bluuebunny/crossref_metadata_2025 huggingface dataset:
Thresholds and (or?) Signal Detection Theory
Authors: Campbell Richard A.
Published: October 2016

Discussions of signal detection theory and psychophysics (acquiring thresholds) appear unanimous in condemning the threshold as an adequate measure of the sensory system of a listener. The viewpoint is here presented that signal detection theory and thresholds need not he antagonistic concepts. Rather, a plea is made for the utilization of signal detection theory information to develop more adequate threshold-obtaining procedures.
Efficient analytical moments for the robustness analysis in design optimisation
Authors: Rajan Arvind , Ooi Melanie Po‐Leen , Kuang Ye Chow , Demidenko Serge N.
Published: October 2016

System uncertainties play a vital role in the robustness (or sensitivity) analysis of system designs. In an iterative procedure such as design optimisation, the robustness analysis that is simultaneously accurate and computationally efficient is essential. Accordingly, the current state‐of‐the‐art techniques such as univariate dimension reduction method (DRM) and performance moment integration (PMI) approach have been developed. They are commonly used to express the sensitivity while utilising the statistical moments of a performance function in an advanced design optimisation paradigm known as the reliability‐based robust design optimisation (RBRDO). However, the accuracy and computational efficiency scalability for increasing the problem dimension (i.e. the number of input variables) have not been tested. This study examines the scalability of the above‐mentioned pioneering techniques. Additionally, it also introduces a novel analytical method that symbolically calculates the sensitivity of the performance function prior to the iterative optimisation procedure. As a result, it shows a better computational cost scalability when tested on performance functions with increased dimensionality. Most importantly, when applied to real‐world RBRDO problems such as the vehicle side impact crashworthiness, the proposed technique is three times faster than the mainstream method while yielding a high quality and safe vehicle design.
Kopf-Hals-Krebs in der Schwangerschaft – Empfehlungen zu Diagnostik und Therapie mit Fallbericht
Authors: Mozet C. , Kuhnt T. , Sattler B. , Remmele J. , Thome U. , Stepan H. , Kluge R. , Dietz A. , Knoedler M.
Published: October 2016

Hintergrund: Die Diagnose einer Krebserkrankung in der Schwangerschaft ist selten, aufgrund einer Verschiebung des Alters der Erstgebärenden hin zum letzten Drittel des reproduzierfähigen Alters aber auch für Kopf-Hals-Tumorpatientinnen möglicherweise zunehmend relevant. Dabei besteht eine große Unsicherheit bezüglich des Nutzens und Risikos von diagnostischen oder therapeutischen Tumortherapiemodalitäten für das Ungeborene, sodass eine fundierte Empfehlung in diesen Fällen besonders schwer fällt. Nach neuen Literaturdaten scheint aber sogar eine multimodale Tumortherapie (Operation, Bestrahlung, Chemotherapie) trotz Schwangerschaft möglich und sollte streng gegen das Risiko einer Frühgeburtlichkeit abgewogen werden.

Material und Methoden: Die Arbeit gibt eine Literaturübersicht über aktuelle Erkenntnisse zu diagnostischen Verfahren in der Schwangerschaft und zu dem Risiko von tumortherapeutischen Maßnahmen wie Bestrahlung und Chemotherapie für das Ungeborene. Die Erkenntnisse werden anhand eines konkreten Falls einer Schwangeren mit einem ausgedehnten Gehörgangskarzinom diskutiert und es werden Empfehlungen formuliert.

Ergebnisse: Suffizient durchgeführte diagnostische Modalitäten erreichen die gefährdenden Uterusdosen praktisch nicht. Eine Reihe von Fallberichten und Beobachtungsstudien zeigen auch keinen Entwicklungsnachteil für die Kinder pränatal exponierter tumorkranker Mütter durch Bestrahlung oder Chemotherapie, wohingegen der langfristige Entwicklungsnachteil durch die Frühgeburtlichkeit nachgewiesen ist.

Schlussfolgerung: Wenn während einer Schwangerschaft eine Tumorneuerkrankung im Kopf-Hals-Bereich festgestellt wird, erscheint auch die Durchführung einer etablierten Therapie mittels Operation und/oder Cisplatin-basierter Radiochemotherapie mit vertretbarem Risiko für das ungeborene Kind möglich.
Translocation is a nonequilibrium process at all stages: Simulating the capture and translocation of a polymer by a nanopore
Authors: Vollmer Sarah C. , de Haan Hendrick W.
Published: October 2016

Langevin dynamics simulations of the capture of polymers by a nanopore and the subsequent translocation through the nanopore are performed. These simulations are conducted for several polymer lengths at two different values for the Péclet number, which quantifies the drift-diffusion balance of the system. The capture-translocation process is divided into several stages, and the dynamics of translocation are characterized by measuring the average time for each stage and also the average conformation of the polymer at each stage. Comparison to the standard simulation approach of simulating only the translocation process reveals several important differences. While in the standard protocol, the polymer is essentially equilibrated at the start of translocation, simulations of the capture process reveal a polymer that is elongated when it approaches the pore and either remains elongated or becomes compressed at the start of translocation depending on the drift-diffusion balance. These results demonstrate that translocation is a non-equilibrium process at all stages and that simulations assuming equilibration could yield improper results, even at a qualitative level. The scaling of the translocation time with polymer length is found to be significantly different between the two simulation protocols thus demonstrating that the capture step is an essential part of modeling the translocation process.
Gradings on the real form 𝔢6,−26
Authors: Draper Cristina , Guido Valerio
Published: October 2016

