bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of Regional Trade Agreements? Experience from India’s Regionalism
Authors: Jha Sejuti
Published: July 2013

In the last decade India’s trade policy has focussed on trade liberalization through Regional Trade Agreements (RTAs). This article poses the question whether RTAs benefit the trader, the ultimate user of such agreements. From a primary survey of Indian certifying agencies the article finds four interesting facts: (a) even though ISFTA is used mostly by Indian exporters, utilization rate for ISFTA is as low as 11 per cent; (b) SAPTA is preferred more than SAFTA, despite wider coverage of the latter; stricter Rules of Origin under SAFTA may be the reason; (c) Indian exporters export a lot to Singapore but not through the RTA, even though Singapore has given tariff-free entry to all Indian exports; low tariff preference margins, coupled with costs of proving origin, may be the reason for such low utilisation; (d) the whole gamut of RTAs has not been of much use to Indian exporters—the GSP is utilized much more (96 per cent of issued CoO) by Indian exporters than all of India’s RTAs put together
Influence and Legitimacy in African Regional Parliamentary Assemblies: The Case of the Pan-African Parliament’s Search for Legislative Powers
Authors: Nzewi Ogochukwu
Published: July 2013

This article examines non-legislative avenues for parliamentary influence and legitimacy in the Pan-African Parliament (PAP). It argues for an incremental approach to increasing the powers of the PAP. To make this case, the paper first expounds on the composite nature of regional parliaments, showing the convergence of complex political and institutional issues that make Regional Parliamentary Assemblies unique parliamentary entities. Given the unsuccessful attempt by the PAP to increase its legislative powers through an amendment of its protocol, the aim is to make an alternative argument for legislative powers by locating the legal and institutional legitimacy and influence drivers for the PAP.
Endoscopic third ventriculostomy on a microneurosurgery simulator
Authors: Jiang Di , Hovdebo Jordan , Cabral Anne , Mora Vincent , Delorme Sébastien
Published: July 2013

Endoscopic third ventriculostomy is a procedure used to treat hydrocephalus by making a perforation in the floor of the third ventricle of the brain under endoscopic guidance. We report on our initial experience in developing an endoscopic third ventriculostomy simulator for neurosurgery residents, including the definition of the simulation content and integration on NeuroTouch, a simulator for microneurosurgery training. The simulator includes exercises in which the trainee is asked to choose the location of the burr hole and the orientation of the trajectory to the foramen of Monro, or is required to find the third ventricle with a neuro-endoscope and perforate its floor. The simulator provides feedback on trainee performance either graphically or using quantitative metrics. The simulator allows easily switching from endoscopic third ventriculostomy mode to microscopic craniotomy mode using a retractable stereoscope based on a single screen and mirrors, detachable plastic heads, and quick-connect tool handles to give more realistic haptic feedback.
Income and child mortality in developing countries: a systematic review and meta-analysis
Authors: O'Hare Bernadette , Makuta Innocent , Chiwaula Levison , Bar-Zeev Naor
Published: July 2013

Objective

We aimed to quantify the relationship between national income and infant and under-five mortality in developing countries.

Design

We conducted a systematic literature search of studies that examined the relationship between income and child mortality (infant and/or under-five mortality) and meta-analysed their results.

Setting

Developing countries.

Main outcome measures

Child mortality (infant and /or under-five mortality).

Results

The systematic literature search identified 24 studies, which produced 38 estimates that examined the impact of income on the mortality rates. Using meta-analysis, we produced pooled estimates of the relationship between income and mortality. The pooled estimate of the relationship between income and infant mortality before adjusting for covariates is −0.95 (95% CI −1.34 to −0.57) and that for under-five mortality is −0.45 (95% CI −0.79 to −0.11). After adjusting for covariates, pooled estimate of the relationship between income and infant mortality is −0.33 (−0.39 to −0.26) while the estimate for under-five mortality is −0.28 (−0.37 to −0.19). If a country has an infant mortality of 50 per 1000 live births and the gross domestic product per capita purchasing power parity increases by 10%, the infant mortality will decrease to 45 per 1000 live births.

Conclusion

Income is an important determinant of child survival and this work provides a pooled estimate for the relationship.
An evaluation of the psychological impact of operational rest and recuperation in United Kingdom Armed Forces personnel: a post-intervention survey
Authors: Jones Norman , Fertout Mohammed , Parsloe Laura , Greenberg Neil
Published: July 2013

Objective

Rest and Recuperation (R&R) is a period of home leave taken during an operational deployment; we sought to examine the relationship between taking R&R and mental health.

Design

A survey-based post-intervention evaluation.

Setting

UK

Participants

232 members of the UK Armed Forces; 42 of which completed pre and post R&R surveys.

Main Outcome Measures

Alcohol use, Post Traumatic Stress Disorder, Common Mental Disorder Symptoms and R&R experiences.

