bluuebunny/crossref_metadata_2025 huggingface dataset:
“Who Would Sexually Assault an 80-Year-Old Woman?”: Barriers to Exploring and Exposing Sexual Assault Against Women in Late Life
Authors: Goldblatt Hadass , Band-Winterstein Tova , Lev Sagit , Harel Dovrat
Published: July 2020

The phenomenon of Sexual Assault against Women in Late Life (SAWLL) has received increasing research attention in recent years. Yet, there is still only scant knowledge on it, compared with research on the sexual assault of younger women. Sexual assault is considered a sensitive topic, generally characterized by a conspiracy of silence. The aim of this article is to explore the barriers that hinder the identification and exposure of SAWLL, as reported by professionals. The research question was as follows: How do welfare and health care professionals present the motives and processes that obstruct exploring, exposing, and intervening in cases of SAWLL? A qualitative research design was used. Participants were 18 experienced welfare and health care professionals engaged in intervention with sexual assault in late life victims as well as offenders. Data were collected through in-depth, semi-structured interviews, which were later transcribed and thematically analyzed. Four themes emerged from the data analysis: (a) Leading Negative Emotions, (b) Lack of Language, (c) Implications of Cumulative and Complex Trauma, and (d) Social Exclusion. Women and professionals alike undergo complementary processes involving silence and silencing. These processes construct a “wall” of barriers, requiring professionals’ sensitivity and awareness to deconstruct these barriers. Professional intervention through open discourse with the abused women can break this conspiracy of silence. We recommend that training programs for professionals intervening in cases of elder abuse and neglect will be directed along two paths: The first path should focus on professionals’ competence and skills, and the second path should address the women’s specific needs. These programs will include a particular module that will specifically address SAWLL. This module should comprise knowledge on typical emotional reactions to SAWLL, the use of language in creating reality, cumulative and complex trauma, and the social construction of ageism and sexism, which lead to social exclusion.
Children’s Disclosures of Physical Abuse in a Population-Based Sample
Authors: Lahtinen Hanna-Mari , Laitila Aarno , Korkman Julia , Ellonen Noora , Honkalampi Kirsi
Published: July 2020

Few studies have explored the disclosure of child physical abuse although child sexual abuse disclosure has been widely studied and debated for years. The present study explores the characteristics of child physical abuse disclosures and compares them to previously published findings on child sexual abuse disclosure from the same data. The data consist of a representative sample of 11,364 sixth and ninth graders. Participants responded to a wide variety of questions concerning experiences of violence, including child physical abuse and child sexual abuse, in the Finnish Child Victim Survey conducted in 2013. Within this sample, the prevalence of child physical abuse was 4.1%. Children reporting abuse experiences also responded to questions regarding disclosure, reactions encountered during disclosure, and potential reasons for nondisclosure. Findings show that most of the children who disclosed physical violence had disclosed to their mother. The overall disclosure rate of child physical abuse was 74%. However, only 42% had disclosed to adults, and even fewer had reported their experiences to authorities (12%). The most common reason for nondisclosure was that the youth did not consider the experience sufficiently serious to report (53%). These findings were largely in line with the child sexual abuse disclosure rates in our previous study. Analyses of variables associated with disclosing to an adult indicate that the strongest factors predicting disclosure to an adult are younger age, female gender, no previous experiences of child physical abuse, and parents knowing who their child spends her or his spare time with. Implications for further research and practice are discussed.
Self-Persuasion: An Experimental Evaluation of a Sexual Aggression Preventive Intervention for U.S. College Men
Authors: Wong Y. Joel , McDermott Ryon C. , Zounlome Nelson O. O. , Klann Elyssa M. , Peterson Zoë D.
Published: July 2020

Grounded in the self-persuasion paradigm (an indirect persuasion approach, which places people in situations that motivate them to change their behavior), this study evaluated a brief, online intervention to reduce sexual aggression perpetration and increase prosocial bystander behaviors among heterosexual male college students ( N = 241) in the United States. Students were randomly assigned to three conditions: (a) a self-persuasion intervention, (b) a social norms control condition, and (c) a control condition focusing on sense of belongingness. The self-persuasion intervention integrated three social psychological theoretical perspectives on attitudinal and behavioral change—cognitive dissonance (e.g., creating a personalized video message for incoming male college freshmen to explain the importance of consent in sexual contact), self-affirmation (e.g., reflecting on one’s core values and how they are congruent with sexual consent), and personal relevance (e.g., writing about personally relevant reasons to always seek consent when having sexual contact). Participants in the self-persuasion condition reported greater prosocial bystander behaviors (e.g., intervening in situations to prevent sexual aggression) 6 months after the intervention as compared with those in the other two conditions; however, there were no significant difference in the rate of self-reported sexual aggression perpetration across conditions. The positive effect of the self-persuasion intervention on prosocial bystander behaviors was mediated by reduced self-perceived likelihood to commit sexual aggression and moderated by in-group solidarity with other college students. That is, the intervention had the most positive effect on prosocial bystander behaviors among participants with a lower sense of in-group solidarity. These findings are discussed in light of the promise of self-persuasion for future sexual aggression prevention work.
Lifetime Victimization and Poly-Victimization in a Sample of Adults With Intellectual Disabilities
Authors: Codina Marta , Pereda Noemí , Guilera Georgina
Published: July 2020

