bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Dental Office Lighting Intensity Conditions Influence the Accuracy of Intraoral Scanning?
Authors: Jivanescu Anca , Faur Andrei-Bogdan , Rotar Raul Nicolae
Published: May 2021

The aim of this study was to evaluate the influence of different settings of ambient light intensity inside the dental office on the accuracy (trueness and precision) of an intraoral scanner (IOS). A full crown preparation was conducted on a resin molar which was scanned using a high resolution extraoral scanner to obtain a reference model. Six light settings were chosen based on the most clinically relevant light conditions inside the workspace, and the preparation was scanned using an intraoral scanner (PlanScan, Planmeca). The obtained data was analyzed using a professional 3D quality control software (Geomagic Control X). There was no statistically relevant difference between the groups when regarding trueness, although a slight influence of the light intensity could be observed on the trueness values. Regarding precision, the best results were obtained in the 3800 lux group, with the other groups presenting close values, excepting the extreme values (400 lux and 11 000 lux) groups that proved to be the most deficient.
Enhancement of the Capability Maturity Model for Improving the Quality of Software Projects in Developing Countries
Authors: Hou Li , Liu Qi , Saeed Kiran , Ali Haidery Saqib , Uddin M. Irfan , Khattak Hizbullah
Published: May 2021

Business process modeling was suggested by academia and implemented by the industry to trigger device requirements. Maturity models of software processes are also similar in the software industry. Therefore, business software requirement engineering approaches-based process should aim to fulfil with the maturity models. Although researchers in the area of Software Engineering, Project Management, and Business Intelligent have addressed planning and execution and a lot of research still needs to be done, in this study, we focused on doing a questionnaire based on different prominent universities, major companies, and software houses. The purpose of the questionnaire was to dig out the main factors that negatively affect software houses and their products and services, especially in the medical field. A questionnaire was generated to accomplish these reasons, and interviews were conducted to extract the key explanation why software developers and software houses in developing countries are not familiar with the CMMI (Capability Maturity Model Integration) model for medical software projects. This analysis attempted to figure out why the tech enterprises of developing countries are behind foreign competitors. We aimed to determine why software developers do not meet the international requirements for software. The novelty of the research is that attempts were made to strengthen the new approach by adding agile at level 3 to keep the local software industry appropriate and reveal the requirements for medical software life cycle study, because accurate decision support is really necessary for healthcare systems.
A Subjetividade e as Imagens Alheias: Ressignificação
Authors: Bernadet Jean-Claude
Published: May 2021

Este texto é uma reflexão em torno de dois filmes que realizei, São Paulo sinfonia e cacofonia em 1995, e em 1999, Sobre anos 60. Ambos foram feitos com material de arquivo, o primeiro na totalidade, o segundo tem menos de 10% de filmagens adicionais. Quando São Paulo sinfonia e cacofonia foi apresentado pela primeira vez, Ismail Xavier fez uma piada: você publica um livro contra o cinema de autor e faz um filme de autor. É esta piada que quero comentar aqui. E outra também, esta de Roberto Moreira: você trabalha com imagens prostitutas.
Simultaneous Pharmacologic Inhibition of Yes‐Associated Protein 1 and Glutaminase 1 via Inhaled Poly(Lactic‐co‐Glycolic) Acid–Encapsulated Microparticles Improves Pulmonary Hypertension
Authors: Acharya Abhinav P. , Tang Ying , Bertero Thomas , Tai Yi‐Yin , Harvey Lloyd D. , Woodcock Chen‐Shan C. , Sun Wei , Pineda Ricardo , Mitash Nilay , Königshoff Melanie , Little Steven R. , Chan Stephen Y.
Published: May 2021

Background

Pulmonary hypertension (PH) is a deadly disease characterized by vascular stiffness and altered cellular metabolism. Current treatments focus on vasodilation and not other root causes of pathogenesis. Previously, it was demonstrated that glutamine metabolism, as catalyzed by GLS1 (glutaminase 1) activity, is mechanoactivated by matrix stiffening and the transcriptional coactivators YAP1 (yes‐associated protein 1) and transcriptional coactivator with PDZ‐binding motif (TAZ), resulting in pulmonary vascular proliferation and PH. Pharmacologic inhibition of YAP1 (by verteporfin) or glutaminase (by CB‐839) improved PH in vivo. However, systemic delivery of these agents, particularly YAP1 inhibitors, may have adverse chronic effects. Furthermore, simultaneous use of pharmacologic blockers may offer additive or synergistic benefits. Therefore, a strategy that delivers these drugs in combination to local lung tissue, thus avoiding systemic toxicity and driving more robust improvement, was investigated.

Methods and Results

We used poly(lactic‐co‐glycolic) acid polymer‐based microparticles for delivery of verteporfin and CB‐839 simultaneously to the lungs of rats suffering from monocrotaline‐induced PH. Microparticles released these drugs in a sustained fashion and delivered their payload in the lungs for 7 days. When given orotracheally to the rats weekly for 3 weeks, microparticles carrying this drug combination improved hemodynamic (right ventricular systolic pressure and right ventricle/left ventricle+septum mass ratio), histologic (vascular remodeling), and molecular markers (vascular proliferation and stiffening) of PH. Importantly, only the combination of drug delivery, but neither verteporfin nor CB‐839 alone, displayed significant improvement across all indexes of PH.