Results

12.1% of respondents (n=27) reported symptoms of common mental disorder and 3.7% (n=8) reported probable PTSD. 50.0% (n=110) reported hazardous use of alcohol during R&R. In the pre- and post-assessed sample, mental health status and alcohol use levels were similar at both survey points. Using principal component analysis, five components of R&R were identified; mentally switching off from deployment, travel experience, physical recovery, relaxation, rest and social support. R&R was extremely popular and although it did not improve mental health overall, the ability to engage with or derive satisfaction from aspects of the five components was significantly associated with better mental health and less alcohol use at the end of R&R.

Conclusion

Operational commanders should advise personnel about the best way to actively engage with R&R before they leave theatre and be aware of the significant detrimental impact of disrupted travel arrangements upon the ability to benefit from R&R.
Live viruses to treat cancer
Authors: Donnelly Oliver , Harrington Kevin , Melcher Alan , Pandha Hardev
Published: July 2013

Viruses that selectively replicate in cancer cells, leading to the death of the cell, are being studied for their potential as cancer therapies. Some of these viruses are naturally occurring but cause little if any illness in humans; others have been engineered to make them specifically able to kill cancer cells while sparing normal cells. These oncolytic viruses may be selective for cancer cells because viral receptors are over-expressed on the surface of cancer cells or because antiviral pathways are distorted in cancer cells. Additionally, when oncolytic viruses kill cancer cells, it can stimulate an antitumour immune response from the host that can enhance efficacy. Numerous early phase trials of at least six oncolytic viruses have been reported with no evidence of concerning toxicity either as single agents or in combination with chemotherapies and radiotherapy. Three oncolytic viruses have reached randomized testing in cancer patients; reolysin in head and neck cancer and JX594 in hepatocellular cancers, while results from the first-phase III trial of T-vec in metastatic melanoma are expected shortly.
Spontaneous coronary artery dissection in a 38-year-old: stenting and/or surgery?
Authors: Smelt Jeremy , Youssefi Pouya , Soppa Gopal , Jahangiri Marjan
Published: July 2013

Spontaneous coronary artery dissection is a rare but important differential diagnosis in fit young women presenting with chest pain.
Dynamic modelling and parameter identification of a three-degree-of-freedom spherical actuator
Authors: Wu Xingming , Guo Fanghong , Liu Jingmeng , Chen Weihai , Wen Changyun
Published: July 2013

This paper addresses both dynamic modelling and dynamic parameter identification of a permanent magnet spherical actuator, which is capable of performing three-degree-of-freedom (DOF) motion in one single joint. The dynamic model of the spherical actuator is derived from Lagrange’s equations, but the parameters, called dynamic parameters, in the model are usually uncertain. Then the dynamic model is represented in a form that is linear in these parameters. A new identification method based on the output error (OE) method and recursive least square (LS) estimation is proposed to identify the parameters. This method only requires the current measurement of the stator coils in the identification procedure, which greatly simplifies the experimental process and improves the identification accuracy. Lastly, simulation and experimental results illustrate the effectiveness of the proposed method and its robustness to external disturbances. The proposed method can be also applied to other electromagnetic driving spherical actuators.
An adaptive clustering algorithm for road abnormal region analysis
Authors: Han Qingwen , Zeng Lingqiu , Liu Yingsen , Liu Yuebo
Published: July 2013

Building effective vehicular cyber-physical systems to improve road safety is a non-trivial challenge. The abnormal region of road –‘road abnormal region’– is one of the main reasons for traffic congestion and thus should be taken into account in order to inform the design of a road monitoring mechanism and navigation service. The characteristics of the abnormal region (AR) are investigated in this paper and an evaluation criterion is suggested. AnyLogic 6.0 (Education) is the platform used to simulate the generation of AR and its changing procedure, which provides justification for the proposed algorithm.
Gifted Education in German-Speaking Europe
Authors: Ziegler Albert , Stoeger Heidrun , Harder Bettina , Balestrini Daniel Patrick
Published: July 2013

The authors first briefly describe how the concepts of talents and giftedness found in German-speaking Europe have evolved in the school system and in general over the past two centuries, and how the variety of gifted-education efforts found within and beyond schools as well as counseling efforts attest to these changes. They then discuss four hallmarks of gifted education in German-speaking Europe: (a) the ongoing development of gifted promotion methods through the integration of newer insights about learning and social aspects; (b) the development of new methods of gifted education, particularly in the areas of mentoring, self-regulated learning, and hybrid approaches; (c) a decidedly scientific approach, which is increasingly characterized by systemic perspectives; and (d) the results of research on the effectiveness of various approaches to gifted education in German-speaking Europe.
Tissue Expression and Correlation of a Panel of Urinary Biomarkers Following Cisplatin-induced Kidney Injury
Authors: Wadey Rebecca M. , Pinches Mark G. , Jones Huw B. , Riccardi Daniela , Price Sally A.
Published: July 2013

