bluuebunny/crossref_metadata_2025 huggingface dataset:
Screening for blunt cerebrovascular injury: selection criteria for use of angiography
Authors: Ringer Andrew J. , Matern Elizabeth , Parikh Samir , Levine Nicholas B.
Published: July 2009

Object

Blunt cerebrovascular injury (BCI) to the carotid and vertebral arteries is being recognized with increasing frequency in trauma victims. Yet, only broadly defined criteria exist for the use of screening angiography. In this study, the authors systematically identified the associated injuries that predict BCI and provide guidelines for the types of injuries best evaluated by angiography.

Methods

Criteria for screening angiography were developed with intentionally broad inclusion to maximize sensitivity. Screening criteria for each patient and angiographic results (5-point scale of BCI) were recorded prospectively. Injuries most often associated with a positive angiogram were identified. Dissection grades of 0–1 were classified as minor.

Results

Of 365 patients evaluated for trauma by angiography between January 2000 and December 2005, 40 patients with penetrating trauma were excluded. Of the 325 patients included in the study, 100 (30.8%) had positive angiographic findings, including 79 (24.3%) with major injuries. Fractures of the cervical spine and midface (or mandibular ramus) were associated with major BCI (identified in 30.7% of patients with cervical fractures and 30.8% of patients with midface fractures). However, thoracic trauma and soft tissue injury of the neck were rarely associated with a significant BCI (0 and 3 cases, respectively). Horner syndrome and cervical bruit were associated with arterial dissection in 9 of 10 patients. Skull base fractures and unexplained neurological findings were associated with major BCI in 13 (18.3%) of 71 and 11 (16.9%) of 65 patients, respectively.

Conclusions

Cervical and facial fractures resulting from blunt trauma were highly associated with BCI. After significant thoracic trauma or soft tissue injury to the neck, angiography should be reserved for patients with unexplained neurological findings or expanding hematomas of the neck.
Decompressive craniectomy for the treatment of traumatic brain injury: does an age limit exist?
Authors: De Bonis Pasquale , Pompucci Angelo , Mangiola Annunziato , D'Alessandris Q. Giorgio , Rigante Luigi , Anile Carmelo
Published: July 2009

Object

It is generally believed that the outcome of traumatic brain injury is not improved by decompressive craniectomy in patients older than 30–50 years. A literature search was performed to assess the level of evidence with respect to the effect of age on outcome in these cases.

Methods

References were identified by PubMed searches of journal articles published between 1995 and December 2008. The inclusion criteria were as follows: 1) clinical series including adults; and 2) focus on age as a prognostic factor. Technical notes and laboratory investigations were excluded.

Results

Fourteen English-language articles were finally selected. In 5 of the 14 studies, the authors performed no statistical analysis. In 6 studies they concluded that age was not significantly related to outcome (with 1 of these studies showing a correlation between age and outcome only after 65 years). Three studies showed a correlation between age and outcome.

Conclusions

With respect to age and effectiveness of decompressive craniectomy, there are no robust data to establish any degree of core evidence and the referred age thresholds are arbitrary.
Decimative Multiplication of Entropy Arrays, with Application to Influenza
Authors: Thompson William  A. , Martwick Andy , Weltman Joel  K.
Published: July 2009

The use of the digital signal processing procedure of decimation is introduced as a tool to detect patterns of information entropy distribution and is applied to information entropy in influenza A segment 7. Decimation was able to reveal patterns of entropy accumulation in archival and emerging segment 7 sequences that were not apparent in the complete, undecimated data. The low entropy accumulation along the first 25% of segment 7, revealed by the three frames of decimation, may be a sign of regulation at both protein and RNA levels to conserve important viral functions. Low segment 7 entropy values from the 2009 H1N1 swine flu pandemic suggests either that: (1) the viruses causing the current outbreak have convergently evolved to their low entropy state or (2) more likely, not enough time has yet passed for the entropy to accumulate. Because of its dependence upon the periodicity of the codon, the decimative procedure should be generalizable to any biological system.
A Simulation Tool for Geometrical Analysis and Optimization of Fuel Cell Bipolar Plates: Development, Validation and Results
Authors: Iranzo Alfredo , Rosa Felipe , Pino Javier
Published: July 2009

Bipolar plates (BPs) are one of the most important components in Proton Exchange Membrane Fuel Cells (PEMFC) due to the numerous functions they perform. The objective of the research work described in this paper was to develop a simplified and validated method based on Computational Fluid Dynamics (CFD), aimed at the analysis and study of the influence of geometrical parameters of BPs on the operation of a cell. A complete sensibility analysis of the influence of dimensions and shape of the BP can be obtained through a simplified CFD model without including the complexity of other components of the PEMFC. This model is compared with the PEM Fuel Cell Module of the FLUENT software, which includes the physical and chemical phenomena relevant in PEMFCs. Results with both models regarding the flow field inside the channels and local current densities are obtained and compared. The results show that it is possible to use the simple model as a standard tool for geometrical analysis of BPs, and results of a sensitivity analysis using the simplified model are presented and discussed.
RNA Relics and Origin of Life
Authors: Demongeot Jacques , Glade Nicolas , Moreira Andrés , Vial Laurent
Published: July 2009

