bluuebunny/crossref_metadata_2025 huggingface dataset:
Low expression of estrogen receptor β in renal tubular epithelial cells may cause hyperuricemia in premenopausal patients with systemic lupus erythematosus
Authors: Liu Haijun , Peng Liqin , Ma Jianda , He Liping , Long Kangxia , Ouyang Xia , Wu Cuiyi , Xie Minyan , Dai Lie , Cai Xiaoyan
Published: January 2021

We investigated the impact of estrogen receptor (ER) expression in renal tubular epithelial cells on serum uric acid (UA) levels in premenopausal patients with systemic lupus erythematosus (SLE). Thirty patients underwent renal biopsy: 18 with SLE (LN group) and 12 with IgA nephritis (IgAN group). ERs (ERα and ERβ) in renal tubular epithelial cells were measured using immunohistochemistry. The ER expression levels of the two groups were compared, and the relationship between the expression of ERs and serum UA levels was analyzed. Mean serum UA levels in the LN group were significantly higher than those of the IgA nephropathy group, while the mean creatinine levels and GFRs of the two groups were similar. Pathological changes in the LN group were significantly more severe than those in the IgAN group. ERβ was expressed in renal tubular epithelial cells in both groups, but not in the glomeruli. ERβ expression in the LN group was significantly lower than that in the IgAN group. ERβ expression scores significantly negatively correlated with serum UA levels. These findings suggest that the expression of ERβ in premenopausal female SLE patients may cause hyperuricemia, and may subsequently promote glomerular damage, suggesting that ERβ may be involved in UA excretion.
The influence of obesity on hydroxychloroquine blood levels in lupus nephritis patients
Authors: Pedrosa Tatiana , Kupa Léonard de Vinci Kanda , Pasoto Sandra Gofinet , Aikawa Nádia Emi , Borba Eduardo Ferreira , Duarte Nilo JC , Leon Elaine Pires , Silva Clovis Artur , Bonfá Eloisa
Published: January 2021

Introduction

In 2016 the American Academy of Ophthalmology(2016-AAO) recommended a maximum daily HCQ use of 5.0 mg/kg real body weight(RBW) taking into consideration minimizing eye toxicity. Retinopathy in systemic lupus erythematosus(SLE) patients was recently associated with obesity and this condition is progressively more common in these patients. However, the impact of obesity in HCQ blood levels remains controversial.

Objective

To determine if the 2016-AAO recommendation based on RBW with and without maximum daily dose restriction results in adequate and safe blood levels in obese lupus nephritis(LN) patients.

Methods

A cross-sectional study was performed with 108 LN patients under the prescribed 2016-AAO dose for at least 3 months. LN patients were assessed for demographic characteristics, body mass index(BMI), disease parameters, HCQ dose, concomitant treatment and HCQ blood levels measured by liquid chromatography-tandem mass spectrometry. Obesity was defined as BMI ≥30kg/m2.

Results

Obesity was identified in 35/108(32%) LN patients. The calculation of HCQ daily dosage revealed that obese patients were under a lower prescribed daily dose according to the real body weight (RBW) [4.4(2.9-5.4) vs. 4.9(4-5.5)mg/Kg/day, p < 0.001] due to the maximum limit used. Regardless of that the median of HCQ blood levels was significantly higher in obese compared to non-obese patients (1562 ± 548.6 vs. 1208 ± 448.9 ng/mL, p = 0.002). Further analysis of patients under the 20016-AAO recommendation by RBW without the restriction of maximum daily dose confirmed that in spite of comparable daily dose in 14 obese patients and 61 non-obese patients [4.8 (4.5-5.4) vs. 5.0(4.5-5.5) mg/kg, p = 0.312], the median of HCQ blood levels was significantly higher in obese patients than in non-obese (1734 ± 457.3 vs. 1189 ± 449.4 ng/mL, p < 0.001).

Conclusion

Obese patients under the 2016-AAO prescribed dose of HCQ based on RBW with and without maximum daily dose restriction have a very high HCQ blood levels compared to non-obese patients, with a potential increased risk of ocular toxicity. The use of 2016-AAO dose of HCQ according to the ideal body weight for this group of patients should be considered.Clinicaltrials.gov #NCT0312243.
Schematic incongruity, conversational power play and criminal mind style in Thomas Harris’ Silence of the Lambs
Authors: Gregoriou Christiana
Published: January 2021

