bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal design in bionic wear-resistant structures by multiscale DEM simulation
Authors: Zhang Rui , Zhao Liangliang , Pang Hao , Chen Guangming , Zhang Hua , Hu Zhenyu , Wen Lige
Published: September 2023

To address the problems of long optimization times of bionic wear-resistant structures in discrete element simulation. We established two-dimensional homoscale discrete element simulation models for four biomimetic structures, along with their respective abrasive wear computational models. We then deliberated upon their wear behavior in relation to the structural morphology, contact constraints, contact force, and wear volume during the wear process. The study found that the shedding of brittle wear body surface abrasives had little effect on the substrate of the bionic structure. Based on the above findings, a multi-scale/cross-level study of the interaction between biological wear surface structure and abrasive was conducted. The findings evince that utilization of a multi-scale computational model ensures the precise examination of the mechanical response of a material to external forces, while also economizing computational time. Finally, the design of the conical bionic structure is optimized based on the multi-scale/cross-level computational model. The results show that the conical bionic structure has good wear resistance when the abrasive grain size is small and when the monomer spacing is not larger than the monomer width. The bionic structure/abrasive interaction multi-scale numerical simulation system established in this paper reduces the complexity of dynamic numerical simulation of wear behavior on the surface of wear- resistant organisms, improves the calculation efficiency, and provides an important research means and method for optimizing the design of bionic wear-resistant parts.
A compact hydro-mechanical transmission solution to wheel loader propulsion system and its control strategy
Authors: Wang Feng , Lin Zhenchuan , Zhang Haoxiang , Zhang Chen , Xu Bing
Published: September 2023

Given the need for high efficiency to wheel loader powertrain, hydro-mechanical transmission is a promising solution to wheel loader propulsion system since it enables efficient engine operations owing to its continuously variable transmission function. The current hydro-mechanical transmission consists of planetary gear set and two hydrostatic units, making it bulky and complex in controls. This study proposes a simple and compact hydro-mechanical transmission solution to wheel loader powertrain. It improves vehicle acceleration performance by providing hydraulic torque assistance at low vehicle speed. The steady-state characteristics of the proposed hydro-mechanical transmission are analyzed, and the mathematical models of proposed wheel loader powertrain are constructed. An optimization strategy is developed as a reference for the design of an engine-speed based control strategy. The simulation results of the key components of proposed powertrain are analyzed. Furthermore, the engine-speed based control strategy is evaluated by the optimization strategy in different forms of the loading cycles. The results demonstrate the effectiveness of proposed wheel loader powertrain and its control strategy.
Optimal design of rotor structure for vibration and noise reduction in electric vehicle generator
Authors: Guo Dong , Shi Qingqiao , Wang Yawen , Zhang Xiaoting , Shen Qiping
Published: September 2023

In order to reduce the vibration noise of an extended-range electric vehicle (EREV) generator, an optimization method based on changing the rotor structure is proposed in this paper. Firstly, the specific optimization scheme is determined by theoretical and simulation analysis to perform skew pole segmentation of the rotor, while using an eccentric pole arc design to determine the optimal parameters with the target of cogging torque. Then, in order to verify the feasibility of the scheme, the main performance of the generator before and after the optimization is analyzed, including radial electromagnetic force wave, counter-electromotive force (counter EMF), electromagnetic torque, and rotor strength. Finally, a high-precision finite element model of the generator was established, the vibration acceleration, as well as the sound pressure level before and after optimization, were calculated, and a noise test was completed. The results show that the optimized scheme significantly weakened the cogging torque of the generator, while reducing the radial electromagnetic force wave and counter EMF distortion rate to a certain extent, and finally significantly improved the vibration and noise performance of the generator.
Issue Responsiveness in Canadian Politics: Are Parties Responsive to the Public Salience of Climate Change in the Question Period?
Authors: Alvarez R. Michael , Morrier Jacob
Published: September 2023

This paper explores how politicians respond to the public salience of policy issues when determining which topics to publicly address. Using new data and state-of-the-art methodology, our study provides a fresh perspective on this fundamental question. We focus on a multi-party parliamentary system, specifically the Canadian House of Commons, with a specific emphasis on the issue of climate change. To assess the attention given by political parties to various policy issues, we analyze transcripts from the Question Period spanning from April 2006 to June 2021. To gauge the public’s level of concern for these issues, we incorporate data obtained from Google Trends. Employing an instrumental variable estimation strategy, our study causally estimates the extent to which the public salience of climate change influences elite attention. Our findings reveal that the public salience of climate change significantly influences the attention given to this issue by parties, albeit with noticeable partisan variations. Moreover, our research highlights the effectiveness of the Question Period in compelling the government to address challenging or potentially embarrassing issues. Lastly, we uncover evidence suggesting that the Liberal Party of Canada successfully increased the public salience of climate change during its tenure in government.
Tourists’ Value Co-Creation With Service Robots: Antecedents and Mechanisms
Authors: Lin Vera Shanshan , Zhang Xinyi , Ren Yuting , Huang Wei-Jue , Xiao Honggen
Published: September 2023

