bluuebunny/crossref_metadata_2025 huggingface dataset:
The First World War and the Myth of the Young Man's War in Western Europe
Authors: Brian Amanda M.
Published: August 2018

During and after the First World War, authors in several of the main belligerent nations presented the war as a young man's war. The young man's war proved to be a powerful trope, and a myth emerged about the typical trench soldier as handsome, white, and eighteen. In this article, I examine literature about the Great War across several nations – primarily Germany, Great Britain, and France – to demonstrate how and why youth became embedded in the collective memory and representation of the war. I argue, in part, that notions of youth in the early twentieth century allowed participating nations to emphasise innocence and tragedy, claiming the moral high ground in the process. As a result, it is now difficult to accurately depict the First World War soldiers as fathers as well as sons, husbands as well as fiancés, men with careers as well as boys fresh from school. The generation of 1914 must be conceived more broadly, which would disallow easy teleologies to later tragic events in the 1930s.
Maintaining an Effective Circle: Volunteer Experiences of Operational Aspects of Circles of Support and Accountability
Authors: Lowe Giulia , Willis Gwenda
Published: August 2018

In Circles of Support and Accountability (CoSA), trained volunteers support an individual convicted for sexual offenses to reintegrate safely into the community. Developed in Canada, CoSA has been established in many jurisdictions with a growing number of volunteers; however, little is known about whether the training and support provided meets volunteer needs. Using a mixed-methods approach, the aim of the present research was to explore New Zealand CoSA volunteer experiences of the training and support they received and their perceptions about what contributed to the effective operation of a circle. In total, 18 volunteers took part in an interview and 23 volunteers completed a questionnaire. The findings found a mixed response to the training and support received, whereby some volunteers thought the training and support was adequate, whereas other felt the training support they received was inadequate. Findings also illustrate that adequate training, having access to a circle coordinator, selecting the right volunteers and core member, clear communication, and setting up boundaries were important factors in maintaining an effective circle. Findings are discussed in terms of implications for the training and support offered to current and future volunteers, as well as for maintaining the effectiveness of future circles.
Extracorporeal membrane oxygenation in trauma: A single institution experience and review of the literature
Authors: Strumwasser Aaron , Tobin Joshua M , Henry Reynold , Guidry Chrissy , Park Caroline , Inaba Kenji , Demetriades Demetrios
Published: August 2018

Introduction:

Limited options exist for cardiovascular support of the trauma patient in extremis. This patient population offers challenges that are often considered insurmountable. This article identifies a heterogeneous group of trauma patients in extremis who may benefit from extracorporeal membrane oxygenation.

Methods:

Data were sourced from the medical records of all patients placed on extracorporeal membrane oxygenation following trauma at a Level I Trauma Center between 1 December 2016 and 1 December 2017.

Results:

All patients were male (N = 7), mostly with blunt injuries (n = 5), with an average age of 41 years and with an average Injury Severity Scores of 33 (median = 34). Two out of seven patients survived (28.5%). Survivors tended to have a longer duration on extracorporeal membrane oxygenation (13.5 vs 3.8 days), had extracorporeal membrane oxygenation initiated later (15 vs 7.8 days), and had suffered a blunt injury. Two patients were initiated on veno-arterial extracorporeal membrane oxygenation (both non-survivors) and five were initiated on veno-venous extracorporeal membrane oxygenation (two survivors, three non-survivors). Five patients were heparinized immediately (one survivor, four non-survivors), and two patients were heparinized after clotting was noted in the circuit (one survivor, one non-survivor). Three of the seven (42.8%) patients suffered cardiac arrest either prior to, or during, the initiation of extracorporeal membrane oxygenation (all non-survivors).

Discussion:

Extracorporeal membrane oxygenation use in the trauma patient in extremis is not standard; however, this article demonstrates that extracorporeal membrane oxygenation is feasible in a complex, heterogeneous patient population when treated at designated centers.
In situ thermal-conductivity measurements and morphological characterization of intumescent coatings for fire protection
Authors: Kang Jiyuan , Takahashi Fumiaki , T’ien James S
Published: August 2018

Thermal insulating performance and char-layer properties have been studied for water-based intumescent coatings for structural steel fire protection using a new laboratory-scale mass-loss cone apparatus. A specimen (100 × 100 mm mild steel plate; the initial coating thickness: 0.3–2.0 mm) is placed horizontally and exposed to a constant incident radiant heat flux (25, 50, or 75 kW/m2). The apparent thermal conductivity of the expanding char layer is determined in situ based on real-time measurements of the temperature distribution in the char layer and the heat flux transmitted through the char layer. Three-dimensional morphological observations of the expanded char layer are made using a computed tomographic–based analytical method. The vertical variation of the porosity of the expanded char layer is measured. The measured heat-blocking efficiency is correlated strongly with the incident heat flux, which increases the expanded char-layer thickness, and porosity for sufficiently large initial coating thicknesses (>0.76 mm). For a thin coating (0.30 mm), violent off-gassing disrupts the intumescing processes to form a consistent char layer after abrupt exposure to higher incident heat fluxes, thus resulting in lower heat-blocking efficiency. Therefore, the product application thickness must exceed a proper threshold value to ensure an adequate thermal insulation performance.
Nodular granulomatous Pneumocystis jiroveci pneumonia consequent to delayed immune reconstitution inflammatory syndrome
Authors: Taeb Abdalsamih M , Sill Joshua M , Derber Catherine J , Hooper Michael H
Published: August 2018

