bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on autonomous underwater vehicle wall following based on reinforcement learning and multi-sonar weighted round robin mode
Authors: Wang Xiangbin , Zhang Guocheng , Sun Yushan , Wan Lei , Cao Jian
Published: May 2020

When autonomous underwater vehicle following the wall, a common problem is interference between sonars equipped in the autonomous underwater vehicle. A novel work mode with weighted polling (which can be also called “weighted round robin mode”) which can independently identify the environment, dynamically establish the environmental model, and switch the operating frequency of the sonar is proposed in this article. The dynamic weighted polling mode solves the problem of sonar interference. By dynamically switching the operating frequency of the sonar, the efficiency of following the wall is improved. Through the interpolation algorithm based on velocity interpolation, the data of different frequency ranging sonar are time registered to solve the asynchronous problem of multi-sonar and the system outputs according to the frequency of high-frequency sonar. With the reinforcement learning algorithm, autonomous underwater vehicle can follow the wall at a certain distance according to the distance obtained from the polling mode. At last, the tank test verified the effectiveness of the algorithm.
A novel nonlinear observer for fault diagnosis of induction motor
Authors: Yi Lingzhi , Liu Yue , Yu Wenxin , Zhao Jian
Published: May 2020

In order to accurately diagnose the fault of induction motor, a fault diagnosis of nonlinear observer method based on BP neural network and Cuckoo Search algorithm is proposed. It is a new method which mixes analytical model and artificial neural network; firstly, the induction motor model is divided into linear and nonlinear parts, and BP neural network is used to approximate the nonlinear part. Then an adaptive observer is established, in which a simple and effective method for selecting the feedback gain matrix is offered. Cuckoo Search algorithm is utilized to improve the convergence speed and approximation accuracy in BP Neural Network. Compared with some other algorithms, the simulation results show that the proposed method has higher prediction accuracy. The designed nonlinear observer can estimate the current and speed accurately. Finally, the experiment of winding fault is implemented, and the online fault detection of induction motor is realized by analyzing the current residual errors.
Upending the status quo: Power-sharing and community building in Schitt’s Creek
Authors: Schaab Katharine
Published: May 2020

In the CBC sitcom Schitt’s Creek, a family adjusts to living in a small, rural town after losing their fortune. While Schitt’s Creek embraces the ‘fish out of water’ trope, the series explores a community’s efforts to build equity and empathy across difference. This article argues characters undergo a philosophical shift – from understanding power as an all-or-nothing proposition to an approach that values multiple perspectives and just collective action. Noting the severity of wealth inequality and unequal access to resources around the world, the series shows possibilities for growth and recovery when the status quo has been upended.
Tivozanib in renal cell carcinoma: a new approach to previously treated disease
Authors: Salgia Nicholas J. , Zengin Zeynep B. , Pal Sumanta K.
Published: May 2020

Targeted therapies have been a mainstay of the renal cell carcinoma (RCC) treatment paradigm for the better part of two decades. Multikinase inhibitors of the vascular endothelial growth factor receptor tyrosine kinases (VEGF-TKIs) comprise nearly all targeted therapies in RCC, having been prospectively tested through large, multi-institutional phase III trials. Tivozanib is a VEGF-TKI with high selectivity for VEGF receptors 1–3. Tivozanib has been under investigation for nearly 15 years, with a robust portfolio of preclinical and clinical data. This review seeks to characterize tivozanib within the context of RCC by highlighting preclinical and early clinical trials alongside the phase III trials in RCC, TIVO-1, and TIVO-3. We also aim to explore further trials of tivozanib, whether in combination with other agents and/or in differing disease settings, while providing insight into the utility of tivozanib as a clinical tool for the management of RCC.
High-Modernist Urban Planning in Beijing for Population Control
Authors: Immel Philipp C.D.
Published: May 2020

This article analyses the implementation process of Beijing’s current urban master plan using the background of modernisation theory. The line of thought behind the new urban master plan follows a high-modernist ideology embedded in an environment of reflexive modernity. Intermediate goals of the urban master plan are to tighten population control and increase social legibility of the city, providing an additional explanation for state-led urbanisation besides economic reasons. Urban planning is thus used as a social control mechanism and has emerged as a new means to maintain social distinction, creating new forms of exclusion. It can be observed that disruptive Mao era style pushes are still being employed in the policy cycle even today. This becomes evident from the implementation style of urban planning, where campaign-style and regularised implementation methods are complementing each other. This is corroborated through documentary analysis, interviews, and fieldwork conducted by the author.
Effectiveness Comparison of Dexmedetomidine and Remifentanil for Perioperative Management in Patients Undergoing Endoscopic Sinus Surgery
Authors: Huh Hyub , Park Jeong Jun , Seong Hyun Young , Lee Sang Hag , Yoon Seung Zhoo , Cho Jang Eun
Published: May 2020

Background

For patients undergoing endoscopic sinus surgery, intranasal injection of epinephrine can cause acute increases in heart rate and blood pressure.

Objective

Among the drugs for reducing hyperdynamic effects, dexmedetomidine and remifentanil are expected to blunt the acute hemodynamic responses after intranasal injection of epinephrine. Our study compared a difference in the 2 drugs in their abilities to blunt the hemodynamic responses in intraoperative period and postoperative profile.