Recent research on the use of robotics in hospitality and tourism has called attention to tourists’ post-adoption behavior, including value co-creation. Guided by the stimulus–organism–response (SOR) framework, a mixed-method study was conducted to explore the antecedents and mechanisms of tourists’ value co-creation behavior with robots. Qualitative interviews revealed robots’ anthropomorphism and economic rewards as tourists’ key concerns regarding robot-provided services. Subsequently, partial least squares structural equation modeling was employed to investigate how robot service attributes influenced tourist–robot co-creation, including participation and citizenship behaviors, and enhancing tourists’ experiences at tourist attractions. Findings indicated that three types of perceived experiential value fully mediated the relationships between robots’ degree of anthropomorphism and tourists’ value co-creation behavior, as well as between economic rewards and participation behavior. However, the relationship between economic rewards and citizenship behavior was partially mediated. Theoretical and practical implications are discussed.
Breathe easy: inhalational therapy for feline inflammatory airway disease
Authors: Barchilon Michael , Reinero Carol R
Published: September 2023

Practical relevance:

Feline inflammatory airway diseases, including (but not limited to) asthma, chronic bronchitis and bronchiectasis, are common and incurable disorders. These diseases require lifelong therapy and may result in substantial morbidity and, in some cases, mortality. Goals of therapy include reduction or resolution of clinical signs and the underlying pathologic processes driving those clinical signs. Inhalational therapy has the advantage of topical delivery of drugs to target tissues at higher doses with fewer systemic effects than oral medications. There are multiple options for delivery devices, and proper selection and training on the use of these devices - including acclimation of the cat to the device - can maximize therapeutic efficacy.

Aim:

As inhalational therapy is uncommonly used by many veterinarians and owners, this review article provides a foundation on the selection and use of devices and inhalant medications for specific feline inflammatory airway diseases. Cats present a unique challenge with respect to the use of inhalers, and easy-to-follow steps on acclimating them to the devices are provided. The review also discusses the mechanics of inhalational therapy and helps clarify why certain medications, such as albuterol (salbutamol), fluticasone or budesonide, are chosen for certain diseases. The ultimate aim is that the practitioner should feel more comfortable managing common airway diseases in cats.

Evidence base:

In compiling their review, the authors searched the veterinary literature for articles in English that discuss inhalational therapy in cats, and which focus primarily on inhaled glucocorticoids and bronchodilators. While most literature on inhalational therapy in cats is based on experimental feline asthma models, there are some studies demonstrating successful treatment in cats with naturally occurring inflammatory airway disease.
‘Terebi banare’: Historicising internet-distributed television and the ‘departure from television’ in Japan
Authors: Tse Yu-Kei
Published: September 2023

This article historicises and examines the implications of internet-distributed television for televisual culture and viewing in Japan. It challenges the simplistic media discourse of ‘ terebi banare’ (i.e. the audiences’ departure from television), which overlooks the complexities of evolving viewing practices. It explains why, largely due to the dominance of major terrestrial broadcasters in the media ecosystem, online consumption of television was slower to take hold in Japan than in other developed countries. It also demonstrates how, while Netflix and Amazon Prime Video have popularised pay online viewing from the late 2010s, the content Japanese viewers consume online remains inclined towards local outputs from terrestrial broadcasters. By elaborating on how terrestrial broadcasters have continued to play an important role in shaping audience experiences with their evolving content, frames, and services, this article provides a critical account of the meaning of terebi banare in the age of streaming.
The Untested Assumption: Can a Net Promoter Study Be Used to Improve Net Promoter Score?
Authors: Bettencourt Lance A , Houston Mark B
Published: September 2023

Despite scholarly critiques, use of the Net Promoter Score (NPS®) continues to grow in popularity among firms. Even researchers who criticize NPS recognize its potential for predicting desirable customer behaviors and revenue growth. However, a firm’s goal in measuring NPS is not to simply assess it, but to be empowered to improve that score. This goal begs an important question: Does a “net promoter” study provide the insights that a firm needs to improve their NPS? The critical, but untested, assumption in NPS use is that the insights gained from open-ended customer comments in a net promoter study can be used to set improvement priorities that will increase future NPS likely-to-recommend ratings. Through two distinct studies, one in a business-to-business context with auto dealership decision-makers and one in a business-to-consumer context with vehicle repair customers, we investigate this assumption. Our results reveal that the critical untested assumption of a net promoter study is questionable. The convergence is low to moderate between open-ended priorities from a net promoter study and predictors of the standard ‘likely-to-recommend’ NPS question. We also find that the convergence between customers’ open-ended priorities and their stated and derived priorities from closed-ended responses is higher for NPS detractors and passives than promoters, but it is still only moderate. The strength of this convergence of priorities is also impacted by the wording of the questions used to elicit customers’ open-ended priorities. Firms using open-ended comments to set priorities should ask customers, especially detractors, to identify areas for improvement. In addition, they should supplement open-ended customer feedback with closed-ended questions to get customers’ performance ratings in relation to their specific needs.
Fatigue damage analysis of a Kaplan turbine model operating at off-design and transient conditions
Authors: Roig Rafel , Sánchez-Botello Xavier , de la Torre Oscar , Ayneto Xavier , Högström Carl-Maikel , Mulu Berhanu , Escaler Xavier
Published: September 2023

