bluuebunny/crossref_metadata_2025 huggingface dataset:
Properties of laminated silica aerogel fibrous matting composites for footwear applications
Authors: Kraner Zrim P , Mekjavic I B , Rijavec T
Published: September 2015

This paper describes a lamination method of commercially produced silica aerogel composite and investigates its suitability for thermal insulation within protective footwear applications for severe cold and extreme high-altitude environments. A silica aerogel composite was used with a thickness of 2.7 mm and mass per unit area of 500 gm–2. Silica aerogel dust, which is generated during the crushing of brittle silica aerogel, was prevented from spreading into the environment by two-sided lamination of silica aerogel composite. A solid 5 µm thick membrane was used, reinforced with an abrasive resistant polyester knitted fabric. The thermal conductivity of laminated silica aerogel composite was comparable to that of the non-laminated one and amounted to 0.016 Wm–1K–1. Water vapor permeability of the laminated silica aerogel composite was 1.31 mgcm–2h–1. The silica aerogel composite was subjected to 30,000 cycles of flexing in order to study the impact of its irreversible crushed structure on the water vapor permeability and thermal resistances of laminated samples. It was observed that flexing did not damage the membrane of the laminated composite and had no statistically significant effect on its thermal resistance and water vapor permeability. During this study it was confirmed that the newly developed laminate has potential applications within protective footwear for extreme cold temperature environments.
Controlled release of borneol from nano-fibrous poly(L-lactic acid)/ cellulose acetate butyrate membrane
Authors: Li Li , Luo Xue , Leung Polly HM , Law Helen KW
Published: September 2015

Borneol, one of the commonly used Chinese medicines, can be used to treat many diseases. The main ingredient of natural borneol is d-borneol extracted from the volatile oil of dipterocarp trees. Numerous studies have proved the effectiveness of borneol. It has been widely used in relieving symptoms of anxiety, fatigue and insomnia; inducing anaesthesia and analgesia to alleviate abdominal pain, wounds and burns; relieving rheumatic pain, hemorrhoids, skin diseases and ulcerations of the mouth, ears, eyes or nose; treating sore throats and skin infections; and is mainly used to treat cardiovascular and cerebrovascular diseases. Although borneol has a significant therapeutic effect, its easy sublimation and low water absorbability make it difficult to control the efficiency of delivery and decrease its function in connecting to various applications in the needs of modern society. Electrospun nanofiber has been commonly used as a delivery vehicle for various medicines for biomedical applications. Poly(L-lactic acid) and cellulose acetate butyrate (CAB) nano-fibrous nonwoven membranes were electrospun and used as drug carriers for borneol. To load borneol into a PLLA/CAB composite membrane, borneol/acetone solution was sprayed on PLLA/CAB fibers. While part of the CAB was dissolved by acetone, borneol was combined with CAB by hydrogen bonds between hydroxyl and carbanyl groups. PLLA still kept a porous morphology of the whole drug-loaded membrane since it does dissolve in acetone. This structure provided a high quality and stable drug delivery system. With adjustable drug release properties, PLLA/CAB nano-fibrous composite nonwoven membranes can be alternative candidates for developing novel external medical textiles.
Evaluation of a Collaborative Operation to Improve Child Sexual Abuse Reporting in Western Australian Indigenous Communities
Authors: Bailey Cate , Mace Glenn , Powell Martine , Benson Mairi
Published: September 2015

This study presents an evaluation of Operation RESET, a community engagement intervention designed to help remote Indigenous communities and human service agencies to uncover, respond to, and prevent child sexual abuse. The primary aim of this evaluation was to determine whether the intervention was associated with increased reporting. Data were obtained for six Western Australian regions between 2007 and 2012. Number of reports and arrests significantly increased in the intervention areas during the intervention compared with the pre-intervention time period but not in the control areas. Arrest rates significantly increased during the intervention and increased further following the intervention. There were no changes in arrest rates in regions that did not participate in the operation. This evidence suggests that the reforms led to a marked improvement in some key outcomes for Indigenous victims of child sexual abuse and supports the adoption of this collaborative approach by other jurisdictions.
Fat‐Modified Enteral Formula Improves Feeding Tolerance in Critically Ill Patients: A Multicenter, Single‐Blind, Randomized Controlled Trial
Authors: Qiu Chunfang , Chen Chuanxi , Zhang Weixing , Kou Qiuye , Wu Shengnan , Zhou Lixin , Liu Jiyun , Ma Gang , Chen Juan , Chen Minying , Luo Hua , Zhang Xiaofei , Lai Jianbo , Yu Zhihui , Yu Xiaochun , Liao Wei , Guan Xiangdong , Ouyang Bin
Published: September 2015