A number of small RNA sequences, located in different non-coding sequences and highly preserved across the tree of life, have been suggested to be molecular fossils, of ancient (and possibly primordial) origin. On the other hand, recent years have revealed the existence of ubiquitous roles for small RNA sequences in modern organisms, in functions ranging from cell regulation to antiviral activity. We propose that a single thread can be followed from the beginning of life in RNA structures selected only for stability reasons through the RNA relics and up to the current coevolution of RNA sequences; such an understanding would shed light both on the history and on the present development of the RNA machinery and interactions. After presenting the evidence (by comparing their sequences) that points toward a common thread, we discuss a scenario of genome coevolution (with emphasis on viral infectious processes) and finally propose a plan for the reevaluation of the stereochemical theory of the genetic code; we claim that it may still be relevant, and not only for understanding the origin of life, but also for a comprehensive picture of regulation in present-day cells.
Improving the Accuracy of Land Use and Land Cover Classification of Landsat Data Using Post-Classification Enhancement
Authors: Manandhar Ramita , Odeh Inakwu  O. A. , Ancev Tiho
Published: July 2009

Classifying remote sensing imageries to obtain reliable and accurate land use and land cover (LULC) information still remains a challenge that depends on many factors such as complexity of landscape, the remote sensing data selected, image processing and classification methods, etc. The aim of this paper is to extract reliable LULC information from Landsat imageries of the Lower Hunter region of New South Wales, Australia. The classical maximum likelihood classifier (MLC) was first applied to classify Landsat-MSS of 1985 and Landsat-TM of 1995 and 2005. The major LULC identified were Woodland, Pasture/scrubland, Vineyard, Built-up and Water-body. By applying post-classification correction (PCC) using ancillary data and knowledge-based logic rules the overall classification accuracy was improved from about 72% to 91% for 1985 map, 76% to 90% for 1995 map and 79% to 87% for 2005 map. The improved overall Kappa statistics due to PCC were 0.88 for the 1985 map, 0.86 for 1995 and 0.83 for 2005. The PCC maps, assessed by McNemar’s test, were found to have much higher accuracy in comparison to their counterpart MLC maps. The overall improvement in classification accuracy of the LULC maps is significant in terms of their potential use for land change modelling of the region.
Teaching Transcultural Nursing Through Literature
Authors: Halloran Laurel
Published: July 2009

One of the biggest challenges in nursing education is to develop culturally sensitive graduates. Although theory and lecture are appropriate to introduce cultural issues, the application of those skills is limited by the kinds of clinical experiences and patient populations students may treat. Literary works are a rich source of information for nursing. This assignment was created to sensitize the students to the influence of cultural diversity. Students were assigned to read one novel from an approved list and answer the questions posed on the Cultural Discovery worksheet. The only direction that was given regarding novel selection was that the novel had to represent a culture other than the student's own. The focus was to expose students to a different culture. Classroom discussion, based on worksheet answers, followed. The assignment's good, bad, and ugly outcomes are discussed. Suggestions for adaptation of this assignment to an online format are also provided.
Assuring Ethical Treatment of Students as Research Participants
Authors: Ridley Renee T.
Published: July 2009

Nurse educators are obligated to design protocols that include ethical sensitivity when conducting education research using students as participants. Because students are vulnerable to the power differential between them and faculty, the principles of autonomy, nonmaleficence, beneficence, veracity, and justice can help researchers make choices that are intended to preserve the trust and respect formed during this collegial relationship. This article presents the basic assumptions and examples of how these principles have been applied to nursing education research.
Educating Health Professions Students About the Issues Involved in Communicating Effectively: A Novel Approach
Authors: Corless Inge B. , Michel Theresa H. , Nicholas Marjorie , Jameson Deborah , Purtilo Ruth , Dirkes Angelique M.A.
Published: July 2009

The Schwartz Center Educational Rounds, the first Schwartz Center Rounds held at an educational institution, emphasize the overall theme of difficult conversations faced by students and professionals with patients, families, and other members of the health care team. Students in the health care professions do not have sufficient opportunities to practice the communication and decision making skills integral to compassionate caregiving. Such practice enhances communication with patients and families, as well as with other members of the interdisciplinary team. This article presents the underlying assumptions for this change-oriented project and describes the development, implementation, and evaluation of the Rounds for an interdisciplinary group of graduate students during a 4-year period.
Algorithmic Tools for Interpreting Vital Signs
Authors: Rathbun Melina C. , Ruth-Sahd Lisa A.
Published: July 2009

Today's complex world of nursing practice challenges nurse educators to develop teaching methods that promote critical thinking skills and foster quick problem solving in the novice nurse. Traditional pedagogies previously used in the classroom and clinical setting are no longer adequate to prepare nursing students for entry into practice. In addition, educators have expressed frustration when encouraging students to apply newly learned theoretical content to direct the care of assigned patients in the clinical setting. This article presents algorithms as an innovative teaching strategy to guide novice student nurses in the interpretation and decision making related to vital sign assessment in an acute care setting.
Faculty Perceptions of an Accelerated Baccalaureate Nursing Program
Authors: Lockwood Suzy , Walker Charles Alan , Tilley Donna Scott
Published: July 2009

