bluuebunny/crossref_metadata_2025 huggingface dataset:
Simply and doubly periodic arrangements of the equi-stress holes in a perforated elastic plane: The single-layer potential approach
Authors: Vigdergauz Shmuel
Published: February 2017

The layer potentials of two-dimensional linear elastostatics are applied as a novel building block for the semi-analytical design of non-standard arrangements of the equi-stress holes in an infinite plate under a given bulk-type loading. Thematically, this paper begins where our previous work left off with the main attention being focused on periodic structures of low rotational symmetry which are hard to tackle by the more customary conformal mapping technique. The analytical derivations are backed up by numerical simulations, in which a genetic algorithm is utilized to identify the optimal interface shapes for different geometries and a wide range of the governing parameters.
Noteworthy Literature Published in 2016 for Thoracic Organ Transplantation Anesthesiologists
Authors: Subramaniam Kathirvel , Nazarnia Soheyla
Published: February 2017

This article is first in the series to review the published literature on perioperative issues in patients undergoing thoracic solid organ transplantations. We present recent literature from 2016 on preoperative considerations, organ preservation, intraoperative anesthesia management, surgical techniques, postoperative complications, and the impact of perioperative management on short- and long-term outcomes that are pertinent to thoracic transplantation anesthesiologists.
Epidemic failure detection and consensus for extreme parallelism
Authors: Katti Amogh , Di Fatta Giuseppe , Naughton Thomas , Engelmann Christian
Published: February 2017

Future extreme-scale high-performance computing systems will be required to work under frequent component failures. The MPI Forum’s User Level Failure Mitigation proposal has introduced an operation, MPI_Comm_shrink, to synchronize the alive processes on the list of failed processes, so that applications can continue to execute even in the presence of failures by adopting algorithm-based fault tolerance techniques. This MPI_Comm_shrink operation requires a failure detection and consensus algorithm. This paper presents three novel failure detection and consensus algorithms using Gossiping. Stochastic pinging is used to quickly detect failures during the execution of the algorithm, failures are then disseminated to all the fault-free processes in the system and consensus on the failures is detected using the three consensus techniques. The proposed algorithms were implemented and tested using the Extreme-scale Simulator. The results show that the stochastic pinging detects all the failures in the system. In all the algorithms, the number of Gossip cycles to achieve global consensus scales logarithmically with system size. The second algorithm also shows better scalability in terms of memory and network bandwidth usage and a perfect synchronization in achieving global consensus. The third approach is a three-phase distributed failure detection and consensus algorithm and provides consistency guarantees even in very large and extreme-scale systems while at the same time being memory and bandwidth efficient.
Mixed Methods in the Organizational Sciences
Authors: Molina-Azorin José F. , Bergh Donald D. , Corley Kevin G. , Ketchen David J.
Published: February 2017

A growing methodological trend is emerging from the recognition that integrating qualitative and quantitative methods in the same study, that is, employing a mixed methods approach, can provide the necessary empirical intricacy and rigor to match the complexities of organizational phenomena. The authors describe opportunities and challenges of mixed methods research in the organizational sciences, explain how the articles offered in this Feature Topic help to advance mixed methods in our field, and offer suggestions for future work that may create additional progress.
New insights into the burden and costs of multiple sclerosis in Europe
Authors: Kobelt Gisela , Thompson Alan , Berg Jenny , Gannedahl Mia , Eriksson Jennifer ,   the MSCOI Study Group,   the European Multiple Sclerosis Platform
Published: February 2017

Background:

The current focus in multiple sclerosis (MS) is on early diagnosis and drug intervention, with a view to modifying disease progression. Consequently, healthcare costs have shifted from inpatient care and rehabilitation to outpatient care.

Objectives:

This European burden of illness study provides data that can be combined with other evidence to assess whether management approaches provide value to society.

Methods:

A cross-sectional study was conducted in 16 countries. Patients reported on their disease, health-related quality of life (HRQoL) and resource consumption. Descriptive analyses were performed by disease severity. Costs are reported from a societal perspective in 2015€ PPP (adjusted for purchasing power parity).

Results:

The 16,808 participants had a mean age of 51.5 years, and 52% had relapsing–remitting multiple sclerosis (RRMS). Work capacity declined from 82% to 8%, and utility declined from normal population values to less than zero with advancing disease. Mean costs were 22,800€ PPP in mild, 37,100€ PPP in moderate and 57,500€ PPP in severe disease; healthcare accounted for 68%, 47% and 26%, respectively. Fatigue and cognitive difficulties were reported by 95% and 71% of participants, respectively; both had a significant independent effect on utility.

