bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing 10-Year Cardiovascular Disease Risk in Malaysians With Type 2 Diabetes Mellitus: Framingham Cardiovascular Versus United Kingdom Prospective Diabetes Study Equations
Authors: Yew Sheng Qian , Chia Yook Chin , Theodorakis Michael
Published: September 2019

In this study, we evaluated the performance of the Framingham cardiovascular disease (CVD) and the United Kingdom Prospective Diabetes Study (UKPDS) risk equations to predict the 10-year CVD risk among type 2 diabetes mellitus (T2DM) patients in Malaysia. T2DM patients (n = 660) were randomly selected, and their 10-year CVD risk was calculated using both the Framingham CVD and UKPDS risk equations. The performance of both equations was analyzed using discrimination and calibration analyses. The Framingham CVD, UKPDS coronary heart disease (CHD), UKPDS Fatal CHD, and UKPDS Stroke equations have moderate discrimination (area under the receiver operating characteristic [aROC] curve = 0.594-0.709). The UKPDS Fatal Stroke demonstrated a good discrimination (aROC curve = 0.841). The Framingham CVD, UKPDS Stroke, and UKPDS Fatal Stroke equations showed good calibration ( P = .129 to .710), while the UKPDS CHD and UKPDS Fatal CHD are poorly calibrated ( P = .035; P = .036). The UKPDS is a better prediction equation of the 10-year CVD risk among T2DM patients compared with the Framingham CVD equation.
A shape memory alloy torsion actuator for static blade twist
Authors: Ameduri Salvatore , Concilio Antonio
Published: September 2019

Active blade twist is an option to increase helicopter performance, for instance moving its condition from hovering to cruise. Shape memory alloys give the possibility of realizing compact devices, with high energy density. Several devices have been proposed in literature, showing limitations in terms of effectiveness and necessary room. In this article, the capability of a shape memory alloy torque tube to induce a certain twist law along the blade, while preserving its integrability within the structure, has been exploited. The study refers to a complex theoretical model, made of different specialized modules. In detail, transmitted twist action by the shape memory alloy actuators, aerodynamic effects caused by the induced geometrical change, inertial impact following the motor system integration, and system layout influence on the blade response have been taken into account. Through this model, a parametric investigation has been organized to highlight the importance of selected design variables. Tube thickness, mass, and length have been considered. Two different configurations have been initially taken into account, distinguished for the twist transmission mode and their outline. In the first hypothesis, a pre-stressed wire system converts tensile stress into a rotary action. In the second sketch, a pre-twisted solid tube connects two different stations of the blade, transmitting relative rotation. After the first trade-off, the second architecture has been selected for further analysis, focusing on its performance in terms of net transmitted twist, aerodynamic effects, while paying attention to a proper mass balance. In the chosen approach, the actuator has been installed at the torsion center. A finite element model has been used to validate the assessed analytical representation and has permitted establishing the applicability domain. Apart elastic forces, acting both in the shape memory alloys and the blade components, centrifugal forces have been taken into account by considering an increased stiffness of the reference structural element. Aerodynamic forces have been evaluated after the target configuration has been reached; helicopter trim has been considered to this purpose. The researchers aim at developing this concept by integrating the reverse action of the aerodynamic field and evaluating the importance of the actuator position along the chord. The research herein presented has been carried out within the SABRE project, project ID 723491, gratefully funded by the European Union within the Horizon 2020 program.
Is Film as a Research Tool the Future of Public Health? A Review of Study Designs, Opportunities, and Challenges
Authors: Baumann Sara E. , Merante Monica , Folb Barbara L. , Burke Jessica G.
Published: September 2019

Among public health researchers, there is growing interest in film methods due to their ability to highlight subtleties in practices, capture emotions, engage hard-to-reach populations, and advocate for social change. Still, little is known about strengths and challenges associated with using film methods in public health. This review synthesizes peer-reviewed, public health research studies that apply film methods, and describes opportunities and challenges. Of the 3,431 identified articles, 20 met the inclusion criteria. Fifteen different film methods were found that offer numerous methodological strengths, including the ability to provide rich descriptions, capture emic perspectives, increase comfort in participation, empower participants, and be used for advocacy. Future studies may explore engaging participants throughout the entire research process and using visuals created in the study to communicate findings. Keeping in mind their challenges, film methods are long overdue in public health and provide unique opportunities to capture sensory data.
Measurement Invariance of the Five Factor Model of Personality: Facet-Level Analyses Among Euro and Asian Americans
Authors: Lui P. Priscilla , Samuel Douglas B. , Rollock David , Leong Frederick T. L. , Chang Edward C.
Published: September 2019

