bluuebunny/crossref_metadata_2025 huggingface dataset:
Colorblind Policy in a Carceral Geography: Reclaiming Public Education
Authors: Schlesinger Traci , Schmits-Earley Margaret
Published: June 2020

During the last decade, the federal government, states, and school districts implemented changes in school discipline policy to shift schools’ reliance from punishment and exclusion toward prevention, intervention, and restoration. In order to assess the impact of the last decade of reforms on attempts to decrease punishment and increase equity in schools, we examine nine large metropolitan districts that both revised their Codes of Conduct to limit their reliance on exclusionary discipline and implemented schoolwide behavioral and/or restorative programs. We find that while reforms are associated with decreases in students’ experience of three of four exclusionary discipline outcomes from 2009 to 2015, these benefits tend to accrue to the least vulnerable students – White students without disabilities. One explanation of this finding is that colorblind, risk-based, carceral assumptions of school and state policies undercut efforts to increase equity in school discipline.
Reliability of crack quantification via acousto-ultrasound active-sensing structural health monitoring using surface-mounted PZT actuators/sensors
Authors: Yadav Susheel Kumar , Mishra Spandan , Kopsaftopoulos Fotis , Chang Fu-Kuo
Published: June 2020

This work presents the introduction and experimental investigation of an active-sensing acousto-ultrasound structural health monitoring approach for damage size quantification based on piezoelectric sensors/actuators mounted on multiple seemingly identical structural components. The objective of this work is to determine how reliable the damage diagnostics can be from one component to another similar (nominally identical) component using surface-mounted PZT (lead zirconate titanate) sensors/actuators, and also to evaluate how sensitive a sensor network configuration in terms of the number of sensors/actuators is with respect to its detection reliability. Extensive crack growth experiments on multiple identical coupons outfitted with the same sensor network configuration under cyclic loads were conducted to assess the damage quantification reliability from one coupon to another using the same diagnostic algorithm. The results of the study indicate that the crack size estimates obtained from the active-sensing structural health monitoring system can vary within the population of identical structural components (coupons), but the difference in quantifying damage among coupons decreases with the increase in the number of sensors and actuators used, that is, wave propagation paths. Furthermore, it is shown that the diagnostic results in terms of damage quantification converge with the increase in the number of sensors. The results of the study indicate that the diagnostic approach using a multi-path sensor network can reduce the damage quantification error from one component to another within a “hotspot” configuration (damage location is known or suspected a priori). Finally, the results of this study indicate that the more wave propagation paths used in the diagnostic active-sensing algorithm, the more reliable the damage quantification results are, provided that the same sensor network is used and installed at nominally identical locations for all coupons.
Impact diagnosis in stiffened structural panels using a deep learning approach
Authors: Zargar Sakib Ashraf , Yuan Fuh-Gwo
Published: June 2020

Low-velocity impact on a structure emanates an elastic wave that propagates through the structure carrying a wealth of information about the impact event. This propagating wave can be visualized through a series of images (time-frames in the context of computer-vision) in the time–space domain collectively referred to as the wavefield. An approach for the autonomous analysis of these wavefields is presented in this article for the purpose of impact diagnosis, that is, identifying the impact location and reconstructing the impact force time-history. The high spatio-temporal dimensionality of the wavefield mandates the use of deep neural networks for analysis; however, unlike the traditional object detection problem in computer-vision, the nature of the impact diagnosis problem requires the capturing of context from the wavefield evolution. This necessitates learning across multiple time-frames of the wavefield simultaneously rather than focusing independently on each frame. While scanning simultaneously across multiple time-frames provides indispensable information about the wave propagation phenomenon in terms of its interactions with geometric features, boundaries, and so on, it mandates the use of deep learning models that can analyze this complex phenomenon in both spatial and temporal domains. A unified CNN-RNN network architecture is employed in this article to address this issue of spatio-temporal information extraction. The proposed approach is verified using simulated wavefields obtained from the finite element analysis of a five-bay stiffened aluminum panel. In order to demonstrate the generalization capabilities of the model, simulated wavefields corresponding to highly idealized impact scenarios are used for training, whereas for testing, the ones corresponding to more realistic impacts are used. It is shown that by incorporating the physics-based concept of time-reversal in the recurrent part of the network, better network performance can be achieved. The potential extension of the proposed methodology to an end-to-end vision-based impact monitoring system is also discussed at the end.
Skin microvascular reactivity correlates to clinical microangiopathy in type 1 diabetes: A pilot study
Authors: Tehrani Sara , Bergen Karin , Azizi Louisa , Jörneskog Gun
Published: June 2020

Aim:

The aim of this study was to investigate the correlation between skin microvascular reactivity and clinical microangiopathy in patients with type 1 diabetes.

Methods:

We included 61 patients with type 1 diabetes, that is, 31 patients with and 30 without clinical microangiopathy, and 31 healthy controls. A microangiopathy scoring system was introduced for comparison of data between patients with microangiopathy. Responses to iontophoresis of acetylcholine and sodium nitroprusside were assessed by laser Doppler imaging.

