bluuebunny/crossref_metadata_2025 huggingface dataset:
Patterns of Location and Other Determinants of Retail Stores in Urban Commercial Districts in Changchun, China
Authors: Hao Feilong , Yang Yuxin , Wang Shijun
Published: January 2021

Knowledge of the patterns of location of retail stores in urban areas supports the development of effective urban planning and the reasonable allocation of commercial facilities. Using point of interest data and consumer survey data in three main commercial districts in Changchun, China, this study investigates the spatial structures of commercial districts and the patterns of distribution of retail stores to assess the determinants of the development of retail stores in commercial districts. Kernel density estimation, nearest neighbor index, and Pearson’s correlation analysis were used for this study. The following conclusions are drawn. (1) The spatial distribution of retail stores in Changchun commercial districts generates the coexistence of a concentration in the core area and diffusion in the peripheral area. The emergence of shopping malls has challenged the traditional single‐center structure, resulting in the transformation of commercial districts from single‐center to multicenter layouts, while also producing a hierarchical trend in development. (2) The Chongqing Road and Hongqi Street commercial districts have a relatively high spatial concentration of retail stores. Retail stores in Guilin Road exhibit distinct characteristics, namely, stores selling textiles, clothing, and daily necessities show the highest concentration, and food, beverage, and tobacco outlets as well as integrated stores show the lowest concentration. (3) The selected locations of the differing categories of stores on Chongqing Road strongly correlate, and textile, clothing, and daily necessity stores show a high correlation with other retail categories. (4) Four main factors affect the development and spatial layout of retail in the commercial districts. First, the interaction between consumer behavior and location choice in retail stores promotes the evolution of retail formats and trends in the development of comprehensive, specialized, and hierarchical retail commercial spaces. Second, the retail format determines the spatial layouts and the historical inheritance of the format. Third, governmental planning and policies lead to the agglomeration and diffusion of commercial activities in different areas. Fourth, such spatial clustering effects are an external driving factor for integration and aggregation among retail formats.
Risk Assessment of Intermittent and Continuous Nasogastric Enteral Feeding Methods in Adult Inpatients: A Meta-Analysis
Authors: Yang Guang , Zheng Bojun , Yu Yi
Published: January 2021

Diarrhea and pneumonia are common and serious complications in hospitalized patients requiring nasogastric enteral feeding. Our study aimed to compare the risk of diarrhea and pneumonia between intermittent nasogastric enteral feeding (IEF) and continuous nasogastric enteral feeding (CEF). We systematically searched PubMed, Web of Science, and Cochrane for relevant articles published from August 9, 1992, to September 1, 2019. A total of 637 IEF and CEF patients were included in our meta-analysis. Odds ratios (ORs) with associated 95% confidence intervals (CIs) were calculated to estimate the effects of diarrhea and pneumonia. We showed that hospital patients that required IEF had an increased risk of diarrhea compared with CEF. In the subgroup analyses, similar conclusions were identified in the non-China group and small sample size group (size < 100). However, our results showed no significant differences in the China group or large sample size group (size ≥ 100). Furthermore, our analysis showed that no significant association was observed for the risk of pneumonia between IEF and CEF patients. For inpatients requiring nasogastric enteral feeding, CEF is a better method of enteral nutrition compared with IEF, of which patients experience a significantly increased risk of diarrhea.
[Retracted] Study on Mechanical Characteristics of Energy‐Absorbing and Anti‐Scour Bolts
Authors: Tang Zhi , Wu Hao , Lv Jinguo , Xin Zhuangzhuang , Zuo Wenbo
Published: January 2021

In order to improve the impact resistance and mechanical performance of anchor rods and satisfy the requirements for supporting rockburst roadways, the energy balance equation of the energy‐absorbing support and roadway surrounding rock system is established. Moreover, to effectively prevent rockburst disasters, the energy criterion for roadway instability is derived. From the perspective of an energy‐absorbing support, a yield‐absorbing anti‐shock anchor composed of a rod body, tray, constant resistance energy‐absorbing device, and special‐shaped nut is designed and developed; compared with ordinary anchor rods, this rod has stronger mechanical properties for resisting impact. Theoretical and numerical simulation studies show that the energy‐absorbing device has a repeatable deformation failure mode and a constant yield force. The paper also presents the principle involved in the design of anti‐shock bolt supports. The energy‐absorbing support not only effectively guides and controls the release and conversion of impact energy but also consumes the impact energy in the buffering process of the anchor to ensure the stability of surrounding rock and support protection system. This study aims to provide reference for roadway support design and to improve rock bolts used in rockburst roadways.
Influence of Valleys Terrain on Pressure of Fully Mechanized Working Faces in Shallow Coal Seams
Authors: Liu YingJie , Qi Qingjie , Wang Anhu
Published: January 2021

The absence of a key stratum during overburden rock movement is crucial to the mining pressure of fully mechanized coal mining faces. Using physical and numerical simulations, the 21304 mechanized mining in Daliuta and Huojitu coal mining faces 1−2 appeared twice during a pressure frame accident analysis. The results indicate that a lack of key overlying strata is crucial to the mining of lower coal seams, particularly for the upper sections of a single key stratum of coal. When the key stratum of the upper coal seam is absent, a stable masonry structure is formed after mining. It is easy to form stable stacked strata at the bottom of a coal seam. When developing gullies in deep terrains, the formation of the key stratum will be an upper rock fracture affected by the impact, resulting in a partial absence of the key stratum. When the key stratum is absent, the mining of upslope working faces and the probability of dynamic strata pressure increase with the overburden on the working face and mining of downslope faces. The face mine pressure development laws on the upper and lower coal seam mining were similar, mainly manifesting as “slope section >valley bottom section >back slope section.”
Bacterial Infection among Cancer Patients: Analysis of Isolates and Antibiotic Sensitivity Pattern
Authors: Bhat Sevitha , Muthunatarajan Shruthi , Mulki Shalini Shenoy , Archana Bhat K. , Kotian K. Himani
Published: January 2021

