bluuebunny/crossref_metadata_2025 huggingface dataset:
It shouldn’t be this hard: Systemic, situational, and intrapersonal barriers to exiting homelessness among homeless young adults
Authors: Sample Katie , Ferguson Kristin M
Published: April 2019

The purpose of this qualitative study was to explore homeless young adults’ perceptions of the systemic, situational, and intrapersonal barriers they encounter across multiple systems in trying to exit homelessness and the ways these barriers are interrelated. Thirty-one homeless young adults (ages 18–26) in Phoenix and Tempe, Arizona were recruited for in-depth interviews from two resource centers serving homeless youth. Template analysis was used to systematically analyze and code participants’ verbatim transcripts from the interviews into a template (codebook). Characteristic quotes from the interviews are used to illustrate the emergent themes. Findings indicate that structural barriers faced by homeless youth include inadequate homeless resources, employment challenges, discrimination by law enforcement, hot climate, lack of transportation, and legal concerns. Situational barriers include interpersonal relationships, the street environment, and lack of personal resources. Intrapersonal barriers include behavioral, mental, and physical health challenges, reluctance to reach out for help, money management, and lack of desire for stable housing. Participants also outlined multiple ways in which these barriers interact to hinder their exiting homelessness. Findings support current literature applying ecological theory to the issue of homelessness while highlighting young people’s own contextual descriptions of their lived experiences. Three approaches are recommended for improving homeless services with integrated housing, employment, and clinical interventions to help young adults successfully exit homeless.
A snapshot of cyber supervision in Mainland China
Authors: Mo Yuen Han , O’ Donoghue Kieran
Published: April 2019

This article presents a qualitative study that explores the use of technology in distance supervision by social work supervisors in Mainland China. From the interviews with 24 participants, four themes emerged concerning the participants’ supervision needs, supervision context, supervision ethics, and supervision skills. Overall, the participants’ experiences and views are given in detail: (1) the development of cyber supervision in Mainland China; (2) the contribution this new supervision method makes to ever-increasing supervisory demands; (3) the supervisory knowledge and skills required for successful cyber supervision, and (4) the government’s influence on the development and promotion of cyber supervision. The themes and views of the participants contribute to the development of the “4S” model for cyber supervision in Mainland China.
The Effect of Blocked Versus Serial Practice in the Treatment of Developmental Motor-Based Articulation Disorder
Authors: Geertsema Salomé , le Roux Mia
Published: April 2019

The application of specific motor learning principles (MLPs) in treatment for developmental motor-based articulation disorder in children has not been reported to date. The aims were to determine treatment effects of a novel hybrid intervention approach for a single participant with motor-based articulation disorder, and to examine the role of specific MLP, namely blocked versus serial practice schedules, in performance, generalization, and maintenance of speech skills. Results suggested that the novel hybrid treatment approach produced measurable gains in most instances. However, there were no systematic differences between the different practice schedules. Possible reasons for these specific treatment and generalization effects were explored.
Activated carbon powder derived from cashmere guard hair
Authors: Zou Zhuanyong , Liu Xin , Ding Jiahui , Chen Tanqi , Wang Xungai
Published: April 2019

Converting waste fiber to high value-added carbonaceous materials has been considered as an effective and affordable route in response to the increasing volume of waste fiber in recent year. In this study, we are the first to prepare activated carbon powder derived from cashmere guard hair as a renewable waste protein fiber, using a chemical activation method at different impregnation ratios of K2CO3/cashmere guard hair char and activation temperatures ranging from 400℃ to 600℃. Characterization of the activated carbon powder was carried out by morphology study, specific surface area study, and adsorption study. Results have shown that the increase of the impregnation ratio and the activation temperature created more microporous structure in the activated carbon powder, and then increased the specific surface area of the activated carbon powder as well as the amount of methylene blue adsorbed. However, the carbon yield increases with the increase in the impregnation ratio of K2CO3/cashmere guard hair char and decreases with the increase in the activation temperature. The activated carbon powder, activated by the condition of 1:2 K2CO3/cashmere guard hair char impregnation ratio and 600℃ activation temperature, has a specific surface area of 764.86 m2g−1 and a carbon yield of 14.07 wt%. Compared to the activated carbon powder derived from fine merino wool fibers, the activated carbon powder derived from cashmere guard hair has higher carbon yield, surface area, and total pore volume, showing a superior adsorption performance.
Multiplexed Single-Cell Measurements of FDG Uptake and Lactate Release Using Droplet Microfluidics
Authors: Sengupta Debanti , Mongersun Amy , Kim Tae Jin , Mongersun Kellen , von Eyben Rie , Abbyad Paul , Pratx Guillem
Published: April 2019

Introduction:

Glucose utilization and lactate release are 2 important indicators of cancer metabolism. Most tumors consume glucose and release lactate at a higher rate than normal tissues due to enhanced aerobic glycolysis. However, these 2 indicators of metabolism have not previously been studied on a single-cell level, in the same cell.

Objective:

To develop and characterize a novel droplet microfluidic device for multiplexed measurements of glucose uptake (via its analog 18F-fluorodeoxyglucose) and lactate release, in single live cells encapsulated in an array of water-in-oil droplets.

