bluuebunny/crossref_metadata_2025 huggingface dataset:
Proposal for new sleep disorder criteria in patients with chronic liver disease: Influence of liver‐related complications
Authors: Miyaaki Hisamitsu , Hiraoka Atsuhi , Haraguchi Masafumi , Uojima Haruki , Kawaratani Hideto , Hiramatsu Akira , Hanai Tatsunori , Hiasa Yoichi , Yoshiji Hitoshi , Okita Kiwamu , Nakao Kazuhiko , Koike Kazuhiko
Published: November 2021

Aim

Sleep disorder is common in patients with chronic liver disease (CLD). Liver‐related silent complications, including muscle cramps, covert hepatic encephalopathy (HE), and sarcopenia, often reduce the quality of life of patients with CLD and have been reported to cause sleep disorders. In this study, we clarified the prevalence of liver‐related complications associated with sleep disorders in patients with CLD.

Methods

We conducted a multicenter cohort study of 271 patients with CLD. The Athens Insomnia Scale, muscle cramps questionnaires, and Stroop test were used to assess insomnia, muscle cramps, and covert HE, respectively. In addition, sarcopenia, dynapenia, and myopenia were diagnosed according to the guidelines of the Japan Society of Hepatology.

Results

In total, 136 patients (50.2%) had sleep disorders. Serum albumin and hemoglobin levels and prothrombin time activity were significantly lower in patients with sleep disorders than in those without sleep disorders. On univariate and multivariate analyses adjusted with inverse probability weighting, muscle cramps, covert HE, and dynapenia were associated with a sleep disorder. Sleep disorder was categorized as follows: cramp, covert HE, dynapenia, multiple complications, and others. In total, 106 of 136 patients (77.9%) with sleep disorder had at least one liver‐related complication, whereas 75 patients had multiple liver‐related complications.

Conclusion

Sleep disorder in patients with CLD was classified into four categories (muscle cramp, covert HE, dynapenia, and others). Questionnaire for sleep disorder might be an easy primary step for surveillance of high‐risk patients with silent complications associated CLD.
Recruitment of academic staff: An institutional logics perspective
Authors: Henningsson Malin , Geschwind Lars
Published: November 2021

Recently, a number of inbreeding cases have surfaced that have fuelled public criticism of recruitment practices and the lack of mobility in the Swedish higher education sector. This study focuses on recruitment practices at Swedish universities, particularly the divergence between what seems to be a practice of hiring internal candidates and a policy aiming at increasing mobility. The empirical material comprises 14 interviews with heads of departments at a selection of Swedish universities. Institutional logics are used as an analytical framework. It is found that academic recruitment is situated in a tangle of different practices and ideals comprising six logics: state, academic, managerial, market, community and family. Heads of departments show that recruitment practices are the result of several considerations where, for example, meritocracy, bureaucracy and loyalty do not always pull in the same direction.
Correlation between leukocyte‐platelet aggregates and thrombosis in myeloproliferative neoplasms
Authors: Šefer Dijana , Miljić Predrag , Kraguljac‐Kurtović Nada , Bižić‐Radulović Sandra , Bogdanović Andrija , Knežević Vesna , Marković Dragana , Beleslin‐Čokić Bojana , Novaković Ivana , Marinković Jelena , Leković Danijela , Gotić Mirjana , Čokić Vladan
Published: November 2021

Introduction

The impact of activated blood and endothelial cells on the thrombosis in myeloproliferative neoplasms (MPN) has not yet been clarified. We prospectively analyzed correlation between circulating leukocyte‐platelet aggregates and soluble selectins to thrombosis occurrence in MPN, in the context of standard and cardiovascular risk factors, and different clinical and biological characteristics.

Methods

Flow cytometric analysis of neutrophil‐platelet (Neu‐Plt) and monocyte‐platelet (Mo‐Plt) aggregates in peripheral blood, as well as quantification of soluble E‐/L‐/P‐selectins by enzyme immunoassay, was performed on 95 newly diagnosed MPN patients.

Results

During the follow‐up, thrombosis occurred in 12.6% MPN patients (arterial 9.4%, venous 3.2%), with a mean time of 39 months. The overall incidence rate of main thrombotic events was 4.36 per 100 patient‐years. The incidence of arterial hypertension (HTA) was significantly higher in patients with thrombosis, compared to those without thrombosis (P < .05). The level of soluble P‐selectin was significantly higher in patients with thrombosis compared to those without thrombosis (346.89 ng/mL vs 286.39 ng/mL, P = .034). The mean level of Neu‐Plt (26.7% vs 22.4%) and Mo‐Plt (17.8% vs 12.3%) aggregates did not differ significantly between the groups with and without thrombosis. A multivariate COX proportional hazard regression model confirmed an independent predictive significance of Mo‐Plt aggregates (HR = 1.561, 95% CI: 1.007‐2.420, P = .046), as well as the cumulative effect of Mo‐Plt aggregates and HTA (HR = 1.975, 95%CI: 1.215‐3.212, P = .006) for thrombosis occurrence.