Conclusion:

Costs and utility were highly correlated with disease severity, but resource consumption was heavily influenced by healthcare systems organisation and availability of services.
Self-inflicted penetrating injury: A review
Authors: Stephen Andrew H , Karlin Daniel R , Luppens Carolyn L , Adams Charles A
Published: February 2017

Penetrating self-inflicted injury is a mechanism that occurs with significant frequency at many trauma centers in the United States and internationally. With high rates of unemployment and growing numbers of individuals with mental illness, we expect more and more patients to present with these injuries. Additionally, there are known to be misconceptions about the seriousness of injuries that can occur when penetrating trauma is self-inflicted, especially with stab wounds. There is also often uncertainty among surgeons regarding how to treat these patients effectively in a multidisciplinary fashion while working with psychiatry services. Our goal was to review the epidemiology, mechanisms, anatomic considerations, role of substance use, and psychiatric illness in these injuries and the approach to evaluation and treatment of these patients.
Three-dimensional in-situ imaging of cracks in concrete using diffuse ultrasound
Authors: Zhang Yuxiang , Larose Eric , Moreau Ludovic , d’Ozouville Grégoire
Published: February 2017

Locadiff, an innovative imaging technique based on diffuse waves, has recently been developed in order to image mechanical changes in heterogeneous, geological, or man-made materials. This manuscript reports the on-site application of Locadiff to locate several pre-existing cracks on an aeronautical wind tunnel made of pre-stressed concrete. Using 32 transducers working at ultrasonic frequencies (80–220 kHz) where multiple scattering occurs, we monitor during 15 min an area of 2.5 m×2.5 m of a 35-cm-thick wall. With the wind tunnel in its routine operation, structural changes around the cracks are detected, thanks to their closing or opening due to slight pressure changes. By mapping the density of such microstructure changes in the bulk of the material, locating three pre-existing cracks is properly performed in three dimensions.
An unsupervised learning approach by novel damage indices in structural health monitoring for damage localization and quantification
Authors: Entezami Alireza , Shariatmadar Hashem
Published: February 2017

The aim of this article is to propose novel damage indices for damage localization and quantification based on time series modeling. In order to extract damage-sensitive features from time series models, it is essential to choose adequate and robust orders in such a way that the models are able to extract uncorrelated residuals. On this basis, a new iterative order determination method is proposed to select robust orders of time series models under residual analysis by Ljung–Box Q-test. The damage-sensitive features are the parameters and residuals of an AutoRegressive (AR) model obtained from current feature extraction approaches. In this study, the AR model is identified as the most compatible time series model with measured vibration time-domain responses using Box–Jenkins methodology and Leybourne–McCabe hypothesis test. The proposed damage indices are the parametric assurance criterion and the residual reliability criterion that exploit the parameters and residuals of AR models, respectively. The main idea behind locating a damage is to define threshold limits for both damage indices using the features of undamaged conditions based on an unsupervised learning way. The major contributions of this article are to propose an iterative order determination method for time series models and two novel damage indices for locating and quantifying damage. The accuracy and performance of the proposed methods are experimentally demonstrated on a three-story laboratory frame and a model-scale steel structure. Results show that the proposed iterative approach leads to uncorrelated residuals, and the proposed parametric assurance criterion and the residual reliability criterion methods are promising and efficient tools in damage detection problems under varying operational and environmental conditions.
Using Citations to Measure Influence on the Supreme Court
Authors: Pryor Tom
Published: February 2017

I develop a new measure of interpersonal influence on the U.S. Supreme Court. Following Altfeld and Spaeth, I define influence as “the act of producing an effect on the behavior of another without the use of coercion, authority, or political control.” I propose a measure of influence based on the number of times a justice cites her colleagues’ concurring and dissenting opinions. My analysis proceeds in two stages. First, I verify that this citation-based measure is a valid method of gauging influence. From there, I use this measure to help explain justice behavior in two pivotal stages of the Supreme Court’s decision-making process: oral arguments and opinion assignments. The results demonstrate that a citation-based measure of influence can help explain and predict behavior on the Supreme Court.
Using Functional Behavioral Assessment to Develop a Multicomponent Treatment for Sleep Problems in a 3-Year-Old Boy With Autism
Authors: McLay Laurie , France Karyn , Blampied Neville , Danna Kate , Hunter Jolene
Published: February 2017

A large number of children with autism spectrum disorder (ASD) and their families are affected by sleep disturbance. Given the concomitant negative effects of sleep problems, it is essential to identify effective treatments. This case study exemplifies the use of Functional Behavioral Assessment (FBA) to develop treatments for sleep problems in a 3-year old boy with ASD. A function-based, multicomponent intervention resulted in the elimination of nighttime breastfeeding, a reduction in the frequency of curtain calls, and the frequency and duration of nighttime awakenings, although not all gains were maintained at follow-up. This case study highlights the importance of FBA in the assessment of sleep problems for each individual, and the need to develop treatments that address the unique function of sleep disturbance for each individual. Further research into the assessment and treatment of sleep problems in children with ASD is required.
Therapeutic Assessment With a Client With Persistent Complex Bereavement Disorder: A Single-Case Time-Series Design
Authors: Durosini Ilaria , Tarocchi Anna , Aschieri Filippo
Published: February 2017

