bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence supporting wound care end points relevant to clinical practice and patients’ lives. Part 2. Literature survey
Authors: Driver Vickie R. , Gould Lisa J. , Dotson Peggy , Allen Latricia L. , Carter Marissa J. , Bolton Laura L.
Published: October 2018

Patients with wounds bear significant clinical, personal, and economic burdens yet complete wound healing is the only United States Food and Drug Administration (FDA) recognized primary clinical trial end point. The overall goal of this project is to work with FDA to expand the list of acceptable primary end points, recognizing that new and innovative treatments, devices, and drugs may not have complete healing as the focus. Part 1 of the project surveyed 628 wound care experts who identified and content‐validated 15 end points most relevant to clinical practice and benefitting patients’ lives as primary outcomes in clinical trials. Part 2 is focused on critical appraisal of the evidence in the wound care literature supporting FDA criteria to qualify these 15 end points as primary end points in clinical trials. Further research involved systematic review of the literature regarding the most promising end points. Forty volunteer, interdisciplinary, wound healing experts in fields related to the end points compiled evidence from systematic MEDLINE searches and society databases supporting the FDA criteria of reliability, clinical construct validity, capacity to detect concurrent or longitudinal change, and responder analysis. The search revealed 485 references involving over 462,000 subjects supporting FDA‐required parameters for all 15 end points More than 50 references supported FDA‐required parameters qualifying the following outcomes for use in clinical trials supporting interventions for FDA clearance: Pain reduction, Physical function and ambulation, Infection reduction, Time to heal, and Percent wound area reduction in 4–8 weeks. Among these, only Time to heal is currently recognized by the FDA as a primary wound outcome in clinical trials. These results suggest that wound science is already serving patients and professionals by improving these content‐validated outcomes that merit regulatory consideration.
A New Model Approach for Convective Wall Heat Losses in DQMOM-IEM Simulations for Turbulent Reactive Flows
Authors: Emmi Yeshaswini , Fiolitakis Andreas , Aigner Manfred , Genin Franklin , Syed Khawar
Published: October 2018

A new model approach is presented in this work for including convective wall heat losses in the direct quadrature method of moments (DQMoM) approach, which is used here to solve the transport equation of the one-point, one-time joint thermochemical probability density function (PDF). This is of particular interest in the context of designing industrial combustors, where wall heat losses play a crucial role. In the present work, the novel method is derived for the first time and validated against experimental data for the thermal entrance region of a pipe. The impact of varying model-specific boundary conditions is analyzed. It is then used to simulate the turbulent reacting flow of a confined methane jet flame. The simulations are carried out using the DLR in-house computational fluid dynamics code THETA. It is found that the DQMoM approach presented here agrees well with the experimental data and ratifies the use of the new convective wall heat losses model.
Optimized decentralized adaptive control of noise and vibration for periodic disturbances
Authors: An Fengyan , Cao Yin , Liu Bilong
Published: October 2018

Decentralized control has great potential to facilitate the implementations of multichannel active noise/vibration control systems. The main drawback, however, is its inherent risk of system instability. In this letter an optimized decentralized adaptive control algorithm subject to periodic disturbances is reported. The algorithm employs the scheme of a decentralized filtered-x least mean square algorithm and utilizes optimized reference filters so that the stability of the control system can be ensured. Simulation results based on a realistic vibration isolation system demonstrate that both the stability and the convergent speed could be significantly improved.
Broad Recognition of Circulating HIV-1 by HIV-1-Specific Cytotoxic T-Lymphocytes with Strong Ability to Suppress HIV-1 Replication
Authors: Murakoshi Hayato , Kuse Nozomi , Akahoshi Tomohiro , Zhang Yu , Chikata Takayuki , Borghan Mohamed Ali , Gatanaga Hiroyuki , Oka Shinichi , Sakai Keiko , Takiguchi Masafumi
Published: October 2018

In recent T-cell AIDS vaccine trials, the vaccines did not prevent HIV-1 infection, although HIV-1-specific T cells were induced in the vaccinated individuals, suggesting that the T cells have a weak ability to suppress HIV-1 replication and fail to recognize circulating HIV-1. We previously demonstrated that the T-cell responses to 10 epitopes were significantly associated with good clinical outcome. However, there is no direct evidence that these T cells have strong abilities to suppress HIV-1 replication and recognize circulating HIV-1. Here, we demonstrated that the T cells specific for the 10 epitopes had strong abilities to suppress HIV-1 replicationin vitro. Moreover, the T cells cross-recognized most of the circulating HIV-1 in HIV-1-infected individuals. This study suggests the use of T cells specific for these 10 epitopes in clinical trials of T-cell vaccines as a cure treatment.
Oral Administration of Porphyromonas gingivalis Alters the Gut Microbiome and Serum Metabolome
Authors: Kato Tamotsu , Yamazaki Kyoko , Nakajima Mayuka , Date Yasuhiro , Kikuchi Jun , Hase Koji , Ohno Hiroshi , Yamazaki Kazuhisa
Published: October 2018