Conclusion

Monocyte‐platelet aggregates represent an independent risk factor for thrombosis occurrence, further on supported by HTA.
Competing Visions of Mission and Unity among Japanese Protestants and Missionaries in Japan (1859–1912)
Authors: Hastings Thomas John
Published: November 2021

After a brief clarification of terms, this article focuses on the early history of the minority Protestant movement in Japan around the turn of the 20th century, examining rival perspectives on mission and unity among certain Japanese church leaders and Western missionaries. The sudden rise of Japan as the regional political power in Northeast Asia strongly influenced both constituencies, albeit in differing ways. While Protestant missionaries imagined Japanese Christians as future agents in their strategy for world evangelization, Japanese Protestant leaders were more modest, focusing their energies on the development of an independent national church. They did hope that their theological “liberation” from British, Dutch, and German confessional traditions would inspire similar theological developments in “younger churches” elsewhere. In light of the Japanese case, the author turns to John 17 for a “post‐instrumentalist” proposal for Christian unity and mission grounded in the inner life of God and wonders if such a perspective may be better attuned to the polycentric ecumenism of this new era of World Christianity.
A service evaluation to examine the use of compression strapping for the management of patients with retromalleolar leg ulcers in a specialist community setting
Authors: Haynes Samantha , Holloway Samantha
Published: November 2021

Leg ulcers are costly to the NHS, and they have a significant impact on patients' physical, social, and psychological well‐being. Compression therapy is traditionally the “gold‐standard” treatment for the management of venous leg ulcers and can be beneficial for those individuals with mixed ulcer aetiology. Evidence suggests that the application of standard, strong, graduated compression bandaging does not apply therapeutic compression to the retromalleolar fossa. The addition of compression strapping has been found to increase sub‐bandage pressure, promote healing, reduce pain and increase quality of life in patients with retromalleolar leg ulcers. This service evaluation aimed at evaluating the use of compression strapping with patients with retromalleolar leg ulcers. The service evaluation included 24 patients with 41 ulcers treated with compression strapping by a specialist team. Patients treated with CS had multiple comorbidities and shared common characteristics including foot and ankle oedema, previous ulceration, reduced mobility, and failure to heal despite the application of “gold‐standard” compression therapy. Following application of compression strapping, 17 patients (n = 27/41 ulcers) healed, mean pain scores decreased, and mean quality of life scores increased. The compression strapping was tolerated well, and patients reported a positive experience. This service evaluation has contributed towards a growing evidence base that supports the use of CS for the management of patients with retromalleolar leg ulcers.
Maturational changes in song sparrow song
Authors: Kochvar Katja H. , Peters Susan , Zipple Matthew N. , Nowicki Stephen
Published: November 2021

Age‐related changes in the production of sexually selected assessment signals have been identified across a diverse range of taxa, and in some cases, these changes have been shown to affect receiver response to those signals. One important type of change occurs even after a signaler reaches breeding age, a phenomenon known as delayed maturation. Delayed maturation has been observed in the songs of several bird species, with potential fitness consequences for males as a byproduct of female choosiness or male competition. Here, we analyzed songs recorded across the first three years of life in a cohort of hand‐reared song sparrows Melospiza melodia to detect early‐life age‐related changes in song. We focused on three measures of song complexity, including within song type variation, the average number of notes and the number of unique note types for the most common variant of each song type, and five measures of song production patterns, including singing rate, time interval between songs within a bout of the same song type, time interval between bouts (i.e. when the song type changes), within‐song stereotypy and between‐song consistency. All measures of song complexity and most measures of song production patterns (excluding within‐song stereotypy) changed significantly within individuals as birds aged from one to two years as well as from one to three years (excluding within‐bout time interval), whereas no significant changes occurred from two to three years of age. Based on these features, a linear discriminant model could distinguish between the song of young (age 1) and older (age 2 and 3) adult males, providing support that song could serve as an indicator of age in this species. We discuss potential implications of these results for mate choice and male–male competition in song sparrows.
Consumers’ active choice behaviour promotes coevolutionary units in antagonistic networks
Authors: de Alvarenga Allan Maurício Sanches Baptista , Borges Marcelo Eduardo , Jorge Leonardo Ré , Varassin Isabela Galarda , Araújo Sabrina Borges Lino
Published: November 2021

Individual behaviour and local context can influence the evolution of ecological interactions and how they structure into networks. In trophic interactions, consumers can increase their fitness by actively choosing resources that they are more likely to explore successfully. Mathematical modelling is often employed in theoretical studies to understand the coevolutionary dynamics between consumers and resources. However, they often disregard the individual consumer behaviour since the complexity of these systems usually requires simplifying assumptions about interaction details. Using an individual‐based model, we model a community of several species that interact antagonistically. Each individual has a trait (attack or defence) that is explicitly modelled and the probability of the interaction to occur successfully increases with increased trait‐matching. In addition, consumers can actively choose resources that guarantee greater fitness. We show that active consumer choice can generate coevolutionary units over time. It means that the traits of both consumers and resources converge into multiple groups with similar traits and the species interactions stay restricted to these groups over time. We also observed that network structure is more dependent on the parameter that delimits active consumer choice than on the intensity of selective pressure. Thus, our results support the idea that consumer active choice behaviour plays an important role in the ecological and evolutionary processes that structure interacting communities.
Gaseous chlorine dioxide inactivation of microbial contamination on whole black peppercorns
Authors: Rane Bhargavi , Lacombe Alison , Guan Jiewen , Bridges David F. , Sablani Shyam , Tang Juming , Wu Vivian C. H.
Published: November 2021

