bluuebunny/crossref_metadata_2025 huggingface dataset:
Proximity and the evolving knowledge polycentricity of megalopolitan science: Evidence from China’s Guangdong-Hong Kong-Macao Greater Bay Area, 1990–2016
Authors: Ma Haitao , Li Yingcheng , Huang Xiaodong
Published: August 2020

Despite the two key defining features of megalopolises as incubators and hinges in a globalising knowledge economy, how intercity knowledge flows could shape the polycentric structure of the science system of a megalopolis has only gained popularity in recent years. This study focuses on measuring and explaining the evolving knowledge polycentricity of the science system of China’s Greater Bay Area (GBA) megalopolis during the 1990–2016 period. Our empirical results are generally robust when we adopt different measurement approaches and draw upon different publication databases. Overall, the degrees of knowledge polycentricity at different geographical scales have been generally increasing during the study period, though with some fluctuations. In addition, the degree of knowledge polycentricity becomes smaller at higher geographical scales. The mechanisms behind the evolving knowledge polycentricity have been further investigated from the proximity perspective. The increasing geographical proximity, institutional proximity and social proximity between cities within and beyond the GBA megalopolis have contributed to the strengthening knowledge polycentricity of its science system at different geographical scales.
The acute effects of cannabidiol on the neural correlates of reward anticipation and feedback in healthy volunteers
Authors: Lawn Will , Hill James , Hindocha Chandni , Yim Jocelyn , Yamamori Yumeya , Jones Gus , Walker Hannah , Green Sebastian F , Wall Matthew B , Howes Oliver D , Curran H Valerie , Freeman Tom P , Bloomfield Michael AP
Published: August 2020

Background:

Cannabidiol has potential therapeutic benefits for people with psychiatric disorders characterised by reward function impairment. There is existing evidence that cannabidiol may influence some aspects of reward processing. However, it is unknown whether cannabidiol acutely affects brain function underpinning reward anticipation and feedback.

Hypotheses:

We predicted that cannabidiol would augment brain activity associated with reward anticipation and feedback.

Methods:

We administered a single 600 mg oral dose of cannabidiol and matched placebo to 23 healthy participants in a double-blind, placebo-controlled, repeated-measures design. We employed the monetary incentive delay task during functional magnetic resonance imaging to assay the neural correlates of reward anticipation and feedback. We conducted whole brain analyses and region-of-interest analyses in pre-specified reward-related brain regions.

Results:

The monetary incentive delay task elicited expected brain activity during reward anticipation and feedback, including in the insula, caudate, nucleus accumbens, anterior cingulate and orbitofrontal cortex. However, across the whole brain, we did not find any evidence that cannabidiol altered reward-related brain activity. Moreover, our Bayesian analyses showed that activity in our regions-of-interest was similar following cannabidiol and placebo. Additionally, our behavioural measures of motivation for reward did not show a significant difference between cannabidiol and placebo.

Discussion:

Cannabidiol did not acutely affect the neural correlates of reward anticipation and feedback in healthy participants. Future research should explore the effects of cannabidiol on different components of reward processing, employ different doses and administration regimens, and test its reward-related effects in people with psychiatric disorders.
Development of Operating Mode Distribution Models for Light-Duty Vehicles on Unrestricted Access Roadways
Authors: Li Jia , He Hanhui , Peng Bo
Published: August 2020

The key correlating traffic variable for modeling vehicle emissions has evolved from average speed to vehicle-specific power (VSP), and recently to operating mode as defined in Motor Vehicle Emission Simulator (MOVES). The analysis of operating mode and its distribution, however, requires a large amount of data and is time consuming and challenging. This paper attempts to build models between the operating mode distributions and the common traffic variable—average speed—to facilitate the emission estimation. Focusing on light-duty vehicles and unrestricted access roadways, a floating car survey was conducted separately on arterials and collectors in Shaoshan, China. The trajectory data were processed to reveal the characteristics of operating mode distributions. A key finding is that, when the data points of the operating mode of idle are excluded, the VSP distributions of the remaining data points follow logistic distributions and the parameters can be linearly regressed with the average speed. Arterials and collectors feature different operating mode distributions even at the same average speed, and therefore different models were developed. The models were then applied to generate operating mode distributions, which were validated with the real-world data from the test bed and which, when compared with the default values generated by MOVES, fit the real-world condition better.
The Impact of Economic Inequality on Entrepreneurship: Does a Society’s Stage of Development Make a Difference?
Authors: Auguste Daniel
Published: August 2020

In recent studies linking inequality to the entrepreneurial process, some scholars claim that inequality creates entrepreneurial incentives, thereby increasing entrepreneurship, while others contend that inequality deters entrepreneurship by restricting market opportunities. Building on Kuznets’s inverted- U hypothesis on the inequality–development relationship, I posit that the nature of the inequality–entrepreneurship relationship is contingent on a society’s development level. Results from mixed-effects logistic regressions and 60 countries support this argument. Although inequality increases entrepreneurship overall, the results of this study show a curvilinear relationship between the inequality–entrepreneurship association and development. That is, the inequality–entrepreneurship association is weak at low levels of development, strengthens as development increases from low to intermediate levels, and lessens again at advanced development levels. I discuss the implications of these findings for future entrepreneurship research and policy initiatives aimed at mitigating adverse impacts of inequality on social welfare.
Effects of anisotropy in correlation structure on reliability-based slope stability analysis of a landfill
Authors: Mehdizadeh Mohammad Javad , Shariatmadari Nader , Karimpour-Fard Mehran
Published: August 2020

