bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance Metrics for the Comparative Analysis of Clinical Risk Prediction Models Employing Machine Learning
Authors: Huang Chenxi , Li Shu-Xia , Caraballo César , Masoudi Frederick A. , Rumsfeld John S. , Spertus John A. , Normand Sharon-Lise T. , Mortazavi Bobak J. , Krumholz Harlan M.
Published: October 2021

Background:

New methods such as machine learning techniques have been increasingly used to enhance the performance of risk predictions for clinical decision-making. However, commonly reported performance metrics may not be sufficient to capture the advantages of these newly proposed models for their adoption by health care professionals to improve care. Machine learning models often improve risk estimation for certain subpopulations that may be missed by these metrics.

Methods and Results:

This article addresses the limitations of commonly reported metrics for performance comparison and proposes additional metrics. Our discussions cover metrics related to overall performance, discrimination, calibration, resolution, reclassification, and model implementation. Models for predicting acute kidney injury after percutaneous coronary intervention are used to illustrate the use of these metrics.

Conclusions:

We demonstrate that commonly reported metrics may not have sufficient sensitivity to identify improvement of machine learning models and propose the use of a comprehensive list of performance metrics for reporting and comparing clinical risk prediction models.
Laminar Flow on Endothelial Cells Suppresses eNOS O-GlcNAcylation to Promote eNOS Activity
Authors: Basehore Sarah E. , Bohlman Samantha , Weber Callie , Swaminathan Swathi , Zhang Yuji , Jang Cholsoon , Arany Zoltan , Clyne Alisa Morss
Published: October 2021

Rationale:

In diabetic animals as well as high glucose cell culture conditions, eNOS (endothelial NO synthase) is heavily O-linked-N-acetylglucosaminylated (O-GlcNAcylated), which inhibits its phosphorylation and NO production. It is unknown, however, whether varied blood flow conditions, which affect eNOS phosphorylation, modulate eNOS activity via O-GlcNAcylation-dependent mechanisms.

Objective:

The goal of this study was to test if steady laminar flow, but not oscillating disturbed flow, decreases eNOS O-GlcNAcylation, thereby elevating eNOS phosphorylation and NO production.

Methods and Results:

Human umbilical vein endothelial cells were exposed to either laminar flow (20 dynes/cm
2
shear stress) or oscillating disturbed flow (4±6 dynes/cm
2
shear stress) for 24 hours in a cone-and-plate device. eNOS O-GlcNAcylation was almost completely abolished in cells exposed to steady laminar but not oscillating disturbed flow. Interestingly, there was no change in protein level or activity of key O-GlcNAcylation enzymes (OGT [O-GlcNAc transferase], OGA [O-GlcNAcase], or GFAT [glucosamine-fructose-6-phosphate aminotransferase]). Instead, metabolomics data suggest that steady laminar flow decreases glycolysis and hexosamine biosynthetic pathway activity, thereby reducing UDP-GlcNAc (uridine diphosphate N-acetylglucosamine) pool size and consequent O-GlcNAcylation. Inhibition of glycolysis via 2-deoxy-2-glucose in cells exposed to disturbed flow efficiently decreased eNOS O-GlcNAcylation, thereby increasing eNOS phosphorylation and NO production. Finally, we detected significantly higher O-GlcNAcylated proteins in endothelium of the inner aortic arch in mice, suggesting that disturbed flow increases protein O-GlcNAcylation in vivo.

Conclusions:

Our data demonstrate that steady laminar but not oscillating disturbed flow decreases eNOS O-GlcNAcylation by limiting glycolysis and UDP-GlcNAc substrate availability, thus enhancing eNOS phosphorylation and NO production. This research shows for the first time that O-GlcNAcylation is regulated by mechanical stimuli, relates flow-induced glycolytic reductions to macrovascular disease, and highlights targeting hexosamine biosynthetic pathway metabolic enzymes in endothelial cells as a novel therapeutic strategy to restore eNOS activity and prevent endothelial cell dysfunction in cardiovascular disease.
Diastolic Function and Ambulatory Hypertension in Children With Chronic Kidney Disease
Authors: Mitsnefes Mark M. , Xu Yunwen , Ng Derek K. , Hill Garick , Kimball Thomas , Furth Susan L. , Warady Bradley A.
Published: October 2021

Diastolic dysfunction is one of the earliest cardiac abnormalities in patients with chronic kidney disease. We analyzed echocardiographic markers of left ventricular function from 786 children and adolescents (1658 person-visits) enrolled in the CKiD (Chronic Kidney Disease in Children) cohort, a large prospective observational study of children with chronic kidney disease. Primary outcome was early mitral inflow velocity-to-early mitral annular peak velocity (E/e′) ratio as a marker of left ventricular compliance. Abnormal diastolic function was defined as E/e′>8.0. Those with an abnormal E/e′ ratio were younger, had a lower estimated glomerular filtration rate and hemoglobin, and a higher prevalence of hypertension and left ventricular hypertrophy compared to children with a normal E/e′. In adjusted analysis, a higher E/e′ ratio was independently associated with ambulatory (sustained) hypertension (1.66 [95% CI, 1.15–2.42]). Other significant independent predictors were higher left ventricular mass index
Z
score, increased body mass index
Z
score, lower hemoglobin, higher phosphorus level, and younger age. Casual blood pressure was not significantly associated with higher E/e′. These data indicate that ambulatory blood pressure might better identify children with chronic kidney disease at risk for subclinical cardiac dysfunction than clinic blood pressure alone.

