bluuebunny/crossref_metadata_2025 huggingface dataset:
Could Anti‐Hypertensive Drug Therapy Affect the Clinical Prognosis of Hypertensive Patients With COVID‐19 Infection? Data From Centers of Southern Italy
Authors: Sardu Celestino , Maggi Paolo , Messina Vincenzo , Iuliano Pasquale , Sardu Antonio , Iovinella Vincenzo , Paolisso Giuseppe , Marfella Raffaele
Published: July 2020

BACKGROUND

Coronavirus disease 2019 (COVID‐19) is the cause of a pandemic disease, with severe acute respiratory syndrome by binding target epithelial lung cells through angiotensin‐converting enzyme 2 in humans. Thus, patients with hypertension with COVID‐19 could have worse prognosis. Indeed, angiotensin‐converting enzyme inhibitors and/or angiotensin receptor blockers may interfere with angiotensin‐converting enzyme 2 expression/activity. Thus, patients with hypertension undergoing angiotensin‐converting enzyme inhibitor and/or angiotensin receptor blockers drug therapy may be at a higher risk of contracting a serious COVID‐19 infection and should be monitored. Moreover, in the present study we investigated the effects of angiotensin‐converting enzyme inhibitor versus angiotensin receptor blockers versus calcium channel blockers on clinical outcomes as mechanical ventilation, intensive care unit admissions, heart injury, and death in 62 patients with hypertension hospitalized for COVID‐19 infection.

METHODS AND RESULTS

The multicenter study was prospectively conducted at Department of Infectious Diseases of Sant'Anna Hospital of Caserta, and of University of Campania "Luigi Vanvitelli" of Naples, at Department of Advanced Surgical and Medical Sciences of University of Campania "Luigi Vanvitelli," Naples, and at General Medical Assistance Unit "FIMG," Naples, Italy. Lowest values of left ventricle ejection fraction predicted deaths (1.142, 1.008–1.294,
P
<0.05), while highest values of interleukin‐6 predicted the admission to intensive care unit (1.617, 1.094–2.389), mechanical ventilation (1.149, 1.082–1.219), heart injuries (1.367, 1.054–1.772), and deaths (4.742, 1.788–8.524).

CONCLUSIONS

Anti‐hypertensive drugs didn't affect the prognosis in patients with COVID‐19. Consequently, tailored anti‐inflammatory and immune therapies in addition to chronic antihypertensive therapy, could prevent a worse prognosis, as well as improve the clinical outcomes in patients with hypertension with COVID‐19 infection.
Full-Day Kindergarten: Effects on Maternal Labour Supply
Authors: Dhuey Elizabeth , Lamontagne Jessie , Zhang Tingting
Published: July 2020

We examine the effects of offering full-day kindergarten as a replacement for half-day kindergarten on mothers' labour supply using the rollout of full-day kindergarten in Ontario, Canada. We find no effect on the extensive margin but found an effect on the intensive margin. In particular, we find that access to full-day kindergarten increases weekly hours worked and decreases absenteeism among mothers with kindergarten-aged children. This effect is driven by specific sub-groups, namely non-immigrant mothers with low education levels who live in urban areas and have only one child.
A Review on Treatment-Related Brain Changes in Aphasia
Authors: Schevenels Klara , Price Cathy J. , Zink Inge , De Smedt Bert , Vandermosten Maaike
Published: July 2020

Numerous studies have investigated brain changes associated with interventions targeting a range of language problems in patients with aphasia. We strive to integrate the results of these studies to examine (1) whether the focus of the intervention (i.e., phonology, semantics, orthography, syntax, or rhythmic-melodic) determines in which brain regions changes occur; and (2a) whether the most consistent changes occur within the language network or outside, and (2b) whether these are related to individual differences in language outcomes. The results of 32 studies with 204 unique patients were considered. Concerning (1), the location of treatment-related changes does not clearly depend on the type of language processing targeted. However, there is some support that rhythmic-melodic training has more impact on the right hemisphere than linguistic training. Concerning (2), we observed that language recovery is not only associated with changes in traditional language-related structures in the left hemisphere and homolog regions in the right hemisphere, but also with more medial and subcortical changes (e.g., precuneus and basal ganglia). Although it is difficult to draw strong conclusions, because there is a lack of systematic large-scale studies on this topic, this review highlights the need for an integrated approach to investigate how language interventions impact on the brain. Future studies need to focus on larger samples preserving subject-specific information (e.g., lesion effects) to cope with the inherent heterogeneity of stroke-induced aphasia. In addition, recovery-related changes in whole-brain connectivity patterns need more investigation to provide a comprehensive neural account of treatment-related brain plasticity and language recovery.
The first Sri Lankan species of Labomimus Sharp (Coleoptera: Staphylinidae: Pselaphinae)
Authors: LI NING , YIN ZI-WEI
Published: July 2020

