bluuebunny/crossref_metadata_2025 huggingface dataset:
Functional Heterogeneity of Antiheparin-Platelet Factor 4 Antibodies: Implications in the Pathogenesis of the HIT Syndrome
Authors: Ahmad Sarfraz , Walenga Jeanine M. , Jeske Walter P. , Cella Giuseppe , Fareed Jawed
Published: July 2017

Heparin-induced thrombocytopenia represents one of the most severe drug-induced disorders of platelets. This syndrome is believed to be mediated through antibodies generated against a heparin-platelet factor 4 complex. Complexation of a sulfated mucopolysaccharide chain of heparin with a platelet granular protein (platelet factor 4) produces an allosteric modification of platelet factor 4 resulting in neoepitope formation and the generation of antiheparin-platelet factor 4 antibodies. These antibodies are capable of activating platelets by binding to heparin, platelet factor 4 and the Fc receptor on platelets, resulting in a complex pathophysiology involving ischemic, thrombotic, and inflammatory processes. To characterize this antibody, IgG fractions were obtained from the serum of patients with heparin-induced thrombocytopenia using ammonium sulphate precipitation and heparin-platelet factor 4-sepharose 4B affinity chromatography methods. With the affinity purification, two major components, peaks I and II, with high antiheparin-platelet factor 4 antibody titers were eluted. The purity of all the fractionated immunoglobulins was established by sodium dodecylsulphate-polyacrylamide gel electrophoretic analyses. While peak I did not induce 14C-serotonin release from platelets in the heparin-dependent assay for heparin-induced thrombocytopenia antibodies (14C-serotonin release assay), peak II and the IgGs obtained with the ammonium sulphate precipitation method exhibited a strong and concentration-dependent activation in the presence and absence of heparin and low molecular weight heparin. These immunoglobulins were treated with heparinase, a cationic ion-exchange resin (Heparsorb), or dialyzed to remove traces of heparin, and when tested in the 14C-serotonin release assay, showed the same high degree of activity. These data are suggestive of the generation of heparin-induced thrombocytopenia antibodies capable of activating platelets directly in a nonheparin-dependent manner. These observations underscore the complex pathophysiology of heparin-induced thrombocytopenia syndrome and suggest that the severity of this syndrome in some patients may be due to the generation of “super-active” heparin-induced thrombocytopenia antibodies capable of activating platelets without the requirement of heparin. This could explain why the cessation of heparin in patients does not necessarily correct the symptoms of heparin-induced thrombocytopenia or associated thrombosis.
Soluble Adhesion Molecules in the HIT Syndrome: Pathophysiologic Role and Therapeutic Modulation
Authors: Fareed Jawed , Walenga Jeanine M. , Hoppensteadt Debra A. , Jeske Walter P. , Ahmad Sarfraz , Lietz Helen , McKenna Rajalaxmi , Messmore Harry L. , Haas Sylvia
Published: July 2017

Heparin-induced thrombocytopenia pathophysiology is now known to be a complex process that involves platelets, vascular endothelium, and leukocytes/lymphocytes. The activation products from these sites also contribute to the activation of coagulation and fibrinolytic deficit. While many of the markers of hemostatic activation processes have been found to be increased during the acute phase of heparin-induced thrombocytopenia syndromes, the circulating levels of soluble adhesion molecules such as the P, E, and L selectins, and intracellular and vascular cell adhesion molecules have not been reported. Since the pathophysiology of heparin-induced thrombocytopenia involves the activation of platelets, endothelium, and leukocytes, it is expected that the activation products related to these hemostatic systems including soluble selectins and cellular adhesion molecules will also be increased in circulating blood. These alterations may also provide an index of the pathophysiologic process. With the availability of highly sensitive enzyme-linked immunosorbent assays for soluble P, E, and L selectins, intracellular and vascular cell adhesion molecules, it is now possible to measure these adhesion molecules in biological fluids. This study reports on the circulating levels of various adhesion molecules in patients with heparin-induced thrombocytopenia and their modulation after therapeutic interventions by the use of direct thrombin inhibitors. With the availability of recombinant hirudin, it is now possible to treat these patients with alternate antithrombin agents. However, the immunoactivation of platelets and other cells as shown here indicates the possible need for additional adjunct therapeutic approaches to suppress their participation in the thrombotic process. The reported increase in the circulating levels of the soluble adhesion molecules during the heparin-induced thrombocytopenia and heparin-induced thrombocytopenia with thrombosis syndrome suggests that the antiheparin platelet factor 4 antibody is capable of modulating their regulation. The prognostic role of these mediators in the management of heparin-induced thrombocytopenia syndrome warrants further investigation.
Heparin-Induced Thrombocytopenic Potential of GAG and Non-GAG-Based Antithrombotic Agents
Authors: Jeske Walter P. , Jay Allison M. , Haas Sylvia , Walenga Jeanine M.
Published: July 2017

