bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial potential field neuro-fuzzy controller for autonomous navigation of mobile robots
Authors: Imrane Mahamat Loutfi , Melingui Achille , Mvogo Ahanda Joseph Jean Baptiste , Biya Motto Fredéric , Merzouki Rochdi
Published: December 2020

Some autonomous navigation methods, when implemented alone, can lead to poor performance, whereas their combinations, when well thought out, can yield exceptional performances. We have demonstrated this by combining the artificial potential field and fuzzy logic methods in the framework of mobile robots’ autonomous navigation. In this article, we investigate a possible combination of three methods widely used in the autonomous navigation of mobile robots, and whose individual implementation still does not yield the expected performances. These are as follows: the artificial potential field, which is quick and easy to implement but faces local minima and robustness problems. Fuzzy logic is robust but computationally intensive. Finally, neural networks have an exceptional generalization capacity, but face data collection problems for the learning base and robustness. This article aims to exploit the advantages offered by each of these approaches to design a robust, intelligent, and computationally efficient controller. The combination of the artificial potential field and interval type-2 fuzzy logic resulted in an interval type-2 fuzzy logic controller whose advantage over the classical interval type-2 fuzzy logic controller was the small size of the rule base. However, it kept all the classical interval type-2 fuzzy logic controller characteristics, with the major disadvantage that type-reduction remains the main cause of high computation time. In this article, the type-reduction process is replaced with two layers of neural networks. The resulting controller is an interval type-2 fuzzy neural network controller with the artificial potential field controller’s outputs as auxiliary inputs. The results obtained by performing a series of experiments on a mobile platform demonstrate the proposed navigation system’s efficiency.
A self-organizing multi-model ensemble for identification of nonlinear time-varying dynamics of aerial vehicles
Authors: Emami Seyyed Ali , Ahmadi Kasra KA
Published: December 2020

This article presents a novel identification approach which can deal with nonlinear and time-varying characteristics of complex dynamic systems, especially an aerial vehicle in the entire flight envelope. A set of local sub-models are first developed at different operating points of the system, and subsequently a self-organizing multi-model ensemble is introduced to aggregate the outputs of the local models as a single model. The number of employed local models in the proposed multi-model ensemble is optimized using a novel self-organizing approach. Also, wavelet neural networks, which combine both the universal approximation property of neural networks and the wavelet decomposition capability, are used as the local models of the proposed method. In addition, a generalized online sequential extreme learning machine is adopted in the introduced approach to determine the optimal validity function of the local models at each time step. Finally, the introduced self-organizing multi-model ensemble is applied to the NASA Generic Transport Model as a complex nonlinear system to demonstrate the effectiveness of the proposed identification approach. Furthermore, the results obtained from the conventional artificial neural networks are carefully compared with those from the wavelet neural networks, which are employed as the local models of the introduced multi-model ensemble. The simulation results suggest that the introduced wavelet neural network–based self-organizing multi-model ensemble can be used satisfactorily as the prediction model of model-based control systems for long prediction horizons.
Kalman-filter-based sensor fusion applied to road-objects detection and tracking for autonomous vehicles
Authors: Farag Wael
Published: December 2020

In this article, a real-time road-Object Detection and Tracking (LR_ODT) method for autonomous driving is proposed. This method is based on the fusion of lidar and radar measurement data, where they are installed on the ego car, and a customized Unscented Kalman Filter is employed for their data fusion. The merits of both devices are combined using the proposed fusion approach to precisely provide both pose and velocity information for objects moving in roads around the ego car. Unlike other detection and tracking approaches, the balanced treatment of both pose estimation accuracy and its real-time performance is the main contribution in this work. The proposed technique is implemented using the high-performance language C++ and utilizes highly optimized math and optimization libraries for best real-time performance. Simulation studies have been carried out to evaluate the performance of the LR_ODT for tracking bicycles, cars, and pedestrians. Moreover, the performance of the Unscented Kalman Filter fusion is compared to that of the Extended Kalman Filter fusion showing its superiority. The Unscented Kalman Filter has outperformed the Extended Kalman Filter on all test cases and all the state variable levels (−24% average Root Mean Squared Error). The employed fusion technique shows how outstanding is the improvement in tracking performance compared to the use of a single device (−29% Root Mean Squared Error with lidar and −38% Root Mean Squared Error with radar).
Neural network inverse system decoupling fuzzy self-tuning proportional–derivative control strategy of a bearingless induction motor
Authors: Bu Wenshao , Zhang Fei , He Fangzhou , Sun Ligong , Qiao Yanke
Published: December 2020

