise the relevance of their findings on claims of empirical realism, I argue that under certain conditions, deductive theorizing on the basis of as-if behavioral assumptions can lead to powerful theories that improve our understanding of IR and may help decision-makers promote desired ends.
“Flying over the crisis”: A study on interdisciplinary metaphors of resilience
Authors: Kriegsmann-Rabe Lisa Milena , Hiebel Nina , Maus Katja , Geiser Franziska
Published: November 2022

Background/Aim: Metaphors on theoretical concepts may be congruent or divergent from their explicit definitions. We carried out a secondary qualitative analysis on metaphors of members of an interdisciplinary research group on resilience and investigated: (A) Which metaphors do experts in different disciplines use to describe people showing resilience? (B) Do these (implicit) metaphors support the (explicit) theses of the research group on resilience? (C) Do we find differences between experts from different disciplines in the use of metaphors on resilience? Method: Nine guideline-based interviews with experts from medicine, psychology, philosophy, and theology were studied using a systematic metaphor analysis, basing on inductive and deductive categorizations. Results: Eight metaphor sources were identified, for example, battle, path. Experts used similar metaphors to describe resilience that often overarched the concepts of resilience as a trait, process, and outcome. Moments of vulnerability within the resilience trajectory were found. Conclusions: The analysis revealed high concordance of metaphors across different disciplines, reflecting both the ideas of the group as well as the mainstream view of resilience. This supports that implicit concepts may be more difficult to reframe than explicit theories. Few differences between disciplines may point to the impact of an overarching Western concept of individual resilience.
The predictive role of anxiety and motivation in L2 proficiency: An empirical causal model
Authors: Alrabai Fakieh
Published: November 2022

This study attempts to empirically examine the predictive power of learner anxiety and motivation and their causality in explaining proficiency in English as a foreign language (EFL) and other interrelated affective variables, including attitudes, self-confidence, and grit via a treatment-based causal model. To achieve this, the study carried out a 12-week experimental intervention employed by 8 EFL teachers with 282 EFL learners divided into four groups: in group 1, learners were exposed to anxiety-regulating strategies, those in group 2 were exposed to motivational strategies, those in group 3 were exposed to both anxiety-controlling and motivational strategies, and those in group 4 were not exposed to specific anxiety or motivation strategies. Data was gathered using questionnaires, classroom observations, and proficiency tests. ANOVA and ANCOVA tests were employed to assess the treatment effects, and confirmatory factor analysis (CFA), structural equation modelling (SEM) and partial least squares structural equation modelling (PLS-SEM) analyses were deployed to test a causal model for the relationship between affective variables and second language (L2) proficiency in the group in which the experiment was most effective. Significant direct paths were captured from all affective variables to L2 proficiency. Motivation and anxiety exerted significant direct, indirect, and high total effects on L2 proficiency, confirming them as the best predictors and the causal variables of learners’ proficiency and other affective variables.
Strain-path-dependent stress–strain model for ultrahigh-performance concrete columns constrained by stirrups
Authors: Chang Yafeng , Shi Junping , Cao Xiaoshan , Qiu Yongliang
Published: November 2022

The incorporation of steel fibers improves the microscopic ductility of ultrahigh-performance concrete (UHPC) materials, and their macroscopic ductility can also be improved by the restraining effect of composite stirrups. Two defects can be found in the stress–strain model of UHPC restrained by stirrups based on the design-oriented method: the restraint coefficient of the stirrup is the effective restraint coefficient at the peak state of the specimen, while the variation in the restraint stress of the stirrup with the axial–hoop strain relationship (strain path) is ignored. In this study, a strain-path-dependent stress–strain model for UHPC constrained by stirrups and fibers is proposed through a database with 10 sets of test results on UHPC columns, which alleviates the shortcomings of the design-oriented model. (1) On the basis of the axial–hoop strain relationship curve in the test results, an axial–hoop strain model of UHPC restrained by stirrups is established. (2) The variation in the restraint stress of the stirrup with strain path is considered. (3) On the basis of the stress–strain model of actively constrained concrete, an iterative method of subsections is adopted, and a UHPC stress–strain model restrained by stirrup based on strain path is established. Results show that the established axial–hoop strain equation can better predict the hoop strain of UHPC restrained by stirrups and steel fibers, the calculated value of peak stress of UHPC constrained by stirrups based on strain path is in good agreement with the test results, and the outcomes of the path-dependent stress–strain model are in better agreement with the experimental results than those of the design-oriented stress–strain model.
Orthodontic retention experience of university students: A qualitative study
Authors: Wilson Sophie , Idicula David , Littlewood Simon J , Barber Sophy
Published: November 2022

Objective:

To explore university students’ experience of retention and identify potential barriers and facilitators to long-term adherence.

