bluuebunny/crossref_metadata_2025 huggingface dataset:
A Persistent Left Superior Vena Cava, with the Accessory Nerve Passing through a Duplicate Segment of the Left Internal Jugular Vein: A Unique Presentation
Authors: Ayoub Omar , Benton Jamie , Jackson Shaun
Published: January 2019

The internal jugular vein and the spinal accessory nerve are important landmarks during neck dissection; unexpected variations in their positions can result in inadvertent iatrogenic damage to adjacent structures. We report the case of a 79-year-old man who was found during neck dissection to have a duplicate segment of his left internal jugular vein (IJV), a persistent left superior vena cava, and an absent right superior vena cava. The spinal accessory nerve passed through the duplicate section of the IJV. A MEDLINE search found no previously reported case of these anomalies occurring together. We also review 10 previously reported cases of IJV duplication. Finally, we discuss the embryologic and anatomic background of these malformations so that otolaryngologists may be aware that identification of such anomalies may help to prevent postoperative morbidity.
Lingual Hamartoma Associated with a Cleft Palate in a Newborn
Authors: Daramola Opeyemi O. , Suchi Mariko , Chun Robert H.
Published: January 2019

A hamartoma is a benign malformation of native tissue that may occur in any area of the body. Hamartoma of the tongue is a rare developmental lesion. We describe the case of a pendulant lingual hamartoma in a 2-day-old girl that had not been identified on prenatal ultrasonography. We also review the utility of prenatal imaging options, the role of preoperative imaging, the mechanical relationship between lingual hamartoma and cleft palate, the histopathology of this tumor, surgical treatment, and emergency airway management.
Glottic Myxoma Presenting as Chronic Dysphonia: A Case Report and Review of the Literature
Authors: Tang Christopher G. , Monin Daniel L. , Puligandla Balaram , Cruz Raul M.
Published: January 2019

Myxomas of the vocal fold are rare benign tumors often presenting with chronic dysphonia and less frequently with airway obstruction. The current consensus is that all laryngeal myxomas should be totally excised with clear margins to prevent recurrences. The recommendation for complete excision, however, has to be balanced with consideration of preserving vocal fold phonatory and sphincteric function. We report a case of vocal fold myxoma recurring twice after subtotal excision via two surgical approaches. This case illustrates a benign lesion with potential for recurrence and the need for a balanced treatment approach.
Post-thyroidectomy Hypocalcemia: Impact on Length of Stay
Authors: Grainger Joe , Ahmed Mohammed , Gama Rousseau , Liew Leonard , Buch Harit , Cullen Ronald J.
Published: January 2019

Hypocalcemia is a recognized complication following thyroid surgery. Variability in the definition of hypocalcemia and different opinions on its management can lead to unnecessary patient morbidity and longer hospital stays as a result of inappropriate or untimely treatment. Therefore, we developed a management guideline for the recognition and treatment of post-thyroidectomy hypocalcemia, and we conducted a retrospective study to assess its impact on length of stay (LOS). Between April 1, 2007, and March 31, 2009, 29 adults had undergone a total or completion thyroidectomy at our large district general hospital. Of this group, postoperative hypocalcemia (defined as a serum calcium level of <2.00 mmol/L) developed in 13 patients (44.8%) during the first 3 postoperative days. Our guideline went into effect on July 1, 2009, and from that date through June 30, 2010, 18 more adults had undergone a total or completion thyroidectomy. Of that group, hypocalcemia developed in 7 patients (38.9%); the guideline was actually followed in 5 of these 7 cases (71.4%). In the preguideline group, the development of hypocalcemia increased the mean LOS from 2.0 days to 7.0 days (p < 0.001). The management of postoperative hypocalcemia in these cases was highly variable and was dictated by variations in practice rather than patient needs. In the postguideline group, postoperative hypocalcemia increased the mean LOS from 2.7 days to only 3.7 days (p = 0.07). While the difference between LOS in the two hypocalcemic groups did not reach statistical significance, we believe it merely reflects the relatively small number of patients rather than any lack of guideline efficacy. The implementation of a simple flowchart guideline for the management of postoperative hypocalcemia in our hospital has resulted in more uniform management and a reduced LOS.
Maxillary Sinus Angiomyolipoma: A Case Report and Overview
Authors: Weindling Steven M. , Menke David M. , Bolger William E.
Published: January 2019

Otolaryngologists are called upon to evaluate and treat sinonasal masses discovered incidentally on imaging studies. Although common conditions such as sinonasal polyps and mucus retention cysts predominate, it is prudent practice to formulate a differential diagnosis to identify unusual conditions. We present a case of a maxillary sinus mass in a 78-year-old man that was discovered incidentally on brain imaging and subsequently identified on biopsy as an angiomyolipoma (AML). AMLs are benign hamartomatous tumors that rarely occur in extrarenal locations. Only a few cases have been reported in the nasal cavity. We believe our case represents the first reported instance of AML arising within a maxillary sinus. Identification of intratumoral fat within the mass on imaging studies may suggest the diagnosis of AML preoperatively. Close interdisciplinary collaboration among the otorhinolaryngology, radiology, and pathology services is beneficial for patient management. We report this case to raise awareness that AML can arise in this previously unreported location. Moreover, we wish to emphasize that AML should be considered in the differential diagnosis when imaging studies demonstrate a well-defined, heterogeneous, fat-containing solitary mass in the nasal cavity or maxillary sinus.
Myeloid Sarcomas of the Head and Neck in Pediatric Patients with Myeloid Leukemia
Authors: Cuthbertson David W. , Nain Punia Jyotinder , Owczarzak Vicki L.
Published: January 2019

