bluuebunny/crossref_metadata_2025 huggingface dataset:
Securing guarantees: How nuclear proliferation can strengthen great power commitments
Authors: Phillips Julianne
Published: June 2022

How does expanding the nuclear club alter the structure of the international system? The structure of alignments in the international system clearly shapes nuclear proliferation, as great powers often pressure subordinates into eschewing nuclear pursuit. What remains unclear, however, is how nuclear acquisition by subordinate states can, in turn, affect these alignments. I use a formal model to show that including great powers’ preferences after their allies have acquired nuclear weapons reveals a new mechanism behind proliferation: nuclear possession can allow states to change their patrons’ incentives and draw them closer, even against their wishes, thereby tightening hierarchies.
Study on surface properties and fatigue performance of aluminum alloy plate with prestressed ultrasonic peening
Authors: Zhang Tao , Li Huigui , Gong Hai , Wu Yunxin
Published: June 2022

Prestressed ultrasonic peening (UP) is beneficial to enlarge bending deformation and improve surface properties of the plate compared to free UP process. The effects of processing parameters on variation of surface topography, surface roughness and hardness, residual stress distribution are analyzed. Then the microstructure and fatigue life with prestressed UP is studied. The results show that smaller surface roughness, larger surface hardness, larger and deeper compressive residual stress are generated in prestressed UP compared to free UP. Small prebending curvature radius and offset distance both contribute to enhancement of surface properties. Large firing pin velocity is beneficial for large surface hardness as well as larger and deeper compressive residual stress; nevertheless, it will increase the surface roughness. The UP process mainly improves the high cycle fatigue life of the material, while there is no difference of the low cycle fatigue life between the peened and un-peened samples. The high cycle fatigue life significantly increases at small stress after peening process and it can be further enhanced after prestressed UP. Deformation band with peened indentations are generated on the surface. With the experiments of distributions for hardness, yield stress and residual stress, the strengthening mechanism in peening process is discussed.
Radial basis function neural network based second-order sliding mode control for robotic manipulator
Authors: Chen Jiqing , Tang Qingsong , Zhao Chaoyang , Zhang Haiyan
Published: June 2022

An adaptive second-order sliding mode control method based on RBF neural network is proposed for n-DOF robotic manipulators in the presence of external disturbances. First, RBF neural network is used to approximate the model information. Second, by using adaptive technology to compensate the uncertainty, whose prior knowledge about upper bound is not required. In addition, since the proposed control scheme is continuous, the chattering phenomenon is almost completely eliminated. Finally, the stability and finite time convergence of the proposed method are proved by Lyapunov stability theory. Through the simulation of 2-DOF manipulator and 5-DOF manipulator, the effectiveness and superiority of the control scheme are verified.
Tensile properties of cross cryo-rolled and room temperature rolled 6063 Al alloy
Authors: Hussain Maruff , Sharma Kamal , Mohammed Kahtan A. , Kumar Nikhil
Published: June 2022

In the present work, 6063 Al alloy was subjected to cross cryo-rolling (XCR) at liquid nitrogen and room temperature for producing the ultrafine grained Al alloy. The XCR and cross room temperature rolling (XRTR) were performed by doing a reduction of 90%. The mechanical properties were investigated by measuring the hardness and tensile properties of investigated alloys. The increases in the average ultimate tensile strength (332 MPa), yield strength (300 MPa), and ductility (11.66%) of the XCR sample were observed as compared to the XRTR sample. The increase in the strength of the XCR sample was due to the extensive dislocation strengthening as compared to the XRTR sample. The increase in the ductility of the XCR sample was due to the softening mechanism dominated during the rolling. The microstructural properties were reported with the help of transmission electron microscopy (TEM), scanning electron microscopy and X-ray diffraction analysis and correlated with the mechanical properties. The TEM investigation revealed that XCR promotes the formation of heavily deformed sub-grains, dislocation tangles, and fragmented initial grains. The presence of dislocations inside the XRTR sample was low as compared to the XCR sample. It was observed that cross rolling at liquid nitrogen temperature further helped in the accumulation of a large number of dislocations and further improved the strength of 6063 Al alloy by suppressing the dislocations annihilations.
A Multi-Dimensional Analysis of English tweets
Authors: Clarke Isobelle
Published: June 2022

