bluuebunny/crossref_metadata_2025 huggingface dataset:
Handling the imbalanced data with missing value elimination SMOTE in the classification of the relevance education background with graduates employment
Authors: Desiani Anita , Yahdin Sugandi , Kartikasari Annisa , Irmeilyana Irmeilyana
Published: May 2021

The imbalanced data affect the accuracy of models, especially for precision and sensitivity, it makes difficult to find information on minority class. The problem is identified in the tracer study dataset Universitas Sriwijaya that has 2934 data. The label attribute is divided into several label classes, namely not tight, somewhat-tight, tight, very tight, and tightest. The number of the tightest and very tight is 27% and 38.6% of the number majority classes. In the study, the SMOTE is combined with eliminating the missing value of data to handle the imbalanced data. The method was evaluated by the classification methods KNN, ANN, and C4.5. The results of these methods show a significant increase in accuracy as a whole and a significant increase in the precision and sensitivity of minority classes. The precision and sensitivity of both the majority and minority are not too different, although the number of the minority is very less compared to the majority class. the information on minority classes can be obtained with quite high precision and sensitivity. As a conclusion, the proposed method is passably to improve accuracy and greatly affects the increase in sensitivity and precision.
Multi-scale fusion for underwater image enhancement using multi-layer perceptron
Authors: Sudhakara M. , Meena M. Janaki
Published: May 2021

Underwater image enhancement (UIE) is an imperative computer vision activity with many applications and different strategies proposed in recent years. Underwater images are firmly low in quality by a mixture of noise, wavelength dependency, and light attenuation. This paper depicts an effective strategy to improve the quality of degraded underwater images. Existing methods for dehazing in the literature considering dark channel prior utilize two separate phases for evaluating the transmission map (i.e., transmission estimation and transmission refinement). Accurate restoration is not possible with these methods and takes more computational time. A proposed three-step method is an imaging approach that does not need particular hardware or underwater conditions. First, we utilize the multi-layer perceptron (MLP) to comprehensively evaluate transmission maps by base channel, followed by contrast enhancement.  Furthermore, a gamma-adjusted version of the MLP recovered image is derived. Finally, the multi-scale fusion method was applied to two attained images. The standardized weight is computed for the two images with three different weights in the fusion process. The quantitative results show that significantly our approach gives the better result with the difference of 0.536, 2.185, and 1.272 for PCQI, UCIQE, and UIQM metrics, respectively, on a single underwater image benchmark dataset. The qualitative results also give better results compared with the state-of-the-art techniques.
Estimating PV models using multi-group salp swarm algorithm
Authors: Al-Shabi Mohammad , Ghenai Chaouki , Bettayeb Maamar , Faraz Ahmad Fahad , El Haj Assad Mamdouh
Published: May 2021

In this paper, a multi-group salp swarm algorithm (MGSSA) is presented for estimating the photovoltaic (PV) solar cell models. The SSA is a metaheuristic technique that mimics the social behavior of the salp. The salps work in a group that follow a certain leader. The leader approaches the food source and the rest follows it, hence resulting in slow convergence of SSA toward the solution. For several groups, the searching mechanism is going to be improved. In this work, a recently developed algorithm based on several salp groups is implemented to estimate the single-, double-, triple-, Quadruple-, and Quintuple-diode models of a PV solar cell. Six versions of MGSSA algorithms are developed with different chain numbers; one, two, four, six, eight and half number of the salps. The results are compared to the regular particle swarm optimization (PSO) and some of its newly developed forms. The results show that MGSSA has a faster convergence rate, and shorter settling time than SSA. Similar to the inspired actual salp chain, the leader is the most important member in the chain; the rest has less significant effect on the algorithm. Therefore, it is highly recommended to increase the number of leaders and reduce the chain length. Increasing the number of leaders (number of groups) can reduce the root mean squared error (RMSE) and maximum absolute error (MAE) by 50% of its value.
How Kalanchoe marmorata (Crassulaceae subfam. Kalanchooideae), a distinctive central and east African species, received its name, and the later, valid publication of K. macrantha by Maire

Authors: SMITH GIDEON F.
Published: May 2021

Aspects of the nomenclature of Kalanchoe marmorata (Crassulaceae subfam. Kalanchooideae), which was validly published in 1892, are discussed and clarified. Although mentioned, but not validly published, by John G. Baker in 1892, K. macrantha was eventually validly published in 1976 in the volume of the Flore de l’Afrique du Nord that included the Crassulaceae, a posthumous treatment of the family by René C.J.E. Maire. However, K. macrantha, although a validly published name, is illegitimate as the earlier published K. marmorata was included in the synonymy of one of its varieties. The nomenclature of the three varieties that Maire recognised in K. macrantha is discussed. The typification of the names K. grandiflora and K. marmorata is clarified.
Elevation of Symplocos macrophylla subsp. namboodiriana (Symplocaceae) to the species rank

