bluuebunny/crossref_metadata_2025 huggingface dataset:
Gait in Cerebral Amyloid Angiopathy
Authors: Sharma Breni , Gee Myrlene , Nelles Krista , Cox Emily , Irving Elisabeth , Saad Feryal , Yuan Jerald , McCreary Cheryl R. , Ismail Zahinoor , Camicioli Richard , Smith Eric E.
Published: September 2022

Background

Gait is a complex task requiring coordinated efforts of multiple brain networks. To date, there is little evidence on whether gait is altered in cerebral amyloid angiopathy (CAA). We aimed to identify impairments in gait performance and associations between gait impairment and neuroimaging markers of CAA, cognition, and falls.

Methods and Results

Gait was assessed using the Zeno Walkway during preferred pace and dual task walks, and grouped into gait domains (Rhythm, Pace, Postural Control, and Variability). Participants underwent neuropsychological testing and neuroimaging. Falls and fear of falling were assessed through self‐report questionnaires. Gait domain scores were standardized and analyzed using linear regression adjusting for age, sex, height, and other covariates. Participants were patients with CAA (n=29), Alzheimer disease with mild dementia (n=16), mild cognitive impairment (n=24), and normal elderly controls (n=47). CAA and Alzheimer disease had similarly impaired Rhythm, Pace, and Variability, and higher dual task cost than normal controls or mild cognitive impairment. Higher Pace score was associated with better global cognition, processing speed, and memory. Gait measures were not correlated with microbleed count or white matter hyperintensity volume. Number of falls was not associated with gait domain scores, but participants with low fear of falling had higher Pace (odds ratio [OR], 2.61 [95% CI, 1.59–4.29]) and lower Variability (OR, 1.64 [95% CI, 1.10–2.44]).

Conclusions

CAA is associated with slower walking, abnormal rhythm, and greater gait variability than in healthy controls. Future research is needed to identify the mechanisms underlying gait impairments in CAA, and whether they predict future falls.
Longitudinal Adherence to Diabetes Quality Indicators and Cardiac Disease: A Nationwide Population‐Based Historical Cohort Study of Patients With Pharmacologically Treated Diabetes
Authors: Abdel‐Rahman Nura , Calderon‐Margalit Ronit , Cohen Arnon , Elran Einat , Golan Cohen Avivit , Krieger Michal , Paltiel Ora , Valinsky Liora , Ben‐Yehuda Arie , Manor Orly
Published: September 2022

Background

Evidence of the cardiovascular benefits of adherence to quality indicators in diabetes care over a period of years is lacking.

Methods and Results

We conducted a population‐based, historical cohort study of 105 656 people aged 45 to 80 with pharmacologically treated diabetes and who were free of cardiac disease in 2010. Data were retrieved from electronic medical records of the 4 Israeli health maintenance organizations. The association between level of adherence to national quality indicators (2006–2010: adherence assessment) and incidence of cardiac outcome; ischemic heart disease or heart failure (2011–2016: outcome assessment) was estimated using Cox proportional hazards models. During 529 551 person‐years of follow‐up, 19 246 patients experienced cardiac disease. An inverse dose–response association between the level of adherence and risk of cardiac morbidity was shown for most of the quality indicators. The associations were modified by age, with stronger associations among younger patients (<65 years). Low adherence to low‐density lipoprotein cholesterol testing (≤2 years) during the first 5 years was associated with 41% increased risk of cardiac morbidity among younger patients. Patients who had uncontrolled low‐density lipoprotein cholesterol in all first 5 years had hazard ratios of 1.60 (95% CI, 1.49–1.72) and 1.23 (95% CI, 1.14–1.32), among patients aged <65 and ≥65 years, respectively, compared with those who achieved target level. Patients who failed to achieve target levels of glycated hemoglobin or blood pressure had an increased risk (hazard ratios, 1.50–1.69) for cardiac outcomes.

Conclusions

Longitudinal adherence to quality indicators in diabetes care is associated with reduced risk of cardiac morbidity. Implementation of programs that measure and enhance quality of care may improve the health outcomes of people with diabetes.
Myocardial Work in Patients Hospitalized With COVID‐19: Relation to Biomarkers, COVID‐19 Severity, and All‐Cause Mortality
Authors: Olsen Flemming Javier , Lassen Mats Christian Højbjerg , Skaarup Kristoffer Grundtvig , Christensen Jacob , Davidovski Filip Soeskov , Alhakak Alia Saed , Sengeløv Morten , Nielsen Anne Bjerg , Johansen Niklas Dyrby , Graff Claus , Bundgaard Henning , Hassager Christian , Jabbari Reza , Carlsen Jørn , Kirk Ole , Lindholm Matias Greve , Wiese Lothar , Kristiansen Ole Peter , Nielsen Olav W. , Lindegaard Birgitte , Tønder Niels , Ulrik Charlotte Suppli , Lamberts Morten , Sivapalan Pradeesh , Gislason Gunnar , Iversen Kasper , Jensen Jens Ulrik Stæhr , Schou Morten , Svendsen Jesper Hastrup , Aalen John Moene , Smiseth Otto Armin , Remme Espen Wattenberg , Biering‐Sørensen Tor
Published: September 2022

Background

COVID‐19 infection has been hypothesized to affect left ventricular function; however, the underlying mechanisms and the association to clinical outcome are not understood. The global work index (GWI) is a novel echocardiographic measure of systolic function that may offer insights on cardiac dysfunction in COVID‐19. We hypothesized that GWI was associated with disease severity and all‐cause death in patients with COVID‐19.

