bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune thrombocytopenia in alemtuzumab-treated MS patients: Incidence, detection, and management
Authors: Cuker Adam , Bass Ann D , Nadj Congor , Agius Mark A , Steingo Brian , Selmaj Krzysztof W , Thoits Timothy , Guerreiro Alexandre , Van Wijmeersch Bart , Ziemssen Tjalf , Meuth Sven G , LaGanke Christopher C , Thangavelu Karthinathan , Rodriguez Claudio E , Baker Darren P , Margolin David H , Jannsens Ann
Published: February 2019

Background:

Alemtuzumab is a highly effective therapy for relapsing-remitting multiple sclerosis (RRMS), and immune thrombocytopenia (ITP) has been identified as a risk.

Objective:

To examine ITP incidence, treatment, and outcomes during the clinical development of alemtuzumab for RRMS and discuss postmarketing experience outside clinical trials.

Methods:

CAMMS223 and Comparison of Alemtuzumab and Rebif® Efficacy in Multiple Sclerosis (CARE-MS) I and II investigated two annual courses of alemtuzumab 12 mg (or 24 mg in CAMMS223/CARE-MS II) versus subcutaneous interferon beta-1a three times per week. Patients completing core studies could enroll in an extension. Monthly monitoring for ITP continued until 48 months after the last alemtuzumab infusion.

Results:

Of 1485 alemtuzumab-treated MS patients in the clinical development program, 33 (2.2%) developed ITP (alemtuzumab 12 mg, 24 [2.0%]; alemtuzumab 24 mg, 9 [3.3%]) over median 6.1 years of follow-up after the first infusion; most had a sustained response to first-line ITP therapy with corticosteroids, platelets, and/or intravenous immunoglobulin. All cases occurred within 48 months of the last alemtuzumab infusion. Postmarketing surveillance data suggest that the ITP incidence is not higher in clinical practice than in clinical trials.

Conclusion:

Alemtuzumab-associated ITP occurs in approximately 2% of patients and is responsive to therapy. Careful monitoring is key for detection and favorable outcomes.
“I feel like I’m being stabbed by a thousand tiny men”: The challenges of communicating endometriosis pain
Authors: Bullo Stella
Published: February 2019

Endometriosis, as a widespread gynecological condition, affects an estimated 1 in 10 women and yet has a worldwide average diagnosis length of 7.5 years. Causing incapacitating pain, among other associated manifestations, the condition severely impacts on women’s lives. This article uses online survey data to investigate how pre-diagnosis endometriosis pain is conceptualized and articulated in order to explore communication challenges reported in early consultations that can potentially be seen to play a role in diagnosis delay. The findings of this study indicate that women feel that they do not have the appropriate tools to describe their pain and, in many instances, feel dismissed therefore prolonging diagnosis. The article finds that the majority of the pain descriptors identified use elaborate metaphorical scenarios to convey the intensity of the pain and concludes with some reflections on the issue of metaphorical language in endometriosis pain communication practices while calling for interdisciplinary work in order to devise appropriate tools for endometriosis pain communication.
Field measurement of near-surface typhoon characteristics using a smart monitoring system on a long-span arch bridge site
Authors: Wang Xu , Li Huaqiang , Chen Zengshun , Qian Yuanhao , Wang Yanru , Peng Xinlai
Published: February 2019

During landfall of Typhoon Haikui in Eastern China in 2012, ground level wind data were recorded using a smart monitoring system installed on JiuBao Bridge in Hangzhou, China. This article documents the mean flow and turbulence characteristics from data recorded during the storm. The results show that both turbulence intensity and gust factor decrease with the increase in the mean wind velocity. However, as the mean wind velocity increases, this trend gradually attenuates. The peak factor distribution with gust averaging time duration derived with the Typhoon Haikui data agrees well with the Durst curve. However, the longitudinal gust factor derived from the typhoon wind-speed record in this study is higher compared with the curves proposed by Durst and Krayer-Marshall. Analyses of the gust factor distribution with the turbulence intensity during the passage of the storm reveal a similarity to the empirical curves of Ishizaki and Choi. Results show that the relationship between lateral turbulence and gust factors can be well represented by a quadratic polynomial. Turbulence scale increased with mean wind velocity. The values of autocorrelation coefficients in longitudinal direction are larger than those in lateral direction. There has no obvious dependency of cross-correlation coefficients with mean wind velocity. In general, the wind characteristics in this study are shown to be very similar to those of winds under normal circumstance.
Theoretical study of the double concave friction pendulum system under variable vertical loading
Authors: Zhou Fangyuan , Xiang Weilin , Ye Kun , Zhu Hongping
Published: February 2019

