bluuebunny/crossref_metadata_2025 huggingface dataset:
Lubrication in hot die forging processes
Authors: Hawryluk Marek , Ziemba Jacek
Published: June 2018

This article presents selected aspects of lubricant application, as well as lubrication methods and devices in the context of forging tool durability and accessories used in die forging processes at elevated temperatures. The properties and applications of the currently used lubricating and cooling agents in selected industrial forging processes were analyzed. The authors’ original studies on the influence of lubricant application, dose size, time and feed direction as well as other factors affecting tribological conditions are also presented. A review of lubricating and cooling systems and devices is provided, as well as a lubricating device built on the basis of the authors’ knowledge and experience is presented. The developed system, implemented into an industrial process, makes it possible to select and maintain its optimal tribological conditions through the control of the size and frequency of the administered lubricant dose. It may be an alternative to the manual lubricant application method, where human error is a factor, or to fully automated, but expensive, lubrication systems.
Development and psychometric properties of the Self-efficacy for Mindfulness Meditation Practice scale
Authors: Birdee Gurjeet S , Wallston Kenneth A , Ayala Sujata G , Ip Edward H , Sohl Stephanie J
Published: June 2018

This study aimed to develop a self-efficacy measure for mindfulness meditation practice (Self-efficacy for Mindfulness Meditation Practice scale). The scale was developed through a process of expert consensus, cognitive interviewing, and evaluation among 199 mindfulness meditation practitioners who completed an online survey. The 9-item Self-efficacy for Mindfulness Meditation Practice scale was unidimensional with three subconstructs of attention, compassion, and emotion. The omega hierarchical coefficient for the total scale was 0.78, and test–retest reliability was intraclass correlation coefficient = 0.85 (95% confidence interval: 0.80, 0.89). This study provides preliminary evidence that Self-Efficacy for Mindfulness Meditation Practice scale is a reliable and valid measure of self-efficacy for mindfulness meditation practice.
Behaviour of partly stiffened cold-formed steel built-up beams: Experimental investigation and numerical validation
Authors: Dar M Adil , Subramanian N , Dar A R , Anbarasu M , Lim James BP , Atif Mir
Published: June 2018

To address the various instability problems in cold-formed steel members, many researchers have mainly focused on developing innovative sectional profiles wherein geometry of the section plays a vital role in enhancing the inherent resistance of such sections against premature buckling. However, the process of forming such innovative shapes is not only complex and time-consuming but sometimes such sections fail to mobilize their complete reserve strength. Hence, a stiffening arrangement of weaker zones for mobilizing the untapped reserve strength is suggested. The contribution of this simple, effective and partly stiffening arrangements, aimed at eliminating/delaying the premature local buckling, is studied both experimentally and numerically and also compared with existing codes. Experimental study was carried out on different simply supported cold-formed steel beams with judiciously proposed stiffening arrangements under four-point loading. An equivalent hot-rolled steel beam was also tested to compare the efficiency of the cold-formed steel beams. The cold-formed steel beams investigated had different width-to-thickness ratio, different geometries and different stiffening arrangements. The test strengths, failure modes, deformed shapes, load versus mid-span displacements and geometric imperfections were measured and reported. The test strengths of the beam models are also compared with the design strength predicted by North American Standards and Eurocode for cold-formed steel structures. To validate the test results further, a numerical study was carried out on such stiffened cold-formed steel beams using finite element software ABAQUS. All these results show that the proposed strengthening system is efficient and economical and allow cold-formed steel beams to reach greater load carrying capacity.
Sailing the seven seas
Authors: Vonk Gijsbert
Published: June 2018

The purpose of this final contribution is to offer a broad schematic overview of ‘mechanisms’ that can be used to strengthen the social security protection of persons moving in and out of the EU. Seven mechanisms have been selected for discussion: national unilateral standards, EU unilateral standards, bilateral agreements, EU coordination of bilateral agreements, EU third country agreements, multilateral co-operation and global standards. The existence of this plethora of mechanisms, each with its own merits and shortcomings, casts a shadow over the possibility of a uniform EU regime for external social security relations. Any attempt to introduce such an approach can immediately be contradicted by alternative approaches and mechanisms which can be used both by the EU and by the individual Member States. It is suggested that more coherence in external EU social security coordination can perhaps be found in a conceptual way, by layering the seven mechanisms in a logical manner.
Beyond uniform reproduction: Exploring children’s imaginative play through the lenses of their teacher
Authors: Grindheim Liv Torunn
Published: June 2018

The voices of both early childhood education teachers and children tend to be weak in the choir of agents that constitute the aims and practices of early childhood education. In this article, a video that a teacher made of four children playing dragons, followed by open-ended interviews exploring why she found this particular activity of interest and then open-ended interviews with the involved children while watching and commenting on the video, forms the basic material for discussing how children’s imaginative play can inform what might be valuable activities in early childhood education. The theoretical framework and concepts for analysis draw on an understanding of cultural formation and a cultural-historical approach that outlines children’s development through participation in activities framed by contextual conditions. By tracing conflicts caused by differences in the involved children’s values and motives while meeting conditions and demands in their context, at the personal, institutional and societal levels, the exploration of friendship, danger, space, institutional rooms and what good play ‘is’ are depicted in children’s imaginative role play. From this, imaginative play is seen as being endowed with valuable activities in early childhood education and forms a contrast to the emphasis on future academic competences that are far removed from the children’s experiences.
Depression and Prostate Cancer: Examining Comorbidity and Male-Specific Symptoms
Authors: Rice Simon M. , Oliffe John L. , Kelly Mary T. , Cormie Prue , Chambers Suzanne , Ogrodniczuk John S. , Kealy David
Published: June 2018