Authors: STEPHAN JEYAMARY , FRITSCH PETER W. , MOHANAN NARAYANAN NAIR , LIRIINA DAIHRII KAIKHO
Published: May 2021

In a comprehensive taxonomic revision of the Old World species of Symplocos (Symplocaceae) many infraspecific taxa were recognized within S. macrophylla, but subsequently most of these have been either moved to other species or recognized at the species rank. Following this trend, we provide herewith morphological evidence to warrant the elevation of S. macrophylla subsp. namboodiriana to the species rank. Symplocos namboodiriana comb. & stat. nov. differs from the other subspecies of S. macrophylla in its 1-flowered inflorescences (versus multi-flowered), shorter bracts, and 4 to 6 secondary leaf veins (versus longer bracts and 6 to 13 secondary veins). We provide an updated description of the species along with photographic images of live specimens and a conservation threat assessment.
1. Introduction
Authors: Lewis Richard S.
Published: May 2021

This chapter provides an introduction and overview of the current trend of an ever-increasingly media-saturated world and how media literacy currently responds. The importance of the technological medium and the technological relation are discussed, as well as describing the importance of better understanding the human subject. Finally, the overall structure of this book is described and the various fields that will be addressed are touched upon briefly.
3. Understanding the Medium Through the Technological Relation
Authors: Lewis Richard S.
Published: May 2021

The effects of the technological medium are explored through two lenses: a micro lens and a macro lens. The first helps to better understand technological mediation—how our specific relations with technologies transform not only the media messages, but our own selves. The second aspect helps to better understand the technological medium as an environment of complex relations. In order to understand these micro and macro effects of the technological relations, concepts from two fields of study—postphenomenology and media ecology—are used. Concepts from each field are brought together to help create a way to understand a posthuman subject, which is developed in the following chapter. While not meant to be an extensive review of either postphenomenology or media ecology, the concepts from the two fields begin a holistic investigation of the technological medium, which is not sufficiently developed in most discussions concerning media literacy.
7. Conclusion
Authors: Lewis Richard S.
Published: May 2021

In this conclusion, I summarize my findings concerning how to expand media literacy. I then reflect on strengths and weaknesses of the study. I conclude with further recommendations for how the intrasubjective mediating framework could be used outside of media literacy.
Echocardiographic Diagnosis of Congenital Arterial Catheter Function Changes
Authors: Shen Dan , Li Jie , Fan Li
Published: May 2021

Arterial catheter is physiological flow channel between pulmonary artery and descending aorta in fetal circulation. Most right heart blood flow through artery catheter into descending aorta during embryo period. Most term neonates are usually stopped after fetal delivery. Functional
closure occurs in 48 h after birth, while 88% should be closed completely at 8 weeks after birth. There was no significant difference between PDA occlusion technique guided by transthoracic echocardiography and conventional funnel PDA closure rate, total closure rate, long term closure rate,
pulmonary systolic pressure before surgery and pulmonary artery pressure difference before and after operation (P < 0.05). Conversely, under similar therapeutic effects, funnel type PDA closure guided by transthoracic echocardiography has advantages such as shorter anesthesia time,
less total ray volume and contrast agent, lower hospitalization expense and fewer complications. Therefore, through transthoracic echocardiography guidance delivery of order vein approach interventional closure therapy funnel type PDA especially suitable for children, worthy of clinical application.
Amplitude Integrated Electroencephalogram Integration to Monitor the Relationship Between Development and Changes of the Nervous System in Late Preform Infants
Authors: Qu Sehua , Shan Lianqiang , Chen Xin , Zhou Rui , Yin Huaixiang , Yang Mei , Zheng Yingjuan , Dong Huaifu
Published: May 2021

This article uses amplitude integration of electroencephalogram integration to detect the development of the nervous system of late perform infants, and to study its changes, using a stratified randomized controlled trial method. The preform infants in the neonatal department of postnatal birth had the research object. The sample size was calculated, according to the first set of tires into small gestational age groups, and gestational age large. The subjects of each group were randomly divided into small gestational age groups, small gestational age intervention groups, large gestational age groups and large gestational age intervention groups. Two preterm children increased with age growth. The performance of the broadband and narrowband sector decreased voltage need the voltage lower bound ofa growing trend to the voltage difference becomes smaller. Oral exercise intervention is safe and effective for premature infants over 30 weeks old and can be used clinically as a neuroprotective strategy.
Analysis and Management of COVID-19 Using Computational Intelligence Technologies
Authors: Meng Xiangmin , Zhang Jie
Published: May 2021

After the outbreak of COVID-19, the world economy and people’s health have been greatly challenged. What is the law of the spread of COVID-19, when will it reach its peak, and when will it be effectively controlled? These have all become major issues of common concern throughout
China and the world. Based on this background, this article introduces a variety of classic computational intelligence technologies to predict the spread of COVID-19. Computational intelligence technology mainly includes support vector machine regression (SVR), Takagi-Sugeuo-Kang fuzzy system
(TSK-FS), and extreme learning machine (ELM). Compare the predictions of the infection rate, mortality rate, and recovery rate of the COVID-19 epidemic in China by each intelligent model in 5 and 10 days, the effectiveness of the computational intelligence algorithm used in epidemic prediction
is verified. Based on the prediction results, the patients are classified and managed. According to the time of illness, physical fitness and other factors, patients are divided into three categories: Severe, moderate, and mild. In the case of serious shortage of medical equipment and medical
staff, auxiliary medical institutions take corresponding treatment measures for different patients.
Comparing Symptomatic and Asymptomatic Carotid Artery Atherosclerosis in Patients With Bilateral Carotid Vulnerable Plaques Using Magnetic Resonance Imaging
Authors: Xin Ruijing , Yang Dandan , Xu Huimin , Han Hualu , Li Jin , Miao Yingyu , Du Ziwei , Ding Qian , Deng Shasha , Ning Zihan , Shen Rui , Li Rui , Li Cheng , Yuan Chun , Zhao Xihai
Published: May 2021

