bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of Pattern-Scaled Climate Projections under High-End Warming. Part I: Surface Air Temperature over Land
Authors: Osborn Timothy J. , Wallace Craig J. , Lowe Jason A. , Bernie Dan
Published: April 2018

Pattern scaling is widely used to create climate change projections to investigate future impacts. We consider the performance of pattern scaling for emulating the HadGEM2-ES general circulation model (GCM) paying particular attention to “high end” warming scenarios and to different choices of GCM simulations used to diagnose the climate change patterns. We demonstrate that evaluating pattern-scaling projections by comparing them with GCM simulations containing unforced variability gives a significantly less favorable view of the actual performance of pattern scaling. Using a four-member initial-condition ensemble of HadGEM2-ES simulations, we infer that the root-mean-square errors of pattern-scaled monthly temperature changes over land are less than 0.25°C for global warming up to approximately 3.5°C. Some regional errors are larger than this and, for this GCM, there is a tendency for pattern scaling to underestimate warming over land. For warming above 3.5°C, the pattern-scaled projection errors grow but remain small relative to the climate change signal. We investigate whether patterns diagnosed by pooling GCM experiments from several scenarios are suitable for emulating the GCM under a high-end warming scenario. For global warming up to 3.5°C, pattern scaling using this pooled pattern closely emulates GCM simulations. For warming beyond 3.5°C, pattern-scaling performance is notably improved by using patterns diagnosed only from the high-forcing representative concentration pathway 8.5 (RCP8.5) scenario. Assessments of climate change impacts under high-end warming using pattern-scaling projections could be improved by using change patterns diagnosed from pooled scenarios for projections up to 3.5°C above preindustrial levels and patterns diagnosed from only strong forcing simulations for projecting beyond that. Similar findings are obtained for five other GCMs.
An Operational Rapid Intensification Prediction Aid for the Western North Pacific
Authors: Knaff John A. , Sampson Charles R. , Musgrave Kate D.
Published: April 2018

This work describes tropical cyclone rapid intensification forecast aids designed for the western North Pacific tropical cyclone basin and for use at the Joint Typhoon Warning Center. Two statistical methods, linear discriminant analysis and logistic regression, are used to create probabilistic forecasts for seven intensification thresholds including 25-, 30-, 35-, and 40-kt changes in 24 h, 45- and 55-kt in 36 h, and 70-kt in 48 h (1 kt = 0.514 m s−1). These forecast probabilities are further used to create an equally weighted probability consensus that is then used to trigger deterministic forecasts equal to the intensification thresholds once the probability in the consensus reaches 40%. These deterministic forecasts are incorporated into an operational intensity consensus forecast as additional members, resulting in an improved intensity consensus for these important and difficult to predict cases. Development of these methods is based on the 2000–15 typhoon seasons, and independent performance is assessed using the 2016 and 2017 typhoon seasons. In many cases, the probabilities have skill relative to climatology and adding the rapid intensification deterministic aids to the operational intensity consensus significantly reduces the negative forecast biases.
Multiracial Identification and Racial Gaps: A Work in Progress
Authors: Bratter Jenifer L.
Published: April 2018

For nearly 20 years, the U.S. Census has allowed respondents to report multiple races, offering new opportunities to assess the well-being of multiracial groups. Multiple-race reporting provides much-needed nuance for assessing the racial stratification of social outcomes as the distinctions between racial groups is less clear. Here, I explore the promises and the pitfalls of working with multiple-race data in studies of race inequality. I begin with a discussion of prior work using multiple-race data, showing how they inform our understanding of race-based patterns, and also consider issues raised by the conceptual and methodological fuzziness inherent in using multiple-race responses. I then provide a brief picture of current racial differences in adult poverty rates for single- and multiple-race groups, revealing that some multiracial groups experience parity with single-race groups while others occupy a space in between. While these patterns are meaningful, multiple interpretations are possible given the nature of multiple-race data.
Finding the Lost Generation: Identifying Second-Generation Immigrants in Federal Statistics
Authors: Massey Douglas S.
Published: April 2018

This article underscores the importance of adding a question on parental birthplace to the American Community Survey (ACS). This question was removed from the long form of the U.S. Census after 1970 and replaced by a question on ancestry. While the former provides accurate information about a demographic fact that is critical to the identification of the children of immigrants, the latter refers to a subjective social construction that has limited utility for purposes of program administration, apportionment, or governance. At the time that the parental birthplace question was eliminated, the percentage of ACS respondents who were foreign-born had reached an all-time low, and the second generation was aging and shrinking, so the loss to the nation’s statistical system was not immediately apparent. With the revival of immigration in the final quarter of the twentieth century, the inability to identify and study the second generation has become glaringly apparent. Immigrants and their children now constitute a quarter of the U.S. population: their nonwhite racial origins and a widespread lack of legal documents among them render their prospects for integration uncertain. Our current inability to accurately measure progress between first- and second-generation immigrants now constitutes a major weakness in the U.S. statistical system.
Growing U.S. Ethnoracial Diversity: A Positive or Negative Societal Dynamic?
Authors: Bean Frank D.
Published: April 2018