We describe four fine gradings on the real form 𝔢6,−26 of the complex Lie algebra 𝔢6. They are precisely the gradings whose complexifications are fine gradings on the complex algebra. The universal grading groups are Z26, Z×Z24, Z2×Z23, and Z4×Z24.
Carbon K-edge electron-energy-loss near-edge structure in the reflection mode on graphene/Ni(111)
Authors: Cupolillo A. , Ligato N. , Osman S. M. , Caputi L. S.
Published: October 2016

Electron-energy-loss near-edge structure (ELNES) in the transmission mode is a useful tool to investigate the properties of materials, in conjunction with transmission electron microscope (TEM) imaging. The ELNES technique has been extensively applied on graphene and other carbon-based materials. Of course, such method is applicable only on thin systems; thus, it cannot be used to investigate the properties of massive samples, or thin layers adsorbed on thick substrates, for example, graphene on metal supports. Here, we show that it is possible to use electron energy loss in the reflection mode to measure the fine structure of the carbon K-edge in monolayer graphene on Ni(111), thus demonstrating that reflection ELNES is a very sensitive tool, particularly useful in cases where the TEM-based ELNES cannot be applied.
Composite one-way transmission waveguide based on the curved metal slit and 1D photonic crystal
Authors: Gao Qi , Zhou Yun-Song , Gao Hua , Wang Huai-yu
Published: October 2016

The one-way devices in optical circuits are the key components just as the diodes in electric circuits, which allow the light going in only one direction. A novel one-way transmission structure is proposed which is a curved waveguide containing a confined photonic crystal. When the waveguide is made of perfect electric conductor, the exact calculation results demonstrate that the device shows excellent one-way properties. The forward transmissivity approaches 100% and the largest transmission ratio exceeds 100.92N, where N is the cell number of the photonic crystal in the structure. When the waveguide is made of real metal, the device also presents excellent one-way transmission properties, which can be confirmed by an approximate calculation as well as by the simulation. In working region, the lowest forward tranmissivity is about 30% and the largest one exceeds 70%. The highest transmission ratio exceeds 104.
Measurements of the principal Hugoniots of dense gaseous deuterium−helium mixtures: Combined multi-channel optical pyrometry, velocity interferometry, and streak optical pyrometry measurements
Authors: Li Zhi-Guo , Chen Qi-Feng , Gu Yun-Jun , Zheng Jun , Chen Xiang-Rong
Published: October 2016

The accurate hydrodynamic description of an event or system that addresses the equations of state, phase transitions, dissociations, ionizations, and compressions, determines how materials respond to a wide range of physical environments. To understand dense matter behavior in extreme conditions requires the continual development of diagnostic methods for accurate measurements of the physical parameters. Here, we present a comprehensive diagnostic technique that comprises optical pyrometry, velocity interferometry, and time-resolved spectroscopy. This technique was applied to shock compression experiments of dense gaseous deuterium–helium mixtures driven via a two-stage light gas gun. The advantage of this approach lies in providing measurements of multiple physical parameters in a single experiment, such as light radiation histories, particle velocity profiles, and time-resolved spectra, which enables simultaneous measurements of shock velocity, particle velocity, pressure, density, and temperature and expands understanding of dense high pressure shock situations. The combination of multiple diagnostics also allows different experimental observables to be measured and cross-checked. Additionally, it implements an accurate measurement of the principal Hugoniots of deuterium−helium mixtures, which provides a benchmark for the impedance matching measurement technique.
Uptake and trends in ordering of funded hepatitis B immunisation for priority populations in Victoria, Australia, 2013–2014
Authors: MacLachlan Jennifer H. , Cowie Benjamin C.
Published: October 2016

Background
The Department of Health and Human Services in Victoria provides funded hepatitis B vaccine to many priority groups at risk of acquiring infection. We aimed to determine the uptake of vaccine ordering for at-risk groups over time, to assess any trends and identify any gaps in prevention of hepatitis B for those at risk. Methods: Routinely collected administrative data regarding the indication for vaccine ordered by practitioners were analysed for the period June 2013 to December 2014. Number of doses and courses distributed was determined and compared with the estimated size of the priority populations. Results: During the 18-month period assessed, 20 498 doses of funded hepatitis B vaccine were ordered, equating to ~5700 complete courses, with the overall number of orders per quarter increasing between 2013 and 2014. The most common indication was being a household or sexual contact of people living with hepatitis B (2803 courses, 49.2% of the total), equating to approximately one course per new chronic hepatitis B notification. The remaining doses were largely distributed to people living with HIV (648 courses, 11.4%), people living with hepatitis C (621 courses, 10.9%), and people who inject drugs (594 courses, 10.4%). Conclusions: This analysis demonstrates that access to hepatitis B immunisation among priority populations appears to have increased in Victoria during 2013–14, however it could still be improved. Continued assessment of these data over time will be important to measure the impact of interventions on increasing the reach of the funded vaccine program.
Study of heavy metal fractionation in the Lami municipal disposal facility, Fiji
Authors: Chandra Shaneel , Gangaiya Philomena , Togamana Culwick , Prasad Surendra
Published: October 2016