Results:

Surprisingly, 18F-fluorodeoxyglucose uptake and lactate release were only marginally correlated at the single-cell level, even when assayed in a standard cell line (MDA-MB-231). While 18F-fluorodeoxyglucose-avid cells released substantial amounts of lactate, the reverse was not true, and many cells released high amounts of lactate without taking up 18F-fluorodeoxyglucose.

Discussion:

These results confirm that cancer cells rely on multiple metabolic pathways in addition to aerobic glycolysis and that the use of these pathways is highly heterogeneous, even under controlled culture conditions. Clinically, the large cell-to-cell variability suggests that positron emission tomography measurements of 18F-fluorodeoxyglucose uptake represent metabolic flux only in an aggregate sense, not for individual cancer cells within the tumor.
Swift Cure of a Chronic Wound Infected With Multiresistant Staphylococcus aureus in an Elderly Patient With Stage 5 Renal Disease
Authors: Kyriakopoulos Anthony M. , Grapsa Eirini , Marcinkiewicz Janusz , Nagl Markus
Published: April 2019

We present a case of a 91-year-old female with stage 5 renal disease, diabetes type 2, and considerable weakness, suffering from a 2-month-old wound infected by a multiresistant Staphylococcus aureus. The wound measured 7 cm in length, 5 cm in width, and 1.5 cm in depth, having purulent white edges and exudates exceeding the size of the wound. The systemic antibiotic use was opposing to improve the patient’s clinical condition due to underlying nephrotoxicity that may have deteriorated renal failure and resistance of the infecting pathogen. The halogenated taurine (Tau) derivatives N-chlorotaurine (NCT) and N-bromotaurine (NBrT) with potent anti-inflammatory and antimicrobial efficacy were alternatively employed as combination topical treatment to provide a therapeutic solution. Each agent was applied separately with an interval of 5 minutes as a 1% spray in aqueous solution every 30 minutes during the day for 3 days. This treatment was very well tolerated and led to rapid disappearance of the purulent exudate, rapid epithelialization, and complete healing. To avoid relapse, the application was continued 4 times daily for a further 4 days. No complications occurred in the course of treatment. This case report confirms the therapeutic efficacy of NCT in chronic purulent wounds. NBrT is well tolerated, too, and can be used in combination with NCT in emergency clinical settings. Its potential as a single agent should be investigated in further studies. Advancement of wound closure by these agents proved to be life-saving for this patient. Further molecular research is needed to identify mechanisms that promote wound healing.
Narratives of democracy: A call for historical studies
Authors: Müller Tim B , Nevers Jeppe
Published: April 2019

Historians have long been aware of the power of narratives; but they have been hesitant to analyse the production of national narratives of democracy, in which their own profession played an important role. This issue and introduction aims to insert and study the role of narratives in the history of democracy. It builds on the growing literature in both the conceptual and political history of democracy, which has stressed the importance of the late 19th century and the first half of the 20th century in the coming of modern democracy, albeit in non-linear and highly contested ways and often in contrast to the retrospective teleology at work in most older histories of democracy. Therefore, from the 19th century onwards, languages and narratives of democracy developed in many countries, but it happened at different times, at different speeds, and in different forms. This issue encourages and exemplifies systematic and comparative historical analysis of how narratives of democracy were created in that context: What national narratives of democracy did, in fact, exist in specific periods and contexts? Where have these narratives come from? How were nations ‘narrated’ as democratic, what purposes did different narratives serve, and how did they change over time?
Woe of Tale? The emergence, vicissitudes and (over-) efficiency of the Swiss narrative of democracy
Authors: Herrmann Irene
Published: April 2019

The Swiss narrative of democracy is a well-known and well-studied topic. Not only is it still used by current—mostly populist and xenophobic—political actors, but it has been explored by at least two generations of historians who have tracked its development before the French Revolution and, to a lesser extent, during the 19th century, a period during which Swiss democracy was undergoing dramatic changes. This literature shows that this narrative was first an account of Swiss liberty before focusing on democracy per se. It also demonstrates that the democracy it depicts has very little to do with its medieval counterpart. However, historians mostly overlook a crucial element, which is highlighted in this volume, as they fail to truly analyse the use of the narrative form—and the consequences of its use, per se. By focusing first on the emergence of this narrative and then by thoroughly exploring its development during the post-revolutionary period, along with the evolution of democracy itself, this article seeks to prove the importance of the narrative (form) for the evolution of Swiss modern democracy—even today.
Doubtful democrats: Democracy in Britain since 1800
Authors: Saunders Robert
Published: April 2019

