bluuebunny/crossref_metadata_2025 huggingface dataset:
CFD simulations of a suspension bridge deck for different deck shapes with railings and vortex mitigating devices
Authors: Kusano I , Jakobsen J B , Snæbjörnsson J T
Published: November 2019

Aerodynamic response of a single-box suspension bridge girder is investigated using CFD simulations. The importance of including railings and vortex mitigating devices such as guide vanes and a spoiler in the simulations is explored since they alter the flow field around the deck greatly. The paper compares results from a bare deck section and a section with mitigating devices. A clear vortex shedding observed for the bare deck section is suppressed by the use of mitigating devices and the aerodynamic force coefficients are very different between these cases. The effect of varying deck width is also studied. Flutter derivatives are defined based on quasi-steady formulation and flutter velocity is computed for each section. The section with the largest width to depth ratio has the best performance against flutter. This study is an initial phase of multi-fidelity optimization of bridge deck shape considering aerodynamic constraints.
Assessment of wave runup and wave rundown based on observed long-term wave conditions
Authors: Myrhaug D , Sunde T
Published: November 2019

The article presents an analytical method that can be applied to provide first estimates of wave runup (RU) and wave rundown (RD) on shorelines and coastal structures based on observed long-term wave statistics and is supplementary to [12] who based their results on long-term wind statistics. Some recently published wave RU and wave RD formulae are used, together with joint statistics of significant wave height and spectral peak period from the Northern North Sea. Results are exemplified for the average statistical properties of wave RU and wave RD in terms of the expected values and the standard deviations, as well as values estimated from 1-, 10- and 100-years return period contour lines.
Numerical study on aerodynamic drag reduction and energy harvest for electric vehicle: a concept to extend driving range
Authors: Huluka A W , Kim C H
Published: November 2019

Energy efficiency of road vehicles is highly attributed to its aerodynamic performance. Over the last decades, significant reduction of aerodynamic drag has been made. But, beyond the current achievement, further improvement become a challenge for car industries and professionals working in the area. This paper focuses on new approach to further find aerodynamic performance improvement particularly for electric vehicles. Therefore, a preliminary numerical study on ducting and concept of energy harvesting from aerodynamic resistance is introduced as an alternative to improve energy efficiency. Ducted and slightly modified Ahmed model is used to study aerodynamic characteristics of ducted models and how ducting would contribute to the reduction of energy consumption due to air resistance. Three-dimensional, incompressible, and steady flow governing equations are solved by CFD code (PHOENICS ver.2018) with extended turbulent model proposed by Chen-Kim (1987). From the study, it is found that the total drag reduction of over 15% on the ducted models compared to the base model. The kinetic energy preserved due to ducting is also significant. Harvesting this energy and utilizing it to extend driving range is believed to be a potential area to be dealt in detail. Therefore, the idea of duct application and energy harvesting introduced in this paper, either to reduce or use aerodynamic resistance is expected to have potential contribution to the development of future energy efficient road vehicles.
Numerical simulation of flow around two 5:1 rectangular cylinders at a high Reynolds Number
Authors: Yin G , Monaci T , Ong M C
Published: November 2019

The unsteady flows around two stationary rectangular cylinders with a chord-to-thickness ratio of B/D = 5 at ReD
= 2 × 105 (based on the free stream velocity and the width length D), are investigated using two-dimensional Unsteady Reynolds-Averaged Navier-Stokes equations with a standard k − ω SST turbulence model. The computational model is validated by carrying out simulation of the flow around a single rectangle and comparing the hydrodynamic quantities (time-averaged drag coefficient, root-mean-square of fluctuating lift coefficient) with the previous published data. The aim of the present study is to study the influence of the relative positions between the two rectangular cylinders on their hydrodynamic quantities and the surrounding flow fields.
Fly ash as a raw material for geopolymerisation - chemical composition and physical properties
Authors: Korniejenko K , Halyag NP , Mucsi G
Published: November 2019

The article discuss the main features of fly ashes as raw material for geopolymerisation. This article is focused on the examination of the fly ash (FA) from the CHP plant in Skawina (Poland) and assessment it as a main component of geopolymers. The article is focused on chemical and physical properties. The characteristic of the FA is presented, including particle size distribution, density, and chemical composition. The all parameters are discussed according to advantages and disadvantages using this FA to geopolymerisation process, including possibilities to achieve better results through proper preparation of the raw material.
Geopolymer’s radiation absorption detected by Geiger-Muller counter
Authors: Süzgeç Elif , Doğan-Sağlamtimur Neslihan , Bozkurt Vakkas , Ertürk Sefa
Published: November 2019

