bluuebunny/crossref_metadata_2025 huggingface dataset:
Update in the understanding of new daily persistent headache
Authors: Peng Kuan-Po , Rozen Todd D
Published: February 2023

Background Accumulating evidence suggests various specific triggers may lead to new daily persistent headache (NDPH)-like presentations, suggesting that new daily persistent headache is a heterogenous syndrome, and challenging the concept that new daily persistent headache is a primary headache disorder.

Method We searched the PubMed database up to August 2022 for keywords including persistent daily headache with both primary and secondary etiologies. We summarized the literature and provided a narrative review of the clinical presentation, diagnostic work-ups, possible pathophysiology, treatment response, and clinical outcomes.

Results and conclusion New daily persistent headache is a controversial but clinically important topic. New daily persistent headache is likely not a single entity but a syndrome with different etiologies. The issue with past studies of new daily persistent headache is that patients with different etiologies/subtypes were pooled together. Different studies may investigate distinct subsets of patients, which renders the inter-study comparison, both positive and negative results, difficult. The identification (and removal) of a specific trigger might provide the opportunity for clinical improvement in certain patients, even when the disease has lasted for months or years. Nonetheless, if there is a specific trigger, it remains unknown or unidentified for a great proportion of the patients. We need to continue to study this unique headache population to better understand underlying pathogenesis and, most importantly, to establish effective treatment strategies that hopefully resolve the continuous cycle of pain.
Oxygen Diffusion Coefficients of Asphalt Mixtures and Their Impacts on Mixture Aging
Authors: Chen Xingyu , Wang Yuhong , Wen Yong , Cheng Huailei , Hao Gengren
Published: February 2023

The oxidative aging of asphalt binder affects the long-term performance of flexible pavement. Apart from the intrinsic property of asphalt binder, binder aging in an asphalt mixture is also affected by the mixture’s oxygen transport efficiency, which can be characterized by the oxygen diffusion coefficient. In this study, the diffusion coefficients ( Ds) of compacted asphalt mixtures of different designs were determined. The same mixture samples were also aged in one dimension for a relatively long period of time. Asphalt binders from different slices of the aged specimens were extracted and recovered, and their aging states were determined. Influences of Ds and air void content on binder aging gradient and binder aging extent in the mixture samples were systematically examined and compared. The results indicate that, as compared with air voids, Ds is more closely related to the aging susceptibility of asphalt binders in asphalt mixtures. It may serve as a useful and convenient parameter in mixture design optimization, modeling and prediction of in situ pavement aging, and quality control and quality assurance (QC/QA) in pavement construction.
Head Start in Time or in Space? Determining Needed Leading Pedestrian Interval Length as a Function of Intersection Layout
Authors: Saeidi-Razavi Ray , Furth Peter
Published: February 2023

Where signalized pedestrian crossings run concurrently with vehicles, the permitted conflict between right-turning vehicles and pedestrians can be mitigated by giving pedestrians a head start. With a head start, pedestrians can establish themselves in the crosswalk before right-turning traffic can get there, reinforcing pedestrians’ priority and engendering better motorist yielding behavior. In some U.S. cities, it is becoming common to give pedestrians a head start “in time” by means of a leading pedestrian interval (LPI); however, pedestrians can also be given a head start “in space” using corner bulbouts, setback stoplines, and other protected intersection features that increase the distance from the pedestrian stopline to the vehicle stopline. A model was developed for determining the necessary LPI length as a function of an intersection’s corner geometry. Model elements include determining the path of a right-turning vehicle, defining the conflict zone, determining maximum vehicle speed, and modeling vehicle acceleration, so that vehicle and pedestrian time to reach the conflict zone can be determined. Application to a particular intersection showed that with (a) traditional corner geometry, (b) corner bulbouts added, and (c) a protected intersection layout, necessary LPI was 3.7, 1.1, and 0 s, respectively. The benefits of replacing an LPI with a head start in space included greater vehicle capacity and reduced cycle length, which in turn reduced pedestrian-, transit-, and vehicle delay and improved pedestrian compliance. To fully achieve these benefits, the Manual on Uniform Traffic Control Devices should consider eliminating its recommended minimum of 3 s for an LPI.
Active Road User Interactions With Autonomous Vehicles: Proactive Safety Assessment
Authors: Alozi Abdul Razak , Hussein Mohamed
Published: February 2023

This study aims to conduct a thorough assessment of pedestrian and cyclist safety in autonomous vehicle (AV) environments. To that end, the study utilized AV sensor data of over 1,500 driving hours from five sources in Canada, the United States, and Singapore. The sensor data were used to extract conflicts between AVs and active road users. The conflicts were then processed to develop accurate estimates of AV collisions involving pedestrians and cyclists based on the extreme value theory. Further in-depth assessments were conducted on the identified conflicts, by type and location, to highlight potential issues leading to risky conflicts. The results showed that the total number of predicted AV collisions involving active road users was 2.17 collisions per million AV kilometers travelled. Collisions involving pedestrians were slightly higher than those involving cyclists. Also, collisions in clear weather conditions slightly exceeded collisions in adverse weather conditions, although the difference was not statistically significant. The relative risk of collisions was developed for both pedestrian and cyclist conflicts per AV movement type. The results showed that for pedestrians, interactions with right-turning AVs are the riskiest, while interactions with left-turning AVs are the riskiest for cyclists. A thorough analysis of conflicts revealed many issues, including a higher tendency for pedestrian violations when interacting with AVs, aggressive AV behavior (particularly when interacting with pedestrians while making a right turn), AVs struggling to predict the path of cyclists (mainly because of cyclist violations), and AVs failing to interpret pedestrian intentions in some cases.
Does Avoiding Distressing Thoughts and Feelings Influence the Relationship between Carer Subjective Burden and Anxiety Symptoms in Family Carers of People with Dementia?
Authors: Van Hout Elien , Contreras Milena L , Mioshi Eneida , Kishita Naoko
Published: February 2023

