bluuebunny/crossref_metadata_2025 huggingface dataset:
MFC Free-Flow Model: Introducing Vehicle Dynamics in Microsimulation
Authors: Makridis Michail , Fontaras Georgios , Ciuffo Biagio , Mattas Konstantinos
Published: April 2019

Free-flow movement of vehicles in microsimulation software is usually defined by a set of equations with no explicit link to the instantaneous dynamics of the vehicles. In some cases, the car and the driver are modeled in a deterministic way, producing a driving behavior, which does not resemble real measurements of car dynamics or driving style. Depending on the research topic, the interest in microsimulation is to capture traffic dynamics phenomena, such as shockwave propagation or hysterisis. Existing car-following models are designed to simulate more the traffic evolution, rather than the vehicle motion, and consequently, minimal computational complexity is a strong requirement. However, traffic-related phenomena, such as the capacity drop are influenced by the free-flow acceleration regime. Furthermore, the acceleration pattern of a vehicle plays an essential role in the estimation of the energy required during its motion, and therefore in the fuel consumption and the CO2 emissions. The present work proposes a lightweight microsimulation free-flow acceleration model (MFC) that is able to capture the vehicle acceleration dynamics accurately and consistently, it provides a link between the model and the driver and can be easily implemented and tested without raising the computational complexity. The proposed model is calibrated, validated, and compared with known car-following models on road data on a fixed route inside the Joint Research Centre of the European Commission. Finally, the MFC is assessed based on 0–100 km/h acceleration specifications of vehicles available in the market. The results prove the robustness and flexibility of the model.
Nonlinear dynamic modeling and decoupling for rigid–flexible coupled system of spacecraft with rapid maneuver
Authors: Cao Yuteng , Cao Dengqing , Huang Wenhu
Published: April 2019

In this paper, the rigid–flexible coupled model of a spacecraft composed of a rigid platform and two flexible solar arrays is investigated. Considering the rapid maneuver of a spacecraft, the first-order approximation coupling model should be adopted. The nonlinear dynamic equations, which remain the second-order coupling terms of axial displacement caused by the transverse motion of solar arrays, are obtained by using the Hamilton principle. Then the global mode method is adopted to obtain the mode shapes of the linearized model. The global mode shapes are proved to be orthogonal and used to discrete the continuum first-order approximation coupling model. Then the rigid–flexible coupled model of the spacecraft is decoupled by global mode shapes. The model is validated by comparing with that obtained from the finite element method. The simulation results demonstrate that the global mode method has the advantage of lower dimensions but higher accuracy. The analysis of parameters variation and dynamic responses shows that the first-order approximation coupling model is more accurate than the linearized model and has a broader scope of application than that of the zero-order approximation coupling model.
The influence of dynamic swash plate vibration on outlet flow ripple in constant power variable-displacement piston pump
Authors: Pan Yang , Li Yibo , Liang Dedong
Published: April 2019

The vibration of a swash plate is caused by the piston forces and the control actuator acting on the swash plate. An earlier study of the outlet flow ripple of variable-displacement axial piston pumps assumed a fixed swash plate angle; it ignored the influence of swash plate vibration on the outlet flow ripple of the axial piston pump. In this work, a theoretical model of the outlet flow ripple and pressure pulsation was established in a constant power variable-displacement piston pump. The vibration of swash plate, flow leakage, and valve dynamic characteristics are considered in the theoretical model. The computational results of the theoretical model at different external load pressures are verified by comparison with experimental results. The vibration of the swash plate is strongly influenced by both the piston chamber pressure variation and the control actuator mechanism. The study proved the influence of the swash plate vibration on the outlet flow ripple and the pressure pulsation of an axial piston pump. Compared to the case of a fixed swash plate angle, accounting for swash plate vibration is much more suitable for the accurate determination of the outlet flow ripple and pressure pulsation of an axial piston pump. It is also shown that the vibration of the swash plate affects the valve plate design. Accordingly, valve plate optimization based on the theoretical model of the outlet flow ripple was also studied in this work. The amplitude of the instantaneous outlet flow ripple was considered as the optimization objective function. Finally, the optimized design parameters for a constant power variable-displacement swash plate axial piston pump were evaluated.
The landscape setting of bog bodies: Interdisciplinary research into the site location of Yde Girl, The Netherlands
Authors: van Beek R , Candel JHJ , Quik C , Bos JAA , Gouw-Bouman MTIJ , Makaske B , Maas GJ
Published: April 2019

Past studies of archaeological bog finds, such as bog bodies, wooden trackways and a wide variety of other materials, are characterized by a strong focus on material culture. Their original environmental and cultural context has received far less attention. This paper centres on the original landscape setting of bog bodies. Interdisciplinary reconstructions of the physical and cultural landscape at the time of deposition can lead to significant new and more detailed insights into the context and meaning of this remarkable phenomenon. We aim to show the value of such interdisciplinary research by reconstructing the original physical and cultural landscape setting of the most iconic bog body of The Netherlands: Yde Girl. This approximately 16-year-old girl was killed about 2000 years ago and deposited in a bog south of the modern-day village of Yde (province of Drenthe). Our interdisciplinary research team used a combination of research methods from physical geography, geomorphology, palynology and archaeology to analyse both the site itself and its wider environment. This kind of integrated, detailed landscape research on bog bodies has hardly been done yet. We expect that our research design, methodology and results may also be applied in future research of other bog bodies. Furthermore, they may inspire research on other types of archaeological find categories from peatlands.
Guaranteeing the ECB’s democratic accountability in the post-Banking Union era: An ever more difficult task?
Authors: Fromage Diane
Published: April 2019