Myeloid sarcoma is a rare extramedullary tumor composed of malignant myeloid cells that occur in the presence of myeloid leukemia. We report a case series of pediatric head and neck myeloid sarcomas representative of the epidemiology, symptomatology, laboratorial correlations, prognoses, and treatment of extramedullary leukemia. Presented are 3 cases involving patients ranging from 17 months to 11 years of age. Two patients were successfully treated with chemotherapy, and in the third patient, a large lytic lesion was treated palliatively with proton beam therapy. Knowledge and recognition of myeloid sarcomas is important as they can be locally invasive, and they may also be used as a diagnostic tool or a prognostic indicator for leukemia.
Isolated Epiglottic Lymphatic Malformation in a 2-Year-Old: Diagnosis and Treatment
Authors: Naylor Tate , Sheyn Anthony , Lenes-Voit Felicity , Berg Eric
Published: January 2019

Airway obstruction in children has a wide differential diagnosis that includes laryngomalacia, infectious processes, paralysis, extrinsic compression, and other rare anatomic anomalies. Isolated laryngeal lymphatic malformations are rare developments that can manifest with clinically significant airway obstruction. To the best of our knowledge, there have been fewer than 20 reported cases. These laryngeal mucosal lesions are best managed with radiofrequency ablation or laser ablation. We present a case of a 2-year-old child who presented with airway obstruction, initially diagnosed with laryngomalacia, who was subsequently diagnosed and treated for an isolated epiglottic lymphatic malformation.
Facial Trauma Caused by Electronic Cigarette Explosion
Authors: Vaught Brian , Spellman Joseph , Shah Anil , Stewart Alexander , Mullin David
Published: January 2019

Electronic cigarettes are increasingly popular as a supposed safer alternative to tobacco cigarettes or a smoking cessation tool. Research and debate have focused primarily on possible adverse effects caused by the inhaled aerosol produced by electronic cigarettes and on smoking cessation efficacy. Few reports in the medical literature describe injuries secondary to device malfunction. We present a case of electronic cigarette explosion, with a projectile fracturing the patient's right naso-orbital-ethmoid complex and anterior and posterior frontal sinus tables, with frontal sinus outflow tract involvement. The patient underwent combined open and endoscopic repair, including open reduction internal fixation, with reconstitution and preservation of the frontal sinus and frontal sinus outflow tract. Additionally, we review the available data on electronic cigarette malfunction-including fires, explosions, associated injuries, and possible reasons for device malfunction–and discuss new 2016 U.S. Food and Drug Administration regulations pertaining to electronic cigarettes.
The Rising Incidence of Major Salivary Gland Cancer in the United States
Authors: Del Signore Anthony G. , Megwalu Uchechukwu C.
Published: January 2019

We performed a population-based historical cohort study using the Surveillance, Epidemiology, and End Results (SEER) database to determine trends in the incidence of major salivary gland cancer and to evaluate the effect of sex, tumor size, histology, primary site, and extent of disease. Participants were men and women with major salivary gland cancer, diagnosed 1973–2009. The incidence of major salivary gland cancer increased from 10.4 per 1,000,000 in 1973 to 16 per 1,000,000 in 2009 (annual percent change [APC] 0.99; 95% confidence interval [CI] 0.78 to 1.20; p < 0.05). The incidence of parotid cancers increased (APC 1.13; 95% CI 0.88 to 1.39; p < 0.05) and paralleled the increase in major salivary gland cancer overall. There was an increase in the incidence of tumors measuring 0 to 2.0 cm (APC 1.99; 95% CI 0.61 to 3.38; p < 0.05), but no change in tumors measuring 2.1 to 4.0 cm (APC 1.02; 95% CI -0.46 to 2.52; p > 0.05) and tumors measuring >4 cm (APC -0.52; 95% CI -1.72 to 0.69; p > 0.05). There was an increase in the incidence of regional (APC 0.77; 95% CI 0.32 to 1.23; p < 0.05) and distant (APC 2.43; 95% CI 1.43 to 3.45; p < 0.05) disease, but not localized disease (APC 0.35; 95% CI 0 to 0.71; p > 0.05). We conclude that the incidence of major salivary gland cancer is increasing, especially small parotid tumors. The incidence of tumors with regional and distant metastasis is also increasing. These findings highlight the need for further research on the etiology of salivary gland cancer, which may reveal opportunities for further public health efforts aimed at prevention.
Treatment Success with Titratable Thermoplastic Mandibular Advancement Devices for Obstructive Sleep Apnea: A Comparison of Patient Characteristics
Authors: Wang Tang-Chuan , Tsou Yung-An , Wu Yi-Fan , Huang Chia-Chang , Lin Wesley Wen-Yang , Li Yu-Fen , Chen Michael Yuan-Chien , Tai Chih-Jaan , Tsai Ming-Hsui
Published: January 2019

