bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybrid design-based modelling and multi-objective optimization of hybrid machining of hybrid metal matrix composites
Authors: Singar Yadav Ram , Yadava Vinod
Published: July 2018

Electrical discharge diamond face surface grinding (EDDFSG) is a hybrid machining technique consisting of face surface electrical discharge grinding and diamond face surface grinding. The machining of hybrid metal matrix composites (HMMCs) is still facing challenges for better machining performance. In the present article, an effort was made for hybrid design-based experimental modelling, performance prediction and multi-objective optimization of EDDFSG of Al/Al2O3p/B4Cp and Al/SiCp/B4Cp HMMCs. Gap current, on-time, off-time, abrasive grit number, revolutions per minute (RPM) of wheel and table speed are the process parameters whose effects on material removal rate and surface roughness ( Ra) were analysed. The machining characteristics of HMMCs were investigated using performance predictions. Binary coded modified distance-based Pareto genetic algorithm was integrated with hybrid design-based RSM models for multi-objective optimization of EDDFSG process. The surface texture and re-solidified layers were also analysed using scanning electron microscopy. The selected optimized results were found to have better material removal rate and surface finish along with negligible presence of re-solidified layers during verification experiments.
Statistical methods for characterizing transfusion-related changes in regional oxygenation using near-infrared spectroscopy (NIRS) in preterm infants
Authors: Guo Ying , Wang Yikai , Marin Terri , Easley Kirk , Patel Ravi M , Josephson Cassandra D
Published: July 2018

Near infrared spectroscopy (NIRS) is an imaging-based diagnostic tool that provides non-invasive and continuous evaluation of regional tissue oxygenation in real-time. In recent years, NIRS has shown promise as a useful monitoring technology to help detect relative tissue ischemia that could lead to significant morbidity and mortality in preterm infants. However, some issues inherent in NIRS technology use on neonates, such as wide fluctuation in signals, signal dropout and low limit of detection of the device, pose challenges that may obscure reliable interpretation of the NIRS measurements using current methods of analysis. In this paper, we propose new nonparametric statistical methods to analyze mesenteric rSO2 (regional oxygenation) produced by NIRS to evaluate oxygenation in intestinal tissues and investigate oxygenation response to red blood cell transfusion (RBC) in preterm infants. Specifically, we present a mean area under the curve (MAUC) measure and a slope measure to capture the mean rSO2 level and temporal trajectory of rSO2, respectively. We develop estimation methods for the measures based on multiple imputation and spline smoothing and further propose novel nonparametric testing procedures to detect RBC-related changes in mesenteric oxygenation in preterm infants. Through simulation studies, we show that the proposed methods demonstrate improved accuracy in characterizing the mean level and changing pattern of mesenteric rSO2 and also increased statistical power in detecting RBC-related changes, as compared with standard approaches. We apply our methods to a NIRS study in preterm infants receiving RBC transfusion from Emory University to evaluate the pre- and post-transfusion mesenteric oxygenation in preterm infants.
Extra-Hepatic Islet Transplantation
Authors: Schaschkow Anaïs , Sigrist Séverine , Mura Carole , Dissaux Caroline , Bouzakri Karim , Lejay Anne , Bruant-Rodier Catherine , Pinget Michel , Maillard Elisa
Published: July 2018

Following the tremendous development of hydrogels for cell therapy, there is now a growing need for surgical techniques to validate in vivo scaffold benefits for islet transplantation. Therefore, we propose a newly designed surgical procedure involving the injection of hydrogel-embedded pancreatic islets in the omentum, which is considered a favorable environment for cell survival and function. Our technique, called h-Omental Matrix Islet filliNG (hOMING) was designed to test the benefits of hydrogel on islet survival and function in vivo. Islets were implanted in the omentum of diabetic rats using the hOMING technique and alginate as an islet carrier. Blood glucose and C-peptide levels were recorded to assess graft function. After 2 months, grafts were explanted and studied using insulin and vessel staining. All rats that underwent hOMING exhibited graft function characterized by a glycemia decrease and a C-peptidemia increase ( P < 0.001 compared with preoperative levels). Furthermore, hOMING appeared to preserve islet morphology and insulin content and allowed the proper revascularization of grafted islets. The results suggest that hOMING is a viable and promising approach to test in vivo the benefits of hydrogel administration for islet transplantation into the omental tissue.
Frank Utten Purchas 1861–1909: Physician in Wales and descendant of slave owners
Authors: Jones Rachael
Published: July 2018

Frank Utten Purchas was born into a family which had a long history of benefitting from slavery. He was born in Jamaica where both his paternal and maternal lines owned slaves who were forced to work on their sugar plantations. Purchas left this life behind him, however, trained in medicine in Edinburgh and became a respected and committed physician in Wales. He married into a prominent local family, and lived through a time that saw significant political, religious and medical changes. He contributed to the founding of an infirmary that exists to this day although he himself did not live to see its opening.
Oskar Kobyliński (1856–1926) and the first description of Noonan syndrome in the medical literature
Authors: Marcinowski Filip
Published: July 2018