Conclusions

Simultaneous, lung‐specific, and controlled release of drugs targeting YAP1 and GLS1 improved PH in rats, addressing unmet needs for the treatment of this deadly disease.
Implantable Cardioverter‐Defibrillator Shocks During COVID‐19 Outbreak
Authors: Adabag Selçuk , Zimmerman Patrick , Black Adam , Madjid Mohammad , Safavi‐Naeini Payam , Cheng Alan
Published: May 2021

Background

COVID‐19 was temporally associated with an increase in out‐of‐hospital cardiac arrests, but the underlying mechanisms are unclear. We sought to determine if patients with implantable defibrillators residing in areas with high COVID‐19 activity experienced an increase in defibrillator shocks during the COVID‐19 outbreak.

Methods and Results

Using the Medtronic (Mounds View, MN) Carelink database from 2019 and 2020, we retrospectively determined the incidence of implantable defibrillator shock episodes among patients residing in New York City, New Orleans, LA, and Boston, MA. A total of 14 665 patients with a Medtronic implantable defibrillator (age, 66±13 years; and 72% men) were included in the analysis. Comparing analysis time periods coinciding with the COVID‐19 outbreak in 2020 with the same periods in 2019, we observed a larger mean rate of defibrillator shock episodes per 1000 patients in New York City (17.8 versus 11.7, respectively), New Orleans (26.4 versus 13.5, respectively), and Boston (30.9 versus 20.6, respectively) during the COVID‐19 surge. Age‐ and sex‐adjusted hurdle model showed that the Poisson distribution rate of defibrillator shocks for patients with ≥1 shock was 3.11 times larger (95% CI, 1.08–8.99;
P
=0.036) in New York City, 3.74 times larger (95% CI, 0.88–15.89;
P
=0.074) in New Orleans, and 1.97 times larger (95% CI, 0.69–5.61;
P
=0.202) in Boston in 2020 versus 2019. However, the binomial odds of any given patient having a shock episode was not different in 2020 versus 2019.

Conclusions

Defibrillator shock episodes increased during the higher COVID‐19 activity in New York City, New Orleans, and Boston. These observations may provide insights into COVID‐19–related increase in cardiac arrests.
New‐Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long‐Term Risk of Adverse Events: An Analysis From the CORONARY Trial
Authors: Conen David , Wang Michael K. , Devereaux P. J. , Whitlock Richard , McIntyre William F. , Healey Jeff S. , Yuan Fei , Yusuf Salim , Lamy Andre
Published: May 2021

Background

Perioperative atrial fibrillation (POAF) is common in patients undergoing cardiac surgery. Conflicting evidence exists whether patients with POAF after cardiac surgery have an increased long‐term risk of stroke and other adverse events.

Methods and Results

We prospectively followed for up to 5 years 4624 patients without prior atrial fibrillation who underwent coronary artery bypass grafting in an international study. POAF was defined as atrial fibrillation that occurred during the initial hospitalization for surgery, lasted for ≥5 minutes, and required treatment. Outcomes assessed were a composite of death, nonfatal myocardial infarction or nonfatal stroke, and its individual components. Median age was 67 years, and 778 (16.8%) had an episode of POAF. The incidence of the composite outcome was 6.84 and 4.10 per 100 patient‐years in patients with and without POAF, and the incidence of stroke was 0.75 versus 0.45, respectively. The adjusted hazard ratios (aHRs) were 1.36 (95% CI, 1.16–1.59) for the composite outcome; 1.33 (95% CI, 1.10–1.61) for death; 1.58 (95% CI, 1.23–2.02) for myocardial infarction, and 1.27 (95% CI, 0.81–2.00) for stroke. In a landmark analysis excluding events of the initial hospital admission, the aHRs were 1.26 (95% CI, 1.03–1.54) for the composite outcome, 1.28 (95% CI, 1.03–1.59) for death, 1.70 (95% CI, 0.86–3.36) for myocardial infarction, and 1.07 (95% CI, 0.59–1.93) for stroke. At hospital discharge, 10.7% and 1.4% of patients with and without POAF received oral anticoagulation, respectively.

Conclusions

Patients with POAF after cardiac surgery had an increased long‐term risk of adverse outcomes, mainly death and myocardial infarction. The risk of stroke was low and not increased in patients with POAF.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00463294.
The Decline of Green-Glazed Jars after the Early Abbasid Period
Authors: Harvey Elon
Published: May 2021

Green-glazed jars were manufactured in southern Iraq during the Parthian, Sasanian, and early Islamic periods. In the latter period, they were distributed in great numbers in the Near East and in coastal areas along the Indian Ocean from the Horn of Africa to China and Japan. The jars are thought to have been used chiefly for storing “date-syrup.” Around the 4th/10th century their production was significantly reduced and their prevalence greatly declined, a phenomenon that has puzzled archeologists. In this study, I identify these jars with “the green jars” (al-jarr al-akhḍar or ḥantam) mentioned in some classical Islamic texts. According to numerous Ḥadīth, the Prophet prohibited nabīdh (date-wine) in “green jars.” While many Muslim jurists held that the Prophet withdrew this prohibition and that these jars were lawful, many found the use of these jars reprehensible or even forbidden. I suggest that the Ḥadīth in which the Prophet prohibited green jars may have contributed to the decline of green-glazed jars.
Power Lies in the Barrel of a Gun: Diplomacy Without Strategic Military Capability Is Futile
Authors: Leshoele Moorosi
Published: May 2021

