bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and validation of an advanced entrained flow reactor system for studies of rapid solid biomass fuel particle conversion and ash formation reactions
Authors: Wagner David R. , Holmgren Per , Skoglund Nils , Broström Markus
Published: June 2018

The design and validation of a newly commissioned entrained flow reactor is described in the present paper. The reactor was designed for advanced studies of fuel conversion and ash formation in powder flames, and the capabilities of the reactor were experimentally validated using two different solid biomass fuels. The drop tube geometry was equipped with a flat flame burner to heat and support the powder flame, optical access ports, a particle image velocimetry (PIV) system for in situ conversion monitoring, and probes for extraction of gases and particulate matter. A detailed description of the system is provided based on simulations and measurements, establishing the detailed temperature distribution and gas flow profiles. Mass balance closures of approximately 98% were achieved by combining gas analysis and particle extraction. Biomass fuel particles were successfully tracked using shadow imaging PIV, and the resulting data were used to determine the size, shape, velocity, and residence time of converting particles. Successful extractive sampling of coarse and fine particles during combustion while retaining their morphology was demonstrated, and it opens up for detailed time resolved studies of rapid ash transformation reactions; in the validation experiments, clear and systematic fractionation trends for K, Cl, S, and Si were observed for the two fuels tested. The combination of in situ access, accurate residence time estimations, and precise particle sampling for subsequent chemical analysis allows for a wide range of future studies, with implications and possibilities discussed in the paper.
Note: Optics design of a periscope for the KSTAR visible inspection system with mitigated neutron damages on the camera
Authors: Lee Kyuhang , Ko Jinseok , Wi Hanmin , Chung Jinil , Seo Hyeonjin , Jo Jae Heung
Published: June 2018

The visible TV system used in the Korea Superconducting Tokamak Advanced Research device has been equipped with a periscope to minimize the damage on its CCD pixels from neutron radiation. The periscope with more than 2.3 m in overall length has been designed for the visible camera system with its semi-diagonal field of view as wide as 30° and its effective focal length as short as 5.57 mm. The design performance of the periscope includes the modulation transfer function greater than 0.25 at 68 cycles/mm with low distortion. The installed periscope system has confirmed the image qualities as designed and also as comparable as those from its predecessor but with far less probabilities of neutral damages on the camera.
Preface: Special Topic on Ions in Water
Authors: Allen Heather C. , Tobias Douglas J.
Published: June 2018

This special topic contains a diverse collection of 40 articles that span the vast range of subjects that fall under the heading “Ions in Water,” a longstanding mainstay of chemical physics. The investigations reported herein employ state-of-the-art theoretical, computational, and experimental techniques, as well as combinations thereof, to provide new insights into the fundamental aspects of ion solvation and the important roles that ions play in mediating physicochemical processes occurring in solutions and at interfaces in a wide variety of settings relevant to biological, environmental, and technological applications.
The Sun’s magnetic midlife crisis
Authors: Metcalfe Travis S.
Published: June 2018

Old Sun-like stars observed by the Kepler Space Telescope spin faster than astronomers expected. Apparently, they experience a dramatic shift in their rotation and magnetism at about middle age.
Seed germination of coastal monsoon vine forest species in the Northern Territory, Australia, and contrasts with evergreen rainforest
Authors: Thusithana Vidushi , Bellairs Sean M. , Bach Christine S.
Published: June 2018

Seed germination traits of seasonal rainforest species differ from permanently moist evergreen rainforest species due to the prolonged seasonal drought. We investigated whether seed germination traits used to categorise evergreen rainforest species into pioneer and climax guilds were applicable to seasonal rainforest species. Seed dormancy, light requirements for germination and seed storage types of five climax and thirteen pioneer species of a coastal vine thicket were studied. Results were compared with published studies of evergreen rainforest species. Evergreen rainforest pioneer species are typically dormant, require light to germinate and tolerate desiccation, whereas climax species are typically non-dormant, tolerate shade during germination and are sensitive to desiccation. In seasonal rainforest we found that a high proportion of pioneer species had seeds that were non-dormant (62%), and a high proportion of pioneer species germinated equally well in light and dark conditions. In seasonal rainforest, we found that the majority of climax species had desiccation tolerant seeds, whereas in evergreen rainforest the proportion of climax species producing desiccation sensitive seeds is equal to or greater than the proportion of species with desiccation tolerant seeds. In seasonal rainforest species physical, physiological and epicotyl dormancy types were found. Generally, for seasonal rainforest species, the prevalent form of dormancy in pioneer species was physical dormancy whereas physiological dormancy was most common in evergreen rainforest pioneer species with dormancy. Our results suggest that the contrasting seed biology traits that typically apply to pioneer and climax species of evergreen rainforest species don’t typically apply to seasonal rainforest species.
Proteomic analysis of follicular fluid in carriers and non-carriers of the Trio allele for high ovulation rate in cattle
Authors: Kamalludin Mamat H. , Garcia-Guerra Alvaro , Wiltbank Milo C. , Kirkpatrick Brian W.
Published: June 2018

