bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental Study of Impact-Protective Elements for Unidirectional Ribs of Lattice Composite Aircraft Structures
Authors: Chernov Andrey , Kondakov Ivan , Mirgorodskiy Yury
Published: December 2019

Lattice structures based on unidirectional composite ribs is currently one of the most promising directions of research aiming to create lightweight and reliable structure of future aircrafts [1]. Hybrid structure concepts based on lattice layouts have been developed for a number of conventional and non-conventional civil aircraft configurations, giving up to 15-20% weight saving as compared to conventional composite structures based on laminated skin and stiffeners [2]. One of the most critical problems of load-bearing lattice composite structures is very high sensitivity to impact loads, which is even more crucial than for the laminated composite structures. At the same time, topology of lattice grid makes it possible to create reliable protective system for the ribs, which can be effective in terms of weight expenses.
Numerical investigation of initial crack growth in composite laminates under tension
Authors: Dubovikov Evgeny , Shanygin Alexander , Vedernikov Dmitry
Published: December 2019

The simplified automated strength model of a fragment of composite laminate at microlevel based on the finite elements (FE) method is offered. The model allows investigating the growth of microcracks which arise in the resin in monolayers, orthogonal to a direction of external tensile force. On the basis of automated strength FE model of a fragment of composite laminate and the method of reduction of stiffness characteristics of the resin, the scenario of growth of primary destructions at the microlevel is offered and proved. The scenario is confirmed with experimental investigations of composite samples under tension with registration of acoustic emission. In the work, the dependences of decrease of strength characteristics of composite laminates are obtained as functions of characteristics of resin, angles of orientation of monolayers, volume ratio of fibres in a composite laminate.
Evaluation of research initiatives on the problem of reducing the aviation transport noise rate in accordance with the tasks of Flightpath 2050 goal 9
Authors: Dmytriyev Sergiy , Loginov Vasyl , Mitrakhovich Mykhailo , Doroshenko Ekaterina
Published: December 2019

The technical solutions to reduce noise level in engines of power plants were reviewed in the work. The review on priority of the projects directed to solve the problems of air vehicle acoustic reduction proceeding from evaluation of the main requirements of Strategic Research and Innovation Agenda of ACARE was presented. One of the main directions of research within Flightpath 2050 (goal 9) is a rational integration of airframe elements and power plant. The evaluation results of research initiatives as for the problem to reduce noise of GTE were substantiated according to program Flightpath 2050. On the grounds of the analytical data it was estimated that electrical airplanes and Open Rotor engines characterized by higher efficiency compared to bypass engines with a high bypass ratio (m=50...70) would further develop to a new level by 2050. It was marked that the aircraft with a distributed electrical power plant could essentially influence the solution of the problem to reduce noise of power plants in future.
Nonlinear vortex lattice method for stall prediction
Authors: Goitia Hasier , Llamas Raúl
Published: December 2019

The stall behavior of an empennage is a crucial and conditioning factor for its design. Thus, the preliminary design of empennages requires a fast low-order method which reliably computes the stall behavior and which must be sensitive to the design parameters (taper, sweep, dihedral, airfoil, etc.). Handbook or semi-empirical methods typically have a narrow scope and low fidelity, so a more general and unbiased method is desired. This paper presents a nonlinear vortex lattice method (VLM) for the stall prediction of generic fuselage-empennage configurations which is able to compute complete aerodynamic polars up to and beyond stall. The method is a generalized form of the van Dam algorithm, which couples the potential VLM solution with 2.5D viscous data. A novel method for computing 2.5D polars from 2D polars is presented, which extends the traditional infinite swept wing theory to finite wings, relying minimally on empirical data. The method has been compared to CFD and WTT results, showing a satisfactory degree of accuracy for the preliminary design of empennages.
Experimental and Computational Analysis of Model–Support Interference in Low-Speed Wind-Tunnel Testing of Fuselage-Boundary-Layer Ingestion
Authors: Della Corte Biagio , Perpignan André A.V. , van Sluis Martijn , Gangoli Rao Arvind
Published: December 2019

Junction flow caused by the aerodynamic interaction between a wind-tunnel model and the support structure can largely influence the flowfield and hence the experimental results. This paper discusses a combined numerical and experimental study which was carried out to mitigate the model–support interference in a wind-tunnel test setup for the study of fuselage boundary-layer ingestion. The setup featured an axisymmetric fuselage mounted through a support beam, covered by a wing-shaped fairing. The junction flow appearing at the fuselage–fairing connection produced undesired flow distortions at the fuselage aft section, due to the formation of an horseshoe vortex structure at the fairing leading edge. Numerical and experimental analysis were performed with the aim of reducing the distortion intensity by improving the fairing design. Results show that modifying the leading-edge shape of the fairing effectively decreased the flowfield distortions. Moreover, the addition of a dummy fairing diametrically opposed to the first one was found to be beneficial due to the enhancement of the configuration symmetry.
Analysis of a combined cycle propulsion system for STRATOFLY hypersonic vehicle over an extended trajectory
Authors: Ispir Ali Can , Gonçalves Pedro Miguel , Saracoglu Bayindir H.
Published: December 2019