Design:

Cross-sectional qualitative study using virtual focus groups.

Setting:

University of Leeds.

Participants:

Dental and non-dental students from the University of Leeds, who had previously undergone orthodontic treatment and had received removable retainers.

Methods:

Students were invited to participate via email. Virtual focus groups were undertaken using Microsoft Teams. A topic guide was used to explore the experience of orthodontic retention including factors that influence long-term retainer wear. Focus groups were recorded and analysed using an inductive thematic approach.

Results:

In total, 23 students participated in four focus groups, including 13 dental students. The period since the end of orthodontic treatment varied from 9 months to 10 years. Of the 23 participants, 8 (35%) were no longer wearing their retainers. Four themes were identified: (1) experience of orthodontic treatment including knowledge of relapse; (2) experience of retainer wear, including motivators and barriers; (3) role of others; and (4) increasing adherence. Key factors influencing use of retainers were the importance placed on maintaining treatment outcomes, awareness of unwanted tooth movement and understanding of the role of the retainer, access to replacement retainers, and ongoing support to encourage retainer wear. Greater knowledge and dental awareness reported by dental students did not necessarily increase adherence.

Conclusion:

Adherence to removable retainer wear is an important aspect of orthodontic treatment but it is recognised that long-term retainer wear is highly variable. The understanding of relapse and retention is variable. Challenges in gaining access to replacement retainers are a common cause of cessation of retainer wear. Dental professionals are perceived to be important in encouraging and supporting retainer wear and individuals reported they would like more follow-up.
Visual cues to interpersonal evaluations for pedestrians
Authors: Hamoodh K , Fotios S , Cheal C
Published: November 2022

Pedestrians need to be able to evaluate other people to support their feeling of safety. While past studies have thus investigated the degree to which road lighting supports facial identity and facial emotion evaluations, it is not yet known whether the face is the most important visual cue. Following a pilot study that indicated the importance of the ability to see the face and hands of other people, an experiment was conducted in which test participants evaluated safety when shown photographs of an approaching person in night-time scenes. These photographs displayed variations in the exposure or concealment of the face and hands. Two procedures were used, category rating and paired comparisons. The results suggest that the face is a more important visual cue than the hands for pedestrians’ evaluations of the intent of other pedestrians after dark.
Topology based modelling of crochet structures
Authors: Storck Jan Lukas , Gerber Dennis , Steenbock Liska , Kyosev Yordan
Published: November 2022

Crocheted textiles receive scarce scientific study and are at present not produced in automatized industrial scale. Computer-aided modelling and simulation offer capabilities for investigating possible technical fields of application. In this context a novel approach for modelling crocheted textiles consisting of chains, slip stitches and single crochets using a topology based and parameterized key point representation at the meso scale is proposed. According to the stitch size, yarn diameter and pattern spline interpolated models, which are free of interpenetrations up to approximately a 1/10 ratio of yarn diameter to stitch size, are generated by a developed Python program and software from the company TexMind. The models are suitable for finite element method (FEM) applications with LS-DYNA with which the mechanical properties of crocheted textiles can be studied. Exemplary simulations show anisotropic properties and homogeneous distribution of stresses in a crocheted textile. Due to the computationally simple and flexible modelling the presented approach may serve as a tool for designing planar crocheted textiles. This allows for estimation of the required yarn length and offers the prediction capabilities of simple and fast FEM simulations based on beam elements.
Ergonomic design and evaluation of carbon nanotube film (CNTF) and metal wire based flexible electrically heated gloves
Authors: Wang Lu , Chen Qing , Zhou Yijia , Zheng Rong , Zhou Xiaohong , Fan Jintu
Published: November 2022

Electric heating gloves are essential for people working in severe cold environments which could protect their hands warm efficiently. Existing electric heating gloves, however, tend to restrict the movement of the fingers and have limited thermal protection, affecting the working efficiency of the wearers. Here, we report on the development and evaluation of carbon nanotube film (CNTF) and metal fiber based electric heating gloves. The electric heating elements were placed in the back of the gloves, and we tested the electric heating properties of the gloves. They showed great electrothermal performance and it had a certain repeatability and stability through multiple experiments. Then the electro-thermal and ergonomic performance of the gloves were evaluated under the severe cold outdoor environment of −20 ± 2°C. In comparison with conventional single layer polar fleece gloves and carbon fiber electric heating gloves that purchased from the market, CNTF based gloves and metal fiber-based gloves demonstrated outstanding advantages in terms of faster heating speed, great warmth retention, and enhanced finger agility, which is attributed to the electrothermal properties of CNTF and metal fiber as well as the structural design of the gloves.
Association Between COVID-19 and Activities of Daily Living in Older Adults
Authors: Bae Suyeong , Malcolm Matt P. , Nam Sanghun , Hong Ickpyo
Published: November 2022