In this study, a reliability-based analysis of slope stability in a landfill considering the spatial variability of shear strength (c and φ) and unit weight ( γ) of municipal solid waste was performed using the random finite difference method. The effect of the anisotropic correlation (AC) structure of random variables including c, φ, and γ on mean and coefficient of variation (CoV) of safety factor values was investigated using Monte Carlo simulation. Also, probability of failure was determined through probability distribution fitting to a series of safety factor data. The results showed that the AC of the random variables has a significant effect on the stochastic safety factor of landfill slope. In general, the mean of the stochastic safety factor decreases with increasing horizontal and vertical correlation lengths (CLs). Also, the CoV of the safety factor increased with increase in horizontal or vertical CLs or both. Moreover, it was found that failure probability increases with an increase in the horizontal and vertical CLs and assuming isotropic structure for the correlation of random variables leads to the underestimation of failure probability. Overall, the results indicate that assuming an AC structure results in different failure mechanisms in the landfill slope, which are different from the deterministic cases.
Development of Voluntary Assisted Dying Training in Victoria, Australia: A Model for Consideration
Authors: White Ben P. , Willmott Lindy , Close Eliana , Hewitt Jayne , Meehan Rebecca , Greaves Laura Ley , Parker Malcolm H. , Yates Patsy
Published: August 2020

Background:

Voluntary assisted dying was legalized in Victoria, Australia in June 2019, and was the first jurisdiction internationally to legislatively mandate training for doctors conducting eligibility assessments of patients. Mandatory training was designed as a safeguard to ensure compliance within the system, so that only eligible patients would gain access to voluntary assisted dying.

Objective:

This article outlines the development of training mandated for doctors prior to undertaking eligibility assessments for voluntary assisted dying. The training addressed required legal knowledge, including doctors’ roles, duties and legal protections, and also provided instruction on relevant clinical skills.

Design:

Training design was based on 2 main principles: to comprehensively impart the legal duties imposed by the legislation; and to be readily accessible for busy doctors. The law was first mapped into a curriculum, and circulated to medical colleges, societies and professional organizations as well as international experts for feedback. The training was converted into an online e-learning format and tested at a focus group of doctors.

Results:

The training comprises 9 modules including an assessment module. While the predominant focus of the modules is on law, they also contain some clinical components and links to further resources. Modules also contain videos, case studies and interactive exercises. The assessment consists of 30 questions, selected randomly from a question bank, with a pass mark of 90%.

Conclusion:

The Victorian legislatively-mandated voluntary assisted dying training provides standardized baseline knowledge to enhance the quality and consistency of decision-making by doctors. While further evaluation of this training is needed, it may provide a model for other jurisdictions considering making voluntary assisted dying lawful.
A comprehensive tune of coupled roll and lateral dynamics and parameter sensitivity study for a vehicle fitted with hydraulically interconnected suspension system
Authors: Qi Hengmin , Zhang Nong , Chen Yuanchang , Tan Bohuan
Published: August 2020

Roll and lateral dynamics of a vehicle are heavily coupled together, the increase of roll stability does not necessarily result in the improvement of stability in the lateral plane, but the decrease in lateral stability possibly contributes to instability in the roll plane. To address this challenge, a comprehensive tune of coupled roll and lateral dynamics for a vehicle fitted with hydraulically interconnected suspension system is presented in this paper. A typical sport utility vehicle is selected and modeled with 10 degrees of freedom to conduct the dynamic simulation. Also, the fluid equations of the proposed hydraulically interconnected suspension system with nonlinear damper model are derived and incorporated into the vehicle model. Furthermore, the integrated model is validated by the field test. The simulation is also conducted to assess and compare the vehicle roll and lateral dynamic performances under fishhook maneuver. The results show that the well-tuned hydraulically interconnected suspension can suppress its body motion in roll plane, enhance the yaw rate tracking ability, minimize the sideslip angle at the center of gravity, and also decrease the slip angles for tires. Last, the parameter sensitivity analysis for a strongly nonlinear hydraulically interconnected suspension system illustrates how individual hydraulically interconnected suspension parameters (roll stiffness, roll stiffness nonlinearity, roll stiffness distribution ratio, and damping ratio) contribute to different dynamic aspects of a vehicle. The results indicate that, by controlling hydraulically interconnected suspension key parameters, the vehicle dynamic performance can be effectively controlled in both roll and lateral planes. The parameter sensitivity analysis findings have pointed out the direction for controller design and laid the foundation for active hydraulically interconnected suspension system development in the future.
An in vitro assessment of atrial fibrillation flow types on cardiogenic emboli trajectory paths
Authors: Malone Fiona , McCarthy Eugene , Delassus Patrick , Buhk Jan-Hendrick , Fiehler Jens , Morris Liam
Published: August 2020

