bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior Cruciate Ligament Injuries Alter the Kinematics of Knees With or Without Meniscal Deficiency
Authors: Zhang Yu , Huang Wenhan , Yao Zilong , Ma Limin , Lin Zefeng , Wang Shaobai , Huang Huayang
Published: August 2016

Background:

Numerous studies have investigated kinematic alterations in patients with an isolated anterior cruciate ligament (ACL) injury. However, a substantial proportion of patients with injured ACLs also have concomitant meniscal tears.

Purpose:

To evaluate the in vivo alteration of knee kinematics after an ACL tear, with or without a combined medial or lateral meniscal tear, during level walking activity.

Study Design:

Controlled laboratory study.

Methods:

Fifty-six patients with unilateral ACL-deficient (ACLD) knees were studied. Among these patients, 15 had isolated ACL injuries (group 1), 15 had combined ACL and medial meniscal injuries (group 2), 15 had combined ACL and lateral meniscal injuries (group 3), and 11 had combined ACL and medial/lateral meniscal injuries (group 4). The kinematics of each knee was determined using an optical tracking system during treadmill gait. Range of motion (ROM) and kinematic alterations were compared between the contralateral ACL-intact (ACLI) and ACLD knees.

Results:

All ACLD knees, with or without meniscal deficiency, had significantly less flexion than the ACLI knees (~3°-8°; P < .05). In groups 1, 3, and 4, the injured knees exhibited more femoral external rotation by approximately 1° to 2° ( P < .05). Group 4 showed posterior femoral translation (anterior tibial translation) in the swing phase (~13 mm), while groups 2 and 3 showed increased anterior femoral translation (~2-3 mm). During medial-lateral translation, patients in group 2 had a more medial femoral shift (~4 mm) relative to the tibia initially, while those in group 4 exhibited a lateral femoral shift.

Conclusion:

The results indicate that meniscal injuries alter the kinematics of the ACLD knee when compared with knees with an isolated ACL injury. The location of the meniscal tear also affects knee kinematics.

Clinical Relevance:

Considering the varying effects of meniscal injuries on knee joint kinematics, these data provide insight into the pathological function of the ACL-injured knee joint during walking.
Results of Bone Peg Grafting for Capitellar Osteochondritis Dissecans in Adolescent Baseball Players
Authors: Oshiba Hiroyuki , Itsubo Toshiro , Ikegami Shota , Nakamura Koichi , Uchiyama Shigeharu , Kato Hiroyuki
Published: August 2016

Background:

Bone peg grafting (BPG) has been advocated for early-stage humeral capitellar osteochondritis dissecans (COCD). However, the clinical and radiological results of BPG, along with its indications, have not been described in detail.

Hypothesis:

COCD classified as International Cartilage Repair Society (ICRS) osteochondritis dissecans (OCD) I or II in adolescent baseball players can be treated successfully by BPG.

Study Design:

Case series; Level of evidence, 4

Methods:

Eleven male baseball players (age range at surgery, 13-16 years) who underwent BPG for COCD were enrolled in this study. No improvement had been seen in any patient after 6 months of preoperative nonthrowing observation. During surgery, 2 to 5 bone pegs were inserted into the COCD lesion after confirmation of lesion stability to the bony floor. All patients were directly evaluated at 12 and 24 months after surgery by physical findings, radiological prognosis, and magnetic resonance imaging (MRI).

Results:

Of the 11 patients, 10 could return to comparable baseball ability levels within 12 months. The Timmerman-Andrews score improved significantly from a mean ± SD of 171.8 ± 12.1 preoperatively to 192.3 ± 6.5 at the final observation. Radiological healing of the lesions was determined as complete in 8 patients and partial in 3. Patients possessing a centrally positioned lesion or a lesion <75% of the size of the capitellum tended most strongly to achieve complete radiological healing, while growth plate status appeared unrelated to outcome. The mean Henderson MRI score improved from 6.3 ± 1.5 to 4.8 ± 1.6 at 12 and 24 months after BPG, respectively. MRI findings also suggested that remodeling of COCD lesions had continued to up to 24 months postoperatively.

Conclusion:

BPG enabled 91% of COCD patients with ICRS OCD I or II to return to preoperative baseball abilities within 12 months. Integration of the grafted site may continue until at least 24 months postoperatively. An ICRS OCD I or II lesion with central positioning and/or occupying <75% of the size of the capitellum in the coronal plane is a good indication for BPG.
Kruppel-like factor 6 suppresses growth and invasion of hepatocellular carcinoma cells in vitro and in vivo
Authors: Wen Pei-Hao , Wang Dong-Yu , Zhang Jia-Kai , Wang Zhi-Hui , Pan Jie , Shi Xiao-Yi , Yang Han , Zhang Shui-Jun , Guo Wen-Zhi
Published: August 2016