People with intellectual disabilities appear to be more vulnerable to victimization. However, few studies have assessed victimization in these groups and those that do exist are highly heterogeneous and tend to focus only on specific forms of violence. This study attempts to shed light on the phenomenon of victimization among adults with intellectual disabilities by assessing victimization and poly-victimization throughout their life course. The sample consisted of 260 adults (154 men and 106 women) with an intellectual disability diagnosis, recruited from the Catalan Federation for People with Intellectual Disabilities (DINCAT) in Spain. They ranged in age from 20 to 71 years ( M = 41.69, SD = 12.05). Victimization experiences were assessed by means of an adaptation of the retrospective version of the Juvenile Victimization Questionnaire (JVQ). The results showed that 96.9% of the participants had suffered some kind of victimization throughout their lives. With respect to the types of victimization, the most frequent were common victimization (87.7%), witnessing and indirect victimization (67.3%), victimization by caregivers (59.2%), sexual victimization (35%), and electronic victimization (23.5%). Women and early adults tended to experience higher rates of victimization. The poly-victimized group experienced 13 or more incidents of victimization throughout their lives. This study highlights the elevated rates of lifetime victimization among people with intellectual disabilities. It adds to previous evidence that special protection programs are required to address this issue and emphasizes the need for prevention and intervention measures in this particularly vulnerable group.
An Experimental Laboratory Examination of the Psychological and Physiological Effects of Civic Empowerment: A Novel Methodological Approach
Authors: Ballard Parissa J. , Muscatell Keely A. , Hoyt Lindsay Till , Flores Abdiel J. , Mendes Wendy Berry
Published: July 2020

Civic engagement can be empowering and might promote well-being, especially for individuals from marginalized backgrounds. This study uses a novel experimental approach to simulate civic engagement in a laboratory study and to test whether this approach engenders civic empowerment and buffers psychological and physiological reactivity to stress and social rejection. Young adults, primarily experiencing low socioeconomic status ( N = 128), were randomly assigned to deliver a speech about a civic or a neutral issue. Giving a civic speech leads to higher feelings of empowerment compared with giving a neutral speech. Delivering the civic speech buffers sympathetic nervous system reactivity to stress (measured through the pre-ejection period) and leads to higher identification with social class background. This is one of the first studies to use an experimental approach and psychophysiological methods to examine the effects of civic empowerment on civic, psychosocial, and physiological reactivity outcomes.
Disinformation as a Threat to Deliberative Democracy
Authors: McKay Spencer , Tenove Chris
Published: July 2020

It is frequently claimed that online disinformation threatens democracy, and that disinformation is more prevalent or harmful because social media platforms have disrupted our communication systems. These intuitions have not been fully developed in democratic theory. This article builds on systemic approaches to deliberative democracy to characterize key vulnerabilities of social media platforms that disinformation actors exploit, and to clarify potential anti-deliberative effects of disinformation. The disinformation campaigns mounted by Russian agents around the United States’ 2016 election illustrate the use of anti-deliberative tactics, including corrosive falsehoods, moral denigration, and unjustified inclusion. We further propose that these tactics might contribute to the system-level anti-deliberative properties of epistemic cynicism, techno-affective polarization, and pervasive inauthenticity. These harms undermine a polity’s capacity to engage in communication characterized by the use of facts and logic, moral respect, and democratic inclusion. Clarifying which democratic goods are at risk from disinformation, and how they are put at risk, can help identify policies that go beyond targeting the architects of disinformation campaigns to address structural vulnerabilities in deliberative systems.
Peripherally inserted central catheter malposition to a persistent left superior vena cava: A successful case to leave the catheter till the end of chemotherapy
Authors: Li Qi , Liu Yuxiu , Wang Min , Yu Zhongjie , Gao Yufang
Published: July 2020

Persistent left superior vena cava is rare and asymptomatic and is usually discovered incidentally during or after insertion of a central venous catheter. There is uncertainty as to whether or not the catheter should be removed after its malposition resulting in persistent left superior vena cava. We reported an unusual case of a breast cancer patient with a persistent left superior vena cava detected after a peripherally inserted central catheter insertion. The patient had undergone a modified radical mastectomy and needed to insert a peripherally inserted central catheter for chemotherapy. After the peripherally inserted central catheter insertion, the chest X-ray and computed tomography showed that the catheter was located in the persistent left superior vena cava. After an assessment of the persistent left superior vena cava and the catheter tip position, the peripherally inserted central catheter remained in the persistent left superior vena cava for further therapy. To ensure the integrity of the catheter, special follow-ups and tip position observations were carried out. The peripherally inserted central catheter was safe until the end of chemotherapy with no complications. Although the peripherally inserted central catheter tip was located in persistent left superior vena cava, given that the persistent left superior vena cava coexisted with a right superior vena cava with the similar lumen, the peripherally inserted central catheter could be used normally under strict attention.
Tragedy or over-achievement: a media analysis of spinal cord injury in Australia
Authors: Rees Leanne , Sherwood Merryn , Shields Nora
Published: July 2020