Increasing evidence suggest that alterations of the gut microbiome underlie metabolic disease pathology by modulating gut metabolite profiles. We have shown that orally administered
Porphyromonas gingivalis
, a representative periodontopathic bacterium, alters the gut microbiome; that may be a novel mechanism by which periodontitis increases the risk of various diseases. Given the association between periodontal disease and metabolic diseases, it is possible that
P. gingivalis
can affect the metabolites. Metabolite profiling analysis demonstrated that several amino acids related to a risk of developing diabetes and obesity were elevated in
P. gingivalis
-administered mice. Our results revealed that the increased risk of various diseases by
P. gingivalis
might be mediated at least in part by alteration of metabolic profiles. The findings should add new insights into potential links between periodontal disease and systemic disease for investigators in periodontal disease and also for investigators in the field of other diseases, such as metabolic diseases.
Screening for coeliac disease in 1624 mainly asymptomatic children with type 1 diabetes: is genotyping for coeliac-specific human leucocyte antigen the right approach?
Authors: Binder Elisabeth , Rohrer Tilmann , Denzer Christian , Marg Wolfgang , Ohlenschläger Ute , Schenk-Huber Heike , Schierloh Ulrike , Skopnik Heino , Fröhlich-Reiterer Elke Elisabeth , Holl Reinhard W , Prinz Nicole
Published: October 2018

Objectives

To investigate the frequency of coeliac disease (CD)-specific human leucocyte antigen (HLA) genotypes in paediatric patients with type 1 diabetes (T1D), who are known to have a higher prevalence of CD than the general population, and to evaluate whether HLA genotyping is a suitable first-line screening method for CD.

Study design

The study was a multicentre observational analysis of patients with T1D aged <20 years of whom a subgroup had undergone HLA genotyping. Patient data were retrieved from the Diabetes Prospective Follow-up database, a large diabetes follow-up registry. The present analysis included data from 439 centres throughout Germany, Austria, Switzerland and Luxembourg.

Results

In March 2017, the database contained 75 202 patients with T1D (53% male, mean age (SD) 14.6 (4.1) years, mean age at diagnosis 8.8 (4.3) years and mean diabetes duration 5.8 (4.3) years). 1624 patients had undergone coeliac-specific HLA genotyping, of whom 1344 (82.8%) were positive for HLA-DQ2, HLA-DQ8 or both, while 17.2% had no coeliac-specific HLA-markers. 26.6% of at-risk patients had a clinical suspected diagnosis of CD, and 3.6% had biopsy-proven CD.

Conclusions

Genotyping for HLA-DQ2, HLA-DQ8 or both is positive in the vast majority (>80%) of patients with T1D. Therefore, screening for coeliac-specific HLA genotypes as a first-line test is not a suitable method to exclude CD in T1D. Regular screening for coeliac-specific antibodies in T1D is still recommended.
Neonatal punctate calcifications associated with maternal mixed connective tissue disorder (MCTD)
Authors: Pandita Aakash , Panghal Astha , Gupta Girish , Singh Vijay
Published: October 2018

Chondrodysplasia punctate (CDP) is a rare group of disorders with both genetic and non-genetic underlying aetiologies. The genetic causes associated with CDP include peroxisomal disorders, type two mucolipidosis, type 3 mucopolysaccharidosis, GM1 gangliosidosis and chromosomal disorders. Peroxisomal disorders include deficiency of dihydroxyacetone phosphate acyltransferase, encoded by GNPAT, deficiency of the peroxisomal enzyme alkyl-dihydroxyacetone phosphate synthase, encoded by AGPS and Zellweger syndrome. The chromosomal disorders include Turner syndrome, trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome) and trisomy 9. Among non-genetic causes, teratogen exposure like warfarin and acenocoumarol is well known but for the past few years cases have been reported with maternal autoimmune disease mainly systemic lupus erythematosus and rarely with mixed connective tissue disorder (MCTD). However, the exact mechanism for the occurrence of CDP in MCTD is still unknown. We present here a 35-week appropriate for gestational age baby born to a second gravid mother, a known case of MCTD on treatment with hydroxychloroquine. The baby had mid-facial hypoplasia and bilateral talar region punctuate calcification suggestive of chondrodysplasia punctata. Global data on such cases are very scant. Further research work is needed to explore the association of specific antibody titre with the occurrence of such condition in maternal autoimmune disease.
Mesenteric panniculitis: diagnostic precision
Authors: Sousa Domingos , Varela Ana Verónica , Coelho Margarida Viana , Jorge Catarina
Published: October 2018