Kruppel-like factor 6 (KLF6) as a novel tumor suppressive gene participates in multiple biological behaviors and plays an important role in regulating tumor cell growth and invasion. However, the functions of KLF6 in hepatocellular carcinoma (HCC) remain poorly understood. The expression level of KLF6 was examined by immunohistochemical assay in human HCC tissues, and KLF6-overexpressed HCC cells (SMCC-7721 and HepG2) were used for evaluating cell proliferation and invasion by MTT and Transwell assays. A subcutaneous HCC tumor model was established for assessing tumor growth in vivo. Our results showed that the expression of KLF6 was significantly downregulated in HCC tissues compared with the adjacent non-cancerous tissues (50.0% vs. 72.0%, P = 0.034) and negatively associated with the lymph-vascular space invasion (LVSI) in HCC patients ( P = 0.003). Furthermore, overexpression of KLF6 reduced cell proliferation and weakened the cell invasive potential followed with the decreased expression of PCNA and MMP-9 in HCC cells. The in vivo experiment indicated that KLF6 overexpression suppressed the xenograft tumor growth. Therefore, our findings show that KLF6 suppresses growth and invasion of HCC cells in vitro and in vivo, suggesting a tumor suppressive function in HCC and provides the potential therapeutic target for the treatment of HCC.
Effective thermal conductivity of two-phase composites containing highly conductive inclusions
Authors: Khan Kamran A , Khan Sohaib Z , Khan Muhammad A
Published: August 2016

Thermal conductivity is one of the key material properties to understand the effective thermo-mechanical behavior of advanced composites. Experimental studies show that when highly conductive inclusions are embedded in a less thermally conductive matrix, the effective thermal conductivity of the composite changes drastically with the increase of volume fraction ( Vf) of the inclusions. This study presents a theoretical model to predict the effective thermal conductivity of two-phase particulate composites containing highly conductive inclusions in a polymeric matrix. The probabilistic approach presented by Tsao (1961) has been modified and extended for predicting the effective thermal conductivity of two-phase composites. The expression for the effective thermal conductivity of a unit cube of two-phase composite is derived implicitly in terms of distribution function, Vf and thermal conductivity of the constituents. Different distribution functions of the inclusions are proposed and the optimum function is obtained to describe the effective thermal conductivity of highly conductive particulate composites. Results of the effective thermal conductivity of a cubic unit cell obtained from different distributions of inclusions are compared with published experimental data, and other analytical and numerical models for particulate composites available in the literature. The results show a linear distribution of inclusions gives reasonable estimates of the effective thermal conductivity of the particulate composites. It is anticipated that the proposed approach can be used to develop models for the effective thermal conductivity of advanced composites containing highly conductive inclusions.
Domestic diversion and strategic behavior by minority groups
Authors: Martinez Machain Carla , Rosenberg Leo
Published: August 2016

Diversionary war theory states that leaders may initiate an international conflict in order to invoke internal cohesion and distract the public from domestic issues. Recent developments in diversionary literature suggest the possibility that leaders can alternately divert against domestic targets, such as minority groups. Empirical support for domestic diversion, though, has been mixed. In this paper we seek to reconcile this by further examining the different dynamics at play between actors who are faced with diversionary incentives. We suggest that a major reason why we do not observe many cases of domestic diversion is strategic behavior by minority groups. Much like states do, minority groups that are potential targets of repression engage in strategic conflict avoidance when they observe diversionary incentives to be present. We test our theory through a multivariate probit model that uses the state–minority group dyad as the unit of analysis.
Comparison of Permanent Versus Absorbable Suture in the Tongue-in-Groove Technique in Endonasal Rhinoplasty
Authors: Kadakia Sameep , Ovchinsky Alexander
Published: August 2016

The tongue-in-groove technique in endonasal rhinoplasty is a commonly used method for making changes in tip rotation and projection. We examine the outcomes of absorbable and permanent suture tongue-in-groove technique in relation to maintaining postoperative tip rotation and projection. A retrospective review of the preoperative and postoperative photographs of 18 patients treated with endonasal tongue-in-groove technique were analyzed. Twelve patients were treated with nylon suture and 6 with polydioxanone suture (PDS). There were 9 females (50%) and 9 males (50%), with the age ranging from 17 to 49 years. The mean follow-up time was 12.1 months. All patients were treated by the senior author in a New York City hospital. All patients were treated with the tongue-in-groove technique in endonasal rhinoplasty; 5.0 clear Nylon suture was used on 12 patients and 5.0 clear PDS on 6 patients. Using an unpaired t test and an alpha value of 0.05, the difference between the preoperative and postoperative tip rotation and projection was statistically significant for nylon ( P = .0069, P = .026) but not for PDS ( P = .27, P = .15). Using permanent suture in tongue-in-groove technique during endonasal rhinoplasty seems to be a more reliable method for maintaining postoperative changes in tip rotation and projection.
Why Are Children With Epileptic Encephalopathies Encephalopathic?
Authors: Barry Jeremy M. , Holmes Gregory L.
Published: August 2016

