bluuebunny/crossref_metadata_2025 huggingface dataset:
Synchroniser control with proportional pressure reducing valves and displacement feedback
Authors: Wu Wei , Luo Junlin , Hu Jibin , Yuan Shihua , Xiao Bingqing
Published: March 2021

In order to improve the shift quality of automatic transmission with synchroniser, a synchroniser electrohydraulic control system equipped with the proportional pressure reducing valves is proposed. The principle of the control system is introduced in detail. The PID controller is used to realise closed-loop control of shift displacement to achieve the synchronisation. A numerical model and a test apparatus have built up to validated the control performance. The simulated and measured engagement and disengagement of the synchroniser with the proposed control system are investigated in detail. The results indicate that the shift displacement is controllable by changing the cylinder chamber pressure. The back pressure value is useful for a smooth synchroniser operation. It is determined by the sleeve motion and the throttle parameter. The back pressure affects little on the synchronisation stage during the engagement process. The proposed method can be used for the optimising design of the electrohydraulic system for the synchroniser control.
Analysis of modified Fourier law and melting heat transfer in a flow involving carbon nanotubes
Authors: Gnaneswara Reddy M , Punith Gowda RJ , Naveen Kumar R , Prasannakumara BC , Ganesh Kumar K
Published: March 2021

The dynamics of non-Newtonian liquids flow along with suspension of nanoparticles are pretty exciting with many industrial applications. In view of this, we examined Darcy-Forchheimer two-dimensional carbon nanotubes flow in light of a melting surface with warm nonlinear radiation, Cattaneo-Christov heat flux and slip condition. Similarity transformations are utilized to deal with the problem equations for non-dimensionality. Runge-Kutta-Felberg-45 method by adopting shooting scheme is applied for the simulation of the demonstrated equations. The thermal framework is investigated for all the implanted parameters whose impacts are appeared through various graphs. There exist fascinating outcomes because of the impacts of various constraints on various profiles. Results reveals that, velocity and corresponding thickness of the boundary layer declines for rising values of Forchheimer parameter and porosity parameter. Moreover, rate of declination of velocity gradient in MWCNT-water stream is slower than SWCNT-water stream. Also, inclined values of melting parameter display a diminishing pattern for the temperature field. Further, rate of declination in heat transfer of SWCNT-water stream is faster than MWCNT-water stream.
Analysis of tool vibration and surface roughness during turning process of tempered steel samples using Taguchi method
Authors: Kam Menderes , Demirtaş Mustafa
Published: March 2021

This study analyzed the tool vibration (Vib) and surface roughness (Ra) during turning of AISI 4340 (34CrNiMo6) tempered steel samples using Taguchi Method. In this context, Taguchi design L18 (21 × 32) was used to analyze the experimental results. The vibration amplitude values from cutting tools were recorded for different machining parameters, control factors; two different sample hardness (46 and 53 HRc), three different cutting speeds (180, 220, 260 m.min−1), and feed rates (0.08, 0.14, 0.20 mm.rev−1) were selected. The machining parameters giving optimum Vib and Ra values were determined. Regression analysis is applied to predict values of Vib and Ra. Analysis of variance was used to determine the effects of machining parameters on the Vib and Ra values. The most important machining parameters were found to be the feed rate, sample hardness, and cutting speed for Vib and Ra, respectively. The lowest Vib and Ra values were obtained in 46 HRc sample as 0.0022 gRMS and 0.255 µm, respectively. The surface quality can be improved by reducing the sources of vibration by using appropriate machining parameters. As a result, there is a significant relationship between Ra and Vib. The lower Ra values were found during turning process of tempered steel samples according to the literature studies. It is suggested that the process can be preferred as an alternative process to grinding process due to lower cost and machining time. In application of the turning of experiment samples by ceramic cutting tool, a substantial technological and economical benefit has been observed.
Effect of tri-hybridized metallic nano cutting fluids in end milling of AA7075 in minimum quantity lubrication environment
Authors: Vignesh S , Mohammed Iqbal U
Published: March 2021

The current paper is concentrated on the mechanical and machining process exploration of metallic nano-lubricant with the concept of tri-hybridization with improved lubricative and cooling properties by using TiO2, ZnO and Fe2O3 metallic nano particles with neat cold-pressed coconut oil in a fixed volumetric proportion (10:90). End milling of gummy material like aluminium requires a solution to the conventional dry and wet machining due to high productivity requirement and to obtain good surface quality. So, the prepared nanofluids were tested for their rheological behavior and latter introduced into milling of AA7075 as a solution to the above stated problem. Overall, the nanofluids gave good performance when compared to conventional methods. Furthermore, the results obtained from the experiments confirm that the trio-hybridized lubricant has reduced the cutting force, tool wear and surface roughness in an improved way when related to monotype nano fluids. The response surface methodology is performed to evaluate the interaction of process parameters in minimum quantity lubrication environment with nano fluids. The results show that the cutting forces, surface roughness, tool wear was minimized while machining with hybrid cutting fluids and well within the desirability.
A detailed review on research, technology, configurations and application of wire ribs as artificial roughness in rectangular solar air heater duct
Authors: Sahu Mukesh Kumar , Priyam Abhishek , Mishra Shivam , Bishnoi Pardeep
Published: March 2021

