bluuebunny/crossref_metadata_2025 huggingface dataset:
Prior Authorization, Copayments, and Utilization of Sacubitril/Valsartan in Medicare and Commercial Plans in Patients With Heart Failure With Reduced Ejection Fraction
Authors: Ozaki Aya F. , Krumholz Harlan M. , Mody Freny Vaghaiwalla , Tran Tien T. , Le Quan T. , Yokota Mai , Jackevicius Cynthia A.
Published: September 2021

Background:

Slow uptake of sacubitril/valsartan in patients with heart failure with reduced ejection fraction has been reported, which may negatively impact clinical outcomes. We characterized prior authorization (PA) burden, prescription copayment, and utilization of sacubitril/valsartan by insurance plan type to identify potential barriers to its use.

Methods:

We conducted a national population-level, cross-sectional study using PA data from an insurance coverage website accessed in March 2019 and IQVIA National Prescription Audit data from August 2018 to July 2019. Primary outcomes were proportion of plans requiring PA, frequency of specific PA criteria, number of sacubitril/valsartan prescriptions, and copayments per insurance plan type.

Results:

Overall, 48.1% (1394/2896) of insurance plans required PA for sacubitril/valsartan. Fewer Medicare (27.7%) than commercial (57.2%) plans required PA (
P
<0.001). For both plan types, the most frequently required PA criteria were ejection fraction (71.6%, 90.9%) and New York Heart Association class (60.4%, 90.8%) for Medicare and commercial plans, respectively. Copayment amounts varied by plan type, with more sacubitril/valsartan prescriptions for commercial plans not requiring a patient copayment (32.4%) compared with Medicare plans (19.3%;
P
<0.001). There were 814 437 sacubitril/valsartan prescriptions for Medicare and 822 292 for commercial plans dispensed from August 2018 to July 2019. Based on estimated heart failure with reduced ejection fraction populations for each plan type, 4-fold more sacubitril/valsartan prescriptions were dispensed in commercial than in Medicare plans (820 versus 215 prescriptions/1000 individuals in the heart failure with reduced ejection fraction population). The estimated proportion of heart failure with reduced ejection fraction patients prescribed sacubitril/valsartan was 3.6% (1.5%–6.8%) for Medicare and 13.7% (4.9%–31.8%) for commercial plan populations.

Conclusions:

Despite commercial plans having greater PA requirements than Medicare, population-adjusted use of sacubitril/valsartan was higher in commercial plans. Given that commercial plans had more prescriptions with low copayments than Medicare, copayment policies may be more influential on sacubitril/valsartan use than its PA policies. Low sacubitril/valsartan use in both plan types highlights the multifactorial nature of medication underutilization that includes factors beyond the drug policies that we evaluated.
Comparison Between Invasive and Noninvasive Methods to Estimate Subendocardial Oxygen Supply and Demand Imbalance
Authors: Salvi Paolo , Baldi Corrado , Scalise Filippo , Grillo Andrea , Salvi Lucia , Tan Isabella , De Censi Lorenzo , Sorropago Antonio , Moretti Francesco , Sorropago Giovanni , Gao Lan , Rovina Matteo , Simon Giulia , Fabris Bruno , Carretta Renzo , Avolio Alberto P. , Parati Gianfranco
Published: September 2021

Background

Estimation of the balance between subendocardial oxygen supply and demand could be a useful parameter to assess the risk of myocardial ischemia. Evaluation of the subendocardial viability ratio (SEVR, also known as Buckberg index) by invasive recording of left ventricular and aortic pressure curves represents a valid method to estimate the degree of myocardial perfusion relative to left ventricular workload. However, routine clinical use of this parameter requires its noninvasive estimation and the demonstration of its reliability.

Methods and Results

Arterial applanation tonometry allows a noninvasive estimation of SEVR as the ratio of the areas directly beneath the central aortic pressure curves obtained during diastole (myocardial oxygen supply) and during systole (myocardial oxygen demand). However, this “traditional” method does not account for the intra‐ventricular diastolic pressure and proper allocation to systole and diastole of left ventricular isometric contraction and relaxation, respectively, resulting in an overestimation of the SEVR values. These issues are considered in the novel method for SEVR assessment tested in this study. SEVR values estimated with carotid tonometry by "traditional” and "new” method were compared with those evaluated invasively by cardiac catheterization. The “traditional” method provided significantly higher SEVR values than the reference invasive SEVR: average of differences±SD= 44±11% (limits of agreement: 23% – 65%). The noninvasive “new” method showed a much better agreement with the invasive determination of SEVR: average of differences±SD= 0±8% (limits of agreement: ‐15% to 16%).

Conclusions

Carotid applanation tonometry provides valid noninvasive SEVR values only when all the main factors determining myocardial supply and demand flow are considered.
Switching to Tenecteplase for Stroke Thrombolysis
Authors: Mahawish Karim , Gommans John , Kleinig Timothy , Lallu Bhavesh , Tyson Alicia , Ranta Annemarei
Published: September 2021

Background and Purpose:

Due to practical advantages, increasing trial safety data, recent Australian Guideline endorsement and local population needs we switched to tenecteplase for stroke thrombolysis from alteplase. We describe our change process and real-world outcome data.