Graphic Abstract:

An online
graphic abstract
is available for this article.
Serum Potassium and Mortality in High-Risk Patients: SPRINT
Authors: Byrne Christina , Pareek Manan , Vaduganathan Muthiah , Biering-Sørensen Tor , Krogager Maria Lukács , Kragholm Kristian Hay , Steensig Kamilla , Mortensen Martin Bødtker , Mishra Shiva Raj , McCullough Megan J. , Desai Nihar R. , Torp-Pedersen Christian , Olsen Michael Hecht , Bhatt Deepak L.
Published: October 2021

A U-shaped association between serum potassium (s-potassium) and short-term mortality has been reported for patients with hypertension. Less is known about the long-term prognostic implications of s-potassium and whether this relationship is modified by intensive blood pressure (BP) control. SPRINT (Systolic Blood Pressure Intervention Trial) was a randomized, controlled trial of 9361 high-risk patients aged ≥50 years without diabetes, who were allocated to intensive versus standard BP control. We investigated associations between baseline and on-treatment s-potassium and death, using Cox proportional hazards regression (including s-potassium as a time-dependent covariate) and restricted cubic splines. We further explored the effects of intensive BP control across the s-potassium spectrum. Baseline s-potassium was available in 9336 individuals, and 8473 had a measurement at 12 months. Mean baseline s-potassium was similar between the 2 treatment groups (intensive 4.21 mmol/L versus standard 4.20 mmol/L;
P
=0.74), but on-treatment s-potassium was lower in the intensive group (4.14 mmol/L versus 4.18 mmol/L;
P
=0.001). Median follow-up was 3.3 years, with 365 all-cause deaths (3.9%) and 102 cardiovascular deaths (1.1%). Baseline s-potassium had a linear association with both types of death events (
P
<0.05). On-treatment potassium also had a linear association with all-cause death (
P
=0.04) but not with cardiovascular death (
P
=0.13). None of the associations remained significant after multivariable adjustment (
P
≥0.05). S-potassium did not modify the effect of intensive BP control (
P
≥0.05). In SPRINT, neither baseline nor on-treatment s-potassium levels were independently associated with death, and the effect of intensive BP control was not modified by s-potassium. Careful monitoring of patients on antihypertensive medications may eliminate the risks associated with abnormal s-potassium.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01206062
Disruption of the Blood-Brain Barrier by Extracellular Vesicles From Preeclampsia Plasma and Hypoxic Placentae: Attenuation by Magnesium Sulfate
Authors: León José , Acurio Jesenia , Bergman Lina , López Juán , Karin Wikström Anna , Torres-Vergara Pablo , Troncoso Felipe , Castro Fidel Ovidio , Vatish Manu , Escudero Carlos
Published: October 2021

Preeclampsia, a pregnancy-related endothelial disorder, is associated with both cardiovascular and cerebrovascular complications. Preeclampsia requires the presence of a placenta as part of its pathophysiology, yet the role of this organ in the cerebrovascular complications remains unclear. Research has shown that circulating small extracellular vesicles (also known as exosomes) present in preeclampsia plasma can generate endothelial dysfunction, but it is unclear whether the impairment of function of brain endothelial cells at the blood-brain barrier is secondary to plasma-derived or placental-derived exosomes. In this study, we evaluated the effect of small extracellular vesicles isolated from plasma samples of women with preeclampsia (n=12) and women with normal pregnancy (n=11) as well as from human placental explants from normotensive pregnancies (n=6) subjected to hypoxia (1% oxygen) on the integrity of the blood-brain barrier, using both in vitro and animal models. Exposure of human-derived brain endothelial cell monolayers to plasma and plasma-derived small extracellular vesicles from preeclamptic pregnancies increased the permeability and reduced the transendothelial electrical resistance. A similar outcome was observed with hypoxic placental-derived small extracellular vesicles, which also increased the permeability to Evan’s blue in the brain of C57BL6 nonpregnant mice. Cotreatment with magnesium sulfate reversed the effects elicited by plasma, plasma-derived, and hypoxic placental-derived small extracellular vesicles in the employed models. Thus, circulating small extracellular vesicles in plasma from women with preeclampsia or from hypoxic placentae disrupt the blood-brain barrier, which can be prevented using magnesium sulfate. These findings provide new insights into the pathophysiology of cerebral complications associated with preeclampsia.
Diagnostic value of cerebrospinal fluid levels of D-lactate, tumour necrosis factor-alpha and interleukin-6, -8, and -17 in suspected nosocomial meningitis
Authors: Goktas Sibel Yorulmaz , Oral Arzu Yılmaztepe , Yılmaz Emel , Akalın Emin Halis , Guvenc Furkan , Ozkaya Guven , Kocaeli Hasan , Dogan Seref , Yılmazlar Selcuk , Oral Haluk Barbaros
Published: October 2021

Introduction:

This study aimed to determine the diagnostic value of interleukin (IL)-6, IL-8, IL-17, tumour necrosis factor-alpha (TNF-α) and D-lactate levels in the cerebrospinal fluid (CSF) of nosocomial meningitis patients.

