bluuebunny/crossref_metadata_2025 huggingface dataset:
Cerebrovascular Autoregulation Monitoring in the Management of Adult Severe Traumatic Brain Injury: A Delphi Consensus of Clinicians
Authors: Depreitere B. , Citerio G. , Smith M. , Adelson P. David , Aries M. J. , Bleck T. P. , Bouzat P. , Chesnut R. , De Sloovere V. , Diringer M. , Dureanteau J. , Ercole A. , Hawryluk G. , Hawthorne C. , Helbok R. , Klein S. P. , Neumann J. O. , Robba C. , Steiner L. , Stocchetti N. , Taccone F. S. , Valadka A. , Wolf S. , Zeiler F. A. , Meyfroidt G.
Published: January 2021

Background

Several methods have been proposed to measure cerebrovascular autoregulation (CA) in traumatic brain injury (TBI), but the lack of a gold standard and the absence of prospective clinical data on risks, impact on care and outcomes of implementation of CA-guided management lead to uncertainty.

Aim

To formulate statements using a Delphi consensus approach employing a group of expert clinicians, that reflect current knowledge of CA, aspects that can be implemented in TBI management and CA research priorities.

Methods

A group of 25 international academic experts with clinical expertise in the management of adult severe TBI patients participated in this consensus process. Seventy-seven statements and multiple-choice questions were submitted to the group in two online surveys, followed by a face-to-face meeting and a third online survey. Participants received feedback on average scores and the rationale for resubmission or rephrasing of statements. Consensus on a statement was defined as agreement of more than 75% of participants.

Results

Consensus amongst participants was achieved on the importance of CA status in adult severe TBI pathophysiology, the dynamic non-binary nature of CA impairment, its association with outcome and the inadvisability of employing universal and absolute cerebral perfusion pressure targets. Consensus could not be reached on the accuracy, reliability and validation of any current CA assessment method. There was also no consensus on how to implement CA information in clinical management protocols, reflecting insufficient clinical evidence.

Conclusion

The Delphi process resulted in 25 consensus statements addressing the pathophysiology of impaired CA, and its impact on cerebral perfusion pressure targets and outcome. A research agenda was proposed emphasizing the need for better validated CA assessment methods as well as the focused investigation of the application of CA-guided management in clinical care using prospective safety, feasibility and efficacy studies.
Elucidating Methods for Isolation and Quantification of Exosomes: A Review
Authors: Kurian Talitha Keren , Banik Soumyabrata , Gopal Dharshini , Chakrabarti Shweta , Mazumder Nirmal
Published: January 2021

Exosomes are the smallest extracellular vesicles present in most of the biological fluids. They are found to play an important role in cell signaling, immune response, tumor metastasis, etc. Studies have shown that these vesicles also have diagnostic and therapeutic roles for which their accurate detection and quantification is essential. Due to the complexity in size and structure of exosomes, even the gold standard methods face challenges. This comprehensive review discusses the various standard methods such as ultracentrifugation, ultrafiltration, size-exclusion chromatography, precipitation, immunoaffinity, and microfluidic technologies for the isolation of exosomes. The principle of isolation of each method is described, as well as their specific advantages and disadvantages. Quantification of exosomes by nanoparticle tracking analysis, flow cytometry, tunable resistive pulse sensing, electron microscopy, dynamic light scattering, and microfluidic devices are also described, along with the applications of exosomes in various biomedical domains.
‘Strangely Like a Person’: Cole and the Queering of Asexuality in Dragon Age: Inquisition
Authors: Brown Melissa Shani , Partridge Nichola Lucy
Published: January 2021

In this article we consider the representation of the character Cole in Bioware’s Dragon Age: Inquisition (Electronic Arts, San Mateo, 2014), focusing upon how his asexuality is treated by other characters and its significance within his narrative arc. As well as contributing to the discussion of the representation of sexualities and gender within games, we seek to add to the ‘representational archive of asexuality’ (Cerankowski and Milks, Asexualities: Feminist and Queer Perspectives, Routledge, Abingdon, p 40, 2014), including games as media depicting and defining asexuality through fictional characterisation. We argue that it is particularly through humour that Cole is marked as being ambiguously set apart from the other characters in the game, and is infantilized as a ‘boy’ rather than a young man. Within a party of diverse genders, sexualities and indeed species, Cole’s absent interest in sex is treated as though it were something strange and in need of being overcome for Cole to become fully ‘human’. Beyond the scope of this game, this raises further questions for the representation of asexuality within media culture, and broader cultural discourses concerning whether asexuality is conceived of as being within the bounds of both masculinity and human normality.
Clinical practice guidelines for high-resolution breast PET, 2019 edition
Authors: Satoh Yoko , Kawamoto Masami , Kubota Kazunori , Murakami Koji , Hosono Makoto , Senda Michio , Sasaki Masayuki , Momose Toshimitsu , Ito Kengo , Okamura Terue , Oda Keiichi , Kuge Yuji , Sakurai Minoru , Tateishi Ukihide , Fujibayashi Yasuhisa , Magata Yasuhiro , Yoshida Takeshi , Waki Atsuo , Kato Katsuhiko , Hashimoto Teisuke , Uchiyama Mayuki , Kinuya Seigo , Higashi Tatsuya , Magata Yasuhiro , Machitori Akihiro , Maruno Hirotaka , Minamimoto Ryogo , Yoshinaga Keiichiro
Published: January 2021

