bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Bulk-Fill Composites, Polimerization Modes, and Remaining Dentin Thickness on Intrapulpal Temperature Rise
Authors: Akarsu Serdar , Aktuğ Karademir Sultan
Published: December 2019

Objectives. The aim of this study was to compare the effects of different bulk-fill resin composites, polimerization modes, and the thickness of remaining dentin on the increase of intrapulpal temperature. Methods. Human-extracted upper premolar teeth (n = 10) were used to design a single-tooth model with remaining dentin thicknesses of 1 mm and 0.5 mm. Estelite Bulk-fill Flow (Tokuyama, Japan), Surefil SDR™ Flow (Dentsply Caulk, Brazil), Filtek Bulk-Fill Posterior (3M, USA), and SonicFill™ 2 Bulk-fill (Kerr, USA) composites were applied according to the manufacturer’s instructions. The standard and high modes of a light emitted diode (LED) light curing unit (LCU) (VALO™ Utradent, USA), were used for polymerization. In order to mimic the in vivo conditions of pulpal circulation, digital flowmetry (SK-600II, SK Medical, China) was used. Intrapulpal temperature rise was measured using K type thermocoupling (CEM DT 610B, Robosem Engineering, China). Data were analyzed using three-way variance analysis (ANOVA) and the independent t-test. Results. No significant statistical differences in intrapulpal temperature rise between low viscosity bulk-fill composites (SDR and Estelite) were found. The lowest intrapulpal temperature rise was found in groups which used the Filtek Bulk-fill composite. Decreases in the remaining dentin thickness increased the intrapulpal temperature rise. Significance. This study demonstrated that remaining dentin thickness, filler ratio of bulk-fill composites, and power and application time of the LED-LCU may affect intrapulpal temperature rise.
A Case of Maternal Sepsis and Fetal Demise Associated with Streptococcus pseudoporcinus
Authors: Pierce Stephanie L. , Shibib Dena R. , Robison Denise , Edwards Rodney K.
Published: December 2019

Streptococcus pseudoporcinus has recently been described in relation to its colonization of the female genitourinary tract. Since prior reports have linked S. pseudoporcinus only with minor morbidities, the organism previously has not been considered to be a cause of serious puerperal infections. A 41-year-old gravida 2, para 1-0-0-1 presented with abdominal pain and intrauterine fetal demise. A beta hemolytic Streptococcus was isolated from her placenta, endometrium, urine, and two blood culture sets. The isolate was a Streptococcus pseudoporcinus, which colonizes the female genital tract and can resemble Streptococcus agalactiae. This case demonstrates that S. pseudoporcinus is a potential cause of severe maternal and fetal morbidity and mortality.
Analytical Strategies in Lipidomics for Discovery of Functional Biomarkers from Human Saliva
Authors: Agatonovic-Kustrin Snezana , Morton David William , Smirnov Valeriy , Petukhov Alexey , Gegechkori Vladimir , Kuzina Vera , Gorpinchenko Natalya , Ramenskaya Galina
Published: December 2019

Human saliva is increasingly being used and validated as a biofluid for diagnosing, monitoring systemic disease status, and predicting disease progression. The discovery of biomarkers in saliva biofluid offers unique opportunities to bypass the invasive procedure of blood sampling by using oral fluids to evaluate the health condition of a patient. Saliva biofluid is clinically relevant since its components can be found in plasma. As salivary lipids are among the most essential cellular components of human saliva, there is great potential for their use as biomarkers. Lipid composition in cells and tissues change in response to physiological changes and normal tissues have a different lipid composition than tissues affected by diseases. Lipid imbalance is closely associated with a number of human lifestyle-related diseases, such as atherosclerosis, diabetes, metabolic syndromes, systemic cancers, neurodegenerative diseases, and infectious diseases. Thus, identification of lipidomic biomarkers or key lipids in different diseases can be used to diagnose diseases and disease state and evaluate response to treatments. However, further research is needed to determine if saliva can be used as a surrogate to serum lipid profiles, given that highly sensitive methods with low limits of detection are needed to discover salivary biomarkers in order to develop reliable diagnostic and disease monitoring salivary tests. Lipidomic methods have greatly advanced in recent years with a constant advance in mass spectrometry (MS) and development of MS detectors with high accuracy and high resolution that are able to determine the elemental composition of many lipids.
Transport Sector Impacts of a Border between Ireland and Northern Ireland after a Hard Brexit
Authors: Morchid Khaoula , O’Mahony Margaret
Published: December 2019