Hypersonic civil aviation is an important enabler for extremely shorter flight durations for long-haul routes and using unexploited flight altitudes. Combined cycle engine concepts providing extended flight capabilities, i.e. propelling the aircraft from take-off to hypersonic speeds, are proposed to achieve high-speed civil air transportation. STRATOFLY project is a continuation of former European efforts in hypersonic research and aims at developing a commercial reusablevehicle for cruise speed of Mach 8 at stratospheric altitudes as high as 35 km above ground level. The propulsion plant of STRATOFLY aircraft consists of combination of two different type of engines: an array of air turbo rockets and a dualmode ramjet/scramjet. In the present study, 1D transient thermodynamic simulations for this combined cycle propulsion plant have been conducted between Mach 0 to 8 by utilizing 1D inviscid flow transport relations, numerical tools availablein EcosimPro software platform and the European Space Propulsion System Simulation libraries. The optimized engine parameters are achieved by coupling EcosimPro software with Computer Aided Design Optimization which is a differential evolution algorithm developed at the von Karman Institute.
Propeller Selection by Means of Pareto Optimal Sets Applied to Flight Performance
Authors: Slavik Svatomir , Klesa Jan
Published: December 2019

Selection process of the propeller for short take-off and landing (STOL) category aircraft is described. The aim is to achieve the highest possible performance with fixed propeller. The requirements are following: high maximal horizontal and cruise speeds, short take-off, high rate of climb and fixed propeller. These requirements are contradictory and so Pareto sets were used in order to find the optimal propeller. The method is applied for a family of geometrically similar propellers that are suitable for 73.5 kW (100 hp) piston engine designed for ultralight category aircraft with maximal take-off weight 472.5 kg. The propellers have from two to eight blades, blade angle settings from 15° to 40° and diameter from 1.1m to 2.65m. Pareto frontier is designed for each couple of parameters and the optimal propeller is selected according to these results. For comparison, the optimal propeller selection from the propeller family by means of a standard single-optimal process based on the speed power coefficient cs is also used. Using of Pareto sets leads to considerable performance increase for the set of contradictory requirements. So, high performance power system with low price (fixed pitch propeller) for STOL category aircraft can be designed. The described method can be used for the propeller optimization in similar cases.
Design and Development of Hybrid-Electric Propulsion Model for Aeronautics
Authors: Di Lorenzo Giuseppe , Frosina Emma , De Petrillo Luigi , Lauria Davide , Senatore Adolfo , Curreri Francesco , Saccone Guido , Kivel Mazuy Marcello , Pascarella Ciro
Published: December 2019

Nowadays, worldwide environmental issue, associated to reduction of pollutant and greenhouse emissions are gaining considerable attention. Aviation sector contribution to the whole CO2 released accounts to around 2%, but it is expected to grow in the next future due to increase of demand. Probably, combustion engine design and fuel efficiency have already reached their optimum technology level and only a breakthrough as hybrid-electric propulsion could be able to satisfy the new international more demanding requirements. However, an improvement of the technology readiness level of hybrid-electric propulsion is strongly necessary and many operational and safety challenges should be addressed. In the work here reported, a hybrid-electric model was designed and developed for general aviation aircrafts, by means of the Mathworks® Matlab – Simulink 1D/0D simulation environment. Both thermal and electric energy storage units, transmission systems and power management devices were considered and the overall performances were evaluated during cruise phase and a conventional training mission, characterized by several run(lap) “touch-and-go”. Furthermore, an innovative mathematical methodology was implemented for battery pack discharge profile interpolation. Finally, reliability and accuracy of the new proposed model were evaluated through comparison with the commercial code Simcenter AMESim® software and an average bias only equal to 5% was achieved.
A new active asymmetry monitoring and control technique applied to critical aircraft flap control system failures
Authors: Belmonte Dario , Dalla Vedova Matteo Davide Lorenzo , Quattrocchi Gaetano
Published: December 2019

Asymmetry limitation requirements between left and right wing flap surfaces play an important role in the design of the implementation of the secondary flight control system of modern airplanes. In fact, especially in the case of sudden breaking of one of the torsion bars of the flap transmission line, the huge asymmetries that can rapidly develop could compromise the lateral-directional controllability of the whole aircraft (up to cause catastrophic occurrences). Therefore, in order to guarantee the aircraft safety (especially during take-off and landing flight phase in which the effects of asymmetries could generate uncontrollable aircraft attitudes), it is mandatory to timely detect and neutralize these asymmetries. The current monitoring techniques generally evaluate the differential angular position between left and right surfaces and, in most the events, limit the Flaps Control System (FCS) asymmetries, but in severe fault conditions (e.g. under very high aerodynamic loads), unacceptable asymmetries could be generated, compromising the controllability of the aircraft. To this purpose, in this paper the authors propose a new active monitoring and control technique capable of detecting the increasing angular error between the different flap surfaces and that, after stopping the whole actuation system, acts on the portion of the actuation line still connected to the PDU to minimize the FCS asymmetries.
Charting the Edges of Human Performance
Authors: Kirwan Barry , Wies Matthias , Charles Rebecca , Dormoy Charles-Alban , Letouze Theodore , Lemkadden Alia , Maille Nicolas , Nixon Jim , Ruscio Daniele , Schmidt-Moll Carsten
Published: December 2019