Atrial fibrillation is the most significant contributor to thrombus formation within the heart and is responsible for 45% of all cardio embolic strokes, which account for approximately 15% of acute ischemic strokes cases worldwide. Atrial fibrillation can result in a reduction of normal cardiac output and cycle length of up to 30% and 40%, respectively. A total of 240 embolus analogues were released into a thin-walled, patient-specific aortic arch under normal (60 embolus analogues) and varying atrial fibrillation (180 embolus analogues) pulsatile flow conditions. Under healthy flow conditions (n = 60), the embolus analogues tended to follow the flow rate split through each outlet vessel. There was an increase in clot trajectories along the common carotid arteries under atrial fibrillation flow conditions. A shorter pulse period (0.3 s) displayed the highest percentage of clots travelling to the brain (24%), with a greater percentage of clots travelling through the left common carotid artery (17%). This study provides an experimental insight into the effect varying cardiac output and cycle length can have on the trajectory of a cardiac source blood clots travelling to the cerebral vasculature and possibly causing a stroke.
Pubic hair grooming practices in KwaZulu-Natal, South Africa: prevalence, side effects and association with sexually transmitted infections
Authors: Beksinska Mags , Lulie Bethel , Beesham Ivana , Smit Jenni
Published: August 2020

Pubic hair grooming is common in many countries, but little is known about this practice in Africa. Grooming has been positively associated with self-reported sexually transmitted infections (STIs). This study aimed to investigate the prevalence and safety of pubic hair grooming in two South African settings. In KwaZulu-Natal province, 1218 women participating in the Evidence for Contraceptive Options and HIV Outcomes Trial completed an interviewer-administered questionnaire on pubic hair grooming practices, and were tested for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and herpes simplex virus type 2 (HSV-2). Pubic hair removal was reported by 705 (58.2%) of women. Common areas for grooming were the pubis (n = 616, 99.4%), vagina/perineum (n = 529, 85.3%) and inner thigh (n = 255, 41.1%). Half (n= 361, 51.4%) removed some or all of their pubic hair at least monthly and 59 (8.4%) once a week or more often. Common side effects reported included itching (n = 439, 77.1%) and pimples and blisters (n = 249, 43.9%). A quarter (n = 173, 24.5%) of groomers had a positive result for either or both of CT and NG compared to a fifth (n = 98, 19.4%) of non-groomers (p-value < 0.033). There was no difference between the groups for HSV-2. After adjusting for age and having more than one sex partner, groomers were significantly more likely to have CT or NG than non-groomers (OR: 1.31; 95% CI: 1.19–1.45). Similarly, those who experienced hair removal-related complications had 1.26 times the odds of testing positive for CT or NG (95% CI: 1.03–1.54). The practice of pubic hair removal is common and reporting of side effects is high in this population. These injuries could put women at a higher risk of STIs.
Obstructive cholangiopathy patient caused by cytomegalovirus and Kaposi sarcoma in a person living with HIV and hepatitis C
Authors: Islas-Muñoz B , Méndez-Sotelo B , Reyes-Pérez J , Jiménez-de los Santos M , Herrera-Goepfert R , Volkow-Fernández P
Published: August 2020

We present the case of a 28-year-old man with recently-diagnosed human immunodeficiency virus and hepatitis C virus infection. He developed obstructive cholangiopathy secondary to cytomegalovirus and Kaposi sarcoma, both diagnosed by endoscopic retrograde cholangiopancreatography and biopsies. He received antiretroviral therapy, chemotherapy and valganciclovir with full recovery.
Confidence as a Priority Signal
Authors: Aguilar-Lleyda David , Lemarchand Maxime , de Gardelle Vincent
Published: August 2020

When dealing with multiple tasks, we must establish the order in which to tackle them. In multiple experiments, including a preregistered replication ( Ns = 16–105), we found that confidence, or the subjective accuracy of decisions, acts as a priority signal, both when ordering responses about tasks already completed or ordering tasks yet to be completed. Specifically, when participants categorized perceptual stimuli along two dimensions, they tended to first give the decision associated with higher confidence. When participants selected which of two tasks they wanted to perform first, they were slightly biased toward the task associated with higher confidence. This finding extends to nonperceptual decisions (mental calculation) and cannot be reduced to effects of task difficulty, response accuracy, response availability, or implicit demands. Our results thus support the role of confidence as a priority signal, thereby suggesting a new way in which it may regulate human behavior.
Modeling of impact of the poppet element on its seat body in pressure relief valves
Authors: Gad Osama
Published: August 2020

