bluuebunny/crossref_metadata_2025 huggingface dataset:
Ruptured Abdominal Aortic Aneurysm—Outcome in a Community Teaching Hospital Intensive Care Unit
Authors: Ho K. , Burgess K. R. , Braude S.
Published: January 2019

Ruptured abdominal aortic aneurysm (RAAA) is a surgical emergency associated with a high mortality often requiring postoperative intensive care. Our objectives were to assess the outcome of RAAA management in a non-tertiary community hospital intensive care unit (ICU) and to compare this with historical data from tertiary hospitals. We also sought to identify variables related to outcome and evaluate the potential of an organ failure score to identify patients at increased risk of death.

The study was a retrospective chart review of patients with RAAA over 11 years (1986–1996 inclusive) at Manly District Hospital, a 210 bed community teaching hospital with eight intensive care beds. Forty patients were identified in the study period as having been admitted to ICU after RAAA surgery. There was an overall hospital mortality rate of 47.5% and intensive care mortality rate of 42.5% for successfully operated RAAA. Five variables were significantly different between survivors and non-survivors. These were age, total amount of blood products required, duration of operation, development of hypotension (systolic blood pressure <90 mmHg) in ICU postoperatively, and APACHE II score at Day 1 ICU. A trend was also found between mortality rate and the number of failed systems after 48 hours intensive care stay. Mortality for a patient with zero failed systems was 38%, one failed system 42%, two 58% and three 67%.

Based on these results, management of RAAA in a non-tertiary setting appears appropriate with postoperative care occurring in an ICU where there is adequate equipment and medical and nursing staff experienced in the care of complex critical illness.
Remifentanil in Emergency Caesarean Section in Pre-Eclampsia Complicated by Thrombocytopenia and Abnormal Liver Function
Authors: Johannsen E. K. , Munro A. J.
Published: January 2019

We describe the use of remifentanil in a woman with severe pre-eclampsia who presented for emergency caesarean section. Remifentanil was effective in obtunding the hypertensive response to laryngoscopy and intubation. Previous studies have found no significant adverse effects of remifentanil on the neonate. With its short duration of action, the use of this new opioid has several potential advantages in the above setting. Further studies are required to explore the use of remifentanil as an adjunct to obstetric general anaesthesia.
Validation of the PBIS-ACT Full: An Updated Measure of Staff Commitment to Implement SWPBIS
Authors: Filter Kevin J. , Brown Jeffrey
Published: January 2019

School-wide positive behavior interventions and supports (SWPBIS) relies on the implementation efforts of frontline service providers such as teachers, administrators, and staff. The full version of the positive behavior interventions and supports–action and commitment tool (PBIS-ACT Full) measures the individual implementer variable of commitment to implement SWPBIS. The purpose of the present study was to evaluate the validity and reliability of the PBIS-ACT Full in relation to a previous brief version of the measure. Results indicated that the factor structure closely mirrors the original theoretical design of the PBIS-ACT Full. The measure demonstrated strong internal consistency and was more sensitive to differences in commitment on the high end of the scale when compared with scores from the previous version. Based on the present results, the PBIS-ACT Full demonstrates strong potential to facilitate research and practice relating to staff commitment to implement SWPBIS.
Socio-material directions for developing empirical research on children’s e-reading: A systematic review and thematic synthesis of the literature across disciplines
Authors: Kucirkova Natalia
Published: January 2019

This review integrates literature on cross-disciplinary quantitative and qualitative studies related to children’s reading on screen published between January 2016 and September 2017, with a focus on the researchers’ epistemological perspectives on knowledge and learning. Johri’s (2011) framework of socio-material assemblages, which synthesises epistemological dualities, is used to examine the ways in which researchers conceptualise children’s learning with digital books. The review shows that extant empirical studies map directly onto the social part of Johri’s framework (examination of child and adult variables and behavioural characteristics) and onto the material aspects of children’s digital books (examination of books’ contents and features). Only theoretical studies pay equal attention to social and material aspects in their conceptualisation of children’s reading on screen. Overall, it is recommended that in addition to cross-disciplinary and multiple methods, researchers consider socio-material assemblages to advance the field. A socio-material perspective could address time and space shifts in children’s reading on screen and might provide a springboard for future epistemological developments within the field.
Investigation of the mechanical response of a deep-water drilling riser to ocean currents and waves
Authors: Tang Liping , Huang Zemin , Zhu Xiaohua , Zhou Yunlai , Li Bo
Published: January 2019

The drilling riser is an important piece of equipment used to link the subsea wellhead with the drilling platform. Its operating environment is extremely complex because of the effects of ocean currents, which can cause riser overload, fatigue, leading to economic loss. Therefore, in order to improve design and prevent premature failure of drilling riser, it is important to research the mechanical response to ocean currents. The effects of tension ratio and platform deflection on the lateral displacement, bending moment, and the stress of the drilling riser are analyzed, under actual working conditions and shear flow. The results show that the bending moment and lateral displacement of the drilling riser decrease significantly and the stress of the riser increases with increasing tension ratio. There is an increase in the lateral displacement of the drilling riser and the bending moment at the lower end of the drilling riser, with an increase in the initial offset of the offshore drilling platform. However, the initial offset of the offshore drilling platform has little effect on the stress of the riser. Under shear flow conditions, the lateral displacement, bending moment, and stress initially increase, then decrease, and finally stabilize. These results can be used to improve the design of drilling riser.
Dynamic axial contact stiffness analysis of position preloaded ball screw mechanism
Authors: Liu Jun , Ou Yi
Published: January 2019