We compared plaque characteristics between symptomatic and asymptomatic sides in patients with bilateral carotid vulnerable plaques using magnetic resonance imaging (MRI). Participants (n = 67; mean age: 65.8 ± 7.7 years, 61 males) with bilateral carotid vulnerable plaques were included. Vulnerable plaques were characterized by intraplaque hemorrhage (IPH), large lipid-rich necrotic core (LRNC), or fibrous cap rupture (FCR) on MRI. Symptomatic vulnerable plaques showed greater plaque burden, LRNC volume (median: 221.4 vs 134.8 mm3, P = .003), IPH volume (median: 32.2 vs 22.5 mm3, P = .030), maximum percentage (Max%) LRNC (median: 51.3% vs 41.8%, P = .002), Max%IPH (median: 13.4% vs 9.5%, P = .022), cumulative slices of LRNC (median: 10 vs 8, P = .005), and more juxtaluminal IPH and/or thrombus (29.9% vs 6.0%, P = .001) and FCR (37.3% vs 16.4%, P = .007) than asymptomatic ones. After adjusting for plaque burden, differences in juxtaluminal IPH and/or thrombus (odds ratio [OR]: 5.49, 95% CI: 1.61-18.75, P = .007) and FCR (OR: 2.90, 95% CI: 1.16-7.24, P = .022) between bilateral sides remained statistically significant. For patients with bilateral carotid vulnerable plaques, symptomatic plaques had greater burden, more juxtaluminal IPH and/or thrombus, and FCR compared with asymptomatic ones. The differences in juxtaluminal IPH and/or thrombus and FCR between bilateral sides were independent of plaque burden.
Effect of fiber orientation on the tensile properties of cross-ply laminates of PP reinforced continuous carbon fiber
Authors: Mizumoto Kazuya , Kanda Yoshihiko , Isaki Takeharu , Sanada Kazuaki , Nagata Kazuya , Miyata Atsushi , Fujihara Kazutoshi
Published: May 2021

This paper presents an experimental study of tensile properties, using a carbon–polypropylene uni-directional sheet with a thickness of 0.15 mm, which shows that highly non-linear stress–strain curves can be achieved with cross-angle-ply laminates. Generally, these properties are studied from the scanning electronic microscope and X-ray computed tomography. Cross-ply laminates with fiber orientation angles from 15 to 60° are investigated and it is found that there are the pseudo-ductile behavior with the fiber rotation, especially at fiber orientation angles from 30° to 60°.The Pseudo-ductile behavior is a phenomenon in which the apparent strain increases after yielding with strain hardening. It is greatly affected by the fiber reorientation in the loading direction. The fiber reorientation is allowed the plasticity of the polypropylene and thickness of each layer.
Global Mediatized Death and Emotion: Parasocial Grieving—Mourning #stephenhawking on Twitter
Authors: Akhther Najma , Tetteh Dinah A.
Published: May 2021

This study examined mediatized death and emotion, specifically parasocial grieving, toward high-profile celebrity Stephen Hawking’s death from a global perspective. A thematic analysis of public tweets explored how social media mourners expressed parasocial grieving following Hawking’s death and how that shaped mediatized global flows of emotion in terms of digital affect culture. Findings showed varied forms of mediatized emotional responses associated with parasocial grievings, such as sadness, shock, confusion, love, and longing. Mourners also adopted varied coping mechanisms, including individualized tributes, reminiscing, memorializing, and advocacy. Findings suggested that Hawking’s mourners performed parasocial death rituals on Twitter as a legitimate public space of mourning. Findings contribute to parasocial grieving scholarship and mediatization of death and emotion.
The introduction of a paediatric ENT and anaesthesia skills course in Kilimanjaro Christian Medical Centre hospital, (KCMC), Moshi, Tanzania
Authors: Kotwica Aleksandra , Shija Peter , Hampton Tom , Howard David
Published: May 2021

Human factors and a safe operating theatre environment are of paramount importance, wherever surgery is undertaken. The majority of patients in sub-Saharan Africa do not yet have access to safe surgery. The Paediatric ENT Skills and Airway Course introduced and evaluated here was designed to improve outcomes and safety in a typical East African environment. The lectures, tutorials and practicals covered technical and non-technical skills. Responses from pre- and post-course questionnaires were evaluated as an initial surrogate for effectiveness of this course. The latter showed improvement in all taught skills and found universal recommendation. The course had been established to try to minimise morbidity and mortality after paediatric surgery at our institution, KCMC. We encouraged team co-operation in the care of patients, and recommend other centres consider similar courses building on human factors for safer operating theatre working practices.
Life satisfaction and the conventionality of political participation: The moderation effect of post-materialist value orientation
Authors: Cheng Edmund W , Chung Hiu-Fung , Cheng Hoi-wa
Published: May 2021

