bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of minimal invasive extracorporeal circulation on the need of red blood cell transfusion
Authors: Ellam Sten , Pitkänen Otto , Lahtinen Pasi , Musialowicz Tadeusz , Hippeläinen Mikko , Hartikainen Juha , Halonen Jari
Published: April 2019

Objective:

Minimal invasive extracorporeal circulation may decrease the need of packed red blood cell transfusions and reduce hemodilution during cardiopulmonary bypass. However, more data are needed on the effects of minimal invasive extracorporeal circulation in more complex cardiac procedures. We compared minimal invasive extracorporeal circulation and conventional extracorporeal circulation methods of cardiopulmonary bypass.

Methods:

A total of 424 patients in the minimal invasive extracorporeal circulation group and 844 patients in the conventional extracorporeal circulation group undergoing coronary artery bypass grafting and more complex cardiac surgery were evaluated. Age, sex, type of surgery, and duration of perfusion were used as matching criteria. Hemoglobin <80 g/L was used as red blood cell transfusion trigger. The primary endpoint was the use of red blood cells during the day of operation and the five postoperative days. Secondary endpoints were hemodilution (hemoglobin drop after the onset of perfusion) and postoperative bleeding from the chest tubes during the first 12 hours after the operation.

Results:

Red blood cell transfusions were needed less often in the minimal invasive extracorporeal circulation group compared to the conventional extracorporeal circulation group (26.4% vs. 33.4%, p = 0.011, odds ratio 0.72, 95% confidence interval 0.55-0.93), especially in coronary artery bypass grafting subgroup (21.3% vs. 35.1%, p < 0.001, odds ratio 0.50, 95% confidence interval 0.35-0.73). Hemoglobin drop after onset of perfusion was also lower in the minimal invasive extracorporeal circulation group than in the conventional extracorporeal circulation group (24.2 ± 8.5% vs. 32.6 ± 12.6%, p < 0.001). Postoperative bleeding from the chest tube did not differ between the groups (p = 0.808).

Conclusion:

Minimal invasive extracorporeal circulation reduced the need of red blood cell transfusions and hemoglobin drop when compared to the conventional extracorporeal circulation group. This may have implications when choosing the perfusion method in cardiac surgery.
Is it possible to incentivise and capture local wealth? The business rate challenge
Authors: Muldoon-Smith Kevin
Published: April 2019

How can Government and the Treasury reconcile two often contradictory aspects of the commercial property tax model in England? On the one hand, commercial property tax is required to be responsive to economic conditions, promoting investment in property and business. On the other hand, local commercial property tax, in part, is required to fund local public services. This situation reveals a contradiction in government tax policy that has a direct impact upon local, regional and national economic activity. This Viewpoint article considers the nature of commercial property tax in England, the business rate system, the competing pressures upon the business rate system before considering the main alternative on offer in England, land value tax. Despite the undoubted economic elegance of this instrument, any move towards land value tax should be approached with caution. Any solution to the current business rates impasse should not be led by a pragmatic focus on tax collection. Nor should prevalent issues, the high street, the need for digital tax or public finance demands be considered in isolation – they should be tackled together because they are part of the same complex situation.
Occupational justice within residential aged care settings – Time to focus on a collective approach
Authors: du Toit Sanetta HJ , Casteleijn Daleen , Adams Fasloen , Morgan-Brown Mark
Published: April 2019

Occupational therapists promote meaningful engagement in occupations and associated role continuity, and encourage agency and citizenship. A lack of engagement can be understood as occupational deprivation, alienation and marginalisation, which are concepts associated with occupational injustice. However, occupational injustices associated with collectives, such as residential aged care settings, receive little professional attention. This article encourages the occupational therapy profession to research and develop practice addressing occupational injustice within collectives, specifically in residential aged care settings. Proposed key considerations include environmental adaptations, creating occupational spaces and upskilling staff to promote citizenship, agency and self-determination for residents.
A panel analysis of Brazilian regional inequality
Authors: Arestis Philip , Phelps Peter
Published: April 2019

A growing body of literature has concluded that financial liberalisation, in terms of the increased weight and influence of the financial sector, has contributed in a significant way to increasing disparities in income, wealth and society since the 1980s within advanced and emerging economies. Against a backdrop of financialisation, extreme inequality and evolving financial instability, this paper’s primary contribution is to analyse the determinants of personal income inequality within one of the world’s prominent emerging economies, Brazil. We pay particular attention to the magnitude, significance and scale of the determinants in a financialisation context, from which this paper’s relative contributions emerge. Our empirical strategy utilises modern panel data techniques and different instrumental variables approaches for robustness. This paper’s analysis provides a first step in the direction of identifying the main mechanisms through which the Brazilian model of financial liberalisation has affected income inequality at the sub-national scale; while providing an early indication of how inequality might evolve in the future. In conclusion, the revealed significant linkages between financialisation, local liquidity preferences, capital account liberalisation and social protection expenditure threaten more extreme inequality, both in Brazil’s financial centre-space and beyond.
Delays of Shared-Short Lanes at Unsignalized Intersections
Authors: Wu Ning , Brilon Werner
Published: April 2019