Solving problems of race relations in the United States requires avoiding binary ethnoracial classifications and understanding the nature, extent, and consequences of today’s diversity resulting from immigration. Recent demographic change has involved not only growth in the size of the nonwhite U.S. population but also increases in the number of new ethnoracial groups. Modest socioeconomic improvements have recently occurred among most nonwhite groups, and the rise in the number of different groups has led to some positive changes (i.e., boosting intermarriage and multiracial identification, blurring color lines among ethnoracial groups, and fostering creativity and economic growth) without diminishing social cohesion and solidarity. However, the benefits of multigroup diversity appear not to have reached many Americans who have less felt the social and economic benefits of free trade, globalization, and immigration. This underscores the need for universal policies that transcend identity- and grievance-based politics and provide security and benefits for all Americans.
Railway History in English Local Records
Authors: Simmons Jack
Published: April 2018

In the last number of this JOURNAL the Archivist of the British Transport Commission described the records in his charge and the facilities he can offer to students who wish to consult them.1 The Commission's archives represent an amalgamation of the surviving official records of practically all the British railway and canal companies. Necessarily, therefore, they form the most important single source of material to the transport historian in this country, rivalled only by the records of the Board of Trade, now in the Public Record Office. But these are not the only sources; and it will be the object of this paper, and some of its successors in this series, to describe other groups of documents that can usefully supplement the two great metropolitan collections.
The Impact of Religion on Family Functioning in Low-Income African American Families With Adolescents
Authors: Sisselman-Borgia Amanda , Budescu Mia , Taylor Ronald D.
Published: April 2018

The current study explores the association between religion and family functioning. Specifically, this study examined whether two aspects of religion, social religious support (from clergy and members of the congregation) and support from God (or spirituality), were related to frequency of household routines and parenting strategies as reported by both parents and adolescents, as well as adolescent problem behaviors. The sample consisted of 115 low-income African American mother-adolescent (age 14-18 years) dyads. Families were recruited as part of a larger study on the lives of low-income African American families with adolescents. Results indicated that higher levels of social religious support and spirituality were associated with increased levels of family routine as reported by caregivers. These results highlight the important roles relationships with God and other church members may play in supporting the lives of low-income African American parents and their children.
Long-term follow-up of clozapine prescribing
Authors: Gee Siobhan H , Shergill Sukhwinder S , Taylor David M
Published: April 2018

Objective:

Clozapine is uniquely effective for treatment-resistant schizophrenia, and so treatment continuation is essential. We aimed to identify factors associated with an increased likelihood of clozapine discontinuation in a cohort of patients in South East London.

Methods:

We gathered demographic and treatment information such as duration of illness and antipsychotic treatment history. t-tests, chi-square tests and binary logistic regression were used to compare patients who continued and discontinued clozapine during the study and to identify predictor variables for discontinuation.

Results:

Out of the study population of 133 patients, 48 discontinued clozapine at least once during the study period. The majority of these (75%) stopped treatment within the first 4 years of clozapine therapy. Age, ethnicity, diagnosis and antipsychotic treatment history were not predictive of the risk of clozapine discontinuation. However, male patients were more likely to stop taking clozapine (χ2 = 6.81, p = 0.009). The odds of discontinuing clozapine were 2.15 times higher for male patients. The most common reason for discontinuation was patient refusal of treatment.

Conclusion:

We found that patients who discontinue clozapine are more likely to be male, but no other demographic variable was found to predict treatment cessation. Discontinuation usually occurred due to patient refusal of treatment.
A case of ankylosing spondylitis with concurrent Takayasu arteritis
Authors: Matsushita Masakazu , Kobayashi Shigeto , Tada Kurisu , Hayashi Eri , Yamaji Ken , Amano Atsushi , Tamura Naoto
Published: April 2018

We herein report a case involving a 56-year-old man who had experienced neck and lower back pain since the age of 23 years. Ankylosing spondylitis (AS) was diagnosed at 41 years of age, and treatment with sulfasalazine was initiated. At 44 years of age, the patient developed respiratory distress on exertion and chest pain. Aortic regurgitation (AR) was diagnosed via echocardiography, and the patient presented to our hospital for close examination and treatment. Coronary computed tomography angiography revealed no lesions in the coronary artery; however, magnetic resonance angiography revealed stenotic lesions in the left common carotid artery and left subclavian artery. Based on the findings of a physical examination, fundus examination, and blood tests, the patient was diagnosed with AS with concurrent Takayasu arteritis (TA). Upon administration of steroids to alleviate inflammation caused by an autoimmune mechanism, the patient’s chest symptoms and inflammatory findings improved. AR was treated with aortic valve replacement and prosthetic blood vessel replacement, after which the patient progressed well. Intraoperative aortic biopsy revealed findings pathologically consistent with TA. Although AS with concurrent AR is well described, AS with concurrent TA, as in the present case, is rare.
Inversion Impairs Expert Budgerigar Identity Recognition: A Face-Like Effect for a Nonface Object of Expertise
Authors: Campbell Alison , Tanaka James W.
Published: April 2018