In recent years, there has been considerable activity to identify urinary biomarkers of nephrotoxicity as noninvasive measurements with greater sensitivity and specificity than traditional biomarkers, such as serum creatinine and blood urea nitrogen. Our study aimed to use cisplatin-treated rats to evaluate the use of immunohistochemistry directed at multiple urinary biomarkers in kidney tissue. Tissue levels were compared to urinary levels of these biomarkers to demonstrate tissue specificity and sensitivity. These techniques could also be used in studies where urine samples are not available, such as retrospective studies in drug safety testing, to demonstrate the potential utility of using these biomarkers in future preclinical or clinical studies. All of the biomarkers investigated showed either an increase (kidney injury molecule [KIM-1], osteopontin [OPN], and, clusterin) or a decrease (alpha-glutathione S-transferase and trefoil factor 3) except beta 2 microglobulin (β2MG) that showed no significant changes 5 days after 1.0 mg/kg or 2.5 mg/kg cisplatin treatment. All of the biomarkers except β2MG showed utility as tissue biomarkers, but KIM-1 and OPN expression correlated closely with urinary biomarker measurements and reflect tissue damage. Future studies are needed to determine the wider application of these two markers for detecting renal toxicity following administration of other nephrotoxicants.
Readiness for digital reference service (DRS) in university libraries
Authors: Malik Amara , Mahmood Khalid
Published: July 2013

The paper reports a research study aimed to explore the readiness for digital reference service (DRS) of university libraries of the province of Punjab, Pakistan, in terms of organizational awareness, willingness, planning and strength of resources. This descriptive research employed the survey method. The survey instrument (questionnaire) was reviewed by a panel of LIS experts of national level and was worded to achieve an official organizational response to probe the status. Thirty-eight libraries of Higher Education Commission (HEC) recognized universities participated in the study. The findings reveal that only a few libraries were at a level of DRS readiness while the others were adopting this system at a slow pace.
What we don’t (but should) teach young researchers
Authors: Dick Archie L
Published: July 2013

Emotions in research remain largely unaddressed. One reason is that we are beholden to a narrow social scientific conception of LIS (library and information science). By teaching young researchers where and how emotions operate in all phases of the research process we will discover some unexpected insights.
Spirituality and Desistance From Substance Use Among Reentering Offenders
Authors: Bakken Nicholas W. , DeCamp Whitney , Visher Christy A.
Published: July 2013

Prior research has indicated an inverse relationship between religion and criminal behavior; however, few studies have specifically examined the effect of spirituality on the desistance process among a contemporary and diverse sample of reentering drug-involved offenders. A comprehensive understanding of how spirituality is related to desistance from substance use can lead to more effective and evidence-based preventive and rehabilitative interventions. Using data from a longitudinal study of 920 diverse offenders returning to the community after a period of incarceration, the current study examines three distinct forms of substance use (alcohol, marijuana, and cocaine) to gauge the effect that spirituality plays in the desistance process. The findings suggest a relatively high importance of spirituality in terms of preventing substance use during reentry, particularly concerning the use of both alcohol and cocaine.
Efficacy of Platelet-Rich Plasma for Chronic Tennis Elbow
Authors: Mishra Allan K. , Skrepnik Nebojsa V. , Edwards Scott G. , Jones Grant L. , Sampson Steven , Vermillion Doug A. , Ramsey Matthew L. , Karli David C. , Rettig Arthur C.
Published: July 2013

Background:

Elbow tenderness and pain with resisted wrist extension are common manifestations of lateral epicondylar tendinopathy, also known as tennis elbow. Previous studies have suggested platelet-rich plasma (PRP) to be a safe and effective therapy for tennis elbow.

Purpose:

To evaluate the clinical value of tendon needling with PRP in patients with chronic tennis elbow compared with an active control group.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

A total of 230 patients with chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at least 3 months of symptoms and had failed conventional therapy. There were no differences in patients randomized to receive PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the point of care and contained both concentrated platelets and leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled with or without PRP. Patients and investigators remained blinded to the treatment group throughout the study. A successful outcome was defined as 25% or greater improvement on the visual analog scale for pain.

Results:

Patient outcomes were followed for up to 24 weeks. At 12 weeks (n = 192), the PRP-treated patients reported an improvement of 55.1% in their pain scores compared with 47.4% in the active control group ( P = .163). At 24 weeks (n = 119), the PRP-treated patients reported an improvement of 71.5% in their pain scores compared with 56.1% in the control group ( P = .019). The percentage of patients reporting significant elbow tenderness at 12 weeks was 37.4% in the PRP group versus 48.4% in the control group ( P = .143). Success rates for patients at 12 weeks were 75.2% in the PRP group versus 65.9% in the control group ( P = .104). At 24 weeks, 29.1% of the PRP-treated patients reported significant elbow tenderness versus 54.0% in the control group ( P = .009). Success rates for patients with 24 weeks of follow-up were 83.9% in the PRP group compared with 68.3% in the control group ( P = .037). No significant complications occurred in either group.