More than half of British voters chose to leave the European Union (EU) leading to a series of negotiations between the United Kingdom and the EU. The withdrawal of the UK from the EU is widely referred to as Brexit. As the only country that shares a land border with the UK, the impact of Brexit on Ireland is expected to be greater than on any other European country. The objective of the research is to evaluate the potential impact of Brexit on the transport sector in Ireland at a micro level by focusing on cross‐border commuters and by also assessing the impact on road freight transport. Potential crossing scenarios are examined at six crossing locations. Assuming a hard border is implemented, each crossing is modelled in VISSIM, a microscopic traffic flow simulation software, using traffic data from Transport Infrastructure Ireland (TII) and dwell time estimated based on the US–Canada border crossings. Six scenarios are considered to determine the impact on cross‐border traffic at different flow conditions and with varying levels of technology used in border infrastructure leading to short versus long processing times. The paper evaluates travel measures including delays, queue lengths and emissions. The worst‐case scenario has a vehicle delay of 18.4 min and the highest delay‐associated costs across all locations modelled are estimated at €60.7 million per year. Estimated emissions generated at the border crossings raise concerns about environmental impacts of a hard Brexit. Interviews with stakeholders emphasized the critical role of technology in reducing the impact of a hard Brexit on cross‐border commuters and on the freight sector. A key finding is the importance of using technology tools to facilitate controls and reduce processing times. The results indicate that technology use leads to significant time and cost savings as well as reduced environmental impacts.
Efficacy and Tolerability of Tremelimumab in Locally Advanced or Metastatic Urothelial Carcinoma Patients Who Have Failed First-Line Platinum-Based Chemotherapy
Authors: Sharma Padmanee , Sohn Joohyuk , Shin Sang Joon , Oh Do-Youn , Keam Bhumsuk , Lee Hyo Jin , Gizzi Marco , Kalinka Ewa , de Vos Filip Y.F.L. , Ruscica Dario , Ferro Salvatore , Xiao Feng , Baverel Paul , Chen Cecil Chi-Keung , Asubonteng Kobby , Morsli Nassim , Dirix Luc
Published: December 2019

Purpose:

Patients with advanced urothelial carcinoma who fail platinum-containing chemotherapy (treatment fails) have a poor prognosis and limited treatment options. Recent approvals of immune-checkpoint inhibitors confirmed the value of immunomodulatory therapy in urothelial carcinoma. Tremelimumab is a selective human immunoglobulin G2 (IgG2) monoclonal antibody against cytotoxic T-lymphocyte–associated antigen 4 with demonstrated durable response rate in metastatic melanoma. This is the first study to report the efficacy and safety of tremelimumab in urothelial carcinoma.

Patients and Methods:

We report the results of the urothelial carcinoma cohort from a phase II, open-label, multicenter study of patients with advanced solid tumors (NCT02527434). Patients with locally advanced/metastatic urothelial carcinoma were treated with tremelimumab monotherapy (750 mg via intravenous infusion every 4 weeks for seven cycles, then every 12 weeks for two additional cycles) for up to 12 months or until disease progression, initiation of other anticancer therapy, unacceptable toxicity, or consent withdrawal.

Results:

In 32 evaluable patients with metastatic urothelial carcinoma, objective response rate was 18.8% (95% confidence interval, 7.2–36.4), including complete response (CR) in 2 (6.3%), and partial response in 4 patients (12.5%). Median duration of response has not been reached. Stable disease of ≥12 months was reported in 1 patient (3.1%), yielding a disease control rate at 12 months of 21.9%. Overall, tremelimumab was generally well tolerated; safety results were consistent with the known safety profile.

Conclusions:

Tremelimumab monotherapy demonstrated clinical activity and durable responses in patients with metastatic urothelial carcinoma. This study is the first in which CR has been observed with tremelimumab as a single agent in urothelial carcinoma.
The Outcomes of Switching from Short- to Long-Term Intravitreal Corticosteroid Implant Therapy in Patients with Diabetic Macular Edema
Authors: Vaz-Pereira Sara , Castro-de-Sousa João Paulo , Martins David , Prates Canelas Joaquim , Reis Pedro , Sampaio António , Urbano Helena , Kaku Paulo , Nascimento João , Marques-Neves Carlos
Published: December 2019

Background: First-line treatment for diabetic macular edema (DME) is usually with antivascular endothelial growth factor agents, followed by intravitreal corticosteroids as a second-line treatment option. Long-term corticosteroids may offer quality of life and effectiveness benefits over short-term implants. Objectives: To evaluate outcomes of patients with persistent or recurrent DME who switched from a short-term (dexamethasone) to a long-term (fluocinolone acetonide, FAc) corticosteroid intravitreal implant in a real-world setting. Methods: This is a retrospective study in 9 Portuguese centers. An FAc intravitreal implant was administered according to product labeling. Effectiveness outcomes were mean change in visual acuity (VA; ETDRS letters), central retinal thickness (CRT; µm), and macular volume (MV; mm3). The safety outcome was mean change in intraocular pressure (IOP; mm Hg). All were analyzed at months 1 and 3, and then quarterly until month 24 after implantation. Results: Forty-four eyes from 36 patients were analyzed. Mean duration of DME was 3.3 ± 1.9 years, and mean follow-up was 8 months. From baseline following FAc implantation, VA increased significantly at months 1 and 6 (mean +6.82 and +13.02 letters, respectively; p = 0.005), and last observation carried forward (LOCF; mean +8.3 letters; p = 0.002). CRT improved significantly at months 1 and 6 (mean –71.81 and –170.77 µm, respectively; p = 0.001), and LOCF (mean –121.46 µm; p = 0.001). MV was consistently, but not significantly, decreased from baseline to LOCF (mean –0.69 mm3; p = 0.062). The mean change in IOP was –0.25 and +0.88 mm Hg at months 1 and 6, respectively (p = 0.268), and +1.86 mm Hg at LOCF (p = 0.036). Increases were controlled with topical medication in most cases. Conclusions: The FAc intravitreal implant is effective in patients previously treated with short-term corticosteroid implants. Thus, after a suboptimal response to antiangiogenics or a short-term corticosteroid, a single FAc implant may be considered an effective and tolerable treatment that can improve long-term outcomes for patients with sight-threatening DME.
Open Intrauterine Fetal Myelomeningocele Repair: Changes in the Surgical Procedure and Perinatal Complications during the First 8 Years of Experience at a Single Center
Authors: Kahr Maike K. , Winder Franziska M. , Vonzun Ladina , Mazzone Luca , Moehrlen Ueli , Meuli Martin , Hüsler Margaret , Krähenmann Franziska , Zimmermann Roland , Ochsenbein-Kölble Nicole
Published: December 2019

