bluuebunny/crossref_metadata_2025 huggingface dataset:
Values of Intelligent Alarm System Under Photoelectric Sensor Networks
Authors: Sun Shousheng , Li Shaoping
Published: March 2021

This work was aimed to construct the intelligent alarm system with multiple photoelectric sensors as the core in this study. The system is first designed the circuit with microprocessor as the core, and then, there was a principle analysis of photoelectric measurement in the height, speed, and temperature to design a network mode of photoelectric sensor, circuits to control security doors and manage password, substation, and the monitoring center. The fusion approach based on deep learning is designed for the data collected by security alarm system. The 1-dimensional (1-D) representation of 2-dimensional (2-D) data is also designed according to the most of key information represented by the eigenvalue set of singular value decomposition of data matrix. The original 1-D signal sequence and the characteristics after 1-D were for data fusion, which is applied to identify, thus improving the accuracy of the alarm system and reducing its labor cost. During the experiment, the data fusion method proposed in this study is compared with naive bayes (NB) method and the weighted majority voting (WMV) method. The random data sets are generated with the help of a Gaussian function. The extreme learning machine (ELM) neural network classifier and k-nearest neighbors (KNN) classifier are carried in the alarm system designed in this study, respectively. The simulation analysis shows that WMV can obtain better performance of information classification compared with NB and data fusion methods, so the accuracy of classification is improved obviously. Besides, the fusion results accuracy of WMV is greatly higher than the other two.
Photoelectric Detection System and Machine Learning Recognition Method of Its Detection Images
Authors: Liao Ding-An
Published: March 2021

In the photoelectric detection system, the photoelectric detector can convert the optical signal to be measured into a current signal, and the current amplifier transforms the current signal output by the detector into a voltage signal for amplification. In this study, the photo-multiplier tube (PMT) is selected as the photoelectric detector. Compared with other photoelectric detectors, it can obtain higher internal gain, higher sensitivity, and better response performance. The current amplifier is prepared by pre-amplifier and voltage amplifier. In order to capture photoelectric signals well, a large-format scanning system is set up to design each component module, control module, and host computer module of the system. Besides, a machine learning-based algorithm is proposed, namely semi-supervised manifold image recognition algorithm, which is used for identify photoelectric detection images. In the test process, the printed circuit board (PCB) and sapphire material are firstly used as the substrate of the current amplifier, and their influences in the circuit are compared. The peak value of the output noise of each substrate circuit is around 2.8 mV when the input of the current amplifier is short-circuited. Then, the signal gain and signal bandwidth of the photoelectric detection system remain stable when there is no optical signal input. During the process of changing the system signal gain ratio, the noise output of the system is the lowest when the voltage of PMT is 0.50 V and the current amplifier gain is set to 2.2 × 105 V/A. The proposed recognition algorithm can identify different types of targets well. After the image is projected into a two-dimensional space by the algorithm, the distance between classes increases, and the targets in the class promote aggregation, thereby enhancing the identify-ability between samples.
Neighborhoods, Activity Spaces, and the Span of Adolescent Exposures
Authors: Browning Christopher R. , Calder Catherine A. , Boettner Bethany , Tarrence Jake , Khan Kori , Soller Brian , Ford Jodi L.
Published: March 2021

Since the inception of urban sociology, the “neighborhood” has served as the dominant context to capture developmentally significant youth experiences beyond the home. Yet no large-scale study has examined patterns of exposure to the most commonly used operationalization of neighborhood—the census tract—among urban youth. Using smartphone GPS data from the Adolescent Health and Development in Context study ( N = 1,405), we estimate the amount of time youth spend in residential neighborhoods and consider explanations for variation in neighborhood exposure. On average, youth (ages 11 to 17) spend 5.7 percent of their waking-time in their neighborhood but not at home, 60 percent at home, and 34.3 percent outside their neighborhood. Multilevel negative binomial regression models indicate that residence in economically disadvantaged neighborhoods is associated with less time in one’s neighborhood. Higher levels of local violence and the absence of a neighborhood school are negatively associated with time in-neighborhood and mediate the concentrated disadvantage effect. Fractional multinomial logit models indicate that higher violence is linked with increased time at home, and school absence is associated with increased outside-neighborhood time. Theoretical development and empirical research on neighborhood effects should incorporate findings on the extent and nature of neighborhood and broader activity space exposures among urban youth.
Spin the Abstracts of Systematic Reviews and Meta-Analyses Regarding the Treatment of Ménière’s Disease
Authors: Heigle Benjamin , Kee Micah , Ottwell Ryan , Arthur Wade , Brame Lacy , Wright Drew N. , Hartwell Micah , Khojasteh Jam , Vassar Matt
Published: March 2021

Objectives:

To identify, quantify, and characterize the presence of spin—specific strategies leading to misrepresentation of study results—in the abstracts of systematic reviews and meta-analyses of Ménière’s disease treatment.

Methods:

Using a cross-sectional design, we searched MEDLINE and Embase on May 28, 2020, for systematic reviews and meta-analyses focused on Ménière’s disease treatment. Returned searches were screened, and data were extracted in a masked, duplicate fashion.