Following the Great Financial Crisis, the European Central Bank’s functions have been significantly altered. It is now involved in the functioning of a variety of European Union bodies and agencies, new powers in the field of banking supervision have been attributed to it and it has resorted to unconventional monetary policy. Such a concentration of powers arguably gives rise to issues of accountability and institutional balance within the European Union: (i) the resulting institutional framework is particularly complex and difficult to understand; (ii) the numerous functions the European Central Bank assumes makes it increasingly difficult to identify in which arena(s) it should be held to account for which action; and (iii) its role in the different bodies or agencies may vary in theory and in practice, which, in turn, influences the degree to which the European Central Bank should be held to account. This article aims at showing to what extent the European Central Bank’s role has multiplied and diversified with a view to assess how it is held to account in those different instances, and what the consequences are for the European Central Bank’s democratic accountability, primarily towards the European Parliament, as well as towards the Council of the European Union and national parliaments where applicable.
A RANZCP trainee’s experience of working with patients with an intellectual disability: a case series
Authors: Naveed Sheikh
Published: April 2019

Objectives:

This study aimed to highlight the interplay of intellectual disability and psychiatric presentation using a case series.

Methods:

A brief review of the current literature and an illustrative case series of five intellectually disabled patients with psychiatric patients whose diagnosis were clarified over time who presented with a psychiatric illness are provided.

Results:

The presence of intellectual disability often compounds the difficulty of establishment of mental-health diagnosis.

Conclusions:

More focus is required on training and skills development across mental-health services regarding the assessment of psychiatric disorders in people with an intellectual disability.
Social Support to Reduce Uncertainty in Childhood Cancer in South Texas: A Case Study
Authors: Gunter M. Danielle , Duke Gloria
Published: April 2019

Purpose: To determine if supportive measures are found to be most helpful and feasible for families of children with cancer by obtaining in-depth perspectives of uncertainty and adaptation. Hypotheses: Traditional methods of psychosocial support do not meet the needs of parents and families dealing with cancer. Participants prefer more informal meetings and gatherings that are more social in nature. Method: A descriptive single embedded case study was used to study uncertainty and social support for families with children treated at a pediatric hematology/oncology department in south Texas. The sample included members of the health care team in a pediatric cancer/bone marrow transplant unit and parents of children diagnosed with cancer. Data were gathered through audio-recorded interviews. Data Analysis: Data were transcribed and analyzed through thematic content and pattern matching using computer software. Results: Four themes were identified: meaning of uncertainty in parents and members of the health care team, facilitators of parental adaptation, education and psychosocial support, and patient/family obstacles hindering successful adaptation. These demonstrated aspects of care interventions, clarifying what uncertainty means and how it affects the ability of parents to adapt to life with pediatric cancer, perceptions regarding the helpfulness of education and support interventions or lack thereof, and what internal and external obstacles hinder the family’s adaptation. Implications for Practice: Improving patient education through individualization and delivery time frame as well as providing opportunities for informal sharing and community building are key to reducing uncertainty and improving family adaptation to life with childhood cancer.
A Scoping Review of Contemporary Social Work Practice With Veterans
Authors: Bloeser Katharine J. , Bausman Margaret
Published: April 2019

Objective:

Social work served U.S. veterans and service members throughout its history as a profession. Social workers continue to support the physical and psychological health of veterans in both the public and private sectors. This scoping review sought to characterize the social work research on practice with veterans.

Methods:

Both academic sources and gray literature were reviewed.

Results:

A total of 536 items were reviewed to determine methodology, sample, social work’s role in the research, content area, and publication type. The largest category of research methodology was descriptive studies (50%). An additional 9% of studies were experimental in nature. Most of the peer-reviewed empirical literature came from U.S. Department of Veterans Affairs settings. A slight majority, 58% of peer-reviewed articles, identified a social worker as an author. The most frequently used key words in social work journals reflected mental health (33%), most focused on post-traumatic stress disorder (41%).