Methods

In this study, the patients were randomly divided into the dexmedetomidine and remifentanil groups. During the intraoperative period, the hemodynamic values were recorded. The surgical condition was assessed by a single surgeon. During the postoperative period, hemodynamic values, sedation scale score, and pain score were recorded.

Result

No significant differences in hemodynamic variables were found between the groups before and after intranasal injection of epinephrine. Comparison of the group mean values before endotracheal intubation revealed that the blood pressure values in the remifentanil group were significantly lower than those in the dexmedetomidine group. At 2 minutes after endotracheal intubation, blood pressure and heart rate values in the remifentanil group were significantly lower than those in the dexmedetomidine group. The sedation score was significantly lower in the dexmedetomidine group on arrival and at 30 minutes after arrival at the postanesthetic care unit ( P < .001 and P = .001, respectively). At 30 and 60 minutes after the operation, the pain scores were significantly lower in the dexmedetomidine group ( P = .015 and P = .001, respectively).

Conclusion

Dexmedetomidine had better postoperative sedative and analgesic effects than remifentanil for patients undergoing endoscopic sinus surgery in this study. Remifentanil and dexmedetomidine attenuated acute hemodynamic responses to be within normal ranges after intranasal injection of epinephrine, and no significant differences in terms of hemodynamic variables. Remifentanil was superior to dexmedetomidine in inducing hypotension during endotracheal intubation.
Whole exome sequencing identifies compound heterozygous variants of CR2 gene in monozygotic twin patients with common variable immunodeficiency
Authors: Mat Ripen Adiratna , Ghani Hamidah , Chear Chai Teng , Chiow Mei Yee , Syed Yahya Sharifah Nurul Husna , Kassim Asiah , Mohamad Saharuddin Bin
Published: May 2020

Objectives:

A pair of female Malay monozygotic twins who presented with recurrent upper respiratory tract infections, hepatosplenomegaly, bronchiectasis and bicytopenia were recruited in this study. Both patients were suspected with primary immunodeficiency diseases. However, the definite diagnosis was not clear due to complex disease phenotypes. The objective of this study was to identify the causative gene mutation in these patients.

Methods:

Lymphocyte subset enumeration test and whole exome sequencing were performed.

Results:

We identified a compound heterozygous CR2 mutation (c.1916G>A and c.2012G>A) in both patients. These variants were then confirmed using Sanger sequencing.

Conclusion:

Whole exome sequencing analysis of the monozygotic twins revealed compound heterozygous missense mutations in CR2.
A partial micro-foundation for the ‘two-worlds’ theory of morality policymaking: Evidence from Germany
Authors: Arzheimer Kai
Published: May 2020

The two-worlds framework is currently the most important account of morality policymaking in Europe. For this theory of elite behaviour to be valid, a number of implicit assumptions about political belief systems at the mass level must hold. This contribution spells out these assumptions and tests them within a structural equation modelling framework, using original survey data from Germany, a country that constitutes a crucial case for the two-worlds theory. The results showed that the implicit individual-level preconditions of the two-worlds framework were fulfilled. Political secularism and partisanship were strongly associated. Political secularism also had strong effects on morality policy preferences regarding the preferred regulation of abortion, embryo and stem cell research, and gene therapies, even when controlling for a host of background variables. However, the size of the effects did not vary across politicised and non-politicised issues. This casts some doubt over the ability of partisan actors to unilaterally control the morality policy agenda.
Adherence to e-mental health among youth: Considerations for intervention development and research design
Authors: Achilles Melinda R , Anderson Melissa , Li Sophie H , Subotic-Kerry Mirjana , Parker Belinda , O’Dea Bridianne
Published: May 2020

E-mental health programmes have great potential to provide young people with access to mental health support. However, it is commonly reported that adherence to these programmes is low. Low adherence can be problematic, particularly if young people do not receive the full benefits of a programme. In a research trial setting, non-adherence to treatment recommendations can prevent researchers from drawing strong conclusions about effectiveness. Although adherence has been recognised as an issue in need of attention, many of the reviews available are focused on adults and lack clear direction towards what strategies to employ. This paper presents a broad review of the adherence literature, focusing on factors associated with improving adherence to e-mental health among youth. Our view on the key elements to improve adherence identified from the existing literature are presented, and key recommendations for e-mental health intervention design are provided. These include: developing and communicating adherence guidelines based on individuals’ needs and symptom severity, including customisable features to provide a tailored experience and promote a sense of agency, including engagement checks and adopting a user-centred approach by utilising strategies such as co-design. This paper provides guidance to intervention designers and researchers by outlining recommendations and considerations for intervention development and research design.
Exploring Educator Values Alignment Strategies in an Intervention Context: The Emergence of the Beacon Strategy
Authors: Kalogeropoulos Penelope , Russo James Anthony , Clarkson Philip
Published: May 2020

Purpose:

The purpose of this paper is to explore whether the four value alignment strategies available to educators (Scaffolding, Balancing, Intervention, and Refuge) previously identified in the mathematics education literature comprehensively capture educator value alignment strategies in an intervention context.

Design/Approach/Methods:

To this end, we analyse semi-structured interview data with two teacher-leaders involved in the Getting Ready in Numeracy (G.R.I.N.) intervention program through a value alignment lens.