This study was conducted to characterise differences in follicular fluid proteins between carriers and non-carriers of a bovine allele for high ovulation rate. A total of four non-carrier and five carrier females were used in an initial study with four and six additional non-carriers and carriers respectively used in a validation study. Emergence of the follicular wave was synchronised and the ovaries containing the dominant follicle(s) were extracted by ovariectomy for follicular fluid collection. A hexapeptide ligand library was used to overcome the masking effect of high-abundance proteins and to increase detection of low-abundance proteins in tandem mass spectrometry. After correcting for multiple comparisons, only two proteins, glia-derived nexin precursor (SERPINE2) and inhibin β B chain precursor (INHBB), were significantly differentially expressed (false-discovery rate <0.05). In a replicate study of analogous design differential expression was confirmed (P < 0.05). Joint analysis of results from the two studies indicated that three additional proteins were consistently differentially expressed between genotypes. For three of these five, previous studies have indicated that expression is increased by transforming growth factor-β–bone morphogenetic protein signalling; their reduction in follicular fluid from carrier animals is consistent with the ~9-fold overexpression of SMAD family member 6 (SMAD6) in carriers that is inhibitory to this pathway.
Nationalism as classification: suggestions for reformulating nationalism research
Authors: Maxwell Alexander
Published: June 2018

Instead of thinking about “national identity,” scholars of nationalism would do well to study nationalism as a process of classification, treating national conflict as disputes over nationalized categories. Disputes over national classification take various forms: patriots argue over which category applies, which categories exist, and which categories have which status. Techniques for imposing classificatory categories also deserve attention. The contributors to this themed issue ofNationalities Papersillustrate the power of analysis based on classification.
Erosion wear characterisation of DLC and AlCrN-based coated AISI-304/316 steels
Authors: Singh Gursharan , Singh Sukhinderpal , Grewal Jasmaninder Singh
Published: June 2018

This study has been made, in the context of a live problem at GNDTPP, Bathinda, Punjab, to evaluate to erosion wear behaviour of diamond-like carbon (DLC) and AlCrN-based coated AISI-304 & AISI-316 boiler steels. Most of the power is generated through the thermal power produced through using coal which produces a lot of ash which is the primary reason behind solid particle erosion (SPE) of the components. The objective of this work is to improve surface properties so as to counter SPE specifically in boiler components. DLC, AlCrN-based monolayer and AlCrN-based multilayer coatings were deposited using PVD technique on the stainless steels substrates. The substrates were tested at an angle of 90 and 30° with air velocity taken as 35 m s–1, air temperature as 800°. X-ray diffraction and SEM/EDAX technique were used for analysing different samples. AlCrN-based multilayer coating can reduce the weight loss from 30 to 80%.
Diffusion brazing repair of IN738 superalloy with crack-like defect: microstructure and tensile properties at high temperatures
Authors: Ye Y. , Zou G. , Long W. , Jia Q. , Bai H. , Wu A. , Liu L.
Published: June 2018

In this study, tapered slots with an opening width about 200 μm were artificially fabricated in IN738LC superalloy to imitate service cracks. The ‘cracks’ were repaired by diffusion brazing with a Ni–Cr–Co–Al–Ta–B filler alloy at 1150°C and then heat treated at 1180°C (HT-A) and 1190°C (HT-B), respectively. A joint with uniform microstructure, chemical composition and hardness was obtained using HT-B. The mechanisms of the borides evolution during homogenisation were discussed. The tensile strength of the HT-B joint tested at 20, 600 and 800°C reached up to approximately 96, 90 and 87% of the base metal, respectively. The fracture modes of the joints tensile tested at various temperatures were discussed.
Comparison of the air-kerma standards of the NRPA, the STUK, the SSM and the LNE-LNHB in low-energy and mammography x-ray ranges (EURAMET.RI(I)-S14)
Authors: Bjerke H , Plagnard J , Bordy J-M , Kosunen A , Lindholm C , Persson L , Hetland P O
Published: June 2018

A supplementary comparison has been made between the air-kerma standards of the NRPA, Norway, the STUK, Finland, the SSM, Sweden and the LNE-LNHB, France in the low-energy x-ray range, and between the NRPA and the LNE-LNHB in the mammography x-ray range. The technical protocol was approved by the CCRI(I) in April 2016. The results show the standards to be in agreement at the level of the standard uncertainty of the comparison of 6.8, 10.0 and 7.4 parts in 10³ for the NRPA, the STUK and the SSM respectively. For mammography, the standard uncertainty was 5.3 parts in 103 for the NRPA. The results are analysed and presented in terms of degrees of equivalence.

KEY WORDS FOR SEARCH

Supplementary comparison, air kerma, low energy x-rays, mammography, radiation dosimetry

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Comparison of the air-kerma x-ray standards of the NRPA, the STUK, the SSM and the LNE-LNHB in the ISO 4037 narrow spectrum series in the range 40 kV to 300 kV (EURAMET.RI(I)-S3.2)
Authors: Bjerke H , Plagnard J , Bordy J-M , Kosunen A , Huikari J , Persson L , Hetland P O
Published: June 2018

A supplementary comparison has been made between the air-kerma standards of the NRPA (Norway), the STUK (Finland) the SSM (Sweden) and the LNE-LNHB (France) in the ISO 4037 narrow spectrum series in the range 40 kV to 300 kV. The technical protocol was approved by the CCRI(I) in April 2016. The results show the standards to be in agreement at the level of the standard uncertainty of 12, 14 and 8 parts in 10³ for the NRPA, the STUK and the SSM respectively. The results are analysed and presented in terms of degrees of equivalence.