Introduction: Open fetal myelomeningocele (fMMC) repair is nowadays a therapeutic option in selected cases. We aimed to evaluate changes in maternal and fetal outcome after fMMC repair during the first 8 years of experience at a tertiary referral fetal medicine center in Switzerland. ­Materials and Methods: Between 2010 and 2018, fMMC repair and delivery of the neonate via planned cesarean section was performed in 67 cases. Cases were retrospectively stratified into 2 groups: a “training phase” (TP) with supervision from an external surgeon during 11 operations (2010–2014, 15 cases) followed by an “experienced phase” (EP, 2014–2018, 52 cases); each phase lasted about 4 years. Both phases were compared with regard to various maternal and fetal outcome parameters. Results: Analyses did not reveal differences between TP and EP in major outcome parameters such as gestational age at delivery, chorionic membrane separation, or the incidence of placental abruption. Although more complex surgical techniques were applied in EP (e.g., dermal closure using a rotational flap), surgery time was not different from TP. At the same time, surgical complications such as oligohydramnios (27 vs. 8%, p = 0.046) with MRI-confirmed leakage (13 vs. 4%, nonsignificant) and subchorionic hematoma (20 vs. 2%, p = 0.009) were less common in EP than TP. Conclusions: This study shows that the level of competence at our center with regard to major perinatal outcome parameters was already high in the first years of fMMC repair. However, more complex surgical techniques and significantly less minor complications were observed during the most recent years.
Chronic Electrical Stimulation of the Otolith Organ: Preliminary Results in Humans with Bilateral Vestibulopathy and Sensorineural Hearing Loss
Authors: Ramos Macias Angel , Ramos de Miguel Angel , Rodriguez Montesdeoca Isaura , Borkoski Barreiro Silvia , Falcón González Juan Carlos
Published: December 2019

Introduction: Bilateral vestibulopathy is an important cause of imbalance that is misdiagnosed. The clinical management of patients with bilateral vestibular loss remains difficult as there is no clear evidence for an effective treatment. In this paper, we try to analyze the effect of chronic electrical stimulation and adaptation to electrical stimulation of the vestibular system in humans when stimulating the otolith organ with a constant pulse train to mitigate imbalance due to bilateral vestibular dysfunction (BVD). Methods: We included 2 patients in our study with BVD according to Criteria Consensus of the Classification Committee of the Bárány Society. Both cases were implanted by using a full-band straight electrode to stimulate the otoliths organs and simultaneously for the cochlear stimulation we use a perimodiolar electrode. Results: In both cases Vestibular and clinical test (video head impulse test, videonistagmography cervical vestibular evoked myogenic potentials, cVEMP and oVEMP), subjective visual vertical test, computerized dynamic posturography, dynamic gait index, Time UP and Go test and dizziness handicap index) were performed. Posture and gait metrics reveal important improvement if compare with preoperartive situation. Oscillopsia, unsteadiness, independence and quality of life improved to almost normal situation. Discussion/Conclusion: Prosthetic implantation of the otolith organ in humans is technically feasible. Electrical stimulation might have potential effects on balance and this is stable after 1 year follow-up. This research provides new possibilities for the development of vestibular implants to improve gravito-inertial acceleration sensation, in this case by the otoliths stimulation.
Long-Term Follow-Up and Oncological Outcome of Patients Undergoing Radical Cystectomy for Bladder Cancer following an Enhanced Recovery after Surgery (ERAS) Protocol: Results of a Large Randomized, Prospective, Single-Center Study
Authors: Ziegelmueller Brigitte Katharina , Jokisch Jan-Friedrich , Buchner Alexander , Grimm Tobias , Kretschmer Alexander , Schulz Gerald Bastian , Stief Christian , Karl Alexander
Published: December 2019

Introduction: Enhanced recovery after surgery (ERAS) concepts are implemented in various surgical disciplines. For patients undergoing radical cystectomy, prospective data are still rare. In the year 2014, our group could prove significant benefits of ERAS for these patients in a prospective randomized study compared to a conservative regimen. Objective: To evaluate long-term follow-up results of ERAS concepts in patients undergoing radical cystectomy for bladder cancer. Methods: Of the 101 patients who had initially prospectively been randomized to ERAS or a conservative regimen, 35 patients could be included in the study. Median follow-up time was 83 months. Primary end point assessed quality of life. Secondary end points were cancer-specific survival and overall survival. Results: Five to seven years after the initial inclusion to the study, no significant difference regarding quality of life parameters was detected (p values range between 0.112 and 0.970). Continence status in patients with neobladder showed no significant differences between ERAS and conservative regimens (p = 0.785). Cancer-specific survival in the ERAS group did not differ significantly from that in the conservative group (49 vs. 58%, p = 0.725). Conclusions: While ERAS represents an excellent way to improve postoperative reconvalescence and quality of life in the short-term follow-up, our data do not support the idea that there is also a long-term effect in terms of quality of life issues.
Prenatal Effects of a 1,800-MHz Electromagnetic Field on Rat Livers
Authors: Tumkaya Levent , Yilmaz Adnan , Akyildiz Kerimali , Mercantepe Tolga , Yazici Zihni Acar , Yilmaz Hamit
Published: December 2019

