bluuebunny/crossref_metadata_2025 huggingface dataset:
Pragmatism, pluralism, and eclecticism: Sil and Katzenstein’s “Analytic eclecticism” in Beyond Paradigms
Authors: Chernoff Fred
Published: October 2020

This paper seeks to show ways in which analytic eclecticism can be strengthened to encourage hybrid theorizing capable of yielding more practically useful principles for foreign policy decision-makers. The paper also seeks to show that some of the advantages of analytic eclecticism are overstated, notably the ability to sidestep difficult questions in the philosophy of social science. Nevertheless, with a proper deepening of their discussion of pragmatism, the core of the practical consequences of analytic eclecticism can be advanced with greater force and with a strengthened methodological rationale.
The Problematics of Language-in-Education Policies in Post-Independence in Zimbabwe
Authors: Nhongo Raphael , Tshotsho Baba Primrose
Published: October 2020

Language policies that are designed in African countries fail to solve communication problems because they are only there to fight the hegemony of English instead of addressing real linguistic problems. The paper analyses the language-in-education policies that were put in place after independence in Zimbabwe. A qualitative approach is used to analyse documents that include the Education Act of 1987, the Nziramasanga Commission, Ministry of Primary and Secondary Education circulars and the Constitution of Zimbabwe. It is argued in this paper that there is a need for the country to come up with policies that are in sync with the linguistic realities that acknowledge the coexistence of languages.
The instrument fault detection and identification based on kernel principal component analysis and coupling analysis in process industry
Authors: Liang Yanjie , Gao Zhiyong , Gao Jianmin , Xu Guangnan , Wang Rongxi
Published: October 2020

This paper investigates the fault detection problem of instruments in process industry. Considering the difficulty of fault identification and the problems of multivariable and large computation complexity based on traditional kernel principal component analysis (KPCA), this paper presents a new method for fault detection and identification, which combines the coupling analysis with kernel principal component for multivariable fault detection and employed the local outlier factor (LOF) for multivariable fault identification. The new method consists of three parts. Firstly, according to nonlinear correlation of multivariable, coupling analysis and module division of variables based on detrended cross-correlation analysis (DCCA) are considered to reduce false alarm rate (FAR) and missed detection rate (MDR) in fault detection and identification. Secondly, KPCA is employed to detect fault in each sub-module of variables. Finally, for the sub-module which has the fault detected in second step, the LOF is adopted to calculate abnormal contribution of each variable in sub-modules to realize fault identification. To prove that the new method has the better capability of processing multivariable fault detection and the more accuracy rate on fault detection and identification than the conventional methods of KPCA, a case study on Tennessee process is carried out at the end.
Building the ship in dry dock: The case for pre-independence constitution-building in Scotland
Authors: Bulmer W Elliot
Published: October 2020

For newly independent states, constitution-building can be a defining moment: a time when national identities are asserted, values and norms articulated, and founding myths created. The constitution-building process is a critical juncture between the divergent paths of stable and well-functioning democracy, on one hand, or persistent instability, coups, repression, and state failure, on the other. But what is the proper relationship of constitution-building to state formation? Should constitution-building occur before or after state formation? Or should the two processes somehow proceed in parallel? To address these questions in a Scottish context, this article draws on state-formation and constitution-building processes in the Westminster-derived tradition. The article considers the advantages and disadvantages of these sequences, and discusses the circumstances in which they might be applicable. It concludes by making some tentative recommendations for a pre-independence constitution-building process in Scotland.
Journalism and science as alternatives for defending Colombian journalists
Authors: González-Quiñones Fidel , Romo-González José Refugio , Laverde María del Rosario , Machin-Mastromatteo Juan D.
Published: October 2020

Colombia is one of the Latin American countries with the most human rights violations directed toward journalists. This article presents a brief review that identifies the main characteristics of Colombian journalism, among others its connections with powerful corporate and political sectors that have facilitated the development of an official kind of journalism that is comfortable with those in power. We also identified another facet, represented by critical journalists, not aligned with official institutions and that have suffered various kinds of violations to their rights, censorship and have even been murdered. Finally, we highlight initiatives that have strived to protect Colombian journalists and we present a proposal for linking science, the academia and investigative journalism.
Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery This Practice Guidelines document has been co-published in Phlebology [DOI: 10.1177/0268355520953759] and Journal of Vascular Surgery: Venous and Lymphatic Disorders [DOI: 10.1016/j.jvsv.2020.06.008]. The publications are identical except for minor stylistic and spelling differences in keeping with each journal’s style. The contribution has been published under a Attribution-Non Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0), (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Authors: Kabnick Lowell S. , Sadek Mikel , Bjarnason Haraldur , Coleman Dawn M. , Dillavou Ellen D. , Hingorani Anil P. , Lal Brajesh K. , Lawrence Peter F. , Malgor Rafael , Puggioni Alessandra
Published: October 2020

The American Venous Forum (AVF) and the Society for Vascular Surgery set forth these guidelines for the management of endothermal heat-induced thrombosis (EHIT). The guidelines serve to compile the body of literature on EHIT and to put forth evidence-based recommendations. The guidelines are divided into the following categories: classification of EHIT, risk factors and prevention, and treatment of EHIT.