Anxiety remains understudied in family carers of people with dementia. Understanding factors that moderate the relationship between stressors and anxiety symptoms in this population is critical to inform interventions. This study examined whether generic experiential avoidance (AAQ-II) and experiential avoidance specific to caregiving-related thoughts and feelings (EACQ) moderate the relationship between subjective burden (ZBI-12) and anxiety symptoms (GAD-7) in carers of people with dementia. The first model ( R2 = .66, ∆R 2 = .03) exploring the moderating effect of AAQ-II demonstrated a significant interaction term between AAQ-II and subjective burden. The second model ( R2 = .53, ∆R 2 = .03), exploring the moderating effect of EACQ, demonstrated a significant interaction term between EACQ and subjective burden. These results provide evidence that carers with higher levels of experiential avoidance may be particularly prone to the negative effect of subjective burden on anxiety symptoms. Clinical implications for assessment of experiential avoidance and its treatment in carers of people with dementia are discussed.
The limits of shame: UN shaming, NGO repression, and women's protests
Authors: Adhikari Bimal , King Jeffrey , Santoso Lie Philip
Published: February 2023

Within the human rights literature, a growing number of studies have focused on the factors that explain engagement in protests. Most prior studies of this type give little or no consideration to the effect of these factors on gender. Recently, though, some scholars have begun focusing on the gender dimension, exploring why women engage in protests specifically. In this study, we examine a previously unexplored factor, that of naming and shaming by the United Nations Human Rights Council (UNHRC), and its effect on the likelihood of women's protest activities. We argue that UNHRC shaming increases the likelihood of women engaging in protests. Moreover, given its preeminent position within the UN, UNHRC shaming should be much more effective in mobilizing women in comparison with shaming by non-governmental organizations (NGOs). However, in countries where governments actively repress NGOs, the effect of UNHRC shaming on women's protests should be smaller.
Diurnal Changes in Capecitabine Clock-Controlled Metabolism Enzymes Are Responsible for Its Pharmacokinetics in Male Mice
Authors: Akyel Yasemin Kubra , Ozturk Civelek Dilek , Ozturk Seyhan Narin , Gul Seref , Gazioglu Isil , Pala Kara Zeliha , Lévi Francis , Kavakli Ibrahim Halil , Okyar Alper
Published: February 2023

The circadian timing system controls absorption, distribution, metabolism, and elimination processes of drug pharmacokinetics over a 24-h period. Exposure of target tissues to the active form of the drug and cytotoxicity display variations depending on the chronopharmacokinetics. For anticancer drugs with narrow therapeutic ranges and dose-limiting side effects, it is particularly important to know the temporal changes in pharmacokinetics. A previous study indicated that pharmacokinetic profile of capecitabine was different depending on dosing time in rat. However, it is not known how such difference is attributed with respect to diurnal rhythm. Therefore, in this study, we evaluated capecitabine-metabolizing enzymes in a diurnal rhythm-dependent manner. To this end, C57BL/6J male mice were orally treated with 500 mg/kg capecitabine at ZT1, ZT7, ZT13, or ZT19. We then determined pharmacokinetics of capecitabine and its metabolites, 5′-deoxy-5-fluorocytidine (5′DFCR), 5′-deoxy-5-fluorouridine (5′DFUR), 5-fluorouracil (5-FU), in plasma and liver. Results revealed that plasma Cmax and AUC0-6h (area under the plasma concentration-time curve from 0 to 6 h) values of capecitabine, 5′DFUR, and 5-FU were higher during the rest phase (ZT1 and ZT7) than the activity phase (ZT13 and ZT19) ( p < 0.05). Similarly, Cmax and AUC0-6h values of 5′DFUR and 5-FU in liver were higher during the rest phase than activity phase ( p < 0.05), while there was no significant difference in liver concentrations of capecitabine and 5′DFCR. We determined the level of the enzymes responsible for the conversion of capecitabine and its metabolites at each ZT. Results indicated the levels of carboxylesterase 1 and 2, cytidine deaminase, uridine phosphorylase 2, and dihydropyrimidine dehydrogenase ( p < 0.05) are being rhythmically regulated and, in turn, attributed different pharmacokinetics profiles of capecitabine and its metabolism. This study highlights the importance of capecitabine administration time to increase the efficacy with minimum adverse effects.
Comparison of Person-Centered and Cumulative Risk Approaches in Explaining the Relationship Between Adverse Childhood Experiences and Behavioral and Emotional Problems
Authors: Hales George , Debowska Agata , Rowe Richard , Boduszek Daniel , Levita Liat
Published: February 2023