In the Horizon 2020 funded Future Sky Safety programme, the Human Performance Envelope project pushed airline pilots to the edges of their performance in real-time cockpit simulations, by increasing stress and workload, and decreasing situation awareness. The aim was to find out how such factors interact, and to detect the edges of human performance where some form of automation support should be employed to ensure safe continued flight. A battery of measures was used, from behavioural to physiological (e.g. heart rate, eye tracking and pupil dilation), to monitoring pilot performance in real time. Several measures – e.g. heart rate, heart rate variability, eye tracking, cognitive walkthrough, and Human Machine Interface (HMI) usability analysis – proved to be useful and relatively robust in detecting performance degradation, and determining where changes in information presentation are required to better support pilot performance in challenging situations. These results led to proposed changes in a prototype future cockpit human-machine interface, which were subsequently validated in a final simulation. The results also informed the development of a ‘Smart-Vest’ that can be worn by pilots to monitor a range of signals linked to performance.
Quand science et musique se rencontrent
Authors: Alberman Garance , Gagez Jean-Marie , Miné-Hattab Judith
Published: December 2019

Musique et sciences ont souvent été liées dans l’histoire de la musique. Cependant, rares sont les compositeurs qui ont eu l’occasion d’interagir avec un scientifique pour s’imprégner de son travail et l’utiliser comme source d’inspiration. Le projet Muse-IC se propose de donner cette opportunité à des compositeurs d’aujourd’hui, en leur commandant une œuvre inspirée par une découverte scientifique récente. À la suite d’un double appel réalisé auprès de chercheurs et de compositeurs, des compositeurs se sont immergés dans l’univers scientifique de chercheurs afin de repousser les limites de leur démarche créative. Entre 2017 et 2019, six compositeurs ont écrit une pièce inspirée de la découverte d’un chercheur avec lequel ils ont interagit directement. L’aboutissement de ce projet a donné lieu à une conférence-concert à la salle Cortot, à Paris, une occasion unique de sensibiliser le public à l’importance de la recherche fondamentale au travers d’une rencontre originale entre compositeurs, musiciens et chercheurs.
L’épidémiologie entre le terrain des épidémies et l’approche populationnelle, XIX-XXesiècle
Authors: Corvol Pierre , Griset Pascal , Paillette Céline
Published: December 2019

L’émergence d’une épidémiologie moderne est fréquemment associée au basculement de la discipline, d’une science des épidémies vers une science des populations. L’avènement et le développement d’une épidémiologie fondée sur une approche statistique et mathématique n’exclut cependant pas la persistance d’une épidémiologie sur le terrain des épidémies, dans le sillage de l’hygiène publique et de la bactériologie triomphante du tournant des XIXeet XXesiècles. De plus, l’histoire de l’épidémiologie ne saurait être cantonnée à une histoire de savoirs scientifiques ou de savoir-faire techniques et organisationnels. Elle doit intégrer, plus sans doute encore que d’autres branches de la médecine, les dimensions économiques et politiques qui participèrent à l’institutionnalisation et au développement de la discipline et à son inscription dans les processus de décision.
Effekt des oralen BTK-Inhibitors Evobrutinib auf Multiple Sklerose
Authors: Riester Dr. Karin Dorota
Published: December 2019

Die Bruton-Tyrosin-Kinase (BTK) ist ein Enzym, welches die Funktion von Immunzellen wie B-Zellen und Myeloidzellen reguliert. Diese Zellarten spielen bei der Pathogenese von Multipler Sklerose (MS) eine bedeutende Rolle. Im Rahmen dieser Phase-II-Studie untersuchten die Forscher, wie sich die orale Einnahme verschiedener Dosen des BTK-Inhibitors Evobrutinib auf die Entstehung von Läsionen im Gehirn von MS-Patienten auswirkt.
Schläfenlappenepilepsie
Authors: Niehusmann Pitt , Becker Albert J.
Published: December 2019

Die Schläfenlappenepilepsie stellt die häufigste fokale Epilepsieform dar. Trotz etablierter Pathologiemuster ergaben sich zuletzt grundlegende Innovationen im Hinblick sowohl auf erworbene Epilepsien mit hippocampalem Ursprung als auch bei fokalen kortikalen Dysplasien und epilepsieassoziierten, oft glioneuronalen Tumoren. Besondere Erwähnung finden Verbesserungen des molekulargenetischen Verständnisses der Erkrankungen.
DEVASYS – Entwicklung eines Online-Tools zur
Unterstützung der systematischen Evaluation von Interventionsprojekten
der Prävention und Gesundheitsförderung
Authors: Wichmann Frauke , Brandes Mirko , Jahn Ingeborg , Muellmann Saskia , Peters Manuela , Pischke Claudia Ruth , Zeeb Hajo
Published: December 2019

Ziele der Arbeit Das Wissen über Wirkungen und
Umsetzungsqualität in praxisbezogenen Projekten der Prävention
und Gesundheitsförderung in Deutschland ist aktuell sehr begrenzt.
Für die Evaluation solcher Projekte gibt es derzeit kaum strukturierte
Evaluationssysteme, die leicht und mit wenig Aufwand, auch im Rahmen von
Selbstevaluationen, genutzt werden können. Das Ziel der vorliegenden
Arbeit war die wissenschaftsbasierte Entwicklung und Pilotierung eines
Online-Tools zur Unterstützung einer strukturierten Dokumentation und
Selbstevaluation von Interventionsprojekten der Prävention und
Gesundheitsförderung, das zu einer zyklischen Projektentwicklung
beiträgt.