Results:

Patients with microangiopathy had reduced acetylcholine- and sodium nitroprusside-mediated flux in forearm skin microcirculation compared to healthy controls ( p = 0.03 and p < 0.001, respectively, repeated measures analysis of variance), whereas no significant differences were found between patients without microangiopathy and controls. Skin reactivity was reduced in patients with microangiopathy compared to patients without microangiopathy: 1.43 ± 0.38 versus 1.59 ± 0.39 arbitrary units for acetylcholine-mediated peak flux and 1.44 ± 0.46 versus 1.74 ± 0.34 arbitrary units for sodium nitroprusside-mediated peak flux ( p < 0.05 for both). A tendency of gradual decrease in acetylcholine and sodium nitroprusside responses was found in patients with increasing microangiopathy scores.

Conclusion:

We conclude that skin microvascular reactivity is associated with clinical microangiopathy in patients with type 1 diabetes. Impaired skin microvascular function in type 1 diabetes seems to be multifactorial and involves both endothelial-dependent and endothelial-independent pathways. We introduce a novel microangiopathy score that could easily be used in a clinical setting for comparison of patients with various degrees of microangiopathy.
A Performance Improvement Initiative for Implementing an Evidence-Based Discharge Bundle for Lung Transplant Recipients
Authors: Fitz Sarah , Diegel-Vacek Lauren , Mahoney Erin
Published: June 2020

Background:

Lung transplant recipients have high hospital readmission rates. Readmissions are costly to institutions and associated with higher mortality among patients within the first year of transplant. Strong evidence indicates that in hospitalized patients, the use of discharge bundles results in lower 30-day hospital readmission rates.

Local Problem:

A lung transplant team at a Midwest academic medical center performs 40 to 50 lung transplants annually and provides comprehensive, ongoing care for approximately 300 lung transplant recipients. The objective of this quality improvement project was development and implementation of an evidence-based discharge bundle (standardized patient discharge process) to reduce 30-day hospital readmission rates for this patient population.

Methods:

A gap analysis was performed using focus groups to identify strategies to reduce readmissions. Using that data, a standardized discharge bundle was developed in collaboration with the transplant team.

Interventions:

The discharge bundle included improvements in discharge planning, scripted communication methods between team members, a standardized medication template for patient education, standardized follow-up appointment process, and increased telephone calls to the patient after discharge.

Results:

The primary outcome measured was the monthly 30-day hospital readmission rate of facility lung transplant recipients from June through August of 2019 as compared to the same time period in 2018. The readmission rate did not change during the evaluation period. Team members reported improved communication, efficiency, and improved standardization of follow-up care using the discharge bundle.

Conclusions:

Implementing a discharge bundle for lung transplant recipients resulted in improved staff satisfaction with the discharge process.
A combined loading transducer for calculating the bending moment and torque in a slender circular beam using the minimum numbers of strain gauges, strain grids, and measurement channels
Authors: Socha Bernard J , Bednarz Edward T , Zhu Wei-Dong
Published: June 2020

The purpose of this work is to develop a new methodology that uses the minimum numbers of strain gauges, strain grids, and measurement channels to calculate the bending moment and torque in a slender circular beam under combined loading from measured strains in it. In general, each independent variable requires a minimum of one independent measurement. Two grids of a single-rosette strain gauge located at 45° and −45° from the longitudinal axis of the beam are used in conjunction with two measurement channels to gather all measurements and form a combined loading transducer. A theoretical set of equations of the new methodology is developed to minimize numbers of strain grids and measurement channels, and an experimental configuration was tested in a variety of scenarios. Calibration factors were independently developed for the bending moment and torque of the beam by separately loading it in their respective directions. These calibration factors were applied to different combined loading scenarios, where errors were found to be on average 1.6% for moment comparison and 6.7% for torque comparison.
Applying a deployment strategy and data analysis model for water quality continuous monitoring and management
Authors: Chen Fan-Lun , Yang Bo-Chieh , Peng Shu-Yi , Lin Tzu-Chi
Published: June 2020

In Taiwan, where residential and industrial areas are in close proximity, finding ways to effectively continuous monitor and manage water quality is an essential issue. This study established a total solution for an Internet of things water quality monitoring network that integrates domestic miniaturized water quality monitoring sensors for real-time transport data of pH, temperature, conductivity, chemical oxygen demand, and copper ions. The data will be used to establish an analysis model based on continuous monitoring of the nation’s background concentration. We designed an automatic continuous monitoring and early warning analysis module for automatic analysis of environmental and instrumental anomalies for decision makers, a “pollution source analysis module” utilizing static and dynamic cross-environment data to swiftly trace upstream pollution sources, and a “pollution hotspot analysis module” to evaluate the impact area of pollutants, and immediate response measures to achieve early warning and swift evaluation for the prevention of water pollution. To do this, we installed 100 domestic miniaturized water monitoring devices in Taoyuan City for testing the solution. We found that the establishment of an Internet of things environment analysis and response model integrated with cross-environment analysis can be applied in water quality monitoring and management to assure improved environmental quality.
Research Integrity Among PhD Students at the Faculty of Medicine: A Comparison of Three Scandinavian Universities
Authors: Hofmann Bjørn , Bredahl Jensen Lone , Eriksen Mette Brandt , Helgesson Gert , Juth Niklas , Holm Søren
Published: June 2020