Depression in men with prostate cancer is a significant and complex issue that can challenge clinicians’ diagnostic efforts. The objective of the current study was to evaluate prototypic and male-specific depression symptoms and suicidal ideation in men with a diagnosis of prostate cancer relative to those with and without comorbidity. The Patient Health Questionnaire-9 (PHQ-9) and Male Depression Risk Scale-22 (MDRS-22) were completed online along with demographic and background variables by 100 men with a diagnosis of prostate cancer ( n = 54 prostatectomy, n = 33 receiving active treatment). Hierarchical logistic regression was used to examine recent (past 2 weeks) suicide ideation. Over one-third of the sample (38%) reported a comorbidity, and this group had significantly higher total depression scores on the PHQ-9 (Cohen’s d = 0.65), MDRS-22 emotion suppression ( d = 0.35), and drug use subscales ( d = 0.38) compared to respondents without comorbidity. A total of 14% reported recent suicidal ideation, of which 71.4% of cases were identified by the PHQ-9 “moderate” cut-off, and 85.7% of cases were identified by the MDRS-22 “elevated” cut-off. After control variables, MDRS-22 subscales accounted for 45.1% of variance in recent suicidal ideation. While limited by the exclusive use of self-report data, findings point to the potential benefits of evaluating male-specific symptoms as part of depression and suicide risk screening in men with prostate cancer and the need to be mindful of the heightened risk for depression among men with prostate cancer who have comorbidity.
Nonmuscle myosin II isoforms interact with sodium channel alpha subunits
Authors: Dash Bhagirathi , Han Chongyang , Waxman Stephen G , Dib-Hajj Sulayman D
Published: June 2018

Sodium channels play pivotal roles in health and diseases due to their ability to control cellular excitability. The pore-forming α-subunits (sodium channel alpha subunits) of the voltage-sensitive channels (i.e., Nav1.1–1.9) and the nonvoltage-dependent channel (i.e., Nax) share a common structural motif and selectivity for sodium ions. We hypothesized that the actin-based nonmuscle myosin II motor proteins, nonmuscle myosin heavy chain-IIA/myh9, and nonmuscle myosin heavy chain-IIB/myh10 might interact with sodium channel alpha subunits to play an important role in their transport, trafficking, and/or function. Immunochemical and electrophysiological assays were conducted using rodent nervous (brain and dorsal root ganglia) tissues and ND7/23 cells coexpressing Nav subunits and recombinant myosins. Immunoprecipitation of myh9 and myh10 from rodent brain tissues led to the coimmunoprecipitation of Nax, Nav1.2, and Nav1.3 subunits, but not Nav1.1 and Nav1.6 subunits, expressed there. Similarly, immunoprecipitation of myh9 and myh10 from rodent dorsal root ganglia tissues led to the coimmunoprecipitation of Nav1.7 and Nav1.8 subunits, but not Nav1.9 subunits, expressed there. The functional implication of one of these interactions was assessed by coexpressing myh10 along with Nav1.8 subunits in ND7/23 cells. Myh10 overexpression led to three-fold increase ( P < 0.01) in the current density of Nav1.8 channels expressed in ND7/23 cells. Myh10 coexpression also hyperpolarized voltage-dependent activation and steady-state fast inactivation of Nav1.8 channels. In addition, coexpression of myh10 reduced ( P < 0.01) the offset of fast inactivation and the amplitude of the ramp currents of Nav1.8 channels. These results indicate that nonmuscle myosin heavy chain-IIs interact with sodium channel alpha subunits subunits in an isoform-dependent manner and influence their functional properties.
Nuclear factor kappa B regulated monocyte chemoattractant protein-1/chemokine CC motif receptor-2 expressing in spinal cord contributes to the maintenance of cancer-induced bone pain in rats
Authors: Wang Yungong , Ni Huadong , Li Hongbo , Deng Houshen , Xu Long S , Xu Shijie , Zhen Ying , Shen Hui , Pan Huan , Yao Ming
Published: June 2018

Background:

Chemokine, monocyte chemoattractant protein-1 (MCP-1), is a potential factor to cause cancer-induced bone pain (CIBP). NF-κB signaling is very important in mediating the expression of chemokines and may have a role in CIBP. However, the mechanism is still unclear. This study investigates the role of NF-κB in CIBP by regulating MCP-1/chemokine CC motif receptor-2 (CCR2) signaling pathway.

Methods:

A rat CIBP model was established by injecting Walker-256 cells into the tibia medullary cavity. Nine days later, animals were intrathecally administrated with MCP-1 neutralizing antibody, CCR2 antagonist (RS504393), or NF-кB inhibitor (BAY11–7081). Mechanical paw withdrawal threshold was used to assess pain behavior and sciatic functional index, and radiographic images were adopted to evaluate the damage of nerve and bone. The spinal cords were harvested for Western blot and quantitative reverse transcription polymerase chain reaction. The distribution of MCP-1, CCR2, and NF-кB was detected by double immunofluorescent staining.