Conclusions:

Characterizing the social work literature continues to be a challenge. Social workers practice in a variety of arenas with veterans and should be afforded opportunities to engage in research especially endeavors that focus on marginalized populations of veterans.
A Qualitative Analysis of Contextual Factors Relevant to Suspected Late-Onset ADHD
Authors: Mitchell John T. , Sibley Margaret H. , Hinshaw Stephen P. , Kennedy Traci M. , Chronis-Tuscano Andrea , Arnold L. Eugene , Swanson James M. , Hechtman Lily T. , Molina Brooke S. G. , Caye Arthur , Tamm Leanne , Owens Elizabeth B. , Roy Arunima , Weisner Thomas S. , Murray Desiree W. , Jensen Peter S.
Published: April 2019

Objective: Recent studies suggest attention-deficit/hyperactivity disorder (ADHD) may emerge post-childhood. We integrate qualitative methods to systematically characterize contextual factors that may (a) delay identification of ADHD in childhood and (b) inform why ADHD symptoms emerge post-childhood. Method: Suspected late-onset ADHD cases from the local normative comparison group of the Multimodal Treatment Study of ADHD completed a qualitative interview (14 young adults and 7 caregivers). Interviews were qualitatively analyzed. Results: We identified five themes. Three themes may attenuate or delay identification of childhood ADHD: external factors (e.g., supportive adults), internal factors (e.g., strong intellectual functioning), and other factors (e.g., dismissive attitudes toward ADHD). Two themes may accompany an increase in ADHD symptoms post-childhood: external factors (e.g., increased external demands) and internal factors (e.g., perceived stress). Conclusion: Clinicians should probe these factors in suspected late-onset cases to address (a) whether, how, and to what extent ADHD was attenuated in childhood and (b) why symptoms emerge post-childhood.
‘There’s nothing wrong with the picture’: representations of diversity through cultural branding
Authors: Khamis Susie
Published: April 2019

To attract consumers ever more distracted and dispersed, and achieve cultural resonance, brand advertisers increasingly speak to discourses of diversity. These representations are often contentious, particularly when they refer to certain aspects of contemporary identity politics. As these controversies play out on social media such as Facebook, they reveal key insights into branding today: the discursive volatility that shadows representations of diversity, asymmetries of communicative power between brands and consumers in online discussions and the extent to which representations of diversity are rendered more or less divisive depending on their proximity to already existing anxieties and/or resistance. This article contextualises this interplay through three Australian brand campaigns from late 2015 to early 2016 and shows how social media further problematise what was an already dynamic, tense and dialectical relationship between consumers and brands.
Reporting terrorism in Muslim Asia: the Peshawar massacre
Authors: Ali Saira , Khattab Umi
Published: April 2019

Terrorism is not a threat to Western civilisation alone. Drawing on interdisciplinary perspectives and using Pakistan as a case, where the war-on-terror is being fought ceaselessly, analysis was carried out on Pakistan’s mainstream media coverage of, and citizen media reactions to, the December 2014 Peshawar school terror attack where 144 people, mostly children, were killed. Discourse analysis of media texts reflects that Pakistan’s mainstream media was spineless in openly fighting terrorism as it focused on the victims of the attack while camouflaging stories with shahadat-ism (martyrdom). On the other hand, citizen media condemned the Taliban perpetrators and hotly debated the perils of Taliban-ism and Islamo-fascism. Attempts to fight militant Islamism and mitigate terrorism were evident in an emerging citizen sphere where the issue took on new meanings, unlike the West. It is important for journalists to be culturally alert in reporting ‘terrorism’ in the light of the intersections of Islamism.
Relapsing lumbosacral myeloradiculitis: An unusual presentation of MOG antibody disease
Authors: Sundaram Soumya , Nair Sruthi S , Jaganmohan Deepasree , Unnikrishnan Gopikrishnan , Nair Muralidharan
Published: April 2019

Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) seropositivity is being increasingly reported in diverse demyelinating syndromes with monophasic and relapsing presentations. Conus myelitis is described as a typical feature of MOG-Ab seropositivity. However, the association with lumbosacral radiculitis in this disease is not well-recognized. Here, we report a patient with relapsing MOG-Ab disease who presented clinically and radiologically with a relapsing lumbosacral myeloradiculopathy. This presentation raises the diagnostic possibilities of chronic infections, sarcoidosis, and neoplastic infiltration. This case illustrates the need to consider MOG-Ab disease as one of the differential diagnosis for a non-compressive lumbosacral myeloradiculopathy.
User involvement in social work innovation: A systematic and narrative review
Authors: Müller Maja , Pihl-Thingvad Signe
Published: April 2019

This article focuses on user involvement in social work innovations in the public sector and provides an overview of how public innovation via user involvement in social work has been studied to date. Through analyses based on a systematic review combined with a narrative review of the identified literature, we offer a typology of social work innovations. The article concludes by discussing possibilities and barriers inherent in user involvement in social work and suggesting topics for future research.

Findings

Through a systematic review we identify the relevant literature describing different kinds of user involvement in social work innovation. In the narrative review, we analyze the literature and identify three types of innovation: user-centered innovation, co-produced innovation, and citizen-driven innovation. With empirical examples we illustrate the different types of innovation and the citizen’s role in the different innovation processes.

Application

The typology provides an analytic tool to differentiate types of innovation and user involvement, but it may also function as inspiration to practitioners to reflect more about the roles of users and frontline workers and to be more aware of existing barriers when designing new social initiatives in the public sector.
Surgical Treatment of Severe Hallux Abductovalgus With Dislocation of the First Metatarsophalangeal Joint: A Case Presentation and Surgical Technique
Authors: Tootle Kevin , Hollnagel JennaLou , Kinmon Kyle
Published: April 2019

Severe hallux abductovalgus deformity with dislocation and contracture at the first metatarsophalangeal joint is difficult to manage, especially in the presence of concomitant, long-standing rheumatoid arthritis. This article highlights a novel surgical technique that may be used to successfully address this challenging condition while minimizing the likelihood of complications.