This study investigates research integrity among PhD students in health sciences at three universities in Scandinavia (Stockholm, Oslo, Odense). A questionnaire with questions on knowledge, attitudes, experiences, and behavior was distributed to PhD students and obtained a response rate of 77.7%. About 10% of the respondents agreed that research misconduct strictly defined (such as fabrication, falsification, and plagiarism, FFP) is common in their area of research, while slightly more agreed that other forms of misconduct is common. A nonnegligible segment of the respondents was willing to fabricate, falsify, or omit contradicting data if they believe that they are right in their overall conclusions. Up to one third reported to have added one or more authors unmerited. Results showed a negative correlation between “good attitudes” and self-reported misconduct and a positive correlation between how frequent respondents thought that misconduct occurs and whether they reported misconduct themselves. This reveals that existing educational and research systems partly fail to foster research integrity.
The Response of Hip Joint Cartilage to Exercise in Children: An MRI Study Using T2-Mapping
Authors: Fernquest Scott , Palmer Antony , Pereira Claudio , Arnold Calum , Hirons Emma , Broomfield John , Newman Simon , Glyn-Jones Sion
Published: June 2020

Objective

The aim of this study was to determine the effects of activity and cam morphology on cartilage composition during adolescence and investigate the development of cartilage composition with age.

Design

Cross-sectional observational cohort study of individuals from football club academies and an age-matched control population, aged 9 to 18 years. Assessments included questionnaires and T2-mapping of hips. Primary imaging outcome measures were T2 relaxation time of acetabular and femoral cartilage, average alpha angle, and lateral epiphyseal extension.

Results

The cohort consisted of 109 elite male footballers, 49 male controls, and 51 female controls. Elite male footballers had an acetabular cartilage T2 value 4.85 ms greater than male controls ( P < 0.001). A significant positive correlation existed between Physical Activity Questionnaire Score and acetabular cartilage T2 value (coefficient 1.07, P < 0.001) and femoral cartilage T2 value (coefficient 0.66, P = 0.032). Individuals with a closed physis had an acetabular cartilage T2 value 7.86 ms less than individuals with an open physis. Acetabular cartilage T2 values decreased with age in elite footballers. No correlation existed between alpha angle and anterosuperior acetabular cartilage T2 value and no difference in T2 value existed between individuals with and without cam morphology.

Conclusions

This study demonstrates that high activity levels may significantly affect acetabular cartilage composition during adolescence, but cam morphology may not detrimentally affect cartilage composition until after adolescence.
A prospective community engagement initiative to improve clinical research participation in patients with peripheral artery disease
Authors: Levenberg Kate , Proctor David N , Maman Stephan R , Luck J Carter , Miller Amanda J , Aziz Faisal , Radtka John F , Muller Matthew D
Published: June 2020

Objective:

Patients diagnosed with peripheral artery disease are difficult to recruit into clinical trials. However, there is currently no high-quality, patient-centered information explaining why peripheral artery disease patients choose to participate or not participate in clinical research studies.

Methods:

The current study was a prospective community engagement initiative that specifically asked patients with and without peripheral artery disease: (1) what motivates them to participate in clinical research studies, (2) their willingness to participate in different research procedures, (3) the barriers to participation, (4) preferences about study design, and (5) demographic and disease-related factors influencing participation. Data were gathered through focus groups ( n = 19, participants aged 55–79 years) and mailed questionnaires ( n = 438, respondents aged 18–85 years).

Results:

More than half of the respondents stated that they would be willing to participate in a study during evening or weekend time slots. Peripheral artery disease patients ( n = 45) were more willing than those without peripheral artery disease ( n = 360) to participate in drug infusion studies (48% versus 18%, p < 0.001) and trials of investigational drugs (44% versus 21%, p < 0.001). Motivating factors and barriers to participation were largely consistent with previous studies.

Conclusion:

Adults in our geographic region are interested in participating in clinical research studies related to their health; they would like their doctor to tell them what studies they qualify for and they prefer to receive a one-page advertisement that has color pictures of the research procedures. Peripheral artery disease patients are more willing than those without peripheral artery disease to participate in drug infusion studies, trials of investigational drugs, microneurography, and spinal/epidural infusions.
Vibrotactile perception on the sole of the foot in an older group of people with normal glucose tolerance and type 2 diabetes
Authors: Peterson Magnus , Pingel Ronnie , Rolandsson Olov , Dahlin Lars B
Published: June 2020

Objectives:

To evaluate vibrotactile sense in an older group of people with normal glucose tolerance and type 2 diabetes relative to other sensory tests.

Methods:

Vibration perception thresholds on the sole of the foot (Multifrequency vibrametry and Biothesiometer) were compared to the results from evaluation of touch (monofilament), electrophysiology (sural nerve) and thermal sensation (Thermotest®).