The genus Labomimus Sharp is represented by 44 species widely distributed in Asia, yet no species have been recorded from Sri Lanka. In the present paper, the first Sri Lankan species, L. srilankensis Li & Yin, sp. nov., is described and illustrated.
Domestic Abuse, Suicide and Liability for Manslaughter: In Pursuit of Justice for Victims
Authors: Lodge Anne
Published: July 2020

There is significant debate about the attribution of criminal responsibility for involuntary manslaughter to a defendant who has subjected a victim to a protracted campaign of emotional abuse (falling short of psychiatric injury), where the victim has consequently taken their own life. By virtue of it having been subjected to the most comprehensive judicial and academic scrutiny in this context, the primary focus of this discussion is on the applicability of the unlawful act manslaughter offence to the circumstances described above. The offence requires proof that the victim was placed at risk of some harm by virtue of the defendant’s criminal conduct and that the abusive conduct significantly contributed to the victim’s death. The accused does not have to foresee or intend the victim’s death, and while the imposition of criminal responsibility for serious homicide offences in cases where the defendant displays no subjective advertence to the risk of death has long been controversial, it is nonetheless well established in English and Welsh criminal law. Therefore, assuming satisfaction of the requisite offence elements, there is arguably no principled reason to deny the extension of liability to domestic abuse-induced suicide cases. It is proposed that a more progressive and transparent approach to the interpretation of the unlawful act manslaughter offence requirements provides the most appropriate means of securing prosecutions in deserving cases, although alternative options for the imposition of liability—the offence of gross negligence manslaughter and the creation of a context-specific homicide offence—are also acknowledged. It is argued that the constructive manslaughter offence label reflects both the moral culpability of the perpetrator’s patterned and invasive conduct and the exceptional gravity of the harm caused by non-physical domestic abuse.
Female outsiders in South Korea’s dual labour market: Challenges of equal pay for work of equal value
Authors: Lee Sophia Seung-Yoon , Kim Yuhwi
Published: July 2020

South Korea has a persistent gender pay gap despite its ratification of the Equal Remuneration Convention of the International Labour Organisation (ILO 100) and regulatory commitments to equal pay. This article identifies the extent to which the South Korean gendered dual labour market structure, notably the marked and gendered division between regular and irregular work, presents barriers to gender pay equality, and specifically to the implementation of equal pay principles. A layered examination of employment data, narrowing from aggregate statistics to occupations within two sub-industry groups, is used to examine how pay differences between women and men in work that is similar in content and educational requirements arise from their mode of employment, whether they are employed as regular or irregular workers. These structural divisions in the South Korean labour market are underpinned by a divided wage-setting system within which irregular workers are mostly excluded from benefits such as wage increases arising from seniority, and objective assessments of work value are lacking. In combination, these features help to explain why the principle of equal pay for equal work is breached and why limited progress has been made in meeting the requirements of equal pay for work of equal value.
Barriers to Impact Factor Growth in Two Major Psychiatry Journals in India
Authors: D’cruz Migita , Andrade Chittaranjan
Published: July 2020

Background:

Despite exponential growth in Indian research, Indian journals have low impact factors. A previous study by one of the authors (CA) of this paper showed that articles published in the Indian Journal of Psychiatry (IJP) under-referenced previously published relevant papers in the same journal. Based on this, we decided to investigate the citation characteristics of contemporary scientific articles published in the Indian Journal of Psychological Medicine (IJPM).

Methods:

The citation characteristics of scientific articles published in 2018 (Vol 40, issues 1–6) in the IJPM were examined to determine how well the authors cited relevant articles published during the past ten years in the IJPM and the IJP.

Results:

There were 145 and 142 citation-worthy articles in the IJPM and the IJP, respectively; of these, 85.5% and 65.5%, respectively, had not been cited.

Conclusions:

Authors publishing in the IJPM under-reference previous relevant research published in the IJPM and IJP. This suggests unawareness of, deliberate disregard of, or even disdain for prior Indian research in the field. Additionally, if Indian researchers do not cite previous Indian research in the field published in Indian journals, the citation metrics of Indian journals will not grow.
A soft manipulator for efficient delicate grasping in shallow water: Modeling, control, and real-world experiments
Authors: Gong Zheyuan , Fang Xi , Chen Xingyu , Cheng Jiahui , Xie Zhexin , Liu Jiaqi , Chen Bohan , Yang Hui , Kong Shihan , Hao Yufei , Wang Tianmiao , Yu Junzhi , Wen Li
Published: July 2020