This article deals with modeling of the impact between the moving elements and their seats bodies in pressure relief valves. Four different impact models, such as the Kelvin–Voigt, the Maxwell, the standard-solid and the Hunt–Crossley models, are considered. A comprehensive dynamic model of the studied valve, considering the four models, is deduced. The simulation results show that the Kelvin–Voigt model cannot be used to represent the impact in pressure relief valves because, by the end of impact period, the model results in a tensile force, which is physically impossible in rigid bodies impacting. In the Maxwell model, a considerable number of discontinuities appeared in the impact force, which causes the poppet element to make a number of rebounds with the seat body during the impact period. However, in the standard-solid model, the poppet element barely rebounds. In the Hunt–Crossley nonlinear model, a certain penetration distance between the poppet element and the seat body occurs, which is certainly unrealistic in rigid bodies impacting. The validation of the impact models showed that the Maxwell model is the suitable impact model that can be used to represent the impact in pressure relief valves. However, the validation of the proposed dynamic model proved that the impact has no significant effect on the dynamic performance of pressure relief valves. The main reason behind this is that the impact occurs when the operating pressure has fallen down (the valve is out of operation).
Passivity-based adaptive delay compensation for real-time hybrid tests
Authors: Peiris Lokukankanamge Dushyantha Hashan , du Bois Jonathan L , Plummer Andrew R
Published: August 2020

This article presents a novel passivity-based adaptive delay compensation scheme for cancelling actuator dynamics in real-time hybrid testing. This scheme uses the energy added to the system by actuation hardware, to quantify a variable delay, which is subsequently used for delay compensation. It offers the advantage of correcting for tracking errors and instability in hybrid tests and can be implemented without any information of the actuator’s dynamics. Thus, it offers an advantage over most conventional actuator dynamics mitigation schemes which require an accurate model of the actuator prior to testing. Experimental results compare the performance of passivity-based adaptive delay compensation with that of a state-of-the-art adaptive delay compensation scheme based on position. It was found that passivity-based adaptive delay compensation continuously updates the delay estimate while the position-based scheme only updates the delay when the system crosses zero. The performance of both schemes was found to be similar for sinusoidal inputs, mitigating phase lags of up to 35.6° at 10 Hz in the hybrid system tested. Passivity-based adaptive delay compensation requires no extra hardware as it can be run on the same hardware used to drive the actuator, enabling an affordable solution applicable to a wide range of hybrid tests.
Waving the historian’s magic wand: Temporal comparisons and analogies in the writing of history
Authors: Fernández-Sebastián Javier
Published: August 2020

The main purpose of this article is to raise some questions about temporal comparisons and analogies in the writing of history. The article has four parts. The first one shows that historical discipline, conceptual history and language itself can scarcely be conceived of in the absence of comparisons, implicit or explicit, between events, processes and individuals. The second section provides a few samples of the sources of inspiration of some recurrent temporal parallelisms in the Western tradition. The third identifies two key moments in the history of modern Europe when temporal analogies assumed particular importance. These two periods – two turns of the century (16th century and 18th century) – correspond to transitional phases between successive stages in the development of Western historical consciousness. The article ends with a brief reflection on the usefulness and limits of temporal analogies in the writing of history.
Calculative practices and socio-political tensions: A historical analysis of entertainment, arts and accounting in a government agency
Authors: Rentschler Ruth , Lee Boram , Subramaniam Nava
Published: August 2020

The article examines entertainment, arts and accounting practices of a national arts council that funds arts organisations and artists. It does so by investigating the first 25 years of annual reports of the Australian Council for the Arts (1973-1996), using media reports to triangulate the data. Set against a background of socio-political change, the study explicates the differing treatments of entertainment and the arts, as political parties come in and out of power, national policy shifts, and macro-economic changes occur. Guided by legitimacy theory, analysis of narratives and budgets as calculative practices in annual reports illustrates how the nexus between entertainment and the arts changes over time, with the emphasis or value placed on entertainment diminishing relative to the arts. We conclude that the arts council has become the ‘arts council for the performing arts’, calling into question moral, pragmatic and cognitive legitimacy of the arts council.
Amicus cum Laude: Ethnodramatic Inquiry Regarding Sharing Mental Health in College
Authors: Hall Robert D.
Published: August 2020

In this manuscript, I utilize an ethnodramatic methodology in reanalyzing two data sets about college friends disclosing and receiving mental health-related information. After describing ethnodrama and how this methodology applies to mental health–related inquiry, I detail my process of creating an ethnodrama from two extant data sets. The result is an ethnodrama called Amicus cum Laude: Becoming a Friend with Honor for Mental Illness, a one-act play about how friends discuss mental health issues with one another. After providing the ethnodrama, I offer recommendations for taking the ethnodrama from page to stage while reflecting on and critiquing the final product.
Extensor Retinaculum Flap and Fibular Periosteum Ligamentoplasty After Failed Surgery for Chronic Lateral Ankle Instability
Authors: Pintore Ernesto , Cipollaro Lucio , Pintore Raffaele , Oliva Francesco , Maffulli Nicola
Published: August 2020

Background:

The anterior talofibular ligament and the calcaneofibular ligament are 2 of the most frequently injured structures in sports, being damaged in 30% to 45% of all sports injuries. Most reconstructive procedures are successful but can deteriorate with time and can lead to low-grade radiographic degeneration.

Methods:

We operated on 26 consecutive patients from 2001 to 2008 who had failed previous surgical procedures for the lateral ligamentous complex of the ankle, with an average of 104 (range, 75-140) months.