KEY WORDS FOR SEARCH

Supplementary comparison, air kerma, narrow spectrum series, radiation dosimetry

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCRI, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
High-density peripheral nerve cuffs restore natural sensation to
individuals with lower-limb amputations
Authors: Charkhkar Hamid , Shell Courtney E , Marasco Paul D , Pinault Gilles J , Tyler Dustin J , Triolo Ronald J
Published: June 2018

Objective. Sensory input in lower-limb amputees is critically
important to maintaining balance, preventing falls, negotiating uneven terrain,
responding to unexpected perturbations, and developing the confidence required
for societal participation and public interactions in unfamiliar environments.
Despite noteworthy advances in robotic prostheses for lower-limb amputees, such
as microprocessor knees and powered ankles, natural somatosensory feedback from
the lost limb has not yet been incorporated in current prosthetic technologies.
Approach. In this work, we report eliciting somatic
sensation with neural stimulation delivered by chronically-implanted,
non-penetrating nerve cuff electrodes in two transtibial amputees. High-density,
flexible, 16-contact nerve cuff electrodes were surgically implanted for the
selective activation of sensory fascicles in the nerves of the posterior thigh
above the knee. Electrical pulses at safe levels were delivered to the nerves by
an external stimulator via percutaneous leads attached to the cuff electrodes.
Main results. The neural stimulation was perceived by
participants as sensation originating from the missing limb. We quantitatively
and qualitatively ascertained the intensity, modality as well as the location
and stability of the perceived sensations. Stimulation through individual
contacts within the nerve cuffs evoked repeatable sensations of various
modalities and at discrete locations projected to the missing toes, foot and
ankle, as well as in the residual limb. In addition, we observed a high overlap
in reported locations between distal versus proximal cuffs suggesting that the
same sensory responses could be elicited from more proximal points on the nerve.
Significance. Based on these findings, the high-density
cuff technology is suitable for restoring natural sensation to lower-limb
amputees and could be utilized in developing a neuroprosthesis with natural
sensory feedback. The overlap in reported locations between proximal and distal
cuffs indicates that our approach might be applicable to transfemoral amputees
where distal muscles and branches of sciatic nerve are not available.
Two Harvests Are Better than One: Double Cropping as a Strategy for Climate Change Adaptation
Authors: Kawasaki Kentaro
Published: June 2018

Adaptation of agriculture to climate change is essential for reducing its negative impacts. This article evaluates the feasibility of double cropping, which has received relatively little consideration yet holds potential as an adaptation strategy. To assess its feasibility, growing seasons and economic profitability as calculated from crop yield and quality are considered. Accordingly, methods are developed for quantifying the determinants of crop yield and quality grade in a simultaneous equation system that directly expresses the ordered and fractional nature of grade shares. An empirical application to rice and wheat production in Japan reveals that, without any adaptation strategy, climate change will decrease revenues of both crops due to the reduction in yield and quality. Adjusting planting dates helps to avoid such negative impacts for rice but not enough for wheat in southern Japan. However, climate change provides an opportunity for another adaptation strategy—double cropping. Warmer climates enable many regions to shift from a single cropping system to a rice‐wheat double cropping system by shortening the length of the wheat growing season and by delaying the optimal timing of rice planting. As a consequence, the area suitable for double cropping is nearly tripled, suggesting a strong potential to offset climate‐induced production and profit losses.
OpenNotes and shared decision making: a growing practice in clinical transparency and how it can support patient-centered care
Authors: Fossa Alan J , Bell Sigall K , DesRoches Catherine
Published: June 2018

Objective

Prior studies suggest inviting patients to read their visit notes (OpenNotes) has important benefits for patient engagement. We utilized survey data to investigate our hypothesis that patients who read more notes would report greater shared decision making (SDM).

Materials and Methods

Our survey focused on the safety and quality implications of OpenNotes. 24 722 patients at an urban healthcare organization were invited to complete the survey, which included an item assessing the number of notes read and the CollaboRATE scale to measure SDM. We used log-binomial regression to estimate the relative probability of top CollaboRATE scores across number of notes read while controlling for several covariates.

Results

6913 patients responded (28% response rate). Patients reading 4+ clinical notes in the past 12 months were 17% more likely to have top CollaboRATE scores when compared to patients who had not read a note in the previous 12 months (RR: 1.17, 95%CI: 1.04-1.32).

Discussion

There is a clear relationship between what SDM requires and the transparency OpenNotes provides. Access to clinicians’ notes can support the SDM model, which relies on efficient information exchange between clinicians and well-informed patients.