Conclusion:

No significant differences were found at 12 weeks in this study. At 24 weeks, however, clinically meaningful improvements were found in patients treated with leukocyte-enriched PRP compared with an active control group.
Morphology, thermal properties, and fire behavior of epoxy resin nanocomposites containing octaammonium polyhedral oligomeric silsesquioxane-modified montmorillonite
Authors: Pan Miao , Guan Dongbo , Wang Tingting , Huang Rong , Mu Jianxin , Zhang Chunling
Published: July 2013

A series of epoxy resin (EP) nanocomposites containing octaammonium polyhedral oligomeric silsesquioxane-modified montmorillonite (OAPOSS-MMT) was prepared via in situ polymerization using 4,4′-diaminodiphenyl sulfone as the curing agent. X-Ray diffraction and transmission electron microscopy were used to characterize the morphology of the resulting nanocomposites. Characterization results indicated the formation of intercalated and exfoliated structures. Thermogravimetric analysis (TGA) was performed to study the thermal properties of epoxy nanocomposites. Analysis results revealed that OAPOSS-MMT improved the thermal stability of EP matrix. TGA coupled with Fourier transform infrared spectrometry was used to detect pyrolytic gases. The gas species produced by epoxy nanocomposites were the same as those of control EP. A cone calorimeter was used to evaluate the flame retardancy of epoxy nanocomposites containing different concentrations of OAPOSS-MMT. Results showed that OAPOSS-MMT improved the flame retardancy of EP to some extent. The enhanced thermal oxidative stability was also confirmed by the data obtained through x-ray photoelectron spectroscopy.
Effects of damper failure on vehicle stability
Authors: Bedük M Durukan , Çalışkan Kemal , Henze Roman , Küçükay Ferit
Published: July 2013

The general approach in vehicle dynamics analysis is to use mint state characteristics of the chassis components in vehicle simulation models. However, some of the chassis components are vulnerable to damage which might induce drastic changes in component characteristics. A comprehensive vehicle stability analysis should, therefore, account for the changing characteristics of the components. In the literature, such analyses exist only for slowly-developing damper wear cases. In recent years, there has been an increase in the popularity of controlled dampers. These dampers include an increased number of structural elements and their characteristics depend on the control current supplied by a complex control system. In this study, the effect of sudden shifts in controlled damper characteristics on the stability of the vehicles is examined in detail. Two different types of damper-characteristic shifts are taken into account; the first one is a soft-to-hard transition that takes place due to control current cut-off and the other is a hard-to-soft transition originating from failure of the mechanical components in the damper. A detailed vehicle simulation model is developed, verified and used to simulate different driving manoeuvres where damper failure might affect vehicle stability. The analysis is extended to a vehicle configuration employing a simple ESP structure in order to observe the effects of chassis control systems in minimizing the effects of the damper failure. The results obtained in this study show that the failure of a damper might lead to vehicle instability in some critical driving situations for vehicles lacking advanced chassis control systems.
Performance analysis of a variable-displacement vane-type oil pump for engine lubrication using a complete mathematical model
Authors: Truong Dinh Quang , Ahn Kyoung Kwan , Trung Nguyen Thanh , Lee Jae Shin
Published: July 2013

Variable-displacement vane-type oil pumps represent one of the most innovative pump types for industrial applications, especially for engine lubrication systems. The aim of this paper is to develop a complete and accurate mathematical model for a typical variable-displacement vane-type oil pump to investigate its working performance. First, the detailed theoretical model was built on the basis of pump geometric design and dynamic analyses. Next, numerical simulations with the constructed model and experiments on the actual pump system were carried out to analyse the main power loss factors in order to develop the complete model for high modelling accuracy. The estimated pump performance using the complete pump model was finally verified by numerical simulations in comparison with practical tests.
Nonlinear model for Galfenol cantilevered unimorphs considering full magnetoelastic coupling
Authors: Shu Liang , Headings Leon M , Dapino Marcelo J , Chen Dingfang , Lu Quanguo
Published: July 2013

This article presents a fully coupled, nonlinear model for the dynamic response of Galfenol-driven unimorph actuators in a cantilever configuration. The hysteretic magnetomechanical behavior of Galfenol is modeled using a discrete energy-averaged model, and the structural behavior of the unimorph is modeled using the finite element method. The weak form equations that describe bending of the unimorph are obtained using the principle of virtual work. Since the local strain and stress are nonlinearly coupled with both the vertical and horizontal displacements, a nonlinear solver is developed to approximate the coupled finite element equations. The nonlinear solver is verified against the analytical solution and experimental data for the case of a passive beam. The analytical solution is obtained using beam theory for free and harmonic responses. The analytical model and experimental data verify that the nonlinear solver correctly quantifies the first natural frequency of the composite beam. The numerical simulations match the analytical solutions for both free and harmonic responses. Finally, the dynamic response of the nonlinear magnetoelastic model is investigated and experimentally validated from 0.1 to 500 Hz, the range in which the model is accurate without the need for adjustable parameters.
Delamination detection in composite beams using pure Lamb mode generated by air-coupled ultrasonic transducer
Authors: Liu Zenghua , Yu Hongtao , He Cunfu , Wu Bin
Published: July 2013