Methods:

The CSF levels of cytokines and D-lactate were compared across 29 episodes of nosocomial meningitis, 38 episodes of pleocytosis (without meningitis) and 54 control subjects.

Results:

The CSF levels of IL-6, IL-8, and D-lactate were higher in the group with nosocomial meningitis compared to the control group and the group with pleocytosis without meningitis (P < 0.05). For IL-6 levels (threshold: >440 pg/mL), the sensitivity and specificity were 55.17% and 94.74%, respectively. For IL-8 levels (threshold: >1,249 pg/mL), the sensitivity and specificity were 44.83% and 84.21%, respectively. In patients with nosocomial meningitis, when the threshold of D-lactate levels was >1.05 μmol/mL, the sensitivity and specificity were 75.86% and 63.16%, respectively. In pleocytosis (without meningitis) CSF samples and in nosocomial meningitis CSF samples, the highest area under the receiver operating characteristic curve (AUC) was calculated for triple combination model of IL-6, IL-8 and D-lactate levels (AUC 0.801, P < 0.001) and double combination model of IL-6 and IL-8 (AUC 0.790, P < 0.001).

Conclusion:

Our study findings suggest that IL-6, IL-8 and D-lactate levels could be diagnostic markers for nosocomial meningitis.
Comparison of the safety and efficacy between minimally invasive cardiac surgery and median sternotomy in a low-risk mixed Asian population in Singapore
Authors: Ong Zhi Xian , Wu Duoduo , Luo Haidong , Chang Guohao , Sazzad Faizus , Sule Jai Ajitchandra , Hu Peggy , Kofidis Theo
Published: October 2021

Introduction:

Minimally invasive cardiac surgery (MICS) has attracted increasing attention, with institutions increasingly adopting this approach over conventional median sternotomy (MS). This study aimed to describe the outcomes of minimally invasive cardiac surgery in our institution as the only centre with an established MICS programme in Singapore.

Methods:

Patients who had undergone cardiac procedures such as heart valve replacement or repair, coronary artery bypass grafting or atrial septal defect repair were included in the study. We analysed 4063 patients who had undergone MS and 390 patients who had undergone MICS between January 2009 and February 2020.

Results:

Over the years, the number of MICS procedures performed increased, along with an increase in MICS operations with two or more concomitant cardiac procedures and a decrease in postoperative length of stay. Compared with patients who underwent MS, those who underwent MICS had shorter length of postoperative hospital stay (P < 0.001). On multivariate analysis, patients who underwent MICS had lower rates of atrial fibrillation (P = 0.021), reoperation (P = 0.028) and prolonged ventilation (P < 0.001). However, the rates of other postoperative complications were comparable between patients who underwent MICS and those who underwent MS.

Conclusion:

In our institution, MICS is a safe, reproducible and efficacious technique that yields superior outcomes compared with conventional MS procedures, in some aspects. The results of this study provide further evidence and support towards adopting the minimally invasive approach to cardiac surgery in a carefully selected group of cardiac patients in Singapore.
Cleisostoma luopingense, a new species of Orchidaceae from Yunnan, China
Authors: WU XUN-FENG , WANG YU-QIAN , CHI KUAN-BO , LIU QIANG , WANG WEN-HUA
Published: October 2021

Cleisostoma luopingense, a new species of Orchidaceae, is described and illustrated from Yunnan Province, China. It is morphologically similar to C. williamsonii, but can be easily distinguished from the latter in having unbranched inflorescence and laxly placed 6–10 flowers; elliptic petals (size: 3.0–3.2 × 1.8–2.0 mm); back wall callus of spur yellow, T-shaped and mid-lobule deeply bilobed at base, column without stelidia.
Contribution to the Glolarnaca Gorochov, 2008 (Orthoptera: Gryllacrididae: Hyperbaeninae) from China
Authors: YANG ZIZHON , LU XIANGYI , BIAN XUN
Published: October 2021

Herein two new species of Glolarnaca Gorochov, 2008 are reported. Images illustrating the morphology of the two new species are provided. And the type specimens are deposited in the Institute of Entomoceutics Research, Dali University (DUIER) and Guangxi Normal University (GXNU).
A new species of Epopostruma (Hymenoptera: Formicidae) from monsoonal Australia
Authors: PETTIT MAGEN J. , ANDERSEN ALAN N.
Published: October 2021

Epopostruma is an uncommon genus of myrmicine ants endemic to relatively mesic regions of southern and eastern Australia. Here we describe a new species recently recorded from the ‘Top End’ of Australia’s Northern Territory, E. topendi sp. n. from Melville Island and Nitmiluk National Park. The new species is known from one specimen from each of two sites in the Australian monsoonal tropics, the only records of the genus from this region. This addition brings the number of described species of Epopostruma to twenty.
Long-Term Effect of Barotropic Instability across the Moat in Double-Eyewall Tropical Cyclone–Like Vortices in Forced and Unforced Shallow-Water Models
Authors: Lai Tsz-Kin , Hendricks Eric A. , Yau M. K.
Published: October 2021

