bluuebunny/crossref_metadata_2025 huggingface dataset:
PP16 Creating a linked dataset to explore patient outcomes after leaving ambulance care
Authors: Crum Annabel , Coster Joanne , Turner Janette , Siriwardena Niro
Published: September 2017

Background

Most English ambulance services have implemented electronic patient report forms (ePRF), enabling electronic capture of patient information; previously all information was collected using paper forms. This development brings new opportunities, including linking ambulance data to patient information post ambulance discharge and improving ambulance quality measures. This research aims to create a linked ambulance service, A and E, inpatient and mortality dataset.

Methods

EMAS supplied CAD operational and ePRF clinical data from the study period to the University of Sheffield, and patient identifiers (name, date of birth, address, NHS number) to NHS Digital. NHS Digital traced missing NHS numbers, retrieved patient-level HES A and E, HES inpatient, and ONS mortality data, and returned this data to the University of Sheffield. We created a linked ambulance service and subsequent care dataset by linking EMAS clinical information to data from NHS Digital. This allows us to identify subsequent recontacts, A and E attendances, admissions and deaths.

Results

Our sample comprised only calls recorded via ePRF plus Hear and Treat – excluding 38.90% of total calls. 80.06% of patients in our sample were successfully traced by NHS Digital; unsuccessful traces were due to missing or incomplete CAD/ePRF data. Only CAD identifiers were available for hear and treat patients, limiting tracing success. Non-traced patients could not be linked to HES/ONS data. Of the successfully traced patients, 94.61% were linked to at least one record in the HES or mortality data.

Conclusions

We successfully created a linked dataset for 154927 EMAS patients. This can be used to identify patient outcomes after leaving ambulance care and to develop and test new ways of monitoring ambulance service care quality and performance. Missing information was problematic for data linkage and may be more common among patients who were unable to provide personal details on scene e.g. sicker patients or those who died.
PP17 Reliability and validity of an ambulance patient reported experience measure (a-prem): pilot study
Authors: Siriwardena Aloysius Niroshan , Togher Fiona , Akanuwe Joseph , Spaight Anne
Published: September 2017

Background

There are no prehospital ambulance Patient Reported Experience Measures (A-PREMs) routinely used to support service comparisons and improvement. We developed an A-PREM, generating items through secondary analysis of ambulance patient interview data, and refining the instrument using expert assessment and cognitive interviews of service users. We aimed to pilot the A-PREM (48 experience and 12 attribute items) investigating user acceptability, reliability and construct validity.

Methods

Ambulance users attended by a UK regional ambulance service within the previous six months, excluding those suffering cardiac arrest, were sent a self-administered A-PREM. Returned questionnaires were entered into Microsoft Excel and imported into SPSS v22 for analysis. Experience items were recoded to range from 0 (don’t know/can’t remember) to 3 (best recorded experience). Descriptive analysis for item frequencies and missing values, reliability analyses for potential scales and tests of correlation and association were conducted.

Results

In all, 111 A-PREMs (22.2%) were returned. Missing data were highest for call-taking items. There was a significant association with a shorter wait for first response for four items measuring overall experience of call-taking (χ, p=0.05), ambulance staff (p<0.001), ambulance overall (p=0.001) and A and E (p=0.023). Four separate experience scales encompassing call taking (AmbCallScore, α=0.91), care at scene (AmbCareScore, α=0.90), care on leaving the patient (AmbLeaveScore, α=0.69), and care on transport (AmbTranScore α=0.71), showed satisfactory to high internal consistencies and distributions indicating generally positive experiences. AmbCallScore, AmbCareScore and AmbLeaveScore showed significantly higher scores (ANOVA) with shorter wait to first response. There were no significant differences for overall measures or scales by sex or age of participant, whether they were transported to hospital or not and whether it was their first experience of the ambulance service.

Conclusion

Our findings show that the A-PREM should be tested more widely for evidence of reliability, validity and sensitivity to different care and settings.
PP20 Using conversation analysis (ca) to explore 999-call recordings: what can micro-analysis of ‘talk’ reveal about help seeking for low-acuity conditions?
Authors: Booker Matthew , Barnes Rebecca , Heawood Alison , Purdy Sarah
Published: September 2017

Background

Ascertaining the appropriate clinical urgency of a 999 call is vital to ensure optimal resource utilisation. With numbers of calls to ambulances services for lower-acuity situations continuing the rise, it is necessary to accurately identify early that the helpneededis not always exactly the same as the helpasked for. Undertaking effective prioritisation can be further complicated when the patient is not the caller. This study seeks to explore how a detailed analysis of dialogue between call-taker and caller might better understand how talk is used to convey and respond to expectations and anxieties.

Method

Audio recordings of 45 telephone calls made through the ‘999’ system to an NHS Ambulance Trust were transcribed according to Jeffersonian Notation, and analysed in accordance with the theory and conventions of Conversation Analysis (CA). CA is a well-established inductive method that focuses on extracting sequential patterns in high-quality recordings of interactional data. CA involves the search for communication actions and/or formats that form evidence of systematic usage that can be identified as a ‘practice’.

