bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of Basal Ganglia and Thalamic Inflammation in Children With Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection and Tourette Syndrome
Authors: Kumar Ajay , Williams Mitchel T. , Chugani Harry T.
Published: August 2014

We applied PET scanning with 11C-[R]-PK11195 (PK) to evaluate neuroinflammatory changes in basal ganglia and thalamus in children with clinically diagnosed pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) and Tourette syndrome. Seventeen children with PANDAS (mean age: 11.4 ± 2.6 years; 13 males), 12 with Tourette syndrome (mean age: 11.0 ± 3.0 years; 10 males), and 15 normal adults (mean age: 28.7 ± 7.9 years; 8 males) underwent dynamic PK PET imaging and binding potential, a measure of ligand-TSPO receptor (expressed by activated microglia) binding, was calculated for basal ganglia and thalamus. Binding potential values, suggesting underlying activated microglia-mediated neuroinflammation, were found to be increased in bilateral caudate and bilateral lentiform nucleus in the PANDAS group and in bilateral caudate nuclei only in the Tourette syndrome group, compared to control group. These differences in the pattern and extent of neuroinflammation also signify a possible difference in pathophysiological etiology between PANDAS and Tourette syndrome patients.
Efficacy and Safety of Using L‐cysteine as a Catheter‐Clearing Agent for Nonthrombotic Occlusions of Central Venous Catheters in Children
Authors: Pai Vinita B. , Plogsted Steven
Published: August 2014

Critically ill pediatric patients, especially in the intensive care unit, receive multiple medications and have a higher risk of central venous catheter (CVC) occlusion. If an occlusion occurs immediately after the administration of multiple medications or incompatible medications, either an acidic solution such as 0.1 N hydrochloric acid (HCl) or a basic solution of 1 mEq/mL sodium bicarbonate or 0.1 N sodium hydroxide can be used. However, compounding and storing of 0.1 N HCl has become more complex due to USP <797> guidelines for sterile compounding, and an alternative is needed. We report a series of cases in which L‐cysteine was used instead of HCl to clear CVCs occluded due to administration of multiple medications. L‐cysteine is a commercially available, sterile solution with a pH of 1–2.5. CVC occlusion was resolved in 10 of the 16 episodes in 13 patients. Two of the 16 occlusions were phenytoin related and would not have responded. An L‐cysteine dose of 50 mg was used during 10 of the 16 episodes, 100 mg during 5 episodes, and 25 mg during 1 episode. A correlation between catheter clearance and dose was not observed. Occlusion resolution due to L‐cysteine was not correlated to the prior use of tissue plasminogen activator. Metabolic acidosis, adverse effects, or damage to the catheters due to L‐cysteine were not observed. On the basis of this limited experience, we propose L‐cysteine as an effective alternative to 0.1 N HCl for clearing CVC occlusions caused by drugs with an acidic pKa.
Microbial Contamination of Enteral Feeding Products in Thermoneutral and Hyperthermal ICU Environments
Authors: Perry Jeffery , Stankorb Susan M. , Salgueiro Marybeth
Published: August 2014

Background: Temperature is known to affect bacterial growth, but current safety recommendations for enteral formula are based on studies conducted in thermoneutral environments, which are not representative of select burn intensive care units (ICUs) that are kept therapeutically hyperthermal. This project evaluated microbial growth in 3 enteral feeding systems: closed, open, and open with modular additives (modular tube feeding [MTF]) exposed to 2 different environments. Procedures: Product for each of the 3 systems was prepared and hung in both a thermoneutral (23.3°C) and a hyperthermal (32.5°C) ICU room. At baseline, 4 hours, and 8 hours, samples were plated and incubated overnight and the number of colony‐forming units (CFUs) counted. Findings: In the thermoneutral and hyperthermal environments, there was no evidence of microbial growth in the open or closed feeding systems at any time point. The MTF exhibited baseline contamination with a median of 10 CFUs (95% CI, 8–16) and significant growth over time to 54 CFUs (95% CI, 20–230) by 8 hours in the thermoneutral setting. In the hyperthermal environment, the MTF showed baseline contamination of 390 CFUs (95% CI, 40–1600) and significant growth over time, with 30% of samples exhibiting contamination levels exceeding Food and Drug Administration standards by 4 hours and CFUs being too numerous to count by 8 hours. Conclusion: CFUs in enteral formula did not differ between open and closed feeding systems in either environment for up to 8 hours; however, the addition of modulars to open systems may result in an unacceptable risk of contamination in hyperthermal environments.
Intake and Macronutrient Content of Human Milk Given to Extremely Preterm Infants
Authors: Stoltz Sjöström Elisabeth , Öhlund Inger , Tornevi Andreas , Domellöf Magnus
Published: August 2014

Background:

Human milk (HM) is the preferred basis of nutrition for infants, including those born prematurely. Information on HM macronutrient content is necessary to optimize nutritional support of preterm infants.

Objectives:

This study aimed to describe the types and amounts of enteral feeds given to Swedish extremely preterm infants during hospitalization and to investigate the energy and macronutrient contents in HM given to these infants.