Breast positron emission tomography (PET) has had insurance coverage when performed with conventional whole-body PET in Japan since 2013. Together with whole-body PET, accurate examination of breast cancer and diagnosis of metastatic disease are possible, and are expected to contribute significantly to its treatment planning. To facilitate a safer, smoother, and more appropriate examination, the Japanese Society of Nuclear Medicine published the first edition of practice guidelines for high-resolution breast PET in 2013. Subsequently, new types of breast PET have been developed and their clinical usefulness clarified. Therefore, the guidelines for breast PET were revised in 2019. This article updates readers as to what is new in the second edition. This edition supports two different types of breast PET depending on the placement of the detector: the opposite-type (positron emission mammography; PEM) and the ring-shaped type (dedicated breast PET; dbPET), providing an overview of these scanners and appropriate imaging methods, their clinical applications, and future prospects. The name “dedicated breast PET” from the first edition is widely used to refer to ring-shaped type breast PET. In this edition, “breast PET” has been defined as a term that refers to both opposite- and ring-shaped devices. Up-to-date breast PET practice guidelines would help provide useful information for evidence-based breast imaging.
The Design Model for Robotic Waitress
Authors: Yang Jiaji , Chew Esyin
Published: January 2021

With the rapid development of traditional industries, intelligent robots have been widely used in the hospitality industry. Although the development of intelligent robots faces a positive trend and a good market in the hospitality industry, it also faces the problem that robots cannot effectively collect and use user data in the field of human–computer interaction. It not only affects the interaction experience between users and robots, but also prevents companies from getting valuable feedback in a timely manner. In order for intelligent robots to effectively utilize interactive information, the user experience of robot entertainment is improved. This paper proposes and establishes a basic technical model called iRCXM. Combining the iRCXM model with a decision tree classification algorithm is excepted effectively improve the interaction experience between humans and robots in hospitality. This paper designs a model of intelligent robot based on decision tree algorithm. The model divides the user into three sections, each corresponding to a different standard function. Using a decision tree classification algorithm model is excepted effectively judge users’ current stage and whether they can move to the next stage. When the user reaches the final stage, it proves that the user has obtained a good interactive experience. At the same time, for users at different stages, the model will provide strategies for downward transformation so that companies can adjust and improve existing problems in a timely manner. In addition, the research developed a robot user interaction system based on the existing technology. The system is based on Android. Using HTTP protocol and Baidu Cloud AI API to realize simple face recognition and Sanbot-OpenSDK to implement simple robot control, the development of this system is to verify the feasibility of the model. The developed samples were tested in a real environment and feedback from customer experience was collected through semi-structured interviews. Finally, the feasibility of the model is verified.
The Möbius strip of market spatiality: mobilizing transdisciplinary dialogues between CCT and the marketing mainstream
Authors: Coffin Jack , Chatzidakis Andreas
Published: January 2021

This paper develops the Möbius strip as an ‘ordering theory’ (Sandberg and Alvesson, 2020) that brings CCT studies into dialogue with mainstream marketing approaches. The aim is to work toward a transdisciplinary understanding of market spatiality, a topic that has become increasingly important for theorists and practitioners (Warnaby and Medway, 2013; Castilhos et al., 2016; Chatzidakis et al., 2018). Building on psychosocial interpretations of the Möbius strip as a ‘tactical’ way of thinking, a range of insights and ideas are organized along a single strip of theorization. This paper maps a continuous plane of logic between the concepts of space, place, emplacement, spatiality, implacement, and displacement. The potential applications of the Möbius strip are then demonstrated by showing how the transdisciplinary topic of ‘atmosphere’ can be theorized from multiple perspectives. The paper concludes by exploring how the Möbius strip might also be employed in other areas of marketing theory and practice, potentially generating further transdisciplinary conversations between CCT and the marketing mainstream.
Combined support mechanism of rock bolts and anchor cables for adjacent roadways in the external staggered split-level panel layout
Authors: Batugin Adrian , Wang Zhiqiang , Su Zehua , Sidikovna Shermatova Sayyora
Published: January 2021

Using the spatial structure of the external staggered split-level panel layout, a combined support technology for adjacent roadways was developed and analyzed for a rock bolt and anchor cable mechanism. The influence of the side rock bolt and anchor cable parameters on the mechanical properties of the anchorage body and the support stress distribution of the lateral coal body were revealed using the FLAC3D software. The optimal support parameters of the side rock bolts and anchor cables were subsequently determined, and the support effect of gob-side entry in a mining scenario was verified. The results show that the support of the side rock bolts and anchor cables improves the mechanical properties and stress state of the anchorage body, producing a good protective effect on the coal body of the air-intake entry roof and side wall. This is beneficial to the stability of the side wall and the realization of the suspension effect for roof rock bolts and anchor cables, which in turn makes the surrounding rock maintenance of the gob-side entry to a thick coal seam more favorable.
Spontaneous Dramatization as Dialogical Space in the School Context
Authors: Pascarella Federica , Vicigrado Antonietta , Tateo Luca , Marsico Giuseppina
Published: January 2021