Introduction. Cancer patients being immunosuppressed are vulnerable to develop infections. Knowledge of the changing epidemiology of infections has a pivotal role in its management. Aims and Objectives. The study is undertaken to assess the types of bacterial infections in cancer patients undergoing anticancer treatment, the associated bacterial pathogens, and their antibiotic sensitivity patterns. Materials and Methods. A retrospective surveillance study was undertaken in our center. Positive culture reports and other clinical details of cancer patients diagnosed with infection during a stay in the tertiary care center from 1st January 2015 to 31st December 2016 were analysed by descriptive statistical methods chi-square test and odds ratio to study the association. Results. Out of 638 cancer patients diagnosed with infections in the 2-year period, 140 patients had positive cultures, representing 272 specimens and 306 isolates. Common specimens sent for culture were blood sputum, urine, and pus. 214 isolates (69.9%) were gram-negative bacilli, and 92 (30.1%) were gram-positive cocci. The most common isolates were Klebsiella spp. (18.30%), Pseudomonas spp. (17.65%), and Escherichia coli (14.71%) followed by Staphylococcus aureus (13.72%). Among the gram-negative organisms, the antibiotic resistance rates reported to fluoroquinolones, aminoglycosides, and third-generation cephalosporins were 45.13%, 39.20%, and 48.58%, respectively. 26.92% of the organisms are resistant to all three antibiotics. 50.4% of Klebsiella spp. and Escherichia coli were ESBL producers. Gram-negative organisms showed 11.63% resistance to β-lactam/β-lactamase inhibitor combination, and 22.22% of gram-negative organisms are resistant to carbapenems. 50% of the Staphylococcus spp. were methicillin resistant, but all were sensitive to vancomycin. Conclusion. The surge in the number of gram-negative infections emphasizes the need for broad-spectrum empirical therapy targeting the same. Rate of resistance of the isolated gram-negative organisms to the routinely used empirical therapy is alarming. Prudent use of antibiotics, based on culture reports wherever possible, is of utmost importance to save the lives of infected patients and prevent further development of antibiotic resistance.
Two‐Stage Precoding Based on Overlapping User Grouping Approach in IoT‐Oriented 5G MU‐MIMO Systems
Authors: Lukic Djordje B. , Markovic Goran B. , Drajic Dejan D.
Published: January 2021

Downlink transmission techniques for multiuser (MU) multiple‐input multiple‐output (MIMO) systems have been comprehensively studied during the last two decades. The well‐known low complexity linear precoding schemes are currently deployed in long‐term evolution (LTE) networks. However, these schemes exhibit serious shortcomings in scenarios when users’ channels are strongly correlated. The nonlinear precoding schemes show better performance, but their complexity is prohibitively high for a real‐time implementation. Two‐stage precoding schemes, proposed in the standardization process for 5G new radio (5G NR), combine these two approaches and present a reasonable trade‐off between computational complexity and performance degradation. Before applying the precoding procedure, users should be properly allocated into beamforming subgroups. Yet, the optimal solution for user selection problem requires an exhaustive search which is infeasible in practical scenarios. Suboptimal user grouping approaches have been mostly focused on capacity maximization through greedy user selection. Recently, overlapping user grouping concept was introduced. It ensures that each user is scheduled in at least one beamforming subgroup. To the best of our knowledge, the existing two‐stage precoding schemes proposed in literature have not considered overlapping user grouping strategy that solves user selection, ordering, and coverage problem simultaneously. In this paper, we present a two‐stage precoding technique for MU‐MIMO based on the overlapping user grouping approach and assess its computational complexity and performance in IoT‐oriented 5G environment. The proposed solution deploys two‐stage precoding in which linear zero forcing (ZF) precoding suppresses interference between the beamforming subgroups and nonlinear Tomlinson‐Harashima precoding (THP) mitigates interuser interference within subgroups. The overlapping user grouping approach enables additional capacity improvement, while ZF‐THP precoding attains balance between the capacity gains and suffered computational complexity. The proposed algorithm achieves up to 45% higher MU‐MIMO system capacity with lower complexity order in comparison with two‐stage precoding schemes based on legacy user grouping strategies.
Follicular Lymphoma–associated BTK Mutations are Inactivating Resulting in Augmented AKT Activation
Authors: Hu Nan , Wang Fangyang , Sun Tianyu , Xu Zhengfan , Zhang Jing , Bernard Denzil , Xu Shilin , Wang Shaomeng , Kaminski Mark , Devata Suma , Phillips Tycel , Malek Sami N.
Published: January 2021

Purpose:

On the basis of the recent discovery of mutations in Bruton tyrosine kinase (BTK) in follicular lymphoma, we studied their functional properties.

Experimental Design:

We identified novel somatic BTK mutations in 7% of a combined total of 139 follicular lymphoma and 11 transformed follicular lymphoma cases, none of which had received prior treatment with B-cell receptor (BCR) targeted drugs. We reconstituted wild-type (WT) and mutant BTK into various engineered lymphoma cell lines. We measured BCR-induced signal transduction events in engineered cell lines and primary human follicular lymphoma B cells.