Adverse childhood experiences (ACEs) commonly co-occur, and researchers often estimate their impact using a cumulative risk approach. The person-centered approach offers another approach to operationalize the co-occurrence of ACEs. This study aims to estimate latent classes of ACEs in a sample of U.K. children, examine their relationship with emotional and behavioral problems, and compare the explanatory value of the latent classes to cumulative risk scores. Data were collected among a general population sample of British 10-year-old children extracted from the U.K. Household Longitudinal Study ( N = 601). Seven items characterized ACEs, comprising parent-report physical discipline, emotional abuse, supervisory neglect, maternal psychological distress, child-report parental educational disinterest, bullying victimization, and adverse neighborhood. Outcome measures were derived from the self-report Strengths and Difficulties Questionnaire including total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior. Latent class analysis resulted in a three-class solution: low ACEs, household challenges, and community challenges. Compared to the other classes, the community challenges class scored substantially worse on total difficulties, emotional symptoms, and peer subscales. The cumulative risk score was associated with all outcomes except prosocial behavior. Cumulative risk models accounted for a larger proportion of variance compared with the latent class models, except for peer problems which the person-centered model explained better. This study confirms that ACEs are associated with impairment in child functioning, and that both person-centered and cumulative risk approaches can capture this relationship well. Specifically, the person-centered approach demonstrated how co-occurring risk factors in the community challenges class produced particularly poor internalizing outcomes.
Does It Matter Who Evaluates Teachers? Principal Versus Teacher-Led Evaluation and Teacher Motivation
Authors: Ford Timothy G. , Lavigne Alyson L.
Published: February 2023

Increasing job demands and continuing struggles to improve teacher evaluation practice raise the question of how peers might assist principals with teacher evaluation. Using a robust international sample (TALIS2013) of 36,411 teachers from 2,759 schools in 11 countries, we tested the hypothesis that teacher-led evaluation practices are associated with more teacher-reported positive changes in classroom practice, confidence, and motivation than principal-led evaluation practices in three areas evaluation: (1) classroom observations, (2) assessments of teacher content knowledge, and (3) analysis of student test score data. We found that teacher-led evaluation is associated with more positive feelings of motivation and change in practice for all three evaluation areas, but particularly for assessments of teacher content knowledge and test score data analysis. Further, principals’ reported use of extrinsic motivational tools to reward or punish teachers based upon their evaluation was also negatively associated with teachers’ motivation and reports of positive change in practice.
Ultrasonic and FEM residual stress measurement in dissimilar St37–St52 welding
Authors: Safikhanlu Hamed , Salehi Amir Mohammad , Ahmadi Najafabadi Mehdi
Published: February 2023

Numerous industries, like the military, the oil and gas industry, etc., rely heavily on dissimilar welding. The welding process leaves the structure with a variety of defects, such as residual stress, that degrade its performance and static and fatigue properties. Consequently, weld residual stress must be accurately measured. In this study, ultrasonic and finite element techniques are developed to assess the residual stress in dissimilar St37/St52 welding. In addition, hole-drilling technique is employed to confirm FEM and ultrasonic data. Probe fixture is designed and built for ultrasonic stress measurement, and the acoustoelastic coefficient is measured in St37 and St52. In welding finite element analysis, the Goldak model is used as the heat source, the Brekstad model is employed as the heat loss, and the Dflux subroutine is developed to apply the heat source to the weld line using the sedimentary method. The FEM and ultrasonic data are in good correlation with the hole drilling results (maximum error of 9%). The findings indicate that there is a high degree of concordance between the data gathered by FEM and ultrasonic technique (with error less than 1.75% at the weld zone).
Effect of trigger point acupuncture on pain and functional activity in patients with chronic non-specific low back pain: a randomised controlled trial
Authors: Liu Hong , Li Ya-Ping , Hou Mei-Jin , Huang Wu-Jie , Chen Xiao-Lin , Gao Zhen , Jiang Zheng
Published: February 2023

Background:

Trigger point (TrP) acupuncture is commonly used to treat chronic non-specific low back pain (CNLBP). Evidence for the efficacy of most TrP acupuncture modalities is weak or lacking.

Objective:

To assess the effect of TrP acupuncture on pain, disability, gait and muscle activation in patients with CNLBP.

Methods:

From May 2019 to February 2020, a randomised, single-blind clinical trial was carried out involving 33 participants with CNLBP, divided into one of two intervention groups or a control group ( n = 11 per group). The intervention groups received TrP acupuncture or traditional acupuncture treatment three times a week for 4 weeks, and the control group remained on a waiting list and received no treatment. Pain, disability, gait and muscle activation were assessed at baseline and at 4 and 8 weeks of follow-up.

Results:

At baseline, the three groups showed no significant differences in age, gender, height, weight, body mass index (BMI) or disease course ( p ⩾ 0.05). At 4 weeks, pain was relieved (measured by visual analogue scores, p = 0.036) and disability was improved (reflected by lower Oswestry disability index scores, p = 0.029) in TrP acupuncture versus waiting list groups. Moreover, lumbar extension range of motion was increased in TrP acupuncture versus both traditional acupuncture and waiting list groups ( p = 0.029 and p = 0.027, respectively). At 8 weeks, there were no significant differences in any parameter between the three groups ( p > 0.05).