The use of dramatization as teaching/learning methodology, useful for the improvement of social, emotional, creative skills, and for the acquisition of knowledge on subject matters such as history, is an established field of research and practice. Yet, there are very few studies on children’s spontaneous dramatization in educational context and its potential role in development. The term dramatization, as we will use here, refers to the human activity of staging in narrative and ritualistic form, enacted through the whole person and multiple channels, communicative and self-presentation meanings. The school context is a privileged arena to observe spontaneous dramatization between peers and between children and adults. Besides, school everyday routine is often filled with staged dramatizations aimed for instance at building collective identity or providing moral orientation. We propose a new theoretical framework and analyse field observation in kindergarten and primary school to interpret spontaneous dramatization and collective school routines.
Isolation of secondary metabolites from the mediterranean sponge species; Hemimycale columella and its biological properties
Authors: Marmouzi Ilias , Ezzat Shahira M. , Mostafa Eman Sherien , El Jemli Meryem , Radwan Rasha Ali , Faouzi My El Abbes , Tamsouri Naoufal , Kharbach Mourad
Published: January 2021

Despite the richness and biodiversity of invertebrates and algae in the Mediterranean Sea, these organisms are still poorly studied. The objective of our research is the discovery of bioactive lead compounds from the Mediterranean Sea sponge Hemimycale Collumella (HC). HC sponge (189.0 g) was collected from Mdiq costs on the Mediterranean Sea and extracted with methanol to yield (10 g) which was then subjected to fractionation. A bio-guided protocol was applied through evaluation of 2,2-diphenyl-1-picrylhydrazyl (DPPH) scavenging and Oxygen Radical Absorbance Capacity (ORAC), α-amylase, β-glucosidase, pancreatic lipase inhibition as well as anti-collagenase, anti-elastase, antityrosinase and cytotoxic activity. 2,3-O-Hexahydroxydiphenoyl-(α/β)-glucose (1) and gentisic acid 2-O-β-glucoside (2) were isolated from the water fraction, quercetin-3-O-β-glucopyranoside (3), kaempferol 3-O-β-glucopyranoside (4) and isorhamnetin 3-O-β-glucopyranoside (5) from n-butanol fraction, gallic acid (6) from ethyl acetate fraction and gallic acid-3-methyl ether (7) from methylene chloride fraction. Compound 5 had the highest DPPH and ORAC activity. Compounds 1–5 had promising lipase inhibition activities which exceeded that of the standard Orlistat, while compounds 1–7 showed anti-tyrosinase activity higher than that of the standard Hydroquinone monomethyl ether. This is the first report for evaluation of the biological activities of 2, 3-O-hexahydroxydiphenoyl-(α/β)-glucose (1), gentisic acid 2-O-β-glucoside (2) and gallic acid-3-methyl ether (7).
Effect of carbon anode production parameters on anode cracking
Authors: Amrani Salah , Kocaefe Duygu , Kocaefe Yasar , Bhattacharyay Dipankar , Bouazara Mohamed , Côté Jules
Published: January 2021

Carbon anodes are used in the electrolytic production of aluminum. The quality of anodes is directly related to the production cost, carbon and energy consumption, and environmental emissions. It is desired that the anodes have high density, low porosity/cracks, low electrical resistivity as well as low air and CO2 reactivities. Low resistivity of anodes reduces energy required to produce aluminum during electrolysis. The presence of cracks and pores increases the anode electrical resistivity. Therefore, it is important to know how and when the pores and cracks form during the anode production so that the necessary actions could be taken to prevent their formation. A study was carried out to investigate the effect of different anode production parameters such as anode composition, type of raw material used, time and top-former bellow pressure of vibro-compactor, green anode cooling medium, and heating rate used during baking on the crack formation. The anodes are fabricated at the carbon laboratory of University of Quebec at Chicoutimi (UQAC) and characterized by measuring their properties (density, electrical resistivity, and surface crack density). The anode properties, hence the anode quality, were correlated with the anode production parameters. Also, their tomographic analysis was carried out to visualize and quantify the internal cracks.

Graphical abstract
Consecutive 2-year data analysis to assess the soil quality and ecological risk of heavy metals in Tobacco field: a case study in Northern Bangladesh
Authors: Salam Md. Tareq Bin , Zaman S. M. Shahriar , Hossen S. M. Tanzim , Nur Md. Asaduzzaman
Published: January 2021

A successive 2-year (2019 and 2020) field experiment was conducted in northern Bangladesh (Rangpur district) to observe the status of soil quality and heavy metal risk due to tobacco cultivation in this area. Soil samples were collected randomly from four major sub-districts (Rangpur Sadar, Badargonj, Gangachara, and Mithapukur Upazila) where Mithapukur was a non-cultivating tobacco field and the rests were tobacco-growing fields. Along with heavy metal concentrations, physicochemical parameters were analyzed to observe the progressive change in the soil. Results depicted that values of bulk density, particle density, porosity, soil organic matter (SOM), and major nutrients (N, P, K, S) were decreased in the tobacco-growing field from 2019 to 2020, whereas significant improvement was observed in non-tobacco-growing field at successive year analysis. However, exchangeable bases were raised in the tobacco cultivated field from 40.86 to 52.98% compared to the non-tobacco cultivated field which was in a declining trend (43.66–34.33%). Overall, the soil pollution index depicted that Pb was shown a moderate risk of contamination in 2020. The ecological risk analysis also stated that the tobacco field in Rangpur Sadar was at a moderate risk of soil pollution (RI = 126.16), although the non-tobacco field in Mithapukur was at no risk of pollution (RI = 45.23). So, it can be recommended that tobacco cultivation harms the soil health, and thus, it should be prohibited from the agricultural field.
Characteristics of experimental ductility energy index of hybrid-CFRP reinforced concrete deep beams
Authors: Hason Mahir M. , Hanoon Ammar N. , Saleem Sarah J. , Hejazi Farzad , Al Zand Ahmed W.
Published: January 2021