Does life satisfaction (LS) predict people’s likelihood of participating in politics? Although the relationship between LS and political participation (PP) has been widely debated, its correlation and causality remain inconclusive. We contribute to the literature by exploring the moderation effect of post-materialist value orientation. By conceptualizing the conventionality of PP as a continuous spectrum, we suggest a new typology beyond the dichotomous understanding. Seventh-wave data from the World Values Survey in Hong Kong indicate that individuals who are more dissatisfied with their lives are more likely to engage in radicalized actions such as strikes and boycotts. This negative relationship is particularly strong among people with a post-materialist orientation, yet LS is not related to electoral participation and normalized actions, including peaceful demonstrations commonly regarded as ‘unconventional’ in previous studies. Furthermore, the results of propensity score matching reinforce the causal claim that LS predicts radicalized action negatively.
Religious and secular value divides in Western Europe: A cross-national comparison (1981–2008)
Authors: Pless Anna , Tromp Paul , Houtman Dick
Published: May 2021

Studies on cultural divisions in Western European politics typically combine two different value divides. The first divide is moral traditionalism versus progressiveness, which pits the religious and the secular against each other on matters of procreation, family and gender roles. The second one is authoritarianism versus libertarianism, which captures the opposition between the high- and low-educated about basically secular attitudes towards matters of immigration and law and order. Since the first divide is religiously inspired and the second one is basically secular, this article systematically distinguishes between them and studies whether secularization in Western Europe affects them differently. We perform multilevel regression analysis using European Values Study data (four waves, 1981–2008) for 17 Western European countries. Our findings show that the divide between the religious and the secular about moral issues declines with secularization, while the divide between the high- and low-educated about secular issues becomes wider.
Secondary Crash Identification using Crowdsourced Waze User Reports
Authors: Zhang Zhihua , Liu Yuandong , Han Lee D. , Freeze Phillip Bradley
Published: May 2021

Secondary crashes are crashes that occur as a result of the nonrecurrent congestion originating from primary crashes, and always have a greater impact on safety and traffic than a single crash. A better understanding of secondary crashes would benefit traffic incident management, and this requires accurate identification of secondary crashes. This study explores using crowdsourced Waze user reports to identify secondary crashes. A network-based clustering algorithm is proposed to extract the primary crash cluster, including all user reports originating from the primary crash, and any crash that occurred within the cluster would be a secondary crash. This method works as a filter to select accurate primary–secondary relationships, thus precisely identifying secondary crashes. A case study is performed with crashes occurring from June to December 2019 on a 30-mi stretch of I-40 in Knoxville, TN. A static threshold method (crash duration and 10 mi) was used to preselect the potential primary–secondary crash pairs, and 75 out of 708 crashes were identified as potential secondary crashes. Based on the preselected primary–secondary crash pairs, 17 secondary crashes were obtained with the proposed method and the results were compared with one of the commonly used methods, the speed contour plot method. Though the proposed method captured fewer secondary crashes, it did identify several secondary crashes that could not be observed with the speed contour plot method. The results showed the applicability of the method and the potential of crowdsourced Waze user reports in secondary crash identification.
The Mexican social unconscious—part I: The roots of a nation
Authors: Hernández-Tubert Reyna
Published: May 2021

The social unconscious of a country or people is shaped by their origins and by the major collective traumatic experiences of their past. In the case of Mexico, this has been the trauma of the Spanish Conquest, that aimed to subjugate its originary peoples and obliterate their whole culture, language, and religion, which nonetheless subsisted subterraneously, syncretized with those of their invaders. It was a veritable genocide, both physical and cultural.

The Mexican population was born from the mating of a brutal foreign conqueror and a subjected native woman, resulting in mestization, both physical and cultural. The psychic and social aftermath of these origins has been a deep ambivalence of Mexicans towards their identity and the foreign invader. This is similar to the fate of the unwelcome and abused child described by Ferenczi.

Such underlying factors, derived from the collective history of peoples should be taken into account in any psychoanalytic or group-analytic enquiry of individual patients and groups.
Extended state observer–based output feedback control for spacecraft pose tracking with control input saturation
Authors: Gong Kejie , Liao Ying , Mei Yafei
Published: May 2021

This article proposed an extended state observer (ESO)–based output feedback control scheme for rigid spacecraft pose tracking without velocity feedback, which accounts for inertial uncertainties, external disturbances, and control input constraints. In this research, the 6-DOF tracking error dynamics is described by the exponential coordinates on SE(3). A novel continuous finite-time ESO is proposed to estimate the velocity information and the compound disturbance, and the estimations are utilized in the control law design. The ESO ensures a finite-time uniform ultimately bounded stability of the observation states, which is proved utilizing the homogeneity method. A non-singular finite-time terminal sliding mode controller based on super-twisting technology is proposed, which would drive spacecraft tracking the desired states. The other two observer-based controllers are also proposed for comparison. The superiorities of the proposed control scheme are demonstrated by theory analyses and numerical simulations.
Investigation of the flowfield on a vaneless counter-rotating turbine with seal cavity flow ejection
Authors: Sui Xiuming , Zhao Wei , Xiang Xiaorong , Pi Te , Zhao Qingjun
Published: May 2021