This article establishes an axial contact stiffness model of position preloaded ball screw mechanism based on Hertz contact theory. The analysis of dynamic axial contact stiffness is one of the foundations of the research on the dynamic characteristic of the ball screw feed drive system. The model takes into account the coupling relationship between the contact angle and the normal contact force, as well as the coupling relationship between the elastic deformation and the contact deformation coefficient. The static and dynamic axial contact stiffness characteristics of the preloaded ball screw mechanism are studied. The numerical analysis result shows that the static contact stiffness of the preloaded ball screw mechanism increases with the increase in the preload and decreases with the increase in the axial load. The dynamic contact stiffness of the preloaded ball screw mechanism increases with the increase in the screw’s rotational speed. The variation range of dynamic contact stiffness increases with the increase in axial load under the same preload. And the variation range of dynamic contact stiffness decreases with the increase in preload under the same axial load. The axial contact stiffness model established in this article can be used to analyze either static or dynamic contact stiffness of position preloaded ball screw mechanism.
Structural safety and fatigue reliability assessments of a metro-train bolster
Authors: Hu Jiexin , Xie Liyang , Sun Weiguang , Li Xinkang , Lv Xiao , Meng Weiying
Published: January 2019

This article presents an economical and efficient way to assess the structural safety and fatigue reliability of the bolster, a key structure for the metro-train. First, its finite element model was validated based on the comparison between numerical results and experimental data of stresses and displacements recorded during a static test. Then, the fatigue life of the bolster under loading scheme was predicted using Gerber diagram, in which the validated finite element model was applied to determine the weak points, and its structural safety was also evaluated by a full-scale fatigue test and non-destructive test method. Finally, the metro-train bolster was modeled as a series system of weak points, and a new fatigue reliability model for mechanical component derived based on stress-life interference model was used to assess its fatigue reliability under the application of the design passenger number spectra. The results show that not only does this bolster satisfy the structural safety requirement during its service life, but also its fatigue reliability is more than 99.993% after 30-year service under normal atmospheric conditions.
Hybrid ACL reconstruction in a 6-year-old female with fibular hemimelia
Authors: Tate Patrick G , Wojtys Edward M
Published: January 2019

Fibular hemimelia is a rare congenital malformation that is commonly associated with other lower limb abnormalities. This is a unique case of a bicruciate ligament, anterior cru ciate ligament/posterior cruciate ligament (ACL/PCL) deficiency in a 6-year-old female with fibular hemimelia in which we describe an ACL reconstruction using autograft–allograft hybrid technique. This case focuses on the technical aspects of an ACL reconstruction using a physeal-sparing technique with a hybrid ACL graft in a pediatric patient with fibular hemimelia. When evaluating patients with fibular hemimelia, it is important to consider implications of treatment in a stepwise manner as this condition commonly presents with other abnormalities that will most likely require multiple procedures, including limb lengthening.
Outcomes of patients with relapsed/refractory double-expressor B-cell lymphoma treated with ibrutinib monotherapy
Authors: Landsburg Daniel J. , Hughes Mitchell E. , Koike Alexa , Bond David , Maddocks Kami J. , Guo Ling , Winter Allison M. , Hill Brian T. , Ondrejka Sarah L. , Hsi Eric D. , Nasta Sunita D. , Svoboda Jakub , Schuster Stephen J. , Bogusz Agata M.
Published: January 2019

Key Points

The B-cell receptor signaling pathway is active in diffuse large B-cell lymphomas, with increased expression of MYC and BCL2 protein. The overall response rate was 60% for relapsed/refractory non–germinal center double-expressor lymphoma patients treated with ibrutinib.
Dizziness at a Canadian tertiary care hospital: A cost-of-illness study
Authors: Le Andre , Lelli Daniel A. , Van Katwyk Sasha , Hogan Debora , Thavorn Kednapa , Tse Darren
Published: January 2019

Background

In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures.

Methods

We conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st, 2014 with a main diagnosis of dizziness or dizziness-related disease. De-identified patient information was acquired through TOH Data Warehouse and included a patient's sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission. We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars.

Results

The average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000).

Conclusions

The estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.
Chronic Atypical Antipsychotic Use Is Associated With Reduced Need for Postoperative Nausea and Vomiting Rescue in the Postanesthesia Care Unit: A Propensity-Matched Retrospective Observational Study
Authors: Jabaley Craig S. , Gray Dennis W. , Budhrani Gaurav S. , Lynde Grant C. , Adamopoulos Panagiotis , Easton George S. , O’Reilly-Shah Vikas N.
Published: January 2019

BACKGROUND:

Atypical antipsychotics are efficacious for chemoprophylaxis against chemotherapy-induced nausea and vomiting, but perioperative investigations have been scant. We sought to examine the association between chronic atypical antipsychotic therapy and the likelihood of postoperative nausea and vomiting.