Conclusion

Our study showed evidence of a relationship between note reading and perceived SDM. Implementation of SDM is likely to expand, given its association with improved patient satisfaction, adherence, and medical decision making. Findings from this study highlight OpenNotes as a policy that institutions can implement as a facilitator of SDM and a manifestation of their commitment to patient autonomy and transparency.
Sources of state discipline: lessons from Israel’s developmental state, 1948–1973
Authors: Maggor Erez
Published: June 2018

Both the classic literature on the developmental state and more recent accounts of rapid-innovation-based (RIB) development highlight the importance of the state's capacity to discipline underperforming firms. Although long acknowledged, the sources of this capacity remain relatively understudied, and existing knowledge draws almost exclusively on the East Asian experience. To address this lacuna, I examine the successful industrialization experience of Israel in the two and a half decades following its independence (1948–1973). Drawing on archival materials and other original sources, I identify a novel path to state discipline. Whereas East Asian developmental states became disciplinarian through their engagement with export competition, in Israel, state elites generated discipline by leveraging their embedded relations with collectively owned enterprises to foster a competitive domestic market. In the conclusion, I explore the relevance of this model for more contemporary cases of RIB development in both developed and late-developing economies.
Periosteal Electrical Dry Needling as an Adjunct to Exercise and Manual Therapy for Knee Osteoarthritis
Authors: Dunning James , Butts Raymond , Young Ian , Mourad Firas , Galante Victoria , Bliton Paul , Tanner Michelle , Fernández-de-las-Peñas César
Published: June 2018

Objectives:

To compare the effects of adding electrical dry needling into a manual therapy (MT) and exercise program on pain, stiffness, function, and disability in individuals with painful knee osteoarthritis (OA).

Materials and Methods:

In total, 242 participants (n=242) with painful knee OA were randomized to receive 6 weeks of electrical dry needling, MT, and exercise (n=121) or MT and exercise (n=121). The primary outcome was related-disability as assessed by the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index at 3 months.

Results:

Individuals receiving the combination of electrical dry needling, MT, and exercise experienced significantly greater improvements in related-disability (WOMAC: F=35.504; P<0.001) than those receiving MT and exercise alone at 6 weeks and 3 months. Patients receiving electrical dry needling were 1.7 times more likely to have completely stopped taking medication for their pain at 3 months than individuals receiving MT and exercise (OR, 1.6; 95% confidence interval, 1.24-2.01; P=0.001). On the basis of the cutoff score of ≥5 on the global rating of change, significantly (χ2=14.887; P<0.001) more patients (n=91, 75%) within the dry needling group achieved a successful outcome compared with the MT and exercise group (n=22, 18%) at 3 months. Effect sizes were large (standardized mean differences >0.82) for all outcome measures in favor of the electrical dry needling group at 3 months.

Discussion:

The inclusion of electrical dry needling into a MT and exercise program was more effective for improving pain, function, and related-disability than the application of MT and exercise alone in individuals with painful knee OA.

Level of Evidence:

Level 1b—therapy. Prospectively registered February 10, 2015 on www.clinicaltrials.gov (NCT02373631).
Building Resilience Among Orphaned and Vulnerable Children Through the Memory Book Intervention
Authors: Braband Barbara J. , Faris Tamara , Wilson-Anderson Kaye
Published: June 2018

Children who are orphaned and vulnerable due to poverty, war, or disease (HIV/AIDS) may experience childhood traumatic grief. A qualitative phenomenological approach was implemented to explore and compare the lived experiences of orphaned children, adolescents, and caregivers who had used the Memory Book intervention at six children's homes in India, Kenya, and South Africa. Study findings revealed similar themes between the countries, with primary themes of identity and relationships, and secondary themes of coping, hope, and emotion. Findings suggest the value of Memory Book resources to encourage the preservation of a child's story and grief recovery that can be used for any child facing recovery from difficult life events.
Seeking Spiritual Solutions to Nurse Incivility
Authors: Wetter Vicki
Published: June 2018

After experiencing a hostile clinical environment as a student nurse, the author's resolve to reduce nurse hostility resulted in investigation of workplace incivility and the creation of a learning module for nurses at her facility. Applying biblical counsel and personal reflection are tools a Christian nurse can draw on to counteract workplace hostility.
The Association Between Length of Recovery Following Sport-Related Concussion and Generic and Specific Health-Related Quality of Life in Adolescent Athletes: A Prospective, Longitudinal Study
Authors: Valovich McLeod Tamara , Bay R. Curtis , Lam Kenneth C. , Snyder Valier Alison R.
Published: June 2018

Objective:

Our purpose was to determine the association between concussion recovery and health-related quality of life (HRQOL).

Setting:

Secondary school athletic training facilities.

Participants:

Patients (N = 122) with a concussion.

Study Design:

Prospective, longitudinal cohort.

Main Measures:

The Pediatric Quality-of-Life Inventory (PedsQL), PedsQL Multidimensional Fatigue Scale (MFS), and Headache Impact Test-6 (HIT-6) were completed at preseason and days 3 (D3), 10 (D10), and 30 (D30) postconcussion. The independent variable was the recovery group.

Results:

Interactions between group and time (P < .001) were noted for all PedsQL subscales, except Social Functioning (P = .75). Significantly lower scores were found among Prolonged than in Short on D3 (P < .05). Significant interactions (P < .001) were also noted for all MFS subscales. Pairwise comparisons for General and Sleep subscales revealed Prolonged had lower scores than Short and Moderate on D3 and D10. A group by time interaction was found for the HIT-6 (P < .001), with scores being higher (P < .01) in Prolonged than in Short on D3 and D10.

Conclusions:

Adolescents with a prolonged recovery demonstrated lower HRQOL in the immediate days postinjury, particularly in physical and school functioning, fatigue, and headache. There was a strong association between recovery length and school functioning. Additional research is needed to understand how to minimize the impact of concussion on HRQOL.
Race/Ethnicity and Retention in Traumatic Brain Injury Outcomes Research: A Traumatic Brain Injury Model Systems National Database Study
Authors: Sander Angelle M. , Lequerica Anthony H. , Ketchum Jessica M. , Hammond Flora M. , Gary Kelli Williams , Pappadis Monique R. , Felix Elizabeth R. , Johnson-Greene Douglas , Bushnik Tamara
Published: June 2018

Objective:

To investigate the contribution of race/ethnicity to retention in traumatic brain injury (TBI) research at 1 to 2 years postinjury.