The current renewable energy market forces hydraulic turbines to operate for longer periods of time at off-design and transient conditions. Their life expectancy is then decreased due to the wear provoked by flow instabilities and stochastic flow excitations. This study presents an experimental investigation into the fatigue damage induced on the runner blades of a Kaplan turbine model when working at speed-no-load (SNL), part load (PL) and during ramps of load. The unit was equipped with on-board sensors on the blades and the shaft as well as with off-board sensors installed on the supporting structure and the draft tube cone. The results reveal that operation at SNL induces more fatigue damage on the runner blades than at PL. The damage is then mainly induced by stochastic flow excitations at SNL and by the rotating mode of the rotating vortex rope (RVR) at PL. The ramps of load, when crossing each operating condition, cause levels of damage similar to those found in stationary operation. Finally, it was proved that the blade fatigue damage can be estimated from on-board shaft measurements at any condition. However, the blade fatigue damage can only be estimated using off-board measurements when the RVR is fully developed at PL.
Time-frequency analysis-based impulse feature extraction method for quantitative evaluation of milling tool wear
Authors: Guo MingAng , Tu Xiaotong , Abbas Saqlain , Zhuo Shuangmu , Li Xiaolu
Published: September 2023

Mechanical system condition monitoring is an important procedure in modern industry, which not only reduces maintenance costs but also ensures safe equipment operation. At present, the monitoring method based on signal processing is one of the most common and effective fault diagnosis methods. In this work, the time-frequency distribution (TFD) obtained by generalized horizontal synchrosqueezing transform is used to extract the impulse feature of the non-stationary vibration signal of the tool. By using the TFD result, the two-dimensional (2D) Fourier transform can further detect the periodic pulses. Next, the energy proportion factor of periodic frequency point is proposed to evaluate the different tool wear degrees. Numerical simulations and experimental data analysis demonstrate the effectiveness of the proposed method as well as the potential for condition monitoring.
The factor structures of the Classroom Assessment Scoring System Pre-K and mature play observation tool in multi-ethnic Norwegian early childhood centers
Authors: Karlsen Lisa , Rydland Veslemøy , Solheim Buøen Elisabet , Vandell Deborah Lowe , Lekhal Ratib
Published: September 2023

The use of standardized assessment tools for the evaluation of quality in early childhood education and care (ECEC) is on the rise, yet a greater understanding of the applicability of these tools across contexts is still needed. This study investigates the factor structure of two assessment tools, the Classroom Assessment Scoring System Pre-K (CLASS) and Mature Play Observation Tool (MPOT) in a free-play focused context serving high numbers of children with diverse language backgrounds in Norway. The study also evaluates the extent to which these tools complement each other to create a more comprehensive understanding of children’s experiences in ECEC in this context. Using confirmatory factor analyses, our results from a sample of 125 multi-ethnic ECEC groups in Norway show a good fit for the two-factor (i.e., adult- and child-focused) model proposed by the authors of MPOT. In line with previous research, the three-factor (i.e., emotional support, classroom organization, and support for learning) model of CLASS required post hoc modifications, resulting in a marginally acceptable model fit. Overall, our findings provide evidence that the original factor structures of these tools can be modeled in urban ECEC centers in Norway, and using these tools provides different insights into children’s ECEC experiences.
Centering disability visibility in reproductive health care: Dismantling barriers to achieve reproductive equity
Authors: Fletcher Jordan , Yee Halina , Ong Bonnie , Roden Rosemary Claire
Published: September 2023

Access to comprehensive and culturally competent reproductive health care is essential for individuals and communities to realize and achieve health and well-being, as one prefers. The disability community represents a diverse group of individuals with a wide spectrum of functional, physical, sensory, and/or neurodivergent abilities. Existing barriers to reproductive health care are a consequence of environmental and attitudinal barriers, not from the disabilities themselves. People with disabilities are also not frequently centered or included in discussions surrounding reproductive rights. This article reviews the intersection of the Disability Justice Movement and the history of discrimination in the United States against people with disabilities with a particular focus on reproductive oppression. We discuss the mechanisms of inequity and barriers to health care, including financial barriers, inaccessible medical facilities, provider discrimination and competency, and guardianship; as well as the importance of open access to contraception, menstrual health, and abortion for people with disabilities. Finally, we explore the intersection of the Disability Justice Movement and the Reproductive Justice Movement to better promote reproductive autonomy.
Systematic review: Pharmacological interventions for the treatment of post-stroke fatigue
Authors: Chu Shuk Han , Zhao Xu , Komber Ahmad , Cheyne Joshua , Wu Simiao , Cowey Eileen , Kutlubaev Mansur , Mead Gillian
Published: September 2023

Background:

Post-stroke fatigue (PSF) affects around 50% of stroke survivors. Previous systematic reviews of randomized controlled trials found insufficient evidence to guide practice, but most excluded Chinese studies. Furthermore, their searches are now out-of-date.