Fly ash (FA), which is an industrial solid waste released by the burning of coal in thermal power plants, is responsible for causing environmental problems. Radiation is also an environmental problem besides causing health problems for human being. Geopolymer is a specialized building material resulting from the reaction of a source material, which is rich in silica and alumina, with alkaline solution. It is ordinary Portland cement (OPC) free building material. It has been reported that geopolymer building material has good engineering properties with a reduced carbon footprint resulting from the total replacement of OPC as greener alternative. In this study, it is aimed to measure radiation absorption of geopolymers produced from the reaction of FA, which was supplied from İsken Sugözü Thermal Power Plant (Adana, Turkey) and rich in silica and alumina in total content of 83.74, with alkaline activators (sodium hydroxide and sodium silicate) at curing temperatures (70 °C and 100 °C). In the study, lattice measurement system consisting of nested lead plates to avoid unwanted radiation was designed to determine radiation absorption of geopolymers. By using this new system, geopolymer was found to be 5% better radiation absorption capacity than OPC building material when it is compared.
Production of geopolymer composites by using different alkaline solution/material ratio
Authors: Doğan-Sağlamtimur Neslihan , Öz Hatice Öznur , Bilgil Ahmet , Süzgeç Elif , Vural Türkan
Published: November 2019

This study reports an experimental program to optimize mix design parameters of fly ash-based geopolymer engineering composites. Fly ash (FA) supplied from Çatalağzı Thermal Power Plant (Zonguldak, Turkey) and Rilem Cembureau Standard Sand were used together with a constant ratio of 0.50 for producing geopolymer. In the first step, two different alkaline solution/material ratio (FA+standard sand) (L/M) were determined as 0.20 and 0.40, respectively. After that, sodium silicate ((Na2SiO3) and 12M sodium hydroxide (NaOH) were utilized at a ratio of 1, 2, and 3, respectively. 6 mixtures obtained by using different design parameters were cured at 70 °C for 24 hours, respectively, and then they were stored at room temperature until testing age. While the physical properties of the samples were measured by the bulk density and water absorption tests at 28 days, mechanical properties were tested via the compressive and flexural strength tests at 90 days, respectively.

The results indicated that the highest compressive strength for geopolymer materials was found as 36.5 MPa in the mixture produced with the ratios of L/M=0.2 and Na2SiO3/NaOH=2 (by weight). However, less alkali reaction caused by using excessive activator solutions decreased the strength characteristics of geopolymer.
Mechanical properties of composites based on geopolymers reinforced with sizal
Authors: Korniejenko K , Łach M , Mikuła J
Published: November 2019

The aim of the study was to evaluate the usefulness of composites based on alkali activated materials reinforced with natural fiber - sisal, as an ecological material for selected applications in the building industry. Microscopic analysis of the created structure and examination of compression and bending strength were carried out. Strength tests show a slight increase in compression and bending strength compared to a geopolymer matrix without fibers.
Electrochemical impedance spectroscopy analysis of iodine/potassium iodide electrolyte influence on spin-coated platinum counter-electrode on FTO glass
Authors: Walter J , Mierzwiński D , Marszałek K , Sanetra J
Published: November 2019

Very low concentrated precursor solution has been carried out for producing catalytic platinum layers by a spin-coating method. Direct deposition of platinum nanoparticles from low concentrated precursor solution on a conductive substrate results in many nanoparticles remaining in solution. They are not adhesive enough to be able to load them onto another submerged element. The spin-coating method has been applied to use them for catalytic layer preparation. Electrochemical impedance spectroscopy measurements were carried out using a symmetrical setup with the test electrolyte showing, in general, the better properties if more layers are applied. The circuit model for the symmetric setup, containing two identical Pt layers with electrolyte between them, has been proposed. It was found deteriorating layer properties expressed by charge transfer resistance increasing while the platinum layers were influenced by the electrolyte due to a decrease in the amount of platinum on the electrode surfaces. Layers of platinum retain their properties for some hours in contact with electrolyte without measurable decreasing of properties. The spin-coated platinum layer obtained by described method can be used in laboratory tests of Dye Sensitised Solar Cells different components filled with iodide-triiodide electrolyte.
Contribution of polypropylene fibres melting to permeability change in heated concrete - the fibre amount and length effect
Authors: Hager I , Mróz K , Tracz T
Published: November 2019

The paper presents the investigations related to concrete permeability change during heating and the contribution of polypropylene fibres melting at the temperature of 163°C to permeability. Permeability is an important parameter governing the occurrence of the explosive behaviour also known as concrete spalling due to fire. To limit the spalling of concrete, the polypropylene fibres are used to act as a fuse and, by melting, reduce gas pressure in concrete pore system. The investigations consisted of testing the permeability change of seven high performance concretes with polypropylene fibres. The permeability was measured after temperature exposure to temperature 140, 160, 180 and 200°C. The results have shown to what extent the fibre length and content affect the permeability when melting. Moreover the results have shown that the addition of polypropylene fibres had the desired impact causing a considerable increase in concrete permeability after fibre melting.
Strength and leachability of geopolymers with the addition of municipal solid waste ashes
Authors: Łach M , Hebdowska-Krupa M , Komar N
Published: November 2019