This work reports the first screening study of the bioavailability of heavy metals such as copper, zinc, lead and nickel in the Lami municipal disposal facility, Suva, Fiji where virtually uncontrolled dumping had been carried out for over fifty years. The soil samples from three parts of the facility were collected and the potential for mobility into the surrounding marine environment was assessed according to international guidelines. The results showed high levels of Pb in Site A (109.0 mg kg–1) and that Zn was the predominant metal across Sites B and C with 550.7 mg kg–1 and 206.8 mg kg–1, respectively. Ni was present in the least amount with the highest value 8.7 mg kg–1. In addition, Cu, Pb and Zn concentrations exceeded commonly used eco-toxicity threshold values. Moreover, there were indications that considerable leaching of the studied heavy metals may have been occurring for long periods of time at the sites. Overall, this study showed that even in areas with little industrialization, lack of adequate waste management controls could result in unusually high levels of heavy metals contamination of the soil. The results raise concerns about the wellbeing of the communities living adjacent to the Lami municipal disposal facility that depend on the adjacent marine environment for their subsistence.
Reducing machining distortion in AA 6061 alloy through re-heating technique
Authors: Rafey Khan A. , Nisar S. , Shah A. , Khan M. A. , Khan S. Z. , Sheikh M. A.
Published: October 2016

Solution-treated AA 6061 alloy contains residual stresses which cause unwanted deformation during the machining operation rendering the parts unacceptable for use. Usually for AA 6061 alloy, stress relieving is performed by re-heating the parts at 343°C for 1 h. This stress relieving is however accompanied by a considerable loss of material strength which subsequently reduces the functionality of the parts. This paper is based on an effort to evaluate the effectiveness of lower re-heating temperatures for stress relieving without significant loss of strength. Temperatures within the range of 200–343°C were used and treated samples were tested for both the strength and machining distortion. The experimental results indicate 60% reduction in machining distortions with 21% decrease in the strength.
α-Defensin 5 gene expression is regulated by gut microbial metabolites
Authors: Sugi Yutaka , Takahashi Kyoko , Kurihara Kenta , Nakano Kou , Kobayakawa Tetsuro , Nakata Kazuaki , Tsuda Masato , Hanazawa Shigemasa , Hosono Akira , Kaminogawa Shuichi
Published: October 2016

α-Defensin 5 is important to both maintenance of a gut microbiota and host immunity. While previous reports have shown that gut bacteria are able to upregulate α-defensin 5 through Toll-like receptor signaling, we demonstrate here that α-defensin 5 expression can also be regulated by microbial metabolites. Among these, lactate appeared to significantly suppress α-defensin 5 gene transcription. Actually, fractions of <3 kD compounds obtained from the ceca of SPF mice were suppressed α-defensin 5 gene transcription at specific concentrations. Our results also suggest that cecal content may include as yet unidentified factors that can enhance α-defensin 5 expression. Our data point to a novel function for the gut microbial metabolites in controlling the expression of antimicrobial peptides in the intestine.
Influence of short‐term inertial training on swimming performance in young swimmers
Authors: Naczk Mariusz , Lopacinski Artur , Brzenczek‐Owczarzak Wioletta , Arlet Jarosław , Naczk Alicja , Adach Zdzisław
Published: October 2016

The aim of this study was to evaluate the influence of dry‐land inertial training (IT) on muscle force, muscle power, and swimming performance. Fourteen young, national‐level, competitive swimmers were randomly divided into IT and control (C) groups. The experiment lasted four weeks, during which time both groups underwent their regular swimming training. In addition, the IT group underwent IT using the Inertial Training Measurement System (ITMS) three times per week. The muscle groups involved during the upsweep phase of the arm stroke in front crawl and butterfly stroke were trained. Before and after training, muscle force and power were measured under IT conditions. Simultaneously with the biomechanical measurements on the ITMS, the electrical activity of the triceps brachii was registered. After four weeks of training, a 12.8% increase in the muscle force and 14.2% increase in the muscle power (p < .05) were noted in the IT group. Moreover, electromyography amplitude of triceps brachii recorded during strength measurements increased by 22.7% in the IT group. Moreover, swimming velocity in the 100 m butterfly and 50 m freestyle improved significantly following the four weeks of dry‐land IT (−1.86% and −0.76%, respectively). Changes in the C group were trivial. Moreover, values of force and power registered during the ITMS test correlated negatively with the 100 m butterfly and 50 m freestyle swimming times (r value ranged from −.80 to −.91). These results suggest that IT can be useful in swimming practice.
Action
Authors: Grumett David
Published: October 2016