Relative to broad Big Five domains, personality facets provide incremental value in predicting life outcomes. Valid between-group comparisons of means and correlates of facet scores are contingent upon measurement invariance of personality measures. Research on culture and Big Five personality has been largely limited to cross-national comparisons of domains, without assessing measurement invariance across ethnoracial groups within the same country. Using the NEO Inventories, we tested facet-level measurement invariance between Euro ( N = 418, 63.2% women, Mage = 18.43) and Asian Americans ( N = 429, 56.6% women, Mage = 18.00). Multigroup exploratory factor analysis within a confirmatory factor analysis framework showed partial strong invariance. Assertiveness and activity did not load onto extraversion as strongly for Asian Americans. Self-consciousness showed a stronger cross-loading onto extraversion among Asian Americans than Euro Americans. Achievement striving, competence, warmth, tender-mindedness, and excitement seeking showed noninvariant intercepts across groups. Collectivistic values emphasizing interpersonal harmony and modesty should be considered when examining narrow and broad traits among Asian Americans.
Modeling Relations Between Triarchic Biobehavioral Traits and DSM Internalizing Disorder Dimensions
Authors: Latzman Robert D. , Palumbo Isabella M. , Krueger Robert F. , Drislane Laura E. , Patrick Christopher J.
Published: September 2019

The biobehavioral traits of the triarchic model of psychopathy have well-known correlates with externalizing psychopathology. Although evidence also suggests associations with internalizing disorders, research has yet to formally model relationships between dimensions of internalizing psychopathology and triarchic traits. Employing a sample of 218 adults (50.2% female), the current study used confirmatory factor analysis to characterize how triarchic trait dimensions—delineated using different scale operationalizations—relate to internalizing when modeled as a single broad factor, and as distinct fear and distress subfactors. Findings demonstrated (a) robust opposing relations for triarchic boldness (+) and disinhibition (−), and an interactive association for the two, with general internalizing, along with a modest negative relationship for meanness; and (b) distinct associations for the three triarchic trait dimensions with fear and distress subfactors of internalizing. This work clarifies how facets of psychopathy relate to the internalizing psychopathology spectrum and provides a means for interfacing this spectrum with biological variables.
Sexual Violence Perpetration Within Intimate Relationships: An I3 Model Analysis of the Effects of Sexual Violence Victimization and Psychological Flexibility
Authors: Grom Jessica L. , Crane Cory , Leone Ruschelle M. , Parrott Dominic J. , Eckhardt Christopher
Published: September 2019

The I3 Model posits that intimate partner violence (IPV) is determined by the relative strength of instigatory, impellance, and inhibitory factors. Although much research has examined nonsexual IPV, few studies have used the I3 Model to examine sexual IPV. This study investigated the effects of sexual IPV victimization (an impellor) and psychological flexibility (an inhibitor) on sexual IPV perpetration within a dyadic framework. Participants nested within 617 intimate couples completed measures of psychological flexibility and sexual IPV perpetration and victimization. Results showed that Actor IPV victimization was positively and Actor psychological flexibility was negatively associated with Actor IPV perpetration. Among those who experienced low levels of IPV victimization, psychological flexibility inhibited IPV perpetration. This inhibiting effect did not extend to Actors who experienced high levels of IPV victimization. Findings highlight the complex interactions between I3 factors and support continued dyadic examination of IPV perpetration etiology.
Foundations of Arrogance: A Broad Survey and Framework for Research
Authors: Cowan Nelson , Adams Eryn J. , Bhangal Sabrina , Corcoran Mike , Decker Reed , Dockter Ciera E. , Eubank Abby T. , Gann Courtney L. , Greene Nathaniel R. , Helle Ashley C. , Lee Namyeon , Nguyen Anh T. , Ripley Kyle R. , Scofield John E. , Tapia Melissa A. , Threlkeld Katie L. , Watts Ashley L.
Published: September 2019

We consider the topic of arrogance from a cross-disciplinary viewpoint. To stimulate further research, we suggest three types of arrogance (individual, comparative, and antagonistic) and six components contributing to them, each logically related to the next. The components progress from imperfect knowledge and abilities to an unrealistic assessment of them, an unwarranted attitude of superiority over other people, and related derisive behavior. Although each component presumably is present to some degree when the next one operates, causality might flow between components in either direction. The classification of components of arrogance should reduce miscommunication among researchers, as the relevant concepts and mechanisms span cognitive, motivational, social, and clinical domains and literatures. Arrogance is an important concept warranting further study for both theoretical and practical reasons, in both psychopathology and normal social interaction. Everyone seems to have qualities of arrogance to some degree, and we consider the importance of arrogance on a spectrum. We contend that humankind can benefit from a better understanding of the cognitive limitations and motivational biases that, operating together, appear to contribute to arrogance. We bring together information and questions that might lead to an invigorating increase in the rate and quality of cross-disciplinary research on arrogance.
Obesity and 1-Year Mortality in Adults After Sepsis: A Systematic Review
Authors: Robinson Jamie , Swift-Scanlan Theresa , Salyer Jeanne
Published: September 2019

Purpose:

In recent years, researchers have noted an “obesity paradox,” where individuals with obesity survive sepsis at higher rates than their nonobese counterparts. This systematic review summarizes the literature on studies examining the association between obesity and 1-year mortality among patients admitted with sepsis, severe sepsis, or septic shock.

Materials and Methods:

Using a comprehensive search strategy, a systematic review was conducted to identify studies examining the association of obesity and sepsis mortality. PubMed, Cumulative Index of Nursing and Allied Health Literature, and Elton B. Stephens Company host databases were searched for the terms sepsis, obesity, mortality, and adult.