Black peppercorn is a common ingredient imported and used in uncooked or ready‐to‐eat foods in the United States. They might be exposed to fecal coliforms and other microbial contamination due to a lack of good agricultural and manufacturing practices in some developing countries under which they were grown and harvested, thus causing economic losses to the peppercorn industry in the United States. We investigated the effect of gaseous chlorine dioxide (ClO2) on reducing the microbial population levels of coliforms, aerobic bacteria, yeasts, and molds on unprocessed black peppercorns. Treatments on peppercorns were conducted in a 30‐L airtight chamber, and equal amounts of dry media precursors were used to generate gaseous ClO2. Whole peppercorns (200 g) were exposed to 20, 30, and 40 g of precursor dose for up to 60 min at 21 ± 0.4°C and in combination with mild heat at 40 ± 2°C. Aerobic bacteria, coliforms, yeasts, and molds on peppercorns were enumerated before (7.4, 7.2, and 7.1 log CFU/g, respectively) and after treatments. Results after treatment demonstrated 0.8–1 log10 (90%) reduction for all the microbes post‐treatment at 21 ± 0.4°C. The treatments conducted with a 30 g precursor dose for 60 min at 21 ± 0.4°C reduced statistically higher (p < .05) microorganisms than those at 40 ± 2°C. Our work demonstrated that gaseous ClO2 could be used as a part of an overall hurdle technology to reduce the coliforms, aerobes, yeasts, and molds on black peppercorns without affecting the visual quality.
Structure and evolution of the sexually dimorphic integumentary swelling on the hands of dendrobatid poison frogs and their relatives (Amphibia: Anura: Dendrobatoidea)
Authors: Cavalcanti Isabela Rodrigues de Souza , Luna María Celeste , Faivovich Julián , Grant Taran
Published: November 2021

The hands of adult males of many dendrobatid poison frogs and their relatives possess swelling formed by glandular tissue hypothesized to secrete courtship pheromones delivered to the female during cephalic amplexus. Variation in the occurrence and external morphology of the swelling of finger IV has provided important evidence for dendrobatoid systematics for decades, but its underlying structure has not been investigated. We undertook a detailed comparative analysis of the integument of the hand, including both external morphology and histology, of 36 species representing the diversity of dendrobatoid frogs and several close relatives. The swelling is caused by four densely packed, hypertrophic, morpho‐histochemical types of specialized mucous glands (SMGs). We observed type I SMGs on fingers II–V and the wrist, including areas that are not swollen, types II and IV exclusively on finger IV, and type III on finger IV and the wrist. Type I SMGs occur either in isolation or together with types II, III, or IV; types II, III, and IV never occur together or without type I. We delimited 15 characters to account for the variation in external morphology and the occurrence of SMGs. Our data suggest that type I SMGs are a new synapomorphy for Dendrobatoidea and that type II SMGs originated in either the most recent common ancestor (MRCA) of Dendrobatidae or independently in the MRCAs of Aromobatidae and Colostethinae, respectively, while types III and IV are restricted to Anomaloglossus. The discovery of these SMGs adds a new dimension to studies of poison frog reproductive biology, which have investigated acoustic, visual, and tactile cues in courtship, mating, and parental care across the diversity of Dendrobatoidea for decades but have almost entirely overlooked the possible role of chemical cues.
Nurses’ perspectives on workarounds in clinical practice: A phenomenological analysis
Authors: Bianchi Monica , Ghirotto Luca
Published: November 2021

Aims and objectives

To explore the phenomenon of workarounds in clinical practice through the nurses’ perspective and identify which factors according to their experience contribute to activities carried forth non‐compliantly to procedures, protocols and rules defined by an Institution.

Background

A workaround in clinical practice is a non‐compliance and a violation of an organisation's defined procedures, regulations or rules that may prevent adverse events. Its increasing recurrence in the workplace calls for a deeper analysis of the phenomenon.

Design

A phenomenological descriptive design, following Colaizzi's analysis.

Methods

In‐depth interviews were conducted with 16 nurses about their experience of workarounds. The interviews were digitally audio‐recorded and transcribed verbatim. Two researchers conducted data analysis independently and followed three phases: extracting significant statements, creating formulated meanings and aggregating them into themes. The process employed NVivo 12 software. COREQ checklist was used for reporting.

Results

Data analysis identified 17 sub‐themes falling into the four macro‐themes: (i) living the profession in saved times; (ii) Perceiving contingencies as a guide to action; (iii) sense of personal responsibility; and (iv) emotional aspects.

Conclusions

From a nurses’ perspective, a workaround is often triggered by the need to overcome problems interfering with efficient and timely patient care in everyday clinical practice. This will of undertaking responsibilities favouring gained efficiency is closely linked to their confidence acquired over years of experience in the field.

Relevance to clinical practice

The results of this study can help clinical leadership to acknowledge workaround, understand the underlying triggers and work towards reconciling official procedures with real‐world situations. They can help nurses working in clinical practice to reflect and understand how to reconcile the needs related to the demands of organisations with the need to live their profession, which is more patient‐oriented.
Longitudinal associations between sibling relationship quality and child adjustment after divorce
Authors: van Dijk Rianne , van der Valk Inge E. , Buist Kirsten L. , Branje Susan , Deković Maja
Published: November 2021

Objective

This study examined the interplay between the parent–child and sibling relationships in their associations with child adjustment after divorce, in order to understand the postdivorce impact of the sibling relationship more thoroughly.