Findings:

We ascertain that a fifth strategy, the Beacon strategy, is needed to describe the range of value alignment strategies employed by educators in the G.R.I.N. program. The Beacon strategy involves the educator digging in and reasserting their expectations until the student behaves in a manner that aligns with the educator’s values. In part it involves the educator being able to recognize their own values and clearly communicating these values to students.

Originality/Value:

This article further explores strategies that educators have at their disposal for aligning their values with those of their students. The uncovering of the Beacon strategy is particularly valuable as it suggests that educators could be purposefully pursuing value alignment even when they do not appear to take any active steps to move further towards their students’ sets of values.
Implementation a Context-Aware Plant Ecology Mobile Learning System
Authors: Wang Chih-Chiang , Lo Chia-Lun , Hsu Ming-Ching , Tsai Chih-Yung , Tsai Chun-Ming
Published: May 2020

Mobile devices are becoming ubiquitous methodologies and tools, providing application for learning and teaching field. On the basis of the widespread use of wireless devices and mobile computing technology, this study proposes a context-aware plant ecology learning system (CAPELS) based on context-aware technology; adapting deep neural networks (DNN) and leaf vein and shape identification algorithm which can identify plant leaves, this system automatically provides relevant botanical and growth environment knowledge to the learners. Therefore, during outdoor education, it can assist learners in accurately obtaining the required relevant botanical and growth environment knowledge. The experimental results indicate that students who used CAPELS performed better learning about plant ecology than those who did not. We also delivered questionnaires to those who used CAPELS and analyzed the results by using the partial least squares (PLS) method. The results have shown that CAPELS can encourage student’s learning motivation and thus improve their learning effectiveness. Thus, CAPELS provides a new educational platform for promoting ecology learning approach and effectively improves student learning efficiency and motivation.
The Differential Effects of Subtitles on the Comprehension of Native English Connected Speech Varying in Types and Word Familiarity
Authors: Wong Simpson W. L. , Lin Cherry C. Y. , Wong Isabella S. Y. , Cheung Anisa
Published: May 2020

Connected speech produced by native speakers poses a challenge to second language learners. Video subtitles have been found to assist the decoding of English connected speech for learners of English as a foreign language (EFL). However, the presence of subtitles may divert the listeners’ attention to the visual cues while paying less attention to the speech signals. To test this proposal, we employed a bi-modal audio-visual listening test and examined whether EFL listeners were able to correctly identify the connected speech when misleading subtitles were present. We further tested whether connected speech with words of lower frequency further reduced the accuracy rate. Twenty-eight adolescent EFL learners, all with more than 10 years of experiences in learning English in schools, were tested with three major types of connected speech phonological processes, namely assimilation, elision, and juncture. The results of statistical analyses showed that matched and mismatched subtitles facilitated the comprehension of both familiar and unfamiliar connected speech. Error analyses revealed the degree of item-specific variations across the three types of connected speech processes as well as across the three subtitling conditions. This research provides insights on the immediate and long-term impact of subtitles on the decoding of English connected speech.
Predictors of Individual Differences in Emerging Adult Theory of Mind
Authors: Stewart Suzanne L. K. , Kirkham Julie A.
Published: May 2020

Little is known about what factors are associated with emerging adult theory of mind (ToM). We predicted that childhood fantasy play (CFP), need for cognition (NfC), and fiction reading would be positive predictors due to their deliberative, perspective-taking nature while engagement with media and technology would be a negative predictor due to increased interpersonal distance. The best-fit mixed logit model ( N = 369) showed that CFP, texting frequency, and NfC were significant positive predictors while smartphone usage and preference for task switching were significant negative predictors. Email and phone call usage were contributing nonsignificant negative predictors. Our study extends previous findings regarding NfC and highlights the importance of CFP engagement for ToM beyond immediate childhood. Future research should investigate how subtly different media (e.g., texting vs. smartphone use) have differential predictive relationships with social cognition. Data and code are available at doi: 10.17605/OSF.IO/CBD9J.
Does Intravenous Dexamethasone Prevent Nausea and Vomiting after Reduction Mammoplasty?
Authors: Campbell Nicola , Bryson Gregory L , Rosaeg Ola , Crossan Mary Lou , Bragg Paul , Bell Michael
Published: May 2020

Background

Postoperative nausea and vomiting (PONV) is a common and unpleasant experience for patients after reduction mammoplasty. PONV may delay discharge from hospital. Dexamethasone is an effective and widely used antiemetic.

Objectives

This study was designed to evaluate the efficacy of dexamethasone as a single antiemetic agent to reduce the incidence of PONV in patients undergoing reduction mammoplasty.

Methods

Fifty women scheduled for reduction mammoplasty were randomly assigned to receive either intravenous dexamethasone 0.150 mg/kg or saline before the induction of anesthesia. Postoperative analgesia was provided with intravenous morphine via a patient controlled device and rectally administered indomethacin. The presence or absence of nausea, retching and vomiting, and pain scores were assessed upon arrival in the postanesthesia care unit and at 2, 6, 8 and 12 h, and by phone interview at 24 and 48 h after surgery.

Results

The two groups were comparable in terms of age, history of motion sickness, duration of anesthesia and opioid consumption, both intraoperatively and postoperatively. There was no difference in the incidence of PONV between the two groups, but the patients who received dexamethasone required fewer doses of rescue antiemetic medication.

