bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing the Economic Independence Hypothesis: Union Formation Among Single Mothers in Chile
Authors: Cuesta Laura , Reynolds Sarah
Published: February 2021

Despite the increasing proportion of single-mother families, the literature on union formation among unpartnered parents in Latin America is scant. Using a sample from a Chilean longitudinal survey ( N = 3,318), we estimated regression models to test associations between single mothers’ economic resources in 2010 and coresidence with the biological father of their children in 2012. We also examined whether these associations differed in subgroups with higher rates of labor market participation. We found that mothers’ paid work was not associated with union formation. Receiving government benefits and living with a parent were associated with lower probability of coresidence with the biological father, even among the most advantaged subgroups. We conclude that in contexts in which most mothers of young children are not doing paid work, economic resources coming from government and extended family may be more consequential than earnings’ potential in influencing single mothers’ union formation behavior.
Aging Without Children: The Link between Parental Status and Tangible Support
Authors: Kjær Agnete Aslaug , Siren Anu
Published: February 2021

Having children is a potential resource for care and support in later life. However, whether and, if so, under what conditions, childless older individuals risk insufficient support remains unclear. Using the Danish Longitudinal Study of Ageing (2017), restricted to respondents aged 67 years to 97 years ( n = 5,006), our study analyzes the link between availability of tangible support and parental status in a Nordic welfare state. Our results confirm a negative link between childlessness and support mainly among unpartnered individuals. This combined disadvantage is stronger among men than among women, and the support gap intensifies with increased health needs. Taken together, although childlessness in itself is no major disadvantage for support in late life, childless men living alone risk insufficient support, particularly when in poor health. Our findings have important policy implications for future cohorts of older individuals, who will have less access to support from either a spouse or children.
Can indigenous music learning processes inform contemporary schooling?
Authors: Isabirye James
Published: February 2021

This autoethnographic study investigated possibility of incorporating indigenous pedagogies into Ugandan school music and, possibly, general education. School music education in Uganda currently occurs within a colonial-influenced system that does not connect with learners’ indigenous cultures. The colonial system fosters belief that “western” is modernity and “indigenous” is backwardness that should be erased. School music learning is currently experienced in a teacher-dominated, “banking” (Freire, 1970) school system that disempowers learners and produces graduates who cannot address the musical needs of their worlds. Ugandan government measures to improve music and general education have not improved the situation. Literature on the role that indigenous pedagogies could play in a contemporary music education is limited. Through this study, I sought to understand what might happen when indigenous education pedagogies are incorporated in a contemporary, formal school setting. Informed by relevant literature, I interrogated and analyzed my own learning and teaching experiences in Ugandan communities and schools and found that embedding indigenous learning and teaching processes in music classrooms fostered growth in learner leadership, ownership, agency, and identity in the context of mutually shared participatory experiences that learners found relevant and meaningful—experiences that engendered joyful, passionate, collaborative learning, and reification of reflective practice among learners.
The Early Impact of COVID-19 on Textile Industry: An Empirical Analysis
Authors: Kaur Kiranpreet
Published: February 2021

The COVID-19 pandemic has exposed the economy to immense distress, ruptured multiple systems and left the economy out of breath. The present study has made an exploratory attempt to unleash the business-related issues faced by the textile entrepreneurs of India (Punjab) due to COVID-19. The data were collected from 123 entrepreneurs from the textile industry in Punjab. Factor analysis and regression analysis have been used for the purpose of analysis. It was found that the major business-related issues faced by entrepreneurs due to COVID-19 include the radical effect on the working capital of the business and on future marketing campaigns to seek new orders. However, the majority of them were found to be digitally equipped to accept digital know-how instantly and grabbed opportunities by manufacturing N95 masks and personal protective equipment (PPE). The present study is a maiden attempt to unleash the early impact of COVID-19 on the textile industry in Punjab.

JEL Codes: E30, E32, L26
Perceived environmental supports for fruit and vegetable consumption among older adults in the US
Authors: Jiang Qianzhi , Francis Sarah L. , Chapman-Novakofski Karen M. , Wilt McKenzie , Carbone Elena T. , Cohen Nancy L.
Published: February 2021

Background:

The physical and social environments surrounding food, whether perceived or observed, can influence consumers’ food choices by changing food access, and affordability, or by changing settings where food-related behaviors occur.

Aim:

To describe older adults’ perceived food environment, identify the most important sites and factors that enable healthy eating, and explore older adults’ recommendations for communities to facilitate fruit and vegetable consumption.

Methods:

Participants aged 60 and older from metropolitan areas in Massachusetts, Iowa, and Illinois completed a researcher-administered survey to rate the perceived environment including accessibility, availability, and affordability of fruits and vegetables, and perceived importance of factors and establishments related to fruit and vegetable consumption. Participants also suggested changes for establishments to facilitate fruit and vegetable consumption.

Results:

The majority of the 142 participants perceived their food environment for fruits and vegetables as not difficult to access (85.2%) with good or excellent availability (90.1%). Education, marital status, and race were associated with some aspects of the perceived food environment. Perceived accessibility and supermarkets were rated as the most important factor and establishment, respectively, to facilitate fruit and vegetable consumption across all study sites. Participants proposed recommendations to address the availability, quality, accessibility and affordability of fruits and vegetables.