Background

The sibling relationship is unique in its lifetime duration and frequent interactions, and is associated with child adjustment in intact families. Research on the sibling relationship in divorced families is warranted, as it is one of the few stable factors in children's lives shortly after divorce.

Method

To examine direct and moderating effects of the sibling relationship, data from N = 117 children (Mage = 12.85) of 65 families and their recently divorced parents (60 mothers, 45 fathers) were used. Longitudinal associations of sibling support, sibling conflict, parent–child relationship quality, and their interactions with child adjustment were estimated with generalized estimating equations.

Results

The sibling relationship was related to children's (relative change in) externalizing problems and self‐esteem over time, but not to internalizing problems. Especially high sibling support was found beneficial and buffered the adversity of sibling conflict regarding children's self‐esteem. There was no substantial evidence that siblings moderated parent–child relationship quality.

Conclusions

In the context of divorce and adequate parent–child relationship quality, the sibling relationship seems to be complementary rather than compensatory to that of parents. Given the role of siblings in externalizing behaviors and self‐esteem, potential benefits of targeting the sibling relationship in (preventive) interventions aimed at divorced families should be explored.
Spinal cord‐predominant neuropathology in an adult‐onset case of POLR3A‐related spastic ataxia
Authors: Sytsma Trevor M. , Chen Dong‐Hui , Rolf Bradley , Dorschner Michael , Jayadev Suman , Keene C. Dirk , Zhang Jing , Bird Thomas D. , Latimer Caitlin S.
Published: November 2021

Biallelic mutations in POLR3A have been associated with childhood‐onset hypomyelinating leukodystrophies and adolescent‐to‐adult‐onset spastic ataxia, the latter of which has been linked to the intronic variant c.1909 + 22G>A. We report a case of adult‐onset spastic ataxia in a 75‐year‐old man, being a compound heterozygous carrier of this variant, whose brain and spinal cord were for the first time investigated by neuropathological examination. We describe prominent degeneration of the posterior columns, spinocerebellar tracts, and anterior corticospinal tracts of the spinal cord in a pattern resembling Friedreich's ataxia, with a notable lack of significant white matter pathology throughout the brain, in marked contrast with childhood‐onset cases. Immunohistochemical examination for the POLR3A protein demonstrated no apparent differences in localization or staining intensity between the proband and an age‐matched control subject. We demonstrate the clinicopathologic description of POLR3A‐related neurodegenerative disease and also mention the differential diagnosis of the childhood‐onset hypomyelinating leukodystrophy and late‐onset spastic ataxia phenotypes.
Oral and parenteral anti‐neuropathic agents for the management of pain and discomfort in irritable bowel syndrome: A systematic review and meta‐analysis
Authors: Lambarth Andrew , Zarate‐Lopez Natalia , Fayaz Alan
Published: November 2021

Background

Irritable bowel syndrome (IBS) is a highly prevalent and economically burdensome condition; and pain is often the most unpleasant, disruptive, and difficult‐to‐treat symptom. Visceral hypersensitivity is a common feature driving pain in IBS, suggesting that neuropathic mechanisms may be implicated. We conducted a systematic review of available evidence to examine the role of anti‐neuropathic medicines in the management of pain in IBS.

Methods

We systematically searched scientific repositories for trials investigating conventional oral, and/or parenteral, pharmaceutical antineuropathic treatments in patients with IBS. We summarized key participant characteristics, outcomes related to pain (primary outcome), and selected secondary outcomes.

Key results

We included 13 studies (n = 629 participants): six investigated amitriptyline, three duloxetine, three pregabalin, and one gabapentin. There was considerable methodological and statistical heterogeneity, so we performed a narrative synthesis and limited meta‐analysis. Amitriptyline was most extensively studied, though only in diarrhea‐predominant patients. In individual trials, amitriptyline, pregabalin and gabapentin generally appeared beneficial for pain outcomes. While duloxetine studies tended to report improvements in pain, all were un‐controlled trials with high risk of bias. Meta‐analysis of three studies (n = 278) yielded a pooled relative‐risk of 0.50 (95%CI 0.38–0.66) for not improving with anti‐neuropathic agent vs control. We did not identify any eligible studies investigating the role of parenteral anti‐neuropathics.

Conclusions and inferences

Anti‐neuropathic analgesics may improve pain in IBS, and deserve further, high‐quality investigation, potentially considering parenteral administration and agents with minimal gastrointestinal motility effects. Investigation of amitriptyline’s efficacy in non‐diarrhea‐predominant subtypes is currently lacking, and we recommend particular caution for its use in IBS‐C.
Genetic support of carbapenemases: a One Health systematic review and meta‐analysis of current trends in Africa
Authors: Ragheb Suzan Mohammed , Govinden Usha , Osei Sekyere John
Published: November 2021