Conclusion

Intravenous dexamethasone before the induction of anesthesia is ineffective as a single agent antiemetic prophylactic treatment in patients undergoing reduction mammoplasty.
Sclerotic lesions of the femoral head–neck junction for diagnosis of femoroacetabular impingement
Authors: Hananouchi Takehito , Aoki Stephen Kenji
Published: May 2020

The morphological characteristics associated with a diagnosis of femoroacetabular impingement (FAI) observed on plain radiographs can also be seen in subjects without hip joint symptoms. Therefore, the purpose of this study was to investigate whether sclerotic lesions on femoral head–neck junction (FHNJ) could be used as a supplemental diagnostic feature. A total of 128 hips from 119 patients (43 male and 76 female) diagnosed with FAI and 24 hips from 21 patients (2 male and 19 female) with other hip pathologies as control were compared in this study. Using standing frog-leg plain radiographs, the prevalence of sclerotic lesions on the FHNJ was established. Additionally, the pixel intensity (PI) of the sclerotic lesions between the FAI and the control groups were quantitatively compared. Sclerotic lesions were present in 96.1% of FAI hips (123 of 128) and only 37.5% of control hips (9 of 24) ( p < 0.05). The ratio of PI in the FAI group was significantly higher (approximately 10%) than in the control group ( p < 0.05). The evaluation of sclerotic lesions may be used as a supplement to aid in the diagnosis of FAI.
Over-the-Counter Drug Causing Acute Pancreatitis
Authors: Parvataneni Swetha , Essrani Rajesh , Mehershahi Shehriyar , Essrani Rajesh , Lohana Ajeet Kumar , Mehmood Asif
Published: May 2020

Acute pancreatitis is caused by alcohol, gall stone disease, drugs, trauma, infections, and metabolic causes such as hypercalcemia and hyperlipidemia. Hypercalcemia-induced acute pancreatitis has been well documented but only rarely occurs due to over-the-counter calcium carbonate. In this article, we present a case of over-the-counter calcium carbonate–induced acute pancreatitis.
Case of Gut Necrosis in Adult-Onset Immunoglobulin A Vasculitis (Henoch-Schönlein Purpura)
Authors: Weissman Amanda S. , Patel Viral Sanjay , Mushfiq Omar
Published: May 2020

Immunoglobulin A vasculitis (IgAV), formerly known as Henoch-Schönlein purpura, is an immune-mediated small vessel vasculitis characterized by palpable purpura, arthralgia, abdominal pain, and renal disease. It is primarily a childhood disease and usually resolves spontaneously with supportive therapy. Treatment of IgAV in adults is controversial with no clearly established guidelines. We report a rare case of IgAV in an adult male who developed gut necrosis and perforation while receiving glucocorticoid therapy for treatment of acute glomerulonephritis. A 44-year-old male was admitted with joint pain, leg swelling, mild abdominal pain, and a diffuse rash. Laboratory values revealed acute kidney injury with significant proteinuria and hematuria. The patient was started on glucocorticoid therapy for suspected IgAV nephritis, which was confirmed by kidney biopsy. Several days later, he complained of worsening abdominal pain. Imaging demonstrated bowel ischemia and perforation requiring multiple abdominal surgeries. The patient was critically ill in the intensive care unit with worsening renal failure requiring dialysis. He was discharged a month later after gradual recovery with stable but moderately impaired kidney function. IgAV is less common in adults; however, the disease is more severe with a higher risk of long-term complications. Adult patients with renal involvement may benefit from glucocorticoid therapy in preventing progression to end-stage renal disease. However, glucocorticoids may mask the symptoms of abdominal complications like gut necrosis and perforation causing delay in diagnosis and treatment. Therefore, vigilance to detect early signs of gut ischemia is imperative when treating an adult case of IgAV nephritis with glucocorticoids.
Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in NCAA Division I Athletes: Experience at a Single Institution
Authors: Weber Alexander E. , Nakata Haley , Mayer Eric N. , Bolia Ioanna K. , Philippon Marc J. , Snibbe Jason , Romano Russ , Tibone James E. , Gamradt Seth C.
Published: May 2020

Background:

The rate of return to sport after surgical treatment of femoroacetabular impingement (FAI) syndrome (FAIS) has been studied in high-level athletes. However, few studies examining this rate have focused exclusively on National Collegiate Athletic Association (NCAA) Division I athletes.

Purpose:

To evaluate the return-to-sport rate after hip arthroscopy for FAIS and to examine the influence of sport type on the clinical presentation of FAIS in collegiate athletes.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included in this study were NCAA Division I student-athletes who underwent hip arthroscopy for FAIS at our institution between 2010 and 2017. Exclusion criteria were history of previous hip pathology, pediatric hip disease, radiographic evidence of osteoarthritis (Tönnis grade >0), prior lower extremity procedure, history of chronic pain, osteoporosis, or history of systemic inflammatory disease. Athletes were categorized into 6 subgroups based on the type of sport (cutting, contact, endurance, impingement, asymmetric/overhead, and flexibility) by using a previously reported classification system. Patient characteristics and preoperative, intraoperative, and return-to-sport variables were compared among sport types.