Conclusion:

TrP acupuncture had a significant short-term effect on pain relief and disability in patients with CNLBP, but there was no evidence of a long-term influence (at 8 weeks following the intervention). Further high-quality randomised controlled trials are needed for verification in the future. Trial registration number: ChiCTR1900022838 (Chinese Clinical Trial Registry)
Overcoming barriers: Modelling the effect of potential future changes of organized breast cancer screening in Italy
Authors: Zielonke Nadine , Senore Carlo , Ponti Antonio , Csanadi Marcell , de Koning Harry J , Heijnsdijk Eveline A M , van Ravesteyn Nicolien T
Published: February 2023

Objectives

Organized breast cancer screening may not achieve its full potential due to organizational and cultural barriers. In Italy, two identified barriers were low attendance in Southern Italy and, in Italy as a whole, underscreening and overscreening in parts of the eligible population. The objective of this study was to identify potential changes to overcome these barriers and to quantify their costs and effects.

Methods

To assess the impact of potential measures to improve breast cancer screening in Italy, we performed an evaluation of costs and effects for increasing adherence for Southern Italy and harmonizing screening intervals (biennial screening) for the whole of Italy, using an online tool (EU-TOPIA evaluation tool) based on the MIcrosimulation SCreening ANalysis (MISCAN) model.

Results

Increasing adherence in Southern Italy through investing in mobile screening units has an acceptable cost-effectiveness ratio of €9531 per quality-adjusted life year gained. Harmonizing the screening interval by investing in measures to reduce opportunistic screening and simultaneously investing in mobile screening units to reduce underscreening is predicted to gain 1% fewer life-years, while saving 19% of total screening costs compared to the current situation.

Conclusions

Increasing adherence in Southern Italy and harmonizing the screening interval could result in substantial improvements at acceptable costs, or in the same benefits at lower costs. This example illustrates a systematic approach that can be easily applied to other European countries, as the online tools can be used by stakeholders to quantify effects and costs of a broad range of specific barriers, and ways to overcome them.
The exercise of parental care of children born out of wedlock and the ECtHR: Reflections on Paparrigopoulos v. Greece
Authors: Koukoulis Andreas-Nikolaos
Published: February 2023

This contribution analyses the recent judgment of the European Court of Human Rights in Paparrigopoulos v. Greece and examines its implications for cross-border surrogacy in Europe. This judgment is significant because it sets new standards in terms of the concept of discrimination between parents under Article 14 of the European Convention on Human Rights read in conjunction with Article 8 (right to respect for private and family life). The Court held that there was no reasonable relationship of proportionality between the preclusion of the applicant's exercise of parental responsibility and the aim pursued, which had been to protect the best interests of children born out of wedlock. Finally, this case note critiques the Court's findings and examines its likely impact on the parental care of the child, who was born and remains unmarried by his parents.
The Effects of Breathing Exercises on Patients Having Laparoscopic Cholecystectomy Surgery
Authors: Bulut Gamze , Karabulut Neziha
Published: February 2023

The aim of the study is to determine the effect of breathing exercises on patients who underwent laparoscopic cholecystectomy in terms of their level of anxiety, sleep, and recovery of quality after surgery. A randomized, controlled experimental research model was used in this work. This study was conducted in surgery clinic of a university hospital between December 2020 and May 2021. The research was completed with 58 patients in the experimental group and 57 patients in the control group. The mean Visual Analog Sleep Scale and state anxiety score of the patients in the control group was higher in the morning of the operation and on the 1st, 15th, and 30th days after the operation than that of the experimental group patients, and the difference was statistically significant ( p < .05). The correlations between recovery quality, state anxiety, and sleep quality on the first postoperative day were significant at ( p < .05) in the opposite direction.
Resilience After COVID-19: A Descriptive, Cross-Sectional Study
Authors: Fernández-Alonso Víctor , Rodríguez-Fernández Sara , Secadas-Rincón Laura , Pérez-Gómez Manuela , Moro-Tejedor María Nieves , Salcedo Magdalena
Published: February 2023

The main purpose of this study was to examine the relationship between resilience and health-related quality of life in patients following COVID-19 disease among those with and without lingering symptoms. The study design is descriptive and cross-sectional. Participants ( n = 97) were adults who had earlier contracted COVID-19 disease and were in post-infection status between July and October 2020. Participants completed the following instruments: Connor-Davidson Resilience Scale, Short-Form 12-item Health Survey, and Hospital Anxiety and Depression Scale. Approximately 35% post-COVID-19 patients had a low level of resilience. The impact on the health status and resilience of those who had reported symptoms after 6 months was also significant. Age and depression had a significant impact on level of resilience. This relationship can affect patient recovery and negatively impact the ability to cope with COVID-19 disease. It is necessary to implement specialized training for clinicians on the effects of long-term COVID-19 to improve patient care. Long COVID symptoms might manifest months after an acute COVID-19 illness; clinicians who can confirm patient reports of these symptoms may help patients recover and become more resilient.
A Review of the Use of Buccal Fat Pad in Cleft Palate Repair
Authors: Adekunle Adegbayi Adeola , James Olutayo , Olanbiwonnu Aliyah Oluwabusayo , Adeyemo Wasiu Lanre
Published: February 2023

Objective

To review the available evidence on the use of the Buccal Fat Pad in primary and secondary Cleft Palate repair.