Methodik Der multimethodische Ansatz beinhaltete 2 Abschnitte, eine
Literatur- und Datenbankrecherche zur Erstellung eines Rahmenmodells sowie eine
Praxisanpassung, einschließlich einer Fokusgruppe und einem
Anwendungstest mit Stakeholdern aus unterschiedlichen Praxisbereichen der
Prävention und Gesundheitsförderung (N=12).

Ergebnisse Das Dokumentations- und Evaluationssystem (DEVASYS)
unterscheidet die Bereiche „Planung“,
„Dokumentation“ und „Evaluation“, die jeweils
auch unabhängig voneinander bearbeitet werden können.
Konzeptionelle Grundlage des Tools bildet das RE-AIM Framework. Zur Bestimmung
der Projektqualität können sowohl Dimensionen der Output-Ebene
(Reichweite, Akzeptanz, Implementierung) als auch der Outcome-Ebene
(Wirksamkeit, Aufrechterhaltung) erfasst werden.

Schlussfolgerung DEVASYS ist ein praxiserprobtes Werkzeug, das zu einer
verbesserten Evaluation existierender praxisbezogener Interventionsprojekte und
zu einer Qualitätsentwicklung zukünftiger Projekte in der
Prävention und Gesundheitsförderung beiträgt.
Nächste Schritte sind die systematische Dissemination und
Implementierung.
Medial Femoral Trochlea Graft for Scaphoid Waist Nonunion: A Case Report and Review of the Literature
Authors: Crepaldi Bruno E. , Keating Cameron , Ek Eugene T. , Tham Stephen K. Y.
Published: December 2019

The medial femoral trochlea (MFT) of the knee is a donor site for convex osteochondral vascularized bone that has been used for the salvage of fractures of the proximal pole of the scaphoid. Chronic nonunited fractures of the scaphoid may lead to a sequence of degenerative change often referred to as scaphoid nonunion advance collapse. The vascularized MFT osteochondral graft has been reported as a salvage procedure for fractures of the proximal pole of the scaphoid, in situations where fixation is not an option. In this “Special review,” we describe the technique of free vascularized MFT graft in a case in which the nonunited scaphoid fracture was associated with segmental loss of the articular surface of the scaphoid waist. Given the likely progression of arthritis, if left untreated, we elected to treat this by replacing the lost articular surface using a vascularized intercalary osteochondral MFT graft between the nonunited scaphoid segments.
Efficient and accurate description of adsorption in zeolites
Authors: Klimeš Jiří , Tew David P.
Published: December 2019

Accurate theoretical methods are needed to correctly describe adsorption on solid surfaces or in porous materials. The random phase approximation (RPA) with singles corrections scheme and the second order Møller-Plesset perturbation theory (MP2) are two schemes, which offer high accuracy at affordable computational cost. However, there is little knowledge about their applicability and reliability for different adsorbates and surfaces. Here, we calculate adsorption energies of seven different molecules in zeolite chabazite to show that RPA with singles corrections is superior to MP2, not only in terms of accuracy but also in terms of computer time. Therefore, RPA with singles is a suitable scheme for obtaining highly accurate adsorption energies in porous materials and similar systems.
Phase-space dynamics of near-wall streaks in wall-bounded turbulence with spanwise oscillation
Authors: Yuan Wenjun , Zhang Mengqi , Cui Yongdong , Khoo Boo Cheong
Published: December 2019

This work presents systematical investigations on the skin-friction drag reduction (DR) of turbulent channel flow subjected to spanwise wall oscillation using direct numerical simulation. Altogether 12 different oscillatory cases have been studied with a reference at Reτ = 200, varying the controlling parameters characterized by maximum wall velocity Wm+ and oscillation period T+. Some of the previously established facts have been reproduced by our analysis with a new focus on the phase-space dynamics of the near-wall streaks, on the basis of statistical data over entire oscillation periods and over phasewise variations. It is revealed that streamwise vortices are generated in the vicinity of oscillation walls, disrupting the formation of near-wall low-speed streaks. Although the overall turbulence is weakened, the Stokes layer is thicker within wall acceleration phases for larger Wm+, which causes the turbulence intensity to increase in the upper viscous sublayer. In addition, regarding the effect of T+, a long oscillation period promotes the formation of energetic near-wall structures, while for short T+, the streak-generation time scale preferentially restricts the growth of spanwise streaks. From a new vorticity-transport perspective of the Reynolds shear stress, our results further indicate that high drag-reducing phenomena are connected to the near-wall sweep events, and the shear stress variation is principally driven by the distortion of the spanwise transport of wall-normal vorticity, i.e., vortex tilting/stretching. The DR process is seen to be linked to the increase in enstrophy and turbulence-energy dissipation in the near-wall region.
Association between different methods of assessing blood pressure variability and incident cardiovascular disease, cardiovascular mortality and all-cause mortality: a systematic review
Authors: Smith Toby O , Sillito Julia Ann , Goh Choon-Hian , Abdel-Fattah Abdel-Rahman , Einarsson Alice , Soiza Roy L , Mamas Mamas A , Tan Maw Pin , Potter John F , Loke Yoon K , Myint Phyo K
Published: December 2019

Background

Blood pressure variability (BPV) is a possible risk factor for adverse cardiovascular outcomes and mortality. There is uncertainty as to whether BPV is related to differences in populations studied, measurement methods or both. We systematically reviewed the evidence for different methods to assess blood pressure variability (BPV) and their association with future cardiovascular events, cardiovascular mortality and all-cause mortality.