Background: Improvement of fat digestion and absorption was supposed to relieve feeding intolerance. This trial aimed to evaluate the effect of a fat‐modified enteral formula on feeding tolerance in critically ill patients. Materials and Methods: This trial was conducted in 7 hospitals in China. In total, 144 intensive care unit (ICU) patients with estimated need of enteral nutrition (EN) for at least 5 days were randomly given fat‐modified enteral formula containing medium‐chain triglycerides (MCT), carnitine, and taurine (interventional feed group, n = 71) or standard enteral formula (control feed group, n = 73). EN intake, feeding intolerance (diarrhea, vomiting, gastric retention, and abdominal distension) and outcomes (mechanical ventilator‐free days of 28 days, length of ICU stay, length of hospital stay, and in‐hospital mortality) were collected. Results: Daily calories and protein intake were increased in the interventional feed group compared with the control feed group (P < .01). Total incidence of feeding intolerance was 42.3% in the interventional feed group and 65.7% in the control feed group (P < .001). Daily incidence of feeding intolerance was 11.3%, 18.3%, 14.1%, 25.4%, and 26.1% in the interventional feed group and 31.5%, 32.9%, 34.2%, 34.2%, and 30.4% in the control feed group from study days 1–5 (P = .0083). Incidence of feeding intolerance without abdominal distention was 32.9% in the interventional feed group and 49.3% in the control feed group (P = .047), while the incidence of abdominal distension was 26.8% in the interventional feed group and 43.8% in the control feed group (P = .03). No significant differences existed in outcomes between the 2 groups. Conclusions: The fat‐modified enteral formula containing MCT, carnitine, and taurine may improve feeding tolerance in critically ill patients.
NGOs, Management and Development: Harnessing Counter-Hegemonic Possibilities
Authors: Girei Emanuela
Published: September 2015

Over the last decade, development management thinking, tools and practices have gained a prominent position in international development. In response to recent calls to problematize development management, this article, drawing on 14 months of empirical work with a Ugandan NGO, illuminates the spread of managerialism in the indigenous NGO sector and explores whether and how management thinking and practice have shaped the work and the role of NGOs in international development. This research shows how development management orthodoxy narrows the possibility for NGOs to engage in transformative practice and in social change agendas, while it wittingly or unwittingly supports the expansion of the political and cultural hegemony of western donors.
‘We Can Tell Them to Get Lost, but We Won’t Do That’: Cultural Control and Resistance in Voluntary Work
Authors: O’ Toole Michelle , Grey Christopher
Published: September 2015

Although cultural control and resistance in organizations have been widely researched, this has invariably been within the context of paid work. This paper examines how they operate within voluntary work, using the case of the Royal National Lifeboat Institution (RNLI). Here, volunteers undertake the dangerous work of sea rescues, working for local lifeboat stations. While the RNLI deploys standard techniques of cultural control, the combination of volunteering, localism and dangerous work creates the possibility of complex and ambiguous forms of resistance to cultural control, thereby extending our understanding of these phenomena.
Labor human rights and human dignity
Authors: Gilabert Pablo
Published: September 2015

The current legal and political practice of human rights invokes entitlements to freely chosen work, to decent working conditions, and to form and join labor unions. Despite the importance of these rights, they remain under-explored in the philosophical literature on human rights. This article offers a systematic and constructive discussion of them. First, it surveys the content and current relevance of the labor rights stated in the most important documents of the human rights practice. Second, it gives a moral defense of these rights arguing that their support involves an appropriate response to important human interests and to the human dignity of workers. Finally, it explores central normative issues about the relation between labor rights and human dignity. It responds to some objections about the importance of work, explains why labor human rights may not exhaust the demands of dignity regarding labor and arbitrates a common tension between independence and solidarity within our practical affirmation of human dignity.
Does Lack of Health Insurance Mediate the Relationship Between Employment Hardships and Unmet Health Care Needs Among Single Mothers?
Authors: Wu Chi-Fang , Eamon Mary Keegan , Wang Ming-Sheng
Published: September 2015

Using data from a national sample of 451 single mothers collected 24 months during and after the Great Recession, this study tested four hypotheses related to comprehensive measures of employment problems, number of months without health insurance, and unmet medical or dental needs. The results indicate positive relationships between employment problems and unmet medical or dental needs, employment problems and lacking health insurance, and lacking health insurance and unmet medical or dental needs. Most important, lack of health care coverage significantly reduced the relationships between unemployment (by 26%) and underemployment (by 56%) and unmet medical or dental needs. These results indicate that lack of health insurance at least partially mediates the effects of employment problems on single mothers experiencing an unmet medical or dental need. The findings have implications for these mothers’ medical and dental care access, which are discussed within the context of the recent health care reforms.
Spiritual intelligence
Authors: Sisk Dorothy A
Published: September 2015

This article will share the intellectual journey E. Paul Torrance and I traveled in 2001, in which we explored psychology, science and ancient wisdom and traditions, including Native American and indigenous traditions, to establish a foundation for spiritual intelligence. This section will be followed by ways to develop and nurture spiritual intelligence in the classroom, focusing on service learning with student examples; a section on seven ways to develop or raise spiritual intelligence; a section examining efforts initiated and developed in business to develop spiritual intelligence; and servant leadership that incorporates much of what E. Paul Torrance and I called spiritual intelligence: The capacity to use a multi-sensory approach, including intuition, meditation and visualization, to tap inner knowledge to solve problems of a global nature.
Impact of the glucocorticoid receptor BclI polymorphism on reward expectancy and prediction error related ventral striatal reactivity in depressed and healthy individuals
Authors: Ham Byung-Joo , Greenberg Tsafrir , Chase Henry W , Phillips Mary L
Published: September 2015