While a student of University in Dorpat (now Tartu, Estonia) Oskar Kobyliński published an article reporting on his 22-year-old patient Leisar Eischikmann, who suffered from a congenital deformity of the neck. Kobyliński described this rare anomaly and called it “flüghautige Verbreitung des Halses” (wing-like extension of the neck). It was only in 1902 when the name pterygium colli was introduced, and it has been in use ever since. This malformation is part of some congenital syndromes, most prominently, Turner syndrome and, more rarely, of Noonan syndrome. As Opitz et al. pointed out, the patient described in the 1883 article from Archiv für Anthropologie is probably the first person with Noonan syndrome to have been pictured in the medical literature. The article was signed only by “O. v. Kobylinski, student of medicine.” Further archival research was needed to identify this physician and provide more details about his unusual career.
Environmental Fiscal Instruments: A Few International Experiences
Authors: Verma Rajat , Gayithri K.
Published: July 2018

This article attempts to document the status of environmental fiscal instruments (EFIs) so as to explore relevant international experiences on ecotaxes in the context of India and to examine India’s specificities in these taxes within a wider perspective of other fiscal measures. Environmental levies across 15 countries were reviewed and the countries categorised are into two groups: Annex II and Non-Annex I. The revenues from levies imposed in the countries were also analysed. The most common form of taxes in Annex II countries in the form of energy taxes, followed by transport taxes. For India, energy and transport taxes could prove to be vital types of ecotaxes for addressing issues of climate change. Pollution taxes are difficult to levy for administrative reasons, but resource taxes are imperative because of severe environmental problems associated with mining and related activities. The revenue generated from environmental taxes and charges for all Annex II countries hovered between 2 and 4 per cent of their respective GDPs, except for Canada and the United States of America, whereas for Non-Annex I nations, this ranged only between 0 and 1 per cent.

JEL Classification: H23, Q50, Q58
Slowdown in Bank Credit Growth: Aggregate Demand or Bank Non-performing Assets?
Authors: Goyal Ashima , Verma Akhilesh
Published: July 2018

We estimate the determinants of credit and of non-performing assets (NPAs) using a firm and a bank panel with data up to 2015 in order to test bank lending against the aggregate demand channel as an explanation for slow Indian credit growth. The results support demand as the key constraint. Only demand variables affect corporate credit for a broad set of firms. Balance sheet weakness reduced credit only for a narrow subset of indebted firms in a difference-in-difference type analysis. Even so, sales remained the dominant variable. From the bank panel, the asset quality review (AQR) did have a strong negative effect on advances but gross NPAs did not. While high interest rates and low growth raised NPAs, so did past credit. Low demand not only reduced credit, it also increased NPAs. That the capital adequacy ratio (CAR) significantly reduces NPAs points to the productivity of fund infusion. When other determinants are controlled, bank ownership does not affect NPA ratios, again supporting external shocks as causal. The results suggest that apart from structural reform to clean balance sheets, recovery of demand is necessary for revival of credit growth.

JEL Classification: G21, E51
A liquid spring–magnetorheological damper system under combined axial and shear loading for three-dimensional seismic isolation of structures
Authors: Cesmeci Sevki , Gordaninejad Faramarz , Ryan Keri L , Eltahawy Walaa
Published: July 2018

This study focuses on experimental investigation of a fail-safe, bi-linear, liquid spring magnetorheological damper system for a three-dimensional earthquake isolation system. The device combines the controllable magnetorheological damping, fail-safe viscous damping, and liquid spring features in a single unit serving as the vertical component of a building isolation system. The bi-linear liquid spring feature provides two different stiffnesses in compression and rebound modes. The higher stiffness in the rebound mode prevents a possible overturning of the structure during rocking mode. For practical application, the device is to be stacked together along with the traditional elastomeric bearings that are currently used to absorb the horizontal ground excitations. An experimental setup is designed to reflect the real-life loading conditions. The 1/4th-scale device is exposed to combined dynamic axial loading (reflecting vertical seismic excitation) and constant shear force that are up to 245 and 28 kN, respectively. The results demonstrate that the device performs successfully under the combined axial and shear loadings and compare well with the theoretical calculations.
Approximation of surface wave velocity in smart composite structure using Wentzel–Kramers–Brillouin method
Authors: Singh Manoj Kumar , Sahu Sanjeev A , Singhal Abhinav , Chaudhary Soniya
Published: July 2018

In mathematical physics, the Wentzel–Kramers–Brillouin approximation or Wentzel–Kramers–Brillouin method is a technique for finding approximate solutions to linear differential equations with spatially varying coefficients. An attempt has been made to approximate the velocity of surface seismic wave in a piezo-composite structure. In particular, this article studies the dispersion behaviour of Love-type seismic waves in functionally graded piezoelectric material layer bonded between initially stressed piezoelectric layer and pre-stressed piezoelectric half-space. In functionally graded piezoelectric material stratum, theoretical derivations are obtained by the Wentzel–Kramers–Brillouin method where variations in material gradient are taken exponentially. In the upper layer and lower half-space, the displacement components are obtained by employing separation of variables method. Dispersion equations are obtained for both electrically open and short cases. Numerical example and graphical manifestation have been provided to illustrate the effect of influencing parameters on the phase velocity of considered surface wave. Obtained relation has been deduced to some existing results, as particular case of this study. Variation in cut-off frequency and group velocity against the wave number are shown graphically. This study provides a theoretical basis and practical utilization for the development and construction of surface acoustics wave devices.
This Girl is on Fire: Seeking a Home for the Narrative
Authors: Gorman Geraldine
Published: July 2018

Using memory as the bridge between two related encounters separated by decades, the author explores the relationship between the narrative and nursing practice and education. Do academic ethics belong in the realm inhabited by the interpersonal encounter? In this era of evidence-based practice and large data sets, is there a place for the personal narrative? These questions impact the values which inform the education we offer our future practitioners.
Selection of surgical intervention for congenital dacryocystocele
Authors: Zhang Yi , Fan Yu , Fan Jinlu , Cui Yanhui
Published: July 2018

Purpose:

To evaluate the surgical intervention and its effect on congenital dacryocystocele.