Antimicrobial resistance (AMR) is a public health threat globally. Carbapenems are β‐lactam antibiotics used as last‐resort agents for treating antibiotic‐resistant infections. Mobile genetic elements (MGEs) play an important role in the dissemination and expression of antimicrobial resistance genes (ARGs), including the mobilization of ARGs within and between species. The presence of MGEs around carbapenem‐hydrolyzing enzymes, called carbapenemases, in bacterial isolates in Africa is concerning. The association between MGEs and carbapenemases is described herein. Specific plasmid replicons, integrons, transposons, and insertion sequences were found flanking specific and different carbapenemases across the same and different clones and species isolated from humans, animals, and the environment. Notably, similar genetic contexts have been reported in non‐African countries, supporting the importance of MGEs in driving the intra‐ and interclonal and species transmission of carbapenemases in Africa and globally. Technical and budgetary limitations remain challenges for epidemiological analysis of carbapenemases in Africa, as studies undertaken with whole‐genome sequencing remained relatively few. Characterization of MGEs in antibiotic‐resistant infections can deepen our understanding of carbapenemase epidemiology and facilitate the control of AMR in Africa. Investment in genomic epidemiology will facilitate faster clinical interventions and containment of outbreaks.
Design and validation of a chart‐based measure of the limits of spatial contrast sensitivity
Authors: Adhikari Prakash , Carter Drew D , Feigl Beatrix , Zele Andrew J
Published: November 2021

Purpose

Current chart‐based tests of spatial contrast sensitivity (SCS) with fixed or narrow frequency ranges (≤18 cycles/°) cannot characterise the limits of spatial contrast vision. Here we present the design and validation of a chart‐based measure of the spatial contrast envelope.

Methods

Following the principles of the standard visual acuity (Bailey‐Lovie) and contrast sensitivity (Pelli‐Robson) charts, a combined spatial‐contrast and visual acuity chart was designed using a language‐independent triangular symbol for a four‐alternative forced‐choice procedure plus chart rotation. Symbol frequencies ranged between 0.38 and 60 cycles/° spaced along 10 radial axes (0.55%–100% contrast). The chart was validated with reference to the Bailey‐Lovie and Pelli‐Robson charts; its reliability and sensitivity to changes in illumination, simulated cataract and blur was evaluated in healthy adults.

Results

The photopic SCS function could be measured in 5.5 ± 0.5 min; thresholding around the spatial contrast resolution limit reduced completion times to ~2 min. There was good agreement with high‐contrast visual acuity (difference = 0.08 ± 0.02 logMAR) and contrast‐sensitivity at 1.5 cycles/° (0.13 ± 0.06 logCS). Test‐retest reliability was excellent at all spatial frequencies (ICC = 0.99). Mesopic illumination or simulated cataract caused a generalised SCS loss; myopic blur reduced high‐frequency sensitivity. Spatial contrast sensitivity was independent of radial axis orientation (cardinal or oblique).

Conclusions

The chart provides a time‐efficient, reliable and inexpensive measure of SCS with applications in research and clinic for detecting subtle deficits in early stages of ocular and neurological conditions that often manifest at higher frequencies. It is sensitive to vision changes occurring in dim lighting and with simulated cataract and blur. The chart is available open‐access for self‐printing; contrast variation in print can be controlled through user calibration and/or establishing normative SCS functions using the theoretical values.
Morphology of Herniated Disc as a Predictor for Outcomes of Posterior Percutaneous Full‐endoscopic Cervical Discectomy in Treating Cervical Spondylotic Radiculopathy
Authors: Liu Yi , Tang Guo‐ke , Wang Wei‐heng , Shi Chang‐gui , Wang Shuang , Yu Lei , Yu Jiang‐ming , Ye Xiao‐jian
Published: November 2021

Objective

To quantitively characterize the morphology of cervical disc herniation (CDH) causing cervical spondylotic radiculopathy (CSR) and investigate whether the morphological features of CDH are associated with clinical outcomes in CSR patients treated by posterior percutaneous full‐endoscopic cervical discectomy (PPECD).

Methods

This is a single‐center retrospective study. Eighty‐seven PPECD‐treated patients meeting the inclusion criteria were included between May 2017 and May 2019. Based on preoperative T2‐weighted magnetic resonance imaging (MRI), we designed and measured six morphological parameters of CDH for all patients to reflect its relative position to cervical spinal cord and protruding degree: DC‐SC distance from the center of disc (DC) and the center of spinal cord (SC); DC‐DP distance from the center of cervical disc (DC) to the peak of herniation (DP); internal diameter of the disc; axial length of CDH; central angle of CDH formed by central axes of CDH and spinal cord; the modified index of CDH. We recorded general information, neck disability index (NDI) scores, visual analog scale (VAS) scores of neck and arm of all patients preoperatively and postoperatively at 1‐year follow‐up. The association of preoperative general variables and morphological parameters with clinical outcomes were explored by utilizing logistic regression and receiver operating characteristic curve (ROC) analysis.