We have undertaken these studies of the heparin-like, or glycosaminoglycan, and nonglycosaminoglycan-based antithrombotics in an effort to add to the understanding of the pathophysiologic mechanism of heparin-induced thrombocytopenia by investigations of how glycosaminoglycan-related agents interact with the heparin-induced thrombocytopenia antibodies. The low molecular weight heparins, originally thought to be useful alternatives to heparin because of their smaller size, show platelet activation and aggregation responses in platelet heparin-induced thrombocytopenia serum systems (P-selectin expression, microparticle formation, serotonin release, platelet aggregation). Although the molecular mass and sulfation of the heparinoid Lomoparan is similar to that of heparin and low molecular weight heparins, its chemical structure is different and probably is not recognized by the heparin-induced thrombocytopenia antibodies. The heparin-related pentasaccharide did not show a positive reaction in any system of platelet activation/aggregation. These studies have shown that the antibodies produced in patients with heparin-induced thrombocytopenia are reactive to highly sulfated glycosaminoglycans and nonglycosaminoglycan agents and less dependent on the molecular mass of these agents; whether the agent is a heparin or nonheparin compound was not critical. A combination of a moderate sulfation but low molecular mass in a heparin-like molecule was sufficient to prevent interaction with the heparin-induced thrombocytopenia antibodies. However, a chemical structure that is different from heparin (e.g., a heparinoid or a thrombin inhibitor) will also be nonreactive to platelet activation by heparin-induced thrombocytopenia antibodies.
Vascular Damage Correlates between Heparin-Induced Thrombocytopenia and the Antiphospholipid Syndrome
Authors: Walenga Jeanine M. , Michal Kathryn , Hoppensteadt Debra , Wood Jennifer J. , Robinson John A. , Bick Rodger L.
Published: July 2017

Antibody-mediated disorders of heparin-induced thrombocytopenia and antiphospholipid antibody syndrome have remarkably similar clinical presentations, both of which can progressively result in severe vascular and thrombotic disorders. We hypothesized that the mechanism of platelet activation as occurs in heparin-induced thrombocytopenia may also occur in antiphospholipid antibody syndrome particularly at the vascular wall, that endothelial injury may be similar in heparin-induced thrombocytopenia and antiphospholipid antibody syndrome, and that these alterations may be caused by related antibodies. Antibody titers and vascular endothelial damage in patients with heparin-induced thrombocytopenia and antiphospholipid antibody syndrome were studied in plasma samples collected from normals (n = 17), heparin-induced thrombocytopenia patients (n = 15), antiphospholipid antibody syndrome patients (n = 30), and patients clinically diagnosed with antiphospholipid antibody syndrome and heparin-induced thrombocytopenia (n = 8). Diagnosis of heparin-induced thrombocytopenia was confirmed by 14C-serotonin release assay or positive antiheparin-platelet factor 4 antibody titer, and antiphospholipid antibody syndrome was confirmed by positive anti-β2-glycoprotein (GP) 1/cardiolipin (IgG or IgM) antibody titer. The antiheparin-platelet factor 4 antibody was not detected in any patient with antiphospholipid antibody syndrome. Patients with heparin-induced thrombocytopenia did not have elevated IgG anti-β2-GP1 titers, but three (20%) patients had low-positive IgM anti-β2-GP1 titers. The endothelial damage markers of soluble thrombomodulin, soluble P-selectin ( p < 0.05 vs. normal), plasminogen activator inhibitor-1 and tissue factor were elevated in heparin-induced thrombocytopenia and antiphospholipid antibody syndrome patients. The soluble E-selectin was elevated only in the patients with both heparin-induced thrombocytopenia and antiphospholipid antibody syndrome ( p < 0.05 vs. normal). Levels of soluble L-selectin and von Willebrand factor were not different from normals. The pathogenesis of heparin-induced thrombocytopenia and antiphospholipid antibody syndrome appears to be due to two distinct antibodies but associated with similar damage to the vascular endothelium in both diseases.
There Be Dragons: The Dangerous Pedagogy of the First Person
Authors: Abrahamson David
Published: July 2017

This article is an essay exploring the unique pedagogical challenges of an approach to journalistic writing instruction which not only allows—but actually might even encourage—students to consider using a first-person narrator. While some of the pitfalls of the technique are discussed, the central argument is that the first-person voice, rather than being off-limits in the classroom, can be both appropriate and persuasive. Specific instructional examples are also provided.
The Effect of Alcohol on the Responses of Sexually Coercive and Noncoercive Men to an Experimental Rape Analogue
Authors: Marx Brian P. , Gross Alan M. , Adams Henry E.
Published: July 2017

This study examined the impact of the psychological and pharmacological effects of alcohol on the ability of sexually coercive and noncoercive men to discriminate when a female wants a partner to stop sexual advances. In a 2 (alcohol vs. no alcohol) × 2 (expectancy vs. no expectancy) × 2 (sexually coercive vs. noncoercive status) randomized factorial design, male college students were exposed to an audiotape of a date rape. Participants who consumed, or expected to consume, alcohol took significantly longer to determine that the man should refrain from attempting further sexual contact. In addition, nonsexually coercive participants assigned to conditions in which they expected to consume alcohol responded similarly to their sexually coercive counterparts in their responses. The implications of these findings are discussed.
Dynamics of discontinuities in elastic solids
Authors: Berezovski Arkadi , Berezovski Mihhail
Published: July 2017