Although Pneumocystis jiroveci pneumonia (PCP) is a frequent manifestation of acquired immune deficiency syndrome (AIDS), the granulomatous form is uncommon. Here, we present an unusual case of granulomatous PCP consequent to immune reconstitution inflammatory syndrome (IRIS) after highly active antiretroviral therapy. A 36-year-old woman with human immunodeficiency virus (HIV) presented with cough and dyspnea that were attributed to typical PCP associated with AIDS. She was successfully treated with antibiotic, steroid, and antiretroviral therapies. After six months, however, she presented with consolidating lung lesions caused by bronchial obstruction from PCP granulomatous disease. Although antibiotics were ineffective, the effectiveness of steroid therapy suggested a diagnosis of granulomatous IRIS caused by persistent PCP antigens. Physicians should strongly suspect PCP in HIV-positive patients with nodular lung lesions and must remain aware that these lesions, if immune in origin, might not respond to antimicrobial therapy.
Treatment of disseminated histoplasmosis in advanced HIV using itraconazole with increased bioavailability
Authors: Mangalore Rekha P , Moso Michael A , Cronin Katie , Young Katrina , McMahon James H
Published: August 2018

Disseminated histoplasmosis (DH), an endemic mycosis caused by the dimorphic fungus Histoplasma capsulatum, is a life-threatening infection in immunocompromised hosts. A patient with newly-diagnosed human immunodeficiency virus (HIV) infection presented with a violaceous, raised, indurated, pruritic rash over the face, arms and trunk on a background of significant weight loss, fevers with sweats, diarrhoea and worsening shortness of breath. His CD4+ T cell count was 14 cells/µl (12%). Histoplasmosis was diagnosed from histology, fungal stain and culture of skin biopsy. In addition to DH, he was found to have Pneumocystis jiroveci pneumonia and multi-resistant Salmonella choleraesuis bacteraemia. He improved with treatment with antibiotics and was commenced on conventional itraconazole, orally. Antiretroviral therapy was commenced soon after. He was unable to achieve therapeutic levels with the conventional formulation due to gastrointestinal side effects and had ongoing fevers. A newer formulation of oral itraconazole with improved bioavailability was commenced. He achieved therapeutic drug levels and had no further intolerance. His fevers settled and the rash improved. He has now completed one year of treatment and is well. To our knowledge this is the first case of moderate DH in an advanced HIV patient treated successfully with oral itraconazole with improved bioavailability.
Reactive hemophagocytic syndrome in the setting of acute human immunodeficiency virus 1 infection: case report and review of the literature
Authors: Tulloch Luis G , Younes Ramee , Jeng Arthur
Published: August 2018

We report a case of reactive hemophagocytic syndrome (RHS) in the setting of acute human immunodeficiency virus type 1 infection (AHI). In addition, we review 11 previously reported cases of RHS precipitated by AHI and discuss strategies in the diagnosis and management of these overlapping clinical entities.
The Structural and Functional Signature of Action Control
Authors: Schlüter Caroline , Fraenz Christoph , Pinnow Marlies , Friedrich Patrick , Güntürkün Onur , Genç Erhan
Published: August 2018

Individuals differ in their ability to initiate self- and emotional-control mechanisms. These differences have been explicitly described in Kuhl’s action-control theory. Although interindividual differences in action control make a major contribution to our everyday life, their neural foundation remains unknown. Here, we measured action control in a sample of 264 healthy adults and related interindividual differences in action control to variations in brain structure and resting-state connectivity. Our results demonstrate a significant negative correlation between decision-related action orientation (AOD) and amygdala volume. Further, we showed that the functional resting-state connectivity between the amygdala and the dorsal anterior cingulate cortex was significantly associated with AOD. Specifically, stronger functional connectivity was associated with higher AOD scores. These findings are the first to show that interindividual differences in action control, namely AOD, are based on the anatomical architecture and functional network of the amygdala.
Metastatic thymoma in the liver of a dog
Authors: Wiles Valerie , Haddad Jamie , Leibman Nicole , Avery Anne C. , Hughes Kelly L.
Published: August 2018

A 12-y-old neutered male Portuguese Water dog was presented because of a 1-y history of persistent hyporexia, diarrhea, and recurrent pyelonephritis. Abdominal ultrasound revealed hepatic nodules and diffuse splenomegaly, and radiographs revealed a mediastinal mass. Fine-needle aspirates of the liver, spleen, and mediastinal mass were suspicious for lymphoma. Flow cytometry identified small T cells that co-expressed CD4 and CD8 at all sites, most suspicious for thymoma, but lymphoma could not be ruled out. PCR for antigen receptor rearrangements analysis identified polyclonal amplification of the T-cell receptor genes, more consistent with thymoma than lymphoma. Histopathology of the liver and thymic mass confirmed thymoma with hepatic metastasis.
Bisphosphonate Use in Pediatric Oncology for Pain Management
Authors: Anghelescu Doralina L. , Pankayatselvan Varayini , Nguyen Rosa , Ward Deborah , Wu Jianrong , Wu Huiyun , Edwards Denaya D. , Furman Wayne
Published: August 2018