The face-inversion effect is the finding that picture-plane inversion disproportionately impairs face recognition compared to object recognition and is now attributed to greater orientation-sensitivity of holistic processing for faces but not common objects. Yet, expert dog judges have showed similar recognition deficits for inverted dogs and inverted faces, suggesting that holistic processing is not specific to faces but to the expert recognition of perceptually similar objects. Although processing changes in expert object recognition have since been extensively documented, no other studies have observed the distinct recognition deficits for inverted objects-of-expertise that people as face experts show for faces. However, few studies have examined experts who recognize individual objects similar to how people recognize individual faces. Here we tested experts who recognize individual budgerigar birds. The effect of inversion on viewpoint-invariant budgerigar and face recognition was compared for experts and novices. Consistent with the face-inversion effect, novices showed recognition deficits for inverted faces but not for inverted budgerigars. By contrast, experts showed equal recognition deficits for inverted faces and budgerigars. The results are consistent with the hypothesis that processes underlying the face-inversion effect are specific to the expert individuation of perceptually similar objects.
Perivascular Leiomyomatosis: A Unique Case Report
Authors: Wolfe Scott , Sullivan James , Kahn Leonard
Published: April 2018

There are 3 histologically benign smooth muscle neoplasms that have unusual growth patterns. These include intravascular leiomyomatosis, benign metastasizing leiomyoma, and leiomyomatosis peritonealis desseminata. We report a unique case of perivascular leiomyomatosis. The tumor showed multiple nodules of benign smooth muscle with some of the nodules closely associated with the periphery of the medial muscle layer of venous channels. All the neoplastic nodules were located on the outer surface of venous channels, thus precluding a diagnosis of intravascular leiomyomatosis. To the best of our knowledge, this is the first documentation of such an entity.
Identification of Inequalities in the Selection of Liver Surgery for Colorectal Liver Metastases in Sweden
Authors: Norén A. , Sandström P. , Gunnarsdottir K. , Ardnor B. , Isaksson B. , Lindell G. , Rizell M.
Published: April 2018

Background:

Liver resection for colorectal liver metastases offers a 5-year survival rate of 25%–58%. This study aimed to analyze whether patients with colorectal liver metastases undergo resection to an equal extent and whether selection factors play a role in the selection process.

Material and Methods:

Data were retrieved from the Swedish Colorectal Cancer Registry (2007–2011) for colorectal cancer and colorectal liver metastases. The patients identified were linked to the Swedish Registry of Liver and Bile surgery and the National Patient Registry to identify whether liver surgery or ablative treatment was performed. Analyses for age, sex, type of primary tumor and treating hospital (university, county, or district), American Society of Anesthesiologists class, and radiology for detection of metastatic disease were performed.

Results:

Of 28,355 patients with colorectal cancer, 21.6% (6127/28,355) presented with liver metastases. Of the patients with liver metastases, 18.5% (1134/6127) underwent liver resection or ablation. The cumulative proportion of liver resection/ablation was 4% (1134/28,355) of all colorectal cancer. If “not bowel resected” were excluded, the proportion slightly increased to 4.7% (1134/24,262). Around 15% of the patients with metastases were registered as referrals for liver surgery. In a multivariable analysis patients treated at a university hospital for primary tumor were more frequently surgically treated for liver metastases (p < 0.0001). Patients with liver metastases from rectal cancer (p < 0.0001) and men more often underwent liver resection (p = 0.006). A difference was found between health-care regions for the frequency of liver surgery (p < 0.0001). Patients >70 years and those with American Society of Anesthesiologists class >2 underwent liver resection less frequently. Magnetic resonance imaging of the liver was more often used in diagnostic work-up in men.

Conclusion:

Patients with colorectal liver metastases are unequally treated in Sweden, as indicated by the low referral rate. The proximity to a hepatobiliary unit seems important to enhance the patient’s chances of being offered liver surgery.
A framework for secure and decentralized sharing of medical imaging data via blockchain consensus
Authors: Patel Vishal
Published: April 2018

The electronic sharing of medical imaging data is an important element of modern healthcare systems, but current infrastructure for cross-site image transfer depends on trust in third-party intermediaries. In this work, we examine the blockchain concept, which enables parties to establish consensus without relying on a central authority. We develop a framework for cross-domain image sharing that uses a blockchain as a distributed data store to establish a ledger of radiological studies and patient-defined access permissions. The blockchain framework is shown to eliminate third-party access to protected health information, satisfy many criteria of an interoperable health system, and readily generalize to domains beyond medical imaging. Relative drawbacks of the framework include the complexity of the privacy and security models and an unclear regulatory environment. Ultimately, the large-scale feasibility of such an approach remains to be demonstrated and will depend on a number of factors which we discuss in detail.
The platformization of cultural production: Theorizing the contingent cultural commodity
Authors: Nieborg David B , Poell Thomas
Published: April 2018