Results:

Our sample included 36 systematic reviews and meta-analyses. Of the 36 included studies, 22 (61.1%) abstracts contained spin while 14 (38.9%) did not. The most common spin types were selective reporting of benefit (10/36, 27.8%) or harm (8/36, 22.2%). Other types of spin occurred when findings were extrapolated to the global improvement of the disease (5/36, 13.9%), beneficial effects were reported with high risk of bias in primary studies (3/36, 8.3%), and when beneficial effects were extrapolated to an entire class of interventions (1/36, 2.8%). No instances of other spin types occurred. Abstracts containing spin were substantively associated with studies of critically low methodological quality compared with studies with low and moderate quality. No studies had a methodological rating of high quality. No associations were observed between spin and intervention types, journal recommendation of adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or funding. We found a negative correlation ( r = −.31) between abstract word limit and presence of spin.

Conclusions:

Our study highlights that spin in the abstracts of systematic reviews of Ménière’s disease is common, and it further enhances the discussion surrounding spin in abstracts of scientific research. Spin in an abstract does not discredit a study’s findings; however, its occurrence should be eliminated.
COVID-19 Economic Response and Recovery: A Rapid Scoping Review
Authors: Mawani Farah N. , Gunn Virginia , O’Campo Patricia , Anagnostou Michelle , Muntaner Carles , Wanigaratne Susitha , Perri Melissa , Ziegler Carolyn , An Angie
Published: March 2021

This rapid scoping review of existing evidence and research gaps addressed the following question: what research evidence exists and what are the research gaps at global, regional, and national levels on interventions to protect jobs, small- and medium-sized enterprises, and formal/informal sector workers in socioeconomic response to the coronavirus disease 2019 (COVID-19) pandemic? The results are based on 79 publications deemed eligible for inclusion after the screening and prioritizing of 1,658 records. The findings are organized according to the 3 main categories of socioeconomic interventions—protecting jobs, enterprises, and workers—although the 3 are intertwined. Most results were derived from global-level gray literature with recommendations for interventions and implicit links to the sustainable development goals. Based on research gaps uncovered in the review, future implementation science research needs to focus on designing, implementing, evaluating, and scaling: effective evidence-based socioeconomic interventions; equity-focused, redistributive, and transformative interventions; comprehensive packages of complementary interventions; interventions to upend root causes of systemic social inequities; collaborative and participatory approaches; interventions that integrate environmental sustainability; and city-level interventions. Failing to consider the environmental dimensions of economic recovery is shortsighted and will ultimately exacerbate social inequities and poverty and undermine economic stability in the long term.
From ‘Defending Sovereignty’ to ‘Fighting Corruption’: The Political Place of Law in Zimbabwe After November 2017
Authors: Verheul Susanne
Published: March 2021

In this article, I examine the shifting language of debates over law and justice in Zimbabwe in the run-up to, and following, the November 2017 coup. I argue that the rhetoric Zimbabwe African National Union–Patriotic Front (ZANU–PF) drew upon to secure its authority and negotiate legitimacy through law, shifted from a focus of ‘sovereignty’ and ‘protection’, to one of battling ‘corruption’ and ‘criminality’. At the same time, there remained a consistency in the manner that the legal system was used to target a select part of the country’s population, those opposed to ZANU–PF and its vision for the future.
Participatory Sense-Making in Therapeutic Interventions
Authors: García Enara
Published: March 2021

Given the holistic and phenomenological character of Gestalt therapy, the body has a primordial role in enhancing the here and now experience of the client. In order to examine the role of embodiment in therapeutic interventions more closely, this article applies Merleau-Ponty’s phenomenology of corporeality and its development in the embodied and enactive cognitive sciences to the study of therapeutic interventions. Taking Merleau-Ponty’s theory of Fundierung as starting point, the article describes the enactive idea of sense-making as the movement from prereflective to reflective consciousness, a movement that is driven by the primordial valence of affectivity and e-motion. As a process of participatory sense-making, mutual regulation between therapist and client can happen at different levels of consciousness. Here, in addition to the well-known declarative (reflective level) and resonance-based (prereflective level) interventions, I will focus on interventions that operate between levels which constitute a genuine modality of embodied therapeutic interventions. I introduce the notion of cross-salience as the prefigurative participation of the therapist’s reflective consciousness in the client’s sense-making process. I will illustrate this idea by the analysis of an intervention extracted from Fritz Perls’ work Gestalt Therapy Verbatim.
Objective Conditions Count, Political Beliefs Decide: The Conditional Effects of Self-Interest and Ideology on Redistribution Preferences
Authors: Armingeon Klaus , Weisstanner David
Published: March 2021

How can we explain variation in demand for redistribution among cross-pressured voters? We argue that redistributive preferences reflect an interaction between material self-interest and political ideology. The self-interest argument predicts growing opposition to redistribution as income increases, while the argument of ideologically driven preferences suggests that left-leaning citizens are more supportive of redistribution than right-leaning citizens. Focusing on cross-pressured voters, we expect that the difference in redistribution preferences between left- and right-leaning citizens is smaller at the bottom of the income hierarchy than at the top. Among the group of left-leaning citizens, the role of material self-interest is expected to be smaller than among right-leaning citizens. We provide evidence in line with our argument analysing data from the European Social Survey in 25 European democracies between 2008 and 2018.
Experiences of Compassion in Adults With a Diagnosis of Borderline Personality Disorder: An Interpretative Phenomenological Analysis
Authors: Fagan Stephanie , Hodge Suzanne , Morris Charlotte
Published: March 2021

