bluuebunny/crossref_metadata_2025 huggingface dataset:
Volcanic Influence on European Summer Precipitation through Monsoons: Possible Cause for “Years without Summer”*
Authors: Wegmann Martin , Brönnimann Stefan , Bhend Jonas , Franke Jörg , Folini Doris , Wild Martin , Luterbacher Jürg
Published: February 2014

Strong tropical volcanic eruptions have significant effects on global and regional temperatures. Their effects on precipitation, however, are less well understood. Analyzing hydroclimatic anomalies after 14 strong eruptions during the last 400 years in climate reconstructions and model simulations, a reduction of the Asian and African summer monsoons and an increase of south-central European summer precipitation in the year following the eruption was found. The simulations provide evidence for a dynamical link between these phenomena. The weaker monsoon circulations weaken the northern branch of the Hadley circulation, alter the atmospheric circulation over the Atlantic–European sector, and increase precipitation over Europe. This mechanism is able to explain, for instance, the wet summer in parts of Europe during the “year without a summer” of 1816, which up to now has not been explained. This study underlines the importance of atmospheric teleconnections between the tropics and midlatitudes to better understand the regional climate response to stratospheric volcanic aerosols.
Characteristics of Precipitation Features and Annual Rainfall during the TRMM Era in the Central Andes
Authors: Mohr Karen I. , Slayback Daniel , Yager Karina
Published: February 2014

The central Andes extends from 7° to 21°S, with its eastern boundary defined by elevation (1000 m and greater) and its western boundary by the coastline. The authors used a combination of surface observations, reanalysis, and the University of Utah Tropical Rainfall Measuring Mission (TRMM) precipitation features (PF) database to understand the characteristics of convective systems and associated rainfall in the central Andes during the TRMM era, 1998–2012. Compared to other dry (West Africa), mountainous (Himalayas), and dynamically linked (Amazon) regions in the tropics, the central Andes PF population was distinct from these other regions, with small and weak PFs dominating its cumulative distribution functions and annual rainfall totals. No more than 10% of PFs in the central Andes met any of the thresholds used to identify and define deep convection (minimum IR cloud-top temperatures, minimum 85-GHz brightness temperature, maximum height of the 40-dBZ echo). For most of the PFs, available moisture was limited (<35 mm) and instability low (<500 J kg−1). The central Andes represents a largely stable, dry to arid environment, limiting system development and organization. Hence, primarily short-duration events (<60 min) characterized by shallow convection and light to light–moderate rainfall rates (0.5–4.0 mm h−1) were found.
A Time Series Sodar Simulator Based on Large-Eddy Simulation
Authors: Wainwright Charlotte E. , Stepanian Phillip M. , Chilson Phillip B. , Palmer Robert D. , Fedorovich Evgeni , Gibbs Jeremy A.
Published: February 2014

A sodar simulator capable of producing time series data emulating sodar signals has been developed and tested. The atmospheric fields used to populate the sodar simulator are taken from output of a large-eddy simulation code. The characteristics of the sodar (number and zenith angle of beams, beamwidth, transmit frequency, range resolution, etc.) are defined by the user to allow emulation of existing systems. The range of the reflected acoustic signal is calculated based upon a temperature-dependent speed of sound. Realistic acoustic background noise is simulated using filtered white noise. The raw acoustic time series data are processed using a Fourier transform to yield acoustic Doppler spectra, from which the radial velocities are calculated. The design of the simulator allows for the testing of and comparisons between various signal-processing techniques and averaging periods. An example case of feeding the sodar simulator with large-eddy simulation data representative of a developing convective boundary layer is presented and discussed.
Flexible relations, frail contacts and failing demands: How community groups and local institutions interact in local governance in the Netherlands
Authors: de Wilde Mandy , Hurenkamp Menno , Tonkens Evelien
Published: February 2014

This paper explores the way community groups, central to new systems of local governance, are related to local institutions and how those relations influence them. We draw from two theoretical approaches – behavioural and institutional – that offer different answers to the question: what makes community groups thrive? Based on an analysis of 386 community groups in the Netherlands, we distinguish four types of groups: feather light, cooperative, networked and nested groups. Then, in a neighbourhood case study we focus on the relations between groups and local institutions to gain a deeper insight into the institutional dynamics of urban governance. Moreover, we combine the findings of both studies claiming that different groups need different things from local institutions, and that in the current NPM-driven world only the higher educated community groups have productive relationships with local institutions, while others are somewhere in between frail contacts and failing demands.
The Modulating Role of Stress in the Onset and Course of Tourette’s Syndrome
Authors: Buse Judith , Kirschbaum Clemens , Leckman James F. , Münchau Alexander , Roessner Veit
Published: February 2014