Conclusion:

Interventions promoting accessible, affordable, quality fruits and vegetables may improve older adult consumers’ perceptions of their food environment. Communities may also use undervalued resources such as mobile markets more strategically to provide additional support for healthy eating in older adults.
Educational Intervention Reduced Family Medicine Residents’ Intention to Request Diagnostic Tests: Results of a Controlled Trial
Authors: Schneider Antonius , Bühner Markus , Herzog Therese , Laverty Siona , Ziehfreund Stefanie , Hapfelmeier Alexander , Schneider Dagmar , Berberat Pascal O. , Roos Marco ,   for the Bavarian Competence Center for Residency Training (BCCRT) Network
Published: February 2021

Objective

Dealing with uncertainty is a core competence for physicians. To evaluate the impact of an educational intervention on family medicine residents’ (FMRs’) intention to request diagnostic tests and their attitudes toward uncertainty.

Methods

Nonrandomized controlled trial. Intervention group (IG) FMRs participated in interactive “dealing with uncertainty” seminars comprising statistical lessons and diagnostic reasoning. Control group (CG) FMRs participated in seminars without in-depth diagnostic lessons. FMRs completed the Dealing with Uncertainty Questionnaire (DUQ), comprising the Diagnostic Action and Diagnostic Reasoning scales. The Physicians’ Reaction to Uncertainty (PRU) questionnaire, comprising 4 scales (Anxiety Due to Uncertainty, Concern about Bad Outcomes, Reluctance to Disclose Uncertainty to Patients, and Reluctance to Disclose Mistakes to Physicians) was also completed. Follow-up was performed 3 months later. Differences were calculated with repeated-measures analysis of variance.

Results

In total, 107 FMRs of the IG and 102 FMRs of the CG participated at baseline and follow-up. The mean (SD) Diagnostic Action scale score decreased from 24.0 (4.8) to 22.9 (5.1) in the IG and increased in the CG from 23.7 (5.4) to 24.1 (5.4), showing significant group difference ( P = 0.006). The Diagnostic Reasoning scale increased significantly ( P = 0.025) without a significant group difference ( P = 0.616), from 19.2 (2.6) to 19.7 (2.4) in the IG and from 18.1 (3.3) to 18.8 (3.2) in the CG. The PRU scale Anxiety Due to Uncertainty decreased significantly ( P = 0.029) without a significant group difference ( P = 0.116), from 20.5 (4.8) to 18.5 (5.5) in the IG and from 19.9 (5.5) to 19.0 (6.0) in the CG.

Conclusion

The structured seminar reduced self-rated diagnostic test requisition. The change in Anxiety Due to Uncertainty and Diagnostic Reasoning might be due to an unspecific accompanying effect of the extra-occupational seminars for residents.
Judged Beauty of Fractal Symmetries
Authors: Friedenberg Jay , Martin Preston , Uy Naomi , Kvapil Mackenzie
Published: February 2021

Fractals are patterns that show self-similarity at different levels of scale. Typically they appear in nature and this degree of similarity is approximate or statistical. However, artificial or exact fractals have also been studied and the advantage of these stimuli is the ability to more carefully control the relationships that occur across various hierarchies. In two experiments we studied the perceived beauty of a novel class of exact visual fractal in which we introduced reflection, rotation, translation, and random symmetries that repeated at a local and global levels. Rotation and reflection were consistently preferred to translation and randomness. Only reflected patterns were preferred at a vertical orientation. For all other symmetries there was no difference in preference between vertical and horizontal. In a second experiment we progressively eliminated the salience of local symmetry through opaque shading . Perceived beauty decreased with an increase in shading . For these patterns greater discriminability of their fractal quality makes them more aesthetically appealing.
Isolated cerebellar progressive multifocal leukoencephalopathy after allogeneic bone marrow transplantation: focus on imaging
Authors: Mazzai Linda , Facchinelli Davide , Borghero Carlo , Vitale Valerio , Ruggeri Marco , Iannucci Giuseppe
Published: February 2021

Introduction:

Progressive multifocal leukoencephalopathy (PML) is caused by JC virus opportunistic infection in the setting of immunodeficiency. Typical imaging features are multifocal and asymmetric lesions within supratentorial subcortical white matter in parieto-occipital regions.

Case description:

A 47-year-old patient experienced a relapse of acute myeloid leukemia 21 months after hematopoietic stem cell transplantation. He also had visual impairment and magnetic resonance imaging showed an isolated cerebellar lesion without mass effect or enhancement. Common opportunistic infections and leukemic central nervous system involvement were excluded by cerebrospinal fluid (CSF) analysis. Given the worsening clinical and radiologic scenario, PML was suspected, and CSF protein chain reaction analysis was positive for JC virus.