A titratable thermoplastic mandibular advancement devices (MAD) is clearly an effective treatment option in some patients with obstructive sleep apnea (OSA). Determining which patients may be more likely to respond to treatment with thermoplastic MADs and to adhere to treatment would be of obvious clinical relevance. This was an experimental descriptive study (N = 60). Patients with OSA were instructed to wear a titratable thermoplastic MAD for 3 months. Treatment success was defined as a ≥50% reduction from baseline in the apnea-hypopnea index (AHI) or AHI <10 when wearing MAD. Adherence was defined as MAD use ≥5 nights/week. Treatment was successful in 66.7% of patients and 60.0% were adherent. All Polysomnographic parameters and visual analogue scale scores (sleep quality, snoring, waking refreshed) were significantly improved after treatment. The patients in whom treatment failed had significantly higher neck circumferences (39.3 cm vs. 37.5 cm, p = 0.014), higher baseline AHI values (26.6 vs. 18.0, p = 0.016), and smaller AHI reduction (-31.8 vs -53.1, p < 0.001) than those in the group in whom treatment succeeded. There were no significant differences in Polysomnographic, cephalometric, or visual analogue scale measures between patients for whom treatment was and was not successful, regardless of baseline values or the change rates after the MAD was placed. Titratable thermoplastic MADs can improve indicators of sleep quality, even in patients in whom treatment is considered to have failed.
The use of high venous ligation as an adjunct to endovenous therapy in the management of great saphenous vein incompetence: A systematic review and meta-analysis of randomized controlled trials
Authors: Aherne Thomas M , Medani Mekki , Sahebally Shaheel , Kheirelseid Elrasheid , Mulkern Edward , McDonnell Ciaran , Walsh Stewart R , O’Donohoe Martin K
Published: January 2019

Background

In recent years, endovenous intervention has emerged as a minimally invasive alternative to open venous surgery. However, endovenous intervention does not formally disconnect the deep and superficial venous systems and it is hypothesized that recurrence may be greater in the absence of high venous ligation. This study aims to compare the efficacy of a hybrid endovenous approach with adjuvant high venous ligation and standard operative intervention in the management of great saphenous incompetence.

Methods

In March 2018, Medline and Embase were systematically searched for relevant randomized controlled trials. All randomized controlled trials comparing a hybrid approach with standard operative intervention were included. Studies were required to include at least one pre-defined outcome. Data were extracted and assessed by two independent reviewers. Pooled risk ratios were calculated using a random effects model. Additional subgroup analyses were performed.

Results

Eight randomized controlled trials including 1244 patients were analysed. Pooled standardized data revealed no difference in overall recurrence (pooled RR = 1.00 [95% CI = 0.57, 1.77]), major operative morbidity (RR = 0.43 [95% CI = 0.06, 2.89]), or re-interventions (RR = 0.94 [95% CI = 0.12, 7.24]) for the hybrid group compared with standard operative intervention alone. Subgroup analysis revealed comparable short-, medium- and long-term recurrence rates between both cohorts. Furthermore, no difference in recurrence was identified when the hybrid approach was compared to open surgery alone (RR = 1.01 [95% CI = 0.63, 1.61]) or endovenous monotherapy (RR = 0.67 [95% CI = 0.04, 12.24]).

Conclusion

The use of a hybrid approach in the management of great saphenous incompetence appears to offer no recurrence, re-intervention or morbidity benefit when compared to standard operative intervention.
Impaired meningeal lymphatic vessel development worsens stroke outcome
Authors: Yanev Pavel , Poinsatte Katherine , Hominick Devon , Khurana Noor , Zuurbier Kielen R , Berndt Marcus , Plautz Erik J , Dellinger Michael T , Stowe Ann M
Published: January 2019

The discovery of meningeal lymphatic vessels (LVs) has sparked interest in identifying their role in diseases of the central nervous system. Similar to peripheral LVs, meningeal LVs depend on vascular endothelial growth factor receptor-3 (VEGFR3) signaling for development. Here we characterize the effect of stroke on meningeal LVs, and the impact of meningeal lymphatic hypoplasia on post-stroke outcomes. We show that photothrombosis (PT), but not transient middle cerebral artery occlusion (tMCAo), induces meningeal lymphangiogenesis in young male C57Bl/J6 mice. We also show that Vegfr3wt/mut mice develop significantly fewer meningeal LVs than Vegfr3wt/wt mice. Again, meningeal lymphangiogenesis occurs in the alymphatic zone lateral to the sagittal sinus only after PT-induced stroke in Vegfr3wt/wt mice. Interestingly, Vegfr3wt/mut mice develop larger stroke volumes than Vegfr3wt/wt mice after tMCAo, but not after PT. Our results reveal differences between PT and tMCAo models of stroke and underscore the need to consider method of stroke induction when investigating the role of meningeal lymphatics. Taken together, our data indicate that ischemic injury can induce the growth of meningeal LVs and that the absence of these LVs can impact post-stroke outcomes.
Graft protection of the liver by hypothermic machine perfusion involves recovery of graft regeneration in rats
Authors: Jia Jun-Jun , Xie Hai-Yang , Li Jian-Hui , He Yong , Jiang Li , He Ning , Zhou Lin , Wang Weilin , Zheng Shu-Sen
Published: January 2019

Objective

This study was performed to evaluate the impact and underlying mechanisms of hypothermic machine perfusion (HMP) on half-size liver graft regeneration.