Older adults gradually decrease their independence with activities of daily living (ADL) due to aging. The coronavirus disease-19 (COVID-19), the recent pandemic, can accelerate the decline in functions, such as ADL. This study aimed to examine whether there is an association between positive COVID-19 results and decreased independence with ADL in older adults. Data for a total of 3,118 older adults were extracted from the 2020 National Health and Aging Trends Study–COVID-19. A total of 71 (2.29%) participants presented with positive COVID-19 tests. There was a significant association between a positive COVID-19 result and decreased independence with ADL (relative risk [RR] = 1.47, 95% confidence interval [CI] = [1.11, 1.96], p = .0079). The study findings revealed that COVID-19 survivors had a high risk of decreased independence with ADL. These findings indicate that COVID-19 survivors have residual functional deficits and would need comprehensive health care services.
Co-Benefits Through Coordination of Climate Action and Peacebuilding: A System Dynamics Model
Authors: Morales-Muñoz Héctor , Bailey Arwen , Löhr Katharina , Caroli Giulia , Villarino Ma. Eliza J. , LoboGuerrero Ana María , Bonatti Michelle , Siebert Stefan , Castro-Nuñez Augusto
Published: November 2022

Climate disasters affect human security and development, moreso in fragile and conflict-affected contexts where population’ capacities to cope with climate change are compromised. Responses to such crises lie at the nexus of humanitarian assistance, development, and peacebuilding. Yet, there are still too few integrated programmatic responses coordinating peacebuilding and climate actions to ensure a progressive human development. This research develops a multi-scalar model to help actors identify thematic areas to inform synergistic efforts and programs at different scales to better coordinate their actions. Findings suggest that climate action and peacebuilding sectors can coordinate actions around climate and conflict risk assessments, the management of land and water resources, ecosystem restoration, nature-based climate adaptation, climate and conflict smart agriculture, natural resources governance, and sustainable market development. These collaborative efforts have the potential to generate co-benefits, such as increased social cohesion and livelihood creation.
Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon
Authors: Soares Antonio S. , Clancy Neil T. , Bano Sophia , Raza Imran , Diana Michelle , Lovat Laurence B. , Stoyanov Danail , Chand Manish
Published: November 2022

Background

Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess interobserver variability in selection of the transection point during fluorescence angiography before anastomosis.

Methods

An online survey with still images of fluorescence angiography was distributed through colorectal surgery channels containing images from 13 patients where several areas for transection were displayed to be chosen by raters. Agreement was assessed overall and between pre-planned rater cohorts (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists), using Fleiss’ kappa statistic.

Results

101 raters had complete image ratings. No significant difference was found between raters when choosing a point of optimal bowel transection based on fluorescence angiography still images. There was no difference between pre-planned cohorts analysed (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists). Agreement between these cohorts was poor (<.26).

Conclusion

Whilst there is no learning curve for the technical adoption of FA, understanding the fluorescent signal characteristics is key to successful use. We found significant variation exists in interpretation of static fluorescence angiography data. Further efforts should be employed to standardise fluorescence angiography assessment.
Prediction approach of compression loss in bent-axis piston pump with cavitation
Authors: Qing Lv-jun , Gu Li-chen , Yang Bin , Lei Zhu-feng
Published: November 2022

Compression loss is one of the volumetric losses of bent-axis piston pumps, and its accurate evaluation is the basis for predicting the effective flow rate and volumetric efficiency of bent-axis piston pumps. The effect of changes in gas content on the effective bulk modulus rarely is considered in the existing compression loss models, which does not apply to the compression loss of bent-axis piston pumps under cavitation. However, cavitation exists in the actual work, especially in increasing the speed of the bent-axis piston pump. To solve this problem, a compression loss model is proposed. Firstly, the modified Henry’s law and the simplified transport equations of gas are used to describe the oil gas content under cavitation, and the effective bulk modulus equation is established. Then, combined with the definition of compressibility, the compression loss model of the bent-axis piston pump is proposed. Finally, the compression loss of the bent-axis piston pump under different operating conditions is analyzed through simulation, and the results are verified by experiment. The results show that the model prediction results are a good agreement with the experimental results under different operating conditions. The conclusions provide a new method for evaluating the effective flow rate and volumetric efficiency in the bent-axis piston pump.
Discussion on dynamic characteristics of long journal bearings considering surface roughness
Authors: Tian Zhuxin , Chen Guohua
Published: November 2022