Results:

CIBP caused remarkable bone destruction, injury of sciatic and femoral nerve, and persistent (>15 days) mechanical allodynia in rats. Tumor cell inoculation upregulate MCP-1 and NF-кB in activated neurons as well as CCR2 in neurons and microglia of the spinal cord. MCP-1 antibody, RS504393, and BAY11–7081 partially reversed CIBP-induced mechanical allodynia, and CIBP regulated the expression levels of pro-inflammatory cytokines, tumor necrosis factor-α and interferon-γ, and anti-inflammatory cytokine, interleukin 4, and BAY11–7081 lowered CIBP-induced MCP-1 and CCR2 expressions in a dose-dependent manner.

Conclusion:

In conclusion, NF-кB signaling pathway regulates the expressions of MCP-1/CCR2-induced inflammatory factors in the spinal cord of CIBP rats.
Baseline NIH Stroke Scale is an inferior predictor of functional outcome in the era of acute stroke intervention
Authors: Reznik Michael E , Yaghi Shadi , Jayaraman Mahesh V , McTaggart Ryan A , Hemendinger Morgan , Mac Grory Brian C , Burton Tina M , Cutting Shawna M , Siket Matthew S , Madsen Tracey E , Thompson Bradford B , Wendell Linda C , Mahta Ali , Potter N Stevenson , Furie Karen L
Published: June 2018

Background and aims

Baseline National Institutes of Health Stroke Scale (NIHSS) scores have frequently been used for prognostication after ischemic stroke. With the increasing utilization of acute stroke interventions, we aimed to determine whether baseline NIHSS scores are still able to reliably predict post-stroke functional outcome.

Methods

We retrospectively analyzed prospectively collected data from a high-volume tertiary-care center. We tested strength of association between NIHSS scores at baseline and 24 h with discharge NIHSS using Spearman correlation, and diagnostic accuracy of NIHSS scores in predicting favorable outcome at three months (defined as modified Rankin Scale 0–2) using receiver operating characteristic curve analysis with area under the curve.

Results

There were 1183 patients in our cohort, with median baseline NIHSS 8 (IQR 3–17), 24-h NIHSS 4 (IQR 1–11), and discharge NIHSS 2 (IQR 1–8). Correlation with discharge NIHSS was r = 0.60 for baseline NIHSS and r = 0.88 for 24-h NIHSS. Of all patients with follow-up data, 425/1037 (41%) had favorable functional outcome at three months. Receiver operating characteristic curve analysis for predicting favorable outcome showed area under the curve 0.698 (95% CI 0.664–0.732) for baseline NIHSS, 0.800 (95% CI 0.772–0.827) for 24-h NIHSS, and 0.819 (95% CI 0.793–0.845) for discharge NIHSS; 24 h and discharge NIHSS maintained robust predictive accuracy for patients receiving mechanical thrombectomy (AUC 0.846, 95% CI 0.798–0.895; AUC 0.873, 95% CI 0.832–0.914, respectively), while accuracy for baseline NIHSS decreased (AUC 0.635, 95% CI 0.566–0.704).

Conclusion

Baseline NIHSS scores are inferior to 24 h and discharge scores in predicting post-stroke functional outcomes, especially in patients receiving mechanical thrombectomy.
Infarct location is associated with quality of life after mild ischemic stroke
Authors: Lin Chen , Sangha Rajbeer , Lee Jungwha , Corado Carlos , Jalasutram Anvesh , Chatterjee Neil , Ingo Carson , Carroll Timothy , Prabhakaran Shyam
Published: June 2018

Background

In patients with mild ischemic stroke, small but eloquent infarcts may have devastating effects, particularly on health-related quality of life.

Aim

This study investigates the association between acute infarct location and three-month health-related quality of life in patients with mild ischemic stroke.

Methods

We evaluated consecutively enrolled patients from a single center between August 2012 and July 2013. Our primary outcome at three months was impairment in any health-related quality of life domain (upper extremity, lower extremity, executive function, and general concerns) defined by a T-score <45. We analyzed the association between acute infarct locations and impaired health-related quality of life at three months in univariate and multivariable analysis.

Results

Among 229 patients (mean age 64.9 years, 55% male, 29.7% black, and median initial NIHSS score 1), impaired health-related quality of life was noted in 84 (36.2%) patients at three months. In univariate analysis, patients with subcortical infarcts (56.0% vs. 39.3%, p = 0.02) and brainstem infarcts (21.4% vs. 10.3%, p = 0.02) were more likely to have impaired health-related quality of life. In multivariable analysis, patients with subcortical and/or brainstem infarcts had increased odds of impaired health-related quality of life (adjusted OR 2.54, 95% CI 1.29–5.01, p = 0.01).

Conclusions

After mild ischemic stroke, subcortical and brainstem infarct locations predict impairment in health-related quality of life.
Arthroscopically Repaired Bucket-Handle Meniscus Tears: Patient Demographics, Postoperative Outcomes, and a Comparison of Success and Failure Cases
Authors: Saltzman Bryan M. , Cotter Eric J. , Wang Kevin C. , Rice Richard , Manning Blaine T. , Yanke Adam B. , Forsythe Brian , Verma Nikhil N. , Cole Brian J.
Published: June 2018

Objective

To define patient demographics, preoperative, and intraoperative surgical variables associated with successful or failed repair of bucket-handle meniscal tears.