Although the ductility energy ratio ($$\mu_{E}$$

μ
E

) of the reinforced concrete beam has been the topic of numerous study purposes and critical inquiry for the last decades, narrow consideration, especially in terms of reinforced concrete deep beams (RCDBs), is conducted to examine the ductility energy of hybrid-RC deep beams with various CFRP configurations. Growing the ductility of RCDB by CFRP reinforcement is significant in terms of shear resistance. Therefore, the objective herein is to explore the consequence of CFRP configurations (full side warped, 45° and 90° side stripes) on the ductility energy of RCDBs per two values of the shear span over depth proportion ($$a/d$$

a
/
d

) of 1.0 and 1.75, and shear reinforcement ratios ($$\rho_{v}$$

ρ
v

) of 0.0% and 0.4%. The experimental testing program included 12 RCDBs, three ordinaries (unstrengthen), and nine retrofitted with several CFRP configurations. The results show that the CFRP strengthened beams is presented a higher degree of increase in terms of mid-span deflection with respect to conventional beams. The ductility energy index ($$\mu_{E}$$

μ
E

) increases with the increase of the shear reinforcement ratio ($$\rho_{v}$$

ρ
v

). The dissipated energy demonstrated by strengthening beam with CFRP is from 45 to 80%, and it was higher than those of reference RCDBs. The energy absorption of RCDBs is improved due to the attendance of CFRP configurations of about 15% and 51% for $$a/d$$

a
/
d

proportion of 1.0 and 1.75, respectively, and for $$\rho_{v}$$

ρ
v

of 0% and 0.4% are about 15% and 86% consecutively.
Increased average annual prevalence of upper respiratory tract infection (UTRI) in the central Indian population residing near the coal-fired thermal power plants
Authors: Barik Puspita , Naoghare Pravin , Sivanesan Saravanadevi , Kannan Krishnamurthi , Middey Anirban
Published: January 2021

People are vulnerable to health risks due to particulate matter generated through the coal combustion processes. The air pollution due to the thermal power plant is a primary concern among all sources of pollution. The air pollution due to the coal-fired thermal power plant is a primary concern among all the different sources of pollution. The air quality (suspended particulate matter; SPM) modeling in the study area of central India was carried out using CALAUFF model. In addition, real-time air monitoring of particulate matter PM1, PM2.5 and PM10 was carried out in the study area. Real-time air quality monitoring data showed higher concentration of particulate matter (PM1 and PM2.5) at different locations in the study area, exceeding the regulatory limits set by NAAQS (National Ambient Air Quality Standards) and WHO (World Health Organization). Considering the most probable health impacts due to coal-fired thermal power plant, diseases such as chronic upper respiratory tract infections (URTI), and asthma were focused in this study. Hospital admission data were collected for respiratory disorders from six different public health centers (PHCs) located in the study area for the years 2012 and 2013. Average annual prevalence (AAP) of asthma at Dhapewada, Patansaongi, Chicholi, Satak, Droli and Kanhan PHCs was observed to be 0.581, 0.218, 0.201, 0.155, 0.377 and 0.198%, respectively, whereas AAP of UTRI at Dhapewada, Patansaongi, Chicholi, Satak, Droli and Kanhan PHCs was 24.961, 40.693, 0.769, 12.775, 28.605 and 14.898%, respectively. Thus, we conclude that the study population residing nearby the coal-fired thermal power plants may have an increased risk to upper respiratory tract infections (URTI) than asthma.
The Abstraction of an Idealization: Cartographic Representations of Model Railroads
Authors: Kühne Olaf , Edler Dennis , Jenal Corinna
Published: January 2021

Das gestaltete Gelände einer Modelleisenbahn hat – will der Erbauer als ‚ernsthafter Modellbahner‘, nicht als ‚Spielbahner‘ gelten – mehrere Funktionen: es legitimiert die Bahnanlagen, es schafft eine zeitliche Kontextualisierung für das rollende Material und es kaschiert dem Blick zu entziehende Teile der Modellbahn. Ein wesentliches Medium der Vermittlung von Konventionen der Gestaltung dieses Geländes, auf Grundlage einesCommon SenseVerständnisses von Landschaft, dient Modelleisenbahn bezogene Literatur. Diese wiederum greift häufig auf kartographische Darstellungen zurück. Diese Darstellungen ordnen sich zwischen der Polarität reiner Gleispläne (unter Rückgriff) auf abstrakte Signaturen und topographischen Darstellungen, die zu abstrakten Liniensignaturen für Gleisdarstellungen auf eine konkrete Signaturensprache zurückgreifen. Darüber hinaus vermitteln Blockbilder einen dreidimensionalen Eindruck der darzustellenden Anlage. Insgesamt dominiert eine eher schlichte, intuitiv erschließbare Darstellung, die innerhalb von gewissen Konventionen individuelle Gestaltungsspielräume offenlässt. Dieser Beitrag stellt die Ergebnisse einer explorativen Studie in den Kontext aktueller landschaftstheoretischer Forschung.
Experimental and modelling study of the grain refinement of Fe-30wt%Ni-Nb austenite model alloy subjected to severe plastic deformation process
Authors: Svyetlichnyy D. S. , Majta J. , Kuziak R. , Muszka K.
Published: January 2021