Methods

This is a narrative review. A computerized literature search was conducted for articles published till February 2022 using the Mesh phrases buccal fat pad AND cleft palate, Bichat's Fat pad AND cleft palate, buccal fat pad OR Bichats Fat pad AND cleft palate.

Results

A total of 35 articles were included in this review based on the set eligibility criteria. Most of the studies were retrospective case reviews (n  =  16, 45.7%), and the aggregate number of patients from all included studies was 666. Reported uses of the buccal fat pad (BFP) in association with cleft palate repair include the closure of central cleft palate defect and nasal floor in primary cleft palate repair, oronasal fistula repair following primary repair of cleft palate, and closure of relieving incision defect in primary repair of cleft palate. Complications reported were 24 cases of Oronasal Fistula (ONF), 2 dehiscences, and 4 transient mucosal defects.

Conclusion

The high success rate, vascularity, ease of tissue harvest, and low donor site morbidity all support its use as an adjunct flap in cleft palate repair, especially in the closure of wide palatal clefts, to prevent post-palatal repair fistula, wound contracture, and subsequently velopharyngeal insufficiency and possibly midface hypoplasia.
Clinical differences in symptomology, characteristics, and risk factors in patients with post-acute sequelae of COVID-19: an experience from a tertiary-care academic center
Authors: Munipalli Bala , Paul Stefan , Mohabbat Arya , Siddiqui Habeeba , Li Zhuo , Abu Dabrh Abd Moain
Published: February 2023

Coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus SARS-CoV-2 and has caused significant mortality and morbidity since it was first recognized in Wuhan, China in December 2019. Patients may suffer from a constellation of symptoms termed post-acute sequelae of COVID-19 (PASC) . Here we present findings of a retrospective cohort study describing the prevalence and predicting factors of patient-reported post-acute sequelae of COVID-19 (PASC). Categorical variables were summarized as frequency (percentage) and compared between vaccine status groups using Fisher’s exact test. Continuous variables were reported as median (range) and compared between the groups using Kruskal-Wallis test. All tests were two-sided with p value <0.05 considered statistically significant. Survey data from 132 patients with a median age of 45 years, 68% female, 83% Caucasian/Non-Hispanic. The most frequently reported PASC symptoms include fatigue (84.8%), dyspnea (54.5%), cognitive dysfunction (53%), myalgias (37.1%), lightheadedness or vertigo (36.4%), chest pain (34.8%), palpitations (34.8%), headaches (34.1%), arthralgias (31.8%), and unrefreshing sleep (31.1%). There is mounting evidence that supports higher prevalence of PASC in women, White/Caucasian, and middle-aged individuals. This knowledge can provide guidance to clinical practices to anticipate and support healthcare and self-care needs for patients at higher risk to developing PASC.
Regulation of oxidized LDL-induced proliferation and migration in human vascular smooth muscle cells by a novel circ_0007478/miR-638/ROCK2 ceRNA network
Authors: Guan Zeyu , Lu Ran , Sun Yong , Wang Xiaogao , Yu Chaowen , Song Tao
Published: February 2023

Background:

Circular RNAs (circRNAs) have been implicated in the pathogenesis of atherosclerosis (AS) and the migration and proliferation of vascular smooth muscle cells (VSMCs) under oxidized low-density lipoprotein (ox-LDL). Here, we defined the exact action of human circ_0007478 in VSMC migration and proliferation induced by ox-LDL.

Methods:

Human VSMCs (HVSMCs) were exposed to ox-LDL. Circ_0007478, microRNA (miR)-638, and rho-associated protein kinase 2 ( ROCK2) levels were gauged by quantitative real-time PCR (qRT-PCR) and western blot. Cell viability and proliferation were assessed by MTT and EdU assays, respectively. Transwell assays were used to detect cell migration and invasion. Dual-luciferase reporter and RNA immunoprecipitation (RIP) assays were used to evaluate the direct relationship between miR-638 and circ_0007478 or ROCK2.

Results:

Our data indicated that circ_0007478 expression was augmented in AS serum samples and ox-LDL-treated HVSMCs. Depletion of circ_0007478 attenuated HVSMC proliferation, migration, and invasion induced by ox-LDL. Mechanistically, circ_0007478 targeted miR-638 by directly pairing to miR-638. Reduction of miR-638 reversed the effects of circ_0007478 depletion on ox-LDL-evoked proliferation, migration, and invasion in HVSMCs. ROCK2 was a direct miR-638 target and miR-638-mediated inhibition of ROCK2 relieved ox-LDL-evoked HVSMC proliferation, migration, and invasion. Furthermore, circ_0007478 was identified as a competing endogenous RNA (ceRNA) for miR-638 to modulate ROCK2 expression.