This article presents the results of a study into the effectiveness of therapeutic assessment (TA), a brief form of intervention that incorporates the results of assessment findings into psychological treatment. The history of Anthony, a man who reported symptoms of persistent complex bereavement disorder (PCBD), associated with major depression disorder (MDD) and post-traumatic stress disorder (PTSD), is presented. After his parents’ deaths, Anthony became detached from reality, lost all pleasure in his everyday life, and found it impossible to overcome the devastating feelings related to the loss. Following TA principles, the assessor created a supportive and empathic relationship with Anthony and helped him attain his goals for the assessment. The assessment was monitored using a single-case quasi-experimental design with time-series analysis. Results of this study revealed a specific trajectory of Anthony’s self-reported symptoms and a statistically significant trend toward improvement in severity at the end of the TA. This case study highlights the utility and efficacy of TA in helping clients process traumatic losses and complicated bereavements.
Acceptance and Commitment Therapy-Specific Processes in the Psychotherapeutic Treatment of Obsessive Compulsive Disorder: A Single Case Study
Authors: Wheeler Claire Heather Boynton
Published: February 2017

This single case study describes acceptance and commitment therapy (ACT) with exposure and response prevention (ERP) used with a client presenting with symptoms of obsessive compulsive disorder (OCD). Standardized and idiographic outcome measures, including OCD-specific measures (Brief Yale-Brown Obsessive Compulsive Scale; Obsessional Compulsive Inventory), general measures of well-being and risk (CORE Outcome Measure; Outcome Rating Scale), an idiographic measure (Easy Personal Questionnaire), and a Sessional Rating Scale, were used across baseline and treatment phases. Statistical measures of reliable and clinical change were calculated, and client perspective on change was sought through interview. Cause–effect analysis was used to evaluate the extent to which therapeutic change was due to ACT-specific processes. Results showed reliable positive change with a probability of p < .05 across measures, and clinical change in three of five of the measures in which it could be calculated. The client reported improvements in well-being and the extent to which she lives her life according to her values. ACT-specific processes as well as generic therapy processes influenced change. The client’s own strengths and personal contributions to therapy played a major role in her achievement of therapeutic goals. The use of ACT with ERP in treating OCD and collaborative use of outcome measures with careful evaluation are recommended to clinicians.
A power storage station placement algorithm for power distribution based on electric vehicle
Authors: Xu Jianwen , Yi Ping , Wang Wei , Zhu Ting
Published: February 2017

Inspired by the concept of energy internet and energy problems including greenhouse gas emission and regional shortage, this article will propose an idea of electric power distribution using city bus lines running electric vehicles. The designed power distribution system includes renewable energy sources as the energy input, power storage stations placed at some bus stops as the fixed energy output, and bus lines running electric vehicles as the connections between them. As the basic and priority problem, choosing the suitable location to place power storage stations can not only reduce the total number of construction but also increase the utilization rate of each one. Main work involves the two branch algorithms for solving the placement problem; simulation while using real-world transportation data of two city bus maps and analysis about the advantages and disadvantages of algorithms.
Micro-Trivium: A lightweight algorithm designed for radio frequency identification systems
Authors: Zhang Shiyong , Chen Gongliang
Published: February 2017

Distributed sensor networks have been widely applied to healthcare, environmental monitoring and management, intelligent transportation, and other fields in which network sensors collect and transmit information about their surrounding environment. Radio frequency identification technology transmits an object’s identification as a unique serial number—using radio waves as the transmission carrier—and is becoming an important building block for distributed sensor networks. However, the security of radio frequency identification systems is a major industrial concern that can significantly hinder the market growth of distributed sensor networks. Trivium is a well-known lightweight synchronous stream cipher that was submitted to the European eSTREAM project in April 2005. In this article, we generalize Trivium to the Trivium-Model algorithm and highlight that security is mainly determined by the internal state bits and the number of nonlinear terms. We propose principles for choosing parameters and generating better parameters that are feasible for low-cost radio frequency identification tags in distributed sensor networks. The new algorithm, named Micro-Trivium, requires less power and a smaller chip area than the original Trivium, which is proven using experimental data and results. Mathematical analysis shows that using Micro-Trivium is as secure as using Trivium.
Life After Research Misconduct
Authors: Galbraith Kyle L.
Published: February 2017

Research misconduct is a serious violation of a scientific community’s ethical standards. Scientists who commit research misconduct typically face corrective actions from employers and funding agencies, as well as significant professional stigma. Unfortunately, there is little systematic data about the post-misconduct career of these guilty parties. Through a review of Office of Research Integrity (ORI) case summaries, I identified a pool of 284 researchers who engaged in research misconduct and were subject to ORI corrective actions. To assess the prevalence of post-misconduct research activities for these scientists, I searched publicly available databases and online resources for evidence of post-misconduct research activities (such as publications and federal research support). The data demonstrate that researchers often receive second chances as researchers, with indicators of post-misconduct research activities identified for 134 (47.18%) of the offending researchers. In addition, those researchers have received more than US$123 million in federal support for their post-misconduct research efforts.
European Universities’ Guidance on Research Integrity and Misconduct
Authors: Aubert Bonn Noémie , Godecharle Simon , Dierickx Kris
Published: February 2017