Results:

Vibration perception and temperature thresholds, as well as sural nerve function, differed between normal glucose tolerance and type 2 diabetes. Measuring vibration perception thresholds at lower frequencies with multifrequency vibrametry versus biothesiometer provided correlations similar to sural nerve amplitude. Temperature thresholds correlated with vibration perception thresholds and sural nerve function. Monofilaments revealed pathology in only a few participants with type 2 diabetes.

Conclusions:

In an older group of people, vibration perception thresholds show a correlation similar to sural nerve amplitude on tactile and non-tactile surfaces. Measuring a vibration perception threshold on a tactile surface in type 2 diabetes provides no clear advantage over measuring it on the medial malleolus. In older type 2 diabetes subjects, both large and small diameter nerve fibers are affected.
Cost-effectiveness of assisted reproductive technologies in Saudi Arabia: Comparing in vitro fertilization with intrauterine insemination
Authors: Almaslami Faisal , Aljunid Syed Mohamed
Published: June 2020

Objectives:

The aim of this study was to compare the cost-effectiveness of in vitro fertilization and intrauterine insemination for the management of unexplained, mild male and mild female factor infertility in Saudi Arabia.

Methods:

A cost-effectiveness analysis from a societal perspective was conducted for couples seeking assisted reproductive technology services between January and December 2016 in one of the largest private hospitals in Saudi Arabia. Activity-Based Costing and Step-Down Costing methodologies with expert interviews were used to compute the costs of in vitro fertilization and intrauterine insemination. A total of 710 assisted reproductive technology procedures were observed by the embryologist in charge. The costs calculated included direct and indirect costs. A cost-effectiveness analysis and a Monte Carlo simulation probabilistic sensitivity analysis were conducted.

Results:

The average cost per in vitro fertilization and intrauterine insemination cycle was SR 27,360 (range: SR 19,541–29,618) and SR 10,143 (range: SR 7568–11,976), respectively, and the live birth rate per initiated in vitro fertilization and intrauterine insemination cycle was 20.7% and 7.9%, respectively, resulting in an average cost per live birth per in vitro fertilization and intrauterine insemination treatment cycle of SR 132,174 (95% confidence interval: 120,802–143,546) and SR 128,392 (95% confidence interval: 124,468–132,316), respectively. The incremental cost-effectiveness ratio was SR 134,508 per extra live birth implicit in a decision to treat with in vitro fertilization. Probabilistic sensitivity analysis confirms the robustness of the cost-effectiveness results.

Conclusion:

This study found that from a societal perspective, one in vitro fertilization treatment cycle was more cost-effective than intrauterine insemination in Saudi Arabia.
Gaming Algorithmic Hate-Speech Detection: Stakes, Parties, and Moves
Authors: Haapoja Jesse , Laaksonen Salla-Maaria , Lampinen Airi
Published: June 2020

A recent strand of research considers how algorithmic systems are gamed in everyday encounters. We add to this literature with a study that uses the game metaphor to examine a project where different organizations came together to create and deploy a machine learning model to detect hate speech from political candidates’ social media messages during the Finnish 2017 municipal election. Using interviews and forum discussions as our primary research material, we illustrate how the unfolding game is played out on different levels in a multi-stakeholder situation, what roles different participants have in the game, and how strategies of gaming the model revolve around controlling the information available to it. We discuss strategies that different stakeholders planned or used to resist the model, and show how the game is not only played against the model itself, but also with those who have created it and those who oppose it. Our findings illustrate that while “gaming the system” is an important part of gaming with algorithms, these games have other levels where humans play against each other, rather than against technology. We also draw attention to how deploying a hate-speech detection algorithm can be understood as an effort to not only detect but also preempt unwanted behavior.
“Good Social Media?”: Underrepresented Youth Perspectives on the Ethical and Equitable Design of Social Media Platforms
Authors: Brough Melissa , Literat Ioana , Ikin Amanda
Published: June 2020

This study investigates underrepresented youths’ perspectives on social media design and how these may inform the development of more ethical and equitable social media apps. In contrast to the tradition of universal design in the field of human–computer interaction, this study centers difference to investigate how users’ perspectives and expectations, shaped by their identities, help determine the affordances of social media and their ethical implications. Twenty-five in-depth interviews and youth-guided “think aloud” social media tours were carried out with a diverse range of young people from underrepresented groups. Findings illustrate how young people perceive and experience empowering and disempowering aspects of social media design. Interviewees expressed a palpable sense of underrepresentation in the digital technology design sector and noted several ways in which design elements of social media can exacerbate a sense of inadequacy. The negative implications of user profile design and popularity rating systems that encourage conformity were found to be of particular concern for low-income youth, youth of color, and other underrepresented groups. However, our findings also illuminate youth perspectives on how social media can sometimes serve as a tool to counter negative stereotypes and build social capital. The analysis includes concrete suggestions from underrepresented youth for more ethical and equitable social media design.
Intracranial subdural osteoma
Authors: Yang Yunna , Gu Zheng , Song Yinglun
Published: June 2020