Spinal cord injury has evolved from a condition not to be treated, to one that is treated and rehabilitated. People with spinal cord injury now live longer active lives; however, barriers to participation such as attitudes and misunderstandings of spinal cord injury still exist. Acknowledging that media can shape attitudes and understanding of disability, primary aim of this study was to explore how spinal cord injury has been framed in Australian media through a newspaper content analysis. A secondary aim was to understand how framing changed overtime. Findings show consistent traditional news frames, with emphasis on disability and hardship. Progressive framing emerged in later years. Thematic analysis revealed two contrasting narratives tragedy and over-achievement, and a third financial burden. Traumatic spinal cord injury was most reported. This coverage, and exclusion of stories in between, has potential implications towards attitudes and understanding of spinal cord injury, and the lived experience.
Reconstruction of full-field complex deformed shapes of thin-walled special-section beam structures based on in situ strain measurement
Authors: Xu Hao , Zhou Qi , Yang Lei , Liu Minjing , Gao Dongyue , Wu Zhanjun , Cao Maosen
Published: July 2020

This study proposed a method capable of reconstructing complex deformations of thin-walled special-section beam structures subjected to highly coupled loading cases, in terms of the combination of tension/compression, biaxial bending, and warping torsion. The complex beam deformation was decoupled, depending on axial strain measurement strategy on beam surface, and leads to reconstructed full-field displacements (deformed shapes) as the linear superposition of deformations subject to individual loading types. Full-filed strain/stress distributions can then be derived based on the reconstructed displacements. Particular efforts were focused on reconstructing beam deformation subject to warping torsion, where both rotations angles and warping displacements across the beam cross-section and along the beam length were identified precisely. As a proof-of-concept validation, the effectiveness of the method was examined using finite element analysis, where the deformed shape of a thin-walled hat-section beam under the coupling between uniaxial bending and warping torsion was reconstructed., Experiments were conducted subsequently to reconstruct deformation of an aluminum hat-section beam using distributed optical fiber sensors for the measurement of axial strains on the beam surface. The reconstructed full-field deformed shapes of the beam were compared with the three-dimensional displacement signals captured using a non-contact digital image correlation system. The effectiveness of the proposed methodology for complex deformation reconstruction is possible to be extended to a variety of thin-walled beam-type structures which are typical in civil and aerospace engineering, showing potential contributions in fields such as on-line structural health monitoring and active structural control.
Family relationships and LGB first homelessness in Australia: What do we know and where should we go?
Authors: Dempsey Deborah , Parkinson Sharon , Andrews Cal , McNair Ruth
Published: July 2020

Family conflict is a well-documented causal factor in the international literature on youth homelessness. Less is known about how childhood experiences within family of origin contribute to first homelessness among Australian lesbian, gay, bisexual, transgender and queer (LGBTQ+) young people. In this article, which draws on an analysis of the Australian Journeys Home survey, we argue that homelessness risk among LGB young people is cumulative and stems from multiple childhood disadvantages. LGB respondents were more likely than their heterosexual peers to report leaving home in the early teens. They were also more likely to have experienced conflict, abuse and deprivation in their families of origin, including: the threat of harm from someone within the family home environment; a lack of adequate food and shelter during childhood; high levels of childhood sexual abuse; and early experience of parental divorce. We discuss the implications of these findings for future LGBTQ+ research agendas.
Autoignition characteristics of diesel spray under different injection pressures and cold start strategy for compression ignition engines
Authors: Yang Ziming , Liu Fushui , Li Yikai
Published: July 2020

Poor cold start performance is one of the main factors restricting the application range of compression ignition engines. Stable flame generation in the cylinder is the prerequisite for the successful start of the engine. In order to explore ways to improve the cold start ability of the compression ignition engine, the ignition characteristics of diesel sprays at different injection pressures were studied in a constant volume combustion chamber. A high-speed photography technique was used to obtain the color images of the initial flames of diesel free sprays. And the yellow flame is introduced as the criterion for a successful flame generation. It was found that under moderate injection pressures, the reactant concentration and energy dissipation rate reached equilibrium. Under this condition, the duration of the blue flame is relatively stable, and it is most conducive to the generation of the yellow flame in the cylinder. The negative temperature coefficient phenomenon is also observed, and the temperature range in which this phenomenon occurs is identical with the change of injection pressure. A cold start strategy for the compression ignition engine is proposed by controlling the compression-end temperature in the cylinder to be higher than the threshold ignition temperature of diesel spray.
Youth and Parental Perceptions of a Holistic Juvenile Public Defense Model
Authors: Phillippi Stephen , Berman Jeffrey , Thomas Casey L. , Beiter Kaylin , Test Ariel
Published: July 2020