Methods

Literature databases were searched to June 2019. Observational studies were eligible if they measured short-term BPV, defined as variability in blood pressure measurements acquired either over a 24-hour period or several days. Data were extracted on method of BPV and reported association (or not) on future cardiovascular events, cardiovascular mortality and all-cause mortality. Methodological quality was assessed using the CASP observational study tool and data narratively synthesised.

Results

Sixty-one studies including 3,333,801 individuals were eligible. BPV has been assessed by various methods including ambulatory and home-based BP monitors assessing 24-hour, “day-by-day” and “week-to-week” variability. There was moderate quality evidence of an association between BPV and cardiovascular events (43 studies analysed) or all-cause mortality (26 studies analysed) irrespective of the measurement method in the short- to longer-term. There was moderate quality evidence reporting inconsistent findings on the potential association between cardiovascular mortality, irrespective of methods of BPV assessment (17 studies analysed).

Conclusion

An association between BPV, cardiovascular mortality and cardiovascular events and/or all-cause mortality were reported by the majority of studies irrespective of method of measurement. Direct comparisons between studies and reporting of pooled effect sizes were not possible.
Greek in Their Own Way: Writing India and Japan into the World History of Architecture at the Turn of the Twentieth Century
Authors: Conrad Sebastian
Published: December 2019

At the turn of the twentieth century, two architects—Itō Chūta in Japan and Rajendralal Mitra in Bengal—sought to counter Eurocentric accounts of aesthetic modernity by insisting on the inclusion of Japanese and Indian building traditions in the world history of architecture. In different and indeed opposing ways, they mobilized the idea of classical Greece; while Itō saw ancient Japanese buildings as directly influenced by Greek models, Mitra denied any such connections. Beyond these differences, however, both scholars were aligned in their effort to use references to “Greece” in order to claim equivalence for their native architecture on a world stage. While invoking a Eurocentric standard to battle Eurocentrism may sound paradoxical, this article shows that a confluence of global forces went into the making of this late Victorian moment of imperial universalism. The globality of the standards both actors referred to should not be imagined as the result of a gradual spread and diffusion from a European center. Rather, actors constantly invented and co-produced these standards as they resonated both with global change and with social dynamics locally.
Combination Antihypertensive Therapy Prescribing and Blood Pressure Control in a Real-World Setting
Authors: Magvanjav Oyunbileg , Cooper-Dehoff Rhonda M , McDonough Caitrin W , Gong Yan , Hogan William R , Johnson Julie A
Published: December 2019

BACKGROUND

Specific combinations of two drug classes are recommended in a variety of clinical situations in the management of hypertension. These preferred combinations are based on complimentary blood pressure (BP) lowering mechanisms or benefit for a concomitant disease.

METHODS

Using electronic health records (EHRs) data from 27,579 ambulatory hypertensive patients, we investigated antihypertensive therapy prescribing patterns and associations of preferred two drug classes with BP control.

RESULTS

Overall, BP control, defined as BP <140/90 mm Hg, was 65% among treated patients. Preferred dual antihypertensive therapy was prescribed in 55% of patients with uncomplicated hypertension, 49% of patients with diabetes, and 47% of patients with a history of myocardial infarction (MI); these prescribing frequencies of preferred combinations were not explained by worse BP control on those combinations. In fact, we found suggestive evidence of association between prescribing of preferred two drug classes and improved BP control among post-MI (OR: 1.21, 95% CI: 0.99–1.48, P = 0.061) and uncomplicated hypertensive (OR: 1.11, 95% CI: 0.98–1.26, P = 0.089) patients.

CONCLUSIONS

Prescribing of guideline-recommended antihypertensive drug classes for concomitant diseases is suboptimal and prescribing of preferred/optimized drug class combinations was moderate. We did not find a clear association between the use of optimized drug class combinations and greater BP control. Overall, using EHR data, we identified potential opportunities for re-examining prescribing practices with implications for clinical decision support and healthcare improvement at the community and health system-wide levels.
Avian influenza viruses in humans: lessons from past outbreaks
Authors: Li Yao-Tsun , Linster Martin , Mendenhall Ian H , Su Yvonne C F , Smith Gavin J D
Published: December 2019

Background

Human infections with avian influenza viruses (AIV) represent a persistent public health threat. The principal risk factor governing human infection with AIV is from direct contact with infected poultry and is primarily observed in Asia and Egypt where live-bird markets are common.

Areas of agreement

Changing patterns of virus transmission and a lack of obvious disease manifestations in avian species hampers early detection and efficient control of potentially zoonotic AIV.

Areas of controversy

Despite extensive studies on biological and environmental risk factors, the exact conditions required for cross-species transmission from avian species to humans remain largely unknown.

Growing points

The development of a universal (‘across-subtype’) influenza vaccine and effective antiviral therapeutics are a priority.