The use of bisphosphonates for pain control in children with cancer is not extensively studied. We retrospectively evaluated 35 children with cancer treated with intravenous bisphosphonates for pain management at a single institution from 1998 through 2015. We analyzed pain scores and opioid and adjuvant medication consumption before bisphosphonate administration, daily for 2 weeks, and at 3 and 4 weeks after administration. We also determined the time interval between diagnosis and first administration of bisphosphonates and duration of life after bisphosphonate administration. Mean pain scores were 2.45 (±2.96) and 0.75 (±1.69) before and 14 days after bisphosphonate administration, respectively ( P = .25), and morphine equivalent doses of opioids were 5.52 (±13.35) and 5.27 (±9.77), respectively ( P = .07). Opioid consumption was significantly decreased at days 4 to 8, days 11 to 12, and week 3 after first bisphosphonate administration. The median duration of life after first bisphosphonate administration was 80 days, indicating its use late in the course of treatment. Bisphosphonates did not significantly improve pain outcomes at 2 weeks, but opioid consumption was reduced at several time points during the first 3 weeks. The use of bisphosphonates earlier in the course of pediatric oncological disease should be evaluated in prospective investigations.
Efficacy, Acceptability, and Tolerability of Lisdexamfetamine, Mixed Amphetamine Salts, Methylphenidate, and Modafinil in the Treatment of Attention-Deficit Hyperactivity Disorder in Adults: A Systematic Review and Meta-analysis
Authors: Stuhec Matej , Lukić Petar , Locatelli Igor
Published: August 2018

Objective: Psychostimulants are the first-line treatment in adults with attention-deficit hyperactivity disorder (ADHD). This meta-analysis aimed to evaluate the efficacy, acceptability, and tolerability of lisdexamfetamine (LDX), mixed amphetamine salts (MASs), modafinil (MDF), and methylphenidate (MPH) in comparison with placebo. Data Sources: We systematically searched PubMed/MEDLINE and Clinicaltrials.gov in May 2016, along with CENTRAL and EU Clinical Trials Register in February 2016, for the randomized, double-blind, placebo-controlled, parallel-group clinical trials conducted on adults diagnosed with ADHD. Study Selection and Data Extraction: Substantial comorbidity, substance abuse or dependence, and nonpharmacological interventions represented grounds for exclusion. Published reports were the sole source for data extraction. Improvement in ADHD symptoms was the primary outcome. Random-effects model meta-analysis was applied to calculate the standardized mean difference (SMD) with 95% CIs. Data Synthesis: The search retrieved 701 records, of which 20 studies were eligible for analysis. High effect size (expressed as SMD) in reducing ADHD symptoms was observed for LDX (−0.89; 95% CI = −1.09, −0.70), whereas MASs (−0.64; 95% CI = −0.83, −0.45) and MPH (−0.50; 95% CI = −0.58, −0.41) reduced symptoms moderately compared with placebo. No efficacy was shown for MDF (0.08; 95% CI; −0.18, 0.34). Relevance to Patient Care and Clinical Practice: In this meta-analysis, the efficacy, tolerability, and acceptability of psychostimulants were compared with that for placebo. Five of the included trials have not been evaluated in any of the previously published meta-analyses. Conclusions: The results suggest that LDX has the largest effect size and has a promising potential for treating adults with ADHD.
Glucose Concentration Affects Fibrin Clot Structure and Morphology as Evidenced by Fluorescence Imaging and Molecular Simulations
Authors: Hood Jacob E. , Yesudasan Sumith , Averett Rodney D.
Published: August 2018

Although in vivo studies have been conducted in the past to determine hyperglycemic effects and influence on clotting risk in patients with diabetes, the true extent of hyperglycemia on unstable and spontaneous clot formation remains highly debated. Factors such as increased glycation, elevated fibrinogen concentration, elevated prothrombin levels, and decreased plasminogen are known to influence fibrin conversion, clot morphology, and thrombus formation in these individuals. In this regard, the isolated effects of hyperglycemia on irregular fibrin clot formation were investigated in a controlled fibrinogen system. In this study, fibrin clot characteristic differences at 3 glucose concentrations were analyzed to determine the effects of glucose concentration on fibrinogen glycation and fibrin clot morphology using confocal microscopy, glycation quantification, molecular simulations, and image processing methods. Algorithms coupled with statistical analysis support in vivo findings that hyperglycemia increases fibrinogen glycation, with ensuing altered fibrin clot structure characteristics. Our experimental and molecular simulation results consistently show an increased glucose adsorption by fibrinogen with increased glucose concentration. Significant differences in clot structure characteristics were observed, and the results of this work can be used to further develop diagnostic tools for evaluating clotting risk in individuals with hypercoagulable and hyperglycemic conditions.
Across culture, mind and history
Authors: Marková Ivana , Jahoda Andrew
Published: August 2018