The epileptic encephalopathies are devastating conditions characterized by frequent seizures, severely abnormal electroencephalograms (EEGs), and cognitive slowing or regression. The cognitive impairment in the epileptic encephalopathies may be more concerning to the patient and parents than the epilepsy itself. There is increasing recognition that the cognitive comorbidity can be both chronic, primarily due to the underlying etiology of the epilepsy, and dynamic or evolving because of recurrent seizures, interictal spikes, and antiepileptic drugs. Much of scholars’ understanding of the neurophysiological underpinnings of cognitive dysfunction in the epileptic encephalopathies comes from rodent studies. Frequent seizures and interictal EEG discharges in rats lead to considerable spatial and social-cognitive deficits. Paralleling these cognitive deficits are dyscoordination of dynamic neural activity within and between the neural networks that subserve normal cognitive processes.
Elution profiles of tobramycin and vancomycin from high-purity calcium sulphate beads incubated in a range of simulated body fluids
Authors: Cooper JJ , Florance H , McKinnon JL , Laycock PA , Aiken SS
Published: August 2016

The aim of this study was to characterise the elution profiles of antibiotics in combination with pharmaceutical grade calcium sulphate beads in phosphate buffered saline and other physiological solutions which more closely mimic the in vivo environment. Synthetic recrystallised calcium sulphate was combined with vancomycin hydrochloride powder and tobramycin sulphate solution and the paste was formed into 3 mm diameter hemispherical beads. Then 2 g of beads were immersed in 2 ml of either phosphate buffered saline, Dulbecco’s Modified Eagle Medium or Hartmann’s solution and incubated at 37℃ for up to 21 days. At a range of time points, eluent was removed for analysis by liquid chromatography-mass spectrometry (LC-MS). Tobramycin sulphate and vancomycin hydrochloride release was successfully quantified against standard curves from solutions eluted in all three physiological media (phosphate buffered saline, Dulbecco’s Modified Eagle Medium and Hartmann’s solution) during incubation with calcium sulphate beads. One hour eluate concentrations were high, up to 2602 µg/ml for tobramycin in phosphate buffered saline and 7417 µg/ml for vancomycin, whereas in DMEM, the levels of tobramycin were 2458 µg/ml and 4401 µg/ml for vancomycin. The levels in HRT were 2354 µg/ml for tobramycin and 5948 µg/ml for vancomycin. The results show highest levels of antibiotic elution over the first 24 h, which gradually diminish over the following 21 days.
A Novel Exercise Initiative for Seniors to Improve Balance and Physical Function
Authors: Sales Myrla , Polman Remco , Hill Keith D. , Levinger Pazit
Published: August 2016

Objective: To investigate the feasibility, effectiveness, and short-term effects of an exercise intervention using a novel exercise park in improving seniors’ balance, physical function, and quality of life. Method: Randomized controlled trial with pre- and post-intervention design (baseline and 18-week intervention) was used. Outcome measures included measures of balance, strength, and function, as well as quality of life and fear of falling. MANCOVA was used to assess differences between groups (control and exercise intervention) over time. Results: Intervention group showed significant improvement on single leg stance ( p = .02, 95% confidence interval [CI] = [−8.35, −0.549]), knee strength ( p < .01, 95% CI = [−29.14, −5.86]), 2-min walk ( p = 0.02, 95% CI = [−19.13, −0.859]), and timed sit to stand ( p = .03, 95% CI = [−2.26, −0.143]) tests. Discussion: The exercise park program improved physical function and had high adherence and participation rate. Such intervention has been shown to be safe and therefore might enhance participation in exercise programs for older adults.
Development of a STEP-compliant design and manufacturing framework for discrete sheet metal bend parts
Authors: Faraz Zahid , Waheed ul Haq Syed , Ali Liaqat , Mahmood Khalid , Tarar Wasim Akram , Baqai Aamer Ahmed , Khan Mushtaq , Jaffery Syed Husain Imran , Choudhry Rizwan Saeed
Published: August 2016

Metal sheets have the ability to be formed into nonstandard sizes and sections. Displacement-controlled computer numerical control press brakes are used for three-dimensional sheet metal forming. Although the subject of vendor neutral computer-aided technologies (computer-aided design, computer-aided process planning and computer-aided manufacturing) is widely researched for machined parts, research in the field of sheet metal parts is very sparse. Blank development from three-dimensional computer-aided design model depends on the bending tools geometry and metal sheet properties. Furthermore, generation and propagation of bending errors depend on individual bend sequences. Bend sequence planning is carried out to minimize bending errors, keeping in view the available tooling geometry and the sheet material properties’ variation. Research reported in this article attempts to develop a STEP-compliant, vendor neutral design and manufacturing framework for discrete sheet metal bend parts to provide a capability of bidirectional communication between design and manufacturing cycles. Proposed framework will facilitate the use of design information downstream at the manufacturing stage in the form of bending workplan, bending workingsteps and a feedback mechanism to the upstage product designer. In order to realize this vendor neutral framework, STEP (ISO 10303), AP203, AP207, and AP219 along with STEP-NC (ISO14649) have been used to provide a basis of vendor neutral data modeling.
A novel relative degree-of-freedom criterion for a class of parallel manipulators with kinematic redundancy and its applications
Authors: Qu Haibo , Guo Sheng , Zhang Ying
Published: August 2016