Methods

Forty rats were randomly assigned to five groups: two in vitro groups (static cold storage [SCS] and HMP) and three in vivo groups (orthotopic liver transplantation, SCS, and HMP). Perfusates and plasma samples were collected for analysis of hepatic enzymes. Liver tissue was obtained for evaluation of histology, immunohistochemistry (Ki67 and proliferating cell nuclear antigen [PCNA]), and the regeneration rate. Cell cycle genes were analyzed by quantitative real-time polymerase chain reaction, and cyclin D1 and cyclin E1 were semiquantified by western blot.

Results

HMP improved histopathological outcomes and decreased hepatic enzyme release. The expression of Ki67 and PCNA demonstrated a greater proliferation activity in the HMP than SCS group, and the expression of almost all cell cycle genes was elevated following HMP. Western blot results showed higher protein levels of cyclin D1 and cyclin E1 in the HMP than SCS group.

Conclusions

Our findings suggest for the first time that half-size liver graft protection by HMP involves recovery of graft regeneration.
Wind capacity growth in the Northwest United States: Cooptimized versus sequential generation and transmission planning
Authors: Maloney Patrick , Liu Ping , Xu Qingyu , McCalley James D , Hobbs Benjamin F , Daubenberger Sara , Johnson Anders , Williams Stan
Published: January 2019

This article demonstrates the benefits of simultaneous cooptimization on a 312-bus network representation of the Western Interconnection power grid with emphasis on The Bonneville Power Administration’s operational area in the Pacific Northwest. While generation and transmission expansion planning has traditionally been solved sequentially, simultaneous cooptimization of both guarantees plans at least as cost effective as sequential approaches and better integrates high-quality remote resources like wind into power grids. For three scenarios with varied carbon and transmission costs, results indicate that (1) simultaneous cooptimization provides up to 6 billion dollars in net present value benefits over sequential optimization during the 50-year planning horizon, (2) cooptimization is more adept at tapping into superior remote resources like wind that the sequential approach has trouble identifying for low iterations, and (3) 10 iterations of sequential cooptimization only capture 75%–96% of the transmission benefits of simultaneous cooptimization.
A Method to Quantify Reclaimed Asphalt Pavement Binder Availability (Effective RAP Binder) in Recycled Asphalt Mixes
Authors: Kaseer Fawaz , Arámbula-Mercado Edith , Martin Amy Epps
Published: January 2019

State highway agencies recognize the environmental and economic benefits of utilizing reclaimed asphalt pavement (RAP) in asphalt mixes. Currently, most agencies assume all of the RAP binder content is available for mix design purposes. However, the percentage of available or effective RAP binder in the asphalt mix is usually less than 100% and not quantified, which could yield dry asphalt mix with a high air void content, potentially leading to premature distress. The term available or effective RAP binder refers to the binder that is released from the RAP, becomes fluid, and blends with virgin binder under typical mixing temperatures. This study proposes a method to estimate the RAP binder availability factor (BAF) which can be used to adjust the virgin binder content in RAP mixes to ensure that the mix design optimum binder content is achieved. In this method, asphalt mixes were prepared so that, after mixing and conditioning, the RAP material can be separated from the virgin aggregate, which allows for a thorough evaluation of the extent of RAP binder availability in the asphalt mix. This method was verified in a preliminary experiment and then used to estimate the BAF of RAP from different sources, and a correlation between RAP BAF and the high temperature performance grade (PG) of each RAP source was established. Finally, factors affecting the RAP BAF were also evaluated such as mixing temperature, conditioning period, the use of recycling agents (or rejuvenators), and the method of adding the recycling agent to the mix.
Development of a QC/QA Process for Caltrans Automated Pavement Condition Survey Data
Authors: Zhou Haiping , Wang Zhongren , Sherrick Robert , Mathison Scott
Published: January 2019

The California Department of Transportation (Caltrans) awarded a contractor a three-year contract to collect, analyze, and report pavement condition of the state highway system for 2018 and 2019 using automated pavement condition survey (APCS). The contract covers 12 Caltrans districts with roughly 52,000 lane miles of on-system roadways and 6,000 lane miles of off-system roadways. Before investing significant resources on statewide APCS data collection, Caltrans and the contractor initiated a pilot study. The purpose is to establish a workable process for data quality control (QC) and quality assurance (QA), making sure the data collected closely reflect the field condition. The pilot study was conducted on selected routes in Caltrans District 12. The study included a total of 113 lane miles of roadway, representing roughly 5% of the total lane miles in the district. Of these lane miles, 69 lane miles are asphalt pavements and 44 lane miles are jointed plain concrete pavements. The developed data QC/QA process functioned very well. With this process, the contractor was responsible for performing the QC of the APCS data before submitting to Caltrans. Caltrans performed data QA, which included data completeness check; image review; field review and office verification; data upload into Caltrans pavement management system, and year-by-year data consistency check. The joint effort has resolved many data inconsistency issues caused either by interpretation or software issues. The data quality was thus well improved. It is recommended that this QC/QA process be implemented for all APCS data collections in California.
Evaluation of Acoustic Devices for Measuring Airport Operations Counts
Authors: Mott John H. , Sambado Nikolas A.
Published: January 2019