The interaction of Lamb wave A0 mode with delamination and delamination detection in 16-ply carbon fiber–reinforced epoxy composite beams are investigated through three-dimensional finite element simulation and experimental studies in this article. Wave propagation in composite beams with delamination with different lengths and located at different interfaces are investigated in finite element simulations, and some unique mechanisms of interaction between A0 mode and delamination are revealed in detail. Experimental results obtained with air-coupled ultrasonic transducers are well in accordance with finite element simulation results. In an experimental study, an air-coupled ultrasonic transducer is oriented at a coincidence angle such that it generates a pure fundamental antisymmetric Lamb wave mode A0 for delamination detection in laminated composite beams. The receiving transducer can be oriented either to detect the transmitted wave propagating in the same direction as incident wave or to detect the reflected wave in contrast to incident wave. The location and size of delamination can be evaluated quantitatively using the time-of-flight of reflected wave from both ends of the delamination.
A miniature magneto-rheological actuator with an impedance sensing mechanism for haptic applications
Authors: Yang Tae-Heon , Koo Jeong-Hoi , Kim Sang-Youn , Kwon Dong-Soo
Published: July 2013

This article presents a miniature haptic actuator (or haptic button) based on magneto-rheological fluids, designed to convey realistic and vivid haptic sensations to users in small electronic devices. The haptic sensation, which is generated in the form of resistive force, should vary according to the stroke of the actuator (or the pressed depth of its plunger). Thus, a sensing method for gauging the stroke should be integrated into the proposed magneto-rheological actuator to demonstrate real-world haptic applications. To determine the pressed depth of the magneto-rheological actuator, this article proposes an impedance sensing mechanism. The proposed sensing method measures the impedance change of the solenoid coil built in the actuator in the form of voltages to estimate the pressed depth. A control system was constructed to evaluate the simultaneous sensing and actuating performance of the proposed. The results show that the sensitivity of the proposed sensing method is sufficient to regulate the output resistive force over the small stroke range of the actuator. The results further show that the controller with the proposed sensing method enables users to measure the displacement of the plunger and concurrently generate resistive forces to convey haptic sensations to users without additional sensors.
Experimental synthesis of sound pressure fields for active structural acoustic control testing
Authors: Algermissen Stephan , Meyer Sebastian , Appel Christina , Monner Hans P
Published: July 2013

For next generation aircraft, contra rotating open rotor propulsion systems are currently discussed. Their economic advantages are in conflict with their high noise emission, which concentrates in distinct frequency bands. To bring contra rotating open rotor engines into operation at commercial aircraft and to maintain the passenger comfort level, active systems for noise reduction are considered. In this article, a contra rotating open rotor noise simulator for the future testing of active systems is presented. The simulator consists of a 14 × 8 loudspeaker array, which is placed close to a test fuselage. Driving each loudspeaker by a particular signal, complex sound pressure fields can be synthesized on the fuselage. The algorithm presented here calculates loudspeaker signals to synthesize the target sound pressure spectra on the fuselage. These target spectra were derived from numerical contra rotating open rotor engine simulations, coupled with a Ffowcs Williams–Hawkings solver to propagate the calculated sound pressure field toward virtual surface microphone positions on the test fuselage. Requirement for such synthesis is the knowledge of the transfer paths from all loudspeakers to all surface microphones. In experiments, these paths are measured, and the loudspeaker signals are synthesized by the algorithm. Finally, measurements with the loudspeaker array and a microphone array are shown which prove the concept.
Modeling and analysis of magnetorheological inner mass single unit impact dampers
Authors: Afsharfard Aref , Farshidianfar Anooshiravan
Published: July 2013

In this article, ongoing studies to apply semi-active control devices to reduce undesired vibrations of civil engineering structures are investigated. In doing so, the barrier of the nonlinear inner mass single unit impact dampers is equipped by the magnetorheological fluid dampers. For convenience, this kind of impact dampers is briefly named smart impact dampers. Dynamic behavior of a vibratory system equipped with the smart impact damper is modeled based on the modified Bouc–Wen model for the magnetorheological damper. Performance of the smart impact damper to suppress free vibration of an Euler–Bernoulli beam is investigated. Furthermore, effects of varying applied current to the magnetorheological fluid damper on vibratory behavior of the beam are illustrated in user-oriented charts. The analysis results show that the smart impact dampers with optimal parameters can suppress undesired vibrations much better than conventional impact damper systems.
Tools and Strategies for Making Co-teaching Work
Authors: Brown Nancy Beyers , Howerter Catherine S. , Morgan Joseph John
Published: July 2013