The paper presents the results of the study concerning the possibility of immobilization of secondary waste from municipal waste incineration plants in geopolymers. The study was conducted for 2 different sources of ash from Poland and Lithuania. Three different types of waste were tested. Geopolymers were made with 70% added waste from incineration plants. The samples were made in many variants: geopolymers were made on the basis of fly ash and metakoline and waste was added untreated and after washing with water in a ratio of 1:5 (solid/liquid). Compressive strength and water leaching tests were carried out. As a result of the study, geopolymers as a material for immobilization of secondary waste from waste incineration plants were found to be useful. Water leaching tests proved that all the tested wastes stabilized in geopolymers are characterized by very low leachability values of metals suchas: copper, zinc, lead, etc.
Mechanical properties of geopolymers reinforced with carbon and aramid long fibers
Authors: Łach M , Hebdowska-Krupa M , Mierzwiński Dariusz , Korniejenko Kinga
Published: November 2019

The paper presents the results of the study of geopolymer composites reinforced with carbon and aramid fibers. Geopolymers were made on the basis of fly ash activated with 10 mole sodium hydroxide solution with an addition of aqueous sodium silicate solution. The fibers were introduced in the form of a roving. Carbon fibers 800 tex and aramid fibers 805 tex were used. Additionally, to compare the influence of the number of fibers on the properties of geopolymer composites for carbon fiber, 1600 tex fiber was also used. The flexural strength of composites made with the fibers was tested. Fiber reinforced geopolymer composites showed a higher value of flexural strength than unreinforced ones. The higher value was noted for carbon fiber reinforced composites (800 tex) compared to aramid fiber roving composites (805 tex). The study also showed that the application of higher fiber mass in the case of carbon fiber roving does not bring the expected increase in mechanical properties of the composites. The use of carbon fiber roving (1600 tex) resulted in a lower flexural strength than in the case of 800 tex roving. Double increase of fiber mass in the composite caused a decrease in strength parameters.
Autoclaving of alkali-activated materials
Authors: Mierzwiński D , Walter J
Published: November 2019

Alkali-activated materials are amorphous materials that look like natural stone or a concrete structure. As in the case of concrete, on the surface of alkali-activated materials, a white coating appears in the form of efflorescence. For conventional efflorescent concrete, the reaction between Ca(OH)2 with water and CO2 is generally harmless, except for the discolouration. In the case of alkali-activated materials, efflorescence can be a big problem, especially if they are exposed to moisture or in contact with water. The white efflorescence on the surface of the materials is sodium carbonate heptahydrate Na2CO3·7H2O [1]. Various chemicals to prevent primary and secondary efflorescence can be used to reduce the appearance of the efflorescence. In the case of alkali-activated materials, this is a more complex process. The following paper proposes the use of hydrothermal processing during alkali-activated materials production. Hydrothermal treatment in an autoclave significantly reduced the appearance of efflorescence on the alkali-activated materials surfaces.
Influence of heat treatment on microstructure and mechanical properties of titanium alloy grade TI6AL4V
Authors: Bogucki R , Hytroś E
Published: November 2019

In this work, the effect of heat treatment on the control of the volume share of α phase in a two-phase titanium alloy α + β from the Ti6A14V grade was analyzed. The applied heat treatments resulted in obtaining a volume share of alpha phase in the range of 60% to 96%. The highest hardness was obtained with a sample share 88% α phase, which was characterized by a microstructure consisting of grains of α phase and β phase regions of the phase precipitates of α’.
Neutral geopolymer foams reinforced with cellulose studied with the FT-Raman spectroscopy
Authors: Szechyńska-Hebda M , Marczyk J , Ziejewska C , Hordyńska N , Mikuła J , Hebda M
Published: November 2019

In this work, cellulose fibers were successfully used as a reinforcement agent in a metakaolin-based geopolymer composite to produce, by direct foaming, sustainable and lightweight material with neutral properties for eco-friendly agricultural purposes. The structure of these materials after the neutralization process as well as changes during curing were investigated in their relations to the Raman spectra. The results showed both, a strong degree of conversion of the starting materials to the innovative neutral geopolymer product, and an advantage of the Raman spectroscopy in order to confirm the type of SiO4 polymerization.
Possibilities of using the 3D printing process in the concrete and geopolymers application
Authors: Marczyk J , Ziejewska C , Łach M , Korniejenko K , Lin W T , Hebda M
Published: November 2019

Additive manufacturing, also known as three-dimension printing (3DP) has a lot of advantages over traditional construction technology, including high building efficient, less construction wastes and greatly reduced labor. This paper presents the possibility of applying this technique to 3D printing of geopolymers and concrete. Moreover, a general overview of the research and progress of 3D printing of geopolymers and concrete in recent times was characterized. This paper also identifies the most interesting and innovative solutions in this area and highlights emerging trends to stimulate further research.
The synthesis of carbon-based nanomaterials by pulsed laser ablation in water
Authors: Ganash Entesar A , Al-Jabarti Ghaliah A , Altuwirqi Reem M
Published: November 2019