One major feature is to standardize the reporting under one classification system. The Kabnick and Lawrence classification systems are now combined into the AVF EHIT classification system. The novel classification system affords standardization in reporting but also allows continued combined evaluation with the current body of literature. Recommendations codify the use of duplex ultrasound for the diagnosis of EHIT. Risk factor assessments and methods of prevention including mechanical prophylaxis, chemical prophylaxis, and ablation distance are discussed.

Treatment guidelines are tailored to the AVF EHIT class (ie, I, II, III, IV). Reference is made to the use of surveillance, antiplatelet therapy, and anticoagulants as deemed indicated, and the recommendations incorporate the use of the novel direct oral anticoagulants. Last, EHIT management as it relates to the great and small saphenous veins is discussed.
Egocentric Distance Perception: A Comparative Study Investigating Differences Between Real and Virtual Environments
Authors: Feldstein Ilja T. , Kölsch Felix M. , Konrad Robert
Published: October 2020

Virtual reality systems are a popular tool in behavioral sciences. The participants’ behavior is, however, a response to cognitively processed stimuli. Consequently, researchers must ensure that virtually perceived stimuli resemble those present in the real world to ensure the ecological validity of collected findings. Our article provides a literature review relating to distance perception in virtual reality. Furthermore, we present a new study that compares verbal distance estimates within real and virtual environments. The virtual space—a replica of a real outdoor area—was displayed using a state-of-the-art head-mounted display. Investigated distances ranged from 8 to 13 m. Overall, the results show no significant difference between egocentric distance estimates in real and virtual environments. However, a more in-depth analysis suggests that the order in which participants were exposed to the two environments may affect the outcome. Furthermore, the study suggests that a rising experience of immersion leads to an alignment of the estimated virtual distances with the real ones. The results also show that the discrepancy between estimates of real and virtual distances increases with the incongruity between virtual and actual eye heights, demonstrating the importance of an accurately set virtual eye height.
The Impact of Neoliberal Evaluation Systems on Rural Schools, Teachers, and their Bilingual Learners
Authors: Ruecker Todd
Published: October 2020

Over the past several decades, neoliberal reformers have had immense success advancing their reforms. While studies have pointed to the negative impact of these reforms on students and literacy instruction, there has been limited work focused on the well-being of teachers and the impact these reforms have on growing teacher shortages, especially in rural schools serving growing numbers of bilingual learners. Drawing on data collected from five rural schools during the implementation in New Mexico of what was dubbed the “toughest teacher evaluation system” in the U.S., this article explores how the evaluation system threatened teacher professional autonomy and career satisfaction, leading to teacher shortages that mirror a nationwide trend in the U.S. While existing work has largely taken a resigned stance towards the continual march of neoliberal education reform, this article closes by emphasizing the agency of individuals and organizations to enact change.
The Effects of Overcrowding on the Rehabilitation of Offenders: A Case Study of a Correctional Center, Durban (Westville), KwaZulu Natal
Authors: Nkosi Nozibusiso , Maweni Vuyelwa
Published: October 2020

The existing misclassifications in correctional centers have negative effects on inmates’ well-being—emotional and physical. This is fueled by overcrowding in correctional centers, making rehabilitation of offenders, as envisaged by the Department of Correctional Services (DCS), an impossible mandate. Overcrowding causes various issues, including poor healthcare, scarcity of resources, lack of nutritious meals, and the perpetuation of violent behavior. The aim of the article is to determine the effects of overcrowding on the rehabilitation process of offenders. This study was conducted at the biggest correctional center (Durban Westville) in KwaZulu-Natal (KZN), with the use of semi-structured interviews with selected inmates and officials at the Medium B facility. The findings of this article reveal the negative physical, social, and psychological effects of overcrowding on the lives of offenders and the effects they have on rehabilitation programs. The article suggests that in order for rehabilitation programs to be a success, decisive steps need to be taken to improve the correctional environment.
CD3-CD20–positive nodal lymphoma with cross-lineage rearrangement in a dog
Authors: Nicoletti Arturo , Aresu Luca , Marino Michele , Massaro Maria , Martignani Eugenio , Caporali Elisa , Capuccini Silvia , Bonfanti Ugo , Gola Cecilia
Published: October 2020