Areas timely for developing research

Sustained virus surveillance and collection of ecological and physiological parameters from birds in different environments is required to better understand influenza virus ecology and identify risk factors for human infection.
Reinforcing at the Top or Compensating at the Bottom? Family Background and Academic Performance in Germany, Norway, and the United States
Authors: Grätz Michael , Wiborg Øyvind N
Published: December 2019

Research on educational mobility usually studies socioeconomic differences at the mean of children’s academic performance but fails to consider the variation in the shape of socioeconomic differences across the outcome distribution. Theories of social mobility as well as theories about the resource allocation within families predict such variation. We use quantile regression models to estimate variation in socioeconomic differences across the distribution of academic performance using different indicators of family background (parental education, occupation, earnings, and wealth). We apply this approach to data on Germany, Norway, and the United States, three countries that represent different welfare and education regimes that may affect the intergenerational transmission of educational advantage. We find stronger socioeconomic differences at the bottom than at the middle and the smallest differences at the top of the performance distribution. These findings are virtually identical across all four indicators of family background. We also find no cross-national differences in the shape of socioeconomic differences in academic performance.
Metrics for assessing physician activity using electronic health record log data
Authors: Sinsky Christine A , Rule Adam , Cohen Genna , Arndt Brian G , Shanafelt Tait D , Sharp Christopher D , Baxter Sally L , Tai-Seale Ming , Yan Sherry , Chen You , Adler-Milstein Julia , Hribar Michelle
Published: December 2019

Electronic health record (EHR) log data have shown promise in measuring physician time spent on clinical activities, contributing to deeper understanding and further optimization of the clinical environment. In this article, we propose 7 core measures of EHR use that reflect multiple dimensions of practice efficiency: total EHR time, work outside of work, time on documentation, time on prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of undivided attention patients receive from their physicians during an encounter, undivided attention. We also illustrate sample use cases for these measures for multiple stakeholders. Finally, standardization of EHR log data measure specifications, as outlined here, will foster cross-study synthesis and comparative research.
A conserved role for γ-tubulin as a regulator of E2F transcription factors
Authors: Raynaud Cécile , Nisa Maherun
Published: December 2019

This article comments on:

Kállai BM, Kourová H, Chumová J, Papdi C, Trögelová L, Kofroňová O, Hozák P, Filimonenko V, Mészáros T, Magyar Z, Bögre L, Binarová P. 2020. γ-Tubulin interacts with E2F transcription factors to regulate proliferation and endocycling in Arabidopsis. Journal of Experimental Botany 71, 1265–1277.
The Short-term Effect of Graded Motor Imagery on the Affective Components of Pain in Subjects with Chronic Shoulder Pain Syndrome: Open-Label Single-Arm Prospective Study
Authors: Araya-Quintanilla Felipe , Gutiérrez-Espinoza Héctor , Jesús Muñoz-Yanez María , Rubio-Oyarzún David , Cavero-Redondo Iván , Martínez-Vizcaino Vicente , Álvarez-Bueno Celia
Published: December 2019

Objective

To determine the short-term effect of graded motor imagery (GMI) on the affective components of pain and range of motion in subjects with chronic shoulder pain syndrome.

Design

Open-label single-arm prospective study.

Setting

The Physical Therapy Laboratory, Universidad de las Americas.

Subjects

One hundred seven patients with chronic shoulder pain syndrome.

Methods

The subjects received a six-week GMI program based on laterality training, imagined movements, and mirror therapy. We assessed pain intensity using a visual analog scale (VAS), fear of movement was assessed using the Tampa Scale of Kinesiophobia (TSK), and catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). The patient’s flexion active range of motion (AROM) was also recorded.

Results

At the end of treatment, the VAS showed a decrease of 4.2 cm (P < 0.001, Cohen’s d = 3.3), TSK showed a decrease of 17.0 points (P < 0.001, Cohen’s d = 2.8), catastrophizing showed a decrease of 19.2 points (P < 0.001, Cohen’s d = 3.2), and shoulder flexion AROM showed an increment of 30.3º (P < 0.000, Cohen’s d = 1.6).

Conclusions

We conclude that a short-term GMI program improves the affective components of pain and shoulder flexion AROM in patients with chronic shoulder pain syndrome.
Reducing the Pain Behind Opioid Prescribing in Primary Care
Authors: González José Luis , Prabhakar Radhika , Marks Jennifer , Vigen Cheryl L P , Shukla Jagruti , Bannister Beatrisa
Published: December 2019

Objective

To describe the efficacy of a comprehensive approach aimed at reducing opioid prescribing in an internal medicine resident clinic.

Design

Retrospective observational study.

Setting

Internal medicine primary care resident clinic at a large urban academic medical center.

Subjects

All patients receiving opioid prescriptions from the primary care clinic.

Methods

We reviewed pharmacy dispensing data for two hospital-affiliated pharmacies for resident primary care patients filling opioid prescriptions between July 2016 and July 2018. We instituted a comprehensive set of interventions that included resident education, limiting supervision of encounters for long-term opioid therapy (LTOT) to a fixed set of faculty champions, and providing alternate modalities for pain control. We calculated the change in number of opioid prescriptions dispensed, number of patients receiving opioid prescriptions, morphine milligram equivalents (MMEs) dispensed, and average per-patient daily MMEs dispensed.

Results

We observed an average monthly reduction of 2.44% (P < 0.001) in the number of prescriptions dispensed and a 1.83% (P < 0.001) monthly reduction in the number of patients receiving prescriptions. Over the two-year period, there was a 74.3% reduction in total MMEs prescribed and a 66.5% reduction in the average MMEs prescribed per patient.