At unsignalized intersections, both on the major street and on the minor street, there may be short turning lanes alongside the through lanes following downstream from one single lane. This combined system is termed a shared-short lane (SSL). Up to now it has only been possible to calculate the capacity of these lanes at the stop line and the capacity of the diverging point, where the turning lane diverges from the through lane. For the total average delay of the involved individual movements, there is no applicable estimation procedure. As a special case, the shared lane (SL), which is used by several movements without a separate turning lane, must also be reconsidered. This paper presents a new model for the estimation of average delays of SSL with SL as a special case at unsignalized intersections. The model is based on the analogy to standard queuing systems. The results depend on the length of the short lane. The model is validated by simulation. The results demonstrate that the outcome of the models in current highway capacity manuals may be misleading, with the risk of inaccurately classifying the level of service of an intersection. Therefore, there is an urgent need to complete the relevant procedures in highway capacity manuals by more realistic estimation procedures for the total delay at an SSL or an SL. The methods in this paper—even if they are rather complex—are recommended to be incorporated into future versions of highway capacity manuals using some simplifications.
Driving Simulator Study: Eco-Driving Training System Based on Individual Characteristics
Authors: Yao Ying , Zhao Xiaohua , Ma Jianming , Liu Chang , Rong Jian
Published: April 2019

This research sought to establish an eco-driving training system based on a driving simulator. The eco-driving training system contained five modules: human machine interface, data management, scene management, mode management, and evaluation algorithm management. It was proposed to base the new eco-driving training system on drivers’ individual characteristics. This system first asked drivers to conduct a diagnostic drive on a stretch of roadway in a driving simulator. The data on each driver’s non-ecological driving behaviors under different events were collected. Then each driver was given a customized training course based on an evaluation of his/her driving behaviors during the diagnostic drive. This training process is called eco-driving training based on individual characteristics (EDTIC). Eighty taxi drivers were recruited and divided into two groups for eco-driving training. One group was trained by watching videos, and the other was trained by the EDTIC training. An analysis of results shows that the EDTIC training was significantly more effective than traditional video training. Under the EDTIC training, all driving behaviors improved and emissions and fuel consumption were greatly reduced; the reduction was as great as 8.3–8.4%. The EDTIC training was proven effective at improving the eco-driving behavior of taxi drivers (i.e., professional drivers), and it could also be employed to train other professional drivers (bus and truck drivers) and non-professional drivers.
The Relationship Between Alcohol Consumption and Hip Fracture Recovery Among Older Adults
Authors: Zanjani Faika , Gruber-Baldini Ann L. , Resnick Barbara , Orwig Denise , Hochberg Marc , Magaziner Jay
Published: April 2019

Background: We examined the relationship between alcohol consumption and hip fracture recovery. Methods: Repeated measures analysis was used to analyze Baltimore Hip Studies (BHS) seventh cohort 12-month prospective data of hip fracture patients. The analytical sample was limited to individuals with baseline and follow-up alcohol data, representing n = 278 sample size, 49% male, and mean age 81 years. Results: In the year prior to fracture, sample reporting indicated 45% nondrinking, 48% one to seven drinks per week, and 7% eight or more drinks per week alcohol levels. There were some changes in alcohol status during the study period ( p < .001); 42% remained nondrinkers and 47% remained alcohol consumers, but 8% stopped alcohol use, and 3% reported alcohol consumption after nondrinking at baseline. Alcohol was a predictor ( p < .05) of disability and physical function, not showing worse recovery for drinkers. Conclusion: Almost half of the sample consumed alcohol throughout the study period, with no clear indication of negative effects on hip fracture recovery.
Bombyx mori silk-based materials with implication in skin repair: Sericin versus regenerated silk fibroin
Authors: Su Dihan , Ding Shenglong , Shi Weiliang , Huang Xuefeng , Jiang Libo
Published: April 2019

Recently, regenerated silk fibroin is one of the most investigated silk-based materials for tissue engineering. However, it needs complex preparation process and will irresistibly denature to solid state with time, which is the biggest challenge to produce in large scale and widely use it as commercial material. In this work, industrially produced sericin, silk fibroin amino acid, and silk fibroin powder were investigated on its physico–chemical and biological properties compared with laboratory prepared regenerated silk fibroin, in order to excavate the potential application in biomedical and therapeutical fields. The results showed that sericin may be the most suitable silk materials to use as an alternative in tissue engineering compared with regenerated silk fibroin. It was found that sericin can absorb UV in the range of 223–300 nm, inhibit tyrosinase, resist to free radicals, and retain water capacity similar to hyaluronic acid. Importantly, cell experiment on human fibroblast showed that sericin (0.05 wt%) could stimulate cell proliferation and obviously up-regulate the expression of collagen type I, collagen type III, and hyaluronidase I compared with the control at seven days, which is the closest equivalent to regenerated silk fibroin. These results suggested that sericin might be a valuable ingredient for skin repair on tissue engineering.
Effects of bio-inspired bioglass/collagen/magnesium composites on bone repair
Authors: Gabbai-Armelin Paulo Roberto , Wilian Kido Hueliton , Fernandes Kelly Rossetti , Fortulan Carlos Alberto , Muniz Renno Ana Claudia
Published: April 2019