A 7-y-old mixed-breed male dog was presented with a history of generalized lymphadenopathy. Fine-needle aspirates of the enlarged peripheral lymph nodes were suggestive of lymphoma. Histologic examination of a retromandibular lymph node was suggestive of high-grade, medium large-cell lymphoma. Immunohistochemistry revealed concurrent expression of CD3 and CD20. The co-localization of the 2 antigens was confirmed by immunofluorescence. PCR for antigen receptor gene rearrangements (PARR) detected clonal rearrangements for both T-cell receptor gamma and B-cell receptor. The final diagnosis was CD3-CD20–positive anaplastic lymphoma with cross-lineage rearrangement.
Multilevel Methods and Statistics: The Next Frontier
Authors: Eckardt Rory , Yammarino Francis J. , Dionne Shelley D. , Spain Seth M.
Published: October 2020

The purpose of this article is to take stock of extant multilevel methodological and statistical work and highlight needed areas for future research. A basic overview of the history and progression of multilevel methods and statistics in the organizational sciences is provided, as well as a discussion of recent developments to summarize the current state of the science. The eight articles in the current feature topic are also summarized and integrated to depict several themes and directions for the next wave of multilevel methods and statistics. Last, to highlight what still needs to be accomplished in the field, several unresolved issues and future research topics are noted and an agenda related to future multilevel work is discussed.
Scabies: Diagnostic and Therapeutic Update
Authors: Richards Robert N.
Published: October 2020

Background

Scabies is globally ubiquitous and is a significant health issue for institutions, the economically disenfranchised, resource-poor areas, and for those with weakened immune systems. Topicals are usually effective, but are cumbersome and expensive to use in large populations and for those nonadherent to topicals. Oral ivermectin became available in Canada for the off-label treatment of scabies in the fall 2018.

Objectives

To review the diagnosis and management of scabies. Dose schedules and concomitant management measures are outlined for scabies simplex and for crusted scabies. Ivermectin use is outlined.

Methods

Medline, colleague discussions, practice review, and experience from managing scabies in institutions.

Results

Oral ivermectin is safe, easier to use, cheaper, more effective, and more economical than topicals in widespread institutional scabies, for those nonadherent to topicals, and in crusted scabies.

Conclusions

Oral ivermectin is the treatment of choice in large populations, the nonadherent, and for crusted scabies. Oral ivermectin is produced by Merck Canada as Stromectol 3 mg. The treatment dose for noncrusted scabies is 200 µg/kg, taken in a single dose with food. For example, 15 mg (5 tablets) for a 70 kg person. Retreat in 10-14 days to enhance effectiveness, and perhaps to reduce scabicide resistance.
Trends in alcohol consumption among older adults in Denmark in the 21st century
Authors: Jensen Heidi Amalie Rosendahl , Bloomfield Kim , Lau Cathrine Juel , Ekholm Ola
Published: October 2020

Background:

Previous studies have indicated that the alcohol consumption among older Danish individuals has increased during the last three decades of the 20th century. However, the research is limited and, hence, the aim of the present article is to describe the trends and peculiarities in the development of the present situation in older people’s drinking patterns in Denmark.

Methods:

Data were obtained from the Danish Health and Morbidity Survey (2005) and the Danish National Health Survey (2010, 2013, and 2017). Data used in this study were collected via self-administered questionnaires from random samples of the adult (≥ 16 years) Danish population. Response rates varied between 50.8% (2005) and 59.5% (2010). Drinking patterns are described using the following indicators: alcohol consumption during the past 12 months; alcohol consumption at least two days a week; mean number of standard drinks consumed in a typical week and heavy episodic drinking (at least monthly). Results are presented as percentages or means.

Results:

The prevalence of overall 12-month alcohol use in all individuals aged 60 years or older has slightly increased between 2010 (83.9%) and 2017 (85.2%). On the other hand, the prevalence of consuming alcohol at least twice a week has overall decreased slightly between 2010 (54.0%) and 2017 (52.0%) in the same age group. A decrease was also observed in the mean number of standard drinks consumed in a typical week, from 8.3 in 2010 to 7.0 in 2017. Additionally, the prevalence of consuming at least five standard drinks on one occasion at least monthly decreased markedly from 24.8% in 2005 to 14.8% in 2013 (the prevalence remained stable between 2013 and 2017). The trends in prevalence of various alcohol indicators varied by sex and age.

Conclusions:

The findings of this study suggest an overall decline in alcohol consumption among older Danes in the study period. The continuation of this trend will be the subject of future studies.
Development of multibody dynamical using MR damper based semi-active bio-inspired chaotic fruit fly and fuzzy logic hybrid suspension control for rail vehicle system
Authors: Bhardawaj Sono , Sharma Rakesh Chandmal , Sharma Sunil Kumar
Published: October 2020