Subdural osteomas are extremely rare benign neoplasms. Here, we report the case of a 35-year-old female patient with a right frontal and parietal subdural osteoma. The patient presented with a 2-year history of intermittent headache and fatigue. Computerized tomography (CT) scan showed a high-density lesion attached to the inner surface of the right frontal and parietal skull. Magnetic resonance imaging (MRI) demonstrated T1 hyperintensity and T2 hypointensity of the lesion. Intraoperatively, the hard mass was located in subdural space and attached to the dura mater. Histopathological examination revealed lamellated bony trabeculae lined by osteoblasts and the intertrabecular marrow spaces occupied by adipose tissue. The patient underwent neurosurgical resection and recovered without complication. Surgical excision is recommended to extract the symptomatic lesions with overlying dura mater.
Improving the design of heart failure care from the perspective of frontline providers and administrators: A qualitative case study of a large, urban health system
Authors: Marani Husayn , Baranek Hayley , Abrams Howard , McDonald Michael , Nguyen Megan , Posada Juan Duero , Ross Heather , Schofield Toni , Shaw James , Bhatia R Sacha
Published: June 2020

Background:

Heart failure patients often present with frailty and/or multi-morbidity, complicating care and service delivery. The Chronic Care Model (CCM) is a useful framework for designing care for complex patients. It assumes responsibility of several actors, including frontline providers and health-care administrators, in creating conditions for optimal chronic care management. This qualitative case study examines perceptions of care among providers and administrators in a large, urban health system in Canada, and how the CCM might inform redesign of care to improve health system functioning.

Methods:

Sixteen semi-structured interviews were conducted between August 2014 and January 2016. Interpretive analysis was conducted to identify how informants perceive care among this population and the extent to which the design of heart failure care aligns with elements of the CCM.

Results:

Current care approaches could better align with CCM elements. Key changes to improve health system functioning for complex heart failure patients that align with the CCM include closing knowledge gaps, standardizing treatment, improving interdisciplinary communication and improving patient care pathways following hospital discharge.

Conclusions:

The CCM can be used to guide health system design and interventions for frail and multi-morbid heart failure patients. Addressing care- and service-delivery barriers has important clinical, administrative and economic implications.
Tumor Lysis Syndrome in a Patient With Gastric Adenocarcinoma
Authors: Lingamaneni Prasanth , Desai Parth , Vennikandam Madhu Mathew , Moturi Krishna , Baranwal Anmol , Gupta Shweta
Published: June 2020

Tumor lysis syndrome (TLS) is a severe metabolic complication that usually occurs in patients with aggressive tumors who undergo treatment with chemotherapy. Traditionally, it was mainly associated with hematologic malignancies. However, over the past 4 decades, there have been increasing reports of TLS in solid tumors. We report a case of TLS in a patient with gastric cancer, as a complication of FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) chemotherapy. Our patient was a 48-year-old man with metastatic gastric adenocarcinoma who presented with altered mental status and slurred speech. On examination, he was confused and disoriented, but the rest of his examination, including vitals, was unremarkable. Laboratory findings on admission were significant for an elevated uric acid of 14.5 mg/dL, creatinine of 4.1 mg/dL, and phosphorus of 6.9 mg/dL. He had received his first cycle of FOLFOX chemotherapy 4 days prior to admission. The constellation of electrolyte abnormalities and the temporal relationship to chemotherapy led to the diagnosis of chemotherapy-induced TLS. He was treated with aggressive fluid repletion and rasburicase, following which the electrolyte derangements resolved, and he improved clinically. This case highlights the importance of early recognition of TLS in patients with gastric cancer. Initiation of early treatment can reduce the high morbidity and mortality associated with this oncologic emergency.
Non-Decision Power and Political Opportunity: Exposing Structural Barriers to Mobilization in Louisiana’s Coastal Restoration Conflict
Authors: Lipsman Jacob E.
Published: June 2020

Louisiana’s Comprehensive Master Plan for a Sustainable Coast is the state of Louisiana’s ambitious response to its continuing land loss crisis. Coastal restoration enjoys universal approval as a political issue in the state; however, controversy exists over a specific project type that seeks to divert sediment from the Mississippi River into surrounding marsh. While the State argues that sediment diversions are critical for land building, widespread concerns persist that changes to the estuary will generate economic hardship for coastal communities. This study investigates the structural challenges that diversion opponents have faced in their effort to mount effective resistance to the State’s sediment diversion projects. The study uses Lukes’ radical perspective of power to explore the ways in which the institutional configuration in Louisiana’s coastal zone produces an insular bureaucratic coalition that limits political opportunity for excluded groups to affect the coastal planning process. This article argues that this coalition, and the State and the energy industry in particular, has been able to leverage non-decision power and ideology to inhibit mobilization against the diversion component of the coastal master plan.
The User Experience on a 3-Dimensional Heads-Up Display for Vitreoretinal Surgery Across All Members of the Health Care Team: A Survey of Medical Students, Residents, Fellows, Attending Surgeons, Nurses, and Anesthesiologists
Authors: Shoshany Talia N. , Agranat Joshua S. , Armstrong Grayson , Miller John B.
Published: June 2020

Purpose:

This work assesses the educational use of a 3-dimensional (3D) heads-up visualization system for vitreoretinal surgery.