This article explores how the political economy of the cultural industries changes through platformization: the penetration of economic and infrastructural extensions of online platforms into the web, affecting the production, distribution, and circulation of cultural content. It pursues this investigation in critical dialogue with current research in business studies, political economy, and software studies. Focusing on the production of news and games, the analysis shows that in economic terms platformization entails the replacement of two-sided market structures with complex multisided platform configurations, dominated by big platform corporations. Cultural content producers have to continuously grapple with seemingly serendipitous changes in platform governance, ranging from content curation to pricing strategies. Simultaneously, these producers are enticed by new platform services and infrastructural changes. In the process, cultural commodities become fundamentally “contingent,” that is increasingly modular in design and continuously reworked and repackaged, informed by datafied user feedback.
Study on a supercritical CO2 solar water heater system induced by the natural circulation
Authors: Zhang Xing-Wei , Niu Xiao-Dong , Yamaguchi Hiroshi , Iwamoto Yuhiro
Published: April 2018

This article proposes a solar water heater system induced by natural convective flow using supercritical CO2 as a working fluid. In order to investigate the characteristics of the system, the dynamic characteristics and heat transfer property of the supercritical CO2 flow are measured under variable ambient conditions. The performance parameters such as the heat recovery efficiency, effective energy efficiency ratio, effective energy efficiency, highest temperature of the water, and the amount of hot water supplied by this heater system are presented and analyzed in detail. The effects of weather and season on the system performance are respectively examined. Furthermore, the methods to obtain higher efficiency of the system are also studied. The current results indicate that the circulation of supercritical CO2 flow in this solar heater system can be easily induced by natural convection. Without a driving pump, the highest heat recovery efficiency can be up to 90.4%, which is higher than the efficiencies of other conventional solar water heater systems. It is also found that the natural convection in the system is mainly affected by the intensity, stability, and continuity of solar radiation in a day. Furthermore, the amount of hot water supplied by this system is adequate for an ordinary house-hold usage with the highest temperature of the hot water in summer being 78°C.
Fault isolation of thrusters under redundancy in frame-structure unmanned underwater vehicles
Authors: Liu Fuqiang , Xu Demin , Yu Jin , Bai Long
Published: April 2018

This article deals with fault isolation issue for the redundant thrusters of frame-structure unmanned underwater vehicles (UUVs). Consistency check is adopted to accomplish this task while solving the reformed control input equations that are produced after getting rid of some fault-free terms from the given equations. Specially selected column vectors from the given control matrix together with the corresponding hypothetical thrust output faults are taken as the known/unknown elements for these equations. Redundant relations among the thrusters support the vector selection, which are revealed by analyzing the maximally linearly independent vectors of the given control matrix. Simulation with faulty thrusters under redundancy in a frame-structure unmanned underwater vehicle illustrates the effectiveness of the proposed methodologies.
Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke
Authors: Hirayama Atsushi , Goto Tadahiro , Faridi Mohammad K , Camargo Carlos A , Hasegawa Kohei
Published: April 2018

Background

Little is known about the association between age and readmission within 30 days after hospitalization for acute ischemic stroke.

Aim

To examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke.

Methods

In this retrospective, population-based cohort study using State Inpatient Databases from eight US states, we identified all adults hospitalized for acute ischemic stroke. We grouped the patients into four age categories: < 65, 65–74, 75–84, and ≥85 years. Outcomes were any-cause readmission within 30 days of discharge from the index hospitalization for acute ischemic stroke and the principal diagnosis of 30-day readmission.

Results

We identified 620,788 hospitalizations for acute ischemic stroke. The overall 30-day readmission rate was 16.6% with an increase with advanced age. Compared to patients aged <65 years, the readmission rate was significantly higher in age 65–74 years (OR 1.19; 95% CI 1.16–1.21), in age 75–84 years (OR 1.29; 95% CI 1.27–1.31), and in ≥ 85 years (OR 1.24; 95% CI 1.22–1.27; all P<0.001). There was heterogeneity in the age-readmission rate association between men and women (Pinteraction < 0.001). Overall, 45.8% of readmissions were assigned stroke-related conditions or rehabilitation care. Compared to younger adults, older adults were more likely to present with non-stroke-related conditions (46.1% in < 65 years, 50.6% in 65–74 years, 57.1% in 75–84 years, and 62.9% in ≥ 85 years; P<0.001).

Conclusions

Advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.
Reconciling hospital-acquired complications and CHADx+ in Victorian coded hospital data
Authors: Shepheard Jennie , Lapiz Elsa , Read Carla , Jackson Terri J
Published: April 2018

Background:

The Council of Australian Governments has focused the attention of health service managers and state health departments on a list of hospital-acquired complications (HACs) proposed as the basis of funding adjustments for poor quality of hospital inpatient care. These were devised for the Australian Commission on Safety and Quality in Health Care as a subset of their earlier classification of hospital-acquired complications (CHADx) and designed to be used by health services to monitor safety performance for their admitted patients.