Use of artificial roughness in the duct of solar air heater (SAH) has been an interesting area of research during the last few decades. In present review article a holistic view about application of circular shape wire ribs as roughness element and its different geometry on the absorber plate of SAH duct for performance enhancement has been done. This article, reported in details numerous experimental as well as analytical studies for rib roughened SAHs which have been carried out by different researchers positively. Correlations for heat transfer and friction factor, developed by various investigators for different artificially roughened solar air heaters (SAHs) geometry have been reported in chronological order and in well tabulated form. The roughness and operating parameters into which investigators have obtained their maximum performances of SAHs have also been presented separately in the table. Effects of various rib roughness parameters on heat transfer and fluid flow process are also discussed in details.
The influence of resistant force equations and coupling system on long train dynamics simulations
Authors: Bosso N , Magelli M , Rossi Bartoli L , Zampieri N
Published: March 2021

In the simulation of the longitudinal dynamics of long trains, the modeling of the resistant forces and of the coupling system are two essential aspects. The modeling of the resistant forces directly affects the speed reached by each vehicle as well as the in-train forces. A literature review witnesses different laws for the calculation of both ordinary and accidental resistances. One of the objectives of this paper is to evaluate from the numerical point of view the influence of the resistant forces modeling strategy on the simulation outputs, i.e., on the speeds and in-train forces, by comparing different laws for propulsion and curving resistances. For what concerns the connection between the vehicles of the train, it is well known that the connection system is of utmost importance for the safety and running stability of the train. In this paper, the two existing coupling systems, i.e., the European buffer-hook system and the coupler used outside the European continent are first described, both in terms of operation and modelling techniques, and then they are compared on the same simulation scenario. All the simulations are performed on the first scenario of the International benchmark of the longitudinal train dynamic simulators, using the LTDPoliTO code developed by the railway research team from Politecnico di Torino.
Strengthening Agriculture Value Chain through Collectives: Comparative Case Analysis
Authors: Kumari Sneha , Bharti Nisha , Tripathy K. K.
Published: March 2021

Indian agriculture has always been less profitable. Several factors contribute to the low profitability in agriculture, but less value addition, weak value chain system and weak market linkage are some of the most important factors. Producer companies are helping small farmers to emerge in the market. The farmer producer organisations (FPOs) linked with the producer companies are the best example of collective actions. The collective actions for the agriculture value chain (AVC) have resulted in a decrease in the cost and an increase in revenue. FPO and producer company find a good place in the underpinning theory of collective action theory. This study examines various successful examples of strengthening AVC through cooperatives and tried to identify various factors responsible for the success of these collectives.

This study has adopted a case study approach. Three successful cases, that is, Vasundhara Agriculture Horticulture Producer Company Ltd: a multi-state FPO, Abhinav Farms Club and Sahyadri Farmer Producer Company have been selected for the case study based on their successful interventions for strengthening the agriculture value chain. Primary and secondary data has been collected through telephonic interviews from the board of directors, chairman and the members of the FPO. Both primary and secondary data have been collected to compare the three cases for AVC models. The data has been analysed using a comparative case study approach. The parameters of AVC have been identified using the Delphi technique. The study has found that collective actions have helped the farmers to strengthen the agriculture value chain. The study also concluded that leadership played an important role in defining the success of the FPOs. The study brings out future directions to excel in AVC through collectives.
Inclusive vis-à-vis Exclusionary Constitution: An Analysis of the Current Constitutions of Nepal and Bhutan from Ethnic Lens
Authors: Pandey Krishna Prasad
Published: March 2021

Nepal and Bhutan, two Shangri-las of South Asia, share similar geo-political features but substantially differ in terms of demographic size and ethno-political history. The Constitution of Nepal 2015 which was promulgated by the second Constituent Assembly formed in 2013 came up with its inclusive character as it secured reasonable space for the ethnic minorities and owned their political, economic and cultural concerns. On the contrary, Bhutan adopted a different course in terms of accommodating ethnic and minority aspirations, although the country has also chosen parliamentary democracy in a narrow sense since 2008. From constitutional point of view, Nepal’s move from a liberal to an inclusive constitution made strenuous effort to bring all sections of Nepali society on board but Bhutan’s shift from a royal decree to an exclusionary constitution consciously left a large section of minority behind by suppressing their legitimate claims for basic democratic rights. This article explores the inclusive and exclusionary characters of the current constitutions of these countries from ethnic perspective.
The elimination of political demands: Ordoliberalism, the big society and the depoliticization of co-operatives
Authors: Costa Vieira Thomas Da , Foster Emma A
Published: March 2021