Accumulating data indicate a common occurrence of tic exacerbations and periods of psychosocial stress. Patients with Tourette’s syndrome (TS) also exhibit aberrant markers of hypothalamic-pituitary-adrenal (HPA) axis activation. Based on these findings, a functional relationship between stress and tic disorders has been suggested, but the underlying mechanism of how stress may affect tic pathology remains to be elucidated. We suggest that dopaminergic and noradrenergic neurotransmission as well as immunology play a crucial role in mediating this relationship. Two possibilities of causal direction might be assumed: (a) psychosocial stress might lead to an exacerbation of tics via activation of HPA axis and subsequent changes in neurotransmission or immunology and (b) TS-related abnormalities in neurotransmission or immunology result in a higher vulnerability of affected patients to respond to psychosocial stress with a strong activation of the HPA axis. It may also be the case that both assumptions hold true and interact with each other.
Histologic Changes in Traumatized Skeletal Muscle Exposed to Seawater
Authors: Stacy B. A. , Costidis A. M. , Keene J. L.
Published: February 2014

Wounds were created by incision in skeletal muscle of 2 mixed-breed canine cadavers at multiple time points from 0.5 to 74.5 hours postmortem and were exposed to artificial seawater (35 parts per thousand), 0.9% saline (8 parts per thousand), or freshwater for 24 hours before fixation for histology. Discoid and segmental disintegration of myofibers deep to the severed edges was observed in injuries inflicted within 6.5 hours of death and exposed to 0.9% saline and seawater and was not observed in injuries made at later time points or in other treatments. Exposure to artificial seawater had pronounced effects on histomorphology that markedly diminished with increasing postmortem wounding interval. In a third cadaver, these changes were shown to be detectable with confidence following up to 10 days of submergence in seawater at 22.2°C despite decomposition. These findings are important for evaluation of skeletal muscle injuries that are exposed to seawater, such as those occurring in marine animals, and may assist in recognizing wounds inflicted either antemortem or within the supravital period.
Maximizing self-care through familiarity: The role of practice effects in enhancing music listening and progressive muscle relaxation for pain management
Authors: Finlay Katherine A. , Rogers Joanna
Published: February 2014

Distraction and relaxation are regularly recommended as part of a pain management toolkit, with increasing research highlighting the inclusion of music as part of pain management toolkit. However, minimal research has assessed the role of practice effects or familiarity with these techniques when used consistently over time. Passive distraction (participant-selected preferred music) and active distraction (Progressive Muscle Relaxation; PMR) were compared against a no distraction control on the cold-pressor test (CPT). Seventy healthy participants completed the CPT with and without distraction at baseline and 1 week later. Experimental participants practised their distraction strategies daily between trials (7 days), with control participants keeping an activity log. Familiarity with and preference for distractors increased significantly over time, enhancing pain threshold. PMR and music reduced anxiety, enhanced pain tolerance, minimized pain perception and pain ratings. The active distraction of PMR enhanced self-efficacy to a greater extent than music and also regulated heart rate. Repeated exposure to distraction and relaxation approaches enhanced optimal arousal and complexity, maximizing pain management. It is suggested that both PMR, and music, are used together as part of a multidimensional toolkit for pain management.
Bioelectricity from kitchen and bamboo waste in a microbial fuel cell
Authors: Moqsud M Azizul , Omine Kiyoshi , Yasufuku Noriyuki , Bushra Quazi S , Hyodo Masayuki , Nakata Yukio
Published: February 2014

This study evaluated bioelectricity generation by using kitchen garbage (KG) and bamboo waste (BW) as a solid waste management option by a microbial fuel cell (MFC) method. The nutrient content [nitrogen, phosphorus and potassium (NPK)] of the by-products of bioelectricity were also analyzed and assessed for their potential use as a soil amendment. A one-chamber MFC was used for bioelectricity generation in laboratory experiments using both KG and BW. A data-logger recorded voltage every 20 mins at a constant room temperature of 25°C over 45 days. The trend of voltage generation was different for the two organic wastes. In the case of KG, the voltage at the initial stage (0–5 days) increased rapidly and then gradually to a peak of 620 mV. In contrast, the voltage increased gradually to a peak of 540 mV in the case of BW. The by-products of bioelectricity can be used as soil conditioner as its NPK content was in the range of soil conditioner mentioned in other literature. Thus, the MFC has emerged as an efficient and eco-friendly solution for organic waste management, especially in developing and technologically less sophisticated countries, and can provide green and safe electricity from organic waste.
An overview of waste crime, its characteristics, and the vulnerability of the EU waste sector
Authors: Baird J , Curry R , Cruz P
Published: February 2014