The paper is devoted to evolving discontinuities in elastic solids. A discontinuity is represented as a singular set of material points. Evolution of a discontinuity is driven by the configurational force acting at such a set. The main attention is paid to the determination of the velocity of a propagating discontinuity. Martensitic phase transition fronts and brittle cracks are considered as representative examples.
Influence of sensory quality on preferences for apples of primary school children
Authors: Lanza B , Sabatini N , Bacceli M
Published: July 2017

In this research work, sensorial features of four varieties of fresh apples have been investigated by children aged 6–10 years (n = 336) of the Centre-East region of Italy (Abruzzo). The examined sensory properties were visual appealing, aromatic flavour, sourness, sweetness, firmness and crunchiness. Statistical analysis was performed by means of principal component analysis which underlined the differences and similarities between the examined fruits and the most responsive variables. Results are very interesting and allow to better understand the most important descriptors which influence the appreciation of the different tested varieties. Furthermore, it has been noted that different varieties influence each other for the perception of some sensory characteristics. Thus, improving the knowledge of the most appreciated organoleptic properties of apples by young consumers would be very useful and it might stimulate the development of new and more appealing cultivars in the future.
Severe Aortic Valve Stenosis Due to Alkaptonuric Ochronosis
Authors: El-Sayed Ahmed Magdy M , Hussain Omar , Ott David A , Aftab Muhammad
Published: July 2017

Alkaptonuric ochronosis is a rare cause of aortic valve stenosis. We report the case of a 61-year-old female patient with alkaptonuria who presented to our institute with the clinical picture of severe aortic valve stenosis, which was confirmed by transthoracic echocardiography. On aortotomy, she was noted to have an impressive black discoloration of ascending aorta and the aortic root complex involving the aortic valve leaflets. She underwent an uneventful aortic valve replacement. She was discharged home 10 days postoperatively.
Hepatic Calcified Tumor-like Mass Complicating Umbilical Vein Catheterization in a Neonate
Authors: Resnick Jeffrey M , Carmichael Brett , Winder Audra , Dominguez Kathleen M
Published: July 2017

Presented is a case of a hepatic calcified mass complicating umbilical vein catheterization in a neonate and diagnosed by wedge biopsy. Wedge biopsy of the hepatic mass, situated in proximity to the falciform ligament, revealed expansion of portal tracts by fibrosis and calcification. Some aggregates of calcified material appeared in ectatic vascular spaces. The biopsy findings accounted for the radiographic appearance of the mass and the constellation of features were deemed indicative of calcification secondary to umbilical vein catheterization. Umbilical vein catheterization in neonates may be complicated by a calcified mass that requires histologic evaluation for distinction from other space-occupying lesions. Such a calcified pseudotumor may develop after an umbilical catheter has been in place for only 5 days.
Pathologic Characteristics, Natural History, and Prognostic Implications of BRAFV600E Mutation in Pediatric Papillary Thyroid Carcinoma
Authors: Hardee Steven , Prasad Manju L , Hui Pei , Dinauer Catherine A , Morotti Raffaella A
Published: July 2017

The BRAFV600E mutation is the most common genetic aberration in papillary thyroid cancer (PTC), found in up to 68% of PTC in adults where it is associated with aggressive features. The incidence of this mutation in pediatric PTC is less frequent, reported as 0%–20% in the past and up to 63% in one recent series. Data suggest the mutation is not associated with an aggressive course in children; however, there are limited numbers of reported case series, so the prognostic implications remain poorly understood. The aim of this retrospective study was to examine the histologic characteristics and clinical outcomes of BRAF positive pediatric PTC at a single institution. A 12-year retrospective review of all thyroidectomies performed at a tertiary medical center identified 59 pediatric cases with a surgical pathology diagnosis of PTC. Fifty patients had BRAFV600E mutation analysis data and were selected for further study. BRAFV600E mutations were present in 48% of cases (n = 24) and absent in 52% (n = 26). The molecular characteristics of the BRAF negative cases will further be evaluated in future studies. BRAF positive cases occurred in patients who were on average older than the BRAF negative patients. Classic histology PTC was present in both BRAF positive and negative cases; however, only cases with classic PTC histology were positive for the mutation. No patients died and BRAF mutation was not associated with an increased recurrence rate. Our study supports BRAFV600E is more common in children than previously thought and does not portend a more aggressive clinical course.
Equivalent core concept for large-scale structural-level applications
Authors: Lee Woo Geun , Kim Jung Seok , Lim Jae-Yong
Published: July 2017