This article considers the construction of the profilers and criminals in Thomas Harris’ (2013) [1988] novel Silence of the Lambs through the analysis of selected indicative criminal mind-related extracts. The aim is to consider such characters’ construction through analysis of schematic incongruity, conversational power play, language depicting the actual fictional criminal viewpoint and, lastly, psychological profiling language, the style of which has criminal mind style ‘potential’. Schematic incongruity has a role to play in generating impressions of both the normality and abnormality of psychological profilers and the killers they pursue. Serial killers are constructed as not only physically/psychologically ‘abnormal’ but also as ‘abnormals’ amongst other ‘abnormals’ in terms of their conversational patterns, too. Where some criminals’ apparent reluctance, or inability, to accord to conversational norms marks them as uncivilised, killer/profiler Lecter’s mostly conventional conversational politeness marks him out as indirectly mocking the social norms he sometimes chooses to accord to. Where killer Gumb is concerned, profiling language and language depicting his criminal viewpoint draws on metaphors and references to killing being likened to hunting, work and art, suggesting that killing is necessary, commendable and ceremonial, the victims’ mere things to be utilised in a venture that can only be described as worthy. Though Lecter is shown to be ‘born’ into deviant behaviour, and Gumb is suggested to have been ‘made’ into a criminal, the novel undoubtedly suggests connections, similarities even, between both such character types’ extreme criminal behaviour and those wanting to understand ‘criminal minds’ through the profiling practice.
Text-worlds, blending and allegory in ‘Flamingos in Dudley Zoo’ by Emma Purshouse
Authors: McLoughlin Nigel
Published: January 2021

This paper will develop a cognitive stylistic framework drawn from Conceptual Integration (Blending) Theory ( Fauconnier and Turner 2002 ), and Text World Theory, which uses the idea of elaboration sites as potential structural enablers in mapping across blend spaces. The framework will be used to investigate the operation of allegory and metaphor in Emma Purhouse’s poem ‘Flamingos in Dudley Zoo’. Previous work on blending and allegory is taken as a departure point for the exploration of the relationship between text-worlds and blends in allegory in order to investigate how a hybrid approach may produce a richer understanding of how the poem achieves its effects. The paper will examine the conceptual blends created by metaphors suggested by the allegory in terms of their input (source and target) spaces, and examine how these may create and enrich metaphoric text-worlds in the poem. The paper develops a text-world mechanism, the peri-text-world, that allows the source, target and blended worlds to be integrated into one complex that can allow the necessary mappings to proceed from the source world-system of the allegory, through the allegorical blend, to structure a target world. It will also consider how this mapping process creates the potential for a number of candidate targets and how that uncertainty helps the poem make its point.
India’s Demographic Dividend: The Millennials’ Savings Conundrum
Authors: Bohini Karuna , Yaganti C. Hussain , Thomas Mini P.
Published: January 2021

India’s working-age group has been over 60 per cent of its population for over two decades, with a record high of 66 per cent in 2018. The gross domestic savings (GDS), yet, plummeted during the previous decade, recording a low of 29.34 per cent in 2018. This is a divergence from the demographic theories which indicate that a rising working-age population will increase savings. Past research on India’s demographic transitioning implications on economic growth and demographic dividend focused on the working-age group. This article brings in a new dimension to existing studies and analyses savings trends by examining working-age youth, and the millennials within this subgroup, in particular. By considering data from between 1980 and 2017, the article investigates the influence of these two demographic variables on the GDS, along with key macroeconomic variables. The estimation techniques applied are the autoregressive distributed lag (ARDL) cointegration technique and the vector error correction model (ECM). The results indicate that the millennial youth’s influence on GDS is statistically significant. Though the long-term influence of the millennial youth working-age group indicates a positive effect on GDS, the adverse impact reflected in the short run may be pointing towards the future financial sustainability of this segment. Although youth savings are expected to be the lowest in the working-age segment, the significant fall in the youth ratio of employment-to-population in the 20–29 years segment, especially since 2005 onwards, raises the thrust for youth policies that can unravel the millennial savings conundrum and thereby pave the way for India’s demographic dividend.
Effects of a Video-Based Preoperative Educational Intervention Plus Nurse-Led Reinforcement Discussion on Knowledge, Self-Efficacy, and Resilience in Patients Undergoing Major Surgery
Authors: Gonella Silvia , Delfino Cristina , Rolfo Monica , Rizzo Alessio , Esposito Valeria , Berchialla Paola , Campagna Sara
Published: January 2021

This study aimed to verify the feasibility of a video-based preoperative educational intervention plus one-to-one, nurse-led reinforcement discussion in patients undergoing elective major surgery and to assess the impact of this combined intervention on patient- and nurse-perceived patient knowledge, self-efficacy, and resilience. Patients received written material at pre-admission and were offered the intervention at admission. Patients reported their knowledge and self-efficacy at pre-admission and after the intervention, and resilience at pre-admission and discharge. Nurses assessed patients’ knowledge and self-efficacy after the intervention. In all, 88/97 (90.7%) patients completed the intervention. The 80 patients with complete data reported a significant increase in their knowledge ( p < .001) and self-efficacy ( p < .001), but no difference in resilience ( p = .72). Nurse-perceived patient knowledge agreed with patients’ perceptions ( p = .57) but nurses scored patients’ self-efficacy lower ( p < .001). The combined intervention was feasible, and patients perceived an improvement in their knowledge and self-efficacy. Nurses’ assessment partially agreed with patients’ perceptions.
The Effect of Smart Shopper Self-Perceptions On Word-Of-Mouth Behaviors in the Loyalty Reward Program Context
Authors: Hwang YooHee , Mattila Anna S.
Published: January 2021