Conclusions:

Given its potential curability, PML should be thoroughly investigated in patients with hematologic neoplasms and atypical isolated cerebellar presentation.
Acoustic Modeling of Meteorological Effects on Roadway Noise
Authors: Wayson Roger L. , Kaliski Kenneth
Published: February 2021

Modeling road traffic noise levels without including the effects of meteorology may lead to substantial errors. In the United States, the required model is the Traffic Noise Model which does not include meteorology effects caused by refraction. In response, the Transportation Research Board sponsored NCHRP 25-52, Meteorological Effects on Roadway Noise, to collect highway noise data under different meteorological conditions, document the meteorological effects on roadway noise propagation under different atmospheric conditions, develop best practices, and provide guidance on how to: (a) quantify meteorological effects on roadway noise propagation; and (b) explain those effects to the public. The completed project at 16 barrier and no-barrier measurement positions adjacent to Interstate 17 (I-17) in Phoenix, Arizona provided the database which has enabled substantial developments in modeling. This report provides more recent information on the model development that can be directly applied by the noise analyst to include meteorological effects from simple look-up tables to more precise use of statistical equations.
Structure design and mechanical performance test of a direct ventricular assist device pneumatic flexible actuator
Authors: Yun Zhong , Xu Kang , Yang Fan , Tang Xiaoyan
Published: February 2021

The purpose of this research is to overcome the shortcomings of the current direct ventricular assist device in structure design, material selection and design a pneumatic flexible actuator that can be used to drive a fully flexible cup-shaped direct ventricular assist device according to the human heart shape. In this study, the structural parameters of the flexible actuator are initially determined based on the existing research, then the flexible actuator model is constructed with SOLIDWORKS, then the model is imported into ABAQUS for finite element simulation, lastly, the actuator structure is optimized according to the simulation results. The flexible actuator is made by molding, and its mold is made by 3D printing. Finally, the final structural plan is determined by testing the mechanical properties of the flexible actuator. The pneumatic flexible actuator designed in this research can be combined into the required direct ventricular assist device in a reasonable way, which will provide ideas for the design of a fully flexible direct ventricular assist device.
How―and Why―Middle School Intensive Reading Teachers Make Adaptations to a Scripted Curriculum
Authors: Chapman Lindsey A. , Elbaum Batya
Published: February 2021

The adoption of highly scripted curricular programs to promote literacy has become increasingly widespread. Little is known, however, about the extent to which teachers implement these programs as prescribed or, instead, make adaptations to the curriculum and its delivery. Even less is known about teachers’ reasoning behind this decision-making. Using qualitative thematic analysis, in this study, the authors investigate middle school intensive reading teachers’ challenges and solutions to implementing the curricular program mandated by their school district. Analysis of 10 teachers’ descriptions of their instructional decision-making highlighted the tensions teachers must navigate to provide effective literacy instruction to students with and without disabilities in a high accountability context. The central construct of negotiation was identified as an explanation of how and why teachers made (or did not make) curricular adaptations.
Study on dynamic characteristic and forging capacity of the direct drive press with symmetrical toggle booster mechanism driven by TPMLM
Authors: Gao Jingzhou , Zhao Shengdun , Li Jingxiang , Du Wei , Wang Yongfei
Published: February 2021

Compared with the conventional servo press, the direct drive press even has no transmission mechanism, so it has advantages in controllability, precision and energy management. But, the forging capacity of the direct drive press is limited by the power of the linear motor. In this paper, a novel press driven by a tubular permanent magnet linear motor (TPMLM) is presented, and a symmetrical toggle booster mechanism is specially proposed to enhance the forging capacity. The mathematical model of the toggle booster mechanism is established, The TPMLM is designed, and the experimental prototype of the novel press is manufactured. The forging capacity and dynamic characteristics of the press are studied theoretically and experimentally. The results show that the introduction of the symmetrical toggle booster mechanism enriches the dynamic characteristic curve of the press and enhances the forging capacity. Therefore, the structural parameters of the toggle mechanism and the working position of the slider can be adjusted to meet different technological requirements. In addition, based on the research work, three directions are proposed to improve the forging capacity of the novel press. The research contributes to the performance optimization and development of direct drive press.
A deep reinforcement learning-based approach for autonomous driving in highway on-ramp merge
Authors: Wang Huanjie , Yuan Shihua , Guo Mengyu , Li Xueyuan , Lan Wei
Published: February 2021

In this paper, we focus on the problem of highway merge via parallel-type on-ramp for autonomous vehicles (AVs) in a decentralized non-cooperative way. This problem is challenging because of the highly dynamic and complex road environments. A deep reinforcement learning-based approach is proposed. The kernel of this approach is a Deep Q-Network (DQN) that takes dynamic traffic state as input and outputs actions including longitudinal acceleration (or deceleration) and lane merge. The total reward for this on-ramp merge problem consists of three parts, which are the merge success reward, the merge safety reward, and the merge efficiency reward. For model training and testing, we construct a highway on-ramp merging simulation experiments with realistic driving parameters. The experimental results show that the proposed approach can make reasonable merging decisions based on the observation of the traffic environment. We also compare our approach with a state-of-the-art approach and the superior performance of our approach is demonstrated by making challenging merging decisions in complex highway parallel-type on-ramp merging scenarios.
Coping with Covid-19: The case of the National Library of Jamaica
Authors: Lashley Beverley , Graham Nicholas , Prawl Nicole
Published: February 2021