Research integrity is imperative to good science. Nonetheless, many countries and institutions develop their own integrity guidance, thereby risking incompatibilities with guidance of collaborating institutions. We retrieved guidance for academic integrity and misconduct of 18 universities from 10 European countries and investigated accessibility, general content, principles endorsed, and definitions of misconduct. Accessibility and content differ substantially between institutions. There are general trends of common principles of integrity and definitions of misconduct, yet differences remain. Parallel with previous research, we distinguish different approaches in integrity guidance; one emphasizes broad values of integrity, and the other details negative behaviors of misconduct. We propose that a balance between both approaches is necessary to preserve trust, meaning, and realism of guidance on research integrity.
Strain as a Function of Time in Extrinsic Wrist Ligaments Tensioned Through External Fixation
Authors: Rectenwald Joseph P. , Bentley K. Ashley , Murray Peter M. , Saha Subrata
Published: February 2017

Background: The objective of this study is to determine the time-dependent dissipation of extrinsic wrist ligament tension following the application external fixation with axial distraction of the wrist in a cadaveric model. Methods: Six paired fresh-frozen cadaveric specimens underwent mechanical testing simulating external fixation with 1 arm of each pair osteotomized to simulate a distal radius fracture. The change in tension was then recorded over 24 hours. Results: The rate of stress relaxation decreased with time. The average loss in tension in the control arms and osteotomized arms was 55% and 59%, respectively, over a 24-hour period. There was no statistically significant difference in the stress relaxation behavior between the 2 groups. Conclusion: This study further supports the recommendation that comminuted distal radius fractures treated with an external fixator should have Kirschner wire augmentation or other additional means of fixation to help maintain fracture length and alignment. The results of this study call in to question the efficacy of ligamentotaxis alone through external fixation as the sole means of maintaining reduction of displaced, unstable distal radius fractures.
Associations between having an informal caregiver, social support, and self-care among low-income adults with poorly controlled diabetes
Authors: Bouldin Erin D , Trivedi Ranak B , Reiber Gayle E , Rosland Ann-Marie , Silverman Julie B , Krieger James , Nelson Karin M
Published: February 2017

Objective

To determine whether the presence of an informal caregiver and the patient’s level of social support are associated with better diabetes self-care among adults with poorly controlled diabetes.

Methods

Cross-sectional study using baseline data from 253 adults of age 30–70 with poorly controlled diabetes. Participants who reported receiving assistance with their diabetes from a friend or family member in the past month were classified as having a caregiver. We used multivariate linear and logistic regression models to evaluate the associations between having a caregiver and level of social support with five self-reported diabetes self-care behaviors: diet, foot checks, blood glucose monitoring, medications, and physical activity.

Results

Compared to participants with no informal caregiver, those with an informal caregiver were significantly more likely to report moderate or high medication adherence (OR = 1.93, 95% CI: 1.07–3.49, p = 0.028). When we included social support in the model, having a caregiver was no longer significantly associated with medication adherence (OR = 1.50, 95% CI: 0.80–2.82), but social support score was (OR = 1.22, 95% CI: 1.03–1.45, p = 0.023).

Discussion

Among low-income adults with poorly controlled diabetes, having both an informal caregiver and high social support for diabetes may have a beneficial effect on medication adherence, a key self-care target to improve diabetes control.
Understanding uncertainty in young-onset Parkinson disease
Authors: Ravenek Michael , Rudman Debbie L , Jenkins Mary E , Spaulding Sandi
Published: February 2017

Objectives

Individuals living with young-onset Parkinson’s disease compose a rare subtype of a disease typically associated with older age. Situated within a large grounded theory study exploring information behavior, this paper describes the core category of the theory, i.e. uncertainty.

Methods

Data were collected with 39 individuals living with young-onset Parkinson’s disease who took part in in-depth interviews, focus groups and/or an online discussion board. Fourteen autobiographies written by individuals living with young-onset Parkinson’s disease were also used as data sources.

Results

Through experiencing young-onset Parkinson’s disease, participants were confronted with uncertainty along two main lines. First, they experienced uncertainty with respect to their identities as young- and middle-aged adults, deviating from the idealized age-graded life path marked out within their socio-cultural context. Second, they experienced uncertainty with respect to their functioning, as the heterogeneous nature of Parkinson’s progression meant that it would not be possible to chart how their disease would change over time. This uncertainty was associated with feelings of lost control over their lives and increased grief.