Methods and Results

In a multicenter study of patients admitted with COVID‐19 (n=305), 249 underwent pressure‐strain loop analyses to quantify GWI at a median time of 4 days after admission. We examined the association of GWI to cardiac biomarkers (troponin and NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide]), disease severity (oxygen requirement and CRP [C‐reactive protein]), and all‐cause death. Patients with elevated troponin (n=71) exhibited significantly reduced GWI (1508 versus 1707 mm Hg%;
P
=0.018). A curvilinear association to NT‐proBNP was observed, with increasing NT‐proBNP once GWI decreased below 1446 mm Hg%. Moreover, GWI was significantly associated with a higher oxygen requirement (relative increase of 6% per 100–mm Hg% decrease). No association was observed with CRP. Of the 249 patients, 37 died during follow‐up (median, 58 days). In multivariable Cox regression, GWI was associated with all‐cause death (hazard ratio, 1.08 [95% CI, 1.01–1.15], per 100–mm Hg% decrease), but did not increase C‐statistics when added to clinical parameters.

Conclusions

In patients admitted with COVID‐19, our findings indicate that NT‐proBNP and troponin may be associated with lower GWI, whereas CRP is not. GWI was independently associated with all‐cause death, but did not provide prognostic information beyond readily available clinical parameters.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04377035.
Association Between the Affordable Care Act Medicaid Expansion and Receipt of Cardiac Resynchronization Therapy by Race and Ethnicity
Authors: Mwansa Hunter , Barry Ibrahim , Knapp Shannon M. , Mazimba Sula , Calhoun Elizabeth , Sweitzer Nancy K. , Breathett Khadijah
Published: September 2022

Background

Black and Hispanic patients are less likely to receive cardiac resynchronization therapy (CRT) than White patients. Medicaid expansion has been associated with increased access to cardiovascular care among racial and ethnic groups with higher prevalence of underinsurance. It is unknown whether the Medicaid expansion was associated with increased receipt of CRT by race and ethnicity.

Methods and Results

Using Healthcare Cost and Utilization Project Data State Inpatient Databases from 19 states and Washington, DC, we analyzed 1061 patients from early‐adopter states (Medicaid expansion by January 2014) and 745 patients from nonadopter states (no implementation 2013–2014). Estimates of change in census‐adjusted rates of CRT with or without defibrillator by race and ethnicity and Medicaid adopter status 1 year before and after January 2014 were conducted using a quasi‐Poisson regression model. Following the Medicaid expansion, the rate of CRT did not significantly change among Black individuals from early‐adopter states (1.07 [95% CI, 0.78–1.48]) or nonadopter states (0.79 [95% CI, 0.57–1.09]). There were no significant changes in rates of CRT among Hispanic individuals from early‐adopter states (0.99 [95% CI, 0.70–1.38]) or nonadopter states (1.01 [95% CI, 0.65–1.57]). There was a 34% increase in CRT rates among White individuals from early‐adopter states (1.34 [95% CI, 1.05–1.70]), and no significant change among White individuals from nonadopter states (0.77 [95% CI, 0.59–1.02]). The change in CRT rates among White individuals was associated with the timing of the Medicaid implementation (
P
=0.003).

Conclusions

Among states participating in Healthcare Cost and Utilization Project Data State Inpatient Databases, implementation of Medicaid expansion was associated with increase in CRT rates among White individuals residing in states that adopted the Medicaid expansion policy. Further work is needed to address disparities in CRT among Black and Hispanic patients.
Impact of Renal Function on Short-Term Outcome After Reperfusion Therapy in Patients With Ischemic Stroke
Authors: Park Hyungjong , Kim Young Dae , Nam Hyo Suk , Yoo Joonsang , Sohn Sung-Il , Hong Jeong-Ho , Kim Byung Moon , Kim Dong Joon , Bang Oh Young , Seo Woo-Keun , Chung Jong-Won , Lee Kyung-Yul , Jung Yo Han , Lee Hye Sun , Ahn Seong Hwan , Shin Dong Hoon , Choi Hye-Yeon , Cho Han-Jin , Baek Jang-Hyun , Kim Gyu Sik , Seo Kwon-Duk , Kim Seo Hyun , Song Tae-Jin , Kim Jinkwon , Han Sang Won , Park Joong Hyun , Lee Suk Ik , Heo Joon Nyung , Lee Hyung Woo , Lee Il Hyung , Baik Minyoul , Heo Ji Hoe ,   on behalf of the SECRET Study Investigators
Published: September 2022

Background:

A high and low estimated glomerular filtration rate (eGFR) could affect outcomes after reperfusion therapy for ischemic stroke. This study aimed to determine whether renal function based on eGFR affects mortality risk in patients with ischemic stroke within 6 months following reperfusion therapy.

Methods:

This prospective registry–based cohort study included 2266 patients who received reperfusion therapy between January 2000 and September 2019 and were registered in the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) study or the Yonsei Stroke Cohort. A high and low eGFR were based on the Chronic Kidney Disease Epidemiology Collaboration equation and defined, respectively, as the 5th and 95th percentiles of age- and sex-specific eGFR. Occurrence of death within 6 months was compared among the groups according to their eGFR such as low, normal, or high eGFR.