While waste is increasingly viewed as a resource to be globally traded, increased regulatory control on waste across Europe has created the conditions where waste crime now operates alongside a legitimate waste sector. Waste crime,is an environmental crime and a form of white-collar crime, which exploits the physical characteristics of waste, the complexity of the collection and downstream infrastructure, and the market opportunities for profit. This paper highlights some of the factors which make the waste sector vulnerable to waste crime. These factors include new legislation and its weak regulatory enforcement, the economics of waste treatment, where legal and safe treatment of waste can be more expensive than illegal operations, the complexity of the waste sector and the different actors who can have some involvement, directly or indirectly, in the movement of illegal wastes, and finally that waste can be hidden or disguised and creates an opportunity for illegal businesses to operate alongside legitimate waste operators. The study also considers waste crime from the perspective of particular waste streams that are often associated with illegal shipment or through illegal treatment and disposal. For each, the nature of the crime which occurs is shown to differ, but for each, vulnerabilities to waste crime are evident. The paper also describes some approaches which can be adopted by regulators and those involved in developing new legislation for identifying where opportunities for waste crime occurs and how to prevent it.
Municipal solid waste generation rates and its management at Yusmarg forest ecosystem, a tourist resort in Kashmir
Authors: Bhat Rouf Ahmad , Nazir Rumisa , Ashraf Samia , Ali Mudasir , Bandh Suhaib A , Kamili Azra N
Published: February 2014

The present study was carried out at Yusmarg, a forest ecosystem and tourist resort, in the Kashmir valley during 2012 with the objectives of determining the municipal solid waste (MSW) generation rates per capita and on a daily basis, and assessing the existing MSW system. It was estimated that daily generation of MSW at Yusmarg by tourists, as well as residents, was 107.74 kg; on average, the MSW generated at each site was about 36.48 kg/day. The per capita generation of MSW was highest (0.97 kg/person/day) at site 1 followed by 0.288 kg/person/day at site 2 and 0.201 kg/person/day at site 3, with an average per capita MSW generation rate of 0.484 kg/person/day. Manual segregation of the collected wastes showed that it comprised some recyclable, combustible, compostable and inert materials. Among the different waste categories, 56% of waste was recyclable materials, 29% was compostable wastes, 9% was combustible wastes and 6% was inert materials. The present study infers that MSW management in Yusmarg was inappropriate, and infrastructure, skilled manpower and a proper scientific disposal mechanism is lacking in the area. In order to conserve the forest wealth of the area there is a great need to focus on the solid waste problem of the tourist resort.
Physical, mechanical and hydration kinetics of particleboards manufactured with woody biomass (Cupressus lusitanica, Gmelina arborea, Tectona grandis), agricultural resources, and Tetra Pak packages
Authors: Moya Róger , Camacho Diego , Oporto Gloria S , Soto Roy F , Mata Julio S
Published: February 2014

Lignocellulosic wastes resulting from agricultural activities as well as Tetra Pak residues from urban centres can cause significant levels of pollution. A possible action to minimize this problem is to use them in the production of particleboards. The purpose of this study was to evaluate the physical, mechanical, and hydration properties of particleboards manufactured with the mixture of woody biomass ( Cupressus lusitanica, Gmelina arborea, and Tectona grandis) and either agricultural wastes [pineapple leaves ( Ananas comosus) and palm residues ( Elaeis guineensis)] or Tetra Pak residues (TP). The results show that the particleboards prepared with TP and woody biomass can reduce the swelling and water absorption in up to 40% and 50% compared with particleboards without TP. Also, these particleboards had increased flexure resistance and shear stress (up to 100%) compared with those without TP. On the contrary, particleboards prepared with pineapple leaves in combination with woody biomass showed the lowest mechanical properties, particularly for tensile strength, hardness, glue-line shear, and nail and screw evaluation.
Temperature fields in a channel partially filled with a porous material under local thermal non-equilibrium condition – An exact solution
Authors: Karimi Nader , Mahmoudi Yasser , Mazaheri Kiumars
Published: February 2014

This work examines analytically the forced convection in a channel partially filled with a porous material and subjected to constant wall heat flux. The Darcy–Brinkman–Forchheimer model is used to represent the fluid transport through the porous material. The local thermal non-equilibrium, two-equation model is further employed as the solid and fluid heat transport equations. Two fundamental models (models A and B) represent the thermal boundary conditions at the interface between the porous medium and the clear region. The governing equations of the problem are manipulated, and for each interface model, exact solutions, for the solid and fluid temperature fields, are developed. These solutions incorporate the porous material thickness, Biot number, fluid to solid thermal conductivity ratio and Darcy number as parameters. The results can be readily used to validate numerical simulations. They are, further, applicable to the analysis of enhanced heat transfer, using porous materials, in heat exchangers.
A novel bi-directional deformable fluid actuator
Authors: Ferraresi Carlo , Franco Walter , Quaglia Giuseppe
Published: February 2014

The deformable fluid actuators available on the market, i.e. pneumatic muscles and pneumatic springs, are designed to mainly exert compressive or tensile forces. This paper deals with a novel fluid deformable actuator, with three membranes, called BiFAc3, whose particular feature is the ability to exert both tensile and compressive forces. The structure of the actuator is based on three cylindrical coaxial nonisotropic membranes connected to two end plates, whose original shape allows the independent supply of the three internal chambers. The first part of the paper deals with the internal structure and the geometry of the actuator, describes the operating principle and presents a prototype. The second part presents a modelling methodology that can be used to design and analyse the actuator in dynamic applications. The mathematical model of the actuator is based on three different levels of complexity which correspond to three consecutive design stages. The model has been experimentally validated: it is a useful tool for the choice of the actuator’s geometrical dimensions, in order to satisfy specific applicative requirements.
Achilles tendinopathy following Kaletra (lopinavir/ritonavir) use
Authors: Cresswell FV , Tomlins J , Churchill DR , Walker-Bone K , Richardson D
Published: February 2014