This editorial highlights the contributions of Gustav Jahoda to cross-cultural and cultural psychology. Gustav’s broad and deep scholarship, focusing on culture, mind and history, crossed disciplinary boundaries of psychology, anthropology and sociology in his attempts to understand human psyche and concrete activities in various situations and locations. Gustav’s legacy is inspirational for human and social scientists who search for ‘the establishment of general psychology of a new kind’.
Sex-related differences in outcomes after vascular interventions
Authors: Brinza Ellen K , Armstrong Ehrin J
Published: August 2018

Peripheral artery disease (PAD) affects a growing number of women, with a prevalence equal to that of men. Still, little is known about sex-specific differences in disease manifestations of PAD and how these differences in presentation impact outcomes of surgical and endovascular intervention. Women have also been consistently underrepresented in clinical trials evaluating treatment options for vascular disease. Thus, many of the practice guidelines in place today were generated from clinical trial data that either included a small number of women or excluded them entirely, and, consequently, whose findings may not be applicable to female patients. This review discusses key differences in outcomes based on sex for intervention of lower extremity, carotid, and abdominal aortic aneurysmal (AAA) disease. Elucidating sex-specific differences in disease manifestation and outcomes will provide insight into ways to optimize patient care, particularly for women afflicted with vascular disease.
Work and Intimacy: Reassessing the Career/Couple Norm through a Narrative Case Approach
Authors: Potter Jesse
Published: August 2018

It is argued that ‘career’, as linear progression through one industry or two, and ‘coupledom’, as hetero, cohabitive, and moving towards marriage, have both been undermined by alternate arrangements for work and intimacy. In the face of these changes, this article considers how the hallmarks of coupling and the tenets of career manifest themselves in everyday interactions within partnerships. The article uses a narrative case approach to explore these interactions in depth. It reveals not only the persistence of normative assumptions within couple relationships but also how the ‘work’ of couple relationships draw on particular expectations surrounding what it means to negotiate a successful ‘career’. The paradigm of progress transects career/couple narratives, blurring the already opaque boundaries between productive and personal realms. This entanglement presents challenges for individuals, limiting prescriptions for what are considered ‘acceptable’ narratives of work and intimacy.
Autism at a glance: A pilot study optimizing thin-slice observations
Authors: Hampton Lauren H , Curtis Philip R , Roberts Megan Y
Published: August 2018

Borrowing from a clinical psychology observational methodology, thin-slice observations were used to assess autism characteristics in toddlers. Thin-slices are short observations taken from a longer behavior stream which are assigned ratings by multiple raters using a 5-point scale. The raters’ observations are averaged together to assign a “thin-slice” value for each observation. In this study, a total of 60 toddlers were selected from a video archive: 20 children with typical development, 20 children with developmental language disorder, and 20 children with autism. In the first part of this study, 20 raters observed small play segments between toddlers and an assessor. Raters assigned scores to each of the 60 toddlers on items related to autism symptomatology. Item analysis and generalizability and decision studies were conducted to determine the factor structure and optimal number of raters to achieve a stable estimate of autism characteristics. In the second part of the study, generalizability and decision studies were conducted to determine the most efficient and optimal combination of raters and naturalistic contexts. This pilot study provides recommendations for optimizing the utility of thin-slice observations for measuring autism symptomatology in young children.
Parent descriptions of the presentation and management of anxiousness in children on the autism spectrum
Authors: Adams Dawn , Young Kate , Simpson Kate , Keen Deb
Published: August 2018

The complex interaction between anxiety and autism has led to debate about the presentation of anxiety in individuals on the spectrum and questions about the extent to which traditional checklists assess the entire range of symptomatology. Moreover, studies to date have not explored how the presentation of anxiety may differ between settings. Through a combination of open-ended questions, closed questions and standardised measures, parents of 173 children (aged 6–13) on the autism spectrum provided (1) descriptors of their child’s anxiety at home, school and in the community and (2) strategies used to reduce their child’s anxiety in each setting. Over half (52.6%) felt their child was anxious at home, 77.6% at school and 76.2% in the community. Parents reported differing presentations of anxiety between settings, with the majority of descriptions relating to observable, behavioural changes (e.g. hides/shuts down, repetitive behaviours) rather than cognitive or physiological signs. Parents also reported using different strategies across settings. The use of open-ended questions allowed the identification of signs of anxiety not explored within traditional questionnaires and highlighted the potential for signs to vary across settings. This knowledge is critical to inform the development or adaptations of anxiety measures and interventions.
On the effectiveness of ventilation to mitigate the damage of spherical chambers subjected to confined trinitrotoluene detonations
Authors: Hernandez Francisco , Hao Hong , Zhang Xihong
Published: August 2018

This article presents a comparative study on the effectiveness of ventilation to mitigate blasting effects on chambers subjected to confined detonations of high explosives. The pressure time-history that acts on the chamber walls is described by three components: (1) the first shock wave, (2) the train of re-reflected shock waves, and (3) the gas pressure. The radial response of spherical chambers is described by the radial breathing mode and modeled by an equivalent single degree of freedom system. The three pressure components are considered for the calculation of the maximum ductility ratio, which is obtained from the numerical solution of the single degree of freedom chamber response. It is assumed that openings reduce the gas pressure but they have an insignificant effect on shock waves. The dynamic response of fully and partially confined chambers are calculated and compared. Results show that intermediate/small openings (less than 10% of the surface of the chamber) are ineffective to mitigate the chamber response and damage. The vibratory response of the chamber is susceptible to elastic or plastic resonance but it is not considerably modified by the long-term gas pressure because of its high radial breathing mode frequency, allowing concluding that ventilation is ineffective to reduce the maximum response of spherical chambers subjected to internal high explosive explosion.
Drift capacity of high-strength concrete columns with mixed-grade longitudinal reinforcements
Authors: Alaee Pooya , Sato Yoshiharu , Li Bing
Published: August 2018