Pulsed Laser Ablation in liquid (PLAL) is considered as a robust and simple technique for producing nanoparticles (NPs) using lasers. The carbon-based nanoparticles were fabricated via the PLAL approach by irradiating a graphite target with a pulsed Nd:YAG laser of wavelength 532 nm. The graphite target was immersed in distilled water and irradiated for 10 min. The pulse length, reputation rate, and fluence were 6 ns, 10 Hz, and 0.4 J cm−2, respectively. The structural and physical properties of the synthesized NPs were investigated and analyzed using different characterization methods. For example, Transmission Electron Microscopy (TEM) images revealed diverse carbon nanostructures such as graphene nanosheets, nanospheres, nanospheres in the shape of a necklace, and nanotubes. The spectrum of Energy Dispersive X-Ray spectroscopy (EDX) confirmed successful synthesis of high purity carbon nanostructures. Moreover, the result of X-Ray Diffraction (XRD) Spectroscopy indicated the presence of reduced Graphene Oxide (rGO) with a (002) plane and the absence of Graphene Oxide (GO). The transmission spectrum from Ultraviolet-Visible (UV–vis) analysis showed a strong trough at 266 nm which is attributed to the presence of carbon nanostructures. Furthermore, Fourier-Transform Infrared Spectroscopy (FTIR) analysis demonstrated the vibration bonds related to carbon. The nanostructures produced were semi-stable with little agglomeration as was inferred from the results of the Zeta Potential. Finally, the Dynamic Light Scattering (DLS) analysis supported the TEM results. PLAL technique is proved to be a simple method for producing carbon-based nanomaterials. Moreover, the laser fluence was found to be an important factor which affects greatly the type of nanostructures that could be synthesized during laser ablation.
Agonistic Pluralism and Journalism: De-centering Dominant Journalistic Norms
Authors: Budarick John
Published: November 2019

In this article I apply a poststructuralist perspective to journalism. I argue that Chantal Mouffe’s theory of agonistic pluralism provides a powerful theoretical site from which to critically analyze dominant forms of journalistic professionalism, their relationship to race, ethnicity and ethnic media, and the ways they shape expectations of the role of journalism in democratic society. There are two main themes in this analysis. In the first instance, the post-structuralist approach insists on seeing current professional journalistic norms as examples of hegemonic discursive formations that achieve ascendancy over other options. Through this perspective, one can interrogate how ethnic media and journalism are excluded from democratic public debates on the basis of contingent communicative values dressed up as objective norms. Secondly, Mouffe’s work provides a theoretical basis for aligning journalistic contingency with a plural agonistic democracy. The article also will discuss several challenges that arise when applying agonistic pluralism to media.
The epigenetic legacy of illicit drugs: developmental exposures and late-life phenotypes
Authors: Wanner Nicole M , Colwell Mathia L , Faulk Christopher
Published: November 2019

The effects of in utero exposure to illicit drugs on adult offspring are a significant and widespread but understudied global health concern, particularly in light of the growing opioid epidemic and emerging therapeutic uses for cannabis, ketamine, and MDMA. Epigenetic mechanisms including DNA methylation, histone modifications, and expression of non-coding RNAs provide a mechanistic link between the prenatal environment and health consequences years beyond the original exposure, and shifts in the epigenome present in early life or adolescence can lead to disease states only appearing during adulthood. The current review summarizes the literature assessing effects of perinatal illicit drug exposure on adult disease phenotypes as mediated by perturbations of the epigenome. Both behavioral and somatic phenotypes are included and studies reporting clinical data in adult offspring, epigenetic readouts in offspring of any age, or both phenotypic and epigenetic measures are prioritized. Studies of licit substances of abuse (i.e. alcohol, nicotine) are excluded with a focus on cannabis, psychostimulants, opioids, and psychedelics; current issues in the field and areas of interest for further investigation are also discussed.
COUSIN (COdon Usage Similarity INdex): A Normalized Measure of Codon Usage Preferences
Authors: Bourret Jérôme , Alizon Samuel , Bravo Ignacio G
Published: November 2019