The double concave friction pendulum system has been recognized as an efficient device for decreasing the seismic response of a structure during an earthquake excitation. Previous studies have focused mainly on the properties of the double concave friction pendulum system under constant vertical loading, and the width of the hysteretic loop changed by the vertical ground motion is less considered. In view of this, a theoretical study of the double concave friction pendulum system under variable vertical loading is conducted in this article. Meanwhile, the properties of the hysteretic loops of the double concave friction pendulum system with different friction coefficients between the articulated slider with the upper and lower sliding surfaces are investigated. The results show that the hysteretic loops of the double concave friction pendulum system will be affected by the variation of the vertical loading and the difference of the friction coefficients between the articulated slider with the upper and lower sliding surfaces.
Experimental evaluation of the lateral load distribution in the elastic-plastic phase of timber-steel hybrid structures with a novel light timber-steel diaphragm
Authors: Ma Zhong , He Minjuan , Ma Renle , Li Zheng , Zhang Linlin
Published: February 2019

A cyclic loading experiment involving a timber-steel hybrid structure consisting of a steel frame and a novel light timber-steel diaphragm is presented to quantify the flexibility of the diaphragm and its ability to distribute lateral loads in the elastic-plastic phase of the structure. A lateral load-distribution factor was proposed, and its relationship to the ratio of the stiffness of the diaphragm to that of the lateral load-resisting elements was investigated. The diaphragm was classified based on these variables. The results indicated that the failure modes of the structure were associated with the forms of damage experienced by the lateral load-resisting elements, whereas little damage was observed for the diaphragm. The diaphragm exhibited the ability to continuously adjust the distribution of lateral loads to each lateral load-resisting element; accordingly, each lateral load-resisting element had approximately the same shear force, the same lateral stiffness, and the same lateral displacement during the loading process. As the lateral displacement increased, the stiffness ratio and load-distribution factor both gradually increased, and the diaphragm correspondingly changed from semi-rigid to rigid. At times, as the lateral displacement increased, the diaphragm rapidly became rigid, and it was unnecessarily rigid during the initial loading phase when the in-plane stiffness reached a certain threshold.
Blunt Abdominal Trauma in a European Trauma Setting: Need for Complex or Non-Complex Skills in Emergency Laparotomy
Authors: Kosola J. , Brinck T. , Leppäniemi A. , Handolin L.
Published: February 2019

Background and Aims:

Blunt abdominal trauma can lead to substantial organ injury and hemorrhage necessitating open abdominal surgery. Currently, the trend in surgeon training is shifting away from general surgery and the surgical treatment of blunt abdominal trauma patients is often done by sub-specialized surgeons. The aim of this study was to identify what emergency procedures are needed after blunt abdominal trauma and whether they can be performed with the skill set of a general surgeon.

Materials and Methods:

The records of blunt abdominal trauma patients requiring emergency laparotomy (n = 100) over the period 2006–2016 (Helsinki University Hospital Trauma Registry) were reviewed. The organ injuries and the complexity of the procedures were evaluated.

Results:

A total of 89 patients (no need for complex skills, NCS) were treated with the skill set of general surgeons while 11 patients required complex skills. Complex skills patients were more severely injured (New Injury Severity Score 56.4 vs 35.9, p < 0.001) and had a lower systolic blood pressure (mean: 89 vs 112, p = 0.044) and higher mean shock index (heart rate/systolic blood pressure: 1.43 vs 0.95, p = 0.012) on admission compared with NCS patients. The top three NCS procedures were splenectomy (n = 33), bowel repair (n = 31), and urinary bladder repair (n = 16). In patients requiring a complex procedure (CS), the bleeding site was the liver (n = 7) or a major blood vessel (n = 4).

Conclusion:

The majority of patients requiring emergency laparotomy can be managed with the skills of a general surgeon. Non-responder blunt abdominal trauma patients with positive ultrasound are highly likely to require complex skills. The future training of surgeons should concentrate on NCS procedures while at the same time recognizing those injuries requiring complex skills.
Sleep stage detection using only heart rate
Authors: Mitsukura Yasue , Fukunaga Koichi , Yasui Masato , Mimura Masaru
Published: February 2019

Getting enough quality sleep plays a vital role in protecting our mental health, physical health, and quality of life. Sleep deprivation can make it difficult to concentrate on daily activities, and lower sleep quality is associated with hypertension, hyperglycemia, and hyperlipidemia. The amount of sleep we get is important, but in recent years, quality sleep has also been deemed significant. Polysomnography, which has been the gold standard in assessing sleep quality based on stages, requires that the subject be attached to electrodes, which can disrupt sleep. An easier method to objectively measure sleep is therefore needed. The aim of this study was to construct an easy and objective sleep stage monitoring method. A cross-sectional study for healthy subjects has been done in our research. A new easy model for monitoring the sleep stages is built on only heart rate calculated by the electrocardiogram. This enabled us to easily assess the sleep quality based on five stages. This experiment included a total of 50 subjects. The overall accuracy in determining the five sleep stages was 66.0 percent. Four stages for sleep are identified accurately compared with other conventional methods. Despite there are no five sleep stage separation method using only heart rate, our method achieved the five separation for sleep with a relatively good accuracy. This study represents a great contribution to the field of sleep science. Because sleep stages can be recognized by the heart rate alone, sleep can be noninvasively assessed with any heart rate meter. This method will make it easier to determine sleep stages and diagnose sleep disorders.
Online secondary path modeling method with auxiliary noise power scheduling strategy for multi-channel adaptive active noise control system
Authors: Yuxue Pu , Pengfei Shu
Published: February 2019