A unique reinforced concrete column design method which aims to improve the ductile behavior of reinforced concrete columns by utilizing various steel grades for longitudinal reinforcements is evaluated in this article. Six large-scale reinforced concrete columns were tested, with the columns subjected to axial load and cyclic forces under reversed bending. The parameters varied in the test program including the axial loading level and the ratio and strength of longitudinal steel reinforcement. It was found from the test results that utilizing longitudinal high-strength steel reinforcement by the ratio of 30%, 50%, and 100% of the total longitudinal reinforcement in a column section will increase the lateral loading drift capacity by 18%, 26%, and 55% on average, respectively. Parametric studies via nonlinear finite-element approach were performed to study the influence of various design parameters on the ultimate drift capacity of reinforced concrete columns. The correlation between the ultimate drift capacity and the confinement level, the axial loading level, and the ratio and grade of longitudinal high-strength reinforcing bars was investigated. Design charts for various ultimate drift levels in terms of other design parameters were developed.
Stumbling upon the other side: Incidental learning of counter-attitudinal political information on Facebook
Authors: Lu Yanqin , Lee Jae Kook
Published: August 2018

Drawing on a panel survey and a laboratory experiment, this study investigates incidental exposure to counter-attitudinal political information on Facebook. The frequency of Facebook use is found positively associated with incidental exposure to counter-attitudinal political information, suggesting the important role of Facebook in exposing users to political disagreement. In addition, the findings of the experiment indicate that individuals coming across counter-attitudinal Facebook posts are able to recognize the information of these posts. This study suggests that incidental exposure is an important mechanism through which social media users encounter and learn about counter-attitudinal political information. Implications are discussed in terms of the influence of social media use on democracy.
Featured Article: Deterioration of visual function mediated by senescence-associated endoplasmic reticulum stress in inflammatory tie2-TNF mice
Authors: Lenin Raji , Nagy Peter G , Gentry Jordy , Gangaraju Rajashekhar
Published: August 2018

Stress-associated premature senescence plays a major role in retinal diseases. In this study, we investigated the relationship between endothelial dysfunction, endoplasmic reticulum (ER) stress, and cellular senescence in the development of retinal dysfunction. We tested the hypothesis that constant endothelial activation by transmembrane tumor necrosis factor-α (tmTNF-α) exacerbates age-induced visual deficits via senescence-mediated ER stress in this model. To address this, we employed a mouse model of chronic vascular activation using endothelial-specific TNF-α-expressing (tie2-TNF) mice at 5 and 10 months of age. Visual deficits were exhibited by tie2-TNF mice at both 5 months and 10 months of age, with the older mice showing statistically significant loss of visual acuity compared with tie2-TNF mice at age 5 months. The neural defects, as measured by electroretinogram (ERG), also followed a similar trend in an age-dependent fashion, with 10-month-old tie2-TNF mice showing the greatest decrease in “b” wave amplitude at 25 cd.s.m2 compared with age-matched wildtype (WT) mice and five-month-old tie2-TNF mice. While gene and protein expression from the whole retinal extracts demonstrated increased inflammatory (Icam1, Ccl2), stress-associated premature senescence (p16, p21, p53), and ER stress (Grp78, p-Ire1α, Chop) markers in five-month-old tie2-TNF mice compared with five-month-old WT mice, a further increase was seen in 10-month-old tie2-TNF mice. Our data demonstrate that tie2-TNF mice exhibit age-associated increases in visual deficits, and these data suggest that inflammatory endothelial activation is at least partly at play. Given the correlation of increased premature senescence and ER stress in an age-dependent fashion, with the loss of visual functions and increased endothelial activation, our data suggest a possible self-enhanced loop of unfolded protein response pathways and senescence in propagating neurovascular defects in this model.

Impact statement

Vision loss in most retinal diseases affects the quality of life of working age adults. Using a novel animal model that displays constant endothelial activation by tmTNF-α, our results demonstrate exacerbated age-induced visual deficits via premature senescence-mediated ER stress. We have compared mice of 5 and 10 months of age, with highly relevant human equivalencies of approximately 35- and 50-year-old patients, representing mature adult and middle-aged subjects, respectively. Our studies suggest a possible role for a self-enhanced loop of ER stress pathways and senescence in the propagation of retinal neurovascular defects, under conditions of constant endothelial activation induced by tmTNF-α signaling.
Endovascular Repair of Ruptured Hepatic Artery Pseudoaneurysm Secondary to Fibromuscular Dysplasia
Authors: Rothenberg Kara A. , McFarland Graeme E. , Stern Jordan R.
Published: August 2018