The United States of America invests heavily on their military capability and it is estimated that it spends, alone, approximately 40 per cent of what the whole world spends on military. Four of the other super powers that make up the five permanent members of the United Nations Security Council (UN-SC) also spend a significant percentage of their national budgets on military. Chinweizu has for a long time argued that Africa needs a well-resourced African Standby Force (or the Black Africa League) that will protect the interests of the continent so as to prevent the history of Africans enslavement and colonialism repeating itself. This article seeks to analyse Africa’s investment on its military defense capability vis-à-vis the five permanent members of the UN-SC and North Korea, by critiquing two case studies of two of the continent’s economic giants – South Africa and Egypt. Realist and Sankofa perspectives are used as the prisms through which the article was researched.

In line with Chinweizu’s observation, the article argues that without serious political will and dedication to building Africa’s nuclear weapons capability and ensuring that Africa is economically self-reliant, diplomatic engagements with the rest of the world as (un)equal partners will remain a pipe dream and the looting of Africa’s mineral wealth will continue unabated. It is clear that given the reality of the African Holocust if African countries fail to collectively defend themselves, Africa will continue to be a political football for the rest of the world.
Fiction vs. Evidence: A Critical Review of Ataa Ayi Kwei Armah’s Wat Nt Shemsw and the Eurasian Rhetorical Ethic
Authors: Kambon Ọbádélé Bakari , Songsore Lwanga
Published: May 2021

At the 2018 Outstanding African Thinkers Conference on Nna Chinweizu, attendees – the first author included – took a pledge that “In all branches of our lives, we must be capable of criticizing and of accepting criticism. But criticism, proof of the willingness of others to help us or of our willingness to help others, must be complemented by self-criticism – proof of our own willingness to help ourselves to improve our thoughts and our actions. This is a sacred principle and it is my sacred duty to apply and defend it at all costs” (Chinweizu 2018). In response to that call to action, this article represents an effort to restore MꜢꜤt ‘Maat.’ Ataa Ayi Kwei Armah’s Wat Nt Shemsw: The Way of Companions epitomizes undeclared fiction masquerading as an accurate reflection of the mythology of classical Kmt ‘Land of Black People.’ By cross-checking Ataa Armah’s undeclared fiction with actual historical, iconographical, and archaeological data, we are able to debunk his numerous misrepresentations. We find that the best way to approach Kmt ‘Land of Black People’ is through direct engagement with actual evidence rather than through the distortions of fiction writers turned Egyptologists. Further, we will address the personality cult, or what we term “Ataa Armah’s Manor Shemsw model,” which embodies the rhetorical ethic whereby all egalitarians are equal, but some egalitarians are more equal than others (Orwell, Baker, and Woodhouse 1996).
An Encounter with God
Authors: Seal David
Published: May 2021

Scholars acknowledge that most ancient people experienced the written text of Hebrews by hearing it read out loud. Several studies also recognize the book’s emphasis on divine speech. However, research has not examined how the occurrences of divine speech in Hebrews would have been spoken by the person reading the text once it arrived at its intended destination or how the speech would have been perceived by the communities that heard it recited. The oral cultural context from which Hebrews originated decisively shaped the form and delivery of the written divine speech and must be considered in any analysis. In this study I will address this gap by examining how the divine word from Psalm 95 cited in Hebrews 3:7–11 might have been vocalized in its original context and examine the kinds of rhetorical appeals the author made to the audience.
Revolutionizing Theological Imagination
Authors: Stout Andrew C.
Published: May 2021

The Reformed tradition helped provide the rationale for Southern slavery and for South African apartheid. If Reformed theology is going to speak to the racial issues of our day, it must come to terms with the tradition of Black theology. Some Reformed evangelical theologians have begun to engage with the insights of Black theologians, but they have done so very selectively. Reformed Evangelicals need to learn from the theological imaginations of such Black theologians as James Cone and Allan Boesak. By doing so, they can undermine the tradition’s racist legacy and unleash its liberative potential.
Persuading the Giant? Explaining Eastern Partnership States’ (Unexpected) Negotiation Success in Relations with the European Union
Authors: Bosse Giselle , Höpner Moritz , Vieira Alena
Published: May 2021

In bilateral relations and negotiations with the European Union (EU), smaller and economically weaker states are often unable to express their national preferences. Despite their limited bargaining power, however, some Eastern Partnership (EaP) countries obtained significant concessions from the EU. This article analyzes the factors that explain EaP states’ unexpected negotiation success in the context of the Deep and Comprehensive Free Trade Agreement (DCFTA) with Ukraine, the Comprehensive and Enhanced Partnership Agreement (CEPA) with Armenia, and enhanced economic partnership with Belarus. We identify negotiation strategies that are crucial to understanding of the puzzle.
Negotiating Norwegian Mission Education in Zululand and Natal during World War II
Authors: Rosnes Ellen Vea
Published: May 2021