Results:

Of the 2266 patients, 2051 (90.5%) had a normal eGFR, 110 (4.9%) a low eGFR, and 105 (4.6%) a high eGFR. Patients with high eGFR were younger or less likely to have hypertension, diabetes, or atrial fibrillation than the other groups. Active cancer was more prevalent in the high-eGFR group. During the 6-month follow-up, there were 24 deaths (22.9%) in the high-eGFR group, 37 (33.6%) in the low-eGFR group, and 237 (11.6%) in the normal-eGFR group. After adjusting for variables with
P
<0.10 in the univariable analysis, 6-month mortality was independently associated with high eGFR (hazard ratio, 2.22 [95% CI, 1.36–3.62];
P
=0.001) and low eGFR (HR, 2.29 [95% CI, 1.41–3.72];
P
=0.001). These associations persisted regardless of treatment modality or various baseline characteristics.

Conclusions:

High eGFR as well as low eGFR were independently associated with 6-month mortality after reperfusion therapy. Kidney function could be considered a prognostic factor in patients with ischemic stroke after reperfusion therapy.
Short‐Term Outcomes of Acute Stroke During COVID‐19 by Race and Ethnicity in the United States: The Society of Vascular and Interventional Neurology Multicenter Collaboration
Authors: Zha Alicia M. , Sharrief Anjail Z. , Czap Alexandra L. , Liebeskind David S. , Vora Nirav , Rai Vivek , Desai Shashvat , Jadhav Ashutosh P. , Infante Italo , Starosciak Amy , Hassan Ameer , Farooqui Mudassir , Ortega‐Gutierrez Santiago , Jillella Dinesh V. , Mohammaden Mahmoud , Haussen Diogo C. , Nogueira Raul G. , Nguyen Thanh N. , Abdalkader Mohamad , Khandelwal Priyank , Zaidat Osama , Higham Christopher , Heslin Mark E. , Jovin Tudor G. , Siegler James E.
Published: September 2022

Background

The COVID‐19 pandemic has disproportionately affected Black and Hispanic communities, whose stroke care has been previously shown to experience existing disparities. We sought to evaluate how these disparities in stroke care and in‐hospital mortality have been affected by the COVID‐19 pandemic.

Methods

In this retrospective observational cohort study, we evaluated stroke hospitalizations in the Society of Vascular and Interventional Neurology COVID‐19 registry. We compared stroke characteristics between non‐Hispanic White, non‐Hispanic Black, and Hispanic patients pre–COVID‐19 and post–COVID‐19 (March–July 2019 versus March–July 2020) and evaluated whether racial and ethnic differences present before the pandemic were exacerbated during the pandemic. Our primary outcome was in‐hospital mortality/discharge to hospice, and secondary outcomes were acute treatment use.

Results

Of the 4908 included patients, numerically fewer non‐Hispanic White and Hispanic patients were evaluated during COVID‐19. Non‐Hispanic White and non‐Hispanic Black patients with large‐vessel occlusion were more likely to undergo thrombectomy (
P
<0.01 for both) when compared with the pre–COVID‐19 epoch. In‐hospital mortality/hospice rates were higher during COVID‐19 (12.8% versus 9.9%;
P
<0.01), with higher rates observed across all race and ethnic groups, although the odds of death/hospice during the pandemic period became nonsignificant after multivariable adjustment (adjusted odds ratio, 1.23 [95% CI, 0.95–1.62];
P
=0.12).

Conclusions

There was an increase in mortality/hospice discharges among all races during the COVID‐19 period. There were no noted racial or ethnic differences in rates of thrombolytic use, thrombectomy, or mortality within racial groups prepandemic compared with during the pandemic. Although other studies have demonstrated deepening disparities in these outcomes during COVID‐19, our data suggest that declines in stroke presentations and use of acute stroke therapies were not a uniform phenomenon. Disparities in stroke care were differentially affected in thrombolytic versus endovascular therapies and among non‐Hispanic Black and Hispanic patients.
“Guilty of Publishing Only”: Jury Nullification as a Legal Defense in the Eighteenth Century
Authors: Otis Andrew
Published: September 2022

Previous research is largely mute about the strategies that printers and their legal counsels used to defend state libel lawsuits. Analysis of the legal arguments employed in sixty-eight state libel jury trials in anglophone courts from 1699 to 1792 identifies which of them were most associated with acquittal. Jury-nullification arguments, based on freedom of the press, which encouraged jurors to disregard judges’ directives and to contravene the law, had a higher rate of success than did approaches based on the standard legal precedents of the period. These findings suggest that the public was sympathetic with a broad interpretation of press freedom at a time when many Crown judges attempted to limit it exclusively to prior restraint.
On Writing the History of Human Infectious Disease
Authors: Webb James L. A.
Published: September 2022

Until recently, no historian had taken up the challenge of synthesizing the burgeoning literature on the genomics of pathogenic agents, situating the major human infectious diseases in the context of human history and attempting to evaluate their impacts. For this reason, the publication of Harper’s accomplished survey of the effects of infectious diseases on human history, Plagues Upon the Earth, is timely, needed, and most welcome.
Diff-Explainer: Differentiable Convex Optimization for Explainable Multi-hop Inference
Authors: Thayaparan Mokanarangan , Valentino Marco , Ferreira Deborah , Rozanova Julia , Freitas André
Published: September 2022