Levels of Evidence: Level IV
Effectiveness and safety of physician–pharmacist collaborative care for rheumatoid arthritis patients: The Changi General Hospital’s experience
Authors: Lee Elena Meishan , Vasudevan Archana Ramaswamy , Wee Ian Yew Jin , Yeow Serene Dingju , Dinh Vinh Thuc Uyen
Published: April 2019

Background:

Increasing demand for follow-up of rheumatoid arthritis has encouraged pharmacists to collaborate with physicians to assist with patient care.

Objective:

The aim of this study was to assess the effectiveness and safety of the collaborative care model in a rheumatoid arthritis clinic.

Methods:

We performed a retrospective review of patient case notes and medication records from March 2013 to February 2016. The effectiveness and safety of collaborative care was examined in pre-implementation (standard care) versus post-implementation (collaborative care) cohorts. All patients were assessed for 12 months. Effectiveness of clinic was measured using the percentage of patients that achieved optimal doses of non-biologic disease-modifying anti-rheumatic drugs (nb-DMARDs). Clinic safety performance was evaluated based on the percentage of patients in each cohort that achieved compliance to in-house hospital guidelines on nb-DMARD monitoring. Other clinic safety factors monitored included the incidence and characteristics of nb-DMARD-associated adverse drug events.

Results:

Thirty-eight patients who had received standard care and collaborative care were reviewed. More patients receiving collaborative care achieved nb-DMARD dose optimization within a year of initiation of therapy (68.4% vs 39.5%; p-value < 0.05). Compliance to safety recommendations from hospital guidelines on nb-DMARD monitoring was significantly higher in the collaborative care group (70.6% vs 44.1%; p-value < 0.05). Collaborative care resulted in a higher incidence of nb-DMARD-associated adverse drug events being detected (26.3% vs 18.4%; p-value < 0.05). The most common adverse drug events were gastrointestinal (29.4%), dermatological (17.6%), and hematologic (17.6%), the majority being mild in severity.

Conclusion:

Collaborative rheumatoid arthritis care contributed to improvements in nb-DMARD dose optimization, compliance to hospital guidelines on monitoring, and the detection of nb-DMARD-related adverse drug events.
A probable case of catastrophic antiphospholipid syndrome: Should high-dose steroids be given in the setting of polymicrobial sepsis?
Authors: Tucker Shanna Ariane , Choi Justin , Khullar Dhruv
Published: April 2019

In this clinical vignette, we present a case of a 59-year-old woman with catastrophic antiphospholipid syndrome likely triggered by polymicrobial sepsis. The diagnostic criteria and clinical manifestations of catastrophic antiphospholipid syndrome are reviewed. We also compare diagnostic criteria and clinical manifestations with other clinical entities in the differential diagnosis, including thrombotic thrombocytopenic purpura–hemolytic-uremic syndrome, disseminated intravascular coagulation, sepsis, and inflammatory bowel disease. Catastrophic antiphospholipid syndrome is a rare, but lethal condition, and treatment recommendations are based on expert consensus and analyses of the international Catastrophic Antiphospholipid Syndrome Registry. Current management guidelines recommend triple therapy, with anticoagulation, glucocorticoids, and plasma exchange or intravenous immunoglobulins. This case brings this rare clinical entity to the attention of clinicians and emphasizes the need for more research to understand the best management. It also raises the question of whether high-dose steroids should be continued for treatment of catastrophic antiphospholipid syndrome in the setting of a severe sepsis.
Wolffian tumor (female adnexal tumor of Wolffian origin) presenting as a pelvic side wall mass: Report of a case
Authors: Rosen Claire , Reardon Emily , Shyu Susan , Terhune Julia , Saats Paul , Ioffe Olga , Kavic Stephen
Published: April 2019

The Wolffian tumor, previously identified as “female adnexal tumor of probable Wolffian origin,” is a rare tumor first described in 1973. The tumor is usually benign and is characterized by diffuse and tubular patterns, accentuated by reticulum and periodic acid–Schiff stains. Immunohistochemistry is used to further identify and classify these tumors, which are positive for cytokeratins, vimentin, inhibin, calretinin, and CD10 and negative for cytokeratin 20, epithelial membrane antigen, estrogen receptor, progesterone receptor, 34betaE12, and glutathione S-transferase. We report the case of a 47-year-old female with Wolffian tumor arising from the pelvic sidewall, separate from all reproductive organs. This is the first reported case of Wolffian tumor in this location.
Expectations Regarding Workplace Health Coaching: A Qualitative Study With Stakeholders
Authors: Dejonghe Lea A. L. , Biallas Bianca , McKee Lorna , Rudolf Kevin , Froböse Ingo , Schaller Andrea
Published: April 2019