Missionaries from the Lutheran Norwegian Mission Society (NMS) came to South Africa from the 1840s. By 1940, more than 6000 pupils were attending NMS-owned schools in Zululand and Natal. World War II brought about different forms of negotiations between the missionaries and other actors. The War resulted in the missionaries losing contact with their central board in Norway and the provincial authorities of the Union were among those bodies who came to rescue them financially. Local congregations took over more of the mission responsibilities and the nature and forms of cooperation with other Lutheran missions changed. Added to these changes was the growing aspiration among Zulu pastors for more independence that also manifested itself in the management of schools. This paper presents an analysis of the ways in which the Norwegian missionaries negotiated their educational work in Zululand and Natal during the World War II period.
Secularizing Effects of Christian Mission: Fifty Years After Elmer Miller’s “The Christian Missionary, Agent of Secularization”
Authors: Kruithof Maryse
Published: May 2021

It has been suggested that Christianity is inextricably linked with secularization due to its emphasis on purification and rationalization. But if we believe secularization in Europe is at least partly caused by internal developments within Christianity, may we then assume that secularization emerges wherever Christian missionaries are successful? Has the Christian mission unwittingly instigated secularization in its mission fields? This literature review analyses the argument that American anthropologist Elmer Miller made in the article “The Christian Missionary, Agent of Secularization” (1970) and explores whether his thesis has been confirmed in academic literature during the past fifty years. Miller presents rationalization as the primary driver of secularization and explains how missionaries have played a decisive role in this process. This paper demonstrates that while rationalization has often been mentioned as an effect of the Christian mission in other sources, the process has rarely been linked to secularization in the mission field.
Wounded Because of Religion: Identifying the Components of Gender-Specific Religious Persecution of Christians
Authors: Fisher Helene , Miller Elizabeth Lane , Sauer Christof
Published: May 2021

Emerging understanding of gender-specific religious persecution in some of the world’s most difficult countries for Christians offers timely insight into complex dynamics in which the church and missions have too often been unwittingly complicit due to limited visibility of the components contributing to these wounds. Fresh research into these deeply wounding global phenomena stands as both a warning and a pointer towards an avenue for effective ministrations by churches and Christian ministries that are working in the most severely affected areas of the world. Drawing on the latest trends identified by World Watch Research, outcomes of the Consultation for Christian Women under Pressure for their Faith, a contemporary case study from Central African Republic, and a biblical narrative, we will explore practical opportunities for a holistic approach to bring preparedness, healing, and restoration for communities under severe pressure for their Christian faith.
The Impacts of a Climate Change SSI-STEAM Program on Junior High School Students’ Climate Literacy
Authors: Choi Su-Yeon , Won A-Rang , Chu Hye-Eun , Cha Hyun-Jung , Shin Hyeonjeong , Kim Chan-Jong
Published: May 2021

This study aims to investigate climate literacy among junior high school students participating in an SSI-STEAM climate change education program and to examine the impacts of the program on the cultivation of climate literacy. Thirty-one eighth-grade students in Seoul, Korea, participated in this study. Data were collected using pre- and post-program surveys with a climate literacy questionnaire (CLQ), students’ background survey questions, interviews with participants, and from the artifacts produced by students during the program. Participants’ climate literacy was shown to improve substantially after attending the program, especially in the domains of perception and action. The four characteristics of climate literacy change were identified in the participants’ responses: more concrete ideas, extension of the scope of thinking, positive responsibility, and relevance recognition. The climate literacy program developed showed potential for fostering young people’s climate literacy along with their understanding of responsible national and global citizenship. The study discusses the implications of these findings and includes suggestions for future climate literacy program development and for both curricular and extra-curricular climate change education that can together nurture students’ more profound understanding of climate change.
20 years of Zootaxa: Tardigrada (Ecdysozoa: Panarthropoda)
Authors: MCINNES SANDRA J. , JØRGENSEN ASLAK , MICHALCZYK ŁUKASZ
Published: May 2021

Over the last two decades, Zootaxa has hosted nearly 200 papers concerning tardigrade taxonomy, systematics, phylogeny, and evolution. A total of 160 researchers from all continents (except the Antarctic) published descriptions of almost 200 new taxa, mostly species, but also genera and higher taxonomic ranks, such as families and superfamilies. This editorial is dedicated to the late Professor Clark W. Beasley who was the first tardigrade Associate Editor for Zootaxa.
Radiative feedbacks on land surface change and associated tropical precipitation shifts
Authors: Laguë Marysa M. , Swann Abigail L. S. , Boos William R.
Published: May 2021