The mobility of a whole parallel manipulator and the relative degree-of-freedom are the key points in mechanism synthesis and analysis, which often can be used to verify the existence of mechanisms. In this paper, the difference between the mobility of a parallel manipulator and the relative degree-of-freedom is discussed. First, a novel relative degree-of-freedom criterion is proposed based on the principle of determining the moving platform by N point positions, which is suitable for a kind of parallel manipulator with spherical joints attached to the moving platform. Next, the relative degree-of-freedom criterion is used to calculate the independent motions of the moving platform compared with the modified Kutzbach–Grübler criterion. The proposed relative degree-of-freedom criterion is different from the modified Kutzbach–Grübler criterion in result value and physical meaning. Finally, the type synthesis of such parallel manipulator with open-loop limbs or closed-loop limbs is performed based on the proposed relative degree-of-freedom criterion.
A computer-aided system for automatic extraction of femur neck trabecular bone architecture using isotropic volume construction from clinical hip computed tomography images
Authors: Vivekanandhan Sapthagirivasan , Subramaniam Janarthanam , Mariamichael Anburajan
Published: August 2016

Hip fractures due to osteoporosis are increasing progressively across the globe. It is also difficult for those fractured patients to undergo dual-energy X-ray absorptiometry scans due to its complicated protocol and its associated cost. The utilisation of computed tomography for the fracture treatment has become common in the clinical practice. It would be helpful for orthopaedic clinicians, if they could get some additional information related to bone strength for better treatment planning. The aim of our study was to develop an automated system to segment the femoral neck region, extract the cortical and trabecular bone parameters, and assess the bone strength using an isotropic volume construction from clinical computed tomography images. The right hip computed tomography and right femur dual-energy X-ray absorptiometry measurements were taken from 50 south-Indian females aged 30–80 years. Each computed tomography image volume was re-constructed to form isotropic volumes. An automated system by incorporating active contour models was used to segment the neck region. A minimum distance boundary method was applied to isolate the cortical and trabecular bone components. The trabecular bone was enhanced and segmented using trabecular enrichment approach. The cortical and trabecular bone features were extracted and statistically compared with dual-energy X-ray absorptiometry measured femur neck bone mineral density. The extracted bone measures demonstrated a significant correlation with neck bone mineral density ( r > 0.7, p < 0.001). The inclusion of cortical measures, along with the trabecular measures extracted after isotropic volume construction and trabecular enrichment approach procedures, resulted in better estimation of bone strength. The findings suggest that the proposed system using the clinical computed tomography images scanned with low dose could eventually be helpful in osteoporosis diagnosis and its treatment planning.
Stroke in a young patient with neurosyphilis and HIV
Authors: Patira Riddhi , Smith-Benjamin Sarah , Wang Jijo J
Published: August 2016

Syphilis has long been known as the great imitator. Its heterogeneity can manifest in the form of meningitis, space occupying gummas, vasculitis, strokes, cranial neuropathies, myelopathy, dementia, and seizures. The incidence has been rising with each year, mainly in men who have sex with men accounting for 83% of cases. With the coexistence of immunocompromised states, especially HIV (human immunodeficiency virus), the usually chronic and insidious course of tertiary neurosyphilis can be accelerated. Stroke can occur as a result of neurosyphilis in its meningovascular form, and the likelihood of this increases with HIV co-infection, especially in high-risk groups such as intravenous drug users and men who have sex with men. Here, we discuss a case of a young man who presented with an ischemic stroke found to have neurosyphilis and HIV and consider the management of these co-morbid conditions.
Low levels of neurocognitive impairment detected in screening HIV-infected men who have sex with men: The MSM Neurocog Study
Authors: Barber TJ , Bansi L , Pozniak A , Asboe D , Nelson M , Moyle G , Davies N , Margetts A , Ratcliffe D , Catalan J , Boffito M , Gazzard B
Published: August 2016

This study aimed to determine the prevalence of HIV neurocognitive impairment in HIV-infected men who have sex with men aged 18–50 years, using a simple battery of screening tests in routine clinical appointments. Those with suspected abnormalities were referred on for further assessment. The cohort was also followed up over time to look at evolving changes. HIV-infected participants were recruited at three clinical sites in London during from routine clinical visits. They could be clinician or self-referred and did not need to be symptomatic. They completed questionnaires on anxiety, depression, and memory. They were then screened using the Brief Neurocognitive Screen (BNCS) and International HIV Dementia Scale (IHDS). Two hundred and five HIV-infected subjects were recruited. Of these, 59 patients were excluded as having a mood disorder and two patients were excluded due to insufficient data, leaving 144 patients for analysis. One hundred and twenty-four (86.1%) had a normal composite z score (within 1 SD of mean) calculated for their scores on the three component tests of the BNCS. Twenty (13.9%) had an abnormal z score, of which seven (35%) were symptomatic and 13 (65%) asymptomatic. Current employment and previous educational level were significantly associated with BNCS scores. Of those referred onwards for diagnostic testing, only one participant was found to have impairment likely related to HIV infection. We were able to easily screen for mood disorders and cognitive impairment in routine clinical practice. We identified a high level of depression and anxiety in our cohort. Using simple screening tests in clinic and an onward referral process for further testing, we were not able to identify neurocognitive impairment in this cohort at levels consistent with published data.
Parenting African American Children With Autism: The Influence of Respect and Faith in Mother, Father, Single-, and Two-Parent Care
Authors: Burkett Karen , Morris Edith , Anthony Jean , Shambley-Ebron Donna , Manning-Courtney Patricia
Published: August 2016