In view of the problems that the analytical inverse system decoupling method of bearingless induction motor is sensitive to the change of motor parameters and is greatly affected by unmodeled dynamics, and that of traditional proportional–derivative controller lacking the self-adaptive regulation ability, a neural network inverse system decoupling fuzzy self-tuning proportional–derivative control strategy is proposed for a bearingless induction motor system. First, under the conditions of considering the stator current dynamic of torque winding, and by neural network inverse system method, the bearingless induction motor system is decoupled into four pseudo-linear integral subsystems. Second, the traditional proportional–derivative controller is improved, and the fuzzy control algorithm is used to adjust the parameters of improved proportional–derivative controller adaptively. Thus, a neural network inverse system decoupling fuzzy self-tuning proportional–derivative control system is constructed for a bearingless induction motor. The simulation experimental results show that the proposed control strategy not only can effectively improve the stability, robustness and steady-state control accuracy of bearingless induction motor system, but also can significantly improve the dynamic response speed and the ability to resist the influences of motor parameter change and load disturbance.
LncRNA PART1 promotes lung squamous cell carcinoma progression via miR-185-5p/Six1 axis
Authors: Cao Y , Zhang R , Luo X , Yang Y
Published: December 2020

Dysregulation of the long non-coding RNA prostate androgen regulated transcript 1 (lncRNA PART1) is involved in the tumorigenesis of various cancers. However, little is known about its function and molecular mechanism in the development of lung squamous cell carcinoma (LSCC). In this study, we examined the expression of PART1 in LSCC clinical tissue samples and cell lines, and gain- and loss-of-function experiments were performed to explore the function of PART1 in LSCC proliferation, invasion and migration. We found that PART1 was overexpressed in both LSCC tissues and cell lines. Functional studies revealed that PART1 knockdown significantly suppressed cell proliferation, invasion and migration but enhanced apoptosis in LSCC cells, whereas overexpression of PART1 showed the opposite results. Mechanistically, we identified that PART1 acted as a sponge of miR-185-5p, and sineoculis homeobox homolog 1 (Six1) was a direct downstream target of miR-185-5p. Moreover, restoration of miR-185-5p or silencing of Six1 partially abolished the oncogenic effect of PART1 in LSCC cells. Clinically, The areas under the receiver operating characteristic (ROC) curve of PART1, miR-185-5p, and Six1 were 0.7857, 0.7332, 0.8112, respectively. Notably, high PART1, low miR-185-5p, and high Six1 expressions were significantly associated with severe clinical parameters and were the independent risk factors for poor prognosis of LSCC patients. Thus, we concluded that the PART1/miR-185-5p/Six1 axis might serve as a novel biomarker for the diagnosis and treatment of LSCC.
Cell Transplantation Combined with Recombinant Collagen Peptides for the Treatment of Fabry Disease
Authors: Kami Daisuke , Yamanami Masashi , Tsukimura Takahiro , Maeda Hideki , Togawa Tadayasu , Sakuraba Hitoshi , Gojo Satoshi
Published: December 2020

Fabry disease is caused by a decrease in or loss of the activity of alpha-galactosidase, which causes its substrates globotriaosylceramide (Gb3) and globotriaosylsphingosine (lyso-Gb3) to accumulate in cells throughout the body. This accumulation results in progressive kidney injury due to glomerulosclerosis and in heart failure due to hypertrophy. Enzyme replacement therapy (ERT) has been used as the standard therapy for Fabry disease, but it causes a significant financial burden, and regular administration is inconvenient for patients. Because of the short half-life of alpha-galactosidase in vivo, therapeutic methods that can supplement or replace ERT are expected to involve continuous release of alpha-galactosidase, even at low doses. Cell transplantation therapy is one of these methods; however, its use has been hindered by the short-term survival of transplanted cells. CellSaic technology, which utilizes cell spheroids that form after cells are seeded simultaneously with a recombinant collagen peptide scaffold called a μ-piece, has been used to improve cell survival upon implantation. In this study, syngeneic murine embryonic fibroblasts were used to generate CellSaic that were transplanted into Fabry mice. These spheroids survived for 28 days in the renal subcapsular space with forming blood vessels. These results indicate CellSaic technology could be a platform to promote cellular graft survival and may facilitate the development of cell transplantation methods for lysosomal diseases.
Grexit and Brexit: Incidents, accidents and wake-up calls on the bumpy road of European (dis)integration
Authors: Petrakos George , Sotiriou Alexandra
Published: December 2020

Almost 30 years since the Maastricht Treaty and 20 years since the introduction of the euro, it is clear that the European Union (EU) has lost its appeal to wider constituencies and citizen groups that realize that the promises for convergence and prosperity have not been delivered. Rising dissatisfaction and Euroscepticism (expressed both in the ballot box and in Eurobarometer reports) is evident even in traditional pro-EU countries of the European core. As this long decade comes to an end, incidents (or accidents) like these ones, either in the form of open discontent, or in the form of rising populism, will exert pressure on the EU policy agenda that will either increase the frequency of deadlocks and inefficiency in policy making or will eventually lead to an honest effort to address the roots of these phenomena. This paper examines the drivers behind these two incidents (and the ones that may follow) and the limits of the current market and policy integration arrangements in the EU, arguing that a new policy agenda addressing the real weaknesses of the Union is inevitable if disintegration is to be avoided. Luckily enough, some elements of this new policy agenda may already be here.
Effect of Long Working Hours on Cardiovascular Disease in South Korean Workers: A Longitudinal Study
Authors: Kim Soojung , Jung Youn
Published: December 2020