Methods:

Mixed-methods including stakeholder engagement, preimplementation and postimplementation surveys, and assessment of patient treatment rates, metrics, and clinical outcomes preimplementation and postimplementation adjusting regression analyses for age, sex, National Institutes of Health Stroke Scale, premorbid modified Rankin Scale score, and thrombectomy using New Zealand National Stroke Registry data.

Results:

Preswitch consultation involved stroke and emergency clinicians, pharmacists, national regulatory bodies, and hospital legal teams. All survey responders (90% response rate) supported the proposed change and remained satisfied 12 months postimplementation. Between January 2018 and February 2021, we treated 555 patients with alteplase and 283 with tenecteplase. Patients treated with tenecteplase had greater odds of a favorable modified Rankin Scale using both shift (adjusted odds ratio, 1.60 [95% CI, 1.15–2.22]) and dichotomous analyses (modified Rankin Scale score, 0–2; adjusted odds ratio, 2.17 [95% CI, 1.31–3.59]) and shorter median (interquartile range) door-to-needle time (median, 53 [38–73.5] versus 61 minutes [45–85],
P
=0.0002). Symptomatic intracranial hemorrhage rates (tenecteplase 1.8% versus 3.4%; adjusted odds ratio, 0.46 [95% CI, 0.13–1.64]), death by day 7 (tenecteplase 7.5% versus 11.8%; adjusted odds ratio, 0.46 [95% CI, 0.21–0.99]), and median (interquartile range) needle to groin time for the 42 transferred regional patients (tenecteplase 155 [113–248] versus 200 [158–266];
P
=0.27) did not significantly differ.

Conclusions:

Following stakeholder endorsement, a region-wide switch from alteplase to tenecteplase was successfully implemented. We found evidence of benefit and no evidence of harm.
Access to bank credit by smallholder farmers in Tanzania: a case study
Authors: Isaga Nsubili
Published: September 2021

Tanzania like many other developing countries is highly dependent on agriculture for income generation and job creation for its citizens. Because the sector is mainly composed of smallholder farmers, lack of finance remains the leading obstacle to development. This study seeks to determine factors that affect access to bank credit by smallholder farmers in the Mvomero District of Morogoro, Tanzania. The study used a cross-sectional design, with data being collected via the survey method. Purposeful sampling was used to obtain the respondents who fitted into the study objective. The data were analyzed using descriptive statistics and a logistic regression model. The Logit regression model in particular was employed to determine factors that affect smallholder farmers’ access to bank services. The study reveals that the value of assets invested in farming activities, education and gender are significant factors affecting smallholder farmers’ access to bank credit. Policy recommendations include the establishment of a government bank that would exclusively provide financial services to agriculturalists by establishing a credit guarantee scheme, and the development of new financial products by the banks that would cater to the needs of smallholder farmers.
An annotated checklist of the chaetonotidan Gastrotricha from India
Authors: CHATTERJEE TAPAS , TODARO M. ANTONIO
Published: September 2021

India has a long history of research on freshwater and marine Gastrotricha. In more than 110 years of study on Order Chaetonotida, two families consisting of 11 genera and 39 species have been described. Thirty of these species are taxa originally described from other continents, while only nine species (7 freshwater, 2 marine) are only known from India. The large percentage (77%) of so-called cosmopolitan species in India has contributed to the phenomenon known as the “meiofauna paradox”. However, a careful review of the pertaining literature provides a different biogeographical picture of the chaetonotidan fauna of India. Herein we show that the high incidence of European and North American species reported from India is mainly due to a mixture of misidentification and species lumping. In fact, for only 12 species there are enough data that would make the Indian specimens morphological similar to taxa previously reported from Europe and/or North America. However, without the appropriate molecular sequence data for comparison, there is no way to rule out the possibility of cryptic speciation.We conclude that further sampling throughout India and the use of more powerful microscopical techniques (e.g., DIC optics) and molecular sequencing will reveal more species and improve the quality of re-descriptions of those (9 spp.) that so far appear to be endemic to the subcontinent. Here we recommend six species to be excluded from the fauna of India while another 11 species (non endemic to India) should be considered dubitatively present in the Indian fauna.
Taxonomic study of the leafhopper genus Anufrievia Dworakowska (Hemiptera: Cicadellidae: Typhlocybinae: Erythroneurini) from China, with descriptions of two new species
Authors: LIN SHUANGHU , ZHANG YALIN
Published: September 2021

The genus Anufrievia Dworakowska is reviewed with two new species from China: A. anchoroides sp. nov., and A. drepanoides sp. nov.. Detailed morphological descriptions and illustrations of these two new species and a key to all known species (males) from China are provided.
Reducing the number of unnecessary laboratory tests within hospital through the use of educational interventions
Authors: Thurm Michael , Craggs Helen , Watts Merlin , Brooks Anthony
Published: September 2021

Background

The growing number of laboratory investigation requests is placing an increased burden upon NHS resources. Around a quarter of all tests are unnecessary repeats, and almost a third have no impact on patient management. Doctors recognise that tests should only be performed when clinically indicated, but a culture persists of undertaking unnecessary repeat investigations.

Methods

A cohort study was undertaken at a district general hospital to observe the impact of introducing educational interventions in the form of a poster and a series of educational lectures, encouraging clinicians to consider whether an investigation was clinically indicated. Data was collected from nine different sites across the hospital run by different medical teams regarding the number of tests undertaken and the impact on patient care.