METHODS:

In this single-center, propensity-matched, retrospective, observational study, elective noncardiac surgical cases from January 2014 to December 2017 were examined with regard to the primary outcome of rescue antiemetic administration in the postanesthesia care unit as a measure of postoperative nausea and vomiting. Chronic administration of olanzapine, aripiprazole, and risperidone was the exposure of interest. Other independent variables included outpatient antiemetics, modified Apfel score, age, American Society of Anesthesiologists physical status score, case length, and exposures to emetogenic and chemoprophylactic agents. Logistic regression was performed using case-level data. Conditional logistic regression was performed after 1:2 propensity matching, sampling without replacement. Monte Carlo simulation was performed to compute the mean patient-level treatment effect on the treated.

RESULTS:

Of 13,660 cases, 154 cases with patients receiving atypical antipsychotics were matched against 308 cases without, representing 115 and 273 unique patients, respectively. In a well-balanced cohort, the mean patient-level odds of being administered rescue antiemetic was lower for patients chronically taking the 3 atypical antipsychotics under consideration as compared to those not on atypical antipsychotics, with an odds ratio of 0.29 (95% CI, 0.11–0.75; P = .015).

CONCLUSIONS:

Chronic atypical antipsychotic therapy is associated with reduced risk of postanesthesia care unit antiemetic administration. These findings support the need for prospective studies to establish the safety and efficacy of postoperative nausea and vomiting chemoprophylaxis with these agents.
Applying Conflict Management Strategies to the Pediatric Operating Room
Authors: Sinskey Jina L. , Chang Joyce M. , Shibata Gail S. , Infosino Andrew J. , Rouine-Rapp Kathryn
Published: January 2019

Effective communication is essential in today’s health care environment, and poor communication can lead to conflict among health care providers. Differences in cultures and beliefs can further incite conflict among health care team members, families, and patients. Pediatric patient care has a higher potential for conflict because decision-making responsibilities are shared among patients, parents/guardians, and clinicians. It is important to understand the phases and types of conflict because each conflict situation requires a different approach to optimize management. Equally important is an understanding of styles used by individuals to manage conflict. The Thomas–Kilmann Conflict Mode Instrument and the Dutch Test for Conflict Handling are 2 validated tools used to assess conflict management styles. The different styles include competing/forcing, collaborating/problem solving, compromising, avoiding, and yielding/accommodating. A successful physician should be able to identify the phases and types of conflict to use the conflict management approach most suitable for the given conflict.

There are several techniques for managing conflict in the pediatric operating room. Acknowledging and managing one’s own emotions during conflict is a pivotal first step toward diffusing the situation. Active listening is an important communication skill that improves team dynamics. Aligning the interests of the parties involved in conflict will encourage collaborative problem solving. Cultural competency training can improve communication and conflict management skills. Effective conflict management through formal education of all perioperative team members can lead to improved communication and teamwork and better patient outcomes.
Intraoperative Hyperoxia Does Not Reduce Postoperative Pain: Subanalysis of an Alternating Cohort Trial
Authors: Cohen Barak , Ahuja Sanchit , Schacham Yehoshua N. , Chelnick David , Mao Guangmei , Ali-Sakr Esa Wael , Maheshwari Kamal , Sessler Daniel I. , Turan Alparslan
Published: January 2019

BACKGROUND:

Postoperative pain is common and promotes opioid use. Surgical wounds are hypoxic because normal perfusion is impaired. Local wound ischemia and acidosis promote incisional pain. Some evidence suggests that improving oxygen supply to surgical wounds might reduce pain. We therefore tested the hypothesis that supplemental (80% inspired) intraoperative oxygen reduces postoperative pain and opioid consumption.

METHODS:

We conducted a post hoc analysis of a large, single-center alternating cohort trial allocating surgical patients having general anesthesia for colorectal surgery to either 30% or 80% intraoperative oxygen concentration in 2-week blocks for a total of 39 months. Irrespective of allocation, patients were given sufficient oxygen to maintain saturation ≥95%. Patients who had regional anesthesia or nerve blocks were excluded. The primary outcome was pain and opioid consumption during the initial 2 postoperative hours, analyzed jointly. The secondary outcome was pain and opioid consumption over the subsequent 24 postoperative hours. Subgroup analyses of the primary outcome were conducted for open versus laparoscopic procedures and for patients with versus without chronic pain.

RESULTS:

A total of 4702 cases were eligible for analysis: 2415 were assigned to 80% oxygen and 2287 to 30% oxygen. The groups were well balanced on potential confounding factors. Average pain scores and opioid consumption were similar between the groups (mean difference in pain scores, −0.01 [97.5% CI, −0.16 to 0.14; P = .45], median difference in opioid consumption, 0.0 [97.5% CI, 0 to 0] mg morphine equivalents; P = .82). There were also no significant differences in the secondary outcome or subgroup analyses.