The integration of health coaching in workplace interventions has increased over the past several years. However, the tasks and the qualifications of the coaches have not been clearly defined. The objective of this qualitative study was to assess workplace stakeholders’ expectations regarding a health coach. Systematic field notes of 11 meetings and 14 semi-structured interviews with stakeholders of a workplace intervention, including employees, company doctors, and representatives of health insurances, were analyzed according to the structured content analysis. Stakeholders reported that the main aspect of a health coach’s work should be the motivation of clients (workers) to achieve their internally developed goals. Regarding the coach’s competencies, personal, methodological, and social skills were desired. They also expected that the health coach use a range of different approaches to develop contacts and, in terms of content, focus on physical activity. These findings provide a step toward establishing criteria for professional health coaching and an evidence-based curriculum for coach training.
On Fights and Break-ups Between Couples
Authors: Mukherjee Conan
Published: April 2019

We present a new economic model of romantic relationships by theorizing breakup as an intertemporal process, unlike the traditional static approach in terms of outside options. Contrary to Becker (2009), our approach underlines the possibility of divorces even when outside options are less than gains from marriage. This allows us to provide a rationale for the anti-Benthamite legally mandated separation periods during divorce proceedings, within the Benthamite paradigm. Further, we provide a rational explanation for the curious tendency of partners of being in long periods of acrimonious fight before making up by undertaking actions that they could have undertaken right at the start of their fight. Finally, in line with a UK government report (1989), our paper posits that unions without legal recognition are likely to be more unstable in comparison to legally recognized marriages.

JEL codes: K36, C72,D90
Severe and Progressive Cellulitis Caused by Serratia marcescens Following a Dog Scratch
Authors: Pithadia Deeti J. , Weathers Erena N. , Colombo Rhonda E. , Baer Stephanie L.
Published: April 2019

Soft tissue infections occur in over 30% of patients with chemotherapy-induced neutropenia. Gram-positive bacterial infections predominate early in neutropenia, and likelihood of infection by resistant bacteria and fungi increases with prolonged neutropenia. Prior infections and exposures influence the risk of rare pathogens. A 55-year-old woman with chemotherapy-induced neutropenia was scratched on her forearm by a dog. She cleaned the wound with isopropanol and was treated empirically with amoxicillin-clavulanate. Over the next 4 days, she developed fever along with erythema, edema, and mild tenderness of the forearm without purulence or crepitus. She was hospitalized and received empiric treatment with intravenous vancomycin, piperacillin-tazobactam, tobramycin, and voriconazole. Despite therapy, her fevers persisted and the cellulitis progressed for over a week. After 10 days of hospitalization, her neutrophil count began to recover and a bulla developed at the wound site. Culture of the bullous fluid grew Serratia marcescens, and antibiotics were switched to cefepime based on susceptibility. She defervesced and showed substantial improvement of cellulitis within 48 hours and was discharged on oral ciprofloxacin. Serratia marcescens skin infections are rare, and this may be the first report of Serratia cellulitis associated with trauma from dog contact. This case highlights the need to consider unusual pathogens based on exposure history and immune status and to obtain cultures from fluid collections or tissue in cases of treatment-resistant soft tissue infections.
Factors Affecting Uptake of PMTCT Services, Lodwar County Referral Hospital, Turkana County, Kenya, 2015 to 2016
Authors: Ongaki Dominic , Obonyo Mark , Nyanga Nancy , Ransom James
Published: April 2019

Kenya is one of 22 countries globally that account for 90% of all HIV-positive pregnant women. This study aimed to determine factors affecting uptake of prevention of mother-to-child transmission (PMTCT) services among HIV-positive pregnant women at Lodwar County Referral Hospital in Turkana County, an arid area in northern Kenya. We conducted a retrospective review of HIV-positive pregnant women attending antenatal care (ANC) and accessing PMTCT services between January 2015 and December 2016. We used infant prophylaxis as a proxy measure of PMTCT uptake, and records across programs were linked using the mother’s unique medical identification number. A total of 230 participants were included in the study. Bivariate analyses showed maternal prophylaxis (odds ratio [OR] = 45.71; 95% confidence interval [CI]: 10.35-202.00), residing in urban center (OR = 2.64, 95% CI: 1.45-4.81), and having at least one ANC visit (OR = 2.78; 95% CI: 1.25-6.17) were significantly associated with uptake of PMTCT.
Genomic Balance and Speciation
Authors: Birchler James A , Veitia Reiner A
Published: April 2019

The role of genomic balance in accumulating species hybrid incompatibilities is discussed. Aneuploidy has been shown to produce more global modulations than polyploidy with the responsible genes being transcription factors and signaling components involved in molecular complexes, illustrating a stoichiometric component to gene expression. Genomic imbalance is usually detrimental to the organism and in many cases results in lethality. Here, it is proposed that once gene flow is prevented between or within populations by various speciation initiating processes, the stoichiometric relationship of members of macromolecular complexes can change via compensatory drift with the eventual result of newly established functional balances. However, when these new relationships are brought together in interspecific hybrids, detrimental consequences will occur. We suggest that these detrimental interactions contribute to hybrid incompatibilities.
Volatile organic compound profiles in outlet air from extracorporeal life-support devices differ from breath profiles in critically ill patients
Authors: Leopold Jan Hendrik , Philipp Alois , Bein Thomas , Redel Andreas , Gruber Michael , Schultz Marcus J. , Abu-Hanna Ameen , Brinkman Paul , Janssen Hans-Gerd , Bos Lieuwe D.J.
Published: April 2019