Results

Data from over 13,000 tests and over 2000 patients was analysed from nine different sites across the hospital. There was a significant reduction (33%, p = 0.0001) in the number of blood tests performed. This reduction in testing saved £7006 over the course of 1 month, in addition to other benefits. There was a reduction in testing in eight out of the nine sites in which the study was undertaken, demonstrating good generalisability of results. There was no significant increase in length of admission or mortality.

Conclusion

Educational interventions to doctors have a significant and safe impact in reducing the number of unnecessary investigations, providing cost saving benefits to the NHS.
Suicide mortality after a nonfatal suicide attempt: A systematic review and meta-analysis
Authors: Demesmaeker Alice , Chazard Emmanuel , Hoang Aline , Vaiva Guillaume , Amad Ali
Published: September 2021

Introduction:

Deliberate self-harm and suicide attempts share common risk factors but are associated with different epidemiological features. While the rate of suicide after deliberate self-harm has been evaluated in meta-analyses, the specific rate of death by suicide after a previous suicide attempt has never been assessed. The aim of our study was to estimate the incidence of death by suicide after a nonfatal suicide attempt.

Method:

We developed and followed a standard meta-analysis protocol (systematic review registration—PROSPERO 2021: CRD42021221111). Randomized controlled trials and cohort studies published between 1970 and 2020 focusing on the rate of suicide after suicide attempt were identified in PubMed, PsycInfo and Scopus and qualitatively described. The rates of deaths by suicide at 1, 5 and 10 years after a nonfatal suicide attempt were pooled in a meta-analysis using a random-effects model. Subgroup analysis and meta-regressions were also performed.

Results:

Our meta-analysis is based on 41 studies. The suicide rate after a nonfatal suicide attempt was 2.8% (2.2–3.5) at 1 year, 5.6% (3.9–7.9) at 5 years and 7.4% (5.2–10.4) at 10 years. Estimates of the suicide rate vary widely depending on the psychiatric diagnosis, the method used for the suicide attempt, the type of study and the age group considered.

Conclusion:

The evidence of a high rate of suicide deaths in the year following nonfatal suicide attempts should prompt prevention systems to be particularly vigilant during this period.
Characterising DSCATT: A case series of Australian patients with debilitating symptom complexes attributed to ticks
Authors: Schnall Jesse , Oliver Georgina , Braat Sabine , Macdonell Richard , Gibney Katherine B , Kanaan Richard A
Published: September 2021

Objectives(s):

To characterise the clinical profile, aetiology and treatment responsiveness of ‘Australian Lyme’, or Debilitating Symptom Complexes Attributed to Ticks.

Methods:

Single-centre retrospective case analysis of patients referred to the Infectious Diseases Unit at Austin Health – a tertiary health service in Heidelberg, Australia – between 2014 and 2020 for investigation and treatment of suspected Debilitating Symptom Complexes Attributed to Ticks. Patients were included if they had debilitating symptoms suggested by either themselves or the referring clinician as being attributed to ticks.

Results:

Twenty-nine Debilitating Symptom Complexes Attributed to Ticks cases were included in the analysis. Other than Lyme disease (83%), the most common prior medical diagnoses were Epstein–Barr virus (38%), chronic fatigue syndrome (28%) and fibromyalgia (24%). Prior histories of anxiety (48%) and depression (41%) were common. The most frequently reported symptoms included fatigue (83%), headache (72%) and arthralgia (69%). National Association of Testing Authorities/Royal College of Pathologists of Australasia–accredited serology was not diagnostic of acute infective causes, including Lyme disease, in any patient. Of 25 cases with available data, 23 (92%) had previously been prescribed antimicrobials, with 53% reporting benefit from them. The most common diagnoses made by our hospital were chronic fatigue syndrome (31%), migraines (28%) and fibromyalgia (21%). Only one patient’s symptoms were not accounted for by other diagnoses.

Conclusion:

This is the first case series of patients with Debilitating Symptom Complexes Attributed to Ticks. They had high rates of other medically unexplained syndromes, and no evidence of acute Lyme disease, or any common organic disease process. Debilitating Symptom Complexes Attributed to Ticks remains medically unexplained, and may therefore be due to an as yet unidentified cause, or may be considered a medically unexplained syndrome similar to conditions such as chronic fatigue syndrome.
A longitudinal analysis of a work inclusion model for psychiatric patients in the Mental Health Departments of the city of Milan
Authors: Ferrara Luca , Varinelli Alberto , Caricasole Valentina , Dragoni Chiara , Mazzardis Sonia , Quarenghi Andrea , Rubelli Paola , Fusi Antonio , Percudani Mauro , Cisima Michele , Mencacci Claudio , Maranesi Teodoro , Gambini Orsola , Barbieri Valentina , Brambilla Paolo , Lazzaretti Matteo , Carrà Giuseppe , Latina Aldo , Viganò Caterina , Dell’Osso Bernardo
Published: September 2021

Background:

Work functioning impairment is a key diagnostic and transnosographic criterion for psychiatric disorders in both DSM-5 and ICD-11. Occupational inclusion is a fundamental aspect of the care path for patients attending the territorial services provided by the Italian Mental Health and Addiction Departments (DSMDs). Since 2009, the Regional Innovative Programme (PIR) TR106, promoted by the Fatebenefratelli-Sacco hospital of Milan, Italy, in collaboration with six other metropolitan DSMDs, was created to promote integration for people suffering from mental health problems in the city of Milan.