CONCLUSIONS:

Supplemental intraoperative oxygen does not reduce acute postoperative pain or reduce opioid consumption.
Rates of Mechanical Ventilation for Patients With Dementia in Ontario: A Population-Based Cohort Study
Authors: Borjaille Cristiana Z. , Hill Andrea D. , Pinto Ruxandra , Fowler Robert A. , Scales Damon C. , Wunsch Hannah
Published: January 2019

The number of elderly patients with dementia receiving invasive mechanical ventilation is increasing over time in the United States, while the balance of potential benefits and harms of intensive care interventions in this population is unclear. In this report, we describe trends in use of invasive mechanical ventilation in elderly individuals with and without dementia in Ontario, Canada, and provide projections of the use of invasive mechanical ventilation through 2025. We show that rates of invasive mechanical ventilation for elderly patients with dementia are increasing faster than for the rest of the elderly (nondementia) population.
Impact of Preoperative Erythropoietin on Allogeneic Blood Transfusions in Surgical Patients: Results From a Systematic Review and Meta-analysis
Authors: Cho Brian C. , Serini Jessica , Zorrilla-Vaca Andres , Scott Michael J. , Gehrie Eric A. , Frank Steve M. , Grant Michael C.
Published: January 2019

BACKGROUND:

Erythropoietic-stimulating agents such as erythropoietin have been used as part of patient blood management programs to reduce or even avoid the use of allogeneic blood transfusions. We review the literature to evaluate the effect of preoperative erythropoietin use on the risk of exposure to perioperative allogeneic blood transfusions.

METHODS:

The study involved a systematic review and meta-analysis of randomized controlled trials evaluating the use of preoperative erythropoietin. The primary outcome was the reported incidence of allogeneic red blood cell transfusions during inpatient hospitalizations. Secondary outcomes included phase-specific allogeneic red blood cell transfusions (ie, intraoperative, postoperative), intraoperative estimated blood loss, perioperative hemoglobin levels, length of stay, and thromboembolic events.

RESULTS:

A total of 32 randomized controlled trials (n = 4750 patients) were included, comparing preoperative erythropoietin (n = 2482 patients) to placebo (n = 2268 patients). Preoperative erythropoietin is associated with a significant decrease in incidence of allogeneic blood transfusions among all patients (n = 28 studies; risk ratio, 0.59; 95% CI, 0.47–0.73; P < .001) as well as patients undergoing cardiac (n = 9 studies; risk ratio, 0.55; 95% CI, 0.37–0.81; P = .003) and elective orthopedic (n = 5 studies; risk ratio, 0.36; 95% CI, 0.28–0.46; P < .001) surgery compared to placebo, respectively. Preoperative erythropoietin was also associated with fewer phase-specific red blood cell transfusions. There was no difference between groups in incidence of thromboembolic events (n = 28 studies; risk ratio, 1.02; 95% CI, 0.78–1.33; P = .68).

CONCLUSIONS:

Preoperative erythropoietin is associated with a significant reduction in perioperative allogeneic blood transfusions. This finding is also confirmed among the subset of patients undergoing cardiac and orthopedic surgery. Furthermore, our study demonstrates no significant increase in risk of thromboembolic complications with preoperative erythropoietin administration.
Postoperative Acute Angle-Closure Glaucoma: A Rare but Serious Complication: A Case Report
Authors: Roor Tessa L. , Kooijman Johan A. , van der Ploeg J. Marinus , de Boer Hans D.
Published: January 2019

Acute angle-closure glaucoma is a rare complication of general anesthesia. If not treated in time, acute angle-closure glaucoma can potentially cause permanent loss of vision. Physicians should therefore be vigilant for the possibility of acute angle-closure glaucoma in patients who experience postoperative change or loss of vision. Recently, some reported a case of bilateral acute angle-closure glaucoma after general anesthesia, in which the use of ephedrine was a possible trigger. This report begins by examining a case of unilateral acute angle-closure glaucoma. The potential triggers of this complication are discussed. This article concludes with a flowchart to aid anesthesiologists to accurately diagnose postoperative ophthalmic pathology.
Crossed Swords Sign: A 3-Dimensional Echocardiographic Appearance
Authors: Gao Zhifeng , Bortman Jeffrey M. , Mahmood Feroze , Matyal Robina , Khabbaz Kamal R.
Published: January 2019

Intraoperative evaluation of mitral regurgitation is a complex undertaking. Bileaflet prolapse/flail can result in divergent mitral regurgitation jets with a characteristic “crossed swords sign” appearance. We present a case of divergent mitral regurgitation jets that were detected intraoperatively and evaluated using 3-dimensional imaging. The accurate assessment of eccentric mitral regurgitation jets, especially bilateral eccentric mitral regurgitation jets, is challenging before surgical repair. Intraoperative 3-dimensional transesophageal echocardiography with and without color-flow Doppler can significantly improve the localization of the anatomical lesion.
Implementation of an Innovative Residency Leadership Development Curriculum
Authors: Grantham Ashley , Hauck Jennifer , Stafford-Smith Mark , Mathew Joseph P. , Thompson Annemarie
Published: January 2019