The sealing of the rotor-rotor gap and rotor disk cooling are vital to the safe operation of the vaneless counter-rotating turbine(VCRT). In order to quantifies the influence of the wheel-space cavity flow on the VCRT aerodynamic performance, and to improve turbine efficiency of the VCRT at certain rim seal ejection rates, numerical studies which considered the effects of rotor-rotor rim seal flow ejection are carried out in this paper. The three dimensional unsteady computational fluid dynamic analysis of a VCRT at the engine conditions are performed, and the seal flow ejected downstream of the high pressure rotor row at six sealing flow rate are modeled. The interaction among the high pressure rotor trailing shock wave, the downstream secondary flow and the seal flow has been studied and quantitatively characterized as a function of the purge ejection rate. Numerical results show that seal flow- mainstream flow interaction is entirely dominated by the high pressure rotor trailing edge shock at the hub, low pressure hub passage vortex and the mixing of the sealing flow from wheelspace and mainstream. When the mass flow rate of the coolant is smaller than some threshold value, the shock loss of the high pressure rotor and hub secondary flow loss of the low pressure rotor are decreased with the increasing of the coolant mass flow rate. It causes that the VCRT efficiency is gradually increased. On condition that the amount of the seal flows is beyond the threshold value, the key roles in modification of the VCRT performance are changed. The increment of the hub secondary flow loss and the mixing loss are gradually larger than the decrement of the shock loss. As a result, the turbine efficiency gradually decreases.
Meeting Maternal and Reproductive Health Needs in a Post-Disaster Setting: A Qualitative Case Study From Indonesia
Authors: Sajow Hely Stenly , Winnington Rhona , Water Tineke , Holroyd Eleanor
Published: May 2021

Meeting and planning for maternal and reproductive health (MRH) needs during post-disaster scenarios is paramount, however, not without considerable challenges. This study was aimed at understanding the provision of MRH services in Siosar, a relocation site for a population displaced by the volcanic eruption in 2013 of Mount Sinabung, Indonesia. A qualitative case study approach was used, and data were collected through focus group discussions and individual interviews with women of reproductive age, community leaders, health personnel, and policymakers. The findings show that while considerable efforts were made to provide MRH services, these were described as “unfinished,” due to challenges such as changes to funding, inadequate provision of supplies and health personnel, and geographical location. Recommendations are that health and other sectors design a relocation site that counts physical, psychological, and social needs of a community and policymakers integrate humanitarian and development plans that include MRH services into World Health Organization’s Building Blocks of Health System.
A case of endophthalmitis following needling procedure after PRESERFLO® Micro Shunt implantation
Authors: Brambati Maria , Bettin Paolo , Ramoni Andrea , Battista Marco , Bandello Francesco
Published: May 2021

Purpose:

To report a case of endophthalmitis following bleb needling in a patient previously implanted with a PRESERFLO® MicroShunt.

Methods:

Case report.

Results:

A 40-year-old woman with bilateral malformative glaucoma repeatedly operated on in childhood underwent PRESERFLO® MicroShunt implantation in her right eye and six needling revisions (NRs) and a surgical revision due to unsatisfactory intraocular pressure (IOP) control due to bleb encapsulation. About 3 months after the surgical revision the bleb encapsulation relapsed and she underwent a further NR with betamethasone. About 4 days after the last NR, she experienced visual acuity reduction and was therefore advised to come immediately to the hospital for an unscheduled visit, showing up with hypopyon and diffuse vitreous haze. A clinical diagnosis of endophthalmitis (later confirmed by bacteria culture tests) was made and she was treated with pars-plana vitrectomy with silicone oil and intravitreal antibiotics. Preoperative visual function was luckily completely restored.

Conclusions:

Endophthalmitis can occur after NR in an eye with PRESERFLO® MicroShunt implant which therefore does not prevent reflux of bacteria from a filtering bleb to the anterior chamber.
Aqueous misdirection after Nd:YAG goniopuncture in deep sclerectomy treated with Nd:YAG irido-zonulo-hyaloidotomy
Authors: Almobarak Faisal A
Published: May 2021

Background:

To report a case of aqueous misdirection after goniopuncture in deep sclerectomy treated with Nd:YAG laser irido-zonulo-hyaloidotomy.

Case presentation:

About 72 years old patient with pseudoexfoliation glaucoma who underwent deep sclerectomy, developed aqueous misdirection after Nd:YAG laser goniopuncture. Medical management failed and subsequent peripheral Yag laser iridotomy to expose the zonules coupled with laser zonulo-hyaloidotomy was done and an instant gush of aqueous and vitreous substance prolapse through the iridotomy was noticed. Later, the anterior chamber was deep and the pressure was controlled.

Conclusions:

Aqueous misdirection can occur after Nd:YAG laser goniopuncture. Nd:YAG laser irido-zonulo-hyaloidotomy can be effective in breaking the attack.
Barriers to Human Papillomavirus Vaccine Series Completion among Insured Individuals in an Integrated Healthcare Setting
Authors: Kamineni Aruna , Blasi Paula R , Gundersen Gabrielle D , Oliver Malia , Dunn John B , Galloway Denise A , Madeleine Margaret M
Published: May 2021

Introduction:

Infection with certain types of human papillomavirus (HPV) can lead to cervical cancer as well as other cancers in both men and women. However, the requirement for multiple doses may limit the vaccine’s effectiveness for cancer prevention. We conducted a pilot study to investigate barriers to HPV vaccine series completion among members of an integrated healthcare system with clinical documentation of only 1 dose.