Secondary eyewall formation and the ensuing eyewall replacement cycles may take place in mature tropical cyclones (TCs) during part of their lifetime. A better understanding of the underlying dynamics is beneficial to improving the prediction of TC intensity and structure. Previous studies suggested that the barotropic instability (BI) across the moat (aka type-2 BI) can make a substantial contribution to the inner-eyewall decay through the associated eddy radial transport of absolute angular momentum (AAM). Simultaneously, the type-2 BI can also increase the AAM of the outer eyewall. While the previous studies focused on the early stage of the type-2 BI, this paper explores the long-term effect of the type-2 BI and the underlying processes in forced and unforced shallow-water experiments. Under the long-term effect, it will be shown that the inner eyewalls repeatedly weaken and strengthen (while the order is reversed for the outer eyewalls). Sensitivity tests are conducted to examine the sensitivity of the long-term effect of the type-2 BI to different vortex parameters and the strength of the parameterized diabatic heating. Implication of the long-term effect for the intensity changes of the inner and outer eyewalls of real TCs are also discussed.
A cyclone-centered perspective on the drivers of asymmetric patterns in the atmosphere and sea ice during Arctic cyclones
Authors: Clancy Robin , Bitz Cecilia M. , Blanchard-Wrigglesworth Edward , McGraw Marie C. , Cavallo Steven M.
Published: October 2021

Arctic cyclones are an extremely common, year-round phenomenon, with substantial influence on sea ice. However, few studies address the heterogeneity in the spatial patterns in the atmosphere and sea ice during Arctic cyclones. We investigate these spatial patterns by compositing on cyclones from 1985-2016 using a novel, cyclone-centered approach that reveals conditions as functions of bearing and distance from cyclone centers. An axisymmetric, cold core model for the structure of Arctic cyclones has previously been proposed, however, we show that the structure of Arctic cyclones is comparable to those in the mid-latitudes, with cyclonic surface winds, a warm, moist sector to the east of cyclones and a cold, dry sector to the west. There is no consensus on the impact of Arctic cyclones on sea ice, as some studies have shown that Arctic cyclones lead to sea ice growth and others to sea ice loss. Instead, we find that sea ice decreases to the east of Arctic cyclones and increases to the west, with the greatest changes occurring in the marginal ice zone. Using a sea ice model forced with prescribed atmospheric reanalysis, we reveal the relative importance of the dynamic and thermodynamic forcing of Arctic cyclones on sea ice. The dynamic and thermodynamic responses of sea ice concentration to cyclones are comparable in magnitude, however dynamic processes dominate the response of sea ice thickness and are the primary driver of the east-west difference in the sea ice response to cyclones.
Machine learning for precipitation forecasts post-processing — Multi-model comparison and experimental investigation
Authors: Zhang Yuhang , Ye Aizhong
Published: October 2021

Obtaining high-quality quantitative precipitation forecasts is a key precondition for hydrological forecast systems. Due to multisource uncertainties (e.g., initial conditions, model structures and parameters), raw forecasts are subject to systematic biases; hence, statistical post-processing is often required to reduce these errors before the forecasts can proceed to hydrological applications. Machine learning (ML) algorithms are canonical statistical models, and they are diverse in type and variation. It is important to verify and compare their performance in the same scenario (e.g., precipitation post-processing). In this paper, we conduct a large-scale comparison study for the major ML models with diverse model structures and regularization strategies as post-processors for improving the quality of precipitation forecasts. Specifically, we compare the efficiency and effectiveness of 21 ML algorithms on solving this task. Daily reforecast precipitation with lead times up to 8 days from the Global Ensemble Forecast System and corresponding observations are employed to determine the usability of different models in the Yalong River basin in China. The performance of each model is validated by a group of carefully designed experiments and statistical metrics. The results reveal that improvements in model structures are more effective than regularization strategies. Among these algorithms, the optimized extra-trees regressor exhibit the best performance, effectively reduce overestimation and achieve the best skill in forecasting precipitation. Eleven ensemble members and a 2-day time window can be used as predictors to obtain the best model performance. The systematic experiments and findings also offer useful guidelines for other related studies.
Probabilistic fire-danger forecasting: A framework for week-two forecasts using statistical post-processing techniques and the Global ECMWF Fire Forecast System (GEFF)
Authors: Worsnop Rochelle P. , Scheuerer Michael , Di Giuseppe Francesca , Barnard Christopher , Hamill Thomas M. , Vitolo Claudia
Published: October 2021

Wildfire guidance two weeks ahead is needed for strategic planning of fire mitigation and suppression. However, fire forecasts driven by meteorological forecasts from numerical weather prediction models inherently suffer from systematic biases. This study uses several statistical-postprocessing methods to correct these biases and increase the skill of ensemble fire forecasts over the contiguous United States 8–14 days ahead. We train and validate the post-processing models on 20 years of European Centre for Medium-range Weather Forecast (ECMWF) reforecasts and ERA5 reanalysis data for 11 meteorological variables related to fire, such as surface temperature, wind speed, relative humidity, cloud cover, and precipitation. The calibrated variables are then input to the Global ECMWF Fire Forecast (GEFF) system to produce probabilistic forecasts of daily fire-indicators which characterize the relationships between fuels, weather, and topography. Skill scores show that the post-processed forecasts overall have greater positive skill at Days 8–14 relative to raw and climatological forecasts. It is shown that the post-processed forecasts are more reliable at predicting above- and below-normal probabilities of various fire indicators than the raw forecasts and that the greatest skill for Days 8–14 is achieved by aggregating forecast days together.
The Centrality of Rivalry
Authors: Ahdar Rex
Published: October 2021