This paper presents Diff-Explainer, the first hybrid framework for explainable multi-hop inference that integrates explicit constraints with neural architectures through differentiable convex optimization. Specifically, Diff- Explainer allows for the fine-tuning of neural representations within a constrained optimization framework to answer and explain multi-hop questions in natural language. To demonstrate the efficacy of the hybrid framework, we combine existing ILP-based solvers for multi-hop Question Answering (QA) with Transformer-based representations. An extensive empirical evaluation on scientific and commonsense QA tasks demonstrates that the integration of explicit constraints in a end-to-end differentiable framework can significantly improve the performance of non- differentiable ILP solvers (8.91%–13.3%). Moreover, additional analysis reveals that Diff-Explainer is able to achieve strong performance when compared to standalone Transformers and previous multi-hop approaches while still providing structured explanations in support of its predictions.
Understanding Justice
Authors: Welch David A.
Published: September 2022

People often disagree about what counts as “just” in a particular case. Such disagreement is natural and understandable once we realize that people commonly bring to the concept of justice different understandings of what makes something just or unjust, interpret general principles differently in specific circumstances, and/or fail to see eye to eye on appropriate ways of resolving justice disputes. But in all cases, disagreement about what is just logically requires that the parties share an understanding of what it is that they are disagreeing about. Similarly, any analysis of the role justice might play in a particular domain – here, negotiation – requires a shared understanding of what it is that is playing the role in question. The purpose of this article is to articulate and justify a shared understanding of the concept of justice that facilitates both the understanding and resolution of justice disputes.
Offering the Carrot and Hiding the Stick?
Authors: Newby Vanessa F.
Published: September 2022

Credibility has been used to explain theories of deterrence and cooperation in international relations. In the peacekeeping environment, for what purposes should credibility be built and how can it be signaled? Despite being listed by the UN as a success factor in peace operations, our understanding of credibility in peacekeeping remains limited and focused on deterrence. This article argues that credibility in peace operations must be built for both deterrence and cooperation purposes. Drawing on the international relations, civil war, and peacekeeping literatures, it conceptualizes credibility in peacekeeping by identifying the purposes for which credibility must be built and signaled: deterrence and cooperativeness. It contends that while a peace operation’s ability to deter is limited, signaling cooperativeness - credibility in cooperation—enables a force to cultivate cooperation with national and subnational audiences. This helps to create a more predictable security environment by enabling the force to function on a daily basis.
A Theory of Standing Meanders of the Antarctic Circumpolar Current and Their Response to Wind
Authors: Zhang Xihan , Nikurashin Maxim , Peña-Molino Beatriz , Rintoul Stephen R. , Doddridge Edward
Published: September 2022

Standing meanders of the Antarctic Circumpolar Current (ACC) and associated eddy hotspots play an important role for the meridional heat flux and downward momentum transfer in the Southern Ocean. Previous modeling studies show that the vorticity balance characterizing standing meanders in the upper ocean is dominated by advection of relative vorticity and stretching. Through the adjustment of this vorticity balance, standing meanders have been suggested to provide a pathway for the transfer of the momentum input by the wind from the surface to the bottom, leading to stronger bottom flows and energy dissipation. However, the dynamics governing the meander formation and its adjustment to wind remain unclear. Here we develop a quasigeostrophic theory and combine it with a regional model of the Macquarie Ridge region and an idealized channel model to explore the dynamics and vertical structure of standing meanders of the ACC. The results show that the entire vertical structure of the meander, including its dynamics in the upper ocean, is controlled by the bottom flow interacting with topography. Based on our results, we suggest a novel mechanism for the response of the ACC to wind in which “flexing” of the meander, or change in its curvature, is a response to changes in the bottom (barotropic) flow. Stronger bottom flow in response to stronger wind interacts with topography and generates a larger-amplitude Rossby wave propagating into the upper ocean. The ACC mean shear aloft amplifies the Rossby wave and leads to a larger-amplitude meander in the upper ocean dominated by advection of relative vorticity and stretching.
Nuancing Drug Harms: Exploring the Context of Substance Use Among Street-Involved Women in Uyo, Nigeria
Authors: Nelson Ediomo-Ubong E.
Published: September 2022

Recent studies on women’s substance use have emphasized the role of structural and environmental contexts in shaping substance use patterns and harms, but the dynamics constitutive of specific substance use contexts are seldom unpacked. This study works with Cameron Duff’s elaboration of context as an assemblage of space, embodiment and practice to explore the contextual dynamics that mediate substance use practices among socially marginalized women. In-depth interviews were used to gather data from a purposive sample of street-involved women who use drugs ( n = 16) in Uyo, Nigeria. Data revealed that substance use was mediated by actors, social norms and processes within social networks developed in street environments. The women used substances to achieve particular affective states such as pleasure, stress relief and coping with trauma. Social network dynamics combined with the use of drugs to manage trauma and social stress, within a wider context of social and material deprivations, to foster substance use practices that created risk for harm. Drug harms were not inherent to the substance use experience or incidental to benefits and pleasures. Instead, they were unintended, but inevitable, outcomes of the embodied practices of beneficial substance use. On the other hand, corporeal techniques of controlled drug use served to minimize drug harms. Findings indicate a need to address the contextual dynamics that influence harmful patterns of substance use, and to leverage the harm reducing potentials of controlled use practices.
Migration Aspirations and Adolescents’ Ideal age at Union Formation in Western Mexico
Authors: Alcaraz Melissa
Published: September 2022