This study addresses some aspects regarding a computer modelling based on three-dimensional Frontal Cellular Automata (FCA) for the simulation of ultrafine-grained (UFG) microstructure development in purpose-designed microalloyed austenite model alloy i.e. FCC structure. Proposed in the present study model is a step forward towards understanding the deformation and microstructure development mechanisms occurring during severe plastic deformation (SPD) processes with high accumulation of the plastic deformation effects in FCC structures. The analysed microalloyed austenite microstructures were developed due to SPD effects. Using the proposed computer model, based on three-dimensional FCA it has been shown that it is possible to predict some characteristics of the FCC microstructures such as the grain size and the distribution of the boundaries misorientation angle. These abilities were proved by the qualitative and quantitative comparisons of the modelling and SEM/EBSD results. The capabilities of the proposed model were tested using experimental results of the wire drawing processes. The paper presents the new original results of experimental studies of multi-staged MaxStrain technology with the microscopic investigation. Basing on data obtained from these studies, the dependencies of the evolution of grain structure and misorientation angle on the accumulative strain and cycle number were obtained in a form of approximation equations. The equations were implemented into the CA model, and MaxStrain technology was simulated. Comparison of the results obtained in experimental studies and simulations shows a satisfactory agreement. Industrial verification of the developed model as well shows a satisfactory agreement.
High Social Vulnerability and “Textbook Outcomes” after Cancer Operation
Authors: Hyer Madison J. , Tsilimigras Diamantis I. , Diaz Adrian , Mirdad Rayyan S. , Azap Rosevine A. , Cloyd Jordan , Dillhoff Mary , Ejaz Aslam , Tsung Allan , Pawlik Timothy M.
Published: January 2021

BACKGROUND:

The effect of community-level factors on surgical outcomes has not been well examined. We sought to characterize differences in “textbook outcomes” (TO) relative to social vulnerability among Medicare beneficiaries who underwent operations for cancer.

METHODS:

Individuals who underwent operations for lung, esophageal, colon, or rectal cancer between 2013 and 2017 were identified using the Medicare database, which was merged with the CDC's Social Vulnerability Index (SVI). TO was defined as surgical episodes with the absence of complications, extended length of stay, readmission, and mortality. The association of SVI and TO was assessed using mixed-effects logistic regression.

RESULTS:

Among 203,800 patients (colon, n = 113,929; lung, n = 70,642; rectal, n = 14,849; and esophageal, n = 4,380), median age was 75 years (interquartile range 70 to 80 years) and the overwhelming majority of patients was White (n = 184,989 [90.8%]). The overall incidence of TO was 56.1% (n = 114,393). The incidence of complications (low SVI: 21.5% vs high SVI: 24.0%) and 90-day mortality (low SVI: 7.0% vs high SVI: 8.4%) were higher among patients from highly vulnerable neighborhoods (both, p < 0.05). In turn, there were lower odds of achieving TO among high-vs low-SVI patients (odds ratio 0.83; 95% CI, 0.78 to 0.87). Although high-SVI White patients had 10% lower odds (95% CI, 0.87 to 0.93) of achieving TO, high-SVI non-White patients were at 22% lower odds (95% CI, 0.71 to 0.85) of postoperative TO. Compared with low-SVI White patients, high-SVI minority patients had 47% increased odds of an extended length of stay, 40% increased odds of a complication, and 23% increased odds of 90-day mortality (all, p < 0.05).

CONCLUSIONS:

Only roughly one-half of Medicare beneficiaries achieved the composite optimal TO quality metric. Social vulnerability was associated with lower attainment of TO and an increased risk of adverse postoperative surgical outcomes after several common oncologic procedures. The effect of high SVI was most pronounced among minority patients.
Clinical profile of Aboriginal and Torres Strait Islander adults with stroke and traumatic brain injury at a regional Australian hospital: a retrospective chart audit
Authors: Cochrane Frances , Siyambalapitiya Samantha , Cornwell Petrea
Published: January 2021

Background:

The clinical profile of Aboriginal and Torres Strait Islander adults admitted to hospital with neurological injury is not well documented. Understanding these profiles may enable health professionals to provide more culturally responsive health care for this patient group. This study aimed to report the clinical profile of Aboriginal and Torres Strait Islander adults admitted to a regional Queensland hospital due to stroke or traumatic brain injury (TBI).

Method:

A 2-year retrospective medical record review of Aboriginal and Torres Strait Islander adults (≥18 years) admitted to a regional Queensland hospital with principal diagnoses of stroke or TBI.

Results:

There were 132 Aboriginal and Torres Strait Islander adult stroke (51.5%) or TBI (48.5%) admissions. The mean ages were 56.7 years for stroke and 42.7 years for TBI. The majority of patients (83.3%) were of Aboriginal descent with others identifying as Torres Strait Islander only, or both Aboriginal and Torres Strait Islander. Patients were from 26 diverse home locations across northern Australia, primarily Outer Regional or Remote/Very Remote geographical locations. All patients’ language backgrounds were documented as English only. Over 90% of stroke and 50% of TBI patients presented with medical co-morbidities.