Results

Analysis focussed on the opening sequence following the question “tell me exactly what happened”. Various phenomena contained within the subsequent dialogue are identified, including how the concept of ‘preference organisation’ can aid understanding of how certain triage dispositions might occur. Examples of how callers attempt to ‘repair’ talk, and offer ‘resistance’ to the perceived trajectory of the dialogue are also explored.

Conclusion

Even in very structured and partially-scripted interactions, revealing patterns of naturalistic utterances do occur. People use talk in 999 calls in distinct and definable ways to try and convey their expectations. Further focussed exploration of how people use the mechanics of talk in these situations is proposed, with the aim of identifying how cases might be managed differently through more nuanced triage questioning strategies.
PP21 Can paramedics correctly recognise cardiac arrhythmias and does recency of training have an impact?
Authors: Sharp Alex
Published: September 2017

Background

Paramedics increasingly utilise alternative care pathways and direct referrals to reduce Emergency Department admissions. The National Institute of Clinical Effectiveness (NICE) Transient Loss of Consciousness (TLoC) guidelines are one such example, with questions previously raised on the ability of paramedics to identify the arrhythmias. Studies identify that paramedics can safely recognise ST segment Myocardial Infarctions, however there remains a lack of evidence around arrhythmia recognition. This study aims to identify if paramedics can identify key arrhythmias and whether the recency of training impacts on recognition.

Method

A quasi-experimental methodology was adopted for the study using a bespoke website. Paramedics were shown 20 12-lead ECGs of key arrhythmias. Each ECG appeared on the screen for a maximum of 60 s. During this time the paramedic was directed to identify the arrhythmia within a free text box, before proceeding to the next arrhythmia.

Results

356 paramedics consented into the study with 230 completing the study. The majority completing the study were standard paramedics [73.04%, n=168], with alternate paramedic roles such as critical care paramedics and paramedic practitioners making up the remainder The mean recognition rate was 47.03% [95% CI 43.82–50.22] with individual paramedics ranging from 10% to 95% and a median recognition rate of 45%. Recognition of individual arrhythmias ranged from 94.78% [95% CI 91.91–97.65] for Atrial Flutter to 3.91% [95% CI 1.4–6.42] for Prolonged QTc. No statistical difference was demonstrated between participants who had received training within the past two years and those who had not (47.96% vs. 46.19%, p=0.59).

Conclusion

This study identified a wide variation in the ability of paramedics to recognise arrhythmias with no obvious patterns identified. The results of the study indicate that the current lack of arrhythmia recognition within paramedic training and curriculum guidance needs to be addressed.
PP24 The transient ischaemic attack 999 emergency referral (tier) feasibility trial: development of a complex intervention
Authors: Rees Nigel , Ali Khalid , Bulger Jenna , Dewar Richard , Edwards Adrian , Evans Bridie , Evans Lyn , Ford Gary , Hampton Chelsey , John Roger , Jones Charlene , Moore Chris , Porter Alison , Pryce Alan , Representative Lay , Quinn Tom , Seagrove Anne , Snooks Helen , Watkins Alan , Whitman Shirley
Published: September 2017

Background

Transient Ischaemic Attack (TIA) is a neurologic event with symptom resolution within 24 hours. Early specialist assessment of TIA reduces risk of stroke and death. NICE (2008) recommends patients with TIA are seen in specialist clinics within 24 hours (if high risk) and seven days (if low risk).

We aimed to develop a complex intervention for patients with low risk TIA presenting to the emergency ambulance service. The intervention was then to be used in the TIER feasibility trial, in line with the MRC guidance on staged development and evaluation of complex interventions.

Methods

We conducted three interrelated activities to produce the TIER intervention:

Survey of UK Ambulance Services (n=13) to gather information about TIA pathways already in use

Scoping review of literature describing prehospital care of patients with TIA

Synthesis of data and definition of the intervention by specialist panel of: paramedics; ED and stroke consultants; service users; ambulance service managers.

Results

The panel defined the TIER intervention to include:

Protocol for paramedics to assess patients presenting with TIA and identify and refer low risk patients for prompt (<7 day) specialist review at TIA clinic

Patient Group Directive and information pack to allow paramedic administration of aspirin to patients left at home with referral to TIA clinic

Referral process via clinical desk in ambulance control room

Training package for paramedics

Agreement with TIA clinic service provider to ensure rapid review of referred patients

Conclusion

We followed MRC guidance to develop a clinical intervention which assesses and refers low risk TIA patients requesting 999 care. We will test feasibility of implementing and evaluating this in the TIER feasibility trial. We will then develop a fully powered randomised multicentre trial, if findings indicate this is appropriate.
PP29 Exploring factors increasing paramedics’ likelihood of administering analgesia in pre-hospital pain: cross sectional study (explain)
Authors: Asghar Zahid , Niroshan Siriwardena A , Phung Viet-Hai , Lord Bill , Foster Theresa , Pocock Helen , Williams Julia , Snooks Helen
Published: September 2017

Background

Paramedics play an important role in reducing pain in patients calling an ambulance. We aimed to identify how patient factors (age, sex), clinical condition and paramedic factors (sex, role seniority) affected pain treatment and outcomes.