Loyalty reward members who redeem their reward points for materials/experiences may perceive themselves as “smart shoppers.” The purpose of this study is to illustrate the effect of smart shopper self-perceptions on word-of-mouth behaviors and to demonstrate emotional attachment as the mechanism underpinning such an effect. Study 1 used a recall-based survey and showed that smart shopper self-perceptions are positively associated with emotional attachment to redeemed products. Using cross-country data, Study 2 utilized a scenario-based experiment and showed that the effect of smart shopper self-perceptions on emotional attachment is greater with experiential (vs. material) products. Using a recall-based survey, Study 3 revealed that emotional attachment mediates the effect of smart shopper self-perceptions on word-of-mouth behaviors. Given the prevalence of redeeming experiential products, such as hotel stay and air travel, social media managers may need to monitor online platforms where loyalty reward program members post reviews about their redemption experiences (e.g., the Points Guy).
Thermomechanical analysis on the frictional contact behavior of a high-strength steel 22MnB5–die steel H13 tribopair at 800 °C by experiment and finite-element simulation
Authors: Zhang Yi , Wang Wei , Liu Kun , Tong Baohong , Hu Zhaowen , Song Ruhong
Published: January 2021

High-strength boron steels are widely used in manufacturing the auto bodies and parts of light-weight vehicles, but the high rates of surface scratches and die wear have consistently occurred during hot stamping for these steels. For an in-depth understanding of the tribological characteristics at this interface, the frictional contact behavior and thermomechanical mechanisms of boron steel 22MnB5 against die steel H13 at 800 °C were studied through experiments and finite-element simulations. The coefficient of friction and worn surface topography were investigated by pin-on-disk sliding tests. A three-dimensional thermomechanical finite-element model of a friction pair was established to explore the interfacial dynamic variations. Experimental and simulation results show that severe elastic–plastic deformation occurred on the worn surface of the boron steel, whereas an increase in the load decreased the coefficient of friction within a certain range because the growth rate of shear force was slower than that of the normal force. When the finite-element model was changed from the gradual loading stage to the initial sliding stage, the tangential friction force further increased the plastic deformation on the surface of boron steel. The scratches and furrows were mainly caused by the compression and shear from asperities of the rough surface, as confirmed by the high-frictional-stress regions concentrated on the peaks and flanks of asperities. During the high-temperature and high-pressure experiments, the plasticized and softened surface materials of the boron steel adhered to the die surface readily, resulting in peeling and delamination.
Cumulative effects of therapies on disability in relapsing multiple sclerosis
Authors: Rollot Fabien , Casey Romain , Leray Emmanuelle , Debouverie Marc , Edan Gilles , Wiertlewski Sandrine , Vukusic Sandra , Laplaud David-Axel
Published: January 2021

Background:

Long-term effectiveness of treatment remains a key question in multiple sclerosis (MS) and the cumulative effects of past treatment have not been investigated so far.

Objective:

Explore the relationship between treatment exposure and disability risk in patients with relapsing-remitting multiple sclerosis (RRMS).

Methods:

A total of 2285 adult patients from the French nationwide cohort were included. Outcomes were irreversible EDSS4, and conversion to secondary progression of multiple sclerosis (SPMS). Associations between treatments and risk of disability were assessed using a novel weighted cumulative exposure model, assuming a 3-year lag to account for reverse causality. This flexible approach accounts for past exposure in a multivariate Cox proportional hazards model by computing a weight function.

Results:

At baseline, mean ± standard deviation age of patients was 33.4 ± 8.9 years and 75.0% were women. A 15-year continuous treatment starting 20 years ago was associated with a decrease in risk of 26% for irreversible EDSS4, and 34% for SPMS compared to a 5-year treatment starting 10 years ago. The risk of disability decreased with increasing duration of exposure to disease-modifying treatment (DMT).

Conclusion:

Long-term use of treatments in RRMS has a stronger beneficial cumulative impact than only early uses and delays the occurrence of moderate disability and conversion to SPMS.
Autistic parents’ views and experiences of talking about autism with their autistic children
Authors: Crane Laura , Lui Lok Man , Davies Jade , Pellicano Elizabeth
Published: January 2021

Little is known about how parents talk about autism with their autistic children, particularly among families in which both a parent and child are autistic. Using an online survey, we gathered quantitative and qualitative data from 34 autistic parents (most of whom had told their children about their diagnosis) to address this knowledge gap. There was considerable overlap between the views and experiences of the autistic parents in this study and the largely non-autistic parent samples in previous research. Specifically, parents emphasised the importance of being open and honest about the diagnosis, disclosing the diagnosis as early as possible, individualising discussions to children’s needs and framing the diagnosis positively. There were, however, areas in which the views and experiences of the current sample differed from previous research on non-autistic samples. First, our sample of autistic parents outlined the benefits of their own experiential expertise, which they felt resulted in heightened understanding and empathy with their children. Second, our sample tended not to express concerns about disclosure potentially having a negative impact. Finally, our participants did not express a want or need for professional support with disclosure. Instead, they reported feeling well equipped to support their children using their own knowledge and lived experience.