There is evidence that reward-related neural reactivity is altered in depressive disorders. Glucocorticoids influence dopaminergic transmission, which is widely implicated in reward processing. However, no studies have examined the effect of glucocorticoid receptor gene polymorphisms on reward-related neural reactivity in depressed or healthy individuals. Fifty-nine depressed individuals with major depressive disorder ( n=33) or bipolar disorder ( n=26), and 32 healthy individuals were genotyped for the glucocorticoid receptor BclI G/C polymorphism, and underwent functional magnetic resonance imaging during a monetary reward task. We examined the effect of the glucocorticoid receptor BclI G/C polymorphism on reward expectancy (RE; expected outcome value) and prediction error (PE; discrepancy between expected and actual outcome) related ventral striatal reactivity. There was a significant interaction between reward condition and BclI genotype ( p=0.007). C-allele carriers showed higher PE than RE-related right ventral striatal reactivity ( p<0.001), whereas no such difference was observed in G/G homozygotes. Accordingly, C-allele carriers showed a greater difference between PE and RE-related right ventral striatal reactivity than G/G homozygotes ( p<0.005), and also showed lower RE-related right ventral striatal reactivity than G/G homozygotes ( p=0.011). These findings suggest a slowed transfer from PE to RE-related ventral striatal responses during reinforcement learning in C-allele carriers, regardless of diagnosis, possibly due to altered dopamine release associated with increased sensitivity to glucocorticoids.
Using the Pool Activity Level instrument to support meaningful activity for a person with dementia: A case study
Authors: Dudzinski Emma
Published: September 2015

Statement of context

Activity participation is beneficial for the wellbeing of people with dementia; however, care staff and caregivers experience difficulties with facilitating activity for this client group.

Critical reflection on practice

This practice analysis outlines the therapy process conducted by an occupational therapist using the Pool Activity Level instrument, to support meaningful activity for a person with dementia, in an acute inpatient environment.

Implications for practice

The Pool Activity Level instrument enables people with dementia to engage in meaningful activity. Occupational therapists are well positioned to integrate this tool within daily care, to enable all staff and caregivers to engage alongside a person with dementia in activity at an appropriate level.
Nurses as Instruments of Healing
Authors: Lubinska-Welch Izabela , Pearson Tamera , Comer Linda , Metcalfe Sharon E.
Published: September 2015

Objective: To better understand current self-care practices and health-promoting behaviors of nursing staff in a rural hospital and determine if there is a need for further development of a holistic self-care program for nursing staff in the hospital. Method: In this cross-sectional, descriptive study, a structured questionnaire was used to collect data on current self-care practices and health needs and interests of hospital registered nurses, licensed practical nurses, and certified nursing assistants from inpatient, outpatient, and emergency departments. A convenience sample of 45 was employed. Results: Most prevalent self-care practices included humor/laughter/play, music, spirituality/prayer, healthy sleep habits, reading, healthy nutrition, and walking. At least 75.6% answered to be extremely or likely to use three of five fitness programs (95% confidence interval [CI: 63.05%, 88.15%]). All four nutrition education programs were rated extremely likely or likely by at least two thirds of respondents (66.7%; 95% CI [52.93%, 80.47%]). Other programs of interests included health education programs and job stress management programs. Majority would participate in self-care program at work if one was offered (73.3%; 95% CI [60.37%, 86.23%]). Conclusions: Majority of nursing staff recognize the importance of self-care. There is a strong preference toward fitness programs and nutrition education programs at work to other programs.
Numerical investigation of fragmentation initiation threshold for sphere impacting on thin wall at hypervelocity
Authors: Zhang Xiaotian , Liu Tao , Li Xiaogang
Published: September 2015

The sphere impacting on the thin wall is simulated with node-separation finite element method, and investigations of the projectile fragmentation initiation threshold are processed based on the numerical results. The bumper-thickness-to-projectile-diameter ratio ( t/ D) is found to be the main determinant of the velocity threshold. The simulation cases contain the t/ D ranging from 0.008 to 0.424 and impact velocity ranging from 2 km/s to 7 km/s. The numerical results are in good agreement with the tests in sphere fragmentation initiation threshold, inner spall of the sphere, debris cloud pattern. The simulations reproduce the fragmentation initiation threshold curve that is obtained by the tests. That shows the feasibility of node-separation finite element method for hypervelocity impact simulation. The shock wave analyses show that the propagation/reflection process of shock wave in the thin wall cases is very different from that in thick wall cases. That inherently results in the different variations of the threshold in the low and high intervals of t/ D. The extreme thin plate case shows that when t/ D is further reduced, a thick layer of debris cloud would form at the rear of the plate. Compared to the projectile residual, the debris cloud from the plate would induce wider destruction in the inner structure.
Single- and double-layer aluminum corrugated core sandwiches under quasi-static and dynamic loadings
Authors: Kılıçaslan Cenk , Odacı İsmet K , Güden Mustafa
Published: September 2015