Conclusions:

Patients had diverse geographical locations and cultural backgrounds, with many likely impacted by dislocation from home and country, as well as potential delays in receiving treatment. Despite this diversity, English was documented in patients’ medical records as their only language. The majority of patients also presented with multiple medical co-morbidities. Health professionals should consider these factors to ensure patients receive optimum and culturally responsive health care.
Fit-failure rate associated with simulated reuse and extended use of N95 respirators assessed by a quantitative fit test
Authors: Jung Jiwon , Kim Jiyun , Yang Hyejin , Lim Young-Ju , Kwak Sun-Hee , Hong Min Jee , Kim Eun Ok , Kim Sung-Han
Published: January 2021

Objective:

We quantitatively assessed the fit failure rate of N95 respirators according to the number of donning/doffing and hours worn.

Design:

Experimental study.

Setting:

A tertiary-care referral center in South Korea.

Participants:

In total, 10 infection control practitioners participated in the fit test.

Methods:

The first experiment comprised 4 consecutive 1-hour donnings and fit tests between each donning. The second experiment comprised 2 consecutive 3-hour donnings and fit tests between each donning. The final experiment comprised fit tests after an 1-hour donning or a 2-hour donning.

Results:

For 1-hour donnings, 60%, 70%, and 90% of the participants had fit failures after 2, 3, and 4 consecutive donnings, respectively. For 3-hour donnings, 50% had fit failure after the first donning and 70% had failures after 2 consecutive donnings. All participants passed the fit test after refitting whenever fit failure occurred. The final experiment showed that 50% had fit failure after a single use of 1 hour, and 30% had fit failure after a single use of 2 hours.

Conclusions:

High fit-failure rates were recorded after repeated donning and extended use of N95 respirators. Caution is needed for reuse (≥1 time) and extended use (≥1 hour) of N95 respirators in high-risk settings such as those involving aerosol-generating procedures. Although adequate refitting may recover the fit factor, the use of clean gloves and strict hand hygiene afterward should be ensured when touching the outer surfaces of N95 respirators for refitting.
Pride amid Prejudice: The Influence of LGBT+ Rights Activism in a Socially Conservative Society
Authors: AYOUB PHILLIP M. , PAGE DOUGLAS , WHITT SAM
Published: January 2021

How do mass publics react to lesbian, gay, bisexual, and transgender (LGBT+) advocacy efforts in socially conservative societies? We consider how the first-ever LGBT+ Pride in Sarajevo, Bosnia and Herzegovina influences ordinary citizens’ attitudes and behavior regarding LGBT+ support. Using nationwide and local panel surveys, we find that support for LGBT+ activism increased locally after the Pride but did not diffuse nationwide, signaling how proximity mechanisms reinforce Pride effects. In survey experiments, we show that subjects are responsive to both mobilization and counter-mobilization appeals by local activists. We also find evidence from a behavioral experiment that the Pride had a positive effect on shifting the allocation of financial resources toward local pro-LGBT+ activists and away from opposition groups. Finally, in-depth interviews with local LGBT+ activists underscore the challenges facing LGBT+ activism in socially conservative societies but also point to the substantial possibilities of collective action on behalf of minorities at risk.
Testing for Negative Spillovers: Is Promoting Human Rights Really Part of the “Problem”?
Authors: Strezhnev Anton , Kelley Judith G. , Simmons Beth A.
Published: January 2021

The international community often seeks to promote political reforms in recalcitrant states. Recently, some scholars have argued that, rather than helping, international law and advocacy create new problems because they have negative spillovers that increase rights violations. We review three mechanisms for such spillovers: backlash, trade-offs, and counteraction and concentrate on the last of these. Some researchers assert that governments sometimes “counteract” international human rights pressures by strategically substituting violations in adjacent areas that are either not targeted or are harder to monitor. However, most such research shows only that both outcomes correlate with an intervention—the targeted positively and the spillover negatively. The burden of proof, however, should be as rigorous as those for studies of first-order policy consequences. We show that these correlations by themselves are insufficient to demonstrate counteraction outside of the narrow case where the intervention is assumed to have no direct effect on the spillover, a situation akin to having a valid instrumental variable design. We revisit two prominent findings and show that the evidence for the counteraction claim is weak in both cases. The article contributes methodologically to the study of negative spillovers in general by proposing mediation and sensitivity analysis within an instrumental variables framework for assessing such arguments. It revisits important prior findings that claim negative consequences to human rights law and/or advocacy, and raises critical normative questions regarding how we empirically evaluate hypotheses about causal mechanisms.
Prenatal choline, cannabis, and infection, and their association with offspring development of attention and social problems through 4 years of age
Authors: Hunter Sharon K. , Hoffman M. Camille , D'Alessandro Angelo , Wyrwa Anna , Noonan Kathleen , Zeisel Steven H. , Law Amanda J. , Freedman Robert
Published: January 2021

Background

Prenatal choline is a key nutrient, like folic acid and vitamin D, for fetal brain development and subsequent mental function. We sought to determine whether effects of higher maternal plasma choline concentrations on childhood attention and social problems, found in an initial clinical trial of choline supplementation, are observed in a second cohort.

Methods

Of 183 mothers enrolled from an urban safety net hospital clinic, 162 complied with gestational assessments and brought their newborns for study at 1 month of age; 83 continued assessments through 4 years of age. Effects of maternal 16 weeks of gestation plasma choline concentrations ⩾7.07 μM, 1 s.d. below the mean level obtained with supplementation in the previous trial, were compared to lower levels. The Attention Problems and Withdrawn Syndrome scales on Child Behavior Checklist 1½–5 were the principal outcomes.