Results:

A total of 49 hip arthroscopies for FAIS were performed in 39 collegiate athletes (10 females, 29 males; mean age, 19.5 ± 1.3 years). A total of 1 (2.6%) cutting athlete, 15 (38.5%) contact athletes, 8 (20.5%) impingement athletes, 6 (15.4%) asymmetric/overhead athletes, and 9 (23.1%) endurance athletes were included in the study. There were no differences among sports groups with respect to the FAI type. Endurance athletes had lower rates of femoral osteochondroplasty (45.5%) and labral debridement (0.0%) ( P < .0001). Contact sport athletes had higher rates of labral debridement (50.0%; P < .0001). Patients were evaluated for return to sport at an average of 1.96 ± 0.94 years. Overall, the return-to-sport rate was 89.7%. There were no differences in return-to-sport rates based on the sport type except for endurance athletes, who returned at a lower rate (66.6%; P < .001). No differences in return-to-sport rate ( P = .411), duration after return ( P = .265), or highest attempted level of sport resumed ( P = .625) were found between patients who underwent labral repair versus debridement.

Conclusion:

Collegiate-level athletes who underwent hip arthroscopy for FAIS returned to sport at high and predictable rates, with endurance athletes possibly returning to sport at lower rates than all other sport types. Surgical procedures may be influenced by sport type, but the rate of return to sport between athletes who underwent labral debridement versus labral repair was similar.
Dynamic Between-Leg Differences While Walking in Anterior Cruciate Ligament–Deficient Patients With and Without Medial Meniscal Posterior Horn Tears
Authors: Ren Shuang , Shi Huijuan , Yu Yuanyuan , Liang Zixuan , Jiang Yanfang , Wang Qi , Miao Xin , Li Dai , Zhang Si , Hu Xiaoqing , Huang Hongshi , Ao Yingfang
Published: May 2020

Background:

Patients with anterior cruciate ligament–deficient (ACLD) knees with medial meniscal posterior horn tears (MMPHTs) have been reported to demonstrate a combined stiffening and pivot-shift gait pattern compared with healthy controls. Movement asymmetries are implicated in the development and progression of osteoarthritis.

Purpose:

To investigate the knee kinematics and kinetic asymmetries in ACLD patients with (ACLD + MMPHT group) and without (ACLD group) MMPHTs while walking on level ground.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 15 patients with isolated unilateral ACL ruptures, 10 with unilateral ACL ruptures and MMPHTs, and 22 healthy controls underwent gait testing between January 2014 and December 2016. Between-leg differences (BLDs) in knee kinematics and kinetics were compared among participants in all groups.

Results:

The ACLD + MMPHT group demonstrated significantly greater BLDs in knee moments in the sagittal plane during the loading response phase than the ACLD and control groups. Compared with the control group, the ACLD and ACLD + MMPHT groups demonstrated significantly greater BLDs in knee angles in the sagittal plane during the midstance and terminal stance phases. Compared with the control group, significantly greater BLDs in knee rotation moments were found throughout the stance phase in both the ACLD and the ACLD + MMPHT groups. BLDs in lateral ground-reaction forces (GRFs) in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. BLDs in anterior GRFs in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. Only the ACLD + MMPHT group demonstrated greater BLDs in vertical GRFs than the control group during the loading response phase, while no significant differences were observed between the ACLD and control groups.

Conclusion:

The ACLD + MMPHT group demonstrated significantly more knee flexion moment asymmetries than the ACLD and control groups during the loading response phase. Both the ACLD + MMPHT and the ACLD groups demonstrated significant knee angle and moment asymmetries in the sagittal plane during the terminal stance phase than the control group. Both the ACLD + MMPHT and the ACLD groups demonstrated knee rotation moment asymmetries during the midstance and terminal stance phases compared with the control group. A rehabilitation program for ACLD patients both with and without MMPHTs should take into consideration these asymmetric gait patterns.
Endoscopic Gluteus Medius Repair With an ITB-Sparing Versus ITB-Splitting Approach: A Systematic Review and Meta-analysis
Authors: Parker Emily A. , Meyer Alex M. , Laskovski Jovan R. , Westermann Robert W.
Published: May 2020

Background:

During hip endoscopy, the iliotibial band (ITB) can be split or preserved to access the peritrochanteric workspace. To our knowledge, no comparative studies have been performed to analyze patient-reported outcomes (PROs) and surgical failure rates (gluteus medius retear and/or revision surgery rates) for ITB-sparing versus ITB-splitting approaches in endoscopic gluteus medius repairs.

Purpose:

To perform a systematic review and meta-analysis of the literature to evaluate PROs and failure rates of patients undergoing ITB-sparing versus ITB-splitting repairs of the gluteus medius.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review was performed by following PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines and using the PubMed, Cochrane CENTRAL, and Embase databases. The quality of evidence was evaluated using the modified Coleman Methodology Score. Level 1-4 studies were evaluated for endoscopic abductor repair techniques on all types of gluteus medius tears. Given the small number of studies and varying population sizes, all quantitative data were adjusted for study population size.