Bone disorders and fractures affect millions of people worldwide. In critical situations, proper healing may not happen which may lead to non-union fractures. Consequently, the development of new clinical approaches is necessary. In this context, the present work developed bioglass/collagen/magnesium composites in order to mimic natural bone, toward the enhancement of material mechanical properties, but keeping bioactivity and performance of bioglass and collagen. So, the aim of this investigation was to explore the biological outcomes of bioglass/collagen/magnesium composites over bone repair, using tibial defect in Wistar rats. For this purpose, histopathological, morphometrical and immunohistochemical analyses, as well as mechanical test, were performed after 15 and 45 days of the composites implantation in rats. Histopathological assessment indicated that the biocompatible composites degraded over time, leading to a progressive new bone formation from the border to the core of the defect. Immunohistochemistry showed that all groups presented runx-2 and Rank-L immunostaining, with improved runx-2 labeling for bioglass/magnesium compared to plain bioglass 45 days post-implantation. Mechanical tests of the tibiae indicated good mechanical properties of these Mg-based materials, but no statistical differences among groups were found. Additional studies should be done to confirm the outcomes of bioglass/collagen/magnesium on bone restoration, using different animal models and new balanced amounts of Mg (3 wt%< Mg < 5 wt%), as well as compromised, long-term and critical bone defect conditions.
Analytical model and material equivalent methods for steady state heat partition coefficient between two contact discs in multi-disc clutch
Authors: Xiong Cenbo , Chen Man , Yu Liangyao
Published: April 2019

The heat partition coefficient between two finite thickness contact discs during long-time sliding is studied with a coupled finite element method. Results show that the heat partition coefficient varies from its initial value to another steady state value rapidly instead of being a constant all the time. An analytical solution of the temperature field under invariant heat flux input is deduced, which tells that there exists a unique critical thickness ratio between the contact discs that keeps the heat partition coefficient a constant. An equivalent method for single-material contact bodies is proposed that is capable of calculating the steady state heat partition coefficient for any thickness ratio. It reveals that the steady state heat partition coefficient only has relationship with the mass density and the heat capacity of the materials and the thickness ratio. Based on this method, a two-step material equivalent method is further proposed for the contact discs that have friction linings on them. The solution shows that the steady state heat partition coefficient in this situation is also only determined by the material properties and the layer thicknesses. A test bench of multi-disc clutch is set up and a series of sliding experiments are conducted to validate the proposed equivalent methods and solutions of steady state heat partition coefficient. The measured experimental temperature variations show that the temperature level of the separator disc in the clutch is overestimated with the constant heat partition coefficient of semi-infinite model, while it is close to those calculated results with steady state heat partition coefficient. Therefore, the temperature fields of the contact discs during long-time sliding with constant speed can be figured out efficiently using the steady state heat partition coefficient with only small error, and these equivalent methods benefit the multi-disc clutch design and temperature estimation in practical applications.
Study on the contribution ratios of particulate matter emissions in differential provinces concerning condensable particulate matter
Authors: Choi Doo Sung , Kim Young-Min , Lee Im Hack , Jeon Ki-Joon , Choi Byung Jin , Park Young-Kwon
Published: April 2019

This study attempted to reanalyze the emission property of particulate matter and set up the strategy on the emission reduction of particulate matter by considering the condensable particulate matter additionally as the total particulate matter together with filterable particulate matter. For this, total suspended particles and particulate matter 2.5 emitted in 2013 were selected as pollutants. Fuel classifications were divided into major and minor categories, and the sources were divided into major, medium, and minor categories. Three provinces were set as administrative areas: Gyeonggi-do, Chungcheongnam-do, and Jeollanam-do. The condensable particulate matter emission factors used were obtained from National Institute of Environmental Research. The condensable particulate matter emission factors of liquefied natural gas, diesel, and bunker C oil were measured in boilers with no preventive facilities, and the coal power plant emission factor was obtained at the end of the prevention facility. The condensable particulate matter emissions were calculated by multiplying the particulate matter 2.5 filterable particulate matter emissions by the ratio of the condensable particulate matter emissions to the filterable particulate matter of the National Institute of Environmental Research data. Different patterns of emission sources were observed for each province depending on the consideration of condensable particulate matters. Considering only the filterable particulate matters, the proportion of mobile pollutants was high. On the other hand, considering the condensable particulate matters, the contribution of the nonindustrial combustion category emissions using gaseous fuels, such as city gas, increased in the metropolitan area, whereas the contributions of the manufacturing combustion category emissions increased in the nonmetropolitan areas. Therefore, in the case of collecting energy facilities and the manufacturing burning facilities planned in the local cities in Korea, it is necessary to consider the filterable particulate matter, and condensable particulate matter emission amount.
Distinctive features of positive anti-cell antibody tests (indirect immunofluorescence on HEp-2 cells) in patients with non-autoimmune diseases
Authors: Agustinelli R A , Rodrigues S H , Mariz H A , Prado M S , Andrade L E C
Published: April 2019