Results:

We uncovered that all BTK mutants destabilized the BTK protein and some created BTK kinase-dead mutants. The phospholipase C gamma 2 (PLCγ2) is a substrate of BTK but the BTK mutants did not alter PLCγ2 phosphorylation. Instead, we discovered that BTK mutants induced an exaggerated AKT phosphorylation phenotype in anti-Ig-treated recombinant lymphoma cell lines. The short hairpin RNA–mediated knockdown of BTK expression in primary human nonmalignant lymph node–derived B cells resulted in strong anti-Ig-induced AKT activation, as did the degradation of BTK protein in cell lines using ibrutinib-based proteolysis targeting chimera. Finally, through analyses of primary human follicular lymphoma B cells carrying WT or mutant BTK, we detected elevated AKT phosphorylation following surface Ig crosslinking in all follicular lymphoma B cells, including all BTK-mutant follicular lymphoma. The augmented AKT phosphorylation following BCR crosslinking could be abrogated by pretreatment with a PI3Kδ inhibitor.

Conclusions:

Altogether, our data uncover novel unexpected properties of follicular lymphoma–associated BTK mutations with direct implications for targeted therapy development in follicular lymphoma.

See related commentary by Afaghani and Taylor, p. 2123
Functional Common and Rare ERBB2 Germline Variants Cooperate in Familial and Sporadic Cancer Susceptibility
Authors: Bao Riyue , Ng Anita , Sasaki Mark , Esai Selvan Myvizhi , Katti Alyna , Lee Hyesan , Huang Lei , Skol Andrew D. , Lavarino Cinzia , Salvador Hector , Klein Robert J. , Gümüş Zeynep H. , Mora Jaume , Onel Kenan
Published: January 2021

We investigated a Spanish and Catalan family in which multiple cancer types tracked across three generations, but for which no genetic etiology had been identified. Whole-exome sequencing of germline DNA from multiple affected family members was performed to identify candidate variants to explain this occurrence of familial cancer. We discovered in all cancer-affected family members a single rare heterozygous germline variant (I654V, rs1801201) in ERBB2/HER2, which is located in a transmembrane glycine zipper motif critical for ERBB2-mediated signaling and in complete linkage disequilibrium (D' = 1) with a common polymorphism (I655V, rs1136201) previously reported in some populations as associated with cancer risk. Because multiple cancer types occurred in this family, we tested both the I654V and the I655V variants for association with cancer across multiple tumor types in 6,371 cases of Northern European ancestry drawn from The Cancer Genome Atlas and 6,647 controls, and found that the rare variant (I654V) was significantly associated with an increased risk for cancer (OR = 1.40; P = 0.021; 95% confidence interval (CI), 1.05–1.89). Functional assays performed in HEK 293T cells revealed that both the I655V single mutant (SM) and the I654V;I655V double mutant (DM) stabilized ERBB2 protein and activated ERBB2 signaling, with the DM activating ERBB2 significantly more than the SM alone. Thus, our results suggest a model whereby heritable genetic variation in the transmembrane domain activating ERBB2 signaling is associated with both sporadic and familial cancer risk, with increased ERBB2 stabilization and activation associated with increased cancer risk.

Prevention Relevance:

By performing whole-exome sequencing on germline DNA from multiple cancer-affected individuals belonging to a family in which multiple cancer types track across three generations, we identified and then characterized functional common and rare variation in ERBB2 associated with both sporadic and familial cancer. Our results suggest that heritable variation activating ERBB2 signaling is associated with risk for multiple cancer types, with increases in signaling correlated with increases in risk, and modified by ancestry or family history.
Design and Efficacy of a Monovalent Bispecific PD-1/CTLA4 Antibody That Enhances CTLA4 Blockade on PD-1+ Activated T Cells
Authors: Dovedi Simon J. , Elder Matthew J. , Yang Chunning , Sitnikova Suzanne I. , Irving Lorraine , Hansen Anna , Hair James , Jones Des C. , Hasani Sumati , Wang Bo , Im Seock-Ah , Tran Ben , Subramaniam Deepa S. , Gainer Shelby D. , Vashisht Kapil , Lewis Arthur , Jin Xiaofang , Kentner Stacy , Mulgrew Kathy , Wang Yaya , Overstreet Michael G. , Dodgson James , Wu Yanli , Palazon Asis , Morrow Michelle , Rainey Godfrey J. , Browne Gareth J. , Neal Frances , Murray Thomas V. , Toloczko Aleksandra D. , Dall'Acqua William , Achour Ikbel , Freeman Daniel J. , Wilkinson Robert W. , Mazor Yariv
Published: January 2021

The clinical benefit of PD-1 blockade can be improved by combination with CTLA4 inhibition but is commensurate with significant immune-related adverse events suboptimally limiting the doses of anti-CTLA4 mAb that can be used. MEDI5752 is a monovalent bispecific antibody designed to suppress the PD-1 pathway and provide modulated CTLA4 inhibition favoring enhanced blockade on PD-1+ activated T cells. We show that MEDI5752 preferentially saturates CTLA4 on PD-1+ T cells versus PD-1− T cells, reducing the dose required to elicit IL2 secretion. Unlike conventional PD-1/CTLA4 mAbs, MEDI5752 leads to the rapid internalization and degradation of PD-1. Moreover, we show that MEDI5752 preferentially localizes and accumulates in tumors providing enhanced activity when compared with a combination of mAbs targeting PD-1 and CTLA4 in vivo. Following treatment with MEDI5752, robust partial responses were observed in two patients with advanced solid tumors. MEDI5752 represents a novel immunotherapy engineered to preferentially inhibit CTLA4 on PD-1+ T cells.