Purpose: Parents are the most significant contributor to care of children with autism spectrum disorder (ASD), and as such research on African American parenting in ASD is conspicuously absent. Findings relevant to parenting are discussed from a study with urban African American families caring for children with ASD. Design: An ethnonursing study was conducted with 24 African American family members of children with ASD and 28 professionals. Data were analyzed and reported as themes. Findings: Two universal themes of were found of respect and faith in God and family that influenced parental care. Two diverse themes of mother’s watchful care and father’s protective care, along with differences in feelings of isolation and dependence on supports were found among single- and two-parent families. Discussion and Practice Implications: When health care professionals increase their knowledge and understanding of cultural practices in the parental care of children with ASD, they provide health care that is culturally congruent.
What’s Epistemology Got to Do With It?
Authors: Caputo Richard K.
Published: August 2016

Feminist standpoint epistemology is neither a necessary nor a sufficient starting point for social work intervention research. Contemporary social scientists readily grapple with cultural, political, and/or structural aspects of social problems either in the absence of or in conjunction with an explicitly formulated feminist standpoint epistemology. The article also argues against privileging any group’s voice for purposes of social work intervention research, including the voices of marginalized and oppressed groups whose judgments, perceptions, and statement of facts are as prone to error or likely to be as mistaken as anyone else’s.
What Value Can Qualitative Research Add to Quantitative Research Design? An Example From an Adolescent Idiopathic Scoliosis Trial Feasibility Study
Authors: Toye Francine , Williamson Esther , Williams Mark A. , Fairbank Jeremy , Lamb Sarah E.
Published: August 2016

Using an example of qualitative research embedded in a non-surgical feasibility trial, we explore the benefits of including qualitative research in trial design and reflect on epistemological challenges. We interviewed 18 trial participants and used methods of Interpretive Phenomenological Analysis. Our findings demonstrate that qualitative research can make a valuable contribution by allowing trial stakeholders to see things from alternative perspectives. Specifically, it can help to make specific recommendations for improved trial design, generate questions which contextualize findings, and also explore disease experience beyond the trial. To make the most out of qualitative research embedded in quantitative design it would be useful to (a) agree specific qualitative study aims that underpin research design, (b) understand the impact of differences in epistemological truth claims, (c) provide clear thematic interpretations for trial researchers to utilize, and (d) include qualitative findings that explore experience beyond the trial setting within the impact plan.
A Brief Coaching Intervention for Teaching Naturalistic Strategies to Parents
Authors: Lane Justin D. , Ledford Jennifer R. , Shepley Collin , Mataras Theologia K. , Ayres Kevin M. , Davis Alicia B.
Published: August 2016

Coaching parents to implement evidence-based strategies is one method for increasing the number of hours young children with autism spectrum disorder (ASD) access intervention services. The purpose of this study was to teach parents of young children with ASD to implement naturalistic strategies during play in a clinic setting. Results indicate a brief coaching procedure was effective for training parents to implement behavioral strategies, with concomitant changes in child behavior. Additional research is needed to determine how to facilitate maintenance over time and whether effects generalize to typical settings.
What Is Implementation Science and What Forces Are Driving a Change in Medical Education?
Authors: Thomas David C. , Berry Arnold , Djuricich Alexander M. , Kitto Simon , Kreutzer Kathy O’Kane , Van Hoof Thomas J. , Carney Patricia A. , Kalishman Summers , Davis Dave
Published: August 2016

Evidence-based interventions to improve health care and medical education face multiple complex barriers to adoption and success. Implementation science focuses on the period following research dissemination, which is necessary but insufficient to address important gaps in clinician performance and patient outcomes. This article describes the forces on health care institutions, medical schools, physician clinicians, and trainees that have created the imperative to design educational interventions to address the gap between evidence and practice. These forces include accreditation, certification, licensure, and regulatory and research funding initiatives focused on improving the quality of health professions education and clinical practice. Medical educators must expand their focus on “what to change” to include “how to change” in order to prepare health care professionals and institutions to effectively adopt new evidence-based practices to improve patient, and ultimately population, outcomes.
Team Training in the Perioperative Arena: A Methodology for Implementation and Auditing Behavior
Authors: Rhee Amanda J. , Valentin-Salgado Yessenia , Eshak David , Feldman David , Kischak Pat , Reich David L. , LoPachin Vicki , Brodman Michael
Published: August 2016

Preventable medical errors in the operating room are most often caused by ineffective communication and suboptimal team dynamics. TeamSTEPPS is a government-funded, evidence-based program that provides tools and education to improve teamwork in medicine. The study hospital implemented TeamSTEPPS in the operating room and merged the program with a surgical safety checklist. Audits were performed to collect both quantitative and qualitative information on time out (brief) and debrief conversations, using a standardized audit tool. A total of 1610 audits over 6 months were performed by live auditors. Performance was sustained at desired levels or improved for all qualitative metrics using χ2 and linear regression analyses. Additionally, the absolute number of wrong site/side/person surgery and unintentionally retained foreign body counts decreased after TeamSTEPPS implementation.
Cholesteryl Ester Transfer Protein Inhibitors
Authors: McLain Julian Hardy , Alsterda Andrew Jacob , Arora Rohit R.
Published: August 2016