Accurate model of secondary paths is very crucial for the multi-channel filtered-X least mean square algorithm applied in adaptive active noise control system. The auxiliary random noise technique is popular for online secondary path modeling during adaptive active noise control operation. This paper proposes a simplified variable step-size strategy and an effective auxiliary noise power scheduling strategy for the multi-channel filtered-X least mean square algorithm. Through a defined indirect error signal, the proposed method can guarantee every online secondary path modeling filter has its own exclusive variable step-size strategy to update their coefficients, and every injected noise has its own exclusive scheduling strategy considering all of the corresponding online secondary path modeling filters. The proposed method can improve the adaptive performance and simplifies the complexity of multi-channel adaptive active noise control system. Computer simulations show that the proposed method gives much better noise reduction and secondary path modeling accuracy at a somewhat faster convergence rate comparing with the competing methods.
Pioneer journalism: Conceptualizing the role of pioneer journalists and pioneer communities in the organizational re-figuration of journalism
Authors: Hepp Andreas , Loosen Wiebke
Published: February 2019

Recent journalism research often argues that it is high time that we moved beyond the newsroom and begin asking who it is that is stimulating transformation and not what it is, as individual journalists, entrepreneurs, technology firms, and startups assume an increasingly critical role in the development of the field. This article introduces the concept of ‘pioneer journalism’ to provide just such an analysis across different organizational contexts. Pioneer journalism is understood as a particular group of journalists that incorporates new organizational forms and experimental practice in pursuit of redefining the field and its structural foundations. To introduce this concept, the article argues along three stages. First, it develops a theoretical basis on which to pin our understanding of pioneering practice by reviewing previous research into journalism’s transformation beyond the newsroom. Second, it extends the theoretical discussion into the empirical realm by looking at five extreme cases of pioneer journalists through an explorative interview analysis. Third, and to conclude, an integrated concept of pioneer journalism is outlined as a point of departure from which to further consider journalism’s re-figuration more generally.
Perspective by incongruity in the performance of dialectical ironic analysis: a disciplined approach
Authors: Watson Cate
Published: February 2019

The importance of dialectic to sociological thought has been recognised by many of the discipline’s most eminent thinkers. Adopting a dialectical world view infused with irony provokes insights revealing logical contradictions, so opening up possibilities for the development of alternative interpretations of the social world. There is, however, very little in the way of method to support the development of dialectical irony as a key analytical tool for the social sciences. This article seeks to remedy this deficit. Drawing on three key examples (trained incapacity, functional stupidity and interpassivity) the article examines Kenneth Burke’s ‘perspective by incongruity’ as a means for interrogating the dialectical moment, so contributing towards the development of dialectical ironic analysis within a methodology of humour.
Reflexivity and the challenges of collecting sensitive data in India: a research note
Authors: Fletcher-Brown Judith
Published: February 2019

As health advertising researchers we become involved with a variety of health and well-being issues in order to advance social marketing research. Health advertising research involves mainly face-to-face encounters with participants using qualitative methodologies. This article explores the challenges a researcher of British origin faced undertaking fieldwork in India in an effort to collect qualitative data about breast cancer awareness (BCA) and prevention, a culturally taboo subject. Key obstacles included cultural barriers, research method assumptions and researcher resilience. Reflexivity has been recognized as a crucial stage in the process of generating knowledge via qualitative research processes. Thereby applying the critical lens of reflexivity, this article reflects upon the complexities of accessing Indian women (a fiercely private demographic) to participate in discussions about the sensitive topic of breast cancer. The results are discussed and recommendations from this researcher’s experience are presented as a resource to assist future qualitative health advertising inquiry
Inequality and inequity in the emergence of conventions
Authors: Cochran Calvin , O’Connor Cailin
Published: February 2019

Many societies have norms of equity – that those who make symmetric social contributions deserve symmetric rewards. Despite this, there are widespread patterns of social inequity, especially along gender and racial lines. It is often the case that members of certain social groups receive greater rewards per contribution than others. In this article, we draw on evolutionary game theory to show that the emergence of this sort of convention is far from surprising. In simple cultural evolutionary models, inequity is much more likely to emerge than equity, despite the presence of stable, equitable outcomes that groups might instead learn. As we outline, social groups provide a way to break symmetry between actors in determining both contribution and reward in joint projects.
‘Entextualisation’ Across Institutional Contexts: The Impact of Discourse in School Reports on the Juvenile Justice Trajectories of Roma Youth
Authors: Petintseva Olga
Published: February 2019