Changes in land surface albedo and land surface evaporation modulate the atmospheric energy budget by changing temperatures, water vapor, clouds, snow and ice cover, and the partitioning of surface energy fluxes. Here idealized perturbations to land surface properties are imposed in a global model to understand how such forcings drive shifts in zonal mean atmospheric energy transport and zonal mean tropical precipitation. For a uniform decrease in global land albedo, the albedo forcing and a positive water vapor feedback contribute roughly equally to increased energy absorption at the top of the atmosphere (TOA), while radiative changes due to the temperature and cloud cover response provide a negative feedback and energy loss at TOA. Decreasing land albedo causes a northwards shift in the zonal mean intertropical convergence zone (ITCZ). The combined effects on ITCZ location of all atmospheric feedbacks roughly cancel for the albedo forcing; the total ITCZ shift is comparable to that predicted for the albedo forcing alone. For an imposed increase in evaporative resistance that reduces land evaporation, low cloud cover decreases in the northern mid-latitudes and more energy is absorbed at TOA there; longwave loss due to warming provides a negative feedback on the TOA energy balance and ITCZ shift. Imposed changes in land albedo and evaporative resistance modulate fundamentally different aspects of the surface energy budget. However, the pattern of TOA radiation changes due to the water vapor and air temperature responses are highly correlated for these two forcings because both forcings lead to near-surface warming.
“I Do Not Have a Racist Bone in My Body”: Psychoanalytic Perspectives on What is Lost and Not Mourned in Our Culture’s Persistent Racism
Authors: Holmes Dorothy Evans
Published: May 2021

Racism is a disavowed marauding presence in the white psyche, a pathological formation that weakens psychic structures and creates a vulnerability to acting out that is hateful, discombobulated, and destructive. Examining it in its cultural, historical, and clinical contexts can enable its conscious ownership and mastery, which entails a process of mourning. Because racism is carried widely in the cultural surround and individually, it must be addressed by psychoanalysts. Cases are presented to show that racism is accessible to analysis in the consulting room.
Murderous Racism as Normal Psychosis: The Case of Dylann Roof
Authors: Bass Alan
Published: May 2021

Dylann Roof killed nine people in a Black church in 2015 in order to start a “war” between the white and Black races. This case is used here to develop a psychoanalytic theory of murderous racism, and even genocide. Major concepts from Freud (self-preservation, hatred, narcissism, life and death drives, delusion), Klein (projective identification), and Bion (psychotic and nonpsychotic parts of the personality) are employed. Particular attention is given to the hearing to determine Roof’s capacity to represent himself after he dismissed his lawyers, who wanted to use an insanity defense to avoid the death penalty. This hearing was confronted with an undecidable dilemma, which led to legal cooperation with Roof’s suicidal impulses. The deconstructive approach to undecidability, and its use in questions of law, especially as concerns the relation between psychoanalysis and the death penalty, leads to tentative recommendations for the prevention of racist murder.
Outcomes After Laparoscopic Cholecystectomy in Hyperkinetic Biliary Dyskinesia
Authors: Whitaker Litton F. , Bosley Maggie E. , Refugia Justin M. , Powell Myron S. , McNatt Stephen S. , Westcott Carl J. , Koch Kenneth L. , Bennett Paige , Rigdon Joseph , Fernandez Adolfo Z.
Published: May 2021

Background

Biliary dyskinesia (BD) is a poorly understood functional gallbladder disorder. Diagnosis is made with abdominal pain and an intact gallbladder without signs of anatomical obstruction on imaging or pathology. Our aim was to assess whether laparoscopic cholecystectomy (LC) resolves hyperkinetic BD symptoms.

Methods

Records of patients ≥18 years of age, who underwent LC by four surgeons at a tertiary care center between 2012 and 2020, were retrospectively reviewed. Patients were excluded if they had a documented gallbladder ejection fraction (GBEF) <80% or had biliary stones or sludge on pathology or imaging. Demographic information, HIDA results, preoperative testing, operative details, gallbladder pathology, and symptom status at follow-up were collected from electronic medical records. Improvement in BD symptoms was assessed using McNemar’s test. Risk differences with standard errors were employed to estimate percent reduction in symptoms.

Results

Ninety-eight patients met inclusion criteria. Of those who presented for follow-up (n = 91), 92.3% (n = 84) reported partial or complete resolution of symptoms. Preoperative symptoms, including back pain (16.7%, 95% CI: [7.9%, 25.5%]; P < .0001), epigastric pain (31.1% [21.3%, 41.3%]; P < .0001), nausea (56.7% [45.0%, 65.8%]; P < .0001), RUQ pain (57.8% [46.1%, 66.9%]; P < .0001), and vomiting (27.8% [18.4%, 37.7%]; P < .0001) showed significant improvement after LC. Chronic cholecystitis and/or cholesterolosis were present on pathology in 79.8% of gallbladders.

Discussion

Our study currently represents the largest cohort of patients with hyperkinetic BD. Laparoscopic cholecystectomy appears to result in resolution of symptoms for this clinical entity.
Insurance Status Impacts Hospital Discharge for Penetrating Trauma Survivors
Authors: Olafson Samantha N. , Cohen Ryan B. , Parsikia Afshin , Moran Benjamin , Kaplan Mark J. , Leung Pak
Published: May 2021

Background

Despite equalized acute care in trauma, disparities exist in the long-term outcomes of trauma survivors. Prior studies have revealed insurance status plays a role in the discharge destination of blunt trauma survivors. This is yet to be described in patients with penetrating traumatic injury.