Lay abstract

Previous research examining how parents talk about autism with their children has tended to focus on parents who are not autistic themselves. We collected information on this topic from 34 autistic parents of autistic children (most of whom had told their children about their diagnosis). We found similarities, but also differences, between the views and experiences of autistic parents in this research and those reported in previous research (in studies of largely non-autistic parents). Similarities include the following: it is important to be open and honest about the diagnosis; the diagnosis should be introduced/discussed as early as possible; discussions should be tailored to each individual child’s needs; and we should not overlook the challenges associated with autism, but it is important to focus on positive aspects too. Differences include the following: autistic parents used personal experiences in conversations about autism, which was felt to result in increased understanding and empathy with their children; autistic parents overwhelmingly focused on more positive aspects of an autism diagnosis; our sample did not express concerns that discussions could have negative consequences too (e.g. making children more anxious); and autistic parents did not want or need professional support to talk about autism with their children (instead, they felt confident in using their own knowledge/experiences to guide discussions).
Victim legal representation and the adversarial criminal trial: A critical analysis of proposals for third-party counsel for complainants of serious sexual violence
Authors: Kirchengast Tyrone
Published: January 2021

The past several decades have witnessed a shift toward victim interests being considered and incorporated within adversarial systems of justice. More recently, some jurisdictions have somewhat contentiously considered granting sex offences complainants’ legal representation at trial. In Australia, the Royal Commission into Institutional Responses to Child Abuse (2017), the Royal Commission into Family Violence (2016) and the Victorian Law Reform Commission (2016) considered the potential role of legal counsel for complainants in the criminal trial process. While contrasting quite significantly with the traditional adversarial framework—which sees crime as contested between state and accused—legal representation for complainants is not unprecedented, and victims may already retain counsel for limited matters. Despite broader use of victim legal representation in the United States, Ireland and Scotland, and as recently considered by the Sir John Gillen Review in Northern Ireland, legal representation for sex offences complainants is only just developing in Australia. Notwithstanding recent reference to legal representation for complainants where sexual history or reputational evidence may be adduced, there exists no sufficient guidance as to how such representation may be integrated in the Australian criminal trial context. This article explores the implications of introducing such counsel in Australia, including the possible role of non-legal victim advocates.
Potential risk analysis of medical staff when performing endotracheal intubation in negative pressure isolation ward
Authors: Li He , Zhong Ke , Zhai Zhiqiang (John)
Published: January 2021

This study investigated, using validated computational fluid dynamics techniques, the potential infection risks to medical staff when performing endotracheal intubation in the negative pressure isolation ward during treatment of COVID-19 patients. The research first simulated the airflow distribution in negative pressure isolation ward and then examined the potential infection risks to medical staff under two different respiratory conditions of a patient (i.e. patient with endotracheal intubation and patient with normal respiration). The results revealed that medical staff have high possibility to be contracted when performing endotracheal intubation. Personal protective equipment during endotracheal intubation is thus critical to mitigate the potential infection risk to medical staff. Space position and body posture of the medical staff (e.g. standing upright and bent over) would influence the contamination risk. Higher infection risk was noted for the medical staff who performs endotracheal intubation as compared to the other who delivers assistance. A bent-over posture of the medical staff encounters more particle exposure due to a closer distance to the patient head as well as the unfavourable airflow pattern/direction. Protection by using a plastic aerosol box over the head of the patient was studied, which shows promising improvement by preventing more than 75% of virus particles from spreading around.
Numerical model for composite patch repair of notched aluminum plates under impact loading
Authors: Caliskan Umut , Ekici Recep , Yildiz Bayazit Ayse , Apalak M Kemal
Published: January 2021

The damaged area for various structures can be effectively repaired using composite materials. With the effect of impact, damage can occur that cannot be clearly seen in the inner structure of a laminated composite. This can cause delamination and other damage modes in layered composite structures. In this study, three-dimensional dynamic progressive damage analysis was performed in adhesively bonded composite patch-repaired metal notched plates under impact loads to investigate the effect of external composite patch material and thickness. Three-dimensional Hashin damage models were used for the progressive damage model. A user-defined subroutine, VUMAT was written to transfer the damage models to finite element code. By writing a separate script in Python language that relates to the damage models, the weakness in the laminate of the composite patch was transferred to the finite element model with a different degradation model proposed. It was found that plastic deformations occurring after impact damage in the notched metal plates was prevented by the use of composite patches. While glass and carbon fiber exhibit similar behavior at lower impact velocities, the progress of damage is prevented by increasing patch thickness. These behaviors were confirmed by the numerical model and showed an advanced agreement with experimental results.
Comparison of responses of different types of steel alloys under the same loading and environmental conditions
Authors: Brnic Josip , Krscanski Sanjin , Brcic Marino
Published: January 2021