Objective

The objective of this study was to determine whether characteristics of positive results in the indirect immunofluorescence assay on HEp-2 cells for anti-cell antibodies (HEp-2 IFA) differ between patients with non-autoimmune diseases (NADs) and patients with systemic autoimmune rheumatic diseases (SARDs).

Methods

Cross-sectional observational study comparing HEp-2 IFA test results in three groups: (a) 558 NAD patients comprising four subgroups (cancer ( n = 95), infectious diseases ( n = 148), psychiatric diseases ( n = 163), common non-infectious chronic diseases ( n = 152)); (b) 194 SARD patients; (c) 1217 healthy individuals (HIs). Sera were tested at 1:80 dilution and diluted to the end titer. Slides were analyzed by two independent blinded examiners.

Results

A positive HEp-2 IFA test occurred in 102 (18.3%) NAD patients, 170 (87.6%) SARD patients and 150 (12.3%) HIs. The four NAD subgroups did not differ regarding HEp-2 IFA frequency, titer or pattern. HEp-2 IFA titer was higher in NAD patients than in HIs and both had lower titer than SARD patients. Nuclear dense fine speckled pattern was more frequent in NAD patients and HIs than in SARD patients ( p < 0.001). Nuclear homogeneous and nuclear coarse speckled patterns were more frequent in SARD patients than in the other groups ( p < 0.001). The nuclear fine speckled pattern was prevalent in all three groups, but presented a gradient in titer across them; HIs and NAD patients had low and intermediary titers, which were significantly lower than in SARD patients ( p < 0.001).

Conclusion

Positive HEp-2 IFA frequency, pattern and titer present differential features in NAD and SARD patients, and this attribute adds value to the test in the diagnosis of SARDs.
Diet and lupus: what do the patients think?
Authors: Robinson G A , Mcdonnell T , Wincup C , Martin-Gutierrez L , Wilton J , Kalea A Z , Ciurtin C , Pineda-Torra I , Jury E C
Published: April 2019

Objectives

Cardiovascular disease is the leading cause of mortality in patients with systemic lupus erythematosus. Therefore, using diet to control blood lipid levels and modify cardiovascular disease risk could be a promising therapeutic strategy to control disease symptoms. The primary objective of this study was to learn about systemic lupus erythematosus patient experiences with diet, including their opinion on considering diet as a therapeutic option. The secondary objective was to obtain this information in a cost- and time-effective manner.

Methods

A lay summary and a 15-question diet-based online survey were publicly available for 3 weeks. Social media was used to promote the survey through relevant charities, hospitals and research groups.

Results

A total of 300 responses were received, 284 from patients with systemic lupus erythematosus. Patients reported that there was a lack of clinical counselling regarding diet, with only 24% stating their doctor had spoken to them about diet. Despite this, 100% of patients stated they would change their diet if they knew it would help their symptoms and 83% would take part in a future diet-based clinical trial. Text analysis of patient research suggestions identified a particular interest in using diet to treat fatigue and manage disease flares.

Conclusions

This project successfully gathered patient information regarding diet and systemic lupus erythematosus over a short timeframe using an anonymous social media platform. The survey provided evidence that patients support further research and potential diet intervention studies investigating the effect of diet on the symptoms of systemic lupus erythematosus.
The audience as artist? The audience’s experience of participatory music
Authors: Toelle Jutta , Sloboda John A
Published: April 2019

This study aimed to uncover potential effects on and meanings experienced by audience members who participated in performances (‘participants’) of intentional efforts to integrate participatory elements in art music practice. We document a recent project in which two contemporary composers were commissioned to write new pieces including parts for audience participants. We analysed observational and questionnaire data from three concerts that interrogated the experiences of participants at three participatory performances in different countries ( n = 273), and identified key emergent themes from participant responses: special group experience, interactive musical experience, experiencing shifting power relationships as well as an evaluative theme about the consequences of participatory elements. These categories connected substantially to concepts of active/passive, empowerment and community prevalent in discourses about participatory theatre. Quantitative analysis of participants’ ratings showed high levels of affective and cognitive engagement, moderated most by prior attendance at a preparatory workshop, and least by demographics or levels of prior musical engagement/experience.
Finite element simulation of controlled frequency response of skew multiphase magneto-electro-elastic plates
Authors: Mahesh Vinyas , Kattimani Subhaschandra
Published: April 2019