The crushing of single- and double-layer zig-zag trapezoidal corrugated core sandwiches was investigated experimentally and numerically at quasi-static and dynamic rates. The buckling stress of sandwiches increased when the rate increased from quasi-static to dynamic. The increased buckling stresses were ascribed to the micro-inertial effects, which altered the buckling mode of the core from three plastic hinges to higher number of plastic hinge formations. The initial buckling stress was numerically shown to be imperfection sensitive when the imperfection size was comparable with the buckling length. The numerical buckling stresses of zig-zag and straight corrugated cores were similar, while higher inertial effects were found in triangular corrugated core.
An approach in deformation and stress analysis of elasto-plastic sandwich cylindrical shell panels based on harmonic differential quadrature method
Authors: Shokrollahi H , Fallah F , Kargarnovin MH
Published: September 2015

Using harmonic differential quadrature method, an approach to analyze sandwich cylindrical shell panels with any sort of boundary conditions under a generally distributed static loading, undergoing elasto-plastic deformation is proposed. The faces of the sandwich shell panel are made of some isotropic materials with linear work hardening behavior while the core is assumed to be an isotropic material experiencing only elastic behavior. The faces are modeled as thin cylindrical shells obeying the Kirchhoff–Love assumptions. For the core material, it is assumed to be thick and the in-plane stresses are negligible. Upon application of an inner and outer general lateral loading, the governing equations are derived using the principle of virtual displacements. Using an iterative approach, named elasto-plastic harmonic differential quadrature method (EP-HDQM), the equations are solved. The obtained results are compared with the results from finite element software Ansys for different sandwich shell panel configurations. Then, the effects of changing different parameters on the stress and displacement components of sandwich cylindrical shell panels in different elasto-plastic conditions are investigated.
Representation, recognition and foreign policy in the Iran–US relationship
Authors: Duncombe Constance
Published: September 2015

In the past two decades, scholars have illustrated how important representation is to understanding the dynamics of world politics. However, there is a distinct absence in the literature surrounding how representations of one state by another influence foreign policymaking behaviour. This article fills a gap in knowledge by offering an empirical examination of the role that representation and recognition play. I contribute to these discussions through an examination of the representations evident within the Iran–US relationship. I argue that binary representations of Self and Other inform the identity narratives of each state and how they are recognised. Furthermore, these representations contribute to misrecognition, which creates a feeling of disrespect, exacerbating tensions between Iran and the US as they engage in nuclear negotiations.
The Trap of Triage
Authors: Cooper-McCann Patrick
Published: September 2015

In 1975, consultants from Team Four Inc. advised St. Louis planners to pursue a strategy of neighborhood triage: “conservation” for areas in good health, “redevelopment” for areas just starting to decline, and “depletion” for areas already in severe distress. The firm’s recommended strategy reflected the latest thinking among urban planners, but it provoked outrage among residents of the city’s predominantly black North Side, who read “depletion” as a promise of benign neglect. In this article, I explain how Team Four justified its advice, and why, four decades later, the controversy over its memo persists.
Habitus, capital, and conflict: Bringing Bourdieusian field theory to criminology
Authors: Shammas Victor L , Sandberg Sveinung
Published: September 2015

Bourdieu’s key conceptual tools, including the forms of capital and habitus, have recently come to be deployed with greater frequency in criminological research. Less attention has been paid to the concept of the field, which plays a crucial role in Bourdieu’s vision of how the social world operates. We develop the concept of the “street field” as a tool for scholars of crime and deviance. The concept serves as a guide for research and an instrument of vigilance, drawing attention to the agonistic nature of social relations and the role of domination, the importance of contextual factors in shaping the objects we study, the skillfulness of agents, and the transformative effects of remaining within semi-enclosed domains of social action over extended periods of time.
Biomechanical comparison of expanded polytetrafluoroethylene (ePTFE) and PTFE interpositional patches and direct tendon-to-bone repair for massive rotator cuff tears in an ovine model
Authors: McKeown Andrew DJ , Beattie Rebekah F , Murrell George AC , Lam Patrick H
Published: September 2015

Background

Massive irreparable rotator cuff tears are a difficult problem. Modalities such as irrigation and debridement, partial repair, tendon transfer and grafts have been utilized with high failure rates and mixed results. Synthetic interpositional patch repairs are a novel and increasingly used approach. The present study aimed to examine the biomechanical properties of common synthetic materials for interpositional repairs in contrast to native tendon.

Methods

Six ovine tendons, six polytetrafluoroethylene (PTFE) felt sections and six expanded PTFE (ePTFE) patch sections were pulled-to-failure to analyze their biomechanical and material properties. Six direct tendon-to-bone surgical method repairs, six interpositional PTFE felt patch repairs and six interpositional ePTFE patch repairs were also constructed in ovine shoulders and pulled-to-failure to examine the biomechanical properties of each repair construct.

Results

Ovine tendon had higher load-to-failure (591 N) and had greater stiffness (108 N/mm) than either PTFE felt (296 N, 28 N/mm) or ePTFE patch sections (323 N, 34 N/mm). Both PTFE felt and ePTFE repair techniques required greater load-to-failure (225 N and 177 N, respectively) than direct tendon-to-bone surgical repairs (147 N) in ovine models.