The hydrodynamic bearing is the key part of many rotating machines, and dynamic characteristics of the bearing would affect the operation performance of machines directly. Thus, this study focused on dynamic characteristics of long journal bearings and tried to illustrate the influence of surface roughness on dynamic performances of long bearings. Applying Christensen stochastic model and long bearing approximation, the modified Reynolds equation was established. To solve the modified Reynolds equation, the numerical integration method was applied. It is found that the surface roughness would significantly weaken the stability threshold speed, normal stiffness coefficients ([Formula: see text], [Formula: see text]), and crossed dampness coefficients ([Formula: see text] and [Formula: see text]) for the long bearing with a large eccentricity ratio. In summary, the influences of surface roughness cannot be ignored during discussing dynamic characteristics of long journal bearings.
A nonlinear total variation based denoising method for electrostatic signal of low signal-to-noise ratio
Authors: Zhong Zhirong , Zuo Hongfu , Jiang Heng
Published: November 2022

Aero-engine electrostatic monitoring technology (EMT) is a novel and effective condition monitoring technology. With the help of EMT, effective monitoring of early failures can be achieved. Since the electrostatic monitoring of the running engine will be strongly interfered, the sampled electrostatic signal has various noise components and low signal-to-noise ratio (SNR). After analyzing the source of the noise components carried by the electrostatic signal, this paper proposes a method for electrostatic signal denoising in a strong interference environment, which is based on the nonlinear total variation theory. In the experiments, the simulated electrostatic measurement signal and the actual test-run electrostatic measurement signal were used as the analysis objects, and the denoising test was carried out by using the proposed method. Meanwhile, the denoising effect was compared and analyzed with other classical methods. The experimental results show that the proposed denoising method can effectively remove random noise, electromagnetic pulse and periodic noise in electrostatic signal, and is more applicable to the measured electrostatic signal with low SNR than the classical electrostatic signal denoising methods such as wavelet threshold denoising method and empirical mode decomposition method.
Vibration characteristics analysis of a type of turbine disk-blade assembly system in the civil aero-engine
Authors: Yu Ming , Wu Di , Zhao Jian , Liu Sinan , Gong Kun , Qu Ziyi
Published: November 2022

The coupled vibration in the turbine disk-blade system (TDS) is one of the main bottlenecks that hinder the further development of high-performance engines. To analyze the vibration of the TDS, three types of contact conditions, involving bonded, frictionless, or frictional were used to simulate the contact between the turbine disk and the blades. Three finite element analysis (FEA) models of a typical TDS based on the tenon structure were developed. The experimental system was developed and experimental modal analysis (EMA) was performed. According to the comparison between FEA and EMA results, the most accurate model is the frictional contact FEA model. The average error of the frictional contact FEA model is 1.42%, and the root mean square error is 0.75%. The working modes of the TDS at different speeds were calculated using the frictional contact FEA model. Meanwhile, based on the newly developed FEA model, it is found that the weak links in the TDS are the blades. This work can provide a theoretical basis for the TDS structure optimization and promote the development of high-quality aero-engines.
Analysis of lightning ablation damage of composite laminates with multiple fasteners
Authors: Zezhong Shan , Xuyu Liu , Xiang Lu , Kai Ma , Haijian Xiao , Minghui Tian
Published: November 2022

Composite materials have been widely used in civil aviation aircraft, but a large area of ablation damage occurs after lightning strikes, which threatens the operation safety of civil aviation aircraft. The composite material is fixed by multiple fasteners. The different installation positions of fasteners have a great influence on the result of lightning damage of composite. Based on these, a lightning ablation damage model of laminates with multiple fasteners is established, and the accuracy of the model is verified by comparing with the results in the references. In addition, the effect of different installation methods of multiple fasteners on the lightning ablation damage of laminates is studied. The results show that the number of fasteners is not the decisive factor among the factors that affect the ablation damage of laminates with multiple fasteners, and the installation layout of fasteners has an important impact on the damage results. When the fiber direction and aspect ratio of the laminate are the same, the maximum ablation damage area of terrible fasteners layout is 1.27 times the minimum ablation damage area of best fasteners layout under the action of lightning peak current of 200 kA.
Navigating data governance approvals to use routine health and social care data to evidence the hidden population with severe obesity: a case study from a clinical academic’s perspective
Authors: Williamson Kath , Nimegeer Amy , Lean Mike
Published: November 2022

Background:

Front-line professionals are uniquely placed to identify evidence gaps and the way routinely-collected data can help address them. This knowledge can enable incisive, clinically-relevant research.