Methods:

A total of 531 children with congenital dacryocystocele admitted to the Department of Ophthalmology of Beijing Children’s Hospital, Shanghai Aier Eye Hospital, Nanjing Aier Eye Hospital, and the First Affiliated Hospital of Jinzhou Medical University between January 2007 and January 2017 were retrospectively analyzed.

Results:

A total of 531 patients were followed up for 3–24 months, with an average of 13.3 months. No serious intraoperative complications (such as bleeding and tissue damage) and postoperative complications (bleeding, infection, and hole atresia) were found. We classified the outcomes into three categories based on the signs (overflowing tears and empyema) and objective routine follow-up by endoscopy. Cure indicated that mass, overflow of tears, and breathing difficulties disappeared, and 81.5% cases (433/531) were postoperatively cured. Improvement indicated disappearance of mass, overflow empyema, and the presence of residual tears (due to trocar and tears puncture), and 18.5% cases (98/531) were postoperatively improved. Unhealed indicated overflowing pus and tears, and 0% cases did not heal after surgery.

Conclusions:

Nasal endoscopic surgery is relatively safe, with high success rate for treatment of congenital dacryocystocele. Systematic training is required to promote the application of nasal endoscopy, so that more ophthalmologists can learn this technique.
Clinical feature and visual prognosis of acute retinal necrosis according to the initially involved zone and extent: 10-year experience
Authors: Kim Dong Yoon , Jo Jaehyuck , Joe Soo Geun , Lee Joo Yong , Yoon Young Hee , Kim June-Gone
Published: July 2018

Purpose:

We aimed to analyze the visual prognosis and clinical characteristics of acute retinal necrosis according to the initially involved zone and extent.

Study design:

Retrospective, consecutive, cross-sectional study.

Methods:

We retrospectively reviewed acute retinal necrosis patients who were treated with systemic antiviral treatment, and assessed the visual prognosis of acute retinal necrosis following antiviral treatment based on the initially involved zone and the extent of acute retinal necrosis at the time of diagnosis. Moreover, we evaluated whether prophylactic laser photocoagulation had preventive effects on retinal detachment.

Results:

A total of 43 eyes from 35 patients with acute retinal necrosis were included. Eyes with zone I involvement/extensive retinal lesions showed poor visual prognosis (logMAR: 1.17 ± 0.97 vs 0.49 ± 0.81; p = 0.014) and a higher incidence of retinal detachment (9/30 (30.0%) vs 0/13 (0%); p = 0.039) after treatment. Retinal detachment was observed in 20.9% of cases, and its incidence was significantly lower in eyes that had undergone prophylactic laser photocoagulation.

Conclusion:

The overall visual prognosis of acute retinal necrosis is poor and can be determined at the time of diagnosis. Prophylactic laser photocoagulation exhibits preventive effects with regard to the development of retinal detachment. Therefore, laser photocoagulation should be actively considered in eyes with extensive retinal lesions to prevent retinal detachment and thus eventually improve the overall visual prognosis of acute retinal necrosis.
Acute Hereditary Angioedema With Airway Compromise: Avoiding Airway Intervention With C1 Inhibitor Concentrate
Authors: Fu WeiZhong Ernest , Tan Sze-Chin , Ho Eu Chin
Published: July 2018

Introduction:

Hereditary angioedema (HAE) is an autosomal dominant disease caused by deficiency of the plasma protein C1 inhibitor (C1-INH). Patients classically present with recurrent localized subcutaneous or submucosal edema lasting for 2 to 5 days, severe abdominal pain, or acute airway obstruction which can be fatal.

Case presentations:

We highlight 2 patients with acute airway compromise secondary to HAE who were successfully treated with plasma-derived C1-INH concentrates.

Conclusions:

The timely administration of plasma-derived C1-INH concentrates for the acute treatment of HAE has been proven to be effective in both patients in aborting an airway complication. A high index of suspicion is required for the early diagnosis and treatment of this potentially fatal condition.
The effectiveness of psychological interventions with adoptive parents on adopted children and adolescents’ outcomes: A systematic review
Authors: Ní Chobhthaigh Sorcha , Duffy Fiona
Published: July 2018