The role of the anesthesiologist in the perioperative environment requires facility in leadership; however, leadership education is not part of the traditional curriculum for anesthesiology trainees. To address this educational gap, we developed a leadership program for anesthesiology residents at an academic medical center to build competency in the areas of teamwork, emotional intelligence, integrity, selfless service, critical thinking, and patient-centeredness, constructs that correlate with the Accreditation Council for Graduate Medical Education competencies of interpersonal and communication skills and professionalism. This report describes the design and implementation of the program, including the curriculum, and offers recommendations for implementation at other institutions.
Novel Axillary Block Management for Tendon Transfer Surgery: A Case Report
Authors: Garnaud Thierry , Toulemonde Julien
Published: January 2019

The outcome of upper limb tendon transfer surgery is improved when the patient is able to voluntarily contract specific muscles during the surgical procedure. Tumescent local anesthesia is suitable, but we describe an alternative option that involves the novel management of an axillary block. A 47-year-old man, injured in a motor vehicle crash, exhibited a thumb extensor deficit because of severe muscular trauma to the forearm. He underwent a tendon transfer of the fourth superficial flexor tendon to the extensor pollicis longus under an axillary block. First, individual injections of ropivacaine were performed around the musculocutaneous, radial, and ulnar nerves with ultrasound guidance. Second, a perineural catheter was placed near the median nerve and lidocaine injected. Voluntary flexor muscle contraction reappeared in time for the surgeon to adjust his suture tension.
Lidocaine as a Rare and Hidden Allergen in the Perioperative Setting: A Case Report
Authors: Kvisselgaard Ask D. , Melchiors Birgitte B. , Krøigaard Mogens , Garvey Lene H.
Published: January 2019

Local anesthetics are used throughout the health care system. In the perioperative setting and in other settings of exposure to local anesthetics, true allergy is reported very rarely. We present an unusual case of immediate-type perioperative hypersensitivity to lidocaine with cross-reaction to mepivacaine, which was missed on initial investigation. This case illustrates that lidocaine may be a “hidden allergen” in the perioperative setting and should always be considered a potential culprit in cases of suspected perioperative hypersensitivity. The case also demonstrates that suspected perioperative hypersensitivity requires highly specialized investigation and close collaboration between allergists and anesthesiologists.
Cannulation of the Internal Mammary Vein With a Single-Lumen Infusion Catheter in a Patient With Portal Hypertension: A Case Report
Authors: Tashjian Brian C. , Schoor Michael E. , Grant Masilo
Published: January 2019

We present a central venous catheter misplacement case. A left internal jugular vein percutaneous introducer was inserted for fluid resuscitation with a single-lumen infusion catheter placed through the lumen for medication infusions. Placement was performed under ultrasound guidance, with confirmation of the wire within the venous lumen. Radiographs suggested that the introducer had perforated the innominate vein. Contrast was injected through the single-lumen infusion catheter and showed cannulation of the left internal mammary vein. The link between portal hypertension and increased risk of central line misplacement as well as diagnosis and potential methods to avoid this rare complication are discussed.
Maternal Mirror Syndrome Masquerading as Congestive Heart Failure: A Case Report
Authors: Xu Wen , Smith C. Tyler , Binstock Anna , Lim Grace
Published: January 2019

Mirror syndrome is a rare pregnancy complication, life-threatening to mother and fetus. Increasing survival rates of congenital heart disease into reproductive age mean that complications like Mirror syndrome in this population may be more challenging to diagnose, given overlapping signs of edema in cases of heart failure exacerbation. We report a case of a pregnant woman with a history of unspecified congenital heart disease, presenting with swelling and distension, with diagnostic findings not consistent with preeclampsia. Her course was complicated by dyspnea, oliguria, and fetal hydrops. A cesarean delivery under neuraxial anesthesia was performed. We review the clinical manifestations of Mirror syndrome and discuss anesthetic and obstetric management considerations for this condition.
de novotranscription of multiple Hox cluster genes takes place simultaneously in earlyXenopus tropicalisembryos
Authors: Kondo Mariko , Matsuo Megumi , Igarashi Kento , Haramoto Yoshikazu , Yamamoto Takayoshi , Yasuoka Yuuri , Taira Masanori
Published: January 2019