This paper applies Multi-Dimensional Analysis (MDA) to a corpus of English tweets to uncover the most common patterns of linguistic variation. MDA is a commonly applied method in corpus linguistics for the analysis of functional and/or stylistic variation in a particular language variety. Notably, MDA is an approach aimed at identifying and interpreting the frequent patterns of co-occurring linguistic features across a corpus, such as a corpus of spoken and written English registers (Biber, 1988). Traditionally, MDA is based on a factor analysis of the relative frequencies of numerous grammatical features measured across numerous texts drawn from that variety of language to identify a series of underlying dimensions of linguistic variation. Despite its popularity and utility, traditional MDA has an important limitation – it can only be used to analyse texts that are long enough to allow for the relative frequencies of many grammatical forms to be estimated accurately. If the texts under analysis are too short, then few forms can be expected to occur sufficiently frequently for their relative frequency to be accurately estimated. Tweets are characteristically short texts, meaning that traditional MDA cannot be used in the present research. To overcome this problem, this paper introduces a short-text version of MDA and applies it to a corpus of English tweets. Specifically, rather than measure the relative frequencies of forms in each tweet, the approach analyses their occurrence. This binary dataset is then aggregated using Multiple Correspondence Analysis (MCA), which is used much like factor analysis in traditional MDA – to return a series of dimensions that represent the most common patterns of linguistic variation in the dataset. After controlling for text length in the first dimension, four subsequent dimensions are interpreted. The results suggest that there is a great deal of linguistic variation on Twitter. Notably, the results show that Twitter is commonly used for self-commodification, as people manage their identities, engaging in practices of self-branding through stance-taking, self-reporting, promotion and persuasion, as well as broadcasting their message beyond their followership, distributing news and expressing opposition, and this often occurs in order to attract attention. Additionally, the results show that interaction is common, suggesting that Twitter is also used for social and interpersonal gain.
Machine learning and Serious Game for the Early Diagnosis of Alzheimer’s Disease
Authors: Mezrar Samiha , Bendella Fatima
Published: June 2022

Background and Aim

Aging people can suffer from cognitive impairments with a range of symptoms, including memory, perception, and difficulty in solving problems called Alzheimer’s disease (AD). The early detection of Mild Cognitive Impairment (MCI), which can develop AD, plays a major role in the management of patients to slow the decline in cognitive function, as treatments are effective at an early stage of the disease course. For this purpose, advanced computer technologies can provide a tool for the early detection of AD and prediction of disease progression. This article presents a serious game, including 16 mini-games that aimed at detecting AD or MCI in the mild stage. Based on gamification techniques and machine learning (ML), by overcoming the limitations of traditional tests. This gamified cognitive tool, entitled AlzCoGame, evaluates the main cognitive domains considered to be the most pertinent indicators in diagnosing cognitive impairments: working memory, episodic memory, executive functions, Visio-spatial orientation, concentration, and attention.

Results and Conclusion

Six predictive ML models have been implemented using the AlzCoGame dataset. We used the K-fold cross-validation and classification metrics to validate the model's performance. Based on the results of the pilot study, the best overall performance was obtained by the RF classifier with average Sensitivity = 0.89, Specificity = 0.93, Accuracy = 0.92, F1-Score = 0.91, and ROC = 0.91. We can deduce that including machine learning techniques and serious games could help improve certain aspects of the clinical diagnosis of cognitive impairment. Moreover, clinical trials are required to prove the impact of this gamified program on cognitive skills and evaluate usability measures.
Family Cohesion in Adulthood as a Function of Parenting Style in Childhood and Enduring Personality Traits
Authors: Aloia Lindsey S. , Strutzenberg Claire
Published: June 2022

This study examined family cohesion in adulthood as a function of both parenting style in childhood and enduring personality traits. One hundred and ninety eight college freshmen completed measures assessing their parents’ communication strategies during childhood, the strength of their families’ cohesion during adulthood, and their enduring personality traits. Authoritative parenting was positively associated with family cohesion; this association was stronger for individuals with higher scores of conscientiousness and nonsignificant for individuals with higher scores for neuroticism. In addition, authoritarian parenting was only significantly and negatively associated with family cohesion at high levels of conscientiousness.
Corneal Endothelial Cell Loss Following Airbag Injury
Authors: Alshehri Omar Abdulaziz , Alsulami Raed Eid , Alqahtani Bader Saad , Alamri Osama Saeed , Alharbi Mosa
Published: June 2022

Purpose:

To report a rare incidence of corneal endothelial cell loss following airbag injury.

Observation:

A 27-year-old female who sustained a motor vehicle accident with airbag deployment presented with hand motion vision in the left eye. Ocular examination demonstrated corneal abrasion, significant corneal stromal edema with descemet folds, and a central pachymetry of 999 µm. The patient was managed with topical steroids and antibiotic drops. One week later, specular microscopy revealed a central endothelial cell count of 2200/mm2 with pleomorphism, polymegathism, and a decreased central corneal thickness of 569 µm. A repeat of specular microscopy 6 months later showed a decreased central endothelial cell count of 1611/mm2 with recovered visual acuity of 20/30.