Conclusions

Synthetic materials lacked several biomechanical properties, including strength and stiffness, compared to ovine tendon. Interpositional surgical repair models with these materials were significantly stronger than direct tendon-to-bone model repairs.
Attitudes Toward Chiropractic
Authors: Weis Carol Ann , Stuber Kent , Barrett Jon , Greco Alexandra , Kipershlak Alexander , Glenn Tierney , Desjardins Ryan , Nash Jennifer , Busse Jason
Published: September 2015

We assessed the attitudes of Canadian obstetricians toward chiropractic with a 38-item cross-sectional survey. Ninety-one obstetricians completed the survey, for a response rate of 14% (91 of 659). Overall, 30% of respondents held positive views toward chiropractic, 37% were neutral, and 33% reported negative views. Most (77%) reported that chiropractic care was effective for some musculoskeletal complaints, but 74% disagreed that chiropractic had a role in treatment of non-musculoskeletal conditions. Forty percent of respondents referred at least some patients for chiropractic care each year, and 56% were interested in learning more about chiropractic care. Written comments from respondents revealed concerns regarding safety of spinal manipulation and variability among chiropractors. Canadian obstetricians’ attitudes toward chiropractic are diverse and referrals to chiropractic care for their patients who suffer from pregnancy-related low back pain are limited. Improved interprofessional relations may help optimize care of pregnant patients suffering from low back pain.
Daily estimation of the severity of organ dysfunctions in critically ill children by using the PELOD-2 score
Authors: Leteurtre Stéphane , Duhamel Alain , Deken Valérie , Lacroix Jacques , Leclerc Francis ,   on behalf of the Groupe Francophone de Réanimation et Urgences Pédiatriques (GFRUP)
Published: September 2015

Introduction

Daily or serial evaluation of multiple organ dysfunction syndrome (MODS) scores may provide useful information. We aimed to validate the daily (d) PELOD-2 score using the set of seven days proposed with the previous version of the score.

Methods

In all consecutive patients admitted to nine pediatric intensive care units (PICUs) we prospectively measured the dPELOD-2 score at day 1, 2, 5, 8, 12, 16, and 18. PICU mortality was used as the outcome dependent variable. The discriminant power of the dPELOD-2 scores was estimated using the area under the ROC curve and the calibration using the Hosmer-Lemeshow chi-square test. We used a logistic regression to investigate the relationship between the dPELOD-2 scores and outcome, and between the change in PELOD-2 score from day1 and outcome.

Results

We included 3669 patients (median age 15.5 months, mortality rate 6.1 %, median length of PICU stay 3 days). Median dPELOD-2 scores were significantly higher in nonsurvivors than in survivors (p < 0.0001). The dPELOD-2 score was available at least at day 2 in 2057 patients: among the 796 patients without MODS on day1, 186 (23.3 %) acquired the syndrome during their PICU stay (mortality 4.9 % vs. 0.3 % among the 610 who did not; p < 0.0001). Among the1261 patients with MODS on day1, the syndrome worsened in 157 (12.4 %) and remained unchanged or improved in 1104 (87.6 %) (mortality 22.9 % vs. 6.6 %; p < 0.0001). The AUC of the dPELOD-2 scores ranged from 0.75 (95 % CI: 0.67-0.83) to 0.89 (95 % CI: 0.86-0.91). The calibration was good with a chi-square test between 13.5 (p = 0.06) and 0.9 (p = 0.99). The PELOD-2 score on day1 was a significant prognostic factor; the serial evaluation of the change in the dPELOD-2 score from day1, adjusted for baseline value, demonstrated a significant odds ratio of death for each of the 7 days.

Conclusion

This study suggests that the progression of the severity of organ dysfunctions can be evaluated by measuring the dPELOD-2 score during a set of 7 days in PICU, providing useful information on outcome in critically ill children. Its external validation would be useful.
Discordant identification of pediatric severe sepsis by research and clinical definitions in the SPROUT international point prevalence study
Authors: Weiss Scott L. , Fitzgerald Julie C. , Maffei Frank A. , Kane Jason M. , Rodriguez-Nunez Antonio , Hsing Deyin D. , Franzon Deborah , Kee Sze Ying , Bush Jenny L. , Roy Jason A. , Thomas Neal J. , Nadkarni Vinay M. ,   for the SPROUT Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: September 2015

Introduction

Consensus criteria for pediatric severe sepsis have standardized enrollment for research studies. However, the extent to which critically ill children identified by consensus criteria reflect physician diagnosis of severe sepsis, which underlies external validity for pediatric sepsis research, is not known. We sought to determine the agreement between physician diagnosis and consensus criteria to identify pediatric patients with severe sepsis across a network of international pediatric intensive care units (PICUs).

Methods

We conducted a point prevalence study involving 128 PICUs in 26 countries across 6 continents. Over the course of 5 study days, 6925 PICU patients <18 years of age were screened, and 706 with severe sepsis defined either by physician diagnosis or on the basis of 2005 International Pediatric Sepsis Consensus Conference consensus criteria were enrolled. The primary endpoint was agreement of pediatric severe sepsis between physician diagnosis and consensus criteria as measured using Cohen’s κ. Secondary endpoints included characteristics and clinical outcomes for patients identified using physician diagnosis versus consensus criteria.