Collecting in shallow water (water depth: ~30 m) is an emerging field that requires robotics for replacing human divers. Soft robots have several promising features (e.g., safe interaction with the environments, lightweight, etc.) for performing such tasks. In this article, we developed an underwater robotic system with a three-degree-of-freedom (3-DoF) soft manipulator for spatial delicate grasping in shallow water. First, we present the design and fabrication of the soft manipulator with an opposite-bending-and-stretching structure (OBSS). Then, we proposed a simple and efficient kinematics method for controlling the spatial location and trajectory of the soft manipulator’s end effector. The inverse kinematics of the OBSS manipulator can be solved efficiently (computation time: 8.2 ms). According to this inverse kinematics method, we demonstrated that the OBSS soft manipulator could track complex two-dimensional and three-dimensional trajectories, including star, helix, etc. Further, we performed real-time closed-loop pick-and-place experiments of the manipulator with binocular and on-hand cameras in a lab aquarium. Hydrodynamic experiments showed that the OBSS soft manipulator produced little force (less than 0.459 N) and torque (less than 0.228 N·m), which suggested its low-inertia feature during the underwater operation. Finally, we demonstrated that the underwater robotic system with the OBSS soft manipulator successfully collected seafood animals at the bottom of the natural oceanic environment. The robot successfully collected eight sea echini and one sea cucumber within 20 minutes at a water depth of around 10 m.
Developing an Automated Technique to Calibrate the AASHTOWare Pavement ME Design Software
Authors: Islam Shuvo , Bose Avishek , Jones Christopher A. , Hossain Mustaque , Vahl Cristopher I.
Published: July 2020

Many state highway agencies are in the process of implementing the AASHTOWare Pavement ME Design (PMED) software for routine pavement design. However, a recurring implementation challenge has been the need to locally calibrate the software to reflect an agency’s design and construction practices, materials, and climate. This study introduced a framework to automate the calibration processes of the PMED performance models. This automated technique can search PMED output files and identify relevant damages/distresses for a project on a particular date. After obtaining this damage/distress information, the technique conducts model verification with the global calibration factors. Transfer function coefficients are then automatically derived following an optimization technique and numerical measures of goodness-of-fit. An equivalence statistical testing approach is conducted to ensure predicted performance results are in agreement with the measured data. The automated technique allows users to select one of three sampling approaches: split sampling, jackknifing, or bootstrapping. Based on the sampling approach chosen, the automated technique provides the calibration coefficients or suitable ranges for the coefficients and shows the results graphically. Model bias, standard error, sum squared error, and p-value from the paired t-test are also reported to assess efficacy of the calibration process.
Culturally Sensitive Care in the Neonatal Setting to Infants Born to Parents From the Traveler Community: An Exploration of the Perspectives of Neonatal Staff
Authors: Beirne Irene , Bradshaw Carmel , Barry Maebh
Published: July 2020

Introduction: Culture and traditions influence people’s health beliefs and these influence their actions and behaviors to prevent ill health and promote health and well-being. This qualitative study explored nurses’/midwives perspectives of culturally sensitive care in a neonatal setting to infants born to parents from the Traveler community. Method: A descriptive qualitative approach was used to interview 10 nurses/midwives from a neonatal unit in Ireland. Data were analyzed using Burnard’s framework. Results: Themes identified were as follows: (a) barriers to breastfeeding for women from the Traveler community, (b) cultural issues affecting care provision to Traveler families in the neonatal unit, and (c) concerns of neonatal staff for infants born within the Traveler community. Discussion: The culture of the Traveler group was recognized as a major influence on decision making and interactions within the neonatal unit. Strategies are identified that could enhance the care of this group and the care of other ethnic groups.
The Public Health Value of Opioid Litigation
Authors: Haffajee Rebecca L.
Published: July 2020

Opioid litigation continues a growing public health litigation trend in which governments seek to hold companies responsible for population harms related to their products. The litigation can serve to address gaps in regulatory and legislative policymaking and in market self-regulation pervasive in the prescription opioid domain. Moreover, prior opioid settlements have satisfied civil tort litigation objectives of obtaining compensation for injured parties, deterring harmful behavior, and holding certain opioid manufacturers, distributors and pharmacies accountable for their actions. In this way, opioid litigation represents progress over prior public health litigation campaigns involving tobacco, lead paint, and asbestos, which had more limited tort litigation effects. Although opioid litigation is not a comprehensive solution to the opioid crisis, it can complement other strategies and infuse much needed money, behavior changes, and public accountability for prescription opioid and related harms.
Assessing, Consulting, Reporting Heuristics in Professional Decision-Making Regarding Suspected Child Maltreatment in Community Healthcare Services
Authors: Enosh Guy , Alfandari Ravit , Nouman Hani , Dolev Lilach , Dascal-Weichhendler Hagit
Published: July 2020

This study investigated child protection decision-making practices of healthcare-professionals in community-health-services. We examined the effect of heuristics in professional judgments regarding suspected maltreatment, as affected by the child’s ethnicity, gender, and family socioeconomic-status, as well as the healthcare-worker’s workload-stress, and personal and professional background. Furthermore, we examined how these variables influence judgments regarding suspected maltreatment and intentions to consult and report child-maltreatment. We used an experimental survey design including vignettes manipulating the child’s characteristics. Data was collected from 412 professionals employed at various community-health-service-clinics of the largest health-management organization in northern Israel. Findings show that all subjective factors have a significant effect on suspected child-maltreatment assessment, which appears as a significant predictor of later decisions regarding consultation and reporting. This study lends support to prior research indicating that healthcare-professionals’ decisions may incorporate biases, and suggests how the effects of these biases’ are mediated through a sequence of decisions. Recommendations focus on providing regular consultation opportunities for practitioners.
Social policy outcomes of government participation by radical right parties
Authors: Chueri Juliana
Published: July 2020