Design

All patients who underwent arthroscopic repair of a bucket-handle meniscus tear at a single institution between May 2011 and July 2016 with minimum 6-month follow-up were retrospectively identified. Patient demographic, preoperative (including imaging), and operative variables were collected and evaluated. A Kaplan-Meier curve was generated to demonstrate meniscus repair survivorship.

Results

In total, 75 patients (78 knees) with an average age of 26.53 ± 10.67 years met inclusion criteria. The average follow-up was 23.41 ± 16.43 months. Fifteen knees (19.2%) suffered re-tear of the repaired meniscus at an average 12.24 ± 9.50 months postoperatively. Survival analysis demonstrated 93.6% survival at 6 months, 84.6% survival at 1 year, 78.4% survival at 2 years, and 69.9% survival at 3 years. There was significant improvement from baseline to time of final follow-up in all patient-reported outcome ( P < 0.05) except Marx score ( P = 0.933) and SF-12 Mental Subscale ( P = 0.807). The absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively was the only variable significantly associated with repair failure ( P = 0.024). Concurrent anterior cruciate ligament reconstruction (vs. no concurrent anterior cruciate ligament reconstruction) trended toward significance ( P = 0.059) as a factor associated with successful repair.

Conclusions

With the exception of the absence of other knee pathology (including ligament tear, contralateral compartment meniscal tear, or cartilage lesions) noted intraoperatively, no other variables were significantly associated with re-tear. The results are relatively durable with 84.6% survival at 1 year. Surgeons should attempt meniscal repair when presented with a bucket-handle tear.
On theoretical approaches to the Anthropocene challenge
Authors: Soriano Carles
Published: June 2018

Frank Oldfield (Oldfield F (2018) A personal review of the book reviews. The Anthropocene Review 5: 97–101) reflects about the need for conceptual frameworks to confront the Anthropocene challenge and about the capability of Marxism in this regard. Against his view, I argue that conceptual or epistemological frameworks are necessary to face this challenge and that Marxism is in the best position to do so when it is compared with other theoretical approaches.
Anti-inflammatory effect of wogonin on allergic responses in ovalbumin-induced allergic rhinitis in the mouse
Authors: Kim Kyeong Ah , Jung Joo Hyun , Choi Yun Sook , Kang Gyu , Kim Seon Tae
Published: June 2018

Background

Wogonin is commonly used for the treatment of allergic diseases. However, neither its precise effect in preventing allergic rhinitis (AR) nor its mechanism of action are known.

Objectives

In this study, the effect of wogonin on allergic responses in ovalbumin (OVA) induced AR was investigated in mice.

Methods

BALB/c mice were sensitized with intraperitoneal (i.p.) OVA and then challenged intranasally with OVA. Wogonin (10 and 30 mg/kg) was given to the treatment groups, and the effect of wogonin on the release of allergic inflammatory mediators, specifically OVA-specific immunoglobulin E (IgE) and inflammatory cytokines, was explored. Eosinophil infiltration and the levels of interleukin (IL) 5 and IL-13 were measured by immunohistochemistry.

Results

In mice with AR, wogonin decreased OVA-specific IgE levels in serum, and the levels of the cytokines IL-4, IL-5, IL-13, eotaxin, and RANTES in nasal lavage fluid. Serum levels of IL-4, IL-5, and IL-13 were lower in both groups of wogonin-pretreated mice than in the OVA group. A reduction in eosinophil infiltration of the nasal mucosa and inhibition of the expression of IL-5 and IL-13 were also noted in the treated groups.

Conclusion

Wogonin induced antiallergic effects in a murine model of AR by decreasing the infiltration of eosinophils and levels of T-helper type 2 cytokines. Thus, wogonin merits consideration as a therapeutic agent for treating AR.
Analysis of differential expression of protease-activated receptors in patients with allergic fungal rhinosinusitis
Authors: Sawhney Shikhar , Bansal Sandeep , Kalyan Madhur , Verma Indu , Singh Virk Ramandeep , Gupta Ashok Kumar
Published: June 2018

Background

Ever since its characterization in the 1970s, allergic fungal rhinosinusitis (AFRS) has been the subject of much controversy, especially regarding its pathogenesis. In this study, we analyzed the differential expression of genes that encode protease-activated receptors (PAR) in patients with AFRS and patients with chronic rhinosinusitis, and tried to understand the pathogenic basis of this disease.

Objective

To analyze the differential expression of PAR genes in patients with AFRS and in patients with chronic rhinosinusitis.

Methods

Mucosa from ethmoid sinuses of 51 patients (tests and controls) was biopsied and evaluated for messenger RNA expression of PAR genes by using reverse transcriptase–polymerase chain reaction. Each of the four PAR genes, i.e., par1, par2, par3 and par4 was amplified, the final gene products were run on 1.8% agarose gel and analyzed by densitometry to calculate differential expression. The significance level was determined as p ≤ 0.05.