Methods:

We surveyed parents or legal guardians of 11-17-year-old girls (n = 10) and boys (n = 18), as well as 18-31-year-old women (n = 20) and men (n = 9), about their reasons for not completing the HPV vaccine series.

Results:

Most participants (70.2%) were non-Hispanic white. Among parents of children, commonly reported barriers to HPV vaccine series completion included not being aware or informed of the need for additional doses (28.6%), as well as the inconvenience of returning for additional doses (17.9%). Concerns about the HPV vaccine or vaccines in general were more common among parents of girls (30.0%) compared with parents of boys (16.7%). Among adults, barriers to HPV vaccine series completion included the inconvenience of returning for additional doses (31.0%), not being aware or informed of the need for additional doses (10.3%), and forgetting (10.3%).

Conclusion:

Our findings suggest that clinicians and healthcare systems can play a greater role in promoting awareness of the multiple-dose requirement, addressing vaccine concerns, and increasing opportunistic vaccination in a variety of settings. Increasing these efforts may facilitate HPV vaccine completion and increase its effectiveness in cancer prevention.
Blue-Light Therapy Strengthens Resting-State Effective Connectivity within Default-Mode Network after Mild TBI
Authors: Bajaj Sahil , Raikes Adam C , Razi Adeel , Miller Michael A , Killgore William DS
Published: May 2021

Background:

Emerging evidence suggests that post concussive symptoms, including mood changes, may be improved through morning blue-wavelength light therapy (BLT). However, the neurobiological mechanisms underlying these effects remain unknown. We hypothesize that BLT may influence the effective brain connectivity (EC) patterns within the default-mode network (DMN), particularly involving the medial prefrontal cortex (MPFC), which may contribute to improvements in mood.

Methods:

Resting-state functional MRI data were collected from 41 healthy-controls (HCs) and 28 individuals with mild traumatic brain injury (mTBI). Individuals with mTBI also underwent a diffusion-weighted imaging scan and were randomly assigned to complete either 6 weeks of daily morning BLT (N = 14) or amber light therapy (ALT; N = 14). Advanced spectral dynamic causal modeling (sDCM) and diffusion MRI connectometry were used to estimate EC patterns and structural connectivity strength within the DMN, respectively.

Results:

The sDCM analysis showed dominant connectivity pattern following mTBI (pre-treatment) within the hemisphere contralateral to the one observed for HCs. BLT, but not ALT, resulted in improved directional information flow (ie, EC) from the left lateral parietal cortex (LLPC) to MPFC within the DMN. The improvement in EC from LLPC to MPFC was accompanied by stronger structural connectivity between the 2 areas. For the BLT group, the observed improvements in function and structure were correlated (at a trend level) with changes in self-reported happiness.

Conclusions:

The current preliminary findings provide empirical evidence that morning short-wavelength light therapy could be used as a novel alternative rehabilitation technique for mTBI.

Trial registry:

The research protocols were registered in the ClinicalTrials.gov database (CT Identifiers NCT01747811 and NCT01721356).
“Missing minorities” in blood donation: Rethinking blood procurement in Europe as a citizenship regime
Authors: Wittock Nathan , Monforte Pierre , Hustinx Lesley
Published: May 2021

Although European blood collection organizations are currently obtaining sufficient and safe blood from the majority population, they report having difficulty recruiting first and second-generation immigrants from non-European countries. Most existing studies on these underrepresented groups, who have been coined the “ missing minorities” in blood donation, have adopted an instrumental approach that focuses on the development of targeted recruitment strategies to overcome specific barriers to donation faced by members of these minorities. Although this approach does offer several short-term benefits, our central argument is that it is one-sided in its questioning of the non-participation of ethnic minorities. The literature currently lacks research on how the blood procurement system is failing to include minorities. Drawing on recent social theory, we seek a broader sociological understanding of minority under-representation in blood donor populations by shifting the analytic focus toward a critical examination of the main pillars of the procurement system within the European context. This paper advances a novel analytical framework based on two general propositions. First, we apply the literature on “citizenship regimes” to argue that blood donation is part of one specific institutionalization of citizenship and solidarity. We then reconceptualize the “problem” of missing minorities in European blood donation as an application for social change, suggesting avenues related to blood collection as a way of renegotiating minority-majority relations of solidarity.
“I Knew It Was Gonna Be Hard, but I Always Knew I Had Support From My Parents”: The Role of Family on Undocumented Students’ College Aspirations and Persistence
Authors: Salazar Cinthya
Published: May 2021

Literature shows that undocumented students in the United States experience significant challenges to and through higher education. Only a few studies have uncovered the mechanisms that undocumented students use to persist in college; in particular, the role that family plays on their postsecondary success is understudied. In this qualitative study, I examine the role that family plays on undocumented students’ college aspirations and persistence. Findings from a sample of 16 undocumented students attending a four-year public university show that their families are the stimulus motivating them to pursue higher education, as well as the support system they can rely on to manage college barriers. However, the data also revealed that for a few participants, their families are a source of stress, resulting in additional challenges they must manage as they navigate higher education. I present these findings using participants’ vignettes and conclude with implications for higher education research and practice.
Assessing the external validity of the VALIDATE-SWEDEHEART trial
Authors: Rylance Rebecca T , Wagner Philippe , Omerovic Elmir , Held Claes , James Stefan , Koul Sasha , Erlinge David
Published: May 2021

Aims:

The VALIDATE-SWEDEHEART trial was a registry-based randomized trial comparing bivalirudin and heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention. It showed no differences in mortality at 30 or 180 days. This study examines how well the trial population results may generalize to the population of all screened patients with fulfilled inclusion criteria in regard to mortality at 30 and 180 days.