Results:

A total of 13 studies met our inclusion criteria, while more granular data, including ITB approach, were available for 8 studies. Because of the paucity of literature on the subject, all included studies were of lower quality per the modified Coleman Methodology Score. The visual analog scale for pain, the modified Harris Hip Score (mHHS), and the surgical failure rates were compared between approaches. Patients who underwent ITB splitting had a significantly greater change in mHHS (45.5 ± 4.6 vs 27.3 ± 6.5; P < .001) and lower surgical failure rates (3.67 ± 2.33 vs 4.75 ± 2.54; P = .04). There was no significant difference in change in visual analog scale for splitting versus sparing (4.26 ± 0.41 vs 4.39 ± 0.14; P = .96). The results may have been biased by between-group differences, such as patients who undergo ITB sparing being significantly younger.

Conclusion:

Endoscopic gluteus medius repair is a reliable procedure to improve pain and function in appropriately selected patients. This study highlighted the lack of high-quality literature available regarding ITB approach. However, the evidence to date has suggested that ITB approach may influence hip-specific PROs. Splitting the ITB during abductor repair may be associated with a greater improvement in mHHS and lower surgical failure rates. Further prospective comparative studies are warranted to evaluate the effect of ITB approach.
Addition of Povidone-Iodine to Fluoride Varnish for Dental Caries: A Randomized Clinical Trial
Authors: Milgrom P. , Tut O. , Rothen M. , Mancl L. , Gallen M. , Tanzer J.M.
Published: May 2020

Introduction:

Dental caries is the most common chronic childhood disease. Products of metabolism by bacteria populating the tooth surface induce development and progression of cavities.

Objectives:

We sought to determine whether a polyvinylpyrrolidone-iodine (PVP-I; povidone-iodine) and NaF topical varnish was superior to one containing only NaF in prevention of new dental caries lesions in a single-center randomized active-controlled trial based on a double-blind, parallel-group design.

Methods:

The site was Pohnpei State, Federated States of Micronesia. The study population was healthy children 49 to 84 mo old who were enrolled in early childhood education: 284 were randomized (1:1 allocation), and 273 were included in year 1 analysis and 262 in year 2. The test varnish contained 10% PVP-I and 5.0% NaF. The comparator contained only 5.0% NaF but was otherwise identical. Varnishes were applied every 3 mo during 2 y. The primary outcome was the surface-level primary molar caries lesion increment (d2-4mfs) at 2 y. Caries lesion increments from baseline to year 1 and year 2 were compared between conditions with log-linear regression, adjusting for age and sex and whether the tooth was sound at baseline (free of caries lesions).

Results:

At year 1, the caries lesion increment for primary molars sound at baseline was 0.9 surfaces (SD = 1.5) for the test varnish versus 1.8 (SD = 2.2) for the comparator varnish with fluoride alone (adjusted rate ratio, 0.50; 95% CI, 0.31 to 0.81; P = .005). At year 2, the caries lesion increment for primary molars sound at baseline was 2.3 surfaces (SD = 2.8) for the test varnish as compared with 3.3 (SD = 2.7) for the comparator (adjusted rate ratio, 0.74; 95% CI, 0.52 to 1.03; P = .073). Teeth that were already cavitated at baseline did not show a preventive effect. There were no harms.

Conclusions:

A dental varnish containing PVP-I and NaF is effective in the primary prevention of cavities in the primary dentition (NCT03082196).

Knowledge Transfer Statement:

This study demonstrates that periodic application of a varnish containing NaF and PVP-I is effective in prevention of caries lesions and useful in assessing the potential of combined treatment.
Clinical impact of the 0.2 µg/day fluocinolone acetonide intravitreal implant: outcomes from the ILUVIEN® clinical evidence study in Portugal
Authors: Carneiro Angela , Meireles Angelina , Castro Sousa João Paulo , Teixeira Carla
Published: May 2020

Introduction:

The ILUVIEN® (fluocinolone acetonide) Clinical Evidence in Portugal (ICE-PT) study is a retrospective, multicenter, observational study evaluating the effectiveness and safety of the FAc implant in patients with diabetic macular edema.

Methods:

Patients included in this study had received the 0.2 µg/day fluocinolone acetonide implant for the treatment of diabetic macular edema and had measurements of visual acuity and retinal thickness assessed by optical coherence tomography for at least 12 months pre- and post-fluocinolone acetonide implant administration, with ⩾2 follow-up visits. Outcomes measured included visual acuity, central foveal thickness, and intraocular pressure.

Results:

There was a significant increase in mean visual acuity compared with baseline at 3, 6, 9, and 12 months post-fluocinolone acetonide in both the overall study population and the pseudophakic subgroup ( p < 0.05 at all time points in both groups). A significant reduction in mean central foveal thickness compared with baseline was seen in the overall study population at 3, 6, 9, and 12 months post-fluocinolone acetonide ( p < 0.05 at all time points). At 12-month post-fluocinolone acetonide, a small but significant intraocular pressure increase of 1.0 mmHg was seen in the overall study population.