Conclusion:

Our present study establishes an undescribed ceRNA regulatory network, in which circ_0007478 targets miR-638 to upregulate ROCK2, thereby contributing to ox-LDL-induced proliferation and migration in HVSMCs.
Lower-extremity pressure, staging, and grading thresholds to identify chronic limb-threatening ischemia
Authors: Choi Justin Chin-Bong , Miranda Jorge , Greenleaf Erin , Conte Michael S , Gerhard-Herman Marie D , Mills Joseph L , Barshes Neal R
Published: February 2023

Introduction:

The Society for Vascular Surgery Threatened Limb Classification System (‘WIfI’) is used to predict risk of limb loss and identify peripheral artery disease in patients with foot ulcers or gangrene. We estimated the diagnostic sensitivity of multiple clinical and noninvasive arterial parameters to identify chronic limb-threatening ischemia (CLTI).

Methods:

We performed a single-center review of 100 consecutive patients who underwent angiography for foot gangrene or ulcers. WIfI stages and grades were determined for each patient. Toe, ankle, and brachial pressure measurements were performed by registered vascular technologists. CLTI severity was characterized using Global Limb Anatomic Staging System (GLASS stages) and angiosomes. Medial artery calcification in the foot was quantified on foot radiographs.

Results:

GLASS NA (not applicable), I, II, and III angiographic findings were seen in 21, 21, 23, and 35 patients, respectively. A toe–brachial index < 0.7 and minimum ipsilateral ankle–brachial index < 0.9 performed well in identifying GLASS II and III angiographic findings, with sensitivity rates 97.8% and 91.5%, respectively. The diagnostic accuracy rates of noninvasive measures peaked at 74.7% and 89.3% for identifying GLASS II/III and GLASS I+ angiographic findings, respectively. The presence of medial artery calcification significantly diminished the sensitivity of most noninvasive parameters.

Conclusions:

The use of alternative noninvasive arterial testing parameters improves sensitivity for detecting PAD. Abnormal noninvasive results should suggest the need for diagnostic angiography to further characterize arterial anatomy of the affected limb. Testing strategies with better accuracy are needed.
Accuracy of the pedal acceleration time to diagnose limb ischemia in patients with and without diabetes using the WIfI classification
Authors: de Castro-Santos Guilherme , Gonçalves Patric Emerson Oliveira , Procópio Ricardo Jayme , Dardik Alan , Navarro Túlio Pinho
Published: February 2023

Introduction:

Evaluation of limb hemodynamics using the ankle–brachial index (ABI) may be difficult due to skin lesions, extensive necrosis, and obesity, such as commonly present in patients with diabetes with chronic limb-threatening ischemia (CLTI). We hypothesized that the pedal acceleration time (PAT) correlates with ABI and Wound, Ischemia, and foot Infection (WIfI) scores in patients with diabetes to serve as a new modality to accurately stage CLTI.

Methods:

A single-center, cross-sectional study included patients with and without diabetes > 18 years with CLTI. Limbs were categorized in three grades of ischemia based on the ABI (ABI < 0.8, < 0.6, and < 0.4) and in two classes based on WIfI stages of amputation risk. Receiver operator characteristic (ROC) curves were used to determine PAT sensitivity, specificity, and accuracy to predict lower-limb ischemia.

Results:

A total of 141 patients (67 nondiabetic and 74 diabetic) and 198 lower limbs (94 nondiabetic and 104 diabetic) met the inclusion criteria. In patients without diabetes, the accuracy of PAT for detecting an ABI < 0.8 was 85%; for detecting an ABI < 0.6 was 85%; and for detecting an ABI < 0.4 was 87%. In patients with diabetes, the accuracy of PAT in detecting an ABI < 0.8 was 91%; for detecting an ABI < 0.6 was 79%; and for detecting an ABI < 0.4 was 88%. In patients without diabetes, the accuracy for detecting WIfI stages of moderate and high amputation risk was 77% and for patients with diabetes was also 77%.

Conclusions:

PAT shows high correlation with the ABI as well as with the WIfI stages of amputation risk and the grades of ischemia, with high accuracy.
Study on the forming process and shear mechanical behavior of CFRP/Al self-piercing riveting employed 3D modeling
Authors: Kong Dewen , Wang Dengfeng , Zhang Xiaopeng
Published: February 2023

In this work, a 3D finite-element model (FEM) was developed to accurately predict the mechanical behavior of CFRP/Al self-piercing riveting (SPR) during the forming and shearing process. A continuous damage model based on the modified Hashin failure criterion was proposed to model the CFRP, and a cohesive model considering the traction-separation criterion was used to capture the delamination between CFRP layers. The simulation results were in good agreement with the experimental results. Based on the developed FEM, the damage of CFRP in the SPR forming process, the shear mechanical properties and damage of joints in the SPR shearing process, the effects of CFRP plate thickness and rivet length on the SPR forming cross-section and shear strength were investigated. The results showed that, the maximum interlock value of 0.46 mm was obtained when the rivet length was 6.5 mm and the CFRP plate thickness was 1.6 mm. The maximum shear peak load of 3611.98 N was obtained when the rivet length was 6.5 mm and the CFRP plate thickness was 2.2 mm. The interaction between rivet length and CFRP plate thickness should be considered in the actual SPR connection.
Justifying non-violent resistance: The perspectives of healthcare workers
Authors: Essex Ryan , Aked Hil , Daniels Rebecca , Newton Paul , Weldon Sharon M.
Published: February 2023