In response to one of the most severe staff and faculty shortages in the history of the nursing profession, second-degree accelerated nursing programs are springing up throughout the United States. Struggles, solutions, and learning experienced by faculty teaching in an accelerated baccalaureate program in its inaugural year are described in this article. Focus groups were conducted and themes were identified. Themes included adapting to a new clinical teaching model, effectively teaching a different type of student, combining accelerated and traditional students, and learning as you go. Recommendations were made based on the data and the extant literature.
The Use of Standards for Peer Review of Online Nursing Courses: A Pilot Study
Authors: Little Barbara Battin
Published: July 2009

This article describes a pilot study on the use of online course standards for peer review of Web-based nursing courses. A peer review team consisting of a nurse educator and an instructional designer piloted the use of two sets of online course standards in two RN-to-baccalaureate nursing courses. The College of Public Health Online Course Standards and the Quality Matters (QM) Peer Course Review Rubric were used to review the courses. The standards facilitated the peer review process and supplied important criteria for measuring the quality of the courses. Analysis of the rubric scores revealed trends in criteria not met in either course, indicating the need for educational program improvement and faculty training. The QM tool had more consistent results among peer reviewers and was perceived as easier to use. In addition, QM standards provided a useful mechanism for benchmarking against higher education courses throughout the United States.
Multiple Evanescent White Dot Syndrome After Vaccination for Human Papilloma Virus and Meningococcus
Authors: Cohen Steven M.
Published: July 2009

Multiple evanescent white dot syndrome is a rare chorioretinopathy causing transitory vision loss, usually in females and generally in one eye. In 2007, widespread vaccination of older children against human papilloma virus and meningococcus was recommended by the Centers for Disease Control and Prevention. A 17-year-old girl presented with multiple evanescent white dot syndrome 1 month after receiving these two vaccinations.
Molluscum Contagiosum–Induced Periocular Toxic Dermatitis
Authors: Ghosh Yajati K. , Freeth M. , Sandramouli S.
Published: July 2009

This report describes an unusual case of a 9-year-old boy with a 6-month history of right lower eyelid lesion and excoriation of the adjoining skin that had not responded to topical treatment. The umbilicated lesion was electively excised and the base of the lesion was cauterized under general anesthesia, which resulted in complete resolution of the periocular dermatitis without additional treatment. It is important to consider molluscum contagiosum in the differential diagnosis in patients with periocular dermatitis, especially in the presence of an umbilicated vesicle, although it is classically taught that these lesions present with toxic conjunctivitis.
Cholesterolosis Bulbi of the Anterior Chamber in Coats Disease
Authors: Gupta Noopur , Beri Sarita , D'Souza Pamela
Published: July 2009

Coats disease is characterized by the presence of cholesterol crystals and lipid-laden macrophages in the subretinal space. These cholesterol crystals may rarely be found in the anterior chamber in Coats disease, a phenomenon known as cholesterolosis bulbi. This report describes a patient with advanced Coats disease who presented with anterior chamber cholesterolosis.
Diffuse Corneoscleral Limbal Neuromas With Prominent Corneal Nerves in Multiple Endocrine Neoplasia Syndrome Type IIB
Authors: Puvanachandra Narman , Aroichane Maryam
Published: July 2009

This report describes a 7-year-old boy with multiple endocrine neoplasia type 2B who presented to the ophthalmology department because of peripheral corneal changes. In addition to prominent corneal nerves and eyelid neuromas, the patient was found to have substantial corneoscleral limbal thickening with corneal neovascularization.
[J Pediatr Ophthalmol Strabismus 2010;47:171–173.]
Retinopathy of Prematurity in Twin–Twin Transfusion Syndrome
Authors: Puvanachandra Narman , Clifford Luke , Gaston Hannah
Published: July 2009

The authors present the first reported case of retinopathy of prematurity in twin–twin transfusion syndrome. A 31-year-old woman gave birth to twins at 31 weeks' gestation. The pregnancy had been complicated by twin–twin transfusion syndrome and had been managed with two amnioreductions and laser ablation of the interplacental blood vessels. The donor twin, born at 1,310 g, had threshold retinopathy of prematurity and underwent argon laser retinal photocoagulation treatment. The recipient twin (1,775 g) did not show any evidence of retinopathy of prematurity.
[J Pediatr Ophthalmol Strabismus 2009;46:226–227.]
Benign Hamartoma Masquerading as a Deep Orbital Hemangioma
Authors: Earl James B. , Kramm Lee , Durairaj Vikram D.
Published: July 2009