Conclusion:

Corneal endothelial loss is a severe complication of ocular airbag injury. Serial ophthalmic assessment is recommended because endothelial cell loss may continue for some time after the initial impact.
Inequality and legitimacy in global governance: an empirical study
Authors: Jongen Hortense , Scholte Jan Aart
Published: June 2022

This article undertakes an empirical investigation of the relationship between structural inequalities and legitimacy beliefs in global governance. Normative theory often emphasises inequality as a major source of injustice in global politics, but we lack empirical research that examines the implications of inequality for legitimacy in concrete situations of global governance. This paper draws on large mixed-method survey evidence regarding inequality perceptions and legitimacy beliefs at the Internet Corporation for Assigned Names and Numbers (ICANN), a key site of global Internet governance that has given particular priority to issues of diversity and inclusion. Our analysis arrives at four main findings. First, participants in ICANN do perceive substantial structural power asymmetries and often find them to be problematic. Second, persons on the perceived subordinate side of these power stratifications tend to observe larger inequalities and to find them more problematic than persons on the perceived dominant side. However, third, these perceptions and concerns about inequality almost never associate with legitimacy beliefs towards ICANN, even among people in structurally subordinated positions and among people who express the greatest worries regarding power inequalities. Fourth, in forming legitimacy perceptions, participants at ICANN generally prioritise other aspects of institutional purpose, procedure and performance, unconnected with inequality. This lack of a relationship between perceptions of inequality and legitimacy beliefs suggests that, however sympathetic policy elites at ICANN might be towards greater equality in principle, they are unlikely to give it precedence in practice.
The art of uncommitment: the costs of peacetime withdrawals from alliance commitments
Authors: Levin Dov H. , Kobayashi Tetsuro
Published: June 2022

Are there significant domestic political costs for leaders who disengage from long-standing alliances, costs that discourage such disengagement? Leaders of major powers occasionally look for ways to disengage in non-crisis situations from some long-term commitments to other countries following the legal procedures laid out in the alliance treaty or commitment. However, leaders interested in disengagement from alliances sometimes fear that they will pay domestic disengagement costs, for example, a decline in domestic public support, if they try to withdraw from alliances in that manner in practice. To examine if such fears are justified, we conducted two survey experiments among representative samples of the US public investigating the effects of a presidential decision to end an alliance commitment through the legally prescribed means. We find that disengagement costs exist in general and that some characteristics of the country in question can increase their size and make them more long-lasting. For example, withdrawal from alliances with countries perceived as similar on some key criteria to the United States and as loyal allies, or widespread opposition by experts to this withdrawal, will all increase the size of the disengagement costs and make them more long-lasting. Leaving an existing alliance in peacetime will frequently be a politically losing proposition for American leaders in many plausible situations—one possible reason for the endurance of some US alliances.
Informal learning contexts in the construction of physical education student teachers’ professional identity
Authors: Virta Jukka , Hökkä Päivi , Eteläpelto Anneli , Rasku-Puttonen Helena
Published: June 2022

This study aimed to investigate the significance of informal learning contexts in physical education (PE) student teachers’ professional identity construction. It addressed two research questions: How do informal learning contexts contribute to the construction of PE student teachers’ professional identity? What forms of relationships can be identified between the informal and formal contexts of learning in PE student teachers’ professional identity construction? The data consisted of 20 semi-structured interviews with PE student teachers during the final teaching practice period. The data were analysed using structural and pattern coding methods. The analysis revealed that informal learning contexts contributed to three elements of professional identity construction: professional ambitions, professional values and principles, and professional knowledge and competencies. Three distinct forms of relationships between informal and formal learning contexts in the construction of professional identity were also discovered: complementary, reconstructive and disconnected. Informal learning contexts appear highly influential in the construction of professional identity. The results also point towards a holistic notion of professional identity, where professional and personal aspects of identity merge and overlap in the construction of professional identity.
Distinct trajectories of psychological distress among resettled refugees: Community acceptance predicts resilience while low ingroup social support predicts clinical distress
Authors: O’Donnell Alexander W. , Paolini Stefania , Stuart Jaimee
Published: June 2022

Refugees can experience elevated levels of psychological distress upon resettlement, although disparate outcomes over time are expected. The current study modeled trajectories of changes in distress over a 5-year period among resettled refugees and sought to explicate post-settlement factors that influence distress over time. A large-scale sample of refugees resettled in Australia (2,399) was tracked over a 5-year period, completing measures of psychological distress at each wave and initial risk and protective factors immediately after resettlement. A latent class growth analysis conducted on distress found four unique classes characterized by (1) resilient levels of distress, (2) consistent clinical distress, (3) recovering levels of distress, and (4) deteriorating distress. Lower perceived discrimination and greater positive context of reception predicted membership to the resilient group and differentiated the recovering and deteriorating groups. Further, lower ingroup social support predicted membership to the clinically distressed group relative to all others. We conclude by echoing calls to strengthen community support for refugees and promote ingroup ties, particularly among those who are the most vulnerable.
The effect of sudden-onset distractors on reading efficiency and comprehension
Authors: Luke Steven G , Jensen Tanner
Published: June 2022