Discussion

With a deeper appreciation for how uncertainty is experienced in the lives of those with young-onset Parkinson’s disease, health professionals may be better prepared to discuss these issues with patients and provide support and resources.
Paediatric axillary artery pseudo-aneurysm after simple shoulder dislocation
Authors: Gowda Sush Ramakrishna , Hartley Richard , Allison Robert , Aarvold Alexander
Published: February 2017

We report the unique case of a 14-year-old male with axillary artery pseudo-aneurysm associated with brachial plexus compression after a simple shoulder dislocation. Following shoulder reduction under anaesthetic, the child was discharged on chemical deep vein thrombosis (DVT) prophylaxis. However, progressive shoulder swelling and upper limb neurological symptoms developed. A multi-disciplinary approach was taken to diagnose and treat this complication. After stopping the anti-coagulants, a combination of endovascular stent-graft and open surgical decompression of the brachial plexus was employed. Paediatric guidelines on DVT prophylaxis are scarce but DVT has never been reported in children following upper limb trauma.
Cement Casting to Optimize Reconstruction of Chronic Osteochondral Lesions of the Talus
Authors: Pulgar Jorge , Escudero Mario , Carcuro Giovanni , Schiff Adam , Pellegrini Manuel
Published: February 2017

Few surgical techniques have been described for reconstruction in massive osteochondral lesions of the talus, and there is limited evidence of techniques for accurately reproducing native talar anatomy with bone auto/allograft techniques. In this article, we present a novel technique, which is highly reproducible, using bone cement to restore the congruence and anatomy of the ankle joint.

Levels of Evidence: Level V: Technical tip
CT venography after knee replacement surgery: comparison of dual-energy CT-based monochromatic imaging and single-energy metal artifact reduction techniques on a 320-row CT scanner
Authors: Kidoh Masafumi , Utsunomiya Daisuke , Oda Seitaro , Nakaura Takeshi , Funama Yoshinori , Yuki Hideaki , Hirata Kenichiro , Hatemura Masahiro , Namimoto Tomohiro , Yamashita Yasuyuki
Published: February 2017

Background

An optimal metal artifact reduction (MAR) technique is needed for a reliable and accurate image-based diagnosis.

Purpose

Using a 320-row scanner, we compared the dual-energy computed tomography (CT)-based monochromatic and the single-energy metal artifact reduction (SEMAR) techniques for CT venography (CTV) to identify the better imaging method for diagnosing deep vein thrombosis (DVT) in patients who had undergone knee replacement surgery.

Material and Methods

Twenty-three consecutive patients with suspected DVT after unilateral knee replacement surgery underwent dual-energy CT (135/80 kVp). Monochromatic images of 35–135 keV were generated; the monochromatic image with the best signal-to-noise ratio (SNR) of the popliteal vein near the metal prosthesis were selected. The projection data of 80 kVp were reconstructed using MAR algorithm. The mean SNR ON MAR and the best SNR ON monochromatic images were compared. Two radiologists evaluated visualization of the metal artifacts on a four-point scale where 1 = extensive artifacts, 2 = strong artifacts, 3 = mild artifacts, and 4 = minimal artifacts.

Results

The mean SNR was significantly higher on the MAR than the monochromatic images (12.8 ± 4.7 versus 7.7 ± 5.1, P < 0.01) and the visual scores were significantly higher for MAR than monochromatic images (2.6 ± 0.8 versus 1.3 ± 0.4, P < 0.01).

Conclusion

For CTV after knee replacement surgery, the MAR technique is superior to the monochromatic imaging technique.
Relations between quantitative ultrasound assessment of calcaneus and grip and key pinch power in Japanese mountain village residents
Authors: Nagai Ayako , Tajika Tsuyoshi , Yamamoto Atsushi , Okura Chisa , Kanazawa Saeko , Takagishi Kenji
Published: February 2017

Purpose:

It seems to be important to recognize bone health condition using a simple method in Japanese super-aged society. The aim of our study was to investigate whether grip and key pinch strength were associated with bone quality.

Methods:

Medical examinations were conducted of 337 adult residents (123 men, 214 women; average age of 64.7 years) of a mountain village. Bilateral grip and key pinch strength were measured. The sound of speed (SOS) of calcaneus was assessed using an ultrasound bone densitometer. Study participants were divided into non-osteoporotic and osteoporotic groups according to the relevant WHO classification to evaluate statistical significance by age-adjusted analysis. Stepwise linear regression was used to identify the predictor of SOS using the following factors as explanatory variables: age, height, weight BMI, grip and key pinch power strength in bilateral side. A P value of < .05 was regarded as statistically significant.

Results:

In age-adjusted analysis, significant associations were found between osteoporosis and BMI (OR 0.87, 95%CI 0.80–0.95), gender (OR 3.21, 95%CI 1.83–5.62), grip strength (right side:, OR 0.95, 95%CI 0.92–0.98; left side: OR 0.95, 95% CI 0.92–0.98) and key pinch strength (right side: OR 0.76, 95%CI 0.65–0.88; left side: OR 0.79, 95%CI 0.68–0.91). In stepwise linear regression, age and left key pinch strength were predictors of calcaneal SOS (age β coefficient = −0.46, P = .00; left key pinch strength β coefficient = 0.17, P = .0049).