Setting:

Community.

Participants:

With dates of injury between October 1, 2002, and March 31, 2013, 5548 whites, 1347 blacks, and 790 Hispanics enrolled in the Traumatic Brain Injury Model Systems National Database.

Design:

Retrospective database analysis.

Main Measure:

Retention, defined as completion of at least 1 question on the follow-up interview by the person with TBI or a proxy.

Results:

Retention rates 1 to 2 years post-TBI were significantly lower for Hispanic (85.2%) than for white (91.8%) or black participants (90.5%) and depended significantly on history of problem drug or alcohol use. Other variables associated with low retention included older age, lower education, violent cause of injury, and discharge to an institution versus private residence.

Conclusions:

The findings emphasize the importance of investigating retention rates separately for blacks and Hispanics rather than combining them or grouping either with other races or ethnicities. The results also suggest the need for implementing procedures to increase retention of Hispanics in longitudinal TBI research.
Traumatic Brain Injury and the Risk for Subsequent Crime Perpetration
Authors: Bonow Robert H. , Wang Jin , Zatzick Douglas F. , Rivara Frederick P. , Rowhani-Rahbar Ali
Published: June 2018

Objective:

To examine whether patients with traumatic brain injury (TBI) are at higher risk for subsequent crime perpetration compared with injured patients without TBI and those hospitalized for reasons other than injury.

Setting and Participants:

Patients hospitalized in Washington State from 2006-2007.

Design:

A retrospective cohort study using linked statewide datasets.

Main measures:

Primary outcomes were arrest for any violent or nonviolent crime within 5 years of discharge. Adjusted subhazard ratios were calculated using regression models incorporating death as a competing risk.

Results:

Compared with uninjured patients (n = 158 247), the adjusted rate of arrest for any crime was greater among injured patients with TBI (n = 6894; subdistribution hazard ratios [sHR], 1.57; 95% confidence interval [CI], 1.49-1.62) and without TBI (n = 40 035; sHR, 1.55; 95% CI, 1.49-1.62). When patients with TBI were directly compared with injured patients without TBI, no effect of TBI on subsequent arrests was found (sHR, 1.02; 95% CI, 0.94-1.11). TBI did not increase the likelihood of either violent or nonviolent crime when these outcomes were examined separately.

Conclusions:

TBI survivors do not appear to be at increased risk for criminality compared with injured individuals without TBI. However, injured persons with or without TBI may be at elevated risk of crime perpetration compared with those who are uninjured.
Preloaded Descemet Membrane Endothelial Keratoplasty Donor Tissue: Surgical Technique and Early Clinical Results
Authors: Newman Lara R. , DeMill David L. , Zeidenweber Dorian A. , Mayko Zachary M. , Bauer Alex J. , Tran Khoa D. , Straiko Michael D. , Terry Mark A.
Published: June 2018

Purpose:

To describe the technique, advantages, and early complication rates of using Descemet membrane endothelial keratoplasty (DMEK) donor tissue that is prestained and preloaded into an injector at the eye bank and delivered in a storage medium to the surgeon for transplantation 1 to 2 days later.

Methods:

A total of 111 eyes with endothelial failure underwent DMEK using donors that were prestripped, prestained, S-stamped, and preloaded into a Straiko modified Jones tube and delivered in an Optisol-filled viewing chamber 1 to 2 days later. Scroll tightness, time to unscroll and center the tissue, postoperative rebubble rate, and graft failure rate were recorded. Endothelial cell density was measured at 3 and 6 months.

Results:

All tissues remained well stained with easy visualization at the time of surgery (n = 111). The mean scroll tightness was 2.2 (range: 1–4). The mean time to center and unscroll the tissue was 3.5 minutes (range: 0.5–11.25 min). There was no primary graft failure. There were 16 cases with the placement of another bubble postoperatively (with a 14.4% rebubble rate). Of those 16 cases, 2 required a second rebubble. Endothelial cell loss at 3 and 6 months postoperatively was 26.7% (n = 63 eyes) and 30.9% (n = 67 eyes), respectively.

Conclusions:

This is the first report of the clinical use of prestained, preloaded tissue for DMEK. The characteristics and handling of the tissue were not different from those of surgeon-loaded tissue. Because punching, staining, and loading the graft intraoperatively is not necessary, the surgery time and risk of damaging donor tissue are reduced when using preloaded tissue.
Possible Risk Factors and Clinical Outcomes of Black Areas in Small-Incision Lenticule Extraction
Authors: Ma Jiaonan , Wang Yan , Chan Tommy C. Y.
Published: June 2018

Purpose:

To investigate the possible risk factors and clinical effects of black areas in small-incision lenticule extraction.

Methods:

Thirty-one cases and 126 controls were enrolled in a case–control study from the database of a single center from September 2012 to July 2017. A retrospective analysis of surgical procedures with video and medical records was performed. Logistic regression analysis was used to assess the possible risk factors for black areas between cases with black areas and controls without black areas.