Over the ‘long’ 19th century, British politics underwent a quiet revolution: a revolution, not in its governing institutions, but in the ideas that underpinned them. In little more than a century, the idea of ‘democracy’—once a term of abuse, from which even radical politicians sought to disassociate themselves—established itself as the civic religion of British politics: the one authority against which there could be no court of appeal. Like other religions, democracy spawned a variety of sects and denominations, each of which sought to defend it against false democratic creeds: ranging from ‘social democracy’ and ‘industrial democracy’ to ‘Tory democracy’, ‘the property-owning democracy’, and ‘the democracy of the market’. The result, paradoxically, was to establish democracy both as the universal principle of British politics and as its central battlefield: an idea to which all paid tribute, but which seemed permanently under siege. This article explores the peculiar voyage of British democratic thought over the 19th and 20th centuries, focusing on its usage as an instrument of political warfare. The first section charts its emergence as the most potent challenge to the dominant narratives of the early-19th century: Whig constitutionalism and ‘reform’. A second section then charts the absorption of democracy into the core narratives of British political thought, while exploring the very different ends to which its authority could be put. A final section identifies three narrative battlegrounds for democracy in the 19th century, opening up fault lines that continue to structure British politics in the present.
Narrating democracy in interwar Yugoslavia: From state creation to its collapse
Authors: Falina Maria
Published: April 2019

This article examines the narratives of democracy in interwar Yugoslavia. It starts with the premise that the commitment to democracy in the immediate post-war period was deep and sincere as it was seen as an answer to domestic and international political challenges. The article focuses on how democracy was understood and narrated, and maintains that virtually every political actor engaged with the idea and/or practice of democracy, thereby making it a subject of an important debate. Thus, democracy was at the time as significant a concept and theme as was nationalism, which usually receives more attention in historical analysis. Such issues as national self-determination, the establishment of the state, and the symbolic place of Yugoslavia among well-established European nations impacted the way democracy was debated. At the same time, local political actors used claims to possess better expertise in democracy to back up specific ideological and national projects. Finally, socio-economic issues emerged in the later half of the period to complement the national considerations. A significant difference in the narratives of democracy as understood primarily in political terms and the narrative of democracy that emphasizes its social and economic dimension emerged towards the late 1930s.
Denmark during the First World War: Neutral policy, economy and culture
Authors: Gram-Skjoldager Karen
Published: April 2019

When war broke out in the summer of 1914, the Danish government responded by declaring the country neutral. This decision marked the beginning of a particular neutral Danish war experience. This article analyses how Danish politics and society were affected by and responded to the war. It explores four themes in particular: the relationship between neutrality, trade and economic warfare; internationalist and humanitarian practices; political and redistributive responses to the war and the particular ‘neutral’ cultural processing of the war in Denmark. It argues that while the material and human consequences of the war were negligent compared to those experienced by belligerent societies, the war did have substantial effect on the Danish state and society, creating new diplomatic and political practices, reshaping economic relations and shifting domestic power balances.
Weaponized iconoclasm in Internet memes featuring the expression ‘Fake News’
Authors: Smith Christopher A
Published: April 2019

The expression ‘Fake News’ inside Internet memes engenders significant online virulence, possibly heralding an iconoclastic emergence of weaponized propaganda for assaulting agencies reared on public trust. Internet memes are multimodal artifacts featuring ideological singularities designed for ‘flash’ consumption, often composed by numerous voices echoing popular, online culture. This study proposes that ‘Fake News’ Internet memes are weaponized iconoclastic multimodal propaganda (WIMP) discourse and attempts to delineate them as such by asking: What power relations and ideologies do Internet memes featuring the expression ‘fake news’ harbor? How might those manifestations qualify as WIMP discourse? A multimodal critical discourse analysis of a small pool of ‘fake news’ Internet memes drawn from four popular social media websites revealed what agencies were often targeted and from what political canons they likely emerged. Findings indicate that many Internet memes featuring ‘fake news’ are specifically directed, revealing an underlying hazard that WIMP discourse could diminish democratic processes while influencing online trajectories of public discourse.
Tissue Response to Subcutaneous Infusion Catheter
Authors: Zhang Ershuai , Cao Zhiqiang
Published: April 2019

Insulin infusion pump, continuous glucose monitoring (CGM), and insulin infusion set (IIS) have been developed to be increasingly feasible for people with type 1 diabetes (T1D). Several recently approved CGMs are transitioning from 7-day to 10-day wear time without the need for fingerprick recalibration. Nevertheless, studies and improvements on IIS, a critical part of insulin pump therapy, have been limited. In particular, the recommended wear time of IIS is still 2-3 days, which can hardly match the current duration of CGM for potential closed-loop system development. It is generally believed that both the inserted catheter and the subsequent infused insulin drug could induce particular subcutaneous tissue response and skin-related complications at the infusion site. In certain cases, poor glycaemic control, increased risk of hypoglycemia, and serious cosmetic impact on people with diabetes were observed. Skin complication has also been attributed as an important factor resulting users to discontinue insulin pump therapy. This article provides the rare systematic review of IIS induced subcutaneous tissue responses and skin complications, including the impacts from the inserted catheters, the subcutaneous infused insulin, and the adhesive or tape used to immobilize the catheter. The FDA’s recommendation for the frequency of IIS change was further discussed. Future studies on this topic are required to further understand the IIS-related problems, and future strategies could be developed accordingly to significantly reduce the incidence of these problems, extend the wear time, and increase the acceptance of insulin pump based therapy.
Evaluating Glucose Control With a Novel Composite Continuous Glucose Monitoring Index
Authors: Leelarathna Lalantha , Thabit Hood , Wilinska Malgorzata E. , Bally Lia , Mader Julia K. , Pieber Thomas R. , Benesch Carsten , Arnolds Sabine , Johnson Terri , Heinemann Lutz , Hermanns Norbert , Evans Mark L. , Hovorka Roman
Published: April 2019

Objective:

The objective was to describe a novel composite continuous glucose monitoring index (COGI) and to evaluate its utility, in adults with type 1 diabetes, during hybrid closed-loop (HCL) therapy and multiple daily injections (MDI) therapy combined with real-time continuous glucose monitoring (CGM).