The use of devices, including mobile phones, generating electromagnetic fields (EMF) is widespread and is progressively increasing. It has also been shown that EMF may have detrimental effects. This is the first study to investigate the postnatal biochemical and histological effects of prenatal exposure of rat livers to 1,800-MHz EMF at different time intervals in uteroplacental life. The 3 EMF groups of rats were exposed to 1,800-MHz EMF for 6, 12, or 24 h daily for 20 days. Unexposed rats served as control group. All rats were subjected to anesthesia, and on postnatal day 60, the livers were excised, and blood was collected for histological and biochemical analyses. Malondialdehyde levels were significantly higher in the exposed groups than the unexposed controls (p < 0.05). In contrast, EMF-exposed groups had lower liver tissue glutathione levels than controls (p < 0.05). Serum Ca2+, alanine transaminase, and aspartate aminotransferase levels were higher in EMF-exposed groups than controls (p < 0.05). In addition, liver tissue total oxidant status levels were increased (p < 0.05), and liver tissue total antioxidant status levels were decreased (p < 0.05) compared to the control group. Furthermore, in the EMF groups, extensive vacuolation and degeneration of the hepatocytes in the portal area, as well as those surrounding the sinusoids, were evident. Affected hepatocytes had polygonally shaped nuclei and vacuolic cytoplasm imparting eosinophilic staining. Loss of cellular membrane integrity and invaginations, as well as picnotic nuclei, was prominent. This study has shown that intrauterine liver damage caused by 1,800-MHz EMF exposure persists into puberty in rats.
Waiting List and Kidney Transplant Vascular Risk: An Ongoing Unmet Concern
Authors: Hernández Domingo , Alonso-Titos Juana , Armas-Padrón Ana Maria , Lopez Veronica , Cabello Mercedes , Sola Eugenia , Fuentes Laura , Gutierrez Elena , Vazquez Teresa , Jimenez Tamara , Ruiz-Esteban Pedro , Gonzalez-Molina Miguel
Published: December 2019

Background: Chronic kidney disease (CKD) is an important independent risk factor for adverse cardiovascular events in patients waitlisted for kidney transplantation (KT). Although KT reduces cardiovascular risk, these patients still have a higher all-cause and cardiovascular mortality than the general population. This concerning situation is due to a high burden of traditional and nontraditional risk factors as well as uremia-related factors and transplant-specific factors, leading to 2 differentiated processes under the framework of CKD, atherosclerosis and arteriosclerosis. These can be initiated by insults to the vascular endothelial endothelium, leading to vascular calcification (VC) of the tunica media or the tunica intima, which may coexist. Several pathogenic mechanisms such as inflammation-related endothelial dysfunction, mineral metabolism disorders, activation of the renin-angiotensin system, reduction of nitric oxide, lipid disorders, and the fibroblast growth factor 23-klotho axis are involved in the pathogenesis of atherosclerosis and arteriosclerosis, including VC. Summary: This review focuses on the current understanding of atherosclerosis and arteriosclerosis, both in patients on the waiting list as well as in kidney transplant recipients, emphasizing the cardiovascular risk factors in both populations and the inflammation-related pathogenic mechanisms. Key Message: The importance of cardiovascular risk factors and the pathogenic mechanisms related to inflammation in patients waitlisted for KT and kidney transplant recipients.
An Investigation of Nine Patients with Gastrointestinal Immune-Related Adverse Events Caused by Immune Checkpoint Inhibitors
Authors: Miyahara Koichi , Noda Takahiro , Ito Yoichiro , Hidaka Hidenori , Fujimoto Shun , Takedomi Hironobu , Akutagawa Takashi , Sakata Yasuhisa , Shimamura Takuya , Tominaga Naoyuki , Yamaguchi Daisuke , Fujimoto Kazuma
Published: December 2019

Introduction/Aims: Immune checkpoint inhibitors (ICIs) sometimes cause immune-related adverse events (irAEs), of which there is little information in the literatures. The objective of this study was to characterize the clinical features of gastrointestinal irAEs (GI irAEs). Materials and Methods: From a total of 250 patients who were administered anti-PD-1 antibodies (nivolumab and pembrolizumab), we retrospectively identified 9 patients with grade 2 or higher GI irAE based on medical records. Patient characteristics, clinical features, imaging and pathological findings, and treatment course were evaluated. Results: Grade 2 or higher GI irAEs were observed in 9 (3.6%) patients. Of the 9 patients who experienced GI irAE, 8 were male, and mean age was 63.2 years. Five patients received nivolumab and 4 received pembrolizumab. The GI irAEs observed were diarrhea in 7 patients and bloody stool in 2 patients. Grade 2 GI irAEs were identified in 3 patients and grade 3 GI irAEs in 6 patients. The average time from ICI administration to the onset of GI irAEs was 22.2 weeks (range 7–56 weeks) for nivolumab and 19.7 weeks (range 11–28 weeks) for pembrolizumab. Endoscopic findings showed ulcerative colitis-like findings in 3 of 7 patients, and pathological examination revealed crypt epithelial cell apoptosis in 6 of 7 patients. Eight of the 9 patients received steroids, and 2 patients received infliximab additionally. All GI irAEs were manageable. Conclusions: Because of the lack of specific clinical, imaging, and pathological findings, information of ICI use was indispensable for diagnosis. Although GI irAEs are controllable by steroid and infliximab, further studies regarding management strategy will be needed.
1/2SH
Authors: Zhao Biao , Jia Wan-bing , Zhang Li-ying , Wang Ting-zhong
Published: December 2019

Background and Purpose—

1/2ABC has been used widely for assessing the volume of intracerebral hematoma. However, it is only suitable for calculating regular and small volume hematomas. Therefore, we re-explored the formula of hematoma volume to find a method that can calculate hematoma volumes accurately, reliably, and quickly.