Results

It was observed that the expressions of all four par genes were higher in the test samples compared with the controls, but statistical significance was achieved only for par1 (p=0.004) and par2 (p=0.05). Comparative expression of the four PAR genes was also performed within the test and control groups, and a statistically significant difference was seen between par1 and par2 (p=0.007), par1 and par3 (p=0.029), par1 and par4 (p=0.0001), par2 and par4 (p=0.002), and par3 and par4 (p=0.009) in the test group. In the control group as well, par1, par2, and par3 exhibited a higher expression compared with par4 but the difference was significant between par3 and par4 genes only.

Conclusion

Patients with AFRS expressed increased levels of PAR genes in their nasal mucosa, and, of the four PAR genes, a higher expression of par1, par2, and par3 was observed in both the groups compared with par4. This information contributes toward our understanding of pathogenesis and possibly treatment of AFRS.
Medical dispatch decision support for transfer time estimation: Individual operator differences in system use
Authors: Giang Wayne C.W. , Ponnambalam Canmanie T. , He Xiaonian , Donmez Birsen
Published: June 2018

Medical dispatchers use estimates of patient transfer times to inform dispatch decisions, and decision support tools that assist with time estimation may lead to improved patient outcomes. However, individual differences between medical dispatchers may result in variances in how these tools are used in practice. A study was conducted to explore how individual difference factors such as numeracy ability, impulsiveness, and venturesomeness are associated with different time prediction strategies when using decision support tools that display historical transfer time information. It was found that individuals did exhibit different time prediction strategies, and some of the variance in behavior could be explained by differences in numeracy and impulsiveness. These preliminary results suggest caution when designing support tools, especially when the target population has large variability in terms of numeracy and impulsiveness characteristics.
Gaps Between Alarm Capabilities and Decision-making Needs: An Observational Study of Detecting Patient Decompensation
Authors: Horwood Chelsea R. , Rayo Michael F. , Fitzgerald Morgan , Balkin E. Asher , Moffatt-Bruce Susan D.
Published: June 2018

Decompensation is a change in the overall ability to maintain physiological function in the presence of a stressor or disease. In the medical setting, clinicians utilize a wide range of technological tools to aid in their clinical decision making and to identify early warning signals for decompensation. However, many of these technologies have underperformed and are not aligned with the actual role of practitioners, resulting in unintended consequences and adverse events. The primary aim of this study is to explore how different nurses interpret early warning signs in order to anticipate decompensation. The secondary aim is to assess which technologies nurses rely on when anticipating decompensation, and if those technologies are adequately aiding them in their clinical decision making. Two researchers performed semi-structured ethnographic interviews that were recorded and transcribed during the summer of 2017. In total, 43 nurses were interviewed from different medical and surgical floors within the same hospital. Participants were asked questions focused on how they use and respond to alarms and how they anticipate patient decompensation. Constant Comparative Analysis was used to reveal patterns of responses between participants. Based on the qualitative analysis 6 major themes emerged:

 1. Anticipating patient decompensation requires creating a complete mental “picture of the patient” by the nurses

 2. Nurse-to-nurse communication and expertise is essential to understanding the patient’s history

 3. Warning signs for decompensation were largely determined by a patient’s baseline

 4. Change over time, or trends, is informative for anticipating decompensation. Numbers (regarding vital signs and labs) alone are not

 5. Consistent care of patients improved nurse’s confidence in decision making

 6. Anticipating decompensation requires “staying ahead of the machines

Our research suggests that there is a gap between the information practitioners need to accurately anticipate patient decompensation, and the information current alarm technologies provide. Alarms are the primary tool provided to nurses to aid them in detecting hazardous events, however, current alarms are not well-suited in supporting signals that anticipate patient decompensation before it happens.
Guidance for Selecting Health Care Products Using Human Factors Techniques
Authors: Fuller Helen J. A. , Arnold Timothy , Bagian Tandi
Published: June 2018

In health care, a wide variety of professionals use a wide variety of products when providing care to a wide variety of patients. In addition, safety reports support the idea that medical products vary in terms of usability, compatibility, and functionality. All this variability may contribute to purchasers failing to fully understand and define the needs for and risks of these products. Some purchasing decisions in the Veterans Health Administration (VHA) utilize well-defined procedures such as investigation by Integrated Product Teams (IPTs), which includes a hands-on evaluation of multiple options prior to crafting a national contract. Ideally, all products would go through rigorous functionality and usability testing under a variety of conditions prior to purchase, but such an approval process does not currently exist. The Purchasing Checklist aids purchasers in investigating patient safety concerns related to usability when planning a purchase when extensive hands-on evaluation is not possible. The checklist includes steps such as assembling a team that includes key representatives, considering the purchase needs and options, performing heuristic evaluation of the product literature and other available information, and documenting trade-offs to identify the best option.
Thematic Issues in Analysis and Visualization of Emergency Department Patient Flow
Authors: Bauchwitz Benjamin , Lynn Spencer , Weyhrauch Peter , Ratwani Raj , Weldon Danielle , Howe Jessica , Niehaus James
Published: June 2018