A 3-month-old infant with a digital hemangioma had relative proptosis of the left eye. Ultrasound, computed tomography, and magnetic resonance imaging showed a retro-orbital mass with features consistent with a capillary hemangioma. Despite the radiographic appearance, however, biopsy findings showed histologically benign tissues of a hamartomatous nature, inconsistent with a capillary hemangioma.
[J Pediatr Ophthalmol Strabismus 2009;46:228–231.]
Cavernous Sinus Syndrome as the Initial Presentation of Childhood Non-Hodgkin Lymphoma
Authors: Akinci Arsen , Acaroglu Golge , Sayli Tulin Revide , Demir Baver
Published: July 2009

A 10-year-old boy with unilateral ophthalmoplegia, ptosis, and proptosis underwent diagnostic examination. Symptoms of headache, nausea, dyspnea, fatigue, weakness, and loss of appetite began 14 days after the onset of ocular manifestations and 7 days before he was examined. Complete blood count showed an increased white blood cell count with 64% blast cells, anemia, and thrombocytopenia. The patient was transferred to a pediatric hematology unit, where he underwent bone marrow aspiration biopsy. Bilateral ocular inflammatory findings and left-sided mild proptosis became evident. He was diagnosed as having B-cell non-Hodgkin lymphoma infiltrating the bilateral cavernous and sphenoid sinuses.
[J Pediatr Ophthalmol Strabismus 2009;46:232–234.]
Optic Nerve Head Drusen and Idiopathic Intracranial Hypertension in a 14-Year-Old Girl
Authors: Granger Robert H. , Bonnelame Thomas , Daubenton John , Dreyer Michael , McCartney Paul
Published: July 2009

A 14-year-old girl had a 3-month history of headache and blurred vision. Funduscopy showed bilateral optic disc edema. Findings on brain imaging were normal, and a diagnosis of idiopathic intracranial hypertension was confirmed after lumbar puncture showed an elevated opening pressure of 32 cm H
2
O. Optic nerve head drusen were noted on computed tomography scan and confirmed with B-scan ultrasound. After 2 years, resolution of symptoms coincided with variable compliance to treatment with acetazolamide and concomitant papilledema. In general, optic disc edema poses a clinical conundrum due to the more common occurrence of optic nerve head drusen, potentially resulting in delayed diagnosis and treatment of idiopathic intracranial hypertension.
[J Pediatr Ophthalmol Strabismus 2009;46:238–240.]
Presumed Early-Onset Sarcoidosis: A Case of Devastating Ocular Inflammation in an Infant
Authors: Bhojwani Rajan , Houtman Anne-Cees , Stanga Paulo , Bonshek Richard , Lloyd I. Chris , Baildam Eileen , Biswas Susmito
Published: July 2009

Involvement of the orbit and posterior segment of the eye in early-onset sarcoidosis may necessitate prompt and aggressive immunosuppressive treatment to prevent a poor visual outcome.
[J Pediatr Ophthalmol Strabismus 2009;46:245–248.]
Confidence Levels Can Broaden the Application of Clinical Research Findings and Promote Evidence-Based Practice
Authors: Graham James E. , Reistetter Timothy A. , Mallinson Trudy R. , Ottenbacher Kenneth J.
Published: July 2009

The traditional method of presenting quantitative research findings based on the statistical results of null hypothesis testing can limit the ability of clinicians and consumers to translate research findings into meaningful information for treatment planning and evaluation. In this article, the authors compare results from an illustrative study based on traditional statistical methods, including a t test and p values, to a more clinically useful approach using confidence levels. The process of calculating confidence levels using the basic quantitative information included in most clinical research articles is described. The argument is made that confidence levels do not replace traditional (null) hypothesis testing. Rather, they facilitate the interpretation of statistical findings, improve clinical decision making, and support the development of evidence-based occupational therapy practice.
A Comparison of Perceptions among Employed and Unemployed Individuals with Psychiatric Disabilities regarding Factors Affecting Employment
Authors: Wu Yi-Jung , Su Wei-Lieh , Lin Yueh-Hsien , Chueh Ching-Mo , Su Chwen-Yng
Published: July 2009

This study compared the perspectives of employed and unemployed individuals with psychiatric disabilities regarding factors influencing employment. Ninety-six employed and 113 unemployed individuals completed questionnaires assessing the importance of several factors in successfully maintaining employment. These factors included psychiatric symptoms; the person's ability, work habits, and attitudes; and environmental factors. Exploratory factor analyses supported a unidimensional structure for each of the four subscales, with high internal consistency estimates across all subscales (coefficient alpha values ranging from 0.84 to 0.95). The results indicated no significant differences between the two groups in mean ratings for the items and subscales. Employed people perceived psychiatric symptoms as being more important than the other three subscales; however, in comparison, unemployed people gave the highest mean rating to environmental factors (e.g., employer's acceptance, absence of stigma, working in a safe environment, and supportive family). Overall, the two groups had moderate agreement on the most important influences on employment. Implications for services are discussed.
Developing Assessments That Account for the Role of the Environment: An Example Using the Test of Playfulness and Test of Environmental Supportiveness
Authors: Bundy Anita C. , Waugh Katrina , Brentnall Jennie
Published: July 2009