Results:

The initial search identified 189 studies, 9 of which met inclusion criteria. Of these, four provided evidence that obese or very obese patients with sepsis have lower mortality than nonobese patients. Methodologic differences in the remaining five studies, which reported conflicting results, limit generalizability.

Conclusion:

This systematic review on the association of obesity and sepsis mortality found three studies that demonstrated lower sepsis mortality among obese patients in the first 30 days and one showing that this protective effect extends up to 1 year. Given the increased number of patients surviving sepsis, it is important to consider long-term mortality and further describe the variables associated with increased survival.
Aerococcus urinae and Globicatella sanguinis Persist in Polymicrobial Urethral Catheter Biofilms Examined in Longitudinal Profiles at the Proteomic Level
Authors: Yu Yanbao , Tsitrin Tamara , Bekele Shiferaw , Thovarai Vishal , Torralba Manolito G , Singh Harinder , Wolcott Randall , Doerfert Sebastian N , Sizova Maria V , Epstein Slava S , Pieper Rembert
Published: September 2019

Aerococcus urinae ( Au) and Globicatella sanguinis ( Gs) are gram-positive bacteria belonging to the family Aerococcaceae and colonize the human immunocompromised and catheterized urinary tract. We identified both pathogens in polymicrobial urethral catheter biofilms (CBs) with a combination of 16S rDNA sequencing, proteomic analyses, and microbial cultures. Longitudinal sampling of biofilms from serially replaced catheters revealed that each species persisted in the urinary tract of a patient in cohabitation with 1 or more gram-negative uropathogens. The Gs and Au proteomes revealed active glycolytic, heterolactic fermentation, and peptide catabolic energy metabolism pathways in an anaerobic milieu. A few phosphotransferase system (PTS)–based sugar uptake and oligopeptide ABC transport systems were highly expressed, indicating adaptations to the supply of nutrients in urine and from exfoliating squamous epithelial and urothelial cells. Differences in the Au vs Gs metabolisms pertained to citrate lyase and utilization and storage of glycogen (evident only in Gs proteomes) and to the enzyme Xfp that degrades d-xylulose-5′-phosphate and the biosynthetic pathways for 2 protein cofactors, pyridoxal 6′-phosphate and 4′-phosphopantothenate (expressed only in Au proteomes). A predicted ZnuA-like transition metal ion uptake system was identified for Gs while Au expressed 2 LPXTG-anchored surface proteins, one of which had a predicted pilin D adhesion motif. While these proteins may contribute to fitness and virulence in the human host, it cannot be ruled out that Au and Gs fill a niche in polymicrobial biofilms without being the direct cause of injury in urothelial tissues.
How much mixed/boundary friction is there in an engine — and where is it?
Authors: Taylor RI , Morgan N , Mainwaring R , Davenport T
Published: September 2019

Automotive engines are believed to operate predominantly in the hydrodynamic regime, as evidenced by the (1) the successful strategy of reducing lubricant viscosity to reduce engine friction and improve vehicle fuel consumption, and (2) for most engine operating conditions, direct measurements of engine friction (either motored or fired) find that engine friction increases with increasing engine speed. However, certain components in an engine are known to operate mainly in the mixed/boundary lubrication (e.g. the valve train) and other components (such as the piston rings) operate in the mixed/boundary regime for a portion of the time. In order to quantify the amount of mixed/boundary lubrication in an engine, and in the individual components of the engine, motored and fired friction tests have been carried out for a range of lubricants (of differing viscosity grade, and with/without friction modifier additives). A full discussion of the implications of this work, which includes the impact of fuel dilution and “running-in” is included with insights given into how the work reported here guides the development of future fuel-efficient engine lubricants.
The “central vein sign” in patients with diagnostic “red flags” for multiple sclerosis: A prospective multicenter 3T study
Authors: Maggi Pietro , Absinta Martina , Sati Pascal , Perrotta Gaetano , Massacesi Luca , Dachy Bernard , Pot Caroline , Meuli Reto , Reich Daniel S , Filippi Massimo , Pasquier Renaud Du , Théaudin Marie
Published: September 2019

Background:

The central vein sign (CVS) has been shown to help in the differential diagnosis of multiple sclerosis (MS), but most prior studies are retrospective.

Objectives:

To prospectively assess the diagnostic predictive value of the CVS in diagnostically difficult cases.

Methods:

In this prospective multicenter study, 51 patients with suspected MS who had clinical, imaging, or laboratory “red flags” (i.e. features atypical for MS) underwent 3T fluid-attenuated inversion recovery (FLAIR*) magnetic resonance imaging (MRI) for CVS assessment. After the diagnostic work-up, expert clinicians blinded to the results of the CVS assessment came to a clinical diagnosis. The value of the CVS to prospectively predict an MS diagnosis was assessed.

Results:

Of the 39 patients who received a clinical diagnosis by the end of the study, 27 had MS and 12 received a non-MS diagnosis that included systemic lupus erythematosus, sarcoidosis, migraine, Sjögren disease, SPG4-spastic-paraparesis, neuromyelitis optica, and Susac syndrome. The percentage of perivenular lesions was higher in MS (median = 86%) compared to non-MS (median = 21%; p < 0.0001) patients. A 40% perivenular lesion cutoff was associated with 97% accuracy and a 96% positive/100% negative predictive value.