This study examined the applicability of the equivalent core concept, which replaces a discrete core with a homogenized solid core representing its elastic properties, on a large-scale structure. To this end, numerical verifications were performed for corrugated core structures at two levels, the specimen level and structural level. Before the verifications, analytical equations were gathered from previous reports to obtain the homogenized elastic properties of corrugated cores. At the specimen-level verifications, the maximum deflections of the corrugated core panel specimens subject to three-point bending were calculated with sandwich beam theory, finite element models with discretely modeled cores and equivalent cores. For the structural-level verifications, the maximum deflection and natural frequency were computed from a discrete finite element model and an equivalent model of a railway car body structure. The results revealed that the equivalent models gave excellent agreement with the theoretical values if the same underlying boundary conditions were used; however, greater discrepancies were observed with the discrete models. In addition, for the structural-level verifications the equivalent core model reasonably approximated the discrete model with marginal accuracy. Therefore, employing the equivalent core concept can be expected to save computational costs in the initial design stage of large-scale structures.
Dynamic buckling of sensor/functionally graded-carbon nanotube-reinforced laminated plates/actuator based on sinusoidal-visco-piezoelasticity theories
Authors: Hajmohammad Mohammad Hadi , Zarei Mohammad Sharif , Nouri Ali , Kolahchi Reza
Published: July 2017

In this article, the dynamic buckling behavior of a sandwich plate composed of laminated viscoelastic nanocomposite layers integrated with viscoelastic piezoelectric layers is investigated. The core due to the existence of carbon nanotubes is subjected to the magnetic field while the piezoelectric layers at the top and the bottom of the core are subjected to the electric filed and plays the role of the actuator and the sensor, respectively. The core layers are reinforced by functionally graded carbon nanotubes and their equivalent material properties are obtained using the extended rule of mixture. According to Kelvin–Voigt theory, the realistic behavior of the structure is simulated by considering the viscoelastic properties. The structure is assumed resting on viscoelastic medium which is simulated using orthotropic visco-Pasternak model. The governing equations of the system are derived based on the sinusoidal shear deformation theory and by employing Hamilton's principle. To obtain the dynamic stability region of the system, the differential quadrature method is applied. Also, a proportional-derivative controller is employed to control the dynamic behavior of the structure. The influences of various parameters like structural damping, viscoelastic medium, geometric constants, applied voltage, number of layers, volume fraction and distribution of carbon nanotubes, temperature changes and magnetic field on the control and analysis of the dynamic stability region of the structure are studied. The results reveal that by applying the negative voltage to the actuator layer, the stability region of the system occurs in higher frequencies. Also, the highest bending stiffness of the structure can be achieved for Functionally graded-Xtype (FGX) distribution type of carbon nanotubes.
Reading real person fiction as digital fiction: An argument for new perspectives
Authors: Fathallah Judith
Published: July 2017

‘Real person fiction’ (RPF) is a subset of fanfiction that has gone largely unnoticed by academics. A handful of articles have argued for the justification of stories about real (living) people as a legitimate and morally sound art form, but only a very few studies have begun to consider RPF as a genre with its own aesthetics and conventions. This article argues that, to understand fannish RPF, we need to incorporate tools developed by scholars of digital fiction. Almost all fanfic is now produced for and on digital platforms, and moreover, the natural fit between RPF specifically and the study of metalepsis, or self-conscious movement between ‘levels’ of reality and fiction, makes this tool and others imported from the study of digital fiction an illuminating set of lenses through which read it. Along the way, I will incorporate further narrative theory to suggest that we understand appeals to the putative subject of RPF as directed to a ‘fictiona lized addressee’, that is, an addressee who is neither purely fictional nor purely nonfictional, but a construct of mediated activity that demonstrates fandom’s participation in the construction of the subcultural celebrity.
Three myths of digital media
Authors: Webster James G.
Published: July 2017

Accounts of our digital future, both optimistic and dystopian, are often founded on three myths: users are in charge, big data is neutral and people will opt to live in enclaves. This article describes and challenges those myths. As an alternative, it posits a dynamic model of the digital media marketplace in which users, media and metrics constantly interact. It concludes by arguing that the structural features of the marketplace play an important role in shaping crossmedia encounters and inviting readers to consider the power of media to reshape preferences.
Toy robots on YouTube: Consumption and peer production at the robotic moment
Authors: Chesher Chris
Published: July 2017

Robots are increasingly prominent in the popular imagination, partly through people playing with toys and using social media. This article examines a selection of user-created YouTube videos in different genres that reveal how people experiment with toy robots such as the Furby. These devices have features that support different styles of play, which producers of YouTube clips explore in short narratives. They reveal how the intersubjective conventions for relating to robots are currently being developed. YouTube stars produce vlogs (video blogs) telling stories about their search for Furbys, unboxing them, and experimenting with the toy’s playful and uncanny features. Set-piece video producers experiment with how Furbys interact with others, such as trying to communicate, confronting family pets or being destroyed with weapons. Being ‘almost alive’, toy robots are harbingers of autonomous technologies that have social agency.
‘There’s a Starman waiting in the sky’: Mourning David #Bowie on Twitter
Authors: Van den Bulck Hilde , Larsson Anders Olof
Published: July 2017