Methods:

A population-based study of Swedish extremely preterm infants (n = 586) born before 27 gestational weeks was conducted. Data on ingested volumes of different milk during hospitalization and analyses of macronutrient content in HM samples were obtained from hospital records. Nutritional content of HM was determined by mid-infrared spectrophotometry analysis.

Results:

During the first 4 weeks of life, 99% of the infants were exclusively fed HM, and at 4 weeks of life, 70% of the infants received only mother’s own milk (MOM). Nutritional content in 821 MOM samples was analyzed. Protein content in MOM decreased significantly from 2.2 to 1.2 g/100 mL during the first 112 postpartum days, whereas fat and energy content were highly variable within and between MOM samples. In addition, 354 samples of donor milk were analyzed. Content of protein, fat, and energy in pooled donor milk (n = 129) was lower compared to single donor milk.

Conclusion:

Swedish extremely preterm infants receive MOM to a large extent during hospitalization. Protein, carbohydrates, and energy in MOM changed significantly with time. Weekly analyses of MOM during the first month of lactation would allow more individualized nutritional support for these vulnerable infants.
Student Loans, Debtfare and the Commodification of Debt: The Politics of Securitization and the Displacement of Risk
Authors: Soederberg Susanne
Published: August 2014

Student loans represent the largest and fastest growing segment of unsecured consumer debt in the US; yet, the literature is silent on the power relations of the industry. Who benefits from the expansion and reproduction of student debt to low-income students, and how? To address these questions, I explore two key features of the industry: the high level of upstream repackaging of student loan asset-backed securities (SLABS) and the high default rates. By historically contextualizing SLABS, I reveal the intrinsic political nature of the processes surrounding the commodification of debt. Through the temporal displacements inherent in the commodification of debt (i.e. accelerating the repayment schedule for lenders), SLABS serve to reduce financial risk for private lenders, whilst relocating the social dimensions of risk onto student debtors. The neoliberal state plays an integral role in attempting to mediate, discipline, and depoliticize the social fallout involved in the relocation of risk, primarily through regulatory reforms.
Experimental modeling and multiobjective optimization of electrical discharge drilling of aerospace superalloy material
Authors: Yadav Umacharn Singh , Yadava Vinod
Published: August 2014

In this article, an attempt has been made to optimize the selected input process parameters for material removal rate ( MRR), average surface roughness ( Ra) and average circularity ( Ca) of the hole made by electrical discharge machining in a nickel-based superalloy material especially used in aerospace applications. The concept of twist drill is introduced by attaching a self-developed setup on sinking an electrical discharge machining machine by replacing the actual tool holder of the electrical discharge machining machine and terming it as electrical discharge drilling. Also application of an altogether new approach of hybrid methodology comprising the Taguchi methodology coupled with response surface methodology for modeling and response surface methodology coupled with principal component analysis–based grey relational analysis for multiobjective optimization of process parameters is used. In this application of hybrid methodology, at the first stage, optimum level of process parameters is determined by the Taguchi methodology and used as the central value in response surface methodology for developing the second-order response model, and at the second stage, taking the reference of developed central composite rotatable design matrix of response surface methodology model, grey relational analysis with principal component analysis is applied to determine the grey relational grade for further determination of the optimum level of process parameter. It is observed that with the use of present hybrid approach in this experimental study, an appreciable improvement in MRR by 82.27%, Ra by 39.28% and Ca by 25.00% is achieved, which confirm the viability of using it with future scope for researchers.
Reliability analysis of a repairable system with geometric reneging and threshold-based recovery policy
Authors: Yang Dong-Yuh , Wu Zong-Ru , Tsou Ching-Shih
Published: August 2014

This article attempts to investigate the reliability measures of a repairable system with [Formula: see text] identical operating units, [Formula: see text] standby units, and a repairman. The repairman is subject to breakdowns and operates threshold-based recovery policy. As soon as the repairman breaks down, the repair does not start immediately until the number of failed units in the system reaches a specified threshold value [Formula: see text]. When the repairman is working or broken down, failed units arriving for maintenance may renege and decide sequentially whether to leave the queue or not. The failed times of operating and standby units, maintenance times and reneging time of failed units, and breakdown and repair times of the repairman are all assumed to be exponential distributions. We develop the system reliability and mean time to system failure. Through numerical results, sensitivity analysis is carried out to assess the impact of various system parameters on the system reliability and mean time to system failure. Finally, an application example is given to evaluate the reliability measures of an electric power system.
Differentiated pricing policy for new, remanufactured and refurbished products
Authors: Gao Pan , Wang Xu , Jing Yi , Deng Lei
Published: August 2014

An original equipment manufacturer is studied, which makes new products and re-products (remanufactured and refurbished products) simultaneously. Facing the product diversity, the original equipment manufacturer needs to choose differentiated prices. The monopoly environment is analyzed in single-period and two-period (with invariable market and then variable market) planning horizons, and the optimal pricing strategy for the original equipment manufacturer is characterized. The results of the single-period planning horizon show that remanufactured products not only grab some market share from new and refurbished ones to form “bank run” but also maintain the total number constant and keep the profit increasing, while the refurbished products do it to remanufactured ones but not new ones and make the market growing and the profit increasing. Then, the results of the two-period planning horizon with the invariable market show that there is still “bank run” between new products and re-products. And in the variable market, as the market growth rate increases, the profit and the proportion of re-products increase simultaneously.
Cutting force–based analysis and correlative observations on the tool wear in diamond turning of single-crystal silicon
Authors: Wang Chao , Cheng Kai , Nelson Nico , Sawangsri Worapong , Rakowski Richard
Published: August 2014