Migration systems shape social life, including the timing and sequencing of key demographic behaviors such as marriage, childbearing, and household formation. Existing research has linked migration and marriage in Mexico through various mechanisms but provides less guidance on whether aspirations for migration and marriage are closely linked. Given that union formation is distinct within migration contexts, this article focuses on adolescents’ plans for marriage and the extent to which migration aspirations shape the desired timing of their union formation, by examining how four distinct measures of migration aspirations are related to adolescents’ ideal ages at union formation in rural Jalisco, Mexico. Drawing from data on adolescents ( n = 1,403 adolescents) from the Family Migration and Early Life Outcomes (FAMELO) project (collected in 2017–2018), it uses ordinary least squares (OLS) regression to analyze how various types of adolescent migration aspirations — including permanent migration, temporary labor migration, leaving the community at any point in time, and expected migration location — are associated with adolescents’ ideal age at union formation. Results reveal that all migration aspirations are associated with higher ideal ages at the marriage in unconditional models. However, these associations are not always robust to the inclusion of other factors, including adolescent aspirations in other life domains, particularly education. Results highlight the ongoing transition from a “culture of migration” to a “culture of education” in Mexico. Given that Mexican migration has changed dramatically in recent years, the findings presented here provide a window for understanding how these changes in migration are reflected in adolescent goals and likely subsequent behavior.
Challenges in rating signed production: A mixed-methods study of a Swiss German Sign Language form-recall vocabulary test
Authors: Batty Aaron Olaf , Haug Tobias , Ebling Sarah , Tissi Katja , Sidler-Miserez Sandra
Published: September 2022

Sign languages present particular challenges to language assessors in relation to variation in signs, weakly defined citation forms, and a general lack of standard-setting work even in long-established measures of productive sign proficiency. The present article addresses and explores these issues via a mixed-methods study of a human-rated form-recall sign vocabulary test of 98 signs for beginning adult learners of Swiss German Sign Language (DSGS), using post-test qualitative rater interviews to inform interpretation of the results of quantitative analysis of the test ratings using many-facets Rasch measurement. Significant differences between two expert raters were observed on three signs. The follow-up interview revealed disagreement on the criterion of correctness, despite the raters’ involvement in the development of the base lexicon of signs. The findings highlight the challenges of using human ratings to assess the production not only of sign language vocabulary, but of minority languages generally, and underscore the need for greater effort expended on the standardization of sign language assessment.
Veno-venous extra-corporeal membrane oxygenation in a COVID-19 patient with cold-agglutinin haemolytic anaemia: A case report
Authors: Raes Matthias , De Becker Ann , Blanckaert Jeroen , Balthazar Tim , De Ridder Simon , Mekeirele Michael , Verbrugge Frederik Hendrik , Poelaert Jan , Taccone Fabio Silvio
Published: September 2022

Overview

The use of extra-corporeal membrane oxygenation (ECMO) therapy to treat severe COVID-19 patients with acute respiratory failure is increasing worldwide. We reported herein the use of veno-venous ECMO in a patient with cold agglutinin haemolytic anaemia (CAHA) who suffered from severe COVID-19 infection.

Description

A 64-year-old man presented to the emergency department (ED) with incremental complaints of dyspnoea and cough since one week. His history consisted of CAHA, which responded well to corticosteroid treatment. Because of severe hypoxemia, urgent intubation and mechanical ventilation were necessary. Despite deep sedation, muscle paralysis and prone ventilation, P/F ratio remained low. Though his history of CAHA, he still was considered for VV-ECMO. As lab results pointed to recurrence of CAHA, corticosteroids and rituximab were started. The VV-ECMO run was short and rather uncomplicated. Although, despite treatment, CAHA persisted and caused important complications of intestinal ischemia, which needed multiple surgical interventions. Finally, the patient suffered from progressive liver failure, thought to be secondary to ischemic cholangitis. One month after admission, therapy was stopped and patient passed away.

Conclusion

Our case report shows that CAHA is no contraindication for VV-ECMO, even when both titre and thermal amplitude are high. Although, the aetiology of CAHA and its response to therapy will determine the final outcome of those patients.
Prevention of Blood Donation-related Vasovagal Response by Applied Muscle Tension: a Meta-analysis
Authors: Wang Cong , Chen Li , Sun Chenyu , Zhang Yan , Cao Can , Ma Yuanyuan , Shi Wenwen
Published: September 2022

Objective

Vasovagal reaction (VVR) is an adverse reaction to blood donation. Applied muscle tension (AMT) has been reported to reduce the probability of VVR during blood donation; however, the results have been controversial. We therefore conducted a meta-analysis to systematically evaluate the effect of AMT in reducing VVR.

Methods

We searched six major databases using “applied muscle tension” and “blood donation-related vasovagal response” as keywords. Relevant articles published in English or Chinese between 1 January 2000 and 30 June 2021 were included in the analysis. The quality of the included articles was evaluated and publication bias was assessed by forest and funnel plots and by Egger's test.