In the liturgy, actions can speak louder than words. Silence may powerfully intensify the significance of the bread, wine, and other material elements employed in the Eucharist, as in the Great Entrance in the Orthodox liturgy. Silence also encourages an allegorical liturgical exegesis, in which actions, although often performed for practical reasons, symbolically represent the whole life, death, resurrection, and ascension of Jesus, rather than just his sacrifice on the cross. In historical perspective, lay participation in the Eucharist has been central, such as in the singing of the Sanctus, which may be viewed as participation in the angelic worship of heaven. The way in which laypeople receive communion is significant, and they exercise a priesthood of transformative action in the world.
Transnational Corporations as Drivers and Targets of Change
Authors: Green Duncan
Published: October 2016

This chapter focuses on transnational corporations (TNCs), not only as economic heavyweights, but also as influential players in political and social change. It traces the origins of the modern TNC to the East India Company, which was established in 1600 and grew to become a trading empire that encircled the globe. The chapter next looks at the ways in which TNCs drive change, arguing that they do so both through their normal business operations, and through their behaviour as political players. The world of TNCs is seething with expressions of power, hidden in their political connections, and invisible in the extraordinary influence on consumers exerted by brands and the values they claim to embody, as well as the apparently mesmerizing authority of giant corporations in the eyes of policy makers. With this in mind, the chapter also discusses the ways in which activists can in turn influence TNCs.
Seven Lives from Mass Observation
Authors: Hinton James
Published: October 2016

The book uses autobiographical writing contributed to Mass Observation since 1981 to explore the social and cultural history of late-twentieth-century Britain. Prompted by thrice-yearly open-ended questionnaires, Mass Observation’s volunteers wrote about their political attitudes, religious beliefs, work, childhoods, education, friendships, marriages, sex lives, mid-life crises, aging—the whole range of human emotion, feeling, attitudes, and experience. At the core of the book are seven ‘biographical essays’, intimate portraits of individual lives set in the context of the shift towards a more tolerant and permissive society from the 1960s and of the rise of Thatcherite neo-liberalism as the structures of Britain’s post-war settlement crumbled from the later 1970s. The mass observers featured in the book, four women and three men, are drawn from across the social spectrum—wife of a small businessman, teacher, social worker, RAF wife, mechanic, lorry driver, banker: all active and forceful characters with strong opinions and lives crowded with struggle and drama. All of them were born before the Second World War, so they experienced the changing shape of post-1960s Britain as already fully formed adults. The honesty and frankness with which they wrote about themselves takes us below the surface of public life to the efforts of ‘ordinary’, but exceptionally articulate and self-reflective, people to make sense of their lives in rapidly changing times.
The meaning of tones
Authors: Büring Daniel
Published: October 2016

A given prosodic structure—prosodic constituents, metrical stress, and pitch accents aligned with them—may be realized in different ways, depending on the shape of individual accents or the overall ‘tune’ created by them. Theories exist about the effects of various choices of so-called boundary tones—marking the right edges of the intermediate/intonational phrases—running the gamut from the signaling of structural or rhetorical sub/superordination to speech act types and speakers’ commitments. Likewise, approaches to the choice of pitch accents variously relate it to accessibility status, common ground, rhetorical relations, or speakers’ expectations and commitments. Controversy surrounds the question whether the meaning/function of pitch accents resides at the level of individual tones, complex accents, or entire tunes. Experimental studies shed some light on the empirical picture, but more work seems required in this realm. The chapter closes with a discussion of contrastive topic and rise–fall–rise accents.
Association with focus
Authors: Büring Daniel
Published: October 2016

Associated focus—co-occurring with focus-sensitive particles like only/also—has been central to the development of focus semantics. This chapter highlights similarities and differences between those and pragmatic/free foci. Associated foci are, by all indications, free foci, but their effects on interpretation have not been successfully derived from their status as free focus alone. Work by Beaver and Clark argues that the association between focus and (certain) particles manifests itself not only semantically, but also morphosyntactically, in a ‘hard-wired’, grammatical relationship. Associated foci open new ways of controlling/probing what is focussed, so new, complex issues about sentences with multiple foci can be tackled, for example if it is necessary to make the relation between particles and their foci selective by employing coindexing (as argued by Kratzer, as well as examples combining several particles in a single clause as discussed by Rooth, Krifka, and Wold) A fully formalized indexing system is provided.
A framework for the pedagogical use of a corpus of spoken French
Authors: Detey Sylvain , Lyche Chantal
Published: October 2016

This chapter introduces the PFC-EF programme (Phonology of Contemporary French—French language education), which aims at pedagogical exploitation of the PFC corpus in French-language education and linguistics teaching. It offers a brief overview of the history of oral corpora and language education in France before detailing the PFC project’s approach to turning phonological data into multipurpose pedagogical resources. These resources are freely available on the project’s website and have been subdivided into four categories: illustration of varieties of spoken French, pedagogical explanations of the linguistic features of sample conversations, pre-formatted linguistic material for pedagogical use, and ready-to-use teaching and learning material.
French in Nord (Nord-Pas-de-Calais)
Authors: Dawson Alain , Auran Cyril , Bouzon Caroline , Delrue Laurence , Loock Rudy , O’Connor Kathleen M. , Patin Cédric
Published: October 2016