Codon Usage Preferences (CUPrefs) describe the unequal usage of synonymous codons at the gene, chromosome, or genome levels. Numerous indices have been developed to evaluate CUPrefs, either in absolute terms or with respect to a reference. We introduce the normalized index COUSIN (for COdon Usage Similarity INdex), that compares the CUPrefs of a query against those of a reference and normalizes the output over a Null Hypothesis of random codon usage. The added value of COUSIN is to be easily interpreted, both quantitatively and qualitatively. An eponymous software written in Python3 is available for local or online use (http://cousin.ird.fr). This software allows for an easy and complete analysis of CUPrefs via COUSIN, includes seven other indices, and provides additional features such as statistical analyses, clustering, and CUPrefs optimization for gene expression. We illustrate the flexibility of COUSIN and highlight its advantages by analyzing the complete coding sequences of eight divergent genomes. Strikingly, COUSIN captures a bimodal distribution in the CUPrefs of human and chicken genes hitherto unreported with such precision. COUSIN opens new perspectives to uncover CUPrefs specificities in genomes in a practical, informative, and user-friendly way.
Dietary Restriction Improves Fitness of Aging Parents But Reduces Fitness of Their Offspring in Nematodes
Authors: Mautz Brian S , Lind Martin I , Maklakov Alexei A
Published: November 2019

Dietary restriction (DR) is a well-established intervention to extend lifespan across taxa. Recent studies suggest that DR-driven lifespan extension can be cost-free, calling into question a central tenant of the evolutionary theory of aging. Nevertheless, boosting parental longevity can reduce offspring fitness. Such intergenerational trade-offs are often ignored but can account for the “missing costs” of longevity. Here, we use the nematode Caenorhabditis remanei to test for effects of DR by fasting on fitness of females and their offspring. Females deprived of food for 6 days indeed had increased fecundity, survival, and stress resistance after re-exposure to food compared with their counterparts with constant food access. However, offspring of DR mothers had reduced early and lifetime fecundity, slower growth rate, and smaller body size at sexual maturity. These findings support the direct trade-off between investment in soma and gametes challenging the hypothesis that increased somatic maintenance and impaired reproduction can be decoupled.
A Dilute and Shoot LC–MS/MS Method for Antipsychotics in Urine
Authors: Feng Sheng , Enders Jeffrey R , Cummings Oneka T , Strickland Erin C , McIntire Timothy , McIntire Gregory
Published: November 2019

Adherence to prescribed antipsychotics is an ongoing problem. Traditionally, estimates of adherence have been made from patient interviews, pill counting and blood testing. A number of methods for the analysis of antipsychotics in blood have been reported for both therapeutic drug monitoring and postmortem testing for toxicity. This report details a dilute and shoot method for the analysis of 19 different antipsychotics and metabolites. The method takes advantage of earlier reports demonstrating unique, prevalent urine metabolites for aripiprazole, brexpiprazole, haloperidol and lurasidone to enhance sensitivity for these analytes. With a fast analysis time and minimal sample preparation, this method can be used for quantitation of antipsychotics in urine. Finally, this method has been used to test samples for over a year with the results summarized in this report. While further improvements are certainly possible, this method is selective and sensitive for this group of important compounds.
Historicising the “Crisis” in Undergraduate Mental Health: British Universities and Student Mental Illness, 1944–1968
Authors: Crook Sarah
Published: November 2019

This article explores how and why student mental health became an issue of concern in British universities between 1944 and 1968. It argues that two factors drew student mental health to the attention of medical professionals across this period: first, it argues that the post-war interest in mental illness drew attention to students, who were seen to be the luminaries of the future, investing their wellbeing with particular social importance. Second, it argues that the development of university health services made students increasingly visible, endorsing the view that higher education posed distinctive yet shared mental challenges to young people. The article charts the expansion of services and maps the implications of the visibility of student mental distress for post-war British universities. It suggests that claims that British higher education is currently in the midst of an unprecedented mental health “crisis” should be seen within this broader historical context, for while the contours of the debates around student mental health have shifted substantially, evidence that there was anxiety around student mental wellbeing in the immediate post-war years undermines accusations that contemporary students constitute a unique “snowflake generation.”
Digital Trade Provisions in Preferential Trade Agreements: Introducing a New Dataset
Authors: Burri Mira , Polanco Rodrigo
Published: November 2019