Adopted children and adolescents are at an increased risk of experiencing emotional, behavioural and relational difficulties compared to their non-adopted peers. This systematic review aimed to establish the effectiveness of interventions with adoptive parents on adopted children and adolescents’ psychological well-being, behavioural functioning and parent–child relationship. A systematic search was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), including studies that assessed the effects of interventions with adoptive parents on adopted child and adolescent outcomes. Electronic databases, key journals, grey literature sources, reference and citation lists were searched and published authors in the field were contacted; 19 papers describing 15 interventions were included. The findings from this review provide preliminary support for the use of interventions with adoptive parents for improving adopted children’s emotional and behavioural outcomes. However, overall, the studies were found to have a high risk of bias, and the significant heterogeneity across the studies limits the conclusions that can be drawn. Further research is required to provide conclusive recommendations regarding the effectiveness of interventions with adoptive parents on the outcomes of adopted children.
Remediation and hypermediacy: Ezekiel’s World as a case in point
Authors: Kohn Ayelet , Weissbrod Rachel
Published: July 2018

This article deals with Kovner’s graphic narrative Ezekiel’s World (2015) as a case of remediation and hypermediacy. The term ‘remediation’ refers to adaptations which involve the transformation of the original work into another medium. While some adaptations strive to eliminate the marks of the previous medium, others highlight the interplay between different media, resulting in ‘hypermediacy’. The latter approach characterizes Ezekiel’s World due to its unique blend of artistic materials adapted from different media. The author, Michael Kovner, uses his paintings to depict the story of Ezekiel – an imaginary figure based on his father, the poet Abba Kovner who was one of the leaders of the Jewish resistance movement during World War II. While employing the conventions of comics and graphic narratives, the author also makes use of readymade objects such as maps and photos, simulates the works of famous artists and quotes Abba Kovner’s poems. These are indirect ways of confronting the traumas of Holocaust survivors and ‘the second generation’. Dealing with the Holocaust in comics and graphic narratives (as in Spiegelman’s Maus: A Survivor’s Tale, 1986) is no longer an innovation, nor is their use as a means to deal with trauma; what makes this graphic narrative unique is the encounter between the works of the poet and the painter, which combine to create an exceptionally complex work integrating poetry, art and graphic narration.
“I have to be both mother and father”: The impact of Young-onset dementia on the partner’s parenting and the children’s experience
Authors: Gelman Caroline , Rhames Kate
Published: July 2018

There has been increasing research on the experience and needs of caregivers for persons with YOD, who are mainly spouses. Yet one little-explored area is their evolving parental role. As the person with YOD becomes less able to parent, the partner must take on more and more parental responsibilities. This occurs in much-changed familial context, with children often asked to assume caretaking roles and experiencing strong feelings such as grief, anger, and fear. How do the parents without YOD understand and negotiate their ever-changing parenting role, and how do their children experience it? We conducted in-depth, semi-structured interviews with four parents without YOD (coincidentally all mothers) and eight children ages 16–20 (3–18 when parent was diagnosed) regarding the changing nature of the parental-child relationship. These data were analyzed using thematic narrative analysis, in which respondents' material is closely read as it is gathered and analyzed for patterns. Three primary themes emerged. First, there are significant changes in family structures and role. Mothers increasingly assume all parental responsability. Children assume roles of carers and earners, and at times reluctant decision-making partners. Such responsabilities can feel overwhelming at times. However, the cildren discribed not wanting to burden mother with their feelings and experience, a second prominent theme. Finally, such muting of their experience likely contributes to mothers feeling they are managing the YOD so as to minimize the impact on their children, creating divergent experiences of the YOD on family life. Facilitating family members' articulation of what feel like “inadmissible” feelings, improving familial communication, and developing a range of support and resources are all important areas for intervention.
Nonlinear ultrasonic detection for evaluating fatigue crack in metal plate
Authors: Wang Rong , Wu Qi , Yu Fengming , Okabe Yoji , Xiong Ke
Published: July 2018

In engineering structures, metal materials always endure fatigue cracks under long-term service. There has been a demand for developing a structural health monitoring method to evaluate micro-sized fatigue cracks, as cracking is considered as a precursor to structural failure. However, conventional linear-ultrasound-based technology is not sensitive to crack when it is barely visible in a metal medium. In this article, we present a nonlinear ultrasonic technology based on crack–wave interaction to investigate the growth of a fatigue crack. A breathing-crack model with a plastic zone around it was precisely established to reveal the change in the Lamb wave. The relative nonlinear parameter calculated from the fundamental and harmonic components of the Lamb wave showed linearly increasing with the growth of the fatigue crack. The relative nonlinearity was related to ultrasonic parameters, such as the cycle number and the excited frequency of the tone-burst signal. In addition, it was also related to the angle between the sensor and the crack rather than their distance. A set of experiments were conducted, demonstrating that the increasing trend of ultrasonic nonlinearity fits very well to the finite element analysis results. In conclusion, the nonlinear ultrasonic method that can be applied to the detection of micro fatigue cracks in metal plates is an effective structural health monitoring technique.
Vertebral Artery Arteriovenous Fistula: Complication Following Cervical Spinal Fusion
Authors: Leix Stephanie J. , Weaver Mitchell , Brown Patricia
Published: July 2018