Methods:

COGI consists of three key components of glucose control as assessed by CGM: Time in range (TIR), time below range (TBR), and glucose variability (GV) (weighted by 50%, 35% and 15%). COGI ranges from 0 to 100, where 1% increase of time <3.9 mmol/L (<70 mg/dl) is equivalent to 4.7% reduction of TIR between 3.9-10 mmol/L (70-180 mg/dl), and 0.5 mmol/L (9 mg/dl) increase in standard deviation is equivalent to 3% reduction in TIR.

Results:

Continuous subcutaneous insulin infusion (CSII) users with HbA1c >7.5-10%, had significantly higher COGI during 12 weeks of HCL compared to sensor-augmented pump therapy, mean (SD), 60.3 (8.6) versus 69.5 (6.9), P < .001. Similarly, in CSII users with HbA1c <7.5%, HCL improved COGI from 59.9 (11.2) to 74.8 (6.6), P < .001. In MDI users with HbA1c >7.5% to 9.9%, use of real-time CGM led to improved COGI, 49.8 (14.2) versus 58.2 (9.1), P < .0001. In MDI users with impaired awareness of hypoglycemia, use of real-time CGM led to improved COGI, 53.4 (12.2) versus 66.7 (11.1), P < .001.

Conclusions:

COGI summarizes three key aspects of CGM data into a concise metric that could be utilized to evaluate the quality of glucose control and to demonstrate the incremental benefit of a wide range of treatment modalities.
Simple Linear Support Vector Machine Classifier Can Distinguish Impaired Glucose Tolerance Versus Type 2 Diabetes Using a Reduced Set of CGM-Based Glycemic Variability Indices
Authors: Longato Enrico , Acciaroli Giada , Facchinetti Andrea , Maran Alberto , Sparacino Giovanni
Published: April 2019

Background:

Many glycemic variability (GV) indices exist in the literature. In previous works, we demonstrated that a set of GV indices, extracted from continuous glucose monitoring (CGM) data, can distinguish between stages of diabetes progression. We showed that 25 indices driving a logistic regression classifier can differentiate between healthy and nonhealthy individuals; whereas 37 GV indices and four individual parameters, feeding a polynomial-kernel support vector machine (SVM), can further distinguish between impaired glucose tolerance (IGT) and type 2 diabetes (T2D). The latter approach has some limitations to interpretability (complex model, extensive index pool). In this article, we try to obtain the same performance with a simpler classifier and a parsimonious subset of indices.

Methods:

We analyzed the data of 62 subjects with IGT or T2D. We selected 17 interpretable GV indices and four parameters (age, sex, BMI, waist circumference). We trained a SVM on the data of a baseline visit and tested it on the follow-up visit, comparing the results with the state-of-art methods.

Results:

The linear SVM fed by a reduced subset of 17 GV indices and four basic parameters achieved 82.3% accuracy, only marginally worse than the reference 87.1% (41-features polynomial-kernel SVM). Cross-validation accuracies were comparable (69.6% vs 72.5%).

Conclusion:

The proposed SVM fed by 17 GV indices and four parameters can differentiate between IGT and T2D. Using a simpler model and a parsimonious set of indices caused only a slight accuracy deterioration, with significant advantages in terms of interpretability.
Social Media Content Analysis of Public Diabetes Facebook Groups
Authors: Stellefson Michael , Paige Samantha , Apperson Avery , Spratt Susannah
Published: April 2019

Introduction:

Relatively little is known about how Facebook groups are used to facilitate diabetes self-management support. This study provides a critical analysis of public diabetes Facebook groups and their content.

Methods:

Two trained researchers independently identified 34 public Facebook diabetes groups. A coding and classification scheme was applied to the 20 most recent “wall posts” within 15 of the 34 (44.1%) largest groups (n = 300 posts). Nonparametric Mann-Whiney U tests examined differences in group characteristics between groups with more (active) and less (inactive) than 50 posts in the past month. Multivariable logistic regressions evaluated associations between group purpose, post types, membership (engagement leader vs regular user), and modality.

Results:

We identified 193 458 members of the 34 largest diabetes Facebook groups (Mdn size = 3124 members, IQR = 1298-8523 members). Many groups (20/34, 58.8%) were created to provide instrumental support, while fewer (12/34, 35.8%) aimed to provide emotional support. Nutrition was the only diabetes self-management topic addressed in more than 30% of posts (n = 107). Posts made by engagement leaders were almost five times more likely to appear within inactive compared to active groups.