This paper focuses on the British state’s attitude towards co-operatives, focusing mainly on the Thatcher (1979–1990) and Cameron (2010–2015) governments. After the 2008 crisis, the Cameron-led government, under the umbrella of its Big Society project, developed measures to shift responsibility on British society for the development of the co-operative model as a contribution to self-help, the pursuit of economic growth and the rebuilding of social bonds. We trace the origins of these efforts to the Thatcher governments, where these attitudes towards workers’ cooperatives were consolidated. In so doing, we find the concept of ordoliberalism rather than neo-liberalism alone, particularly useful for explaining the nuances of the governments’ relationship with the cooperatives; including the symbolic backing of co-operatives for their perfect embodiment of self-help and the entrepreneurial spirit, integrating them into a social policy of total competition and economic growth and the constant legislative and financial control of state support. This exemplified and operationalized a larger governmentality later also pursued by the coalition, aimed at entrenching a competitive order and the bourgeois spirit of self-sufficiency through the deployment of the agenda of popular capitalism. Both the Thatcher and Cameron governments, in the spirit of ordoliberalism, instrumentalized cooperatives as part of a project that sought to govern through society to reshape and depoliticize it. This was an attempt to simultaneously eliminate British society’s political demands while recasting the role that the state is expected to play in social and economic policy.
The dynamics of musical participation
Authors: Schiavio Andrea , Maes Pieter-Jan , van der Schyff Dylan
Published: March 2021

In this paper we argue that our comprehension of musical participation—the complex network of interactive dynamics involved in collaborative musical experience—can benefit from an analysis inspired by the existing frameworks of dynamical systems theory and coordination dynamics. These approaches can offer novel theoretical tools to help music researchers describe a number of central aspects of joint musical experience in greater detail, such as prediction, adaptivity, social cohesion, reciprocity, and reward. While most musicians involved in collective forms of musicking already have some familiarity with these terms and their associated experiences, we currently lack an analytical vocabulary to approach them in a more targeted way. To fill this gap, we adopt insights from these frameworks to suggest that musical participation may be advantageously characterized as an open, non-equilibrium, dynamical system. In particular, we suggest that research informed by dynamical systems theory might stimulate new interdisciplinary scholarship at the crossroads of musicology, psychology, philosophy, and cognitive (neuro)science, pointing toward new understandings of the core features of musical participation.
The effect of changes to Australian Capital Territory mental health legislation on rates of emergency detention
Authors: Saffron Miriam , Singhal Deepa
Published: March 2021

Objectives:

The Australian Capital Territory (ACT) changed from the Mental Health (Treatment and Care) Act 1994 (ACT) to the Mental Health Act 2015 (ACT) on 1 March 2016. The objective was to find the association between legislative changes and detention rates.

Methods:

A cross-sectional study of involuntary order rates in the period 3 years before the legislative change was undertaken. Chi-squared analysis was performed to compare proportions.

Results:

There was a statistically significant decrease in the proportion of Psychiatric Treatment Orders (PTOs) over the two periods, which could be impacted by the change from a period of detention for 7 days to a period of detention of 11 days in Period 2. On the other hand, the total number of Emergency Actions (EAs) increased in Period 2, where ambulance officers could detain patients.

Conclusion:

The change in mental health legislation in the ACT was associated with a change in detention rates, in particular a decrease in the proportion of PTOs and an increase in EAs. Further study needs to be undertaken, given changes to frontline supports since the study period ended.
Comparison of 2 glucose analytical methodologies in immature Kemp’s ridley sea turtles: dry chemistry of plasma versus point-of-care glucometer analysis of whole blood
Authors: Perrault Justin R. , Arendt Michael D. , Schwenter Jeffrey A. , Byrd Julia L. , Tuxbury Kathryn A. , Stacy Nicole I.
Published: March 2021

Blood glucose measurements provide important diagnostic information regarding stress, disease, and nutritional status. Glucose analytical methodologies include dry chemistry analysis (DCA) of plasma and point-of-care (POC) glucometer analysis of whole blood; however, these 2 methods differ in cost, required sample volume, and processing time. Because POC glucometers use built-in equations based on features of mammalian blood to convert whole blood measurements to plasma equivalent units, obtained glucose data must be compared and validated using gold-standard chemistry analytical methodology in reptiles. For in-water, trawl-captured, immature Kemp’s ridley sea turtles ( Lepidochelys kempii) from Georgia, USA, we observed significant, positive agreement between the 2 glucose determination methods; however, the glucometer overestimated glucose concentrations by 1.4 mmol/L on average in comparison to DCA and produced a wider range of results. The discordance of these results suggests that POC glucometer glucose data should be interpreted in the context of methodology- and brand-specific reference intervals along with concurrent packed cell volume data.
Deprescribing in Older Adults With Cancer and Limited Life Expectancy: An Integrative Review
Authors: Brokaar Edwin J. , van den Bos Frederiek , Visser Loes E. , Portielje Johanneke E. A.
Published: March 2021