Methods:

The standardized difference in the mean propensity score for trial inclusion between trial population and the screened not-enrolled with fulfilled inclusion criteria was calculated as a metric of similarity. Propensity scores were then used in an inverse-probability weighted Cox regression analysis using the trial population only to estimate the difference in mortality as it would have been had the trial included all screened patients with fulfilled inclusion criteria. Patients who were very likely to be included were weighted down and those who had a very low probability of being in the trial were weighted up.

Results:

The propensity score difference was 0.61. There were no significant differences in mortality between bivalirudin and heparin in the inverse-probability weighted analysis (hazard ratio 1.11, 95% confidence interval (0.73, 1.68)) at 30 days or 180 days (hazard ratio 0.98, 95% confidence interval (0.70, 1.36)).

Conclusion:

The propensity score difference demonstrated that the screened not-enrolled with fulfilled inclusion criteria and trial population were not similar. The inverse-probability weighted analysis showed no significant differences in mortality. From this, we conclude that the VALIDATE results may be generalized to the screened not-enrolled with fulfilled inclusion criteria.
The Smart Forest Conundrum: Contextualizing Pitfalls of Sensors and AI in Conservation Science for Tropical Forests
Authors: Sarkar Dipto , Chapman Colin A.
Published: May 2021

The term ‘smart forest’ is not yet common, but the proliferation of sensors, algorithms, and technocentric thinking in conservation, as in most other aspects of our lives, suggests we are at the brink of this evolution. While there has been some critical discussion about the value of using smart technology in conservation, a holistic discussion about the broader technological, social, and economic interactions involved with using big data, sensors, artificial intelligence, and global corporations is largely missing. Here, we explore the pitfalls that are useful to consider as forests are gradually converted to technological sites of data production for optimized biodiversity conservation and are consequently incorporated in the digital economy. We consider who are the enablers of the technologically enhanced forests and how the gradual operationalization of smart forests will impact the traditional stakeholders of conservation. We also look at the implications of carpeting forests with sensors and the type of questions that will be encouraged. To contextualize our arguments, we provide examples from our work in Kibale National Park, Uganda which hosts the one of the longest continuously running research field station in Africa.
Third-generation three-dimensional display system for laparoscopic radical nephrectomy reduced surgical complications compared to a two-dimensional display system
Authors: Fujishima Yosuke , Takata Ryo , Tsuyukubo Takashi , Kanzaki Seiko , Isurugi Kazumasa , Kato Yoichiro , Kanehira Mitsugu , Obara Wataru
Published: May 2021

Objective:

Compared with two-dimensional (2D) laparoscope systems, conventional three-dimensional (3D) systems provide a superior understanding of depth. However, they are operator limited due to difficulties with resolution and illumination. A novel third-generation (3G) 3D system may resolve these problems. We prospectively compared the operative performance and perioperative safety results of 2D and 3G 3D systems in laparoscopic radical nephrectomy (LRN).

Patients and methods:

A single experienced surgeon performed 3G 3D LRN for 19 patients and 2D LRN for 16 patients. After the insertion of the access ports, the execution times of each step in the surgical procedure in the two groups were measured and compared, along with the perioperative complications.

Results:

Patients in the 3D group were associated with fewer complications than those in the 2D group. In particular, no peritoneal injury was observed in the 3D group (0% vs. 25%, p=0.04). Logistic regression analysis showed no significant differences between the times of each surgical step and the amount of bleeding.

Conclusions:

The 3G 3D laparoscope system provided a detailed anatomical view for the operator during LRN and may reduce laparoscopic complications. Level of evidence: III.
COVID-19, digital health technology and the politics of the unprecedented
Authors: Wamsley Dillon , Chin-Yee Benjamin
Published: May 2021

The COVID-19 global pandemic has stretched the capacities of public health institutions and health systems around the world, opening the door to a range of technologically-driven solutions. In this article, we seek to historicize the expanding role of digital health technologies and examine the political-economic context from which they have emerged. Drawing on critical insights from science and technology studies, we maintain that the rise of digital health technologies has been catalyzed by broad shifts in global health governance that have expanded the role of market forces in public health and a unique set of political and economic crises that have accelerated the adoption of digital technologies—often under the guise of appeals to technological innovation to address “unprecedented” crises. These interrelated historical trends, we contend, are critical for understanding current state responses to the pandemic and possibilities for more equitable and democratic applications of technology in public health.
Incidence, Risk, and Outcome of Pedicle Screw Loosening in Degenerative Lumbar Scoliosis Patients Undergoing Long-Segment Fusion
Authors: Yuan Lei , Zhang Xinling , Zeng Yan , Chen Zhongqiang , Li Weishi
Published: May 2021

Study Design:

Retrospective study.

Objective:

To investigate the incidence, risk factors, and outcomes of pedicle screw loosening in degenerative lumbar scoliosis (DLS) undergoing long-segment spinal fusion surgery.