Aim:

To document an example of the real-world approvals journey within the current NHS/Higher Education regulatory landscape, from the perspective of an experienced nurse undertaking doctoral study as a clinical academic.

Methods:

An instrumental case-study approach is used to explore the approvals process for a mixed-methods study. Relevant context is highlighted to aid understanding, including introduction of the General Data Protection Regulation and the integration of health and social care services.

Results:

Formal approvals by nine separate stakeholders from four different organisations took nearly 3 years, including 15 initial or revised applications, assessments or agreements. Obstacles included: conflicting views on what constitutes ‘research’ or ‘service evaluation’; isolated decision-making; fragmented data systems; multiple data controllers and a changing data governance environment. The dual perspectives of being both clinician and academic using routine data are explored.

Conclusions:

Practitioners face a complex approvals process to use data they routinely collect, for research or evaluation purposes. Use of data during the COVID-19 pandemic has demonstrated the need for streamlining of data governance processes. Practical recommendations are outlined.
The Demon Child and His Modern Fate: Reconstructing the Nezha Myth in Animated Fabulation
Authors: You Chengcheng
Published: November 2022

Emerging from the 17th-century Chinese classic Fengshen yanyi ( Creation of the Gods), a generic mixture of myth, folklore, history and legend, Nezha, a 7-year-old superboy who is decreed by fate to return his own flesh and bones to his parents and unyieldingly confront paternal authority in combat, has been popularized as an unconventional hero in animated adaptations since the 1970s. This article examines the cultural and historical significance of Nezha’s changing fate in the three Chinese animated feature films produced thus far: Nezha Conquers the Dragon King (Wang et al., 1979), Nezha (Jiaozi, 2019) and New Gods: Nezha Reborn (Zhao, 2021). The author argues that Nezha’s variations of personal individuation reflect China’s shifting historical contexts, changing intergenerational relations and reconfigured notions of selfhood by presenting an existential paradox of fate and freedom of action that ultimately preserves the social systems of patriarchy and filial piety, and puts forward a negotiated compromise between social collectivism and individualism. Combining theories of intertextual aesthetics with Gilles Deleuze’s conceptualization of fabulation, the study proposes a conceptual framework of ‘animated fabulation’ to account for the profound interaction between the literary and the cinematic, the social and the mythic, with a detailed analysis of the aesthetic and socio-political entanglements in the three animated adaptations.
An Age of Splendour for Contemporary Spanish Animation: Evolution of an Industry Over the Last Four Decades
Authors: Alvarez San Román Mercedes
Published: November 2022

Animation in Spain is currently experiencing a golden age. This study identifies 1985 as the starting point for this era and proposes a periodization of the more than three decades since, during which time 120 Spanish animated films have been released. The establishment of new regional institutions during Spain’s transition to democracy was the driving force behind this development, as the newly created governments saw in animation a means of transmitting the culture and language of their own region to new generations. Since the arrival of CGI and the incorporation of Spain into international trade networks, Spain has become the fifth largest producer of animation worldwide and the second largest in Europe. The model has evolved into a transnational cinema model based on private capital and globalized content that has achieved profitability, high export ratios and international recognition.
Music, Memory and Narrative: The Art of Telling in Tale of Tales
Authors: Cross Ian
Published: November 2022

Skazka Skazok/Tale of Tales (Yuri Norstein, 1979) has delighted and puzzled audiences and critics ever since its release. It presents a series of beautifully-animated episodes that seem to make narrative sense at the micro-level and that appear to fit together as a whole, but leaves the audience bemused as to why this should be so. The article discusses the history and context of the film, arguing that the ways in which sound and, particularly, music are deployed in relation to its visual elements provide powerful clues and cues as to the film’s over-arching narrative significances. Close analysis of the film’s music, sound and visuals reveals teleological underpinnings that are realized by means of alignment and re-alignment of music and image, leading to a new understanding of how the film and its success can be interpreted.
Societal Impact Analysis of Community-managed Potable Water Supply System in Rural India
Authors: Ghosal Somnath , Ruj Chhanda
Published: November 2022

Lack of accessibility and affordability to safe and affordable drinking water remains a major challenge in fulfilling sustainable development goals. Community-based water management emerged as a policy response to address the issues. However, the impact of producing community-based water supply institutions on the community is hardly noticed in this context. This paper tries to fill the gap through the relational understanding between the provision of safe water and communities’ socioeconomic upliftment, which remains the main reason behind the establishment of the potable water facility in Porapara village located in West Midnapur district of the state of West Bengal, India. The study findings revealed that community participation through the process of empowerment results in good governance of the potable water project and the socioeconomic well-being of the community in Porapara village. This kind of intervention study may help policymakers in evaluating the societal impact to achieve socioeconomic well-being.
An unusual presentation of hemiparesis with complex ophthalmoplegia: A ‘nine’ syndrome
Authors: Jesuthasan Jansan , Getheeswaran Srivickneswaran , Pirasath Selladurai
Published: November 2022