Reading is an essential skill that requires focused attention. However, much reading is done in non-optimal environments. These days, reading is often done on digital devices or with a digital device nearby. These devices often introduce momentary distractions during reading, interrupting with alerts, notifications, and pop-ups. In two eye-tracking experiments, we investigated how such momentary distractions affect reading. Participants read paragraphs while their eye movements were monitored. During half of the paragraphs, distractions appeared periodically on the screen that required a response from the participants. In Experiment 1, the distractions were arrows that the participant had to respond to and then could immediately forget. In Experiment 2, the participants performed a 1-back task that required them to remember the identity of the last distractor. Compared with the no-distraction condition, the respond-and-forget distractors of Experiment 1 had minimal impact on reading behaviour and comprehension, but the working-memory-load distractors of Experiment 2 led to increased rereading and decreased reading comprehension. It seems a simple pop-up does not disrupt reading, but a message you must remember will.
An ecological approach to binocular vision
Authors: Gillam Barbara
Published: June 2022

An ecological approach to binocular vision was already demonstrated in Wheatstone's initial stereograms and was explicitly called for by J. J. Gibson, but detailed analysis and experimentation supporting this approach has been more recent. This paper discusses several aspects of this more recent research on environmentally occurring spatial layouts that can influence binocular vision. These include gradients of depth and regions that can be seen by only one eye. The resolution of local stereoscopic ambiguity by more global factors is also discussed.
Hereditary multiple exostoses: A case report and literature review
Authors: Ha Thi Hien , Ha Thi Minh Thi , Nguyen Van Mao , Le Trong Binh , Le Nghi Thanh Nhan , Nguyen Thanh Thao , Ngo Dac Hong An
Published: June 2022

Osteochondroma is the most common bone tumor representing 20%–50% of all benign bone tumors and 10%–15% of all bone tumors. Osteochondroma has similar radiological appearance in both solitary and multiple forms; the latter is an autosomal dominant disorder termed hereditary multiple exostoses. Associated complications of osteochondroma include deformity, fracture, neurovascular compromise, bursa formation, and malignant transformation. Measurement of the cartilage cap thickness is an important index suggesting secondary malignancy of osteochondroma. The upper limit of cap thickness after skeletal maturation is 1.5 cm which can be reliably measured on ultrasound or magnetic resonance imaging. Hereditary multiple exostoses are linked to the mutations of different exostoses genes located on chromosome 8, 11, and 19. We reported cases of two siblings presented with multiple osteochondromas managed by surgical excision. We evaluated their clinical and radiological presentation, genetic correlations and compared with the literature.
Polysulfone tailor-made implant for the surgical correction of a frontoparietal meningoencephalocoele in a cat
Authors: Farré Mariné Alba , Pumarola Martí , Luján Feliu-Pascual Alejandro
Published: June 2022

Case summary

A 6-week-old entire female domestic shorthair cat was presented for evaluation of a soft bulge and a palpable skull defect on the forehead, present since adoption a few days earlier. The neurological examination revealed an absent menace response bilaterally and apparent blindness, localising the lesion to the occipital cortex. The main differential diagnoses were meningocoele (MC) and meningoencephalocoele (MEC). Surgical repair was proposed once the cat reached adult size. Meanwhile, the cat developed seizures and was treated with anticonvulsant therapy. At 6 months of age, CT confirmed a frontoparietal MEC with associated porencephaly. Based on a three-dimensional printed skull mould, a polysulfone implant was created. The meninges were dissected from the skin, a durectomy was performed and samples of the protruding brain were obtained. Part of the cerebrospinal fluid was drained until the size of the protruding brain decreased enough to be included below the implant that was anchored on top of the skull with cerclages. Histopathology confirmed the diagnosis of MEC. Three years and 7 months later, the cat had partially recovered vision but continued to seize monthly despite antiepileptic drugs.

Relevance and novel information

MC/MEC is a relatively uncommon disease reported in companion animals, and only four cases of surgical management have been described, and did not use a polysulfone tailor-made implant. In human medicine, surgical intervention is the treatment of choice. This case highlights a new implant option for surgical correction of MEC with good long-term result and no complications after 3 years and 7 months.
Healthcare in the hand: Patients’ use of handheld technology in video consultations with their general practitioner
Authors: Jepsen Carole , Lüchau Elle Christine , Assing Hvidt Elisabeth , Grønning Anette
Published: June 2022

Objective

To analyse how the patient's use of handheld technology in video consultations with their general practitioner affects communication and the possibilities for the delivery of quality healthcare. Focusing on the visually communicated aspects of the video consultation, we present three episodes from our recordings of eight video consultations between Danish general practitioners and patients.

Methods

Using a multimodal social semiotic framework to conduct a micro-level analysis, we present episodes from our data in which the hardware's affordance of mobility gave rise to salient events in the interactions of patients who used handheld devices to carry out their video consultations.

Results

Patients’ use of technology plays a significant role in the interactions between general practitioner and patient and is thus an important factor to consider in how practice is shaped when using handheld video consultation technology.