Method:

Here we present the results of a retrospective epidemiologic analysis on 2,142 interventions on 1,066 patients, conducted between 2012 and 2019.

Results:

Most of the interventions were conducted with people with psychotic disorders (39%), followed by personality disorders (25.2%) and affective disorders (22.2%). The age range of 25 to 54 years represented 91.5% of the whole sample, mainly in the 35 to 44 years range (36.4%). Significant age group-related changes in interventions were observed in the observation period, with a reduction in the interventions provided to subjects of the 35 to 44 age group, and an increase in the 25 to 34 age group.

Conclusions:

PIR TR106 provided the most accurate assessment and data collection so far for the city of Milan. Our data characterised psychiatric groups in order to develop specific treatment plans and work inclusion interventions.
Non-contact detection of polyester filament yarn tension in the spinning process by the laser Doppler vibrometer method
Authors: Zhang Dongjian , Ma Qihua , Tan Yuan , Liao He , Lu Chenhui , Tang Fangming , Liu Xiangyu , Fu Yanan , Wang Xiangyang , Gan Xuehui
Published: September 2021

The precise detection of polyester filament yarn (PFY) tension in the spinning process is critical to ensure product quality. The laser Doppler vibrometer (LDV) method is proposed to achieve non-contact detection of PFY tension in this paper. By employing the Hamilton principle, the transverse dynamics differential equations of PFY are derived, which are discretized and solved by the Galerkin method and Runge–Kutta method, respectively. In the equations, the PFY between two adjacent rollers is simplified as an axially moving string to verify the generality of calculating natural frequencies. The calculated natural frequencies from the axially moving string model are compared with solved results from the transverse dynamics differential equations. It is shown that the approximation of natural frequencies can be obtained from the axially moving string model. This study attempts to establish an approximate generic model among the PFY tension, the spinning speed and the first natural frequency based on axially moving string model, from which the PFY tension can be calculated efficiently by employing the measured natural frequencies. The LDV method is used to measure the natural frequencies. A major advantage of the proposed method is to realize non-contact detection of PFY tension. The method is more useful under high-speed spinning conditions where contact tension detectors are not available. An experimental analysis is carried out to verify the effectiveness and accuracy of the proposed method. Therefore, it is believed that the non-contact detection of PFY tension in the spinning process by the LDV method is feasible.
Improvement of the image analysis method for quantifying low-polarity oily stains on fabric
Authors: Sugita Keiko , Oya Masaru
Published: September 2021

The stain quantification method using image analysis is excellent because it is non-destructive and applicable for non-uniformly adhered stains. The technique is difficult to adapt to colorless stains, but can be used by coloring the stains. However, low-polarity oils have poor compatibility even with oil-soluble dyes, and it is difficult to accurately quantify them from the appearance. The purpose of this paper is to examine the quantification of low-polarity oily stains by three methods: (1) search for a dye tracer suitable for non-polar oil; (2) use an ultraviolet (UV) image by mixing a fluorescent tracer; and (3) use an UV image using a model stain that absorbs UV rays. In the experiment, the soiled samples were prepared by dropping soiling liquid on a cotton fabric and washing with a tergotometer, and the cleaning efficiency was determined from the image obtained with a digital camera. Results showed that Elixa Red 348 with lower polarity than Sudan IV and Oil Red O is superior as a dye tracer for non-polar oil. In the fluorescence tracer method, the sum of G values (Σ G) in the red, green, blue signals of the image data can be used, but the decrease in fluorescence over time is a problem in the case of pyrene. It was also found that UV-absorbing stains such as alkylbenzene can be quantified from UV images by utilizing the slight fluorescence coloration of cotton fabric generated under 254 nm UV irradiation. The future potential of image analysis methods for quantifying non-polar oily stains was suggested.
Optimization of structural parameters on hollow spherical cells manufactured by Fused Deposition Modeling (FDM) using Taguchi method
Authors: Ali Naserddine Ben , Khlif Mohamed , Hammami Dorra , Bradai Chedly
Published: September 2021

There is a growing need for 3D printing of polymer structures in a cost-effective way and green. This study presents an experimental approach to investigate structural parameters effects on mechanical properties of polylactic acid (PLA) hollow-sphere structures manufactured with fused deposition modeling (FDM). The mechanical behavior characteristics of square_hexagonal stacking, closed_open porosity and parallel_perpendicular compression direction compared to the direction of manufacture under quasi-static uniaxial compression are examined using Taguchi method. The S/N ratio analysis and the Analysis of Variance (ANOVA) were used to find the optimal parameters that improve the mechanical properties (Young modulus, yield strength) and to provide a significant ranking of the different parameters analyzed in this paper. It was found that the optimum level and significance of each process parameter vary for “hexagonal cells,” “open porosity” and “parallel direction.” The optimal values of the results give a Young modulus E of 90.12 MPa and a yield strength [Formula: see text] of 3 MPa. Furthermore, the experimental results further reveal that the porous structure with the loading direction that is parallel to the direction of manufacture, has a higher strength and a progressive collapse of the cells to those with a perpendicular direction.
Three regulatory compliant test systems show no signs of MDMA-related genotoxicity
Authors: Cohen Isaac Victor , Barber Laken , Dubnicka Tyson Paul , Hurtado Sara Beth , Tincher Sarah Ann , Stankowski Leon Frank , Yazar-Klosinski Berra
Published: September 2021