We report a rare case of extradural arteriovenous (AV) fistula of the right vertebral artery and vein following cervical spinal fusion. A 68-year-old female patient presented with complaints of a persistent buzzing sound in her right ear for 4 months that began following cervical spinal fusion surgery via an anterior approach. A right-sided bruit was noted and the patient was referred for a carotid duplex study. A carotid duplex was performed on a Philips IU22 using a 9-3 linear array transducer. The exam revealed a high-velocity vertebral artery waveform with spectral broadening and venous component suggestive of an AV fistula. Magnetic resonance angiography (MRA) of the neck confirmed a right extradural AV fistula at the level of C4 between the right vertebral artery and vein. The patient subsequently underwent angiography and coil embolization of the right vertebral artery. Postembolization angiography revealed resolution of the AV fistula and occlusion/near occlusion of the vertebral artery distal to the embolization. While vascular injuries are a known complication of spinal surgery using the anterior approach, it is rare for them to present as a late finding. Duplex evaluations of the carotid arteries for patients’ subjective noise complaints often do not reveal significant pathology; though in cases involving a history of prior surgical intervention, ultrasound may be useful in identifying iatrogenic vascular injury.
Fluorescence of Deep Infiltrating Endometriosis During Laparoscopic Surgery: A Preliminary Report on 6 Cases
Authors: De Neef Auriane , Cadière Guy-Bernard , Bourgeois Pierre , Barbieux Romain , Dapri Giovanni , Fastrez Maxime
Published: July 2018

Background. The standard treatment of rectovaginal deep infiltrating endometriosis nodules (RVDIEN) consists in their surgical removal. RVDIEN are anatomically neovascularized. Indocyanine green (ICG) reveals vascularized structures when becoming fluorescent after exposure to near-infrared (NIR) light. This study aims to evaluate if fluorescence-guided surgery can improve the laparoscopic resection of RVDIEN, thus avoiding a rectal perforation. Materials and Methods. Patients with a symptomatic RVDIEN, scheduled for a laparoscopic rectal shaving, were enrolled in the study. Technically, the RVDIEN was targeted and removed with the help of the NIR imager device Image 1 Spies (Karl Storz GmBH & Co KG, Tuttlingen, Germany) or Visera Elite II (Olympus Europe SE & Co KG, Hamburg, Germany), after an intraoperative, intravenous injection of ICG (0.25 mg/kg). Results. Six patients underwent a fluorescence-guided laparoscopic shaving procedure for the treatment of a nonobstructive RVDIEN. Fluorescence of the RVDIEN was observed in all the patients. In one patient, once the main lesion was removed, the posterior vaginal fornix still appeared fluorescent and was removed. No intraoperative rectal perforation occurred. The postoperative hospital stay was 2 days. No postoperative rectovaginal fistula occurred within a median follow-up of 16 months (range = 2-23 months). Conclusion. In this preliminary study, fluorescence-guided laparoscopy appeared to help in separating the RVDIEN from the healthy rectal tissue, without rectal perforation. Moreover, this technique was helpful in deciding if the resection needed to be enlarged to the posterior vaginal fornix.
Laparoscopic Common Bile Duct Exploration Is a Safe and Effective Strategy for Elderly Patients
Authors: Liu Wen-song , Jiang Yong , Zhang Dong , Shi Long-Qing , Sun Dong-Lin
Published: July 2018

Purpose. Laparoscopic common bile duct exploration (LCBDE) has been widely used to remove common bile duct (CBD) stones. However, surgery is not considered as the first treatment choice for elderly patients with CBD stones because of the potential risk of postoperative complications. This study aims to evaluate the safety and efficiency of LCBDE for elderly patients. Methods. From April 2011 to October 2016, 265 consecutive patients underwent LCBDE. We performed a retrospective study and divided these patients into 2 groups. The younger group was younger than 70 years old (n = 179), and the elderly group was 70 years old or older (n = 86). We compared patient demographics, clinical characteristics, intraoperative parameters, postoperative complications, and incidence of recurrent stone between the 2 groups. Results. The elderly patients had higher preoperative morbidity of chronic diseases, such as pulmonary diseases, heart diseases, arterial hypertension, and abdominal operation history ( P < .05). There were no significant differences between the 2 groups in terms of operation time, intraoperative blood loss, conversion rate to open surgery, total cost, overall complications, and incidence of recurrent stone ( P > .05). Conclusion. LCBDE can also be carried out as a safe and effective approach to remove CBD stones in elderly patients, although they have higher risk of chronic diseases.
Patient Loss to Follow-up After Upper Extremity Surgery: A Review of 2563 Cases
Authors: Rosenbaum Joseph A. , Blau Yoni M. , Fox Hannah K. , Liu X. Shawn , DiBartola Alex C. , Goyal Kanu S.
Published: July 2018

Background: Postoperative care is essential to optimizing patient outcome. We sought to determine the incidence and associated demographic and surgical factors of postoperative patient loss to follow-up following hand and upper extremity surgery. Methods: In all, 2834 surgical cases (2467 patients) were retrospectively reviewed. All surgical cases from July 2014 to June 2015 at a single practice with five surgeons were assessed. Charts were reviewed for compliance with postoperative follow-up. Variables were described with proportions and compared using logistic regression analysis. Results: In total, 2563 cases (2388 patients) met the inclusion criteria. Overall loss to follow-up rate was 26%. Patients lost to follow-up based on insurance type were 13% for worker’s compensation, 22% for private insurance, 21% for Medicare, 38% for Medicaid, and 44% for self-pay. Patients with expected short-term follow-up were lost at a 23% rate. Expected mid- and long-term follow-up patients were lost at 34% and 20% rates, respectively. Patients below 30 years old were lost to follow-up at a 42% rate compared to patients 30 to 64 years old (26%) and greater than or equal to 65 years (13%). Males had a higher rate of loss to follow-up, 32%, compared with females (22%). Patients living greater than 50 miles from our surgery center were lost to follow-up at a rate of 31%, compared with those who lived less than 50 miles (25%). Conclusions: We have identified demographic variables associated with patients being lost to follow-up after hand and upper extremity surgery. With this knowledge, we hope to develop methods of either improving in-office follow-up rates or discover new avenues to deliver postoperative care.
An unmanned aircraft system for maritime operations
Authors: Marques Mario Monteiro , Lobo Victor , Batista R , Oliveira J , Aguiar A Pedro , Silva J Estrela , de Sousa J Borges , Nunes Maria de Fátima , Ribeiro Ricardo Adriano , Bernardino Alexandre , Marques Jorge Salvador
Published: July 2018