The condition of a cutting tool is an important factor to ultraprecision machining processes. Tool wear has a strong influence on the cutting forces, resulting in poor surface roughness and dimensional tolerance of the workpiece, particularly in ultraprecision machining hard brittle materials. This article presents a cutting force–based analysis and correlative observations on diamond tool wear in machining of single-crystal silicon. The Daubechies wavelet (dB3, level 4) was employed to correlate standard deviation of magnitude on the decomposed cutting and radial forces with initial diamond tool wear. Moreover, the flank wear and the micro-fracture were observed using scanning electron microscopy on the respective flank face and rake face of the diamond cutting tool used. No crater wear was detected on the rake face of the diamond tool until cutting distance of up to 9 km.
Blue Intensity for dendroclimatology: The BC blues: A case study from British Columbia, Canada
Authors: Wilson Rob , Rao Rohit , Rydval Miloš , Wood Cheryl , Larsson Lars-Åke , Luckman Brian H
Published: August 2014

Maximum latewood density (MXD) is a strong proxy of summer temperatures. Despite this, there is a paucity of long MXD chronologies in the Northern Hemisphere, which limits large-scale tree-ring-based reconstructions of past temperature which are dominated by ring-width (RW) data – a weaker temperature proxy at inter-annual time-scales. This paucity likely results from the relative expense of measuring MXD and the lack of laboratories with the facilities to measure it. Herein, we test the ability of a relatively new, less expensive, tree-ring parameter, Blue Intensity (BI), to act as a surrogate parameter for MXD. BI was measured on Engelmann spruce samples from British Columbia where MXD had previously been measured to allow direct comparison between the two parameters. Signal strength analyses indicate that 8 MXD series were needed to acquire a robust mean chronology while BI needed 14. Utilising different detrending methods and parameter choices (RW + MXD vs RW + BI), a suite of reconstruction variants was developed. The explained variance from the regression modelling (1901–1995) of May–August maximum temperatures ranged from 52% to 55%. Validation tests over the earlier 1870–1900 period could not statistically distinguish between the different variants, although spectral analysis identified more lower frequency information extant in the MXD-based reconstructions – although this result was sensitive to the detrending method used. Ultimately, despite the MXD-based reconstruction explaining slightly more of the climatic variance, statistically robust reconstructions of past summer temperatures were also derived using BI. These results suggest that there is great potential in utilising BI for dendroclimatology in place of MXD data. However, more experimentation is needed to understand (1) how well BI can capture centennial and lower frequency information and (2) what biases may result from wood discolouration, either from species showing a distinct heartwood/sapwood boundary or from partly decayed sub-fossil samples.
Holocene and ‘Little Ice Age’ glacial activity in the Marboré Cirque, Monte Perdido Massif, Central Spanish Pyrenees
Authors: García-Ruiz José M , Palacios David , de Andrés Nuria , Valero-Garcés Blas L , López-Moreno Juan I , Sanjuán Yasmina
Published: August 2014

The Marboré Cirque, which is located in the southern Central Pyrenees on the north face of the Monte Perdido Peak (42°40′0″N; 0.5°0″W; 3355 m), contains a wide variety of Holocene glacial and periglacial deposits, and those from the ‘Little Ice Age’ (‘LIA’) are particularly well developed. Based on geomorphological mapping, cosmogenic exposure dating and previous studies of lacustrine sediment cores, the different deposits were dated and a sequence of geomorphological and paleoenvironmental events was established as follows: (1) The Marboré Cirque was at least partially deglaciated before 12.7 kyr BP. (2) Some ice masses are likely to have persisted in the Early Holocene, although their moraines were destroyed by the advance of glaciers during the Mid Holocene and ‘LIA’. (3) A glacial expansion occurred during the Mid Holocene (5.1 ± 0.1 kyr), represented by a large push moraine that enclosed a unique ice mass at the foot of the Monte Perdido Massif. (4) A melting phase occurred at approximately 3.4 ± 0.2 and 2.5 ± 0.1 kyr (Bronze/Iron Ages) after one of the most important glacial advances of the Neoglacial period. (5) Another glacial expansion occurred during the Dark Age Cold Period (1.4–1.2 kyr), followed by a melting period during the Medieval Climate Anomaly. (6) The ‘LIA’ represented a clear stage of glacial expansion within the Marboré Cirque. Two different pulses of glaciation were detected, separated by a short retraction. The first pulse occurred most likely during the late 17th century or early 18th century (Maunder Minimum), whereas the second occurred between 1790 and ad 1830 (Dalton Minimum). A strong deglaciation process has affected the Marboré Cirque glaciers since the middle of the 19th century. (7) A large rock avalanche occurred during the Mid Holocene, leaving a chaotic deposit that was previously considered to be a Late Glacial moraine.
Role of forest fires in Holocene stand-scale dynamics in the unmanaged taiga forest of northwestern Russia
Authors: Kuosmanen Niina , Fang Keyan , Bradshaw Richard HW , Clear Jennifer L , Seppä Heikki
Published: August 2014