Discussion:

Diabetes Facebook groups are used to share both information and emotional support, with greater emphasis placed on sharing information about nutrition. While engagement leaders should theoretically increase the credibility of online forums, frequent posts by group engagement leaders may actually lead to group decay. Health and diabetes educators should consider how to more effectively leverage social media engagement leaders to disseminate valid health information on diabetes self-management.
Treatment strategies for post-infarction left ventricular free-wall rupture
Authors: Matteucci Matteo , Fina Dario , Jiritano Federica , Meani Paolo , Blankesteijn W Matthijs , Raffa Giuseppe Maria , Kowaleski Mariusz , Heuts Samuel , Beghi Cesare , Maessen Jos , Lorusso Roberto
Published: April 2019

Left ventricular free-wall rupture is one of the most fatal complications after acute myocardial infarction. Surgical treatment of post-infarction left ventricular free-wall rupture has evolved over time. Direct closure of the ventricular wall defect (linear closure) and resection of the infarcted myocardium (infarctectomy), with subsequent closure of the created defect with a prosthetic patch, represented the original techniques. Recently, less aggressive approaches, either with the use of surgical glues or the application of collagen sponge patches on the infarct area to cover the tear and achieve haemostasis, have been proposed. Despite such modifications in the therapeutic strategy and surgical treatment, however, postoperative in-hospital mortality may be as high as 35%. In extremely high-risk or inoperable patients, a non-surgical approach has been reported.
Uncommon primary Group A streptococcal erector spinae pyomyositis diagnosed as muscle strain in a fit young male
Authors: Zheng Zhongxi , Yoong Chee Seng
Published: April 2019

Acute lower back pain in a fit healthy male with recent strenuous physical activity is often attributed to muscle strain. We report a rare case of erector spinae pyomyositis developing in a young and otherwise healthy young adult male that was almost misdiagnosed as muscle strain. Despite admission and close monitoring, diagnosis was only confirmed on a magnetic resonance imaging of the spine later during the hospital stay. Early diagnosis in this case allowed successful treatment with intravenous antibiotics alone, without requiring further surgical drainage or development of further neurological sequelae, common in later stages of erector spinae pyomyositis.
Feasibility of Portable Fingerstick Cholinesterase Testing in Adolescents in South Texas
Authors: Trueblood Amber B. , Ross Jennifer A. , Shipp Eva M. , McDonald Thomas J.
Published: April 2019

Adolescents are particularly vulnerable to the impacts of pesticide exposures, which can be assessed using surveys, environmental measurements, and biomonitoring. Biomonitoring of blood cholinesterase can be used to determine if an individual has been exposed to pesticides. A limitation of blood cholinesterase testing can be the use of a laboratory as well as time to receive results. In addition to laboratory tests, there are fingerstick cholinesterase (ChE) tests, which can eliminate the need for laboratory testing. Some populations, such as farmworkers, would benefit through fingerstick ChE tests. The objective of this pilot study is to determine the feasibility (eg, can the testing be used to assess ChE levels) of using fingerstick ChE testing in adolescent populations living along the Texas-Mexico border where adolescents who often engage in farm work live. A sub-objective was to explore differences in ChE levels by sex. The Model 400 Test-Mate ChE kit by EQM Research Inc (Cincinnati, OH) was used to assess for ChE inhibition in the participants, specifically acetylcholinesterase (AChE), which is 1 of the 2 ChE enzymes. During the postassessment, males had a mean AChE value of 3.75 U/mL (95% CI 3.51-3.98); whereas females had a mean AChE value of 2.86 U/mL (95% CI 2.64-3.08), which was statistically significant. Overall, the study supports the use of field ChE testing in adolescent populations with a small percentage (6.90%) refusing to complete ChE testing.
Advanced Training and Job Satisfaction Among Recent Canadian Plastic Surgery Graduates
Authors: DeSerres Joshua J. , Curran Matthew W. T. , Fung Eric H. , Tredget Edward E. , Wilkes Gordon H. , Olson Jaret L.
Published: April 2019

Background:

In order to increase one’s competitiveness in the current job market, Canadian plastic surgery graduates may complete additional degrees and multiple fellowships. The authors sought to determine the impact of this additional training on the practice profile of recent graduates and determine the current state of job satisfaction among this group.

Methods:

An anonymous cross-sectional online survey was created and sent to all 250 graduates of Canadian plastic surgery residencies from 2005 to 2015. Demographics were collected and questions grouped into clinical, teaching, research, and administrative components. Questions pertaining to job satisfaction were also included.

Results:

The response rate to the survey was 39%. Sixty-nine (71%) respondents had permanent attending positions at the time of survey completion, while the remaining 28 respondents did not. Among those with permanent positions, 59 (86%) completed at least one fellowship and 30 (43%) have an advanced degree. Of those who did fellowship training, 76% practice primarily in their area of subspecialty. Having an advanced degree showed a trend to a higher percentage of practice dedicated to research (5.6% vs 1.9%; P = .074) and more publications per year were seen among this group (1.31 vs 0.30; P = .028). Eighty-six percent of respondents are satisfied with their current attending position.