Polypharmacy is common in older adults with cancer and deprescribing potentially inappropriate medications becomes very relevant when life expectancy decreases due to metastatic disease. Especially preventive medications may no longer be beneficial, because they may decrease quality of life and reduction in morbidity and mortality may be futile. Although deprescribing of preventive medication is common in the last period of life, it is still unusual during active cancer treatment for advanced disease, although life expectancy is often limited to less than 1 to 2 years in that stage. We performed a systematic search of the literature in Pubmed and Embase on the discontinuation of commonly utilized groups of preventive medication and evaluated the evidence of potential benefits and harms in patients aged 65 years or older with cancer and a limited life expectancy (LLE). From 21 included studies, it can be concluded that deprescribing lipid lowering drugs, antihypertensive drugs, osteoporosis drugs and antihyperglycemic drugs is feasible in a considerable part of patients with a LLE. Discontinuation may be performed safely, without the occurrence of serious adverse events or decrease of survival. The only study that addressed quality of life after deprescribing showed that discontinuation of statins improves quality of life in patients with a LLE. Recurrence of symptoms requiring reintroduction occurred in 0-13% of patients on antihyperglycemic treatment and 8-60% of patients using antihypertensive drugs. In order to reduce pill burden and futile treatment clinicians should discuss deprescribing of preventive medication with older patients with advanced cancer and a LLE.
Nature Connection and 360-Degree Video: An Exploratory Study With Immersive Technology
Authors: Sneed John C. , Deringer S. Anthony , Hanley Adam
Published: March 2021

Background: Immersive technologies may be an avenue to explore the construct of human–nature connection more thoroughly and without some of the obstacles to accessing nature in-person. Purpose: The aim of this project was to discover if self-exposure to immersive virtual nature can lead to any change in nature connectedness. Methodology/Approach: Participants were recruited from the Texas State University campus and randomized into three experimental conditions: a filmed library or nature experience, and an in-nature experience. 360-degree videos of a nature preserve and the university library were projected within a head-mounted display in a laboratory setting. Results of pre- and postsurvey data were compared between experimental groups. Findings/Conclusions: Pairwise comparisons with the Nature Relatedness Scale indicated that participants in the in-nature experience reported significantly stronger beliefs about their connection to nature than those in either virtual condition. With respect to the State of Independence with Nature Scale, planned pairwise comparisons indicated that between participants in the in-nature experience and the virtual nature experience did not differ. Implications: This study suggests that to connect with nature, one should spend time there. In addition, here data support that a virtual immersive nature experience can affect a state-dependent measurement of nature connection, and even equal that of an in-nature experience.
An Evaluation of Effects of the Advancement Via Individual Determination (Avid) Program in Osceola County, Florida
Authors: Maddock David R. , Torres Leah C.
Published: March 2021

The School District of Osceola County, Florida, invests heavily in the Advancement Via Individual Determination (AVID) program, and as such, an evaluation of effects was conducted with a sample of 10 middle schools (12,325 students) and 7 high schools (18,886 students). Propensity matching was used to determine practical effects. Providing schoolwide AVID was correlated with higher school grades in the Florida accountability system, and students in the elective were found to have statistically significantly higher GPAs, higher learning gains scores, greater enrollment in acceleration, and a higher likelihood of receiving college scholarships.
Psychometric Properties of the Weekly Assessment of Child Behavior–Positive Form (WACB-P)
Authors: Timmer Susan Goff , Usacheva Maria , Maise Amanda Ayers , Hutchison Shari L. , Armendariz Lindsay F. , Herschell Amy D.
Published: March 2021

Using measurement-based and feedback-informed approaches is key to providing effective family-centered clinical care; a strength-based approach is shown to improve treatment outcomes and satisfaction. Yet, there are few brief, psychometrically sound assessment tools for preschool-age and elementary school–age children. In response, we developed a nine-item, two-scale measure, the Weekly Assessment of Child Behavior–Positive (WACB-P), suitable for children ages 2 to 12 years. We examined the psychometric properties of the WACB-P based on two low-income clinical samples differing in intervention modality and location (Sample 1: N = 285; Sample 2: N = 137). WACB-P demonstrated high internal validity and test–retest reliability. The item response theory (IRT) paradigm applied to the Intensity Scale revealed that the items showed moderate discrimination and adequate precision, particularly effectively capturing behavioral challenges. Repeated-measures analysis of covariance (RM-ANCOVA) showed significant linear effects from session to session, suggesting sensitivity to change during treatment. WACB-P demonstrated strong convergent validity with established measures of child behavior problems. These favorable results position the WACB-P as a suitable choice for agencies providing measurement-based behavioral health care for young children and their families.
ALK-rearranged Renal Cell Carcinoma (RCC): A Report of 2 Cases and Review of the Literature Emphasizing the Distinction Between VCL-ALK and Non-VCL-ALK RCC
Authors: Wangsiricharoen Sintawat , Zhong Minghao , Ranganathan Sarangarajan , Matoso Andres , Argani Pedram
Published: March 2021

Anaplastic lymphoma kinase (ALK) rearrangement-associated renal cell carcinoma ( ALK-rearranged RCC) is a new provisional entity that has been included in the 2016 World Health Organization classification of RCCs. We report 2 cases of ALK-rearranged RCC, 1 with a vinculin-ALK ( VCL-ALK) fusion and the other with an EML4-ALK fusion. The VCL-ALK RCC occurred in a 14-year-old girl with sickle cell trait and showed features similar to previously described VCL-ALK RCCs, including medullary epicenter, solid architecture, and polygonal cells with cytoplasmic vacuoles. The EML4-ALK RCC occurred in a 14-year-old boy with no evidence of sickle cell trait and had multiple less-specific growth patterns comprising tubular, solid, and tubulopapillary architectures in the desmoplastic stroma, reminiscent of collecting duct carcinoma. Both tumors demonstrated cytoplasmic and membranous ALK protein expression by immunohistochemistry. Fluorescence in situ hybridization confirmed the ALK gene rearrangements in both cases. On review in the literature, we found that solid architecture and cytoplasmic vacuoles were present significantly more frequently in VCL-ALK RCC than in non- VCL-ALK RCC, supporting the distinctive nature of the former.
The Role of Institutions in Creating Circular Economy Pathways for Regional Development
Authors: Henrysson Maryna , Nuur Cali
Published: March 2021