We describe successful endovascular treatment of a patient with fibromuscular dysplasia of the celiac axis leading to development of a common hepatic artery pseudoaneurysm with contained rupture. An 81-year-old woman was transferred to our quaternary care center with concern for a hepatic artery rupture. Further imaging demonstrated a common hepatic artery pseudoaneurysm with surrounding hematoma as well as multifocal areas of narrowing and dilatation in the celiac trunk consistent with fibromuscular dysplasia. A similar pattern was subsequently identified in the bilateral renal and carotid arteries. The patient underwent successful endovascular exclusion of the pseudoaneurysm with a balloon-expandable covered stent and was discharged home without incident. Fibromuscular dysplasia is a nonatherosclerotic arteriopathy that can lead to stenosis, occlusion, dissection, and aneurysm formation. While it primarily affects the carotid and renal arteries, there are rare case reports involving the mesenteric vasculature. Endovascular therapy appears to be a feasible treatment option for the complicated sequelae of this condition in the rare case of mesenteric arterial involvement.
Inverse kinematics solution for robotic manipulator based on extreme learning machine and sequential mutation genetic algorithm
Authors: Zhou Zhiyu , Guo Hanxuan , Wang Yaming , Zhu Zefei , Wu Jiang , Liu Xiangqi
Published: August 2018

This article presents an intelligent algorithm based on extreme learning machine and sequential mutation genetic algorithm to determine the inverse kinematics solutions of a robotic manipulator with six degrees of freedom. This algorithm is developed to minimize the computational time without compromising the accuracy of the end effector. In the proposed algorithm, the preliminary inverse kinematics solution is first computed by extreme learning machine and the solution is then optimized by an improved genetic algorithm based on sequential mutation. Extreme learning machine randomly initializes the weights of the input layer and biases of the hidden layer, which greatly improves the training speed. Unlike classical genetic algorithms, sequential mutation genetic algorithm changes the order of the genetic codes from high to low, which reduces the randomness of mutation operation and improves the local search capability. Consequently, the convergence speed at the end of evolution is improved. The performance of the extreme learning machine and sequential mutation genetic algorithm is also compared with that of a hybrid intelligent algorithm, and the results showed that there is significant reduction in the training time and computational time while the solution accuracy is retained. Based on the experimental results, the proposed extreme learning machine and sequential mutation genetic algorithm can greatly improve the time efficiency while ensuring high accuracy of the end effector.
Fluid dynamics in syringomyelia cavities: Effects of heart rate, CSF velocity, CSF velocity waveform and craniovertebral decompression
Authors: Vinje V , Brucker J , Rognes ME , Mardal KA , Haughton V
Published: August 2018

Purpose

How fluid moves during the cardiac cycle within a syrinx may affect its development. We measured syrinx fluid velocities before and after craniovertebral decompression in a patient and simulated syrinx fluid velocities for different heart rates, syrinx sizes and cerebrospinal fluid (CSF) flow velocities in a model of syringomyelia.

Materials and methods

With phase-contrast magnetic resonance we measured CSF and syrinx fluid velocities in a Chiari patient before and after craniovertebral decompression. With an idealized two-dimensional model of the subarachnoid space (SAS), cord and syrinx, we simulated fluid movement in the SAS and syrinx with the Navier-Stokes equations for different heart rates, inlet velocities and syrinx diameters.

Results

In the patient, fluid oscillated in the syrinx at 200 to 210 cycles per minute before and after craniovertebral decompression. Velocities peaked at 3.6 and 2.0 cm per second respectively in the SAS and the syrinx before surgery and at 2.7 and 1.5 cm per second after surgery. In the model, syrinx velocity varied between 0.91 and 12.70 cm per second. Increasing CSF inlet velocities from 1.56 to 4.69 cm per second increased peak syrinx fluid velocities in the syrinx by 151% to 299% for the three cycle rates. Increasing cycle rates from 60 to 120 cpm increased peak syrinx velocities by 160% to 312% for the three inlet velocities. Peak velocities changed inconsistently with syrinx size.

Conclusions

CSF velocity, heart rate and syrinx diameter affect syrinx fluid velocities, but not the frequency of syrinx fluid oscillation. Craniovertebral decompression decreases both CSF and syrinx fluid velocities.
Analysis of peripheral blood lymphocyte subsets in critical patients at ICU admission: A preliminary investigation of their role in the prediction of sepsis during ICU stay
Authors: Frattari Antonella , Polilli Ennio , Primiterra Vanessa , Savini Vincenzo , Ursini Tamara , Di Iorio Giancarlo , Parruti Giustino
Published: August 2018