Methods

A retrospective chart review from 2009 to 2019 from an urban Level 1 trauma center identified adult patients who survived penetrating trauma to discharge. Patients were categorized by insurance status. Patient demographics, discharge destination, and hospital length of stay (LOS) were analyzed using the t-test and ANOVA.

Results

1806 patients were identified with 1410 survivors to hospital discharge. Among the survivors, 26.8% were uninsured, 13.1% were privately insured, and 60.0% had Medicare/Medicaid. The uninsured patients were significantly less likely to be discharged to a rehabilitation facility or skilled nursing facility (OR = .49, 95% CI .35-.71) compared to the insured patients. Uninsured survivors had shorter LOS compared to the other groups (5.8 vs. 7.3, P < .01.) Severity of injury did not significantly influence the discharge destination or LOS between the groups.

Conclusion

Despite recent health care reform, many trauma patients remain uninsured. Our study shows that uninsured penetrating trauma survivors are less likely to be discharged to rehabilitation and skilled nursing facilities. This may contribute to uninsured trauma survivors not receiving appropriate post-traumatic care and could lead to the accrual of undue disability, long-term complications, and increased societal burdens.
Telemedicine Experience of General Surgery Trainees: Impact on Patient Care and Education
Authors: Nakashima Brandon J. , Kaur Navpreet , Wongjirad Chelsey , Inaba Kenji , Sheikh Mohd Raashid
Published: May 2021

Objective

The COVID-19 pandemic has had a significant impact on patient care, including the increased utilization of contact-free clinic visits using telemedicine. We looked to assess current utilization of, experience with, and opinions regarding telemedicine by general surgery residents at an academic university–based surgical training program.

Design

A response-anonymous 19-question survey was electronically distributed to all general surgery residents at a single academic university–based general surgery residency program.

Setting

University of Southern California (USC) general surgery residency participants: Voluntarily participating general surgery residents at the University of Southern California.

Results

The response rate from USC general surgery residents was 100%. A majority of residents (76%) had utilized either video- or telephone-based visits during their careers. No resident had undergone formal training to provide telemedicine, although most residents indicated a desire for training (57.1%) and acknowledged that telemedicine should be a part of surgical training (75.6%). A wide variety of opinions regarding the educational experience of residents participating in telemedicine visits was elicited.

Conclusions

The COVID-19 pandemic brought telemedicine to the forefront as an integral part of future patient care, including for surgical patients. Additional investigations into nationwide telemedicine exposure and practice among United States general surgery residencies is imperative, and the impact of the implementation of telemedicine curricula on general surgery resident telemedicine utilization, comfort with telemedicine technology, and patient outcomes are further warranted.

Competencies

Practice-based learning, systems-based practice, interpersonal and communication skills
A High C-Reactive Protein Level on Postoperative Day 7 Is Associated With Poor Survival of Patients With Pancreatic Ductal Adenocarcinoma After Resection
Authors: Tani Masaji , Iida Hiroya , Maehira Hiromitsu , Mori Haruki , Miyake Toru , Kaida Sachiko
Published: May 2021

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is a common malignancy. While inflammation-related biomarkers influence patient survival after resection, it has not been known whether postoperative inflammations affect the survival of PDAC patients or not.

Methods

It was investigated whether the universal biomarkers on postoperative day (POD) 7 affect the survival of PDAC patients in the retrospective view, and univariate and multivariate analyses were performed via the Cox regression method.

Results

Overall, 108 consecutive patients underwent resection; 98 (90.7%) had T3 disease and 73 (67.6%) had lymph node metastases. Thirty-four patients (31.5%) experienced postoperative complications. Compared with preoperative values, the white blood cell count and C-reactive protein (CRP) level on POD 7 were significantly elevated ( P < .001 for both); conversely, the lymphocyte count was significantly reduced ( P < .001). Among 108 patients, 72 received adjuvant chemotherapy. The median overall survival was 21.0 months; the 5-year survival rate was 22.3%. On multivariate analysis, receiving adjuvant chemotherapy and low CRP levels on POD 7 (<7.6 mg/dL) were prognosticators of better survival. However, the CD classification was not a prognosticator of survival after resection.

Conclusions

Adjuvant chemotherapy and postoperative low CRP levels on POD 7 were prognosticators of better survival of PDAC patients after resection. Surgeons should be aware of managing postoperative infections because a high postoperative CRP level is related with unfavorable survival.
Arterial Thrombosis and Acute Limb Ischemia as a Complication of COVID-19 Infection
Authors: Khryshchanovich Vladimir Y. , Rogovoy Nicolay A. , Nelipovich Evgeniy V.
Published: May 2021

COVID-19 refers to viral respiratory infections and is the predisposing factor for the development of venous and arterial thrombotic events due to a pronounced inflammatory response, platelet activation, endothelial dysfunction, and stasis. Recent studies have confirmed a high incidence of thromboembolic events, especially in the group of patients with severe coronavirus pneumonia. There have been an increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis are noted in critical ill patients in intensive care setting. However, an increase of adverse arterial events was also noted in cases of asymptomatic or mild forms of COVID-19. Herein, we report a case of patient with asymptomatic SARS-CoV-2 infection, who developed a threatening lower limb ischemia. Our own clinical observation suggests that COVID-19-associated arterial thrombosis can be successfully treated by embolectomy, administration of in-hospital parenteral anticoagulation, and continuation of antithrombotic therapy with a “vascular” dose of rivaroxaban after discharge.
Multi-Disciplinary Skull Base Conference and its Effects on Patient Management
Authors: Kemper Nathan , Shapiro Scott B. , Mains Allie , Lipschitz Noga , Breen Joseph , Hazenfield John Michael , Zuccarello Mario , Forbes Jonathan , Samy Ravi N.
Published: May 2021

Objective:

Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic.