Results

Of the 706 patients, 301 (42.6 %) met both definitions. The inter-rater agreement (κ ± SE) between physician diagnosis and consensus criteria was 0.57 ± 0.02. Of the 438 patients with a physician’s diagnosis of severe sepsis, only 69 % (301 of 438) would have been eligible to participate in a clinical trial of pediatric severe sepsis that enrolled patients based on consensus criteria. Patients with physician-diagnosed severe sepsis who did not meet consensus criteria were younger and had lower severity of illness and lower PICU mortality than those meeting consensus criteria or both definitions. After controlling for age, severity of illness, number of comorbid conditions, and treatment in developed versus resource-limited regions, patients identified with severe sepsis by physician diagnosis alone or by consensus criteria alone did not have PICU mortality significantly different from that of patients identified by both physician diagnosis and consensus criteria.

Conclusions

Physician diagnosis of pediatric severe sepsis achieved only moderate agreement with consensus criteria, with physicians diagnosing severe sepsis more broadly. Consequently, the results of a research study based on consensus criteria may have limited generalizability to nearly one-third of PICU patients diagnosed with severe sepsis.
Nasopharyngeal Cancer: Molecular Landscape
Authors: Bruce Jeff P. , Yip Kenneth , Bratman Scott V. , Ito Emma , Liu Fei-Fei
Published: September 2015

Nasopharyngeal carcinoma (NPC) is a unique epithelial malignancy arising from the superior aspect of the pharyngeal mucosal space, associated with latent Epstein-Barr virus infection in most cases. The capacity to characterize cancer genomes in unprecedented detail is now providing insights into the genesis and molecular underpinnings of this disease. Herein, we provide an overview of the molecular aberrations that likely drive nasopharyngeal tumor development and progression. The contributions of major Epstein-Barr virus–encoded factors, including proteins, small RNAs, and microRNAs, along with their interactions with pathways regulating cell proliferation and survival are highlighted. We review recent analyses that clearly define the role of genetic and epigenetic variations affecting the human genome in NPC. These findings point to the impact of DNA methylation and histone modifications on gene expression programs that promote this malignancy. The molecular interactions that allow NPC cells to evade immune recognition and elimination, which is crucial for the survival of cells expressing potentially immunogenic viral proteins, are also described. Finally, the potential utility of detecting host and viral factors for the diagnosis and prognosis of NPC is discussed. Altogether, the studies summarized herein have greatly expanded our knowledge of the molecular biology of NPC, yet much remains to be uncovered. Emerging techniques for using and analyzing well-annotated biospecimens from patients with NPC will ultimately lead to a greater level of understanding, and enable improvements in precision therapies and clinical outcomes.
Advances in Radiotherapy for Head and Neck Cancer
Authors: Grégoire Vincent , Langendijk Johannes A. , Nuyts Sandra
Published: September 2015

Over the last few decades, significant improvements have been made in the radiotherapy (RT) treatment of head and neck malignancies. The progressive introduction of intensity-modulated RT and the use of multimodality imaging for target volume and organs at risk delineation, together with the use of altered fractionation regimens and concomitant administration of chemotherapy or targeted agents, have accompanied efficacy improvements in RT. Altogether, such improvements have translated into improvement in locoregional control and overall survival probability, with a decrease in the long-term adverse effects of RT and an improvement in quality of life. Further progress in the treatment of head and neck malignancies may come from a better integration of molecular imaging to identify tumor subvolumes that may require additional radiation doses (ie, dose painting) and from treatment adaptation tracing changes in patient anatomy during treatment. Proton therapy generates even more exquisite dose distribution in some patients, thus potentially further improving patient outcomes. However, the clinical benefit of these approaches, although promising, for patients with head and neck cancer need to be demonstrated in prospective randomized studies. In this context, our article will review some of these advances, with special emphasis on target volume and organ-at-risk delineation, use of molecular imaging for tumor delineation, dose painting for dose escalation, dose adaptation throughout treatment, and potential benefit of proton therapy.
Survivorship and Quality of Life in Head and Neck Cancer
Authors: Ringash Jolie
Published: September 2015

Head and neck cancer is becoming more common, and survival rates are improving. Human papillomavirus–associated oropharyngeal cancer, in particular, is increasing in incidence and is associated with an excellent prognosis. However, toxicity from disease and treatment leads to long-term impairment, disability, and handicap. Currently, more than 60% of survivors have unmet needs. As the numbers of survivors increase, current models of care will be increasingly inadequate to meet their needs. Exploration of new strategies and models of care to better address quality-of-life issues and meet the needs of survivors of head and neck cancer is urgently required.
Safety and Antitumor Activity of Anti–PD-1 Antibody, Nivolumab, in Patients With Platinum-Resistant Ovarian Cancer
Authors: Hamanishi Junzo , Mandai Masaki , Ikeda Takafumi , Minami Manabu , Kawaguchi Atsushi , Murayama Toshinori , Kanai Masashi , Mori Yukiko , Matsumoto Shigemi , Chikuma Shunsuke , Matsumura Noriomi , Abiko Kaoru , Baba Tsukasa , Yamaguchi Ken , Ueda Akihiko , Hosoe Yuko , Morita Satoshi , Yokode Masayuki , Shimizu Akira , Honjo Tasuku , Konishi Ikuo
Published: September 2015

Purpose

Programmed death-1 (PD-1), a coinhibitory immune signal receptor expressed in T cells, binds to PD-1 ligand and regulates antitumor immunity. Nivolumab is an anti–PD-1 antibody that blocks PD-1 signaling. We assessed the safety and antitumor activity of nivolumab in patients with platinum-resistant ovarian cancer.