This article analyses Twitter responses to the death of musician David Bowie as an inroad to a discussion about characteristics and functions of Twitter in the mediated relationships between celebrities, fans and the popular culture industry. The study focuses on questions regarding the nature of the Twitter community, types of emotions as well as expressions of fan creativity and the composition of online mourners. To this end, it provides a broad analysis of all tweets with #Bowie in the first 48 h after Bowie passed away ( N = 252,318) and in-depth, quantitative and qualitative analysis of tweets with 100+ retweets ( N = 130). Results show high levels of retweeting and a limited number of tweets retweeted exceptionally often, suggesting a Twitter ‘elite’ leading the online mourning. This elite consists predominantly of media figures, celebrities, artists and music industry representatives rather than ‘regular’ individuals and fans, resulting in limited expressions of parasocial relationships. Besides being conduits of expressions of grief and information exchange, tweets focus on positive affirmation in tribute to Bowie’s work. Results confirm that Twitter provides a virtual gathering of mourners who are (presumably) looking for recognition of loss and for expressions of support.
‘Friendship isn’t an emotion fucknuts’: Manipulating affective materiality to shape the experience of Homestuck’s story
Authors: Veale Kevin
Published: July 2017

Homestuck is a textual and experiential chameleon that manipulates its own structure to shape the audience’s affective experience of the story by mimicking not just the storytelling techniques of other media forms, but their modes of engagement as well. This article introduces terminology to illustrate how and why the online serial Homestuck qualifies as a distinctive form of storytelling. I introduce the term transmodal engagement to illustrate how Homestuck uses the affective, experiential affordances of different media forms to sculpt and shape the experience of the text in completely different ways to ‘transmedia’ storytelling. The second term this article introduces is metamedia storytelling, which describes how the audience’s familiarity with storytelling across multiple media forms can be used to manipulate their experience of fiction. Homestuck deploys metamedia storytelling to continually destabilize the reader’s understanding of the text and their investments in the storyworld by forcing re-evaluations of not just what is happening, but what kind of mediated relationship the readers have with the content of the story.
Realtime Transfer of Live Video Images in Parallel with Three-Dimensional Modelling of the Surgical Field in Computer-Assisted Telesurgery
Authors: Klapan I , Šimičić Lj , Pasarić K , Vlahušić A , Rišavi R , Sruk V , Schwarz D , Barišić J
Published: July 2017

We have carried out three-dimensional, computer-assisted, functional endoscopic sinus telesurgery. Surgeons at different locations up to 300 km apart could not only see and transfer video images but also transfer three-dimensional computer models and manipulate them in realtime during surgery. Two different approaches were used. In the first telesurgery procedure we used M-JPEG compression and transmitted the data using fibre optic connections (ATM OC-3) at a bandwidth of 155 Mbit/s. In the second telesurgery procedure video images were transmitted over four E1 digital lines, amounting to about 8 Mbit/s of bandwidth, with better compression standards, such as MPEG1 and 2. We found that MPEG2 video compression produced the best picture quality for the operating field and endoscopic cameras. For conferencing and consultation between two or more connected sites during the surgery, we used JPEG and MPEG1 video compression with audio. The main feature of our three-dimensional telesurgery was the use of three-dimensional modelling of the operative field. This is important for emergency surgical interventions. We do not advocate that inexperienced surgeons operate on patients, not even with the guidance of a remote surgeon. However, three-dimensional telesurgery may become very valuable for experienced surgeons in the future.
Digital Storage of Glass Slides for Quality Assurance in Histopathology and Cytopathology
Authors: Demichelis Francesca , Della Mea Vincenzo , Forti Stefano , Palma Paolo Dalla , Beltrami Carlo Alberto
Published: July 2017

Proficiency testing programmes for measuring screening skills in pathology are mainly conducted using conventional glass microscope slides. However, the availability of robotic microscopes allows an entire conventional slide to be digitized. Our experiments have shown that, using a widely available robotized microscope and a PC, the image of a single field may be acquired in 2 s on average, including stage movements, autofocus and storage. Digitizing an entire slide, a fully automated procedure, takes up to 8 h. If the image of each field is compressed at an appropriate quality level (a compression ratio of, say, 35:1) it requires about 40 kByte to be stored, resulting in a total storage requirement of about 600 MByte per slide. Thus one CD-ROM can be used to store one virtual slide, as well as a self-installing program to provide a microscope simulator facility. This allows pathologists to examine the virtual case from their computer in a similar manner to looking at a glass slide on a conventional microscope. This permits a new, computer-based approach to proficiency testing in histopathology and cytopathology. Use of virtual slides should encourage the diffusion of national quality assurance programmes, which at present suffer from certain organizational and logistical limitations.
Managing Telemedicine: From Noble Ideas to Action
Authors: Linderoth Henrik C J
Published: July 2017