In the past decade, the circular economy has gained attention as a mechanism of transition toward a regenerative, low carbon, and resource-efficient society. As the history of previous radical transformations shows, successful transition toward the circular economy cannot take place without understanding the institutional features of industrial transformations. This article highlights the significance of institutions by placing the circular economy model in the context of the natural resource–based sector and discusses the importance of institutions in regional path development. The article identifies three institutional determinants of both endogenous and directed transformation toward the circular economy model in the regional context: (i) proximity of physical flows and assets, (ii) maturation and diversity of market networks, and (iii) inherent values and patterns of cooperation. This article offers a starting point for future studies of circular economy transitions and the role of institutions as enabling, as well as at times obstructing transition environments.
Occupational exposure assessment in professionals who manipulate and administer antineoplastic drugs in a university hospital in Southern Brazil
Authors: Ness Sandro Luis R , Mascarenhas Marcello Á , Arbo Marcelo D , Tonietto Bruna D , Cestonaro Larissa V , dos Santos Nícolas G , Garcia Solange Cristina , Ferreira Charles F , Capp Edison
Published: March 2021

Introduction

Our goal was to demonstrate the effects of occupational exposure to antineoplastic drugs on oxidative stress parameters and DNA damage in health professionals who manipulate and administer antineoplastic drugs in a University Hospital in Southern Brazil.

Methods

The case-control study with a longitudinal design, involved 64 individuals, 29 of them pharmacists, pharmacy technicians and nurses who were occupationally exposed to antineoplastic drugs and 35 professionals who were not exposed. Gene mutations were determined by micronucleus from salivary fluid; DNA damage by comet assay and oxidative stress parameters in whole blood were also evaluated.

Results

All workers exposed to antineoplastic drugs used personal protective equipment (PPE). It was demonstrated that the total nonprotein thiol and thiobarbituric acid reactive substances levels showed interaction between group and time, with higher levels one week after handling/administration of antineoplastic drugs in the exposed group (GEE, p ≤ 0.0001 and p = 0,013, respectively). Additionally, there was a group effect on the activities of the catalase and glutathione peroxidase antioxidant enzymes (GEE, p = 0.027 and p ≤ 0.0001, respectively), and workers occupationally exposed to antineoplastic drugs had higher enzyme activities compared to those not exposed. No genotoxic damage was demonstrated through the evaluated parameters.

Conclusions

Despite the correct use of PPE, professionals occupationally exposed to antineoplastic drugs were more susceptible to oxidative stress than those not exposed. The evaluation of the studied parameters is especially important for the definition of conducts and practices in the area, always in search of guaranteeing the establishment of a rational policy to protect workers' health.
Modeling and analysis of a magnetoelastic annular membrane placed in an azimuthal magnetic field
Authors: Ali Mir Numan , Wahi Sajan Kumar , Santapuri Sushma
Published: March 2021

This work presents the development of a 2D nonlinear magnetoelastic framework for a thin membrane undergoing large deformations. An asymptotic [Formula: see text] theory is obtained, starting from the 3D variational magnetostatic and force balance equations for a weakly magnetizable material. The model is subsequently specialized to axisymmetry and applied to a pre-stretched annular membrane deforming under azimuthal magnetic field and transverse pressure loading. Parametric studies are performed by varying the pre-stretch, magnetic field, and transverse pressure inputs.
Unmet Behavioral Health and Social Needs of Home Healthcare Patients and Their Caregivers
Authors: Gerolamo Angela M. , Pogorzelska-Maziarz Monika , Gentsch Alexzandra , Traczuk Ashley , Hsiao TingAnn , Amadio Grace , Haddad Taylor , Rising Kristin L.
Published: March 2021

Lack of recognition and treatment of mental health disorders in the home healthcare (HHC) population has been recognized as a national public health problem. However, there is a gap in understanding the behavioral health needs of HHC patients and caregivers from the perspectives of HHC patients, caregivers, and HHC personnel. These perspectives are critical for informing an acceptable and scalable integrated care model. We conducted semi-structured interviews with HHC patients, caregivers, and HHC personnel to assess the unmet behavioral health needs of HHC patients and their caregivers. Participants were recruited from a Medicare-certified HHC agency that is part of a large health system on the east coast. We completed a total of 31 interviews between January and May 2020. Findings suggest that HHC patients have significant unmet behavioral health and social needs and their caregivers are emotionally and physically drained. Reasons that patients may not be receiving adequate behavioral health services include denial, cost, culture, lack of awareness of available resources, lack of transportation, and homebound status. While most patients discussed the emotional toll of their illness, few were connected to services. HHC personnel offered suggestions on how to meet the behavioral health needs of patients, with the primary focus on providing in-home options. Gaps in meeting the needs of the HHC population necessitate integrated care models that can effectively address the behavioral health and social needs of HHC patients and their families. Future research should develop and test patient and caregiver-directed integrated care models in the HHC setting.
Home Snack Environments in the United States: Latent Class Analysis Findings From a Home Food Environment Survey
Authors: Hermstad April , Kegler Michelle C. , Woodruff Rebecca C. , Raskind Ilana G. , Haardörfer Regine
Published: March 2021