Modern construction must meet the function for which it has been made and must be safe and economical to operate. In order to achieve the foregoing, the design of the structure should strive for an optimal solution. Such a design is usually based on the optimal choice of material and the optimal dimensions of structural elements. In order to select the optimal material for the manufacture of structural elements, it is necessary to have data on the behavior of the material in the intended operating conditions. In this sense, this paper deals with experimental research and analysis of the behavior of several types of materials subjected to approximately the same operating conditions. Under considerations were low-alloy structural steel (1.7225), special structural steel (1.7147), alloy carbon steel (1.5920), and alloy stainless steel (1.4034). The mechanical behavior of the tested materials, in terms of monitoring changes and mutual comparisons of mechanical properties, is shown on the basis of engineering stress–strain diagrams, while their creep resistances are monitored and compared with each other based on creep curves. As for the fracture toughness, it can be estimated based on the results of the fracture impact energy test, applying the known calculation method. In accordance with the tests performed at room temperature, the following results related to the maximum ultimate tensile strength ([Formula: see text]/MPa), Charpy V-notch impact energy ( CVN/J), and fatigue limit ([Formula: see text] at stress ratio [Formula: see text], are shown as follows: [Mat. Nr.[Formula: see text]; [Formula: see text]; [Formula: see text]; [Formula: see text].
Mixed-Methods Evaluation of the Initial Implementation of Advanced Home Visits in Chile
Authors: Garcia-Huidobro Diego , Vergés Alvaro , Basualto Patricia , Calvo Miranda Carlos , Boetto Carolina , Soto Mauricio , Kopplin Erika , Martínez Mayra , Aracena Marcela
Published: January 2021

Home visiting programs are evidence-based interventions that have a myriad outcomes for mothers and newborns. Chile offers these services as part of the Chile Crece Contigo, a nationwide program. However, implementing home visiting programs in community settings is difficult. In this study, we report clinic, provider, and participant engagement with the implementation of advanced home visits (ViDAs) in Chilean primary care clinics. ViDAs include a high number of visits, external supervision, and the use of technology. In this study, qualitative and quantitative data were collected to assess the initial implementation of the home visiting strategy. Qualitative data consisted of individual interviews and focus groups with directors of city health departments, clinic managers, and providers conducting home visits. Quantitative data included clinic, provider, and participant recruitment. City health departments were approached to authorize the participation of primary care clinics in the ViDAs program. Then, clinic directors were invited to approve the implementation of the home visiting program at their health centers. In total, 16 clinics, 42 practitioners, and 185 participants were recruited. A large amount of resources was needed to recruit clinics, providers, and participants. The intervention had low acceptability, low adoption, and a high implementation cost. Initial program implementation experienced several challenges. Identified facilitators and barriers both highlighted the need for community engagement at all levels for the successful implementation of an innovation in Chilean primary care clinics. In addition, this article provides recommendations for practitioners and researchers regarding the conduct of research in community-based settings.
From Boyfriend to Boy’s Love: South Korean Male ASMRtists’ Performances of Digital Care
Authors: Lee So-Rim
Published: January 2021

YouTube-based ASMR (Autonomous Sensory Meridian Response) has become widely popular in South Korea as a readily accessible mode of self-care. However, ASMR scholarship in South Korea has largely overlooked a discussion of its engagement with gender norms. This essay fills the gap by analyzing South Korean male ASMRtists performing digital care through “boyfriend role plays” and “boy’s love (BL) role plays.” Probing into these examples from the perspective of digital gender, I argue that the ASMR’s haptic encounter has the potential to turn the ASMRtist, the audience, and the Internet itself into active performers rehearsing the possibility of subverting the offline society’s normative expectations of gender roles.
Challenges in the management of people with heart failure with preserved ejection fraction (HFpEF) in primary care: A qualitative study of general practitioner perspectives
Authors: Hossain Muhammad Z , Chew-Graham Carolyn A , Sowden Emma , Blakeman Tom , Wellwood Ian , Tierney Stephanie , Deaton Christi
Published: January 2021

Objectives

To explore the perspectives of general practitioners (GPs) on the identification and management of people, including those from ethnic minority groups, with Heart Failure with Preserved Ejection Fraction (HFpEF).

Methods

Qualitative study. Semi-structured, face-to-face or telephone interviews and focus groups were conducted with 35 GPs in England, which were audio-recorded and transcribed verbatim. Framework analysis was used to manage and interpret data.

Results

Themes presented reflect four inter-related challenges: GPs’ 1) lack of understanding HFpEF, impacting on 2) difficulties in communicating the diagnosis, leading to 3) uncertainty in managing people with HFpEF, further hindered by (4) discontinuity across the primary/secondary interface. All were considered more challenging by GPs when managing people from different cultures and languages.