Fossil pollen, conifer stomata, and charcoal records for the last 10,000 years were studied from three small hollow sites (Larix Hollow, Mosquito Hollow, and Olga Hollow) located at the modern western range limit of Siberian larch ( Larix sibirica) in northwestern Russia to investigate the role of forest fires in stand-scale dynamics of taiga vegetation. Wavelet coherence analysis was utilized to reveal the significance of fire on the vegetation composition at different timescales by assessing the phase and strength of the relationship between forest fires and most common boreal tree taxa in a time–frequency window. Pollen and stomata data show that all of the modern-day common tree taxa, including Norway spruce ( Picea abies) and Siberian larch, have been present in the study region since the early Holocene. The absence of charcoal layers at Mosquito Hollow suggests that this site has acted as a fire-free refugium with continuous dominance of spruce throughout the Holocene. Meanwhile, the Larix Hollow record indicates frequent local fire events and as a consequence, a more variable tree species composition. The wavelet coherence results show that the impact of forest fires on vegetation varies from short-term (<200-year periods) changes in individual tree taxa to long-term (400–800 years) changes in forest composition, such as the expansion of spruce population after local high-intensity fires around 7500–7000 cal. yr BP and the increase in abundance of birch and alder during periods of high fire frequency. Our results suggest that Holocene fire histories can be markedly different within a small geographical area, demonstrating the importance of site-specific factors in the local fire regime in the unmanaged taiga forest.
Bog burst in the eastern Netherlands triggered by the 2.8 kyr BP climate event
Authors: van Geel Bas , Heijnis Henk , Charman Dan J , Thompson Gareth , Engels Stefan
Published: August 2014

The nature and cause of the so-called 2.8 kyr BP event have been a subject of much debate. Peat sequences have provided much of the evidence for this event, but the process link between climate and peatland response is not well understood. Multiproxy, high-resolution analysis of a core from Bargerveen in the eastern Netherlands based on pollen, non-pollen palynomorphs, testate amoebae and geochemistry identified an abrupt shift from relatively dry to extremely wet conditions. Radiocarbon-based wiggle-match dating (WMD) and biostratigraphy based on the pollen record show that this shift in local hydrology occurred around 2800 cal. yr BP. We interpret an erosional hiatus lasting up to 950 years immediately prior to this, as the effect of a bog burst after excessive rainfall. This phenomenon was not limited to our sampling location but occurred over a large part of the former Bargerveen. Peat at the hiatus contains microfossils that reflect temporary eutrophication as a consequence of local fires and secondary decomposition because of increased drainage after the erosion event. Our data show how detailed multiproxy analyses can elucidate the past response of peatlands to changing climate and suggest that the climatic change in northwest Europe at this time caused major non-linear disruption to these ecosystems.
Academic vascular unit collaboration with advertising agency yields higher compliance in screening for abdominal aortic aneurysm
Authors: Zarrouk Moncef , Gottsäter Anders , Malina Martin , Holst Jan
Published: August 2014

To improve compliance with abdominal aortic aneurysm (AAA) screening in low compliance areas, individually tailored invitations were developed in collaboration with a professional advertising agency. Compliance increased in two intervention municipalities from 71.4% in 2010–2012 to 78.1% in 2013 (p = 0.025), and was then higher [odds ratio 1.7; 95% confidence interval 1.1–2.6; p = 0.013] than in two control municipalities in which compliance was unchanged (417/552 [75.5%] in 2010–12 and 122/180 [67.8%] in 2013). Compliance with AAA-screening can be increased by collaboration with a professional advertising agency, albeit at a comparably high cost.
Translating Advances in Cardiogenetics Into Effective Clinical Practice
Authors: Silverstein Louise Bordeaux , Stolerman Marina , Hidayatallah Nadia , McDonald Thomas , Walsh Christine A. , Paljevic Esma , Cohen Lilian L. , Marion Robert W. , Wasserman David , Dolan Siobhan M.
Published: August 2014

In this article we describe a qualitative research study in which we explored individuals’ subjective experiences of both genetic testing and cardiogenetic disorders. Using a grounded theory approach, we coded and analyzed interview and focus group transcripts from 50 participants. We found that just under half of the participants who received their diagnosis during the study reported difficulty understanding information about both the purpose of genetic testing and their cardiac disease. A high level of anxiety about genetic testing and cardiac symptoms exacerbated individuals’ cognitive confusion. Participants reported both positive and negative interactions with the medical community, depending on health care professionals’ knowledge of cardiogenetic disorders. Overall, participants expressed a range of attitudes—positive, negative, and ambivalent—toward genetic testing. We conclude with a discussion of the barriers to achieving effective clinical care for genetic conditions and offer suggestions for improving collaborative decision making between physicians and patients.
Barriers to Employment of African American Professionals in Hospice
Authors: Munoz Bridget , Garrett Elizabeth , Reese Dona , Roberts Meaghan
Published: August 2014