Introduction: Non-violent resistance, carried out by healthcare workers, has been a common phenomenon. Despite this and despite the issues this type of action raises, we know little about the healthcare workers who engage in this action and their perspectives about its justification. This exploratory study sought to address this gap, examining these fundamental questions amongst a sample of healthcare workers who have engaged in acts of resistance, exploring their understanding of non-violent resistance, its justification and the barriers they faced in engaging in such action. Methods: Participants were recruited through Medact's ( https://www.medact.org/ ) member database and directed to an online survey hosted on Qualtrics. While participants were unlikely to be representative of the broader UK healthcare community, participants were in an advantageous position to comment on non-violent resistance. Descriptive quantitative analysis and a content analysis were conducted. Results: The majority of participants felt that non-violent resistance could be justified dependent on its cause and/or the action in question. Within this, most felt that if action were non-violent, that if it didn't harm patients and that if the issue in question had to do with health being compromised, action was often justified. A number of others framed their justification as being a right or duty to engage in non-violent resistance. In relation to barriers to engaging in non-violent resistance, these fell into three categories: personal, professional and broader concerns related to society or the general culture found in healthcare. Within these, time and concerns about registration or the consequences of engaging in action were cited as the greatest barriers. Conclusions: These results suggest that healthcare workers who regularly engage in non-violent action carefully thought through their actions, acknowledging the diversity of actions and issues that could be challenged, for many patient care remained a primary concern. There is a need for clarity from regulatory bodies and in particular the need for dialogue between healthcare bodies and healthcare workers who continue to engage in acts of non-violent resistance.
Developing and Evaluating a School-Based Tobacco and E-Cigarette Prevention Program for Deaf and Hard-of-Hearing Youth
Authors: Herrmann Alison K. , Cowgill Burton , Guthmann Debra , Richardson Jessica , Cindy Chang L. , Crespi Catherine M. , Glenn Everett , McKee Michael , Berman Barbara
Published: February 2023

School-based programs are an important tobacco prevention tool. Yet, existing programs are not suitable for Deaf and Hard-of-Hearing (DHH) youth. Moreover, little research has examined the use of the full range of tobacco products and related knowledge in this group. To address this gap and inform development of a school-based tobacco prevention program for this population, we conducted a pilot study among DHH middle school (MS) and high school (HS) students attending Schools for the Deaf and mainstream schools in California (n = 114). American Sign Language (ASL) administered surveys, before and after receipt of a draft curriculum delivered by health or physical education teachers, assessed product use and tobacco knowledge. Thirty-five percent of students reported exposure to tobacco products at home, including cigarettes (19%) and e-cigarettes (15%). Tobacco knowledge at baseline was limited; 35% of students knew e-cigarettes contain nicotine, and 56% were aware vaping is prohibited on school grounds. Current product use was reported by 16% of students, most commonly e-cigarettes (12%) and cigarettes (10%); overall, 7% of students reported dual use. Use was greater among HS versus MS students. Changes in student knowledge following program delivery included increased understanding of harmful chemicals in tobacco products, including nicotine in e-cigarettes. Post-program debriefings with teachers yielded specific recommendations for modifications to better meet the educational needs of DHH students. Findings based on student and teacher feedback will guide curriculum development and inform next steps in our program of research aimed to prevent tobacco use in this vulnerable and heretofore understudied population group.
Reconstruction of Small-Sized Complex Defect on the Foot Dorsum Without Microsurgery: Intrinsic Adipofascial Flap
Authors: Choi Seong Ju , Lee Young Ho , Kim Min Bom , Bae Kee Jeong , Kim Segi , Lee Yohan
Published: February 2023

Dorsal foot defects are difficult to cover and often require major flap surgery by microsurgeons, even for defects of limited sizes. Intrinsic adipofascial flaps for small-sized complex defects are simple and do not require microsurgery; thus, a flap specialist is unnecessary. This study aimed to assess our institutional experience with this technique and define its role in dorsal foot reconstruction. Nine patients aged 48 to 86 years with soft tissue defects of the dorsal foot were treated with the intrinsic adipofascial flap by rotating the adjacent adipofascial tissues from May 2019 and January 2021 in our institution. Demographic, clinical, and followup data were evaluated. Primary outcomes include flap viability, flap bulkiness, ability to wear shoes, and donor site morbidity. The mean followup period was 24.5 months (range, 10-30 months) and the mean defect size was 6.4 cm2 (range, 3.0-9.0 cm2). Eight flaps survived providing an adequate contour and durable coverage with a thin flap. Among 8 cases of healed flaps, 6 required secondary skin grafts while the other 2 healed spontaneously without additional operation. One patient (defect size: 3.0 cm × 3.0 cm) with underlying diabetes mellitus and peripheral arterial occlusive disease encountered flap total necrosis. Revisional flap surgery was performed to cover the flap total necrosis. In conclusion, the intrinsic adipofascial flap is a relatively simple and suitable method for complex dorsal foot defect reconstruction because it provides minimal donor site morbidity. However, relatively large defect size and comorbidities, such as underlying diabetes mellitus and vascular occlusive disease could accompany a risk of flap necrosis.
Numerical investigation of modern threats for ground vehicles with emphasis on fragmentation behavior during hard kill scenario
Authors: Jensen Morten Rikard , Mulligan Philip , Khanna Kshitiz
Published: February 2023