Conclusions:

Key pinch strength assessment might be useful to predict calcaneal SOS in general population.
Bilateral Erosion of Malar Implants Into the Maxillary Sinuses
Authors: Dale Elizabeth L , Sargent Larry A
Published: February 2017

Augmentation malarplasty is a cosmetic procedure rarely associated with complications; however, some reported complications are severe. The authors describe a case of missed diagnosis in a patient with chronic sinusitis secondary to erosion of malar implants into the maxillary sinuses. A review of the literature demonstrates that all severe complications of implant-based malar augmentation involve bone erosion and occur many years after initial placement. Silicone implants may have a higher risk for bone erosion and severe complications; however, it is not clear whether this risk is only associated with implants that have not been adequately fixed to the underlying bone. Surgeons should ensure that implants will not move from their original location, and screw fixation is the most reliable method for this purpose. Patients undergoing augmentation malarplasty should be informed of this potential complication so that lengthy workups and unnecessary treatments can be avoided.
Free Flap Failure Associated with Heparin-Induced Thrombocytopenia: Is It Preventable?
Authors: Aldekhayel Salah , Retrouvey Helene , Izadpanah Ali , Zadeh Teanoosh
Published: February 2017

Heparin-induced thrombocytopenia (HIT) is a serious adverse effect of unfractionated heparin, particularly in the setting of microsurgery, with a reported salvage rate of <25% of free flaps. HIT presenting as venous thromboembolisms (VTEs) can be a more challenging problem to the reconstructive surgeon. The hematology literature reports a prevalence of HIT as high as 12% among patients presenting with VTEs. Complications associated with HIT are preventable if a high index of suspicion is maintained and proper treatment is implemented. A 68-year-old man with VTEs who failed a parascapular fasciocutaneous flap to the forearm secondary to undiagnosed HIT is reported. The authors propose an algorithm to approach such a dilemma and implement adequate treatment measures before commencing any microsurgical procedures in patients to minimize any untoward consequences.
A Unique Case of Bilateral High Ulnar Nerve Laceration
Authors: Robb Jessica , Jassal Rajive , Mehling Blair , Morhart Michael J
Published: February 2017

High ulnar nerve injuries are now commonly treated with a distal nerve transfer, in which the anterior interosseuos nerve to pronator quadratus is coapted to the deep ulnar nerve motor branch. Herein, the authors describe a case of bilateral ulnar nerve laceration that provides an opportunity to directly compare two operative techniques on different extremities of the same patient.

The patient sustained bilateral ulnar nerve injuries 6 cm superior to the medial epicondyle. The right ulnar nerve was proximally repaired with primary neurorraphy and a distal motor nerve transfer. The left ulnar nerve underwent primary nuerorraphy without a nerve transfer because the median nerve was mistakenly tied off to control bleeding.

Physical examination and nerve conduction studies two years postsurgical intervention demonstrated an undeniable difference in cosmesis and function. The clinical findings suggest a superior result with a combined primary neurorraphy and a distal nerve transfer compared with a primary neurorraphy alone.
Novel Approach to Intractable Pectoralis Major Muscle Spasms Following Submuscular Expanderimplant Breast Reconstruction
Authors: Govshievich Alexander , Kirkham Kyle , Brull Richard , Brown Mitchell H
Published: February 2017

Implant-based breast reconstruction is the most commonly used reconstructive modality following mastectomy. Placement of the tissue expander and implant under the pectoralis major muscle is believed to minimize the incidence of capsular contracture, provide adequate soft tissue coverage, and minimize implant visibility and palpability. However, utilization of the submuscular pocket can be associated with discomfort, which may originate from stretching of the cutaneous envelope, distension of the underlying muscle or, rarely, from spasms of the pectoralis major muscle. A case of intractable and involuntary pectoralis major spasms following submuscular implant-based breast reconstruction is presented. An ultrasound-guided pectoral intrafascial plane block is shown to be an effective diagnostic modality, implicating the medial and lateral pectoral nerves in these spasms. The clinical anatomy literature pertaining to the course and branches of the medial and lateral pectoral nerves is reviewed.
Acutely Reconstructed Isolated Supraclavicular Brachial Plexus Injury Caused By a Chainsaw
Authors: Kaiser Radek , Ullas Gautham
Published: February 2017

Lacerations to the brachial plexus are rare. The author describes a case involving a man who sustained a chainsaw wound to the neck with isolated injury to the proximal part of the upper trunk of the brachial plexus. The patient underwent acute surgical exploration. After resection of the lacerated ends of the nerve stumps, four nerve grafts from the sural nerve were used for the reconstruction. Reinnervation was successful and the patient was able to abduct his arm (Medical Research Council 5 of 5) and flex his elbow (Medical Research Council 4 of 5) to its full range, within 24 months.
Immediate Thumb Opposition Following Extensor Indicis Proprius Opponensplasty Using the Wide-Awake Approach
Authors: Moriya Koji , Yoshizu Takae , Maki Yutaka
Published: February 2017

Background:

The wide-awake approach enables surgeons to adjust tendon transfer tension during active movement.

Objective:

To examine the proximity of the index finger to the thumb in the motor network of the brain during extensor indicis proprius (EIP) opponensplasty, performed under local anesthesia, for restoration of thumb opposition in patients with thenar paralysis caused by advanced carpal tunnel syndrome.