Aims:

To systematically review and perform a meta-analysis of randomized placebo-controlled trials of pharmacological interventions for treating PSF.

Methods:

We screened Airitri, CNKI, VIP, CINAHL, ClinicalTrials.gov, CENTRAL, Cochrane Stroke Group Trial Register, EMBASE, EU Clinical Trial Register, ISRCTN, MEDLINE, PsycINFO, Wanfang, and WHO ICTRP up to 11 November 2022. Our primary outcome was fatigue severity. We conducted subgroup analysis by drug type and sensitivity analysis after excluding the trials at high risk of bias. Secondary outcomes included mood and quality of life.

Results:

We screened 33,297 citations and identified 10 published completed trials, 6 unpublished completed trials, and 6 ongoing trials. Pharmacological treatments were associated with lower fatigue severity at the end of treatment (10 published completed trials, 600 participants, pooled standardized mean difference (SMD) = −0.80, 95% confidence interval (CI): −1.29 to −0.31; I2 = 86%, p < 0.00001), but not at follow-up (265 participants, pooled SMD = −0.14, 95% CI: −0.38 to 0.10; I2 = 0, p = 0.51). However, these trials were small and had considerable risk of bias. Beneficial effects were seen in trials with low risk of bias on randomization, missing outcome data, and reporting bias. There were insufficient data on secondary outcomes for meta-analysis, but six trials reported improved quality of life.

Conclusion:

There is insufficient evidence to support a particular pharmacological treatment for PSF, thus current clinical guidelines do not require amendment.
An unusual case of placental chorangioma and intrauterine death: Implications for proper antenatal care and prompt diagnosis
Authors: Devarakonda Kranti Kiran , Kuchana Sai Kiran , Chinthakindi Sai Thrinath , Suvvari Tarun Kumar , Thomas Vimal
Published: September 2023

We present an unusual case of placental chorangioma in a 32-year-old female with poor antenatal care. Abdominopelvic ultrasound revealed polyhydramnios with no fetal cardiac activity and suspected placental cyst. An emergency caesarean was performed, and she had still birth of male baby. The cut specimen of the placenta revealed a well-circumscribed marginal mass of 4 cm. Our case emphasizes the importance of regular antenatal screening for early detection of placental abnormalities. While chorangiomas are rare, they should be considered in the differential diagnosis of placental masses. Prompt diagnosis and appropriate management are essential to reduce the maternal and fetal complications associated with chorangiomas. Histological examination of the placenta plays a vital role in differentiating chorangioma from other placental abnormalities with different clinical implications.
Assessing Tax Compliance Behavior Among Romanian Taxpayers: An Empirical Case Study
Authors: Trifan Vanina Adoriana , Szentesi Silviu Gabriel , Cuc Lavinia Denisia , Pantea Mioara Florina
Published: September 2023

This study explores how different factors affect tax compliance behavior among Romanian individual taxpayers. By unpacking tax compliance into nine drivers—tax system fairness, trust in government and tax authorities, efficiency, and transparency of government spending, knowledge of tax legislation, tax legislation simplicity, personal financial constraints, personal ethics, and moral standards, the social environment, and coercive measures—this study develops clear-cut paths of the drivers of tax compliance from the perspective of a developing country. The proposed research hypotheses were tested with a sample of 402 individual taxpayers and quantitative data analysis was carried out using partial least squares-structural equation modeling. The results showed that seven drivers (tax system fairness, trust in government and tax authorities, knowledge of tax legislation, personal financial constraints, coercive measures, moral standards, and tax legislation simplicity) were significant factors that increase the likelihood of tax compliance among individual taxpayers. Our findings are expected to provide tax authorities and governments new insights on tax compliance behavior that enable them to develop fiscal methods, strategies, policies, and legal measures tailored to local context, and constraints.
Educational Innovation Boosting Students’ Entrepreneurial Intentions
Authors: Pérez-Macías Noemí , Gismera Tierno Laura , De Nicolas Vitor L.
Published: September 2023

The interest in entrepreneurship is growing, due to its relationship with competitiveness, growth, employment, and innovation. In fact, there are numerous studies trying to identify factors influencing entrepreneurial intentions among university students, especially among young people, and in those countries with declining growth rates. Using the Entrepreneurial Event Model, we try to understand the role played by the perceived opportunity in explanatory models of EI development. To this end, we analyze the moderating effect of educational active learning methods on the link between perceived opportunity and entrepreneurial intentions. Partial Least Square-Structural Equation Modeling was used, with a sample of 333 first-year Spanish higher education students. Findings suggest that visual thinking, flipped classroom, visitor’s and teacher’s role model, brainstorming, cooperative case studies, learning by problems, debate, and improving communication skills moderate the relationship between the perceived opportunity, and thus on the entrepreneurial intentions. The results contribute to universities and practitioners as well as to the growth of entrepreneurship.
Association of Psychological Readiness to Return to Sports With Subjective Level of Return at 12 Months After ACL Reconstruction
Authors: Suzuki Makoto , Ishida Tomoya , Matsumoto Hisashi , Kaneko Satoru , Inoue Chiharu , Aoki Yoshimitsu , Tohyama Harukazu , Samukawa Mina
Published: September 2023

Background:

Return-to-sports (RTS) rates after anterior cruciate ligament (ACL) reconstruction (ACLR) differ according to the level at which patients return. It is unclear whether the level of RTS is affected by psychological readiness to return.