Conclusion:

The CVS detected on 3T FLAIR* images can accurately predict an MS diagnosis in patients suspected to have MS, but with atypical clinical, laboratory, and imaging features.
Brain anatomical correlates of fatigue in multiple sclerosis
Authors: Palotai Miklos , Guttmann Charles RG
Published: September 2019

Fatigue is one of the most debilitating symptoms in patients with multiple sclerosis (MS). Despite its clinical significance, the aetiology and pathophysiology of MS-related fatigue are not well understood. Current evidence and understanding of the neuroanatomical underpinnings of MS-related fatigue are reviewed in this article. The aims of this paper are to (1) review the findings of previous structural neuroimaging studies on MS-related fatigue and summarize consistent findings regarding brain circuitry associated with fatigue in MS, (2) contextualize these findings with the neurochemistry of the relevant circuits and (3) discuss future perspectives with regard to impact on fatigue management of MS patients and methodological challenges towards improved understanding of fatigue pathogenesis. The detailed understanding of the neuroanatomical underpinnings of fatigue might contribute to the identification of novel treatment targets and factors determining treatment resistance to drugs used in current clinical practice.
Numerical simulation of a wire–plate solid-state fan for ultra-quiet museum display cases
Authors: He Yijian , Chen Xiangyu , Zheng Youming , Chen Guangming
Published: September 2019

Conventional microenvironment control systems of a museum display case generally use mechanical fans which produce great noise and vibration for heat dissipation of semiconductor air-conditioning units. Solid-state fans (ionic wind) operate with no moving parts and can overcome noise and vibration issues of a microenvironment control system. In this study, a multi-electrode mathematical and physical model of wire–plate solid-state fans was developed, and its performance has been analysed in depth. Simulation results indicate that there is an optimal distance between discharge electrodes ( d), which corresponds to the largest average wind velocity at the exit of the simulation area ( ua). Under the same power consumption, ua and the vertical height from a discharge electrode to a collecting electrode ( H) exhibit a monotonically increasing relationship. Similarly, ua and the radius of a discharge electrode ( r) show a monotonically decreasing relationship. In addition, a manufactured solid-state fan with an average wind velocity of 1.48 m·s−1 shows a noise intensity of 4.3 dB(A), which is considerably lower than that of a mechanical fan, with the same power consumption. These positive results suggest that ultra-quiet microenvironment control technologies of a museum display case can be potentially developed in the near future.
Nonlinear dynamic modeling and analysis for aviation axial piston pump in center spring return mechanism
Authors: Hang Jie , Li Yunhua , Zhang Peng , Yang Liman
Published: September 2019

Aviation axial piston pump is an important energy conversion component in aircraft hydraulic system, and the study on the nonlinearity of key operating mechanism is very necessary for improving the reliable operation of the pump. Addressing the aviation axial piston pump, this article analyzes nonlinear dynamic characteristics of the center spring return mechanism by using theoretical analysis and numerical simulation. Firstly, mathematical models of oil-film forces of slipper/swash plate pair and cylinder/port plate pair are derived. Then, based on the nonlinear dynamic theory, some specific theoretical analysis methods such as Lyapunov index spectrum, bifurcation diagram, time series, phase plane portrait, Poincaré map, and power spectrum are used to carry out the numerical simulation of nonlinear dynamic behaviors. The result indicates that characteristics of the center spring can reveal the reason for the nonlinear vibration of the center spring return mechanism. Meanwhile, the behavior of the oil thickness of slipper/swash plate pair is in the periodic and steady motion, and the variation of the oil thickness of cylinder/port plate pair is in chaotic vibration, which establishes the theoretical foundation of the aviation axial piston pump for the traceability and suppression of vibration. The obtained results are of important guidance significance for optimal design and dynamic control of the center spring return mechanism of aviation axial piston pump.
From “thank god for helping this person” to “libtards really jumped the shark”: Opinion leaders and (in)civility in the wake of school shootings
Authors: Rohlinger Deana A , Williams Cynthia , Teek Mackenzie
Published: September 2019

Drawing on a qualitative analysis of 5996 tweets and 480 mainstream news stories about the Florida State University (FSU) and the Ohio State University (OSU) shootings, we examine who emerges as opinion leaders during crises, the kinds of narratives they help construct about school shootings, and the relative civility of these narratives. We find that the opinion leaders who emerge after a crisis are assumed to have local knowledge about the incident and/or are able to quickly curate information about the incident. In addition, we find that the quality of information spread by opinion leaders is critical to narrative construction and civility. The largely fact-based narratives associated with the FSU incident were far more civil than the OSU narratives, which were based on disinformation and polemics. We conclude the article by calling on scholars to take a more nuanced approach to conceptualizing and studying opinion leaders.
Transition to Grandparenthood and Subjective Well-Being in Older Europeans: A Within-Person Investigation Using Longitudinal Data
Authors: Tanskanen Antti O. , Danielsbacka Mirkka , Coall David A. , Jokela Markus
Published: September 2019