Significance:

The unique characteristics of MEDI5752 represent a novel immunotherapy engineered to direct CTLA4 inhibition to PD-1+ T cells with the potential for differentiated activity when compared with current conventional mAb combination strategies targeting PD-1 and CTLA4. This molecule therefore represents a step forward in the rational design of cancer immunotherapy.

See related commentary by Burton and Tawbi, p. 1008.

This article is highlighted in the In This Issue feature, p. 995
Unusual Presentation in Infratentorial Superficial Siderosis: Acute Intracranial Hypertension
Authors: Guimarães Rocha Maria Sheila , Grangeiro Mirô Hugo Salomão , Manfroi Gregori , de Medeiros Dias Arthur , Cardoso Raphaella , Dozzi Brucki Sonia Maria
Published: January 2021

Superficial siderosis (SS) of the nervous system is a rare acquired condition related to hemosiderin deposits in subpial layers of the brain, brainstem, cerebellum, cranial nerves, and spinal cord, leading to brain iron-mediated neurodegeneration. The cardinal neurological features are slowly progressive hearing loss, ataxia, and pyramidal signs. Here we describe an atypical case of infratentorial SS evolving with acute intracranial hypertension in the absence of typical chronic signs.
Does Body Mass Index Impact the Outcome of Stroke Patients Who Received Intravenous Thrombolysis?
Authors: Zambrano Espinoza Maria Daniela , Lail Navdeep Singh , Vaughn Caila B. , Shirani Peyman , Sawyer Robert N. , Mowla Ashkan
Published: January 2021

Background: We sought to investigate the effect of obesity and BMI on functional outcome and rate of symptomatic intracranial hemorrhage (sICH) in a large sample of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). Methods: In a single-center retrospective, but prospectively collected data, study of patients with AIS treated with IVT in a 10-year period, patients were placed into groups based on their BMI defined as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2), or obese (<30 kg/m2). The rate of sICH and discharge modified Rankin Scale (mRS) were compared between the groups using logistic regression analysis. Results: In a total of 834 patients who received IVT for AIS during a 10-year period, 224 (27.0%) were obese. Obese patients did not have a higher rate of sICH after IVT for AIS on the unadjusted or adjusted analysis (adjusted OR 0.95, 95% CI 0.48–1.88). We did not find an association between obesity and poor functional outcome at discharge (adjusted OR 0.76, 95% CI 0.53–1.09). Conclusions: After adjusting for confounding factors such as age, baseline National Institute of Health Stroke Scale (NIHSS), and comorbidities, obesity was not associated with an unfavorable functional outcome at discharge nor with a higher risk of sICH in patients with AIS treated with IVT.
More than Pus – Primary Hepatic Epithelioid Angiomyolipoma Masquerading as Liver Abscess
Authors: Leong Wen Hao Justin , Tan Xia Huang Andrew , Salazar Ennaliza
Published: January 2021

Hepatic angiomyolipomas (AML) are rare mesenchymal tumours of which the epithelioid type is a rare type with malignant potential. We report a case of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess. A 46-year-old man presented with a 5-day history of fever with epigastric pain and nausea. On the night of admission, his temperature spiked to 39°C, his blood pressure was 135/79, his heart rate 98, his liver function test revealed albumin 37 g/L, bilirubin 25 μmol/L, ALP 298 U/L, ALT 247 U/L, and AST 344 U/L. The clinical suspicion was hepatobiliary sepsis and intravenous ceftriaxone was commenced. CT of the abdomen showed an ill-defined hypodense focus in segment 4A/8 (4.5 × 3.5 cm) with a minimal fluid component implying a developing abscess or phlegmon. The images were reviewed by a radiologist and showed minimal fluid for percutaneous drainage. MRI of the liver was performed to further characterize the lesion and revealed a solid mass with nodular areas of arterial enhancement and washout, suspicious of neoplasm. Ultrasound-guided liver biopsy of the lesion was performed. Histology showed a histiocyte-rich epithelioid neoplasm consistent with the epithelioid variant of AML. Immunohistochemical staining was positive for human melanoma black 45, melan-A and cluster of differentiation 68. He successfully underwent liver resection of segment 4A/8 after 6 weeks of antibiotics. To our knowledge, this is the first reported case in the literature of primary hepatic epithelioid angiomyolipoma masquerading as liver abscess.
Detection of Epileptic Seizure Using Pretrained Deep Convolutional Neural Network and Transfer Learning
Authors: Nogay Hidir Selcuk , Adeli Hojjat
Published: January 2021

Introduction: The diagnosis of epilepsy takes a certain process, depending entirely on the attending physician. However, the human factor may cause erroneous diagnosis in the analysis of the EEG signal. In the past 2 decades, many advanced signal processing and machine learning methods have been developed for the detection of epileptic seizures. However, many of these methods require large data sets and complex operations. Methods: In this study, an end-to-end machine learning model is presented for detection of epileptic seizure using the pretrained deep two-dimensional convolutional neural network (CNN) and the concept of transfer learning. The EEG signal is converted directly into visual data with a spectrogram and used directly as input data. Results: The authors analyzed the results of the training of the proposed pretrained AlexNet CNN model. Both binary and ternary classifications were performed without any extra procedure such as feature extraction. By performing data set creation from short-term spectrogram graphic images, the authors were able to achieve 100% accuracy for binary classification for epileptic seizure detection and 100% for ternary classification. Discussion/Conclusion: The proposed automatic identification and classification model can help in the early diagnosis of epilepsy, thus providing the opportunity for effective early treatment.
Severe Acute Hemolytic Transfusion Reaction Treated with Ruxolitinib and Plasma Exchange
Authors: Deveci Burak , Saba Rabin , Altunay Husnu , Toptas Tayfur , Kublashvilli George , Karadogan Ihsan
Published: January 2021