Conclusions

Our findings demonstrate that the mobility of handheld devices (smartphone, tablet) can be used to augment sensing and embodiment and enhance the delivery of healthcare in video consultations. However, mobility may also disrupt the interaction. As a result, possibilities for the delivery of quality healthcare lie quite literally in the patients’ hands.
Psycho-scapes: Fictionalising Nations and Nationalisation of the Self in Bilal Tanweer’s The Scatter Here Is Too Great
Authors: Afzal Ifrah
Published: June 2022

Bilal Tanweer’s debut novel, The Scatter Here Is Too Great, brings to forefront the metaphor for living in the Pakistani society and discusses what it means to be a nation through blending narratives imbibed in its social milieu. The fiction not only speaks of a nation wrought in a nationalist consciousness culturally, emotionally and aesthetically but also questions what it means to be separating the ‘world’ from ‘home’ and the ‘self’ from the ‘nation’ itself. Through the representation of the private psycho-scape, the ‘I’, Tanweer captures the scattered imaginings of various identities into a national domain. The novel is explored through several features of conscious interiority, mind words and metaphorical mental idioms where the characters are ‘introceived’ through poetic examination of internal organs such as the heart, eye and mind which ironically have become a part of the scattered clutter outside like the body parts after a violent explosion. In an interview, Tanweer agrees that, ‘When you visit a country, you actually visit a city. You rarely visit a country’ (Rehman, Interview by Bilal Tanweer, 2018). For him, the cityscape of Karachi becomes the microcosm of a maelstrom whose macrocosm significantly is Pakistan. His literary craft rejects monolithism and weaves through sensibilities among the lowest strata of the society to portray a conundrum which becomes the final representation of his nation.
Shadows of the shadow state: Grassroots, refugee-led organizations within a multi-scalar and contested resettlement institutional domain
Authors: Benson Odessa Gonzalez
Published: June 2022

In discussions of welfare state restructuring, the focus has largely been on institutions that are well established and funded by the state. This study, focusing on the U.S. refugee resettlement institutional domain, theoretically examines organizational entities that are refugee- run and grassroots, and how they fit as peripheral to their larger, state-funded counterparts. Third-order devolution, as conceptualized in this paper, is the extended delegation of social responsibilities from the state and then unto state-contracted organizations of the third sector, and then further unto state-detached organizations of the informal sector. “Informal,” “unofficial,” “quasi”-organizations run by and for refugee communities in these most peripheral levels at the grassroots are forwarded as shadows of the shadow state. That is, pressure is exerted further downward, but without means nor legitimacy, in multiscalar governance of U.S. refugee resettlement. The contestations and relationalities that constitute the shadow state must thus be viewed against a voluntary sector that is heterogeneous, multi-scalar and power-laden, rather than unitary. Theoretical considerations also raise questions about new organizational forms in addressing resettlement and migration, and the tripartite relationship between the state, state-contracted/funded organizations, and state-detached organizations at the grassroots.
Prognostic disclosure in cancer care: a systematic literature review
Authors: Sutar Roshan , Chaudhary Pooja
Published: June 2022

Background:

Collusion in cancer care is the diplomatic concealment of information between a triad of the health care professional (HCP), patient, and caregiver. Free and expressive communication is determined by multiple factors, which establishes a healthy balance between ‘patient-centric’ and ‘family-centric’ decision making. The lack of a universal approach to prognostic disclosure techniques emphasizes the need for a systematic review of contemporary practice.

Methods:

A systematic review of the literature was conducted till June 2020 using themes based on cancer, communication, prognostic disclosure, and collusion by using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results:

Fifty-three studies involving 10,569 subjects were studied for their utility on prognostic disclosure using different communication methods and interfaces. Twenty-three studies used a face-to-face interview with subjects while in-person telephonic interviews were conducted in two studies, 16 studies implicated semi-structured questionnaires, and 6 studies mentioned the development of a new technique/tool for disclosure. The duration of a session for prognosis-disclosure ranged from 22 min to 1 h. The involvement of palliative care specialists and mental health professionals was limited during the disclosure of the prognosis.

Conclusion:

The findings of the review indicate that patients in cancer care are aware of their diagnosis and to a certain extent of prognosis despite nondisclosure by their family members and treating teams. This review emphasizes the assessment of ‘disclosure wishes’ among patients and caregivers in separate interviews rather than simply relying on one specific method of interviewing. The nonconfrontational approach and training among HCPs are of utmost importance to build therapeutic resilience among the treating team involved in cancer care. Since many factors such as family wishes, cultural dissonance, medical model, and patient perception could become barriers to prognostic disclosure, there is a need to develop a universal approach to prognostic disclosure and handling associated collusion.
Confinement: Spaces and practices of care and control – editorial introduction
Authors: Loughnan Claire , Johns Diana , Spivakovsky Claire
Published: June 2022

On 9 August 2019, a workshop convened at the University of Melbourne, Australia, brought together academics, practitioners and advocates to explore patterns of violence and neglect within and across a range of confined settings: youth and adult prisons, immigration detention, aged and disability care and residential ‘child protection’. Some of the participants in that workshop reflect here in eight pieces of writing that comprise this Special Themed Collection on ‘Confinement: The spaces and practice of care and control’. The contributions are anchored and connected by the parallels in how violence manifests within and across these diverse sites of confinement – corporeally and subtly, individually and collectively. Yet as we reflect, separately and together, the differentiation and demarcation of these sites and systems of confinement serves to maintain their material and symbolic separation, and to conceal their connecting threads and commonalities.