The cholesteryl ester transfer protein (CETP) is a plasma protein that plays an important role in the transfer of lipids between plasma lipoproteins. The CETP inhibitors have been widely studied as a pharmacologic therapy to target plasma cholesterol in order to reduce the risk of atherosclerotic cardiovascular disease . Using CETP inhibitors as cholesterol modifiers was based on the genetic research that found correlations between CETP activity and cholesterol levels. Although CETP inhibitors are successful at altering targeted cholesterol markers, recent phase 3 outcome trials have shown limited benefit on cardiovascular outcomes when combined with the current standard of care. We discuss the science of CETP inhibition, compare the CETP inhibitors developed (torcetrapib, evacetrapib, dalcetrapib, and anacetrapib), the findings from the CETP inhibitor trials, and the future outlook for CETP inhibitors in cholesterol modification.
Combination Use of Clopidogrel and Proton Pump Inhibitors Increases Major Adverse Cardiovascular Events in Patients With Coronary Artery Disease
Authors: Niu Qiang , Wang Zhongsu , Zhang Yong , Wang Jiangrong , Zhang Pei , Wang Cong , Yin Xiangcui , Hou Yinglong
Published: August 2016

Background:

Published data indicated that combination use of clopidogrel and proton pump inhibitors (PPIs) may increase the incidence of major adverse cardiovascular events (MACEs). This has been a highly controversial topic for years.

Design:

The present study was performed to evaluate whether combination therapy of clopidogrel and PPIs is associated with increased risk of MACEs than with clopidogrel alone in patients with coronary artery disease.

Methods:

A systematic search of MEDLINE, EMBASE, and the Cochrane Library was conducted for studies recording the occurrence of MACEs in patients with exposure to concomitant use of clopidogrel and PPIs up to February 2015. Odds ratios (ORs) were combined using a random-effects model.

Results:

Patients receiving combination therapy with PPIs and clopidogrel were at significantly increased risk of MACEs (OR: 1.42; 95% confidence interval [CI]: 1.30-1.55). Adding a PPI to clopidogrel treatment was associated with a higher rate of MACE occurrence in rapid metabolizers (RMs, *1/*1) of CYP2C19 (OR: 1.42; 95% CI: 1.12-1.81), but there was no obviously increased rate (OR: 1.43; 95% CI: 0.89-2.28) in decreased metabolizers (with 1 or 2 loss-of-function allele). The increased risk of MACEs was similar in 4 classes of PPIs (omeprazole, lansoprazole, esomeprazole, and pantoprazole), but rabeprazole (OR: 1.03; 95% CI: 0.55-1.95) wasn’t.

Conclusion:

The combination use of clopidogrel and certain types of PPIs (omeprazole, lansoprazole, esomeprazole, pantoprazole) increases the risk of MACE in patients with coronary artery disease. Only in the RMs of CYP2C19, PPIs were associated with significantly increased MACE in patients coadministered with clopidogrel.
Factors Influencing ACT After Intravenous Bolus Administration of 100 IU/kg of Unfractionated Heparin During Cardiac Catheterization in Children
Authors: Muster Ileana , Haas Thorsten , Quandt Daniel , Kretschmar Oliver , Knirsch Walter
Published: August 2016

Anticoagulation using intravenous bolus administration of unfractionated heparin (UFH) aims to prevent thromboembolic complications in children undergoing cardiac catheterization (CC). Optimal UFH dosage is needed to reduce bleeding complications. We analyzed the effect of bolus UFH on activated clotting time (ACT) in children undergoing CC focusing on age-dependent, anesthesia-related, or disease-related influencing factors. This retrospective single-center study of 183 pediatric patients receiving UFH during CC analyzed ACT measured at the end of CC. After bolus administration of 100 IU UFH/kg body weight, ACT values between 105 and 488 seconds were reached. Seventy-two percent were within target level of 160 to 240 seconds. Age-dependent differences were not obtained ( P = .407). The ACT values were lower due to hemodilution (total fluid and crystalloid administration during CC, both P < .001), with premedication of acetylsalicylic acid ( P = .014) and low-molecular-weight heparin ( P = .049). Arterial thrombosis (3.85%), venous thrombosis (0.55%), and bleeding (1.65%) following CC did not correlate with ACT values but occurred more frequently in children between 1 month and 1 year of age (91%). In conclusion, with a bolus of 100 IU UFH/kg, an ACT target level of 160 to 240 seconds can be achieved during CC in children in 72%, which is influenced by hemodilution and anticoagulant and antiplatelet premedication but not by age.
Favorable Risk Selection in Medicare Advantage: Trends in Mortality and Plan Exits Among Nursing Home Beneficiaries
Authors: Goldberg Elizabeth M. , Trivedi Amal N. , Mor Vincent , Jung Hye-Young , Rahman Momotazur
Published: August 2016