The school context has been found to be highly influential in youth justice assessments of young people. Using Belgium as a case study and based on a study of court files and interviews with youth justice professionals, this article traces the significance of school-based information in decisions made on Roma youth. More specifically, it examines what these discourses communicate and how they shape young people’s correctional trajectories. The article argues that negative school experiences and discriminatory practices in education towards Roma are often reflected in youth justice professionals’ construction of the problems presented by Roma youth, albeit within a different discursive framing. The article draws on the notion of ‘entextualisation’ (extracting discourse from its original context and re-inserting it in another setting) and its consequences for young people from Roma backgrounds who come into conflict with the law.
A Positive Behavioral Approach: Identifying Theoretical Factors Influencing Moderate Drinking Practices
Authors: Buyucek Nuray , Knox Kathy , Rundle-Thiele Sharyn
Published: February 2019

Focusing on problematic behavior can stigmatize the target audience for change campaigns, especially in the context of alcohol consumption. In previous studies, excessive drinking (the problematic behavior) has been the dominant focus. By contrast, this study empirically examines moderate drinking practices (the desired behavior) in an Australian adult population. An online survey was administered, and results were analyzed through structural equation modeling. Findings indicate moderate drinking practices were applied more frequently by females than males. Confidence enhancement and sexual enhancement expectancies were negatively associated with moderate drinking practices. This study indicates higher self-efficacy skills (i.e., refusing alcohol offered) were associated with more moderate alcohol consumption practices. Findings of this study can be used to guide intervention design to attract and retain moderate alcohol drinkers. By taking a positive behavioral approach, modifiable factors to effect the desired change are identified delivering actionable insights that can be implemented to achieve the desired change (e.g., increase moderate drinking practices).
Empowering Youth to Engage in Social Discourse Through Place-Based Songwriting
Authors: Haddox John Christopher
Published: February 2019

This article represents the authors’ place-based songwriting work with youth aged 9 years to 18 years who were participating in two of West Virginia’s 4-H summer camp experiences. Beginning with the simple exercise of having the youth brainstorm and list their likes and dislikes about the communities in which they live, the author adapted an approach for teaching traditional music in West Virginia—the call and response—to create a framework by which the youth could turn their likes/dislike statements into lyrics, ultimately performing their songs for an audience of their peers and the leadership of their respective camps. The goal of the project was to test the methodology and to set the stage for the development of a curriculum module that could be used in schools as a way to engage students in creative and productive conversations about the past, present, and future of their communities. Not only did the youth readily engage in the process, they provided thoughtful and thought-provoking lyrical representations of what they saw as both positive and negative about their communities.
Does Interfraction Cone Beam Computed Tomography Improve Target Localization in Prostate Bed Radiotherapy?
Authors: Elakshar Sara , Tsui James Man Git , Kucharczyk Michael Jonathan , Tomic Nada , Fawaz Ziad Simon , Bahoric Boris , Papayanatos Joseph , Chaddad Ahmad , Niazi Tamim
Published: February 2019

Purpose:

In this prospective phase II study, we investigated whether cone beam computed tomography scan was a superior method of image-guided radiotherapy relative to 2D orthogonal kilovoltage images in the post-radical prostatectomy setting.

Methods:

A total of 419 treatment fractions were included in this analysis. The shifts required to align the patient for each treatment were performed using 3D matching between cone beam computed tomography scans and the corresponding computed tomography images used for planning. This was compared with the shifts obtained from 2D orthogonal kilovoltage images, matching with the corresponding digitally reconstructed radiographs. Patients did not have fiducials inserted to assist with localization. Interfractional changes in the bladder and rectal volumes were subsequently measured on the cone beam computed tomography images for each fraction and compared to the shift differences between orthogonal kilovoltage and cone beam computed tomography scans. The proportion of treatment fractions with a shift difference exceeding the planning target volume of 7 mm, between orthogonal kilovoltage and cone beam computed tomography scans, was calculated.

Results:

The mean vertical, lateral, and longitudinal shifts resulted from 2D match between orthogonal kilovoltage images and corresponding digitally reconstructed radiographs were 0.353 cm (interquartile range: 0.1-0.5), 0.346 cm (interquartile range: 0.1-0.5), and 0.289 cm (interquartile range: 0.1-0.4), compared to 0.388 cm (interquartile range: 0.1-0.5), 0.342 cm (interquartile range: 0.1-0.5), and 0.291 cm (interquartile range: 0.1-0.4) obtained from 3D match between cone beam computed tomography and planning computed tomography scan, respectively. Our results show a significant difference between the kilovoltage and cone beam computed tomography shifts in the anterior–posterior direction ( P = .01). The proportion of treatment fractions in which the differences in kilovoltage and cone beam computed tomography shifts between exceeded the 7 mm planning target volume margin was 6%, 2%, and 3% in the anterior–posterior, lateral, and superior–inferior directions, respectively.

Conclusion:

We prospectively demonstrated that the daily use of volumetric cone beam computed tomography for treatment localization in post-radical prostatectomy patients demonstrated an increased need for a shift in patient position. This suggests that in post-radical prostatectomy patients the daily cone beam computed tomography imaging improved localization of the prostate bed and may have prevented a limited number of geographic misses, compared to daily kilovoltage imaging that was not assisted with fiducials.
Aortic Stenting in Symptomatic Infrarenal Aortic Stenosis and Subtotal Aortic Occlusion
Authors: Tatiana Belyavskaya , Peter Kalmar , Peter Konstantiniuk , Anneliese Baumann , Tina Cohnert
Published: February 2019

Objective:

The aim of this study was to evaluate the long-term results of aortic stent placement in patients with infrarenal aortic occlusive disease.