The study explored experiences of compassion in adults with a diagnosis of Borderline Personality Disorder (BPD) to further the development of the construct of compassion in relation to BPD. Interpretative Phenomenological Analysis was used to develop themes from the narratives of six adults with a diagnosis of BPD. Five themes emerged: Emotional Connection to Suffering, Empathic Understanding, Prioritisation of Needs, A Model of Genuine Compassion and Developing Acceptance and Worth. Participants described the role of compassion in their difficulties, including the adverse impact of experiences of incompassion upon their sense of self. The themes were integrated into a model that highlighted a process of recovery through therapeutic encounters with others in which genuine compassion was modelled. In addition, barriers to compassion and factors facilitating the development of compassion emerged from the analysis and have implications for clinical practice.
Laboratory investigation of permeability property of natural gravels with different particle sizes under different laying conditions
Authors: Li Yongye , Song Xiaoteng , Pang Yaqi , Yang Xiaoni , Zhang Xuelan , Yao Liyue , Sun Xihuan
Published: March 2021

The seepage properties of natural gravel are one of the problems to be considered in seepage project designs. In this paper, the seepage properties of the natural gravel with particle sizes of 5, 20 and 60 mm were investigated under different laying conditions. The effect of the particle size, laying depth, bulk density and pressurized head on the seepage properties of the natural gravel was analyzed by using the combined methods of theoretical analysis with physical model test. The results showed that the seepage flow in the natural gravel was non-laminar flow in the test conditions described in this paper. Meanwhile, the relationship between particle size, laying depth, bulk density, pressurized heads and seepage property was established. The seepage discharge increased with the increase of the pressurized head and particle size, and decreased with the increasing of laying depth and bulk density. The critical laying depth and bulk density can be obtained when the seepage discharge becomes zero. The empirical formula of the seepage discharge of natural gravel with different particle sizes, laying depths, bulk densities and pressurized heads was obtained with the method of nonlinear regression, which can be expressed as: [Formula: see text]. The empirical formula was experimentally validated. The maximum relative error did not exceed 6.73%, proving that the empirical formula of the seepage discharge of natural gravel was rational. The results can provide an important reference to further studying the seepage properties of macropore media, and form a theoretical basis for applying the natural gravel in the seepage projects.
Liminality in Latife Tekin’s Berji Kristin: Tales from the Garbage Hills
Authors: Kaya Hilal
Published: March 2021

The concept of liminality, which is primarily an anthropological term, is not new, but in fact it is a neglected area in Turkish literary and cultural studies. The concept of liminality and its potential to open avenues for future studies remains under-researched. As one of the first steps to fill this gap, the anthropological term liminality is used to analyse a literary text as it pertains to the narration of migrant experience, living in between the rural and the urban, and the use of magical realism in Latife Tekin’s Berji Kristin: Tales from the Garbage Hills (1984). Tekin’s novel is presented as a test case to show the applicability of liminality to the field of literary and cultural studies. Reading Tekin’s Berji Kristin through the lens of liminality reveals how it can be used to understand Tekin’s interest in the problems of liminal communities and her concern for the environment.
Facial Nerve Schwannoma Extending to Jugular Foramen: A Case Report
Authors: Yan Jiangyu , Pan Fangfang , Zhen Mengmeng , Ren Yuan , Hao Wenjuan , Yin Min , Wang Kai
Published: March 2021

Facial nerve schwannoma (FNS) is a benign, slow-growing schwannoma that originates from Schwann cells. Facial nerve schwannoma is the most common tumor of the facial nerve but rare and only accounts for 0.15% to 0.8% of intracranial neurinomas. It may be manifested as asymmetric hearing loss, facial palsy, and hemifacial spasm. A 56-year-old woman was transferred to our department, because of pain behind the right ear and spasm of the right lateral muscle for more than 2 years and pulsatile tinnitus for half a year. Based on the preoperative medical history, physical signs, and auxiliary examination, it was diagnosed with jugular foramen (JF) space-occupying lesion. We removed the tumor through the infratemporal fossa type A approach and found that the tumor originated from the facial nerve. After the tumor resection, sural nerve transplantation was performed. The patient demonstrated postoperative facial palsy (House-Brackman grade VI) and was smoothly discharged after good recovery. Facial nerve schwannoma rarely invades the JF, and the most common tumor in the JF is the glomus jugular tumor, followed by the posterior cranial schwannoma. They have common symptoms, making it difficult to obtain a correct diagnosis. Clinical data, medical history, and auxiliary examinations should be carefully analyzed to avoid misdiagnosis or mistreatment. Infratemporal fossa type A approach is an effective method for treating FNS of JF.
Outcomes following coronary artery bypass surgery in diabetic treatment sub-groups. A propensity matched analysis of >7000 patients over 18 years
Authors: Haqzad Yama , Hobkirk James , Ariyaratnam Priyadharshanan , Chaudhry Mubarak , Carroll Sean , Loubani Mahmoud
Published: March 2021

Background

European System for Cardiac Operative Risk Evaluation II incorporates insulin-controlled diabetes whilst omitting tablet-controlled diabetes. Differences in adverse clinical outcomes following coronary artery bypass graft between these groups are poorly established. Therefore, a propensity matched comparison of short and longer term mortality and morbidity in insulin-controlled diabetes, tablet-controlled diabetes and non-diabetic patients was undertaken.