The article introduces a new dataset that seeks to comprehensively trace developments in the area of digital trade governance. The TAPED (Trade Agreements Provisions on Electronic-Commerce and Data) dataset includes a detailed mapping and coding of all preferential trade agreements that cover chapters, provisions, annexes, and side documents that directly or indirectly regulate digital trade. This article presents the methodology behind TAPED and provides an overview of the evolution of digital trade provisions in preferential trade agreements, highlighting also some emerging trends. It then takes a look at the substance of selected rules found particularly in electronic commerce chapters and maps the diversity of approaches in tackling issues meant to facilitate online trade, such as the customs duty moratorium on electronic transactions or paperless trading, and discusses the very recent rule-making with regard to cross-border data flows. This is of course merely a glimpse of the wealth of information that TAPED provides, and the goal of this article is simply to uncover the great variety and the complexity of the norms found in the preferential trade agreements on digital trade governance, which reveals the value of the dataset.
Anal Dysplasia in Human Immunodeficiency Virus-Infected Men Who Have Sex With Men With Sexually Acquired Early Hepatitis C Virus Infection
Authors: Jacobson Karen B , Gaisa Michael M , Sigel Keith , Foster Andrew L , Fierer Daniel S ,   New York Acute Hepatitis C Surveillance Network, Akil Bisher , Bailey Juan , Bellman Paul , Bowers Daniel , Bungay Krisczar , Burger Susanne , Carpenter Ward , Cantor Aviva , Chasan Rachel , Chavez Robert , Chow Rita , Cohen Robert , Dalton Patrick , Dellosso John , Demidont Adrian , Dillon Stephen , Donlon Eileen , Farrow Terry , Fefer Jose , Gaisa Michael , Guadron Rodolfo , Haber Stuart , Hefron Susan , Higgins Lawrence , Hitzeman Lawrence , Hsu Ricky , Huprikar Shirish , Inada Victor , Jacob Sneha , Johnson Livette , Johnston Barbara , Kaminsky Donald , Klein Oscar , Kwong Jeffrey , Lares-Guia Jose , Leach Eric , Levine Randy , Linetskaya Irina , Litvinova Larisa , Malhotra Amisha , Mandell William , Markowitz Martin , Mayer Gal , Meraz Eddie , Mortensen Erik , Olivieri Joseph , Paolino Charles , Photangtham Punyadech , Psevdos George , Radix Asa , Rapaport Steven , Ray Roona , Rodriguez-Caprio Gabriela , Shay William , Somasundaram Nirupama , Sorra Lembitu , Stivala Alicia , Tran Richie , Urbina Antonio , Vail Rona , Wallach Francis , Wang Wen , Weiss Susan , Wiener Melissa
Published: November 2019

Background

Human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) are at increased risk of anorectal infection with high-risk human papillomavirus and subsequent high-grade squamous intraepithelial lesions (HSIL), the putative precursor to anal cancer. Recently, an epidemic of sexually transmitted hepatitis C virus (HCV) has emerged that shares this anorectal route of transmission. We hypothesized that the prevalence of anal HSIL would be high in HIV-infected MSM with sexually acquired early HCV infection.

Methods

High-resolution anoscopy (HRA) findings from a cohort of HIV-infected MSM with sexually acquired early HCV infection were compared with HRA findings from a contemporary cohort of HIV-infected MSM without HCV infection who underwent HRA due to abnormal anal cytology found during routine screening.

Results

Sixty HIV-infected MSM with sexually acquired early HCV infection and the comparator group of 1150 HIV-infected MSM with abnormal anal cytology but without HCV underwent HRA. The HIV-infected MSM with sexually acquired early HCV had higher CD4 counts compared with the comparator group (656 and 541 cells/μL, respectively; P = .02). Despite this, the prevalence of anal dysplasia was as high among MSM with early HCV as in the comparator group of MSM with abnormal cytology (47 [78%] and 941 [82%], respectively; P = .50), as was the proportion with HSIL (25 [42%] and 379 [33%], respectively; P = .17).

Conclusions

The prevalence of anal dysplasia in HIV-infected MSM with sexually acquired early HCV infection was as high as that of HIV-infected MSM with abnormal anal cytology. These findings suggest that primary screening with HRA may be warranted for HIV-infected MSM with early HCV.
General paediatric practice in autism spectrum disorder screening in Ontario, Canada: Opportunities for improvement
Authors: Ip Angie , Dupuis Annie , Anagnostou Evdokia , Loh Alvin , Dodds Tyler , Munoz Adriana , Smile Sharon
Published: November 2019

Background

Screening is important for early identification of children with autism spectrum disorder (ASD), potentially leading to earlier intervention. Research has identified some barriers to early identification of ASD, however, information about ASD screening in Canadian general paediatric practice is lacking.

Objectives

The aim of the study is to better understand ASD screening practice patterns by examining the use of ASD and general developmental screening tools by general paediatricians.

Methods

The research team conducted a cross-sectional survey of general paediatricians.

Results

Two-hundred and sixty-seven paediatricians responded and 132 were eligible for the study. Ninety-three per cent of the responders used a developmental screening tool. Eighty-five per cent of the responders used an ASD screening tool when there were concerns for ASD, and 15% never used one. The most commonly used ASD screening tool was the M-CHAT. Children suspected of having ASD were referred to specialists not only to confirm the diagnosis but also to facilitate access to resources. General paediatricians were keen to incorporate formal ASD screening tools in their practice but identified the need for clearer guidelines.