While Asian and European countries were grappling with the Covid-19 pandemic, the first imported case from the United Kingdom surfaced in Jamaica on 10 March 2020. The article will trace the steps taken by the National Library of Jamaica (NLJ) before and during the pandemic while improving the value of our cultural heritage to Jamaica and the wider diaspora. The NLJ celebrated 40 years of sterling contribution to the development of Jamaica from March 1979 to April 2020. It has been a leading voice in the region in disaster management and preparedness. Through its Preservation and Conservation Branch, and oversight from the Disaster Preparedness Committee, the NLJ has become a training ground for professionals in the information and conservation field. While highlighting the work of the NLJ, the article will also present statements and surveys conducted on regional and international bodies. These organisations include the Association of Caribbean University, Research and Institutional Libraries (ACURIL), the Community of Directors of National Libraries (a subgroup of the International Federation of Library Associations (IFLA) and the Society of American Archivists. The surveys conducted gleaned a greater appreciation of the impact of Covid-19 on libraries and archives regionally and internationally. The article will address other pandemic crises that have affected Jamaica. It will also demonstrate that being proactive and prepared for viral episodes can mitigate the risks. The NLJ used the opportunity to facilitate service delivery while being socially distant from its patrons.
Severe hyperkalaemia due to a potential drug–drug interaction between eplerenone and antiretrovirals in a HIV-positive patient after a myocardial infarction
Authors: Cordova Ezequiel , Garibaldi Franco , Bono Leandro , Rodriguez Claudia
Published: February 2021

We present a case of a 48-year-old white HIV-1 positive man who presented an acute myocardial infarction. The patient was on ART for the last ten years with emtricitabine/tenofovir and ritonavir-boosted fosamprenavir. Eplerenone 25 mg/day was also initiated due to a left ventricular dysfunction. A week after discharge a routine laboratory examination revealed severe hyperkalaemia. Due to suspicion of a potential drug–drug interaction, both eplerenone and ARVs were interrupted. Despite daily treatment for hyperkalaemia, serum potassium levels normalized after two weeks. Eplerenone is metabolized by the hepatic P450 cytochrome isoenzyme CYP3A4; therefore, concomitant administration with CYP3A4 inhibitors, like ritonavir, may increase plasma levels of eplerenone and, therefore, the risk of side effects, mainly hyperkalaemia. Based on this case, it is important to alert the medical community of this possible life-threatening drug-drug interaction between eplerenone and ritonavir-boosted protease inhibitor.
Cotrimoxazole prophylaxis prevents major infective episodes in patients with systemic lupus erythematosus on immunosuppressants: A non-concurrent cohort study
Authors: Ganu Salil A , Mathew Ashish J , Nadaraj Ambily , Jeyaseelan L , Danda Debashish
Published: February 2021

Background

Prophylactic trimethoprim-sulfamethoxazole (TMP-SMX) prevents pneumocystis jirovecii infection in SLE on immunosuppression. Its role in preventing other major infections in immuno suppressed SLE patients is unknown.

Methods

A non-concurrent cohort study was conducted on patients of SLE fulfilling SLICC and/or ACR 1997 criteria, who received tapering dose of steroid starting with ≥0.5 mg/kg/day of prednisolone or equivalent dose of deflazacort and mycophenolate mofetil ≥1 g/day (or equivalent dose of mycophenolate sodium) at least for the preceding 1 year. Interviewing patients & documenting relevant data from hospital electronic Medical records (EMR), followed by comparison of Incidence densities of major infections between those on prophylactic Trimethoprim 160 mg + Sulfamethoxazole 800 mg and those not on it, was done by student ‘t’ test. Multivariate logistic regression was performed for independent risk of any major infection between the two groups.

Results

Of 228 patients, 162 did not receive TMP-SMX prophylaxis, and 66 had received. The incidence density of major infection was found to be significantly lower in TMP-SMX group (1.25 per 100 person year) as compared to those not on TMP-SMX group (11.201 per 100 person year); P < 0.001 (95% CI 0.027 – 0.449) and odds ratio of 0.03 (CI 0 – 0.24).

Conclusion

Cotrimoxazole prophylaxis in SLE patients on immunosuppression prevents major infections.
Development and Clinical Validation of a Seven-Gene Prognostic Signature Based on Multiple Machine Learning Algorithms in Kidney Cancer
Authors: Tian Mi , Wang Tao , Wang Peng
Published: February 2021