Results:

The overall functional rating was excellent in 14 ankles, good in 10, fair in 1, and poor in 1. Twenty-four patients (92.3%) were satisfied with the procedure and 15 (57.7%) were able to return to their preinjury level of activity. Local complications were detected in 2 patients who presented with skin necrosis; 1 patient developed severe reflex sympathetic dystrophy.

Conclusion:

Revision surgery for the management of failure after surgical treatment of chronic lateral ankle instability is under debate, and the literature is devoid of clinical studies with long-term follow-up. The technique described offers a high rate of long-term excellent and good results, with a low rate of complications and a good rate of return to preinjury level.

Level of Evidence:

Level IV, retrospective case series.
Commented translation of Erwin Schrödinger’s paper ‘On the dynamics of elastically coupled point systems’ (Zur Dynamik elastisch gekoppelter Punktsysteme)
Authors: Mühlich Uwe , Abali Bilen Emek , dell’Isola Francesco
Published: August 2020

The paper ‘ Zur Dynamik elastisch gekoppelter Punktsysteme’ by Schrödinger (1914) does not seem to have attracted the attention that it deserves. We translate it into English here and we discuss its results in detail, with a view to its possible influence in the modern theories of generalised continua. The clever solution found, in terms of Bessel functions, by Schrödinger of the problem of the vibrations of a linear infinite chain of molecules gives some important methodological hints for contemporary research.
Gender inequalities in depression/anxiety and the consumption of psychotropic drugs: Are we medicalising women’s mental health?
Authors: Bacigalupe Amaia , Martín Unai
Published: August 2020

Aims: Clinical studies show that women are more likely to be diagnosed with depression and anxiety, and to consume prescribed psychotropic drugs. Applying an intersectional perspective that considers age, education and social class, the present study assesses gender inequalities in the diagnosis of depression/anxiety and in psychotropic consumption. Methods: We analysed data from the 2018 Basque Country Health Survey (Spain; n=8014). Prevalence rates of poor mental health, diagnosis of depression/anxiety and psychotropic consumption were calculated for each sex by age and socio-economic status. Poisson regression models were calculated to estimate PRs of these variables in women, adjusted for age, mental health status and health-care visits, and for diagnosis of depression/anxiety in the case of psychotropic drug consumption. Results: Women were 2.48 times more likely than men to be diagnosed with depression or anxiety, and this difference remained significant after adjustments (prevalence ratio (PR)=1.86; 95% confidence interval (CI) 1.40–2.47). Women also took significantly more prescribed psychotropic drugs, even controlling for their poorer mental health, their higher prevalence of diagnosis and their more frequent health-care visits (PR=1.52; 95% CI 1.28–1.82). No gender inequalities were observed in those younger than 45 or with the highest level of education. Conclusions: Gender inequalities in the diagnosis and prescription of psychotropic drugs exist, and these cannot be explained by differences in mental-health status or health-care visit frequency. It seems, then, that medicalisation of mental health is occurring among women. Further evidence about the mechanisms that underlie the results is crucial to design truly gender-sensitive health policies that reduce medicalisation of women’s mental health.
Efficient fatigue assessment of the upper and lower hopper knuckle connections of an oil tanker
Authors: Ozguc Ozgur
Published: August 2020

The fatigue of structural details of ships is of great importance in the maritime industry as they can lead to cracks which can jeopardize structural integrity. The hopper knuckle is among the most vulnerable areas in a ship with respect to fatigue damage. Analysis of the hopper knuckle has become mandatory for tankers in the Class Ship Rules and in the International Association of Classification Societies Common Structural Rules. Along with the fatigue damage record of the vessels, the fatigue analysis of the hopper knuckles is essential to ensure that the vessels have sufficient fatigue strength. In the current work, fatigue calculations are performed of the upper and lower hopper knuckle connections within midship of the oil tanker using simplified fatigue calculations based on Det Norske Veritas (DNVGL) Classification Note No. 30.7. The fatigue analysis is based on 25 years of operation in worldwide wave environment. A cargo hold model (½ + 1 + ½) amidships and a local finite element model of the hopper knuckle are generated. The local model provides relevant hotspot stress for fatigue life calculations. The results from the hopper knuckle fatigue analysis show that the vessels may expect fatigue cracks at lower hopper knuckle before the vessel reaches its design life of 25 years. Based on the findings, it is recommended to fit soft brackets and close scallops at the lower hopper knuckle on selected common frames in all cargo holds.
A Qualitative Study on the Perspectives of Latinas Enrolled in a Diabetes Prevention Program: Is the Cost of Prevention Too High?
Authors: Joachim-Célestin Maud , Gamboa-Maldonado Thelma , Dos Santos Hildemar , Montgomery Susanne B.
Published: August 2020