The transition to grandparenthood, that is the birth of the first grandchild, is often assumed to increase the subjective well-being of older adults; however, prior studies are scarce and have provided mixed results. Investigation of the associations between grandparenthood and subjective well-being, measured by self-rated life satisfaction, quality of life scores, and depressive symptoms, used the longitudinal Survey of Health, Ageing and Retirement in Europe from 13 countries, including follow-up waves between 2006 and 2015 ( n = 64,940 person-observations from 38,456 unique persons of whom 18,207 had two or more measurement times). Both between-person and within-person (or fixed-effect) regression models were executed, where between-person associations represent results across individuals, that is, between grandparents and non-grandparents; within-person associations represent an individual’s variation over time, that is, they consider whether the transition to grandparenthood increases or decreases subjective well-being. According to the between-person models, both grandmothers and grandfathers reported higher rate of life satisfaction and quality of life than non-grandparents. Moreover, grandmothers reported fewer depressive symptoms than women without grandchildren. The within-person models indicated that entry into grandmotherhood was associated with both improved quality of life scores and improved life satisfaction. These findings are discussed with reference to inclusive fitness theory, parental investment theory, and the grandmother hypothesis.
Feasibility of Integrating Panel-Based Pharmacogenomics Testing for Chemotherapy and Supportive Care in Patients With Colorectal Cancer
Authors: Kasi Pashtoon Murtaza , Koep Tyler , Schnettler Erica , Shahjehan Faisal , Kamatham Vaishnavi , Baldeo Candice , Hughes Caren L.
Published: September 2019

Introduction:

Pharmacogenomics is about selecting the “right drug in the right amount for the right patient.” In metastatic colorectal cancer, germline pharmacogenomics testing presents a unique opportunity to improve outcomes, since the genes dihydropyrimidine dehydrogenase and UDP-glucuronosyltransferase metabolizing the chemotherapy drugs, 5-fluorouracil, and irinotecan are already well known. In a retrospective analysis of the landmark TRIBE clinical trial [(TRIBE - TRIplet plus BEvacizumab multicenter, phase III trial by the Italian Cooperative GONO (Gruppo Oncologico Nord Ovest) group (NCT00719797)], the proportion of patients with serious adverse events was higher in those with dihydropyrimidine dehydrogenase/UDP-glucuronosyltransferase aberrations and was dose dependent. We aimed to report on the feasibility and the results of incorporating pharmacogenomics testing into clinical practice.

Methods:

As a quality improvement initiative and a center of individualized medicine grant, we integrated the use of OneOme RightMed comprehensive test, which reports on 27 genes related to pharmacogenomics and over 300 medications of interest. We limited initial testing to patients with colorectal cancer. Pharmacists provided dosage recommendations based on test results in real-time.

Results:

At our cancer center, 155 patients underwent pharmacogenomics testing from November 2017 to January 2019. Results were available within 3 to 5 days of testing for most patients and were integrated into treatment decision-making. Of 155 sampled participants, a total of 89 (57.4%) participants had an UGT1A1 variant genotype, NM_000463.2: c.-53_-52[8] *1/*28, n = 74 (47.7%); *28/*28, n = 15 (9.7%). Additionally, 4 (2.6%) participants were heterozygous for dihydropyrimidine dehydrogenase. Two (1.3%) individuals were heterozygous for both UDP-glucuronosyltransferase and dihydropyrimidine dehydrogenase genes. All (100%) the patients had at least 1 actionable aberration related to supportive care medications ( CYP-family) of all the possible medications listed on their pharmacogenomics report.

Conclusion:

Preemptive comprehensive pharmacogenomics testing can be integrated into clinical practice in real-time for patients with cancer given faster turnaround and low cost. Pharmacist-driven, patient-specific medication management consults add further value given the number of genes/drugs. This sets the stage for a prospective randomized clinical trial to demonstrate the amount of benefit this can result in these patients.
Time-Dependent Impact of Irreversible Electroporation on Pathology and Ablation Size in the Porcine Liver: A 24-Hour Experimental Study
Authors: Vogel Jantien A. , van Veldhuisen Eran , Alles Lindy K. , Busch Olivier R. , Dijk Frederike , van Gulik Thomas M. , Huijzer Goos M. , Besselink Marc G. , van Lienden Krijn P. , Verheij Joanne
Published: September 2019

Irreversible electroporation causes cell death through low frequency, high voltage electrical pulses and is increasingly used to treat non-resectable cancers. A recent systematic review revealed that tissue damage through irreversible electroporation is time-dependent, but the impact of time on the ablation zone size remains unknown. Irreversible electroporation ablations were performed hourly during 24 consecutive hours in the peripheral liver of 2 anaesthetized domestic pigs using clinical treatment settings. Immediately after the 24th ablation, the livers were harvested and examined for tissue response in time based on macroscopic and microscopic pathology. The impact of time on these outcomes was assessed with Spearman rank correlation test. Ablation zones were sharply demarcated as early as 1 hour after treatment. During 24 hours, the ablation zones showed a significant increase in diameter (rs = 0.493, P = .014) and total surface (rs = 0.499, P = .013), whereas the impact of time on the homogeneous ablated area was not significant (rs = 0.172, P = .421). Therefore, the increase in size could mainly be attributed to an increase in the transition zone. Microscopically, the ablation zones showed progression in cell death and inflammation. This study assessed the dynamics of irreversible electroporation on the porcine liver during 24 consecutive hours and found that the pathological response (ie, cell death/inflammation), and ablation size continue to develop for at least 24 hours. Consequently, future studies on irreversible electroporation should prolong their observation period.
Physical Activity in Severe Dementia Is Associated With Agitation Rather Than Cognitive Function
Authors: Ishimaru Daiki , Tanaka Hiroyuki , Nagata Yuma , Takabatake Shinichi , Nishikawa Takashi
Published: September 2019

Background:

The authors examined associations between physical activity, cognitive function, activities of daily living, and behavioral and psychological dementia symptoms (BPSD) in severe and moderate dementia.