Methods

We used a cross sectional design using routine retrospective data a one-week sample of all 999 ambulance attendances in two large regional UK ambulance services for all patients aged 18 years or over where pain was identified in people requiring primary transport to hospital. Exclusion criteria patients with a Glasgow Coma Scale score below 13, or patients not attended by a paramedic.

We used a multilevel design, using a regression model to investigate which factors were independently associated with administration of analgesia and reduction in pain, taking into account confounders including patient demographics and other variables. Analysis was performed with Stata.

Results

We collected data on 9574 patients (service 1, 2; n=3344, 6230 respectively) including 4911 (51.3%) male and 4524 (47.3%) females (1.5% missing). Initial pain score was not recorded in 42.4% (4063/9574). The multilevel model suggested that the factors associated with use of strong opiates (morphine intravenously or orally) was a pain score of 7 or above, patient age 50–64 years and suspected fractured neck of femur. Reduction in pain score of 2 or more points was significant whatever the initial pain score and associated with age 50–84 years. There was no association between use of strong opiate analgesic or reduction in pain score and sex of patient and/or sex of paramedic or crew member.

Conclusion

Our initial analysis showed a high level of non-recording of pain scores. There was no association between use of strong opiate analgesics or reduction in pain score of 2 points or more with patient sex or crew sex or paramedic skill level.
PP30 Rapid analgesia for prehospital hip disruption (rapid: feasibility study progress)
Authors: Bulger Jenna , Seagrove Anne , Snooks Helen , Evans Bridie , Fegan Greg , Ford Simon , Pallister Ian , Guy Katy , Brown Alan , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Rees Nigel
Published: September 2017

Background

Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilise and whose long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated. We report on study progress following six months of patient recruitment.

Methods

We undertook a randomised controlled feasibility trial using novel audited scratchcard randomisation to allocate eligible patients to FICB or usual care. FICB is only administered to patients without contraindications. The primary measureable outcome is health related quality of life, measured using SF-12 at 1 and 6 months. Secondary outcome measures include mobility scores at 6 months (using Rivermead Mobility Index); patient satisfaction; pain scores; patient safety and length of hospital stay. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. We will also assess the accuracy of paramedic hip fracture recognition (using sensitivity and positive predictive value as indicators).

Results

We have developed

paramedic pathway to assess patients for hip fracture and FICB

paramedic training package, delivered by Consultant Anaesthetist

randomisation scratchcards

To date we have recruited 19 paramedics; 10 are fully trained and recruiting patients, the remainder are being trained. Twenty-two patients have been randomised and 16 have consented to follow-up.

Discussion

This study will enable us to recommend whether to undertake a definitive multi-centre randomised controlled trial of FICB by paramedics for hip fracture and the procedure is effective for patients and worthwhile for the NHS.
BET 1: Prednisolone for the treatment of acute gouty arthritis
Authors: Simon Taylor Richard
Published: September 2017

A short cut review was carried out to establish whether corticosteroids are safe and effective in managing the symptoms of acute gouty arthritis. Five studies were directly relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that corticosteroids are an effective and safe alternative to non steroidal anti inflammatory drugs (NSAIDs) in patients presenting with acute gouty arthritis.
Global Abstracts
Authors: Weber Ellen J
Published: September 2017

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.
Retrospective UK multicentre study of the pregnancy outcomes of women with a Fontan repair
Authors: Cauldwell Matthew , Steer Philip J , Bonner Samantha , Asghar Omar , Swan Lorna , Hodson Kenneth , Head Catherine E G , Jakes Adam Daniel , Walker Nicola , Simpson Margaret , Bolger Aidan P , Siddiqui Farah , English Katherine M , Maudlin Lucy , Abraham Dilip , Sands Andrew J , Mohan Aarthi R , Curtis Stephanie L , Coats Louise , Johnson Mark R
Published: September 2017

Background

The population of women of childbearing age palliated with a Fontan repair is increasing. The aim of this study was to describe the progress of pregnancy and its outcome in a cohort of patients with a Fontan circulation in the UK.

Methods

A retrospective study of women with a Fontan circulation delivering between January 2005 and November 2016 in 10 specialist adult congenital heart disease centres in the UK.

Results

50 women had 124 pregnancies, resulting in 68 (54.8%) miscarriages, 2 terminations of pregnancy, 1 intrauterine death (at 30 weeks), 53 (42.7%) live births and 4 neonatal deaths. Cardiac complications in pregnancies with a live birth included heart failure (n=7, 13.5%), arrhythmia (n=6, 11.3%) and pulmonary embolism (n=1, 1.9%). Very low baseline maternal oxygen saturations at first obstetric review were associated with miscarriage. All eight women with saturations of less than 85% miscarried, compared with 60 of 116 (51.7%) who had baseline saturations of ≥85% (p=0.008). Obstetric and neonatal complications were common: preterm delivery (n=39, 72.2%), small for gestational age (<10th percentile, n=30, 55.6%; <5th centile, n=19, 35.2%) and postpartum haemorrhage (n=23, 42.6%). There were no maternal deaths in the study period.