A major barrier to African American hospice utilization is the lack of African American hospice professionals. This qualitative study with 10 female African American social work students in a Midwestern university explored whether the participants were interested in hospice employment. Results provided information about reasons for the overall lack of diversity in hospice, reasons for the lack of African American staff in hospice, reasons for the lack of African American patients in hospice, and avenues toward knowledge about hospice by African American professionals. Barriers to African American employment included a lack of hospice content in social work education, differences between African American cultural and religious beliefs and hospice philosophy, and that the lack of African American hospice patients resulted in a lack of desire for employment in hospice. Strategies for recruiting and retaining African American hospice social workers are proposed.
Tall Cell Variant of Papillary Thyroid Carcinoma in Children
Authors: Collini Paola , Massimino Maura , Mattavelli Franco , Barisella Marta , Podda Marta , Rosai Juan
Published: August 2014

Papillary thyroid carcinoma (PTC), tall cell (TC) variant, is exceptional in children. In adults it represents about 20% of PTCs, featuring a high-risk neoplasm, with a 4-fold risk of relapse and a 20-fold relapse-related risk of death. Out of 42 cases of pediatric PTCs, we found 3 cases of PTC-TC (7%) with clinical data at onset and follow-up up to June 2014. They were 3 females aged 13, 15, and 15 years. Local extrathyroid extension was present in 2 cases. Neither nodal nor distant metastases were found. Two patients underwent hemithyroidectomy and 1 patient a total thyroidectomy, followed in all cases by life-long suppressive hormonal therapy. On follow-up, the patients were alive and well after 29, 24, and 29 years, respectively. The rarity of PTC-TC in children was confirmed. The behavior was indolent after a median follow-up of about 29 years, following treatment with hemithyroidectomy in 2 cases and controlled by suppressive hormonal therapy. The results of this series, albeit small, suggest that TC morphology in PTC does not carry the same negative prognostic significance in children as it does in adults. A conservative approach should therefore be considered for these ‘pediatric type’ cases of this tumor type.
Comparison of Continuous Nerve Block Versus Patient-Controlled Analgesia for Postoperative Pain and Outcome After Talar and Calcaneal Fractures
Authors: Luiten Willem E. , Schepers Tim , Luitse Jan S. , Goslings J. Carel , Hermanides Jeroen , Stevens Markus F. , Hollmann Markus W. , van Samkar Gan
Published: August 2014

Background:

Talar and calcaneal fractures and their treatment can cause severe postoperative pain. We hypothesized that a continuous peripheral nerve block (CPNB) would reduce pain scores more effectively than systemic analgesics, improve recovery, and lead to reduced length of stay (LOS).

Methods:

Over a 3-year period patients undergoing open reduction and internal fixation (ORIF) of a talar or calcaneal fracture were retrospectively analyzed. Patients received a CPNB catheter preoperatively or intravenous patient-controlled analgesia (PCA) postoperatively. Primary endpoint was Numerical Rating Scale (NRS) scores on postoperative day 1. Secondary endpoints were NRS scores up to day 3, opioid requirement, analgesia-related side effects, intraoperative blood loss, infection, and LOS. Eighty-seven patients were analyzed; 70 with calcaneal fracture, 21 with talar fracture, 4 with both. In all, 40 patients received CPNB, 47 patients PCA.

Results:

Median NRS scores on day 1 were 1.0 (IQR 3) in the CPNB group and 2.0 (IQR 3) in the PCA group ( ns). Median LOS for patients with CPNB was 5 days (IQR3) and PCA 4 days (IQR 2 ns). Blood loss and incidence of local infections were comparable in both groups. Opioid requirement was significantly increased in the PCA group ( P < .01).

Conclusion:

Significant advantages or disadvantages were not seen in either group. However, the PCA group required about 30-fold more opioids compared to the CPNB group on day 1, although that did not lead to an increased number of side effects.

Level of Evidence:

Level III, retrospective comparative series.
The Prognostic Value of the Hawkins Sign and Diagnostic Value of MRI After Talar Neck Fractures
Authors: Chen Hao , Liu Wenzhou , Deng Lianfu , Song Weidong
Published: August 2014

Background:

The early diagnosis of avascular necrosis of the talus (AVN) and prediction of ankle function for talar fractures are important. The Hawkins sign, as a radiographic predictor, could exclude the possibility of developing ischemic bone necrosis after talar neck fractures, but its relationship with ankle function remains unclear. The purpose of this study was to illustrate the prognostic effect of the Hawkins sign on ankle function after talar neck fractures and to study the value of early MRI in detecting the AVN changes after talus fractures.

Methods:

Cases of talar neck fractures between November 2008 and November 2013 were evaluated. The occurrences of the Hawkins sign and AVN were studied. X-ray imaging was performed at multiple time points from the 4th to the 12th week after the fractures, and MRI examinations were used in the Hawkins sign negative group, with the time span ranging from 1.5 to 12 months. AOFAS scores of the Hawkins sign positive and negative groups were compared during the follow-up. Forty-four cases (48 feet) were evaluated.