Methods:

A cross-sectional study was conducted to assess severe and moderate dementia groups according to the Clinical Dementia Rating. An actigraphy measured physical activity. Other measures included Mini-Mental State Examination, Cognitive Test for Severe Dementia, Hyogo Activities of Daily Living Scale, and Neuropsychiatric Inventory-Nursing Home.

Results:

Sixty-three participants were assessed (mean age = 89.3 ± 6.4). Physical activity was not associated with cognitive function among participants with severe dementia, although there was a trend-level association with cognitive function among those with moderate dementia. Physical activity was significantly associated with BPSD, specifically agitation/aggression symptoms, for participants with severe dementia, and there was a trend-level association with anxiety for participants with moderate dementia.

Conclusions:

Physical activity appears to be associated with BPSD among individuals in the advanced stages of dementia.
Time to Detection of the First Seizure in Patients With Nonconvulsive Status Epilepticus in the Neurological Intensive Care Unit
Authors: Dericioglu Nese , Arsava Ethem Murat , Topcuoglu Mehmet Akif
Published: September 2019

Video-EEG monitoring is often used to detect nonconvulsive status epilepticus (NCSE) in critical care patients. Short recording durations may fail to detect seizures. In this study, we investigated the time required to record the first ictal event, and whether it could be correlated with some clinical or EEG parameters. Video-EEG recordings of patients who were followed up in our neurological intensive care unit were evaluated retrospectively. The EEG recordings of patients with NCSE were reviewed to determine the timing of the first seizure occurrence. Demographic data and EEG findings were obtained from patient charts and EEG reports. Possible correlations between the presence of periodic discharges (PD), Glasgow Coma Scale (GCS) score and early seizure detection (defined as a seizure within the first hour of recording) were explored statistically. Out of 200 patients who underwent video-EEG monitoring, we identified 30 cases (15%; 18 male, 12 female; age 24-86 years; mean recording duration 99 hours) with NCSE. The first seizure was recorded within 0 to 1 hour in 22 patients (73%) and within 1 to 12 hours in 6 patients (22%). Interictal PDs were identified in 19 patients (63%). GCS score was ≤8 in 16 patients (53%). There was no correlation between early seizure detection and PDs (p=1.0) or GCS score ( P = .22). In our study, >90% of the seizures were captured within 12 hours. This finding suggests that most of the NCSE cases can be identified even in centers with limited resources. The presence or absence of PDs or GCS score does not predict the timing of the first seizure.
Benefit of Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass in Octogenarians
Authors: Kitahara Hiroto , McCrorey Mackenzie , Patel Brooke , Nisivaco Sarah , Balkhy Husam H.
Published: September 2019

Objective

An important advantage of robotic beating-heart totally endoscopic coronary artery bypass (TECAB) is early functional recovery, in which fragile patients like octogenarians (age >80 years) benefit most. The aim of this study was to investigate the safety and feasibility of TECAB in octogenarians.

Methods

We retrospectively reviewed patients undergoing TECAB from July 2013 to September 2017 at our institution. Perioperative outcomes of octogenarian patients and that of younger patients were compared.

Results

Of 308 patients who underwent TECAB, 28 patients (9.1%) were octogenarians (mean age 83.8 ± 3.0 years). Octogenarians had a higher rate of hypertension and atrial fibrillation compared to younger patients. TECAB was successfully performed without conversion to any larger incisions in octogenarians. Mean operative time (299 ± 83 minutes vs 281 ± 89 minutes, P = 0.309) and the rate of multivessel bypass (60.7% vs 58.2%, P = 0.798) were similar between octogenarians and younger patients. New atrial fibrillation was observed more frequently in octogenarians compared to younger patients (35.7% vs 18.6%, P = 0.031). Mean length of hospital stay was similar between the 2 groups (octogenarians: 3.9 ± 1.8 days vs younger patients: 3.5 ± 3.0 days, P = 0.475). Twenty-two octogenarians (78.6%) were discharged directly to home. In-hospital mortality was zero in octogenarians.