Introduction

It is highly uncertain whether volatile organic compounds (VOCs) in exhaled breath of critically ill intensive care unit patients are formed in the lung locally, in the air compartment or lung tissue, or elsewhere in the body and transported to the lungviathe bloodstream. We compared VOC mixtures in exhaled breath and in air coming from extracorporeal support devices in critically ill patients to address this issue.

Methods

First, we investigated whether it was safe to connect an electronic nose (eNose) or a gas sampling pump to extracorporeal support membranes. Then, breath and air from extracorporeal support devices were collected simultaneously for continuous monitoring of VOC mixtures using an eNose. In addition, samples for gas chromatography/mass spectrometry (GC-MS) analysis were taken daily at the two measurement sites.

Results

10 critically ill patients were monitored for a median (interquartile range) duration of 73 (72–113) h; in total, we had 887 h of air sampling. The eNose signals of breath correlated moderately with signals of air from the extracorporeal support devices (R2=0.25–0.44). After GC-MS analysis, 96 VOCs were found both in breath and air from the extracorporeal support devices; of these, 29 (30%) showed a significant correlation (p<0.05) between the two measurement sites, of which 17 were identified. VOCs that did not correlate were found in a higher concentration in breath than in air from the extracorporeal support devices.

Conclusion

This study suggests VOC analysis in the extracorporeal circulation is safe, and that VOCs of nonpulmonary origin can be measured in the breath and in the extracorporeal circulation of critically ill patients. For VOCs that did not correlate between the two measurement sites, the breath concentration was higher, suggesting pulmonary production of these molecules in a highly selected population of patients that received extracorporeal support.
The characterisation of interstitial lung disease multidisciplinary team meetings: a global study
Authors: Richeldi Luca , Launders Naomi , Martinez Fernando , Walsh Simon L.F. , Myers Jeffrey , Wang Bonnie , Jones Mark , Chisholm Alison , Flaherty Kevin R.
Published: April 2019

Multidisciplinary team (MDT) diagnosis of interstitial lung disease (ILD) has been proposed as a gold standard, but there are no formal recommendations for MDT process or composition and limited knowledge regarding prevalence in routine practice.

We performed a systematic evaluation of ILD diagnostic practice across a range of healthcare settings around the world. Electronic questionnaires were distributed across all global regionsviasociety and collaborators networks.

Responses from 457 unique centres across 64 countries were included in the analysis. Of the 350 (76.6%) centres holding formal meetings, the majority held face-to-face MDT meetings (80%), for a minimum of 30 min (93%), and discussed diagnosis (96.9%) and patient management (94.9%) at the meetings. Compared with non-academic and academic non-ILD centres, ILD academic centres reported a higher ILD caseload, held more formal MDT meetings, and were more likely to include histopathology and rheumatology specialists in their diagnostic team. Of the centres holding MDT meetings, 5.5% routinely discussed all new cases at such meetings.

An MDT approach to ILD diagnosis is consistently interpreted and widely implemented across a range of routine care settings around the world. This observation will inform future ILD diagnostic agreement studies and diagnostic pathway recommendations.
Service System Design Under Information Uncertainty: Insights from an M/G/1 Model
Authors: Ma Juan , Leung Ying Tat , Kamath Manjunath
Published: April 2019

Note. The minimum [Formula: see text] value is independent of parameter [Formula: see text].
Neuroprotective Effects of Low Dose Anandamide in Pentylenetetrazole-Induced Kindling in Rats
Authors: Abdel-Salam Omar M. E. , Sleem Amany A. , Mohamed Sayed Marawan Abd El-Baset , Youness Eman R. , Shaffie Nermeen
Published: March 2019