Snacking occasions have increased in frequency and energy density in recent decades, with considerable implications for diet. Studies have linked presence of foods in the home with intake of those foods. This study examines home snack food inventories among a large sample of U.S. adults using latent class analysis findings to present latent classes of home snack food inventories and multinomial regression to model classes as correlates of percent of calories from fat. Participants ( n = 4,896) completed an online household food environment survey including presence of 23 snack foods in the home and demographics. Less healthy snack foods were more commonly reported than healthier snack foods ( M = 4.3 vs. M = 3.5). Among White and Latinx participants, high-income households reported greater numbers of both healthier and less healthy snack foods than lower income households, with larger income-based differences in inventory sizes for healthier snack foods. Latent class analysis revealed three classes by inventory size (Small, Medium, and Large) and three classes by inventory content (Healthy Snacks, Standard American, and Limited Standard American). Compared with the Small Inventory class, the Healthy Snacks class had lower caloric intake from fat ( p = .002), the Large and Medium Inventory classes had much higher caloric intake from fat ( p < .0001), and Standard American and Limited Standard American class members had somewhat higher caloric intake from fat ( p < .0001, and p = .0001, respectively). Future research should explore the role of snacks in Americans’ diets, their impact on diet quality and health, and how interventions can support healthy home food and snack food environments to foster healthy eating.
Protective effects of NAC and salubrinal on apoptosis of retinal pigment epithelial cells induced by all-trans retinoic acid
Authors: Wu Juan , Cui Dongmei , li honghui , Zeng Junwen
Published: March 2021

Purpose:

Accumulation of endogenous all-trans retinoic acid (ATRA) plays a role in the degeneration of photoreceptor cells and retinal pigment epithelium (RPE) cells, contributing to age-related macular degeneration (AMD). This study attempted to investigate the influence of antioxidant N-acetylcysteine (NAC) and selective endoplasmic reticulum stress (ERS) inhibitor salubrinal on apoptosis of ARPE-19 cells induced by ATRA.

Methods:

The RPE cell line (ARPE-19) was treated with ATRA, ATRA+NAC, ATRA+salubrinal or ATRA+NAC+salubrinal and the control was untreated. After 24 h of cell culture, the levels of apoptosis, multicaspase and reactive oxygen species (ROS) were detected by flow cytometry. Western blot analysis was employed to detect the expression of vascular endothelial growth factor-A (VEGF-A), C/EBP homologous protein (CHOP) and cleaved caspase-3 in the groups.

Results:

The results of flow cytometry showed that NAC and salubrinal decreased the levels of apoptosis, ROS and multicaspase. ATRA increased VEGF-A levels associated with neovascularisation. NAC and salubrinal inhibited an increase in VEGF-A, CHOP and caspase-3 caused by ATRA in ARPE-19 cells.

Conclusions:

In ARPE-19 cells, the levels of ROS and ERS can be increased by ATRA, contributing to apoptosis, which can be effectively inhibited by NAC and salubrinal. Thus, ATRA may play an important role in the prevention, diagnosis and treatment of age-related macular degeneration.
A case of malignant glaucoma following insertion of Preserflo™ MicroShunt
Authors: Gizzi Corrado , Costa Giacomo , Servadei Roberto , Abed Edoardo , Ning Brigid , Sharma Anant , Barton Keith
Published: March 2021

Purpose:

To describe a case of malignant glaucoma following insertion of a Preserflo™ MicroShunt in a patient with primary open angle glaucoma (POAG).

Design:

Case report.

Case:

A 46-year-old Caucasian man with medically uncontrolled POAG developed malignant glaucoma 1 day after an uncomplicated insertion of a mitomycin C (MMC) augmented Preserflo MicroShunt (PMS).

Results:

Initial medical treatment with aqueous suppressants and atropine 1% resulted in temporary resolution of the episode, although partial occlusion of the PMS with iris required a Nd:YAG laser iridotomy to open the inlet of the device. However, the malignant glaucoma recurred 6 days later. Temporary resolution was subsequently achieved with an Nd:YAG laser peripheral irido-zonulo-hyaloidotomy in combination with topical atropine, though a subsequent PMS revision was required due to bleb encapsulation. Unfortunately, the revision procedure was followed 2 days later, by a further recurrence of malignant glaucoma which was eventually resolved by left pars plana vitrectomy (PPV) in combination with clear lens extraction (CLE) and surgical irido-zonulo-hyaloidectomy. Subsequently, the eye remained stable, with a deep anterior chamber (AC), a partially functioning bleb, and an intraocular pressure (IOP) of 14 mmHg on one topical IOP-lowering agent, 8 months after the last procedure.