The linear frequency response of skew multiphase magneto-electro-elastic composite plate embedded with active constrained layer damping treatment has been studied. The volume fraction of piezoelectric fibres embedded in the piezomagnetic matrix significantly affects the coupling characteristic of this multiferroic material, and hence, the frequency of the skew multiphase magneto-electro-elastic plate is drastically altered. This study emphasizes on evaluating the influence of different volume fraction of barium titanate (BaTiO3) and cobalt ferrite (CoFe2O4) on the frequency characteristics of skew multiphase magneto-electro-elastic. In this regard, a finite element formulation has been proposed to assess the damped response of such skew multiphase magneto-electro-elastic plates. Incorporating the complex modulus approach, the constrained viscoelastic layer of the active constrained layer damping patch is modelled. In addition, the effect of geometrical skewness has also been investigated. Meanwhile, an exhaustive parametric study is carried out to analyse the influence of control gain, patch position and fibre orientation angle of piezoelectric composite.
Creating Pathways to Personal Resilience Through Classroom Simulations
Authors: Walker Lorin , Luechtefeld Ray , Long Walker Jo Anne
Published: April 2019

Background. College or university classroom simulations have the potential to create valuable educational outcomes that are difficult to achieve by other means. Personal resilience is one outcome that has achieved significant attention in the literature. Personal resilience is the ability to bounce back, learn from, and move forward after adverse experiences.

Aim. This study posits that student personal resilience will increase following participation in university undergraduate management courses that use simulations that are grounded in a proposed teleological process model that includes six causal relationships.

Method. Eighty-four students participated in either a Capstone strategy course using the Capsim simulation or a semester-long classroom as organization open simulation called XB that involved student management of all course aspects. The Connor-Davidson Resilience Scale (CD-RISC 10) survey instrument was used to measure personal resilience at both the beginning and end of each course.

Results. In several cases, student personal resilience was significantly increased after courses utilizing simulations involving specific features.

Conclusions. Participation in these kinds of experiences (with faculty support) may significantly increase levels of personal resilience among students.

Recommendations. Simulations with the specified causal attributes might be used to foster student outcomes such as personal resilience, which typically are not a part of traditional course objectives.
Impact of Sagittal Talar Inclination on Total Ankle Replacement Failure
Authors: Le Vu , Escudero Mario , Symes Michael , Salat Peter , Wing Kevin , Younger Alastair , Penner Murray , Veljkovic Andrea
Published: April 2019

Background:

Restoration of ankle alignment is important in total ankle arthroplasty (TAA), but sagittal alignment of the talar component is less studied than coronal sagittal. Little has been published on the importance of sagittal talar alignment in TAA. The radiographic talar component inclination was hypothesized to be predictive of TAA survival, subsidence, and functional outcomes.

Methods:

A retrospective review of the Vancouver End-Stage Ankle Arthritis Database was performed on all TAAs at a single center over 11 years utilizing 1 of 2 implants. Talar component inclination (TCI) angles were measured and standard descriptive statistics were completed with a survival analysis. Inter- and intraobserver reliability were determined. Postoperative TCI angles were analyzed against several definitions of TAA survival and patient-reported outcome measures from the database. A total of 109 TAAs satisfied inclusion and exclusion criteria.

Results:

A postoperative talar component inclination angle greater than 22 degrees was associated with talar component anterior subsidence, defined as a change in that angle of 5 degrees or more between postoperative and last available radiographs. This was still significant after adjusting for confounders: age, gender, body mass index, and presence of inflammatory arthritis. All measured angles had good inter- and intraobserver reliability.

Conclusion:

Surgeons should avoid dorsiflexing the talar prosthesis during TAA, which hypothetically diminishes the ankle critical dorsiflexion range. This may cause anterior talar undercoverage in terminal dorsiflexion and may edge load the talar prosthesis, predisposing to anterior subsidence. Elevated TCI was a simple and reliable radiographic measurement to predict long-term TAA outcome due to predictable anterior subsidence of the talar prosthesis.