Results:

In the study, 19 eyes (61.3%) with black areas were associated with the presence of surface debris, 10 of which had repeated suction during docking and centration (P < 0.001). There was a significant difference in the energy of the femtosecond laser used for the cases (133 ± 4.04 nJ) and controls (138 ± 3.26 nJ) (P < 0.001). The odds ratio for the energy of the laser was 0.180 (95% confidence interval, 0.099–0.328, P < 0.001). Eyes with black areas had poorer uncorrected vision at 1 and 7 days and 1 month postoperatively (0.06, 0.01, and 0.00 logMAR, respectively) compared with controls (−0.01, −0.07, and −0.05 logMAR, respectively) (P < 0.005). At month 3, the safety index was lower in the cases (1.14 ± 0.47) compared with controls (1.36 ± 0.28) (P = 0.003). The postoperative spherical equivalent in the cases was more myopic than in controls (P = 0.036), except for month 3 (P = 0.183).

Conclusions:

Black areas in small-incision lenticule extraction could be caused by repeated suction, presence of surface debris, and a lower energy of the femtosecond laser. These factors could result in rough dissection and slower recovery of visual acuity.
Endothelium-in Versus Endothelium-out Insertion With Descemet Membrane Endothelial Keratoplasty
Authors: Price Marianne O. , Lisek Marek , Kelley Meagan , Feng Matthew T. , Price Francis W.
Published: June 2018

Purpose:

To determine whether graft orientation during insertion affects Descemet membrane endothelial keratoplasty (DMEK) outcomes.

Methods:

This was a retrospective analysis of 754 consecutive DMEK cases performed by 2 experienced surgeons to treat Fuchs dystrophy. Both surgeons used an intraocular lens insertor. One surgeon always inserted the tissue scrolled endothelium outward (group 1, n = 245). The other surgeon tested 3 methods: endothelium-outward scroll configuration (group 2, n = 161), endothelium-inward trifold configuration (group 3, n = 172), and trifold configuration with concurrent use of an anterior chamber maintainer (group 4, n = 176). The main outcome measures were rebubbling rate, regrafting or failure within 6 months, and 6-month endothelial cell loss. The tissue unfolding time from graft insertion to air fill was measured in a subset of 120 cases by 1 surgeon.

Results:

The rebubbling rates were comparable across groups (ie, 12%, 10%, 10%, and 13% for groups 1, 2, 3, and 4, respectively, P = 0.21). The 6-month graft failure/replacement rates were comparable across groups (ie, 0.8%, 1.2%, 2.3%, and 0.6%, respectively, P = 0.18). Similarly, the 6-month endothelial cell loss did not differ significantly between groups (ie, 28% ± 11%, 30% ± 13%, 28% ± 15%, and 27% ± 13%, respectively, P = 0.019). In the subset analysis, the tissue unfolding time was similar for scroll and trifold configurations (6.0 ± 3.5 vs. 5.4 ± 3.0 minutes, respectively, P = 0.43).

Conclusions:

The outcomes were similar for endothelium-out and endothelium-in (trifold) insertion methods with DMEK, suggesting that the choice is a matter of surgeon preference.
Sensory profiles and skin innervation of patients with painful and painless neuropathies
Authors: Üçeyler Nurcan , Vollert Jan , Broll Barbara , Riediger Nadja , Langjahr Melissa , Saffer Nadine , Schubert Anna-Lena , Siedler Gabriela , Sommer Claudia
Published: June 2018

We assessed pain characteristics and sensory profiles of a large and extensively phenotyped cohort of patients with polyneuropathies (PNPs) and small fiber neuropathy (SFN) using quantitative sensory testing (QST). Our aim was to detect potentially discriminative QST profiles of patient subgroups determined by pain, etiology, or skin innervation. We prospectively recruited 350 patients with painful and painless PNPs and with SFN at 1 neuromuscular center. After neurological work-up, patients underwent QST at the dorsal foot and 5-mm skin punch biopsy at the lower leg and upper thigh for intraepidermal nerve fiber counts. A healthy control group of 273 volunteers was investigated accordingly. Pain was present in 50% of the patients with PNP with a median intensity of 6/10 on a numeric rating scale, and, by definition, in all patients with SFN, with a median intensity of 5/10 numeric rating scale. Axonal PNP was painful more often than demyelinating PNP (P < 0.01). Patients with PNP mostly had loss of function profiles, whereas most patients with SFN belonged to the gain of function (hyperalgesia) phenotype. In healthy controls, skin innervation positively correlated with sensory thresholds, whereas this correlation was lost in patients with PNP and SFN. Quantitative sensory testing did not distinguish between painful and painless neuropathies regarding small fiber function, but revealed higher mechanical pain (P < 0.01) and detection thresholds (P < 0.05) and lower mechanical pain sensitivity in the group of patients with painful neuropathies. Etiological neuropathy subgroups were not distinguished by QST.
Trends in Mortality and Risk Characteristics of Congenital Diaphragmatic Hernia Treated With Extracorporeal Membrane Oxygenation
Authors: Guner Yigit S. , Delaplain Patrick T. , Zhang Lishi , Di Nardo Matteo , Brogan Thomas V. , Chen Yanjun , Cleary John P. , Yu Peter T , Harting Matthew T. , Ford Henri R. , Nguyen Danh V.
Published: June 2018