Objective:

To improve uptake of both classification systems by clarifying their purposes and by reconciling the ICD-10-AM code sets used in HACs and the Victorian revisions to the CHADx system (CHADx+).

Method:

Frequency analysis of individual clinical codes with condition onset flag (COF 1) included in both classification systems using the Victorian Admitted Episodes Dataset for 2014/2015 ( n = 2,623,275 separations). Narrative description of the resulting differences in definition of “adverse events” embodied in the two systems.

Results:

As expected, a high proportion of ICD-10-AM codes used in the HACs also appear in CHADx+, and given the wider scope of CHADx+, it uses a higher proportion of all COF 1 diagnoses than HACs (82% vs. 10%). This leads to differing estimates of rates of adverse events: 2.12% of cases for HACs and 11.13% for CHADx+. Most CHADx classes (70%) are not covered by the HAC system; discrepancies result from the exclusion from HACs of several major CHADx+ groups and from a narrower definition of detailed HAC classes compared with CHADx+. Case exclusion criteria in HACs (primarily mental health admissions) resulted in a very small proportion of discrepancies (0.13%) between systems.

Discussion:

Issues of purpose and focus of these two Australian systems, HACs for clinical governance and CHADx+ for local quality improvement, explain many of the differences between them, and their approach to preventability, and risk stratification.

Conclusion:

A clearer delineation between these two systems using routinely coded hospital data will assist funders, clinicians, quality improvement professionals and health information managers to understand discrepancies in case identification between them and support their different information needs.
Non-Destructive Spectroscopic Assessment of High and Low Weight Bearing Articular Cartilage Correlates with Mechanical Properties
Authors: Karchner James P. , Yousefi Farzad , Bitman Stephanie R. , Darvish Kurosh , Pleshko Nancy
Published: April 2018

Objective

Autologous articular cartilage (AC) harvested for repair procedures of high weight bearing (HWB) regions of the femoral condyles is typically obtained from low weight bearing (LWB) regions, in part due to the lack of non-destructive techniques for cartilage composition assessment. Here, we demonstrate that infrared fiber optic spectroscopy can be used to non-destructively evaluate variations in compositional and mechanical properties of AC across LWB and HWB regions.

Design

AC plugs ( N = 72) were harvested from the patellofemoral groove of juvenile bovine stifle joints, a LWB region, and femoral condyles, a HWB region. Near-infrared (NIR) and mid-infrared (MIR) fiber optic spectra were collected from plugs, and indentation tests were performed to determine the short-term and equilibrium moduli, followed by gravimetric water and biochemical analysis.

Results

LWB tissues had a significantly greater amount of water determined by NIR and gravimetric assay. The moduli generally increased in tissues from the patellofemoral groove to the condyles, with HWB condyle cartilage having significantly higher moduli. A greater amount of proteoglycan content was also found in HWB tissues, but no differences in collagen content. In addition, NIR-determined water correlated with short-term modulus and proteoglycan content ( R = −0.40 and −0.31, respectively), and a multivariate model with NIR data was able to predict short-term modulus within 15% error.

Conclusions

The properties of tissues from LWB regions differ from HWB tissues and can be determined non-destructively by infrared fiber optic spectroscopy. Clinicians may be able to use this modality to assess AC prior to harvesting osteochondral grafts for focal defect repair.
Change in R wave in lead V1 predicts survival of patients with pulmonary arterial hypertension
Authors: Sato Shinji , Ogawa Aiko , Matsubara Hiromi
Published: April 2018

Clinical guidelines for pulmonary hypertension recommend evaluating treatment response through various methods; however, electrocardiography (ECG) is not included as one of the methods of choice. We aimed to identify ECG parameters that correlated with prognosis in patients with pulmonary arterial hypertension (PAH). A total of 112 consecutive patients with PAH were enrolled in this study. Among them, 83 with treatment escalation were studied for further analysis. Survival analyses were conducted using the Kaplan–Meier method with the log‐rank test. Cox proportional hazards regression modeling was used to identify predictors of survival. Receiver operating characteristic analysis was used to determine cut‐off values for selected variables. ECG parameters were changed from baseline to three months after treatment. Patients in whom the R wave amplitude in lead V1 decreased by ≥1 mm (0.1 mV) within three months demonstrated significantly better survival (P = 0.017). Our results suggest that evaluation of ECG parameters can contribute to assessments of survival in patients with PAH.
Algorithmic affordances for productive resistance
Authors: Ettlinger Nancy
Published: April 2018