Results

Fifty-one articles were identified, of which six were included according to the pre-defined inclusion and exclusion criteria. A fixed-effects model was adopted for effect size combination and revealed a relative risk of 0.52 (95% confidence interval 0.40 to 0.67). The AMT group was superior to the control in terms of VVR prevention. A funnel plot and Egger's test suggested that the findings were accurate and reliable with low publication bias.

Conclusion

AMT could effectively reduce VVR during blood donation. Further multicenter studies with large sample sizes are needed to confirm these results.
Ectopic papillary thyroid carcinoma mimicking distant metastatic tissue
Authors: Qi Yingsong , Liu Jianwei , Liu Ya , Shen Zhihua , Hu Na
Published: September 2022

We report a case of a 50-year-old woman presenting with a solid nodule in each lung. She was previously suspected of having lung cancer and distant pulmonary metastasis on the basis of imaging findings. Surgical pathology revealed that the left lung nodule was adenocarcinoma, but the contralateral nodule was papillary thyroid carcinoma (PTC). We subsequently performed total thyroidectomy, and the histological findings of the resected specimen showed no suspicious tumor tissue. Overall, the results led to a diagnosis of ectopic intrapulmonary PTC with synchronous lung adenocarcinoma. Ectopic intrapulmonary PTC is a rare but true phenomenon that may be easily mistaken for pulmonary metastasis in daily practice. It is important to improve the recognition of ectopic intrapulmonary thyroid tumors to avoid misdiagnosis.
Illusions, objectivity, and non-reductive emergentism: Reply to Rose
Authors: Cheng Tony
Published: September 2022

In the target article, David Rose makes an interesting and substantive case against a certain kind of sceptical view: “veridical perception is impossible in principle,” combined with a certain version of anti-realism. He proceeds by first illustrating several ideas from George Orwell’s seminal work, and then proposes that a certain kind of non-reductive, levelled emergentist metaphysics can help us respond to such scepticism. In this commentary, I join forces with Rose’s case, but will point out that we need to take seriously two discussions in contemporary philosophy in order to make the realist case stronger: the argument from illusion and hallucination, and the causal exclusion argument. Only then do Rose and his allies can have a more satisfactory case for objectivity and realism.
Within cluster pattern identification: A new approach for optimizing recycle point distribution to support policy implementation on waste management in Malaysia
Authors: Azri Suhaibah , Ujang Uznir , Abdullah Nurul Shafika
Published: September 2022

Despite the government’s policies and objectives, Malaysia lags behind in sustainable waste management techniques, particularly recycling. Bins should be located conveniently to encourage recycling and reduce waste. The current model of bin location-allocation is mostly determined by distance. However, it has been identified that previous studies excluded an important factor: litter pattern identification. Litter pattern is important to identify waste generation hotspots and litter distribution. Thus, we proposed the within cluster pattern identification (WCPI) approach to optimize the recycle point distribution. WCPI gathers the information on litter distribution using geotagged images and analyses the pattern distribution. The optimal location for recycle bin can be identified by incorporating k-means clustering to the pattern distribution. Since k-means faces the non-deterministic polynomial-time-hard challenge of selecting the ideal cluster and cluster centre, WCPI used the total within-cluster sum of square on top of k-means clustering. The proposed location by WCPI is validated in terms of accessibility and suitability. Furthermore, this study provides further analysis of carbon footprint that can be reduced by simulating the data from geotagged images. The results show that 10,323.55 kg of carbon emission can be reduced if the litter is sent for recycling. Thus, we believe that locating bins at an optimal location will embark on consumer motivation to dispose of recycled waste, reduce litter and lessen the carbon footprint. At the same time, these efforts could transform Malaysia into a clean and sustainable nation that aims to achieve Agenda 2030.
Time for Exercise? Exercise and Its Influence on the Skeletal Muscle Clock
Authors: Martin Ryan A. , Esser Karyn A.
Published: September 2022

Circadian rhythms drive our daily behaviors to coincide with the earth’s rotation on an approximate 24-h cycle. The circadian clock mechanism present in nearly every cell is responsible for our circadian rhythms and is comprised of a transcriptional-translational feedback loop in mammals. The central clock resides in the hypothalamus responding to external light cues, whereas peripheral clocks receive signals from the central clock and are also sensitive to cues from feeding and activity. Of the peripheral clocks, the skeletal muscle clock is particularly sensitive to exercise which has shown to be an important time-cue with the ability to influence and adjust the muscle clock phase in response to exercise timing. Since the skeletal muscle clock is also involved in the expression of tissue-specific gene expression—including glucoregulatory genes—this might suggest a role for exercise timing as a therapeutic strategy in metabolic diseases, like type 2 diabetes. Notably, those with type 2 diabetes have accompanied disruptions in their skeletal muscle clock mechanism which may also be related to the increased risk of type 2 diabetes seen among shift workers. Therefore, the direct influence of exercise on the skeletal muscle clock might support the use of exercise timing to provide disease-mitigating effects. Here, we highlight the potential use of time-of-day exercise as a chronotherapeutic tool within circadian medicine to improve the metabolic profile of type 2 diabetes and support long-term glycemic control, potentially working through the skeletal muscle clock and circadian physiology.
Encompassing the Earth: Magellan's voyage from its political context to its expansion of knowledge
Authors: Salonia Matteo
Published: September 2022