In our Editorial Introduction, we draw out themes running through the contributions to illustrate how they connect and collide, and how they illuminate intersections, differences and (sometimes unexpected) resonances between spaces, practices, settings and experiences of confinement. We identify three themes running through the seven other pieces that comprise this collection: erasure, identity and voice. Against the backdrop of the global pandemic and its implications for how we think about and experience freedom, autonomy, isolation and connection, we consider these themes: how violence is hidden from view and erased from public and political memory; how identities are shaped and swallowed by institutional practices and patterns of dehumanisation, coercion and control; and how the voices of those with lived experience of confinement – both as ‘keepers’ and the confined – help deepen our understanding of the threads that connect and comprise the carceral webs in which we are all entangled.
Management of pregnancy in cystic fibrosis
Authors: Montemayor Kristina , Tullis Elizabeth , Jain Raksha , Taylor-Cousar Jennifer L.
Published: June 2022

With recent therapeutic advances in care, people with cystic fibrosis (CF) are living longer and healthier lives. Development of the cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapies has led to improved function of the CFTR protein resulting in improved lung function, decreased rates of pulmonary exacerbations and improved nutritional status for the majority of people with CF. Given improved quality and quantity of life, more people with CF are considering becoming pregnant than ever before. Since the first reported pregnancy in a woman with CF in 1960, the management of pregnancy in CF has been of increased interest and is an active field of research.

In this review, we aim to discuss the management of pregnancy in CF. We discuss the optimisation of preconception health, management of maintenance CF therapies, and use of CFTR modulators during pregnancy and lactation. We also describe the management of pulmonary exacerbations during pregnancy as well as the unique management of pregnancy in a post-transplant patient with CF.

Educational aims

To describe considerations for optimisation of preconception health.

To describe the management of chronic CF therapies including CFTR modulators during pregnancy and lactation.

To describe treatment of an acute pulmonary exacerbation during pregnancy.

To describe the management of pregnancy in individuals with CF following organ transplantation.
Meta-analysis across Nellore cattle populations identifies common metabolic mechanisms that regulate feed efficiency-related traits
Authors: Mota Lucio F. M. , Santos Samuel W. B. , Júnior Gerardo A. Fernandes , Bresolin Tiago , Mercadante Maria E. Z. , Silva Josineudson A. V. , Cyrillo Joslaine N. S. G. , Monteiro Fábio M. , Carvalheiro Roberto , Albuquerque Lucia G.
Published: June 2022

Background

Feed efficiency (FE) related traits play a key role in the economy and sustainability of beef cattle production systems. The accurate knowledge of the physiologic background for FE-related traits can help the development of more efficient selection strategies for them. Hence, multi-trait weighted GWAS (MTwGWAS) and meta-analyze were used to find genomic regions associated with average daily gain (ADG), dry matter intake (DMI), feed conversion ratio (FCR), feed efficiency (FE), and residual feed intake (RFI). The FE-related traits and genomic information belong to two breeding programs that perform the FE test at different ages: post-weaning (1,024 animals IZ population) and post-yearling (918 animals for the QLT population).

Results

The meta-analyze MTwGWAS identified 14 genomic regions (-log10(p -value) > 5) regions mapped on BTA 1, 2, 3, 4, 7, 8, 11, 14, 15, 18, 21, and 29. These regions explained a large proportion of the total genetic variance for FE-related traits across-population ranging from 20% (FCR) to 36% (DMI) in the IZ population and from 22% (RFI) to 28% (ADG) in the QLT population. Relevant candidate genes within these regions (LIPE, LPL, IGF1R, IGF1, IGFBP5, IGF2, INS, INSR, LEPR, LEPROT, POMC, NPY, AGRP, TGFB1, GHSR, JAK1, LYN, MOS, PLAG1, CHCD7, LCAT, and PLA2G15) highlighted that the physiological mechanisms related to neuropeptides and the metabolic signals controlling the body's energy balance are responsible for leading to greater feed efficiency. Integrated meta-analysis results and functional pathway enrichment analysis highlighted the major effect of biological functions linked to energy, lipid metabolism, and hormone signaling that mediates the effects of peptide signals in the hypothalamus and whole-body energy homeostasis affecting the genetic control of FE-related traits in Nellore cattle.