Methods:

A cross-sectional survey was performed among 18 medical students, 18 residents, 7 VR fellows, 6 nurses, 4 anesthesiologists, and 3 surgeons on their experience with the Ngenuity 3D Visualization System (TrueVision and Alcon) compared with the standard microscope.

Results:

Most medical students (88%) reported better identification of surgical landmarks; 63% ranked the Ngenuity as their preferred method of learning (vs microscope or 2-dimensional display). Residents reported a superior understanding of anatomy (69%), an increased ability to ask questions (63%), and improved ergonomics (94%). Epiretinal membrane peel, internal limiting membrane peel, and core vitrectomy were most enhanced (69% to 77%) for residents. Fellows’ experience with trocar placement, vitrectomy, and oil/gas insertion was the same as before (67% to 100%), whereas endolaser and closing were worse (67% to 100%). Regarding autonomy, 83% of fellows reported no change, whereas 17% reported increased levels. Nurses were better able to track case progress (67%) and anticipate which tools were needed (50%). All anesthesiologists reported the same or worse engagement in cases, noting it was difficult to switch between the 3D screen and the anesthesia equipment. All surgeons reported a better awareness of trainees in the room and an improved ability to point out landmarks; 67% reported being more comfortable with resident and fellow autonomy.

Conclusions:

The Ngenuity is most helpful to students and residents. Integrating 3D displays into the surgical curriculum is beneficial, with care to ensure nurse and anesthesiologist satisfaction.
The effects of changing meteorological parameters on fatal aortic catastrophes
Authors: Szilágyi Brigitta , Berczeli Márton , Lovas Attila , Oláh Zoltán , Törő Klára , Sótonyi Péter
Published: June 2020

Background

Over the span of the last decade, medical research has been increasingly putting greater emphasis on the study of meteorological parameters due to their connection to cardiovascular diseases. The main goal of this study was to explore the relationship between fatal aortic catastrophes and changes in atmospheric pressure and temperature.

Methods

We used a Cox process model to quantify the effects of environmental factors on sudden deaths resulting from aortic catastrophes. We used transfer entropy to draw conclusion about the causal connection between mortality and meteorological parameters. Our main tool was a computer program which we developed earlier in order to evaluate the relationship between pulmonary embolism mortality and weather on data sets comprised of aortic aneurysm (AA) and acute aortic dissection (AAD) cases, where one of these two medical conditions had led to fatal rupture of the aorta. Our source for these cases were the autopsy databases of Semmelweis University, from the time period of 1994 to 2014. We have examined 160 aneurysm and 130 dissection cases in relation to changes in meteorological parameters. The algorythm implemented in our program is based on a non-parametric a Cox process model. It is capable of splitting slowly varying unknown global trends from fluctuations potentially caused by weather. Furthermore, it allows us to explore complex non-linear interactions between meteorological parameters and mortality.

Results

Model measures the relative growth of the expected number of events on the nth day caused by the deviation of environmental parameters from its mean value. The connection between ruptured aortic aneurysms (rAA) and changes in atmospheric pressure is more significant than their connection with mean daily temperatures. With an increase in atmospheric pressure, the rate of rAA mortality also increased. The effects of meteorological parameters were weaker for deaths resulting from acute aortic dissections (AAD), although low mean daily temperatures increased the intensity of occurrence for AAD-related deaths.

Conclusion

The occurrence rate of fatal aortic catastrophes showed a slight dependence on the two examined parameters within our groups.
Definitions of poor outcome after total knee arthroplasty: an inventory review
Authors: te Molder Malou E. M. , Smolders José M. H. , Heesterbeek Petra J. C. , van den Ende Cornelia H. M.
Published: June 2020

Background

A significant proportion of patients experiences poor response (i.e. no or little improvement) after total knee arthroplasty (TKA) because of osteoarthritis. It is difficult to quantify the proportion of patients who experiences poor response to TKA, as different definitions of, and perspectives (clinician’s and patient’s) on poor response are being used. The aim of this study was therefore to review the literature and summarize definitions of poor response to TKA.

Methods

A systematic search was performed to identify and review studies that included dichotomous definitions of poor outcome after primary TKA. The type, amount and combination of domains (e.g. functioning), outcome measures, type of thresholds (absolute/relative, change/cut-off), values and moments of follow-up used in definitions were summarized.

Results

A total of 47 different dichotomous definitions of poor response to TKA were extracted from 2163 initially identified studies. Thirty-six definitions incorporated one domain, seven definitions comprised two domains and four definitions comprised three domains. Eight different domains were used in identified definitions: pain, function, physical functioning, quality of life (QoL), patient satisfaction, anxiety, depression and patient global assessment. The absolute cut-off value was the most common type of threshold, with large variety in value and timing of follow-up.