Methods

Isolated first-time coronary artery bypass graft surgeries between April 1999 and April 2017 were propensity score matched by pre- and intra-operative variables.

Results

8241 patients; 23.5% diabetics and 76.5% non-diabetics. The groups’ demographical and clinical characteristics were comparable after matching. Insulin-controlled diabetes patients had significantly higher in-hospital mortality (3.8% vs. 1.7%, p < 0.05), multisystem failure (2.6% vs. 1.8%, p < 0.05), sternal wound infections requiring debridement (3.6% vs. 1.3%, p < 0.05), respiratory complications (25.6% vs. 21.9%, p < 0.05), new dialysis (4.7% vs. 0.9%, p < 0.05) and longer hospital stays (13.5 ± 13.3 vs. 10.6 ± 8.0, p < 0.05) compared to non-diabetic patients. Tablet-controlled diabetes patients had significantly higher strokes (2.9% vs. 1.2, p < 0.05), superficial sternal wound infections (6.7% vs. 5.4%, p < 0.05), respiratory complications (25.7% vs. 22.7%, p < 0.05), new dialysis (1.7% vs. 0.6%, p < 0.05), post-operative atrial fibrillation (37.1% vs. 33.9%, p < 0.05) and readmission with myocardial infarction (22.4% vs. 19.6%, p < 0.05) compared to non-diabetic patients.

Conclusion

Diabetic treatment sub-groups are an independent risk factor for sternal wound infection, new dialysis requirement, multisystem failure and readmission with myocardial infarction after isolated first coronary artery bypass graft surgery. The findings suggest the need for better risk stratification of diabetic groups prior to cardiac surgery and for improved cardiovascular risk management post-surgery in tablet-controlled diabetes patients.
Global proteomic analysis of extracellular matrix in mouse and human brain highlights relevance to cerebrovascular disease
Authors: Pokhilko Alexandra , Brezzo Gaia , Handunnetthi Lahiru , Heilig Raphael , Lennon Rachel , Smith Colin , Allan Stuart M , Granata Alessandra , Sinha Sanjay , Wang Tao , Markus Hugh S , Naba Alexandra , Fischer Roman , Van Agtmael Tom , Horsburgh Karen , Cader M Zameel
Published: March 2021

The extracellular matrix (ECM) is a key interface between the cerebrovasculature and adjacent brain tissues. Deregulation of the ECM contributes to a broad range of neurological disorders. However, despite this importance, our understanding of the ECM composition remains very limited mainly due to difficulties in its isolation. To address this, we developed an approach to extract the cerebrovascular ECM from mouse and human post-mortem normal brain tissues. We then used mass spectrometry with off-line high-pH reversed-phase fractionation to increase the protein detection. This identified more than 1000 proteins in the ECM-enriched fraction, with > 66% of the proteins being common between the species. We report 147 core ECM proteins of the human brain vascular matrisome, including collagens, laminins, fibronectin and nidogens. We next used network analysis to identify the connection between the brain ECM proteins and cerebrovascular diseases. We found that genes related to cerebrovascular diseases, such as COL4A1, COL4A2, VCAN and APOE were significantly enriched in the cerebrovascular ECM network. This provides unique mechanistic insight into cerebrovascular disease and potential drug targets. Overall, we provide a powerful resource to study the functions of brain ECM and highlight a specific role for brain vascular ECM in cerebral vascular disease.
Evaluation of Strategies to Mitigate Culvert-Involved Crashes
Authors: Chawla Hitesh , Megat-Johari Megat-Usamah , Savolainen Peter T. , Day Christopher M.
Published: March 2021

The objectives of this study were to assess the in-service safety performance of roadside culverts and evaluate the potential impacts of installing various safety treatments to mitigate the severity of culvert-involved crashes. Such crashes were identified using standard fields on police crash report forms, as well as through a review of pertinent keywords from the narrative section of these forms. These crashes were then linked to the nearest cross-drainage culvert, which was associated with the nearest road segment. A negative binomial regression model was then estimated to discern how the risk of culvert-involved crashes varied as a function of annual average daily traffic, speed limit, number of travel lanes, and culvert size and offset. The second stage of the analysis involved the use of the Roadside Safety Analysis Program to estimate the expected crash costs associated with various design contexts. A series of scenarios were evaluated, culminating in guidance as to the most cost-effective treatments for different combinations of roadway geometric and traffic characteristics. The results of this study provide an empirical model that can be used to predict the risk of culvert-involved crashes under various scenarios. The findings also suggest that the installation of safety grates on culvert openings provides a promising alternative for most of the cases where the culvert is located within the clear zone. In general, a guardrail is recommended when adverse conditions are present or when other treatments are not feasible at a specific location.
Approach to Quantify the Impact of Disruptions on Traffic Conditions using Dynamic Weighted Resilience Metrics of Transport Networks
Authors: Henry Elise , Furno Angelo , Faouzi Nour-Eddin El
Published: March 2021