Conclusions

Our findings demonstrate a significant reduction in opioid prescribing after implementation of a comprehensive initiative. Although our study was observational in nature, we witnessed a nearly threefold decrease in opioid prescribing compared with national trends. Our results offer important insights for other primary care resident clinics hoping to engender safe prescribing practices and curb high-dose opioid prescribing.
Development and Initial Validation of the Self-Care Practices Scale
Authors: Lee Jacquelyn J , Miller Shari E , Bride Brian E
Published: December 2019

Self-care is regarded as essential for effective social work practice, offsetting occupational stress and promoting well-being and resiliency among practitioners. However, the literature reveals a notable absence of psychometrically sound instruments to measure self-care. The purpose of the present study was to describe the development, refinement, and construct validity of the Self-Care Practices Scale (SCPS). The piloted version of the SCPS is a 38-item instrument designed to measure frequency of engagement in personal and professional self-care practices. Data were collected through mailed surveys from a random sample of master’s-level clinical social workers and members of the National Association of Social Workers (N = 492). Analysis supports the construct validity of an 18-item SCPS with two subscales that demonstrate strong internal validity. The SCPS is useful for social work educators, practitioners, and administrators to ascertain frequency of self-care practice and build a stronger culture of self-care. The role of SCPS in future research is discussed.
Wegbreit: a cautionary tale for trustees, lawyers and wealth owners
Authors: Hunter Chelsea , Gifford James
Published: December 2019

On 8 July 2019, the US Tax Court held that a grantor trust holding offshore life insurance constituted a sham. A review of the facts of the case and the court’s opinion offer a cautionary tale to those planning, maintaining, or benefitting from similar wealth-holding structures. Like most cautionary tales, this one blends a unique factual milieu with tragic decision-making. But, unlike most cautionary tales, this one helps to illustrate some fundamental tax and wealth structure planning points.
International Pediatric Otolaryngology Group (IPOG) Consensus Recommendations: Congenital Cholesteatoma
Authors: Denoyelle Françoise , Simon François , Chang Kay W. , Chan Kenny H. , Cheng Alan G. , Cheng Alan T. , Choo Daniel I. , Daniel Sam J. , Farinetti Anne , Garabedian Erea-Noël , Greinwald John H. , Hoff Stephen R. , Hone Stephen , Licameli Greg R. , Papsin Blake C. , Poe Dennis S. , Pransky Seth , Smith Richard J. H. , Triglia Jean-Michel , Walton Joanna , Zalzal George , Leboulanger Nicolas
Published: December 2019

Objective:

To provide recommendations to otolaryngologists and allied physicians for the comprehensive management of children who present with signs and symptoms of congenital cholesteatoma.

Methods:

A two-iterative Delphi method questionnaire was used to establish expert recommendations by the members of the International Pediatric Otolaryngology Group, on the preoperative work-up, the perioperative considerations, and follow-up.

Results:

Twenty-two members completed the survey, in 14 tertiary-care center departments representing 5 countries. The main consensual recommendations were: a precise otoscopic description of the quadrants involved, extensive audiological workup (bilateral tonal, vocal audiometry, and BERA), and a CT scan are required. Facial nerve monitoring and a combination of microscope and telescope are recommended for surgical removal. Clinical and audiological follow-up should be pursued yearly for at least 5 years. First MRI follow-up should be done at 18 months postoperatively if the removal violated the matrix. MRI follow-up duration depends on the initial extent of the cholesteatoma.

Conclusion:

The goal of preoperative and follow-up consensus from International Pediatric Otolaryngology Group participants is to help manage infants and children with congenital cholesteatoma. The operative techniques may vary, and experienced surgeons must perform these procedures.
Is chorioamnionitis associated with neurodevelopmental outcomes in preterm infants? A systematic review and meta-analysis following PRISMA
Authors: Xing Lu , Wang Guoyu , Chen Ruiqi , Ren Jianhua , Qian Jiahui , Huang Yan
Published: December 2019

Background:

The relationships between chorioamnionitis (CA) and neurodevelopmental outcomes in preterm infants remain controversial. The meta-analysis aims to evaluate the associations between CA and neurodevelopmental deficits in preterm infants.

Methods:

All studies exploring the associations between CA and neurodevelopmental deficits in preterm infants were retrieved from the following databases: PubMed, Embase, OVID, EBSCO, ProQuest, CDSR, and CENTRAL. The NOS was used to evaluate the quality of the studies, RevMan was adopted to analyze the data.

Results:

Twelve studies involving 4267 preterm infants were included. The ORs across studies was 0.95 (P = .77, I

2
 = 51%) for cognitive deficits, 1.09 (P = .44, I

2
 = 10%) for psychomotor deficits, 1.21 (P = .08, I

2
 = 25%) for language deficits, 2.34 (P = .02, I

2
 = 0%) for performance intelligence quotient impairment and 2.81 (P = .03, I

2
 = 0%) for verbal intelligence quotient impairment. Subgroup analyses based on the severity of cognitive deficits indicated that CA might be correlated with severe cognitive deficits (P = .01, I

2
 = 0%) but not with mild cognitive deficits (P = .40, I

2
 = 19%). In terms of the CA category, clinical CA may be related to overall psychomotor deficits (P = .01, I

2
 = 25%) and overall language deficits (P < .00001, I

2
 = 23%) other than histological CA.