The aim of the present study was to elucidate how telemedicine can be used in an integrated and comprehensive manner. Two Swedish telemedicine projects were studied. The technical platform was an ISDN videoconferencing system which could be connected to various items of medical equipment. The first project, general telemedicine, concerned communication between two primary care centres, one county hospital and one university hospital. The specialties involved were dermatology, orthopaedics and otolaryngology. The second project, telepathology, included pathology and cytology at the university hospital, and surgery and gynaecology at a county hospital. The first round of interviews was conducted to reveal the expectations of the physicians regarding the potential benefits and applications of the technology and potential organizational obstacles. Subsequent interview rounds were carried out to reveal what had happened since the previous interview. In total 62 interviews were carried out with 32 respondents. The main conclusions were that the technology's generic features, namely the transmission of pictures and sound, had been translated into appropriate fields of application, which had been diffused and routinized in organizational activities. In order to facilitate this process, there were two crucial issues for managers. First, due to the ‘openness’ of the technology, actors who had the will to test the limits of the technology had to be identified and engaged. Second, while the use of the new technologies implied that new patterns of action were established, it was necessary to discover and develop routines that could be used as a facilitator for the further use of telemedicine.
A Health Monitoring System for Elderly People Living Alone
Authors: Ohta Shigeru , Nakamoto Hiroshi , Shinagawa Yoshimitsu , Tanikawa Tomohiro
Published: July 2017

We have developed a health monitoring system for elderly people living alone. We monitored the in-house movements of eight subjects (average age 81 years) by placing infrared sensors in each room of their homes. Because their movements were unrestricted, monitoring could last longer than other forms of monitoring. Continuous monitoring was performed for 80 months in total. We found that each subject had a specific pattern of movements. We estimated their health condition by comparing the duration of stays in specific rooms, such as the lavatory, with previously recorded data. If after analysis an unusual state was detected, we informed the family of the incident. Final decisions should be made by the family members, not automatically by computer software. For example, after contacting the subject or a neighbour by telephone, family members could call for an ambulance or arrange a visit by a doctor or home help. Thus, this system reduced anxiety for both the elderly subjects living alone and their family members.
Teleradiology from Primary Care: Comparison of User Activity in Two Different Scenarios
Authors: Salvador Carlos H , González Miguel A , Muñoz Adolfo , Pascual Mario
Published: July 2017

We recorded the activity over one year of users of two identical teleradiology systems installed at different primary care centres. In one centre, which generated 3711 cases, the process was conducted according to the decisions made by the general practitioner (GP); in the second, which generated 3786 cases, the radiologist at the referral hospital controlled the process. In a one-year study, the number of studies created, transmitted and interpreted per day was similar in the two scenarios (14.3 vs 14.6, respectively); however, there were considerable differences in the number of images (2.2 vs 1.8, respectively) and folder volume (19.2 vs 14.3 Mbyte, respectively) per study. Also, there were differences in the time taken to create the patient folders (4 min 35 s vs 2 min 55 s, respectively) and the time taken for the radiologist to diagnose a case (3 min 32 s vs 2 min 47 s, respectively), which may be important at high workloads. The radiologist-driven scenario included 64 rejected requests (1.6% of cases) and 280 studies in which additional images were required (7.4% of cases). Whenever it is possible to choose, the radiologist-driven scenario for teleradiology appears to be preferable. A prerequisite for successful teleradiology is the availability of appropriate bandwidth and operational protocols.
A Feasibility Study of Remote Monitoring of Asthmatic Patients
Authors: Steel S , Lock S , Johnson N , Martinez Y , Marquilles E , Bayford R
Published: July 2017

We assessed the feasibility of a remote monitoring system for asthmatic patients to use in their own homes. Eighty-four patients were invited to participate following discharge from hospital after an acute exacerbation of their asthma. We remotely monitored 33 patients from two hospitals for two weeks. Their mean age was 34 years (range 17–50 years). Patient compliance with monitoring was 80% (range 45–231%) and compliance with transmitting the results using a modem was 52% (range 0–100%). The average time spent teaching patients how to perform measurements was 16 min (range 2–55 min) and time spent providing asthma education was 39 min (range 5–135 min). Ninety-six per cent of patients found the equipment easy or very easy to use and 92% said they would use the equipment again in the future. Medical intervention occurred in 48% of patients during the study period, which suggests that the use of remote monitoring could be important in reducing asthma morbidity and improving treatment outcomes.
Cutaneous Vascular Responses to Acetylcholine are Mediated by a Prostanoid-Dependent Mechanism in Man
Authors: Khan Faisel , Davidson Neil C , Littleford Roberta C , Litchfield Stuart J , Struthers Allan D , Belch Jill JF
Published: July 2017