Results:

The occurrence of positive Hawkins sign was 50%, 30%, and 33.3%, the incidence of AVN was 0%, 10%, and 50%, respectively, in type I, type II, and type III and IV talus fractures, respectively. The AOFAS scores showed no statistically significant difference between Hawkins sign positive group and negative group in type I and II fractures. The Hawkins sign positive group had better AOFAS scores than the negative group in type III and IV fractures. However, there was no statistically significant difference between Hawkins sign positive and negative groups when AVN cases were excluded in type III and IV fractures.

Conclusion:

The Hawkins sign was a reliable predictor excluding the possibility of AVN. It did not have predictive value on the ankle function in low-energy fractures and may predict better ankle function in high-energy fractures. MRI can diagnose AVN during an earlier period, and we believe Hawkins sign negative patients should undergo MRI examinations 12 weeks after the fractures, especially in high-energy traumatic cases.

Level of Evidence:

Level III, comparative case series.
Oral Anticoagulants and Status of Antidotes for the Reversal of Bleeding Risk
Authors: Ebright Joseph , Mousa Shaker A.
Published: August 2014

Anticoagulants have been used in clinical practice for more than 50 years. Their indications expand, as more people are diagnosed each year with atrial fibrillation and venous thromboembolism. Vitamin K antagonists have been the most popular choice due to their effectiveness and their ability to reverse bleeding using a known antidote; oral and intravenous vitamin K have long been known to reverse the effects of warfarin. With new classes of anticoagulants making their way onto the market, such as factor Xa inhibitors (rivaroxaban, apixaban) and direct thrombin inhibitors (dabigatran), the need for new reversal agents is paramount. Patients tend to be more receptive to these medications because they do not require routine blood monitoring, can be used at fixed doses, and do not have major drug or food interactions. Antidotes for these medications have shown promise in animal models and are currently in clinical trials.
Sustained Release of Tissue Factor Following Thrombosis of Lower Limb Trauma
Authors: Walenga Jeanine M , Kaiser Phoebe C , Prechel M Margaret , Hoppensteadt Debra , Jeske Walter P , Misselwitz Frank , Bacher Peter , Lassen Michael R , Fareed Jawed
Published: August 2014

This study was undertaken to provide evidence for the mechanism of venous thromboembolism (VTE) in healthy patients with minor lower limb injury (fracture; Achilles tendon rupture) that was medically managed with plaster cast/brace immobilization. The Plaster Cast clinical trial provided a unique opportunity to identify the natural history of VTE using placebo-controlled patients (n = 183) with validation of the mechanism using the low-molecular-weight heparin (LMWH; reviparin)-treated patients (n = 182). Confirmed VTE in this population was associated with a burst of tissue factor release (and a minor fibrinolytic deficit) leading to thrombin generation that was sustained at least 5 weeks, greater with fractures than with soft-tissue injuries and greater with surgery than with conservative treatment. The root cause likely involves platelet/leukocyte activation (inflammation) rather than endothelial cell injury. Thromboprophylaxis with a low dose of LMWH reduced thrombin generation, with patients undergoing surgery benefitting the most.
A Seeming Paradox
Authors: Mihalov Ján , Timárová Gabriela
Published: August 2014

Nowadays, we have a relatively sophisticated standard approach to a patient with acute ischemic stroke, including the sequence of diagnostic methods and treatment modalities. In practice, however, we are occasionally confronted with a patient whose medical history or comorbidities force us to make a decision without the support of guidelines. One such situation is the occurrence of acute ischemic stroke in a patient with known idiopathic thrombocytopenic purpura, where a tendency to use thrombolysis, anticoagulants, or antiplatelet agents collides with the fear of life-threatening bleeding. In this review, we try to outline current understanding of the pathophysiology of “paradoxical” ischemic events in this illness characterized by thrombocytopenia and to summarize clinical experience from case reports dealing with this topic, which could help us to rely on more than individual opinion seen through a purely “neurological” or “hematological” prism.
Vibration and damping characteristics of sandwich plates with viscoelastic core
Authors: Huang Zhicheng , Qin Zhaoye , Chu Fulei
Published: August 2014

As an effective approach to suppress vibrations and noise, passive constrained layer damping (PCLD) treatments are widely used in engineering practice. However most of the studies concentrate on the one-dimensional beams with active/passive constrained damping layer, the analysis on the two-dimensional plates are relatively small. This research proposes an efficient sandwich modeling technique to deal with the vibration and damping characteristics of the PLCD plate structure. A type of three-layer four-node rectangular element with seven degrees of freedom on every node is used to simulate the PLCD plate structure. The displacement relationships of each layer are obtained based on the first-order shear deformation theory. The finite element equations of motions are derived by the Hamilton principle in variation form. The natural frequency and loss factor are discussed based on the eigenvalue problems. Numerical examples are provided to verify the accuracy and efficiency of the present finite element method. Finally, the influences of the layer thickness, the loss factors of the viscoelastic cores on the natural frequencies and loss factors of the PLCD plate structure are discussed as well.
New Method for Sperm Evaluation by 3-Dimensional Laser Scanning Microscopy in Different Laboratory Animal Species
Authors: Weber Klaus , Waletzky Alexander , Fendl Diana , Ordóñez Patricia , Takawale Pradeep , Hein Felix , Riedel Wolfram , König Andres , Kunze Marc , Leoni Anne-Laure , Rivera Javier , Quirici Roberto , Romano Ivano , Paepke Susanne , Okazaki Yoshimasa , Hardisty Jerry F.
Published: August 2014