The authors illustrate a three-stage process for developing assessments that are consistent with occupational therapists' conceptualizations of the interactions among individuals, environments, and occupations. Existing Test of Playfulness (ToP) and Test of Environmental Supportiveness (TOES) data from 265 children aged 15 months to 12 years were used. In Phase 1, the ToP was altered by dropping the statistical adjustment for rater severity (facet). In Phase 2, raw TOES scores, collapsed into categories, were added as a measured facet; the resulting assessment was examined for evidence of validity and reliability. In Phase 3, the assessment was found to be a clinically useful tool. The authors showed that environmental supportiveness has a significant effect on observed playfulness and that it can be measured and accounted for in an assessment. The process is representative of methods that could allow therapists to predict how a client's score on a measure of occupational performance might change in a different environment.
Exploring Occupational Balance in Adults with Rheumatoid Arthritis
Authors: Forhan Mary , Backman Catherine
Published: July 2009

Chronic illness disrupts participation in daily living. The objective of this study was to identify factors associated with three indicators of occupational balance: perceived satisfaction with performance of one's primary occupation, the balance of time spent on occupations, and daily achievements. One hundred sixty-nine adults (78% women) with rheumatoid arthritis completed the Occupational Questionnaire and a survey of health and functional status. Using multiple linear regression, general health status was a significant predictor of all three indicators of occupational balance. Self-efficacy with respect to arthritis symptoms, work limitations, and self-care ability were additional predictors of satisfaction with achievements; social function, pain, and work ability were additional predictors of satisfaction with performance; and the proportion of time spent in occupations deemed as enjoyable was an additional predictor of satisfaction with balance of time spent across occupations. Study results provide support for emerging models of occupational balance as a multidimensional concept.
Development of the Attributed Dignity Scale
Authors: Jacelon Cynthia S. , Dixon Jane , Knafl Kathleen A.
Published: July 2009

A sequential, multi-method approach to instrument development beginning with concept analysis, followed by (a) item generation from qualitative data, (b) review of items by expert and lay person panels, (c) cognitive appraisal interviews, (d) pilot testing, and (e) evaluating construct validity was used to develop a measure of attributed dignity in older adults. The resulting positively scored, 23-item scale has three dimensions: Self-Value, Behavioral Respect-Self, and Behavioral Respect-Others. Item-total correlations in the pilot study ranged from 0.39 to 0.85. Correlations between the Attributed Dignity Scale (ADS) and both Rosenberg's Self-Esteem Scale (0.17) and Crowne and Marlowe's Social Desirability Scale (0.36) were modest and in the expected direction, indicating attributed dignity is a related but independent concept. Next steps include testing the ADS with a larger sample to complete factor analysis, test-retest stability, and further study of the relationships between attributed dignity and other concepts.
Influences of Spiritual Well-Being and Coping on Mental Health of Family Caregivers for Elders
Authors: Yeh Pi-Ming , Bull Margaret
Published: July 2009

The purpose of the study was to describe spiritual well-being of family caregivers of elders with congestive heart failure and examine the relationships among family caregivers' spiritual well-being, coping, and mental health. A descriptive, correlational research design was used, and data were collected from a convenience sample of 50 family caregivers. The findings indicated that positive spiritual well-being was inversely related to negative mental health. Examination of the spiritual well-being subscales suggested that faith/belief systems and life satisfaction contributed to the significant correlation. Positive coping strategies were inversely related to negative mental health. Examination of the coping subscales suggested that scores on Problem Solving and Coping, Alternative Perception of Events, and Dealing with Stress Symptoms contributed to the significant correlation with mental health scores. It is vital to identify processes that contribute to family caregivers' mental health to support them in their role.
Relationships Among Disordered Sleep and Cognitive and Functional Status in Nursing Home Residents
Authors: Cole Catherine S. , Richards Kathy C. , Beck Cornelia C. , Roberson Paula K. , Lambert Corinne , Furnish Allison , Free Jon , Tackett Joan
Published: July 2009

This descriptive study examined relationships among disordered sleep and cognitive and functional status in nursing home residents (
N
= 90). Baseline data were used from a randomized controlled clinical trial that took place in three nursing homes. The sample included individuals age 55 and older with disordered sleep and cognitive impairment. We measured nighttime sleep with attended polysomnography and cognitive status with the Mini-Mental State Examination and assessed two indicators of functional status: level of assistance required and gait speed. Decreased total sleep time (TST), fewer respiratory awakenings, and higher oxygen saturation (SaO
2
) nadir were associated with better cognitive and functional status. After controlling for the effect of cognitive status, the association between decreased TST and better gait speed remained significant. Although correlation does not establish causation, these findings suggest that interventions to decrease nighttime respiratory awakenings and maintain SaO
2
have the potential to support cognitive and functional status in nursing home residents.
Service Oriented Computing in Practice – An Agenda for Research into the Factors Influencing the Organizational Adoption of Service Oriented Architectures
Authors: Luthria Haresh , Rabhi Fethi
Published: July 2009

The paradigm of service-oriented computing (SOC) has emerged as an approach to provide flexibility and agility, not just in systems development but also in business process management. This modular approach to defining business flows as technology independent services has gained unanimous popularity among end-users and technology vendors alike. Although there is a significant amount of ongoing research on the potential of service oriented architectures (SOAs), there is a paucity of research literature on the factors affecting the adoption of service-oriented computing in practice. This paper reviews the current state of the technology, identifies the factors influencing the decision to adopt service-oriented computing as an enterprise strategy and discusses the associated research literature, and concludes with a suggested research agenda and conceptual framework for investigating the use of service-oriented computing in practice.
Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care
Authors: Sorbara Carla , Ray Joel G. , Darling Elizabeth K. , Chung Hannah , Podolsky Sho , Stukel Therese A.
Published: April 2024

Importance

Emergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.