Results

Higher maternal plasma choline was associated with lower mean Attention Problems percentiles in children, and for male children, with lower Withdrawn percentiles. Higher plasma choline concentrations also reduced Attention Problems percentiles for children of mothers who used cannabis during gestation as well as children of mothers who had gestational infection.

Conclusions

Prenatal choline's positive associations with early childhood behaviors are found in a second, more diverse cohort. Increases in attention problems and social withdrawal in early childhood are associated with later mental illnesses including attention deficit disorder and schizophrenia. Choline concentrations in the pregnant women in this study replicate other research findings suggesting that most pregnant women do not have adequate choline in their diets.
Placement Advisors as Innovators. How Professionals Use Enhanced Discretion in Germany’s Public Employment Services
Authors: FREIER CAROLIN , SENGHAAS MONIKA
Published: January 2021

Employees of the public employment services (PES) are street-level bureaucrats who shape activation policy on the ground. This paper examines how PES staff use enhanced discretion in an innovation project carried out by the German Federal Employment Agency. Applying a bottom-up perspective, we reconstruct PES employees’ logic of action and the dilemmas they face in improving counselling and placement services. According to our findings, placement staff use enhanced discretion to promote more individualised support and an adequate matching of jobseekers and employers. The use of discretion is framed by organisational norms and reward mechanisms and by the current labour market situation. Our analyses are based on qualitative interviews and group discussions with placement staff.
Socioeconomic status as a proxy for input quality in bilingual children?
Authors: De Cat Cécile
Published: January 2021

This study investigates the effect of socioeconomic status (SES) as a proxy for input quality, in predicting language proficiency. Different operationalizations of SES are compared, including simple measures (parental education and parental occupation) and complex measures combining two dimensions (among parental education, parental occupation, and deprivation risk). All significantly predict overall English proficiency scores in a diverse group of 5- to 7-year-olds acquiring English and another language. The most informative SES measure in that respect is shown to be a complex measure combining parental education and parental occupation. That measure is used in a second set of analyses showing that different aspects of language are affected differently by variations in SES and in language exposure.
On the role of cost-effectiveness thresholds in healthcare priority setting
Authors: Siverskog Jonathan , Henriksson Martin
Published: January 2021

In the past few years, empirical estimates of the marginal cost at which health care produces a quality-adjusted life year (QALY, k) have begun to emerge. In theory, these estimates could be used as cost-effectiveness thresholds by health-maximizing decision makers, but prioritization decisions in practice often include other considerations than just efficiency. Pharmaceutical reimbursement in Sweden is one such example, where the reimbursement authority (TLV) uses a threshold range to give priority to disease severity and rarity. In this paper, we argue that estimates of k should not be used to inform threshold ranges. Instead, they are better used directly in health technology assessment (HTA) to quantify how much health is forgone when a new technology is funded in place of other healthcare services. Using a recent decision made by TLV as a case, we show that an estimate of k for Sweden implies that reimbursement meant forgoing 8.6 QALYs for every QALY that was gained. Reporting cost-effectiveness evidence as QALYs forgone per QALY gained has several advantages: (i) it frames the decision as assigning an equity weight to QALYs gained, which is more transparent about the trade-off between equity and efficiency than determining a monetary cost per QALY threshold, (ii) it makes it less likely that decision makers neglect taking the opportunity cost of reimbursement into account by making it explicit, and (iii) it helps communicate the reason for sometimes denying reimbursement in a way that might be less objectionable to the public than current practice.
Primitive prime divisors in the critical orbits of one-parameter families of rational polynomials
Authors: REN RUFEI
Published: January 2021

For a polynomial $f(x)\in\mathbb{Q}[x]$ and rational numbers c, u, we put $f_c(x)\coloneqq f(x)+c$, and consider the Zsigmondy set $\calZ(f_c,u)$ associated to the sequence $\{f_c^n(u)-u\}_{n\geq 1}$, see Definition 1.1, where $f_c^n$ is the n-st iteration of fc. In this paper, we prove that if u is a rational critical point of f, then there exists an Mf > 0 such that $\mathbf M_f\geq \max_{c\in \mathbb{Q}}\{\#\calZ(f_c,u)\}$.
The mediating role of adolescents’ loneliness and social withdrawal in the association between maternal depressive symptoms and suicidality in adolescence: A 20-year population-based study
Authors: Psychogiou Lamprini , Ahun Marilyn N. , Boivin Michel , Tremblay Richard E. , Orri Massimiliano , Côté Sylvana M.
Published: January 2021