Although overarching if not foundational conceptualizations of digital governance in the field of critical data studies aptly account for and explain subjection, calculated resistance is left conceptually unattended despite case studies that document instances of resistance. I ask at the outset why conceptualizations of digital governance are so bleak, and I argue that all are underscored implicitly by a Deleuzian theory of desire that overlooks agency, defined here in Foucauldian terms. I subsequently conceptualize digital governance as encompassing subjection as well as resistance, and I cast the two in relational perspective by making use of the concepts “affordance” and “assemblage” in conjunction with multiple subjectivities and Foucault's view of power as productive as well as his view of resistance as an “antagonism of strategies” in his late scholarship on resistance, ethics, and subjectivity. I offer examples of salient modes of what I call “productive” resistance (as opposed to resistance by way of avoidance, disruption or obfuscation), and from a Foucauldian perspective I explain how each mode targets and subverts technologies of repressive power to produce new elements of the digital environment and construct new truths. I conclude by recognizing the agency embodied in resistance as an end in itself, but I also consider that modes of productive resistance can have extrinsic value as they affect the fluid interaction among elements of the digital environment, potentially disrupting the presumed structure of dominance and dependence, and opening our conceptualization of algorithmic life to hopeful possibilities for change.
Interstage Outcomes in Infants With Single Ventricle Heart Disease Comparing Home Monitoring Technology to Three-Ring Binder Documentation: A Randomized Crossover Study
Authors: Bingler Michael , Erickson Lori A. , Reid Kimberly J. , Lee Brian , O’Brien James , Apperson Johnathan , Goggin Kathy , Shirali Girish
Published: April 2018

Background:

Interstage outcomes for infants with single ventricle remain suboptimal. We have previously described a tablet PC-based platform Cardiac High Acuity Monitoring Program (CHAMP) for remote monitoring which provides immediate access to data, videos, and instant alerts to our single ventricle care team.

Methods:

This study compares traditional three-ring binder monitoring (Binder) to CHAMP using a randomized crossover design to evaluate mortality, resource utilization, and caregiver experience. At discharge, all single ventricle infants were monitored using Binder and randomized to receive CHAMP at either one or two months postdischarge. One month after randomization, caregivers could choose either Binder or CHAMP for the remainder of the interstage period. Caregivers experience was recorded using surveys.

Results:

Enrollment included 31 single ventricle infants from May 2014 to June 2015. There was no interstage mortality over 4,911 total interstage days (median: 144/patient). Of 73 readmissions, 45 were unplanned. Of the initial 23 unplanned readmissions, 13 were found to have been based on data obtained exclusively through CHAMP (as instant alerts or based on data review) rather than caregiver concerns. Due to concerns regarding patient safety, additional enrollment was stopped. The CHAMP use was associated with significantly fewer unplanned intensive care unit days/100 interstage days, shorter delays in care, lower resource utilization at readmissions, and lower incidence of interstage growth failure and was preferred by a majority of caregivers.

Conclusions:

These findings suggest that CHAMP may offer benefits over Binder (improved interstage outcomes, delays in care, and caregiver experience). These findings should be tested across multiple centers in larger populations.
Women Plastic Surgeons of Canada: Empowherment Through Education and Mentorship
Authors: Retrouvey Helene , Gdalevitch Perry
Published: April 2018

Gender disparity in plastic surgery in Canada is an important issue. The Women Plastic Surgeons of Canada (WPSC) group was created to highlight the interests and concerns of female members of the Canadian Society of Plastic Surgeons (CSPS). Women Plastic Surgeons of Canada seeks to teach and implement measures to overcome the internal and external factors contributing to “the plastic ceiling.” In addition, the WPSC group was created to raise awareness about the gender gap in our leadership and implement strategies to empower female surgeons to “lean in” and seek out leadership roles in plastic surgery. Education, mentorship, and networking among female CSPS members are first steps in empowering our female surgeons. All members of the CSPS are encouraged to learn about gender disparity in order to work together to address this issue.
Factors Affecting the Achievement of a Patient-Acceptable Symptom State 1 Year After Anterior Cruciate Ligament Reconstruction: A Cohort Study of 343 Patients From 2 Registries
Authors: Hamrin Senorski Eric , Svantesson Eleonor , Beischer Susanne , Grassi Alberto , Krupic Ferid , Thomeé Roland , Samuelsson Kristian
Published: April 2018

Background:

There is insufficient knowledge regarding the influence of concomitant injuries on the recovery of short-term subjective knee function after anterior cruciate ligament (ACL) reconstruction.

Purpose:

To determine whether patient characteristics, concomitant injuries, and graft choice during ACL reconstruction can predict which patients achieve acceptable knee function 1 year after reconstruction.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Data from 1 physical therapist–specific and 1 surgeon-specific register were used. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at 1-year follow-up were included. Additional intraoperative information was extracted from a database. The primary outcome was achieving a patient-acceptable symptom state (PASS) for each subscale of the KOOS. Univariable and multivariable logistic regression models were used, with patient sex, age, and preinjury level of physical activity as covariates.