A multitude of rheumatologic manifestations have been associated with HIV infection and protease inhibitors use. We describe two cases that display a temporal relationship between initiating Kaletra and developing Achilles tendinopathy. Immediate and dramatic resolution of symptoms occurred on switching from Kaletra to an alternative agent. Clinicians may want to consider a trial of an alternative agent in individuals on Kaletra who experience Achilles tendinopathy. Adverse events must be formally reported so that our understanding of antiretrovirals may continually evolve and aid decisions about antiretroviral prescribing.
Viability of Talus Osteochondral Defect Cartilage for Chondrocyte Harvesting
Authors: Kreulen Christopher , Giza Eric , Kim Jason , Campanelli Valentina , Sullivan Martin
Published: February 2014

Background:

Large talar cartilage defects can be treated with either autologous chondrocyte implantation or matrix autologous chondrocyte implantation. Both techniques depend on successful harvesting of the chondrocytes. In the past, they have come from the ipsilateral knee, which has been associated with donor site morbidity. We hypothesized that damaged cartilage from the talus can be used as a reliable source for chondrocyte cell harvesting in preparation for possible matrix-induced autologous chondrocyte implantation (MACI).

Methods:

Chondrocytes were harvested from the injured talar cartilage during ankle arthroscopy and sent to a cell laboratory, measured for initial biopsy weight, cultured for 4 to 6 weeks, and then analyzed for viability. A total of 151 patients were analyzed.

Results:

The average biopsy initial weight was 187.1 mg. The average number of cells was 3.13 × 105. The viability of the chondrocytes provided by the manufacturer averaged 92.3% (range, 33%-100%).

Conclusions:

Chondrocytes harvested from the damaged talar articular cartilage were functional and proliferated with an average viability of 92%.

Clinical Relevance:

This technique may provide a useful source of chondrocytes if needed for a future cell-based regenerative procedure such as MACI while eliminating the need to harvest chondrocytes from the knee or other intact areas of cartilage on the talus.

Level of Evidence:

Level IV, case series.
On the effective strain tensor in heterogeneous materials
Authors: Berger MA , Evans KE , Smith CW
Published: February 2014

This paper considers effective strain tensors within the context of linear elastic equilibrium theory. The elastic properties of structured materials are often averaged over subvolumes of various scales inside the material. For subvolumes smaller than a representative volume element, simple volume-averaging of the stress and strain may not preserve the elastic energy. We introduce an averaging process which preserves the energy for all boundary conditions. This averaging process emphasizes the parts of the material which carry the most stress. Here the effective strain is weighted by the local stress, and can be interpreted as an average strain over all paths taken by loads and forces through the volume. This alternative effective strain may be especially appropriate for materials with voids, such as foams and granular matter, as the averaging only involves the material itself. For uniform boundary conditions the weighted strain matches the volume-averaged strain.

This paper investigates the properties of this weighted strain tensor. First, for each path taken by loads and forces through the volume we can measure a net length as well as a net extension due to the linear deformation. The weighted effective strain equals the ratio of average length to average extension, where the averaging is over all possible force paths. Thus this method provides a connection to load path analysis.

Secondly, even when the average rotation within the subvolume is zero, there may be local fluctuations in the rotation field. These rotations can act like a mechanism, transferring elastic energy between boundaries or degrees of freedom. The effective strain defined here highlights this mechanism effect.
The Children’s Psychological Processes Scale
Authors: Dehn Milton J.
Published: February 2014

Objective: The current study investigated the internal structure and external relations of the Children’s Psychological Processes Scale (CPPS). Method: Principal components analysis and exploratory factor analysis were conducted. Concurrent validity studies were also completed with the Behavior Rating Inventory of Executive Function (BRIEF) and Woodcock–Johnson III Tests of Cognitive Abilities (WJ III COG). Results: A general cognitive ability factor was identified that accounted for up to 85% of the scale’s total variance. Exploratory factor analysis produced a three-factor solution that included general processing ability, executive functions, and visual-motor processing. Subscales comprising the CPPS executive functions factor were found to have high correlations with BRIEF composites and subscales. CPPS subscale correlations with comparable WJ III COG tests indicated that the majority of the CPPS subscales assess the same constructs as those measured by the WJ III COG. Conclusion: The results suggest that rating scale measures of cognitive and metacognitive processes assess the same latent factors and cognitive processes as performance-based measures.
Priority setting in Swedish health care: Are the politicians ready?
Authors: Rosén Per , De Fine Licht Jenny , Ohlsson Henrik
Published: February 2014