Conclusion

Women with a Fontan circulation have a high rate of miscarriage and, even if pregnancy progresses to a viable gestational age, a high rate of obstetric and neonatal complications.
Health-related quality of life and depression among participants in the Sjögren’s International Collaborative Clinical Alliance registry
Authors: Chou Annie , Gonzales John A , Daniels Troy E , Criswell Lindsey A , Shiboski Stephen C , Shiboski Caroline H
Published: September 2017

Objective

To examine health-related quality of life (HRQoL) and depression among participants in an international Sjögren’s syndrome (SS) registry, comparing those with and without SS.

Methods

Cross-sectional study of participants in the Sjögren’s International Collaborative Clinical Alliance (SICCA) registry. The 2016 American College of Rheumatology/European League Against Rheumatism SS classification criteria were used to determine disease status. HRQoL was assessed using the Short Form 12, version 2 Health Survey to derive scores for physical component summary (PCS) and mental component summary (MCS). Depression was assessed using the 9-Item Patient Health Questionnaire. Multivariate linear and logistic regression analyses were performed to identify predictors of HRQoL and depression while controlling for potential confounders.

Results

Among 2401 SICCA participants who had symptoms of dry eyes and dry mouth, 1051 had SS (44%) and 1350 did not (56%). After controlling for confounders, when compared with non-SS participants, those with SS had better PCS (p<0.001, β=2.43, 95% CI 1.57 to 3.29), MCS (p=0.002, β=1.37, 95% CI 0.50 to 2.23) and lower adjusted odds of depression (p<0.001, OR 0.67, 95% CI 0.55 to 0.81). Other significant predictors of HRQoL and depression included employment, country of residence and use of medication with anticholinergic effect or for management of SS-related signs and symptoms.

Conclusion

Our results suggest that among symptomatic patients, having a diagnosis of SS may be associated with better emotional and psychological well-being compared with patients without a diagnosis. Having a definitive diagnosis of SS may encourage patients to obtain a better understanding of their disease and have coping mechanisms in place to better manage their symptoms.
Person-focused care for young people with rheumatic and musculoskeletal diseases: young rheumatologists' and EULAR Young PARE perspectives
Authors: Alunno Alessia , Studenic Paul , Nikiphorou Elena , Balážová Petra , Nieuwkoop Linda van , Ramiro Sofia , Carubbi Francesco , Richez Christophe , Caeyers Nele , Gossec Laure , Kouloumas Marios
Published: September 2017

In recent years, the evolution of healthcare challenged the management of people with rheumatic and musculoskeletal diseases (RMDs). From disease-centred care to person-focused care, a holistic approach along with patient empowerment about their disease, improved the physician-patient relationship and allowed to achieve better outcomes with lower healthcare costs. Nevertheless, RMDs may occur from childhood to the old age and to date very few studies have addressed the needs and priorities of young people with RMDs. However, the image of RMDs is still associated with the elderly population. In this regard, the group of young people with arthritis and rheumatism in Europe (PARE) was recently developed within European League Against Rheumatism to represent the voice of the young affected and to carry out projects aiming for a better understanding of these specific aspects. This viewpoint discusses the needs and priorities of young people compared with adult people with RMDs, based on the available literature and on the results of the PARE Youth research project, aiming to identify the next steps of actions that need to be taken to improve the current situation.
Correlating abdominal pain and intra-abdominal injury in patients with blunt abdominal trauma
Authors: Neeki Michael M , Hendy Dylan , Dong Fanglong , Toy Jake , Jones Kevin , Kuhnen Keasha , Yuen Ho Wang , Lux Pamela , Sin Arnold , Kwong Eugene , Wong David
Published: September 2017

Background

A thorough history and physical examination in patients with blunt abdominal trauma (BAT) is important to safely exclude clinically significant intra-abdominal injury (IAI). We seek to evaluate a correlation between self-reported abdominal pain, abdominal tenderness on examination and IAI discovered on CT or during exploratory laparotomy.

Methods

This retrospective analysis assessed patients with BAT ≥13 years old who arrived to the emergency department following BAT during the 23-month study period. Upon arrival, the trauma team examined all patients. Only those who underwent an abdominal and pelvic CT scan were included. Patients were excluded if they were unable to communicate or lacked documentation, had obvious evidence of extra-abdominal distracting injuries, had a positive drug or alcohol screen, had a Glasgow Coma Scale ≤13, or had a positive pregnancy screening. The primary objective was to assess the agreement between self-reported abdominal pain and abdominal tenderness on examination and IAI noted on CT or during exploratory laparotomy.

Results

Among the 594 patients included in the final analysis, 73.1% (n=434) had no self-reported abdominal pain, 64.0% (n=384) had no abdominal tenderness on examination, and 22.2% (n=132) had positive CT findings suggestive of IAI. Among the 352 patients who had no self-reported abdominal pain and no abdominal tenderness on examination, a significant number of positive CT scan results (14%, n=50) were still recorded. Furthermore, a small but clinically significant portion of these 50 patients underwent exploratory laparotomy (1.1%, n=4). All four of these patients ultimately underwent a splenectomy and all were completed on hospital day one.

Conclusion

Lack of abdominal pain and tenderness in patients with BAT with non-distracting injuries was associated with a small portion of patients who underwent a splenectomy. Patients with BAT without abdominal pain or tenderness may need a period of observation or CT scan to rule out IAI prior to discharge home.