Conclusions:

The management of malignant glaucoma after PMS insertion and its subsequent clinical course is described. Apart from the propensity for a small tube such as the PMS to obstruct with iris when the AC is shallow, management is similar to other scenarios in which malignant glaucoma may develop.
OCT-angiography assessing quiescent and active choroidal neovascularization in retinitis pigmentosa associated with PRPH2 pathogenic variant
Authors: Falfoul Yousra , Matri Khaled EL , Habibi Imen , Halouani Safa , Chebil Ahmed , Schorderet Daniel , El Matri Leila
Published: March 2021

Purpose:

To report multimodal imaging findings including optical coherence tomography angiography (OCT-A) of a patient presenting with a quiescent choroidal neovascularization (CNV) in one eye and an active CNV in the fellow eye, complicating retinitis pigmentosa (RP) linked to PRPH2 pathogenic variant, with follow-up and management of both eyes.

Methods:

Observational case report.

Results:

A 40-year-old female with history of autosomal dominant RP consulted for acute visual loss in her right eye (RE). Multimodal imaging including OCT-A confirmed the diagnosis of active type 2 CNV in the RE and highlighted an incidental asymptomatic non-exudative “quiescent” CNV in the left eye (LE). This complication was managed by intra-vitreal Bevacizumab injections in the RE and regular monitoring of the LE. Frequent follow-up could detect early CNV activation signs in LE allowing early treatment. Mutation analysis of PRPH2 exons identified a known heterozygous pathogenic missense variation c.646C>T, p.P216S in exon 2.

Conclusion:

Multimodal imaging and especially OCT-A can be of a great help in the diagnosis and the management of CNV complicating RP, even at the stage of quiescent CNV. In presence of neovascular complication, PRPH2 gene should be investigated because of its frequent macular involvement despite high phenotypic variability.
Allogenic dehydrated human pericardium patch graft (Tutoplast): A novel use for reconstruction in orbital implant exposure
Authors: Bhatt Hetvi , Okafor Linda , Bhatt Rina
Published: March 2021

Purpose:

Exposure of orbital implant post enucleation or evisceration remains one of the common complications irrespective of the type of implant used. Dermis fat graft and temporalis fascia have been used to repair the implant exposure in anophthalmic sockets. Tutoplast® pericardium, gamma sterilised dehydrated human pericardium, has been used as a scleral patch graft for glaucoma drainage device exposure and scleral thinning post squint surgery. We report the novel use of Tutoplast® patch graft to repair orbital implant exposure in this case series.

Methods:

The case notes of three patients who received Tutoplast® pericardium patch graft to repair implant exposure were reviewed. Data regarding presenting symptoms, implant type, time to exposure from primary surgery, post-operative complications and length of follow up post Tutoplast® pericardium patch graft were collected.

Results:

Three patients presented with implant exposure following evisceration. The presenting symptoms were recurrent infection, discharging socket and discomfort in all three patients. One patient had a Medpore implant, two had silicone implants. Total follow-up ranged from 9 to 22 months. In all three cases, there was relief from symptoms and the graft had incorporated fully into the surrounding orbital tissue with no recurrent exposure noted during the follow-up period.

Conclusion:

Tutoplast® pericardium has demonstrated a good safety profile and is a suitable material to use as a patch graft for orbital implant exposure.
Initial single-center experience with a new external support device for the creation of the forearm native arteriovenous fistula for hemodialysis
Authors: Benedetto Filippo , Spinelli Domenico , Derone Graziana , Cutrupi Andrea , Barillà David , Pipitò Narayana
Published: March 2021

Objective:

To assess and compare the maturation rate of the native radiocephalic arteriovenous fistula (RC-AVF) created with and without a nitinol external support (VasQ™ Laminate Medical Technologies Ltd, Tel Aviv, Israel).

Methods:

Data of all consecutive patients who underwent the creation of native RC-AVFs at our center between October 2018 and January 2020 was prospectively collected and retrospectively analyzed. Selected patients who had a suitable vein and a radial artery with triphasic flow at preoperative duplex ultrasound exam and were selected for the creation of a radiocephalic fistula were included. Exclusion criteria were: malignant tumors, acute renal failure, previous upper limb revascularization, and septic status. Patency and maturation, vein, and artery diameter and blood flow rate were assessed at the following intervals: post-operatively, 24 h post-operatively, 1 month, 3 months, and 6 months post-operatively.

Results:

Forty-nine patients (31 males, mean age 65.7 years old) were included. Patients who received VasQ™ devices were 25 (VasQ group), the other 24 formed the control group. All patients underwent radio-cephalic AVF placement (21 on the wrist, 20 on the forearm, 8 on the proximal forearm). There were no perioperative complications and fatalities. At 1, 3, and 6 months, primary patency rates were 96 ± 4%, 96 ± 4%, 91 ± 6% (VasQ group) versus 87 ± 7%, 87 ± 7%, 80 ± 9% (control group, P 0.17), secondary patency rates were 96 ± 4%, 96 ± 4%, 91 ± 6% (VasQ group) versus 95 ± 4%, 90 ± 7%, 90 ± 7% (control group, P 0.79). A significantly larger vein diameter increase postoperatively (P 0.009) and a greater maturation rate (96% vs 74%, p 0.044) were found in the VasQ group compared to the control group.