In this paper, the semi-active suspension in railway vehicles based on the controlled Magnetorheological (MR) fluid dampers is examined, and compared with the semi-active low and semi-active high suspension systems to enhance the running safety, ride quality and ride comfort for a high-speed rail vehicle. Fuzzy logic and chaotic fruit fly control techniques are used as system controllers to determine desired damping forces for front and rear bogie frame with force track-ability of system controllers. A 28 degrees of freedom (DoF) mathematical model of the rail vehicle is formulated using nonlinear vehicle suspension and nonlinear heuristic creep model. The Modified Dahl model is formulated to characterize the behavior of the MR damper. The simulation result is validated using the experimental results. Four different suspension strategies are proposed with MR damper i.e. passive, semi-active low, semi-active high and semi-active intelligent compound controller based on bio-inspired chaotic fruit and fuzzy logic hybrid controller. A comparison indicates that the semi-active controller gives the optimum performance based on frequency and time response analysis for comfort vibration actuation (9.088 to 15.33%), ride quality (14.81–20.73%) and comfort (24.91–27.81%) and it has little influence on derailment quotients, offload factors, as a result, it will not endanger the running safety of rail vehicle.
A Potential Tumor Suppressor Gene Named miR-508-5p Inhibited the Proliferation and Invasion of Human Melanoma Cells by Targeting KIT
Authors: Dang Lin , Wang Yan , Shi Cuiping , Liao Mengsi , Sun Zhaojun , Fang Sining
Published: October 2020

Melanoma is the main death cause of human skin cancer. Increasing evidences demonstrate that microRNAs act as key roles in mediating tumor occurrence and progression. MiR-508-5p has proved to participate in the development of various types of human malignancies. However, the role of miR-508-5p in melanoma remained unclear. In in vitro study, miR-508-5p level in peripheral blood samples of patients with melanoma and human melanoma A375 cells was downregulated compared to that in normal peripheral blood samples or normal human epidermal melanocytes (MHEM). MiR-508-5p overexpression significantly inhibited the cell proliferation, migration and invasion in A375 cells, and thus inhibiting KIT expression at both gene and protein levels. Furthermore, western blot analysis showed miR-508-5p reduced cell proliferation by targeting KIT to modulate RAS/RAF/MEK/ERK pathway. Taken together, we speculated that miR-508-5p functioned as an important suppressor in human melanoma by targeting KIT, suggesting miR-508-5p might be a promising tumor suppressor gene for further target therapies from bench to clinic.
A Class Act: An interview with Julie Hesmondhalgh on casting, representation and inclusion in British television drama
Authors: Hogg Christopher
Published: October 2020

In this interview, actor Julie Hesmondhalgh reflects on her rich body of work in British TV drama, connecting her own career trajectory with a consideration of wider industry developments in casting and representation, diversity and inclusion. With extended reference to Coronation Street (1960–) and Doctor Who (1963–1989, 2005–), Hesmondhalgh discusses how far UK TV drama production has come in tackling systemic inequalities and exclusions, while also stressing the progress still required, particularly in relation to capturing the complexities of class identity. More broadly, the insights offered within this piece illustrate the value of industry interviews as a methodological approach for TV studies, in revealing the experiences and perspectives of key creative agents within the production process.
Does the content of financial literacy education resources vary based on who made or paid for them?
Authors: Henderson Gail E , Beach Pamela , Sun Lucy , McConnel Jennifer
Published: October 2020

In the decade since the global financial crisis, an increasing number of jurisdictions have added mandatory financial literacy education to school curricula. Governments recognize that this increases the burden on teachers, who may also lack the confidence to teach financial literacy. One response is to encourage the use of resources produced or sponsored by the financial services industry. The concern is that these resources may promote the industry’s interest in maximizing profits and minimizing regulation over students’ interest in becoming empowered financial consumers. As a first step in investigating this concern, we compared resources from the Canadian Financial Literacy Database produced or sponsored by the financial services industry with those produced by government, non-profit organizations and individuals. We focused on online resources intended for use by elementary teachers and students to determine whether the key themes and messages conveyed vary based on who made or paid for the resource. We found that key themes are consistent across resources, regardless of industry affiliation, but that resources produced or sponsored by the financial services industry are more likely to exhibit a moralistic tone.
Comparing Experiential Legal Education in Canada and India
Authors: Mammen Rhea Roy
Published: October 2020

Legal education has evolved over several centuries across the globe, and its effectiveness is a matter of significant concern not merely for legal practitioners but also for society in general. One approach that has been gaining considerable attention is the concept of experiential legal education, which is at different levels of implementation across the world. Countries such as the United States and Canada have been pioneers in implementing this form of legal education, which is also known as clinical legal education (CLE), whereas India is striving to catch up. This article attempts to inspect and compare the development and implementation of CLE in Canada and India. The findings from the comparison are then utilized to inform the way ahead for CLE in India. While pursuing this objective, the article also examines the concept of experiential education, in general, and in the context of legal education, in particular. Moreover, insights are provided regarding CLE. The status of experiential legal education in Canada is reviewed, and the author’s experience in Canada under the Shastri Research Student Fellowship (SRSF) is detailed to provide the author’s insights regarding the implementation of experiential legal education in Canada. The evolution of experiential legal education in India is also detailed, together with insights regarding the regulations of the Bar Council of India (BCI) as are relevant to CLE. Finally, the article compares the author’s opinion of the present status of CLE in Canada and India and provides recommendations to enhance the future implementation of CLE in India.
A Rare Case Report of Septic Embolism and Infective Endocarditis due to Nocardia farcinia from North India
Authors: Singh Sweta , Singh Uday Shanker
Published: October 2020