This study aimed to examine the association between working hours and onset of cardiovascular diseases (CVDs) using a prospective study design. We used the Korean Longitudinal Study of Aging (KLoSA) data from 2006 to 2016. A total of 2405 workers who were working 35 hours or more per week and who did not have CVD at baseline were analyzed. Cox proportional hazard model was used for the analysis to determine the association between working hours per week at baseline and the new onset of CVD. In addition, multivariable logistic regression analysis was used to test the relationship between average working hours throughout the entire follow-up period and the risk of CVD (N = 1134). Working above 52 hours per week at baseline was related to higher risk of CVD than working between 35 and 40 hours a week (hazard ratio [HR] = 2.08, 95% confidence interval [CI] = 1.60-2.70 for 52-60 hours; HR = 1.38, 95% CI = 1.05-1.81 for >60 hours). A worker’s average working hours throughout the following period were also significantly associated with elevated risks of CVD (odds ratio = 4.40, 95% CI = 1.58-12.22 for >60 hours). The findings underline the need for more proactive interventions to protect the health of workers exposed to long working hours.
Associations between music training and the dynamics of writing music by hand
Authors: Bertiaux Aurélien , Gabrielli François , Giraud Mathieu , Levé Florence
Published: December 2020

Learning to write music in the staff notation used in Western classical music is part of a musician’s training. However, writing music by hand is rarely taught formally, and many musicians are not aware of the characteristics of their musical handwriting. As with any symbolic expression, musical handwriting is related to the underlying cognition of the musical structures being depicted. Trained musicians read, think, and play music with high-level structures in mind. It seems natural that they would also write music by hand with these structures in mind. Moreover, improving our understanding of handwriting may help to improve both optical music recognition and music notation and composition interfaces. We investigated associations between music training and experience, and the way people write music by hand. We made video recordings of participants’ hands while they were copying or freely writing music, and analysed the sequence in which they wrote the elements contained in the musical score. The results confirmed experienced musicians wrote faster than beginners, were more likely to write chords from bottom to top, and they tended to write the note heads first, in a flowing fashion, and only afterwards use stems and beams to emphasize grouping, and add expressive markings.
Australian private practice metropolitan telepsychiatry during the COVID-19 pandemic: analysis of Quarter-2, 2020 usage of new MBS-telehealth item psychiatrist services
Authors: Looi Jeffrey CL , Allison Stephen , Bastiampillai Tarun , Pring William , Reay Rebecca
Published: December 2020

Objective:

The Australian Commonwealth Government introduced new psychiatrist Medicare-Benefits-Schedule (MBS)-telehealth items in the first wave of the COVID-19 pandemic to assist with previously office-based psychiatric practice. We investigate private psychiatrists’ uptake of (1) video- and telephone-telehealth consultations for Quarter-2 (April–June) of 2020 and (2) total telehealth and face-to-face consultations in Quarter-2, 2020 in comparison to Quarter-2, 2019 for Australia.

Methods:

MBS item service data were extracted for COVID-19-psychiatrist-video- and telephone-telehealth item numbers and compared with a baseline of the Quarter-2, 2019 (April–June 2019) of face-to-face consultations for the whole of Australia.

Results:

Combined telehealth and face-to-face psychiatry consultations rose during the first wave of the pandemic in Quarter-2, 2020 by 14% compared to Quarter-2, 2019 and telehealth was approximately half of this total. Face-to-face consultations in 2020 comprised only 56% of the comparative Quarter-2, 2019 consultations. Most telehealth provision was by telephone for short consultations of ⩽15–30 min. Video consultations comprised 38% of the total telehealth provision (for new patient assessments and longer consultations).

Conclusions:

There has been a flexible, rapid response to patient demand by private psychiatrists using the new COVID-19-MBS-telehealth items for Quarter-2, 2020, and in the context of decreased face-to-face consultations, ongoing telehealth is essential.
Molecular characterization of encephalomyocarditis virus strains isolated from an African elephant and rats in a French zoo
Authors: Romey Aurore , Lamglait Benjamin , Blanchard Yannick , Touzain Fabrice , Quenault Helene , Relmy Anthony , Zientara Stephan , Blaise-Boisseau Sandra , Bakkali-Kassimi Labib
Published: December 2020

In November 2013, a fatal encephalomyocarditis virus (EMCV) case in a captive African elephant ( Loxodonta africana) occurred at the Réserve Africaine de Sigean, a zoo in the south of France. Here we report the molecular characterization of the EMCV strains isolated from samples collected from the dead elephant and from 3 rats ( Rattus rattus) captured in the zoo at the same time. The EMCV infection was confirmed by reverse-transcription real-time PCR (RT-rtPCR) and genome sequencing. Complete genome sequencing and sequence alignment indicated that the elephant’s EMCV strain was 98.1–99.9% identical to the rat EMCV isolates at the nucleotide sequence level. Phylogenetic analysis of the ORF, P1, VP1, and 3D sequences revealed that the elephant and rat strains clustered into lineage A of the EMCV 1 group. To our knowledge, molecular characterization of EMCV in France and Europe has not been reported previously in a captive elephant. The full genome analyses of EMCV isolated from an elephant and rats in the same outbreak emphasizes the role of rodents in EMCV introduction and circulation in zoos.
Primary sinonasal malignant melanoma with systemic metastasis in a non-gray horse
Authors: Hatai Hitoshi , Hatazoe Takashi , Seo Haruka , Tozaki Teruaki , Ishikawa Shingo , Miyoshi Noriaki , Misumi Kazuhiro , Hobo Seiji
Published: December 2020