A large percentage of students with disabilities are being educated in the general education environment for a majority of the academic day. Many educators have chosen co-teaching as the most appropriate method of educational service delivery to meet the needs of this population of students. To ensure the success of this delivery method, co-teaching teams should engage in active communication, co-planning and preparation, shared instructional delivery and assessment, and conflict resolution. This article presents a variety of tools and resources that co-teaching teams might use to establish a successful classroom environment for all students.
Active suppression of pneumatic vibration isolators using adaptive sliding controller with self-tuning fuzzy compensation
Authors: Liang Jin-Wei , Chen Hung-Yi , Wu Quen-Wei
Published: July 2013

This paper develops intelligent control schemes for a diaphragm-type pneumatic vibration isolation system. The active-control schemes are applied to the pneumatic isolator to enhance isolation performances in the low-frequency range where passive techniques usually have difficulties in remaining effective, especially at the resonance frequency. The functional approximation technique (FAT) is integrated with a sliding-mode control (SMC) design to capture unknown system dynamics and release the requirement of mathematical modeling. To deal with approximation error and system dynamics variation, an adaptive fuzzy sliding-mode controller (AFSMC) is employed as a compensator of the FAT-based SMC. Lyapunov stability theory is used not only to ensure the closed-loop stability, but also to formulate the updating laws for weighting coefficients of expansion basis and fuzzy tuning parameters. To validate the proposed method, a composite control scheme using pressure and velocity measurements as feedback signals is implemented. Experimental explorations indicate that isolation performances obtained using the proposed FAT-based sliding control augmented with AFSMC compensation (FA + AFSMC) are evidently better than those of the traditional proportional integral-derivative control and solely AFSMC scheme.
The influences of rail vibration absorber on normal wheel–rail contact forces due to multiple wheels
Authors: Liu Haiping , Yang Jianzhong , Wu Tianxing
Published: July 2013

A compound track-absorber model with multiple wheels on the rail is employed to study the effects of a rail absorber on the normal wheel–rail contact forces in the frequency domain. Two different absorber models, which are the piecewise continuous absorber and the discrete absorber installed in the middle of the sleeper span, are presented. It can be seen from the calculation results that there are more peaks occurring in the frequency range of 500–1200 Hz due to the wave reflections between the wheels than that of a single wheel–rail interaction. However, these peaks are all suppressed due to the effects of the rail absorber, and there are new peaks appearing at other frequencies while the amplitude of these peaks is relatively small. The peaks in contact force at low frequencies are higher, whereas the peak at pinned-pinned resonance is suppressed.
A case of delayed methotrexate clearance following administration of a complementary medication containing chlorophyll
Authors: Brooks Sally L , Sanders Julie , Seymour John F , Mellor James D
Published: July 2013

A 54-year-old male with relapsed primary cerebral lymphoma and normal renal function was treated with methotrexate (MTX) 3 g/m2 monthly by intravenous infusion. Throughout treatment the patient self-administered a complementary medicine (Jason Winter’s chlorophyll®), which he was advised to cease during methotrexate treatment due to the potential for unknown interactions. For the first four cycles, chlorophyll was ceased two days prior to commencement of methotrexate and withheld until clearance. These cycles were administered without complication, and the methotrexate level reduced to <0.05 µmol/L within three days of each dose. Prior to cycle 5, chlorophyll was not ceased and there were no changes to concomitant medications. A literature search found no documented interactions between methotrexate and chlorophyll and the chemotherapy was administered without a delay in treatment. The methotrexate level three days post-administration was 0.36 µmol/L and did not reduce to <0.05 µmol/L until day 10. Consequently, from cycles 6 to 12, the methotrexate dose was halved, and the patient ceased chlorophyll 48 h prior to methotrexate administration until clearance. There were no further episodes of delayed methotrexate clearance. No impurities were detected in a sample of Jason Winter’s chlorophyll®. It is therefore likely that the patient’s delayed methotrexate clearance was due to an interaction with chlorophyll. It is recommended that such chlorophyll containing preparations be avoided in patients treated with methotrexate.
The Impact of Assertive Community Treatment on Utilization of Primary Care and Other Outpatient Health Services
Authors: Wiley-Exley Elizabeth , Domino Marisa Elena , Ricketts Thomas C. , Cuddeback Gary , Burns Barbara J. , Morrissey Joseph
Published: July 2013