3,4 Methylenedioxymethamphetamine (MDMA)-assisted therapy has been recently found to be highly effective for treatment of posttraumatic stress disorder (PTSD). Previous studies have been inconclusive in elucidating potential MDMA genotoxicity. We performed three regulatory compliant studies to investigate the potential of genotoxic effects of MDMA treatment in humans: (1) an in vitro bacterial reverse mutation (Ames) assay, (2) an in vitro chromosome aberration test in Chinese hamster ovary cells, and (3) an in vivo micronucleus study in male Sprague Dawley rats. MDMA was found to not have genotoxic effects in any of the assays at or above clinically relevant concentrations.
The geopolitics of militarism and humanitarianism
Authors: McCormack Killian , Gilbert Emily
Published: September 2021

In this article, we trace the interconnections between humanitarianism and militarism. We highlight the significance of a geographical perspective in emphasizing the spatial and multiscalar dimensions of this changing relationship, particularly in Western states. In doing so, we reveal the violent geographies produced through militarized humanitarianism and demonstrate the ways political violence can be obscured through invocations of humanitarianism. We look at five overlapping lines of enquiry: the way humanitarianism is used to modulate war; the rationalization of military intervention as humanitarian; military deployment in response to humanitarian crises; the military take-up of humanitarian-style practices; and weapons development and humanitarianism.
Health associations for male survivors of unwanted and non-consensual sex
Authors: Aiken Julia , Griner Stacey B.
Published: September 2021

Literature has established that men with non-consensual sexual experiences exhibit a higher likelihood of engaging in high-risk sexual behaviors; however, previous research does not explore men with unwanted sexual experiences, nor their sexual and general health outcomes. Weighted data from the 2011–2017 National Survey of Family Growth included men aged 18–49 years who ever experienced oral, vaginal, or anal sex by partners of any gender ( N = 10,763). The Pearson χ2 test compared the sociodemographic of men with or without a history of unwanted or non-consensual sex. Logistic regressions were used to examine the association of this history to sexual health and general health outcomes, while controlling for age, race/ethnicity, and education level. Approximately 1 in 10 (10.3%) American men reported experiencing unwanted or non-consensual sex in their lifetime. Men with these experiences were more likely to rate their health as fair or poor (a OR = 1.5, 95% CI = [1.1, 2.0]) and have difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition (a OR = 2.1, 95% CI = [1.7, 2.7]). Men with forced sex experiences reported higher odds of gonorrhea (a OR = 5.4; 95% CI = [3.0, 10.0]) or chlamydia diagnoses (a OR = 2.5; 95% CI = [1.5, 4.4]) in the past year, and a diagnosis of genital herpes (a OR = 2.7; 95% CI = [1.6, 4.6]), genital warts (a OR = 1.7; 95% CI = [1.0, 5.6]), and syphilis (a OR = 2.4; 95% CI = [1.0, 5.6]) in their lifetime than men who did not report these experiences. The association of sexually transmitted infections and general health outcomes to unwanted and non-consensual sex validates the demand for clinicians to integrate trauma-informed care into their practice with male patients.
“We All Play Pretty Much the Same, Except. . .”: Gender-Integrated Quidditch and the Persistence of Essentialist Ideology
Authors: Allison Rachel , Love Adam
Published: September 2021

We use the case of a recreational college Quidditch class to examine the consequences of gender-integrated sport for gender essentialist ideology. Data include ethnographic observations and course journal data from 23 first-year undergraduates playing Quidditch over four months. While a gender-integrated sport provided numerous opportunities for participants to witness similarities in performance among men and women, we found only limited challenge to gender essentialist ideas. Despite rules intended to reduce competitiveness and physical contact, play became increasingly aggressive over time, particularly among men, and an emergent positional segregation located women in less central defensive positions. Students frequently understood these trends as the “natural” result of gender difference. Ultimately, participants’ experiences in Quidditch often drew on and solidified ideas about women’s athletic inferiority to men.
From the Fringe to the Fore: An Algorithmic Ethnography of the Far-Right Conspiracy Theory Group QAnon
Authors: Forberg Peter L.
Published: September 2021

In this article, I examine the convergence of the socio-technological processes that enabled members of far-right conspiracy theory QAnon to expand beyond the “echo chambers” of the online fringe and incorporate themselves into mainstream discourse. Drawing on interdisciplinary research methods to focus on how technology is used in practice, I analyze QAnon’s online life through the concepts of algorithms, user experiences, and routines. I argue that QAnon followers’ deliberate manipulation of and incidental capitalization on algorithms gives QAnon’s content momentum that spreads information across communities; that the affordances of the user experiences of different platforms allow QAnons to curate a variety of strategies for growing their ideas and audience; and that the integration of QAnon participation into personal routines helps move the theory offline. Ultimately, a ground-up approach to digital socialization adds complexity to the analysis of echo chambers and algorithmic power.
An experimental insight of friction stir welding of dissimilar AA 6061/Mg AZ 31 B joints
Authors: Rajesh Jesudoss Hynes N , Vivek Prabhu M , Shenbaga Velu P , Kumar R , Tharmaraj R , Farooq Muhammad Umar , Pruncu Catalin Iulian
Published: September 2021