Aircraft operations counts are essential to the planning and funding allocation process at both the federal and state level, but are often inaccurate, especially at airfields with limited operations personnel. To improve general aviation annual operations counts, some unmonitored general aviation airports employ various combinations of counting and estimation methods. Counting methods include pneumatic, video, and acoustic systems, and estimation approaches include regression models based on limited automatically and manually collected data. Although the use of acoustic counters in particular is relatively common, minimal research has been undertaken to test the effectiveness of these systems. The research described here tested the feasibility and accuracy of a typical acoustic counting system to count aircraft operations at the Purdue University Airport in Indiana. Following a 4-month deployment of the system beginning in December 2017, collected data were compared with data from the FAA’s Air Traffic Activity Data System database. After analysis, it was found that the acoustic counting system recorded 59.72% of the airport’s 34,051 aircraft operations over the period. This inaccuracy, caused by variability from factors such as noise, microphone placement, runway configuration, and adverse weather conditions led the authors to conclude that opportunities for the improvement of acoustic devices exist within the context of measuring general aviation operations over extended periods of time.
Influence of Aggregate Gradation and Nominal Maximum Aggregate Size on the Performance Properties of OGFC Mixtures
Authors: Nekkanti Haripriya , Putman Bradley J. , Danish Behrooz
Published: January 2019

The effect of aggregate gradation and nominal maximum aggregate size (NMAS) on the performance properties of open-graded friction courses (OGFC) mixtures was investigated in this research. Several tests which included porosity, surface texture, indirect tensile strength (ITS), shear strength, and Cantabro abrasion loss were used to compare eight different aggregate gradations having two NMAS (9.5 mm and 12.5 mm) all from one aggregate source. For each NMAS, the gradations varied by adjusting the percent passing the No. 4 (4.75 mm) sieve. The results indicated that aggregate gradation does influence the behavior of OGFC mixtures. An increase in percent passing the No. 4 sieve showed significant decreases in porosity, which were more pronounced for the 12.5 mm NMAS compared with the 9.5 mm NMAS. Conversely, the increase in the percent passing the No. 4 sieve generally resulted in increases in the mixture performance properties as measured by the ITS, Cantabro loss, and shear strength. The results of this study provide laboratory-based evidence that adjusting the OGFC gradation by increasing the allowable percent passing the No. 4 sieve toward the higher end of the current specification range (e.g., near 30% for 12.5 mm NMAS) could potentially have positive effects on mixture durability while also maintaining adequate permeability for water drainage.
Effects of Estrogen-Deficient State on Rotator Cuff Healing
Authors: Tanaka Koji , Kanazawa Tomonoshin , Gotoh Masafumi , Tanesue Ryo , Nakamura Hidehiro , Ohzono Hiroki , Okawa Takahiro , Shiba Naoto
Published: January 2019

Background:

Rotator cuff retears after surgical repair are a concern, despite advances in operative techniques, but few studies have investigated the effects of the estrogen-deficient state on tendon-to-bone healing at the repair site.

Purpose:

We evaluated the effect of the estrogen-deficient state on tendon-to-bone healing after rotator cuff repair in an ovariectomized rat model.

Study Design:

Controlled laboratory study.

Methods:

Female Sprague Dawley rats underwent detachment and immediate repair of the supraspinatus tendon. Surgery was performed in 24 rats at 4.5 weeks of age 17 weeks after ovariectomy (OVX group) and in 24 age-matched control rats without ovariectomy (control group). Animals were sacrificed at 2, 4, 8, and 12 weeks after surgery for biomechanical and histological evaluations of reattachment. Bone mineral density (BMD) at the insertion site and cancellous bone in the humeral head was assessed by micro–computed tomography.

Results:

BMD was significantly lower both at the insertion site and in cancellous area in the OVX group than in the control group at weeks 2 to 12. Ultimate load to failure, ultimate stress, linear stiffness, and the Young modulus were significantly lower in the OVX group than in the control group at 2 and 4 weeks, but the difference was no longer significant at 8 and 12 weeks. At 2 and 4 weeks, relatively immature granulation tissue was observed in the OVX group compared with the control group. At 8 and 12 weeks after surgery, there were differences in the tendon-bone interface in the 2 groups: Direct insertion with well-established chondroid tissue was seen in the control group, and indirect insertion without chondroid tissue was seen in the OVX group. Consistently, the amount of chondroid tissue was greater and collagen organization was better in the control group than in the OVX group. Cells expressing cathepsin K were significantly more numerous both at the insertion site and in cancellous bone in the OVX group than in the control group.

Conclusion:

The estrogen-deficient state by ovariectomy, compared with control rats, led to decreased biomechanical properties and poor development of chondroid tissue that influenced the repair of the tendon insertion after surgery.

Clinical Relevance:

Agents that modulate bone metabolism might improve tendon-to-bone healing in patients with an estrogen-deficient state, such as postmenopausal women who undergo rotator cuff surgery.
Troponin I as an Early Biomarker of Cardiopulmonary Parameters Within the First 24 Hours After Nontraumatic Subarachnoid Hemorrhage in Intensive Care Unit Patients
Authors: Bender Michael , Stein Marco , Uhl Eberhard , Reinges Marcus H. T.
Published: January 2019

Objective:

The elevation of serum cardiac troponin I (TNI) in patients with nontraumatic subarachnoid hemorrhage (ntSAH) is a well-known phenomenon. However, the relation between elevated TNI and different cardiopulmonary parameters (CPs) within the first 24 hours after ntSAH is unknown. The present study was conducted to investigate the association between TNI and different CP in patients with ntSAH within the first 24 hours of intensive care unit (ICU) treatment.