This chapter explores the linguistic features of French spoken in Northern France, based on the analysis of a speaker from La Madeleine, a small city in the Lille metropolitan area. The first part of the chapter analyses the sociolinguistic profiles of both the speaker and the region, focusing on the links between French and Picard and on the importance of the textile and coal industries. The chapter then provides a detailed discussion of specific features of Northern French, illustrated with representative examples from our corpus. It examines (i) lexical regionalisms, with a focus on the lexical fields of work, war, and school; (ii) syntactic and discursive features, e.g. the absence of the feminine third-person plural subject pronoun, ne-deletion, and the use of quoi as a discourse marker; (iii) phonetic and phonological features, in particular palatalization and depalatalization phenomena; and (iv) dialectal features.
French in Haute-Savoie (Rhône-Alpes)
Authors: Pustka Elissa , Vordermayer Martin
Published: October 2016

The chapter presents a discussion about the European Union between a former long-haul truck driver and his nephew. Both are from Passy (Upper Savoy), a commune of 11 000 inhabitants in the French Alps facing Mont Blanc. Passy is situated in the centre of the Franco-Provençal area, and its regional variety can be seen as French with a Franco-Provençal substrate. The commented passage contains no specific regional lexicon or syntax, but illustrates very well the Savoy accent, which is characterized mainly by a stress accent on the penultimate syllable, quantity opposition, and the opposition between /a/ and /ɑ/ (even if this latter opposition is weakening). Other features include the general tendency to the loi de position for the mid vowels and the palatalization of plosives before high front vowels.
French in Belgium
Authors: Hambye Philippe , Simon Anne Catherine , Bardiaux Alice
Published: October 2016

This chapter analyses a conversation between two friends native of the Eastern part of French-speaking Belgium. This conversation is characterized by informality, and its syntax is quite representative of unscripted, interactive speech: disfluency markers are frequent; turn-taking procedures are highly coordinated; and paratactic constructions are compensated by the use of proper prosodic patterns cueing the relation to be drawn between speech segments. The speech observed in this extract is characterized by many features that would not be expected in Reference French (RF): some are rather widespread in French-speaking Belgium, while others are more marked and specific to certain parts of Wallonia. Schwa realization is close to what has been observed in RF. As for consonants, the only noticeable fact is the very ‘German-sounding’ realizations of /d/ and /b/ (devoicing). This regional variety is characterized by prominences on final or penultimate syllables, realized by an important vowel lengthening described as typical of Belgian regional varieties.
French in Algeria
Authors: Leroy Sarah
Published: October 2016

This chapter analyses a short discussion between two sisters, young students living in Chlef, a small town southwest of Algiers. They are both native speakers of Arabic and completely fluent in French. The conversation concerns the way young women can or must dress in this small town. From the point of view of syntax, the excerpt shows the difficulty of expressing temporal relations resulting in a heavy use of the present tense and a specific use of certain prepositions. The phonological system of the two speakers is characterized by a generalization of the loi de position, a tendency to merge the two posterior nasal vowels, and the lack of reduction of obstruent + liquids clusters.
French in Quebec
Authors: Côté Marie-Hélène
Published: October 2016

This chapter introduces Laurentian French, the main variety spoken in Canada, as used in a majority setting in the province of Quebec. Situated in the historical and sociolinguistic context of French in Quebec, the most salient linguistic features of the Laurentian variety are presented on the basis of a three-minute conversation involving a 40-year-old middle-class speaker from Montréal. The lexical analysis of the conversation, about winter and sport activities during the speaker’s high school years, reveals a number of archaisms, dialectalisms, and contact effects with English. Morpho-syntactic and discursive features include the regularization of certain verbal paradigms, specific demonstrative and interrogative constructions, aspects of the pronominal system, and the use of the particule là. The Laurentian phonological system is characterized by a rich set of vocalic oppositions and allophonic processes and specific rules for the realization of schwa, liquid consonants, word-final consonants, and liaison.
Approaching variation in PFC
Authors: Eychenne Julien , Navarro Sylvain , Tchobanov Atanas , Leussen Jan-Willem van
Published: October 2016

This chapter provides an overview of the main tools used within the PFC research programme to perform a wide range of tasks, from annotation to fine-grained measurements. The chapter discusses the structure of the PFC database and its accompanying website, emphasizing the importance of open technologies and open standards in order to ensure long-term availability of the data. It then presents an overview of the main features of the two programs used to work with the PFC data: Praat, a sofware package which is used for data annotation and phonetic analysis, and Dolmen, a tool designed to manage speech corpora and query speech annotations.
Attribute Search in Online Retailing
Authors: Richards Timothy J. , Hamilton Stephen F. , Empen Janine
Published: October 2016

Online retailing has created an empirical opportunity to examine consumer search behavior using click stream data. In this article we examine the implications of greater variety online for consumer search intensity, and equilibrium prices. We test our hypothesis using consumer data on online search and purchase behavior from the comScore Web Behavior Panel. We find that search intensity systematically decreases in categories with broader product ranges, and equilibrium prices rise. Our findings suggests that broader product ranges in online retail markets can produce anti‐competitive effects that are mediated through equilibrium responses in consumer search behavior.
Invited Commentary: Little Steps Lead to Huge Steps—It's Time to Make Physical Inactivity Our Number 1 Public Health Enemy
Authors: Church Timothy S.
Published: October 2016