hox genes are found as clusters in the genome in most bilaterians. The order of genes in the cluster is supposed to be correlated with the site of expression along the anterior-posterior body axis and the timing of expression during development, and these correlations are called spatial and temporal collinearity, respectively. Here we studied the expression dynamics of all hox genes of the diploid species Xenopus tropicalis in four Hox clusters (A to D) by analyzing high-temporal-resolution RNA-seq databases and the results showed that temporal collinearity is not supported, consistent with our previous data from allotetraploid X. laevis. Because the temporal collinearity hypothesis implicitly assumes the collinear order of gene activation, not mRNA accumulation, we determined for the first time, the timing when new transcripts of hox genes are produced, by detecting pre-spliced RNA in whole embryos with reverse transcription and quantitative PCR (RT-qPCR) for all hoxa genes as well as several selected hoxb, hoxc, and hoxd genes. Our analyses showed that, coinciding with the RNA-seq results, hoxa genes started to be transcribed in a non-sequential order, and found that multiple genes start expression almost simultaneously or more posterior genes could be expressed earlier than anterior ones. This tendency was also found in hoxb and hoxc genes. These results suggest that temporal collinearity of hox genes is not held during early development of Xenopus.
Hippo signaling promotes lung epithelial lineage commitment by curbing Fgf10 and β-catenin signaling
Authors: Volckaert Thomas , Yuan Tingting , Yuan Jie , Boateng Eistine , Hopkins Seantel , Zhang Jin-San , Thannickal Victor J. , Fässler Reinhard , De Langhe Stijn P.
Published: January 2019

Organ growth and tissue homeostasis rely on the proliferation and differentiation of progenitor cell populations. In the developing lung, localized Fgf10 expression maintains distal Sox9-expressing epithelial progenitors and promotes basal cell differentiation in the cartilaginous airways. Mesenchymal Fgf10 expression is induced by Wnt signaling but inhibited by Shh signaling, and epithelial Fgf10 signaling activates β-catenin signaling. The Hippo pathway is a well-conserved signaling cascade that regulates organ size and stem/progenitor cell behavior. Here, we show that Hippo signaling promotes lineage commitment of lung epithelial progenitors by curbing Fgf10 and β-catenin signaling. Our findings show that both inactivation of the Hippo pathway (nuclear Yap) or ablation of Yap result in increased β-catenin and Fgf10 signaling, suggesting a cytoplasmic role for Yap in epithelial lineage commitment. We further demonstrate redundant and non-redundant functions for the two nuclear effectors of the Hippo pathway, Yap and Taz, during lung development.
Effects of Obesity and Exercise on Bone Marrow Progenitor Cells after Radiation
Authors: EMMONS RUSSELL , NGU MATTHEW , XU GUANYING , HERNÁNDEZ-SAAVEDRA DIEGO , CHEN HONG , DE LISIO MICHAEL
Published: January 2019

Introduction

The late effects of radiation therapy can have significant consequences for the health and quality of life of long-term cancer survivors. Radiation induces persistent alterations in hematopoietic stem and progenitor cells (HSPC) and the bone marrow environment; however, how relevant host factors such as obesity and exercise differentially regulate HSPC content and the bone marrow environment after radiation exposure remains unknown. The purpose of this investigation was to evaluate how the combination of obesity and exercise training modulates HSPC and their niche after sublethal radiation exposure in mice.

Methods

Mice fed either a control or a high-fat diet to induce obesity remained sedentary or underwent a progressive treadmill exercise program. At 13 wk of age, mice were irradiated (3 Gy) and continued their specific diets and exercise program for four more weeks.

Results

Exercise-trained mice had significantly higher quantities of several HSPC subpopulations and bone marrow stromal cell populations, whereas HSPC subpopulations were significantly lower in obese mice after radiation. Reactive oxygen species content was significantly decreased in HSPC with exercise training. Proteomics analysis of bone marrow supernatant revealed clustering of biologically relevant changes in exercise-trained mice. Functional evaluation of bone marrow supernatant revealed a significant increase in leukemia blast viability in obese mice but not in the exercise-trained mice (P < 0.05).

Conclusion

Together, these data suggest that exercise training partially restores the negative effects of obesity on HSPC and their niche after radiation exposure. As such, exercise training should be considered to mitigate the late effects of radiation therapy on the hematopoietic system for cancer survivors with or without obesity who have undergone radiation therapy.
The Mechanics of Breathing during Swimming
Authors: LEAHY MICHAEL G. , SUMMERS MCKENZIE N. , PETERS CARLI M. , MOLGAT-SEON YANNICK , GEARY CAITLIN M. , SHEEL A. WILLIAM
Published: January 2019

The thorax undergoes unique conditions while swimming. Hydrostatic pressure from water immersion places an external load on the thorax and increases airway resistance, and the horizontal body position results in central venous engorgement and an associated reduction in lung compliance. The aforementioned factors likely increase the work of breathing (W
b); however, this hypothesis remains untested.

Purpose

This study aimed to compare W
b during freestyle swimming relative to cycling and to characterize the differences in the cardiorespiratory responses to swimming relative to cycling in the same individuals.

Methods

Eight collegiate swimmers (four men and four women, age = 22 ± 2 yr) performed an incremental swim test while tethered to a resistance apparatus. On a separate day, subjects performed an incremental cycle test. During swimming and cycling, metabolic and ventilatory parameters were measured using a customized metabolic cart, and inspired W
b was quantified using an esophageal balloon catheter.