Nine syndrome is a rare clinical entity with core clinical signs of one and a half syndrome, ipsilateral facial palsy, and contralateral hemiparesis/hemianesthesia and localizing to the dorsal paramedian pontine tegmentum. The awareness of this sign helps in precise localization and consideration of relevant aetiologies. Here, we report a case consisting of right horizontal gaze palsy with right internuclear opthalmoplegia and right lower motor neuron type VII nerve palsy constituting eight-and-a-half syndrome. With the additional involvement of left upper and lower limb upper motor neuron weakness, it revealed the lesion responsible for the ‘nine’ syndrome in magnetic resonance imaging of the brain. It is our purpose to highlight the genesis of this combination of clinical signs.
Case report: Pure obturator dislocation of the hip, a rare variety of regular dislocations, and long-term clinical outcomes
Authors: Bouziane Walid , Machmachi Amine , Agoumi Omar , Daoudi Abdelkrim
Published: November 2022

Post-traumatic dislocation of the hip is a surgical emergency that is usually caused by a high-energy trauma in a context of polytrauma. The pure obturator hip dislocation variant is very rare. It is considered an emergency, and its management must be done within 6 h by a qualified surgeon in order to reduce the risk of osteonecrosis of the femoral head and iatrogenic fractures. Herein, we report the case of a pure obturator dislocation of the hip, following a high-energy trauma. The patient was treated urgently by closed reduction under general anesthesia. The functional and radiological results after 2 years were satisfactory, without signs of avascular necrosis.
Extreme Hyponatremia Complicated by Osmotic Demyelination in a Previously Healthy Young Individual
Authors: Quigley Nicholas , Garneau Alexandre P. , Haydock Ludwig , Isenring Paul
Published: November 2022

Rationale:

Severe hyponatremia can lead to dramatic complications whether it is treated or not. At times, it may be very severe (serum Na concentration: NaS < 115 mmol/L) or even extreme (NaS < 105 mmol/L)a and its cause difficult to identify, especially in younger individuals with no history of water disorders. The case presented herein illustrates these points quite eloquently and leads us to believe that the current recommendations for the treatment of very severe hyponatremia require some fine-tuning.

Presenting Concerns:

A 26-year-old man was admitted to our intensive care unit for a NaS of 88 mmol/L in the absence of obvious extracellular fluid volume contraction. He had been experiencing vomiting, diarrhea, fatigue, and excessive thirst for the past 6 weeks and minor neurological symptoms just before admission. Laboratory tests at presentation also showed a urine osmolarity of 697 mOsm/L and urine Na of 40 mmol/L.

Diagnoses:

The presenting concerns were consistent with syndrome of inappropriate antidiuretic hormone secretion (SIADH) manifesting as extreme, yet mildly symptomatic hyponatremia. At the same time, they did not point toward a specific cause initially.

Interventions:

The patient was treated through water restriction, subcutaneous desmopressin, and various intravenous (IV) fluids. Our goal had been to increase NaS at a rate of 4 to 6 mmol/L/day and required the amount of NaCl and free water perfused hourly to be readjusted constantly. Access to water also had to be opposed as the patient was unable to tolerate his thirst.

Outcomes:

During the first 6 days, the rate of NaS correction achieved was ~6 mmol/L/day. The patient improved initially but at the end of day 6, he experienced severe extrapontine osmotic demyelination (with widespread pyramidal and extrapyramidal deficits) that did not respond to intravenous immunoglobulin and NaS relowering. A little more than 3 weeks later, he began to develop low blood pressure and a subfebrile state that revealed secondary to severe Addison disease. The water disorder and insatiable thirst subsided gradually upon replacing the deficient hormones but the neurological disorder went on to become permanent and highly disabling.

Teaching points:

(1) Very severe hyponatremia should always be handled as an emergency and monitored stringently in view of its potential to cause irreparable damage. (2) Because it is a major risk factor for osmotic demyelination, it should probably be corrected at a rate of less than 4 mmol/L/day especially if it is in the extreme range, chronic, or of unknown duration. (3) It can be a presenting manifestation of Addison disease.
Prescription Pattern of Cation Exchange Resins and Their Efficacy in Treating Chronic Hyperkalemia Among Patients With Chronic Kidney Diseases: Findings From a Population-Based Analysis in British Columbia, Canada
Authors: Atiquzzaman Mohammad , Birks Peter , Bevilacqua Micheli , Wong Michelle M. Y. , Zheng Yuyan , Djurdjev Ognjenka , Levin Adeera
Published: November 2022

Background:

Little was known about how chronic hyperkalemia (cHK) in patients with chronic kidney disease (CKD) is managed in British Columbia, Canada.