Approximately 50% of the forearm vasodilatation to intra-arterial infusions of acetylcholine is mediated by endothelium-derived nitric oxide. These conclusions have been derived from venous occlusion plethysmographic measurements of total forearm blood flow during co-infusions of acetylcholine and Ng-monomethyl-L-arginine (L-NMMA), an inhibitor of nitric oxide synthase. Since venous occlusion plethysmography measures total limb blood flow, the relative proportion of the measurement from skin cannot be determined precisely. To determine the effects of acetylcholine on skin specifically, we have used laser Doppler flowmetry to measure vascular responses to local iontophoresis of acetylcholine in the forearm of normal male volunteers. To elucidate the possible mechanisms of cutaneous vasodilatation to acetylcholine, vascular responses were measured before and after systemic inhibition of prostanoid production and nitric oxide synthesis by oral aspirin (600 mg daily for 3 days) and intravenous L-NMMA (3 mg/kg for 60 min), respectively. After aspirin administration, dose-dependent vascular responses to acetylcholine were reduced significantly by approximately 53% (p<0.005, ANOVA). In contrast, intravenous L-NMMA appeared to have no significant effect on cutaneous vascular responses to acetylcholine. While the role of nitric oxide is uncertain, vasodilatation to acetylcholine in the forearm skin is mediated largely by a prostanoid-dependent mechanism. Assessment of cutaneous vascular responses to iontophoresis of acetylcholine may, therefore, be useful in diseases where abnormal endothelium-dependent prostanoid function has been implicated.
Noninvasive Assessment of Endothelium-Dependent Flow-Mediated Dilation of the Brachial Artery
Authors: Uehata Akimi , Lieberman Eric H , Gerhard Marie D , Anderson Todd J , Ganz Peter , Polak Joseph F , Creager Mark A , Yeung Alan C
Published: July 2017

Coronary atherosclerosis is characterized by an early loss of endothelium-dependent vasodilation. However, the methods of assessing coronary endothelial function are invasive and difficult to repeat over time. Recently, a noninvasive ultrasound method has been widely used to measure flow-mediated dilation in the brachial artery as a surrogate test for endothelial function. We seek to further validate this method of measuring vascular function.

The brachial artery diameters and blood flow of 20 normal volunteers (10 males and 10 females) were measured using high resolution (7.5 MHz) ultrasound and strain gauge plethysmography. Flow-mediated endothelium-dependent vasodilation was measured in the brachial artery during reactive hyperemia after 5 minutes of cuff occlusion in the upper arm. The brachial artery diameter increased maximally by 9.7 ± 4.3% from baseline at 1 min after cuff release and blood flow increased by 1002 ± 376%. Five min of cuff occlusion was sufficient to achieve 97 ± 6% of maximal brachial artery dilation and degree of dilation was not different whether the cuff was inflated proximally or distally to the image site. The intraobserver variability in measuring brachial diameters was 2.9 % and the variability of the hyperemic response was 1.4%. In young, healthy men and women, the baseline brachial artery diameter was the only factor that was predictive of the flow-mediated vasodilation response.

The brachial noninvasive technique has been further validated by the determination of flow-mediated dilation. This method of assessing endothelial function may help to determine the importance of vasodilator dysfunction as a risk factor in the development of atherosclerosis.
Role of Endothelial Cells in Allograft Rejection
Authors: Rose Marlene L
Published: July 2017

The immunological properties of endothelial cells suggest they perform a pivotal role in acute and chronic rejection following solid organ transplantation. Their constitutive expression of MHC class II molecules (which initiate allograft rejection by activating CD4 T cells) and accessory molecules allows them to present foreign antigen by both the direct and indirect route to the recipient's immune system. The costimulatory molecules used by endothelial cells appear to differ from those used by traditional antigen-presenting cells such as B cells and dendritic cells. Release of non-HLA antigens from damaged endothelial cells results in a chronic antibody response — possibly contributing to graft vasculopathy and chronic rejection. Further understanding of the factors that regulate MHC class II and accessory molecule expression on endothelial cells could lead to novel strategies of therapeutic intervention.
Development of Vascular Complications in Diabetes
Authors: McMillan Donald E
Published: July 2017

Chronic complications of diabetes are dominated by disorders of the vascular system. They are a much larger burden on both diabetic patients and overall medical costs than diabetes itself. Large vessel problems are far more frequent than microvascular disorders. Loss of arterial elasticity alters arterial flow patterns and increases microcirculatory peak flow rates. Hyperglycemia may directly disrupt elastin formation. Diabetic leg artery disease may be generated by nerve damage, reversing this interactive contribution sequence.

The major anatomic feature of microangiopathy in long-term diabetes is an unevenly distributed thickening of the intima of smaller arterioles. The thickening is primarily due to accumulation of type IV (basement membrane) collagen. Arterioles change local vessel diameter to adjust blood distribution to meet current needs. The thickening compromises the maximum local blood flow that may be achieved by this means.

Compromise of maximal arteriolar dilatation does not disrupt exercising muscle but in the kidney, retina, and possibly in nerve, local circumstances can generate serious damage. Each of these system's responses has unique features that mediate its vulnerability, but all these organs show arteriolar hyalinization.