A better knowledge of factors predicting the development of sepsis in patients hospitalized in intensive care unit (ICU) might help deploy more targeted preventive and therapeutic strategies. In addition to the known clinical and demographic predictors of septic syndromes, in this study, we investigated whether measuring T and B lymphocyte subsets upon admission in the ICU may help individualize the prediction of ensuing sepsis during ICU stay. Between May 2015 and December 2016, we performed a prospective cohort study evaluating peripheral blood lymphocyte T-CD4+ (T-helper cells), T-CD8+ (cytotoxic T-cells), T-CD56 + (natural killer cells), and T-CD19+ (B-lymphocytes), using flow cytometry on blood samples collected 2 days after admission in the ICU. We enrolled 176 patients, 65.3% males, with mean age of 61.1 ± 15.4 years. At univariate analyses, higher percentages of CD19 B-cells were significantly associated with ensuing sepsis (20.5% (15.7–27.7)% vs 16.9% (11.3–22)%, P = 0.0001), whereas median interquartile range (IQR) proportions of CD4 T-cells (41.2% (33.4–50.6)% vs 40% (35–47)%, P = 0.5), CD8 T-cells (21.1% (15.8–28.2)% vs 19.6% (14.6–25.1)%, P = 0.2) and CD56 T-cells (1.7% (0.9–3.1)% vs 1.45% (0.7–2.3)%, P = 0.4) did not reveal any significant association. An unexpected, highly significant inverse correlation of CD8 T-cells and CD19 B-cells proportions, however, was observed, suggesting that patients with lower CD19 and higher CD8 proportions might be somehow protected from ensuing sepsis. We therefore studied the ability of the CD8/CD19 ratio to predict ensuing sepsis in our sample. In final models of multivariate logistic regression, the following independent associations were found: previous antibiotic exposure (odds ratio (OR): 3.8 (95% confidence interval (CI): 1.35–10.87), P = 0.01), isolation of at least one multi-drug resistant organism at any time during ICU stay (OR: 8.4 (95% CI: 3.47–20.6), P < 0.0001), decreasing age (OR: 0.9 (95% CI: 0.93–0.99), P = 0.02) and a CD8/CD19 ratio >2.2 (OR: 10.3 (95% CI: 1.91–55.36), P = 0.007). Our data provide preliminary evidence that immune characterization of critically ill patients on ICU admission may help personalize the prediction of ensuing sepsis during their ICU stay. Further polycentric evaluation of the true potential of this new tool is warranted.
Serial electromyographic findings in Guillain-Barré syndrome patients
Authors: Yang Yumei , Lu Jing , Bao Huan
Published: August 2018

We sought to investigate electromyographic characteristics of Guillain-Barré syndrome (GBS) patients in the recovery phase by using serial electromyography (EMG). We included seven GBS patients and assessed their neurologic function at admission and 2, 3 and 6 months post onset using Hughes Functional Grading Scale scores. All patients underwent serial electromyographic assessment of compound muscle action potentials (CMAPs), mean conduction velocity (MCV), and distal motor latency (DML) of peripheral nerves. F wave was recorded of the median nerve and ulnar nerve. All seven patients had a Hughes Functional Grading Scale score between 3 and 6 at admission, while three patients at 2 months, one patient at 3 months, and no patient at 6 months post GBS onset had a Hughes Functional Grading Scale score between 3 and 6 ( P < 0.05). No F wave was elicited in 41.7% (20/48) of the motor nerves examined at admission, which declined to 25% at 6 months post GBS onset. Decreased amplitude in CMAPs was seen in 50% (24/48) of the motor nerves examined at admission, which decreased to 25% at 6 months ( P < 0.05). Moreover, 60.4% (29/48) of the motor nerves showed abnormal abduction velocity, which declined to 0% at 3 and 6 months post GBS onset ( P < 0.01). In conclusion, GBS patients exhibit a variable course in recovery of electromyographic parameters, and amplitude in CMAPs cannot fully reflect recovery of muscle tone. Conduction block is reversible and in line with rapid muscle tone recovery.
Chronic Obstructive Pulmonary Disease Is an Independent Predictor for 30-Day Complications and Readmissions Following 1- to 2-Level Anterior Cervical Discectomy and Fusion
Authors: Malik Azeem Tariq , Jain Nikhil , Kim Jeffery , Khan Safdar N. , Yu Elizabeth
Published: August 2018

Study Design:

Retrospective cohort.

Objectives:

To study evidence to assess the impact of chronic obstructive pulmonary disease (COPD) on 30-day outcomes following 1- to 2-level anterior cervical discectomy and fusion (ACDF).

Methods:

The 2015-2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried using Current Procedural Terminology (CPT) codes 22 551 (single-level) and 22 552 (additional level). Patients undergoing disc arthroplasty, multilevel (>2) fusion, posterior cervical spine surgery, and patients with fracture, tumor, and/or infection were excluded.

Results:

Out of 14 835 patients undergoing an elective 1- to 2-level ACDF, 649 (4.4%) had a diagnosis of COPD at the time of the surgery. Following adjusted logistic regression analysis, prior history of COPD was significantly associated with a longer length of stay (odds ratio [OR] 1.25 [95% confidence interval (CI0 1.04-1.52]; P = .019), superficial surgical site infection (OR 2.68 [95% CI 1.06-6.80]; P = .038), discharge destination other than home (OR 1.49 [95% CI 1.05-2.12]; P = .026), pneumonia (OR 4.37 [95% CI 2.42-7.88]; P < .001), ventilator use >48 hours (OR 5.34 [95% CI 1.88-15.15]; P = .002), unplanned reintubation (OR 3.36 [1.48-7.62]; P = .004), and 30-day readmissions (OR 1.69 [95% CI 1.20-2.38]; P = .003).