Level of Evidence:

Level III, retrospective comparative series.
Integrating Destination Attributes, Political (In)Stability, Destination Image, Tourist Satisfaction, and Intention to Recommend: A Study of UAE
Authors: Eid Riyad , El-Kassrawy Yasser Ahmed , Agag Gomaa
Published: April 2019

Very limited attention has hitherto been paid to political-specific issues that may significantly guide the successful formation of destination image. Therefore, the purpose of this article is to examine the interrelationships between destination attributes, political (in)stability, destination image, tourist satisfaction, and intention to recommend, to build a conceptual framework of the drivers and outcomes of destination image. Twelve hypotheses (null and alternative) were developed and examined, using a sample of 829 tourists visiting the UAE. Results show that tourists’ evaluation of the destination attributes and political (in)stability act as antecedents of perceived destination image. Furthermore, political (in)stability and destination image have a strong effect on tourist satisfaction and intention to recommend. The current study enhances current theorizations by examining the merits of political (in)stability in models of tourists’ intention to recommend. From a practical perspective, the study presents significant implications for destination marketers.
Organizing rocks: Actor–network theory and space
Authors: Jensen Tommy , Sandström Johan
Published: April 2019

In an ethnography of the organizing of an underground mine, this article critically engages with actor–network theory’s theorizing of space, particularly the risk of drifting into spatial pluralism. Inspired by Annemarie Mol’s The Body Multiple, a space multiple approach is enrolled in which seemingly disparate enactments of the mining operations are understood in terms of coexistence and difference, inclusion and exclusion. Such an account attempts to cast aside a kind of neatness that jeopardizes the empirical openness that makes actor–network theory so fruitful to work with in organization studies dealing with spatial complexity.
Time, history and mythology in the cultural construction of the “nature of pain”: positioning Jewish settlements' evacuation within the religious timeline
Authors: Plotkin Amrami Galia
Published: April 2019

The concept of cultural trauma serves as a useful analytical framework for analyzing social processes of the creation of trauma narratives. Following the conceptualization of “cultural trauma” by Jeffrey Alexander, this article focuses on representations of the “nature of pain” produced by mental health professionals who identified with Religious Zionism working Jewish settlers involved in the 2005 evacuation of from Gaza and the West Bank. Based on ethnographic and written materials collected during fieldwork at a mental health center that offered professional interventions to settlers, I argue that the “nature of pain” associated with the evacuation was represented by religious practitioners through reference to otherwise distinct contemporary and biblical events and characters. This specific narrative organization exposes the normalizing function of time in narrating trauma. The article demonstrates how, by framing the evacuation story within a religious timeline, the settlement evacuation was transformed from a painful episode of ideological and messianic failure to a crucial step in a long journey toward national redemption. I argue that the transformation of a narrative of failure into a narrative of redemption is not only a matter of homologation between contemporary and ancient Jewish history and mythology, but also an act of revitalization of collective identity.
Liberal national identity: Thinner than conservative, thicker than civic?
Authors: Gustavsson Gina
Published: April 2019

Many of the political debates in Europe call for the strengthening of a national identity that is, somewhat paradoxically, described in universal liberal terms. Yet previous research has not been able to tell to which extent these conceptions of national identity are indeed liberal. This is because we lack an analytical tool that allows liberal conceptions of national identity to be separated from, for example, conservative ones. There is also a pervasive yet questionable assumption that the more liberal a national identity is, the less it can per definition be truly national. This paper seeks to remedy this gap, by bridging the literature on these empirical trends of civic integration with the normative debates surrounding liberal nationalism. The result is a tripartite typology for the conceptions of national identity in conservative nationalism, liberal nationalism and constitutional patriotism, respectively. Each is specified along the following dimensions: (1) whether the sense of national belonging is defined by vertical or horizontal ties; (2) whether the national history is to be revered, taken as a starting point or critically scrutinised; (3) whether the legitimate place for the shared activity by which the national identity is upheld excludes the private or even the public non-political sphere; (4) whether we are asked to cultivate feelings of piety or loyalty to the homeland; and (5) whether or not the shared public culture of the nation is considered changeable and enforceable. Policy implications for individual rights, immigration and cultural minorities are also discussed.
Delirium in patients with ischaemic and haemorrhagic stroke: findings from a scoping review
Authors: Mansutti Irene , Saiani Luisa , Palese Alvisa
Published: April 2019

Background:

Delirium is a complex syndrome characterised by disturbances in attention and awareness, associated with alterations in cognitive functions, which can emerge in a time frame of hours or days and tend to fluctuate in severity over time. Delirium is a clinical manifestation of the brain’s vulnerability and diminished resilience to insult. Stroke patients are particularly vulnerable to delirium episodes.

Aims:

The aim of this study was to map: (a) studies focused on ischaemic or haemorrhagic post-stroke delirium; (b) factors that have been investigated as being possibly associated with post-stroke delirium; and (c) outcomes that have been studied to date.

Methods:

A scoping review was performed. Medline, CINAHL, Cochrane Database of Systematic Reviews, PsycINFO and Scopus databases were searched. Eligible studies were those: (a) exploring any variable regarding delirium in patients with stroke; (b) involving adults; (c) as primary studies; (d) written in English; and (e) published before April 2017.

Results:

To date 25 studies have been published, mainly prospective or cohort studies. The most commonly studied predisposing factors have been the older age, gender, aetiology of the stroke and its location, and the presence of previous cognitive decline/dementia. The most studied precipitating factors to date have been pneumonia, urinary tract infections and symptoms of neglect. Functional dependence, length of inhospital stays, post-stroke cognitive impairments or dementia, short and long-term mortality have been the most studied post-stroke delirium outcomes.