Conclusions:

The majority of recent Canadian plastic surgery graduates are undergoing fellowship training and are practicing primarily in their fields of subspecialty training. Having a postgraduate degree was associated with a higher number of publications per year as an attending surgeon. Job satisfaction is high among recent graduates.
Streptococcus canis Bacteremia in a Renal Transplant Recipient
Authors: Zaidi Syed M. H. , Eranki Ambika
Published: April 2019

A middle-aged man presented with fever and shortness of breath. He had significant history of congestive heart disease and received deceased donor renal transplant 2 years prior to presentation. He was febrile and found to have sepsis. His initial blood cultures grew Streptococcus canis. Streptococcus canis causes rare infection in humans, and this is most likely the first case in the renal transplant population.
Epidemiology of Hand and Wrist Injuries in NCAA Men’s Football: 2009–2010 to 2013–2014
Authors: Bartels Douglas W. , Hevesi Mario , Wyles Cody , Macalena Jeffrey , Kakar Sanjeev , Krych Aaron J.
Published: April 2019

Background:

Participation in National Collegiate Athletic Association (NCAA) football is at an all-time high. This population of athletes experiences a substantial injury burden, with many injuries affecting the upper extremities.

Purpose/Hypothesis:

The purpose of this study was to describe the epidemiology of hand and wrist injuries in college football players from the academic years 2009–2010 to 2013–2014. We hypothesized that variables such as event type (practice vs game), mechanism of injury, and player position would have an effect on the injury incidence.

Study Design:

Descriptive epidemiological study.

Methods:

An epidemiological study utilizing the NCAA Injury Surveillance Program was performed to investigate rates and patterns of hand and wrist injuries in participating varsity football teams from 2009–2010 to 2013–2014.

Results:

A total of 725 hand and wrist injuries were captured in 899,225 athlete-exposures. The observed practice injury rate was 0.51 injuries per 1000 athlete-exposures, compared with a game injury rate of 3.60 ( P < .01). Player-on-player contact was the most common injury mechanism reported, with blocking being the most common activity at the time of injury. Offensive linemen were most likely to experience an injury. Of all injuries sustained, 71.4% resulted in no time loss from competition, whereas 9.8% of injuries resulted in longer than 7 days of time loss. A fracture resulted in the greatest time loss from competition (mean ± SD, 8.3 ± 24.0 days; median, 0 days [range, 0-148 days] for injuries sustained in a practice setting) (mean ± SD, 7.7 ± 15.8 days; median, 0 days [range, 0-87 days] for injuries sustained in a game setting).

Conclusion:

Hand and wrist injuries were found to be significantly more common in games when compared with practices. This study provides valuable prognostic data regarding expected time loss on a per-injury pattern basis. Further investigation on specific injury subtypes and expected time loss as a result of these injures would provide trainers, players, and coaches with useful information on an expected postinjury recovery and rehabilitation timeline.
Effect of various factors influencing the generation of hemispherical micro features using non-conformal RMEDM
Authors: Roy T. , Balasubramaniam R.
Published: April 2019

Non-conformal reverse micro electrical discharge machining (NC-RMEDM) is a variant of conventional RMEDM developed by the present authors wherein modification in the tool is carried out to generate different shapes of micro features. In this study, the effect of various factors like flat bottom and taper bottom hole, inversing the position of tool and workpiece and changing the hole depth have been experimentally investigated to determine the optimal combination required for generating hemispherical shaped micro features. It was found that hemispherical shaped micro feature can be generated by employing tapered bottom blind hole as tool. Buoyancy assisted machining (BAM) with traverse of workpiece (anode) downwards into the tool (cathode) and vice versa, i.e., buoyancy opposed machining (BOM) with traverse of tool downwards into the workpiece were carried out to study the generation of hemispherical micro feature based on inversion of electrode positions. Although both BAM and BOM generated hemispherical shaped feature, BAM is preferred due to reduced machining time as opposed to BOM. Also, increasing the hole depths led to altering the shape of micro feature from hemispherical to cylindrical with hemispherical end and coni-spherical end. An array of hemispherical micro features was fabricated based on the finding from this study, and surface roughness analysis was carried out which showed that irrespective of the position of micro feature on the array, surface roughness at the tip and base of the micro feature is lower as compared to side portion.
Epigenetic Classifiers for Precision Diagnosis of Brain Tumors
Authors: Orozco Javier IJ , Manughian-Peter Ayla O , Salomon Matthew P , Marzese Diego M
Published: April 2019

DNA methylation profiling has proven to be a powerful analytical tool, which can accurately identify the tissue of origin of a wide range of benign and malignant neoplasms. Using microarray-based profiling and supervised machine learning algorithms, we and other groups have recently unraveled DNA methylation signatures capable of aiding the histomolecular diagnosis of different tumor types. We have explored the methylomes of metastatic brain tumors from patients with lung cancer, breast cancer, and cutaneous melanoma and primary brain neoplasms to build epigenetic classifiers. Our brain metastasis methylation (BrainMETH) classifier has the ability to determine the type of brain tumor, the origin of the metastases, and the clinical-therapeutic subtype for patients with breast cancer brain metastases. To facilitate the translation of these epigenetic classifiers into clinical practice, we selected and validated the most informative genomic regions utilizing quantitative methylation-specific polymerase chain reaction (qMSP). We believe that the refinement, expansion, integration, and clinical validation of BrainMETH and other recently developed epigenetic classifiers will significantly contribute to the development of more comprehensive and accurate systems for the personalized management of patients with brain metastases.
Functional analysis of clinical response to low-dose IL-2 in patients with refractory chronic graft-versus-host disease
Authors: Whangbo Jennifer S. , Kim Haesook T. , Nikiforow Sarah , Koreth John , Alho Ana C. , Falahee Bryn , Kim Soomin , Dusenbury Katharine , Fields Marie J. , Reynolds Carol G. , Alyea Edwin P. , Armand Philippe , Cutler Corey S. , Ho Vincent T. , Antin Joseph H. , Soiffer Robert J. , Ritz Jerome
Published: April 2019