The aim of this article is to argue that the old-fashioned idea of rivalry remains central to the concept of effective competition and, in turn, to the promotion of the competitive process. Rivalry was the core meaning of competition among the early economists. The concern with vigorous, sustained actual rivalry may have been lost sight of, but it ought not to have been. Rivalry cannot of course be the exhaustive focus for many other factors and influences affect the level of effective competition. But a searching rivalry inquiry provides a valuable initial screen. By reemphasizing the primacy of rivalry, we may also foster the ability of competition law to act not just as a key driver of economic efficiency and growth, but also as a pro-democratic vehicle to check powerful private centers of economic power.
How to Reform Without Reforming: School District Racial Composition and Pennsylvania’s “Fair” Funding Formula
Authors: Kelly Matthew Gardner
Published: October 2021

In the United States, researchers have documented persistent racial disparities in school funding for decades. Drawing on evidence from a recent policy change in Pennsylvania, this article contributes to research on the role of state governments in limiting or expanding racial disparities in K-12 education funding by examining differences in the racial composition of school districts positively and negatively impacted by a technical provision lawmakers inserted into a newly created formula for distributing state equalization aid. We find that negatively-impacted districts enroll a substantially higher number of Black and Latinx students, receive less state aid, have lower levels of state and local funding, and have lower spending levels than positively-impacted districts with otherwise similar financial needs. These findings suggest how state lawmakers can exacerbate racial inequities when pursuing reforms ostensibly focused on equity, and these results have implications for both policymakers and educational leaders focused on racial justice.
Educators’ Beliefs and Perceptions of Implementing Restorative Practices
Authors: Dhaliwal Tasminda K. , Daramola Eupha Jeanne , Alonso Jacob D. , Marsh Julie A.
Published: October 2021

Many urban school districts are adopting restorative practices (RP) as a means to reduce suspensions and resolve racial discipline gaps. In this study, we use a sensemaking framework to examine educators’ beliefs about discipline and their perceptions of RP and its implementation. We draw on survey responses ( N = 363) administered after educators attended RP trainings in a large, diverse county in California. Our results show the majority of respondents possess beliefs or an understanding of RP that are compatible with the goals of the approach. Survey respondents cite challenges to implementing RP that are at times consistent (e.g., lack of time) and at times at odds (e.g., relatively low emphasis on lack of leadership as a hindrance) with the current literature. As suggested by sensemaking theory, we find attitudes and beliefs are predictors of educators’ experiences implementing RP, including challenges to implementation and effects of the practices.
Object-Process Methodology as an Alternative to Human Factors Task Analysis
Authors: Dori Dov , Jbara Ahmad , Yang Yongkai E. , Liu Andrew M. , Oman Charles M.
Published: October 2021

Objective

We define and demonstrate the use of OPM-TA—a model-based task analysis (TA) framework that uses object-process methodology (OPM) ISO 19450 as a viable alternative to traditional TA techniques.

Background

A variety of different TA methods exist in human factors engineering, and several of them are often applied successively for a broad task representation, making it difficult to follow.

Method

Using OPM-TA, we modeled how an International Space Station (ISS) astronaut would support extravehicular activities using the existing robotic arm workstation with a new control panel and an electronic procedure system. The modeling employed traditional TA methods and the new OPM-TA approach, enabling a comparison between them.

Results

While the initial stages of modeling with OPM-TA follow those of traditional TA, OPM-TA modeling yields an executable and logically verifiable model of the entire human–robot system. Both OPM’s hierarchical set of diagrams and the equivalent, automatically generated statements in a subset of natural language text specify how objects and processes relate to each other at increasingly detailed levels. The graphic and textual OPM modalities specify the system’s architecture, which enables its function and benefits its users. To verify the model logical correctness model, we executed it using OPM’s simulation capability.

Conclusion

OPM-TA was able to unify traditional TA methods and expand their capabilities. The formal yet intuitive OPM-TA approach fuses and extends traditional TA methods, which are not amenable to simulation. It therefore can potentially become a widely used means for TA and human–machine procedure development and testing.
Stigma, Perceived Discrimination, and Mental Health during China’s COVID-19 Outbreak: A Mixed-Methods Investigation
Authors: Fan Wen , Qian Yue , Jin Yongai
Published: October 2021