Conclusions

Our inventory review shows that definitions of poor response to TKA are heterogeneous. Our findings stresses the need for an unambiguous definition of poor response to draw conclusions about the prevalence of poor-responders to TKA across hospitals and countries, and to identify patients at risk.
Biomechanical evaluation of autologous bone-cage in posterior lumbar interbody fusion: a finite element analysis
Authors: Zhu Haodong , Zhong Weibin , Zhang Ping , Liu Xiaoming , Huang Junming , Liu Fatai , Li Jian
Published: June 2020

Background

An autologous bone-cage made from the spinous process and laminae might provide a stability in posterior lumbar interbody fusion (PLIF) close that of the traditional-cage made of polyetheretherketone (PEEK) or titanium. The biomechanical effect of autologous bone-cages on cage stability, stress, and strains, and on the facet contact force has not been fully described. This study aimed to verify whether autologous bone-cages can achieve similar performance as that of PEEK cages in PLIF by using a finite element analysis.

Methods

The finite element models of PLIF with an autologous bone-cage, a titanium cage, and a PEEK cage were constructed. The autologous bone-cage was compared with the titanium and PEEK cages. The mechanical properties of the autologous bone-cage were obtained through mechanical tests. The four motion modes were simulated. The range of motion (ROM), the stress in the cage-end plate interface, and the facet joint force (FJF) were compared.

Results

The ROM was increased at adjacent levels but decreased over 97% at the treated levels, and the intradiscal pressure at adjacent levels was increased under all conditions in all models. The FJF disappeared at treated levels and increased under extension, lateral bending, and lateral rotation in all models. The maximum stress of the cage-endplate interface was much lower in the autologous bone-cage model than those in the PEEK and titanium cage models.

Conclusions

In a finite model of PLIF, the autologous bone-cage model could achieve stability close that of traditional titanium or PEEK cages, reducing the risk of subsidence.
The journey of aftercare for Australia’s First Nations families whose child had sustained a burn injury: a qualitative study
Authors: Coombes Julieann , Hunter Kate , Mackean Tamara , Ivers Rebecca
Published: June 2020

Background

Access to ongoing multidisciplinary healthcare services for children who have sustained a burn injury is critical for optimal recovery. This paper reports on barriers and facilitators to culturally safe and appropriate burn aftercare for Australia’s First Nations children. The voices of First Nations families whose child had sustained a serious burn are central to this paper.

Methods

Eighteen families, which consisted of 59 family members, of children younger than 16 years who had sustained a burn injury were asked to describe their own journey in accessing appropriate burn aftercare. Interviews were conducted in the families’ homes using yarning (dialogue) and Dadirri (deep listening) as Indigenous research methods. Data was gathered in South Australia, the Northern Territory, Queensland and New South Wales, Australia. Using a cyclic process, transcripts and emerging themes were sent back to participants, and a collaborative approach was used to conduct the final analysis.

Results

Lack of culturally safe communication between service providers and family members, in addition to institutionalised racism, were found to be the major barriers to accessing healthcare services. Distance to medical treatment also impacted children’s access to aftercare. Involvement of First Nations Health Workers and/or Liaison Officers working with health providers, the child and family members, was found to be an important facilitator in reducing miscommunication and alleviating fear and anxiety in the children and families.

Conclusion

There are significant barriers to access to aftercare following a serious burn including miscommunication, lack of cultural safety, distance to medical treatment and racism. However, these can be largely mitigated when First Nations families have input into the care received and the care needed for ongoing burn care to be effective and are supported by First Nations Health/Liaison Officers support.
High variability in bodyweight is associated with an increased risk of atrial fibrillation in patients with type 2 diabetes mellitus: a nationwide cohort study
Authors: Lee Hyun-Jung , Choi Eue-Keun , Han Kyung-Do , Kim Da Hye , Lee Euijae , Lee So-Ryoung , Oh Seil , Lip Gregory Y. H.
Published: June 2020

Background

Bodyweight variability is a risk factor for atrial fibrillation (AF). We aimed to examine the relationship between bodyweight variability and the risk of AF in patients with type 2 diabetes mellitus (DM), and whether this relationship was affected by baseline body mass index (BMI), weight change, or advanced diabetic stage.

Methods

A nationwide population-based cohort of 670,797 patients with type 2 DM from the Korean National Health Insurance Service database without a history of AF and with ≥ 3 measurements of bodyweight over a 5-year period were followed up for AF development. Intra-individual bodyweight variability was calculated using variability independent of mean, and high bodyweight variability was defined as the quintile with the highest variability with the lower four quintiles as reference.

Results

During a median of 7.0 years of follow-up, 22,019 patients (3.3%) newly developed AF. After multivariate adjustment, those in the highest quintile of bodyweight variability showed a higher risk of incident AF (HR 1.16, 95% CI 1.12–1.20) compared to those in the lower 4 quintiles with reference bodyweight variability, irrespective of baseline BMI group and direction of overall weight change. This association was greater in magnitude in subjects with lower BMI, those on insulin, and those with a DM duration of greater than 5 years. In sensitivity analyses, high bodyweight variability was consistently associated with AF development using other indices of variability and adjusting for glycemic variability.