The analysis plan and article in this issue of the Journal by Evenson et al. (Am J Epidemiol. 2016;184(9):621–632) is well-conceived, thoughtfully conducted, and tightly written. The authors utilized the National Health and Nutrition Examination Survey data set to examine the association between accelerometer-measured physical activity level and mortality and found that meeting the 2013 federal Physical Activity Guidelines resulted in a 35% reduction in risk of mortality. The timing of these findings could not be better, given the ubiquitous nature of personal accelerometer devices. The masses are already equipped to routinely quantify their activity, and now we have the opportunity and responsibility to provide evidenced-based, tailored physical activity goals. We have evidenced-based physical activity guidelines, mass distribution of devices to track activity, and now scientific support indicating that meeting the physical activity goal, as assessed by these devices, has substantial health benefits. All of the pieces are in place to make physical inactivity a national priority, and we now have the opportunity to positively affect the health of millions of Americans.
Non-Standard Work and Limits on Freedom of Association: A Human Rights-Based Approach
Authors: De Stefano Valerio
Published: October 2016

The debate on how to adjust existing regulation to keep pace with the rise and spread of the non-standard workforce worldwide has mainly concentrated on individual employment law. This article means to draw attention to some collective labour regulation issues that have a significant impact on the labour protection of non-standard workers. Without subscribing to the idea that the standard employment relationship is an outmoded model of regulation, this article argues that some existing restrictions on collective rights are failing to keep pace with transformations of labour markets that occurred in recent decades and in particular with the growth in the number of non-standard workers. Consequently, these workers are legally or practically denied access to the meaningful exercise of collective rights. Some of these restrictions, such as antitrust bans on collective bargaining, regulations imposing strike ballots, limitations of secondary action and the distinction between political and economic strikes, are called into question since they disproportionately affect non-standard workers and are at odds with the recognition of collective rights, and in particular the right to strike, as human rights.
H1N1-Induced Venous Thromboembolic Events? Results of a Single-Institution Case Series
Authors: Dimakakos Evangelos , Grapsa Dimitra , Vathiotis Ioannis , Papaspiliou Aggeliki , Panagiotarakou Meropi , Manolis Emmanouil , Syrigos Konstantinos
Published: October 2016

We describe the clinical and imaging characteristics of 7 cases with polymerase chain reaction-confirmed novel influenza A H1N1 virus (pH1N1) infection who developed venous thromboembolic events (VTEs) while being hospitalized for influenza pneumonia. Pulmonary embolism (PE) without deep vein thrombosis (DVT) was observed in 6 of 7 cases (85.7%); PE with underlying DVT was found in 1 patient (14.3%).
Role of Cytochrome P4502B6 Polymorphisms in Ketamine Metabolism and Clearance
Authors: Rao Lesley K. , Flaker Alicia M. , Friedel Christina C. , Kharasch Evan D.
Published: October 2016

Background

At therapeutic concentrations, cytochrome P4502B6 (CYP2B6) is the major P450 isoform catalyzing hepatic ketamine N-demethylation to norketamine in vitro. The CYP2B6 gene is highly polymorphic. The most common variant allele, CYP2B6*6, is associated with diminished hepatic CYP2B6 expression and catalytic activity compared with wild-type CYP2B6*1/*1. CYP2B6.6, the protein encoded by the CYP2B6*6 allele, and liver microsomes from CYP2B6*6 carriers had diminished ketamine metabolism in vitro. This investigation tested whether humans with the CYP2B6*6 allele would have decreased clinical ketamine metabolism and clearance.

Methods

Thirty volunteers with CYP2B6*1/*1, *1/*6, or *6/*6 genotypes (n = 10 each) received a subsedating dose of oral ketamine. Plasma and urine concentrations of ketamine and the major CYP2B6-dependent metabolites were determined by mass spectrometry. Subjects’ self-assessment of ketamine effects were also recorded. The primary outcome was ketamine N-demethylation, measured as the plasma norketamine/ketamine area under the curve ratio. Secondary outcomes included plasma ketamine enantiomer and metabolite area under the plasma concentration–time curve, maximum concentrations, apparent oral clearance, and metabolite formation clearances.

Results

There was no significant difference between CYP2B6 genotypes in ketamine metabolism or any of the secondary outcome measures. Subjective self-assessment did reveal some differences in energy and level of awareness among subjects.

Conclusions

These results show that while the CYP2B6*6 polymorphism results in diminished ketamine metabolism in vitro, this allelic variant did not affect single, low-dose ketamine metabolism, clearance, and pharmacokinetics in vivo. While in vitro drug metabolism studies may be informative, clinical investigations in general are needed to validate in vitro observations.
A Multicenter Randomized Control Trial Comparing a Novel Intramedullary Device (InterTAN) Versus Conventional Treatment (Sliding Hip Screw) of Geriatric Hip Fractures
Authors: Sanders David , Bryant Dianne , Tieszer Christina , Lawendy Abdel-Rahman , MacLeod Mark , Papp Steven , Liew Allan , Viskontas Darius , Coles Chad , Gurr Kevin , Carey Tim , Gofton Wade , Bailey Chris , Bartley Debra , Trenholm Andrew , Stone Trevor , Leighton Ross , Foxall Julia , Zomar Mauri , Trask Kelly
Published: October 2016

Objectives:

To compare outcomes in elderly patients with intertrochanteric hip fractures treated with either the sliding hip screw (SHS) or InterTAN intramedullary device (IT).