Between 1519 and 1522, the Magellan–Elcano expedition completed the first circumnavigation of the world. This contribution offers a new interpretation of the political context leading to the voyage and, in particular, it considers the long history of Portuguese–Castilian rivalry in the Atlantic, reassessing the importance of the Treaty of Alcáçovas (1479). The second part of the article clarifies the objectives and achievements of the voyage, arguing that a reading of primary documents concerning Magellan's reward is necessary in order to understand the rationale behind the northerly route followed across the Pacific. It also sheds light on the momentous changes brought to Europe's geographical and cosmographical frameworks by the realization that all the oceans are one and the shattering of previous limits to human mobility. Finally, the article considers the images of Asian maritime and human geographies produced by one of the few survivors of the voyage, Antonio Pigafetta, in his Relazione, proposing a reading of this text centred around the concept of genuine curiosity, even in a broader context of Iberian empire-building.
Novel Technology Deployed for Remote Ventilator Management by Respiratory Therapists During the COVID-19 Pandemic: Lessons Learned
Authors: Rausen Michelle S. , Nahass Thomas A. , Halpern Neil A.
Published: September 2022

A novel remote ventilator management (control) technology (Omnitool) was implemented for use with ICU patients during the COVID-19 pandemic to mitigate in-person respiratory therapist interactions and preserve personal protective equipment. In the latter half of 2020, eight mechanical ventilators were purchased and enabled for Omnitool deployment through the application of a vendor software option. Subsequently, these ventilators were outfitted with commercially available informatics hardware that permitted remote communication and management via the existing hospital network. In total, 17 patients with COVID-19 respiratory failure were placed on Omnitool enabled ventilators between January 1, 2021-April 30, 2021. The median Omnitool use days was 10. Deployment of a novel remote ventilator management technology is feasible; however, further study is needed to simplify the set up and utilization of the system. Future demands for remote ventilator management are predictable, whether in rural areas, military scenarios without adequate RT staffing, or in circumstances with new and easily transmissible toxic infections, and will continue to encourage the development of relatively easy to apply informatics-based solutions. Herein we share five lessons learned from our Omnitool deployment.
Prevalence and Impact of Infection during Extracorporeal Membrane Oxygenation in Oncologic Patients: A Retrospective Analysis of the Extracorporeal Life Support Organization (ELSO) Registry
Authors: Suzuki Yota , Mao Rui-Min D. , Shah Nikhil R. , Schaeffer Lawrence , Deanda Abe , Radhakrishnan Ravi S.
Published: September 2022

Background: Extracorporeal membrane oxygenation (ECMO) is widely utilized for severe cardiopulmonary insufficiency, but its application to the oncologic population has been debated given concern for increased risk of infection. This study aims to analyze the implications of infections acquired during ECMO runs in patients with malignancy. Methods: The Extracorporeal Life Support Organization (ELSO) database was queried for patients with an International Classification of Diseases code of neoplasms over the last two decades (2000–2019). Culture-proven infections during ECMO runs were analyzed and compared to previously reported data for all ECMO runs. Results: Two thousand, seven hundred and fifty-seven patients met inclusion criteria. Infection acquired during ECMO run was found in 687 patients, a significantly greater proportion compared to all ECMO runs (24.9% vs 11.7%; P = .001). Adult patients had a significantly higher rate of infection (27.0%; P < .001) compared to neonatal (11.0%) and pediatric (21.4%) patients. Prevalence of infection was highest in pulmonary ECMO (29.0%), while the infection rate standardized with ECMO duration was highest in extracorporeal cardiopulmonary resuscitation (55.03/1000-day ECMO run). Compared with ECMO for all diagnoses, the prevalence of Candida and Klebsiella infection was significantly higher in adult and pediatric oncologic patients. Regardless of the pathogen, the presence of infection was not associated with lower survival (38.6% vs 40.0%; P = .522). Conclusions: Oncologic patients had a significantly higher infection rate while on ECMO compared with the general ECMO population. However, the prognostic impact of these infections was minimal, thus ECMO should not be withheld in oncologic patients solely with concern for infection.
A Comparison of Service Time and Racial Categories within Traditional and Alternative Route Internship Programs for Special Education Licensure
Authors: Wojcik Andrew J. , Hicks Michelle , Scott LaRon A. , Thoma Colleen A. , Bowman Rachel W. , Frazier Regina
Published: September 2022

We used 14 years of state licensure and classroom data from Virginia to follow 19,878 special education teachers (SETs) who completed either the alternative route (AR) internship or traditional programs. Findings reveal that a greater percentage of SETs of color participated in AR programs compared to traditional licensure programs, while a greater percentage of White SETs completed traditional programs. SETs of color attained approximately three fewer years of service time if they completed the AR program compared to traditional programs. For White SETs, a difference of less than 1 year was found. For SETs from AR programs who did not complete 27 credit hours of university coursework, attrition occurred at higher rates within the first 3 years of service. Implications for future research on AR internship programs and teachers of color are provided, informing both policy and practice.
Educational Stakeholder Sensemaking on Preparing CTE Students for Sub-Baccalaureate Pathways
Authors: Cashdollar Sarah
Published: September 2022