Conclusions

High variability in bodyweight was associated with AF development, independently of traditional cardiovascular risk factors and baseline BMI. This association was stronger in underweight patients and with advanced diabetic stage. Weight fluctuation may interfere with the beneficial effects of weight loss and should be avoided when possible in weight control regimens for DM patients.
Non-alcoholic steatohepatitis and progression of carotid atherosclerosis in patients with type 2 diabetes: a Korean cohort study
Authors: Lee Hyeok-Hee , Cho Yongin , Choi Young Ju , Huh Byung Wook , Lee Byung-Wan , Kang Eun Seok , Park Seok Won , Cha Bong-Soo , Lee Eun Jig , Lee Yong-ho , Huh Kap Bum
Published: June 2020

Background

There is increasing concern regarding cardiovascular risk in individuals with non-alcoholic fatty liver disease. This study was conducted to evaluate whether hepatic steatosis with or without fibrosis is associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.

Methods

From a longitudinal cohort, we enrolled 1120 patients with type 2 diabetes who underwent repeated carotid artery ultrasonography every 1–2 years. Ultrasonographic findings at baseline and after 6–8 years were compared. Presence of hepatic steatosis was mainly assessed by abdominal ultrasonography; patients with hepatic steatosis were further evaluated for hepatic fibrosis according to fibrosis-4 index. We investigated the association between liver status and atherosclerosis progression.

Results

Of 1120 patients, 636 (56.8%) were classified as having hepatic steatosis at baseline. After 6–8 years, 431 (38.5%) showed atherosclerosis progression. Hepatic steatosis was significantly associated with atherosclerosis progression (adjusted odds ratio[AOR]: 1.370, 95% CI 1.025–1.832; p < 0.05). Among patients with hepatic steatosis, only individuals with fibrosis showed significant association with atherosclerosis progression (AOR: 1.615, 95% CI 1.005–2.598; p < 0.05). The association between hepatic fibrosis and atherosclerosis progression was significant in all metabolic subgroups regardless of age, body mass index, presence of metabolic syndrome, or insulin sensitivity (all p < 0.05). Furthermore, subjects with hepatic steatosis & fibrosis and ≥ 4 components of metabolic syndrome criteria showed markedly increased risk of atherosclerosis progression (AOR: 2.430, 95% CI 1.087–5.458; p < 0.05).

Conclusions

Hepatic steatosis with fibrosis is independently associated with the progression of carotid atherosclerosis in patients with type 2 diabetes.
Rationale and design of an investigator-initiated, multicenter, prospective open-label, randomized trial to evaluate the effect of ipragliflozin on endothelial dysfunction in type 2 diabetes and chronic kidney disease: the PROCEED trial
Authors: Tanaka Atsushi , Shimabukuro Michio , Okada Yosuke , Sugimoto Kazuhiro , Kurozumi Akira , Torimoto Keiichi , Hirai Hiroyuki , Node Koichi ,   the PROCEED trial investigators
Published: June 2020

Background

Type 2 diabetes (T2D) is associated with renal impairment and vascular endothelial dysfunction. Therefore, this pathological connection is an important therapeutic target. Recent cardiovascular and renal outcome trials demonstrated that sodium glucose cotransporter 2 inhibitors (SGLT2is) consistently reduced the risks of cardiovascular and renal events and mortality in patients with T2D and various other background risks including chronic kidney disease (CKD). However, the precise mechanisms by which SGLT2is accords these therapeutic benefits remain uncertain. It is also unknown whether these SGLT2is-associated benefits are associated with the amelioration of endothelial dysfunction in patients with T2D and CKD.

Methods

The PROCEED trial is an investigator-initiated, prospective, multicenter, open-label, randomized-controlled trial. The target sample size is 110 subjects. After they furnish informed consent and their endothelial dysfunction is confirmed from their decreased reactive hyperemia indices (RHI), eligible participants with T2D (HbA1c, 6.0–9.0%) and established CKD (30 mL/min/1.73 m2 ≤ estimated glomerular filtration ratio [eGFR] < 60 and/or ≥ urine albumin-to-creatinine ratio 30 mg/g Cr) will be randomized (1:1) to receive either 50 mg ipragliflozin daily or continuation of background treatment (non-SGLT2i). The primary endpoint is the change in RHI from baseline after 24 weeks. To compare the treatment effects between groups, the baseline-adjusted means and their 95% confidence intervals will be estimated by analysis of covariance adjusted for HbA1c (< 7.0% or ≥ 7.0%), age (< 70 y or ≥ 70 y), RHI (< 1.67 or ≥ 1.67), eGFR (< 45 mL/min/1.73 m2 or ≥ 45 mL/min/1.73 m2), and smoking status. Prespecified responder analyses will be also conducted to determine the proportions of patients with clinically meaningful changes in RHI at 24 weeks.

Discussion

PROCEED is the first trial to examine the effects of ipragliflozin on endothelial dysfunction in patients with T2D and CKD. This ongoing trial will establish whether endothelial dysfunction is a therapeutic target of SGLT2is in this population. It will also provide deep insights into the potential mechanisms by which SGLT2is reduced the risks of cardiovascular and renal events in recent outcome trials.

Trial registration Unique Trial Number, jRCTs071190054 (https://jrct.niph.go.jp/en-latest-detail/jRCTs071190054).