Conclusions

Genes and pathways associated with common signals for feed efficiency-related traits provide better knowledge about regions with biological relevance in physiological mechanisms associated with differences in energy metabolism and hypothalamus signaling. These pleiotropic regions would support the selection for feed efficiency-related traits, incorporating and pondering causal variations assigning prior weights in genomic selection approaches.
Dexmedetomidine prolongs the duration of local anesthetics when used as an adjuvant through both perineural and systemic mechanisms: a prospective randomized double-blinded trial
Authors: Bao Nana , Shi Kejian , Wu YiQuan , He Yuting , Chen Zhengjie , Gao Yuan , Xia Yun , Papadimos Thomas J. , Wang Quanguang , Zhou Riyong
Published: June 2022

Background

To study the respective peripheral and systemic mechanisms of action of dexmedetomidine, as adjuvant to regional anesthesia, we compared dexmedetomidine added to ropivacaine for mid-forearm nerve blocks, to either systemic-only dexmedetomidine, and to a control with no dexmedetomidine.

Methods

Sixty patients undergoing hand surgery were randomly divided into three groups (n = 20 per group). Each group underwent a triple-nerve (median, radial and ulnar) mid-forearm blocks with 0.75% ropivacaine. In the DexP group, 60 µg of dexmedetomidine were added to the anesthetic mixture, while in the DexIV group, they were intravenously infused. Normal saline as a placebo was used, either as adjuvant, or intravenously. All patients underwent also a supraclavicular block with 1.5% lidocaine for tourniquet pain. The main outcomes were the duration of analgesia and the duration of sensory blockade separately for each nerve termination of the upper limb, and the duration of motor blockade of the upper limb. Tolerance was assessed by blood pressure and heart rate, and the report of adverse events.

Results

Duration of analgesia was longer in the DexP group, in comparison to the two other groups (P < 0.001), while it was similar in the DexIV and the control group. For cutaneous territories targeted by the three mid-forearm blocks, the between-group differences behaved similarly. For the other cutaneous territories (musculocutaneous and posterior brachial cutaneous nerves), duration of sensory blockade was shorter in the control group than in the two dexmedetomidine groups. For duration of motor blockade, the between-group differences behaved similarly. Both blood pressure and heart rate were reduced in the DexP and the DexIV groups, compared to the control.

Conclusions

Dexmedetomidine used as an adjuvant to regional anesthesia may act mostly though a perineural mechanism, especially for the sensory aspects of anesthesia. A systemic action might however explain other clinical effects.

Trial registration

ChiCTR-IOR-17011149, date of registration: 16/04/2017
Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient
Authors: Itoh Naoya , Akazawa Nana , Ishibana Yuichi , Masuishi Toshiki , Nakata Akinobu , Murakami Hiromi
Published: June 2022

Background

Pandoraea species are multidrug-resistant glucose-nonfermenting gram-negative bacilli that are usually isolated from patients with cystic fibrosis (CF) and from water and soil. Reports of diseases, including bloodstream infections, caused by Pandoraea spp. in non-CF patients are rare, and the clinical and microbiological characteristics are unclear. The identification of Pandorea spp. is limited by conventional microbiological methods and may be misidentified as other species owing to overlapping biochemical profiles. Here, we report the first case of obstructive cholangitis with bacteremia caused by Pandoraea apista in a patient with advanced colorectal cancer.

A 61-year-old man with advanced colorectal cancer who underwent right nephrectomy for renal cell carcinoma 4 years earlier with well-controlled diabetes mellitus was admitted to our hospital with fever for 2 days. The last chemotherapy (regorafenib) was administered approximately 3 weeks ago, and an endoscopic ultrasound-guided hepaticogastrostomy was performed 2 weeks ago under hospitalization for obstructive jaundice. Two days prior, he presented with fever with chills. He was treated with piperacillin-tazobactam for obstructive cholangitis and showed improvement but subsequently presented with exacerbation. Bacterial isolates from the blood and bile samples were identified as P. apista using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S ribosomal RNA sequencing. Based on the susceptibility results of the isolates, he was successfully treated with oral trimethoprim-sulfamethoxazole 160 mg/800 mg/day for 14 days for P. apista infection.

Conclusions

Pandoraea species are often misidentified. Therefore, multiple approaches should be used to identify them, and decisions regarding antimicrobial treatment should be based on actual in vitro susceptibility. Only seven cases of Pandoraea spp. bloodstream infections have been reported, and we report the first case of cholangitis with bacteremia.
Evaluation of the models generated from clinical features and deep learning-based segmentations: Can thoracic CT on admission help us to predict hospitalized COVID-19 patients who will require intensive care?
Authors: Gülbay Mutlu , Baştuğ Aliye , Özkan Erdem , Öztürk Büşra Yüce , Mendi Bökebatur Ahmet Raşit , Bodur Hürrem
Published: June 2022

Background

The aim of the study was to predict the probability of intensive care unit (ICU) care for inpatient COVID-19 cases using clinical and artificial intelligence segmentation-based volumetric and CT-radiomics parameters on admission.