Emergency Department (ED) congestion is a significant problem affecting clinical outcomes, patient satisfaction and hospital costs. Identifying and resolving bottlenecks in the flow of patients from the ED to eventual admission or discharge has the potential to reduce wait times, improve care for individual patients, and increase the volume of patients treated at the hospital over time. Our objective was to review methods commonly used to measure, analyze, and visualize patient flow, characterize drawbacks to these methods, and identify areas in which analysis and visualization can be improved to make bottlenecks easier to identify and resolve. Sixty-five articles obtained from PubMed and Google Scholar searches were reviewed to identify: (1) variables used to measure ED throughput; (2) downstream effects of ED congestion; (3) factors contributing to ED congestion; (4) techniques used to predict or respond to ED congestion; and (5) tools used to visualize data on ED throughput. Hospital resource availability, patient demographics, and environmental factors have all been used to predict contributors to ED congestion. Unfortunately, the hospital practices most critical to ED congestion are unlikely to change as they involve increasing the number of beds and providers or modifying protocols with EMS, insurance, and other care facilities. Therefore, interventions addressing optimization of ED resource allocation and visualization of ED data are the best avenue to yield more efficient ED operation.
Multi-level, multi-discipline, and temporally-diverse handoffs in traumatic brain injury rehabilitation
Authors: Heiden Siobhan M. , Caldwell Barrett S.
Published: June 2018

Traumatic brain injury (TBI) affects approximately 1.7 million Americans annually, and over 5.3 million people in the US are living with a TBI-related disability. Recently the TBI rehabilitation community has championed for TBI to be viewed as a chronic condition, rather than a discrete event. Effective TBI care across the care continuum requires substantial coordination of a variety of clinical types and handoffs between providers, yet these handoffs have not yet been systematically identified. For this exploratory research study, data were collected using semi-structured ethnographic interviews (n=32) with professional care providers in TBI rehabilitation. Study findings identified the patient handoffs across various “levels” of the care system, which range from the shift-change level to the healthcare system transfer level. These handoffs occur over different time scales, and certain types of information are more likely to be lost at certain handoff points. Facility handoffs within the same health systems are also susceptible to incomplete handoffs. Recommendations for improvement and areas for future work include information system (re)design, social network analysis and modeling, and more comprehensive handoff research.
Are Patient Admission Handoffs from the ED to MICU PARfect?
Authors: Ihianle Imade , Burton Shirley , Abraham Joanna
Published: June 2018

Studies have highlighted the importance of using objective physiological measures in quickly identifying critical patients who are at an increased risk of clinical deterioration and decompensation. In this exploratory study, we investigate the use of physiological measures within a modified Patient at Risk (PAR) framework for identifying potential ICU admissions during ED-MICU handoffs.
Creative Research Approaches For Complex Questions In Pre-Hospital Emergency Medicine
Authors: Bitan Yuval , Jaffe Eli , Gisick Logan M. , Hallihan Greg , Keebler Joseph
Published: June 2018

Pre-Hospital Emergency Medical Service work environments are complex, presenting unique challenges for the design of environments and equipment, digital technologies, and inter-organizational operational strategies. As researchers, our challenge is to understand how providers operate in these complex environments, especially during emergency situations, to ensure solutions to these challenges are well informed by representative evidence. This requires collecting data regarding human-system interactions occurring between many people with shifting roles, in dynamic and potentially dangerous environments, with complex patients and often acute time constraints. A lot is happening simultaneously, and our ability to learn and provide meaningful insights is challenged. In search for methods that will help us asses these situations we often use mixed methods that are adapted to the unique and changing conditions of each study.

The goal of this session was to present Case Studies and methods used for the panelist’s research involving the emergency medical services work environment. We took a close look at the tools and methods employed by the panelists for their research, and learned about the benefits and limitations of their unique approaches, as they were implemented in unique contexts.
Identifying Improvements in Healthcare Systems Engineering Models for Chronic Care and Precision Medicine Applications
Authors: Jahn Michelle A. , Heiden Siobhan M. , Caldwell Barrett S.
Published: June 2018

Over 48 million Americans are currently living with a chronic disease. To effectively manage chronic diseases, there is a need for interventions at multiple points in the care process, with integrated health information technology (HIT) systems to assist with information coordination for patients, caregivers, and providers. Systems engineering models can be useful for minimizing unintended consequences with HIT implementation; however, there are gaps in applying such models to precision medicine and chronic care management. The objective of this work was to review the key attributes of systems engineering models for chronic disease management and precision medicine applications. Several key attributes were selected to address: granularity, temporal dynamics, sociotechnical factors, chronic care applications, and HIT integration. The analysis found that the most difficult challenge is depicting granularity and temporal dynamics in systems engineering implementations so that they can still be easily applied by practitioners. Future work aims to determine appropriate systems engineering interventions and implementations that integrate information architecture, systems granularity, and event dynamics for longitudinal coordinated care activities.
Do Hearing Aids Address Real-World Hearing Difficulties for Adults With Mild Hearing Impairment? Results From a Pilot Study Using Ecological Momentary Assessment
Authors: Timmer Barbra H. B. , Hickson Louise , David Michael , Launer Stefan
Published: June 2018