Introduction: Acute hemolytic transfusion reaction is a rare but extremely mortal condition. Even small quantities of ABO-incompatible erythrocytes, as much as 50 mL, can lead to fatality. Since there is no successful standard therapy, preventive measures are very important. In this case report, we presented a 29-year-old woman who was transfused with 2 units of AB Rh-positive instead of 0 Rh-positive red blood cells following a cesarean section. As far as we know, this is the first patient in the literature for whom ruxolitinib was used as a part of therapy. Case Report: The patient was referred to our center 22 h after the ABO-mismatched transfusion. On admission, she had severe hemolysis, acute renal failure, and disseminated intravascular coagulation. Massive plasma exchange, hemodialysis, and pulse steroid therapy were commenced. The patient was refractory to first-line therapies. She was intubated on day 2 due to hypoxia, respiratory failure and changes in consciousness. Ruxolitinib, 2 × 10 mg/day, was started on day 3. The patient’s clinical status improved on day 6. Ruxolitinib was withdrawn on day 15, and the patient was discharged without any complications or sequels on day 26. Conclusion: Ruxolitinib may be life-saving in patients with ABO-incompatible transfusion reaction which follows a severe and catastrophic course.
Sveučilišna nastava kao odraz različitih teorijskih pristupa
Authors: Podgorelec Valerija , Stunić Dalila , Mikšić Štefica
Published: January 2021

Uvod: Kombinacijom teorijskih pristupa u nastavi povećava se motivacija stu- denata i kvaliteta odgojno-obrazovnog procesa. Cilj ovog rada bio je ispitati prisutnost teorijskih pristupa s njihovim odrazom na kvalitetu sveučilišne nastave, kreativnost, samoaktualizaciju, usvajanje znanja, vještina i sposobnosti te pri- sutnost (ne)ugodne klime. Metoda: Uporabom anonimnog anketnog upitnika provedeno je istraživanje najčešćih pristupa u nastavi studenata Učiteljskog studija i Studija sestrinstva u Osijeku te studenata Studija sestrinstva u Čakovcu. Rezultati: Rezultati istraživanja pokazali su da je, bez značajne razlike na obje vrste studija, najviše korišten sociocentristički pristup, kod čak 80 % studena- ta. Na Učiteljskom studiju značajnija je zastupljenost pedocentrističkog pristu- pa (Fisherov egzaktni test, P < 0,001), umjetničkog (Fisherov egzaktni test, P = 0,001), emancipacijskog (Fisherov egzaktni test, P = 0,02), kreativnog (Fishe- rov egzaktni test, P < 0,001) u odnosu na studente Studija sestrinstva. Značaj- nija je zastupljenost komponenata sustavnog (Mann Whitney U test, P = 0,01) i kreativnog pristupa (Mann Whitney U test, P = 0,004) u odnosu na studente Studija sestrinstva. Individualni oblik rada (Mann Whitney U test, P = 0,02), i aktivnost u paru (Mann Whitney U test, P = 0,04), značajnije je primijenjen na Učiteljskom studiju nego na Studiju sestrinstva. Motivacija i opuštenost značaj- ne su na studiju Sestrinstva (Fisherov egzaktni test, P = 0,005). Sveučilišna na- stava Učiteljskog studija kreativna je za 30 ispitanika (38,5 %), dok je na Studiju sestrinstva nastava pedocentrična (Fisherov egzaktni test, P = 0,003). Zaključak: Studenti Učiteljskog studija imaju više zastupljenih kreativnih pri- stupa u odnosu na Studij sestrinstva.
Opća informiranost i stavovi medicinskih sestara o metodama prenatalne genetičke dijagnostike
Authors: Stanojević Stella , Čartolovni Anto
Published: January 2021

Uvod: Prenatalna genetička dijagnostika obuhvaća dijagnostičke postupke kojima ispitujemo bolesti ili patološka stanja kod ploda. Možemo ju podijeliti na dvije vrste metoda: invazivnu i neinvazivnu. S obzirom na to da invazivne metode u značajnoj mjeri mogu naštetiti i majci i plodu, posljednjih desetljeća ubrzano se razvijaju neinvazivne metode. One su sigurnije, no unatoč tome, i jedne i druge predstavljaju značajne etičke izazove. Medicinske sestre u mnogočemu mogu pridonijeti razvoju prenatalne dijagnostike putem pružanja informacija roditeljima, upoznavanja roditelja s dijagnostičkom procedurom, suosjećanja s njima, pružanjem podrške u rješavanju etičkih dilema s kojima se roditelji susreću.
Cilj rada bio je ispitati i utvrditi opću informiranost medicinskih sestara o metodama prenatalne genetičke dijagnostike te ispitati stavove medicinskih sestara o njihovoj ulozi u procesu prenatalne dijagnostike.
Metode: Uzorak ispitanika činile su medicinske sestre koje rade u Kliničkom bolničkom centru Sestre milosrdnice i Općoj županijskoj bolnici Našice na Odjelu ginekologije i porodništva. U istraživanju je sudjelovalo 115 ispitanika. Korišten je upitnik koji se sastoji od 29 pitanja.
Rezultati: Ispitanici su pokazali osrednje znanje o prenatalnoj dijagnostici. Smatraju da bi trudnice trebale obavljati neinvazivne testove, da su prenatalne metode pouzdane te da medicinske sestre mogu pomoći u prihvaćanju informacije o anomalijama djeteta. S druge strane, ispitanici se ne slažu s tvrdnjom da bi medicinske sestre trebale davati savjete trudnicama te da su invazivne metode opasne.
Rasprava: Istraživanje ukazuje na potrebu dodatne edukacije medicinskih sestara kako bi mogle djelovati na području prenatalne dijagnostike i biti uključene u genetička savjetovališta.
Zaključak: Razvojem prenatalne genetičke dijagnostike dolazi do pojave novih etičkih dvojbi koje postaju sve veći izazov medicinskim sestrama. Stoga je iznimno važno poticati obrazovanje sestara na području prenatalne genetičke dijagnostike. Uloga medicinskih sestara ne bi se smjela zadržati samo na asistirajućoj ulozi.
Strategies to improve academic motivation among nursing students
Authors: Cilar Leona , Spevan Marija
Published: January 2021