The literature has pointed to a change in radical right-wing parties’ (RRWPs) position regarding the welfare state. Those parties have abandoned the neoliberal approach on distributive issues and have become defenders of social expenditure for deserving groups. Nevertheless, as RRWPs have joined with right-wing mainstream parties to form governments, their distributive policy position might cause conflict in a coalition. This study, therefore, addresses this puzzle by analysing the social policy outcomes of RRWPs’ government participation. The conclusion is that those parties contribute to the welfare state retrenchment. However, policies are not affected evenly. Expenditure that targets groups regarded as undeserving by the radical right is retrenched the most.
Drug-coated balloons: Technical and clinical progress
Authors: Ang Huiying , Koppara Tobias R , Cassese Salvatore , Ng Jaryl , Joner Michael , Foin Nicolas
Published: July 2020

The advancement of drug-coated balloons (DCB) presents an alternative nonstent method in the percutaneous treatment of atherosclerotic lesions. While the current generation of drug-eluting stents (DES) are the device of choice, especially in coronary artery disease (CAD), DCB has potential applications in the treatment of de novo lesions, in-stent restenosis (ISR), bifurcations, and in peripheral artery disease (PAD). In terms of coronary clinical experience, DCB is used most in ISR scenarios and more data are collected to support the use of DCB in de novo lesions compared to best-in-class DES. The use of DCB in bifurcation side branch treatment has demonstrated safety, and with good angiographic and clinical outcomes, but more data from randomized trials will be required to assess its clinical value. For PAD, the clinical outcomes of DCB with and without debulking devices in diseased femoropopliteal arteries and treatment of below-the-knee (BTK) vessels with DCB are discussed. Current data demonstrated conflicting long-term safety outcomes in the use of paclitaxel devices in the femoral and/or popliteal arteries, while the role of DCB in BTK disease remains uncertain due to a lack of randomized controlled trial data. In summary, this review provides an overall view of current DCB technologies and progress, followed by an update on DCB clinical data in the treatment of CAD and PAD.
Workforce diversity, diversity training and ethnic minorities: The case of the UK National Health Service
Authors: Hussain Basharat , Sheikh Abdullah , Timmons Stephen , Stickley Theodore , Repper Julie
Published: July 2020

This research studied an NHS organization as a case to explore how it is responding to cross-cultural issues against a backdrop of policy expectations about equitable and good quality mental health service provision to service users of a minority ethno-cultural group in the UK. Data were collected by conducting semi-structured interviews with 20 participants from three hierarchical levels of the organization. The research found that the concepts of culture and ethnicity are used in a fixed way in the interventions (staff diversity training and ethnic matching) taken by the case organization. It is argued that this fixed understanding of cultural concepts and related interventions may not be helpful in meeting the needs of service users, especially in the context of United Kingdom, which is characterized as a super-diverse society. It appears that the interventions are developed and implemented on the conceptualization of cultural identity as generic and fixed. Organizations working in a multicultural society, or where they have service users from a variety of ethnic and cultural backgrounds, need to develop and implement interventions based on individualized and fluid understanding of such concepts. The findings of this study contribute to cross-cultural management scholarship by taking a critical stance on the concept of culture, as it is operationalized by a large organization. We show how, even when required by national policy, this one-dimensional model of culture causes human resource management interventions, intended to address cultural diversity, to be perceived as ineffective.
A Stepwise Approach to Systematic Reviews and Meta-analyses of Endovascular Interventions
Authors: Antoniou George A. , Biondi-Zoccai Giuseppe , Versaci Francesco , Antoniou Stavros A.
Published: July 2020

The accrual of clinical studies poses important challenges to researchers and practitioners, especially in the field of endovascular therapy, where patient, lesion, technique, and device subtleties abound. Systematic reviews and meta-analyses may prove particularly fruitful in such settings by increasing statistical precision and bolstering external validity if the evidence base on a specific topic is consistent or by highlighting important discrepancies in the opposite scenario. However, mastering the correct approach to systematic review and meta-analysis is challenging for careful readers or for those interested in conducting such an evidence synthesis exercise. The present article highlights a stepwise approach to systematic reviews and meta-analyses, focusing on endovascular interventions, which will prove useful to anyone reading or wishing to synthesize the evidence base on endovascular topics to optimize decision making or shape future research efforts.
Investigation on the processability, structure and properties of micro-/nano-fiber composite yarns produced by trans-scale spinning
Authors: Yang Yuchen , Quan Zhenzhen , Zhang Hongnan , Qin Xiaohong , Wang Rongwu , Yu Jianyong
Published: July 2020