The 2003 Medicare Modernization Act (MMA) increased payments to Medicare Advantage plans and instituted a new risk-adjustment payment model to reduce plans’ incentives to enroll healthier Medicare beneficiaries and avoid those with higher costs. Whether the MMA reduced risk selection remains debatable. This study uses mortality differences, nursing home utilization, and switch rates to assess whether the MMA successfully decreased risk selection from 2000 to 2012. We found no decrease in the mortality difference or adjusted difference in nursing home use between plan beneficiaries pre- and post the MMA. Among beneficiaries with nursing home use, disenrollment from Medicare Advantage plans declined from 20% to 12%, but it remained 6 times higher than the switch rate from traditional Medicare to Medicare Advantage. These findings suggest that the MMA was not associated with reductions in favorable risk selection, as measured by mortality, nursing home use, and switch rates.
Adjusting the Measurement of the Output of the Medical Sector for Quality: A Review of the Literature
Authors: Hall Anne E.
Published: August 2016

The Bureau of Economic Analysis recently created new price indexes for health care in its health care satellite account and now faces the problem of how to adjust them for quality. I review the literature on this topic and divide the articles that created quality-adjusted price indexes for individual medical conditions into those that use primarily outcomes-based adjustments and those that use only process-based adjustments. Outcomes-based adjustments adjust the indexes based on observed aggregate health outcomes, usually mortality. Process-based adjustments adjust the indexes based on the treatments provided and medical knowledge of their effectiveness. Outcomes-based adjustments are easier to implement, while process-based adjustments are more demanding in terms of data and medical knowledge. In general, the research literature shows adjusting for quality in the measurement of output in the medical sector to be quantitatively important.
Left on Base: Minor League Baseball Stadiums and Gentrification
Authors: van Holm Eric Joseph
Published: August 2016

Researchers have analyzed stadiums as an urban redevelopment tool for two decades but little work has studied what effect sports facilities have on gentrification. This article attempts to fill that void in the literature, using a multicity panel study to understand how minor league baseball stadiums affect the immediately surrounding areas on measures of redevelopment and gentrification. Regression results show that census tracts near a new minor league baseball stadium saw significant increases in the median income and slower growth in the share of minorities, but no change in the median rent or the overall rate of residential turnover. These findings indicate that minor league baseball stadiums create elements of both economic growth and demographic change, an outcome that deserves consideration when planning similar projects in the future.
Sustained clinico-radiologic response to anti-cytotoxic T lymphocyte antigen 4 antibody therapy in metastatic myxoid liposarcoma
Authors: Dasanu Constantin A
Published: August 2016

Rarity and heterogeneity of sarcomas pose significant challenges in terms of developing new therapies. Therefore, efforts towards studying immunotherapy in sarcomas may provide hope for effective control of this group of devastating cancers. A sustained clinico-radiologic response to the anti-cytotoxic T lymphocyte antigen 4 antibody ipilimumab in a patient with metastatic myxoid liposarcoma is reported. Although the patient was treated with this agent for metastatic melanoma, both his metastatic cancers – melanoma and sarcoma – meaningfully responded to this agent. Consideration of enrolling patients in immunotherapy trials using various immune checkpoint inhibitors, where available, is of paramount importance, especially when facing advanced and/or refractory sarcoma situation.
How khipus indicated labour contributions in an Andean village: An explanation of colour banding, seriation and ethnocategories
Authors: Hyland Sabine
Published: August 2016

New archival and ethnographic evidence reveals that Inka style khipus were used in the Andean community of Santiago de Anchucaya to record contributions to communal labour obligations until the 1940s. Archival testimony from the last khipu specialist in Anchucaya, supplemented by interviews with his grandson, provides the first known expert explanation for how goods, labour obligations, and social groups were indicated on Inka style Andean khipus. This evidence, combined with the analysis of Anchucaya khipus in the Museo Nacional de Arqueología, Antropología y Historia Peruana, furnishes a local model for the relationship between the two most frequent colour patterns (colour banding and seriation) that occur in khipus. In this model, colour banding is associated with individual data whilst seriation is associated with aggregated data. The archival and ethnographic evidence also explains how labour and goods were categorized in uniquely Andean ways as they were represented on khipus.
Deviant leisure: A criminological perspective
Authors: Smith Oliver , Raymen Thomas
Published: August 2016

This article explains why an understanding of deviant leisure is significant for criminology. Through reorienting our understanding of ‘deviance’ from a contravention of norms and values to encompassing engagement in behaviour and actions that contravene a moral ‘duty to the other’, the new ‘deviant leisure’ perspective outlined here describes activities that through their adherence to cultural values inscribed by consumer capitalism, have the potential to result in harm. Using the ideological primacy of consumer capitalism as a point of departure, we explore the potential for harm that lies beneath the surface of even the most embedded and culturally accepted forms of leisure. Such an explanation requires a reading that brings into focus the subjective, socially corrosive, environmental and embedded harms that arise as a result of the commodification of leisure. In this way, this article aims to act as a conceptual foundation for diverse yet coherent research into deviant leisure.
Does culture impact on notions of criminal responsibility and action? The case of spirit possession
Authors: Ahmad Ayesha , Dein Simon
Published: August 2016