Research on stigma and discrimination during COVID-19 has focused on racism and xenophobia in Western countries. In comparison, little research has considered stigma processes, discrimination, and their public health implications in non-Western contexts. This study draws on quantitative survey data (N = 7,942) and qualitative interview data (N = 50) to understand the emergence, experiences, and mental health implications of stigma and discrimination during China’s COVID-19 outbreak. Given China’s history of regionalism, we theorize and use a survey experiment to empirically assess region-based stigma: People who lived in Hubei (the hardest hit province) during the outbreak and those who were socially associated with Hubei were stigmatized. Furthermore, the COVID-19 outbreak created stigma around people labeled as patients by the state. These stigmatized groups reported greater perceived discrimination, which—as a stressor—led to psychological distress. Our interview data illuminated how the stigmatized groups perceived, experienced, and coped with discrimination and stigma.
Joining up well-being and sexual misconduct data and policy in HE: ‘To stand in the gap’ as a feminist approach
Authors: Oman Susan , Bull Anna
Published: October 2021

This article joins up evidence and policy relating to two linked concerns in higher education (HE) that are treated as unrelated: postgraduate research student (PGR) well-being, and staff sexual misconduct towards students. Against the standard methodology of systematic reviews, we build on feminist approaches to apply a ‘re-performance’ approach to the review. Re-performance re-enacts established methods, contextualising previous analysis through ethnographic and desk-based research, exposing gaps in evidence, analysis, representation, care and policy. We reveal how aspects of PGR experience, particularly the cultures that engender ill-being and enable sexual misconduct, are silenced in evidence-making. Our ‘re-performance’ uncovers how this occurs in three ways, through: the (mis)construction of the ‘typical student’ in well-being literatures; the (mis)construction of the phenomenon of ‘well-being’ exacerbated by generic survey tools focusing on a medicalised model of mental health; the (mis)construction of HE institutions as integrated, agential and ethical, aided by the fragmentation of administrative systems and knowledge production between disciplines. Together, these organising modes conceal lack of care, staff sexual misconduct and poor well-being. From these findings, specific policy issues are identified: the risks to giving more responsibility to supervisors for PGR well-being; a pattern of institutional listening while silencing; and the need to explore feedback loops between patterns of vulnerability to ill-being and staff sexual misconduct. Through our analysis, the article demonstrates how to ‘stand in the gaps’ – between knowledges; and between evidence and action; between policy and care – in a way that can be generalised across policy domains, epistemologies and policy-making contexts.
Comparative MMPI-2 Norms between Free and United Methodist, Catholic Priest, Episcopal, and Presbyterian Ministry Candidates
Authors: Edwards-Stewart Amanda , Hoyt Tim , Rennebohm Sam , Kurtz Fiona B. , Charleson John S. , Teal Sadie M.
Published: October 2021

The Minnesota Multiphasic Personality Inventory (MMPI-2) is often utilized to assess the suitability of ordination candidates by a religious organization. Published MMPI-2 scale scores for Roman Catholic priest, Episcopal, Presbyterians, and United Methodist ministry samples exist. However, previous research has not provided MMPI-2 scale scores for Free Methodist ordination candidates and has not provided a statistical comparison of scale scores between religious groups. The this study reports on MMPI-2 scale scores for Free Methodist ordination candidates and compares this group’s scores to Roman Catholic priests, Episcopal and Presbyterian ordination candidates, and a United Methodist sample. We found statistically significant differences between Free Methodist and Catholic Priests, Episcopal, Presbyterian ordination candidates on MMPI-2 Hs, Pd, Pt, and Sc scales and L, Pd, Mf, Pa, Pt, Sc, and Ma differences between Free and United Methodist groups. These results seem to indicate that Free Methodist candidates have fewer non-organic health concerns, less obsessive thoughts, positive social relationships, and more readily submit to authority when contracted with other comparative ordination candidates or ministry sample.
Debiasing Causal Inferences: Over and Beyond Suboptimal Sampling
Authors: Rodríguez-Ferreiro Javier , Vadillo Miguel A. , Barberia Itxaso
Published: October 2021

Background

We have previously presented two educational interventions aimed to diminish causal illusions and promote critical thinking. In both cases, these interventions reduced causal illusions developed in response to active contingency learning tasks, in which participants were able to decide whether to introduce the potential cause in each of the learning trials. The reduction of causal judgments appeared to be influenced by differences in the frequency with which the participants decided to apply the potential cause, hence indicating that the intervention affected their information sampling strategies.

Objective

In the present study, we investigated whether one of these interventions also reduces causal illusions when covariation information is acquired passively.

Method

Forty-one psychology undergraduates received our debiasing intervention, while 31 students were assigned to a control condition. All participants completed a passive contingency learning task.

Results

We found weaker causal illusions in students that participated in the debiasing intervention, compared to the control group.

Conclusion

The intervention affects not only the way the participants look for new evidence, but also the way they interpret given information.