Methods:

Between April 2009 and October 2013, seven patients underwent wide-awake opponensplasty of the EIP in conjunction with carpal tunnel release. Under local anesthesia (lidocaine with epinephrine), the EIP tendon was routed subcutaneously, around the distal ulna and across the palm to the abductor pollicis brevis tendon.

Results:

Immediately after severing the EIP tendon over the metacarpophalangeal joint of the index finger, patients exhibited varying degrees of retraction of the proximal end of the EIP tendon into the dorsal subcutaneous space when asked to perform thumb opposition while maintaining active flexion of the index finger. All patients were able to perform palmar abduction of the thumb via the EIP following opponensplasty.

Discussion:

The intraoperative data suggest that single, individuated movements of the thumb opposition activate both the thenar muscle and the EIP. Additionally, these phenomena may be explained by activation of a pre-existing neural network, and overlap between the thumb and index finger in the motor cortex.

Conclusion:

Achievement of immediate thumb opposition without re-education suggests that the index finger and thumb are in close proximity in the motor network of the brain.
Retroperitoneal Femoral Nerve Reconstruction in the Pediatric Population
Authors: Kattan AE , Tsoi K , Stubenitsky Bm , Curtis CG , Gerstle JT , Clarke HM
Published: February 2017

BACKGROUND:

Retroperitoneal femoral nerve lesions in children are rare. They can result in a complete femoral nerve palsy causing severe functional impairment of ambulation and standing and sensory impairment of the anterior and medial thigh extending down the medial aspect of the leg. While treatment can be challenging due to the complex anatomy of the region and the difficulty of achieving adequate surgical access, femoral nerve repair has lead to the recovery of useful function in adult patients.

OBJECTIVE:

The authors review their experience from the surgical treatment of three consecutive cases of this rare lesion in children while focusing on validated outcome measures.

METHODS:

A retrospective chart review of all cases of retroperitoneal femoral nerve transection treated surgically was completed (n=3). Data collected included demographics, timing of repair, surgical approach, Medical Research Council muscle grading scores, the Hospital for Sick Children Active Movement Scale scores and follow-up period.

RESULTS:

Follow-up ranged from two to 4.5 years. All three patients had excellent motor recovery and ambulated without assistance. Sensory function also improved, with a substantial resolution of preoperative dysesthesia in one case. There were no major complications.

CONCLUSIONS:

Complete retroperitoneal femoral nerve transection in children is a rare but devastating injury. Appropriate surgical access to the retroperitoneal space is a prerequisite for lumbar plexus reconstruction and mandates a team approach. In the present series, all patients regained excellent function following reconstruction. The surgical treatment of these unusual lesions in childhood proved highly rewarding.
The Use of Free Tissue Transfer with An Anterolateral Thigh Flap for the Treatment of Large Keloids On the Head and Neck
Authors: Slyke Aaron C Van , Carr Nicholas , Hodges Andrew
Published: February 2017

Keloids are cosmetically, psychologically and functionally debilitating wounds that have proven difficult to treat with surgical excision alone. Large keloids are particularly challenging to treat because many of the current therapies for keloids are unsuitable, and the remaining defect after excision is difficult to close. The authors report a case involving a large disfiguring keloid on the head and neck, which was treated with surgical excision and immediate reconstruction with a free anterolateral thigh fasciocutaneous flap. No further adjuvant therapy was undertaken. At one-year follow-up, there was no recurrence at the recipient site, and the donor site healed without deformity. The free fasciocutaneous anterolateral thigh flap may be effective at treating large keloids in the head and neck region; however, well-controlled clinical studies are needed to establish this.
Resolving phase wrapping by using sliding transform for generation of dispersion curves
Authors: Kumar Jyant , Naskar Tarun
Published: February 2017

The complexity involved with the phase unwrapping procedure, while performing the existing spectral analysis of surface waves (SASW) on the basis of two sensors, makes it difficult to automate and requires frequent manual judgment. As a result, this approach generally becomes tedious and may yield erroneous results. The multichannel analysis of surface waves (MASW) technique can resolve the problem of phase wrapping. However, the MASW technique normally requires a large number of closely spaced sensors, typically 24–48 or even more. We have developed a new method that is fast, accurate, and generally resolves the unwrapping of phase with the use of just two sensors, provided the signal-to-noise ratio remains high. In this approach, the unwrapping of the phase can be performed without any manual intervention and an automation of the process becomes feasible. A few examples, involving synthetic test data and surface-wave tests, have been tested to determine the efficacy of our approach. Comparisons of the results have been made with the corresponding solutions using existing SASW and MASW techniques.
Decoding sill emplacement and forced fold growth in the Exmouth Sub-basin, offshore northwest Australia: Implications for hydrocarbon exploration
Authors: Magee Craig , Jackson Christopher A.-L. , Hardman Jonathon P. , Reeve Matthew T.
Published: February 2017