Although the mortality of infants with congenital diaphragmatic hernia (CDH) has been improving since the late 1990s, this observation has not been paralleled among the CDH cohort receiving extracorporeal membrane oxygenation (ECMO). We sought to elucidate why the mortality rate in the CDH-ECMO population has remained at approximately 50% despite consistent progress in the field by examining the baseline risk profile/characteristics of neonates with CDH before ECMO (pre-ECMO). Neonates with a diagnosis of CDH were identified in the Extracorporeal Life Support Organization (ELSO) Registry from 1992 to 2015. Individual pre-ECMO risk score (RS) for mortality was categorized to pre-ECMO risk-stratified cohorts. Temporal trends based on individual-level mortality by risk cohorts were assessed by logistic regression. We identified 6,696 neonates with CDH. The mortality rates during this time period were approximately 50%. The average baseline pre-ECMO RS increased during this period: mean increase of 0.35 (95% confidence interval [CI]: 0.324–0.380). In the low-risk cohort, the likelihood of mortality increased over time: each 5 year change was associated with a 7.3% increased likelihood of mortality (odds ratio [OR]: 1.0726; 95% CI: 1.0060–1.1437). For the moderate-risk cohort, the likelihood of mortality decreased by 7.05% (OR: 0.9295; 95% CI: 0.8822–0.9793). There was no change in the odds of mortality for the high-risk cohort (OR: 0.9650; 95% CI: 0.8915–1.0446). Although the overall mortality rate remained approximately constant over time, the individual likelihood of death has declined over time in the moderate-risk cohort, increased in the low-risk cohort, and remained unchanged in the high-risk cohort.
Effect of a distal weight-bearing implant on visual analog scale scores in 23 transfemoral amputees
Authors: Guirao Cano Lluis , Samitier Pastor Beatriz , Maldonado Garrido Dolores , Rodriguez-Piñero Duran Manuel , Exposito Tirado Jose , Peraita-Costa Isabel , Morales-Suarez-Varela Maria
Published: June 2018

The objective of this interrupted time series clinical trial was to evaluate the effect of a distal weight-bearing implant on well-being in patients with transfemoral amputations using the visual analog scale (VAS). A total of 29 patients from five hospitals with previous transfemoral amputations were surgically implanted with an osseoanchored implant with a distal spacer that allows a direct load on the residuum over the distal surface of the socket. Patients were followed for a 14-month period and assessed presurgically and postsurgically using the VAS. The Wilcoxon test was used to evaluate the differences between variables. VAS mean scores improved significantly after intervention. Significant and clinically meaningful improvements in the VAS score suggest overall improvement in well-being for patients after receiving a distal weight-bearing implant.
Comparison of Uninjured and Concussed Adolescent Athletes on the Concussion Balance Test (COBALT)
Authors: Massingale Shelly , Alexander Amy , Erickson Steven , McQueary Elizabeth , Gerkin Richard , Kisana Haroon , Silvestri Briana , Schodrof Sarah , Nalepa Bryce , Pardini Jamie
Published: June 2018

Background and Purpose:

Dizziness and balance problems are common symptoms following sports-related concussion (SRC). Most sports require high-level balance skills that integrate the sensory inputs used for balance. Thus, a comprehensive assessment of postural control following SRC is recommended as an integral part of evaluation and management of the injury. The purpose of this exploratory study was to examine performance differences between uninjured and concussed athletes on the Concussion Balance Test (COBALT), as well as complete preliminary analyses of criterion-related validity and reliability of COBALT.

Methods:

COBALT is an 8 condition test developed for both preseason and postinjury assessment using force plate technology to measure sway velocity under dynamic postural conditions that challenge the vestibular system. Retrospective COBALT data obtained through chart review for 132 uninjured athletes and 106 concussed age-matched athletes were compared.

Results:

All uninjured athletes were able to complete the assessment, compared with only 55% of concussed athletes. Concussed athletes committed significantly more errors than uninjured athletes. Sway velocity for concussed athletes was higher (worse) than that for uninjured athletes on 2 conditions in COBALT.

Discussion and Conclusions:

By examining an athlete's ability to complete the protocol, error rate, and sway velocity on COBALT postinjury, the clinician can identify balance function impairment, which may help the medical team develop a more targeted treatment plan, and provide objective input regarding recovery of balance function following SRC.

Video Abstract availablefor more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A204).
Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome
Authors: Miranda Nicole A. , Boris Jeffrey R. , Kouvel Kristen M. , Stiles Lauren
Published: June 2018

Background and Purpose:

Postural orthostatic tachycardia syndrome (POTS) is increasingly recognized as a complication affecting recovery from concussion. Individuals with POTS demonstrate refractory dizziness, lightheadedness, cognitive dysfunction, fatigue, headache, chronic pain, nausea and gastrointestinal dysmotility, activity and exercise intolerance, syncope, and tachycardia. Subtypes of POTS may include hypovolemia, hyperadrenergic states, autonomic neuropathy, and underlying autoimmunity, which may variably impact response to rehabilitation in varying ways. The subtle presentation of POTS postconcussion is often mistaken for underlying anxiety, conversion disorder, or lack of motivation for recovery. This article will present clinical features of POTS that may arise after concussion, and propose a role for physical therapists in the diagnosis and management of POTS during concussion recovery.