Design:

Prospective, randomized, multicenter clinical trial.

Setting:

Five level 1 trauma centers.

Patients:

Two hundred forty-nine patients 55 years of age or older with AO/OTA 31A1 (43) and OA/OTA 31A2 (206) fractures were prospectively enrolled and followed for 12 months.

Intervention:

Computer generated randomization to either IT (n = 123) or SHS (n = 126).

Main Outcome Measurements:

The Functional Independence Measure (FIM) and the Timed Up and Go test (TUG) were used to measure function and motor performance. Secondary outcome measures included femoral shortening, complications, and mortality.

Results:

Demographics, comorbidities, preinjury FIM scores and TUG scores were similar between groups. Patients (17.2%) who received an IT had limb shortening greater than 2 cm compared with 42.9% who received an SHS (P < 0.001). To determine the importance of preinjury function and fracture stability, we analyzed the subgroup of patients with the ability to walk 150 m independently preinjury and an OA/OTA 31A-2 fracture (n = 70). In this subgroup, patients treated with SHS had greater shortening and demonstrated poorer FIM and TUG scores compared with patients treated with an IT.

Conclusions:

Overall, most patients with intertrochanteric femur fractures can expect similar functional results whether treated with an intramedullary or extramedullary device. However, active, functional patients have an improved outcome when the InterTAN is used to treat their unstable intertrochanteric fracture.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
No Incidence of Postoperative Knee Sepsis With Suprapatellar Nailing of Open Tibia Fractures
Authors: Mitchell Phillip M. , Weisenthal Benjamin M. , Collinge Cory A.
Published: October 2016

Objective:

To evaluate the incidence of knee sepsis after suprapatellar (SP) nailing of open tibia fractures.

Design:

Retrospective; Setting: ACS level 1 trauma center.

Patients/Participants:

We reviewed 139 open tibia fractures that underwent SP nailing as definitive treatment over a 5-year period (January 1, 2011 to January 1, 2016). Most patients (90%, n = 126) underwent intramedullary nailing at the time of their initial surgery. We defined knee sepsis as intra-articular infection requiring operative debridement, either open or arthroscopically, within 1 month's time.

Intervention:

Open tibia fractures treated with an SP tibial nail.

Main Outcome Measurements:

Demographic data, fracture characteristics, Gustilo and Anderson classification of open fractures, and occurrence of knee sepsis.

Results:

In 139 open tibia fractures, there were no cases of knee sepsis in the 30 days after treatment with an SP intramedullary nail. Eighty-seven percent of our cohort had Gustilo and Anderson type II (41%) or type III (46%) open fractures. Most open fractures (83%) underwent primary wound closure during the index procedures. Twenty-five limbs (18%) had evidence of infection at the open fracture site of their open fracture necessitating operative intervention and/or antibiotics: none, however, developed knee sepsis.

Conclusions:

Although the SP approach carries intra-articular risks, we found a low risk of knee sepsis using this technique in the treatment of open tibia fractures. Our data suggest that there is no greater risk of intra-articular infection using an SP portal as compared with an infrapatellar one.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Metrics of Arterial Hyperoxia and Associated Outcomes in Critical Care*
Authors: Helmerhorst Hendrik J. F. , Arts Derk L. , Schultz Marcus J. , van der Voort Peter H. J. , Abu-Hanna Ameen , de Jonge Evert , van Westerloo David J.
Published: October 2016

Objective:

Emerging evidence has shown the potential risks of arterial hyperoxia, but the lack of a clinical definition and methodologic limitations hamper the interpretation and clinical relevance of previous studies. Our purpose was to evaluate previously used and newly constructed metrics of arterial hyperoxia and systematically assess their association with clinical outcomes in different subgroups in the ICU.

Design:

Observational cohort study.

Setting:

Three large tertiary care ICUs in the Netherlands.

Patients:

A total of 14,441 eligible ICU patients.

Interventions:

None.

Measurements and Main Results:

In total, 295,079 arterial blood gas analyses, including the Pao2, between July 2011 and July 2014 were extracted from the patient data management system database. Data from all admissions with more than one Pao2measurement were supplemented with anonymous demographic and admission and discharge data from the Dutch National Intensive Care Evaluation registry. Mild hyperoxia was defined as Pao2between 120 and 200 mm Hg; severe hyperoxia as Pao2greater than 200 mm Hg. Characteristics of existing and newly constructed metrics for arterial hyperoxia were examined, and the associations with hospital mortality (primary outcome), ICU mortality, and ventilator-free days and alive at day 28 were retrospectively analyzed using regression models in different subgroups of patients. Severe hyperoxia was associated with higher mortality rates and fewer ventilator-free days in comparison to both mild hyperoxia and normoxia for all metrics except for the worst Pao2. Adjusted effect estimates for conditional mortality were larger for severe hyperoxia than for mild hyperoxia. This association was found both within and beyond the first 24 hours of admission and was consistent for large subgroups. The largest point estimates were found for the exposure identified by the average Pao2, closely followed by the median Pao2, and these estimates differed substantially between subsets. Time spent in hyperoxia showed a linear and positive relationship with hospital mortality.