In the present scenario, aerospace and automobile industries depend on lightweight materials such as magnesium and aluminum alloys because of their great balance between mechanical properties and weight ratio. Despite these benefits during the joining process of these dissimilar materials by welding, many challenges arises. The prominent one is related to the low melting points of these lightweight metals which make it almost impossible the joining using conventional arc welding techniques. To tackle this challenge, Friction Stir Welding (FSW) can be considered as a promising candidate tool. In this study, to demonstrate the FSW performances of joining two dissimilar materials we have investigated the joining of AA 6061 and Mg AZ 31 B using a built-in house a modified milling machine. The dissimilar combinations of AA 6061 and Mg AZ 31 B joints were successfully joined by embedding different welding conditions and varying the offset distance. The mechanical performances were evaluated by conducting specific mechanical tests such as micro-hardness, tensile, and impact tests, respectively. To explain the mechanical results, we have applied optical microscopy observation on the microstructure associated with the bonding location. The results prove that the strength of the Friction Stir Welded joints is much higher as compared to other techniques especially in terms of dissimilar metals.
Fully developed forced convection analysis of magneto-hydrodynamic nano fluid through annular sector duct
Authors: Ahmed Farhan
Published: September 2021

During this study, we have investigated the effect of magnetic field on heat transfer flow of an electrically conducting magneto-hydrodynamic, ( MHD) nano fluid through annular sector duct. The problem is formulated under the assumption of fully developed flow by ignoring the deviation of velocity components in the axial direction only; and simulated with the help of semi implicit method for pressure linked equations revised, ( SIMPLER). The effect of Hartman number, M, on fully developed forced convection flow has been determined for different values of Copper nano particles contribution in base fluid, ϕ, apex angle, β and ratio of radii, Ȓ. With increase in the value of M, a prominent effect has been observed on friction factor, fRe. Furthermore, the influence of nano particles contribution on friction factor, fRe, has been dominated, when we increase the value of M.
Optimization-based subject-specific planar human vertical jumping prediction: Effect of elbow flexion and weighted vest
Authors: Baus Juan , Harry John R , Yang James
Published: September 2021

Jumping strategies differ considerably depending on athletes’ physical activity demands. In general, the jumping motion is desired to have excellent performance and low injury risk. Both of these outcomes can be achieved by modifying athletes’ jumping and landing mechanics. This paper presents a consecutive study on the optimization-based subject-specific planar human vertical jumping to test different loading conditions (weighted vest) during jumping with or without elbow flexion during the arm-swing based on the validated prediction model in the first part of this study. The sagittal plane skeletal model simulates the weighting, unweighting, breaking, propulsion phases and considers four loading conditions: 0%, 5%, 10%, and 15% body weight. Results show that the maximum ground reaction forces, the body center of mass position, and velocities at the take-off instant are different for different loading conditions and with/without elbow flexion. The optimization formulation is solved using MATLAB® with 35 design variables with 197 nonlinear constraints for a five-segment body model and 42 design variables with 227 nonlinear constraints for a six-segment body model. Both models are computationally efficient, and they can predict ground reaction forces, the body center of mass position, and velocity. This work is novel in the sense that presents a simulation model capable of considering different external loading conditions and the effect of elbow flexion during arm swing.
A unified Bayesian framework for exact inference of area under the receiver operating characteristic curve
Authors: Lin Ruitao , Chan KC Gary , Shi Haolun
Published: September 2021

The area under the receiver operating characteristic curve is a widely used measure for evaluating the performance of a diagnostic test. Common approaches for inference on area under the receiver operating characteristic curve are usually based upon approximation. For example, the normal approximation based inference tends to suffer from the problem of low accuracy for small sample size. Frequentist empirical likelihood based approaches for area under the receiver operating characteristic curve estimation may perform better, but are usually conducted through approximation in order to reduce the computational burden, thus the inference is not exact. By contrast, we proposed an exact inferential procedure by adapting the empirical likelihood into a Bayesian framework and draw inference from the posterior samples of the area under the receiver operating characteristic curve obtained via a Gibbs sampler. The full conditional distributions within the Gibbs sampler only involve empirical likelihoods with linear constraints, which greatly simplify the computation. To further enhance the applicability and flexibility of the Bayesian empirical likelihood, we extend our method to the estimation of partial area under the receiver operating characteristic curve, comparison of multiple tests, and the doubly robust estimation of area under the receiver operating characteristic curve in the presence of missing test results. Simulation studies confirm the desirable performance of the proposed methods, and a real application is presented to illustrate its usefulness.
Augmenting contact matrices with time-use data for fine-grained intervention modelling of disease dynamics: A modelling analysis
Authors: van Leeuwen Edwin ,   PHE Joint modelling group, Sandmann Frank
Published: September 2021