Anandamide (N-arachidonoylethanolamine) is an endogenous cannabinoid receptor CB1 ligand that exhibits neuroprotective effects in the brain. In this study, the effect of exogenously given anandamide on pentylenetetrazole (PTZ)-induced chemical kindling oxidative stress and brain damage in rats was studied. Rats were intraperitoneally (i.p.) injected with 35 mg/kg PTZ once every 48 hours for 12 times to induce seizures. Anandamide was i.p. given. 30 min prior to PTZ injection at 100 or 200 mg/kg. Injections of PTZ induced significant increase in brain lipid peroxidation (malondialdehyde: MDA), and nitric oxide associated with marked decrease in brain reduced glutathione (GSH). There were also significant decrements in acetylcholinesterase (AChE) concentration, butyrylcholinesterase (BChE) and paraoxonase-1 (PON-1) activities in brain tissue of PTZ injected rats. Meanwhile, there was no significant effect for PTZ on the concentration of brain neutrophil elastase. Anandamide administered at 100 and 200 mg/kg significantly decreased MDA and increased GSH contents and at 200 mg/kg significantly decreased nitric oxide in brain of PTZ-treated rats. The drug also caused significant increments in AChE concentration and PON-1 activity but had no significant effect on BChE or neutrophil elastase in rats treated with PTZ. Anandamide given at the dose of 200mg/kg significantly decreased the mean seizure scores over the study period by 22.3% and the frequency of myoclonic jerks and rearing (stage 3) by 56.7% compared with the vehicle-treated group. Anandamide given at 100 and 200 mg/kg completely inhibited the development of generalized tonic-clonic seizures (stage 5). It is concluded that in the PTZ-induced seizures, the cannabinoid receptor CB1 agonist anandamide decreases brain oxidative stress, neuronal injury, and exerts an antiepileptic activity.
Ultrasound Guided Transvaginal Aspiration and Mechanical Destruction with Local Methotrexate Injection is a Promising Primary Treatment Approach for Caesarean Scar Ectopic Pregnancy (CSEP)
Authors: Al-Bassam Maha , A. Begam Muzibunnisa , Ghazal Aswad Saad , Al-Jefout Moamar
Published: March 2019

Caesarean scar ectopic pregnancy (CSEP) is considered an extremely rare entity, but life threatening, however, with the increase in C/S rates it is becoming a more common finding. To explore the possibility of utilizing ultrasound guided transvaginal aspiration and injection of 50 mg methotrexate followed by mechanical disruption as a promising primary treatment approach for CSEP. In a series of 11 cases at Tawam Hospital (UAE) diagnosed with CSEP, an ultrasound guided transvaginal aspiration of the amniotic fluid and gestational tissue, followed by injection of 50 mg Methotrexate into the remaining chorionic sac and then disruption of the sac with the needle. B-hCG level were measured on: day of procedure, day 1 or 2 after the procedure and then weekly. Final resolution was considered when B-hCG returned to < 5mIU/mL. All cases presented and diagnosed in the 1st trimester, mean gestational age at diagnosis was 6.6 weeks (range 5-10). The presenting symptoms were mainly lower abdominal pain and vaginal bleeding in 8/11 patients (73%) while three women were asymptomatic (27%) and CSEP was diagnosed incidentally at viability scan. Nine out of eleven cases showed cardiac activity (82%). B-hCG day 1 or 2 post procedure dropped in all cases but by variable levels, ranging from 1.1% to 74.7%, while the drop during days 7-10, was more significant and reassuring; ranged from 45.7% to 92.5 %. No complications were reported with 100% success rate. Ultrasound guided transvaginal aspiration and injection of 50 mg Methotrexate followed by needle mechanical disruption is a promising primary treatment approach for CSEP. However, more studies with more numbers are needed to further support this treatment method.
Ethanol Extraction of Hoya Carnosa Leaves Improved Stroma of Middle Ear Epithelium Infected by Pseudomonas Aeruginosa
Authors: Lely Rahayu Made , Bakta I. Made , Suardana Wayan , Mantik Astawa Nyoman , Arijana I. G. K. , Tunas I. Ketut
Published: March 2019

Hoya carnosa leaves or tebel-tebel leaves are known by the Balinese people in the countryside to treat middle ear infections in the medical language, otitis media or “curek” in the Balinese language. The study is true experimental randomized posttest-only control group design to evaluate the impact of ethanol extract sample as antibacterial. As antibacterial, the extract has an impact on the thickness of stroma middle ear epithelium with otitis media due to Pseudomonas Aeruginosa. The result showed average mean thickness stroma in the treatment group lower than controls.
Prevalence of Iron Deficiency Anemia in Children with Severe Early Childhood Caries
Authors: Gurunathan Deepa , Swathi A. , Kumar M. Senthil
Published: March 2019

Dental caries is an international public health challenge, especially amongst young children. Early childhood caries (ECC) is a serious public health problem in both developing and industrialised countries. ECC can begin early in life, progresses rapidly in those who are at high risk, and often goes untreated. Its consequences can affect the immediate and long-term quality of life of the child's family and can have significant social and economic consequences beyond the immediate family as well. ECC can be a particularly virulent form of caries, beginning soon after dental eruption, developing on smooth surfaces, progressing rapidly, and having a lasting detrimental impact on the dentition. Children experiencing caries as infants or toddlers have a much greater probability of subsequent caries in both the primary and permanent dentitions. Iron deficiency being the most common nutritional deficiency in childhood is often seen associated with severe caries destruction. Lack of iron is one of the most common dietary deficiency observed worldwide particularly in developing countries. In some instances this deficiency is alleviated by supplementary foods with added iron salts. In many countries where the iron deficiency is apparent, the prevalence of dental caries is high.
Evaluation of the Effect of Ceftriaxone on Lipid Peroxidation and Antioxidant Levels in Mice
Authors: Dayana Kunjumon , R. Manasa Megaravalli
Published: March 2019