Methods:

One hundred and thirty DLS patients who underwent long-segment fusion surgery with at least a 12-month follow-up were studied. The incidence and risk factors of screw loosening were investigated. VAS, SRS-22, and ODI scores were obtained preoperatively and at follow-up.

Results:

One hundred and sixty-eight of 1784 (9.4%) screws showed evidence of loosening in 71 (54.6%) patients. Three patients required revision surgery. Screw loosening rates according to vertebral insertion level were lowest instrumented vertebra (LIV): 45.4%; uppermost instrumented vertebra (UIV):17.7%; one vertebra above the LIV: 0.5%; 2 vertebrae above the LIV: 0.4%. Multiple logistic regression analysis of possible risk factors indicated that preoperative lateral subluxation ≥8 mm (odds ratio [OR]: 2.68, 95% confidence interval [CI]: 1.16-6.20), osteopenia (OR: 5.52, 95% CI: 1.64-18.56), osteoporosis (OR: 8.19, 95% CI: 2.40-27.97), fusion to sacrum (OR: 2.55, 95% CI: 1.12-5.83), postoperative TLK greater than 10° (OR: 2.63, 95% CI: 1.14-6.04) and SVA imbalance (OR: 3.44, 95% CI: 1.17-10.14) were statistically significant. No difference was noted in preoperative, follow-up, and change of VAS, ODI, and SRS-22 scores.

Conclusions:

Screw loosening in DLS underwent long-segment surgery is common and tends to occur in the LIV or UIV. Lateral subluxation ≥8 mm, osteopenia, osteoporosis, fusion to the sacrum, postoperative TLK greater than 10°, and SVA imbalance were the independent influencing factors. Screw loosening can be asymptomatic, while longer-term follow-up is required.
A Case of STEMI Masquerading Brugada Syndrome: Emphasizing the Importance of Clinical Decision Making in Emergencies
Authors: Guragai Nirmal , Vasudev Rahul , Shah Dhaval , Singh Balraj , Kaur Parminder , Fernando Ashen , Shamoon Fayez , Pullatt Raja , Joshi Meherwan , Randhawa Preet
Published: May 2021

Brugada syndrome is a rare arrhythmogenic syndrome that is associated with an increased risk of ventricular fibrillation and sudden cardiac death. Electrocardiographic findings include patterns similar to a right bundle branch block (RBBB) and persistent ST-segment elevation in precordial leads (V1 and V2). There are numerous reports of Brugada syndrome mimicking ST-segment elevation myocardial infraction (STEMI); however, we describe a case of 47-year-old male who presented with STEMI mimics Brugada syndrome with preexisting RBBB. The patient developed polymorphic ventricular tachycardia generating into ventricular fibrillation right before catheterization making the diagnosis more challenging. The patient, eventually, was found to have obstructive coronary artery disease and no evidence of abnormal sodium channelopathy on further testing. This case highlights the importance of meticulous history taking and appropriate diagnostic test in establishing proper diagnosis of STEMI in a patient with preexisting RBBB, which can mimic Brugada syndrome.
The effectiveness of contact investigation among contacts of tuberculosis patients: a systematic review and meta-analysis
Authors: Velen Kavindhran , Shingde Rashmi Vijay , Ho Jennifer , Fox Greg James
Published: May 2021

Background

We aimed to evaluate the effectiveness of contact investigation in comparison with passive case detection alone, and estimate the yield of co-prevalent and incident tuberculosis (TB) and latent TB infection (LTBI) among contacts of patients with TB.

Methods

A systematic search was undertaken of studies published between 1 January 2011 and 1 October 2019 in the English language. The proportion of contacts diagnosed with co-prevalent TB, incident TB and/or LTBI was estimated. Evaluation of the effectiveness of contact investigation included randomised trials, while the yield of contact investigation (co-prevalent/incident TB and LTBI) was assessed in nonrandomised studies.

Results

Data were extracted from 244 studies, of which 187 studies measured the proportion of contacts diagnosed with TB disease and 135 studies measured LTBI prevalence. Individual randomised trials demonstrated that contact investigation increased TB case notification (relative risk 2.5, 95% CI 2.0–3.2) and TB case detection (OR 1.34, 95% CI 0.43–4.24) and decreased mortality (relative risk 0.6, 95% CI 0.4–0.8) and population TB prevalence (risk ratio 0.82, 95% CI 0.64–1.04). The overall pooled prevalence of TB was 3.6% (95% CI 3.3–4.0%; I2=98.9%, 181 studies). The pooled prevalence of microbiologically confirmed TB was 3.2% (95% CI 2.6–3.7%; I2=99.5%, 106 studies). The pooled incidence of TB was highest in the first year after exposure to index patients (2.0%, 95% CI 1.1–3.3%; I2=96.2%, 14 studies) and substantially lower 5 years after exposure to index patients (0.5%, 95% CI 0.3–0.9%; one study). The pooled prevalence of LTBI among contacts was 42.4% (95% CI 38.5–46.4%; I2=99.8%, 135 studies).

Conclusions

This systematic review and meta-analysis found that contact investigation was effective in high-burden settings. The higher pooled prevalence estimates of microbiologically confirmed TB compared with previous reviews suggests newer rapid molecular diagnostics contribute to increased case detection.