Level of evidence

Level III, therapeutic/care management.
4-Aminobutyrate (GABA): a metabolite and signal with practical significance
Authors: Shelp Barry J. , Bown Alan W. , Zarei Adel
Published: September 2017

We discuss the origin of 4-aminobutyrate (GABA) from glutamate and polyamines, and its subsequent catabolism to succinic semialdehyde and either succinate or 4-hydroxybutyrate. Promiscuous activities of GABA transaminase, glyoxylate/succinic semialdehyde reductases, and aldehyde dehydrogenase 10As appear to be important determinants of cross-talk among metabolic pathways during stress. Imposition of abiotic stress, as well as genetic or chemical disruption of glutamate decarboxylase, GABA transaminase, and tricarboxylic acid cycle reactions, results in non-cyclic carbon flux in the tricarboxylic acid cycle, demonstrating that stress-induced GABA metabolism is strongly linked with respiration. Metabolic generation of 4-hydroxybutyrate is probably linked to the stimulation of succinic semialdehyde reductase activity by an increasing NADPH/NADP+ ratio. We discuss the potential signaling role of GABA in various processes, including pollen tube guidance, interaction with fungal, bacterial, and invertebrate pests, and stomatal functioning, and argue that further research on short-term responses to stress is required to determine whether or not GABA functions by binding to or regulating the activity of GABA receptor molecules. Finally, we describe how emerging information about the metabolic and signaling roles of GABA is being used to improve plant defenses against biotic and abiotic stresses, and benefit human health.
Synthesis and characterization of a stable non-cyclic bis(amino)arsenium cation
Authors: Kuprat Marcus , Schulz Axel , Thomas Max , Villinger Alexander
Published: September 2017

The reaction of Li[Mes*NH] (1, Mes* = 2,4,6-tri-tert-butylphenyl) with aminoarsane Mes*N(H)AsCl2 (2, Mes* = 2,4,6-t-Bu3C6H2) at −80 °C resulted in the formation of bisamino(chloro)arsane (Mes*NH)2AsCl (3Cl) by elimination of LiCl. 3Cl reacted with the Lewis acids such as AlCl3, GaCl3, and Ag[X] (X = AsF6−, OTf−, BF4−; OTf = trifluoromethanesulfonate = OSO2CF3−) upon chloride ion abstraction to give salts bearing the cation [(Mes*NH)2As]+ (3[X]; X = AsF6−, OTf−, BF4−, ECl4; E = Al, Ga). 3+ represents the first NH-functionalized acyclic bis(amino)arsenium cation. The formation of the salts bearing 3+ could also be observed in the reaction of cyclo-1,3-diarsa-2,4-diazane [ClAs(μ-NMes*)]2 (4) with Lewis acids (AlCl3, GaCl3) in the presence of proton sources in solution. All presented salts 3[X] were stable at room temperature and fully characterized.
Area Efficient Memoryless Reverse Converter for New Four Moduli Set {2n−1,2n−1,2n+1,22n+1−1}
Authors: Jaiswal Ritesh Kumar , Kumar Raj , Mishra Ram Awadh
Published: September 2017

The efficiency of residue number system depends on the reverse converter due to several modulo operations like addition, subtraction and multiplication. In this paper, a design of new four moduli set [Formula: see text], reverse converter is presented. The moduli set have moduli with length ranging from ([Formula: see text]) to ([Formula: see text])-bits. The reverse conversion for moduli set [Formula: see text] has been optimized in existing state of art. Thus, proposed converter is based on two new moduli set [Formula: see text] and utilizes the mixed radix conversion. This converter is memoryless, and occupies least area. The proposed converter is based on carry save adder (CSA) and modulo adder enabling more speed and less hardware complexity for dynamic range of [Formula: see text]-bit, offering good area-delay product.
Interior penalty mixed finite element methods of any order in any dimension for linear elasticity with strongly symmetric stress tensor
Authors: Wu Shuonan , Gong Shihua , Xu Jinchao
Published: September 2017

We propose two classes of mixed finite elements for linear elasticity of any order, with interior penalty for nonconforming symmetric stress approximation. One key point of our method is to introduce some appropriate nonconforming face-bubble spaces based on the local decomposition of discrete symmetric tensors, with which the stability can be easily established. We prove the optimal [Formula: see text]-error estimate for displacement and optimal [Formula: see text] error estimate for stress by adding an interior penalty term. The elements are easy to be implemented thanks to the explicit formulations of its basis functions. Moreover, the method can be applied to arbitrary simplicial grids for any spatial dimension in a unified fashion. Numerical tests for both 2D and 3D are provided to validate our theoretical results.
Adaptive isogeometric methods with hierarchical splines: Optimality and convergence rates
Authors: Buffa Annalisa , Giannelli Carlotta
Published: September 2017

We consider an adaptive isogeometric method (AIGM) based on (truncated) hierarchical B-splines and continue the study of its numerical properties. We prove that our AIGM is optimal in the sense that delivers optimal convergence rates as soon as the solution of the underlying partial differential equation belongs to a suitable approximation class. The main tool we use is the theory of adaptive methods, together with a local upper bound for the residual error indicators based on suitable properties of a well selected quasi-interpolation operator on hierarchical spline spaces.
A General Approach to Derive Stress and Elasticity Tensors for Hyperelastic Isotropic and Anisotropic Biomaterials
Authors: Cheng Jie , Zhang Lucy T.
Published: September 2017