Nocardia farcinia endocarditis is an extremely rare phenomenon. It is an opportunistic ubiquitously present pathogen in the environment. Here, we present an unusual case of septic embolism with infective endocarditis due to Nocardia spp. in a 55-year-old chronic alcoholic male. Radiological imaging techniques and microbiological investigations helped in the timely diagnosis. Timely institution of treatment based on sensitivity results resulted in favorable outcome in the patient.
Cavitation of a Submerged Jet at the Spherical Valve Plate/Cylinder Block Interface for Axial Piston Pump
Authors: Zhao Bin , Guo Weiwei , Quan Long
Published: October 2020

The spherical valve plate/cylinder block pair has the advantages of strong overturning resistance and large bearing area. However, the configurations of the unloading and pre-boosting triangular grooves on the spherical valve plate are different from those in the planar valve plate, resulting in special cavitation phenomenon on the spherical port plate pair. In order to study cavitation characteristics of spherical port plate pair, a dynamic CFD model of the piston pump including turbulence model, cavitation model and fluid compressibility is established. A detailed UDF compilation scheme is provided for modelling of the micron-sized spherical oil film mesh, which makes up for the lack of research on the meshing of the spherical oil film. In this paper, using CFD simulation tools, from the perspectives of pressure field, velocity field and gas volume fraction change, a detailed analysis of the transient evolution of the submerged cavitation jet in a axial piston pump with spherical valve plate is carried out. The study indicates the movement direction of the cavitation cloud cluster through the cloud image and the velocity vector direction of the observation point. The sharp decrease of velocity and gas volume fraction indicates the collapse phenomenon of bubbles on the part wall surface. These discoveries verify the special erosion effect in case of the spherical valve plate/cylinder block pair. The submerged cavitation jet generated by the unloading triangular grooves distributed on the spherical valve plate not only cause denudation of the inner wall surface of the valve plate, but also cause strong impact and denudation on the lower surface of the cylinder body. Finally, the direction of the unloading triangular groove was modified to extend the distance between it and the wall surface which can effectively alleviate the erosion effect.
Penile fracture in a Peyronie’s disease patient: a case report
Authors: Hidayatullah Nur , Kholis Khoirul , Palinrungi Muhammad Asykar , Syahrir Syakri , Syarif Syarif , Faruk Muhammad
Published: October 2020

Background

Penile curvature in men with Peyronie’s disease (PD)—caused by tunica anchoring plaques with loss of focal fiber elasticity—theoretically increases the risk of penile fracture during sexual activity. Penile fracture is the result of tearing of the tunica albuginea of one or both corpora cavernosa, usually during sexual intercourse, and is among the most serious urological emergencies. Generally, a patient presented to a surgical emergency within 48 h of injury can be handled successfully with minimum complications. Immediate surgical treatment is the current standard of care and has a relatively low risk of late complications.

Case presentation

We present a case of penile fracture in a male with a history of PD referred to the emergency department with severe pain. Clinical history assessment and physical examination revealed a penile fracture with underlying PD. He underwent emergency surgical exploration via subcoronal incision. Penile plication was not necessary for our case because the angulation of the penis was less than 15° after examination of artificial erection.

Conclusion

Penile fracture in a patient with underlying PD is a rare urological emergency that should be treated surgically with fracture repair as early as possible. Penile plication might be necessary in severe cases (angulation > 60°).
Views of advanced cancer patients, families, and oncologists on initiating and engaging in advance care planning: a qualitative study
Authors: Toguri J. T. , Grant-Nunn L. , Urquhart R.
Published: October 2020

Background

Advance care planning (ACP) is a process by which patients reflect upon their goals, values and beliefs to allow them to make decisions about their future medical treatment that align with their goals and values, improving patient-centered care. Despite this, ACP is underutilized and is reported as one of the most difficult processes of oncology. We sought to: 1) explore patients’ and families’ understanding, experience and reflections on ACP, as well as what they need from their physicians during the process; 2) explore physicians’ views of ACP, including their experiences with initiating ACP and views on ACP training.

Methods

This was a qualitative descriptive study in Nova Scotia, Canada with oncologists, advanced cancer out-patients and their family members. Semi-structured interviews with advanced cancer out-patients and their family members (n = 4 patients, 4 family members) and oncologists (n = 10) were conducted; each participant was recruited separately. Data were analyzed using constant comparative analysis, which entailed coding, categorizing, and identifying themes recurrent across the datasets.