Introduction: Latinas are among the groups most affected by diabetes health disparities, yet they often benefit less from diabetes interventions even when these are culturally adapted. The purpose of this qualitative study was to explore readiness of Latinas enrolled in a diabetes prevention program to adopt recommended preventive behaviors, and to identify factors associated with the adoption and maintenance of these recommended lifestyle changes. Insights gained will be used to inform future efforts at reducing diabetes disparities and the burden of chronic diseases among Latinas. Methods: Nine focus group discussions (FGDs) and 3 key informant interviews (KIIs) were conducted after the completion of a culturally adapted diabetes prevention program led by Latino community health workers. A grounded theory approach by Charmaz informed by the transtheoretical model guided the questions. Discussions and interviews were audio-taped with participants’ permission, transcribed, coded, and themed. Results: Forty low-income Latinas contributed to FGDs and KIIs. Baseline readiness to engage in new behaviors varied. Negative personal and family health events and physician referral impacted most readiness to enroll and to adopt preventive behaviors. Built environment, financial constraints, and threat of social alienation constituted major barriers to behavior adoption and maintenance, while physician involvement, awareness of diabetes complications, and social support partially mitigated these impediments. Conclusions: Our results suggest that timing of enrollment, physician-patient dynamics, and the emotional personal/family cost of behavior modification should all be considered when planning diabetes prevention programs for low-income Latinas. Besides appropriately timing referrals to accessible culturally informed prevention programs, health educators and health care providers should be aware of the potentially negative impact of behavior modification on family dynamics and be prepared to address resulting repercussions. Future research on Latinas should also include and report data on physician involvement, family context, and social determinants of health for more consistent program comparisons.
Limitations of Plain Film Radiography in Identification of Hyperextension Fractures in Patients With Ankylosing Spinal Disorders
Authors: Barkay Gal , Dan Lantsman Christine , Menachem Shay , Shtewee Anan , Ackshota Nissim , Caspi Israel , Eshed Iris , Friedlander Alon
Published: August 2020

Study Design:

Efficacy study.

Objectives:

To elucidate the limitations of radiography in patients with spinal ankylosing disorders (SAD) with an emphasis on thoracolumbar injuries, which have been less focused upon.

Methods:

We searched our hospital’s emergency room database for patients who underwent a total spine computed tomography (CT) following a diagnosis of SAD on radiographs following a minor fall. A high-quality presentation containing 50 randomly situated anteroposterior + lateral radiographs was created. Of these, 24 contained a hyperextension type fracture diagnosed by CT. Twelve physicians—4 spine surgeons, 4 senior orthopedic residents and 4 junior orthopedic residents were requested to identify the pathologic radiographs and note the fracture level.

Results:

Fracture diagnosis stood at 65% for the best reader. When examining the different subgroups, the mean rate of diagnosis for spine surgeons was 55% and for orthopedic residents 32%. Mean diagnosis of thoracic fractures was 26%, of lumbar fractures was 55%, and for the entire thoracolumbar spine was 40%. The interobserver agreement (kappa coefficient) was found to be 0.37 for the entire group and 0.39 for spine surgeons. This finding was statistically significant.

Conclusions:

The simple radiograph is an inefficient modality for diagnosis of hyperextension type thoracolumbar fractures in patients with SAD. The poor interobserver agreement rate further amplifies this finding. Advanced imaging is recommended in these patients.
Reoccurrence of Stroke in a Patient With Peri-Device Leak of WATCHMAN Device
Authors: Perkins Jordan , Bhagat Riwaj , Nichols Matthew , Shah Jignesh
Published: August 2020

Atrial fibrillation is the leading cause of cardioembolic stroke, with emboli most commonly originating from the left atrial appendage. We report the case of a 71-year-old male with left atrial appendage closure via implantation of the WATCHMAN device, due to possible anticoagulation therapy failure and increased bleeding risk, following a stroke. Following a new stroke over a year later, a 1.8-mm peri-device leak was observed. Surgical records noted a minimal (<5 mm jet flow) peri-device leak after the installation, which was considered successful WATCHMAN implantation per protocol. This case highlights the persistent risk of cardioembolic stroke in patients with nonvalvular atrial fibrillation despite device implantation and questions the significance of peri-device leak and further management with anticoagulation for recurrent stroke.
When it counts the most: Trauma-informed care and the COVID-19 global pandemic
Authors: Collin-Vézina Delphine , Brend Denise , Beeman Irene
Published: August 2020

CONTEXT:

Evidence from the COVID-19 crisis suggests that children and youth are more likely to be subjected to maltreatment and exposure to family violence, while experiencing limited access to the usual services that support vulnerable families and provide targeted services to meet their needs. The current global pandemic itself can also be experienced as a traumatic event. Trauma-informed care draws attention to the potential impacts, from the individual to the global, that myriad traumatic experiences can illicit and proposes using these understandings as foundational to the development and implementation of policy and practice.

OBJECTIVE:

The aim of this opinion paper is to offer insights to guide practices and policies during this unprecedented global crisis through a discussion of the Substance Abuse and Mental Health Services Administration (2014)’s six trauma-informed care principles: trustworthiness and transparency; safety; peer support; collaboration and mutuality; empowerment and choice; and cultural, historical and gender issues.

FINDINGS:

Specific recommendations based on these six principles and applied to the current situation are presented and discussed. These principles can serve both in the immediate crisis and as preventative measures against unforeseen future traumatic contexts.