This study examines client and parent/guardian perceptions of holistic juvenile public defense. A total of 66 subjects responded to a structured survey measuring satisfaction with holistic representation. Differences between perceptions were analyzed using paired T-tests and the Pearson’s correlation coefficient was used to analyze strength of association and interrelationships among variables and satisfaction. Qualitative data were collected through open-ended survey questions. The findings of this study indicate that holistic defense was perceived positively as measured by high client satisfaction. Further empirical research is necessary to evaluate the outcomes of holistic models and offer comparison to traditional models.
Dynamic nonlinearities for identification of the breathing crack type damage in reinforced concrete bridges
Authors: Voggu Srinivas , Sasmal Saptarshi
Published: July 2020

Reinforced concrete structures experience nonlinear vibration response because of softening in concrete due to damage, which results in unstable vibration. Thus, considering the nonlinearity in vibration for assessment of damage is imperative to identify the actual damage scenario. Nonlinearity is predominant during the initial stage of damage when cracks start developing in the concrete exhibiting nonlinear breathing-crack mechanism. By suitably extracting nonlinear features from ambient/forced vibration, information on initial stage of damage (primarily breathing-crack) in large concrete structures can be obtained. In the present study, evaluation of nonlinear dynamic features from an experimental model of a reinforced concrete bridge girder-deck system is investigated. The damage scenarios in the bridge girder is experimentally simulated by monotonically applied static load at different levels. Vibration responses are acquired using the accelerometers positioned at regular intervals, so that the global system behaviour can be assessed. Damage features at various damage levels are evaluated based on the signal statistics, amplitude dependency, harmonics, phase-plane information and so on. The breathing-crack behaviour of the bridge girder during initial damage stages is investigated and the existence of sub- and super-harmonic components in the frequency spectra is distinctly evidenced and their amplitudes are quantified. The change of skewness pattern of the frequency spectra with increasing damage level is also evaluated. A distinct variation in phase space portrait is observed with increase in damage levels. It is found that, in spite of presence of inherent material nonlinearity, nonlinearity caused through system damage, even at initial stages of damage, is predominant and could be distinctly captured without any baseline information. The identified nonlinear vibration characteristics showed a remarkable relevance in detecting breathing-crack type damage in weakly nonlinear bridge. The investigated damage features from this study would pave the way for real-time baseline free assessment and identification of damage in concrete structures.
A hybrid method coupling empirical mode decomposition and a long short-term memory network to predict missing measured signal data of SHM systems
Authors: Li Linchao , Zhou Haijun , Liu Hanlin , Zhang Chaodong , Liu Junhui
Published: July 2020

Missing data, especially a block of missing data, inevitably occur in structural health monitoring systems. Because of their severe negative effects, many methods that use measured data to infer missing data have been proposed in previous research to solve the problem. However, capturing complex correlations from raw measured signal data remains a challenge. In this study, empirical mode decomposition is combined with a long short-term memory deep learning network for the recovery of the measured signal data. The proposed hybrid method converts the missing data imputation task as a time series prediction task, which is then solved by a “divide and conquer” strategy. The core concept of this strategy is the prediction of the subsequences of the raw measured signal data, which are decomposed by empirical mode decomposition rather than directly predicted, as the decomposition can assist in the modeling of the irregular periodic changes of the measured signal data. In addition, the long short-term memory network in the hybrid model can remember more long-range correlations of subsequences than can the traditional artificial neural network. Three widely used prediction models, namely, the autoregressive integrated moving average, support vector regression, and artificial neural network models, are also implemented as benchmark models. Raw acceleration data collected from a cable-stayed bridge are used to evaluate the performance of the proposed method for missing measured signal data imputation. The recovery results of the measured signal data demonstrate that the proposed hybrid method exhibits excellent performance from two perspectives. First, the decomposition by empirical mode decomposition can improve the accuracy of the core long short-term memory prediction model. Second, the long short-term memory model outperforms other benchmark models because it can fit more microscopic changes of measured values. The experiments conducted in this study also suggest that the change patterns of raw measured signal data are complex, and it is therefore important to extract the features before modeling.
Occupational Engagement and Partisanship in the United States
Authors: DeWitt Darin
Published: July 2020

In this article, I present a portrait of the American power elite and their relationship with the party system. I focus on occupational categories as institutional positions and take up three questions: Which occupational categories wield social influence? How politically mobilized is each of these occupational categories? And what partisan tilt is exhibited by each category? My results help clarify the contemporary structure of American electoral competition. Furthermore, they also shed light on which social groups have a voice in American politics and, thus, speak to questions of political equality.
What Do We Want to Tell? And to Whom Do We Wish to Tell It?: The Ethnographer’s Ethical Dilemma
Authors: Lincoln Yvonna S.
Published: July 2020