Hyperelastic models are of particular interest in modeling biomaterials. In order to implement them, one must derive the stress and elasticity tensors from the given potential energy function explicitly. However, it is often cumbersome to do so because researchers in biomechanics may not be well-exposed to systematic approaches to derive the stress and elasticity tensors as it is vaguely addressed in literature. To resolve this, we present a framework of a general approach to derive the stress and elasticity tensors for hyperelastic models. Throughout the derivation we carefully elaborate the differences between formulas used in the displacement-based formulation and the displacement/pressure mixed formulation. Three hyperelastic models, Mooney–Rivlin, Yeoh and Holzapfel–Gasser–Ogden models that span from first-order to higher order and from isotropic to anisotropic materials, are served as examples. These detailed derivations are validated with numerical experiments that demonstrate excellent agreements with analytical and other computational solutions. Following this framework, one could implement with ease any hyperelastic model as user-defined functions in software packages or develop as an original source code from scratch.
Human Trafficking: Source, Transit, Destination Designations
Authors: Mordeson John N. , Mathew Sunil
Published: September 2017

Although governments, international organizations, and civil society are devoting efforts to combat sex trafficking, there still exists a lack of accurate information. Consequently, we use linguistic terms to consider the amount of flow between regions. We use the terms such as very low, low, medium, high, and very high to describe the source, transit and destination designations of countries. We then determine source, transit and destination designations for regions by using a weighted average based on population of the countries in their respective region. Finally, we determine upper bounds in linguistic terms for the flow from and into a region.
Soft Statistics with Respect to Utility and Application to Human Trafficking
Authors: Acharjee Santanu , Mordeson John N.
Published: September 2017

It is well known that statistics deals with quantitative analysis. Thus, there is a lack of approach to do quantitative analysis in the presence of qualitative attributes. Soft set theory has the freedom to deal with attributes, [0, 1], etc. along with quantity. Thus, we introduce some fundamental ideas of soft statistics.

Here, soft mean, soft standard deviation, soft coefficient of variation, soft correlation coefficient are introduced and some theorems are proved with respect to utility. Utility theory provides an analysis of choice behavior. As an application of our notions and results, we find soft correlation coefficients between vulnerability and government responses of various regions across the world. The data from “The Global Slavery Index 2016” are considered for application purposes.
A Biologically-Inspired Smart Grid Replication
Authors: Stefanov S. Z. , Wang Paul P.
Published: September 2017

The characteristics of the replication is investigated in this paper. By invoking the Potts model versus holographic superconductors for “gauge” versus “string”, the pair forms as a duality in natural manner. It can be shown that resulted characteristics of replication hence deserves to be called as an Autopoietic Smart Grid. Furthermore, we are able to trace the factors contributed to these characteristics; the autopoiesis is contributed via gauge self-energy; the surveillance is due to Maxwell’s demon; the organizational adaptivity is due to the communication capacity of the string and the oscillations of the gauge. Finally, it can also be shown that such a Smart Grid replication exists as long as the string is stable and gauge is synchronized.
Semigroups of linear tree languages
Authors: Kitpratyakul Pongsakorn , Pibaljommee Bundit
Published: September 2017

A linear tree language of type [Formula: see text] is a set of linear terms, terms in which each variable occurs at most once, of that type. We investigate a semigroup consisting of the collection of all linear tree languages such that products of any element in the collection are nonempty and the operation of the corresponding linear product especially idempotent elements, Green’s relations [Formula: see text], [Formula: see text], and [Formula: see text], and some of its subsemigroups. We discover that this semigroup is neither factorizable nor locally factorizable. We also study the linear product iteration and show that any iteration is idempotent in this semigroup. Moreover, we study a semigroup with the complement of the universe set of the above semigroup together with the same linear product operation.
The cozero-divisor graph of a module
Authors: Alibemani A. , Hashemi E. , Alhevaz A.
Published: September 2017

Let [Formula: see text] be an associative ring with non-zero identity and [Formula: see text] a non-zero unital left [Formula: see text]-module. The cozero-divisor graph of [Formula: see text], denoted by [Formula: see text], is a graph with vertices [Formula: see text] and two distinct vertices [Formula: see text] and [Formula: see text] are adjacent if [Formula: see text] and [Formula: see text]. In this paper, we study some connections between the graph-theoretic properties of [Formula: see text] and algebraic-theoretic properties of [Formula: see text] and [Formula: see text]. Also, we study girth, independence number, clique number and planarity of this graph.
MgO-based nanosheets loaded with ZnxMg1−xO nanoparticles with UV light-driven photocatalytic performance
Authors: Wu Junshu , Wang Linlin , Wang Jinshu , Du Yucheng , Li Yongli
Published: September 2017