Methods:

Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized.

Results:

A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered.

Conclusions:

For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.
Coherent Anti-Stokes Raman Scattering Spectroscopy Using a Double-Wavelength-Emission Electronically Tuned Ti:Sapphire Laser
Authors: Hirai Nao , Maeda Yasuhiro , Hashimoto Kosuke , Andriana Bibin B. , Matsuyoshi Hiroko , Sato Hidetoshi
Published: May 2021

Coherent anti-Stokes Raman scattering (CARS) spectroscopy is a powerful tool for Raman imaging technology. In contrast, conventional spontaneous Raman spectroscopy is often used for biological analysis with multivariate analysis. This study develops a new type of CARS instrument with a double-wavelength-emission, background-free, electronically tuned Ti:sapphire laser (DW-ETL). DW-ETL generates two laser pulses with different wavelengths simultaneously within its single resonator. The pulse wavelength and buildup time are regulated by acousto-optical tunable filter in the resonator. The present DW-ETL CARS system is free from any mechanical movement to measure a CARS spectrum by controlling each laser pulse of the emission throughout the fingerprint region. Consequently, it is theoretically able to provide stable CARS spectra to apply multivariate analysis in biological applications. The present study demonstrates that the DW-ETL CARS system provides spectra of biomedical samples in the full finger-print region, and the stability and controllability of the system are evaluated.
Clinical Spectroscopy: Lost in Translation?
Authors: Cameron James M. , Rinaldi Christopher , Rutherford Samantha H. , Sala Alexandra , G. Theakstone Ashton , Baker Matthew J.
Published: May 2021

This Focal Point Review paper discusses the developments of biomedical Raman and infrared spectroscopy, and the recent strive towards these technologies being regarded as reliable clinical tools. The promise of vibrational spectroscopy in the field of biomedical science, alongside the development of computational methods for spectral analysis, has driven a plethora of proof-of-concept studies which convey the potential of various spectroscopic approaches. Here we report a brief review of the literature published over the past few decades, with a focus on the current technical, clinical, and economic barriers to translation, namely the limitations of many of the early studies, and the lack of understanding of clinical pathways, health technology assessments, regulatory approval, clinical feasibility, and funding applications. The field of biomedical vibrational spectroscopy must acknowledge and overcome these hurdles in order to achieve clinical efficacy. Current prospects have been overviewed with comment on the advised future direction of spectroscopic technologies, with the aspiration that many of these innovative approaches can ultimately reach the frontier of medical diagnostics and many clinical applications.
Does live-in domestic help reduce unpaid household labor? The paradox of intensive parenting and domestic outsourcing
Authors: Cheung Adam Ka-Lok , Lui Lake
Published: May 2021

This two-stage mixed-method study pulls the literature of domestic outsourcing and intensive parenting together to investigate the role of employing live-in domestic helpers in the time-use patterns of household labor among working parents in Hong Kong. In the first stage, regression models are used to analyze data from a representative household survey of working parents ( N = 791). Regression results show that working parents who hire live-in domestic help spent less time in housework. Yet, the reduction in housework time was partially offset by the managing tasks brought about by the use of live-in help. Working parents with live-in helpers also spent significantly more time on childcare than did working parents without such help. To interpret the regression results, the study draws on qualitative data from in-depth interviews ( N = 20) to unpack the meaning of hiring help and its relationship with the notion and practices of parenting. The findings highlight that the use of live-in domestic help is a specialization strategy to strive for perfection in parenting for parents who juggle work, childcare and household chores. By outsourcing household chores and more routinized childcare tasks to the helpers, working parents, especially mothers, can focus on emotional bonding and tasks conducive to the development of their children.
Book review: Durba Mitra, Indian Sex Life: Sexuality and the Colonial Origins of Modern Social Thought
Authors: Gupta Charu
Published: May 2021

Durba Mitra, Indian Sex Life: Sexuality and the Colonial Origins of Modern Social Thought. Princeton, N.J.: Princeton University Press, 2020, 290 pp.
A machine learning approach to estimate the strain energy absorption in expanded polystyrene foams
Authors: Rodríguez-Sánchez Alejandro E , Plascencia-Mora Héctor
Published: May 2021