On the Run has spurred public debates about the ethics of ethnography. The controversy surrounds the fact that the sociologist/ethnographer drove a participant who was armed with a gun and the intent to commit murder. Ethical concerns are not new to ethnography. A previous generation of sociologists and ethnographers faced similar dilemmas: Did those who studied jazz bands also take drugs with the band members? Did those who studied gangs have knowledge of criminal activity to which the police might prefer to be privy? And yet, with new technologies and media-sharing platforms, ethnographers face increased scrutiny. The paper, as a result, focuses on debates regarding perennial ethical conundrums: what to tell, whether to tell, and to whom it might be told.
Microfinance and Peer Health Leadership Intervention Implementation for Men in Dar es Salaam, Tanzania: A Qualitative Assessment of Perceived Economic and Health Outcomes
Authors: Mhando Frank , Dovel Kathryn , Jennings Mayo-Wilson Larissa , Rwehumbiza Deusdedit , Thompson Noah , Nwaozuru Ucheoma , Rehani Abubakar , Iwelunmor Juliet , Nelson LaRon E. , Conserve Donaldson Fadael
Published: July 2020

Men in sub-Saharan Africa continue to experience health disparities that are exacerbated by low employment. This study qualitatively assessed men’s perceptions of the economic and health-care-seeking effects of participation in an integrated microfinance and peer health leadership intervention on violence and HIV risk reduction in Tanzania. Three focus group discussions with 27 men, aged 20 to 44 years, examined the perceived effects on income generation, employability, mental health, and uptake of HIV and related health services. All discussions were recorded, transcribed, and analyzed using deductive and inductive coding methods. Men reported that the benefits of the intervention included increased employability and income-earning activities due to greater access to entrepreneurial training, low-interest microfinancing, and male-oriented group supports to start or strengthen their businesses. Increased wages through business or other forms of employment were also attributed to men’s lower anxiety and distress as financial providers for their families. However, men indicated that apart from the uptake of free HIV testing services, there was limited change in overall health-care-seeking behavior given the high clinic fees and lost time to earn income when attending routine health visits. Men recommended that future microfinance and health promotion interventions provide larger loan amounts, less frequent repayment intervals, and access to health and social insurance. Microfinance and peer health leadership interventions may help to address economic and health disparities in poor, urban men. Efforts are needed to assist lower income men in accessing financial tools as well as fee-based preventive and health-care services.
Aerodynamic drag reduction in winter sports: The quest for “free speed”
Authors: Brownlie Len
Published: July 2020

The Winter Olympics are a highly competitive sporting environment where subtle improvements in performance can impact the finishing order in many events. Aerodynamic drag is known to be a significant resistive force to human movement in high-speed sports, such as alpine skiing, speed skating and bobsleigh. Aerodynamic drag also represents an important determinant of performance in sports such as ice hockey, snowboard cross and cross-country skiing. From 2000 to 2018, a series of wind tunnel–based research projects were conducted to provide aerodynamically optimized apparel, equipment and wind tunnel simulation training to elite Canadian and American winter sports athletes involved in bobsleigh, skeleton, luge, ice hockey, speed skating, cross-country, alpine and para-alpine skiing, biathlon, ski-cross and snowboard cross. This article reviews the role of aerodynamic drag in winter sports, considers fundamental principles of air flow around bluff bodies and methods of drag reduction in ice and snow sports, while providing experimental results from an extensive database of wind tunnel investigations. Deficits in the literature suggest productive areas for future research to improve athletic performance in these sports.
Patient-Driven Diabetes Technologies: Sentiment and Personas of the #WeAreNotWaiting and #OpenAPS Movements
Authors: Litchman Michelle L. , Walker Heather R. , Fitzgerald Caroline , Gomez Hoyos Mariana , Lewis Dana , Gee Perry M.
Published: July 2020

Background:

Patients with diabetes have developed innovative do-it-yourself (DIY) methods for adapting existing medical devices to better fit individual needs.

Method:

A multiple method study used Symplur Analytics to analyze aggregated Twitter data of #WeAreNotWaiting and #OpenAPS tweets between 2014 and 2017 to examine DIY patient-led innovation. Conversation sentiment was examined between diabetes stakeholders to determine changes over time. Two hundred of the most shared photos were analyzed to understand visual representations of DIY patient-led innovations. Finally, discourse analysis was used to identify the personas who engage in DIY patient-led diabetes technologies activities and conversations on Twitter.

Results:

A total of 7886 participants who generated 46 578 tweets were included. Sentiment analysis showed that 82%-85% of interactions around DIY patient-led innovation was positive among patient/caregiver and physician groups. Through photo analysis, five content themes emerged: (1) disseminating media and conference coverage, (2) showcasing devices, (3) celebrating connections, (4) providing instructions, and (5) celebrating accomplishments. Six personas emerged across the overlapping userbase: (1) fearless leaders, (2) loopers living it up, (3) parents on a mission, (4) the tech titans, (5) movement supporters, and (6) healthcare provider advocates. Personas had varying goals and behaviors within the community.