Patients and Methods

Twenty patients with platinum-resistant ovarian cancer were treated with an intravenous infusion of nivolumab every 2 weeks at a dose of 1 or 3 mg/kg (constituting two 10-patient cohorts) from October 21, 2011. This phase II trial defined the primary end point as the best overall response. Patients received up to six cycles (four doses per cycle) of nivolumab treatment or received doses until disease progression occurred. Twenty nivolumab-treated patients were evaluated at the end of the trial on December 7, 2014.

Results

Grade 3 or 4 treatment-related adverse events occurred in eight (40%) of 20 patients. Two patients had severe adverse events. In the 20 patients in whom responses could be evaluated, the best overall response was 15%, which included two patients who had a durable complete response (in the 3-mg/kg cohort). The disease control rate in all 20 patients was 45%. The median progression-free survival time was 3.5 months (95% CI, 1.7 to 3.9 months), and the median overall survival time was 20.0 months (95% CI, 7.0 months to not reached) at study termination.

Conclusion

This study, to our knowledge, is the first to explore the effects of nivolumab against ovarian cancer. The encouraging safety and clinical efficacy of nivolumab in patients with platinum-resistant ovarian cancer indicate the merit of additional large-scale investigations (UMIN Clinical Trials Registry UMIN000005714).
Feasibility of Preoperative Chemotherapy With or Without Radiation Therapy in Localized Soft Tissue Sarcomas of Limbs and Superficial Trunk in the Italian Sarcoma Group/Grupo Español de Investigación en Sarcomas Randomized Clinical Trial: Three Versus Five Cycles of Full-Dose Epirubicin Plus Ifosfamide
Authors: Palassini Elena , Ferrari Stefano , Verderio Paolo , De Paoli Antonino , Martin Broto Javier , Quagliuolo Vittorio , Comandone Alessandro , Sangalli Claudia , Palmerini Emanuela , Lopez-Pousa Antonio , De Sanctis Rita , Bottelli Stefano , Libertini Michela , Picci Piero , Casali Paolo G. , Gronchi Alessandro
Published: September 2015

Purpose

We report on feasibility of preoperative chemotherapy with or without radiation therapy (RT) in the context of a phase III randomized clinical trial involving localized, high-risk, soft tissue sarcomas.

Patients and Methods

Of 321 eligible patients, 161 were randomly assigned to three preoperative cycles of epirubicin 120 mg/m2 plus ifosfamide 9 g/m2, and 160 were randomly assigned to three preoperative plus two postoperative cycles. Among them, 303 patients were included in this analysis; 169 were male and 134 were female, with a median age of 48 years (range, 15 to 79 years). One hundred fifty-two patients received concurrent RT preoperatively at a total dose of 44 to 50 Gy. Preoperative chemotherapy-related hematologic toxicity and early postoperative complications were reported. The influence of RT, age, and sex on hematologic grade 3 or 4 toxicities and wound complications was analyzed. Chemotherapeutic dose intensity (DI) was analyzed.

Results

Among the patients, 61.4%, 22.4%, and 23.8% experienced, grade 4 leucopenia, grade 3 or 4 anemia, and grade 3 or 4 thrombocytopenia, respectively. Respective rates were 66.4%, 24.3%, and 31.6% when RT was added preoperatively, and 56.3%, 20.5%, and 15.9% when preoperative chemotherapy was administered alone. Patient age affected grade 3 or 4 thrombocytopenia. Grade 4 leucopenia and grade 3 or 4 anemia presented 2.5 times more frequently in female patients than in male patients. Wound complications were observed in 13.5% of patients: 17% with preoperative RT and 10% without. Chemotherapeutic DI was greater than 90%, even in patients receiving preoperative RT and in patients age 65 years or older.

Conclusion

This preoperative chemotherapy is feasible and can also be proposed for selected elderly patients. Grade 3 or 4 hematologic toxicity was common, but DI was excellent. Concurrent preoperative RT is safe, although an increased rate of grade 4 thrombocytopenia and limited increase in wound complications may be observed.
Graphene Oxide as a Heterogeneous Reagent Promoted Synthesis of 2-Substituted 1,3-Benzazoles in Water
Authors: Khalili Dariush , Banazadeh Ali Reza
Published: September 2015

An efficient chemical method for the synthesis of benzimidazoles, benzothiazoles, and benzoxazoles has been developed through the condensation of various aldehydes with o-phenylenediamine, o-aminothiophenol, and o-aminophenol using graphene oxide (GO) as an oxidant in water. These benzazoles are also prepared through a one-pot oxidation/condensation tandem process by reacting alcohols with 2-amino(thio)phenol/aniline in the presence of GO in poly(ethylene glycol) as a safe media. Moreover, this carbonaceous material could be readily separated using a simple filtration.
Interlocking Folded Plate – Integral Mechanical Attachment for Structural Wood Panels
Authors: Robeller Christopher , Weinand Yves
Published: September 2015

Automatic joinery has become a common technique for the jointing of beams in timber framing and roofing. It has revived traditional, integral joints such as mortise and tenon connections. Similarly, but only recently, the automatic fabrication of traditional cabinetmaking joints has been introduced for the assembly of timber panel shell structures. First prototypes have used such integrated joints for the alignment and assembly of components, while additional adhesive bonding was used for the load-bearing connection. However, glued joints cannot be assembled on site, which results in several design constraints.