Objective

To assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.

Design, Setting, and Participants

This retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023.

Exposures

Perinatal care clinician, namely, a midwife or obstetrician.

Main Outcome and Measures

: Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights.

Results

Among 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23 124 women (6.7%) with midwifery-model care compared with 6902 of 81 871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77).

Conclusions and Relevance

In this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.
Artificial Intelligence Chatbots and Their Influence on Learning
Authors: Movaghar Arezoo , Thompson Lindsay A.
Published: April 2024

This JAMA Pediatrics Patient Page describes what artificial intelligence chatbots are and how they may influence learning among children.
Factors Associated With Adherence of Cervical Cancer Screening in Women With Systemic Lupus Erythematosus
Authors: Bruera Sebastian , Bowman Savannah , Huang Yinan , Suarez‐Almazor Maria E. , Lo Grace H. , Lopez‐Olivo Maria , Chiao Elizabeth , Kramer Jennifer R. , Pereira Fred A. , Agarwal Sandeep K.
Published: April 2024

Objective

The objective is to determine cervical cancer screening rates and factors associated with decreased cervical cancer screening in women with systemic lupus erythematosus (SLE).

Methods

We conducted a cross‐sectional study that enrolled consecutive women (age 21–64 years) with SLE. We collected demographics, clinical characteristics, constructs of the Health Beliefs Model (HBM) (ie, susceptibility, severity, barriers, benefits, cues to action, and self‐efficacy), and self‐reported cervical cancer screening (confirmed with the electronic medical record). The primary outcome was adherence to cervical cancer screening according to current guidelines. Multivariable logistic regression models were used to examine the association between SLE disease activity and cervical cancer screening and explore mediation effects from HBM constructs.

Results

We enrolled 130 women with SLE. The median age was 42 years (interquartile range 32–52 years). The cervical cancer screening adherence rate was 61.5%. Women with high SLE disease activity were less likely to have cervical cancer screening versus those with low disease activity (odds ratio 0.59, 95% confidence interval [CI] 0.39–0.89; P = 0.01), which remained statistically significant after adjusting for baseline demographics and drug therapy in a multivariable model (odds ratio 0.25, 95% CI 0.08–0.79; P = 0.02). Regarding the HBM constructs, increased perceived barriers to cervical cancer screening (r = −0.30, P < 0.01) and decreased self‐efficacy (r = −0.21, P = 0.02) correlated with decreased cervical cancer screening.

Conclusion

Patients with SLE with high disease activity undergo cervical cancer screening less frequently than those with low disease activity. Perceived barriers to cervical cancer screening are moderately correlated with decreased screening. These data highlight the need to develop strategies to increase cervical cancer screening in this high‐risk patient population.
Vehicle vibration test platform structure design and control strategy optimization
Authors: Xi Zhiqiang , Guo Yongzheng , Wang Yiliu , Liu Kui , Yang Haiyang , Guo Zhanzheng , Zhang Shuai
Published: April 2024

For the needs of vehicle vibration test platform with high precision, large load capacity and fast response, the three‐dimensional model design and analysis of vehicle vibration test platform are carried out; in order to improve the motion performance of the platform, a vibration test plat‐form control strategy combining hybrid heuristic algorithm and PID control is proposed. Based on the designed 3D model parameters, the single‐channel mathematical model of the servo‐electric cylinder is derived and a hybrid heuristic algorithm PID optimization model is established to compare and analyze the control performance of the platform with the Ziegler‐Nichols method PID. The results show that the step system overshoot is 3.80% and the dynamic performance of the system is significantly improved when the hybrid heuristic algorithm PID control is used. The simulation system model of vehicle vibration test platform control is established, and the operation results show that the platform is closer to the input signal in the spatial position change curve when the hybrid heuristic algorithm PID control is used. Its maximum displacement error is 0.09 mm, and the motion accuracy of the system is improved by 61% compared with the Ziegler‐Nichols method PID control.
Biphasic Liquid Metal Composite for Strain Sensor with High Stretchability and Sensitivity
Authors: Chen Ping , Zhou Xiao‐Ping
Published: April 2024