Methods—

Computed tomography imaging data of 257 patients with intracerebral hemorrhage were collected. Hematoma volumes were estimated using 3-dimensional Slicer and 7 formulas (π/6ABC, 1/2ABC, 1/3ABC, 2/3SH, 1/2SH, π/6SH, and 2.5/6ABC). Taking the hematoma volumes measured by 3-dimensional Slicer as the reference standard, the accuracy and reliability of the 7 formulas were evaluated. Furthermore, the time needed to calculate hematoma volumes by the 1/2SH method was noted for further analysis.

Results—

(1) The accuracy of the 7 formulas based on the error analysis from the highest to the lowest was: π/6SH, 1/2SH, 2.5/6ABC, 1/3ABC, 1/2ABC, and π/6ABC or 2/3SH. According to concordance analysis and receiver operating characteristic curve analysis, the results from the highest to lowest were as follows: 1/2SH, π/6SH, 2.5/6ABC, 1/3ABC, 1/2ABC, 2/3SH, and π/6ABC. After categorizing cases according to size, shape, and location of hematoma, the results were almost the same as the results for overall accuracy evaluation in any subgroup. (2) Intraclass correlation coefficient (ICC) of 1/2SH in intra and inter-researcher were 0.998 and 0.989, respectively. For the formula π/6SH, intraclass correlation coefficient was the same as that of 1/2ABC. Kappa values of 1/2SH for intra- and inter-observer were 0.992 and 0.913, respectively. For π/6SH, kappa values of within- and between-reader were 0.984 and 0.904, respectively. (3) The average time taken to calculate hematoma volumes by 1/2SH was 74 seconds.

Conclusions—

The 1/2SH and π/6SH are accurate, reliable, and rapid methods for calculating hematoma volumes. The accuracy and reliability of 1/2SH were slightly higher than those of π/6SH.
Impact of Stereotactic Ventriculocisternostomy on Delayed Cerebral Infarction and Outcome After Subarachnoid Hemorrhage
Authors: Roelz Roland , Schaefer Jan Hendrik , Scheiwe Christian , Sajonz Bastian , Csok Istvan , Steiert Christine , Buttler Jürgen , Rohr Eva , Grauvogel Jürgen , Shah Mukesch J. , Egger Karl , Niesen Wolf-Dirk , Bardutzky Jürgen , Beck Jürgen , Coenen Volker A. , Reinacher Peter C.
Published: December 2019

Background and Purpose—

Delayed cerebral infarction (DCI) is an important cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH). Stereotactic catheter ventriculocisternostomy (STX-VCS) and fibrinolytic/spasmolytic lavage is a new method for DCI prevention. Here, we assess the effects of implementing STX-VCS in an unselected aSAH patient population of a tertiary referral center.

Methods—

Retrospective cohort study of all consecutive aSAH patients admitted to a neurosurgical referral center during a 7-year period (April 2012 to April 2019). Midterm STX-VCS was introduced and offered to patients at high risk for DCI. We compared the incidence and burden of DCI, neurological outcome, and the use of induced hypertension and endovascular rescue therapy in this consecutive aSAH population 3.5 years before versus 3.5 years after STX-VCS became available.

Results—

Four hundred thirty-six consecutive patients were included: 222 BEFORE and 214 AFTER. Fifty-seven of 214 (27%) patients received STX-VCS. Stereotactic procedures resulted in one (2%) subdural hematoma. Favorable neurological outcome at 6 months occurred in 118 (53%) patients BEFORE and 139 (65%) patients AFTER (relative risk, 0.79 [95% CI, 0.66–0.95]). DCI occurred in 40 (18.0%) patients BEFORE and 17 (7.9%) patients AFTER (relative risk, 0.68 [95% CI, 0.57–0.86]), and total DCI volumes were 8933 (100%) and 3329 mL (36%), respectively. Induced hypertension was used in 97 (44%) and 30 (15%) patients, respectively (relative risk, 0.55 [95% CI, 0.46–0.65]). Thirty (13.5%) patients BEFORE versus 5 (2.3%) patients AFTER underwent endovascular rescue therapies (relative risk, 0.17 [95% CI, 0.07–0.42]).

Conclusions—

Selecting high-risk patients for STX-VCS reduced the DCI incidence, burden, and related mortality in a consecutive aSAH patient population. This was associated with an improved neurological outcome.
Association of Baseline Cardiac Troponin With Acute Myocardial Infarction in Stroke Patients Presenting Within 4.5 Hours
Authors: Sun Yuyao , Miller Małgorzata M. , Yaghi Shadi , Silver Brian , Henninger Nils
Published: December 2019

Background and Purpose—

American Heart Association guidelines recommend obtaining baseline troponin in all patients with acute ischemic stroke. Yet, there is a paucity of data on the prevalence of baseline troponin elevation and specifically its diagnostic yield for acute myocardial infarction (AMI) in patients presenting within the time window for thrombolysis.