Methods:

Between April 1996 and May 2014, 34 patients with symptomatic infrarenal atherosclerotic aortic stenosis or subtotal aortic occlusion underwent percutaneous angioplasty with primary aortic stent implantation. There were 21 patients with Fontaine stage of the peripheral arterial disease (PAD) II, 5 patients with stage III, and 8 patients with stage IV. One patient withdrew informed consent and was excluded from further analysis.

Results:

Patients (n = 34, mean age: 62 ± 12 years) were followed for a mean period of 81 months. There were 2 procedure-related access-related complications. Six patients died during follow-up from non-procedure-related causes. Eight patients had late recurrence of symptoms during follow-up. Only in 2 cases, symptomatic recurrences were due to aortic in-stent stenosis (77 and 132 months after the primary stent implantation). Additionally, these 2 patients required therapy for PAD progression distal to the aorta. Five patients required further surgical or endovascular reconstruction for PAD progression distal to the aorta. In another case, clinical treatment failure was due to the progression of atherosclerotic lesion in the perirenal, nonstented part of the abdominal aorta. The mean estimated primary patency rate was 185.6 months (95% confidence interval: 161.3-209.8).

Conclusion:

Endovascular stent implantation is a safe and long-term effective strategy for the treatment of infrarenal aortic occlusive disease. In our study, the recurrence of symptoms was observed mainly due to atherosclerosis progression by multilevel disease with associated infrainguinal occlusive lesions but not to aortic in-stent restenosis. The prognostic advantage for this relatively young cohort of patients can be the possibility to repeat a percutaneous procedure with less technical difficulties when compared to surgical revision.
Spontaneous Iliac Vein Rupture Due to May-Thurner Syndrome and Its Staged Management
Authors: Ingram Michael , Miladore Julia , Gupta Alok , Maijub John , Wang Keisin , Fajardo Andres , Motaganahalli Raghu
Published: February 2019

We present a case of a 58-year-old otherwise healthy women who presented with left lower extremity deep venous thrombosis and was found to have pulmonary embolism along with a ruptured left internal iliac vein. Our patient was hemodynamically stable upon presentation; therefore, a staged approach was undertaken. Initially, an inferior vena cava filter was placed and the patient was slowly advanced to therapeutic anticoagulation and subsequently discharged. She then returned 2 weeks after discharge for venogram, mechanical thrombectomy, and stenting. At 1-year follow-up in clinic, she was found to have patent stents and resolution of symptoms.
Religious and Spiritual Expressions of Young People with Intellectual and Developmental Disabilities
Authors: Carter Erik W. , Boehm Thomas L.
Published: February 2019

Although the importance and influence of spirituality in the lives of youth and young adults have garnered much attention, few studies have focused on the religious and spiritual lives of young people with intellectual and developmental disabilities (IDD). We examined the congregational activities, spiritual practices, and strength of religious faith of 440 individuals with IDD (aged 13-21 years) as reported by their parents. Such activities and practices were described as having particular prominence, with most youth participating in multiple ways both in a local congregation and at home. However, participation patterns were individualized and strongly associated with the importance of faith in their lives. We offer recommendations for families, congregations, agencies, and researchers aimed at better understanding and supporting this often-overlooked dimension of the lives of youth with IDD.
Locomotor Training Increases Synaptic Structure With High NGL-2 Expression After Spinal Cord Hemisection
Authors: Kobayakawa Kazu , DePetro Kyleigh Alexis , Zhong Hui , Pham Bau , Hara Masamitsu , Harada Akihito , Nogami Jumpei , Ohkawa Yasuyuki , Edgerton V. Reggie
Published: February 2019

Background. We previously demonstrated that step training leads to reorganization of neuronal networks in the lumbar spinal cord of rodents after a hemisection (HX) injury and step training, including increases excitability of spinally evoked potentials in hindlimb motor neurons. Methods. In this study, we investigated changes in RNA expression and synapse number using RNA-Seq and immunohistochemistry of the lumbar spinal cord 23 days after a mid-thoracic HX in rats with and without post-HX step training. Results. Gene Ontology (GO) term clustering demonstrated that expression levels of 36 synapse-related genes were increased in trained compared with nontrained rats. Many synaptic genes were upregulated in trained rats, but Lrrc4 (coding NGL-2) was the most highly expressed in the lumbar spinal cord caudal to the HX lesion. Trained rats also had a higher number of NGL-2/synaptophysin synaptic puncta in the lumbar ventral horn. Conclusions. Our findings demonstrate clear activity-dependent regulation of synapse-related gene expression post-HX. This effect is consistent with the concept that activity-dependent phenomena can provide a mechanistic drive for epigenetic neuronal group selection in the shaping of the reorganization of synaptic networks to learn the locomotion task being trained after spinal cord injury.
Postoperative Pain Management of Non–“Opioid-Naive” Patients Undergoing Hand and Upper-Extremity Surgery
Authors: Wong Kelvin A. , Goyal Kanu S.
Published: February 2019