Igneous sills emplaced at shallow levels in sedimentary basins commonly uplift the overburden and free surface. Uplift produces dome-shaped forced folds that may host economic hydrocarbon accumulations. These intrusion-induced forced folds are typically assumed to develop instantaneously, whereby the oldest onlapping strata constrain the age of sill emplacement, and accommodate the entire volume of intruded magma. However, several studies demonstrate that forced folds may grow over geologic timescales, with additional space-making mechanisms (e.g., compaction) partly accommodating the magma volume. It is thus critical to understand when forced fold traps form and how they evolve in relation to the timing of source rock maturation and migration. We analyze two forced folds imaged in 2D seismic reflection data from offshore northwest Australia. Analyzing the seismic stratigraphy of the forced fold overburden allows us to recognize several distinct phases of fold growth. Subhorizontal reflections onlapping onto the lower portion of the forced folds at a high angle indicate that the first phase of sill emplacement and fold development occurred rapidly, facilitated by normal faulting, prior to the deposition of overlying strata during a period of magmatic quiescence and regional hydrocarbon maturation in the Early Cretaceous. Renewed magmatic activity resulted in a final, protracted phase of doming, which is recorded by a package of onlapping growth strata that was incrementally deformed by successive intrusive pulses. We also demonstrate that in addition to folding and faulting, the magma volume was likely accommodated by porosity reduction within the folded strata. Our observations imply that the age of the lowermost onlapping reflections only constrain the onset of sill emplacement and not the duration of magmatic activity. Constraining the dynamic evolution of intrusion-induced forced folds from the structure of onlapping reflections during hydrocarbon exploration can thus provide critical insights into the potential volume and charge history of any hydrocarbon accumulations.
Response-History Analysis for the Design of New Buildings in the NEHRP Provisions and ASCE/SEI 7 Standard: Part IV - A Study of Assumptions
Authors: Jarrett Jordan A. , Zimmerman Reid B. , Charney Finley A. , Jalalian Afshar
Published: February 2017

The accuracy of several assumptions made when developing the methodology for nonlinear response history analysis of Chapter 16 of ASCE/SEI 7 is investigated. The major findings of this work include: (1) Modeling the gravity system's lateral influence can have a significant effect on system behavior, but it is generally conservative to neglect its contribution. (2) Exclusion of a residual drift check is acceptable when collapse prevention is the primary objective. (3) Spectrally matched ground motions should cautiously be used for near-field sites. (4) The effects of nonlinear accidental torsion can be influential, and should be considered for the analysis of torsionally irregular buildings. (5) When analyzed using FEMA P-695, a structure designed per ASCE/SEI 7 Chapter 16 may have a probability of collapse that is different than the target value associated with the system's risk category.
Osimertinib in Pretreated T790M-Positive Advanced Non–Small-Cell Lung Cancer: AURA Study Phase II Extension Component
Authors: Yang James Chih-Hsin , Ahn Myung-Ju , Kim Dong-Wan , Ramalingam Suresh S. , Sequist Lecia V. , Su Wu-Chou , Kim Sang-We , Kim Joo-Hang , Planchard David , Felip Enriqueta , Blackhall Fiona , Haggstrom Daniel , Yoh Kiyotaka , Novello Silvia , Gold Kathryn , Hirashima Tomonori , Lin Chia-Chi , Mann Helen , Cantarini Mireille , Ghiorghiu Serban , Jänne Pasi A.
Published: February 2017

Purpose

Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) selective for both EGFR-TKI sensitizing ( EGFRm) and T790M resistance mutations. AURA (NCT01802632) is a phase I/II clinical trial to determine the dose, safety, and efficacy of osimertinib. This article reports the results from the phase II extension component.

Patients and Methods

Patients with EGFR-TKI–pretreated EGFRm- and T790M-positive advanced non–small-cell lung cancer (NSCLC) received once-daily osimertinib 80 mg. T790M status was confirmed by central testing from a tumor sample taken after the most recent disease progression. Patients with asymptomatic, stable CNS metastases that did not require corticosteroids were allowed to enroll. The primary end point was objective response rate (ORR) by independent radiology assessment. Secondary end points were disease control rate, duration of response, progression-free survival (PFS), and safety. Patient-reported outcomes comprised an exploratory objective.

Results

In total, 201 patients received treatment, with a median treatment duration of 13.2 months at the time of data cutoff (November 1, 2015). In evaluable patients (n = 198), ORR was 62% (95% CI, 54% to 68%), and the disease control rate was 90% (95% CI, 85 to 94). Median duration of response in 122 responding patients was 15.2 months (95% CI, 11.3 to not calculable). Median PFS was 12.3 months (95% CI, 9.5 to 13.8). The most common possibly causally related adverse events (investigator assessed) were diarrhea (43%; grade ≥ 3, < 1%) and rash (grouped terms; 40%; grade ≥ 3, < 1%). Interstitial lung disease (grouped terms) was reported in eight patients (4%; grade 1, n = 2; grade 3, n = 3; grade 5, n = 3).

Conclusion

In patients with EGFRm T790M advanced NSCLC who progress after EGFR-TKI treatment, osimertinib provides a high ORR, encouraging PFS, and durable response.