Conclusion:

The results of this analysis show that switching from the current standard of care to the fluocinolone acetonide implant leads to beneficial effects in terms of vision and retinal structure in patients with diabetic macular edema and that patients benefited from FAc implant administration, regardless of lens status.
On the role of dehumanization of victims in the perpetration of mass killings: Research notes
Authors: Mariot Nicolas
Published: May 2020

This article discusses the shared idea that dehumanization plays a fundamental role in mass killings, helping executioners in no longer perceiving as fellow human beings those they had to kill. Using perpetrators’ letters and judicial interrogations from German people involved in the War in the East between 1941 and 1944, the article questions what some of the killers say about their victims’ attitudes and actions, and their observations of them. It examines the recognition of attitudes of humanity by some of the executioners themselves and asks a simple question: What are we to do with these traces? The answer is that these last exchanges between some executioners and their victims deserve our attention because they compel us to argue that the executioners killed in spite of having sometimes recognized the humanity of their victims. Such an argument (killing nonetheless) has strong implications for interpretations of extreme violence.
Transcranial Direct Current Stimulation to Optimise Participation in Stroke Rehabilitation – A Sham-Controlled Cross-Over Feasibility Study
Authors: Etherton-Beer Christopher , Lui Yee , Radalj Miranda , Vallence Ann-Maree , Singer Barby
Published: May 2020

Background:

Fatigue and attentional decline limit the duration of many therapy sessions in older adults poststroke. Transcranial direct current stimulation (tDCS) may facilitate participation in rehabilitation, potentially via reduced fatigue and improved sustained attention poststroke.

Objective:

To evaluate whether tDCS results in an increase in the number of completed rehabilitation therapy sessions in stroke survivors.

Methods:

Nineteen participants were randomly allocated to receive 10 sessions of 2-mA anodal (excitatory) tDCS, or sham tDCS, applied to the left dorsolateral prefrontal cortex (DLPFC) for 20 minutes within 1 hour prior to the first rehabilitation therapy session of the day. After a 2-day washout period, participants then crossed-over. Researchers applying the tDCS, and those recording measures were blinded to group allocation. The number of first rehabilitation therapy sessions completed as planned, as well as the total duration of rehabilitation therapy, were used to determine the influence of tDCS on participation in stroke rehabilitation.

Results:

The total number of first therapy sessions completed as planned did not vary according to group allocation (111 of 139 sessions for tDCS, 110 of 147 sessions for sham treatment; chi-square 1.0; P = .31).

Conclusions:

Our results suggest that, while tDCS to the DLPFC was well tolerated, it did not significantly influence the number of completed rehabilitation therapy sessions in stroke survivors.
Studies on the basic issues relevant to sperm cryopreservation in humans
Authors: Hu Huanhuan , Shi Xiaowei , Ji Guojie , Liu Rui , Zhang Jing , Zhang Han , Li Mingwen
Published: May 2020

Rapid freezing and vitrification are becoming popular for sperm freezing in humans; however, basic and critical issues relevant to sperm cryopreservation remain to be resolved. The aims of the present study were to study the effects of osmolality of freezing medium, sperm concentrations, thawing methods, and sugars (sucrose and trehalose) on sperm motility and DNA integrity by rapid freezing using 0.5 ml standard straws loaded with 100 µl sperm each. The results showed that (1) the post-thaw recovery rates of total motility and progressive motility of sperm cryopreserved in freezing medium containing 0.25 M sucrose with 442 mOsm/kg osmolality were significantly higher ( p < 0.05) than that of sperm cryopreserved in freezing medium containing 0.25 M sucrose with 536 mOsm/kg osmolality (36.5 ± 2.8% and 36.9 ± 1.7% versus 30.4 ± 1.9% and 30.3 ± 2.9%, respectively), (2) cryopreservation of both total and progressive motilities was not significantly affected ( p > 0.05) by sperm concentrations in the range from 5 to 20 × 106 sperm/ml, (3) thawing method 37°C for 2 min was better than 42°C for 15 s in terms of post-thaw recovery rates of both total and progressive motilities ( p < 0.05), (4) 0.25 M trehalose was better than 0.25 M sucrose in cryopreserving both total and progressive motilities ( p < 0.05), and (5) sperm nuclear DNA is relatively resistant to the changes of the above factors compared with sperm motility. It was concluded that human sperm can be best cryopreserved by rapid freezing using 0.25 M sucrose or trehalose with osmolality 442 to 457 mOsm/kg at high sperm concentration followed by thawing at 37°C. Trehalose is a stronger cryoprotectant than sucrose for sperm cryopreservation.
Metaphase cytogenetics and plasma cell proliferation index for risk stratification in newly diagnosed multiple myeloma
Authors: Mellors Patrick W. , Binder Moritz , Ketterling Rhett P. , Greipp Patricia T. , Baughn Linda B. , Peterson Jess F. , Jevremovic Dragan , Pearce Kathryn E. , Buadi Francis K. , Lacy Martha Q. , Gertz Morie A. , Dispenzieri Angela , Hayman Suzanne R. , Kapoor Prashant , Gonsalves Wilson I. , Hwa Yi L. , Fonder Amie , Hobbs Miriam , Kourelis Taxiarchis , Warsame Rahma , Lust John A. , Leung Nelson , Go Ronald S. , Kyle Robert A. , Rajkumar S. Vincent , Kumar Shaji K.
Published: May 2020