Objective:

To investigate the trend in sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS) utilization and their efficacy in treating cHK in CKD patients from British Columbia, Canada.

Study Design:

Retrospective cohort.

Setting & Patients:

CKD patients aged ≥18 years, followed in Kidney Care Clinic (KCC), who had at least 2 potassium values ≥5.0 mmol/L separated by no more than 91 days during the period of June 1, 2015, to July 31, 2021, were included. Index date was the first date of the 2 potassium values ≥5.0 mmol/L. Patients who received SPS or CPS within 90 days before index date were excluded. Patients who were on dialysis or received kidney transplantation on or before index date were also excluded.

Exposure:

Continuous exposure to SPS and CPS.

Outcome:

SPS/CPS prescription utilization trend was described by the proportion of patients ever treated with SPS/CPS, median time in days between cHK diagnosis and initiating treatment with SPS/CPS, total and median number of SPS/CPS prescriptions dispensed. Change in mean serum potassium concentration before and after a 90-day continuous treatment with SPS/CPS was estimated.

Analytical Approach:

Descriptive.

Results:

This study included 10 495 patients with cHK (median age 74 years, 60% were male). Median follow-up time was 625 days. Only 2864 (27%) patients were dispensed at least 1 prescription of either SPS or CPS. A total 7300 prescriptions were dispensed; median prescriptions dispensed per patients were 2 (interquartile range [IQR]: 1-3). Median time from index date to the first prescription dispensing date was 154 days (IQR: 36-455). Continuous 90-day treatment with SPS/CPS decreased the mean serum potassium concentration by 0.60 mmol/L, from 5.58 to 4.98 mmol/L.

Limitations:

Descriptive observational study without control group.

Conclusions:

In British Columbia, only 1 in 4 CKD patients with cHK were dispensed with SPS/CPS, mostly with higher degrees of hyperkalemia. These medications appeared to be moderately effective in reducing the serum potassium concentration. Future research is necessary to evaluate the comparative effectiveness of newer generation medications.
The use of a smartphone application to improve stroke code workflow metrics: A pilot study in a comprehensive stroke centre
Authors: Gutiérrez-Zúñiga Raquel , Uclés Jorge , Sánchez-Manso Juan Carlos , Fuentes Blanca , de Celis Elena , Ruiz-Ares Gerardo , Rodríguez-Pardo Jorge , Rigual Ricardo , Casado Laura , Alonso Elisa , Fernández-Prieto Andrés , Navia Pedro , Álvarez-Muelas Alberto , Marín Begoña , Díez Tejedor Exuperio , Alonso de Leciñana María
Published: November 2022

Background

Timely coordination between stroke team members is of relevance for stroke code management. We explore the feasibility and potential utility of a smartphone application for clinical and neuroimaging data sharing for improving workflow metrics of stroke code pathways, and professionals’ opinions about its use.

Methods

We performed an observational pilot study including stroke code activations at La Paz University Hospital in Madrid, from June 2019 to March 2020. Patients were classified according to the activation or not of the JOIN app by the attending physician. Clinical data and time-to-procedures were retrieved from the app or from the hospital records and the Madrid regional stroke registry as appropriate and compared between both groups. An anonymous survey collected professionals’ opinions about the app and its use.

Results

A total of 282 stroke code activations were registered. The JOIN app was activated in 111 (39%) cases. They had a significant reduction in imaging-to-thrombolysis (31 vs 20 min, p = .026) and in door-to-thrombolysis times (51 vs 36 min, p = .004), with more patients achieving a door-to-needle time below 45 min (68.8% vs 37.8%, p = .016). About 50% of the users found the app useful for facilitating the diagnosis and decision-making; interoperability with clinical files was considered an opportunity for improvement.