Strain measurement is crucial for the safety and stability of engineering activities. With the increasing demand for sensors and large strain measurement in engineering monitoring, the study on the large strain measurement is deepening. However, the conventional strain sensors based on rigid conductive materials have limited flexibility and low stretchability, and the research of large strain and flexible sensors in engineering still lacks. In this work, a highly stretchable and sensitive flexible strain sensor based on liquid metal‐Nickle microparticles (LMN) composite is developed to detect large strain. The LMN composite, featuring uniformly dispersed Nickle microparticles within the liquid metal matrix, is deposited onto the elastomer Ecoflex base material.The LMN composite based‐sensor exhibits high sensitivity (GF = 16.14644 at strain of 200%), large stretchability (up to 200%) and low hysteresis. The theoretical relationship between the relative resistance changes and strain is derived, and the theoretical derivation is compared with experimental data to verify the accuracy of theoretical derivation. Additionally, the LMN composite based‐sensors can be used to detect pressure and bending signals in engineering. This work highlights the potential of LMN composite in broad applications and can facilitate the application of flexible sensing devices in engineering.
Mechanical Behaviour, Contact Pose Estimation, and Finite Element Analysis of Vision Based Tactile Sensors Fabricated by Molding and Direct Ink Writing: A Comparative Study
Authors: Solayman Abdullah , Halwani Mohamad , Zaid Islam Mohamed , Ambade Rohan B. , Chang Rui , Ayyad Abdulla , AlMaskari Fahad , Zweiri Yahya , Abdul Samad Yarjan
Published: April 2024

This work pioneers the application of direct ink writing (DIW) to fabricate elastomeric additively manufactured vision based tactile sensor (VBTS). DIW cuts down the fabrication time by 76%, allowing design precise control and reducing the complexities of the process compared to the state‐of‐the‐art (SOTA) molding techniques. Successful fabrication of DIW sensor is verified in three stages. Firstly, the mechanical characteristics of the DIW sensor are at par with those of SOTA molded Ecoflex in terms of depth of compression, compression rate, and the number of cycles. Secondly, using robotic pose estimation as a demonstration, the force enables deformation in the DIW sensor shows comparable normality estimation performance to that of the SOTA Ecoflex with a mean absolute error of less than 0.6°. Thirdly, finite element analysis (FEA) of DIW and SOTA Ecoflex sensors using Yeoh model shows similar stress and strain distributions as another evidence of DIW deformability and durability signaling sensor's successful fabrication.
Heart‐on‐a‐Chip Model of Epicardial–Myocardial Interaction in Ischemia Reperfusion Injury
Authors: Bannerman Dawn , Pascual‐Gil Simon , Wu Qinghua , Fernandes Ian , Zhao Yimu , Wagner Karl T. , Okhovatian Sargol , Landau Shira , Rafatian Naimeh , Bodenstein David F. , Wang Ying , Nash Trevor R. , Vunjak‐Novakovic Gordana , Keller Gordon , Epelman Slava , Radisic Milica
Published: April 2024

Epicardial cells (EPIs) form the outer layer of the heart and play an important role in development and disease. Current heart‐on‐a‐chip platforms still do not fully mimic the native cardiac environment due to the absence of relevant cell types, such as EPIs. Here, using the Biowire II platform, engineered cardiac tissues with an epicardial outer layer and inner myocardial structure are constructed, and an image analysis approach is developed to track the EPI cell migration in a beating myocardial environment. Functional properties of EPI cardiac tissues improve over two weeks in culture. In conditions mimicking ischemia reperfusion injury (IRI), the EPI cardiac tissues experience less cell death and a lower impact on functional properties. EPI cell coverage is significantly reduced and more diffuse under normoxic conditions compared to the post‐IRI conditions. Upon IRI, migration of EPI cells into the cardiac tissue interior is observed, with contributions to alpha smooth muscle actin positive cell population. Altogether, a novel heart‐on‐a‐chip model is designed to incorporate EPIs through a formation process that mimics cardiac development, and this work demonstrates that EPI cardiac tissues respond to injury differently than epicardium‐free controls, highlighting the importance of including EPIs in heart‐on‐a‐chip constructs that aim to accurately mimic the cardiac environment.
Phototuning of Hyaluronic‐Acid‐Based Hydrogel Properties to Control Network Formation in Human Vascular Endothelial Cells
Authors: Elvitigala Kelum Chamara Manoj Lakmal , Mohan Lakshmi , Mubarok Wildan , Sakai Shinji
Published: April 2024

In vitro network formation by endothelial cells serves as a fundamental model for studies aimed at understanding angiogenesis. The morphogenesis of these cells to form a network is intricately regulated by the mechanical and biochemical properties of the extracellular matrix. Here the effects of modulating these properties in hydrogels derived from phenolated hyaluronic acid (HA‐Ph) and phenolated gelatin (Gelatin‐Ph) are presented. Visible‐light irradiation in the presence of tris(2,2′‐bipyridyl)ruthenium(II) chloride hexahydrate and sodium persulfate induces the crosslinking of these polymers, thereby forming a hydrogel and degrading HA‐Ph. Human vascular endothelial cells form networks on the hydrogel prepared by visible‐light irradiation for 45 min (42 W cm−2 at 450 nm) but not on the hydrogels prepared by irradiation for 15, 30, or 60 min. The irradiation time‐dependent degradation of HA‐Ph and the changes in the mechanical stiffness of the hydrogels, coupled with the expressions of RhoA and β‐actin genes and CD44 receptors in the cells, reveal that the network formation is synergistically influenced by the hydrogel stiffness and HA‐Ph degradation. These findings highlight the potential of tailoring HA‐based hydrogel properties to modulate human vascular endothelial cell responses, which is critical for advancing their application in vascular tissue engineering.
Distance‐Driven Terahertz Metallic Metasurface Supporting QGM in the Continuum
Authors: Yang Fan , Wang Zhiyong , Li Jitao , Yue Zhen , Zhang Qianyun , Li Hui , Song Chunyu , Liu Yanyan , Ding Xin , Wu Liang , Zhang Yating , Yao Jianquan
Published: April 2024