Metaphase cytogenetic abnormalities, plasma cell proliferation index (PCPro), and gain 1q by fluorescence in situ hybridization (FISH) are associated with inferior survival in newly diagnosed multiple myeloma (MM) treated with novel agents; however, their role in risk stratification is unclear in the era of the revised International Staging System (R-ISS). The objective of this study was to determine if these predictors improve risk stratification in newly diagnosed MM when accounting for R-ISS and age. We studied a retrospective cohort of 483 patients with newly diagnosed MM treated with proteasome inhibitors and/or immunomodulators. On multivariable analysis, R-ISS, age, metaphase cytogenetic abnormalities (both in aggregate and for specific abnormalities), PCPro, and FISH gain 1q were associated with inferior progression-free (PFS) and overall survival (OS). We devised a risk scoring system based on hazard ratios from multivariable analyses and assigned patients to low-, intermediate-, and high-risk groups based on their cumulative scores. The addition of metaphase cytogenetic abnormalities, PCPro, and FISH gain 1q to a risk scoring system accounting for R-ISS and age did not improve risk discrimination of Kaplan-Meier estimates for PFS or OS. Moreover, they did not improve prognostic performance when evaluated by Uno’s censoring-adjusted C-statistic. Lastly, we performed a paired analysis of metaphase cytogenetic and interphase FISH abnormalities, which revealed the former to be insensitive for the detection of prognostic chromosomal abnormalities. Ultimately, metaphase cytogenetics lack sensitivity for important chromosomal aberrations and, along with PCPro and FISH gain 1q, do not improve risk stratification in MM when accounting for R-ISS and age.
Self-titration of inhaled corticosteroid and β2-agonist in response to symptoms in mild asthma: a pre-specified analysis from the PRACTICAL randomised controlled trial
Authors: Baggott Christina , Hardy Jo , Sparks Jenny , Holliday Mark , Hall Daniela , Vohlidkova Alexandra , Hancox Robert J. , Weatherall Mark , Fingleton James , Beasley Richard
Published: May 2020

Introduction

In mild asthma, as-needed budesonide–formoterol is superior or noninferior to maintenance budesonide plus as-needed short-acting β2-agonist in reducing severe exacerbations. In this pre-specified analysis, we investigated patterns of inhaled corticosteroid (ICS) and β2-agonist use in PRACTICAL, a randomised controlled trial.

Methods

Participants were randomised 1:1 to as-needed budesonide–formoterol (200/6 μg Turbuhaler, one actuation) or maintenance budesonide (200 μg Turbuhaler, one actuation twice a day) with as-needed terbutaline (250 μg, two actuations) for 52 weeks. 110 participants had electronic monitors attached to their study inhalers which captured the time and date of every actuation. Key outcome measures were patterns of ICS and β2-agonist use. One actuation of budesonide–formoterol was considered to be an equivalent bronchodilator dose as two actuations of terbutaline.

Results

Participants randomised to as-needed budesonide–formoterol had more days with no ICS use compared with maintenance budesonide (median total days of no use 156versus22 days, respectively), lower median daily budesonide dose (164versus328 μg, respectively) and a greater median number of days of ≥4 budesonide actuations (4versus1 days, respectively). Participants randomised to as-needed budesonide–formoterol took higher equivalent doses of β2-agonist both overall (median number of actuations 0.8versus0.3 per day, respectively) and in response to worsening asthma (total number of “overuse days” of >8 or >16 actuations of budesonide–formoterol or terbutaline 33versus10 days, respectively).

Conclusions

The timing of ICS dose when self-titrated to β2-agonist use is more important than total ICS dose in reducing severe exacerbation risk in mild asthma, when associated with greater overall use of as-needed β2-agonist.
Effects of downhill walking in pulmonary rehabilitation for patients with COPD: a randomised controlled trial
Authors: Camillo Carlos Augusto , Osadnik Christian Robert , Burtin Chris , Everaerts Stephanie , Hornikx Miek , Demeyer Heleen , Loeckx Matthias , Rodrigues Fernanda Machado , Maes Karen , Gayan-Ramirez Ghislaine , Janssens Wim , Troosters Thierry
Published: May 2020

The development of contractile muscle fatigue (CMF) affects training responses in patients with chronic obstructive pulmonary disease (COPD). Downhill walking induces CMF with lower dyspnoea and fatigue than level walking. This study compared the effect of pulmonary rehabilitation (PR) comprising downhill walking training (DT) to PR comprising level walking (conventional training (CT)) in patients with COPD.

In this randomised controlled trial, 35 patients (62±8 years; forced expiratory volume in 1 s (FEV1) 50±17% predicted) were randomised to DT or CT. Exercise tolerance (6-minute walk test distance (6MWD); primary outcome), muscle function, symptoms, quality-of-life and physical activity levels were assessed before and after PR. Absolute training changes and the proportion of patients exceeding the 30 m 6MWD minimally important difference (MID) were compared between groups. Quadriceps muscle biopsies were collected after PR in a subset of patients to examine physiological responses to long-term eccentric training.

No between-group differences were observed in absolute 6MWD improvement (mean 6MWD change 77±46 m DTversus56±47 m CT; p=0.45), however 94% of patients in DT exceeded the 6MWD MID compared to 65% in CT (p=0.03). Patients in DT tended to have larger improvements than CT in other outcomes. Muscle biopsy analyses did not differ between groups.

PR incorporating downhill walking confers similar magnitudes of effects to PR with conventional walking across clinical outcomes in patients with COPD, however, offers a more reliable stimulus to maximise the achievement of clinically relevant gains in functional exercise tolerance in people with COPD.