A 27-y-old Anglo-Arabian gelding with bay coat color was presented with a swelling of the left maxillary region. Fenestration on the left maxilla revealed that the left maxillary sinus was filled with black-red tissue. A portion of the tissue was excised and diagnosed histologically as malignant melanoma. Genotyping of the STX17 gene for gray coat color revealed that the horse did not have the “gray” factor. The horse was euthanized ~3 mo after first presentation. During autopsy, a black-to-gray mass extended from the left nasal cavity to the surrounding paranasal sinus and invaded the hard palate, cribriform plate, and the cranial portion of the left olfactory bulb. Moreover, identical black nodules were present in lymph nodes from the mandible to the larynx, and in the spleen, liver, kidney, and adrenal glands. However, masses were not found in the skin, perineal region, or pelvic cavity. All of the black-to-gray nodules were malignant melanomas that were histologically identical to the initial biopsy; tumor emboli were also found in the kidney. Sinonasal mucosal melanoma is a rare disease in horses.
The Impact of an Escape Room Simulation to Improve Nursing Teamwork, Leadership and Communication Skills: A Pilot Project
Authors: Valdes Beatriz , Mckay Mary , Sanko Jill S.
Published: December 2020

Background.

Commercial escape room simulation-based educational experiences were piloted on a cohort of ten RN-BSN students to determine the effect on mastery of communication, leadership, and teamwork skills.

Methods.

Pre-test/post-test research design and qualitative questions were used to measure the impact of an escape room simulation activity on teamwork, communication, and leadership skills. The Team Strategies and Tools to Enhance Performance and Patient Safety® Teamwork Attitudes Questionnaire, and self reported levels of confidence and competence questionnaire were administered pre/post escape room simulation to measure communication, team structure and leadership skills. The University of Miami-Crisis Resource Management tool was utilized to measure observed teamwork. Additionally, four open-ended qualitative self-reflective questions were asked following the escape room.

Results.

Data from the analysis of the pre and post observations of simulation encounters found statistically significant time dependent differences noting improvements in observed teamwork and leadership, p <.001, pre-mean 18.5, post-mean 35.0. Qualitative data revealed the participants found the escape room simulation to be an engaging teaching method to master teamwork and leadership skills.

Conclusion.

This pilot study sets the foundation for future use and exploration of escape room experiences to teach teamwork, communication, leadership and situational awareness. Following the escape room simulation, observed improvements in teamwork and leadership were found. Participants found the escape room activity to be an engaging experiential teaching method to promote attainment of critical skills needed to work as an effective member of a team. Study findings suggest that the use of an escape room can impart experiential learning with critical skills needed to work as an effective member of a team. As a result of this pilot study, nursing faculty developed an escape room simulation experience that was initiated the following semester.
The Challenges of Conducting Qualitative Research on “couples” in Abusive Intimate Partner Relationships Involving Substance Use
Authors: Love Beverly , Henderson Juliet , Johnson Amy , Stephens-Lewis Danielle , Gadd David , Radcliffe Polly , Gilchrist Elizabeth , Gilchrist Gail
Published: December 2020

Undertaking qualitative dyad or couple interviews involving intimate partner abuse and substance use presents considerable ethical, safeguarding, and theoretical challenges throughout the research process from recruitment to conducting interviews and analysis. These challenges and how they were managed are outlined using the experience from a qualitative study of 14 heterosexual “couples” that explored the complex interplay between intimate partner abuse and substance use. Managing these challenges for participants, their families, and researchers included the use of safeguarding protocols and procedures to manage risk and the provision of clinical support for experienced researchers. Researchers often felt drawn into the conflicts and complex dynamics of opposing accounts from the male and females’ relationship which could be emotionally and methodologically taxing. Researchers discussing their analysis and felt experiences with each other provided a reflexive space to manage emotions and stay close to the theoretical underpinnings.
Grief: The Epidemic Within an Epidemic
Authors: Petry Sarah Elizabeth , Hughes Dalton , Galanos Anthony
Published: December 2020

COVID-19 has not only dramatically changed the way we live, it has also impacted how we die and how we grieve. With more and more Americans dying in ICU settings, away from family, and more funerals being held virtually, the pandemic has seriously curtailed normal expressions of grief and cultural mourning. Given the CDC guidelines for funerals and social distancing, simple human touch is no longer a mitigating force against prolonged grief. So, while one epidemic has a face and a name, we point to a second, more silent yet potentially equally devastating one, unacknowledged grief, and emphasize how policy can be a current therapeutic. We can wait for a vaccine, but we can also act now through thoughtful policymaking that acknowledges this second epidemic.
Circumstances Related to Moral Distress in Palliative Care: An Integrative Review
Authors: Corradi-Perini Carla , Beltrão Julianna Rodrigues , Ribeiro Uiara Raiana Vargas de Castro Oliveira
Published: December 2020

Background:

The practice of palliative care is involved with ethical conflicts related to the life-death process and relief of suffering. The inability to act in the face of such dilemmas, due to internal or external barriers, can cause moral distress in the healthcare professionals.