Background: Resource allocation in public health care principally involves politicians, administrators, and physicians. They all have their different roles, agendas and ambitions when it comes to how public health care resources should be spent. Previous studies on attitudes among health-care stakeholders have mainly focused on views and preferences among clinical decision-makers, while less attention has been paid to the views of health care politicians. Aim: The study aimed to investigate if the health care politicians’ views on priority setting and decision-making in health care differed from other stakeholder groups. Method: The study was based on a questionnaire conducted among health care politicians, administrators, and physicians in four county councils in Southern Sweden. Results: The findings show significant differences between the politicians and the other two groups in their views on health-care resources, financing, priority setting and decision-making. Conclusions: The findings could, at least partly, be explained by the special situation it means for the politicians to be forced to be re-elected every fourth year to stay in power.
Damage detection in rebar-reinforced concrete beams based on time reversal of guided waves
Authors: Mustapha Samir , Lu Ye , Li Jianchun , Ye Lin
Published: February 2014

The propagation properties of ultrasonic waves in rebar-reinforced concrete beams were investigated and their ability for damage identification was demonstrated. Rectangular piezoelectric ceramics were attached at the exposed ends of the rebar to monitor the wave transmission along the rebar with and without simulated corrosion, which was introduced in the form of partial removal of material from the rebar. Experimental testing demonstrated that the presence of concrete had a significant influence on the propagation characteristics of guided waves along the rebar. In consideration of the inevitable discrepancies in different concrete beams due to individual specimen preparation and sensor installation, the time-reversal process was applied to identify the damage. A damage index was defined based on the correlation coefficient between the actuated and the reconstructed wave signals. Wavelet transform was applied to overcome the wave conversion difficulty and to reduce the noise in the captured wave signals. Damage of different sizes was introduced and then was correlated with the damage index. Enlarging the damage size resulted in an increase in the level of distortion in the reconstructed wave signals, and consequently, a higher damage index was obtained. The results demonstrate the efficiency of the time-reversal process in identifying damage in rebar-reinforced concrete structures.
Controlled Monte Carlo data generation for statistical damage identification employing Mahalanobis squared distance
Authors: Nguyen Theanh , Chan Tommy HT , Thambiratnam David P
Published: February 2014

The use of Mahalanobis squared distance–based novelty detection in statistical damage identification has become increasingly popular in recent years. The merit of the Mahalanobis squared distance–based method is that it is simple and requires low computational effort to enable the use of a higher dimensional damage-sensitive feature, which is generally more sensitive to structural changes. Mahalanobis squared distance–based damage identification is also believed to be one of the most suitable methods for modern sensing systems such as wireless sensors. Although possessing such advantages, this method is rather strict with the input requirement as it assumes the training data to be multivariate normal, which is not always available particularly at an early monitoring stage. As a consequence, it may result in an ill-conditioned training model with erroneous novelty detection and damage identification outcomes. To date, there appears to be no study on how to systematically cope with such practical issues especially in the context of a statistical damage identification problem. To address this need, this article proposes a controlled data generation scheme, which is based upon the Monte Carlo simulation methodology with the addition of several controlling and evaluation tools to assess the condition of output data. By evaluating the convergence of the data condition indices, the proposed scheme is able to determine the optimal setups for the data generation process and subsequently avoid unnecessarily excessive data. The efficacy of this scheme is demonstrated via applications to a benchmark structure data in the field.
Modular Ankle Robotics Training in Early Subacute Stroke
Authors: Forrester Larry W. , Roy Anindo , Krywonis Amanda , Kehs Glenn , Krebs Hermano Igo , Macko Richard F.
Published: February 2014

Background. Modular lower extremity robotics may offer a valuable avenue for restoring neuromotor control after hemiparetic stroke. Prior studies show that visually guided and visually evoked practice with an ankle robot (anklebot) improves paretic ankle motor control that translates into improved overground walking. Objective. To assess the feasibility and efficacy of daily anklebot training during early subacute hospitalization poststroke. Methods. Thirty-four inpatients from a stroke unit were randomly assigned to anklebot (n = 18) or passive manual stretching (n = 16) treatments. All suffered a first stroke with residual hemiparesis (ankle manual muscle test grade 1/5 to 4/5), and at least trace muscle activation in plantar- or dorsiflexion. Anklebot training employed an “assist-as-needed” approach during >200 volitional targeted paretic ankle movements, with difficulty adjusted to active range of motion and success rate. Stretching included >200 daily mobilizations in these same ranges. All sessions lasted 1 hour and assessments were not blinded. Results. Both groups walked faster at discharge; however, the robot group improved more in percentage change of temporal symmetry ( P = .032) and also of step length symmetry ( P = .038), with longer nonparetic step lengths in the robot (133%) versus stretching (31%) groups. Paretic ankle control improved in the robot group, with increased peak ( P ≤ .001) and mean ( P ≤ .01) angular speeds, and increased movement smoothness ( P ≤ .01). There were no adverse events. Conclusion. Though limited by small sample size and restricted entry criteria, our findings suggest that modular lower extremity robotics during early subacute hospitalization is well tolerated and improves ankle motor control and gait patterning.
Trunk Restraint to Promote Upper Extremity Recovery in Stroke Patients
Authors: Wee Seng Kwee , Hughes Ann-Marie , Warner Martin , Burridge Jane H.
Published: February 2014