Current approaches to the measurement of hearing aid benefit typically use clinical or laboratory-based speech perception tests or retrospective self-report surveys. However, when assessing hearing aid outcomes in adults with mild hearing impairment, the traditional outcome measures may not be sufficiently sensitive. An alternative to these techniques are approaches that capture data about real-world experiences as they are experienced, such as ecological momentary assessment. This single-subject experimental design pilot study investigated the feasibility of using ecological momentary assessment in assessing whether hearing aids make a difference to the real-world listening experiences of adults with mild hearing impairment. Ten participants with an average age of 70 years and no previous amplification experience answered survey questions on their listening experiences over a 4-week period (1 week without hearing aids, 2 weeks with hearing aids, and 1 week without hearing aids). A total of 860 surveys were collected. Participants reported significantly better speech understanding and less listening effort during the 2-week trial with hearing aids compared to baseline conditions. In addition, they reported that they were significantly less hampered by their hearing difficulties and had greater enjoyment of listening events with wearing hearing aids. Individual variation in hearing aid benefit was evident. This pilot study showed that ecological momentary assessment has potential to quantify self-reported aided benefit for individuals with mild hearing impairment fitted with hearing aids. This research also highlighted that a real-world approach is needed to explore individualized outcomes and provide different insights to standardized questionnaires.
Education and Its Discontents: Investigating Barriers to Schooling among De-notified and Nomadic Communities
Authors: Kannabiran Kalpana , Mishra Sujit Kumar , Vinayan Soumya , Jafar K.
Published: June 2018

This article is based on a study carried out between 2013–2015 in nine states in Central, Western and Southern India on socio-economic status and educational attainment among the de-notified, nomadic and semi-nomadic communities. The primary objective of the study covering 76 communities and 13,020 households was to track the barriers to educational attainment and the specific linkages between socio-economic status and education among these communities.
Understanding the Dynamics of M&As in Indian IT Sector: An Analysis of the Trends, Patterns, and Directions
Authors: Kar Rabi N. , Soni Amit
Published: June 2018

This study attempts to explore the trend of M&As by IT companies having headquarters in India. The results reveal that trend across the time is not unidirectional. Global recession of 2008 significantly affected the number of deals. It has more severe impact on international deals than on domestic deals. The study also revealed that companies engaged in more international deals than the domestic deals with USA alone, accounting for 56 percent of international deals. For domestic M&As, it has been found that the maximum number of target companies was located in Bengaluru, whereas the maximum number of acquirer companies was from Mumbai. Looking at the regional distribution of M&As, the study revealed that South India had dominant position followed by West, North and East India, respectively. This distribution of inorganic investment (through M&A) is very similar to the agglomeration of IT hubs and concentration of technical institutions in India. Another revealing finding of the study that majority of acquirer and target companies (42%) had headquarters in the same city, indicating that firms preferred deal partners in the same city.
Schmidite and wildenauerite, two new schoonerite-group minerals from the Hagendorf-Süd pegmatite, Oberpfalz, Bavaria
Authors: Grey Ian E. , Keck Erich , Kampf Anthony R. , Cashion John D. , MacRae Colin M. , Glenn Alexander M. , Gozukara Yesim
Published: June 2018

Schmidite, Zn(Fe3+0.5Mn2+0.5)2ZnFe3+(PO4)3(OH)3(H2O)8and wildenauerite, Zn(Fe3+0.5Mn2+0.5)2Mn2+Fe3+(PO4)3(OH)3(H2O)8are two new oxidised schoonerite-group minerals from the Hagendorf-Süd pegmatite, Hagendorf, Oberpfalz, Bavaria, Germany. Schmidite occurs as radiating sprays of orange–brown to copper-red laths on and near to altered phosphophyllite in a corroded triphylite nodule, whereas wildenauerite forms dense compacts of red laths, terminating Zn-bearing rockbridgeite. The minerals are biaxial (+) with α = 1.642(2), β = 1.680(1), γ = 1.735(2) and 2Vmeas= 81.4(8)° for schmidite, and with α = 1.659(3), β = 1.687(3), γ = 1.742(3) and 2Vmeas= 73(1)° for wildenauerite. Electron microprobe analyses, with H2O from thermal analysis and FeO/Fe2O3from Mössbauer spectroscopy, gave FeO 0.4, MgO 0.3, Fe2O323.5, MnO 9.0, ZnO 15.5, P2O527.6, H2O 23.3, total 99.6 wt.% for schmidite, and FeO 0.7, MgO 0.3, Fe2O325.2, MnO 10.7, ZnO 11.5, P2O527.2, H2O 24.5, total 100.1 wt.% for wildenauerite. The empirical formulae, scaled to 3 P and with OH–adjusted for charge balance are Zn1.47Mn2+0.98Mg0.05Fe2+0.04Fe3+2.27(PO4)3(OH)2.89(H2O)8.54for schmidite and Zn1.11Mn2+1.18Mg0.05Fe2+0.08Fe3+2.47(PO4)3(OH)3.25(H2O)9.03for wildenauerite. The two minerals have orthorhombic symmetry, space groupPmabandZ= 4. The unit-cell parameters from refinement of powder X-ray diffraction data area= 11.059(1),b= 25.452(1) andc= 6.427(1) Å for schmidite, anda= 11.082(1),b= 25.498(2) andc= 6.436(1) Å for wildenauerite. The crystal structures of schmidite and wildenauerite differ from that of schoonerite in having minor partitioning of Zn from the[5]Zn site to an adjacent vacant tetrahedral site[4]Zn, separated by ~1.0 Å from[5]Zn. The two minerals are distinguished by the cation occupancies in the octahedralM1 toM3 sites. Schmidite hasM1 =M2 = (Fe3+0.5Mn2+0.5) andM3 = Zn and wildenauerite hasM1 =M2 = (Fe3+0.5Mn2+0.5) andM3 = Mn2+.
SRC-3 is involved in maintaining hematopoietic stem cell quiescence by regulation of mitochondrial metabolism in mice
Authors: Hu Mengjia , Zeng Hao , Chen Shilei , Xu Yang , Wang Song , Tang Yong , Wang Xinmiao , Du Changhong , Shen Mingqiang , Chen Fang , Chen Mo , Wang Cheng , Gao Jining , Wang Fengchao , Su Yongping , Wang Junping
Published: June 2018