While the conventional composite yarns are generally confined to micro-scale fibers, composite yarns of micro-/nano-fibers have been fabricated by integrating carded fibrous web with electospun nanofibers, namely trans-scale spinning proposed in our latest works. In the micro-/nano-fiber composite yarns, the nanofibers with low content were embedded uniformly both inside and outside with short fibrous segments, which endows themselves with superior functionality without altering the intrinsic comfort, such as the durably efficient antibacterial capability of comfortable cotton fabric. In the present work, universal applicability of the trans-scale spinning approach has been investigated systematically. Various composite yarns were successfully fabricated by the novel spinning technique. The effects of three critical factors, microfiber materials, nanofiber polymers and spinning methods, on the structural characteristics and physical properties of composite yarns were demonstrated experimentally and theoretically. It was indicated that nanofibers are distributed uniformly in all resulting yarns, but broken segments of them in synthetic microfiber composite yarns are shorter than that in cotton composite yarns, which may result from different fiber appearance. Besides, the composite yarns present comparable physical properties (tensile performance, hairiness, unevenness) to those of pristine microfiber yarns, which enable themselves of being manufactured into all kinds of fabrics for industrial applications. The results reported in the current study would facilitate the design and preparation of composite yarn and the development of functional textiles.
New-Onset Alzheimer’s Disease and Normal Subjects 100% Separated Statistically by P300 and ICA
Authors: Jervis Barrie William , Bigan Cristin , Besleaga Mircea
Published: July 2020

Previously, we described how patients with new-onset Alzheimer’s disease were differentiated from healthy, normal subjects to 100% accuracy, based on the amplitudes of the nonrhythmic back-projected independent components of the P300 peak at the electroencephalogram electrodes and their latency in the response to an oddball, auditory evoked potential paradigm. A neural network and a voting strategy were used for classification. Here, we consider instead the statistical distribution functions of their latencies and amplitudes and suggest that the 2-sample Kolmogorov-Smirnov test based upon their latency distribution functions offers an alternative biomarker for AD, with their amplitude distribution at the frontal electrode fp2 as possibly another. The technique is general, relatively simple, and noninvasive and might be applied for presymptomatic detection, although further validation with more subjects, preferably in multicenter studies, is recommended. It may also be applicable to study the other P300 peaks and their associated interpretations.
The Meaningful Lived Space of the Acute Stroke Unit: Creating Maps to Evoke the Experience of Stroke Survivors and Health Care Practitioners
Authors: Suddick Kitty Maria , Cross Vinette , Vuoskoski Pirjo , Galvin Kathleen T. , Stew Graham
Published: July 2020

Despite advocates for aesthetic forms of presentation in qualitative enquiry, for going beyond thin description, to share evocative forms of representation that resonate with that (Todres, 2008; Todres & Galvin, 2008), qualitative research in the health care field continues to favor conventional methods. This article adds to existing knowledge by articulating the innovative creation and value of aesthetic offerings in the unique form of visual maps to evoke the lived experience of being on an acute stroke unit, drawn from phenomenological interview findings. The maps helped embody the meaningful lived space and conveyed the complexity, spatiality, and holistic understanding being developed. They embodied the researcher’s involvement, position, and place as she imaginatively lived through the space of the acute stroke unit and proceed to invite others to join the dialogue. This article articulates the methodical alignment of creative mapmaking within three stages, for the development of phenomenological understanding, dialogue in-between, and ongoing life of dialogue for future projections toward practice and within the phenomenological project. This article illustrates the underutilized potential of mapmaking for the human sciences, understanding health care spaces, other meaningful lived spaces, and qualitative research methods.
Shared leadership: Struggles over meaning in daily instances of uncertainty
Authors: Gadelshina Gyuzel
Published: July 2020

Research presented in this article advances existing work on shared leadership and organizational sensemaking by an empirical demonstration of the organizing properties of leadership in daily instances of uncertainty. Drawing on conversation analysis combined with ethnographic data collected during 12-month fieldwork, this article spells out the conversational mechanisms and discursive practices used by leadership actors in the process of sensemaking directed towards organizationally relevant goals. Through a fine-grain analysis of an extended troubles-telling sequence in a particular meeting encounter, this study shows how conversation analysis–inspired research can be used to add a more nuanced understanding of a substantive area of social life, such as shared leadership which is achieved in interaction and which involves various leadership actors, regardless of their hierarchical positions and organizational roles.
Tenecteplase versus alteplase after acute ischemic stroke at high age
Authors: Thommessen Bente , Næss Halvor , Logallo Nicola , Kvistad Christopher E , Waje-Andreassen Ulrike , Ihle-Hansen Hege , Ihle-Hansen Håkon , Thomassen Lars , Morten Rønning Ole
Published: July 2020

Background

Stroke prevalence is increasing with age. Alteplase is the only agent approved for thrombolytic treatment for patients with ischemic stroke, including patients ≥80 years. In the present study, the aim was to compare efficacy and safety of tenecteplase and alteplase in patients ≥80 years.