Transport networks are essential for societies. Their proper operation has to be preserved to face any perturbation or disruption. It is therefore of paramount importance that the modeling and quantification of the resilience of such networks are addressed to ensure an acceptable level of service even in the presence of disruptions. The paper aims at characterizing network resilience through weighted degree centrality. To do so, a real dataset issued from probe vehicle data is used to weight the graph by the traffic load. In particular, a set of disrupted situations retrieved from the study dataset is analyzed to quantify the impact on network operations. Results demonstrate the ability of the proposed metrics to capture traffic dynamics as well as their utility for quantifying the resilience of the network. The proposed methodology combines different metrics from the complex networks theory (i.e., heterogeneity, density, and symmetry) computed on temporal and weighted graphs. Time-varying traffic conditions and disruptions are analyzed by providing relevant insights on the network states via three-dimensional maps.
Effect of Price and Time on Private and Shared Transportation Network Company Trips
Authors: Middleton Scott R. , Schroeckenthaler Kyle A. , Gopalakrishna Deepak , Greenberg Allen
Published: March 2021

Transportation network companies (TNCs) offer two types of service: private-party ridehailing and shared ridehailing. Policymakers have an interest in encouraging shared over private ridehailing to promote more efficient use of the transportation network. While transportation researchers have analyzed ridehailing behavior before, there is limited literature describing the effect of price and time on a rider’s choice between private-party and shared ridehailing. This paper fills this gap by analyzing revealed preferences for private-party and shared ridehailing trips in 15 American cities coupled with a survey of 4,365 users of a large TNC that includes stated preference questions focused on various alternative options for their most recent trip choice. This study finds that an increase in the relative price difference of $1 per mile increases an individual’s probability of sharing by over 8%, while a decrease in the relative travel time difference of 1 min per mile increases the probability of sharing by over 33%. The survey results also show that that a sizable proportion of private-party TNC trips (approximately 35%) will be difficult or even impossible to convert to shared rides through a price-based incentive. Market segmentation analysis reveals user and trip types where price- and time-based incentives have a relatively greater effect on the choice between private and shared rides. Finally, heterogeneity in user time versus money trade-offs suggests new product possibilities that would increase TNC sharing.
Between solid and liquid experience in a socialist port: Gdańsk shipyard workers at the turn of the 1980s
Authors: Perkowski Piotr
Published: March 2021

This article analyzes the Gdańsk shipyard workers, a core group that launched the August 1980 strike. It approaches the phenomenon against the backdrop of the socialist port, regardless of the complexities of the political process. Changing globalizing markets, domestic Polish policies towards socialist ports, and the reactions of shipyard workers to local and global changes all played a central role in defining the experience of work at Gdańsk Shipyard. Its workers were under pressure not only from local conditions, but also, like their foreign counterparts, faced a severe and prolonged crisis in global shipbuilding, evident in reduced demand for new vessels, rapidly evolving regulations and technology, layoffs and fierce competition. As industrial workers, they had strong local connections. As port workers, they were sea-oriented and characterized by occupational mobility. This dual nature – between solidity and liquidity – helped foster cross-sectional unity within Poland and internationally, but also caused dissatisfaction. The article continues by explaining how shipyard workers adapted in the face of new challenges.
Weaving Healthy Families Program: Promoting Resilience While Reducing Violence and Substance Use
Authors: McKinley Catherine E. , Theall Katherine P.
Published: March 2021

Purpose:

We examine pilot results for the culturally adapted Weaving Healthy Families (WHF) program to promote resilience and wellness while preventing substance abuse and violence among Native American (NA) families.

Methods:

Results were drawn from paired sample t tests and analyses of variance (ANOVA) with a convenience sample of 24 adults and adolescents from eight NA families (pretest, posttest, and, where available, 6-month postintervention).

Results:

Along with substance abuse reduction and prevention, t test results indicated reductions in (a) adult depressive symptoms and improvements in adult conflict resolution and health behaviors; (b) adolescent wellness; and (c) adult and adolescent resilience, communal mastery, social support, and sugar-sweetened beverage consumption. ANOVA tests revealed reductions in adult psychological and physical violence and improvements in adult and adolescent family resilience, family environment, and emotional regulation.