Sperm analysis is one of the end points in reproductive toxicology studies. Different methods for quantitative sperm analysis have been described. For qualitative morphological sperm analysis, either such techniques or smears of sperm and histological sperm staging are in use. Any of these methods provides morphological results on a light microscopy level. Laser scanning microscopy is a technique using a focused laser for scanning an object. The Olympus 3D Laser Scanning Microscope LEXT OLS4000 with optional possibilities of differential interference contrast provides a microscopic method for visualizing microasperities, which are far beyond the resolving power of a typical light or laser microscope. This technique was applied to sperm of mice, rats, rabbits, and cynomolgus monkeys at magnifications up to ×17 090. The obtained images are comparable to those of a scanning electron microscope under relatively low-power magnifications. Measurements on sperm parameters were taken by an integrated image analysis software tool. Abnormalities were easily detectable.
Campus Officers’ Explanations of Traffic Stop Sanctions
Authors: Allen Andrea
Published: August 2014

Prior traffic stop studies rarely consider officers’ qualitative explanations of their sanctioning decisions and are based largely on municipal officers. This article explores campus officers’ explanations of how they sanctioned drivers. Data were gathered from fieldwork with campus officers at a large southeastern U.S. university. Findings reveal officers usually handle traffic offenders leniently, opting for no sanction and written warnings over citations and custodial arrest. Officers named seven sanctioning reasons that fit into three broad and interrelated perspectives on crime and punishment. Implications of the findings for future research and policy are discussed.
Deafblindness: A review of the literature
Authors: Dammeyer Jesper
Published: August 2014

Background: Deafblindness or dual sensory loss is a rare condition among young people, but more frequent among older people. Deafblindness is a heterogeneous condition that varies with regard to time of onset and degree of vision and hearing impairment, as well as communication mode, medical aetiology, and number and severity of co-morbidity. Method: We conducted a comprehensive review of public health issues related to deafblindness. Results: Deafblindness often lead to barriers in language and communication, access to information and social interaction, which can lead to a number of health-related difficulties. Some of the reported consequences are a higher risk of depression, cognitive decline, developmental disorder in children and psychological distress. Conclusions: Deafblindness is associated with a number of health-related issues and more knowledge is needed about the impact of dual sensory loss to be able to offer the best support.
Increasing health examination survey participation rates by SMS reminders and flexible examination times
Authors: Tolonen Hanna , Aistrich Anna , Borodulin Katja
Published: August 2014

Aims: Declining participation rates are an increasing problem in population surveys. Different kinds of methods have been used to ensure participation rates as high as possible. Monetary incentives and reminders have been found to be effective ways to increase participation rates, but these are rather expensive to implement in large population surveys. There is a need for cheaper ways to motivate survey invitees to participate. Methods: The Kuusamo Health Examination Survey was conducted in May–June 2011. A random sample of 250 people was selected for the survey. Mobile phone numbers, when available, were obtained for people within the sample. For a random sample of 50% of survey invitees with a mobile phone number, a short message service (SMS) reminder was sent prior to their appointment. All survey participants were asked to fill in a feedback questionnaire. Results: Participation rate was 58% for men and 74% for women. Mobile phone numbers were available for 66% of the sample. Among those receiving an SMS reminder about their appointment, participation rates were up to 25 percentage points higher than among the group not receiving a reminder. In the feedback questionnaire, 9% of the survey participants reported that they would not have participated without the SMS reminder they received. Participants preferred morning hours and Monday–Tuesday as time and day options for the examinations. Conclusions: SMS reminder about the appointment time was an effective way to increase participation rate, especially among the youngest age groups. Also, providing flexible office hours for the examination clinic may increase participation rate.
The relationship of green space, depressive symptoms and perceived general health in urban population
Authors: Reklaitiene Regina , Grazuleviciene Regina , Dedele Audrius , Virviciute Dalia , Vensloviene Jone , Tamosiunas Abdonas , Baceviciene Migle , Luksiene Dalia , Sapranaviciute-Zabazlajeva Laura , Radisauskas Ricardas , Bernotiene Gailute , Bobak Martin , Nieuwenhuijsen Mark J
Published: August 2014

Aims:To assess the relationship between green space proximity, use of green space and depressive symptoms and perceived general health among a random sample men and women. Methods: Cross-sectional study of a population-based sample of 6,944 45–72 year old Kaunas city residents. Self-reported questionnaires provided information on sociodemographic variables, health behaviours, depressive symptoms and poor and very poor perceived general health. Residential proximity to green spaces was defined as living less than 300 m, within interval of 300–999 m, and equal or more than 1 km from a park. The use of the park was divided into two categories: no park use or use <4hrs/week and use of the park ≥4 h/week. The study received approval from the Kaunas Regional Research Ethics Committee. Multiple logistic regression assessed the associations controlling for confounding variables. Results: The prevalence of depressive symptoms and poor and or very poor perceived general health was higher in women than in men. The association between the use of the park and residential proximity to the park revealed that women living >300 m from a green space and who used the space ≥4 h/week showed higher odds 1.92 (1.11–3.3) and 1.68 (0.81–3.48) of depressive symptoms and poor and very poor perceived general health as compared to those who used the park <4 hrs/week and residential proximity was >300 m. Conclusions: The results of our study confirmed an association between use of the green space, residential proximity, and depressive symptoms and poor and very poor perceived general health among women only.
The emergency radiology of pelvic trauma
Authors: Shenton Ayeshea , Choudhary Surabhi
Published: August 2014