Patients and Methods:

We retrospectively analyzed a consecutive group of 117 patients with ntSAH admitted to our emergency department between January 2008 and February 2017. Blood samples were taken to determine TNI values on admission. Demographic data, baseline Glasgow Coma Scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) score, baseline Fisher grade (FG), norepinephrine application rate (NAR) in µg/kg/min, and inspiratory oxygen fraction (OF) were recorded within the first 24 hours.

Results:

An increased TNI value was found in 32 (27.4%) of 117 patients. There was a significant correlation between initial elevated TNI and a low WFNS score ( P = .007), a low GCS score ( P = .003) as well as a high OF ( P = <.001). The FG ( P = .27) and NAR ( P = .08) within the first 24 hours of ICU treatment did not show any significant correlation.

Conclusions:

In the present study, an increased TNI value was significantly associated with a low WFNS score and GCS score on admission. The TNI was a predictor of the need for a higher OF within the first 24 hours after ntSAH so that TNI could be an informative biomarker to improve ICU therapy.
“I Love and Hate Him in the Same Breath”: Relationships of Adult Survivors of Sexual Abuse With Their Perpetrating Siblings
Authors: Tener Dafna
Published: January 2019

The term sibling sexual abuse (SSA) captures a broad continuum of sexual behaviors in childhood and adolescence that exceed the threshold of age-appropriate curiosity. Based on a sample of 15 adult survivors of SSA, this qualitative study examines experiences of relationships with perpetrating siblings during childhood and adulthood. Thematic analysis of semistructured qualitative interviews reveals two continua that characterize SSA survivors’ lives: the “reciprocity–coercion” continuum in childhood and the “distance–closeness” continuum in adulthood. Findings reveal that regardless of how the relationships were perceived in childhood, most participants chose to distance themselves from their perpetrating siblings as adults. Thus, even in cases where the relationships were considered mutual during childhood, reconceptualization of the abuse in adulthood led to renewed understanding of its meanings and implications for the survivors’ personal lives. Research findings underscore the need to further study the experiences of SSA survivors to better inform policy makers, therapists, and welfare workers, to address the complex and multifaceted nature of SSA, and to provide adequate interventions to survivors and other family members.
Flourishing After a Stroke: A Nationally Representative Portrait of Resilience and Mental Health Among Older Canadians
Authors: Fuller-Thomson Esme , Jensen Lisa A.
Published: January 2019

Objectives: The objective of this study is to estimate the prevalence of, and factors associated with, complete mental health (CMH) among stroke survivors aged 50+ years. Method: Bivariate and logistic regression analyses of nationally representative data from the 2012 Canadian Community Health Survey–Mental Health of 11,157 older adults aged 50+ years (300 stroke survivors). CMH included all of these elements: (a) absence of any past-year mental illness (measured by the World Health Organization version of the Composite International Diagnostic Interview [WHO-CIDI] scales), (b) almost daily happiness or satisfaction, and (c) psychological and social well-being. Results: Two thirds of the stroke survivors (68%) were in CMH. Among stroke survivors, the odds of CMH were higher among those with at least one confidant (odds ratio [OR] = 4.34; 95% confidence interval [CI] = [1.52, 12.41]), those without disabling chronic pain (OR = 2.34; 95% CI = [1.24, 4.41]), and those without a history of childhood maltreatment (OR = 2.10; 95% CI = [1.09, 4.05]), depression (OR = 3.83; 95% CI = [1.10, 13.37]), or generalized anxiety disorders (OR = 3.42; 95% CI = [1.19, 9.79]). Discussion: These findings provide encouraging information for stroke survivors.
Guilt, Self-Awareness, and the Good Will in Kierkegaard’s Confessional Discourses
Authors: Morgan Jeffrey
Published: January 2019

The specific aim of this article is to focus on Kierkegaard’s confessional discourses and to examine his appreciation for the experience of guilt—the feeling of guilt and the acknowledgment of guilt—in a person’s efforts to act with a good will, or what he calls ‘purity of heart’. The article offers an interpretation of what Kierkegaard means by the ‘purity of heart’ that guilt serves, and it makes an argument that in this service to ‘purity of heart’ the relationship between guilt and self-awareness is especially significant. For Kierkegaard, without the subjective feeling of guilt and without a self-reflective endorsement of that feeling, a person cannot overcome a bad or divided will; a person who strives to have a good will is a person who is able rightly to acknowledge, appropriate or endorse his or her guilt. Furthermore, Kierkegaard’s claim is not simply that this acknowledgment of guilt is a necessary precondition for a good will but that it is itself a quintessential action of a good will. The article concludes with a note of caution that while Kierkegaard does not want to make guilt a final word about a person, a word that overshadows grace and pardon, he is also very wary of the ways people fail to take their own guilt seriously and thereby forfeit the benefits of its self-disclosing power.
A hybrid continuum robot based on pneumatic muscles with embedded elastic rods
Authors: Sun Cijing , Chen Lisha , Liu Jinguo , Dai Jian S , Kang Rongjie
Published: January 2019