Conclusions:

Results reveal promising preliminary results for the WHF program to promote resilience and thriving while reducing risk for substance abuse and violence in NA families.
Sexual and Reproductive Health Information and Experiences Among Syrian Refugee Adolescent Girls in Lebanon
Authors: El Ayoubi L’Emira Lama , Abdulrahim Sawsan , Sieverding Maia
Published: March 2021

Providing adolescent girls with sexual and reproductive health (SRH) information protects them from risks and improves their well-being. This qualitative study, conducted in Lebanon, examined Syrian refugee adolescent girls’ access to SRH information about and experiences with puberty and menarche, sex, marriage, contraception, and pregnancy. We gathered data through three focus group discussions (FGDs) with unmarried adolescent girls, 11 in-depth interviews with early-married adolescents, and two FGDs with mothers. Our findings highlighted that adolescent participants received inadequate SRH information shortly before or at the time of menarche and sexual initiation, resulting in experiences characterized by anxiety and fear. They also revealed discordance between girls’ views of mothers as a preferred source of information and mothers’ reluctance to communicate with their daughters about SRH. We advance that mothers are important entry points for future interventions in this refugee population and offer recommendations aimed to improve adolescent girls’ SRH and rights.
The Intersection of Problems, Policy, and Politics: The Adoption of an HPV Vaccine School-Entry Requirement in Puerto Rico
Authors: Vázquez-Otero Coralia , Daley Ellen M. , Vamos Cheryl A. , Romero-Daza Nancy , Beckstead Jason , Martinez Tyson Dinorah
Published: March 2021

Persistent human papillomavirus (HPV) infections can cause cancer (e.g., cervical/vaginal/penile/anal/oropharyngeal). The HPV vaccine prevents cancer, yet U.S. vaccination rates remain low. We explored sociopolitical factors in the adoption of Puerto Rico’s HPV vaccine school-entry requirement. Multiple streams framework explains how the intersection of problems, policy, and politics streams influence policy adoption. Policy entrepreneurs work on joining these streams. Interviews ( n = 20) were conducted with stakeholders (e.g., physicians/researchers/nonprofit organizations’ leaders). Data were analyzed using applied thematic analysis. High incidence of HPV and HPV-related cancers in Puerto Rico were indicators of problems. Focusing events included Rhaiza’s case and the HPV-Advisory Panel Report. During summer 2017, a policy window opened; the Department of Health (DOH) adopted the requirement in summer 2018. Stakeholders discussed policy initiatives. Political turnover positively influenced the process. Policy entrepreneurs created an extended period of intersection resulting in the adoption of the requirement. Findings can inform policy initiatives to improve HPV vaccination rates and reduce HPV-related cancers.
High-grade Urothelial Carcinoma with Malignant Melanocytic Differentiation
Authors: Xu Hongzhi , Genega Elizabeth M. , Zhuang Liyan , Zhou Ming
Published: March 2021

Urothelial carcinoma usually shows divergent differentiation and variant histology with squamous and glandular morphology being most common. In this report, we present a case of divergent malignant melanocytic differentiation in a high-grade urothelial carcinoma. A 98-year-old East Asian woman with an anterior bladder wall mass underwent resection, which revealed a high-grade poorly differentiated tumor. A minor component of high-grade papillary urothelial carcinoma and carcinoma in situ is also present. The majority of the tumor cells are morphologically and immunohistochemically consistent with melanoma, a minority of cells are positive for urothelial markers, and rare cells coexpress both melanocytic and urothelial markers. Cells that express melanocytic markers or urothelial markers are intimately admixed together. Taken together, a diagnosis of high-grade urothelial carcinoma with malignant melanocytic differentiation was rendered. This is the first report in the literature of malignant melanocytic differentiation in a high-grade urothelial carcinoma, a finding that may have important diagnostic and therapeutic implications.
Performance Characteristics of DOAC Dipstick in Determining Direct Oral Anticoagulants in Urine
Authors: Harenberg Job , Martini Andrea , Du Shanshan , Krämer Sandra , Weiss Christel , Hetjens Svetlana
Published: March 2021

Testing for direct oral anticoagulants (DOACs) in patient urine may facilitate medical treatment decisions. The aim of this study was to investigate interobserver variability by 2 independent observers compared to laboratory staff in the visual interpretation of factor Xa (DXI) and thrombin inhibitors (DTI) using the DOAC Dipstick test. We also examined whether test pads reacted to other anticoagulants and abnormal urine colors. The colors of the DOAC Dipstick direct factor Xa inhibitor and thrombin inhibitor pads were interpreted with 100% accuracy (95% confidence interval 0.862 to 1.000) for urine samples from persons treated with apixaban (n = 26), rivaroxaban (n = 24), and dabigatran (n = 29) and without anticoagulant therapy (n = 29). The factor Xa and thrombin inhibitor pads did not interact with heparin, nadroparin, fondaparinux, or coumadin. One µg/mL r-Hirudin and 6 µg/mL argatroban interacted with the DTI pad; however, this is unlikely to cause clinical problems because dabigatran is unlikely to be administered together with r-Hirudin and argatroban in clinical circumstances. Abnormal urine color was reliably detected by the urine color pad, so can prevent false interpretation of the DOAC Dipstick pad colors. In conclusion, we have demonstrated that interobserver variability when interpreting the DOAC Dipstick test strip is low and that factor Xa and thrombin inhibitor pads do not react to other anticoagulants such as heparins and coumadin. R-Hirudin and argatroban can be detected by the thrombin inhibitor pad and abnormal urine colors can be detected by the urine color pad to prevent false interpretation of the results in patient urine samples.
Testing, Identifying, and Serving Gifted Children With and Without Disabilities: A Multi-State Parental Perspective
Authors: Mollenkopf Dawn L. , Matyo-Cepero Jude , Lewis Joan D. , Irwin Bailey A. , Joy Jennifer
Published: March 2021