Lipid peroxidation generates free radicals. These free radicals are scavenged by antioxidant defense mechanisms. An imbalance between the free radicals generation and antioxidant mechanisms can result in tissue damage. Several drugs are known to induce lipid peroxidation which can be responsible for their toxic potential. Hence the current study was planned to assess the effect of ceftriaxone, a third generation cephalosporin, on lipid peroxidation and levels of antioxidants in albino mice. Ceftriaxone was injected intraperitoneally at two doses - 100 mg/kg body weight; 200 mg/kg body weight – to albino mice. TBARS (Thiobarbituric acid reactive substance) levels in plasma, erythrocytes as well as tissue and the antioxidant enzymes activities were estimated. The data from ceftriaxone groups was analyzed with control group using ANOVA and Dunnett’s test as post hoc. Ceftriaxone (100 mg/kg body weight) did not alter TBARS levels compared to control. Ceftriaxone - 200 mg/kg body weight, has significantly increased TBARS levels. The activities of antioxidant enzymes were significantly decreased by ceftriaxone at these doses. The present study demonstrates that ceftriaxone has the potential for lipid peroxidation induction and reduction in the antioxidant enzymes acitivities in albino mice.
Effect of Physiohterapy on Fatigue and Psychological Stress in Cancer Patients During the Course of Chemotherapy
Authors: Surve Deepika , Patil Poonam
Published: March 2019

To study the Effect of Physiotherapy on Fatigue Psychological Stress in Cancer Patients during the Course of Chemotherapy. Subjects fulfilling the inclusion and exclusion criteria were included. Prior consent was taken and assessment of their fatigue, stress level and pain was done using the brief fatigue inventory, Cohen perceived stress scale and brief pain inventory. Based upon the findings, a tailor made protocol was given to the patients, wherein 3 sets of each exercises 5times a week for a month’s duration had to be followed. The exercises were altered as per the patients’ requirements and capability. Each session conducted was of 35-45min duration which began with Warm-up Exercises including Stretching for 10min, followed by 6 Minute Walk for 6minutes, Harvard Step for 3 minutes and the session was concluded with a Relaxation period of 20minutes. For relief of pain, TENS was given during the Relaxation period. After the 6minute walk, patient’s exertion was checked by the Borg Scale. The exercises were prescribed according to FITTs principle. Statistical analysis was done using unpaired t test. In this study, pre-intervention Brief Pain Inventory was 71.90±12.33 and post-intervention was 61.03±11.47. In Brief Pain Inventory statistically extremely significant difference and decrease in pain post intervention with (p< 0.0001) with t= 7.028. Pre-intervention Brief Fatigue Inventory was 53.83±11.03 and post-intervention was 41.78±13. In Brief Fatigue Inventory statistically extremely significant difference and decrease in fatigue post intervention with (p=<0.0001) with t=9.57. Stress assessment by Cohen Perceived Stress Scale was 21.71±2.27pre treatment and 19.86±2.23 post treatment. In Cohen Perceived Stress Scale, statistically extremely significant difference and decrease in stress level after treatment with (p=<0.0007) with t=4.998. Pre-treatment Rate of perceived exertion was 12.49±3.23 and post treatment was 10.34±2.94.In Rate of Perceived Exertion statistically significant difference and decrease in exertion level post treatment with (p=<0.0007) with t=8.945. Thus the above concludes that physiotherapy had significant improvement clinically and statistically on fatigue and stress in cancer patients undergoing chemotherapy. So this study accepts the alternate hypothesis.
Correlation Between Hyoid Bone and Pharyngeal Airway Space in Differing Vertical Skeletal Dysplasia
Authors: Philip Jose Nidhin , Sehgal Arjun , Shetty Siddarth , Mary Lida , M. V Ashith
Published: March 2019

The hyoid and the tongue are intimately associated structures. The hyoid bone forms the anterior limit of the pharyngeal airway space. Thus, the position of hyoid bone and position of tongue can be considered determinants of pharyngeal airway space. Sixty samples, divided in three groups based on their growth pattern were studied and McNamara’s airway analysis and hyoid triangle analysis were used to evaluate the pharyngeal airway space and hyoid bone position respectively. A negative correlation was found in hyperdivergent group between the upper and lower airway space and the FMA. A positive correlation was seen in hyperdivergent group between the upper and lower airway space and the anteroposterior position of the hyoid bone.
Exploring volunteering in a food bank and psychological wellbeing
Authors: Armour Simon , Barton Gil
Published: March 2019

In the context of UK austerity policies, asset-based approaches to health offer an attractive proposition to policy makers, promising to reduce demand while improving psychological wellbeing. However, critics suggest that they may inadvertently contribute to increasing health inequalities by implicitly endorsing neoliberal discourses, extolling independence and ascribing individual blame for poverty, while denigrating state welfare support. Food banks, as voluntary sector welfare providers, as places of ambiguous and contested meanings, present a salient setting in which to explore how experiences of volunteering may affect psychological wellbeing. This article provides deep insight into the experiences of four women with direct experience of the welfare system, highlighting the value of social justice-oriented narratives, as well as shared purpose and social connection, in relation to their psychological wellbeing. It highlights the significance of the ethos of such settings, with implications for public health policy, voluntary organisations and those resisting neoliberal policies and discourses.