Discussion

HFpEF is not well understood by GPs, leading to diagnostic difficulty, management uncertainty and potential inequity in care offered. People with HFpEF are seen as complex, with multiple long-term conditions and requiring personalised care. Challenges in their management occur across the healthcare system. This study has identified learning needs for GPs around identification and on-going support for people with HFpEF in primary care. It will contribute to the development of more flexible and patient-centred pathways across the primary/secondary care interface.
Joint optimization of reliability design and spares inventory for a use-oriented product-service system based on the electric vehicle charging station
Authors: Zhang Jing , Zhao Xian , Song Yanbo
Published: January 2021

With the shift of business pattern from the traditional manufacturer orientation to customer orientation, the product-service system has become more and more popular. This paper takes an electrical vehicle charging station as the research object and builds a joint optimization model of reliability design and spares inventory with the objective of maximizing net profit under the constraints of availability and customer’s loss rate. Particularly, this model considers not only two types of services, namely fast charging and slow charging but also the transfer of customers between different types of service. This new model is more accordant with the practical circumstances by involving a series of elements of the product-service system simultaneously, such as the customer’s arrival, service, replacement maintenance and spares replenishment process. Then, the probabilistic indices related to reliability are derived by applying the continuous time Markov Process. A balance between the number of charging piles and spares inventory policy can be achieved by solving the joint optimization model. The influence of model parameters on these indices and the superiority of the proposed joint optimization model are analyzed in detail by numerical examples. Finally, some critical conclusions are obtained with the intent of promoting the system reliability and profit. Furthermore, this joint optimization model can be extended to more circumstances and provides guidances to solve the reliability optimization problems regarding a similar system.
Gesturing toward the common and the desperation: Climate geopoetics’ potential
Authors: Acker Maleea
Published: January 2021

This commentary responds to Magrane’s accomplished article on climate geopoetics. I first ask whether Magrane’s reading could go wider to include some prominent poets who have addressed climate and lyric poetry in recent decades. I then suggest a connection between climate geopoetics and lyric philosophy, and posit the ability of poetry, through lyric’s ability to forfeit the individual self and to gesture toward something common, a universal emotion or state. Finally, I suggest that Magrane unleash his words so that they might match the desperate times in which humans find themselves. This response then ends with a climate geopoetics poem of my own.
Diazoxide‐associated pulmonary hypertension in a patient with noncompaction cardiomyopathy
Authors: Sullivan Rachel T. , Tillman Kathryn A. , Kindel Steven J. , Handler Stephanie S.
Published: January 2021

Development of pulmonary hypertension after initiation of diazoxide for the treatment of neonatal hyperinsulinemic hypoglycemia is a rare, but previously described association. Risk factors for development of diazoxide‐associated pulmonary hypertension include lower gestational age and congenital heart disease. This novel case report describes an infant with noncompaction cardiomyopathy who developed pulmonary hypertension shortly after initiation of diazoxide for hyperinsulinemic hypoglycemia which resolved upon cessation of the drug. This case highlights the benefit of having pre‐treatment knowledge of underlying cardiac anatomy and makes a case for routine echocardiographic screening for neonates initiating diazoxide treatment.
Impact of Face Masks on 6‐Minute Walk Test in Healthy Volunteers
Authors: Swiatek Kevin M. , Lester Charnetta , Ng Nicole , Golia Saahil , Pinson Janet , Grinnan Dan
Published: January 2021

Our objective was to establish the impact of wearing a face mask on the outcome of six‐minute walk test in healthy volunteers. In a study of 20 healthy volunteers who each completed two 6MWTs, one with a mask and one without, there was no difference in distance walked. However, there was a significant difference in perception of dyspnea between the two groups.
Robotic cystectomy histopathology outcomes in patients who have ‘failed’ Bacillus Calmette–Guérin: A case series
Authors: Hart Edward JM , Kavanagh Liam E , Guy Alexandra M , Lindsey Bronagh , Walters Jo , Haagsma Ben , Patil Krishna , Perry Matthew JA
Published: January 2021

Objective:

Robot-assisted radical cystectomy (RARC) is considered the gold-standard for patients who fail Bacillus Calmette–Guérin (BCG) treatment for high-grade non-muscle-invasive bladder cancer. We reviewed our histopathological outcomes to assess whether we are proceeding to cystectomy at an appropriate time.

Methods:

A retrospective analysis of the RARC database (2015–2020) was performed to identify patients who received intravesical BCG before cystectomy. Data regarding demographics, number of BCG instillations and staging were collected. Histopathological stage at cystectomy was compared between patients who received an induction course of BCG only (group A), and those who had continued maintenance doses (group B).

Results:

A total of 73 patients (57 males and 16 females) met the final inclusion criteria, with 24 patients in group A and 49 patients in group B. At cystectomy, 19 patients had ⩾T2 disease (group A: 7; group B: 12). There was no significant difference between groups ( p=0.78). Pelvic lymph node dissection was performed in 68 patients, with six patients found to have lymph node metastases.

Conclusion:

RARC plays a key role in managing BCG failure, considering the number of patients with muscle-invasive disease at final staging. However, prolonged BCG treatment was not associated with more advanced disease in our case series. Thus, persistence with intravesical treatment warrants consideration for selected patients.