Early identification of gifted children, including those twice-exceptional, allows schools and parents to support these children’s needs, but little is known about this early identification process and the role parents and teachers play. Parents of gifted children completed a survey which looked at what age their child was tested and identified, whether or not the parent suspected that the child was gifted, who referred the child for testing, and whether or not their child was twice-exceptional. Schools tested, identified, and started services for gifted children in the early elementary grades, usually between 5 and 6 years of age. Most parents identified giftedness in their children by age 2. Parents were also the most frequent person to refer their child for testing, although teachers also placed a strong role. Twice-exceptional children did not differ significantly from gifted children on any of these measures. Implication for further study are included.
Description, Health Care Utilization, and Outcomes for Home Health Care (HHC) COVID-19 Patients Early in the Pandemic: A Comparison to the General HHC Population
Authors: Videon Tami M. , Rosati Robert J. , Landers Steven H.
Published: March 2021

COVID-19 patients represent a new and distinct population in home health care. Little is known about health care utilization and incremental improvements in health for recovering COVID-19 patients after admission to home health care. Using a retrospective observational cohort study of 5452 episodes of home health care admitted to a New Jersey Home Health Agency between March 15 and May 31, 2020, this study describes COVID-19 Home Health Care (HHC) patients ( n = 842) and compare them to the general HHC population ( n = 4610). COVID HHC patients differ in significant ways from the typical HHC population. COVID patients were more likely to be 65 years of age and younger (41% vs 26%), be from a racial/ethnic minority (60% vs 31%), live with another person (85% vs 76%), have private insurance (28% vs 16%), and began HHC with greater independence in activities-of-daily-living (ADL/IADLs). COVID patients received fewer overall visits than their non-COVID counterparts (11.7 vs 16.3), although they had significantly more remote visits (1.7 vs 0.3). Multivariate analyses show that COVID patients early in the pandemic were 34% (CI, 28%-40%) less likely to be hospitalized and demonstrated significantly greater improvement in all the outcome measures examined compared to the general home health population.
Enhancing motivation and engagement within a PBIS framework
Authors: Petrasek Michael , James Anthony , Noltemeyer Amity , Green Jennifer , Palmer Katelyn
Published: March 2021

A motivating and engaging school environment has been associated with several positive student outcomes. Consequently, schools have an opportunity and responsibility to promote a culture that supports students in developing and maintaining their motivation, engagement, and self-improvement. Efforts to promote such a culture can be embedded within a Positive Behavioral Interventions and Supports (PBIS) framework. In this paper, we begin by describing motivation and engagement, and discussing the relevance of these concepts in schools. Next, we introduce the traditional PBIS framework, highlighting research and core features. Third, we propose how PBIS can be enhanced by incorporating a focus on relationships, engagement, and motivation in the school setting. Finally, we conclude with recommendations for school teams seeking to implement this approach.
A functional model-based approach for ship systems safety and reliability analysis: Application to a cruise ship lubricating oil system
Authors: Dionysiou Kritonas , Bolbot Victor , Theotokatos Gerasimos
Published: March 2021

The lubricating oil systems are essential for ensuring the safe and reliable operation of the cruise ships power plants as demonstrated by recent incidents. The aim of this study is to investigate the safety enhancement of a cruise ship lubricating oil system by employing safety, reliability, availability and diagnosability analyses, which are based on the system functional modelling implemented in the MADe™ software. The safety analysis is implemented by combining a Failure Modes, Effects and Criticality Analysis and the systems functional Fault Tree Analysis. Subsequently, Reliability Block Diagrams are employed to estimate the system reliability and availability metrics. The MADe™ toolbox for determining sensors locations is employed for a more advanced diagnostic system development. A number of design modifications are proposed and the alternative configurations reliability metrics are estimated. The derived results demonstrate that the suction strainer and the lubricating oil pump are the most critical system components. Seven additional sensors are proposed to enhance the original system design. Compared with the original system design, the investigated alternative designs exhibit significantly lower probabilities of failure and higher values of availability.
“Essential Not Optional”: Spiritual Care in Australia during a Pandemic
Authors: Tan Heather , Holmes Cheryl , Flynn Eleanor , Karimi Leila
Published: March 2021

This paper focuses on the impact of COVID19 in Australia. Three areas were investigated: professionalism, contrasting hospital and aged care services and “business as usual”? Impact was low overall, the timing being pre-second wave impact. Two areas of weakness were highlighted: depleted spiritual care teams due to standing down non-professional staff and uncertainty about the role of Chaplains in the care of other staff. Further study of second wave impact is recommended.
Conclusion: What We Learned and Next Steps
Authors: Haythorn Trace
Published: March 2021

In the previous articles, my colleagues have presented analyses of the survey data that have implications for professional preparation, practice and ongoing professional development. I will conclude this volume highlighting six areas that require further investigation, theoretical development and practical integration.
A Review of Price Transparency Policy and Evaluation of Hospital Compliance in Orthopedic Sports Medicine
Authors: Schultz Kyle , Enterline Lakai , Igboechi Oduche , Brahmbhatt Purav , Hinkley Jacob , Clement Carter
Published: March 2021