Conclusions

This pilot study suggests that JOIN helps improve and document workflow metrics in acute stroke management in a comprehensive stroke centre. These results support testing JOIN in a prospective randomised study to confirm its usefulness and the general applicability of the results.
China–India pharmaceutical industry cooperation in the context of “One Belt, One Road”: Opportunities, challenges, and the way forward
Authors: Farooq Muhammad Sabil , Nazia Feroze , Iftikhar Adeel , Chun Cheng Tong
Published: November 2022

To promote the “Belt and Road Initiative” (BRI) in India, it is necessary to highlight the economic attributes, highlight the role of the market, cultivate new growth points of cooperation, and consolidate the foundation of common interests. Industrial cooperation is an important part not only of the “Belt and Road” construction, but also of economic cooperation between the countries. The pharmaceutical product industry is India's most advantageous industry, and it is also an industry with which India hopes to strengthen cooperation with China. In the context of “One Belt, One Road,” China–India pharmaceutical industry cooperation faces both rare opportunities and some challenges, but from the perspective of development trends, obstacles are gradually reducing. Promoting Sino–Indian pharmaceutical industry cooperation requires the joint efforts of government departments, industry chambers of commerce, and pharmaceutical companies. The key is to choose the right cooperation field and path. Strengthening China–India pharmaceutical industry cooperation is conducive to fostering new growth points for China–India economic cooperation, reducing India's concerns about the BRI, and promoting the BRI in India and the entire South Asian region.
Should Mindfulness for Health Care Workers Go Virtual? A Mindfulness-Based Intervention Using Virtual Reality and Heart Rate Variability in the Emergency Department
Authors: Pascual King , Fredman Amiad , Naum Athanasios , Patil Chaitrali , Sikka Neal
Published: November 2022

Background:

Research on burnout in the medical community has extensively studied the impact of mindfulness-based interventions (MBIs), which can include meditation, outdoor retreats, in-person didactics, and/or online wellness modules. However, in addition to these MBIs lacking objective, physiological measures for wellness, there has been little to no research involving virtual reality (VR) as an MBI modality for healthcare professionals in the United States.

Methods:

A randomized controlled intervention trial was used to study the impact of VR-based guided-meditations in the form of brief paced-breathing exercises. Heart-rate variability (HRV), a biomarker for relaxation, was measured during each session. Thirty-two participants, consisting of primarily medical students, resident physicians, and registered nurses, were recruited to complete brief guided-meditations via a VR headset or a standalone mobile app in the emergency department (ED) on-call room of a large urban academic medical center.

Results:

A total of 213 guided-meditation sessions were completed over the course of 4 weeks. Self-reported ratings of anxiety improved in both VR and mobile groups post-study. However, the VR group demonstrated higher intrasession HRV progress, indicating increased state of relaxation that also correlated with the number of sessions completed. Analysis by gender revealed disparity in HRV metrics between male and female VR participants.

Conclusion/Application to Practice:

VR-based guided meditations prove to be a feasible and accessible MBI that does not require extensive time commitment for healthcare workers. VR may be a more effective meditation platform compared with standalone mobile meditation apps, especially when used on a routine basis.
Bringing the Vegetables Back In: The Unruly Dynamics of Postwar Market Gardening in British Colonial Hong Kong
Authors: Chow Sze Chung
Published: November 2022

The Vegetable Marketing Organization (VMO) historically has long been a focal point of the study of the postwar boom of local agriculture in Hong Kong for two reasons. First, it centralized/monopolized the city’s vegetable wholesaling by eradicating all traditional marketing channels; second, its semiofficial status allowed it to accumulate a set of useful statistics on the production and circulation of local fresh produces. This article draws on fieldwork on local market gardeners and studies of colonial marketing institutions to argue that official statistics are rather inadequate to grasp the dynamics of local agriculture. A study of the so-called “dawn markets” and the vegetative dimension of the plants that lie outside the official system is necessary. It also suggests that dawn markets were not any residue from the pre-VMO era, but an “unruly twin” of the post-World War II colonial Hong Kong’s governmentality.
Monitoring Culturable Wastelands Using Satellite Images in A Part of Tarai Region of Uttar Pradesh
Authors: Verma Ranjeet Singh , Singh Amit Kumar , Mishra Manisha , Mathur Alok
Published: November 2022

Land is a basic natural resource on which development of human with other living beings. Inadequate management of natural resources has affected biodiversity, agriculture productivity and ecological balance. It is necessary not only to conserve the degrading natural resources but also to bring in available culturable wastelands under agriculture after reclamation to achieve required production of food. Salt affected wastelands, waterlogged & marshy lands and undulating lands are the common culturable wastelands found in the Tarai region of Uttar Pradesh. In this study the land use changes have been monitored over a period of 16 years in a cluster of villages in a part of Lakhimpur District, using Google earth imageries and GIS software. An on-screen visual interpretation of satellite imageries of 2003, 2011, 2015 and 2019 to monitor land use changes revealed a decrease in culturable wastelands by 46.19 % and increase in agricultural area from 69.34 % to 83.79 % in a period of 16 years. The progressive farmers have used pressmud, which is readily available from nearby sugar mills for reclamation of culturable wastelands.