Results

The preoperative neck‐VAS, arm‐VAS, and NDI were significantly decreased after PPECD and remained at a low value at follow‐up. In regards to the morphological parameters of CDH, the mean value of DC‐SC distance, DC‐DP distance, internal diameter of the disc, axial length of CDH, central angle of CDH, and modified index of CDH were 1.61 ± 0.30 cm, 1.66 ± 0.32cm, 1.04 ± 0.21 cm, 0.63 ± 0.19cm, 39.38° ± 11.94°, and 0.39 ± 0.24, respectively. For patients grouped by difference in the recovery rate of NDI and arm‐VAS (excellent improved group, EI; and limited improved group, LI), there were no differences in the age, gender, surgical segments, and morphological parameters, except for the central angle of CDH. According to binary logistic regression analysis, only the preoperative central angle of CDH was significantly associated with postoperative NDI recovery (odds ratio: 0.873; 95% confidence interval: 0.819–0.931, P = 0.002). ROC analysis showed the optimal cut‐off value of the central angle of CDH for predicting the postoperative improvement of functional outcomes is 33.788°.

Conclusion

Preoperative morphology of CDH is related to the outcomes of CSR patients after PPECD. Patients with a large central angle of CDH (>33.788°) have more likelihood of ameliorating neurological symptoms of CSR. There is the potential to select the central angle of CDH as a predictor for outcomes of PPECD in treating CSR.
Confusions and responses of managerial public health nurses during the COVID‐19 pandemic in Japan
Authors: Honda Chikako , Sumikawa Yuka , Yoshioka‐Maeda Kyoko , Iwasaki‐Motegi Riho , Yamamoto‐ Mitani Noriko
Published: November 2021

Objective

This study aimed to elucidate the experiences of public health nurses (PHNs) in Japan during the first wave of COVID‐19.

Design and sample

Twelve PHNs in charge of responding to COVID‐19 in X‐city within Tokyo metropolis in Japan participated in this case study.

Measurements

Data were collected through self‐administered questionnaires and semi‐structured interviews on PHNs’ experiences from January 2020 to May 2020.

Results

Initially, only infectious disease control division (IDCD) PHNs experienced confusion due to the rapidly increased workload. Managerial PHNs attempted to explain the need for a dispatch system for the IDCD, using available statistical data from other managerial members, within one's maximum understanding of this unprecedented situation. Without having a clear and forward‐looking understanding regarding the purpose and reasons for dispatching, some dispatched PHNs had concerns and frustrations; they did not view the COVID‐19 pandemic as a disaster. In the never‐ending, exhausting work, PHNs managed to modify the provision of conventional services to residents.

Conclusions

Despite experiencing confusion, PHNs worked to continuously provide community services, re‐considering the meaning of public health nursing. Prioritizing the work and shifting tasks to other professionals at an early stage of the pandemic may prevent organizational dysfunction.
Risk of large for gestational age births at early, full and late term in relation to pre‐pregnancy body mass index: Mediation by gestational diabetes status
Authors: Kondracki Anthony J. , Valente Matthew J. , Ibrahimou Boubakari , Bursac Zoran
Published: November 2021

Background

Maternal pre‐pregnancy body mass index (BMI) is strongly associated with infant birthweight and the risk differs in pregnancies complicated by gestational diabetes (GDM).

Objectives

To examine the risk of large for gestational age (LGA) (≥97th percentile) singleton births at early term, full term and late term in relation to maternal pre‐pregnancy BMI status mediated through GDM.

Methods

We analysed data from the 2018 U.S. National Vital Statistics Natality File restricted to singleton term births (N = 3,229,783). In counterfactual models for causal inference, we estimated the total effect (TE), natural direct effect (NDE) and natural indirect effect (NIE) for the association of pre‐pregnancy BMI with subcategories of LGA births at early, full and late term mediated through GDM, using log‐binomial regression and adjusting for race/ethnicity, age, education, parity and infant sex. Proportion mediated was calculated on the risk difference scale and potential unmeasured confounders were assessed using the E‐value.

Results

Overall, 6.4% of women had GDM, and there were 3.6% LGA singleton term births. The highest prevalence of GDM was among pre‐gestational overweight/obesity that also had the highest rates of LGA births at term. The TE estimates for the risk of LGA births were the strongest across women with higher pre‐pregnancy BMI compared to women with normal pre‐pregnancy BMI. The NDE estimates were higher than the NIE estimates for overweight/obese BMI status. The proportion mediated, which answers the causal question to what extent the total effect of the association between pre‐pregnancy BMI and LGA births is accounted for through GDM, was the highest (up to 16%) for early term births.

Conclusions

Term singleton births make up the largest proportion in a cohort of newborns. While the percentage mediated through GDM was relatively small, health risks arising from pre‐pregnancy overweight, and obesity can be substantial to both mothers and their offspring.
Digitalization and Social Innovation in Rural Areas: A Case Study from Indonesia*
Authors: Fahmi Fikri Zul , Arifianto Anandhika
Published: November 2021

This paper aims to identify how rural digitalization influences social innovation in the context of the Global South. Using qualitative research methods, we examine two cases of digitalization in rural areas in Indonesia, which represent differing types of digital technologies and economic activities. Our findings show that the use of digital technologies in livelihood strategies stimulates new social and institutional practices in rural areas. As digital technologies that are adopted differ in both cases, the complexity of adoption and the digital literacy and skills required also vary. Such a complexity generates challenges and hardships for the community, but at the same time, it provides room for expedited learning and urges them to fight the challenges collectively. This nurtures reflexivity between agents and stimulates the legitimation of new practices regarding the adoption of digital technologies and their ability to solve social problems. Cultural values clearly play an essential role in this process. Openness and courage to change facilitate agents to build legitimacy, whereas strong cultural values tend to maintain existing practices in a community.
A novel clinical method to measure skin staining reveals activation of skin damage pathways by cigarette smoke
Authors: Dalrymple Annette , McEwan Michael , Brandt Marianne , Bielfeldt Stephan , Bean Emma‐Jayne , Moga Alain , Coburn Steven , Hardie George
Published: November 2021

Background

Long‐term use of cigarettes can result in localised staining and aging of smokers’ skin. The use of tobacco heating products (THPs) and electronic cigarettes (ECs) has grown on a global scale; however, the long‐term effect of these products’ aerosols on consumers’ skin is unknown. This pilot clinical study aimed to determine whether THP or EC aerosol exposure results in skin staining or activation of biomarkers associated with oxidative stress.