Conclusion

Previous studies have shown that children at risk of ASD continue to be missed through developmental surveillance and targeted screening. Paediatricians are interested in implementing an ASD screening tool and cite brevity and forms that can be completed by parents as factors that would support the use of a screening tool. Clearer guidelines and tools to support ASD screening and access to resources are needed.
Conceptualizing and measuring sustainability of prevention programs, policies, and practices
Authors: Palinkas Lawrence A , Spear Suzanne E , Mendon Sapna J , Villamar Juan , Reynolds Charles , Green Costella D , Olson Charlotte , Adade Audrey , Brown C Hendricks
Published: November 2019

A large knowledge gap exists regarding the measurement of sustainability of evidence-based prevention programs for mental and behavioral health. We interviewed 45 representatives of 10 grantees and 9 program officers within 4 Substance Abuse and Mental Health Services Administration prevention grant initiatives to identify experiences with implementation and sustainability barriers and facilitators; what “sustainability” means and what it will take to sustain their programs; and which Consolidated Framework for Implementation Research (CFIR) elements are important for sustainability. Lists of sustainability determinants and outcomes were then compiled from each data set and compared with one another. Analysis of themes from interviews and free lists revealed considerable overlap between sustainability determinants and outcomes. Four sustainability elements were identified by all three data sets (ongoing coalitions, collaborations, and networks and partnerships; infrastructure and capacity to support sustainability; community need for program; and ongoing evaluation of performance and outcomes), and 11 elements were identified by two of three data sets (availability of funding; consistency with organizational culture; evidence of positive outcomes; development of a plan for implementation and sustainment; presence of a champion; institutionalization and integration of program; institutional support and commitment; community buy-in and support; program continuity; supportive leadership; and opportunities for staff training). All but one of the CFIR domain elements (pressure from other states, tribes, or communities) were endorsed as important to sustainability by 50% or more of participants. It may be more important to implement a standardized process of eliciting determinants and outcomes of sustainability than to implement a single standardized instrument.
A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care
Authors: Mulvaney Shelagh A , Mara Constance A , Kichler Jessica C , Majidi Shideh , Driscoll Kimberly A , Westen Sarah C , Rawlinson Alana , Jacobsen Laura M , Adams Rebecca N , Hood Korey K , Monaghan Maureen
Published: November 2019

Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.
Making a Federal Case: Youth Groups, Students and the 1975 European Economic Community Referendum Campaign to Keep Britain in Europe
Authors: Smedley Stuart
Published: November 2019

To persuade the electorate to vote ‘Yes’ in the June 1975 referendum on the United Kingdom’s membership of the European Economic Community, Britain in Europe, the pro-European campaign organization, adopted a pragmatic approach, focusing on the economic benefits of membership and warning about the potentially grave consequences of withdrawal. Importantly, they avoided discussing proposed future advances in European integration. However, this theme was of importance to pro-European youth and student campaign groups—the subject of this article. Through a detailed analysis of their campaign literature, this article further transforms understanding of the 1975 referendum and, especially, the nature of the ‘Yes’ campaign by demonstrating how radical youth groups’ arguments for continued membership were. It argues that young activists yearned to discuss sovereignty and deeper integration in great detail as they offered idealistic visions for how the EEC could develop and benefit Britain. The article also advances knowledge of youth politics in the turbulent 1970s. Greater light is shone on the frustration pro-European youth groups felt towards the main Britain in Europe campaign. Meanwhile, it serves as a case study on the extent to which the perspectives of party-political youth groups and their superiors differed on a specific, highly salient policy issue.
Addressing Maternal Mortality: The Pregnant Cardiac Patient
Authors: Wolfe D.S. , Hameed A.B. , Taub C.C. , Zaidi A.N. , Bortnick A.E.
Published: November 2019

(Am J Obstet Gynecol. 2019;220(2):167.e1–167.e8)

There has been an upward trend in maternal mortality in the United States over the past 3 years. One major contributor to this trend is cardiovascular disease, which accounted for 15.5% of maternal deaths between 2011 and 2013. To combat the rise in maternal mortality, obstetric and gynecological experts recommend the creation of models of care suited to manage high-complexity pregnant patients. A possible treatment solution would include cardiovascular screening, patient education, and multidisciplinary team planning.
Scratching the Surface: A Review of Dermatitis
Authors: Woo Taylor E. , Somayaji Ranjani , Haber R.M. , Parsons Laurie
Published: November 2019

Eczematous reactions such as atopic dermatitis and contact dermatitis are prevalent worldwide. Despite contrasting pathophysiology, the diagnosis and management of these dermatitides can be challenging for healthcare providers. Differences in the distribution of the affected areas, duration of onset, and associated symptoms may help to distinguish these conditions. Diagnosis of the respective conditions is useful in developing appropriate management plans. Herein, the authors present a case-based review illustrating these different disease entities. Management of these conditions, including the use of topical and systemic therapies, is discussed.