A previously healthy 74-year-old woman was admitted with vespertine fever, tremors, shivers and loss of appetite within the previous month. Blood tests revealed an elevated C reactive protein serum level. Serologies for infection were negative. Blood cultures grew no organisms. Colonoscopy revealed normal findings. CT showed typical findings of mesenteric panniculitis with infiltration of mesenteric fat that was circumscribed by hyperattenuating capsule and contained enlarged homogenous lymph nodes. The histopathological analysis from mesenterium revealed non-specific signs of chronic inflammation. On institution of prednisolone, the clinical symptoms subsided, and we replaced it with azathioprine after 1 month. After 12 months of therapy, the patient remained asymptomatic, normalised the serological inflammatory markers and repeat CT revealed normal mesenteric fat.
Unilateral localized extraocular muscle metastasis by lobular breast carcinoma
Authors: Nifosí Gianfilippo , Zuccarello Mariateresa
Published: October 2018

Here is a case of an isolated orbital metastasis in a previously diagnosed metastatic breast cancer of a 46-year-old woman presenting diplopia and pain in her left eye. The magnetic resonance showed a suspected metastatic localisation in the upper left oblique muscle, which was confirmed by the fine-needle aspiration biopsy. The systemic therapy with liposomal doxorubicin as well as local stereotactic radiotherapy showed a gradual improvement of the local symptoms and signs.
Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves
Authors: Prat Elisabetta , Seo-Mayer Patricia , Agarwal Swati
Published: October 2018

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.
Secondary bacterial peritonitis and pelvic abscess due to Clostridium difficile
Authors: Herberts Michelle , Hicks Bradley , Sohail Muhammad Rizwan , Jagtiani Anil
Published: October 2018

A 70-year-old man with a history of hepatic cirrhosis presented with abdominal discomfort and distention. Physical examination revealed abdominal distention, positive fluid wave and abdominal tenderness. Due to concerns for spontaneous bacterial peritonitis (SBP), paracentesis was performed. Fluid analysis revealed 5371 total nucleated cells with 48% neutrophils. Ceftriaxone was then initiated for the treatment of SBP. Bacterial cultures of the fluid, however, grew Clostridium difficile. Therefore, metronidazole was added. An abdominal ultrasound revealed a pelvic fluid collection that was suspicious for an abscess on an abdominal CT scan. The patient underwent CT-guided drain placement into the pelvic fluid collection. The fluid aspirate was consistent with an abscess. However, cultures were negative in the setting of ongoing antibiotic therapy. The patient was treated with a 10-day course of ceftriaxone and metronidazole and was discharged home with outpatient follow-up.
Case of newly diagnosed bilateral anorchia in a 42-year-old male patient
Authors: Sousa Santos Francisco , Ferrinho Cátia , Limbert Clotilde , Vasconcelos Carlos
Published: October 2018

A 42-year-old African man presented with hypogonadic phenotypical features, including gynoid body distribution, gynaecomastia, absent facial and truncal hair and micropenis. He denied ever experiencing development of male secondary sex characteristics. Endocrine testing revealed hypergonadotropic hypogonadism and undetectable AMH. Human chorionic gonadotropin (hCG) stimulation test failed to increase testosterone levels. Peripheral blood karyotype was 46, XY. Clinical examination and abdominal/pelvic/scrotal ultrasound and MRI failed to identify any testicular structures/remnants. Given the clinical course and the biochemical–radiological presentation, the diagnosis of bilateral anorchia was made (after more than four decades of its probable onset), and surgical exploration was decided against. The patient was subsequently started on monthly intramuscular testosterone experiencing progressive normal virilisation.
Living donor liver transplantation and situs inversus totalis: cutting the Gordian knot
Authors: Shankar Sadhana , Rammohan Ashwin , Reddy Srinivas Mettu , Rela Mohamed
Published: October 2018

Liver transplantation for biliary atresia splenic malformation syndrome associated with situs inversus totalis is a challenging task due to the complexity of associated malformations and the technical proficiency required to overcome them. We present the case of a 6-month-old infant who underwent liver transplantation for biliary atresia. A reduced left lateral segment liver graft from a live donor (his mother) was implanted. The postoperative period was uneventful, and the child remained well on follow-up. Thus, such rare congenital anomalies no longer prove to be a deterrent for successful liver transplantation.
Methicillin-sensible Staphylococcus aureus causing endocarditis, with cerebral and orthopaedic complications, in a 17-month-old child with no risk factor
Authors: Geslain Guillaume , Bourgade Clara , Chomton Maryline , Le Bourgeois Fleur
Published: October 2018