Patients with chronic graft-versus-host disease (cGVHD) have a paucity of regulatory CD4 T cells (CD4Tregs) that mediate peripheral tolerance. In clinical trials, daily low-dose interleukin-2 (IL-2) has been administered safely for prolonged periods in patients with steroid-refractory cGVHD. Peripheral CD4Tregs expand dramatically in all patients during IL-2 therapy but clinical improvement was observed in ∼50% of patients. Here, we examined the impact of low-dose IL-2 therapy on functional T-cell markers and the T-cell repertoire within CD4Tregs, conventional CD4 T cells (CD4Tcons), and CD8+ T cells. IL-2 had profound effects on CD4Tregs homeostasis in both response groups including selective expansion of the naive subset, improved thymic output, and increased expression of Ki67, FOXP3, and B-cell lymphoma 2 within CD4Tregs. Similar changes were not seen in CD4Tcons or CD8 T cells. Functionally, low-dose IL-2 enhanced, in vitro, CD4Treg-suppressive activity in both response groups, and all patient CD4Tcons were similarly suppressed by healthy donor CD4Tregs. High-throughput sequencing of the T-cell receptor β (TCRβ) locus demonstrated that low-dose IL-2 therapy increased TCR repertoire diversity and decreased evenness within CD4Tregs without affecting CD4Tcons or CD8 T cells. Using clone-tracking analysis, we observed rapid turnover of highly prevalent clones in CD4Tregs as well as the conversion of CD4Tcons to CD4Tregs. After 12 weeks of daily IL-2, clinical responders had a greater influx of novel clones within the CD4Treg compartment compared with nonresponders. Further studies to define the function and specificity of these novel CD4Treg clones may help establish the mechanisms whereby low-dose IL-2 therapy promotes immune tolerance.
Peak oxygen uptake reference values for cycle ergometry for the healthy Dutch population: data from the LowLands Fitness Registry
Authors: Mylius Caspar Frederik , Krijnen Wilhelmus Petrus , van der Schans Cornelis Peter , Takken Tim
Published: April 2019

Peak oxygen uptake (V′O2peak) is recognised as the best expression of aerobic fitness. Therefore, it is essential thatV′O2peakreference values are accurate for interpreting a cardiopulmonary exercise test (CPET). These values are country specific and influenced by underlying biological ageing processes. They are normally stratified per paediatric and adult population, resulting in a discontinuity at the transition point between prediction equations. There are currently no age-related reference values available for the lifespan of individuals in the Dutch population. The aim of this study is to determine the best-fitting regression model forV′O2peakin the healthy Dutch paediatric and adult populations in relation to age.

In this retrospective study, CPET cycle ergometry results of 4477 subjects without reported somatic diseases were included (907 females, age 7.9–65.0 years). Generalised additive models were employed to determine the best-fitting regression model. Cross-validation was performed against an independent dataset consisting of 3518 subjects (170 females, age 6.8–59.0 years).

An additive model was the best fitting with the largest predictive accuracy in both the primary (adjusted R2=0.57, standard error of the estimate (see)=556.50 mL·min−1) and cross-validation (adjusted R2=0.57,see=473.15 mL·min−1) dataset.

This study provides a robust additive regression model forV′O2peakin the Dutch population.
Emerging entities of renal cell neoplasia
Authors: Delahunt Brett , Eble John N. , Egevad Lars , Yaxley John , Thunders Michelle , Samaratunga Hemamali
Published: April 2019

The current classification of renal cell carcinoma (RCC) was formulated at the meeting of the World Health Organization Renal Tumor Panel in 2015, with the results published in the fourth edition of the World Health Organization Classification of Tumours of the Urinary System and Male Genital Organs Bluebook in 2016. At that meeting a number of tumor types were designated as emerging or provisional entities as it was felt that they were insufficiently characterized to merit inclusion as a recognized type of RCC. One tumor type included in this designation was thyroid-like follicular RCC. Since the publication of the 2016 classification this tumor type has been further characterized and in addition to this, detailed studies on three other types of RCC (multifocal oncocytoma-like tumors associated with oncocytosis, eosinophilic solid and cystic RCC and biphasic squamoid alveolar RCC) have been published. It is now apparent that these four tumors are unique morphotypes and genotypes of RCC, and are likely to be included in the next edition of the World Health Organization classification of renal tumors. Multifocal oncocytoma-like tumors associated with oncocytosis is a benign process characterized by the presence of hundreds to thousands of oncocytic tumors in a single kidney. These tumors occur sporadically and are unrelated to the tumors of Birt-Hogg-Dubé syndrome. Eosinophilic solid and cystic RCC is characterized by a solid and cystic architecture with tumor cells consisting of bulky eosinophilic and granular cytoplasm with intracytoplasmic vacuolation. Thyroid-like follicular RCC occurs in younger patients with a female predominance. The tumor bears a striking resemblance to follicular carcinoma of the thyroid with follicles containing intraluminal proteineacous material resembling thyroglobulin. Immunostains for thyroid markers are negative. Finally, biphasic squamoid alveolar RCC consists of aggregates of large cells with pale eosinophilic cytoplasm usually arranged in a glomeruloid/alveolar pattern and surrounded by a border of basophilic cells with scanty cytoplasm. The genotype of the tumor, as well its recorded association with typical papillary RCC, has led to the suggestion that it is related to type 1 papillary RCC.
Spinal Cord Stimulation in Patients With Chronic Pain and Restless Legs Syndrome: A Case Report
Authors: Byrne David A. , Sobey Christopher M. , Trahan Jake , Bagai Kanika , Walters Arthur
Published: April 2019