Conclusions:

#WeAreNotWaiting and #OpenAPS on Twitter reveal a fast-moving patient-led movement focused on DIY patient innovation that is further mobilized by an expanding and diverse userbase. Further research is indicated to bring technology savvy persons with diabetes into conversation with healthcare providers and researchers alike.
Caspase Inhibition Affects the Expression of Autophagy-Related Molecules in Chondrocytes
Authors: Vesela Barbora , Svandova Eva , Ramesova Alice , Kratochvilova Adela , Tucker Abigail S. , Matalova Eva
Published: July 2020

Objective. Caspases, cysteine proteases traditionally associated with apoptosis and inflammation, have recently been identified as important regulators of autophagy and reported within the growth plate, a cartilaginous part of the developing bone. The aim of this research was to identify novel autophagy-related molecules affected by inhibition of pro-apoptotic caspases in chondrocytes. Design. Chondrocyte micromasses derived from mouse limb buds were treated with pharmacological inhibitors of caspases. Autophagy-related gene expression was examined and possible novel molecules were confirmed by real-time polymerase chain reaction and immunocytofluorescence. Individual caspases inhibitors were used to identify the effect of specific caspases. Results. Chondrogenesis accompanied by caspase activation and autophagy progression was confirmed in micromass cultures. Expression of several autophagy-associated genes was significantly altered in the caspases inhibitors treated groups with the most prominent decrease for Pik3cg and increase of Tnfsf10. The results showed the specific pro-apoptotic caspases that play a role in these effects. Importantly, use of caspase inhibitors mimicked changes triggered by an autophagy stimulator, rapamycin, linking loss of caspase activity to an increase in autophagy. Conclusion. Caspase inhibition significantly affects regulation of autophagy-related genes in chondrocytes cultures. Detected markers are of importance in diagnostics and thus the data presented here open new perspectives in the field of cartilage development and degradation.
Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure
Authors: Alghalayini Kamal Waheeb
Published: July 2020

Introduction:

It is proposed that access to administering intravenous furosemide outside the hospital can contribute to lowering hospital admissions for heart failure. This study aims to evaluate the effect of outpatient furosemide infusion protocol in preventing hospitalization for patients with decompensating heart failure. This constitutes designing a viable clinical pathway in hospitals using a multidisciplinary heart failure program.

Methods:

A prospective interventional study testing the effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure was conducted on 150 decompensating heart failure patients requiring hospital admission. Only 105 patients met the criteria and subsequently enrolled in the study. Each patient was administered intravenous furosemide infusion one or more times according to the protocol and depending on their symptoms of decompensation. Patients were referred for admission at any point once there is no improvement of their medical condition, or referred to heart failure clinic when clinical picture improved as observed by the treating team.

Results:

In total, 14 of 105 patients who received intravenous furosemide infusion did not respond to diuretic infusion protocol and required hospital admission while 91 patients responded to same protocol and did not require admission, P value was statistically significant in three laboratory test measures of potassium (<0.001), urea (0.004), and creatinine (0.008). Heart failure with reduced ejection fraction was observed in 70 (76.9%) responders with a mean ejection fraction of 23% and in 9 (64.3%) non-responders with mean ejection fraction of 19.9%.

Conclusion:

Outpatient intravenous furosemide infusion protocol is effective in preventing hospitalization for decompensating heart failure and a viable clinical pathway for heart failure programs.
Pelvic organ prolapse management
Authors: Fleischer K , Thiagamoorthy G
Published: July 2020

Pelvic organ prolapse describes the loss of support and subsequent descent of pelvic organs into the vagina. It is common, affecting up to 50% of parous women, and can be accompanied by a number of burdening symptoms. Prolapse has been thrown into the spotlight secondary to mesh-related complications. There are a number of effective treatment options to consider when managing pelvic organ prolapse and most do not require mesh. Patients’ choice, comorbidities and likelihood of treatment success should be considered when making decisions about their care. Vaginal mesh surgery is currently on hold in the UK and even prior to this there has been a reduction both in the number of all prolapse surgeries and the number of women seeking surgery to manage their symptoms. This article reviews the current evidence for the management of pelvic organ prolapse, providing an update on the current state of mesh in prolapse surgery and summarises the key evidence points derived from the literature.
Preventing Prescription Drug Abuse: A Pharmacy Technician Tool Kit
Authors: Wilson Debbie L.
Published: July 2020

The misuse of prescription medications in the United States is a worsening public health problem. Pharmacy technicians are often the first pharmacy staff member to receive newly dropped off prescriptions and to interact with patients in the pharmacy. Having a tool kit of the knowledge and skills needed to distinguish prescriptions that may result in misuse from the legitimate ones and to respond appropriately and professionally to each is essential to pharmacy technicians performing their role and function in the dispensing process.
Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature
Authors: Zhang Ran , Tang Zhiyu , Qiao Qing , Mahmood Feroze , Feng Yi
Published: July 2020

Background

Embolic stroke is a common complication of atrial myxoma, whereas multiple cerebral aneurysms associated with atrial myxoma is rare. The pathogenesis of the cerebral vascular disease related to an atrial myxoma is still not well known, and there are no guidelines to guide treatment and anesthesia management in such patients.