Level of evidence:

Level 4.
Constructionist Learning in School Mathematics: Implications for Education in the Fourth Industrial Revolution
Authors: Ng (吴蔼蓝) Oi-Lam , Tsang (曾咏琪) Wing Ki
Published: January 2021

Highlights

Amid rapid technological development in the Fourth Industrial Revolution, this article engages with an important question, especially in the context of science, technology, engineering, and mathematics (STEM) education: Can technology transform STEM teaching and learning? Constructionist learning responds to the current “maker movement,” which draws upon the innate human desire to make things with our hands. Two important elements of constructionist learning—technology literacy and engineering design—have implications for meeting the global need for expertise in the STEM disciplines. This article discusses how constructionist learning can play an important role in teaching and learning school mathematics via a transdisciplinary approach to STEM education. Two examples of the authors’ empirical research on constructionist learning in school mathematics classrooms with 3D printing are illustrated. Findings suggest that the 3D Printing Pens played an active role in the construction of artifacts (physical) and mathematical meaning (cognitive).
Management and Mid-Term Outcome After “Real SCIWORA” in Children and Adolescents
Authors: Freigang Viola , Butz Katja , Seebauer Caroline Theresa , Karnosky Julia , Lang Siegmund , Alt Volker , Baumann Florian
Published: January 2021

Study Design:

Retrospective analysis.

Objective:

The SCIWORA Syndrome (Spinal Cord Injury Without Radiographic Abnormalities) is a rare but potentially severe injury with a peak in childhood and adolescence. With a better understanding of injury patterns and advances in MRI, there is ongoing discussion regarding the “Real SCIWORA” syndrome, a clinical picture of neurologic deficits on clinical examination but absence of radiographic pathologies even on MRI. The purpose of this study was to evaluate mid-term clinical outcome and the psychological impact of the “Real SCIWORA.”

Methods:

In this retrospective analysis, we evaluated 32 patients treated for “Real SCIWORA” between 2007-2019. Inclusion criteria were: neurologic deficit after trauma, no other cerebral or skeletal injury and a lack of pathological findings in spinal MRI. All patients were followed until complete recovery from initial symptoms. 25/32 patients were re-evaluated after 6.9 years (1-14 years) using the Oswestry Disability Index, the Frankel Score, the EQ-5D score, and the Breslau Short Screening Scale for PTSD.

Results:

Initial neurologic presentation ranged from Frankel Grade A-D. All patients recovered neurologically during 1-13 days to a Frankel Grade E. The analysis of HR-QoL revealed no difference between the cohort of SCIWORA patients and the German population norm, Oswestry Disability Index showed only minimal disabilities. 4/25 patients showed signs of PTSD.

Conclusions:

The “Real SCIWORA” syndrome is a diagnosis per exclusionem requiring a full spinal MRI to ensure exclusion of structural and potentially serious reasons of the neurologic impairment. Further clinical re-evaluation, psychological support seems to be essential.

Level of Evidence:

IV—retrospective study.
Machine Learning Approaches to Define Candidates for Ambulatory Single Level Laminectomy Surgery
Authors: Li Qiyi , Zhong Haoyan , Girardi Federico P. , Poeran Jashvant , Wilson Lauren A. , Memtsoudis Stavros G. , Liu Jiabin
Published: January 2021

Study Design:

retrospective cohort study.

Objectives:

To test and compare 2 machine learning algorithms to define characteristics associated with candidates for ambulatory same day laminectomy surgery.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent single level laminectomy in 2017 and 2018. The main outcome was ambulatory same day discharge. Study variables of interest included demographic information, comorbidities, preoperative laboratory values, and intra-operative information. Two machine learning predictive modeling algorithms, artificial neural network (ANN) and random forest, were trained to predict same day discharge. The quality of models was evaluated with area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) measures.

Results:

Among 35,644 patients, 13,230 (37.1%) were discharged on the day of surgery. Both ANN and RF demonstrated a satisfactory model quality in terms of AUC (0.77 and 0.77), accuracy (0.69 and 0.70), sensitivity (0.83 and 0.58), specificity (0.55 and 0.80), PPV (0.77 and 0.69), and NPV (0.64 and 0.70). Both models highlighted several important predictive variables, including age, duration of operation, body mass index and preoperative laboratory values including, hematocrit, platelets, white blood cells, and alkaline phosphatase.

Conclusion:

Machine learning approaches provide a promising tool to identify candidates for ambulatory laminectomy surgery. Both machine learning algorithms highlighted the as yet unrecognized importance of preoperative laboratory testing on patient pathway design.
Efficacy and safety of nucleo-annuloplasty using radiofrequency ablation for discogenic back pain in a local Hong Kong population
Authors: Yam Joyce Oching , Cheung Philip , Chiang Lan Fong , Wan Shuk Ying Sambo , Mok Wing Yuk
Published: January 2021

Purpose:

Degenerative disk disease is a global and common debilitating condition with substantial healthcare and economic costs. Disc-Fx is a relatively new minimally invasive, percutaneous nucleo-annuloplasty procedure aimed to alleviate symptoms of discogenic back pain via manual discectomy with nuclear and annular modification via means of radiofrequency ablation. The aim of this retrospective study is to report the 1-year outcomes, efficacy and safety of the percutaneous nucleo-annuloplasty procedure for treatment of discogenic back pain in the local Hong Kong population.