Continuum robots have attracted increasing attention in recent years due to their intrinsic compliance and safety. Nevertheless, the use of structure compliance may lead to reduction of stiffness and positioning precision. This paper presents a novel design of a hybrid continuum robot whose actuators are composed of pneumatic muscles and embedded elastic rods. Such robot can switch drive modes between large-scale movement and fine adjustment of position by employing a locking mechanism to change its stiffness. A three-dimensional static model of the robot is presented using an improved Kirchhoff rod theory, where elastic deformation of the robot is accounted for from an optimal control point of view via minimal total potential energy principle. Experiments were carried out to validate the static model and to test the stiffness and precision of the robot. This work provides a possible way to strengthen the control precision of a continuum robot with compliant structure.
Construction of Pedicled Smooth Muscle Tissues by Combining the Capsule Tissue and Cell Sheet Engineering
Authors: Jia Zhiming , Guo Hailin , Xie Hua , Zhou Junmei , Wang Yaping , Bao Xingqi , Huang Yichen , Chen Fang
Published: January 2019

The survival of engineered tissue requires the formation of its own capillary network, which can anastomose with the host vasculature after transplantation. Currently, while many strategies, such as modifying the scaffold material, adding endothelial cells, or angiogenic factors, have been researched, engineered tissue implanted in vivo cannot timely access to sufficient blood supply, leading to ischemic apoptosis or shrinkage. Constructing vascularized engineered tissue with its own axial vessels and subsequent pedicled transfer is promising to solve the problem of vascularization in tissue engineering. In this study, we used the tissue expander capsule as a novel platform for vascularizing autologous smooth muscle cell (SMC) sheets and fabricating vascularized engineered tissue with its own vascular pedicle. First, we verified which time point was the most effective for constructing an axial capsule vascular bed. Second, we compared the outcome of SMC sheet transplantation onto the expander capsule and classical dorsal subcutaneous tissue, which was widely used in other studies for vascularization. Finally, we transplanted multilayered SMC sheets onto the capsule bed twice to verify the feasibility of fabricating thick pedicled engineered smooth muscle tissues. The results indicated that the axial capsule tissue could be successfully induced, and the capsule tissue 1 week after full expansion was the most vascularized. Quantitative comparisons of thickness, vessel density, and apoptosis of cell sheet grafts onto two vascular beds proved that the axial capsule vascular bed was more favorable to the growth and vascularization of transplants than classical subcutaneous tissue. Furthermore, thick vascularized smooth muscle tissues with the vascular pedicle could be constructed by multi-transplanting cell sheets onto the capsule bed. The combination of axial capsule vascular bed and cell sheet engineering may provide an efficient strategy to overcome the problem of slow or insufficient vascularization in tissue engineering.
Study addiction among musicians: Measurement, and relationship with personality, social anxiety, performance, and psychosocial functioning
Authors: Lawendowski Rafał , Bereznowski Piotr , Wróbel Wiktor K. , Kierzkowski Michał , Atroszko Paweł A.
Published: January 2019

Adverse health-related consequences of perfectionistic over-involvement in work are well-documented among professional musicians. The aim of this study was to investigate a recently developed concept of “study addiction” among students of music academies. Study addiction has been defined within the framework of theory and research on work addiction as a potential behavioral addiction. A cross-sectional correlational study was conducted among 132 students of music academies in Poland. The Bergen Study Addiction Scale (BStAS), reflecting seven core addiction symptoms related to studying, was employed together with commonly used measures of personality and well-being. A one-factor solution had an acceptable fit with the data in the sample of music academies’ students. Multiple hierarchical regression analyses showed that study addiction was related to low extraversion and high social anxiety. Study addiction was related to specific aspects of studying (longer learning time, lower academic performance) and to indicators of decreased well-being (impaired general health, decreased quality of life and sleep quality, higher perceived stress). As expected, study addiction was positively related to learning engagement. However, while the latter was associated positively with psychosocial functioning indicators, study addiction was related negatively to these variables. Furthermore, social anxiety was found to be a mediator between emotional stability/extraversion and study addiction. Moderation analyses revealed that social anxiety was related to a lower grade point average (GPA) only for these students who were high on study addiction. Using a cut-off score based on a polythetic approach showed that 16% of students were addicted to studying. The results suggest that among students at music academies, study addiction can be validly measured and that it has similar potential antecedents and consequences to that in the general population of students. Considering the estimate of study addiction prevalence in this group, further systematic studies among musicians are highly warranted.
The Joy of Learning: A Case Study of a Transformative Educator and Activist
Authors: Buck M. Alison , Mercer Wanita N. , St. Clair Norman S. , Herbers M. Sharon
Published: January 2019

Dr. Dorothy, “Dot,” Ettling was a contemplative practitioner, a spiritual leader, a scholar, and a mentor. She had the phenomenal ability to see the talents of others and enlist their aid in serving marginalized people, whether women walking miles for water in Africa or local mothers needing shelter and job skills. This learning leader recruited (or drafted) colleagues across disciplines to enable communities to build capacities through cross-cultural education and leadership development. This article will examine the work and legacy of Ettling through the lens of Learning as a Way of Leading, focusing on the task of creating community. Implications for practice from this case study of a transformative educator are identified.
In Strategy Simulations, Data Analysis Matters Most (More Than Number of Log Ins and More Than Time Spent Logged In)
Authors: Schmeller Rebecca
Published: January 2019

Background. This data study examined the predictive power of student login activities (frequency, duration, opening reports) on simulation performance (seven Assurance of Learning scores), using Glo-Bus strategy simulation.