Results:

A total of 343 patients (51% females) were included. The proportion of patients achieving PASS 1 year after ACL reconstruction varied between 40% and 85% among the KOOS subscales. Younger age at reconstruction and male sex provided favorable odds of achieving acceptable knee function across the KOOS subscales. Patients without cartilage injury had increased odds of achieving PASS in the KOOS sport and recreation subscale; the increase was 1.63-fold (95% CI, 1.01-2.64; P = .045). Patients receiving patellar tendon autograft had a 0.41-fold (95% CI, 0.19-0.85; P = .017) decrease in odds of achieving PASS on the KOOS quality of life (QoL) subscale. In the multivariable analysis, increased odds of achieving PASS on the KOOS QoL subscale were associated with the absence of meniscal injury (odds ratio, 1.62; 95% CI, 1.04-2.54; P = .035), and increased odds were found for hamstring tendon autograft (OR, 2.63; 95% CI, 1.25-5.56; P = .011).

Conclusion:

More than half of the patients reported an acceptable symptom state on 4 of the 5 KOOS subscales 1 year after ACL reconstruction. A lack of consistency was noted related to the effect of concomitant knee injuries and graft choice on acceptable knee function. However, younger age and male sex were favorable, nonmodifiable characteristics that increased the odds of early acceptable function.
Pharmacokinetics of Iodine and Fluoride following Application of an Anticaries Varnish in Adults
Authors: Lin Y.S. , Rothen M.L. , Milgrom P.
Published: April 2018

Researchers have suggested that combining topical fluoride with an antiseptic to reduce cariogenic bacteria may be more effective than fluoride application alone in preventing dental caries. In previous studies, povidone iodine (PVP-I), a widely used bactericidal antiseptic, and sodium fluoride (NaF), used to foster remineralization of enamel, were applied sequentially topically and shown to be safe and effective. The study aim was to characterize the kinetics of iodine and fluoride following topical application of a single combination PVP-I and NaF anticaries varnish in healthy adults. Sixteen participants (aged 23 to 57 y) participated in a pharmacokinetics study following the application of 0.4 mL varnish containing 10% (w/v) PVP-I and 5% (w/v) NaF. Serum and urine samples were collected at various time points over 24 h following application of varnish. Iodine and fluoride concentrations were analyzed, and for each time point, baseline concentrations were subtracted from observed values. Following varnish application, 2 of 16 participants had nearly undetectable baseline-corrected iodine and fluoride levels, suggesting minimal absorption, lack of release of iodine and fluoride from the varnish, or inconsistent dosing. The average peak concentrations were 57 ± 33 ng/mL iodine and 60 ± 34 ng/mL (0.060 ± 0.034 ppm) fluoride and occurred within 3 h of application. The average elimination half-life was 5.5 ± 1.4 h and 3.1 ± 1.6 h for iodine and fluoride, respectively. Renal clearance of iodine and fluoride was similar to literature values. No adverse events related to the study varnish were observed by the investigative team or reported by the participants. In this study, serum fluoride and iodine transiently increased but were within normal range 24 h after application of the varnish. This study has shown that the combination of PVP-I and NaF in a proposed anticaries varnish was well tolerated.

Knowledge Transfer Statement: This clinical study demonstrated that a dental varnish combining 10% (w/v) povidone iodine and 5% (w/v) sodium fluoride is well tolerated. Serum fluoride and iodine transiently increased but were within normal range after 24 h. Further studies should be conducted to assess the efficacy of a combination in preventing dental caries, especially in high-risk populations.
Secure Authentication-Management human-centric Scheme for trusting personal resource information on mobile cloud computing with blockchain
Authors: Kim Hyun-Woo , Jeong Young-Sik
Published: April 2018

The recent advances in information technology for mobile devices have increased the work efficiency of users, the mobility of compact mobile devices, and the convenience of location independence. However, mobile devices have limited computing power and storage capacity, so mobile cloud computing is being researched to overcome these limitations in mobile devices. Mobile cloud computing is divided into two methods: the use of external cloud services and the use of mobile resource management without a cloud server (MRM), which integrates the computing and storage resources of nearby mobile devices. Because mobile devices can freely participate in MRM, it is critical to have authentication technology to determine the correctness of information regarding resources. Conventional technologies require strong authentication techniques because they have vulnerabilities that can easily be tampered with via man-in-the-middle (MITM) attacks. This paper proposes the Secure Authentication Management human-centric Scheme (SAMS) to authenticate mobile devices using blockchain for trusting resource information in the mobile devices that are participating in the MRM resource pool. The SAMS forms a blockchain based on the resource information of the subordinate client nodes around the master node in the MRM. Devices in the MRM that have not been authorized through the SAMS cannot access or falsify data. To verify the SAMS for application with MRM, it was tested for data falsification by a malicious user accessing the SAMS, and the results show that data falsification is impossible.
An observational case study of hospital associated infections in a critical care unit in Astana, Kazakhstan
Authors: Viderman Dmitriy , Khamzina Yekaterina , Kaligozhin Zhannur , Khudaibergenova Makhira , Zhumadilov Agzam , Crape Byron , Azizan Azliyati
Published: April 2018

Background

Hospital Associated infections (HAI) are very common in Intensive Care Units (ICU) and are usually associated with use of invasive devices in the patients. This study was conducted to determine the prevalence and etiological agents of HAI in a Surgical ICU in Kazakhstan, and to assess the impact of these infections on ICU stay and mortality.