Methods:

This retrospective study consists of 16 patients with a total of 24 levels from 2017 to –2019 with at least 6 months of chronic back pain failing conservative management, MRI-confirmed disc degeneration, and who have undergone percutaneous nucleo-annuloplasty via Disc-Fx procedure. All patients had plain radiography and magnetic resonance imaging prior to procedure. Percutaneous nucleo-annuloplasty was only performed in patients with confirmed discogenic back pain via a positive provocative test on discography.

Results:

The mean functional outcome of Oswestry Disability Index improved from 46.25 points preoperatively to 24.12 at the of 1-year follow-up (p-value = 0.00). The Numerical Pain Rating Scale improved from 6.25 points to 4.4 points (p-value: 0.01) and 14.56 points to 8.85 points (p-value = 0.01) at preoperative to 1-year post-procedure respectively. There were no reported procedural related complications in the study population.

Conclusion:

The procedure of percutaneous nucleo-annuloplasty shows to be a relatively safe procedure that can be considered in patients with discogenic back pain. Larger studies would be desired to draw further conclusions about its efficacy.
That one doctor. . . Qualitative thematic analysis of 49 women’s written accounts of their endometriosis diagnosis
Authors: Fernley Nicole
Published: January 2021

Introduction:

One in nine women experience endometriosis, a common gynaecological disease, yet time to diagnosis averages 7 years. People are sharing their endometriosis experiences online. This research’s aim was to expose and synthesise the collective themes of diagnostic experience.

Method:

A qualitative thematic analysis of publicly accessible online autobiographical accounts of women and their endometriosis diagnosis. Themes were coded within NVIVO and thematic maps and tables created. Eighty-nine original accounts were identified, 26 were excluded. Saturation point was 49.

Results:

Women communicated long, painful and emotional journeys to diagnosis. Forty women experienced endometriosis symptoms before the age of 20, 33 before 15 years. Despite repeated GP presentation, 36 women had never heard of endometriosis before diagnosis. Women highlighted the positive impact of ‘that one doctor’ who said the word ‘endometriosis’ who listened, believed, investigated and provided prompt referral to specialists. Diagnosis gave relief and answers to the long journey, provided women a sense of community, hope and personal visibility after feeling alone. While this common disease is undiagnosed women suffer.

Conclusion:

‘That one doctor’ can transform a patient’s experience and create a positive diagnosis pathway towards endometriosis. The doctor patient alliance is vital for prompt diagnosis. Symptom dismissal with long diagnosis delays are having negative, physical and psychological consequences for women. Early detection, GP education and community awareness campaigns are imperative to reduce further delayed diagnosis and long-term negative impacts of undiagnosed endometriosis.
Lesson Study as a Faculty Development Initiative in Higher Education: A Systematic Review
Authors: Hervas Gabriel
Published: January 2021

Lesson study (LS) is a professional development practice that has mainly remained conducted by elementary, secondary, and preservice schoolteachers. However, in recent years, different studies have explored its practice among higher education (HE) faculty members. This article presents the first systematic review on LS among HE faculty members. Twenty-one studies published until December 2019 were analyzed. Among others, findings regarding reveal that (a) most of these studies are of U.S. origin and of linguistic and mathematics disciplines; (b) few faculty members participated in these studies; (c) most LS-related references used are not contextualized in HE; (d) beneficial outcomes of LS in the design of the lessons, the participants’ pedagogical knowledge and the participants’ approach to teaching; (e) mixed results regarding the participants’ reflection and collaboration, and (f) less positive outcomes about organizational issues when conducting LS. I discuss these results and present future research lines and limitations of this study.
Building Community Resilience: Lessons from Flood-affected Residents in a Regional Australian Town
Authors: Darab Sandy , Hartman Yvonne , Pittaway Emma E.
Published: January 2021

This article discusses the relevance and usefulness of a community development approach and community resilience in coping with natural disasters such as floods and their impact. In March 2017, a major flood in Lismore, Australia, resulted in extensive damage to homes and businesses and caused severe disruption and distress to some residents. A small qualitative study of 20 residents was conducted to understand how they were affected in flooded areas in terms of their housing and other impacts. The narrative and thematic analysis of respondents’ stories ‘from the ground’ highlighted both the problems with some institutional responses to the flood and the strength of the community response. One of the key findings was the resilience shown by some parts of the community during and after the flood, particularly in terms of communal self-organisation. This article interrogates that finding in-depth and argues that it provides valuable insights into community resilience and a community development approach, which need to be consciously cultivated to combat the impact of disasters.