The metasurfaces that support high‐Q resonances can provide ultra‐sharp resonance and achieve strong light‐matter interaction, which promotes their application in various fields such as sensing, lasing, and imaging. Bound modes, unable to radiate into free space, can be transformed into quasi‐bound modes and coupled with external radiation, achieving high‐Q resonances. For periodic structures, by introducing appropriate periodic perturbations, the guided modes (GMs) below the light line can be exposed above the light line, forming the high‐Q quasi‐guide modes (QGMs). Herein, a metallic metasurface is designed that supports the QGM in the continuum by introducing the Brillouin zone folding strategy. The simulation and experiment demonstrate that the GM below the light line can be transformed into the QGM in the continuum by tuning the distance parameter, and a typical “electromagnetic‐induced transparency‐like (EIT‐like)” spectrum is observed. The design unlocks additional degrees of freedom for generating high‐Q metallic metasurface. The advantage of avoiding the production of asymmetric defects contributes to releasing the strict requirement on manufacturing precision. The combination of the metallic metasurface supporting QGM resonance with high‐Q factors and the flexible substrate can improve the performance of the flexible devices and broaden its application in terahertz optoelectronic devices.
Structural Evolution of Bacterial Polyphosphate Degradation Enzyme for Phosphorus Cycling
Authors: Dai Shang , Wang Binqiang , Ye Rui , Zhang Dong , Xie Zhenming , Yu Ning , Cai Chunhui , Huang Cheng , Zhao Jie , Zhang Furong , Hua Yuejin , Zhao Ye , Zhou Ruhong , Tian Bing
Published: April 2024

Living organisms ranging from bacteria to animals have developed their own ways to accumulate and store phosphate during evolution, in particular as the polyphosphate (polyP) granules in bacteria. Degradation of polyP into phosphate is involved in phosphorus cycling, and exopolyphosphatase (PPX) is the key enzyme for polyP degradation in bacteria. Thus, understanding the structure basis of PPX is crucial to reveal the polyP degradation mechanism. Here, it is found that PPX structure varies in the length of ɑ‐helical interdomain linker (ɑ‐linker) across various bacteria, which is negatively correlated with their enzymatic activity and thermostability – those with shorter ɑ‐linkers demonstrate higher polyP degradation ability. Moreover, the artificial DrPPX mutants with shorter ɑ‐linker tend to have more compact pockets for polyP binding and stronger subunit interactions, as well as higher enzymatic efficiency (kcat/Km) than that of DrPPX wild type. In Deinococcus‐Thermus, the PPXs from thermophilic species possess a shorter ɑ‐linker and retain their catalytic ability at high temperatures (70 °C), which may facilitate the thermophilic species to utilize polyP in high‐temperature environments. These findings provide insights into the interdomain linker length‐dependent evolution of PPXs, which shed light on enzymatic adaption for phosphorus cycling during natural evolution and rational design of enzyme.
Latent Solvent Induced Reliable Interfacial Chemistry Toward Highly Reversible Zn Anodes
Authors: Su Long , Lu Fei , Dong Jingjing , Dou Xinwei , Zheng Liqiang , Ouyang Chuying , Gao Xinpei
Published: April 2024

Aqueous zinc‐ion batteries have garnered renewed interest owing to their inherent safety and cost‐effectiveness. However, Zn anode suffers from notorious side reactions and dendrite growth, compromising the battery performance. Designing anion‐containing solvation structures to facilitate the in situ formation of a solid electrolyte interphase (SEI) layer proves effective in protecting Zn anode, yet balancing the inherent interactions between the cations‐solvents and cations–anions remains a significant challenge. Herein, latent solvent (hexafluoroisopropanol) with specific anion‐philic and cation‐phobic properties is introduced, which can remarkably increase Zn(TFSI)2 solubility in water and induce anion‐containing solvation structures. The introduction of latent solvent enables anions to preferentially decompose, giving rise to an anion‐derived SEI layer. More interestingly, the direct anion‐cation interaction endows Zn2+ species with stepwise dehydration, minimizing the adsorption of water on Zn anode. The anion‐derived SEI layer and optimized de‐solvation process work in synergy to enable homogeneous Zn deposition and ensure high reversibility. When coupled with a NaV3O8·1.5H2O (NVO) cathode, the resultant full cell delivers a high‐capacity retention of 87.8% after 2000 cycles at 1 A g−1. This work provides valuable insights into the advanced latent solvent electrolyte design and beyond.