Objective

To assess the rate of device-associated infections and causative HAI etiological agents in an ICU at the National Research Center for Oncology and Transplantation (NRCOT) in Astana, Kazakhstan.

Methods

This retrospective, observational study was conducted in a 12-bed ICU at the NRCOT, Astana, Kazakhstan. We enrolled all patients who were admitted to the ICU from January, 2014 through November 2015, aged 18 to 90 years of age who developed an HAI.

Results

The most common type of HAI was surgical site infection (SSI), followed by ventilator-associated pneumonia (VAP), catheter-related blood stream infection (BSI) and catheter-associated urinary tract infection (UTI). The most common HAI was SSI with Pseudomonas aeruginosa as the most common etiological agent. The second most common HAI was VAP also with P. aeruginosa followed by BSI which was also associated with P. aeruginosa (in 2014) and Enterococcus faecalis, and Klebsiella pneumoniae (in 2015) as the most common etiological agents causing these infections.

Conclusion

We found that HAI among our study population were predominantly caused by gram-negative pathogens, including P. aeruginosa, K. pneumoniae, and E. coli. To our knowledge, this is the only study that describes ICU-related HAI situation from a country within the Central Asian region. Many developing countries such as Kazakhstan lack surveillance systems which could effectively decrease incidence of HAIs and healthcare costs for their treatment. The epidemiological data on HAI in Kazakhstan currently is underrepresented and poorly reported in the literature. Based on this and previous studies, we propose that the most important interventions to prevent HAI at the NRCOT and similar Healthcare Institutions in Kazakhstan are active surveillance, regular infection control audits, rational and effective antibacterial therapy, and general hygiene measures.
Substance use disorders and sexually transmitted infections: a public health perspective
Authors: Murali Vijaya , Jayaraman Sabitha
Published: April 2018

It has long been recognised that substance use disorders and sexually transmitted infections (STIs) are common comorbid conditions. It is clear that treating one condition while leaving the other leads to increased morbidity and mortality in this patient population. However, engaging patients in treatment is extremely challenging, which is a huge public health concern. This article focuses on various sexually transmitted infections seen in the substance misuse population and means of primary, secondary and tertiary prevention.

Declaration of interest

None.

Learning objectives

•

Be aware of the current extent of comorbidity between substance use disorders and STIs

•

Learn about primary, secondary and tertiary prevention of STIs in people with substance use disorders

•

Understand the links between high-risk sexual behaviour and illicit drug use, as shown by current evidence
We all know what we mean by treatment-resistant depression – don't we?
Authors: Anderson Ian M.
Published: April 2018

Although in common use, treatment-resistant depression is unhelpful both conceptually and practically. In this issue a new term, multiple-therapy-resistant major depressive disorder, is proposed; although it may be useful in guiding treatment options for patients with persisting depression, it should not be an automatic trigger for further, more invasive treatments.

Declaration of interests

I.M.A. has been a consultant for pharmaceutical companies developing and marketing antidepressants and has been an author on publications that have used the term treatment-resistant depression.
Population Pharmacokinetics of Periarticular Ketorolac in Adult Patients Undergoing Total Hip or Total Knee Replacement Surgery
Authors: Gurunathan Usha , Parker Suzanne L. , Maguire Richard , Ramdath Dale , Bijoor Manu , Wallis Steven C. , Roberts Jason A.
Published: April 2018

BACKGROUND:

Ketorolac tromethamine has been used for joint infiltration by the orthopedic surgeons as a part of postoperative multimodal analgesia. The objective of this study is to investigate the pharmacokinetic properties of S (−) and R (+) enantiomers of ketorolac in adult patients undergoing total hip (THA) and knee arthroplasty (TKA).

METHODS:

Adult patients with normal preoperative renal function received a periarticular infiltration of 30 mg of ketorolac tromethamine along with 100 mL of 0.2% ropivacaine and 1 mg of epinephrine at the end of their THA or TKA surgery. Blood samples were taken from a venous cannula at various time points after infiltration. Pharmacokinetic modeling was performed using PMetrics 1.5.0.

RESULTS:

From 18 participants, 104 samples were analyzed. The peak plasma concentration for S (−) ketorolac was found to be lower than that of R (+) ketorolac, for both THA (0.19–1.22 mg/L vs 0.39–1.63 mg/L, respectively) and TKA (0.28–0.60 mg/L vs 0.48–0.88 mg/L, respectively). The clearance of the S (−) ketorolac enantiomer was higher than R (+) ketorolac (4.50 ± 2.27 vs 1.40 ± 0.694 L/h, respectively).

CONCLUSIONS:

Our study demonstrates that with periarticular infiltration, S (−) ketorolac was observed to have increased clearance rate and highly variable volume of distribution and lower peak plasma concentration compared to R (+) ketorolac.