Background: Patients with prior opioid use are often difficult to manage postoperatively. We examined potential strategies for managing these patients: (1) prescribing a different opioid; and (2) encouraging the use of nonopioid analgesics over opioids. Methods: A pain control program was implemented at an outpatient hand and upper-extremity center. Patients were recruited before (n = 305) and after (n = 225) implementation. Seventy of them were taking opioids prior to surgery. Information about pain control satisfaction and opioid use was collected. The Fisher exact test was used to compare categorical variables with small expected frequencies. Wilcoxon rank sum test was used to compare nonnormally distributed continuous variables. Results: Opioid users used 28.8 ± 25.6 opioid pills; nonopioid users used 14.5 ± 21.5 pills. Furthermore, 41.4% of opioid users sought more pills after surgery compared with 14.0% among nonopioid users. The pain control program was more effective in reducing opioid consumption and waste and increasing nonopioid consumption for nonopioid users than for opioid users. Prior opioid users who were prescribed a different opioid after surgery used 24.6 ± 22.0 opioid pills. Patients prescribed the same opioid used 37.9 ± 30.8 pills. Conclusions: Patients taking opioids prior to hand and upper-extremity surgery use more opioid pills, seek more pills after surgery, and are less satisfied with their pain control than their nonopioid user counterparts. Furthermore, the comprehensive pain plan was less effective in this patient population. Prescribing a different opioid reduced medication requirements for these patients, but additional strategies are needed to address postoperative pain management.
The Importance of Language in Behavior Change
Authors: Daundasekara Sajeevika S. , Arlinghaus Katherine R. , Johnston Craig A.
Published: February 2019

Communication between health care providers and patients is important for behavioral treatment in lifestyle medicine. Ineffective communication can lead to patient dissatisfaction, demotivation, and discontinuation of treatment. It is important for health care providers to understand their biases, praise patients’ behaviors rather than health outcomes, and use language to prevent dichotomous thinking. These strategies may lead to sustained lifestyle behavior changes and better treatment outcomes among patients.
Adaptive tracking control based on neural approximation for the yaw motion of a small-scale unmanned helicopter
Authors: Le Tri-Quang , Lai Ying-Chih , Yeh Chun-Liang
Published: February 2019

This article aims to study a solution that can solve the problem of tracking control for yaw motion of an unmanned helicopter. The non-affine nonlinear equation is converted to a simplified affine model. The unknown parameters are estimated by the Levenberg–Marquardt algorithm. An autonomous flight controller is developed with the Lyapunov-based adaptive controller for a discrete-time system. For flight data collection and verification purpose, the software-in-the-loop is constructed based on Simulink and X-Plane simulator. The designed system is applied in the control of the yaw motion of an R30 V2 helicopter under ideal and turbulent environments. The performance of the proposed method is compared with the fuzzy logic controller, and the simulation results show that the quality of the current approach is considerably better.
Chronic disease and socioeconomic factors among uninsured patients: A retrospective study
Authors: Rahman Shams , Mirza Abu-Sayeef , Wathington Deanna , Green Shikerria , Mayers Yeshuwa , Iranmanesh Elhaam , Woodard Laurie
Published: February 2019

Objectives

Uninsured patients represent an understudied population. The current study aimed to estimate the burden of 10 common chronic conditions and to investigate the associated factors among patients who use free clinics for their health care needs.

Methods

Patient charts from four free clinics were reviewed from January to December of 2015. Proportion of prevalence, adjusted odds ratios (AOR), and 95% confidence intervals (CI) for associations between participant characteristics and chronic conditions are reported.

Results

Prevalence of hypertension and hyperlipidemia significantly differed by clinic, age, gender, race, and marital status. Compared to age 15–44 years, older patients (45–64 years, and ≥65) were 5–10 times more likely to suffer from hypertension. Compared to women, men; compared to White, African-Americans; and compared to single, married patients had higher prevalences of hypertension. Older patients were 5–8 times more likely to suffer from hyperlipidemia. Asians, and married patients were also more likely to experience hyperlipidemia. Prevalence of diabetes, depression and arthritis significantly differed by age and race. Prevalence of coronary artery disease and chronic obstructive pulmonary disease increased 6–13 folds among older patients.