Key Points

SRC-3 deficiency causes reduced quiescence and functional impairment of HSCs. SRC-3 participates in HSC quiescence maintenance by regulating mitochondrial metabolism.
Postnatal developmental dynamics of cell type specification genes in Brn3a/Pou4f1 Retinal Ganglion Cells
Authors: Muzyka Vladimir Vladimirovich , Brooks Matthew , Badea Tudor Constantin
Published: June 2018

Background

About 20–30 distinct Retinal Ganglion Cell (RGC) types transmit visual information from the retina to the brain. The developmental mechanisms by which RGCs are specified are still largely unknown. Brn3a is a member of the Brn3/Pou4f transcription factor family, which contains key regulators of RGC postmitotic specification. In particular, Brn3a ablation results in the loss of RGCs with small, thick and dense dendritic arbors (‘midget-like’ RGCs), and morphological changes in other RGC subpopulations. To identify downstream molecular mechanisms underlying Brn3a effects on RGC numbers and morphology, our group recently performed a RNA deep sequencing screen for Brn3a transcriptional targets in mouse RGCs and identified 180 candidate transcripts.

Methods

We now focus on a subset of 28 candidate genes encoding potential cell type determinant proteins. We validate and further define their retinal expression profile at five postnatal developmental time points between birth and adult stage, using in situ hybridization (ISH), RT-PCR and fluorescent immunodetection (IIF).

Results

We find that a majority of candidate genes are enriched in the ganglion cell layer during early stages of postnatal development, but dynamically change their expression profile. We also document transcript-specific expression differences for two example candidates, using RT-PCR and ISH. Brn3a dependency could be confirmed by ISH and IIF only for a fraction of our candidates.

Conclusions

Amongst our candidate Brn3a target genes, a majority demonstrated ganglion cell layer specificity, however only around two thirds showed Brn3a dependency. Some were previously implicated in RGC type specification, while others have known physiological functions in RGCs. Only three genes were found to be consistently regulated by Brn3a throughout postnatal retina development – Mapk10, Tusc5 and Cdh4.
A denoising framework for microseismic and reflection seismic data based on block matching
Authors: Zhang Chao , van der Baan Mirko
Published: June 2018

Microseismic and seismic data with a low signal-to-noise ratio affect the accuracy and reliability of processing results and their subsequent interpretation. Thus, denoising is of great importance. We have developed an effective denoising framework for surface (micro)-seismic data using block matching. The novel idea of the proposed framework is to enhance coherent features by grouping similar 2D data blocks into 3D data arrays. The high similarities in the 3D data arrays benefit any filtering strategy suitable for multidimensional noise suppression. We test the performance of this framework on synthetic and field data with different noise levels. The results demonstrate that the block-matching-based framework achieves state-of-the-art denoising performance in terms of incoherent-noise attenuation and signal preservation.
Horses for courses: choosing an evidence-based psychological therapy for your patient
Authors: McCormack David , Chalder Trudie
Published: June 2018

Choosing an intervention for a patient experiencing distressing symptoms and/or suffering with a mental disorder is part of routine practice for clinicians. While there are now many effective pharmacological and psychological therapies for mental health problems, syndromes and persistent physical symptoms (e.g. chronic pain), choosing the ‘right’ therapy can sometimes be a challenge. This can certainly be the case when it comes to psychological therapies. There are many different approaches to choose from and many have not been subjected to rigorous study.

In this article, we aim to help inform and guide the busy clinician in choosing a psychological therapy for their patient. We give a brief overview of the major psychotherapy modalities and consider which guidelines to refer to and which psychological therapies have been found to be most effective for the presenting problem(s) seen in clinic. Lastly, we discuss the limitations of the current guidelines in relation to comorbid presentations and consider how this can be best addressed.

LEARNING OBJECTIVES

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Develop knowledge regarding the major psychotherapy approaches

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Be aware that there is no psychotherapy equivalence

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Learn that there is good evidence that some approaches are more effective than others for specific problems and be better able to choose a psychological therapy

DECLARATION OF INTEREST

D. McC. works on research trials funded by the Guy's and St Thomas’ Charity. T. C. receives salary support from the National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and receives several grants for evaluating the efficacy of different cognitive–behavioural approaches. This article received no specific grant from any funding agency, or from the commercial or not-for-profit sectors. The views expressed in this article are those of the authors and not necessarily those of the NIHR or the NHS.