About a third of patients with kidney cancer experience recurrence or cancer-related progression. Clinically, kidney cancer prognoses may be quite different, even in patients with kidney cancer at the same clinical stage. Therefore, there is an urgent need to screen for kidney cancer prognosis biomarkers. Differentially expressed genes (DEGs) were identified using kidney cancer RNA sequencing data from the Gene Expression Omnibus (GEO) database. Biomarkers were screened using random forest (RF) and support vector machine (SVM) models, and a multigene signature was constructed using the least absolute shrinkage and selection operator (LASSO) regression analysis. Univariate and multivariate Cox regression analyses were performed to explore the relationships between clinical features and prognosis. Finally, the reliability and clinical applicability of the model were validated, and relationships with biological pathways were identified. Western blots were also performed to evaluate gene expression. A total of 50 DEGs were obtained by intersecting the RF and SVM models. A seven-gene signature (RNASET2, EZH2, FXYD5, KIF18A, NAT8, CDCA7, and WNT7B) was constructed by LASSO regression. Univariate and multivariate Cox regression analyses showed that the seven-gene signature was an independent prognostic factor for kidney cancer. Finally, a predictive nomogram was established in The Cancer Genome Atlas (TCGA) cohort and validated internally. In tumor tissue, RNASET2 and FXYD5 were highly expressed and NAT8 was lowly expressed at the protein and transcription levels. This model could complement the clinicopathological characteristics of kidney cancer and promote the personalized management of patients with kidney cancer.
Confidence of psychiatry trainees in meeting the needs of borderline personality disorder in comparison with schizophrenia
Authors: Nithianandan Mithira , Heidari Parvaneh , Broadbear Jillian , Rao Sathya
Published: February 2021

Objective:

Borderline personality disorder (BPD) and schizophrenia are both serious and chronic mental health conditions of similar prevalence. This study was designed to assess trainees’ confidence in the assessment, management and treatment of BPD in comparison with schizophrenia.

Methods:

A survey was used to assess psychiatry trainees’ confidence and experience of training with regard to managing BPD and schizophrenia.

Results:

Eighty-two psychiatry trainees completed the survey. Overall, confidence scores of respondents with respect to BPD were significantly lower in comparison with schizophrenia. Trainees reported a preference for working with patients with schizophrenia compared with BPD. Respondents reported receiving less adequate supervision and training in the assessment, management and treatment of BPD than for schizophrenia.

Conclusions:

The results suggest an urgent need to enhance training and supervision in skills related to the diagnosis, management and treatment of BPD, with a greater focus on psychotherapy to improve trainee psychiatrists’ confidence in working with people diagnosed with BPD.
Illness Representation and Self-Efficacy: An Exploration of Fatigue Factors in Middle-Aged Stroke Survivors
Authors: Tsai Su-Ju , Li Chia-Chi , Tsai Shu-Mei , Kao Shu-Chuan , Chen Hsiao-Mei , Pai Hsiang-Chu
Published: February 2021

The purpose of this study is twofold: to examine the relationship between illness representation and self-efficacy and to test the determinants and the effect of self-efficacy, resilience, and stroke impact on fatigue in middle-aged stroke survivors. This study used a cross-sectional and quantitative approach. The instruments included the Chronic Disease Self-Efficacy Scale, Stroke Impact Scale, Resilience Scale, and Fatigue Impact Scale. Structural equation modeling (SEM) was performed to analyze the data. A total of 63 patients with stroke (39 male and 24 female) were recruited form a medical university hospital. The results showed that patients’ illness representation had a significantly effect on self-efficacy for managing disease. In addition, SEM analysis demonstrated that self-efficacy, resilience and stroke impact influenced fatigue, explaining 20.6% of the variance in fatigue. It was concluded that to improve patient fatigue, we believe it is imperative to design interventions that improve patients’ self-efficacy, promote patients’ resilience, and better function.
Changes in the Oral Health-Related Quality of Life in Infants With Cleft Lip and/or Palate Before and After Surgical Treatment
Authors: López Ramos Roxana Patricia , Victorio Daniel José Blanco , Ramos Gilmer Torres , Pajuelo Mónica J. , Abanto Jenny
Published: February 2021

Objective:

To assess oral health-related quality of life (OHRQoL) changes before and after the primary surgical treatment in infants with cleft lip and/or palate (CL/P).

Design:

Quasi-experimental study.

Methods:

A total of 106 infants with CL/P younger than 2 years undergoing primary surgical treatment in the Plastic Surgery Service of the Instituto Nacional de Salud del Niño in Peru. The parent/caregiver answered a questionnaire about OHRQoL named the Peruvian version of the Early Childhood Oral Health Impact Scale (P-ECOHIS) in the pretreatment (baseline) and follow-up post-treatment. The total score of P-ECOHIS and their 2 sections (child impact and family impact) in the baseline and each follow-up period post-treatment scores were assessed. As well as, the type of the CL/P on OHRQoL, standardized effect sizes (ES) based on mean total change scores (difference between baseline and 12th month) were analyzed.

Results:

Improvements in infant’s OHRQoL after treatment were reflected in each follow-up period P-ECOHIS score compared to the baseline score. The total P-ECOHIS scores decreased significantly from 28.07 (baseline) to 7.7 (12th month; P < .0001), as did the individual domain scores ( P < .0001). There were significant differences in the baseline and follow-up post-treatment scores of infants who reported improvement of the OHRQoL ( P < .0001). The ES was large (3.79). The cleft lip had an improvement in the OHRQoL at 12th month post-treatment ( P < .0001).