Methods—

We retrospectively analyzed 1072 consecutive patients admitted for acute ischemic stroke or transient ischemic attack, who presented within 4.5 hours of last known well (LKW). Patients who had baseline cardiac troponin I (bcTnI) obtained within 72 hours from LKW (n=525) were included in the study. Multivariable logistic regression was conducted to determine factors independently related to an elevated bcTnI (>0.04 ng/mL). We calculated the area under receiver operator curves, sensitivity, and specificity, to determine the diagnostic accuracy of (i) the bcTnI for AMI stratified by the time to assessment and (ii) the best time cutoff for obtaining bcTnI.

Results—

Among included subjects, the median time from LKW to the bcTnI was 3.8 hours and 113 (21.5%) subjects had an elevated bcTnI. Assessment of bcTnI within 4.5 hours from LKW was significantly more often associated with normal values as compared to assessment between 4.5 and 72 hours (61.7% versus 38.3%;
P
=0.001). Fifteen (2.9%) patients were diagnosed with AMI. After adjustment for pertinent confounders, time to bcTnI assessment was independently associated with AMI (odds ratio, 1.04 [95% CI, 1.02–1.07]
P
=0.001). When stratified by time, bcTnI assessed within 4.5 hours had a sensitivity of 25% and specificity of 83.7% for AMI, whereas bcTnI assessment between 4.5 and 72 hours was associated with a sensitivity of 90.9% and specificity of 74.8%.

Conclusions—

Assessment of bcTnI after 4.5 hours from LKW was associated with greater diagnostic accuracy than testing within 4.5 hours. This information may inform routine clinical practice.
National Institutes of Health StrokeNet Training Core
Authors: Vahidy Farhaan S. , Sozener Cemal B. , Meeks Jennifer R. , Chhatbar Pratik Y. , Ramos-Estebanez Ciro , Ayodele Maranatha , Richards Rebekah J. , Sharma Richa , Wilbrand Stephanie M. , Prabhakaran Shyam , Bregman Barbara S. , Adams Harold P. , Jordan Lori C. , Liebeskind David S. , Tirschwell David , Janis L. Scott , Marshall Randolph S. , Kleindorfer Dawn
Published: December 2019

Background and Purpose—

The National Institutes of Health (NIH) StrokeNet provides a nationwide infrastructure to advance stroke research. Capitalizing on this unique opportunity, the NIH StrokeNet Training Core (NSTC) was established with the overarching goal of enhancing the professional development of a diverse spectrum of professionals who are embedded in the stroke clinical trials network of the NIH StrokeNet.

Methods—

This special report provides a descriptive account of the rationale, organization, and activities of the NSTC since its inception in 2013. Current processes and their evolution over time for facilitating training of NIH StrokeNet trainees have been highlighted. Data collected for monitoring training are summarized. Outcomes data (publications and grants) collected by NSTC was supplemented by publicly available resources.

Results—

The NSTC comprises of cross-network faculty, trainees, and education coordinators. It helps in the development and monitoring of training programs and organizes educational and career development activities. Trainees are provided directed guidance towards their mandated research projects, including opportunities to present at the International Stroke Conference. The committee has focused on developing sustainable models of peer-to-peer interaction and cross-institutional mentorships. A total of 124 professionals (43.7% female, 10.5% underrepresented minorities) have completed training between 2013 and 2018, of whom 55% were clinical vascular neurologists. Of the total, 85% transitioned to a formal academic position and 95% were involved in stroke research post-training. Altogether, 1659 indexed publications have been authored or co-authored by NIH StrokeNet Trainees, of which 58% were published during or after their training years. Based on data from 109 trainees, 33% had submitted 72 grant proposals as principal or co-principal investigators of which 22.2% proposals have been funded.

Conclusions—

NSTC has provided a foundation to foster nationwide training in stroke research. Our data demonstrate strong contribution of trainees towards academic scholarship. Continued innovation in educational methodologies is required to adapt to unique training opportunities such as the NIH StrokeNet.
Towards a Husserlian Integrative Account of Experiential and Narrative Dimensions of the Self
Authors: Vesterager Mette
Published: December 2019

The aim of this paper is to outline an integrative account of experiential and narrative dimensions of the self based on Husserl’s genetic phenomenology. I argue that we should discard “strong narrativism” which holds that our experiential life has a narrative structure and, accordingly, that experiential and narrative dimensions of the self coincide. We should also refrain from equating the experiential self with the minimal self, as the former does not simply constitute a formally individuated subject as the latter but a properly individualized one with personal characteristics and habituality. Husserl’s genetic phenomenology offers both a description of the individualized self as experiential, i.e. as pre-reflective and embodied, and as narrative, i.e. as an autonomous linguistic agent. Through Husserl’s concepts of sedimentation and secondary passivity, we can explain the dialectical relationship between experiential and narrative dimensions of the self.
Using Husserl’s Natural Attitude to Understand the Change Process within Cognitive Therapy
Authors: Hamblet Charles
Published: December 2019

The following paper argues that Husserl’s description of the natural attitude can be used as an alternative to Beck’s cognitive therapy’s understanding of the change process and the perpetuation of an emotional disorder. Conversely this also provides further insight into the natural attitude. Specifically the works of Sebastian Luft and Alfred Schutz are referred to as a means of developing what is termed by the paper as the universalising attitude. The paper extrapolates the incidental, yet significant, phenomenological structures within CBT’s process of guided discovery to support its hypothesis that the change process can be understood as the patient undertaking at various times in therapy, a series of differing epoché. It is argued that CBT ultimately ‘works’ by the patient learning to achieve a rudimentary phenomenological attitude. The patient acquires insight by ‘standing back’ from their factual understanding of self, others and the world.
Inked or Not: Maras and Their Participation in El Salvador’s Recent Armed Conflict
Authors: Lima Ximena Galvez
Published: December 2019