The increased arteriolar accumulation of type IV collagen appears to be a response to the tangential force generated by flow over local endothelial cells. An increase in peak arteriolar wall force is mediated by a diabetes-specific doubling of erythrocyte membrane curvature change resistance. Red cell aggregation rate determines the rate of damage. The same nonspecific burden may also predispose to heart disease and stroke.

Intensive metabolic control improves red cell deformability and protects against arteriolar damage. Therapies that address the rheologic problem more directly may add to the effectiveness of good diabetes control in the future.
Experimental investigation of shear models for lightweight aggregate concrete deep beams
Authors: Wu Tao , Wei Hui , Liu Xi
Published: July 2017

The strut-and-tie model has become an effective design methodology for deep beams replacing the conventional beam theory that does not apply to these members due to their geometric or static stress discontinuities. This article examines the applicability of shear models for deep beams with lightweight aggregate concrete. Eight lightweight aggregate concrete deep beams were constructed and tested to failure under concentrated loading. Tests were conducted to investigate the effects of shear span-to-effective depth ratio ( a/d), ranging from 0.26 to 1.04, and an effective span–depth ratio ( le/ h), ranging from 2 to 3, on the failure mode and shear behavior of deep beams. All specimens presented a shear compression or shear-flexure failure mode. Failure from the flexure mode showed a dominant pattern with increasing a/d. The le/ h value minimally influenced the diagonal cracking and ultimate strength of deep beams. In contrast, a/d significantly affected the beam strength. Our results were compared with predictions proposed by American Concrete Institute 318-14, Canadian Standard, EC2, the Tan and Cheng model, the softened strut-and-tie model, and the simplified softened strut-and-tie model, which are all based on the strut-and-tie model. These comparisons indicated that all of these shear methods can be used to predict the shear strength of lightweight aggregate concrete deep beams.
Calibration of a simplified macro-model for infilled frames with openings
Authors: Furtado André , Rodrigues Hugo , Arêde António
Published: July 2017

During the last years, some experimental efforts were conducted in order to evaluate the in-plane cyclic behaviour of infilled reinforced concrete frames considering and not openings. From the experiments, it was observed that the openings reduced infill panels’ stiffness, strength and energy dissipation capacity. In the literature, there are different numerical approaches to predict the infill panels expected behaviour with and/or without openings when subjected to in-plane demands. The experimental data are of full importance to calibrate the numerical models and evaluate their accuracy. A good calibration of the numerical models could result on a better and accurate safety assessment of the existing buildings and designing of the new ones. The main aim of this article is to evaluate the capacity of a simplified double strut model to represent the cyclic behaviour of infilled reinforced concrete frames with and without openings using the software OpenSees. The five infilled reinforced concrete frames tested by different authors and with different configurations will be simulated. Details from each specimen modelling will be provided along the article, and the accuracy of this numerical modelling approach will be evaluated in terms of force–displacement hysteretic curves. Additionally, a state-of-art review regarding the in-plane tests will be presented containing the main characteristics of the specimens and conclusions performed by each author.
An improved nonlinear analytical approach to generate fragility curves of reinforced concrete columns subjected to blast loads
Authors: Yu Runqing , Chen Li , Fang Qin , Huan Yi
Published: July 2017

Fragility curve is an efficient tool that is usually used to predict the failure probability of engineering structures in the damage assessment. To generate fragility curves for reinforced concrete columns under blast loads, a deterministic nonlinear analytical approach was first modified to consider the parameter uncertainties in materials, dimensions, and bearded loads. Monte Carlo simulation was applied to generate the corresponding fragility curves on the basis of the proposed approach. Damage of a typical reinforced concrete column under blast loads was assessed with the generated fragility curves. It was concluded that besides the standoff distance and equivalent trinitrotoluene charge, the axial force also significantly affected the damage of reinforced concrete columns under blast loads, especially in the moderate and large scaled distance.
Neoliberalism and the recommodification of health inequalities: A case study of the Swedish welfare state 1980 to 2011
Authors: Farrants Kristin , Bambra Clare
Published: July 2017

Aims: This paper examines the effects of neoliberalism on health inequalities through an empirical examination of the recommodification of the social determinants of health. It uses a detailed case study of changes to three specific welfare policy domains in Sweden: unemployment, healthcare, and pensions. Methods: Using time series data from the repeat cross-sectional Swedish Living Conditions Survey for 1980–2011, it examines: (1) the effects of reductions in the replacement rate value of unemployment benefit on inequalities in self-reported general health between the employed and the unemployed; (2) the effects of reductions in the replacement rate value of pensions on educational inequalities in self-reported general health among pensioners; and (3) the effects of the increase in user charges on inequalities in having visited a doctor in the past 3 months by educational level. Results: The results suggest mixed effects of welfare state recommodification on health inequalities: inequalities increased between the Swedish employed and unemployed, yet they did not increase in the retired population, and inequalities in access to healthcare also remained steady during the study period. Conclusions: The paper concludes that the association between recommodification and health inequalities in Sweden is stronger regarding unemployment benefits than pensions or healthcare, and that this may relate to the stigmatisation of the unemployed.