Discussion

Patients of free clinics suffer from high burden of chronic conditions. Patients who frequent free clinics are primarily older, unemployed, women, minorities, and are of low income.
Role of intraganglionic transmission in the trigeminovascular pathway
Authors: Zhang LuJuan , Kunkler Phillip Edward , Knopp Kelly L , Oxford Gerry Stephen , Hurley Joyce Harts
Published: February 2019

Migraine is triggered by poor air quality and odors through unknown mechanisms. Activation of the trigeminovascular pathway by environmental irritants may occur via activation of transient receptor potential ankyrin 1 (TRPA1) receptors on nasal trigeminal neurons, but how that results in peripheral and central sensitization is unclear. The anatomy of the trigeminal ganglion suggests that noxious nasal stimuli are not being transduced to the meninges by axon reflex but likely through intraganglionic transmission. Consistent with this concept, we injected calcitonin gene-related peptide, adenosine triphosphate, or glutamate receptor antagonists or a gap junction channel blocker directly and exclusively into the trigeminal ganglion and blocked meningeal blood flow changes in response to acute nasal TRP agonists. Previously, we observed chronic sensitization of the trigeminovascular pathway after acrolein exposure, a known TRPA1 receptor agonist. To explore the mechanism of this sensitization, we utilized laser dissection microscopy to separately harvest nasal and meningeal trigeminal neuron populations in the absence or presence of acrolein exposure. mRNA levels of neurotransmitters important in migraine were then determined by reverse transcription polymerase chain reaction. TRPA1 message levels were significantly increased in meningeal cell populations following acrolein exposure compared to room air exposure. This was specific to TRPA1 message in meningeal cell populations as changes were not observed in either nasal trigeminal cell populations or dorsal root ganglion populations. Taken together, these data suggest an important role for intraganglionic transmission in acute activation of the trigeminovascular pathway. It also supports a role for upregulation of TRPA1 receptors in peripheral sensitization and a possible mechanism for chronification of migraine after environmental irritant exposure.
Radical pluralism and the challenges of educating for democratic-ecological civic identities: Reflections from the Mexican school context
Authors: Levinson Bradley A
Published: February 2019

This article builds on the growing importance of concepts of identity and diversity in citizenship education studies and argues for an expanded conception of diversity that ultimately includes the non-human and even inanimate realm. The dramatic pace of human-induced global climate change requires a commensurate urgency in developing forms of citizenship education that shape new ecological as well as political civic identities, and which expand democracy beyond the human community. Situating my empirical work on Mexican civic education reform in a global, comparative context, I consider the challenges that all schools and school systems will need to address to incorporate even deeper practices of respect for diversity and acknowledgment of the radical pluralism that life (and non-life) on earth presents.
Cortical superficial siderosis and recurrent intracerebral hemorrhage risk in cerebral amyloid angiopathy: Large prospective cohort and preliminary meta-analysis
Authors: Charidimou Andreas , Boulouis Gregoire , Roongpiboonsopit Duangnapa , Xiong Li , Pasi Marco , Schwab Kristin M , Rosand Jonathan , Gurol M Edip , Greenberg Steven M , Viswanathan Anand
Published: February 2019

Background

We aimed to investigate cortical superficial siderosis as an MRI predictor of lobar intracerebral hemorrhage (ICH) recurrence risk in cerebral amyloid angiopathy (CAA), in a large prospective MRI cohort and a systematic review.

Methods

We analyzed a single-center MRI prospective cohort of consecutive CAA-related ICH survivors. Using Kaplan–Meier and Cox regression analyses, we investigated cortical superficial siderosis and ICH risk, adjusting for known confounders. We pooled data with eligible published cohorts in a two-stage meta-analysis using random effects models. Covariate-adjusted hazard rations (adj-HR) from pre-specified multivariable Cox proportional hazard models were used.

Results

The cohort included 240 CAA-ICH survivors (cortical superficial siderosis prevalence: 36%). During a median follow-up of 2.6 years (IQR: 0.9–5.1 years) recurrent ICH occurred in 58 patients (24%). In prespecified multivariable Cox regression models, cortical superficial siderosis presence and disseminated cortical superficial siderosis were independent predictors of increased symptomatic ICH risk at follow-up (HR: 2.26; 95% CI: 1.31–3.87, p = 0.003 and HR: 3.59; 95% CI: 1.96–6.57, p < 0.0001, respectively). Three cohorts including 443 CAA-ICH patients in total were eligible for meta-analysis. During a mean follow-up of 2.5 years (range: 2–3 years) 92 patients experienced recurrent ICH (pooled risk ratio: 6.9% per year, 95% CI: 4.2%–9.7% per year). In adjusted pooled analysis, any cortical superficial siderosis and disseminated cortical superficial siderosis were the only independent predictors associated with increased lobar ICH recurrence risk (adj-HR: 2.4; 95% CI: 1.5–3.7; p < 0.0001, and adj-HR: 4.4; 95% CI: 2–9.9; p < 0.0001, respectively).