BACKGROUND:A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. OBJECTIVE: To analyze whether investments in ACT yield savings in primary care and other outpatient health services. DESIGN: Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT ( n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services ( n = 1,426 and n = 41,717 distinct individuals). RESULTS: We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. CONCLUSIONS: Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.
Orthotropic Plate Model of Hat Stiffened Plate
Authors: Tharian Manoj G , Gopalakrishnan Nandakumar C
Published: July 2013

Orthotropic Plate Model of Hat Stiffened Plate has been developed based on the equal rigidity concept that makes use of orthotropy rescaling technique. This Orthotropic Plate Model can readily be analyzed using an orthotropic plate finite element available in the element library of any general-purpose finite element software, which will reduce the effort for modeling, computation and storage required considerably. Orthotropic Plate Model has been developed from representative unit cell of Hat Stiffened Plate for all edges simply supported boundary condition and two edges clamped and two edges simply supported boundary condition. It has been found that the Orthotropic Plate Model developed herein can serve as a structural substitute for Hat Stiffened Plate with four edges simply supported boundary condition. Limitations on the Orthotropic Plate Model with two edges clamped and two edges simply supported boundary condition have been reported.
Visual Manifestations in Alzheimer’s disease
Authors: Pal Sandip , Sanyal Debashis , Biswas Atanu , Paul Neelanjana , Das Shyamal K.
Published: July 2013

Introduction:

Alzheimer’s disease (AD) is characterized by amnesia, though non-memory-cognitive domains like visual are also affected. We planned to study frequency of visual dysfunctions in AD and their relationship with dementia severity.

Materials and Methods:

This study was conducted in the Cognitive clinic of Department of Neurology, Bangur Institute of Neurosciences, Kolkata, between January 2007 and December 2010. 55 patients of AD were evaluated by neurological and neuropsychological assessments and by special tests for visual dysfunctions.

Results:

Common visual dysfunctions were visuo-constructional (87.3%), visuo-perceptual (63.6%), object agnosia(47.3%), prosopagnosia (45.5%), visual hallucination (27.3%) and simultanagnosia (12.7%). Symptoms of ventral visual pathway dysfunction were more common than that of dorsal pathway. MMSE score and number of visual manifestations had a good correlation. Conclusions: Visual dysfunctions are common in AD, elicitation of which helps us to understand the cause of disability so that appropriate steps can be taken.
Central and ulnar cleft hands: a review of concurrent deformities in a series of 47 patients and their pathogenesis
Authors: Al-Qattan M. M.
Published: July 2013

Two main types of cleft hands have been described. The ulnar cleft hand deformity is very rare and is characterized by two constant features: a deep cleft radial to the little finger and hypoplasia of the ulnar digits. The pathogenesis of ulnar clefts is unknown. The second type is the central cleft hand deformity, which is characterized by a soft tissue/bone defect in the hand centrally. Patients with central clefts also have several concurrent deformities in the remaining digits. This paper reviews the clinical features of three cases with ulnar cleft hands and 44 cases of central cleft hands, with special emphasis on concurrent deformities. The author’s hypothesis of pathogenesis for both types of clefts and their concurrent deformities is then offered.
Self-expanding Y stents in the treatment of central airway stenosis: a retrospective analysis
Authors: Gompelmann Daniela , Eberhardt Ralf , Schuhmann Maren , Heussel Claus P. , Herth Felix J.F.
Published: July 2013

Background:

Central airway obstruction (CAO) is a life-threatening situation. Stent insertion re-establishes patency of the central airways. Self-expanding metallic Y stents have been available since 2005, widening the spectrum of interventional bronchoscopic techniques.

Methods:

Retrospective analysis of all patients treated for CAO with a self-expanding metallic Y stent at the Thoraxklinik Heidelberg between May 2005 and January 2009.

Results:

A total of 43 patients aged 26–81 had a metallic Y stent inserted endoscopically for the treatment of CAO; 39 of these patients (90.7%) had CAO due to malignant disease, four patients (9.3%) due to benign disease. In all 43 patients, the Y stent was deployed without any complications. A longitudinal follow up was possible in 32 of the 43 patients. The stents remained in situ for an average of 107.1 days (range 1–640 days). In 29 patients with malignant CAO the stenosis was successfully overcome with a Y stent; 11 of these patients died within 6 weeks following stent insertion. On follow up the remaining 18 patients showed immediate improvement of dyspnoea. Eight out of the 18 patients (44.4%) tolerated the stent without problems, two (11.1%) required further stenting, six (33.3%) had complications such as increased secretions, cough, dyspnoea or granulation tissue formation. The stent was removed in one patient (5.6%) due to increased secretions, and in another (5.6%) as the stent was no longer required due to successful tumour-specific therapy.