Social distancing is an important public health intervention to reduce or interrupt the sustained community transmission of emerging infectious pathogens, such as severe acute respiratory syndrome-coronavirus-2 during the coronavirus disease 2019 pandemic. Contact matrices are typically used when evaluating such public health interventions to account for the heterogeneity in social mixing of individuals, but the surveys used to obtain the number of contacts often lack detailed information on the time individuals spend on daily activities. The present work addresses this problem by combining the large-scale empirical data of a social contact survey and a time-use survey to estimate contact matrices by age group (0--15, 16--24, 25–44, 45–64, 65+ years) and daily activity (work, schooling, transportation, and four leisure activities: social visits, bar/cafe/restaurant visits, park visits, and non-essential shopping). This augmentation allows exploring the impact of fewer contacts when individuals reduce the time they spend on selected daily activities as well as when lifting such restrictions again. For illustration, the derived matrices were then applied to an age-structured dynamic-transmission model of coronavirus disease 2019. Findings show how contact matrices can be successfully augmented with time-use data to inform the relative reductions in contacts by activity, which allows for more fine-grained mixing patterns and infectious disease modelling.
Dealing with Dilemmas: Understanding the Process and Challenges of Disclosing the HIV Status of People Living with HIV/AIDS Through Gender Lens
Authors: Singh Shri Kant , Sharma Nidhi , Sharma Santosh Kumar
Published: September 2021

Disclosure is governed by a host of individual, health and psychological factors that operate in and shape the decisions related to disclosure in a patient among people living with human immunodeficiency virus (PLHIV).This article studies process of disclosure, how gender affects disclosure and how it differs among PLHIV by studying their life events integrating quantitative and qualitative information from 204 respondents. Mix method approach was used to collect the data from selected male and female respondents. A total of 204 completed interviews were carried out. Bivariate and multivariate statistical techniques have been used in the study. One-third respondents reported to not have disclosed status to their partner. Female PLHIV were significantly more likely (AOR: 2.8, p < .05) to disclose their HIV status to their spouse/regular partner. Three-fifths of women were tested after they lost their husbands to AIDS or living with HIV. Around 94% women reported self-perceived stigma and 83% feared of being discriminated. Female PLHIV are approximately 3 times (p < .05) more likely to have the fear of discrimination. Findings of the study reinforce the necessity of integrating gender in every HIV prevention efforts as disclosure of HIV status may provide opportunity for early initiation of anti-retroviral therapy (ART), which may ensure adherence to ART services and suppressing the viral load.
H-Type Tracheoesophageal Fistula Masquerading as Grade V Gastroesophageal Reflux in a Neonate
Authors: Banu Nasreen , Chandrasekharam VVS , Koduru Durga Prasad
Published: September 2021

Tracheoesophageal fistula (TEF) without associated esophageal atresia is a rare congenital anomaly. Diagnosis in neonatal period is usually not made and most of the patients are treated as cases of pneumonia. We report a case of H-type TEF, which was initially diagnosed as grade V gastroesophageal reflux on contrast esophagogram and bronchoscopy done revealed H-type fistula. Through cervical approach, fistula was repaired and baby had uneventful postoperative outcome. High index of clinical suspicion and early diagnosis can provide a better prognosis.
Validation of the Malay, English, and Chinese Translations of the 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in Breast Cancer Patients Making Treatment Decisions
Authors: Shunnmugam Bairave , Ng Chirk Jenn , Aishah Mohd Taib Nur , Chinna Karuthan
Published: September 2021

This study aims to test the psychometric properties of the Malay, English, and Chinese 9-Item Shared Decision Making Questionnaire (SDM-Q-9) in breast cancer patients making treatment decisions. The original German SDM-Q-9 was translated to Malay using the back-translation method. A total of 222 newly diagnosed breast cancer patients making treatment decisions were sampled conveniently from three breast clinics between August 2015 and February 2016. A total of 66 patients answered the SDM-Q-9 in Malay, 87 in English, and 69 in Chinese. Data were analyzed using SPSS and AMOS software. SDM-Q-9 demonstrated good reliability in the three translations. All the items correlated well except for Item 1 in English. The factor loadings were within acceptable range except for Item 1 in Malay, Items 1 and 2 in English, and Items 7 and 9 in Chinese SDM-Q-9. However, no items were deleted in accordance with experts’ opinions and the previous SDM-Q-9 validation studies. The Malay, English, and Chinese SDM-Q-9 demonstrated good reliability and validity.
Opportunities to Improve Palliative Care Delivery in Trauma Critical Illness
Authors: Haines Lindsay , Wang Wei , Harhay Michael , Martin Niels , Halpern Scott , Courtright Katherine
Published: September 2021

Background:

Despite recommendations to integrate palliative care (PC) into care for critically ill trauma patients, little is known about current PC practices in trauma care to inform opportunities for improvement.

Objective:

Describe patterns of PC delivery among a large, critically ill trauma cohort.

Setting/Subjects:

Retrospective cohort study of adult (≥18 years) trauma patients admitted to an intensive care unit (ICU) at an urban, level one trauma center in the United States from March 1, 2017 to March 1, 2019.

Methods:

We linked the electronic medical record with the institutional trauma registry. PC process measures included a PC consult order, advance care planning (ACP) note, and hospice use. Unadjusted results are reported for the total population, decedents, and subgroups at risk for poor outcomes (age ≥55 years, Black race ≥1 pre-existing comorbidity, and severe injury) after trauma.

Results:

Among 1309 eligible admissions, 902 (68.9%) were male, 640 (48.9%) were Black, and 654 (50.0%) were ≥55 years old. Eighty-one (6.2%) patients received a PC consult order, 66 (5.0%) had an ACP note, and 13 (1.1%) were discharged to hospice. Among decedents (N = 91; 7%), 28 (30.8%) received a PC consult order and 36 (39.6%) had an ACP note. For high-risk subgroups, PC consult orders and ACP note rates ranged from 4.5-12.8% and 4.5-11.8%, respectively.