Conclusions:

Primary surgical post-treatment resulted in significant improvement of the infant’s OHRQoL with CL/P.
Risk Reduction and Perioperative Complications in Patients With Diabetes and Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction
Authors: Lyons Madeline , McGregor Patrick Cole , Pinzur Michael S. , Adams William , Wilkos-Prostran Lynette
Published: February 2021

Background:

Modern patient safety programs focus on medical optimization of patients prior to surgery, regional anesthesia when possible, and hospitalist-orthopedic co-management during the perioperative period.

Methods:

Eighty-five consecutive patients with diabetes and multiple medical comorbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized risk reduction program that included medical optimization prior to surgery, regional anesthesia whenever possible, and hospitalist-orthopedic co-management during the perioperative period. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk.

Results:

On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (rate ratio [RR], 1.36; P = .01) and congestive heart failure (RR, 1.42; P = .02). There were 22 (26%) complications, though only 10 (12%) were serious. These included acute kidney injury ( n = 6), sepsis ( n = 2), 1 cardiac event, and 1 pulmonary embolism. Overall, the accuracy of predicting a complication using the ACS NSQIP Risk Calculator was 74% (95% CI, 63%-85%), which was comparable to the accuracy of predicting a complication using only patients’ congestive heart failure and pin-tract infection statuses ( c = 74%, 95% CI, 62%-86%).

Discussion:

Medical optimization of patients with diabetes and multiple medical comorbidities prior to elective complex reconstruction orthopedic surgery allows the surgery to be performed with a predictable risk for perioperative complications. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The ACS NSQIP Risk Calculator appears to be a reliable predictor of complications during the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to perioperative risk.

Level of Evidence:

Level IV, retrospective case series.
The Selection of Treatment Modality for Breast Ductal Carcinoma In Situ: Experience From a Single Institution
Authors: You Kai-yun , Bi Zhuo-fei , Ma Yu-jia , Mao Yong-lin , Zou Wei-liang , Liu Yi-min , Yao He-rui
Published: February 2021

Purpose:

Although breast conservation surgery(BCS) followed by adjuvant radiotherapy is now the mainstream treatment method for breast ductal carcinoma in situ(DCIS), mastectomy is still performed in some patients who refuse to undergo radiation. However, the most effective treatment method for these patients is still unknown. In the current study, we aimed to compare the survival rates between mastectomy and BCS plus adjuvant radiotherapy in patients with DCIS.

Materials and Methods:

We performed a retrospective study of 333 patients with DCIS from May 2004 to December 2016. There were 209 patents who were treated with BCS and adjuvant radiotherapy, while the remaining of 124 patients underwent mastectomy. The disease-free survival (DFS) and local recurrence-free survival(LRFS) rates were compared between the 2 treatment groups. Cox proportional hazards regression was performed to explore factors associated with DFS and LRFS.

Results:

The 10-year local recurrence(LR) rates in the mastectomy and BCS plus adjuvant radiotherapy groups were 2.6% and 7.5%, respectively. There was no difference in the LR rate between the 2 groups. Furthermore the DFS rate was also similar between the mastectomy and BCS plus adjuvant radiotherapy groups. Based on the multivariable analysis, age and tumor grade were significantly correlated with the LRFS and DFS rates. In the subgroup analysis based on the factors of age and tumor grade, patients with a tumor grade of III who underwent mastectomy had better LRFS and DFS rates compared to those who received BCS plus radiotherapy.

Conclusion:

In patients with DCIS, the long-term efficacy was similar between mastectomy and BCS followed by adjuvant radiotherapy. However, in the subgroup of patients with grade III tumors, mastectomy seems to offer a better LRFS and DFS than BCS plus radiotherapy.
On the decay of the energy for radial solutions in Moore–Gibson–Thompson thermoelasticity
Authors: Bazarra Noelia , Fernández José R , Quintanilla Ramón
Published: February 2021

In this paper, we consider the Moore–Gibson–Thompson thermoelastic theory. We restrict our attention to radially symmetric solutions and we prove the exponential decay with respect to the time variable. We demonstrate this fact with the help of energy arguments. Later, we give some numerical simulations to illustrate this behaviour.
2021 AAHA/AAFP Feline Life Stage Guidelines
Authors: Quimby Jessica , Gowland Shannon , Carney Hazel C , DePorter Theresa , Plummer Paula , Westropp Jodi
Published: February 2021

The guidelines, authored by a Task Force of experts in feline clinical medicine, are an update and extension of the AAFP–AAHA Feline Life Stage Guidelines published in 2010. The guidelines are published simultaneously in the Journal of Feline Medicine and Surgery (volume 23, issue 3, pages 211–233, DOI: 10.1177/1098612X21993657) and the Journal of the American Animal Hospital Association (volume 57, issue 2, pages 51–72, DOI: 10.5326/JAAHA-MS-7189). A noteworthy change from the earlier guidelines is the division of the cat’s lifespan into a five-stage grouping with four distinct age-related stages (kitten, young adult, mature adult, and senior) as well as an end-of-life stage, instead of the previous six. This simplified grouping is consistent with how pet owners generally perceive their cat’s maturation and aging process, and provides a readily understood basis for an evolving, individualized, lifelong feline healthcare strategy. The guidelines include a comprehensive table on the components of a feline wellness visit that provides a framework for systematically implementing an individualized life stage approach to feline healthcare. Included are recommendations for managing the most critical health-related factors in relation to a cat’s life stage. These recommendations are further explained in the following categories: behavior and environmental needs; elimination; life stage nutrition and weight management; oral health; parasite control; vaccination; zoonoses and human safety; and recommended diagnostics based on life stage. A discussion on overcoming barriers to veterinary visits by cat owners offers practical advice on one of the most challenging aspects of delivering regular feline healthcare.
Use of magnetic resonance venography for inferior petrosal sinus sampling
Authors: Tokairin Kikutaro , Osanai Toshiya , Fujima Noriyuki , Ishizaka Kinya , Motegi Hiroaki , Ishi Yukitomo , Kameda Hiraku , Sugiyama Taku , Kazumata Ken , Nakayama Naoki
Published: February 2021