CONCLUSION:

COVID-19 renews the imperative to maintain and strengthen trauma-informed practices and policies. We argue that never before has trauma-informed care been so important to promote the health and well-being of all and to protect our marginalized populations at greatest risk.
Prognosis of idiopathic pulmonary fibrosis without anti-fibrotic therapy: a systematic review
Authors: Khor Yet H. , Ng Yvonne , Barnes Hayley , Goh Nicole S.L. , McDonald Christine F. , Holland Anne E.
Published: August 2020

In addition to facilitating healthcare delivery planning, reliable information about prognosis is essential for treatment decisions in patients with idiopathic pulmonary fibrosis (IPF). This review aimed to evaluate the prognosis of patients with IPF without anti-fibrotic therapy. We included all cohort studies and the placebo arms of randomised controlled trials (RCTs) in IPF and follow-up of ≥12 months. Two reviewers independently evaluated studies for inclusion, assessed risk of bias and extracted data. A total of 154 cohort studies and 16 RCTs were included. The pooled proportions of mortality were 0.12 (95% CI 0.09–0.14) at 1–2 years, 0.38 (95% CI 0.34–0.42) between 2–5 years, and 0.69 (95% CI 0.59–0.78) at ≥5 years. The pooled mean overall survival was 4 years (95% CI 3.7–4.6) for studies with a follow-up duration of 10 years. At <2 years, forced vital capacity and diffusing capacity of the lung for carbon monoxide declined by a mean of 6.76% predicted (95% CI −8.92 −4.61) and 3% predicted (95% CI −5.14 −1.52), respectively. Although heterogeneity was high, subgroup analyses revealed lower pooled proportions of mortality at 1 year in the RCT participants (0.07 (95% CI 0.05–0.09))versuscohort study participants (0.14 (95% CI 0.12–0.17)). This review provides comprehensive information on the prognosis of IPF, which can inform treatment discussions with patients and comparisons for future studies with new therapies.
Correction to: Two Switchable Plasmonically Induced Transparency Effects in a System with Distinct Graphene Resonators
Authors: Guan Jingrui , Xia Shengxuan , Zhang Zeyan , Wu Jing , Meng Haiyu , Yue Jing , Zhai Xiang , Wang Lingling , Wen Shuangchun
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Performance of penicillinase detection tests in Staphylococcus epidermidis: comparison of different phenotypic methods
Authors: Aubry Benjamin , Lemarié Carole , Chenouard Rachel , Kempf Marie , Eveillard Matthieu , Pailhoriès Hélène
Published: August 2020

Background

Staphylococcus epidermidis is the leading coagulase negative staphylococci (CoNS) species associated with healthcare associated infections. In order to de-escalate antimicrobial therapy, isolates of S. epidermidis lacking the blaZ gene should be eligible for targeted antimicrobial therapy. However, testing the susceptibility of coagulase negative staphylococci (CoNS) to penicillin G is no longer recommended by EUCAST, given the low performances for penicillinase detection in CoNS. The objective of this work was to determine a phenotypic method with high performance for detecting penicillinase production in S. epidermidis.

Results

Four techniques for the detection of penicillinase production (disk diffusion, zone edge test, nitrocefin test, Minimal Inhibitory Concentration (MIC) by automated system Vitek2®) were evaluated on 182 S. epidermidis isolates, using identification of blaZ gene by PCR as the reference method. The performance of the methods for penicillinase detection was compared by the sensitivity, the specificity, the negative predictive value and the positive predictive value, and with Cohen’s kappa statistical test. Among the 182 S. epidermidis included in this study, 55 carried the blaZ gene. The nitrocefin test, characterized by a poor sensitivity (91%), was therefore excluded from S. epidermidis penicillinase detection. The algorithm proposed here for the penicillinase detection in S. epidermidis involved two common antimicrobial susceptibility techniques: disk diffusion method and MIC by Vitek2® system. Disk diffusion method, interpreted with a 26 mm breakpoint for penicillin G, was associated with a high sensitivity (98%) and specificity (100%). This method was completed with zone edge test for S. epidermidis with penicillin G diameter from 26 to 35 mm (sensitivity of 98%). The Vitek2® system is associated with a low sensitivity (93%) and a high specificity (99%) This low sensitivity is associated with false negative results, in isolates with 0.12 mg/L Penicillin G MIC values and blaZ positive. Thus for penicillin G MIC of 0.06 mg/L or 0.12 mg/L, a second step with disc diffusion method is suggested.

Conclusions

According to our results, the strategy proposed here allows the interpretation of penicillin G susceptibility in S. epidermidis isolates, with an efficient detection of penicillin G resistance.
Significant association between genes encoding virulence factors with antibiotic resistance and phylogenetic groups in community acquired uropathogenic Escherichia coli isolates
Authors: Yazdanpour Zahra , Tadjrobehkar Omid , Shahkhah Motahareh
Published: August 2020

Background

Antibiotic resistance is an increasing phenomenon in many bacterial pathogens including uropathogenic Escherichia coli. Hypothetical anti-virulent agents could be a solution, but first clear virulence associated gene-pool of antibiotic resistant isolates have to be determined. The aim of this study is to investigate the significant associations between genes encoding VFs with antibiotic resistance and phylogenetic groups in UPEC isolates.