Objective:

The purpose of this integrative review is to analyze which circumstances cause moral distress in healthcare professionals who work in palliative care.

Methods:

An integrative review of the literature was made in the SCIELO and PubMed databases, based on the descriptors “palliative care” and “moral distress.” Articles published between 2015-2020, in Portuguese, Spanish and English were included, following the PRISMA criteria.

Results:

From a selection of 97 documents, 56 were completed reviewed and 23 studies were included in the review. Most articles refer to the nursing area, followed by multidisciplinary studies. The circumstances related to moral distress were identified involving: personal aspects; patients and caregivers; team; environment and organization. Communication problems, lack of resources and witnessing professionals giving false hope to patient and family members were the events related to moral distress most mentioned by the articles in the review. Recommendations for reducing and preventing moral distress include empowerment and educational programs in bioethics and palliative care.

Conclusions:

Moral distress is an evident phenomenon in palliative care, involving different situations that can impact on quality-of-care provided as well as the well-being of the healthcare professionals.
Educating Internal Medicine Residents on Palliative Medicine and Hospice Care at a Community Teaching Hospital
Authors: Nicotra Cassandra , Barnes Martin , Macchio Phyllis , Le Thuy-Hong , Kumar Vikas , Haggerty Greg , De Elia Carolina , Kaell Alan
Published: December 2020

Background:

The Accreditation Council of Graduate Medical Education (ACGME) currently requires Internal Medicine (IM) GME programs to incorporate educational opportunities for training and structured experiences in Palliative and Hospice Medicine. Miscomprehension of the differences between palliative medicine and hospice care is a barrier for IM residents ordering palliative consults as many residents may underutilize palliative medicine if a patient is not appropriate for hospice.

Objective:

This educational performance improvement (PI) project assessed 3 domains, including Medical Knowledge (MK) of palliative versus hospice medicine at baseline and following a single didactic session. Additionally, the number of palliative consults ordered was used as a surrogate for interpersonal and communication skills (ICS) and patient care (PC) domains.

Methods:

An 8-question survey and 30-minute didactic session were created based upon experientially-determined issues most confusing to IM residents. Participants included 33 IM residents (PGY-1s-3 s) from July 2018 (first cohort) and 32 (PGY-1 s and any PGY-2s-3 s who did not participate in the first cohort) from July 2019 (second cohort).

Results:

65 of a possible 73 residents participated (89% response rate) Pre-test Questions 5, 6, and 8 correct responses were <50% in both cohorts with average scores, respectively, of 43.1%, 35.4%, and 40%. Residents improved on the post-test for Q5, 6, 8 to, respectively, 80%, 86.7%, and 48.3% (t = 7.68, df = 59, p < 001). Correct Q1 responses declined in the first cohort, but clarification for the second cohort improved from pre-test (36.4%) to post-test (65.5%). The total number of palliative consults placed by IM residents increased as well.

Conclusions:

Baseline MK of palliative versus hospice medicine was <50% on 4/8 questions. A brief educational session significantly improved residents’ short-term comprehension and increased the number of palliative consults.
Appointment of a Healthcare Power of Attorney Among Older Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) Adults in the Southern United States
Authors: Dickson Lexus , Bunting Samuel , Nanna Alexis , Taylor Megan , Hein Liam , Spencer Mindi
Published: December 2020

Background:

The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) older adult population may have a heightened need of medical and supportive care while aging. This makes appointment of a healthcare power of attorney (HCPoA) an essential component of end-of-life care to ensure patients’ wishes are honored at the end of their lives. The objective of this study was to evaluate the prevalence and preferences for HCPoA appointment among older LGBTQ adults living in the Southern United States.

Methods:

An online survey was distributed to older LGBTQ adults living in the Southern US regarding appointment of a HCPoA between January-March 2018.

Participants:

The survey was completed by 789 older LGBTQ adults from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, and Florida in January-March 2018.

Results:

Overall, 61.6% of respondents had appointed a HCPoA. Respondents with an appointed HCPoA were more likely to be married (aOR = 5.04, p < .001), have larger social networks (aOR = 3.87, p < .001) and be older (aOR = 1.07, p < .001). Gender diverse respondents were less likely to have an appointed HCPoA relative to cisgender respondents (aOR = 0.39, p = .04). Overall, the majority of respondents indicated a spouse or significant other served as their HCPoA ( n = 311, 64.5%).

Conclusions:

Nearly 40% of older LGBTQ adults in the Southern US did not have an appointed HCPoA. Specifically, those who were more socially isolated, single, or who identified as transgender or gender non-binary were less likely to have an appointed HCPoA. These people may benefit from targeted outreach regarding advance care planning.
Multi-Site Study of Provider Self-Efficacy and Beliefs in Explaining Judgments About Need and Responsibility for Advance Care Planning
Authors: Baughman Kristin R. , Ludwick Ruth , Jarjoura David , Yeager Mia , Kropp Denise
Published: December 2020

Background and Objectives:

We examined the impact of advance care planning (ACP) self-efficacy and beliefs in explaining skilled nursing facility (SNF) provider judgments about resident need and provider responsibility for initiating ACP conversations.