Results

Themes were identified from the patient / family and oncologist groups, four and five respectively. Themes from patients / families included: 1) positive attitudes towards ACP; 2) healthcare professionals (HCPs) lack an understanding of patients’ and families’ informational needs during the ACP process; 3) limited access to services and supports; and 4) poor communication between HCPs. Themes from oncologists included: 1) initiation of ACP discussions; 2) navigating patient-family dynamics; 3) limited formal training in ACP; 4) ACP requires a team approach; and 5) lack of coordinated systems hinders ACP.

Conclusions

Stakeholders believe ACP for advanced cancer patients is important. Patients and families desire earlier and more in-depth discussion of ACP, additional services and supports, and improved communication between their HCPs. In the absence of formal training or guidance, oncologists have used clinical acumen to initiate ACP and a collaborative healthcare team approach.
Left atrial strain and diastolic function abnormalities in obese and type 2 diabetic adolescents and young adults
Authors: Steele Jeremy M. , Urbina Elaine M. , Mazur Wojciech M. , Khoury Philip R. , Nagueh Sherif F. , Tretter Justin T. , Alsaied Tarek
Published: October 2020

Background

Adults with obesity and type 2 diabetes mellitus (T2DM) related to obesity are at increased risk of heart failure with preserved ejection fraction (HFpEF). Whether left ventricular (LV) diastolic function abnormalities related to obesity and T2DM start in adolescence and early adulthood is unknown. We non-invasively evaluated the differences seen in LV diastolic and left atrial (LA) function in adolescents and young adults with obesity and T2DM.

Methods

We analyzed echocardiographic measures of LV diastolic function in patients with structurally normal hearts which were divided into 3 groups (normal weight, obese, and T2DM). Spectral and tissue Doppler and 2-D speckle tracking measurements of diastolic function were obtained. Logistic regression was performed to compare the prevalence of abnormalities in diastolic function based on the worst 25th percentile for each measure to determine the prevalence of diastolic and LA function abnormalities in obese and T2DM patients.

Results

331 teenagers and young adults (median age 22.1 years) were analyzed (101 normal weight, 114 obese, 116 T2DM). Obese and T2DM group had lower E/A and higher E/e′. Obese and T2DM patients had significantly lower atrial reservoir, conduit, and booster strain and worse reservoir and conduit strain rate compared to normal patients (p < 0.001 for all measures). All patients had normal LA volumes. On multivariable analysis, conduit strain and reservoir and conduit strain rate were independently associated with having below the 25th percentile e′. Conduit strain rate was independently associated with having below the 25th percentile for mitral E/A ratio on multivariable analysis.

Conclusions

Abnormal indices of LV diastolic function are detected in adolescents and young adults with obesity and T2DM. LA function and strain analysis were able to detect evidence of decreased reservoir, conduit, and booster strain in these patients although LA volume was normal. The use of LA function strain may increase our ability to detect early diastolic function abnormalities in this population.
The temperature of growth and sporulation modulates the efficiency of spore-display in Bacillus subtilis
Authors: Petrillo Claudia , Castaldi Stefany , Lanzilli Mariamichela , Saggese Anella , Donadio Giuliana , Baccigalupi Loredana , Ricca Ezio , Isticato Rachele
Published: October 2020

Background

Bacterial spores displaying heterologous antigens or enzymes have long been proposed as mucosal vaccines, functionalized probiotics or biocatalysts. Two main strategies have been developed to display heterologous molecules on the surface of Bacillus subtilis spores: (i) a recombinant approach, based on the construction of a gene fusion between a gene coding for a coat protein (carrier) and DNA coding for the protein to be displayed, and (ii) a non-recombinant approach, based on the spontaneous and stable adsorption of heterologous molecules on the spore surface. Both systems have advantages and drawbacks and the selection of one or the other depends on the protein to be displayed and on the final use of the activated spore. It has been recently shown that B. subtilis builds structurally and functionally different spores when grown at different temperatures; based on this finding B. subtilis spores prepared at 25, 37 or 42 °C were compared for their efficiency in displaying various model proteins by either the recombinant or the non-recombinant approach.

Results

Immune- and fluorescence-based assays were used to analyze the display of several model proteins on spores prepared at 25, 37 or 42 °C. Recombinant spores displayed different amounts of the same fusion protein in response to the temperature of spore production. In spores simultaneously displaying two fusion proteins, each of them was differentially displayed at the various temperatures. The display by the non-recombinant approach was only modestly affected by the temperature of spore production, with spores prepared at 37 or 42 °C slightly more efficient than 25 °C spores in adsorbing at least some of the model proteins tested.