Teaching implications

Our data extending previous results regarding evidence-based educational interventions aimed to promote critical thinking to situations in which we act as mere observers.
The Value of Orientation and Mobility in the Preparation, Response, and Recovery of the 2017 Hurricane Season in Puerto Rico
Authors: McCormack Kevin
Published: October 2021

Introduction: The 2017 hurricanes Irma and Maria significantly affected all people in Puerto Rico, including people with visual impairments. This population has historically been underserved; therefore, access to disaster-related services and the overall availability of training in independence skills are inadequate. This study focuses on independence as related to orientation and mobility (O&M) and was part of a larger case study that sought to determine what unique factors affected people with visual impairments during the aforementioned hurricanes and how challenges could potentially improve. Methods: Qualitative exploratory single-case study of the 2017 hurricane season in Puerto Rico. Interviews used language interpreters and were conducted in-person and by telephone between November 2 and December 17, 2018. Referred sampling included 29 people with visual impairments, four relief agencies, an Americans with Disabilities Act (ADA) technical specialist, and seven organizations serving people with visual impairments. Results: The post-Maria travel environment presented many challenges through altered infrastructure. Impact was also felt due to insufficient disaster-related institutional supports and a lack of empowerment for people with visual impairments. Post-disaster life presented mental health challenges; however, the usage of O&M training helped to curb its effects. For study participants, the greater the acquisition and practice of O&M, the greater their well-being. Discussion: Paternalism minimized the acquisition and practice of O&M. Knowledge and practice of O&M were salient in post-disaster life. The use of O&M aided in mental health before, during, and after the hurricanes. Implications for practitioners: Expressions of the importance of O&M skills among participants can be used to encourage future recipients of O&M training. These testimonials can also be used to advocate for more social support and financial assistance for organizations which provide such training.
Massive Cervical Lymphadenopathy Post-COVID-19 Vaccination
Authors: Ganga Kiran , Solyar Alla Y , Ganga Roopa
Published: October 2021

The coronavirus disease 2019 (COVID-19) is a global pandemic caused by severe acute respiratory syndrome coronavirus 2. Rapid spread with rampant growth of cases and deaths brought forth an urgent need for novel therapies including vaccinations. The mRNA vaccines for COVID-19 disease have been implemented at an unprecedented scale in an effort to combat the unrelenting pandemic. Such a massive scale vaccination program is bound to coincide with adverse events related to treatment. We present a case of massive cervical lymphadenopathy in a 58-year-old male patient post-Moderna COVID-19 vaccination. Additional investigations did not identify malignancy and he was diagnosed with vaccine-related lymphadenopathy. Patient significantly improved with corticosteroid treatment within 2 days of admission. Lymphadenopathy is reported as the second most common local reaction to the Moderna vaccine. Promoting knowledge of this side effect, particularly in the setting widespread vaccination efforts, would allow for better management of cases, especially in relation to oncologic patients.
Psychological and Social Factors Associated with Coexisting Frailty and Cognitive Impairment: A Systematic Review
Authors: Ellwood Alison , Quinn Catherine , Mountain Gail
Published: October 2021

Those living with coexistent frailty and cognitive impairment are at risk of poorer health outcomes. Research often focuses on identifying biological factors. This review sought to identify the association psychological and social factors have with coexisting physical and cognitive decline. Six databases were systematically searched in July 2020. Studies included individuals aged 60 years or older identified as being both frail and cognitively impaired. A narrative synthesis examined patterns within the data. Nine studies were included, most employed a cross-sectional design. Depression was investigated by all nine studies, those with coexistent frailty and cognitive impairment had higher levels of depressive symptoms than peers. Findings were mixed on social factors, although broadly indicate lower education, living alone and lower material wealth were more frequent in those living with coexistent decline. Further research is needed to explore potentially modifiable psychological and social factors which could lead to the development of supportive interventions.
Comprehensive left ventricular outflow tract management beyond septal reduction to relieve obstruction
Authors: Gharibeh Lara , Smedira Nicholas G , Grau Juan B
Published: October 2021

The surgical management of patients with hypertrophic obstructive cardiomyopathy can be extremely challenging. Relieving the left ventricular outflow tract obstruction in these patients is often achieved by performing a septal myectomy. However, in many instances, septal reduction alone is not enough to relieve the obstruction. Interventions on the sub-valvular apparatus, including the anomalous chordae tendineae and the abnormal papillary muscles, are often required. In this review, we summarize the embryology and the pathophysiology of the different elements that may contribute to the left ventricular outflow tract obstruction in the setting of hypertrophic obstructive cardiomyopathy. In addition, we highlight the different surgical procedures that a surgeon may adopt to relieve the left ventricular outflow tract obstruction, beyond the septal myectomy.
Recalibration Methods for Improved Clinical Utility of Risk Scores
Authors: Mishra Anu , McClelland Robyn L. , Inoue Lurdes Y. T. , Kerr Kathleen F.
Published: October 2021

Background

An established risk model may demonstrate miscalibration, meaning predicted risks do not accurately capture event rates. In some instances, investigators can identify and address the cause of miscalibration. In other circumstances, it may be appropriate to recalibrate the risk model. Existing recalibration methods do not account for settings in which the risk score will be used for risk-based clinical decision making.

Methods

We propose 2 new methods for risk model recalibration when the intended purpose of the risk model is to prescribe an intervention to high-risk individuals. Our measure of risk model clinical utility is standardized net benefit. The first method is a weighted strategy that prioritizes good calibration at or around the critical risk threshold. The second method uses constrained optimization to produce a recalibrated risk model with maximum possible net benefit, thereby prioritizing good calibration around the critical risk threshold. We also propose a graphical tool for assessing the potential for recalibration to improve the net benefit of a risk model. We illustrate these methods by recalibrating the American College of Cardiology (ACC)–American Heart Association (AHA) atherosclerotic cardiovascular disease (ASCVD) risk score within the Multi-Ethnic Study of Atherosclerosis (MESA) cohort.