We examined whether adolescents’ loneliness and social withdrawal mediated the association between maternal depressive symptoms and adolescent suicidality. Secondary analyses on the Québec Longitudinal Study of Child Development data were conducted (n = 1,623). Each mother completed the Centre for Epidemiologic Studies Depression Scale (at child ages 5 months, 1.5, 3.5, 5, and 7 years). Adolescent's social withdrawal (adolescent, father, and teacher reported at 10, 12, and 13 years) and loneliness (adolescent reported at 10, 12, and 13 years), were assessed using items from the Social Behavior Questionnaire and the Loneliness and Social Satisfaction Questionnaire, respectively. Adolescents completed self-reports to assess suicidal thoughts and attempts at 13, 15, 17, and 20 years. Children of mothers with higher levels of maternal depressive symptoms had an increased risk for suicidality (OR = 1.15, 95% CI: 1.03–1.28). Loneliness explained 16% of the total effect of maternal depressive symptoms on adolescent suicidality (indirect effect OR = 1.02, 95% CI: 1.00–1.04). There was no indirect effect of maternal depressive symptoms on adolescent suicidal outcomes via social withdrawal (indirect effect OR = 1.00, 95% CI: 0.99–1.02). Interventions that target loneliness may be beneficial for decreasing the risk for suicidality among adolescents of mothers with depressive symptoms.
Les structures interrogatives directes partielles fondées sur où dans les dialogues de romans français du XXesiècle
Authors: Rossi-Gensane Nathalie , Acosta Córdoba Luisa Fernanda , Ursi Biagio , Lambert Margot
Published: January 2021

Nous appuyant sur un corpus de 2731 occurrences constitué au sein de Frantext à partir de 1250 textes (soit 78 063 933 mots), nous proposons un panorama de diverses structures interrogatives directes partielles fondées sur où dans les dialogues de romans français entre 1900 et 1997. Nous relions ces structures à des facteurs tels que la date de l’œuvre, le sexe, l’âge, l’appartenance sociale et l’origine géographique du personnage auquel est attribué le discours direct, etc., en envisageant également la situation de communication fictionnelle. L’article entend, à partir d’études existantes sur l’oral réel, apprécier l’écart – et son évolution – entre celui-ci et l’oral mis en scène à l’écrit, avec un éclairage quantitatif inédit. Malgré l’absence d’études sur l’oral réel dans la première moitié du XXe siècle, il peut être souligné en fin de siècle un réalisme accru, les normes objectives de l’oral mis en scène allant dans le sens (généralement avec décalage) de celles de l’oral réel. Peut alors aussi être mise en évidence une plus grande prise en compte de la dimension diaphasique au détriment de la dimension diastratique.
Aortic root aneurysm repair in a neonate with Loeys–Dietz syndrome
Authors: Li Willa , Cohen William , Combs Pamela , Wong Joshua , Loomba Rohit , Lee Brian K. , El-Zein Chawki , Ilbawi Michel , Vricella Luca , Hibino Narutoshi
Published: January 2021

Loeys–Dietz syndrome is a connective tissue disorder known to cause aggressive aortopathy in paediatric patients, but it is extremely rare for cardiovascular events to present during infancy. We report the first successful aortic repair in a neonate with LDS presenting in extremis with an early onset, massive aortic aneurysm.
COVID-19: can we treat the mother without harming her baby?
Authors: Wiese Michael D. , Berry Mary J. , Hissaria Pravin , Darby Jack R.T. , Morrison Janna L.
Published: January 2021

Medical care is predicated on ‘do no harm’, yet the urgency to find drugs and vaccines to treat or prevent COVID-19 has led to an extraordinary effort to develop and test new therapies. Whilst this is an essential cornerstone of a united global response to the COVID-19 pandemic, the absolute requirements for meticulous efficacy and safety data remain. This is especially pertinent to the needs of pregnant women; a group traditionally poorly represented in drug trials, yet a group at heightened risk of unintended adverse materno-fetal consequences due to the unique physiology of pregnancy and the life course implications of fetal or neonatal drug exposure. However, due to the complexities of drug trial participation when pregnant (be they vaccines or therapeutics for acute disease), many clinical drug trials will exclude them. Clinicians must determine the best course of drug treatment with a dearth of evidence from either clinical or preclinical studies, where at least in the short term they may be more focused on the outcome of the mother than of her offspring.
Changes in the Relationship Between the Variation in Spring Eurasian Snow and the Surface Temperature Over the Northern Hemisphere Around the Late 1980s
Authors: Jia XiaoJing , Wang Min , Qian QiFeng , Wu Renguang
Published: January 2021

The spring snow cover extent (SCE) over central‐eastern Eurasia (SCE_CEE) shows an obvious decrease around 1988. The period 1979–2019 is thus divided into two subperiods spanning 1967–1988 (P1) and 1989–2019 (P2) to investigate the interdecadal changes in the characteristics of the SCE_CEE and its relationship with surface air temperature (SAT) in the Northern Hemisphere. Positive SCE_CEE anomalies are related to a cooler Eurasia–warmer North America (CEWN) spring SAT pattern, which obviously intensifies from P1 to P2. The possible mechanisms responsible for the interdecadal changes in this snow–SAT relationship are investigated. A local energy budget analysis shows that the impact of the SCE_CEE on the overlying atmosphere is weak and the atmospheric circulation anomalies associated with the SCE_CEE variation are confined mainly to eastern Eurasia and the North Pacific in P1. In contrast, positive SCE_CEE anomalies have a significant cooling effect on the atmospheric column through anomalous heat fluxes and wind‐related cold advection in P2. In P2, more SCE_CEE is associated with an anomalous cyclone in the upper atmosphere, which imposes a significant vorticity perturbation near the East Asian westerly jet core and induces eastward propagation of perturbations. The sea surface temperature anomalies in the North Pacific and the North Atlantic as well as the mean flow over the Eurasian continent help to maintain the zonal propagation of this perturbation, thus forming a hemispheric atmospheric wave pattern that contributes to the enhanced snow–CEWN SAT relationship in P2.