Conclusions

In CAA-ICH patients, cortical superficial siderosis presence and extent are the most important MRI prognostic risk factors for lobar ICH recurrence. These results can help guide clinical decision making in patients with CAA.
Memory in the margins: The connecting and colliding of vernacular war memories
Authors: de Smale Stephanie
Published: February 2019

This article examines how war memory circulates, connects and collides on digital media platforms driven by digital publics that form around popular culture. Through a case study of vernacular memory discourses emerging around a game inspired by the Yugoslav war, the article investigates how the commenting practices of YouTube users provide insights into the feelings of belonging of conflict-affected subjects that go beyond ethnicity and exceed geographical boundaries. The comments of 331 videos were analysed, using an open source tool and sequential mixed-method content analysis. Media-based collectivities emerging on YouTube are influenced by the reactive and asynchronous dynamics of comments that stimulate the emergence of micro-narratives. Within this plurality of voices, connective moments focus on shared memories of trauma and displacement beyond ethnicity. However, clashing collective memories cause disputes that reify identification along ethnic lines. The article concludes that memory discourses emerging in the margins of YouTube represent the affective reactions of serendipitous encounters between users of audio-visual content.
Closing traps: Emotional attachment, intervention and juxtaposition in cosplay and International Relations
Authors: Birkedal Katarina HS
Published: February 2019

This article explores the everyday emotional attachments to martial discourses through the embodiment of popular culture representations of war(rior) bodies in cosplay. In cosplay – the (re)creation and wearing of costumes of characters from popular culture – the cosplayer is able to express and experience behaviours and emotions normally unavailable to them. This enables a radical, empathetic form of identity exploration, wherein the cosplayer is able to express and develop an understanding of their own and others’ experiences. Building on autoethnographic fieldwork in cosplay as Black Widow, I posit three links between cosplay and the study of emotions in International Relations (IR): the first, going through the everyday constitutive character of popular culture; the second, linking the embodiment of representations of war(rior) characters in cosplay with the feminist IR challenge to study the human experience of war; and the third, arguing that the study of something so seemingly random can engender exciting insights, like a collage. I argue that cosplay can be used to understand our emotional attachments to violent, gendered discourses found in popular culture narratives, but that in the (re)enactment of these upon the body – in their embodiment – there is a space for resistance.
Anticoagulation in atrial fibrillation
Authors: Utomi Victor , Draper Richard
Published: February 2019

Atrial fibrillation is the most common sustained disturbance of cardiac rhythm. It is a global epidemic and an evolving problem in cardiovascular medicine. Atrial fibrillation is an independent risk factor for embolic stroke, increasing the risk of stroke five-fold. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there is significant under treatment. Anticoagulant prescribing is frequently discordant with all current guidelines and decision aids with both over and under use of oral anticoagulants. It is important that GPs have up-to-date knowledge about atrial fibrillation in terms of both its diagnosis and management, and that patients have an understanding of anticoagulant medication. This article aims to update knowledge about atrial fibrillation, the use and benefits of anticoagulation with insights on some barriers to anticoagulation in primary care. This article does not cover management of atrial fibrillation with control of cardiac rate or rhythm to maintain cardiac function.
Symptoms compatible with functional bowel disorders are common in patients with quiescent ulcerative colitis and influence the quality of life but not the course of the disease
Authors: Mavroudis Georgios , Simren Magnus , Jonefjäll Börje , Öhman Lena , Strid Hans
Published: February 2019

Background:

Whether patients with inactive ulcerative colitis (UC) have symptoms compatible with functional bowel disorders (FBDs) other than irritable bowel syndrome (IBS) is unclear. Our aim was to investigate the prevalence and burden of these symptoms and determine impact on the UC course.

Methods:

We used Mayo score, sigmoidoscopy and calprotectin (f-cal) to define remission in 293 UC patients. Presence of symptoms compatible with FBD, severity of gastrointestinal, extraintestinal and psychological symptoms, stress levels and quality of life (QoL) were measured with validated questionnaires. At 1 year later, remission was determined by modified Mayo score and f-cal in 171 of these patients. They completed the same questionnaires again.

Results:

A total of 18% of remission patients had symptoms compatible with FBD other than IBS, and 45% subthreshold symptoms compatible with FBD. The total burden of gastrointestinal symptoms in patients with symptoms compatible with FBD was higher than in patients without FBD ( p < 0.001), which had negative impact on QoL ( p = 0.02). These symptoms were not correlated with psychological distress, systemic immune activity or subclinical colonic inflammation and were not a risk factor for UC relapse during follow up.

Conclusion:

Symptoms compatible with FBD other than IBS are common during UC remission influencing patients’ QoL but not the UC course.
NMR Spectroscopic Analysis to Evaluate the Quality of Insulin: Concentration, Variability, and Excipient Content
Authors: Malmodin Daniel , Pedersen Anders , Karlsson B. Göran , Forsander Gun
Published: February 2019

Known and consistent bioactivity between samples of insulin is essential to correctly estimate the dose. Insulin concentration is not the same thing as bioactivity, however, and methods to correctly determine both are required. Here we show that one dimensional nuclear magnetic resonance (1D NMR), in contrast to, for example, reverse phase high pressure liquid chromatography, can be used to determine both insulin concentration as well as confirm the structural integrity required for activity. In response to the report by Carter and Heinemann, we decided to investigate insulin intended for public use. Insulin from several manufacturers was investigated. Correct insulin concentrations were found in all tested samples although the general sample variability, which possibly could influence the bioactivity, varied depending on insulin type and manufacturer.