Materials and methods

Eight areas were identified on the backs of 10 subjects. Two areas were used for air control, and two areas exposed to 32‐puffs of cigarette smoke (CS), THP or EC aerosols, which were delivered to the skin using a 3‐cm diameter exposure chamber and smoke engine. Skin colour was measured using a Chromameter. Squalene (SQ), SQ monohydroperoxide (SQOOH) and malondialdehyde (MDA) levels were measured in sebum samples by mass spectrometry and catalase colorimetry.

Results

CS exposure significantly increased skin staining, SQOOH and MDA levels and SQOOH/SQ ratio. THP and EC values were significantly lower than CS; EC values being comparable to air control. THP values were comparable to EC and air control at all endpoints, apart from skin staining. SQ and catalase levels did not change with exposure.

Conclusions

CS stained skin and activated pathways known to be associated with skin damage. THPs and ECs produced significantly lower values, suggesting they could offer hygiene and cosmetic benefits for consumers who switch exclusively from smoking cigarettes. Further studies are required to assess longer‐term effects of ECs and THPs on skin function.
Evaluating apheresis platelets at reduced dose as a contingency measure for extreme shortages
Authors: Smethurst Peter A. , McAndrew Margaret , Proffitt Susan , Procter Simon , Davies Jane , New Helen V. , Stanworth Simon J. , Doughty Heidi , Cardigan Rebecca
Published: November 2021

Background

The COVID19 pandemic highlights the need for contingency planning in the event of blood shortages. To increase platelet supply, we assessed the operational impact and effect on platelet quality of splitting units prior to storage.

Study design and methods

Using production figures, we modeled the impact on unit numbers, platelet counts, and volumes of splitting only apheresis double donations into three units (yielding ⅔ doses), or all standard dose units in half. To assess quality, eight pools of three ABO/Rh‐matched apheresis (Trima Accel) double donations in plasma were split to ⅔ and ½ volumes in both Terumo and Fresenius storage bags. These were irradiated and subject to maximal permitted periods of nonagitation (3 × 8 h) before comparing platelet quality markers (including pH, CD62P expression) to Day 9 of storage.

Results

Splitting all double donations into three predicted inventory expansion of 23% overall whereas halving all standard dose units clearly doubles stock. In our study, ⅔ and ½ doses contained 153 ± 15 × 109 (~138 ml) and 113 ± 11 × 109 (~102 ml) platelets respectively. Following storage, higher pH was observed in ⅔ than in ½ doses and in Terumo compared to Fresenius bags. The higher pH was reflected in better quality markers, including lower CD62P expression. Despite the differences, on Day 8 (of pH monitoring at expiry) all ⅔ doses and most ½ doses were ≥pH 6.4.

Conclusion

A strategy to split apheresis platelets in plasma to lower doses is feasible, maintains acceptable platelet quality, and should be considered by blood services in response to extreme shortages.
Progressive Damage Simulation of Thick Viscoelastic Laminate With Homogenization Technique
Authors: Noh Jae H. , Whitcomb John D.
Published: November 2021

For a thick viscoelastic laminate, modeling of individual lamina and cracks is impractical because it requires huge computational expense. In our previous study, homogenization techniques for undamaged viscoelastic sublaminates were developed. We have also developed a technique for the progressive damage analysis of viscoelastic laminates with transverse matrix cracks. Homogenization at the lamina level was used to account for damage. The method is based on a numerical proof that the variation of the stress state of a viscoelastic laminate depends on the instantaneous crack density not on the time-history of cracking. Combining these two methods, we developed a very efficient multi-level homogenization technique for progressive damage analysis of a thick viscoelastic laminate with cracks. This method is very efficient and accurate.
Fuzzy Torque Distribution Control for a Parallel Hybrid Electric Vehicle
Authors: Won Jong-Seob , Langari Reza
Published: November 2021

A fuzzy torque distribution controller for energy management (and emission control) of a parallel-hybrid electric vehicle is proposed. The proposed controller is implemented in terms of a hierarchical architecture which incorporates the mode of operation of the vehicle as well as empirical knowledge of energy flow in each mode. Moreover, the rule set for each mode of operation of the vehicle is designed in view of an overall energy management strategy that ranges from maximal emphasis on battery charge sustenance to complete reliance on the electrical power source. The proposed control system is evaluated via computational simulations under the FTP75 urban drive cycle. Simulation results reveal that the proposed fuzzy torque distribution strategy is effective over the entire operating range of the vehicle in terms of performance, fuel economy as well as emissions.
Selection of Optimal Machining Parameters Using a Genetic Algorithm
Authors: Krishnamurthy K. , Yan Lei
Published: November 2021