Summary of Key Points:

Data recorded and entered into a database during clinic visits from a large pediatric institution indicate that 11.4% of individuals diagnosed with POTS report onset of symptoms within 3 months of sustaining a concussion. Activation of the sympathetic nervous system can result in lightheadedness, shortness of breath, chest pain, tachycardia, palpitations on standing or with exertion, and activity and exercise intolerance. Identified comorbidities in people with POTS such as joint hypermobility and autoimmune disorders can further influence recovery.

Recommendations for Clinical Practice:

Physical therapists may identify signs and symptoms of POTS in a subset of individuals who remain refractory to typical interventions and who exhibit symptom exacerbation with orthostatic activity. Incorporation of an individualized POTS exercise program into current established concussion interventions may be useful, with emphasis on initial recumbent exercises and ongoing physical therapy assessment of exercise tolerance for dosing of activity intensity and duration.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A211).
Do Healthier Meals Cost More?
Authors: Huang Yue , Houser Robert F. , Roberts Susan B. , Lichtenstein Alice H.
Published: June 2018

One barrier to achieving healthier eating patterns is the perceived higher cost of healthier food. The objective of this cross-sectional study was to investigate the potential association between cost and the nutrition quality among entrées from casual dining restaurants.

Nutrition and price information were collected from 11 restaurants in Boston metropolitan area. A nutrition quality metric (Estimated Nutrition Score [ENS]) was developed based on the 2015-2020 Dietary Guidelines for Americans to allow comparisons between more healthy and less healthy entrées. Associations between entrée price and ENS were assessed as continuous variables and dichotomized based on median ENS, availability of “small,” “half,” and “light” options, and with or without calories as a component of the score.

Of the 11 restaurant chains meeting the inclusion criteria, the association between ENS and price was significant for 6. Of those 6, more healthy options were less expensive at 4 restaurants, and more healthy options were more expensive at 2 restaurants. Eliminating small, half, and light options from the analyses resulted in a null association for 1 restaurant in the former category. Eliminating calories from the score resulted in loss of a significant association between price and ENS for all 6 restaurants, whereas for 2 additional restaurants, significant negative relationships were detected.

There was no consistent association between ENS and entrée price in the sample assessed. Hence, within the category of restaurants evaluated, customers can often choose healthier entrées that are priced less than or equal to less healthy entrées.
FDG PET/CT in a Case of Human African Trypanosomiasis (Sleeping Sickness)
Authors: Xiao Zhengguang , Dong Aisheng , Wang Yang
Published: June 2018

Human African trypanosomiasis imported to nonendemic countries is rare. It is very difficult to establish the correct diagnosis of human African trypanosomiasis in nonendemic areas. We present a case of human African trypanosomiasis with MRI and FDG PET/CT findings. Head MRI showed hyperintense areas in bilateral internal capsules. Abdominal and pelvic MRI showed hepatosplenomegaly and multiple enlarged lymph nodes. FDG PET/CT showed generalized hypermetabolic lymph nodes, diffuse FDG uptake of the spleen, and hepatosplenomegaly mimicking lymphoma. In addition, FDG PET/CT revealed decreased FDG uptake in the medial occipital cortex and cardiomegaly with pericardial effusion.
Total Salvianolic Acid Injection Prevents Ischemia/Reperfusion-Induced Myocardial Injury Via Antioxidant Mechanism Involving Mitochondrial Respiratory Chain Through the Upregulation of Sirtuin1 and Sirtuin3
Authors: Huang Dan-Dan , Wei Xiao-Hong , Mu Hong-Na , Pan Chun-Shui , Li Quan , Hu Bai-He , Chang Xin , Yan Li , Fan Jing-Yu , Liu Yu-Ying , Luo Jian-Yuan , Han Jing-Yan
Published: June 2018

Sirtuin1 (Sirt1) and Sirtuin3 (Sirt3) are known to participate in regulating mitochondrial function. However, whether Total Salvianolic Acid Injection (TSI) protects against myocardial ischemia/reperfusion (I/R) injury through regulating Sirt1, Sirt3, and mitochondrial respiratory chain complexes is unclear. The aim of this study was to explore the effects of TSI on I/R-induced myocardial injury and the underlying mechanism. Male Sprague–Dawley rats were subjected to 30 min occlusion of the left anterior descending coronary artery followed by 90 min reperfusion with or without TSI treatment (8 mg/kg/h). The results demonstrated that TSI attenuated I/R-induced myocardial injury by the reduced infarct size, recovery of myocardial blood flow, and decreased cardiac apoptosis. Moreover, TSI protected heart from oxidative insults, such as elevation of myeloperoxidase, malondialdehyde, hydrogen peroxide, ROS, as well as attenuated I/R-elicited downregulation of Sirt1, Sirt3, NADH dehydrogenase [ubiquinone] 1 alpha subcomplex 10 (NDUFA10), succinate dehydrogenase complex, subunit A, flavoprotein variant (SDHA), and restoring mitochondrial respiratory chain complexes activity. The in vitro study in H9c2 cells using siRNA transfection further confirmed the critical role of Sirt1 and Sirt3 in the effect of TSI on the expression of NDUFA10 and SDHA. These results demonstrated that TSI attenuated I/R-induced myocardial injury via inhibition of oxidative stress, which was related to the activation of NDUFA10 and SDHA through the upregulation of Sirt1 and Sirt3.