Background. Many stroke patients exhibit excessive compensatory trunk movements during reaching. Compensatory movement behaviors may improve upper extremity function in the short-term but be detrimental to long-term recovery. Objective. To evaluate the evidence that trunk restraint limits compensatory trunk movement and/or promotes better upper extremity recovery in stroke patients. Methods. A search was conducted through electronic databases from January 1980 to June 2013. Only randomized controlled trials (RCTs) comparing upper extremity training with and without trunk restraint were selected for review. Three review authors independently assessed the methodological quality and extracted data from the studies. Meta-analysis was conducted when there was sufficient homogenous data. Results. Six RCTs involving 187 chronic stroke patients were identified. Meta-analysis of key outcome measures showed that trunk restraint has a moderate statistically significant effect on improving Fugl-Meyer Upper Extremity (FMA-UE) score, active shoulder flexion, and reduction in trunk displacement during reaching. There was a small, nonsignificant effect of trunk restraint on upper extremity function. Conclusion. Trunk restraint has a moderate effect on reduction of upper extremity impairment in chronic stroke patients, in terms of FMA-UE score, increased shoulder flexion, and reduction in excessive trunk movement during reaching. There is insufficient evidence to demonstrate that trunk restraint improves upper extremity function and reaching trajectory smoothness and straightness in chronic stroke patients. Future research on stroke patients at different phases of recovery and with different levels of upper extremity impairment is recommended.
Actual leisure participation of Norwegian adolescents with Down syndrome
Authors: Dolva Anne-Stine , Kleiven Jo , Kollstad Marit
Published: February 2014

This article reports the actual participation in leisure activities by a sample of Norwegian adolescents with Down syndrome aged 14. Representing a first generation to grow up in a relatively inclusive context, they live with their families, attend mainstream schools, and are part of common community life. Leisure information was obtained in individual, structured parent interviews, and added to existing longitudinal data from a project following the sample. Generally, the leisure activity may be viewed as varying along a continuum—reaching from formal, organized, and assisted activity participation outside home, to informal, self-organized, and independent participation at home. Formal leisure activities were either organized “for all” or “adapted for disabled.” The adolescents’ leisure appears as active and social. However, social participation largely involved parents and family, while socializing with other adolescents mainly took place within formal activities adapted for disabled. Clearly, formal and informal activities provide rather different opportunities for social encounters and assistance.
Opening up spaces for social transformation: Critical citizenship education in a post-conflict South African university context
Authors: Costandius Elmarie , Bitzer Eli
Published: February 2014

In post-conflict countries such as South Africa, some university students to know anything about the conflict-ridden past. As in other parts of the world that suffered from pasts of discrimination and conflict, it is easier for some students than others to argue like this since an unfortunate past does not concretely affect them any longer. Many students are, however, still benefitting or suffering from a privileged or disadvantaged past, and thus subconscious feelings of guilt or resentment prevail. When triggered by critical citizenship education, some students seem to want to avoid confronting issues. Such avoidance, however, can perpetuate and worsen the existing gap between social differences and/or academic performance. Against this background a critical citizenship module was included into a Visual Communication Design curriculum at a university in South Africa. Through fostering social justice, the module constructs a safe environment where historical and current realities can be unravelled. It also allows for dealing with these issues through art and design – a process that triggers the imagination and hence involves participants to see and experience that which cannot necessarily be seen or experienced in any other way. Through written reflections and interviews the project involved students, lecturers and high school learners in a township to whom art was taught by university students. Results showed that a less hierarchical and more self-motivated approach to critical citizenship education in art, which becomes part of the formal curriculum, results in addressing some of the avoidance and difficulties that were experienced earlier.
Recommendations for Insulin Dose Calculator Risk Management
Authors: Rees Christen
Published: February 2014

Several studies have shown the usefulness of an automated insulin dose bolus advisor (BA) in achieving improved glycemic control for insulin-using diabetes patients. Although regulatory agencies have approved several BAs over the past decades, these devices are not standardized in their approach to dosage calculation and include many features that may introduce risk to patients. Moreover, there is no single standard of care for diabetes worldwide and no guidance documents for BAs, specifically. Given the emerging and more stringent regulations on software used in medical devices, the approval process is becoming more difficult for manufacturers to navigate, with some manufacturers opting to remove BAs from their products altogether. A comprehensive literature search was performed, including publications discussing: diabetes BA use and benefit, infusion pump safety and regulation, regulatory submissions, novel BAs, and recommendations for regulation and risk management of BAs. Also included were country-specific and international guidance documents for medical device, infusion pump, medical software, and mobile medical application risk management and regulation. No definitive worldwide guidance exists regarding risk management requirements for BAs, specifically. However, local and international guidance documents for medical devices, infusion pumps, and medical device software offer guidance that can be applied to this technology. In addition, risk management exercises that are algorithm-specific can help prepare manufacturers for regulatory submissions. This article discusses key issues relevant to BA use and safety, and recommends risk management activities incorporating current research and guidance.
Comparative Assessment of Lixisenatide, Exenatide, and Liraglutide Pen Devices
Authors: Stauder Udo , Enginee Diplom , Elton Hina , Penfornis Alfred , Edelman Steve
Published: February 2014