The research covered in this paper is related to numerical modeling of realistic threats. The final goal is to simulate the effects from the impact of an RPG-7 projectile on a GAZ-2975 Tigr infantry vehicle protected by an ERA. The fragmentation that results from the impact is studied. Leading up to the final model, several models are created, starting with an explosively driven cylinder to study fragmentation modeling. The next step was modeling the setup defined by NATO STANAG 4526 which was used to characterize the impact from an RPG-7. Based upon these results, a generic RPG-7 model was developed which impacted an ERA, modeled as two plates with a layer of high explosive (HE) between them. All models ran successfully to normal termination, and they showed how numerical tools can be used to describe and investigate these very complicated events.
Totally Endoscopic Constrictive Pericarditis Treatment: A Case Series
Authors: Gallo Michele , Cresce Giovanni Domenico , Favaro Alessandro , Hinna Danesi Tommaso , Salvador Loris
Published: February 2023

Minimally invasive cardiac surgery has increased in popularity to reduce the morbidity associated with open heart surgery. In this article, a totally endoscopic case series is presented in which anterior pericardiectomy is performed by peripheral femoral arterial and venous cannulation. Right periareoal incision and right submammary incision were used for male and female patients, respectively, to access the heart by the fourth intercostal space.
Transitive inference and the testing effect: Retrieval practice impairs transitive inference
Authors: Mulligan Neil W , Buchin Zachary L , Powers Annaliisa
Published: February 2023

There is substantial interest in the extent to which the testing effect (the finding that retrieval practice enhances memory) extends to more complex forms of learning, especially those entailing greater element interactivity. Transitive inference (TI) requires just such interactivity, in which information must be combined across multiple learning elements or premises to extract an underlying structure. Picklesimer et al. provided preliminary evidence that retrieval practice fails to enhance, and actually disrupts, TI. This study assessed the generality of that result. The current experiments employed a seven- or eight-element TI paradigm in which participants initially learned a set of premise pairs (e.g., A > B, B > C, and C > D) and then engaged in either restudy or retrieval practice of the premise pairs before taking a final test that assessed memory for the original premise pairs and one’s ability to make TIs (e.g., to infer that B > D). Experiments 1 and 2 used pictorial materials and simultaneous presentation of premises during learning, a form of presentation that has induced testing effects on other forms of inference. For TI, the results were unchanged from Picklesimer et al.—TI was worse for retrieval practice than restudy. Experiment 3 used verbal materials and likewise found worse TI for retrieval practice. A small-scale meta-analysis combining the current experiments with those of Picklesimer et al. revealed a significant negative testing effect on TI ( d = −0.37). Although retrieval practice enhances many aspects of memory, this fundamental aspect of human reasoning may be impaired by retrieval practice.
Reliability of WhatsApp images of plain radiographs to diagnose fractures of the hand and wrist
Authors: Khoo Saw Sian , Guruseelan Nishand , Gunasagaran Jayaletchumi , Shamsul Shams Amir , Razak Izzati , Ahmad Tunku Sara
Published: February 2023

We assessed the reliability of plain radiographs interpreted through WhatsApp messaging system in orthopaedic hand trauma consultation in a large teaching hospital. Plain radiographs of 25 hand fractures and five normal radiographs were captured from a picture archiving and communication system using iPhone XS smartphone, anonymized and sent to 53 orthopaedic residents’ and consultants’ personal smartphones. The participants independently assessed the images and answered questions on fracture identification and characteristics, diagnostic confidence, further imaging and surgical inclination. The study was repeated after a 1-month washout period using the picture archiving and communication system on the hospital desktop. The results showed good (0.60 < ƙ < 0.80) intraobserver agreement on fracture identification and characteristics. The overall diagnostic accuracy for hand fractures was 95% on WhatsApp and 99% on the desktop. In conclusion, images of plain radiographs transmitted via WhatsApp were reliable for interpretation in orthopaedic hand trauma consultation.

Level of evidence: IV
Sustainable and efficient E-learning internet of things system through blockchain technology
Authors: Haque Md Alimul , Haque Shameemul , Zeba Sana , Kumar Kailash , Ahmad Sultan , Rahman Moidur , Marisennayya Senapathy , Ahmed Laiq
Published: February 2023

E-Learning Education systems are gaining attention day-to-day because of their inclusive pertinence in the distance education system. Due to COVID-19, the online learning education system has become very popular. Most probably, all education systems have been using the IoT-based E-Learning system to continue the students’ education without hindrance during the COVID lockdown. Several E-Learning IoT schemes are explored that reflect privacy and security, but still, there is no detailed scheme; hence, it needs a sustainable, secure E-Learning IoT system. The characteristics and prospects of the Internet of Things are discussed in this article. By analyzing the various functions and capabilities of the Internet of Things, this article aims to provide an overview of the various advantages and challenges of using the platform for e-learning. This paper proposed the E-Learning IoT architecture with Blockchain technology, with layers of different IoT and Blockchain concepts to secure the online education system. Also, the block diagram of the proposed architecture demonstrates how students can securely access or interact with the online learning system through Blockchain technology. By implementing the proposed e-learning IoT architecture, universities and colleges can improve their distance learning programs and increase efficiency without affecting their academic activities. Finally, the study found that e-learning positively impacts students' learning experience and overall quality of education. It also exhibited a significant positive impact on their flexibility and academic productivity.