Results

Swimming and cycling elicited statistically similar levels of peak oxygen uptake (3.87 ± 0.92 vs 4.20 ± 0.83 L·min−1, P = 0.143). However, peak minute ventilation (V˙
E) (118 ± 3 vs 154 ± 25 L·min−1) and heart rate (164 ± 19 vs 183 ± 8 bpm) were significantly lower during swimming relative to cycling (both P < 0.05). Inspired W
b was higher at a V˙
E of 50 L·min−1 (+27 ± 16 J·min−1), 75 L·min−1 (+56 ± 23 J·min−1), and 100 L·min−1 (+53 ± 22 J·min−1) during swimming compared with cycling (all P < 0.05). Periods of interbreath apnea were observed while swimming (duration = 0.13–2.07 s).

Conclusion

We interpret our findings to mean that the horizontal body position and hydrostatic pressure on the chest wall requires swimmers to generate greater inspiratory pressures to sustain adequate V˙
E during exercise.
A Unified Decomposition Matheuristic for Assembly, Production, and Inventory Routing
Authors: Chitsaz Masoud , Cordeau Jean-François , Jans Raf
Published: January 2019

While the joint optimization of production and outbound distribution decisions in a manufacturing context have been intensively studied in the past decade, the integration of production, inventory, and inbound transportation from suppliers have received much less attention despite its practical relevance. This paper aims to fill the gap by introducing a general model for the assembly routing problem (ARP), which consists of simultaneously planning the assembly of a finished product at a plant and the routing of vehicles collecting materials from suppliers to meet the inventory requirements imposed by the production. We formulate the problem as a mixed-integer linear program and we propose a three-phase decomposition matheuristic that relies on the iterative solution of different subproblems. The first phase determines a setup schedule while the second phase optimizes production quantities, supplier visit schedules and shipment quantities. The third phase solves a vehicle routing problem for each period in the planning horizon. The algorithm is flexible, and we show how it can also be used to solve two well-known outbound distribution problems related to the ARP: the production routing problem and the inventory routing problem. Using the same parameter setting for all problems and instances, we obtain 781 new best-known solutions out of 2,628 standard IRP and PRP test instances. In particular, on large-scale multivehicle instances, the new algorithm outperforms specialized state-of-the-art heuristics for these two problems.

The online appendix is available at https://doi.org/10.1287/ijoc.2018.0817 .
Managing Consumer Deliberations in a Decentralized Distribution Channel
Authors: Li Xi , Li Yanzhi , Shi Mengze
Published: January 2019

A manufacturer may manage consumer deliberation decision through the wholesale price, consumer empowerment, and product qualities.
Mix Stickiness Under Asymmetric Cost Information
Authors: Antle Rick , Bogetoft Peter
Published: January 2019

In most organizations, the agent has superior information about the relative costs of different products or activities. This handicaps the principal when the principal seeks to adjust the product mix. Our main conceptual finding is that there is “mix stickiness.” The agent’s superior information about the relative costs of different products or activities leads to an advantage for the status quo; that is, there is inertia (or stickiness) in the mix of products or activities pursued. The historical mix has an advantage because the asymmetric information about relative costs has less of an impact when the mix does not change. If the mix changes, the producer can extract information rents by claiming high costs on the least reduced or most expanded products. Only in the case of larger shifts in the environment will the mix change. Changing the mix comes with the advantage of making rationing cheaper. Our analysis gives new insight into several business practices. It suggests, for example, that for moderate downsizing, a reinforcement approach of proportionally cutting all activities (lawn mowing) is optimal. When more dramatic downsizing is called for, a reorientation approach of eliminating certain activities (divesting) is optimal. It also suggests that outsourcing may come at the cost of reduced adaptability, and it may help explain why most, if not all, healthcare systems struggle to control cost.

This paper was accepted by Rajgopal Shiva, accounting.
In Search for Islamic Macroprudential Policy in Indonesia: The Case of Financing to Value (FTV) and Property Financing
Authors: Qoyum Abdul , Fauziyyah Neneng Ela
Published: January 2019

This study aims to examine the impact of macroprudential policy particlarly the relaxing of Financing to Value (FTV) on property financing of Islamic bank in case of Indonesia. In addition, this paper also analyzes the impact of macroeconomic variables and specific factors on property financing in Islamic Bank. This paper collects data from the Bank Indonesia website, the Financial Services Authority (FSA) and the Central Statistics Agency (CSA) form January 2010 until April 2016. By employing Vector Error Correction Model (VECM), this study found that inflation and Industry Produce Index (IPI) have been positively influence on the property financing, while the BI rate and financing to deposit ratio (FDR) have been negatively influence on the property financing. While the relaxing of FTV policy also negatively influence on the property financing. Therefore, This study conludes that the policy have not effectived yet.
NOVO MARCO LEGAL PARA A MINERAÇÃO E SUAS IMPLICAÇÕES PARA A ATIVIDADE MINERÁRIA NO BRASIL SOB A LUZ DA JUSTIÇA AMBIENTAL
Authors: Canônico Lopes Virgínia Maria , Leles Romarco de Oliveira Marcelo
Published: January 2019