Conclusion

Our results indicate that the temperature of spore production allows control of the display of heterologous proteins on spores and, therefore, that the spore-display strategy can be optimized for the specific final use of the activated spores by selecting the display approach, the carrier protein and the temperature of spore production.
Using implementation science to mitigate worsening health inequities in the United States during the COVID-19 pandemic
Authors: Jacobson Tyler A. , Smith Lauren E. , Hirschhorn Lisa R. , Huffman Mark D.
Published: October 2020

With the threat of coronavirus disease 2019 (Covid-19) enduring in the United States, effectively and equitably implementing testing, tracing, and self-isolation as key prevention and detection strategies remain critical to safely re-opening communities. As testing and tracing capacities increase, frameworks are needed to inform design and delivery to ensure their effective implementation and equitable distribution, and to strengthen community engagement in slowing and eventually stopping Covid-19 transmission. In this commentary, we highlight opportunities for integrating implementation research into planned and employed strategies in the United States to accelerate reach and effectiveness of interventions to more safely relax social distancing policies and open economies, schools, and other institutions. Implementation strategies, such as adapting evidence-based interventions based on contextual factors, promoting community engagement, and providing data audit and feedback on implementation outcomes, can support the translation of policies on testing, tracing, social distancing, and public mask use into reality. These data can demonstrate how interventions are put into practice and where adaptation in policy or practice is needed to respond to the needs of specific communities and socially vulnerable populations. Incorporating implementation research into Covid-19 policy design and translation into practice is urgently needed to mitigate the worsening health inequities in the pandemic toll and response. Applying rigorous implementation research frameworks and evaluation systems to the implementation of evidence-based interventions which are adapted to contextual factors can promote effective and equitable pandemic response and accelerate learning both among local stakeholders as well as between states to further inform their varied experiences and responses to the pandemic.
Perspectives of clients and providers on factors influencing opioid agonist treatment uptake among HIV-positive people who use drugs in Indonesia, Ukraine, and Vietnam: HPTN 074 study
Authors: Kiriazova Tetiana , Go Vivian F. , Hershow Rebecca B. , Hamilton Erica L. , Sarasvita Riza , Bui Quynh , Lancaster Kathryn E. , Dumchev Kostyantyn , Hoffman Irving F. , Miller William C. , Latkin Carl A.
Published: October 2020

Background

Opioid agonist treatment (OAT) is an effective method of addiction treatment and HIV prevention. However, globally, people who inject drugs (PWID) have insufficient OAT uptake. To expand OAT access and uptake, policymakers, program developers and healthcare providers should be aware of barriers to and facilitators of OAT uptake among PWID.

Methods

As a part of the HPTN 074 study, which assessed the feasibility of an intervention to facilitate HIV treatment and OAT in PWID living with HIV in Indonesia, Ukraine, and Vietnam, we conducted in-depth interviews with 37 HIV-positive PWID and 25 healthcare providers to explore barriers to and facilitators of OAT uptake. All interviews were audio-recorded, transcribed, translated into English, and coded in NVivo for analysis. We developed matrices to identify emergent themes and patterns.

Results

Despite some reported country-specific factors, PWID and healthcare providers at all geographic locations reported similar barriers to OAT initiation, such as complicated procedures to initiate OAT, problematic clinic access, lack of information on OAT, misconceptions about methadone, financial burden, and stigma toward PWID. However, while PWID reported fear of drug interaction (OAT and antiretroviral therapy), providers perceived that PWID prioritized drug use over caring for their health and hence were less motivated to take up ART and OAT. Motivation for a life change and social support were reported to be facilitators.

Conclusion

These results highlight a need for support for PWID to initiate and retain in drug treatment. To expand OAT in all three countries, it is necessary to facilitate access and ensure low-threshold, financially affordable OAT programs for PWID, accompanied with supporting interventions. PWID attitudes and beliefs about OAT indicate the need for informational campaigns to counter misinformation and stigma associated with addiction and OAT (especially methadone).
Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study
Authors: Ranabhat Chhabi Lal , Subedi Radha , Karn Sujeet
Published: October 2020

Background

Compared to other countries in the South Asia Nepal has seen a slow progress in the coverage of health insurance. Despite of a long history of the introduction of health insurance (HI) and a high priority of the government of Nepal it has not been able to push rapidly its social health insurance to its majority of the population. There are many challenges while to achieve universal health insurance in Nepal ranging from existing policy paralysis to program operation. This study aims to identify the enrollment and dropout rates of health insurance and its determinants in selected districts of Nepal.

Methods

The study was conducted while using a mixed method including both quantitative and qualitative approaches. Numerical data related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were selected purposively. Enrollment assistants (EA) of social health insurance program were taken as the participants of study. Focus group discussions (FGD) were arranged with the selected EAs using specific guidelines along with unstructured questions. The results from numerical data and focus group discussions are synthesized and presented accordingly.

Results

The findings of the study suggested variation in enrollment and dropout of health insurance in the districts. Enrollment coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to 2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967 (38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than one-third proportion was subsidy enrollment—free enrollment for vulnerable groups. The population characteristics of unwilling and dropout in social health insurance came from relatively well-off families, government employees, businessman, migrants’ people, some local political leaders as well as the poor class families. The major determinants of poor enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior of health workers, and indifferent behavior of the care personnel to the insured patients in health care facilities and prefer to take health service in private clinic for their own benefits. The long maturation time to activate health service, limited health package and lack of copayment in different types of health care were the factors related to inefficient program and policy implementation.