Background:

Glucagon-like peptide-1 (GLP-1) receptor agonists are a relatively recent addition to the treatment options for type 2 diabetes mellitus (T2DM) and are administered using prefilled pen devices.

Method:

In this open-label task and interview-based pilot study, 3 GLP-1 receptor agonist pen devices—exenatide (Byetta®, Bristol-Myers Squibb/AstraZeneca), liraglutide (Victoza®, Novo Nordisk), and lixisenatide (Lyxumia®, Sanofi-Aventis)—were comparatively assessed in a randomized order in 30 participants with T2DM for ease of use, using a series of key performance measures (time taken to complete a series of tasks, number of user errors [successful performance], and user satisfaction rating). Linear and logistic regression analysis was conducted for the lixisenatide and liraglutide pens versus the exenatide pen. Participants’ mean age was 60 years; 27% and 20% of the participants had visual impairments and reduced manual dexterity, respectively.

Results:

Tasks were completed faster ( P < .001) and with higher successful performance ( P = .001) with the lixisenatide pen than with the exenatide pen, whereas the liraglutide pen was not statistically significant versus the exenatide pen on these parameters. Overall, user satisfaction was statistically higher for the lixisenatide and liraglutide pens versus the exenatide pen ( P < .001 for both).

Conclusions:

Lixisenatide and liraglutide pens are associated with higher user satisfaction compared with the exenatide pen. In addition, the lixisenatide pen is faster and results in fewer errors than its comparator (exenatide). The lixisenatide pen may therefore be a suitable choice for patients with T2DM, including older and pen device-naïve patients, and those with visual impairments and reduced manual dexterity.
Measurement of Lens Autofluorescence for Diabetes Screening
Authors: Stirban Alin
Published: February 2014

Many efforts have been made lately to develop cost-effective, simple, and reproducible tests for diabetes screening besides the already established fasting plasma glucose, the oral glucose tolerance test, and the glycated hemoglobin A1c. Several tests have been proposed lately, based on the measurement of the so-called advanced glycation endproducts (AGEs). AGEs production is exacerbated during hyperglycemia, and their accumulation in different tissues reflects the degree and duration of dysglycemia. The human lens represents a tissue where AGEs accumulation can be particularly well assessed. The present article comments on the article by Cahn et al. published in this issue of the Journal of Diabetes Science and Technology. Cahn and coauthors tested a new scanning confocal biomicroscope for its accuracy to detect noninvasively subjects with diabetes or at risk for developing diabetes.
Measurement of Lens Autofluorescence Can Distinguish Subjects With Diabetes From Those Without
Authors: Cahn Frederick , Burd John , Ignotz Keith , Mishra Shardendu
Published: February 2014

Introduction:

Lens autofluorescence is increased in patients with diabetes mellitus, but clinical application has been limited by the lack of an instrument suitable for routine clinical use. We investigate possible uses of a new scanning confocal biomicroscope (1) to identify subjects with undiagnosed type 2 diabetes and (2) as a marker for the progression of diabetes.

Methodology:

One hundred seventy-eight subjects self-reported as normal and 53 subjects physician-diagnosed with diabetes or prediabetes were recruited. Measurements were collected using a ClearPath DS-120 Lens Fluorescence Biomicroscope calibrated with standards traceable to National Institute of Standards and Technology (NIST).

Results:

Fluorescence intensities were corrected for age by subtracting the value expected from a regression of intensity versus age for normal subjects. This “fluorescence deviation” showed progressively higher values for normal, prediabetes, type 2 diabetes, and type 1 diabetes and a high degree of predictability of diabetes diagnosis. A receiver operating characteristics curve was used to determine sensitivity and specificity for prediction of diabetes type 2. At a fluorescence deviation of 2500, a sensitivity of 67% at 94% specificity was observed detection of type 2 diabetes.

Discussion:

The progressively higher fluorescence deviations are consistent with the physiological mechanisms of accumulation of fluorescent advanced glycation end products as the subject ages. The sensitivity and specificity performance of the lens autofluorescence test for type 2 diabetes is comparable to the performance of glucose threshold tests.