Unmanned air systems are becoming ever more important in modern societies but raise a number of unresolved problems. There are legal issues with the operation of these vehicles in nonsegregated airspace, and a pressing requirement to solve these issues is the development and testing of reliable and safe mechanisms to avoid collision in flight. In this article, we describe a sense and avoid subsystem developed for a maritime patrol unmanned air system. The article starts with a description of the unmanned air system, that was developed specifically for maritime patrol operations, and proceeds with a discussion of possible ways to guarantee that the unmanned air system does not collide with other flying objects. In the system developed, the position of the unmanned air system is obtained by the global positioning system and that of other flying objects is reported via a data link with a ground control station. This assumes that the detection of those flying objects is done by a radar in the ground or by self-reporting via a traffic monitoring system (such as automatic identification system). The algorithm developed is based on game theory. The approach is to handle both the procedures, threat detection phase and collision avoidance maneuver, in a unified fashion, where the optimal command for each possible relative attitude of the obstacle is computed off-line, therefore requiring low processing power for real-time operation. This work was done under the research project named SEAGULL that aims to improve maritime situational awareness using fleets of unmanned air system, where collision avoidance becomes a major concern.
‘The Impact of my Work would be Greater here than there’: Implications of the International Mobility of Colombian Academics
Authors: Bedenlier Svenja
Published: July 2018

Internationalization of higher education affects academic faculty in various ways. However, the internationalization experience of faculty in Latin America, a region concerned with internationalization only quite recently, has not yet been sufficiently researched. This research gap is addressed with this qualitative interview study. Five Colombian academics relate their experiences of internationalization, with a key focus on their own international mobility and the effects this has had on their professional lives and their institutional environment. Qualitative content analysis resulted in the identification of the four wider themes of mobility as personal professional enrichment, the ability to make an impact within Colombian higher education and, on the institutional level, to engage with the concept of internationalization at home and revisiting the role of academics in advancing internationalization. These themes are discussed against the background of literature on faculty mobility and the specific situation of emerging countries.
First User Experiences With a Novel Touchscreen-Based Insulin Pump System in Daily Life of Patients With Type 1 Diabetes Experienced in Insulin Pump Therapy
Authors: Waldenmaier Delia , Zschornack Eva , Kalt Lucas , Buhr Andreas , Pleus Stefan , Haug Cornelia , Freckmann Guido
Published: July 2018

Introduction:

A new insulin pump system was tested under everyday conditions for user evaluation and safety assessment prior to its launch in Europe. This insulin pump is focused on easy handling and uses prefilled cartridges.

Methods:

The pump system was used by 35 adult subjects with type 1 diabetes, experienced in insulin pump therapy, under everyday conditions for approximately one month each. All subjects rated various aspects of the system after home use; technical issues and safety parameters were assessed throughout the study.

Results:

All 35 subjects completed the study as planned and used the system for a total of 1013 days. After home use, 74% of the subjects were very satisfied or quite satisfied with the new pump. The subjects confirmed that the system is easy to use, especially considering general handling, bolus delivery and basal rate settings, infusion set, and cartridge change. Potential for improvements was seen in the touchscreen, warnings and alarms, the blind bolus function, the availability of a bolus calculator (was not available at time of study), and the cartridge size as rated by the study participants. Safety analysis did not raise any concerns for the use of this system.

Conclusion:

The majority of the users testing the system were satisfied with the novel insulin pump system and the system was safe for use under everyday conditions by this study population.
Artificial Pancreas: Clinical Study in Latin America Without Premeal Insulin Boluses
Authors: Sánchez-Peña Ricardo , Colmegna Patricio , Garelli Fabricio , De Battista Hernán , García-Violini Demián , Moscoso-Vásquez Marcela , Rosales Nicolás , Fushimi Emilia , Campos-Náñez Enrique , Breton Marc , Beruto Valeria , Scibona Paula , Rodriguez Cintia , Giunta Javier , Simonovich Ventura , Belloso Waldo H. , Cherñavvsky Daniel , Grosembacher Luis
Published: July 2018

Background:

Emerging therapies such as closed-loop (CL) glucose control, also known as artificial pancreas (AP) systems, have shown significant improvement in type 1 diabetes mellitus (T1DM) management. However, demanding patient intervention is still required, particularly at meal times. To reduce treatment burden, the automatic regulation of glucose (ARG) algorithm mitigates postprandial glucose excursions without feedforward insulin boluses. This work assesses feasibility of this new strategy in a clinical trial.