Conclusion

There is a high proportion of dropout and subsidy enrollment, the key challenge for sustainability of health insurance program in Nepal. Revisiting of existing HI policy on health care packages, more choices on copayment, capacity building of enrollment assistants and better coordination between health insurance board and health care facilities can increase the enrollment and minimize the dropout.
Efficacy and safety of intraarticular corticosteroid injections in adolescents with juvenile idiopathic arthritis in the temporomandibular joint: a Norwegian 2-year prospective multicenter pilot study
Authors: Frid Paula , Augdal Thomas A. , Larheim Tore A. , Halbig Josefine , Rypdal Veronika , Songstad Nils Thomas , Rosén Annika , Tylleskär Karin B. , Berstad Johanna Rykke , Flatø Berit , Stoustrup Peter , Rosendahl Karen , Kirkhus Eva , Nordal Ellen
Published: October 2020

Background

Intraarticular corticosteroids (IACs) have been used to treat temporomandibular joint (TMJ) arthritis. However, prospective clinical studies with magnetic resonance imaging (MRI) scoring are lacking. The aim of this study was to examine efficacy and safety of a single IAC in the TMJ in adolescents with juvenile idiopathic arthritis (JIA) in a clinical setting.

Methods

In this Norwegian prospective multicenter pilot study 15 patients with JIA (mostly persistent oligoarthritis or RF negative polyarthritis categories) and a clinically and MRI-verified diagnosis of TMJ arthritis were treated with IACs and followed for 2 years. Demographics, systemic medication, general disease activity and outcome measures were recorded including a pain-index score and maximal incisal opening (MIO). Inflammation and bone damage scores were assessed, using two recently published MRI scoring systems with masked radiological evaluation.

Results

Among the 15 patients, 13 received a single IAC (5 bilateral), and 2 repeated IACs once unilaterally. Thus, the total number of IACs was 22. Median age was 15 years and the majority had an age not thought of as critical regarding mandibular growth retardation due to steroid injection. During the 2-year observation period systemic medication with disease modifying antirheumatic drugs (DMARDs) including biologics was initiated or adjusted in 10/15 (67%) patients. At the 2-months study visit after injection we observed a minimal improvement in MIO from median 44 (1st, 3rd quartiles; 36, 48) mm to 45 (43, 47) mm, p = 0.045 and decreased MRI mean additive inflammatory score from 4.4 ± 1.8 standard deviations (SD) to 3.4 ± 2.0, p = 0.040. From baseline to the 2-months follow-up pain improved in 6/11 patients but pain scores were not significantly improved. MRI-assessed damage increased in two patients with repeated IACs, and decreased in 3 patients but most of the patients were stable over the 2-year follow-up. Intra-rater repeatability of the MRI scoring system domains varied from poor to excellent.

Conclusions

In this pilot study of predominately single IACs to the TMJ in combination with systemic treatment we observed improvement in MRI-assessed inflammation, mostly stable condylar bone conditions and minimal clinical improvement in adolescents with JIA and TMJ arthritis. No severe side effects were seen.
The impact of diabetes mellitus on acute kidney injury after coronary artery bypass grafting
Authors: Wang Rui , Zhang Hang , Zhu Yifan , Chen Wen , Chen Xin
Published: October 2020

Background

Diabetes mellitus(DM) is an indicator affects postoperative mortality and morbidity after coronary artery bypass grafting (CABG). Acute kidney injury (AKI) is one of the frequent postoperative complications after CABG. This multi-centre register study designed to investigate the impact of DM on postoperative AKI in primary isolated CABG patients.

Methods

We included all patients (n = 4325) from Jiangsu Province CABG register who underwent primary isolated CABG from September 2017 to August 2019. The patients were divided into 3 groups: No-DM group(n = 3067), DM-oral group (DM with oral hypoglycemic agents, n = 706) and DM-insulin group (DM with insulin treatment, n = 552). The development and severity of AKI were based on Acute Kidney Injury Network (AKIN) criteria.

Results

There were totally 338, 108 and 145 patients developed AKI in No-DM, DM-oral and DM-insulin group respectively. Comparing with No-DM group, DM-oral group had a higher rate of AKI(χ2 = 10.071, p = 0.002), DM-insulin group had a higher rate(χ2 = 94.042, p<0.001) and severity of AKI(χ2 = 10.649, p = 0.005). The adjusted odds ratio for AKI was 1.26 (95% CI 1.03–1.57) in DM-oral group and 3.92 (95% CI 3.27–5.16) in DM-insulin group, in comparison with No-DM group.

Conclusions

Independent of baseline renal function or cardiac function, DM was associated with an increased risk of AKI after CABG, especially in patients with insulin treatment, who also had a higher severity of AKI.