Case presentation

In this report, we present a 38-year-old woman with occasional dizziness and headache diagnosed as multiple cerebral fusiform aneurysms, in whom transthoracic echocardiography revealed a mass attached to the interatrial septum in the left atrium. Myxoma resection was performed in fast track cardiac surgery pathway without neurological complications, and no intervention was carried out on the cerebral aneurysms. She was discharged home 6 days after the procedure for followed-up. Furthermore, we reviewed and analyzed the literature in the PubMed and Google Scholar databases in order to conclude the optimal treatment in such cases.

Conclusions

Atrial myxoma-related cerebral aneurysms are always multiple and in a fusiform shape in most occasions. Early resection of myxoma and conservative therapy of aneurysm is an optimal treatment. TEE and PbtO2monitoring play an essential role in anesthesia management. Fast track cardiac anesthesia is safe and effective to early evaluate neurological function. Long term follow-up for “myxomatous aneurysms” is recommended. And outcome of most patients is excellent.
Alterations of kinematics in knees after single versus multiple radius femoral prostheses total knee arthroplasty: a retrospective study
Authors: Li Mengyuan , Fu Guangtao , Huang Wenhan , Lin Bofu , Zhang Ruiying , Zhang Yu , Ma Yuanchen , Zheng Qiujian
Published: July 2020

Background

Design modifications in prostheses may cause alterations in gait kinematics, thus influencing functional restoration of knees after total knee arthroplasty (TKA). The aim of the study was to investigate the differences in gait kinematics and clinical outcomes after single radius (SR) versus multiple radius (MR) TKA.

Method

The present retrospective study included 38 unilateral TKA involving 20 knees using MR design implant and 18 knees using SR design implant. Thirty-six healthy volunteers were also recruited. The mean follow-up time was 16 ± 3 months. At the end of follow-up, the 6 degrees of freedom (DOF) kinematics of knees and range of motion (ROM) were measured with a portable optical tracking system. Knee society score (KSS) and knee injury, and osteoarthritis outcome score (KOOS) were also collected.

Results

Patients in the SR group had significantly higher scores in activities of daily living (84.7 ± 15.9) and sports and recreation (67.5 ± 25.2) KOOS sub-score than MR group (69.9 ± 17.6,P = 0.012; 50.0 ± 20.8,P = 0.027, respectively). Significant differences were detected between MR knees and SR knees (1.82° ± 3.11° vs 4.93° ± 3.58°,P = 0.009), and MR knees and healthy knees (1.82° ± 3.11° vs 3.62° ± 3.52°,P = 0.032) in adduction/abduction ROM. The proximal/distal translation was significantly smaller in MR knees (0.58 ± 0.54 cm) compared with SR knees (1.03 ± 0.53 cm,P = 0.003) or healthy knees (0.84 ± 0.45 cm,P = 0.039). SR knees (0.24 ± 0.40 cm) had smaller translation compared with the MR group (0.54 ± 0.33 cm,P = 0.017) and control group (0.67 ± 0.36 cm,P = 0.028). No significant difference was detected in the other DOFs during the gait cycle. Significant difference was detected in extension/flexion, internal/external rotation, adduction/abduction, proximal/distal and medial/lateral among MR, SR and healthy knees.

Conclusion

After TKA, patients have altered gait kinematics compared with the control group. MR and SR design showed varied characteristics in 6 DOF gait kinematics, which could be the cause of the difference in functional outcome.
Gallbladder cancer with EGFR mutation and its response to GemOx with erlotinib: a case report and review of literature
Authors: Soni Kishan , Kumar Tarun , Pandey Manoj
Published: July 2020

Background

Gallbladder cancer (GBC) is the most common and aggressive extra hepatic biliary tree cancer (BTC) with dismal outcome. Complete surgical resection is the treatment of choice. Chemotherapy is used for palliation in advanced GBC where surgery is not possible, and the most commonly used agent is gemcitabine in combination with cisplatin or oxaliplatin or with capecitabine regimens. Complete remissions are hardly encountered in these cases; therefore, it is important to combine standard therapies with molecular targeting.

Case presentation

A 60-year-old woman presented with pain in abdomen and loss of appetite for 1 month, and imaging showed locally advanced gallbladder carcinoma with liver metastasis. After biopsy confirmation, patient was initially started on gemcitabine and oxaliplatin combination followed by gene sequencing, which showed Tp53 (exon 7—c.713 G > A and exon 5—c.376-2A > G) and EGFR (exon 20—T790M) mutation, and erlotinib was added to chemotherapy, after 6 cycles of chemotherapy patient showed a 90% partial radiological response as per RECIST criteria.