Methods

Data from the Norwegian Tenecteplase Stroke Trial, a randomized controlled trial comparing alteplase and tenecteplase, were assessed.

Results

Of the 273 patients ≥80 years included, mean age was 85.5 years. In the intention-to-treat analyses, 43.1% receiving tenecteplase and 39.9% receiving alteplase reached excellent functional outcome (modified Rankin Scale score 0–1) after 3 months (odds ratio (OR) 1.14, 95% confidence interval (CI) 0.70–1.85, p=0.59). No significant differences among patients in the two treatment groups regarding frequency of symptomatic intracranial hemorrhage during the first 48 h were identified (11 (8.5%) in the tenecteplase group, 10 (7.0%) in the alteplase group, OR 1.23, 95% CI 0.50–3.00, p 0.65). Death within 3 months occurred in 18 patients (14.3%) in the tenecteplase group and in 21 (15.3%) in the alteplase group (p 0.84). After excluding stroke mimics, the proportion of patients with excellent functional outcome was 44.1% in the tenecteplase group and 34.4% in the alteplase group (OR 1.50 CI 0.90–2.52, p 0.12).

Conclusion

No differences in the efficacy and safety of tenecteplase versus alteplase in patients ≥80 years were identified.

Trial registration

Clinicaltrials.gov (NCT01949948)
Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?
Authors: Bouchart Christelle , Navez Julie , Closset Jean , Hendlisz Alain , Van Gestel Dirk , Moretti Luigi , Van Laethem Jean-Luc
Published: July 2020

Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive solid tumours with an estimated 5-year overall survival rate of 7% for all stages combined. In this highly resistant disease that is located in the vicinity of many radiosensitive organs, the role of radiotherapy (RT) and indications for its use in this setting have been debated for a long time and are still under investigation. Although a survival benefit has yet to be clearly demonstrated for RT, it is the only technique, other than surgery, that has been demonstrated to lead to local control improvement. The adjuvant approach is now strongly challenged by neoadjuvant treatments that could spare patients with rapidly progressive systemic disease from unnecessary surgery and may increase free margin (R0) resection rates for those eligible for surgery. Recently developed dose-escalated RT treatments, designed either to maintain full-dose chemotherapy or to deliver a high biologically effective dose, particularly to areas of contact between the tumour and blood vessels, such as hypofractionated ablative RT (HFA-RT) or stereotactic body RT (SBRT), are progressively changing the treatment landscape. These modern strategies are currently being tested in prospective clinical trials with encouraging preliminary results, paving the way for more effective treatment combinations using novel targeted therapies. This review summarizes the current literature regarding the use of RT for the treatment of primary PDAC, describes the limitations of conventional RT, and discusses the emerging role of dose-escalated RT and heavy-particle RT.
Pediatric Palate Fractures: An Assessment of Patterns and Management at a Level 1 Trauma Center
Authors: Gala Zachary , Halsey Jordan N. , Kapadia Kavita , Otaguro Lauren , Hoppe Ian C. , Lee Edward S. , Granick Mark S.
Published: July 2020

Study Design:

Literature discussing palate fractures in the pediatric population is limited. We performed a retrospective review of pediatric palatal fractures at our institution to better understand the impact of this fracture pattern in the pediatric patient.

Objectives:

The goal of our study is to analyze our institutional experience with pediatric palate fractures, focusing on epidemiology, concomitant injuries, and fracture management.

Methods:

Records were collected for all palatal fractures in pediatric patients diagnosed between 2000 and 2016 at an urban Level I trauma center. Patient imaging was reviewed. Demographic characteristics and inpatient clinical data were recorded.

Results:

Nine pediatric patients were diagnosed with fracture of the bony palate. Average age was twelve with male predominance (66%). Pedestrian struck injuries (33%) and motor vehicle accidents (33%) were the most common etiologies. Five patients sustained skull fractures. Three patients were found to have intracranial hemorrhage, two required emergent bolt placement. Two patients sustained cervical spine injury. One patient had severe facial hemorrhage requiring embolization. According to the Hendrickson classification, there were three type I fractures, two type II fractures, one type III fracture, one type IV fracture, and one type V fracture. Lefort I and/or alveolar fracture was present in every patient. Four patients underwent surgical treatment with open reduction and restoration of facial height with maxillomandibular fixation. Three patients underwent concomitant mandible fracture repair.

Conclusions:

Pediatric palatal fractures are rare and are usually accompanied by devastating concomitant injuries. Surgical repair of the palate in the pediatric patient is often necessary to restore facial height.
Invasive Hemodynamic Characteristics in Patients Undergoing Transcatheter Tricuspid Valve-In-Valve Implantation for Treatment of Tricuspid Stenosis
Authors: Patel Krishan , Sadeghi Soraya , Aboulhosn Jamil
Published: July 2020

Background:

We sought to describe invasive hemodynamic measurements in patients with tricuspid stenosis (TS) undergoing transcatheter tricuspid valve-in-valve (TVIV) implantation immediately pre- and postimplantation. Development of TS in patients who have undergone surgical tricuspid valve replacement with a bioprosthetic valve is a serious complication that leads to elevated right atrial (RA) pressures and decreased cardiac output. Transcatheter TVIV implantation is a viable alternative to surgical tricuspid valve replacement, but data on the hemodynamic consequences of TVIV for the treatment of severe TS are currently limited to echocardiographic assessment of Doppler-derived gradients.