El Salvador remains one of the most violent countries in the world undergoing a murder epidemic. The blatant rise in social violence is driven mainly by gangs of the Northern Triangle countries (Guatemala, Honduras and El Salvador), which frequently clash with governmental security forces. The situation legally blurred the lines between the law enforcement and armed conflict regimes. An insufficient amount of time has been dedicated to identifying the applicable international legal framework to El Salvador’s extreme gang violence and its repression. Consequently, the country’s categorization of violence has not been addressed. For this purpose, a contextual background narration of the politics of violence in the country followed by a detailed analysis of the constituent elements of El Salvador’s urban violence were examined. The assessment of facts and their juxtaposition to international jurisprudential criteria and doctrinal contributions on conflict classification suggest the situation reached international humanitarian law’s armed conflict brink.
Protecting Children from Sexual Violence in Armed Conflict under International Humanitarian Law
Authors: Almila Elina
Published: December 2019

Children enjoy special protection from the harms of armed conflict under international humanitarian law. While the protection of children in armed conflict has been widely researched with regard to recruitment and use of children in armed conflict, the research on protection of children from sexual violence has received less attention. In this paper I look at the protection of children in relation to sexual violence under international humanitarian law and its actualisation in the practise of international criminal courts and tribunals. I consider first how the protection of children from sexual violence under international humanitarian law made its way to Conventions. Second, I explore the case law of sexual violence as a war crime in international courts and tribunals and how the special protection of children is reflected in the case law. I argue that despite a gradual improvement, the provisions of the Conventions have not been recognised particularly well. While there have been cases in which more attention has been paid to sexual violence against children, the practice is mostly incoherent and sporadic: there exists a discrepancy between the Conventions, and the practice of international criminal courts and tribunals.
The barracudina genera Lestidium and Lestrolepis of Taiwan, with descriptions of two new species (Aulopiformes: Paralepididae)
Authors: HO HSUAN-CHING , TSAI SONG-YU , LI HSING-HUI
Published: December 2019

Two genera of barracudinas with luminescent duct in abdominal cavity, Lestrolepis and Lestidium, collected from around Taiwan are studied. Two species in each genus are recognized in Taiwan, including one new species in each genus. New diagnostic characters are used to distinguish these species. Lestrolepis nigroventralis sp. nov. is similar to Lestrolepis intermedia and can be distinguished by having 32–35 prehaemal vertebrae; dorsal-fin origin slightly in front of midline of distance between origins of pelvic and anal fins, distance between origins of dorsal and pelvic fin 9.8–11.7% SL; and pelvic-fin origin at or slightly behind midline of body, prepelvic length 50.6–52.6% SL. Lestidium orientale sp. nov. is similar to Lestidium atlanticum and can be distinguished by having prehaemal vertebrae 37–40; caudal vertebrae 41–44; a relatively short and deep head, reflected by a shorter snout (9.7–10.4% SL), shorter upper jaw (8.6–10.1% SL), shorter lower jaw (11.9–13.7% SL) and a deeper head (31.2–33.9% HL). Data of Lestrolepis japonicus and Lestidium prolixium collected from Taiwan, as well as two Atlantic congeners, are provided. DNA barcoding is conducted to support the recognition of these new species.
A new pearlfish, Onuxodon albometeori sp. nov. (Ophidiiformes: Carapidae), from Taiwan
Authors: KOEDA KEITA
Published: December 2019

Onuxodon albometeori sp. nov. (Ophidiiformes: Carapidae) is described from a single specimen collected by commercial trawl off southwestern Taiwan. The new species is most similar to the Indo-Pacific species Onuxodon fowleri (Smith 1955), both process a remarkably slender body, and higher precaudal vertebral counts and a longer pectoral fin, although the two latter features are even more extreme in the former. Onuxodon albometeori sp. nov. is further distinguished from O. fowleri by its lesser body depth, greater head width, higher counts of precaudal vertebrae, and uniformly whitish coloration only on the posterior part of the body.
Are My Pants Lowering Your Test Scores? Blaming Girls and Girls’ Empowerment for the “Boy Crisis” in Education
Authors: Goodkind Sara , Bay-Cheng Laina
Published: December 2019

Drawing on participatory research in a high school implementing single-sex classes, this article demonstrates how single-sex education masks racialized economic inequality by framing low academic achievement among low-income youth of color as a function of gender, thereby scapegoating girls for a supposed “boy crisis” in education. We demonstrate this with data collected by and from students, as well as from educators and parents, delineating how girls of color were held accountable for boys’ sexual and even academic behavior. We argue that this misattribution of blame succeeds by capitalizing on entrenched gender roles that cast girls/women as responsible for boys/men and on neoliberal rhetoric trumpeting postfeminist, commercialized “girl power” and the virtue of personal responsibility. We focus particularly on how girls’ supposed newfound empowerment is folded into the long-standing discourse of girl blame by posing girl power as a problem for boys.
Robust optimal decentralized observer for multi-phase flow measurement
Authors: Farahani Abolfazl Varvani , Montazeri Mohsen , Pourgholi Mahdi
Published: December 2019