Research Design and Methods:

This observational multi-site study of 348 registered nurses, licensed practical nurses, and social workers within 29 SNFs used an anonymous survey in which providers judged vignettes with assigned situational features of a typical SNF resident. Mixed modeling was used to analyze the vignette responses.

Results:

Providers who had more negative beliefs about ACP were less likely to judge residents in need of ACP and less likely to feel responsible for ensuring ACP took place. Self-efficacy did not have a significant impact on judgments of need, but did significantly increase judgments of responsibility for ensuring ACP conversations. Providers with the highest levels of ACP self-efficacy were most likely to feel responsible for ensuring ACP conversations. In an exploratory analysis, these relationships remained the same whether responding to high or low risk residents (i.e., based on risk of hospitalization, type of diagnosis, functional status, and rate of declining health).

Discussion and Implications:

Both negative beliefs about ACP and self-efficacy in one’s ability to conduct ACP discussions were associated with professional judgments regarding ACP. The findings illustrate the importance of addressing negative beliefs about ACP and increasing provider ACP self-efficacy through education and policies that empower nurses and social workers.
Distorted Memories and Related Factors in ICU Patients
Authors: Fukuda Tomohide , Kinoshita Yoshiko , Shirahama Tomoko , Miyazaki Satoko , Watanabe Naoki , Misawa Takuko
Published: December 2020

This study aimed to examine the relationship between memory status of and factors related to patients in the intensive care unit (ICU) using a cross-sectional study design. Participants were adult patients who were admitted to the general ICUs for more than 48 hours. One week after ICU discharge, a survey on memory distortion was conducted. Overall, 133 patients were included, of whom 51.1% reported distorted memories. Among them, 15.0% had memory loss; 48.1% had unrealistic experiences; 27.8% recalled confusion, panic, anxiety, and discomfort during their ICU stay; and 9% had traumatic experiences. Multiple logistic regression analyses revealed that memory loss was associated with an operation, and a significant association was observed between traumatic memory and pain. Opioid use may have a protective effect against memory loss. These results suggest the importance of relieving pain and preserving true memories during ICU treatment.
The Impact of Positive School Climate on Suicidality and Mental Health Among LGBTQ Adolescents: A Systematic Review
Authors: Ancheta April J. , Bruzzese Jean-Marie , Hughes Tonda L.
Published: December 2020

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.
Examining the Outcomes of the InsideOut Dad Fatherhood Education Program for Incarcerated Minority Fathers
Authors: Turner Joshua J. , Bradford Kay , Higginbotham Brian J. , Coppin Andrea
Published: December 2020

Using a mixed-methods approach, this study examined the outcomes and experiences of incarcerated minority fathers ( N = 713) who participated in InsideOut Dad, a widely used, corrections-based fatherhood education program. Quantitative analyses indicated decreases in partner conflict among participants and more positive perceptions of subjective well-being. Qualitative analyses revealed that the program was positively received, with participants noting the skills they developed. As a result of fatherhood education, incarcerated minority fathers reported being empowered and more confident in their roles as fathers and that they learned needed skills to be responsible and responsive fathers. Such findings may inform facilitators of corrections-based parenting programs on best practices for serving incarcerated fathers from historically underserved groups.
Construction and Validation of a Self-report Subjective Emptiness Scale
Authors: Price Adrian L. , Mahler Heike I. M. , Hopwood Christopher J.
Published: December 2020

Subjective emptiness is a psychiatric symptom that is primarily assessed and studied as a criterion of borderline personality disorder, even though research suggests that it may have clinical importance beyond that diagnosis. The aim of this series of studies was to develop and validate a standalone self-report measure of subjective emptiness. A systematic, multistep approach to identifying test content was used to generate 88 items that were then trimmed to 53 via ratings of interviews with patients and experts. This preliminary scale was administered to a sample of 544 university students, and a trimmed version was given to two samples oversampled for clinical problems ( n = 1,067; n = 1,016). A five-item measure fit a unidimensional model well and had satisfactory internal consistency across these samples. External validity analyses suggested that emptiness, as measured by the Subjective Emptiness Scale, is strongly related to a number of clinical constructs, particularly in the internalizing domain, indicating that emptiness is an important construct to consider in its own right, independent of its presence in the borderline criterion set.
Changing Disparity of Gastric Cancer Incidence by Histological Types in US Race-Specific Populations
Authors: Zhu Xuan , Pigazzi Alessio , Zell Jason , Lu Yunxia
Published: December 2020

Background:

The incidence pattern of gastric cancer by histological types across major race/ethnic groups is unknown.

Methods:

Age-standardized rates from 1992-2016 by race/ethnicity were calculated using data from Surveillance, Epidemiology, and End Results Program (SEER). Annual percent changes (APCs) in rates and corresponding 95% confidence intervals (CIs) were calculated and pairwise comparison of rates between race/ethnic groups was performed using the Joinpoint Regression Program. Calendar periods of incidence rates of gastric cardia and non-cardia cancer by histological types across race/ethnicity groups were shown by figures.