This paper reports the synthesis of MgO-based nanosheets loaded with UV-light absorbed, wurtzite ZnxMg[Formula: see text]O nanoparticles based on calcining Zn[Formula: see text]-adsorbed Mg(OH)2 precursor, as evidenced by X-ray diffraction, UV-visible, X-ray photoelectron spectroscopy analyses, etc. The surface modification of magnesium oxide (MgO) sheet-like adsorbents by Zn–Mg–O alloys generates photocatalytic activity for the degradation removal of cationic dye Rhodamine B and anionic dye methyl orange under UV light irradiation. These findings provide a route to chemically controlled synthesis of new and highly robust MgO–ZnxMg[Formula: see text]O materials for water purification. The endowed photocatalysis function of MgO makes it be easily recovered via photodegradation of adsorbed dyes rather than high-temperature calcination, thus extending the applications of MgO in dye wastewater treatment.
Gliotransmission and adenosinergic modulation: insights from mammalian spinal motor networks
Authors: Acton David , Miles Gareth B.
Published: September 2017

Astrocytes are proposed to converse with neurons at tripartite synapses, detecting neurotransmitter release and responding with release of gliotransmitters, which in turn modulate synaptic strength and neuronal excitability. However, a paucity of evidence from behavioral studies calls into question the importance of gliotransmission for the operation of the nervous system in healthy animals. Central pattern generator (CPG) networks in the spinal cord and brain stem coordinate the activation of muscles during stereotyped activities such as locomotion, inspiration, and mastication and may therefore provide tractable models in which to assess the contribution of gliotransmission to behaviorally relevant neural activity. We review evidence for gliotransmission within spinal locomotor networks, including studies indicating that adenosine derived from astrocytes regulates the speed of locomotor activity via metamodulation of dopamine signaling.
Enhanced interlaminar excitation or reduced superficial layer inhibition in neocortex generates different spike-and-wave-like electrographic events in vitro
Authors: Hall Stephen P. , Traub Roger D. , Adams Natalie E. , Cunningham Mark O. , Schofield Ian , Jenkins Alistair J. , Whittington Miles A.
Published: September 2017

Acute in vitro models have revealed a great deal of information about mechanisms underlying many types of epileptiform activity. However, few examples exist that shed light on spike-and-wave (SpW) patterns of pathological activity. SpW are seen in many epilepsy syndromes, both generalized and focal, and manifest across the entire age spectrum. They are heterogeneous in terms of their severity, symptom burden, and apparent anatomical origin (thalamic, neocortical, or both), but any relationship between this heterogeneity and underlying pathology remains elusive. In this study we demonstrate that physiological delta-frequency rhythms act as an effective substrate to permit modeling of SpW of cortical origin and may help to address this issue. For a starting point of delta activity, multiple subtypes of SpW could be modeled computationally and experimentally by either enhancing the magnitude of excitatory synaptic events ascending from neocortical layer 5 to layers 2/3 or selectively modifying superficial layer GABAergic inhibition. The former generated SpW containing multiple field spikes with long interspike intervals, whereas the latter generated SpW with short-interval multiple field spikes. Both types had different laminar origins and each disrupted interlaminar cortical dynamics in a different manner. A small number of examples of human recordings from patients with different diagnoses revealed SpW subtypes with the same temporal signatures, suggesting that detailed quantification of the pattern of spikes in SpW discharges may be a useful indicator of disparate underlying epileptogenic pathologies.

NEW & NOTEWORTHY Spike-and-wave-type discharges (SpW) are a common feature in many epilepsies. Their electrographic manifestation is highly varied, as are available genetic clues to associated underlying pathology. Using computational and in vitro models, we demonstrate that distinct subtypes of SpW are generated by lamina-selective disinhibition or enhanced interlaminar excitation. These subtypes could be detected in at least some noninvasive patient recordings, suggesting more detailed analysis of SpW may be useful in determining clinical pathology.
Vascular Smooth Muscle Cells and Arterial Stiffening: Relevance in Development, Aging, and Disease
Authors: Lacolley Patrick , Regnault Véronique , Segers Patrick , Laurent Stéphane
Published: September 2017

The cushioning function of large arteries encompasses distension during systole and recoil during diastole which transforms pulsatile flow into a steady flow in the microcirculation. Arterial stiffness, the inverse of distensibility, has been implicated in various etiologies of chronic common and monogenic cardiovascular diseases and is a major cause of morbidity and mortality globally. The first components that contribute to arterial stiffening are extracellular matrix (ECM) proteins that support the mechanical load, while the second important components are vascular smooth muscle cells (VSMCs), which not only regulate actomyosin interactions for contraction but mediate also mechanotransduction in cell-ECM homeostasis. Eventually, VSMC plasticity and signaling in both conductance and resistance arteries are highly relevant to the physiology of normal and early vascular aging. This review summarizes current concepts of central pressure and tensile pulsatile circumferential stress as key mechanical determinants of arterial wall remodeling, cell-ECM interactions depending mainly on the architecture of cytoskeletal proteins and focal adhesion, the large/small arteries cross-talk that gives rise to target organ damage, and inflammatory pathways leading to calcification or atherosclerosis. We further speculate on the contribution of cellular stiffness along the arterial tree to vascular wall stiffness. In addition, this review provides the latest advances in the identification of gene variants affecting arterial stiffening. Now that important hemodynamic and molecular mechanisms of arterial stiffness have been elucidated, and the complex interplay between ECM, cells, and sensors identified, further research should study their potential to halt or to reverse the development of arterial stiffness.
Two-Dimensional Modeling of Thermomechanical Responses of Rectangular GFRP Profiles Exposed to Fire
Authors: Zhang Lingfeng , Liu Weiqing , Sun Guoqing , Wang Lu , Li Lingzhi
Published: September 2017