In this paper, we propose the use of dovetail joints without adhesive bonding, on the case study of a timber folded plate structure. Through their single-degree-of-freedom (1DOF) geometry, these joints block the relative movement of two parts in all but one direction. This presents the opportunity for an interlocking connection of plates, as well as a challenge for the assembly of folded plate shells, where multiple non-parallel edges per plate must be jointed simultaneously.
Segmental Timber Plate Shell for the Landesgartenschau Exhibition Hall in Schwäbisch Gmünd—the Application of Finger Joints in Plate Structures
Authors: Li Jian-Min , Knippers Jan
Published: September 2015

Segmental plate shells are an interesting option for the design and construction of cost-effective shell structures. They are composed of prefabricated segmental plates that are joined together to become an integral structure that generates a shell action and transfers external loads into membrane forces. However, connections between segmental plates nearly always weaken shell structures as they disturb the material continuity and thus their stiffness.

The application of finger joint connections can effectively increase the in-plane stiffness and thus makes plate shell structures stiffer and stronger. Moreover, they attract more forces to flow through the connection in the form of in-plane shears instead of axial forces and thus reduce the load in the axial direction of a connection. As a result, the application of finger joints allows a lighter axial joint design with smaller screw diameters, which is preferred in a thin timber plate structure.

The paper presents the Landesgartenschau Exhibition Hall as a successful demonstrator for segmental timber plate shells and highlights the design of the finger joint connections.
Rotational Stiffness at Ridges of Timber Folded-Plate Structures
Authors: Roche Stéphane , Mattoni Geoffroy , Weinand Yves
Published: September 2015

Folded-plate structures provide an efficient design using thin laminated veneer lumber panels. Inspired by Japanese furniture joinery, the multiple tab-and-slot joint was developed for the multi-assembly of timber panels with non-parallel edges without adhesive or metal joints. Because the global analysis of our origami structures reveals that the rotational stiffness at ridges affects the global behaviour, we propose an experimental and numerical study of this linear interlocking connection. Its geometry is governed by three angles that orient the contact faces. Nine combinations of these angles were tested and the rotational slip was measured with two different bending set-ups: closing or opening the fold formed by two panels. The non-linear behaviour was conjointly reproduced numerically using the finite element method and continuum damage mechanics.
Timber Folded Plate Structures – Topological and Structural Considerations
Authors: Stitic Andrea , Weinand Yves
Published: September 2015

This paper analyses the potential of different possible folded form topologies for generating timber folded surface structures. The main advantage of such structures lies primarily in the realm of ecology and sustainability. By offering an integral way of construction, which fulfils both a supporting as well as a covering function, very lightweight structures are achieved. Also, greater degree of prefabrication is possible which leads to reduced overall cost. Timber folded structures consist of a large number of discrete, thin plane elements, mutually connected to form an overall folded surface. Therefore proper edgewise connection details are needed in order to ensure an efficient load bearing system. For structures made of wood products this presents a great challenge using the state-of-the art joining techniques. For this reason, the use of timber folded plates in civil engineering applications has been very limited. However, recently new technical solutions have been proposed for efficient edgewise joining of thin timber panels. In this paper focus is put on integrated mechanical attachment technique which utilises digital prefabrication to integrate connectors through panel geometry. Taking into consideration material, fabrication and connection detail constraints, various topologies are examined for the considered application. Furthermore, structural behaviour of folded systems is studied and three feasible forms are compared by means of Finite Element Analysis. Finally, observations are made on a case study of a built prototype structure and the structural potential of the proposed systems is outlined.
Design Constraints for Linear Folded Stripes
Authors: Maleczek Rupert , Genevaux Chloe
Published: September 2015

In contrast to the common use of folding as surface approach, the work presented here explores its use for reticular structures. The focuses are reticular structures made from linear folded stripes that create a wide variety of forms.

The strategy of linear folded stripes has been intensively investigated and described since a few years. This article will give a compact overview on the different sub-systems and their classifications as well as a description on the underlying design strategies in order to give designers a guideline for potential applications. As a preamble a short description on linear folded stripes, and some general constraints in this particular system, the relation between the stripe generation and an underlying line network will be given here. After this condense introduction relations and approaches constraint to fabrication issues will be discussed to show the actual development of this system towards a construction relevant one.

As the “technical human made nature” is producing most materials either in rectangular plates, linear strings with multiple section profiles, or in very small pieces, one motivation for the investigation on this particular system is the efficient use of plate material by minimizing the produced offcuts working with rectangular stripes.

The folding strategy presented here can be seen as a combination of three different phenomena namely folding, the work with stripes of sheet material and a simple assembly strategy. The authors will give a summary of approaches as well as a classification method that covers all potential possible structures consisting of linear folded stripes.