Restless legs syndrome can be a debilitating condition that affects a patient’s ability to function and their quality of life. Neuromodulation may represent a potential option for nonpharmacological management of restless legs syndrome. We present 3 patients who have a chronic pain diagnosis and medically refractory restless legs syndrome that warranted neuromodulation. After neuromodulation, all 3 patients had improvement in their restless legs syndrome symptoms and were taking less pain medication, and 2 out of 3 had significantly improved functionality at short-term follow-up. This case series suggests that spinal cord stimulation may be a viable nonpharmacological treatment option for medically refractory restless legs syndrome.
Toward a Critical Ocean Studies for the Anthropocene
Authors: DeLoughrey Elizabeth
Published: April 2019

Recently, scholars have called for a “critical ocean studies” for the twenty-first century and have fathomed the oceanic depths in relationship to submarine immersions, multispecies others, feminist and Indigenous epistemologies, wet ontologies, and the acidification of an Anthropocene ocean. In this scholarly turn to the ocean, the concepts of fluidity, flow, routes, and mobility have been emphasized over other, less poetic terms such as blue water navies, mobile offshore bases, high-seas exclusion zones, sea lanes of communication (SLOCs), and maritime “choke points.” Yet this strategic military grammar is equally vital for a twenty-first-century critical ocean studies for the Anthropocene. Perhaps because it does not lend itself to an easy poetics, the militarization of the seas is overlooked and underrepresented in both scholarship and literature emerging from what is increasingly called the blue or oceanic humanities. This essay turns to the relationship between global climate change and the US military, particularly the Navy, and examines Indigenous challenges to the militarism of the Pacific in the poetry of Craig Santos Perez.
The Underwater Imagination
Authors: Cohen Margaret
Published: April 2019

The 1940s and 1950s were a revolutionary era in both access to and imagination of the underwater environment in the most modernized nations of the globe. This article examines new possibilities in the exhibition of the underwater environment in film thanks to new dive and filming technologies. It focuses on how the depths are portrayed as a setting in Richard Fleischer’s 20,000 Leagues under the Sea (1954), by the Disney studio, and Jacques-Yves Cousteau and Louis Malle’s The Silent World (1956). In both films, conventions for portraying terrestrial settings are adapted to the resistant conditions of the aquatic environment. Such adaptation unleashes creativity in filmmaking and results in portrayals in which audiences are at once at home in this alien area of our planet and able to assimilate and enjoy its unprecedented vistas and savage life.
“We Cannot Think of a Time That Is Oceanless”
Authors: Uphaus Maxwell
Published: April 2019

This essay proposes, through an analysis of T. S. Eliot’s “The Dry Salvages,” a model for the study of the sea in modernism based on British modernism’s relationship with the contemporaneous idea that the sea was the essence of British history. “The Dry Salvages” rejects the view of the sea as embodying British history entertained elsewhere in Eliot’s poetry of this period, but it continues to envision Britain as inherently caught up in the new vision it elaborates of oceanic history as an ongoing calamitous process that is nevertheless essential to historical thinking as such. The poem develops this new vision by both suppressing and drawing on Black Atlantic historical experience. As it undertakes this oceanic historical reconceptualization, “The Dry Salvages” demonstrates how, in British modernism, thinking about the sea and thinking about history are intrinsically interconnected.
An Archival Ethnography of Edward Sapir’s Nootka (Nuu-chah-nulth) Texts, Correspondence, and Fieldwork through the Douglas Thomas Drawings
Authors: Green Denise Nicole
Published: April 2019

The practice of using drawing and image rendering to declare rights and histories is long-standing among Nuu-chah-nulth people on the west coast of Vancouver Island. This article analyzes a collection of images created in 1916 by Douglas Thomas, a Nuu-chah-nulth man from the Tseshaht First Nation. His eldest son, Alex Thomas, sold these drawings to linguistic anthropologist Edward Sapir, who was at the time in charge of the anthropology division of the Geological Survey of Canada. The drawings depict critically important cultural information about ceremonial practices and protocols and are similar in style and content to the much larger-scale cedar screens (kiitsaksuu-ulthim) and cloth curtains (thliitsapilthim) of the same time period. By returning facsimile and digital copies to the family of origin, this research illustrates how anthropologists may play a role in fostering productive and reciprocal relationships between Native source communities and the archives that hold some of their treasured information.