Conclusions

Robotic beating-heart TECAB had favorable results in octogenarians with acceptable morbidity and mortality and excellent short length of stay similar to younger patients.
An iodine-promoted one-pot and metal-free access to indolin-2-ones
Authors: Zhang Yong , Zong Xi , Ji Min
Published: September 2019

A new method for the synthesis of indolin-2-ones has been realized by an I2-promoted oxidative reaction from 1,2,3,3-tetramethyl-3 H-indolium iodides. This transformation proceeded smoothly under metal-free and peroxide-free conditions in a cascade manner.
Bourdieu, Latour and Rasha Abbas: The Uses of Actor-Network Theory for Studying the Field(s) of Cultural Production in the Middle East and North Africa
Authors: Lang Felix
Published: September 2019

Since the events of the ‘Arab Spring’ in 2011, the field(s) of cultural production of the Middle East and North Africa (MENA) have attracted considerable scholarly attention. However, the conceptual and methodological tools of cultural sociology, mostly developed for and through research in western societies, often have limited purchase when it comes to the empirical reality of cultural production in the MENA. This article proposes to introduce concepts from actor-network theory (ANT) in order to adapt Bourdieu’s conceptual framework of analysis to the case of globally dominated, transnational and relatively unstable spaces of cultural production. Two main arguments are being pursued: (1) Conceiving the field as network(s) offers a way of opening up the rigid and nation-centred space to include transnational as well as transient relations between actors that may only briefly play a role in cultural production. (2) In a situation where the artwork is the most immediately visible expression of the field’s structure, the role of objects in constituting the field must be reassessed. ANT offers ways of making full use of the heuristic potential of material objects and thus provides a privileged starting point for the analysis of fields in flux.
Contesting the past on the Chinese Internet: Han-centrism and mnemonic practices
Authors: Wang Yi
Published: September 2019

Digital technology has brought critical changes to mnemonic practices in China, such as the empowerment of social groups to discover previously underrepresented historical accounts and produce alternative historical narratives. This article examines the mnemonic practices of Han-centrism, a type of ethnic and cultural nationalist movement based on the Chinese Internet. It analyzes how Han-centrist netizens reinterpret national history through their efforts to rediscover forgotten historical narratives of glory and trauma. It suggests that digital technology in China facilitates the emergence of online groups that are dedicated to the struggle for “historical truth” and social-cultural changes, motivated by a crisis of identity. Their mnemonic practices may be partly tolerated by the authoritarian state under some conditions. However, given China’s complicated and conflictual history, such online groups can easily turn the Internet into a battlefield of nationalism. This article highlights the confusion and contestation of memory and identity in contemporary China and the role of digital technology in the long battle.
Use of nebulised N-acetylcysteine as a life-saving mucolytic in intensive care: A case report
Authors: Brodier Elizabeth A , Raithatha Meera , Kannan Santhana , Karunasekara Niroshini
Published: September 2019

We present a case of critical airway obstruction secondary to a solid tracheal mucus plug in a patient with pneumonia. Following failed conventional mucolysis therapy, nebulised N-acetylcysteine acted as a life-saving mucolytic, and prevented imminent cardiorespiratory arrest. Use of oral N-acetylcysteine as a mucolytic has been long established within respiratory medicine in managing chronic airway disease, but is rarely utilised in critically ill or mechanically ventilated patients due to the lack of comparative studies in literature. A 28-year-old female presented to the emergency department with shortness of breath and a productive cough. She was six weeks post-partum with no past medical history. Initial management for a community acquired pneumonia with type 1 respiratory failure included intensive care admission, antibiotics, fluid therapy and bronchodilators. The patient acutely deteriorated 48 h after admission becoming unresponsive and severely hypoxaemic. Intubation did not achieve ventilation, and subsequent direct bronchoscopy revealed a thick, solid, obstructing tracheal mucus plug, superior to the carina. It was resistant to aspiration despite the use of saline flushes, chest physiotherapy and bronchodilators and the bronchoscope could not pass it. N-acetylcysteine, administered via the bronchoscopic port, caused sufficient mucolysis to enable removal of the thick mucus cast, enabling ventilation and gas exchange. Such resistant mucus plugging is a rare cause of failed ventilation, with limited therapeutic options. Here, the unlicensed and rarely reported use of nebulised N-acetylcysteine was a life-saving mucolytic, allowing removal of the obstructing plug and re-establishing ventilation.
Towards Conservation of Genetic Variation of Tropical Tree Species With Differing Successional Status: The Case of Mansonia altissima A. Chev and Triplochiton scleroxylon K. Schum
Authors: Akinnagbe Akin , Gailing Oliver , Finkeldey Reiner , Lawal Amadu
Published: September 2019

Two important West African timber tree species with differing successional status, Mansonia altissima A. Chev and Triplochiton scleroxylon K. Schum were investigated in this study. Triplochiton scleroxylon is a pioneer species found in open forests, whereas Mansonia altissima is a nonpioneer light-demanding tree species occurring in closed forests. Amplified fragment length polymorphism markers were used to compare the genetic diversities of these two timber species in stands with different degrees of human impact (isolated forest patch, logged forest, farmland, plantation, and primary forest). Contrasting effects of human impact on genetic diversity were detected for these two timber species. The results suggested severe effects of human impact on the genetic diversity of Mansonia altissima, a nonpioneer species. However, no adverse effect was recorded in Triplochiton scleroxylon, a pioneer species. These findings indicate that nonpioneer tree species could be more prone to genetic erosion than pioneer tree species as a result of adverse human impacts. Therefore, conservation of genetic diversity in both pioneer and nonpioneer tree species populations would likely necessitate different measures.
Diagnostic delay does not influence survival of pancreatic cancer patients
Authors: Stornello Caterina , Archibugi Livia , Stigliano Serena , Vanella Giuseppe , Graglia Benedetta , Capalbo Carlo , Nigri Giuseppe , Capurso Gabriele
Published: September 2019

Background

Most pancreatic ductal adenocarcinoma patients present with advanced disease. Whether it is possible to increase survival by earlier diagnosis is unclear.