Results

New methods are implemented in the R package ClinicalUtilityRecal. Recalibrating the ACC-AHA-ASCVD risk score for a MESA subcohort results in higher estimated net benefit using the proposed methods compared with existing methods, with improved calibration in the most clinically impactful regions of risk.

Conclusion

The proposed methods target good calibration for critical risks and can improve the net benefit of a risk model. We recommend constrained optimization when the risk model net benefit is paramount. The weighted approach can be considered when good calibration over an interval of risks is important.
Exploring Models of Care and the Perceived Impact in an Offender Rehabilitation Program
Authors: Carolan Caoimhe , O’Flynn Alice , Guerin Suzanne
Published: October 2021

Offender rehabilitation programs incorporating positive psychology interventions such as a strengths-based model can be effective. This study explores the perceived model of service provided by an offender rehabilitation service and the perceived impact that this service has on the lives of its clients. A qualitative methodology was employed in the context of an action research design, using semi-structured interviews with key stakeholders. The data were analyzed using thematic analysis which is an independent and reliable approach to qualitative analysis. The findings suggest that participants perceive the organization to be operating a strengths-based approach and this is perceived as having the potential to have a range of positive effects for clients. Some contrasting views were also identified within the participant groups and these are discussed in this paper. The results of this study complement the existing research and have several implications for future research in this area.
Preparation and characterization of antibacterial and anti-inflammatory hyaluronic acid-chitosan-dexamethasone hydrogels for peri-implantitis repair
Authors: Zhou Zhen , Zhang Qiang , Wang Yamin
Published: October 2021

Numerous treatment methods for peri-implantitis have been widely used including oral cleaning, traditional metal scraping means, or local antibiotic application. However, to continuously release antibacterial and anti-inflammatory drug in location in situ for effective peri-implantitis repair is still challenging. Herein, an anti-inflammatory drug dexamethasone (DE)–incorporated hyaluronic acid (HA)-chitosan (CT) composite hydrogels system was developed to repair peri-implantitis. The physicochemical characterization and biocompatibility of the hydrogel were evaluated in vitro. The in vivo hydrogels degradation and peri-implantitis repair were assessed in mice. The results showed that the prepared multifunctional hydrogels achieved sustained release, with an equilibrium swelling of 18, and promoted the growth against NIH-3T3 fibroblast cells. The in vitro antibacterial tests showed HA-CT-DE hydrogels can inhibit methicillin-resistant Staphylococcus aureus and Escherichia coli. It down-regulated the expression levels of inflammation factor IL-1β, IL-6 and, TNF-α in peri-implantitis. The prepared HA-CT-DE composite hydrogels with integrated function is promising for the treatment of peri-implantitis.
Antihypertensive Medications Prior to Shock Onset Do Not Impact Initial Vasopressor Requirements in Patients With Shock
Authors: Patel Jaimini S. , Colon Hidalgo Daniel , Capistrano Irene , Mancl Erin , Rech Megan A.
Published: October 2021

Purpose: The effect of the use of antihypertensive agents in patients prior to the development of shock is unclear. The purpose of this study was to determine the impact of antihypertensive agents on vasopressor dose and duration in shock. Materials and Methods: This retrospective, single-center study included patients with shock who received at least one vasopressor for at least 24 hours after shock onset from January 1 to June 30, 2017. Patients taking an antihypertensive agent(s) were compared to those who were not. The primary outcome was the number of vasopressor-free hours at 72 hours. Secondary outcomes included maximum and cumulative vasopressor doses, intensive care unit length of stay, and 30-day mortality. Results: One hundred and sixty-eight patients were included and 99 (59%) were on antihypertensives. Distributive shock was the most common type of shock (75.5%) and more patients taking antihypertensives had hypertension, coronary artery disease, and dyslipidemia at baseline. There was no difference in the number of vasopressor-free hours at 72 hours between patients taking an antihypertensive medication(s) and the control group (2 hours vs 1 hour; P = .11). No difference was found between any of the secondary outcomes. Conclusion: Patients taking antihypertensive agents prior to shock onset did not require increased vasopressor doses or duration.
Numerical modelling of activation energy and hydromagnetic non-Newtonian fluid particle deposition flow in a rotating disc
Authors: Babu B. Hari , Rao P. Srinivasa , Reddy M. Gnaneswara , Varma S.V.K.
Published: October 2021

This mathematical model explains the three-dimensional flow of Casson liquid through a stretchable rotating disk. In momentum equation magnetic effect and in mass equation Arrhenius chemical reaction and activation energy effects are incorporated. The equation which represents the described flow pattern is reduced to ordinary differential equations (ODEs) by using apposite similarity transformations and then they are tackled with the RKF45 method with shooting proficiency. The impact of pertinent parameters on thermal, mass and velocity curves are deliberated graphically. Further statistical values of skin friction, Nusselt number and Sherwood number are portrayed in table format. The result outcome reveals that, increase in the values of a magnetic parameter reduces velocity gradient. The concentration profile declines for augmented values of chemical reaction rate parameter, but a contrasting trend is seen in the concentration gradient for increased values of activation energy. Further, upsurge in thermophoretic and Brownian motion parameter reduces the mass transfer.