Purpose:

To examine the association between psychological readiness to RTS and subjective RTS level 12 months after ACLR.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

A total of 47 patients who underwent unilateral primary ACLR surgery were enrolled. Assessments at 6 and 12 months postoperatively consisted of knee strength testing (isokinetic quadriceps and hamstring strength), the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC-SKF), and the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale to measure psychological readiness to RTS. Patients were assigned to 1 of 3 subgroups based on their subjective assessment of RTS level at 12 months postoperatively: RTS at or above preinjury level (RTS≥Pre; n = 19), RTS below preinjury level (RTS<Pre; n = 24), or no RTS (n = 4). Two-way mixed-model analysis of variance was used to examine the effects of RTS subgroup, postoperative time point, and group × time interaction with patient characteristics, knee strength, and IKDC-SKF and ACL-RSI scores. Multivariate logistic regression analysis was performed to determine which factors were associated with RTS subgroupings.

Results:

Significant differences were found among the RTS≥Pre, RTS<Pre, and no-RTS groups in age, ACL-RSI score at 6 and 12 months, quadriceps strength at 6 and 12 months, and IKDC-SKF score at 6 and 12 months ( P < .001 for all). Multivariate logistic regression analysis revealed that RTS at or above preinjury level was associated with higher ACL-RSI score at 12 months postoperatively (odds ratio [OR], 1.11; 95% CI, 1.05-1.20; P = .003) and younger age (OR, 0.80; 95% CI, 0.61-0.92; P = .012).

Conclusion:

The ACL-RSI score was significantly different among the study groups, and the ACL-RSI score at 12 months postoperatively and younger age were associated with RTS at or above preinjury level.
Understanding street-level urban vibrancy via spatial-temporal Wi-Fi data analytics: Case LivingLine Shanghai
Authors: Zhang Yan , Li Chengliang , Li Jiajie , Gao Zhiyuan , Su Tianyu , Wang Can , Zhang Hexin , Ma Teng , Liu Yang , Xiong Weiting , Doorley Ronan , Alonso Luis , Lou Yongqi , Larson Kent
Published: September 2023

Urban vibrancy is a topic of great concern in the field of urban design and planning. However, the definition and measurement of urban vibrancy have not been consistently and clearly followed. With the development of technologies such as big data and machine learning, urban planners have adopted new methods that enable better quantitative evaluation of urban performance. This research attempts to quantify the impact on the urban vibrancy of the urban interventions introduced by the LivingLine project in a residential neighborhood renovation made in Siping Street, Shanghai. We use Wi-Fi probes to process collected mobile phone data and segment people into different categories according to commuting patterns analysis. We use a pre-trained random forest model to determine the specific locations of each person. Subsequently, we analyze the behavior patterns of people from stay points detection and trajectory analysis. Through statistical models, we apply multi-linear regression and find that urban intervention (well-curated and defined lab events deployed in the street) and people’s behavior are positively correlated, which helps us to prove the impact of urban intervention on street dynamics. The research proposes a novel, evidence-based, low-cost methodology for studying granular behavior patterns on a street level without compromising users’ data privacy.
Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India
Authors: Prajitha Kannamkottapilly Chandrasekharan , Subbaraman Mohan Raja , Siddharth Raman Selva Raja , Sharahudeen Anisha , Chandran Dhanusha , Sawyer Joseph , Kumar Suresh , Anish Thekkumkara Surendran
Published: September 2023

Background:

The existing palliative care services in India are concentrated in urban areas, attached to tertiary care hospitals. This poses issues relating to access and equity for people in rural locations and with low socioeconomic status. A Community-Based Palliative Care (CBPC) service named Sanjeevan has been initiated in Puducherry, a union territory of India to provide physical, social, psychological, and emotional support to incurably ill people, including older adults living in rural areas.

Objectives:

To understand the social mechanisms that underpin the implementation of CBPC in rural parts of India and the challenges to its sustainability.

Design:

Qualitative research using focus group discussions (FGDs) and key informant interviews (KIIs).

Methods:

Community-based participatory research (CBPR) approach was used in this study, and descriptive analysis was done. Through CBPR it was possible to document and interpret local knowledge on the community concerns and assets along with the experiences of the community members. Purposive sampling was used to identify vocal participants involved in patient care and areas of the Sanjeevan program such as financial management, administration, and community mobilization. Seven KIIs and four FGDs were conducted, with 7–8 participants in each.