GENERAL PURPOSE

To present a case-based review illustrating atopic and contact dermatitis, including management of these conditions using topical and systemic therapies.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant should be better able to:

1. Review the prevalence, etiology, and consequences of the various types of dermatitis.

2. Describe the clinical manifestations and differential diagnosis of the various types of dermatitis.

3. Outline the treatment options for the various types of dermatitis.
Suspending Student Selections to Alpha Omega Alpha Honor Medical Society: How One School Is Navigating the Intersection of Equity and Wellness
Authors: Lynch Giselle , Holloway Terrell , Muller David , Palermo Ann-Gel
Published: November 2019

Medical education must provide students with a delicate balance of academic rigor, equity, and wellness. While the medical education community espouses all these values, the authors believe the way medical students are evaluated and rewarded undermines equity and wellness. Alpha Omega Alpha Honor Medical Society (AΩA) membership is arguably the highest honor that a medical student can achieve. In the short term, it opens doors to the most selective training opportunities, and in the long term, ushers students into an elite group of future physician leaders. Yet recent data have demonstrated that AΩA is disproportionately awarded to white students.

At Icahn School of Medicine at Mount Sinai (ISMMS), the authors observed that students underrepresented in science and medicine were persistently underrepresented among those selected for AΩA. They describe efforts at ISMMS to reduce bias in the selection process and the ultimate decision to suspend medical student selection for AΩA altogether. The authors argue that selection to AΩA reinforces the structural biases and social privilege that are embedded in medical education and undermines the ability to deliver an educational experience that has as its core tenets equity and wellness. Suspending participation in student selection for AΩA is an important step toward recognizing that medical school learning environments continue to privilege white students over students who are underrepresented in medicine.
Early results of revision dual mobility uncemented cups with impaction autologous and synthetic bone graft composite in revision hip arthroplasty for cavitary acetabular defects: A retrospective case series
Authors: Abdelazim Haytham , Elerian Sherif , Abdelrahman Amr Ahmed , Nageeb Mahmoud Ahmed
Published: November 2019

Background:

The presence of cavitary acetabular defects can present a major challenge during revision hip arthroplasty. The purpose of this study was to retrospectively review the early clinical and radiographic outcomes of a dual-mobility, cementless acetabular shell system when combined with autologous or synthetic bone graft substitute composite in revision hip arthroplasty for cavitary acetabular defects.

Methods:

Fourteen revision hip arthroplasties for acetabular protrusion and cavitary acetabular defects were performed at our institutions between May, 2015 to June, 2016. A direct lateral approach was used for all patients. All patients were assessed with the Oxford Hip Score. Serial postoperative radiographs were assessed for signs of osseointegration and acetabular component migration. Failures were defined as gross acetabular component migration and deterioration of patient self-reported outcome score postoperatively.

Results:

After a mean follow-up of 28.9 mo, the Oxford Hip Score and hip pain scores were significantly improved (P≤0.01). Radiographically sufficient bone graft osseointegration was obtained in all patients with no detected acetabular component migration.

Conclusions:

This study showed good overall short-term functional and radiographic outcomes of the dual-mobility, uncemented acetabular shell system in combination with autologous or synthetic bone graft composite in revision hip arthroplasty for cavitary acetabular defects.

Level of Evidence:

Level IV.
Expanding the Spectrum of Radiation Necrosis After Stereotactic Radiosurgery (SRS) for Intracranial Metastases From Lung Cancer
Authors: Sharma Akanksha , Mountjoy Luke J. , Butterfield Richard J. , Zhang Nan , Ross Helen J. , Schild Steven E. , Sio Terence T. , Daniels Thomas B. , Paripati Harshita R. , Mrugala Maciej M. , Vora Sujay A. , Patel Naresh P. , Zimmerman Richard S. , Ashman Jonathan B. , Porter Alyx B.
Published: November 2019

Objective:

Radiation therapy (RT) is the primary treatment of intracranial metastasis (ICM) from lung cancer (LC). Radiation necrosis (RN) has been reported post-RT with an incidence of 5% to 24%. We reviewed the spectrum of imaging changes in patients treated with RT for ICM from LC in an effort to identify potential risk factors for RN.

Methods:

We reviewed 63 patients with LC and ICM who received RT (radiosurgery [stereotactic radiosurgery] with/without whole brain radiation therapy) at our institution between 2013 and 2018. Data evaluated included demographics, tumor type, ICM burden and location, chemotherapy, surgery, and RT details as well as treatment choices and outcomes.

Results:

Of the 63 patients, clinical and radiographic criteria for RN were noted in 24 (38%) as early as 2 months and as late as 5 years posttreatment. Six patients required surgical resection due to refractory symptoms revealing pathology-proven RN and occasionally tumor. Patients were significantly more likely to develop RN if they had surgical resection of an ICM (45.8% vs. 20.5%,P=0.05). No differences were found in location, size, or genetic profile of lesions. In total, 80% of patients received treatment for symptoms and/or radiographic change. This was generally a combination of steroids, bevacizumab, laser interstitial thermal treatment, or surgical resection. Most patients required >1 treatment modality.

Conclusions:

This review of outcomes of RT for ICM in LC demonstrates a higher rate of RN than previously reported in the literature in those having had a surgical resection plus stereotactic radiosurgery. Our observation of RN as late as 5 years post-RT for ICM necessitates clinician awareness.