Methods

Twenty-eight clinical/laboratory features, 21 volumetric parameters, and 74 radiomics parameters obtained by deep learning (DL)-based segmentations from CT examinations of 191 severe COVID-19 inpatients admitted between March 2020 and March 2021 were collected. Patients were divided into Group 1 (117 patients discharged from the inpatient service) and Group 2 (74 patients transferred to the ICU), and the differences between the groups were evaluated with the T-test and Mann–Whitney test. The sensitivities and specificities of significantly different parameters were evaluated by ROC analysis. Subsequently, 152 (79.5%) patients were assigned to the training/cross-validation set, and 39 (20.5%) patients were assigned to the test set. Clinical, radiological, and combined logit-fit models were generated by using the Bayesian information criterion from the training set and optimized via tenfold cross-validation. To simultaneously use all of the clinical, volumetric, and radiomics parameters, a random forest model was produced, and this model was trained by using a balanced training set created by adding synthetic data to the existing training/cross-validation set. The results of the models in predicting ICU patients were evaluated with the test set.

Results

No parameter individually created a reliable classifier. When the test set was evaluated with the final models, the AUC values were 0.736, 0.708, and 0.794, the specificity values were 79.17%, 79.17%, and 87.50%, the sensitivity values were 66.67%, 60%, and 73.33%, and the F1 values were 0.67, 0.62, and 0.76 for the clinical, radiological, and combined logit-fit models, respectively. The random forest model that was trained with the balanced training/cross-validation set was the most successful model, achieving an AUC of 0.837, specificity of 87.50%, sensitivity of 80%, and F1 value of 0.80 in the test set.

Conclusion

By using a machine learning algorithm that was composed of clinical and DL-segmentation-based radiological parameters and that was trained with a balanced data set, COVID-19 patients who may require intensive care could be successfully predicted.
Cetuximab and anemia prevention in head and neck cancer patients undergoing radiotherapy
Authors: Maahs Lucas , Ghanem Ahmed I. , Gutta Radhika , Tang Amy , Arya Swarn , Al Saheli Zaid , Ali Haythem , Chang Steven , Tam Samantha , Wu Vivian , Siddiqui Farzan , Sheqwara Jawad
Published: June 2022

Background

Epidermal growth factor receptor (EGFR) activation is associated with increased production of interleukin 6 (IL6), which is intensified by radiotherapy (RT) induced inflammatory response. Elevated IL6 levels intensifies RT-induced anemia by upregulating hepcidin causing functional iron deficiency. Cetuximab, an EGFR inhibitor, has been associated with lower rates of anemia for locally advanced head and neck squamous cell carcinoma (HNSCC). We hypothesized that concomitant cetuximab could prevent RT-induced anemia.

Methods

We queried our institutional head and neck cancers database for non-metastatic HNSCC cases that received RT with concomitant cetuximab or RT-only between 2006 and 2018. Cetuximab was administered for some high-risk cases medically unfit for platinum agents per multidisciplinary team evaluation. We only included patients who had at least one complete blood count in the 4 months preceding and after RT. We compared the prevalence of anemia (defined as hemoglobin (Hb) below 12 g/dL in females and 13 g/dL in males) and mean Hb levels at baseline and after RT. Improvement of anemia/Hb (resolution of baseline anemia and/or an increase of baseline Hb ≥1 g/dL after RT), and overall survival (OS) in relation to anemia/Hb dynamics were also compared.

Results

A total of 171 patients were identified equally distributed between cetuximab-plus-RT and RT-only groups. The cetuximab-plus-RT group had more locally-advanced stage, oropharyngeal and high grade tumors (p < 0.001 for all). Baseline anemia/Hb were similar, however anemia after RT conclusion was higher in the cetuximab-plus-RT vs RT-only (63.5% vs. 44.2%; p = 0.017), with a mean Hb of 11.98 g/dL vs. 12.9 g/dL; p = 0.003, for both respectively. This contributed to significantly worse anemia/Hb improvement for cetuximab-plus-RT (18.8% vs. 37.2%; p = 0.007). This effect was maintained after adjusting for other factors in multivariate analysis. The prevalence of iron, vitamin-B12 and folate deficiencies; and chronic kidney disease, was non-different. Baseline anemia was associated with worse OS (p = 0.0052) for the whole study cohort. Nevertheless, improvement of anemia/Hb was only marginally associated with better OS (p = 0.068).

Conclusions

In contrast to previous studies, cetuximab was not associated with lower rates of anemia after RT for nonmetastatic HNSCC patients compared to RT-alone. Dedicated prospective studies are needed to elucidate the effect of cetuximab on RT-induced anemia.