Introduction: Academic motivation of nursing students is a broad concept that has an impact on academic success, education and personal satisfaction. Motivation to study often decreases with years of study, thus it is important to find out effective strategies for motivating nursing students.
Methods: A scoping review was conducted in 2020 to determine the scope and body of literature on strategies for motivating nursing students. A literature search was performed in four international databases (PubMed, Medline, Science-Direct and Google Scholar) using inclusion and exclusion criteria. The literature search and analysis are shown using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.
Results: Out of 560 identified studies, a total of 14 studies were included in the final analysis. Most of the identified studies were quasi-experimental studies (n=8; 57.14 %) exploring the effectiveness of existing strategy. Strategies that showed positive effects in raising nursing student’s academic motivation are gamification, mobile applications, forums, problem-based learning, and other specific strategies.
Discussion: It is evident that new strategies have positive impact on nursing student’s academic motivation. Nevertheless, there is a need for further research and testing before the process of implementing those strategies in specific learning environment.
Conclusion: There is a constant need for education of future nurses. To ensure appropriate nurses’ knowledge and skills, academic motivation is needed.
Periaortic Ventricular Tachycardias in Nonischemic Cardiomyopathy
Authors: Nakajima Ikutaro , Narui Ryohsuke , Aboud Asad A. , Adeola Oluwaseun , McHugh Julia , Holmes Benjamin , Lugo Ricardo , Richardson Travis D. , Montgomery Jay , Shen Sharon , Kanagasundram Arvindh , Michaud Gregory F. , Stevenson William G.
Published: January 2021

Background:

Periaortic fibrotic ventricular tachycardia (VT) substrate is common in nonischemic cardiomyopathy (NICM), often intramural, and difficult to ablate. We sought to better characterize normal and abnormal periaortic voltage map parameters and NICM periaortic VTs.

Methods:

In 15 patients without heart disease, the 5th percentile of endocardial voltage for increasing distance from the aortic valve ring was determined. In 53 consecutive patients with NICM (64±11 years; left ventricular ejection fraction 31±10%) undergoing ablation of recurrent VT, periaortic electrogram voltage and VT characteristics were analyzed.

Results:

In healthy patients, the fifth percentile of the bipolar voltage increased proportional to the distance from the aortic valve ring, from 1.0 mV at 1 cm to 1.5 mV at 1.5 cm; the corresponding unipolar voltage cutoffs were 5.0 and 7.5 mV. A total of 160 VTs were induced in 53 patients with NICM, of which 28 VTs in 20 patients had periaortic origins. Periaortic VTs were associated with similar periaortic bipolar voltage, but lower UVs consistent with intramural fibrosis as an important substrate. Periaortic VTs could be divided into left and right bundle branch block forms with mapping showing right septal and lateral exits. Left bundle branch block VTs were more often acutely abolished with ablation (100% versus 69%;
P
=0.034), but with a 23% incidence of heart block. Greater extent of low voltage was associated with more induced VTs and worse acute outcome.

Conclusions:

Adjusting voltage parameters based on distance from the aortic valve may improve definition of left ventricular outflow tract arrhythmia substrate. Periaortic VTs are common in NICM, often associated with intramural substrate and can be divided into left bundle branch block and right bundle branch block types associated with different ablation outcomes and risks.
Cryoballoon Versus Laserballoon
Authors: Chun Julian K.R. , Bordignon Stefano , Last Jana , Mayer Lukas , Tohoku Shota , Zanchi Simone , Bianchini Lorenzo , Bologna Fabrizio , Nagase Takahiko , Urbanek Lukas , Chen Shaojie , Schmidt Boris
Published: January 2021

Background:

Pulmonary vein isolation (PVI) represents the cornerstone in atrial fibrillation ablation. Cryoballoon and laserballoon catheters have emerged as promising devices but lack randomized comparisons. Therefore, we sought to compare efficacy and safety comparing both balloons in patients with persistent and paroxysmal atrial fibrillation (AF).

Methods:

Symptomatic AF patients (n=200) were prospectively randomized (1:1) to receive either cryoballoon or laserballoon PVI (cryoballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF versus laserballoon: n=100: 50 paroxysmal atrial fibrillation + 50 persistent AF). All antiarrhythmic drugs were stopped after ablation. Follow-up included 3-day Holter-ECG recordings and office visits at 3, 6, and 12 months. Primary efficacy end point was defined as freedom from atrial tachyarrhythmia between 90 and 365 days after a single ablation. Secondary end points included procedural parameters and periprocedural complications.