Background:

Inferior petrosal sinus (IPS) sampling (IPSS) is a transvenous interventional procedure performed to diagnose Cushing’s disease. The reported IPSS failure rate is approximately 10% because IPS catheter delivery is conducted blindly and is challenging because of IPS anatomical variations. This study aimed to evaluate the usefulness of preprocedural magnetic resonance venography (MRV) for assessing IPS access routes before IPSS.

Methods:

Nineteen consecutive patients who underwent IPSS at a single university hospital in Japan were retrospectively studied. A preprocedural MRV protocol optimized to visualize the IPS before IPSS was established and utilized in the eight most recent cases. An IPSS procedure was considered successful when bilateral IPS catheterization was accomplished. Patient demographics, IPSS success rate, and radiation dose required during IPSS were compared between two groups: MRV group ( N = 8) and no-MRV group ( N = 11) before IPSS.

Results:

There were no significant differences in age, sex, and IPSS success rates between the groups. The average radiation dose was 663.6 ± 246.8 (SD) mGy and 981.7 ± 389.5 (SD) mGy in the MRV group and no-MRV group, respectively. Thus, there was a significant reduction in radiation exposure in the MRV group ( p = 0.044). Catheterization of the left IPS was unsuccessful in only one patient in the MRV group owing to IPS hypoplasty, as found on the MRV.

Conclusions:

Hypoplastic IPSs occur in patients and can complicate IPSS. Preprocedural MRV assessment is useful for understanding venous anatomy and preventing unnecessary intravenous catheter manipulation during IPSS, which involves blind manipulation around the IPS.
First-person, video-stimulated recall method for studying musical improvisation strategies
Authors: Després Jean-Philippe
Published: February 2021

Accessing the strategies implemented during real-time musical creative processes represents a challenge for researchers. Retrospective verbal protocol with subjective aided recall (RVPwSAR), where a first-person video is used as an aid to elicit feedback from a subject, has shown great potential for the study of real-time decision-making in sport, therapy, emergency situations, and consumer behavior. This article reviews research methods studying real-time decision-making and discusses the implications of a previous study using RVPwSAR to observe decision-making strategies during musical improvisation. The objective of this article is twofold: (1) to present the contributions and limitations of the RVPwSAR to arrive at a better understanding of the strategies implemented in real-time during musical improvisation; (2) to discuss the potential of the RVPwSAR for studying the strategies implemented in other real-time musical creative tasks. I argue that research where the RVPwSAR is applied may contribute to a better understanding of the strategies used during the real-time musical process, and, ultimately, contribute to the promotion of creative musical teaching and learning.
Human papillomavirus lesions in 16 MS patients treated with fingolimod: Outcomes and vaccination
Authors: Mhanna Elsa , Nouchi Agathe , Louapre Céline , De Paz Raphael , Heinzlef Olivier , Bodini Benedetta , Assouad Rana , Chochon Florence , Lubetzki Catherine , Papeix Caroline , Pourcher Valérie , Maillart Elisabeth
Published: February 2021

Few cases of human papillomavirus (HPV) diseases have been reported in multiple sclerosis (MS) patients treated with fingolimod. We describe a case series of 16 MS patients (11 women, 5 men) developing HPV lesions after the onset of fingolimod, without previous HPV history. Fingolimod had to be discontinued in six patients. Six patients received vaccination for HPV, with good tolerance. Our report highlights that systematic HPV screening and discussion about HPV vaccination before fingolimod onset are crucial. In case of occurrence of HPV lesions during fingolimod treatment, a comprehensive workup of HPV disease is necessary, with discussion of HPV vaccination to prevent secondary lesions. Prevalence studies of HPV lesions are needed in MS patients with the different disease-modifying therapies.
Unlocking the payment experience: Future imaginaries in the case of digital payments
Authors: Mützel Sophie
Published: February 2021

This article explores sociotechnical imaginaries of digital payments. Drawing on a decade of reports from industry consultants, the analysis of stories on digital payments identifies three sociotechnical imaginaries that shape the banking and payment industry: data monetization, the growth of digital payments, and the payment experience. The article argues that these imaginaries have contributed to the banking industry’s move toward becoming payment platforms, which restructure financial services based on a “re-personalization of money.” In effect, digital payments play a central part in the current economic transformation, led and promoted by global tech giants, that builds on the tracking, production, categorization, and classification of digital data. The article zooms in on recent and current expectations and imaginaries in the banking industry that, in the short run, shape economic decisions, while, in the long run, are set out to change how people interact, and how they are tracked, scored, and categorized.
Future imaginaries in the making and governing of digital technology: Multiple, contested, commodified
Authors: Mager Astrid , Katzenbach Christian
Published: February 2021