Conclusions:

Our results suggest that we should limit the Pao2levels of critically ill patients within a safe range, as we do with other physiologic variables. Analytical metrics of arterial hyperoxia should be judiciously considered when interpreting and comparing study results and future studies are needed to validate our findings in a randomized fashion design.
Suffering of Traumatic Amputees in Spain
Authors: Luis Díaz José , Leal César , Schriewer Klaus , Echevarría Paloma
Published: October 2016

Amputation is a traumatic incident that entails a chain of psychological, physical, and social events. The objectives of the study are to describe the beliefs and the philosophies of life related to the experience of suffering of traumatic amputees, analyze the importance of biomedical care, and describe other forms of care used.
The Effect of Spiritual Care on Mental Health in Mothers of Children With Cancer
Authors: Nikseresht F. , Rassouli M. , Torabi F. , Farzinfard F. , Mansouri S. , Ilkhani M.
Published: October 2016

This study measured the effect of spiritual care on mental health in mothers of children with cancer. The present quasi-experimental study was with one group pretest posttest design. The findings show that implementation of spiritual care in mothers of children with cancer can improve their mental health.
Effects of Reflexology on Pain in Patients With Fibromyalgia
Authors: Akin Korhan Esra , Uyar Meltem , Eyigör Can , Yönt Gülendam Hakverdioğlu , Khorshid Leyla
Published: October 2016

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.
Mechanisms Underlying the Association Between Early-Life Adversity and Physical Health: Charting a Course for the Future
Authors: Bush Nicole R. , Lane Richard D. , McLaughlin Katie A.
Published: October 2016

Early-life adversities (ELA) are associated with subsequent pervasive alterations across a wide range of neurobiological systems and psychosocial factors that contribute to accelerated onset of health problems and diseases. In this article, we provide an integrated perspective on recent developments in research on ELA, based on the articles published in this Special Issue of Psychosomatic Medicine. We focus on the following: 1) the distinction between specific versus general aspects of ELA with regard to the nature of exposure (e.g., physical and sexual abuse, emotional abuse or neglect, relative socioeconomic deprivation), biological and behavioral correlates of ELA, and differences across diseases; 2) the importance of timing in the critical phases of exposure to ELA; and 3) adaptive versus dysfunctional responses to ELA and their consequences for biological and behavioral risk factors for adverse health outcomes. This article concludes with outlining important new targets for research in this area, including the neurobiology of affect as a mechanism linking ELA to adverse health outcomes, and the need for large-scale longitudinal investigations of multisystem processes relevant to ELA in diverse samples, starting prenatally, continuing to late adolescence, and with long-term follow-up assessments that enable evaluation of incident disease outcomes.
Coronary-Pulmonary Artery Fistulas
Authors: Verdini Daniel , Vargas Daniel , Kuo Anderson , Ghoshhajra Brian , Kim Phillip , Murillo Horacio , Kirsch Jacobo , Lane Michael , Restrepo Carlos
Published: October 2016

Purpose:

Coronary-pulmonary arterial fistulas (CPAFs) are rare coronary artery anomalies that have been described only in limited case reports. This study aims to evaluate the clinical presentation and imaging findings of CPAFs collected from 6 participating medical centers along with CPAFs reported in the literature, to discern any general trends present in CPAFs.

Materials and Methods:

A total of 25 cases of CPAF diagnosed by coronary computed tomography angiography were collected across 6 participating institutions. In addition, utilizing a PubMed literature search, 78 additional CPAF cases were obtained. The imaging findings and relevant clinical history were reviewed.

Results:

Of the 103 CPAF patients, 60 (63% of patients with sex known) were male, with ages ranging from newborn to 88 years (mean=46.1 y). The most common symptoms reported were chest pain (n=40, 39%) and dyspnea (n=26, 25%), with a murmur as the most common physical examination finding (n=38, 37%). The most common coronary artery of origin for a CPAF was the left main/left anterior descending (n=87, 84%), followed by the right coronary artery (n=39, 38%). The fistula most commonly terminated in the main pulmonary artery (n=92, 89%). Multiple CPAFs were present in 46 cases (45%). Coronary artery aneurysms were identified in 20 cases (19%). Pediatric CPAF cases were usually associated with pulmonary atresia with ventricular septal defect.

Conclusions:

CPAFs are seen in a variety of clinical settings, from infants with advanced congenital heart disease to elderly patients who have undergone revascularization surgery. Although coronary artery fistulas have previously been described as rarely involving multiple coronary arteries, with the right coronary artery being most often involved, our series demonstrates that multiple fistulas are commonly present, with the most common pattern being between the left main/left anterior descending and the main pulmonary trunk.