Results:

Patient baseline parameters were not different between both groups. In all (n=200) complete PVI was obtained and the entire follow-up accomplished. Balloon only PVI was obtained in 98% (cryoballoon) versus 95% (laserballoon) requiring focal touch-up in 2 and 5 patients, respectively. Procedure but not fluoroscopy time was significantly shorter in the cryoballoon group (50.9±21.0 versus 96.0±20.4 minutes;
P
<0.0001 and 7.4±4.4 versus 8.4±3.2 minutes,
P
=0.083). Overall, the primary end point of no atrial tachyarrhythmia recurrence was met in 79% (cryoballoon: 80.0% versus laserballoon: 78.0%,
P
=ns). No death, atrio-esophageal fistula, tamponade, or vascular laceration requiring surgery occurred. In the cryoballoon group, 8 transient but no persistent phrenic nerve palsy were noted compared with 2 persistent phrenic nerve palsy and one transient ischemic attack in the laserballoon group.

Conclusions:

Both balloon technologies represent highly effective and safe tools for PVI resulting in similar favorable rhythm outcome after 12 months. Use of the cryoballoon is associated with significantly shorter procedure but not fluoroscopy time.
Transition From an Open to Closed Staffing Model in the Cardiac Intensive Care Unit Improves Clinical Outcomes
Authors: Miller P. Elliott , Chouairi Fouad , Thomas Alexander , Kunitomo Yukiko , Aslam Faisal , Canavan Maureen E. , Murphy Christa , Daggula Krishna , Metkus Thomas , Vallabhajosyula Saraschandra , Carnicelli Anthony , Katz Jason N. , Desai Nihar R. , Ahmad Tariq , Velazquez Eric J. , Brennan Joseph
Published: January 2021

Background

Several studies have shown improved outcomes in closed compared with open medical and surgical intensive care units. However, very little is known about the ideal organizational structure in the modern cardiac intensive care unit (CICU).

Methods and Results

We retrospectively reviewed consecutive unique admissions (n=3996) to our tertiary care CICU from September 2013 to October 2017. The aim of our study was to assess for differences in clinical outcomes between an open compared with a closed CICU. We used multivariable logistic regression adjusting for demographics, comorbidities, and severity of illness. The primary outcome was in‐hospital mortality. We identified 2226 patients in the open unit and 1770 in the closed CICU. The unadjusted in‐hospital mortality in the open compared with closed unit was 9.6% and 8.9%, respectively (
P
=0.42). After multivariable adjustment, admission to the closed unit was associated with a lower in‐hospital mortality (odds ratio [OR], 0.69; 95% CI: 0.53–0.90,
P
=0.007) and CICU mortality (OR, 0.70; 95% CI, 0.52–0.94,
P
=0.02). In subgroup analysis, admissions for cardiac arrest (OR, 0.42; 95% CI, 0.20–0.88,
P
=0.02) and respiratory insufficiency (OR, 0.43; 95% CI, 0.22–0.82,
P
=0.01) were also associated with a lower in‐hospital mortality in the closed unit. We did not find a difference in CICU length of stay or total hospital charges (
P
>0.05).

Conclusions

We found an association between lower in‐hospital and CICU mortality after the transition to a closed CICU. These results may help guide the ongoing redesign in other tertiary care CICUs.
Non–Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Prior Gastrointestinal Bleeding
Authors: Kwon Soonil , Lee So-Ryoung , Choi Eue-Keun , Lee Euijae , Jung Jin-Hyung , Han Kyung-Do , Cha Myung-Jin , Oh Seil , Lip Gregory Y.H.
Published: January 2021

Background and Purpose:

Limited data support the benefits of non–vitamin K oral anticoagulants (NOACs) among atrial fibrillation patients with prior gastrointestinal bleeding (GIB). We aimed to evaluate the effectiveness and safety of NOACs compared with those of warfarin among atrial fibrillation patients with prior GIB.

Methods:

Oral anticoagulant–naive individuals with atrial fibrillation and prior GIB between January 2010 and April 2018 were identified from the Korean claims database. NOAC users were compared with warfarin users by balancing covariates using the inverse probability of treatment weighting method. The primary outcomes were ischemic stroke, major bleeding, and the composite outcome (combined ischemic stroke and major bleeding). Fatal events from each outcome were evaluated as secondary outcomes.

Results:

A total of 42 048 patients were included (24 781 in the NOAC group and 17 267 in the warfarin group). The mean time from prior GIB to the initiation of oral anticoagulant was 3.1±2.6 years. After inverse probability of treatment weighting, baseline characteristics were balanced between the two groups (mean age, 72 years; men, 56.8%; and mean CHA
2
DS
2
-VASc score, 3.7). Lower risks of ischemic stroke, major bleeding, and the composite outcome were associated with NOAC use than with warfarin use (weighted hazard ratio, 0.608 [95% CI, 0.543–0.680]; hazard ratio, 0.731 [95% CI, 0.642–0.832]; and hazard ratio, 0.661 [95% CI, 0.606–0.721], respectively). For all secondary outcomes, NOACs showed greater risk reductions compared with warfarin.

Conclusions:

NOACs were associated with lower risks of ischemic stroke and major bleeding than warfarin among atrial fibrillation patients with prior GIB.
Unique Subtype of Microglia in Degenerative Thalamus After Cortical Stroke
Authors: Cao Zhijuan , Harvey Sean S. , Chiang Terrance , Foltz Aulden G. , Lee Alex G. , Cheng Michelle Y. , Steinberg Gary K.
Published: January 2021

Background and Purpose:

Stroke disrupts neuronal functions in both local and remotely connected regions, leading to network-wide deficits that can hinder recovery. The thalamus is particularly affected, with progressive development of neurodegeneration accompanied by inflammatory responses. However, the complexity of the involved inflammatory responses is poorly understood. Herein we investigated the spatiotemporal changes in the secondary degenerative thalamus after cortical stroke, using targeted transcriptome approach in conjunction with histology and flow cytometry.