Conclusion:

The statistically significant difference between fluorescence deviations of normal and type 2 diabetes supports the feasibility of lens autofluorescence to screen subjects for undiagnosed type 2 diabetes. Ophthalmic practices are points of care at which there may be a public health benefit for screening patients for undiagnosed diabetes.
Does Device Make Any Difference? A Real-world Retrospective Study of Insulin Treatment Among Elderly Patients With Type 2 Diabetes
Authors: Miao Raymond , Wei Wenhui , Lin Jay , Xie Lin , Baser Onur
Published: February 2014

Background:

We compared real-world clinical and economic outcomes for insulin glargine treatment administered by disposable pen and traditional vial-and-syringe injections among elderly patients with type 2 diabetes mellitus (T2DM).

Methods:

Using a large database of US retirees, this retrospective longitudinal study examined 1-year follow-up outcomes in patients with T2DM aged 65 years or older who were either insulin naïve and initiated insulin glargine via disposable pen (pen initiators [PI]) or vial (vial initiators [VI]) or were already insulin glargine users but either continued with a vial (vial continuers [VC]) or switched to a disposable pen (pen switchers [PS]).

Results:

There were 7856 propensity-score-matched patients, including 2930 each in the PI and VI cohorts, and 998 each in the VC and PS cohorts. Compared with vial-and-syringe users, the disposable pen users had significantly greater treatment persistence ( P < .0001 for both comparisons), duration of persistence ( P < .0001 for both), and adherence ( P < .01 for both) and lower insulin daily average consumption ( P < .05 for both). Compared with the VI cohort, the PI cohort had significantly fewer hypoglycemia-related events ( P = .0164). Total health care costs were comparable for the respective matched cohorts.

Conclusions:

In elderly patients with T2DM receiving insulin glargine therapy, initiating or switching to a disposable pen was associated with better treatment persistence and adherence than initiating or continuing with vial-and-syringe, without increased total health care costs. Among insulin-naïve patients, initiating insulin glargine by disposable pen was also associated with significantly reduced risk of hypoglycemia compared with vial-and-syringe patients.
Glucose Measurement by Affinity Sensor and Pulsed Measurements of Fluidic Resistances
Authors: Beyer Uwe , Wyss Thomas , Robin Franck , Heinemann Lutz
Published: February 2014

Background:

Affinity sensors for glucose are based on a different measuring principle than the commercially available amperometric needle type sensors: reversible affinity interaction of glucose with specific receptors is the primary recognition mechanism instead of an enzymatic glucose oxidation.

Methods:

A novel pulsed-flow micro-fluidic system was used to characterize first the viscosity of a sensitive liquid containing the glucose receptor Concanavalin A and dextran and in a second approach to characterize the geometry of a fluidic resistance. In the viscometric sensor, glucose of the sensitive liquid is equilibrated, while passing through a dialysis chamber, with the surrounding medium. With the membrane flow sensor, the viscosity of the liquid remains constant but the pores of the flow-resisting membrane contain a swellable hydrogel affecting the width of the pores. Two types of hydrogel were tested with the membrane flow sensor; one is highly sensitive to pH and salt concentration, the other contains receptors of phenyl boronic acids to obtain sensitivity to glucose.

Results:

The viscometric affinity sensor (first approach) showed a linear response over 0 to 30 mmol/L glucose concentration range. The disturbing effect of air bubbles could be compensated for. The sensing proof of principle of the second approach could be demonstrated by its linear response to different saline concentrations; however, the glucose-sensitive membrane developed showed only a small response to glucose.

Conclusions:

Glucose monitoring based on this pulsed flow measuring principle offers interesting alternatives for the development of CGM systems with different options for the glucose sensing part.
CAD/CAM for Double Woven Fabric
Authors: Alali Moussa , Drean Jean-Yves
Published: February 2014

To bond the two layers in double fabrics, various types of stitching can be distinguished such as self-stitching, double stitching, center warp stitching, center weft stitching, and so on. In this article, a mathematic model based on a software program has been developed to automatically generate a double fabric stitched by additional warp called center warp. Each layer has been represented in a 2D binary matrix, and a new matrix called warps order matrix has been defined to demonstrate the modality of position of the center warps in relating to the top and bottom fabrics’ warps. After insertion of all warps in the extended weave matrix, the lifter conditions has been discussed and the stitching points have been determined.
The FortunaDomus(Cartagena, Spain): An Archaeological Analysis of Household Activities in a Hispano-Roman Colonia
Authors: Bermejo Jesús , Quevedo Alejandro
Published: February 2014

This paper analyses the occupation sequence documented in the Roman house of La Fortuna (Cartagena, Spain). We use a contextual approach to study all the material culture documented in the domus. We start with a complete re-documentation of the stratigraphic record, in order to match the finds to their provenance. As a basis for this documentation, we discuss the abandonment typologies and the formation processes documented in the house. Using this framework we make a detailed examination of the artefact assemblages documented and we apply a quantitative study of the production, redistribution and consumption patterns during the different occupation phases. The ultimate objective of this paper is to provide a social and economic reading of the household activities carried out by the successive inhabitants in their own historical context.