Results:

The White population has the highest incidence of gastric cardia adenocarcinoma and the incidence is keeping constant from 1992 through 2016 except the decreasing in the Asian population (AAPC = −1.4, 95%CI (−2.1, −0.8)). Although the incidence of non-cardia adenocarcinoma is decreasing in each group, the descending trend in the Asian population is the quickest (AAPC = −3.8, 95%CI (−4.0, −3.5)). Gastric carcinoids were observed to have statistically significant increasing trends in all race/ethnicity groups, especially in Hispanic women from 0.4 per 100,000 to 1.6 per 100,000 persons. The incidence of gastrointestinal stromal tumors (GISTs) is rising, with Non-Hispanic blacks having the highest incidence.

Conclusion:

This study demonstrated disparities in the incidence of gastric cancer by histological types among different race/ethnic groups. Further investigations are warranted to understand the changing incidence patterns by race/ethnicity.
Dynamin Superfamily at Pre- and Postsynapses: Master Regulators of Synaptic Transmission and Plasticity in Health and Disease
Authors: Arriagada-Diaz Jorge , Prado-Vega Lorena , Cárdenas Ana M. , Ardiles Alvaro O. , Gonzalez-Jamett Arlek M.
Published: December 2020

Dynamin superfamily proteins (DSPs) comprise a large group of GTP-ases that orchestrate membrane fusion and fission, and cytoskeleton remodeling in different cell-types. At the central nervous system, they regulate synaptic vesicle recycling and signaling-receptor turnover, allowing the maintenance of synaptic transmission. In the presynapses, these GTP-ases control the recycling of synaptic vesicles influencing the size of the ready-releasable pool and the release of neurotransmitters from nerve terminals, whereas in the postsynapses, they are involved in AMPA-receptor trafficking to and from postsynaptic densities, supporting excitatory synaptic plasticity, and consequently learning and memory formation. In agreement with these relevant roles, an important number of neurological disorders are associated with mutations and/or dysfunction of these GTP-ases. Along the present review we discuss the importance of DSPs at synapses and their implication in different neuropathological contexts.
Monoamines: Dopamine, Norepinephrine, and Serotonin, Beyond Modulation, “Switches” That Alter the State of Target Networks
Authors: Azizi Sayed Ausim
Published: December 2020

How do monoamines influence the perceptual and behavioral aspects of brain function? A library of information regarding the genetic, molecular, cellular, and function of monoamines in the nervous system and other organs has accumulated. We briefly review monoamines’ anatomy and physiology and discuss their effects on the target neurons and circuits. Monoaminergic cells in the brain stem receive inputs from sensory, limbic, and prefrontal areas and project extensively to the forebrain and hindbrain. We review selected studies on molecular, cellular, and electrophysiological effects of monoamines on the brain’s target areas. The idea is that monoamines, by reversibly modulating the “primary” information processing circuits, regulate and switch the functions of brain networks and can reversibly alter the “brain states,” such as consciousness, emotions, and movements. Monoamines, as the drivers of normal motor and sensory brain operations, including housekeeping, play essential roles in pathogenesis of neuropsychiatric diseases.
The Effect of FAmily-CEntered (FACE®) Pediatric Advanced Care Planning Intervention on Family Anxiety: A Randomized Controlled Clinical Trial for Adolescents With HIV and Their Families
Authors: Lin Christopher J. , Cheng Yao I. , Garvie Patricia A. , D’Angelo Lawrence J. , Wang Jichuan , Lyon Maureen E.
Published: December 2020

Clinicians fear pediatric advance care planning (pACP) for adolescents is too distressing for families. Multisite longitudinal randomized controlled trial of adolescents with HIV tested the effect of FAmily-CEntered (FACE®) pACP intervention on families’ anxiety and depression. One hundred five adolescent/family dyads were randomized to FACE® ( n = 54 dyads) or control ( n = 51 dyads). Families were 90% African American, 37% HIV-positive, and 22% less than high school educated. Families reported lower anxiety 3 months post-FACE® intervention than control (β = −4.71, 95% confidence interval [CI] = [−8.20, −1.23], p = .008). Male family members were less anxious than female family members (β = −4.55, 95% CI = [−6.96, −2.138], p ≤ .001). Family members living with HIV reported greater depressive symptoms than HIV-uninfected families (β = 3.32, 95% CI = [0.254, 6.38], p = .034). Clinicians can be assured this structured, facilitated FACE® pACP model minimized family anxiety without increasing depressive symptoms. Adolescent/family dyads should be invited to have access to, and provision of, evidence-based pACP as part of patient-centered/family-supported care in the HIV continuum of care.
Prospective Assessment of Biomarkers of Hypercoagulability for the Identification of Patients With Severe Coronary Artery Disease. The ROADMAP-CAD Study
Authors: Gerotziafas Grigoris T. , Zografos Theodoros , Pantos Ioannis , Lefkou Eleftheria , Carlo Audrey , Fareed Jawed , Van Dreden Patrick , Katritsis Demosthenes
Published: December 2020