Careful implementation of Career and Technical Education (CTE) programs is necessary in order for programs to achieve the policy goal of college and career readiness, which involves expanding student opportunities for career-relevant learning without limiting their academic preparation for postsecondary degrees. As programs become more widespread, little work has examined how practitioners actually implementing CTE make sense of programs’ intended outcomes. Through interviews and observations with 52 education leaders and their partners in workforce development, I found that education stakeholders believed CTE was important for providing students with the option to pursue financially low-risk pathways toward middle-skill careers that didn’t require bachelor’s degrees. Yet in their efforts to valorize sub-baccalaureate (sub-BA) pathways, they sometimes exaggerated the long-term returns to sub-BA credentials, leaving students with inaccurate information on which to base their postsecondary goals.
Product evolution analysis for design adaptation using big sales data
Authors: Zhang Jian , Xie Guang , Peng Qingjin , Gu Peihua
Published: September 2022

Products are constantly evolving through design adaptations to satisfy market requirements. Efficient design adaptation via maximal reusing of existing design can improve product quality, reduce manufacturing cost, and time to market. Understanding of product evolution mechanism is required for design adaptations through rationalized modularity and interfaces. Emerging big sales data provide rich resources for product evolution analysis. To support efficient design adaptations, a framework and associated methods are developed in this work using big sales data for product evolution analysis. Reproduction, mutation, and crossover of product specifications are introduced as specification adaptation operations. Methods are proposed for identification of specification adaptations and estimation of the adaptation probability. Based on modeling and analyzing relationships among product specifications and components, different types of modules and interfaces are proposed through components clustering and their potential operation (mutation, reproduction, and crossover) probabilities. Design recommendations of adaptable product architecture with modules and interfaces are made for facilitating design adaptations. A case study of consumer Unmanned Aerial Vehicles (UVAs) illustrates the proposed method. Limitations and potential extensions of the newly developed method are discussed. Further investigations of the product evolution mechanism using game theory to support competitive product development are included.
Self-reconfiguration and rescheduling of aero-engine assembly shop with rework disruption in knowledgeable manufacturing environment
Authors: Yan Hong-Sen , Wan Xiao-Qin
Published: September 2022

An aero-engine has to be assembled twice or more to satisfy stringent technical standards. Substandard engines are required to re-enter for additional reassembly, which may trigger rework disruption. Work groups with flexible skills are responsible for the operations and can be reassigned when rescheduling triggers. An integrated problem of rescheduling of engines and reconfiguration of work groups with rework disruption is formulated here. A heuristic is proposed to solve the problem. In self-reconfiguration optimization, work groups are reassigned in accordance with the workload balance criterion without violating the assembly skills constraints. In rescheduling optimization, locally optimal sequencing propositions of operations are derived and applied to generate a feasible schedule. Three neighborhood structures are defined, and a variable neighborhood search is implemented to optimize the assignment and the schedule of operations on parallel work groups. The effectiveness of the proposed algorithm is tested by several numerical experiments. The results show that the proposed algorithm promises apparently lower total cost and more desirable assignment of work groups by scheduling.
Monitoring the drilling process of carbon fibre laminates using acoustic emission
Authors: Eaton Mark J , Crivelli Davide , Williams Robert , Byrne Carlton
Published: September 2022

This work aims to apply Acoustic Emission to monitor the drilling process in carbon fibre laminates. Continuous Acoustic Emission data is captured over the entire drilling process of a through hole. The use of continuous acoustic emission data acquisition allows the identification of lower frequency periodic temporal features related to the cutting process. A new approach to data analysis is presented that utilises an enveloping technique to study these periodic phenomena and show that they correlate to changes in cutting regime as tool wear advances and hole quality reduces. This analysis of Acoustic Emission data is supported by the measurement of tool temperature, thrust force and the assessment of hole quality. Results show that Acoustic Emission activity is correlated to changes in the cutting process, and a correlation between tool wear and Acoustic Emission is observed. This correlation has been confirmed by corresponding increases in thrust force and drill temperature, with a consequent decrease in the observed hole quality.
Study on mechanical properties of wind turbine blades with bend-twist coupling effect
Authors: Ma Huidong , An Zongwen , Han Meiqi , Zeng Shilong
Published: September 2022

Bend-twist coupling (BTC), a method of passive load alleviation for turbine blade, has a significant influence on blade mechanical properties. The coupling behavior between bending and twisting motions stems from the material anisotropy in blade laminate or from the unique blade geometry such as sweep, deflection, and pre-bending. The material-based approach is employed in this research to determine influence regularity of BTC design on blade mechanical properties. To begin with, the blade property analysis tool PreComp that integrates a shear flow method with the classical laminate theory is adopted to compute the cross-sectional stiffnesses of the blades with different degree of BTC effect. Next, the bend-twist coupling coefficients for the BTC blades with different fiber orientation are calculated. Finally, the remaining mechanical properties including static performance, modal characteristics and buckling limits for different BTC blades are determined by the finite element method and the influence of changes in the degree of BTC effect on all these mechanical properties is further evaluated. The results show that the BTC effect markedly influences the different mechanical properties of the blade in different patterns. The 20° BTC blade has the highest BTC coefficient and the edgewise BTC coefficient at 100 m is 2.5 times higher than the flapwise BTC coefficient, while the maximum value of the torsional modal frequency of 3.8429 Hz and the greatest critical buckling load of 4328.1 kN corresponds to the 10° BTC blade and the 15° BTC blade respectively.