Conclusions:

The use of the VasQ™ device was associated with higher maturation rates and larger vein diameters postoperatively. The patency rates were slightly higher but not significantly. Further studies are needed to confirm these findings.
Associations Between Improved Water Supply and Sanitation Usage and Childhood Diarrhea in Ethiopia: An Analysis of the 2016 Demographic and Health Survey
Authors: Soboksa Negasa Eshete
Published: March 2021

Background:

Diarrheal disease is one of the leading causes of death in children under the age of 5. Access to and use of improved water and sanitation services is associated with this, but there is little country-level evidence for this relationship in Ethiopia. Therefore, associations between improved water supply and sanitation usage and childhood diarrhea in Ethiopia have been identified as the objective of this study.

Methods:

This study was a cross-sectional study using data from Ethiopia’s 2016 Demographic and Health Survey. Through interviews with mothers/caregivers who had children under the age of 5 years, data was collected. The outcome of this study was the response of the mothers/caregivers interviewed to the 2-week occurrence of diarrhea. Logistic regression analysis was used to examine the relationship between dependent and independent variables.

Results:

The survey results found that the use of improved drinking water and latrine facilities was 59.3% (95% CI: 58.36-60.31) and 17.3% (95% CI: 16.59-18.09), respectively. With respect to the handling practices of child feces, 24.8% (95% CI: 23.8-25.70) of the child feces of the interviewed mothers/caregivers were disposed of safely. The prevalence of childhood diarrhea in the preceding 2 weeks was 11% (95% CI: 10.36-11.61). Residence of Somali Region (AOR = 1.81, 95% CI: 1.25-2.61), having more than 2 under-5 children (AOR = 1.21, 95% CI: 1.01-1.46), having more than 5 family members (AOR = 1.18, 95% CI: 1.03-1.36), sex of the indexed child (AOR = 0.88, 95% CI: 0.77-0.99) and unsafe child feces disposal practices (AOR: 1.32; 95% CI: 1.14-1.54) were significantly associated with childhood diarrhea.

Conclusion:

Residing in the Somali region, having more than 2 children under the age of 5 and having more than 5 household members, indexed child sex, and safe disposal of child feces were significantly associated with diarrhea. Therefore, in Ethiopia, the prevention of childhood diarrhea should concentrate on eliminating household crowding and encouraging the safe disposal of child feces.
Can Medical Cannabis Therapies be Cost-Effective in the Non-Surgical Management of Chronic Knee Pain?
Authors: Vannabouathong Christopher , Zhu Meng , Chang Yaping , Bhandari Mohit
Published: March 2021

Introduction:

Chronic knee pain is a common musculoskeletal condition, which usually leads to decreased quality of life and a substantial financial burden. Various non-surgical treatments have been developed to relieve pain, restore function and delay surgical intervention. Research on the benefits of medical cannabis (MC) is emerging supporting its use for chronic pain conditions. The purpose of this study was to evaluate the cost-effectiveness of MC compared to current non-surgical therapies for chronic knee pain conditions.

Methods:

We conducted a cost-utility analysis from a Canadian, single payer perspective and compared various MC therapies (oils, soft gels and dried flowers at different daily doses) to bracing, glucosamine, pharmaceutical-grade chondroitin oral non-steroidal anti-inflammatory drugs (NSAIDs), and opioids. We estimated the quality-adjusted life years (QALYs) gained with each treatment over 1 year and calculated incremental cost-utility ratios (ICURs) using both the mean and median estimates for costs and utilities gained across the range of reported values. The final ICURs were compared to willingness-to-pay (WTP) thresholds of $66 714, $133 428 and $200 141 Canadian dollars (CAD) per QALY gained.

Results:

Regardless of the estimates used (mean or median), both MC oils and soft gels at both the minimal and maximal recommended daily doses were cost-effective compared to all current knee pain therapies at the lowest WTP threshold. Dried flowers were only cost-effective up to a certain dosage (0.75 and 1 g/day based on mean and median estimates, respectively), but all dosages were cost-effective when the WTP was increased to $133 428/QALY gained.

Conclusion:

Our study showed that MC may be a cost-effective strategy in the management of chronic knee pain; however, the evidence on the medical use of cannabis is limited and predominantly low-quality. Additional trials on MC are definitely needed, specifically in patients with chronic knee pain.
Cape Town’s “Day Zero” Drought: Notes on a Future History of Urban Dwelling
Authors: Shepherd Nick
Published: March 2021

Taking the events of Cape Town’s “Day Zero” drought as a case study, this article examines the politics and poetics of water in the Anthropocene and the implications of Anthropogenic climate change for urban life. It argues that rather than being understood as an inert resource, fresh drinking water is a complex object constructed at the intersection between natural systems; cultural imaginaries; and social, political, and economic interests. The extraordinary events of Day Zero raised the specter of Mad Max–style water wars. They also led to the development of new forms of solidarity, with water acting as a social leveler. The article argues that events in Cape Town open a window onto the future, to the extent that they tell us something about what happens when the added stresses of climate change are mapped onto already-contested social and political situations. They also underline the precarious nature of many of our urban arrangements. This sense of the precarious is likely to extend beyond the case of Cape Town and to be an abiding feature of urban life as we journey deeper into the Anthropocene/Capitalocene.