Conclusion

This case reports the possible efficacy of erlotinib in combination with gemcitabine and oxaliplatin in treating an EGFR-mutated GBC with liver metastasis. To our knowledge, this is the first article reporting the response to erlotinib combination therapy with this particular solitary mutation.
Lipocalin 2 induces neuroinflammation and blood-brain barrier dysfunction through liver-brain axis in murine model of nonalcoholic steatohepatitis
Authors: Mondal Ayan , Bose Dipro , Saha Punnag , Sarkar Sutapa , Seth Ratanesh , Kimono Diana , Albadrani Muayad , Nagarkatti Mitzi , Nagarkatti Prakash , Chatterjee Saurabh
Published: July 2020

Background

Recent clinical and basic research implicated a strong correlation between NAFLD/NASH phenotypes with ectopic manifestations including neuroinflammation and neurodegeneration, but the mediators and critical pathways involved are not well understood. Lipocalin 2 (Lcn2) is one of the important mediators exclusively produced in the liver and circulation during NASH pathology.

Methods

Using murine model of NASH, we studied the role of Lcn2 as a potent mediator of neuroinflammation and neurodegeneration in NASH pathology via the liver-brain axis.

Results

Results showed that high circulatory Lcn2 activated 24p3R (Lipocalin2 receptor) in the brain and induced the release of high mobility group box 1 (HMGB1) preferably from brain cells. Released HMGB1 acted as a preferential ligand to toll-like receptor 4 (TLR4) and induced oxidative stress by activation of NOX-2 signaling involving activated p65 protein of the NF-κB complex. Further, the HMGB1-derived downstream signaling cascade activated NLRP3 inflammasome and release of proinflammatory cytokines IL-6 and IL-1β from brain cells. In addition, to advance our present understanding, in vitro studies were performed in primary brain endothelial cells where results showed high circulatory Lcn2 influenced HMGB1 secretion. Mechanistically, we also showed that elevated Lcn2 level in underlying NASH might be a likely cause for induction of blood-brain barrier dysfunction since the adipokine decreased the expression of tight junction protein Claudin 5 and caused subsequent elevation of pro-inflammatory cytokines IL-6 and IL-1β.

Conclusion

In conclusion, the NASH-induced brain pathology might be because of increased Lcn2-induced release of HMGB1 and accompanying neuroinflammation.
Accuracy and efficiency of an artificial intelligence tool when counting breast mitoses
Authors: Pantanowitz Liron , Hartman Douglas , Qi Yan , Cho Eun Yoon , Suh Beomseok , Paeng Kyunghyun , Dhir Rajiv , Michelow Pamela , Hazelhurst Scott , Song Sang Yong , Cho Soo Youn
Published: July 2020

Background

The mitotic count in breast carcinoma is an important prognostic marker. Unfortunately substantial inter- and intra-laboratory variation exists when pathologists manually count mitotic figures. Artificial intelligence (AI) coupled with whole slide imaging offers a potential solution to this problem. The aim of this study was to accordingly critique an AI tool developed to quantify mitotic figures in whole slide images of invasive breast ductal carcinoma.

Methods

A representative H&E slide from 320 breast invasive ductal carcinoma cases was scanned at 40x magnification. Ten expert pathologists from two academic medical centers labeled mitotic figures in whole slide images to train and validate an AI algorithm to detect and count mitoses. Thereafter, 24 readers of varying expertise were asked to count mitotic figures with and without AI support in 140 high-power fields derived from a separate dataset. Their accuracy and efficiency of performing these tasks were calculated and statistical comparisons performed.

Results

For each experience level the accuracy, precision and sensitivity of counting mitoses by users improved with AI support. There were 21 readers (87.5%) that identified more mitoses using AI support and 13 reviewers (54.2%) that decreased the quantity of falsely flagged mitoses with AI. More time was spent on this task for most participants when not provided with AI support. AI assistance resulted in an overall time savings of 27.8%.

Conclusions

This study demonstrates that pathology end-users were more accurate and efficient at quantifying mitotic figures in digital images of invasive breast carcinoma with the aid of AI. Higher inter-pathologist agreement with AI assistance suggests that such algorithms can also help standardize practice. Not surprisingly, there is much enthusiasm in pathology regarding the prospect of using AI in routine practice to perform mundane tasks such as counting mitoses.
Teprotumumab: a disease modifying treatment for graves’ orbitopathy
Authors: Ting Michelle , Ezra Daniel G.
Published: July 2020

Background

On 21st January 2020, the FDA approved Tepezza (teprotumumab-trbw) for the treatment of active Graves’ orbitopathy (GO) in adults. This approval was based on positive results from two multinational randomised double-blind placebo-controlled clinical trials.

Discussion

This article discusses the outcomes of those trials and the potential role of teprotumumab in altering current treatment paradigms in Graves’ orbitopathy. Future challenges are explored, including the need to confirm its disease-modifying effect, to establish its optimal position in the treatment pathway, and to define the appropriate subset of patients who would benefit from its use.

Conclusions

The results from these two large clinical trials have shown teprotumumab to have remarkable effects on multiple clinical outcomes in GO, particularly in its ability to reverse proptosis. It may herald a new era in the treatment of thyroid eye disease and could offer an alternative to surgery and its associated complications. Additional studies will continue to shape the treatment of GO and define the role of teprotumumab within the treatment paradigm.