Methods:

Eleven patients undergoing transcatheter TVIV implantation with moderate to severe bioprosthetic valve stenosis were selected for retrospective review. Right atrial mean pressure, right ventricular (RV) systolic and end-diastolic pressure, mean diastolic RA-RV pressure gradient, pulmonary artery capillary wedge pressure, pulmonary artery systolic, end-diastolic and mean pressures, and pulmonary artery pulsatility index (PAPi) both before and after transcatheter valve placement were collected from catheterization reports.

Results:

After transcatheter TVIV implantation, the mean TS gradient decreased significantly ( P < .01), while the mean RV end-diastolic pressure increased ( P = .046). Pulmonary artery pulsatility index also increased as the TS was relieved ( P = .039).

Conclusions:

Tricuspid valve-in-valve implantation results in immediate relief of TS, leading to increased RV preload with resultant augmentation of RV and pulmonary pressures. Increased PAPi following the procedure demonstrates acute improvement in RV output but remains low due to the failure of the RA pressure to decline significantly immediately following intervention.
Efficacy of Nitric Oxide Administration in Attenuating Ischemia/Reperfusion Injury During Neonatal Cardiopulmonary Bypass
Authors: Elzein Chawki , Urbas Cynthia , Hughes Bonnie , Li Yi , Lefaiver Cheryl , Ilbawi Michel , Vricella Luca
Published: July 2020

Objective:

Nitric oxide (NO) plays several protective roles in ischemia/reperfusion (I/R) injury. Neonates undergoing the Norwood procedure are subject to develop I/R injury due to the immaturity of their organs and the potential need to interrupt or decrease systemic flow during surgery. We hypothesized that NO administration during cardiopulmonary bypass (CPB) ameliorates the I/R and could help the postoperative recovery after the Norwood procedure.

Methods:

Twenty-four neonates who underwent a Norwood procedure were enrolled in a prospective randomized blinded controlled trial to receive NO (12 patients) or placebo (12 patients) into the oxygenator of the CPB circuit during the Norwood procedure. Markers of I/R injury were collected at baseline (T0), after weaning from CPB before modified ultrafiltration (T1), after modified ultrafiltration (T2), and at 12 hours (T3) and 24 hours (T4) after surgery, and they were compared between both groups, as well as other postoperative clinical variables.

Results:

There was no difference in age, weight, anatomical diagnosis, CPB, and aortic cross-clamp time between both groups. Troponin levels were lower in the study group at T1 (0.62 ± 58 ng/mL vs 0.87 ± 0.58 ng/mL, P = .31) and became significantly lower at T2 (0.36 ± 0.32 ng/mL vs 0.97 ± 0.48 ng/mL, P = .009).There were no significant differences between both groups for all other markers. Despite a lower troponin level, there was no difference in inotropic scores or ventricular function between both groups. Time to start diuresis, time to sternal closure and extubation, and intensive care unit and hospital stay were not different between both groups.

Conclusion:

Systemic administration of NO during the Norwood procedure has myocardial protective effects (lower Troponin levels) but we observed no effect on postoperative recovery. Larger sample size may be needed to show clinical differences.
Attitudes to Cardiac Xenotransplantation by Pediatric Heart Surgeons and Physicians
Authors: Padilla Luz A. , Sorabella Robert A. , Carlo Waldemar F. , Dabal Robert J. , Rhodes Leslie , Cleveland David C. , Cooper David K. , Paris Wayne
Published: July 2020

Background:

Cardiac transplantation in early childhood is limited by scarcity of organ donors. Advances in cardiac xenotransplantation (XTx) research suggest that xenografts may one day represent an alternative to allografts. We sought to determine the attitudes among surgeons and cardiologists in the field of pediatric cardiac transplantation toward the potential use of XTx if this clinical option were to become a reality.

Methods:

A Likert-scale anonymous survey addressing the use of XTx in pediatric patients was sent to members of the Congenital Heart Surgeons (CHS) Society and the Pediatric Heart Transplant Society. Results were described and compared between the two surgeon/physician groups.

Results:

Ninety-two CHS and 42 pediatric transplant cardiologists (PTC) responded (N = 134). The potential acceptance of XTx was high in both groups, assuming risks and results were similar to those of cardiac allotransplantation (88% CHS vs 81% PTC; P = .07). When asked if they would recommend a xenograft, if the results were anticipated to be inferior to those of cardiac allotransplantation, as a bridge to a human heart, potential acceptance fell dramatically but remained higher among CHS than PTC (41% vs 17%, p 0.02). Approximately only one-third of CHS and half of PTC preferred primary cardiac XTx for hypoplastic left heart syndrome if there was no waitlist time and had similar outcomes to allotransplantation.