Conclusions:

Studies across different clinical settings, also at the international level, including more female patients and a wider range of ages should be designed in order to improve the evidence available to develop specific clinical guidelines. Standardised frameworks of research addressing the great variability of methods and measures used in the field should be established at the international level by clinicians and researchers’ experts in the field.
Transgender adolescents and genital-alignment surgery: Is age restriction justified?
Authors: Horowicz Edmund
Published: April 2019

In the case of controversial interventions there is a need for clinical guidelines to be founded on ‘expert opinion’ and an evidence base, in order to minimise individual clinicians making subjective decisions influenced by bias or cultural norms. This paper considers international clinical guidelines that through recommendation effectively prohibit the provision of genital-alignment surgery for competent adolescents with gender dysphoria. I argue that although the rationale for this particular guideline is based on serious concerns, these need to be better understood to allow reconsideration of this unilateral prohibitive recommendation. I do not propose that genital-alignment surgery should be prima-facia provided for any adolescent with gender dysphoria. Instead I argue that by developing our understanding of the current concerns, we can allow guidelines to incorporate a margin of clinical discretion, to allow clinicians to provide genital-alignment surgery to some adolescents, where clinically appropriate. In facilitating this we can move towards establishing a solid evidence-base. The basis of this position is that clinical guidelines and medical practice should treat these young people with the same standards of evidence-based care as others who have less controversial conditions. Whilst this paper uses English law and UK professional regulation for context, many of the ethical, legal and professional issues highlighted are applicable to other jurisdictions.
SAVI SCOUT as a Novel Localization and Surgical Navigation System for More Accurate Localization and Resection of Pulmonary Nodules
Authors: Cornella Katie N. , Palafox Brian A. , Razavi Mahmood K. , Loh Christopher T. , Markle Kelly M. , Openshaw Lauren E.
Published: April 2019

Background. Current techniques for localization and resection of lung nodules carry many intraoperative challenges for surgeons. This article proposes a new localization method for diagnosis and treatment of pulmonary nodules, which provides a navigational system for more accurate lung resection. Methods. We report the case of a 77-year-old female with a pulmonary nodule of the right lower lobe. A nonradioactive localization technology, known as SAVI SCOUT (Cianna Medical Inc, Aliso Viejo, CA), was placed by interventional radiology under computed tomography guidance preoperatively. Using the SCOUT Wire-Free Radar Localization System, the pulmonary nodule was robotically localized and resected. SCOUT removal was confirmed using the Trident Specimen Radiology System. The efficacy of this procedure was evaluated in terms of ease of use and procedure time by interventional radiology, surgical resection accuracy, diagnostic accuracy, simplicity, and ease to implement this technology in an existing hospital. Results. The SCOUT system allowed for the first reported case of successful SCOUT placement in lung tissue, targeted the pulmonary nodule intraoperatively, and facilitated accurate lung resection. Conclusions. The SCOUT system shows promising advancements in the ability to eliminate many challenges currently seen with lung nodule localization and resection.
Prescribed performance dynamic neural network control for a flexible hypersonic vehicle with unknown control directions
Authors: Zhao He-wei , Liang Yong
Published: April 2019

In this article, we examine the system control design of a flexible hypersonic vehicle with an unknown direction control. Prescribed performance controls, backstepping controls, and radial basis function neural network are used to design the controllers. Different from a traditional radial basis function neural network, the fully tuned dynamic radial basis function neural network has a better approximation ability; and the weight vector, respective centers, and width of the Gaussian function of neural network are regulated by adaptive laws designed in the controller. The proof and analysis of stability are taken in this article for the fully tuned dynamic neural network introduced to control the system. Furthermore, prescribed performance control can guarantee the tracking errors satisfy the specified conditions. The unknown control direction is solved with the Nussbaum function in the controller. Finally, the simulations demonstrate the effectiveness and corrective measures of the control strategy.
The combination of tezacaftor and ivacaftor in the treatment of patients with cystic fibrosis: clinical evidence and future prospects in cystic fibrosis therapy
Authors: Lommatzsch Sherstin T. , Taylor-Cousar Jennifer L.
Published: April 2019

Years of tremendous study have dawned a new era for the treatment of cystic fibrosis (CF). For years CF care was rooted in the management of organ dysfunction resulting from the mal-effects of absent anion transport through the CF transmembrane regulator (CFTR) protein. CFTR, an adenosine triphosphate binding anion channel, has multiple functions, but primarily regulates the movement of chloride anions, thiocyanate and bicarbonate across luminal cell membranes. Additional roles include effects on other electrolyte channels such as the epithelial sodium channel (ENaC) and on pulmonary innate immunity.