Methods. The study used a sample of 351 students at a small, private Ohio university over four academic years (fall 2013 through spring 2017) to conduct regression analysis of three predictor variables (login data about reports, frequency, duration) and seven outcome variables (Assurance of Learning scores for finance, operations, marketing, HR, CSR, leadership, collaboration).

Results. Opening reports was found to be more predictive of simulation performance than the other two login variables (frequency of logins, duration of logins).

Discussion. In the literature, there were studies about strategy simulation login activity, but they did not address how Glo-Bus login activity types were related to Assurance of Learning scores. Some studies about strategy simulations called for more narrowly defined objectives and student accountability. This study supported that call – revealing that opening reports was more predictive of Assurance of Learning scores – suggesting students be held accountable for opening reports.

Conclusions and Recommendations. Because this study found opening reports to be more predictive than other login activity, the software designers should promote report opening by making it a more direct and immediate aspect of the software and by including report analysis skills in the embedded quizzes. Additionally, instructor materials should include guidance on how to teach report use to Glo-Bus simulation students.
Validation of the Attention, Memory, and Frontal Abilities Screening Test (AMFAST)
Authors: Freilich Bryan M. , Feirsen Nicole , Welton Elise I. , Mowrey Wenzhu B. , Rubinstein Tamar B.
Published: January 2019

The aim of this study is to validate the Attention, Memory, and Frontal Abilities Screening Test (AMFAST), a novel, 10-minute, paper-and-pencil measure developed to identify attention, processing speed, memory, and executive functioning deficits in children and adults with various conditions characterized by frontal-subcortical dysfunction. We administered the AMFAST to 186 English-speaking healthy control participants (aged 8-88 years) without reported cognitive impairment. The AMFAST was also administered to a mixed clinical sample that included 114 English-speaking individuals (aged 8-84 years) who also received comprehensive neuropsychological testing. Results indicated that total AMFAST scores in the healthy control sample were not significantly affected by education or gender. There was, however, a significant effect of age, as the 8- to 10-year-old group scored significantly lower than other age groups. Thus, only participants 11+ years were included in further analyses. The AMFAST demonstrated high test–retest and interrater reliabilities, good construct validity, and the identified optimal cutoff score of 70 had excellent sensitivity and specificity for differentiating between cognitively intact and cognitively impaired individuals. These findings demonstrate that the AMFAST is a highly effective screening test that can be used to identify attention, memory, processing speed, and executive functioning deficits in individuals from middle childhood through older adulthood.
Feature frequency extraction based on singular value decomposition and its application on rotor faults diagnosis
Authors: Li Zhen , Li Weiguang , Zhao Xuezhi
Published: January 2019

The selection of effective singular values using the singular value decomposition (SVD) method has always been a hot topic. In this paper, we found that there was a special relationship between effective singular values and feature frequency components. Theoretical derivations illustrated that each frequency component produced two adjacent nonzero singular values with one ranking another closely. Size of singular values was directly proportional to amplitude of feature frequency. The number of singular values was only related to the number of feature frequency components. For these discoveries, a novel feature frequency separation method based on SVD was proposed, through which axis orbits of large rotating machines were readily purified. The results show that the algorithm was very accurate in feature frequency extraction.
Home Care Program Increases the Engagement in Patients With Heart Failure
Authors: Lay Sandra , Moody Nancy , Johnsen Susan , Petersen Denise , Radovich Patricia
Published: January 2019

Heart failure patients seen in the outpatient home care setting and in cardiology clinics have repeated emergency department visits, hospital admissions, and readmissions despite receiving education about their medications diet and self-care interventions such as daily weights. The objective of this evidence-based practice change was to determine, in home care patients, whether the use of standardized teach-back methodology educational materials would improve their knowledge and confidence in the self-care of their chronic disease. Of the 22 patients enrolled, 15 were not readmitted to the hospital within 9 months of home care admission. The Self-Care of Heart Failure Index revealed an improvement in patient and caregiver contributions to heart failure self-care maintenance (daily adherence and symptom monitoring). The findings suggest that engaging patients by increasing their knowledge of their disease and their self-confidence can reduce hospitalizations and subsequent readmissions.
Practical Guidelines for Managing Patients With Psoriasis on Biologics: An Update
Authors: Poelman Susan M. , Keeling Christopher P. , Metelitsa Andrei I.
Published: January 2019

The paradigm for treating inflammatory diseases has shifted dramatically in the past 10 to 20 years with the discovery of targeted therapeutics or “biologic” agents. Patients with rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, and psoriasis, among others, are reaping the benefits of decades of bench to bedside research, allowing them to live more productive lives with less side effects than traditional systemic therapies. Despite these advances, many physicians unfamiliar with biologics are left to care for the basic needs of these patients and may be unaware of the multisystem comorbidities associated with psoriasis and the screening, monitoring, and other special considerations required of biologics patients. This can be overwhelming to primary care physicians and inadvertently expose patients to undue risks. The aim of this review is to provide a practical approach for all health care providers caring for patients with psoriasis being treated with biologics to facilitate communication with their treating dermatologist and ultimately provide patients with more comprehensive care.