In patients with stable coronary artery disease (CAD) blood hypercoagulability figures among factors leading to thrombosis. Tissue factor (TF) exposure at ruptured plaque initiates blood coagulation and hypercoagulability is responsible for thrombus formation. Early identification of patients eligible for angiography is a challenging issue for effective prevention of ACS. This pilot study aimed to identify biomarkers of hypercoagulability that can be prospectively used in risk assessment tools for the evaluation of CAD severity. Biomarkers of hypercoagulability could be a used for the evaluation of CAD severity. Platelet-poor plasma from 66 patients who were referred to coronary angiography was assessed for thrombin generation, phospholipid-dependent clotting time (Procoag-PPL ® ) and D-Dimers, and evaluated against atherosclerotic burden. Patients with CAD, as compared to controls, showed attenuated thrombin generation lag time: 4.7 (3.8-5.4) min versus 2.5 (2.1-2.9) min; p < 0.0001, shorter Procoag-PPL® clotting time 55.0(32-66) s versus 62.8 (42-85) s; p = 0.001), and higher D-Dimer levels 0.509 (0.27-2.58) μg/ml versus 0.309 (0.23-0.39) μg/ml; p = 0.038. Multivariate logistic regression model showed excellent discriminatory value in predicting CAD severity. The ROADMAP-CAD study showed that the Procoag-PPL® clotting time and thrombin Peak are informative for the the burden of the coronary atherosclerotic disease. The clinical relevance of this observation in the development of a new clinic-biological risk assessment model for early diagnosis of severe CAD has to be examined in a prospective study.
Effect of Dabigatran on Clotting Time in the Clotpro Ecarin Clotting Assay: A Prospective, Single-Arm, Open-Label Study
Authors: Fong Alan Yean Yip , Tiong Lee Len , Tan Shirley Siang Ning , Geruka Dominic , Apil Gerald Grino , Choo Chee Wei , Ong Tiong Kiam
Published: December 2020

Routine coagulation tests do not enable rapid, accurate determination of direct oral anticoagulant (DOAC) therapy. The ecarin clotting assay (ECA), performed on the ClotPro viscoelastic testing device, may enable sensitive and specific detection of dabigatran. We assessed the association between trough plasma dabigatran concentration and clotting time (CT) in the ClotPro ECA, in patients with non-valvular atrial fibrillation (NVAF). Each patient provided a single venous blood sample, ∼1 hour before dabigatran dosing. The study included 118 patients, of whom 64 were receiving dabigatran 110 mg twice daily and 54 were receiving 150 mg twice daily. ECA CT was moderately correlated with trough plasma dabigatran concentration ( r = 0.80, p < 0.001). Slight trends toward increased plasma dabigatran concentration and prolonged ECA CT were apparent with 150 mg versus the 110 mg dose (differences not statistically significant). Individuals with creatinine clearance below 50 mL/minute had significantly higher plasma dabigatran concentrations and significantly prolonged ECA CT versus those with creatinine clearance ≥50 mL/minute. In conclusion, this preliminary study has demonstrated that CT in the ClotPro ECA reflects the plasma concentration of dabigatran in patients with NVAF. The ECA could potentially be used to assess the impact of dabigatran on a patient’s coagulation status.
Changes in Coagulation and Fibrinolysis in Post-Cesarean Section Parturients Treated With Low Molecular Weight Heparin
Authors: Liu Ziwei , Liu Chixiang , Zhong Mei , Yang Fang , Chen Hongtian , Kong Wenbing , Lv Piao , Chen Wanjun , Yao Yuan , Cao Qiong , Zhou Huayou
Published: December 2020

Background:

Cesarean section is an independent risk factor for Venous thromboembolism (VTE). Low molecular weight heparin (LMWH) is extensively used for VTE prophylaxis after cesarean section. In this study, the effects of LMWH on coagulation and fibrinolysis after cesarean section and its clinical value were explored by studying the changes in laboratory indicators.

Methods:

Antepartum and postpartum peripheral blood of 44 pregnant women who underwent vaginal delivery and 44 pregnant women who underwent cesarean section treated per routine with LMWH thromboprophylaxis on the first day post-operatively were collected for the following tests: D-dimer; thrombotic markers such as thrombomodulin (TM), thrombin-antithrombin complex (TAT), α2-plasmin inhibitor-plasmin complex (PIC), and tissue plasminogen activator inhibitor complex (t-PAIC); thromboelastography.

Results:

Compared to the antepartum levels, PIC increased, TM, TAT, and t-PAIC decreased significantly in the parturients after a spontaneous vaginal delivery. Compared to the antepartum levels, parturients routinely treated with LMWH after cesarean section had higher PIC levels and lower D-dimer, TAT, and t-PAIC levels. Compared with parturients after vaginal delivery, parturients treated with LMWH after cesarean section had higher levels of TM, R, and MA, while there was no significant differences in the levels of D-dimer, TAT, PIC, t-PAIC, K, angle, LY30, and CI.

Conclusion:

The coagulation and fibrinolytic systems in gravidas and parturients are in a high level of dynamic equilibrium. The levels of coagulation and fibrinolytic system activation were similar in parturients who were routinely treated with LMWH after cesarean section compared with parturients after a spontaneous vaginal delivery.