Conclusion:

PC delivery was rare among this cohort, including those at high risk for poor outcomes. Urgent efforts are needed to identify barriers to and develop targeted interventions for high quality PC delivery in trauma ICU care.
Psychometric Traits of Motherhood Role Acceptance Scale and its Relationship With Psychological Capital
Authors: Mahdavi Maedeh Sadat , Farhadi Hadi , Sadeghi Elaheh , Masaeli Nassim
Published: September 2021

One of the required tools in family-related studies is the maternal role acceptance questionnaire. The current wealth of knowledge in this regard shows that most of the family-related questionnaires have not specifically addressed the role of mothering or acceptance of this role, and no questionnaire is available on this subject. Therefore, the need for a psychometric assessment of motherhood acceptance is useful and essential. The purpose of the research was to identify the psychometric traits of the motherhood acceptance scale and its relationship with psychological capital. The sample of this study consisted of 1735 married women aged between 18 and 40 years in Isfahan who were selected based on virtual snowball sampling. They responded to a researcher-made questionnaire on the acceptance of a mother role whose content validity was confirmed by experts and psychologists. The tool of this research is the Luthans Psychological Capital Inventory (2007), which consists of 24 questions and 4 subscales. The results showed that Cronbach's alpha coefficient for the whole questionnaire was 0.87 and for each of the five components of the scale: individual interaction, social and emotional support, individual attitudes, beliefs and values, and individual characteristics were 0.63, 0.64, 0.70, 0.49, and 0.71, respectively, which indicates the high reliability of the test made by the researcher for motherhood role acceptance scale.
Epidemiological Analysis of 1234 Cases of Laryngeal Cancer in Shanxi Province, China
Authors: Qi Hui , Chen Wenjie , Zhang Chunming , Zheng Xiwang , Peng Chen , Zhao Qinli , Guo Yujia , Wu Yongyan , Gao Wei , Wang Binquan
Published: September 2021

Background

Laryngeal cancer is a common malignancy of the head and neck, especially in northern China, including Shanxi province. This study intends to describe the epidemiological characteristics of laryngeal cancer in Shanxi Province, China, in order to support prevention and treatment efforts.

Methods

Retrospective analysis of the medical records of patients diagnosed with laryngeal cancer in hospitals in Shanxi Province from 2008 to 2012.

Results

The average annual incidence rate of laryngeal cancer in Shanxi province from 2008 to 2012 was 0.70/105, the Chinese population standardized incidence rate was 0.57/105 and the world population standardized incidence rate was 0.60/105. The city with the highest incidence of laryngeal cancer in Shanxi Province is Taiyuan, followed by Yangquan, and the lowest incidence are Yuncheng and Jincheng. The cases included 723 farmers (58.6%), 338 workers (27.4%), 95 government cadres (7.7%), 35 unemployed individuals (2.8%), 30 teachers (2.4%) and 13 individuals with other occupations (1.1%). The incidence of laryngeal cancer in rural areas was 0.78/105, while urban areas was 0.60/105. Of 1006 patients with smoking and drinking status reported, there were 238 both smoking and drinking (23.7%), 491 only smoking but not drinking (48.8%), 4 only drinking but not smoking (0.4%), 273 both not smoking and not drinking (27.1%) (P<0.001), and there were 695 males smoking (95.3%), 34 females smoking (4.7%) (P<0.001). Of 879 patients for whom the primary cancer location was known, 406 cases (46.2%) were supraglottic and 428 cases (48.7%) were glottic. Among 1009 patients with known pathological classification, the vast majority had squamous cell carcinoma (992 cases, 98.3%).

Conclusions

To sum up, the incidence of laryngeal cancer in Shanxi Province exhibited a relatively stable trend from 2008 to 2012, and the incidence is higher in men than in women in all years. The high percentage of smokers in this study underscores the importance of smoking as a risk factor for laryngeal cancer, whereas rates of drinking did not appear to be linked. Incidence of laryngeal cancer was higher in rural areas than in urban areas, a pattern that differs from other regions of China and internationally.
Breast Cancer Treatment Following Health Reform: Evidence From Massachusetts
Authors: Sabik Lindsay M. , Eom Kirsten Y. , Dahman Bassam , Li Jie , van Londen G. J. , Bradley Cathy J.
Published: September 2021

There are well-documented differences in breast cancer treatment by insurance status. Insurance expansions provide a context to assess the relationship between insurance and patterns of breast cancer care. We examine the association of Massachusetts health reform with use of breast conserving surgery, reconstruction, and adjuvant radiation using data from the Massachusetts Cancer Registry and Surveillance Epidemiology and End Results registries for 2001-2013 and a difference-in-differences approach. We observe statistically significant increases in breast conserving surgery among nonelderly women in Massachusetts relative to trends in states and age groups not affected by health reform. We also observe relative increases in reconstruction and adjuvant radiation, though trends in these outcomes were not the same across states prior to reform, limiting our ability to draw conclusions about the relationship between reform and these outcomes. Our results suggest that health reform was associated with some improvements in breast cancer treatment.