Results

The majority of 248 UPEC isolates belonged to phylogenetic group B2 (67.3%). The maximum and minimum resistance was attributed to amoxicillin (90.3%) and both fosfomycin and imipenem (1.6%) respectively. 11.3% of isolates were resistant to all antibiotic agents except that of imipenem, nitrofurantoin and fosfomycin. These highly resistant isolates were placed only in group B2 and D. The most prevalent virulence gene was ompA (93.5%). The hlyA was the only virulence gene that was significantly more prevalent in the highly resistant isolates. The ompA, malX and hlyA genes were obviously more abundant in the antibiotic resistant isolates in comparison to susceptible isolates. The papC gene was associated with amoxicillin resistance (p-value = 0.006, odds ratio: 26.00).

Conclusions

Increased resistance to first line drugs prescribed for UTIs were detected in CA-UPEC isolates in our study.. Minimal resistance was observed against nitrofurantoin, fosfomycin and imipenem. Therefore, they are introduced for application in empirical therapy of UTIs. Fosfomycin may be the most effective antibiotic agent against highly resistant UPEC isolates. The presence of the ompA, malX and hlyA genes were significantly associated with resistance to different antibiotic agents. We assume that the ability of UPEC isolates to upgrade their antibiotic resistance capacity may occurs in compliance with the preliminary existence of specific virulence associated genes. But, more investigation with higher number of bacterial isolates, further virulence associated genes and comparison of gene pools from CA-UPEC isolates with HA-UPEC are proposed to confirm these finding and discovering new aspects of this association.
The correlation of intraoperative hypotension and postoperative cognitive impairment: a meta-analysis of randomized controlled trials
Authors: Feng Xiaojin , Hu Jialing , Hua Fuzhou , Zhang Jing , Zhang Lieliang , Xu Guohai
Published: August 2020

Background

There is no consensus on whether intraoperative hypotension is associated with postoperative cognitive impairment. Hence, we performed a meta-analysis to evaluate the correlation of intraoperative hypotension and the incidence of postoperative delirium (POD) or postoperative cognitive dysfunction (POCD).

Methods

We searched PubMed, Embase, and Cochrane Library databases to find randomized controlled trials (RCTs) in which reported the relationship between intraoperative hypotension and POD or POCD. The retrieval time is up to January 2020, without language restrictions. Quality assessment of the eligible studies was conducted by two researchers independently with the Cochrane evaluation system.

Results

We analyzed five eligible RCTs. Based on the relative mean arterial pressure (MAP), participants were divided into low-target and high-target groups. For the incidence of POD, there were two studies with 99 participants in the low-target group and 94 participants in the high-target pressure group. For the incidence of POCD, there were four studies involved 360 participants in the low-target group and 341 participants in the high-target group, with a study assessed both POD and POCD. No significant difference between the low-target and the high-target group was observed in the incidence of POD (RR = 3.30, 95% CI 0.80 to 13.54,P = 0.10), or POCD (RR = 1.26, 95% CI 0.76 to 2.08,P = 0.37). Furthermore, it also demonstrates that intraoperative hypotension prolonged the length of ICU stay, but did not increased the mortality, the length of hospital stay, and mechanical ventilation (MV) time.

Conclusions

There is no significant correlation between intraoperative hypotension and the incidence of POD or POCD.
The utility of cerebrospinal fluid white cell count during the prognostic assessment for cryptococcal meningitis patients: a retrospective study
Authors: Qu Junyan , Jiang Jingwen , Lv Xiaoju
Published: August 2020

Background

The incidence of cryptococcal meningitis (CM) has gradually increased in recent years. Cerebrospinal fluid (CSF) cytology and cell count are very important for CM on etiology diagnosis and assessment of disease status and therapeutic response. However, the clinical significance of CSF white cell count (WCC) in CM patients is not fully understood. Using longitudinal data of CSF WCC and its relationship with clinical outcomes in CM patients, we aimed to elucidate the clinical significance of this test.

Methods

We retrospectively analyzed the medical records of 150 CM patients admitted to our hospital between January 2008 and December 2018.

Results

CM patients with lower baseline CSF WCC, CSF protein concentration or CD4/CD8 ratio, and those with altered mentation or HIV coinfection were more likely to have poor clinical outcome (P<0.05). CM patients with triple therapy during the induction period presented with a better clinical outcome (P<0.05). Baseline CSF WCC had a moderate positive correlation with peripheral CD4+ T lymphocyte count (r = 0.738, P < 0.001) and CD4+ T lymphocyte percentage (r = 0.616, P < 0.001). The best cut-off value to predict a poor clinical outcome was 40 cells/μL during baseline CSF WCC. The predictive model incorporating longitudinal data of CSF WCC had better sensitivity, specificity, and accuracy than a model incorporating only baseline CSF WCC data.

Conclusions

Our results indicated that baseline CSF WCC and changes in CSF WCC over time could be used to assess the prognosis of CM patients.