In the past three decades, one-dimensional (1D) thermal model was usually used to estimate the thermal responses of glass fiber-reinforced polymer (GFRP) materials and structures. However, the temperature gradient and mechanical degradation of whole cross sections cannot be accurately evaluated. To address this issue, a two-dimensional (2D) thermomechanical model was developed to predict the thermal and mechanical responses of rectangular GFRP tubes subjected to one-side ISO-834 fire exposure in this paper. The 2D governing heat transfer equations with thermal boundary conditions, discretized by alternating direction implicit (ADI) method, were solved by Gauss-Seidel iterative approach. Then the temperature-dependent mechanical responses were obtained by considering the elastic modulus degradation from glass transition and decomposition of resin. The temperatures and midspan deflections of available experimental results can be reasonably predicted. The overestimation of deflections could be attributed to the underestimation of bending stiffness. This model can also be extended to simulate the thermomechanical responses of beams and columns subjected to multiside fire loading, which may occur in real fire scenarios.
Aorto-Right Ventricular Shunt after TAVR: Rare Complication of Common Procedure
Authors: Almanfi Abdelkader , Qurie Ahmad , Strickman Neil
Published: September 2017

Background. The primary treatment of symptomatic aortic stenosis is aortic valve replacement. Instead of open chest surgery, transcatheter aortic valve replacement (TAVR) is an alternative intervention for high-risk surgical candidates. Clinical Case. A 92-year-old male presented with progressive exertional dyspnea and recurrent syncopal attacks secondary to severe AS. The patient underwent successful transfemoral TAVR with 29 mm Edwards SAPIEN XT valve. His postoperative course was complicated by aorto-right ventricular shunt. The patient’s clinical course was followed up for one year. Conclusion. This case reports the incidence and clinical course of one of the rare complications of TAVR, aorto-right ventricular fistula. Conservative medical management is appropriate in hemodynamically stable patients with this specific complication.
Myocardial Expression of PPARγand Exercise Capacity in Patients after Coronary Artery Bypass Surgery
Authors: Wojtkowska Izabela , Bonda Tomasz A. , Wolszakiewicz Jadwiga , Osak Jerzy , Tysarowski Andrzej , Seliga Katarzyna , Siedlecki Janusz A. , Winnicka Maria M. , Piotrowicz Ryszard , Stępińska Janina
Published: September 2017

Activation of PPARs may be involved in the development of heart failure (HF). We evaluated the relationship between expression of PPARγin the myocardium during coronary artery bypass grafting (CABG) and exercise tolerance initially and during follow-up. 6-minute walking test was performed before CABG, after 1, 12, 24 months. Patients were divided into two groups (HF and non-HF) based on left ventricular ejection fraction and plasma proBNP level. After CABG, 67% of patients developed HF. The mean distance 1 month after CABG in HF was397±85 m versus420±93 m in non-HF. PPARγmRNA expression was similar in both HF and non-HF groups. 6MWT distance 1 month after CABG was inversely correlated with PPARγlevel only in HF group. Higher PPARγexpression was related to smaller LVEF change between 1 month and 1 year (R=0.18,p<0.05), especially in patients with HF. Higher initial levels of IL-6 in HF patients were correlated with longer distance in 6MWT one month after surgery and lower PPARγexpression. PPARγexpression is not related to LVEF before CABG and higher PPARγexpression in the myocardium of patients who are developing HF following CABG may have some protecting effect.
SPE-UHPLC-FLD Method for the Simultaneous Determination of Five Anthraquinones in Human Urine Using Mixed-Mode Bis(tetraoxacalix[2]arene[2]triazine) Modified Silica as Sorbent
Authors: Hu Kai , Qiao Yonghui , Deng Zhifen , Wu Mingxia , Liu Wei
Published: September 2017

The five anthraquinones compounds (including aloe-emodin, emodin, physcion, chrysophanol, and rhein) are regarded as the main effective ingredients in rhubarb (Dahuang in Chinese, one of the commonly used Chinese herbal medicines). In this work, a simple and effective solid phase extraction (SPE) method based on bis(tetraoxacalix[2]arene[2]triazine) modified silica gel as adsorbent was developed. Coupled with UHPLC-FLD, the developed method was successfully applied for the measuring of main anthraquinones in human urine after oral administration of the extracts of rhubarb. To obtain the highest recoveries of the five anthraquinones in the SPE process, the main parameters which may affect extraction efficiency were optimized. The optimized sorbent amount, sample loading pH, sample loading rate, washing solution, and eluent condition were obtained. The developed method showed good linearity in 0.012–1.800 μg mL−1 for the five anthraquinones with correlation coefficients more than 0.9993. The investigated LOD values ranged from 3.9 to 5.7 ng mL−1, while the LOQs were between 12.0 and 18.2 ng mL−1. The recoveries of the method were also investigated, which were in the range of 94.8–106.6%. The application of the mixed-mode SPE materials in the proposed method was feasible and simple, and suitable for the enrichment of anthraquinones in urine samples.