Inappropriate luminal anion movement leads to elevated sweat chloride concentrations, dehydrated airway surface liquid, overall viscous mucous production, and inspissated bile and pancreatic secretions. As a result, patients develop the well-known CF symptoms and disease-defining complications such as chronic cough, oily stools, recurrent pulmonary infections, bronchiectasis, chronic sinusitis and malnutrition.

Traditionally, CF has been symptomatically managed, but over the past 6 years those with CF have been offered a new mode of therapy; CFTR protein modulation. These medications affect the basic defect in CF: abnormal CFTR function. Ivacaftor, approved for use in the United States in 2012, is the first medication in CF history to improve CFTR function at the molecular level. Its study and approval were followed by two additional CFTR modulators, lumacaftor/ivacaftor and tezacaftor/ivacaftor.

To effectively use currently available CF therapies, clinicians should be familiar with the side effects of the drugs and their impacts on patient outcomes. As many new modulators are on the horizon, this information will equip providers to discuss the benefits and shortcomings of modulator therapy especially in the context of limited healthcare resources.
Nested–polymerase chain reaction detection of Pneumocystis carinii f. sp. canis in a suspected immunocompromised Cavalier King Charles spaniel with multiple infections
Authors: Petini Matteo , Furlanello Tommaso , Danesi Patrizia , Zoia Andrea
Published: April 2019

A 7-month-old Cavalier King Charles Spaniel female was referred due to a chronic cough refractory to antibiotic treatments. Laboratory findings showed leukocytosis, increased serum C-reactive protein, hypogammaglobulinemia, and decreased total serum immunoglobulin G concentration. Thoracic radiographs showed a mild bronchial pattern. Cytology of the bronchoalveolar lavage fluid revealed a septic inflammation. Bordetella bronchiseptica, Mycoplasma spp., and Pneumocystis carinii were identified by polymerase chain reaction testing, and Klebsiella pneumonia was cultured from the bronchoalveolar lavage fluid. Moreover, Escherichia coli was also cultured from urine. Pneumocystis spp. identification was done by sequencing of genetic amplicons. The dog died due to cardiopulmonary arrest secondary to a spontaneous pneumothorax on the day following the procedure. This report documents the detection of Pneumocystis carinii f. sp. canis in a suspected immunocompromised Cavalier King Charles Spaniel with concurrent pulmonary and urinary tract infections involving four different pathogens, and highlights the importance of the use of polymerase chain reaction testing to detect canine Pneumocystis spp. in cases with negative bronchoalveolar lavage cytology.
Acute kidney injury as initial presentation of renal lymphoma: Diagnostic and therapeutic challenges in a resource-limited setting
Authors: Aminde Jeannine Anyingu , Adze Nkweta Eugene , Dedino Guisilla Ankwatia , Aminde Leopold Ndemnge
Published: April 2019

Non-Hodgkin’s lymphoma is reportedly common in Africa; however, there is limited data on renal involvement. Acute kidney injury only at presentation is rare for lymphoproliferative malignancies. A 7-year old presented to our facility with a 2-week history of progressive abdominal distension and pain, examination revealed anasarca and hypertension. On further evaluation, there were bilateral nephromegaly, acute kidney injury (AKI) and cytomorphological findings suggestive of lymphoma. Patient management was mostly supportive, and evolution was unfavourable leading to his demise. We discuss diagnostic and therapeutic challenges due to unavailability of state-of-the-art facilities in resource-constrained settings.
Rowell syndrome with recurrence from photoexacerbation: A case report
Authors: Alkul Suzanne , Behrens Emily , Stetson Cloyce
Published: April 2019

Rowell syndrome is a controversial entity composed of erythema multiforme-like lesions coexisting with lupus erythematosus. We describe a case of a 61-year-old male with a history of systemic lupus erythematosus who presented with photoexacerbated flaccid bullae and erosive plaques after repetitive sun exposure. Based on his clinical history, biopsy, and laboratory findings, he fulfilled diagnostic criteria for Rowell syndrome as described by Zeitouni et al. With oral prednisone, hydroxychloroquine, mycophenolate mofetil, and local wound care with petrolatum, the patient’s number of lesions decreased, as well as his pain and tenderness. He subsequently did not develop any new erosions. This case highlights the diagnostic criteria of this hybrid clinicopathological syndrome and its nature of photosensitivity.
Giving voice to my childbirth experiences and making peace with the birth event: the effects of the first childbirth on the second pregnancy and childbirth
Authors: Rania Nadia
Published: April 2019

This autoethnographic study describes the author’s waterbirthing experience to evidence the relationship between fear of childbirth and communication with, and support from, healthcare professionals and the medical process during labour and delivery. The study provides a rereading of the author’s experience, which demonstrates how the traumatic consequences of a first childbirth influenced the experience of a second pregnancy and childbirth. This account indicates how lack of training and inadequate communication by medical staff can lead to traumatic childbirth experience. The study enhances understanding of womens’ transition to motherhood with implications for practice, education and research of midwives and other medical providers.