Background: In 2019, the Centers for Medicare and Medicaid Services (CMS) announced that beginning January 1, 2021, hospitals would be required to post pricing information in a usable format for patients via diagnosis-related group (DRG) or charge description master (CDM) sheets. Purpose/Questions: We hypothesized the new price transparency rule would pose challenges for many health care facilities. We therefore sought to find out how much pricing information was available before the rule took effect and how usable it was for patients receiving sports medicine care. Methods: In late 2019, we randomly selected 100 general hospitals (GH) from the CMS hospital list and an additional 21 orthopedic hospitals (OH). The DRG and/or CDM sheets were obtained from hospital websites. Pricing information for 6 sports medicine procedures (rotator cuff repair, shoulder arthroscopy, knee arthroscopy, anterior cruciate ligament reconstruction, meniscal repair, and steroid injection) was evaluated in qualitative and quantitative form. Results: Pricing information was provided by 74% of GH and 86% of OH. The price of steroid injections was frequently reported in usable form, with 80% by GH and 78% by OH. The remaining procedures were reported by less than 27% of GH and 40% of OH. For each procedure, component pricing was provided by at least 60% of GH and 78% of OH. No facility provided a pricing calculator or payer-type specific rates. Conclusions: Prior to the enactment of the new price transparency rule in January 2021, most facilities provided some pricing information to patients. However, reporting rates in sports medicine were low and the available data were of little use to patients.
True Differences in Poor Outcome Risks Between Revision and Primary Lumbar Spine Surgeries
Authors: Cook Chad E. , Garcia Alessandra N. , Park Christine , Gottfried Oren
Published: March 2021

Background: Previous studies have shown that the rates of complications associated with revision spine surgery are higher than those of primary spine surgery. However, there is a lack of research exploring the difference in magnitude of risk of poor outcomes between primary and revision lumbar spine surgeries. Purposes: We sought to compare the risks of poor outcomes for primary and revision lumbar spine surgeries and to analyze different measures of risk to better understand the true differences between the 2 forms of surgery. Methods: This retrospective observational study used data from the Quality Outcomes Database Lumbar Spine Surgical Registry from 2012 to 2018. We included individuals who received primary or revision surgery due to degenerative lumbar disorders. Outcome variables collected were complications within 30 days of surgery and 3 destination variables, specifically, (1) 30-day hospital readmission, (2) 30-day return to operating room, and (3) revision surgery within 3 months. Measures of risk considered were odds ratio (OR), relative risk (RR), relative risk increase (RRI), and absolute risk increase (ARI). Results: There were 31,843 individuals who received primary surgery and 7889 who received revision surgery. After controlling for baseline descriptive variables and comorbidities, revision surgery increased the odds of 4 complications and all 3 destination variables. Risk ratios reflected smaller magnitudes but similar findings as the statistically significant ORs. Conclusion: Revision surgery is related to higher overall risks than primary surgery, but the true magnitudes of these risks are very small. RRI and ARI should be included when reporting ORs to better clarify the significance.
Health and Healthcare Disparities: Impact on Resource Utilization and Costs After Transcatheter Aortic Valve Replacement
Authors: Okoh Alexis K. , Dhaduk Nehal , Shah Aakash M. , Gold Justin , Fugar Setri , Kassotis John , Chen Chunguang , Lee Leonard Y. , Russo Mark J.
Published: March 2021

Objective

We investigated health and healthcare disparities in the treatment of aortic stenosis with transcatheter aortic valve replacement (TAVR) and how they affect resource utilization and costs.

Methods

We retrospectively reviewed all patients who were discharged alive after TAVR between 2012 and 2017 from the National Inpatient Sample. Patients were stratified by race and outcomes investigated were in-hospital complications, total procedural costs, and resource utilization. High resource utilization (HRU) was defined as length of stay (LOS) ≥7 days or discharge to a nonhome location. Multivariable regression models were used to identify predictors of HRU.

Results

TAVR patients ( N = 29,464) were stratified into Caucasians ( n = 25,691), others ( n = 1,274), Hispanics ( n = 1,267), and African Americans (AA, n = 1,232). More AA and Hispanics had TAVR at urban teaching centers ( P = 0.003) and were less likely to be Medicare beneficiaries ( P < 0.001). Distribution of TAVR patients in the lowest income quartile showed AA (50%) versus Caucasian (20%) versus Hispanic (33%, P < 0.001). In-hospital complications were higher among Hispanics and AA than Caucasians with prolonged LOS, procedural costs, and HRU. On multivariable analysis, independent predictors of HRU were TAVR year ( P < 0.001), advanced age ( P < 0.001), female sex ( P < 0.001), non-Caucasian race ( P = 0.038), history of coronary artery bypass grafting ( P < 0.001), smoking ( P < 0.001), chronic lung disease ( P = 0.003), stroke ( P < 0.001), and lowest income quartile ( P = 0.002).

Conclusions

There exist significant healthcare and health disparities among patients undergoing TAVR in the United States. Consequently, this unequal access to care and determinants of heath translate into higher resource utilization and costs.