Conclusion:

Placement of Y stents in symptomatic CAO allows for quick relief of symptoms. Severe complications are rare. Stent removal is possible after successful treatment of the primary tumour. However, the prognostic indicator for survival is the underlying malignancy.
Morphology, Surgical Techniques, and Outcomes in Patients Above 15 Years Undergoing Surgery for Congenitally Corrected Transposition of Great Arteries
Authors: Talwar Sachin , Ahmed Tammem , Saxena Anita , Kothari Shyam Sunder , Juneja Rajnish , Airan Balram
Published: July 2013

Background:

There is a paucity of data about morphology, surgical procedure, and results in older patients with congenitally corrected transposition of great arteries (ccTGAs).

Patients and Methods:

Between January 2002 and August 2012, 15 patients (7 males), median age 25 years, range 16 to 41 years underwent surgery for ccTGA. Associated lesions were tricuspid regurgitation (TR; n = 5) and ventricular septal defect (VSD) with pulmonary stenosis (PS; n = 10). Surgical procedures included tricuspid valve replacement (n = 4), tricuspid valve repair (n = 1), lateral tunnel Fontan (n = 2), extracardiac Fontan (n = 2), Kawashima procedure (n = 1), bidirectional (BD) Glenn (n = 2), Senning + Rastelli procedure (n = 1), and VSD closure + left ventricle to pulmonary artery conduit (n = 1). The details of these procedures and outcomes were analyzed.

Results:

There were no early or late deaths. Mean follow-up period was 49.9 ± 26 months. All patients who underwent tricuspid valve replacement are in New York Heart Association (NYHA) class I, with no progression of right ventricular (RV) dysfunction. One patient who underwent tricuspid valve repair is in NYHA class III and has progressed to severe RV dysfunction. None of the patients undergoing single ventricle palliation had any complications related to the surgery. Both patients who underwent anatomical and physiological biventricular (BV) repair had no complications.

Conclusions:

Older patients with ccTGA present a challenge. Fontan/BD Glenn remains a good option for patients who presented with VSD PS. Both anatomic and physiological BV repairs provide acceptable results. Tricuspid valve replacement is safe for patients presenting with TR who have improvement in functional class, though the right ventricular function may not improve.
Laubry-Pezzi Syndrome With Aortic Root Dilatation Treated With a Bentall and De Bono Procedure
Authors: Martínez-Quintana Efrén , Rodríguez-González Fayna , López-Gude María Jesús
Published: July 2013

Laubry-Pezzi syndrome is a clinical entity in which prolapse of an aortic valve cusp into a subjacent ventricular septal defect (VSD) due to Venturi effect results in progressive aortic valve insufficiency. Aortic valve prolapse is found in over 5% of children with VSDs, most commonly in association with supracristal VSDs, and the risk of development of aortic regurgitation increases during childhood, peaking at 5 to 10 years of age. The VSD closure eliminates the low-pressure zone that is the cause of ongoing aortic valve cusp deformity and, if performed early, prevents the development of aortic regurgitation. However, the management of this rare pathology is still a matter of some debate with respect to indications, operative techniques, and timing. We report the case of a patient with Laubry-Pezzi syndrome, originally operated on at six years of age for VSD closure and plasty between the left and the right aortic cusps. However, in the follow–up the patient developed severe aortic regurgitation and aortic root dilatation. Eventually, a Bentall and De Bono procedure was performed.
Subaortic Membrane and Aorto-Septal Angle
Authors: Barboza Laura A. , Garcia Flor de Maria , Barnoya Joaquin , Leon-Wyss Juan R. , Castañeda Aldo R.
Published: July 2013

Background:

Development of a subaortic membrane is not fully understood. Recurrence after surgical removal continues to be high. We sought to assess the differences in aorto-septal angles (AoSA) to possibly explain alterations within the left ventricular outflow tract, hence in subaortic membrane formation.

Methods:

A total of 113 patients who underwent subaortic membrane resection were matched by age and sex with 113 controls. The subaortic membrane resection group included isolated subaortic membranes (n = 34, group I), associated with ventricular septal defect (n = 29, group II), or patent ductus arteriosus (n = 50, group III).

Results:

Mean (± standard deviation) AoSA (in degrees) were not different between subaortic membrane groups I, II, and III but were steeper than their control groups (126.2 ± 9.2 vs 138.6 ± 7.0, 129.2 ± 9.9 vs 137.7 ± 10.0, and 126.2 ± 8.1 vs 135 ± 8.5, respectively; all Ps < .05). Additionally, group II had lower preoperative gradients (28.8 ± 20.7 mm Hg) compared to groups I and III (67.0 ± 32.9 and 66.2 ± 33.1 mm Hg, respectively, P < .001). Follow-up ranged from 3 to 132 months. In 22 (32%) patients, a subaortic membrane recurred. Early postoperative residual gradients and development of aortic regurgutation were associated with the need for reoperation ( P < .05).

Conclusions:

These findings suggest a contributing role of the AoSA in the development of subaortic membrane. Further rheological experiments are warranted. Whether the steeper the angle the higher the risk of recurrence may be revealed by longer follow-up periods.