Results:

The analysis indicated the need for a CBPC and the factors enabling its establishment. The findings revealed capacity building, resources for palliative care services, and the existing social structure of the community being the main challenges that need to be overcome for better penetration of CBPC services into society. Demand generation through sensitization and administration of services based on the need and regular follow-up remains the key strategies for the sustainability of the program.

Conclusion:

The CBPC program like ‘Sanjeevan’ adopted in the rural area of Puducherry can be cited as an example and can be replicated in other rural settings with similar sociocultural characteristics to support people living with end-stage diseases.
Finding space in the modes of production debate: The value of Latin America
Authors: Hesketh Chris
Published: September 2023

This article is inspired by several recent scholarly developments. First, there has been renewed interest in debates surrounding the concept ‘mode of production’. Second, there has been a passionate debate about how we understand core–periphery relations in relation to the broader question of capitalist development. Finally, it has been argued that, beyond opposition to neoliberal development, there has also been a revival of Marxist theoretical perspectives and praxis in Latin America. However, despite some diverse work engaging with debates that use the concept ‘mode of production’ in the Latin American context, there has been no systematic attempt to look at major Latin America Marxist thinkers and their contribution to this debate. This article seeks to correct for this by looking at the key work of René Zavaleta and José Carlos Mariátegui as two of the continent’s most original Marxist thinkers. By doing so, I offer three distinct contributions. First I remove the mode of production debate from its relatively narrow, Eurocentric preoccupations, and second, I displace the largely temporal concerns of the debate (when was capitalism?) to give it a more spatial rendering (where is capitalism?). This opens the possibilities of thinking about co-existing differential spaces within a social formation. Finally, this method of analysis is therefore able to give a realistic assessment of the social forces involved in contemporary struggles by specifying what social antagonisms exist and where alliances can be constructed. I conclude that an analysis grounded in modes of production is thus attentive to specificity, and this provides a basis for thinking about transformative possibilities in and beyond Latin America.
KNOWS strategy in action: Solving word problems involving ratios
Authors: Emran Afiqah Bari’ah , Shahrill Masitah , Asamoah Daniel
Published: September 2023

This study concerns an intervention incorporating the KNOWS strategy (K—Know, N—Need to know, O—Organize, W—Work, and S—Solution), a mnemonic problem-solving tool to improve students’ performance in ratio word problems. Quantitative data through pre- and post-tests were collected from 42 Year 9 students in one of the secondary schools in Brunei Darussalam. Results from a paired-sampled t-test show that the students scored higher in the post-test compared to the pre-test, confirming the effectiveness of the KNOWS intervention in improving students’ performance in ratio word problems. Despite the improvement in students’ performance, this study highlights some misconceptions and common mistakes of students when solving ratio word problems before and after the KNOWS intervention. It also suggests alternative ways of using the KNOWS strategy as an instructional option to improve students’ performance in ratio word problems.
From pre-COPD to COPD: a Simple, Low cost and easy to IMplement (SLIM) risk calculator
Authors: Divo Miguel J. , Liu Congjian , Polverino Francesca , Castaldi Peter J. , Celli Bartolome R. , Tesfaigzi Yohannes
Published: September 2023

Background

The lifetime risk of developing clinical COPD among smokers ranges from 13% to 22%. Identifying at-risk individuals who will develop overt disease in a reasonable timeframe may allow for early intervention. We hypothesised that readily available clinical and physiological variables could help identify ever-smokers at higher risk of developing chronic airflow limitation (CAL).

Methods

Among 2273 Lovelace Smokers’ Cohort (LSC) participants, we included 677 (mean age 54 years) with normal spirometry at baseline and a minimum of three spirometries, each 1 year apart. Repeated spirometric measurements were used to determine incident CAL. Using logistic regression, demographics, anthropometrics, smoking history, modified Medical Research Council dyspnoea scale, St George's Respiratory Questionnaire, comorbidities and spirometry, we related variables obtained at baseline to incident CAL as defined by the Global Initiative for Chronic Obstructive Lung Disease and lower limit of normal criteria. The predictive model derived from the LSC was validated in subjects from the COPDGene study.

Results

Over 6.3 years, the incidence of CAL was 26 cases per 1000 person-years. The strongest independent predictors were forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <0.75, having smoked ≥30 pack-years, body mass index (BMI) ≤25 kg·m2and symptoms of chronic bronchitis. Having all four predictors increased the risk of developing CAL over 6 years to 85% (area under the receiver operating characteristic curve (AUC ROC) 0.84, 95% CI 0.81–0.89). The prediction model showed similar results when applied to subjects in the COPDGene study with a follow-up period of 10 years (AUC ROC 0.77, 95% CI 0.72–0.81).

Conclusion

In middle-aged ever-smokers, a simple predictive model with FEV1/FVC, smoking history, BMI and chronic bronchitis helps identify subjects at high risk of developing CAL.
The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer
Authors: Zhang Yixiao , Yi Jiawen , Sun Dan , Su Yanping , Zuo Yingting , Zhu Min , Zhang Shu , Huang Kewu , Guo Xiaojuan , Zhang Yuhui
Published: September 2023

Background

Although computed tomography (CT)-defined emphysema is considered a predictor of lung cancer risk, it is not fully clear whether CT-defined emphysema is associated with the prognosis of lung cancer. We aimed to assess the clinical impact of CT-defined emphysema on the survival of lung cancer.