Objective

The purpose of this study was to investigate the association between presenting complaints and risk factors for pancreatic cancer with diagnostic delay, stage and survival.

Methods

This was a single‐centre retrospective cohort study. Consecutive patients were interviewed and data on demographics, medical history, risk factors and complaints leading to pancreatic ductal adenocarcinoma diagnosis and disease stage were recorded. Diagnostic delay was considered as time between first complaint and diagnosis. Patients received appropriate treatments and their outcome was recorded in a dedicated database. The Chi‐square test for comparison of categorical variables and the Mann–Whitney test for continuous variables were employed with Bonferroni corrections. Correlation between continuous variables was evaluated by means of the Spearman correlation coefficient. Survival analysis was performed with the Kaplan–Meier method and a log‐rank test.

Results

The median diagnostic delay for 477 pancreatic ductal adenocarcinoma patients was two months (interquartile range 1–5), being significantly shorter for patients presenting with jaundice compared with those with pain, weight loss, diabetes (p  < 0.001). The global rate of metastatic disease at diagnosis was 40%, being only 22% in those presenting with jaundice. The median diagnostic delay, however, was not significantly different among disease stages but was significantly longer in patients with a body mass index>25 kg/m2. The median survival time was seven months. Factors associated with worse survival at the multivariable analysis were older age (hazard ratio 1.02 per year), metastatic disease (hazard ratio 2.12) and pain as presenting complaint (hazard ratio 1.32), while diagnostic delay was not.

Conclusion

While some complaints are associated with a shorter diagnostic delay and less advanced disease stage, we could not demonstrate that delay is associated with survival, possibly suggesting that prevention rather than early recognition is important to tackle pancreatic cancer lethality.
Disseminated Langerhans cell histiocytosis presenting as oesophageal disease in a cat
Authors: Bellamy Edward , Palma Stefano Di , Ressel Lorenzo , Domínguez Elisabet , Fernández Yordan
Published: September 2019

Case summary

An 11-year-old female spayed domestic shorthair cat was referred with a 2-month history of ptyalism, hyporexia and weight loss. Physical examination revealed reduced body condition score (2/9) and decreased skin turgor. Laboratory abnormalities included mild erythrocytosis, elevated creatine kinase, hypercobalaminaemia and hypofolataemia. CT of the head and abdominal ultrasonography were within normal limits. Gastroesophagoscopy revealed mucosal ulceration and possible stenosis of the distal oesophagus. Thoracic radiographs and iodine oesophagram showed a soft tissue opacity in the caudodorsal thorax compatible with a parietal oesophageal mass causing luminal stenosis or an extra-parietal mass causing ventral displacement and compression of the oesophagus. Pulmonary nodules were observed in the cranial lung lobes. CT of the thorax confirmed the oesophageal origin of the mass and the presence of pulmonary nodules scattered throughout the lung parenchyma. The patient was euthanased given the imaging findings and perceived guarded prognosis. Post-mortem examination revealed multifocal nodular lesions affecting the oesophagus, lungs, kidneys and pancreas. Histopathological examination identified atypical round cells characterised by eosinophilic cytoplasm and pale nuclei with prominent nuclear grooves, compatible with neoplastic histiocytic cells. Immunohistochemistry revealed strong expression for CD18, Iba-1 and vimentin. Transmission electron microscopy demonstrated intracytoplasmic organelles consistent with Birkbeck granules of Langerhans cell origin in lesional histiocytes. These findings were compatible with a diagnosis of disseminated Langerhans cell histiocytosis.

Relevance and novel information

To our knowledge, this is the first report of disseminated Langerhans cell histiocytosis with oesophageal involvement in a cat.
High-Fidelity Microsurgical Simulation: The Thiel Cadaveric Nerve Model and Evaluation Instrument
Authors: Odobescu Andrei , Dawson Deborah , Goodwin Isak , Harris Patrick G. , BouMerhi Joseph , Danino Michel A.
Published: September 2019

With surgical education moving from a time-based to a competency-based model, developing high-fidelity simulation models has become a priority. The Thiel cadaveric model has previously been used for a number of medical and surgical simulations, including microvascular simulation. We aim to investigate the use of the Thiel model in peripheral nerve simulation and validate a novel evaluation instrument. Sixteen residents ranging from postgraduate years 1 to 6 participated in the study. Their nerve coaptations using Thiel cadaveric nerves were video recorded and evaluated by 5 fellowship-trained microsurgeons using the Micro-Neurorrhaphy Evaluation Scale (MNES). The intraclass correlation among the 5 evaluators was 0.75, revealing excellent interrater reliability. The Cronbach α was .77, underlining the internal consistency of the test items. Bivariate analysis revealed a significant association between the MNES scores and the participants’ self-declared level of experience. This correlation was confirmed by mixed modeling. Our results validate the MNES and underscore the utility of the Thiel nerve tissue for peripheral nerve surgical simulation.