Methods:

Cortical ischemic stroke was generated by permanent occlusion of the left middle cerebral artery in male C57BL6J mice. Neurodegeneration, neuroinflammatory responses, and microglial activation were examined in naive and stroke mice at from poststroke days (PD) 1 to 84, in both ipsilesional somatosensory cortex and ipsilesional thalamus. NanoString neuropathology panel (780 genes) was used to examine transcriptome changes at PD7 and PD28. Fluorescence activated cell sorting was used to collect CD11c
+
microglia from ipsilesional thalamus, and gene expressions were validated by quantitative real-time polymerase chain reaction.

Results:

Neurodegeneration in the thalamus was detected at PD7 and progressively worsened by PD28. This was accompanied by rapid microglial activation detected as early as PD1, which preceded the neurodegenerative changes. Transcriptome analysis showed higher number of differentially expressed genes in ipsilesional thalamus at PD28. Notably, neuroinflammation was the top activated pathway, and microglia was the most enriched cell type.
Itgax
(CD11c) was the most significantly increased gene, and its expression was highly detected in microglia. Flow-sorted CD11c
+
microglia from degenerative thalamus indicated molecular signatures similar to neurodegenerative disease–associated microglia; these included downregulated Tmem119 and CX3CR1 and upregulated ApoE, Axl, LpL, CSF1, and Cst7.

Conclusions:

Our findings demonstrate the dynamic changes of microglia after stroke and highlight the importance of investigating stroke network-wide deficits. Importantly, we report the existence of a unique subtype of microglia (CD11c
+
) with neurodegenerative disease–associated microglia features in the degenerative thalamus after stroke.
Steady-State Visually Evoked Potentials and Feature-based Attention: Preregistered Null Results and a Focused Review of Methodological Considerations
Authors: Adam Kirsten C. S. , Chang Lillian , Rangan Nicole , Serences John T.
Published: January 2021

Feature-based attention is the ability to selectively attend to a particular feature (e.g., attend to red but not green items while looking for the ketchup bottle in your refrigerator), and steady-state visually evoked potentials (SSVEPs) measured from the human EEG signal have been used to track the neural deployment of feature-based attention. Although many published studies suggest that we can use trial-by-trial cues to enhance relevant feature information (i.e., greater SSVEP response to the cued color), there is ongoing debate about whether participants may likewise use trial-by-trial cues to voluntarily ignore a particular feature. Here, we report the results of a preregistered study in which participants either were cued to attend or to ignore a color. Counter to prior work, we found no attention-related modulation of the SSVEP response in either cue condition. However, positive control analyses revealed that participants paid some degree of attention to the cued color (i.e., we observed a greater P300 component to targets in the attended vs. the unattended color). In light of these unexpected null results, we conducted a focused review of methodological considerations for studies of feature-based attention using SSVEPs. In the review, we quantify potentially important stimulus parameters that have been used in the past (e.g., stimulation frequency, trial counts) and we discuss the potential importance of these and other task factors (e.g., feature-based priming) for SSVEP studies.
Typically Efficient Lipreading without Motor Simulation
Authors: Vannuscorps Gilles , Andres Michael , Carneiro Sarah Pereira , Rombaux Elise , Caramazza Alfonso
Published: January 2021

All it takes is a face-to-face conversation in a noisy environment to realize that viewing a speaker's lip movements contributes to speech comprehension. What are the processes underlying the perception and interpretation of visual speech? Brain areas that control speech production are also recruited during lipreading. This finding raises the possibility that lipreading may be supported, at least to some extent, by a covert unconscious imitation of the observed speech movements in the observer's own speech motor system—a motor simulation. However, whether, and if so to what extent, motor simulation contributes to visual speech interpretation remains unclear. In two experiments, we found that several participants with congenital facial paralysis were as good at lipreading as the control population and performed these tasks in a way that is qualitatively similar to the controls despite severely reduced or even completely absent lip motor representations. Although it remains an open question whether this conclusion generalizes to other experimental conditions and to typically developed participants, these findings considerably narrow the space of hypothesis for a role of motor simulation in lipreading. Beyond its theoretical significance in the field of speech perception, this finding also calls for a re-examination of the more general hypothesis that motor simulation underlies action perception and interpretation developed in the frameworks of motor simulation and mirror neuron hypotheses.
Atypical core-periphery brain dynamics in autism
Authors: Roy Dipanjan , Uddin Lucina Q.
Published: January 2021

The intrinsic function of the human brain is dynamic, giving rise to numerous behavioral subtypes that fluctuate distinctively at multiple timescales. One of the key dynamical processes that takes place in the brain is the interaction between core-periphery brain regions, which undergoes constant fluctuations associated with developmental time frames. Core-periphery dynamical changes associated with macroscale brain network dynamics span multiple timescales and may lead to atypical behavior and clinical symptoms. For example, recent evidence suggests that brain regions with shorter intrinsic timescales are located at the periphery of brain networks (e.g., sensorimotor hand, face areas) and are implicated in perception and movement. On the contrary, brain regions with longer timescales are core hub regions. These hubs are important for regulating interactions between the brain and the body during self-related cognition and emotion. In this review, we summarize a large body of converging evidence derived from time-resolved fMRI studies in autism to characterize atypical core-periphery brain dynamics and how they relate to core and contextual sensory and cognitive profiles.