Methods

In the prospective cohort study of nonsmall cell lung cancer (NSCLC), the correlation between CT-defined emphysema and clinical variables was analysed. A multivariable Cox regression model was built to assess the association between CT-defined emphysema and overall survival (OS) for up to 8.8 years. The differences in survival analyses were derived by Kaplan–Meier analysis and log-rank testing. Low attenuation area (LAA%) was defined as the per cent of voxels below −950 HU.

Results

854 patients were included and CT-defined emphysema was present in 300 (35.1%) at diagnosis. Epidermal growth factor receptor (EGFR) wild-type (OR 1.998; p<0.001) and anaplastic lymphoma kinase (ALK) wild-type (OR 2.277; p=0.004) were associated with CT-defined emphysema. CT-defined emphysema remained a significant predictor of prognosis adjusting for age, sex, smoking history, tumour histology and Eastern Cooperative Oncology Group Performance Status (ECOG PS), whether in I-IIIA stage (adjusted hazard ratio (HR) 1.745; p=0.017) or in IIIB-IV stage (adjusted HR 1.291; p=0.022). Stratified analyses showed that OS rate among the driver oncogene groups with different CT-defined emphysema status differed significantly (log-rank p<0.001). Furthermore, patients with centrilobular emphysema (CLE) with LAA% >17% displayed poorer survival than those with LAA% ≤17% (median 432versus670 days; HR 1.564; p=0.020).

Conclusions

CT-defined emphysema, especially CLE with LAA%>17%, is an independent predictor of NSCLC prognosis. Moreover, prospective studies are needed to further explore this association.
A bronchial gene signature specific for severe COPD that is retained in the nose
Authors: van Nijnatten Jos , Faiz Alen , Timens Wim , Guryev Victor , Slebos Dirk-Jan , Klooster Karin , Hartman Jorine E. , Kole Tessa , Choy David F. , Chakrabarti Arindam , Grimbaldeston Michele , Rosenberger Carrie M. , Kerstjens Huib , Brandsma Corry-Anke , van den Berge Maarten
Published: September 2023

Introduction

A subset of COPD patients develops advanced disease with severe airflow obstruction, hyperinflation and extensive emphysema. We propose that the pathogenesis in these patients differs from mild–moderate COPD and is reflected by bronchial gene expression. The aim of the present study was to identify a unique bronchial epithelial gene signature for severe COPD patients.

Methods

We obtained RNA sequencing data from bronchial brushes from 123 ex-smokers with severe COPD, 23 with mild–moderate COPD and 23 non-COPD controls. We identified genes specific to severe COPD by comparing severe COPD to non-COPD controls, followed by removing genes that were also differentially expressed between mild–moderate COPD and non-COPD controls. Next, we performed a pathway analysis on these genes and evaluated whether this signature is retained in matched nasal brushings.

Results

We identified 219 genes uniquely differentially expressed in severe COPD. Interaction network analysis identifiedVEGFAandFN1as the key genes with the most interactions. Genes were involved in extracellular matrix regulation, collagen binding and the immune response. Of interest were 10 genes (VEGFA,DCN,SPARC,COL6A2,MGP,CYR61,ANXA6,LGALS1,C1QAandC1QB) directly connected to fibronectin 1 (FN1). Most of these genes were lower expressed in severe COPD and showed the same effect in nasal brushings.

Conclusions

We found a unique severe COPD bronchial gene signature with key roles forVEGFAandFN1, which was retained in the upper airways. This supports the hypothesis that severe COPD, at least partly, comprises a different pathology and supports the potential for biomarker development based on nasal brushes in COPD.
Effects of pharmacological and non-pharmacological interventions on physical activity outcomes in COPD: a systematic review and meta-analysis
Authors: Megaritis Dimitrios , Hume Emily , Chynkiamis Nikolaos , Buckley Christopher , Polhemus Ashley M. , Watz Henrik , Troosters Thierry , Vogiatzis Ioannis
Published: September 2023

Rationale

The effect of pharmacological and non-pharmacological interventions on physical activity (PA) outcomes is not fully elucidated in patients with COPD. The objectives of the present study were to provide estimation of treatment effects of all available interventions on PA outcomes in patients with COPD and to provide recommendations regarding the future role of PA outcomes in pharmacological trials.

Materials and methods

This review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with PRISMA. Records were identified through searches of 12 scientific databases; the most updated search was performed in January 2023.

Results

74 studies published from 2000 to 2021 were included, with a total of 8140 COPD patients. Forced expiratory volume in 1 s % predicted ranged between 31% and 74%, with a mean of 55%. Steps/day constituted the most frequently assessed PA outcome in interventional studies. Compared to usual care, PA behavioural modification interventions resulted in improvements in the mean (95% CI) steps/day when implemented alone (by 1035 (576–1493); p<0.00001) or alongside exercise training (by 679 (93–1266); p=0.02). Moreover, bronchodilator therapy yielded a favourable difference of 396 (125–668; p=0.004) steps/day, compared to placebo.