Methods:

A 36-hour pilot study was performed on five T1DM subjects to validate the ARG algorithm. Subjects wore a subcutaneous continuous glucose monitor (CGM) and an insulin pump. Insulin delivery was solely commanded by the ARG algorithm, without premeal insulin boluses. This was the first clinical trial in Latin America to validate an AP controller.

Results:

For the total 36-hour period, results were as follows: average time of CGM readings in range 70-250 mg/dl: 88.6%, in range 70-180 mg/dl: 74.7%, <70 mg/dl: 5.8%, and <50 mg/dl: 0.8%. Results improved analyzing the final 15-hour period of this trial. In that case, the time spent in range was 70-250 mg/dl: 94.7%, in range 70-180 mg/dl: 82.6%, <70 mg/dl: 4.1%, and <50 mg/dl: 0.2%. During the last night the time spent in range was 70-250 mg/dl: 95%, in range 70-180 mg/dl: 87.7%, <70 mg/dl: 5.0%, and <50 mg/dl: 0.0%. No severe hypoglycemia occurred. No serious adverse events were reported.

Conclusions:

The ARG algorithm was successfully validated in a pilot clinical trial, encouraging further tests with a larger number of patients and in outpatient settings.
Interpretation of Retrospective BG Measurements
Authors: Stewart Kent W. , Pretty Christopher G. , Shaw Geoffrey M. , Chase J. Geoffrey
Published: July 2018

Background:

This study investigates blood glucose (BG) measurement interpolation techniques to represent intermediate BG dynamics, and the effect resampling of retrospective BG data has on key glycemic control (GC) performance results. GC protocols in the ICU have varying BG measurement intervals ranging from 0.5 to 4 hours. Sparse data pose problems, particularly in comparing GC performance or model fitting, and thus interpolation is required.

Methods:

Retrospective data from SPRINT in Christchurch Hospital Intensive Care Unit (ICU) (2005-2007) were used to analyze several interpolation techniques. Piecewise linear, spline, and cubic interpolation functions, which force interpolation through measured data, as well as 1st and 2nd Order B-spline basis functions, are used to identify the interpolated trace. Dense data were thinned to increase sparsity and obtain measurements (Hidden Measurements) for comparison after interpolation. Performance is assessed based on error in capturing hidden measurements. Finally, the effect of minutely versus hourly sampling of the interpolated trace on key GC performance statistics was investigated using retrospective data received from STAR GC in Christchurch Hospital ICU, New Zealand (2011-2015).

Results:

All of the piecewise functions performed considerably better than the fitted interpolation functions. Linear piecewise interpolation performed the best having a mean RMSE 0.39 mmol/L, within 2 standard deviations of the BG sensor error. Minutely sampled BG resulted in significantly different key GC performance values when compared to raw sparse BG measurements.

Conclusion:

Linear piecewise interpolation provides the best estimate of intermediate BG dynamics and all analyses comparing GC protocol performance should use minutely linearly interpolated BG data.
Nondestructive Assessment of Articular Cartilage Electromechanical Properties after Osteochondral Autologous and Allogeneic Transplantation in a Goat Model
Authors: Mickevicius Tomas , Pockevicius Alius , Kucinskas Audrius , Gudas Rimtautas , Maciulaitis Justinas , Usas Arvydas
Published: July 2018

Objective

To determine the applicability of a minimally invasive diagnostic device to evaluate the quality of articular cartilage following autologous (OAT) and allogeneic (OCA) osteochondral graft transplantation in goat model.

Design

OAT grafts were harvested from lateral femoral condyles (LFCs) and transplanted into osteochondral defects created in medial femoral condyles (MFCs) of contralateral knees. OCA grafts were transplanted into MFC condyles after in vitro storage. Autologous platelet-rich plasma (PRP) was administered intraarticularly after the surgery and at 1 and 2 months postoperatively. OAT and OCA grafts were evaluated macroscopically (Oswestry arthroscopy score [OAS]), electromechanically (quantitative parameter, QP), and histologically (O’Driscoll score, safranin O staining intensity) at 3 and 6 months after transplantation. Results were compared with preoperative graft evaluation.

Results

Transplanted cartilage deteriorated within 6 months in all groups. Cartilage quality was better retained in OAT group compared with a decline in OCA group. QP and OAS scores were comparable in OAT and OCA groups at 3 months, but superior in OAT group at 6 months, according to all the methods applied. PRP injections significantly improved QP and OAS score at 6 months compared with 3 months in OAT group. QP moderately correlated with OAS, O’Driscoll score, and safranin O staining intensity.