The imaging of pelvic trauma is complex and may involve different radiological techniques depending on the severity and type of injury. Following high-energy blunt trauma, computed tomography (CT) is the investigation of choice as it can identify life-threatening findings such as arterial extravasation as well as bony and soft tissue injuries, in particular that of the urological system. In this overview of pelvic imaging in trauma, the role of CT, plain radiography and focussed assessment with sonography in trauma (FAST) are considered, as well as the role of interventional radiology for pelvic haemorrhage.
Strengthening the Dementia Care Triad
Authors: Jensen Christine J. , Inker Jennifer
Published: August 2014

This article describes a project to identify the needs of family caregivers and health care providers caring for persons with dementia. Participants included 128 caregivers, who completed a survey, and 27 health care providers, who participated in a focus group and completed a survey. Caregivers reported their primary source of information about the disease was the doctor; however, the majority also reported they were primarily informed of medications and not about needed resources. Health care providers identified limited time with patients and families, and lack of awareness of community services, as their main challenges. Recommendations include strengthening the partnership between physicians, patients, and caregivers (the dementia care triad) through additional support and training for physicians and caregivers, increasing awareness of the Alzheimer’s Association, and utilization of technology for families and professionals to track the needs of persons with dementia.
A Descriptive Study of Elderly Patients With Dementia Who Died Wandering Outdoors in Kochi Prefecture, Japan
Authors: Furumiya Junichi , Hashimoto Yoshiaki
Published: August 2014

This was a descriptive study of elderly persons with dementia who were found dead after becoming lost in the community. Nineteen forensic autopsy cases were performed at Kochi Medical School, Japan. The mean age of the patients (9 males and 10 females) was 82.1 ± 6.6 years. Causes of death were drowning (n = 8), trauma (n = 5), hypothermia (n = 2), and debilitation possibly due to fatigue (n = 1) or were unknown (n = 3). Thirteen (68%) individuals had been reported missing, most at least 6 hours after they had left. They moved on foot (n = 14), by car (n = 3), or by bicycle (n = 2). Distances from residences to spots of death ranged from 20 to 5800 m for 11 patients on foot. In 8 cases, it was less than 500 m. The study has potential implications for enabling their early discovery and protection.
Children’s Views on Long-Term Screening for Type 1 Diabetes
Authors: Swartling Ulrica , Helgesson Gert , Ludvigsson Johnny , Hansson Mats G. , Nordgren Anders
Published: August 2014

There are an increasing number of medical research studies involving children, including many long-term birth cohort studies. Involving children raises many issues, and little is known about children’s own views. This study explored children’s views ( N = 5,851) on participation in a long-term screening study for type 1 diabetes. The results show that children 10 to 13 years of age have in general a positive attitude to pediatric research and emphasized trust in researchers. The children stressed the importance to receive information and to be involved in decisions. The children also reported feeling concerned about blood sampling and disease risk. Researchers involved in long-term pediatric research need to address these issues to promote involvement and decrease worry.
Getting Black Men to Undergo Prostate Cancer Screening
Authors: Dean Lorraine T. , Subramanian S. V. , Williams David R. , Armstrong Katrina , Zubrinsky Charles Camille , Kawachi Ichiro
Published: August 2014

Despite higher rates of prostate cancer–related mortality and later stage of prostate cancer diagnosis, Black/African American men are significantly less likely than non-Hispanic White men to use early detection screening tools, like prostate-specific antigen (PSA) testing for prostate cancer. Lower screening rates may be due, in part, to controversy over the value of prostate cancer screenings as part of routine preventive care for men, but Black men represent a high-risk group for prostate cancer that may still benefit from PSA testing. Exploring the role of social factors that might be associated with PSA testing can increase knowledge of what might promote screening behaviors for prostate cancer and other health conditions for which Black men are at high risk. Using multilevel logistic regression, this study analyzed self-report lifetime use of PSA test for 829 Black men older than 45 years across 381 Philadelphia census tracts. This study included individual demographic and aggregated social capital data from the Public Health Management Corporation’s 2004, 2006, and 2008 waves of the Community Health Database, and sociodemographic characteristics from the 2000 U.S. Census. Each unit increase in community participation was associated with a 3 to 3.5 times greater likelihood of having had a PSA test (odds ratio = 3.35). Findings suggest that structural forms of social capital may play a role in screening behaviors for Black men in Philadelphia. A better understanding of the mechanism underlying the link between social capital and screening behaviors can inform how researchers and interventionists develop tools to promote screening for those who need it.