Visions of the future are omnipresent in current debates about the digital transformation. This introductory article and the full special issue are concerned with the function, power, and performativity of future visions and how they relate to the making and governing of digital technology. Revisiting existing concepts, we particularly discuss and advance the concept of sociotechnical imaginaries. In difference to ephemeral visions and partisan ideas, imaginaries are collectively held and institutionally stabilized. Nonetheless, we hold that they are multiple, contested, and commodified rather than monolithic, linear visions of future trajectories enacted by state actors. Introducing and summarizing the articles of the special issue, we conclude that imaginaries are increasingly dominated by technology companies that not only take over the imaginative power of shaping future society, but also partly absorb public institutions’ ability to govern these very futures with their rhetoric, technologies, and business models.
Conceptualizing histories of multispecies entanglements: Ancient pathogen genomics and the case of Borrelia recurrentis
Authors: Oikkonen Venla
Published: February 2021

This article explores the conceptual and cultural implications of using pathogen ancient DNA (aDNA) collected in archaeological contexts to understand the past. More specifically, it examines ancient pathogen genomics as a way of conceptualizing multispecies entanglements. The analysis focuses on the 2018 sequencing of Borrelia recurrentis bacteria retrieved from a medieval graveyard in Oslo, Norway. B. recurrentis is associated with louse-borne relapsing fever (LBRF), known to have killed several million people in Europe during the past millennium, and it is still encountered in parts of East Africa. The article demonstrates that while aDNA research often foregrounds multispecies entanglements, its epistemic tools cannot easily address the ontological blurriness of pathogens and their embeddedness in vibrant material processes. The article draws on feminist posthumanities work on microbes and materiality to highlight conceptual openings that a theorization of ancient pathogens could engender.
Radioembolization With Holmium-166 Polylactic Acid Microspheres: Distribution of Residual Activity in the Delivery Set and Outflow Dynamics During Planning and Treatment Procedures
Authors: Drescher Robert , Seifert Philipp , Gühne Falk , Aschenbach René , Kühnel Christian , Freesmeyer Martin
Published: February 2021

Purpose:

To evaluate the microsphere outflow dynamics and residual Ho-166 activity during and after transarterial radioembolization planning and treatment procedures, and to assess the distribution and predilection sites of residual activity in the proprietary delivery set and the microcatheter.

Materials and Methods:

Fifteen planning and 12 therapeutic radioembolization procedures were performed with poly-l-lactic acid microspheres loaded with Ho-166. The amount and distribution of residual activity was assessed by dose calibrator measurements and SPECT imaging. The activity flow profile from the microcatheter was assessed dynamically. For planning procedures, different injection methods were evaluated in order to attempt to decrease the residual activity.

Results:

The median residual activities for planning and treatment procedures using standard injection methods were 31.2% (range 17.3%–44.1%) and 4.3% (range 3.5%–6.9%), respectively. Planning residual activities could be decreased significantly with 2 injection methods similar to treatment procedures, to 17.5% and 10.9%, respectively ( P = 0.002). Main predilection sites of residual microspheres were the 3-way stopcock and the outflow needle connector. During treatment procedures, more than 80% of the injected activity is transferred during the first 3 injection cycles.

Conclusion:

After treatment procedures with holmium-loaded microspheres, mean residual activity in the delivery set is reproducibly low and between reported values for glass and resin microspheres. The majority of microspheres is transferred to the patient during the second and third injection cycle. An estimated residual waste of 3% to 4% may be included in the treatment activity calculation. For planning procedures, a modified injection technique should be used to avoid high residual activities.
Hybrid Repair of Type B Aortic Dissection With Thoracoabdominal Aortic Aneurysmal Degeneration in the Setting of Marfan Syndrome
Authors: Aru Roberto G. , Richie Cheryl D. , Badia Daniel J. , Romesberg Amanda M. , Sheppard Mary B. , Minion David J. , Tyagi Sam
Published: February 2021

Aneurysmal degeneration of the thoracoabdominal aorta after aortic dissection is a well-documented sequela of Marfan syndrome (MFS). Hybrid technique (HT), an emerging treatment modality for complex aortic pathologies, decreases morbidity and mortality relative to open surgery. However, outcome data regarding HT in genetic aortopathies such as MFS is limited. We describe a case of a young male with hypertension and type B aortic dissection (AD) complicated by a symptomatic thoracoabdominal aortic aneurysm (TAAA). He underwent staged HT comprised of carotid-carotid transposition followed by zone 1 thoracic endovascular aortic repair and concurrent retrograde left subclavian stent graft placement. Genetic analysis was consistent with Marfan syndrome. Subsequent growth of his TAAA warranted open extent type IV TAAA repair with individual renovisceral and iliac bypasses. The patient recovered from the second surgery without further progression of disease or late complication.