Conclusions

Grafts did not retain preoperative quality parameters at 6 months follow-up; however, OAT were superior to OCA grafts. PRP may have a beneficial effect on macroscopic and electromechanical properties of cartilage; however, histological improvement is yet to be proved. Electromechanical diagnostic device enables reliable assessment of transplanted cartilage.
Rapid Facial Reactions in Response to Facial Expressions of Emotion Displayed by Real Versus Virtual Faces
Authors: Philip Leonor , Martin Jean-Claude , Clavel Céline
Published: July 2018

Facial expressions of emotion provide relevant cues for understanding social interactions and the affective processes involved in emotion perception. Virtual human faces are useful for conducting controlled experiments. However, little is known regarding the possible differences between physiological responses elicited by virtual versus real human facial expressions. The aim of the current study was to determine if virtual and real emotional faces elicit the same rapid facial reactions for the perception of facial expressions of joy, anger, and sadness. Facial electromyography (corrugator supercilii, zygomaticus major, and depressor anguli) was recorded in 30 participants during the presentation of dynamic or static and virtual or real faces. For the perception of dynamic facial expressions of joy and anger, analyses of electromyography data revealed that rapid facial reactions were stronger when participants were presented with real faces compared with virtual faces. These results suggest that the processes underlying the perception of virtual versus real emotional faces might differ.
A De Novo POLD1 Mutation Associated With Mandibular Hypoplasia, Deafness, Progeroid Features, and Lipodystrophy Syndrome in a Family With Werner Syndrome
Authors: Wang Linda R. , Radonjic Aleksandar , Dilliott Allison A. , McIntyre Adam D. , Hegele Robert A.
Published: July 2018

Background. Mandibular hypoplasia, deafness, progeroid features, and lipodystrophy (MDPL) syndrome is a recently recognized genetic disorder comprised of mandibular hypoplasia, deafness, progeroid features, and lipodystrophy. It is caused by an autosomal dominant mutation in the POLD1 gene, with <20 genetically confirmed cases to date. Clinical overlap with other progeroid syndromes including Werner syndrome (WS) can present diagnostic challenges. Case. The proband is a 36-year-old male of Sicilian ancestry who was phenotypically normal at birth. Onset of lipodystrophic and progeroid features began at 18 months, with progressive loss of subcutaneous fat, prominent eyes, and pinched nose. Over the next 2 decades, he developed hearing loss, small fingers, joint contractures, hypogonadism, osteoporosis, and hypertriglyceridemia. Three of his 4 siblings had premature hair graying and loss, severe bilateral cataracts, skin changes, and varying degrees of age-related metabolic conditions, raising suspicion for a genetic progeroid syndrome. Genetic Analysis. A targeted sequencing panel identified a heterozygous WRN mutation in the proband’s genomic DNA. Sanger sequencing further revealed his parents and an asymptomatic brother to be carriers of this mutation, and in his 3 brothers affected with classic WS the mutation was identified in the homozygous state. Whole exome sequencing ultimately revealed the proband harbored the causative de novo in-frame deletion in POLD1 (p.Ser605del), which is the most common mutation in MDPL patients. Conclusion. We report the unusual convergence of 2 rare progeroid disorders in the same family: the proband displayed sporadic MDPL syndrome, while 3 brothers had classical autosomal recessive WS. Whole exome sequencing was invaluable in clarifying the molecular diagnoses in this family.
Queering Intersectional Literacies to Redefine Female Sexualities: A Case Study
Authors: Shelton Stephanie Anne
Published: July 2018

Based on a 1-year interview-based case study of a preservice English teacher, this article considers the limitations of both intersectional literacies and reader-based responses to texts. In an effort to address students’ problematic discussions of female sexuality, the participant implemented a queer pedagogy that emphasized alterity, or the examination of “other,” while pushing students into spaces of discomfort and uncertainty. Using Chaucer’s “Wife of Bath’s Tale” as the basis of her approach, the teacher and her students’ engagement with literacy practices necessarily shifted when they began to interrogate cultural norms and sites of uneasiness in relation to school-mandated texts. The article concludes with a discussion of the ways that literacy practices are necessarily and constantly mediated through sociopolitical contexts and personal understandings, though readers’ individual perspectives cannot be the sole basis of reading practices.
A systematic review of how patients value COPD outcomes
Authors: Zhang Yuan , Morgan Rebecca L. , Alonso-Coello Pablo , Wiercioch Wojtek , Bała Małgorzata M. , Jaeschke Rafał R. , Styczeń Krzysztof , Pardo-Hernandez Hector , Selva Anna , Ara Begum Housne , Morgano Gian Paolo , Waligóra Marcin , Agarwal Arnav , Ventresca Matthew , Strzebońska Karolina , Wasylewski Mateusz T. , Blanco-Silvente Lídia , Kerth Janna-Lina , Wang Mengxiao , Zhang Yuqing , Narsingam Saiprasad , Fei Yutong , Guyatt Gordon , Schünemann Holger J.
Published: July 2018

Our objective was to summarise systematically all research evidence related to how patients value outcomes in chronic obstructive pulmonary disease (COPD).

We conducted a systematic review (systematic review registration number CRD42015015206) by searching PubMed, Embase, PsycInfo and CINAHL, and included reports that assessed the relative importance of outcomes from COPD patients' perspective. Two authors independently determined the eligibility of studies, abstracted the eligible studies and assessed risk of bias. We narratively summarised eligible studies, meta-analysed utilities for individual outcomes and assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.

We included 217 quantitative studies. Investigators most commonly used utility measurements of outcomes (n=136), discrete choice exercises (n=13), probability trade-off (n=4) and forced choice techniques (n=46). Patients rated adverse events as important but on average, less so than symptom relief. Exacerbation and hospitalisation due to exacerbation are the outcomes that COPD patients rate as most important. This systematic review provides a comprehensive registry of related studies.