Selection of optimal machining parameters is a difficult process due to the large number of variables and their complex interdependencies. In this study, a genetic algorithm-based method is presented to determine the optimal machining parameters for machining pockets using multi-pass end milling operations. The number of passes, axial and radial depths of cut, and feed rate are determined to minimize a cost function that is based on the cutting force. Results are presented for two different tool paths using a mechanistic model for predicting the cutting force.
Lateral Control of Automated Vehicles: On Degraded Mode Control Problems
Authors: Suryanarayanan Shashikanth , Tomizuka Masayoshi
Published: November 2021

Lane-keeping operation in automated vehicles used in the PATH* program, is performed with the help of two lateral error measuring sensors mounted on the front and rear bumpers of the vehicles. Prom a fault management perspective, it is natural to investigate the problem of lateral control with just one of these sensors. This paper documents the analysis, design and experimental testing of lateral controllers based on information from either one of these two sensors. In addition, this paper includes a discussion on the problem of lateral control with the help of information from just the rear sensor from a pedagogical perspective. This problem presents an application of control of a non-minimum phase system and leads to counterintuitive results.
A Rapid Engine Prototyping Methodology: Linking Geometry, Flow Field, Combustion, Performance and Control
Authors: Ko Jang-Hyok , Guezennec Yann G. , Radwan Amr , Rizzoni Giorgio , Choi Woong-Chul
Published: November 2021

In this paper, we present an overview of a rapid engine prototyping methodology which can be an extremely valuable tool from preliminary engine design optimization to control system development. The methodology comprises several steps which can be used separately or in conjunction. Specifically, the approach consists of: i) linking engine geometry and valve events to in-cylinder flows; ii) linking in-cylinder flows to combustion characteristics; iii) linking combustion characteristics to crank-angle resolved engine simulation results; and iv) linking crank angle-resolved engine simulation results to a mean value dynamic engine/powertrain simulator to develop and optimize control strategies. One of the chief advantages of the proposed methodology is the ability of performing these tasks prior to having an engine prototype built and running on a dynamometer.
Velocity Control of Hydraulic Cylinders With Only Pressure Feedback
Authors: DeBoer Christopher C. , Yao Bin
Published: November 2021

The lack of position or velocity feedback is a very common problem particularly on construction equipment such as excavators and backhoes. The extra cost of adding position/velocity sensors is prohibitive as well as the high likelihood of sensor failure in such a harsh environment. These factors make the possibility of improving control performance with limited sensory feedback very attractive. This paper studies the velocity control of a single-rod double actuating hydraulic cylinder utilizing a programmable valve with only cylinder pressure feedback. The boom motion control of a scaled-down model of an industrial backhoe loader arm is used as a case study. The programmable valve used in this study is a unique combination of five proportional cartridge valves connected in such a way that the meter-in and meter-out flows can be independently controlled by four of the valves as well as a true cross port flow controlled by the fifth valve. The programmable valve decouples the control of the meter-in and meter-out flows providing tremendous control flexibility to control the cylinder motion while decreasing the pump energy required by utilizing the potential and kinetic energy of the load. This paper demonstrates the potential energy savings possible through the use of the programmable valve. The paper also proves that significant improvements in the velocity tracking performance of hydraulic cylinders can be attained with only pressure feedback.
Control Design for Ultimate Boundedness of Linear Switched Systems With Controlled and Uncontrolled Subsystems
Authors: Yedavalli Rama K. , Sparks Andrew
Published: November 2021

Motivated by the Satellite Formation Keeping Control Problem, this paper presents a theoretical framework for designing controllers for the ultimate boundedness of linear switched systems consisting of both controlled (and thus stable) and uncontrolled (unstable) subsystems. It is shown that if the dwell time in the controlled mode (i.e ‘on time’) and that of the uncontrolled mode (’off time’) are chosen judiciously, ultimate boundedness of the switched system is guaranteed. Towards this direction explicit formulae for the switching times between controlled and uncontrolled modes are provided as a function of the parameters of the ultimate boundedness region. Using Lyapunov theory, a control design procedure is presented that achieves a good trade off between the ratio of ‘off’ and ‘on’ times and the size of the ellipsoidal boundedness regions which are representative of the system performance. The proposed control design technique has useful applications in mechanical and aerospace systems. The importance of this theory and possible extensions of these concepts are discussed.
A Generalization of Poincaré’s Theorem to Periodic Hybrid and Impulsive Dynamical Systems
Authors: Chellaboina V. , Nersesov S. G. , Haddad W. M.
Published: November 2021

Poincaré’s method is well known for analyzing the stability of continuous-time periodic dynamical systems by studying the stability properties of a fixed point as an equilibrium point of a discrete-time system. In this paper we generalize Poincaré’s method to dynamical systems possessing left-continuous flows to address the stability of limit cycles and periodic orbits of left-continuous, hybrid, and impulsive dynamical systems. It is shown that resetting manifold (which gives rise to the state discontinuities) provides a natural hyperplane for defining a Poincaré return map. In the special case of impulsive dynamical systems, we show the Poincaré map replaces an nth-order impulsive dynamical system by an (n − 1)th-order discrete-time system for analyzing the stability of periodic orbits.