Multicultural societies such as the United Kingdom are host to people with diverse belief systems and behavioral norms. Whilst a country requires that all members of society conform to standardized legal requirements, cases arise that involve certain complexities related to the cultural or religious context in which a certain action was committed. This paper addresses the impact of culture on notions of criminal responsibility and action. Through a case study of a recent event in the United Kingdom, we explore whether a cultural defense is relevant for contextualizing incidents in which an individual commits a criminal action during an alleged period of spirit possession From this analysis, we suggest that using a cultural defense can aid understanding of an individual’s relationship to the society that he or she identifies with and facilitate the practice of justice in a multicultural society.
Discussion on two methods for determining static strength of tubular T-joints at elevated temperature
Authors: Shao Yongbo , Zhao Haicheng , Yang Dongping
Published: August 2016

To predict the static strength of a welded tubular joint at elevated temperature using finite element simulation, two methods in the literature were reported. The first method aims to analyze the static strength of a tubular joint at a specified elevated temperature, and a routine mechanical analysis is carried out by defining the material properties at the specified elevated temperature according to some specifications. This method does not consider the heat transfer process of the tubular joint in a fire condition. The second method is used to determine the static strength of a tubular joint using a combination of transient state heat transfer analysis and mechanical analysis. The tubular joint subjected to a specified load is heated in accordance with ISO 834-1 standard fire curve to fail at a critical temperature, and the specified load is considered as the static strength of the joint at the critical temperature. In this study, a detailed parametric study on the failure process of circular hollow section tubular T-joints at elevated temperature is carried out using finite element method. The static strengths of the circular hollow section T-joint models obtained from the two methods are compared. The comparison shows that the first method produces a higher estimation on the static strength compared to the second method. Finally, the effect of some geometrical parameters, chord stress ratio, and elevated temperature on the difference of the two methods is also investigated.
Mediatization and the technologization of discourse: Exploring official discourse on the Internet and information and communications technology within the Evangelical Lutheran Church of Finland
Authors: Moberg Marcus
Published: August 2016

This article explores changing discursive practices on the implications of the continuous development of the Internet and information and communications technology (ICTs) within the Evangelical Lutheran Church of Finland. The article argues that the development of the Internet and new media technologies has been accompanied by the proliferation of a set of influential and widespread discursive formations on the character of institutional communication and practice in a digital era. These developments have motivated an increasing technologization of discourse within the Evangelical Lutheran Church of Finland that has chiefly involved a conscious redesign of its discursive practices vis-à-vis the Internet and ICTs in accordance with new criteria of communication effectivity and a notable new emphasis on training in these new practices.
An alternative method to produce metal/plastic hybrid components for orthopedics applications
Authors: Silva M , Mateus A , Oliveira D , Malça C
Published: August 2016

The demand for additive processes that provide components with high technological performance became overriding regardless of the application area. For medical applications, the orthopedics field—multimaterial orthoses and splints—can clearly benefit from direct additive manufacturing using a hybrid process instead of the traditional handmade manufacturing, which is slow, expensive, inaccurate, and difficult to reproduce. The ability to provide faster better orthoses, using innovative services and technologies, resulting in lower recovery times, reduced symptoms, and improved functional capacity, result in a significant impact on quality of life and the well-being of citizens. With these purposes, this work presents an integrate methodology, that includes the tridimensional (3D) scanning, 3D computer-aided design modeling, and the direct digital manufacturing of multimaterial orthoses and splints. Nevertheless, additive manufacturing of components with functional gradients, multimaterial components, e.g. metal/plastic is a great challenge since the processing factors for each one of them are very different. This paper proposes the addition of two advanced additive manufacturing technologies, the selective laser melting and the stereolithography, enabling the production of a photopolymerization of the polymer in the voids of a 3D metal mesh previously produced by selective laser melting. Based on biomimetic structures concept, this mesh is subject to a previous design optimization procedure in order to optimize its geometry, minimizing the mass involved and evidencing increased mechanical strength among other characteristics. A prototype of a hybrid additive manufacturing device was developed and its flexibility of construction, geometrical freedom, and different materials processability is demonstrated through the case study—arm orthosis—presented in this work.
Transformation of photojournalism practice in the Czech Republic in the age of digital technology
Authors: Štefaniková Sandra , Láb Filip
Published: August 2016

This study investigates the impact of digitalization on the photojournalistic profession and its transformation during the last two decades. The development of digital technology and the Internet by the end of the 20th century has brought several questions to the field of photojournalism and impacted the entire process of photojournalistic material production. Taking the example of the Czech Republic, we examine how photojournalists and photo editors perceive the changes brought on by the adoption of digital technology and how news routines, photojournalistic practices, image content, and professional identity have been reshaped. We conducted in-depth interviews and surveys with 48 photojournalists and photo editors from different Czech news media and magazines. The findings show how Czech photojournalists evaluate the state of their profession after digitalization. We also discuss a new way of image taking, so-called ‘cinematic shooting’, the ‘myth of acceleration’, and new responsibilities laid upon visual news professionals.