Conclusion:

In preterm infants, CA might be a risk factor for performance and verbal intelligence quotient impairment and severe cognitive deficits, and clinical CA might be a risk factor for overall psychomotor and language deficits.
Tissue-infiltrating immune cells contribute to understanding the pathogenesis of Kimura disease
Authors: Maehara Takashi , Munemura Ryusuke , Shimizu Mayumi , Kakizoe Noriko , Kaneko Naoki , Murakami Yuka , Masafumi Moriyama , Kiyoshima Tamotsu , Kawano Shintaro , Nakamura Seiji
Published: December 2019

Rationale:

Kimura disease (KD) is a rare, chronic inflammatory disorder characterized by subcutaneous granuloma in the head and neck region, as well as increased eosinophil counts and high serum immunoglobulin E (IgE) levels. Kimura disease is suspected to be an IgE-mediated disease, associated with an allergic response, in which antigen-specific B cells are stimulated to undergo specific IgE class switching with disease-specific CD4+ T (Th) cells help. Thus, exploration of the Th cells in affected tissues with KD is a highly promising field of the investigation. However, there have been no reports with direct evidence to implicate Th cells in affected lesions with KD. Here we quantitatively demonstrate that CD4+ GATA3+ T cells and interleukin (IL)-4+ IgE+ c-kit+ mast cells prominently infiltrate in affected lesion with KD.

Patient concerns:

A 56-year-old Japanese man who exhibited painless swelling in the left parotid region.

Diagnoses:

Diagnosis of KD was made based on characteristic histopathologic findings, in conjunction with peripheral eosinophilia and elevated serum IgE levels.

Interventions:

The patient underwent corticosteroid therapy and had been followed for 2 years.

Outcomes:

We report a rare case of KD of the parotid region in a 56-year-old man, followed by corticosteroid therapy for 2 years. The mass decreased in size and skin itchiness decreased after therapy. He was discharged without any complications. Furthermore, we quantitatively demonstrate the dominance of CD4+ GATA3+ T cells in affected tissues of KD and detect IL-4+ IgE+ c-kit+ mast cells in lesions by multicolor staining approaches.

Lessons:

The findings from this case suggest that peripheral blood eosinophilia might serve as a marker of recurrent disease, long-term follow-up is necessary due to the possibility of recurrent. Interactions among expanded IgE+ B cells, CD4+ GATA3+ T cells, eosinophils, and activated mast cells might play a critical role in the pathogenesis of KD.
Acupotomy for nerve entrapment syndrome
Authors: Shen Yifeng , Li Ting , Cai Tao , Zhong Juan , Guo Jing , Shen Huarui
Published: December 2019

Background:

Acupotomy has been widely used to treat nerve entrapment syndrome. But its efficiency has not been scientifically and methodically evaluated. The aim of this study is to evaluate the efficacy and safety of the acupotomy treatment in patients with nerve entrapment syndrome.

Methods:

Fifteen databases will be searched from inception to Dec 2019. We will include randomized controlled trials (RCTs) assessing acupotomy for nerve entrapment syndrome. All RCTs on acupotomy or related interventions will be included. Study inclusion, data extraction and quality assessment will be performed independently by 2 reviewers. Assessment of risk of bias and data synthesis will be performed using RevMan 5.3 software. Cochrane criteria for risk-of-bias will be used to assess the methodological quality of the trials.

Results:

This study will provide a high-quality synthesis of pain VAS and functional disability or the quality of life, the success treatment rate, the recurrent rate and the complications rate to assess the effectiveness and safety of acupotomy for nerve entrapment syndrome patients.

Conclusion:

This systematic review will provide evidence to judge whether acupotomy is an effective intervention for patients with nerve entrapment syndrome.

PROSPERO registration number:

CRD42018109086.
Modified double-opposing Z-plasty for patients with Veau I cleft palate
Authors: Seo Hyung Joon , Denadai Rafael , Pascasio Dax Carlo Go , Lo Lun-Jou
Published: December 2019

Low fistula rate and a satisfactory speech outcome were previously reported by adopting a modified Furlow palatoplasty using small double-opposing Z-plasty (DOZ). The purposes of this study were to (1) describe the technical standardization of further modification of this small DOZ using the medial incision (MIDOZ) approach for Veau I cleft repair; (2) assess the early postoperative outcomes of a single surgeon's experience using this technique; and (3) evaluate the temporal association of this standardization with the necessity of lateral relaxing incisions.

A prospective study (n = 24) was performed consecutively to non-syndromic patients with Veau I cleft palate who underwent MIDOZ approach. Patients with similar characteristics who underwent small DOZ were included as a retrospective group (n = 25) to control for the potential effect of the standardization of surgical maneuvers (including the hamulus fracture) on the rate of lateral relaxing incisions. Six-month complication rate was collected.

No postoperative complications, such as bleeding, flap necrosis, dehiscence or fistula were observed. The prospective group had a significantly (all P < .05) higher rate of hamulus fractures (n = 48, 100%) and a lower rate of lateral relaxing incisions (n = 1, 2%) than the retrospective group (n = 16, 32%; n = 26, 52%).

This technical standardization for performing palatoplasty using MIDOZ approach provided adequate Veau I cleft palate closure, without fistula formation, and with a low need of lateral relaxing incisions.