Conclusions:

The findings of this study show that COPD patients are more likely to have postoperative complications and 30-day readmissions, despite elective ACDF itself being a low-risk surgery in general. Results show that majority of the complications were pulmonary in nature, further stressing the need for accurate medical optimization following surgery in these patients.
Health Risks Associated With Benzene Exposure in Children: A Systematic Review
Authors: D’Andrea Mark A. , Reddy G. Kesava
Published: August 2018

Currently, there is a paucity of studies evaluating the adverse health effects of benzene exposure in children or clinical findings of those children who have been exposed. However, emerging studies show that benzene exposure can cause deleterious health effects in children. The objective of this study was to evaluate and summarize published studies on the adverse health effects of benzene exposure in children. More than 77 articles were examined and only the articles that dealt with adverse health effects on pediatric populations were included in the study. The evaluation of those studies provided current understanding of the health effects of benzene exposure in children. Findings from the currently available studies reveal that benzene exposure is associated with abnormalities in hematologic, hepatic, respiratory, and pulmonary functions in children. Published studies clearly support the need for further assessment of the potential adverse effects of benzene exposure in children, and clinical and laboratory findings of these children.
Socio-political drivers and consequences of landslide and flood risk zonation: A case study of Limbe city, Cameroon
Authors: Maes Jan , Molombe Jeff Mbella , Mertens Kewan , Parra Constanza , Poesen Jean , Che Vivian Bih , Kervyn Matthieu
Published: August 2018

Disaster risk zonation is often proposed as a long-term disaster risk reduction strategy by international treaties and academic research. This strategy has been implemented in the city of Limbe, which is known to be a disaster-prone one. Citizens are forced to settle in unsafe terrains, ranging from wetlands to unstable hillslopes due to the city’s geographical location and economic attraction. Following the fatal landslides and floods in 2001, a local crisis committee identified affected areas and declared them ‘risk zones’ to prevent further exposure. Empirically, this study narrates the production and implementation of risk zonation policy in the city of Limbe. Theoretically, it uses an urban political ecology perspective, which incorporates science and technology studies, post-political theory and disaster research to interpret the drivers and implications of the mismatch between research, policy and action. In this case study, we investigate the implications for disaster risk reduction by describing three underlying socio-political drivers of the risk zonation policy: (i) authoritarian science regime, (ii) post-political discourse, and (iii) blame diversion. We argue that authorities from national to local level use a post-political discourse to promote and implement disaster risk reduction in the city of Limbe through the development and the application of risk zonation policy. As a consequence, risk zonation leads to poor enforcement of the law and corruption, ultimately leading to risk accumulation in this case. This analysis allows us to draw broader conclusions on drivers and implications of the implementation of disaster risk zonation policy in urban areas that are primarily governed hierarchically and prone to corruption.
Teaching Early Math Skills to Young Children With Disabilities in Rural Blended Early Childhood Settings
Authors: Hawkins-Lear Sarah , Grisham-Brown Jennifer
Published: August 2018

Two case studies were utilized to teach math skills while embedding the constant time delay teaching strategy. The study targeted children who were at risk for having mathematic difficulty in school due to disabilities, socioeconomic status, and living in a rural area. Four 3- to 5-year-old children with disabilities who attended rural inclusive preschool programs participated. Results indicated that early math skills were acquired with high levels of accuracy when compared with baseline data. Due to the end of the school year, one of the four children did not participate in maintenance or generalization data sessions. However, of the three children who participated, skills were maintained and/or generalized with 100% accuracy.
Clinical characteristics of patients with bipolar disorder and premorbid traumatic brain injury: a cross-sectional study
Authors: Drange Ole Kristian , Vaaler Arne Einar , Morken Gunnar , Andreassen Ole Andreas , Malt Ulrik Fredrik , Finseth Per Ivar
Published: August 2018

Background

About one in ten diagnosed with bipolar disorder (BD) has experienced a premorbid traumatic brain injury (TBI), while not fulfilling the criteria of bipolar and related disorder due to another medical condition (BD due to TBI). We investigated whether these patients have similar clinical characteristics as previously described in BD due to TBI (i.e. more aggression and irritability and an increased hypomania/mania:depression ratio) and other distinct clinical characteristics.

Methods

Five hundred five patients diagnosed with BD type I, type II, or not otherwise specified, or cyclothymia were interviewed about family, medical, and psychiatric history, and assessed with the Young Mania Rating Scale (YMRS) and the Inventory of Depressive Symptoms Clinician Rated 30 (IDS-C30). Principal component analyses of YMRS and IDS-C30 were conducted. Bivariate analyses and logistic regression analyses were used to compare clinical characteristics between patients with (n = 37) and without (n = 468) premorbid TBI.

Results

Premorbid TBI was associated with a higher YMRS disruptive component score (OR 1.7, 95% CI 1.1–2.4, p = 0.0077) and more comorbid migraine (OR 4.6, 95% CI 1.9–11, p = 0.00090) independently of several possible confounders. Items on disruptive/aggressive behaviour and irritability had the highest loadings on the YMRS disruptive component. Premorbid TBI was not associated with an increased hypomania/mania:depression ratio.

Conclusions

Disruptive symptoms and comorbid migraine characterize BD with premorbid TBI. Further studies should examine whether the partial phenomenological overlap with BD due to TBI could be explained by a continuum of pathophysiological effects of TBI across the diagnostic dichotomy.

Trial registration ClinicalTrials.gov: NCT00201526. Registered September 2005 (retrospectively registered)