Conclusions:

Our findings suggest that potential acceptance of XTx by CHS and PTC would not be a major barrier if XTx demonstrated similar outcomes to allotransplantation. Acceptance by other congenital heart stakeholders remains to be investigated.
Rural America’s Hospitals are Not Prepared to Protect Older Adults From a Surge in COVID-19 Cases
Authors: Davoodi Natalie M. , Healy Margaret , Goldberg Elizabeth M.
Published: July 2020

Rural communities with predominantly older adult populations could be especially vulnerable to poor outcomes from COVID-19 due to lacking intensive care unit (ICU) capacity. Our objective is to describe the scope of the problem by summarizing population totals of older adults in rural America and their community’s ICU bed availability. We performed a review of peer-reviewed literature, in addition to hand searching non–peer-reviewed and governmental/non-governmental agency reports, using the Kaiser Health News data report to assess the number of ICU beds in 10 predominantly rural states with the highest older adult populations. We found that while 19% of the U.S. population lives in rural counties, these counties contain only 1% of the ICU beds in the United States. Counties particularly at risk for inadequate ICU capacity include Crittenden, Arkansas; Cass, Minnesota; and Sagadahoc, Maine. Solutions include building new delivery systems, reopening previously closed rural hospitals, and calling on local businesses to create medical supplies. In summary, the 10 million older adults in rural communities in the United States may face challenges with obtaining critical care treatment due to the increased need of ICU beds during the COVID-19 pandemic.
Multiple performance pressure inconsistency, resource slack, and the firm’s R&D investment: A behavioral agency theory perspective
Authors: Diwei Lv David , Chen Weihong , Lan Hailin
Published: July 2020

In the process of operation, firms will face different types of performance pressure. The inconsistency among multiple performance pressure signals has an important impact on resource allocation and R&D investment. However, at present, studies on the impact of multiple performance pressures on the firm’s resource allocation and R&D investment are very limited, and few studies have analyzed the impact of inconsistencies among multiple performance pressure signals on the firm’s R&D investment. Given this research gap, this article empirically tested a model from the perspective of behavioral agency theory, in which inconsistency in long- and short-term performance pressure facilitates the accumulation of organizational slack. We further test the impact of an increase in organizational slack on the firms’ R&D investment intensity and find that this effect is stronger when the level of managerial ownership is comparatively low. These results together indicate that high inconsistency in performance pressure and low managerial ownership jointly facilitate the accumulation of organizational slack, enabling firms to go beyond local search and have more slack searches in the face of multiple performance pressure, which is conducive to an increase in R&D investment.

JEL CLASSIFICATION: M10.
Parent Experiences Caring for a Child With Bronchiolitis: A Qualitative Study
Authors: Campbell Alyson , Hartling Lisa , Louie-Poon Samantha , Scott Shannon D
Published: July 2020

Background:

Bronchiolitis is an acute lower respiratory infection, with significant impacts on children and families and strains on the health care system. Understanding parents’ experiences and information needs caring for a child with bronchiolitis is crucial to highlight misconceptions or issues contributing to the high burden. The objective of this qualitative study was to describe parents’ experiences caring for a child with bronchiolitis.

Methods:

Qualitative description guided this study. Participants were recruited from the Stollery Children’s Hospital emergency department (ED), a specialized pediatric ED in a major Canadian urban center. Semi-structured interviews were conducted with 15 parents.

Results:

Five major themes were identified: (a) their children’s symptoms and behaviors, (b) bronchiolitis affects the entire family, (c) factors influencing parent’s decision to go to ED, (d) ED experience for parents and their children, and (e) bronchiolitis treatment and management. Interviews revealed bronchiolitis has significant effects on both children and families and parents are generally unaware of bronchiolitis symptoms, treatment, and management.

Conclusions:

Our study highlights that parents have knowledge deficits when it comes to recognizing the presence and severity of bronchiolitis symptoms. Parents would benefit from having more evidence-based resources to enhance their knowledge about the nature of bronchiolitis.
Why Companion Animals Are Beneficial During COVID-19 Pandemic
Authors: Hunjan Unnati G , Reddy Jayasankara
Published: July 2020

Companion animals and pets can be helpful during the novel coronavirus-19 pandemic. Interactions with them and positive physical contact lead to a variety of physiological and psychological benefits. It also releases biochemicals which can further boost the immune system and enhance health and well-being. This perspective discusses the benefits of these interactions, the modes of interactions and the activities that can be used. It also highlights the individuals that should avoid this approach and the status of the animal’s health before engaging with them.
The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis
Authors: Meisman Andrea , Daraiseh Nancy M. , Minar Phil , Saxe Marlee , Lipstein Ellen A.
Published: July 2020

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.