In this paper, a non-fragile optimal observer is proposed for the decentralized multiphase flow measurement based on the interconnections between the two subsystems, that is, gas and liquid, constituting the whole system. Due to the dynamic model of system and presence of disturbances and slowly varying quantities, a non-fragile decentralized observer is designed and the states of the condensate and gas sub-systems were separately estimated. Lyapunov-based stability conditions are converted to linear matrix inequality (LMI) and observer gains are optimally selected from solution set such that the effect of the disturbance on the states’ estimation error becomes minimized. The estimation is conducted using the real-time measurements including lines pressures, single-phase gas flow, and single-phase liquid flow in the refinery outlet. To check the stability and performance of the system against the changes, the Lyapunov theory has been used. Finally, the estimation results are compared with real-world data from the industry showing the high accuracy of this method as the estimations were consistent with the operation data. In all stages, the investigations were based on the data collected from the actual process in the South Pars Gas Complex (SPGC), Iran. Additionally, the Extended Kalman Filter (EKF) based on the simplified drift flux model (DFM) was used to estimate the states then both methods’ results are compared and using the HYSYS simulator with the real process data, it is found that both observers are capable to identify the states with some differences in performance and DFM model is sufficient for estimation of parameters and states of the multiphase flow entering the gas refinery. As a result, these techniques not only can be substituted for the existing system at the gas refinery, but also can be as a backup for available measurement systems.
The Promise of Emotion Practice: At the Bedside and Beyond
Authors: Cottingham Marci D. , Erickson Rebecca J.
Published: December 2019

Emotion scholars have documented the relevance of emotional labor for understanding exhaustion, burnout, and other negative outcomes among workers in care-based occupations. Yet, an emotion management framework that centers emotional labor is not without limitations. The authors use audio diary data from 48 acute care hospital nurses to illustrate how an emotion practice approach can empirically capture complex emotional processes beneath and beyond individual acts of emotional labor. This analysis highlights the interplay of context and self in shaping the occupational outcomes of care workers and illustrates how emotions are simultaneously conscious and embodied, dynamic and structured, individual and collective.
Prediction of the Intention to Undergo Cosmetic Surgery Among Female Students Based on the Theory of Reasoned Action
Authors: Barati Majid , Kazemi Kilehgolan Fariba , Parsafar Sahar , Jalilian Farzad , Afshari Maryam
Published: December 2019

Cosmetic surgeries are performed to change the appearance of people and improve their self-esteem, and according to available reports, Iran is ranked first in terms of the percentage of cosmetic surgeries performed. Therefore, this study aimed to predict the intention to undergo cosmetic surgery among female students of Hamadan University of Medical Sciences based on the reasoned action theory. This was a cross-sectional study conducted on 340 female students of Hamadan University of Medical Sciences selected by the random stratified sampling method in 2017. Data collection tools were demographic variables and the questionnaire that measured theoretical constructs of the reasoned action theory about cosmetic surgery. The questionnaire was completed by the participants through the self-reporting method. Data were analyzed by SPSS software (version 24; SPSS Inc., Chicago, IL, USA) using the independent t-test, 1-way analysis of variance (ANOVA), Pearson correlation, and linear regression. Students often obtained information about cosmetic surgery through the Internet (63.2%). Students obtained 45%, 66.4%, 49.2%, 77.5%, and 48.1% of acquired scores for behavioral beliefs, evaluations of behavioral outcomes, motivation for obedience, normative beliefs, and behavioral intention associated with cosmetic surgery, respectively. There was a positive and significant correlation between the constructs of the reasoned action theory. Among the studied constructs, motivation for obedience, evaluations of behavioral outcomes and behavioral beliefs had a significant role in explaining the behavioral intention variance. Considering the role of the constructs of the reasoned action theory and the motivation for obedience in the formation of the process of intention to undergo cosmetic surgery, training by peer group can play an important role in reducing these pressures. Therefore, the formation of student cores under the supervision of academic associations of universities and the training of these cores for the transfer of information and skills to peer groups is recommended.
Orem’s Self-Care Model with Multiple Sclerosis Patients’ Balance and Motor Function
Authors: Afrasiabifar Ardashir , Mehri Zahra , Ghaffarian Shirazi Hamid Reza
Published: December 2019

Orem’s self-care model has been introduced as a nursing model to empower participants with chronic diseases. This study aims to investigate the effectiveness of nursing interventions using Orem’s self-care model with multiple sclerosis participants’ balance and motor function. Sixty-three participants with multiple sclerosis were randomly assigned to intervention and control groups. The nursing intervention using Orem’s self-care model was performed for eight sessions of 45–60 minutes in the intervention group. In the intervention group, a significant increase (improvement) was observed in the mean scores of balance before (17.09 ± 1.97) and after the intervention (33.75 ± 6.01). A significant decrease (improvement) was observed in the mean of motor functions before (4.12 ± 0.34) and after the intervention (1.59 ± 0.71) ( p = 0.001). However, no significant difference existed in the mean scores of balance ( p = 0.10) and motor function in the control group ( p = 0.20). The nursing intervention using Orem’s self-care model improved balance and motor function of participants with multiple sclerosis.
Moving On: From Metaparadigm to Midparadigm for Knowledge Development
Authors: Reed Pamela G.
Published: December 2019

This column on Philosophical Issues introduces a conceptual innovation, the midparadigm, designed to facilitate continued development of nursing knowledge while moving beyond the metaparadigm. The midparadigm is a conceptual structure lower in abstraction than a metaparadigm consisting of an organization of concepts that reflect shared scientific and practical values for theory development in reference to a practice-relevant context. In this introductory article, I explain its philosophical rationale and provide other groundwork about the midparadigm. The feature article is authored by a team of doctoral students who present an exemplar of a midparadigm, which they have called their prismatic midparadigm of nursing.