Resumo: Este estudo analisou o Decreto nº 9.406 de 12 de junho de 2018, para tecer um ensaio crítico sobre a abordagem legislativa acerca das normas minerárias no Brasil, após as mudanças políticas ocorridas em 2016. Neste caso, referenciado pela expectativa de um Novo Marco Legal para a Mineração no Brasil, o estudo permeia a discussão sobre a justiça ambiental, em meio ao processo político e à condução política das questões minerárias. Metodologia: foi realizada uma análise bibliográfica e documental. Documentos em arquivos oficiais, como o próprio decreto em evidência, foram tratados como fontes primárias de pesquisa. As fontes secundárias foram os estudos sobre o tema, reunidos em obras literárias. Concluiu-se que a condução política do projeto mineral no governo brasileiro, à luz da justiça ambiental, ficou relegada ao segundo plano.Palavras-chave: Mineração. Governo. Justiça Ambiental.Abstract: This study analyzed Decree No. 9,406 of June 12, 2018 to provide a critical essay on the legislative approach to mining standards in Brazil, following the political changes in 2016. In this case, referenced by the expectation of a New Legal Framework for Mining in Brazil, the study permeates the discussion on environmental justice in the midst of the political process and political conduct of mining issues. Methodologically, a bibliographic and documentary analysis was carried out. Documents in official archives, such as the decree itself, were treated as primary sources of research. The secondary sources were the studies on the subject collected in literary works. The political conduct of the mineral project in the Brazilian government in the light of environmental justice is relegated to the background.Keywords: Mining. Government. Environmental Justice.
AS CONSTITUIÇÕES SUBNACIONAIS E DIREITOS FUNDAMENTAIS NAS FEDERAÇÕES
Authors: Sampaio José Adércio Leite
Published: January 2019

As federações diferenciam-se entre si quanto ao espaço de autonomia que as suas Constituições deixam aos textos constitucionais das unidades subnacionais, influenciando o nível de proteção normativa dos direitos fundamentais no âmbito do constitucionalismo subnacional. Naqueles em que é deixado um espaço maior ao trabalho constituinte, as declarações de direitos subnacionais tendem a ser mais detalhadas e mais inovadoras do que a existente na Constituição federal. Os direitos sociais, a proteção ambiental e os direitos das minorias estão mais presentes naquelas do que nesta. No Brasil, as Constituições estaduais tendem a detalhar os direitos sociais reconhecidos na Constituição federal, bem como a defesa do meio ambiente, dos direitos sexuais e reprodutivos da mulher, dos afro-brasileiros e de outras minorias. A efetividade dessa proteção, no entanto, é polêmica no Brasil e em outros Estados federais.
História do Serviço Social – resgatando uma história de mulheres | History of Social Work – Recuperating a history of women
Authors: Freitas Rita , Barros Nivia , Mesquita Adriana , Silva Irias Das
Published: January 2019

Este texto tem como objetivo resgatar a participação feminina na constituição da história do Serviço Social, dando visibilidade aos caminhos percorridos e aos papéis desempenhados por algumas mulheres. Para isso, analisamos o caso das pioneiras da Escola de Serviço Social de Niterói, da Universidade Federal Fluminense (ESSN/UFF). O resgate de suas falas, através da história oral, foi o caminho metodologicamente traçado. Iniciamos o texto revisitando a história profissional para, em seguida, discutirmos acerca da necessidade de retirar da invisibilidade o protagonismo dessas mulheres ao construir uma profissão. Aprofundar essa dimensão aponta para a importância de pensarmos algumas questões, como a história das mulheres, o uso da dimensão do gênero e os feminismos na pesquisa acadêmica, o que compreendemos como um grande desafio que se coloca para a profissão.Palavras-Chave: história do Serviço Social; feminismo; gênero e história das mulheres.  Abstract – This text aims to recuperate the participation of women in the constitution of the history of social work, giving visibility to the paths covered and the roles played by women. In order to do this, we analyze the case of the pioneers of the Universidade Federal Fluminense’s Niterói School of Social Service (ESSN/UFF). The recuperation of their speeches, through oral history, was the methodological route. We begin the text revisiting the professional history and then discuss the need to remove from invisibility the protagonism of these women when building a profession. Deepening this dimension points to the importance of thinking about some issues, such as the history of women, the use of the gender dimension and feminisms in academic research, which we understand as a great challenge for the profession.Keywords: history of social work; feminism; gender and women's history.
Protección social y familia: la experiencia de la construcción del Sistema Nacional Integrado de Cuidados de Uruguay – Entrevista con el profesor Marcelo Castillo | Social protection and family: the experience of the construction of the Integrated National System of Care of Uruguay - Interview with Professor Marcelo Castillo
Authors: Dal Prá Keli Regina , Wiese Michelly Laurita
Published: January 2019

Entrevista realizada en las dependencias del Departamento de Ciencias Políticas de la Universidad de la República de Uruguay (UDELAR), en Montevideo em junio de 2018.