Conclusions

PA behavioural modification and pharmacological interventions lead to significant improvements in steps/day, compared to control and placebo groups, respectively. Compared to bronchodilator therapy, PA behavioural modification interventions were associated with a 2-fold greater improvement in steps/day. Large-scale pharmacological studies are needed to establish an intervention-specific minimal clinically important difference for PA outcomes as well as their convergent validity to accelerate qualification as potential biomarkers and efficacy end-points for regulatory approval.
Investigating the relationship between sleep and migraine in a global sample: a Bayesian cross-sectional approach
Authors: Stanyer Emily C. , Brookes Jack , Pang Jia Rong , Urani Alexandre , Holland Philip R. , Hoffmann Jan
Published: September 2023

Background

There is a bidirectional link between sleep and migraine, however causality is difficult to determine. This study aimed to investigate this relationship using data collected from a smartphone application.

Methods

Self-reported data from 11,166 global users (aged 18–81 years, mean: 41.21, standard deviation: 11.49) were collected from the Migraine Buddy application (Healint Pte. Ltd.). Measures included: start and end times of sleep and migraine attacks, and pain intensity. Bayesian regression models were used to predict occurrence of a migraine attack the next day based on users’ deviations from average sleep, number of sleep interruptions, and hours slept the night before in those reporting ≥ 8 and < 25 migraine attacks on average per month. Conversely, we modelled whether attack occurrence and pain intensity predicted hours slept that night.

Results

There were 724 users (129 males, 412 females, 183 unknown, mean age = 41.88 years, SD = 11.63), with a mean monthly attack frequency of 9.94. More sleep interruptions (95% Highest Density Interval (95%HDI [0.11 – 0.21]) and deviation from a user’s mean sleep (95%HDI [0.04 – 0.08]) were significant predictors of a next day attack. Total hours slept was not a significant predictor (95%HDI [-0.04 – 0.04]). Pain intensity, but not attack occurrence was a positive predictor of hours slept.

Conclusions

Sleep fragmentation and deviation from typical sleep are the main drivers of the relationship between sleep and migraine. Having a migraine attack does not predict sleep duration, yet the pain associated with it does. This study highlights sleep as crucial in migraine management.
Recurrent superior orbital fissure syndrome associated with VEXAS syndrome
Authors: Myint Katie , Patrao Namritha , Vonica Oana , Vahdani Kaveh
Published: September 2023

Purpose

To describe a case of recurrent orbital inflammation and superior orbital fissure syndrome associated with VEXAS (vacuoles, E1 enzyme, X-linked, auto-inflammatory, somatic) syndrome.

Case presentation

VEXAS syndrome is a recently identified multi-system inflammatory disease of late adult onset. The authors describe the case of a 76-year-old man who presented with recurrent episodes of orbital inflammation, with superior orbital fissure syndrome, dacryoadenitis and orbital myositis. He had a constellation of systemic disorders including recurrent chest infections, congestive cardiac failure, pulmonary emboli and skin rashes. The underlying diagnosis of VEXAS syndrome was confirmed by genetic testing, which revealed the UBA1 mutation.

Conclusion

VEXAS syndrome should be considered in the differential diagnosis of orbital inflammatory disease associated with multi-system inflammatory disorders.
Giant thoracic hematoma post-transradial coronary angiography: a case report and review of the literature
Authors: Wang Ke , Wen Li , Xie Li , Zhao Maoyu , Liu Xi , Luo Xiaolin , Jin Jun , Qin Zhexue
Published: September 2023

Background

Although there are cardiac interventional procedures, certain transradial access complications might be life-threatening.

Case presentation

A 67-year-old male was admitted for coronary angiography due to chest tightness and shortness of breath on exertion. Hours after the right transradial access angiography, the patients complained the right side of chest pain. Emergent chest X-ray revealed a giant mass in the right chest. The right radial artery was reaccessed and subsequent arteriograms confirmed that the presence of a rupture of the branch of right internal mammary artery. Simultaneously, a microcoil was implanted to seal the perforation. The perforation caused a thoracic hematoma measuring 13.8 cm × 6.7 cm, along with a decrease in hemoglobin concentration from 14.1 g/dL to a minimum of 7.8 g/dL. Additionally, the drainage of the hematoma and red blood cells transfusion were carried out. Further, the patient underwent ascending aortic replacement, aortic valve replacement, mitral valve replacement, and thoracic hematoma removal. Postoperative echocardiography showed that the prosthetic valves were properly positioned and functioning normally. The patient recovered well after the surgery and remained event-free during the latest 14moth follow-up period.

Conclusions

Vascular perforation and subsequent hematoma might occur due to guidewire maneuvering during transradial approach. Awareness of prevention, early recognition and management of access complications may help reduce the occurrence and severity of complications related to the transradial approach.