Traditional modeling of mechanical energy absorption due to compressive loadings in expanded polystyrene foams involves mathematical descriptions that are derived from stress/strain continuum mechanics models. Nevertheless, most of those models are either constrained using the strain as the only variable to work at large deformation regimes and usually neglect important parameters for energy absorption properties such as the material density or the rate of the applying load. This work presents a neural-network-based approach that produces models that are capable to map the compressive stress response and energy absorption parameters of an expanded polystyrene foam by considering its deformation, compressive loading rates, and different densities. The models are trained with ground-truth data obtained in compressive tests. Two methods to select neural network architectures are also presented, one of which is based on a Design of Experiments strategy. The results show that it is possible to obtain a single artificial neural networks model that can abstract stress and energy absorption solution spaces for the conditions studied in the material. Additionally, such a model is compared with a phenomenological model, and the results show than the neural network model outperforms it in terms of prediction capabilities, since errors around 2% of experimental data were obtained. In this sense, it is demonstrated that by following the presented approach is possible to obtain a model capable to reproduce compressive polystyrene foam stress/strain data, and consequently, to simulate its energy absorption parameters.
Interlaminar fracture toughness of a quasi 3D braided composite
Authors: Wente Tony , Mao Xinyu , Zeng Danielle , Torab Homa , Dahl Jeff , Xiao Xinran
Published: May 2021

Fiber reinforced composite materials are a heavily sought after material for next generation vehicles for light-weighting components due to their high specific strength and stiffness. However, these materials have relatively weak interlaminar strength and are prone to delamination. This is especially the case when a delamination crack already exists. Quasi-3D (Q3D) braided composites seek to solve this issue by weaving the bias tows into the adjacent (above and below) plies. The plies are physically connected through fiber tows as opposed to being bonded simply by the epoxy, and the composite will achieve a higher interlaminar strength due to fiber failure being required for crack propagation as opposed to simply matrix failure. The [Formula: see text] UD and Q3D carbon composites are investigated in this study for their better in-plane isotropy. Mode I and Mode II interlaminar fracture toughness tests were conducted on UD and Q3D samples. In Mode I experiments, the samples were continuously loaded to full beam split using the double cantilever beam method to obtain the fracture toughness throughout the sample. 4ENF is used to measure the Mode II fracture toughness to create a full R-curve for the architectures.
Ternary Taiji Models of the Traditional Chinese Self: Centered on Confucian, Taoist, and Buddhist Cultures
Authors: Wang Zhen-Dong , Wang Feng-Yan
Published: May 2021

Traditional Chinese culture is commonly viewed as a trinity of Confucianism, Taoism, and Buddhism. Originally emerging from the Book of Changes, the concept of Taiji has a profound interactive influence with Confucian, Taoist, and Buddhist thought in the history of Chinese philosophy. Because the construction of self-models is often closely related to thinking modes, as a root metaphor in the Chinese culture, the diagram of Taiji that best fits Chinese yin–yang thinking can be used as a prototype to explain the self-structure, the process of self-cultivation, and the realm of person making in the context of Chinese culture. This article reviews the Confucian, Taoist, and Buddhist Taiji model of the self and the theory of self-cultivation realms based on these self-models and examines the similarities and differences among them. The ternary Taiji models of the self can complement one another and contribute to a more comprehensive, profound, and accurate understanding of the pluralistic connotations of the traditional Chinese self.
To What Extent is Collocation Knowledge Associated with Oral Proficiency? A Corpus-Based Approach to Word Association
Authors: Uchihara Takumi , Eguchi Masaki , Clenton Jon , Kyle Kristopher , Saito Kazuya
Published: May 2021

This study examined the relationship between second language (L2) learners’ collocation knowledge and oral proficiency. A new approach to measuring collocation was adopted by eliciting responses through a word association task and using corpus-based measures (absolute frequency count, t-score, MI score) to analyze the degree to which stimulus words and responses were collocated. Oral proficiency was measured using human judgements and objective measures of fluency (articulation rate, silent pause ratio, filled pause ratio) and lexical richness (diversity, frequency, range). Forty Japanese university students completed a word association task and a spontaneous speaking task (picture narrative). Results indicated that speakers who used more low-frequency collocations in the word association task (i.e., lower collocation frequency scores) spoke faster with fewer silent pauses and were perceived to be more fluent. Speakers who provided more strongly associated collocations (as measured by MI) used more sophisticated lexical items and were perceived to be lexically proficient. Collocation knowledge remained as a unique predictor after the influence of learners’ vocabulary size (i.e., knowledge of single-word items) was considered. These findings support the key role that collocation plays in oral proficiency and provide important insights into understanding L2 speech development from the perspective of phraseological competence.
Charting a Course toward a New Vaccine Strategy
Authors: Nadal Gerard M.
Published: May 2021

There has been a long-simmering disquiet in Catholic circles regarding the use cell lines derived from aborted fetal tissue. This concern has exploded into the public consciousness given the use of questionable cell lines in the development and/or testing of the current COVID-19 vaccines, and the debate within the Church over the permissibility of using these vaccines. The history of cell culture and how the biological community came to rely on HEK293 fetal cell lines is explored, as is the way forward, moving the biotech industry away from ethically problematic cells and toward the development of more ethically sourced cell lines. The role of the Church in leading the way forward and the acceptable use of medicines utilizing HEK293 cell lines are all explored.