We report a case of Staphylococcus aureus endocarditis, with large vegetation, in a 17-month-old male infant, complicated with meningitis, ischaemic strokes and osteoarthritis leading to haemorrhagic stroke by aneurysm rupture. He did not present any risk factor for endocarditis. The final course was favourable through, after valve replacement. The strain was sensible to methicillin and belongs to complex clonal 398, with accessory gene regulator I. We did not found immunodeficiency.
Takotsubo syndrome with severe bradycardia initiated by seizure: Is the implantation of a permanent pacemaker necessary?
Authors: Imori Yoichi , Iwasaki Yu-Ki , Takano Hitoshi , Shimizu Wataru
Published: October 2018

Although arrhythmias are frequent in patients with Takotsubo syndrome (TTS), data on sick sinus syndrome remain elusive. Here, we report a case of TTS initiated by a seizure as a physical trigger that led to sinus arrest. The patient presented with cardiogenic shock and bradycardia which required intensive cardiovascular care. However, in the subacute phase of TTS, the sinus function recovered significantly, and pacemaker implantation was deferred.
Evaluating emergency care capacity in Africa: an iterative, multicountry refinement of the Emergency Care Assessment Tool
Authors: Bae Crystal , Pigoga Jennifer L , Cox Megan , Hollong Bonaventure , Kalanzi Joseph , Abbas Gamal , Wallis Lee A , Calvello Hynes Emilie J
Published: October 2018

Healthcare facilities in low-income and middle-income countries lack an objective measurement tool to assess emergency care capacity. The African Federation for Emergency Medicine developed the Emergency Care Assessment Tool (ECAT) to fulfil this function. The ECAT assesses the provision of key medical interventions (signal functions) that emergency units (EUs) should be able to perform to adequately treat six common, life-threatening conditions (sentinel conditions). We describe the piloting and refinement of the ECAT, to improve usability and context-appropriateness. We undertook iterative, multisite refinement of the ECAT. After pilot testing at a South African referral hospital, subsequent studies occurred at district, regional and central facilities across four countries representing the major regions of Africa: Cameroon, Uganda, Egypt and Botswana. At each site, the tool was administered to three participants: one senior physician, one senior nurse and one other clinical provider. Feedback informed refinements of the ECAT, and an updated tool was used in the next-studied country. Iteratively implementing refined versions of the tool in various contexts across Africa resulted in a final ECAT that uses signal functions, categorised by sentinel conditions and evaluated against discrete barriers to emergency care service delivery, to assess EUs. It also allowed for refinement of administration and data analysis processes. The ECAT has a total of 71 items. Advanced facilities are expected to perform all 71 signal functions, while intermediate facilities should be able to perform 53. The ECAT is the first tool to provide a standardised method for assessing facility-based emergency care in the African context. It identifies where in the maturation process a hospital or system is and what gaps exist in delivery of care, so that a comprehensive roadmap for development can be established. Although validity and feasibility testing have now occurred, reliability studies must be conducted prior to amplification across the region.
How do specialist trainee doctors acquire skills to practice patient-centred care? A qualitative exploration
Authors: Patel Veena , Buchanan Heather , Hui Michelle , Patel Prashanth , Gupta Pankaj , Kinder Alison , Thomas Hywel
Published: October 2018

Objectives

The importance of patient-centred care (PCC) has been increasingly recognised. However, there is limited work exploring what doctors actually understand by PCC, and how they perceive they acquire PCC skills in the workplace. The objectives of our study were to explore (1) what UK doctors, in specialist training, perceive to be the essential components of PCC, (2) if/how they acquire these skills, (3) any facilitators/barriers for engaging in PCC and (4) views on their PCC training.

Design

Qualitative study using in-depth individual semi-structured interviews with UK specialist trainees. Interview transcripts were thematically analysed.

Setting and participants

Thirty-one specialist trainee doctors, with at least 4 years postgraduate experience, were interviewed. Participants worked in various medical specialities within the Medical Directorate of an acute hospital in the East Midlands of England.

Results

Interview data were transcribed verbatim and categorised into three main themes. The first theme was ‘Understanding PCC’ where the doctors gave varied perspectives on what they understood by PCC. Although many were able to highlight key components of PCC, there were also some accounts which demonstrated a lack of understanding. The second theme was ‘Learning PCC skills: A work in progress’. Learning to be patient-centred was perceived to be an ongoing process. Within this, trainee doctors reported ‘on-the-job’ learning as the main means of acquiring PCC skills, but they also saw a place for formal training (eg, educational sessions focussing on PCC, role play). ‘Delivering PCC: Beyond the physician’ referred to the many influences the doctors reported in learning and delivering PCC including patients, the organisation and colleagues. Observing consultants taking a patient-centred approach was cited as an important learning tool.

Conclusions

Our findings may assist clinical educators in understanding how trainee doctors perceive PCC, and the factors that influence their learning, thereby helping them shape PCC skills training.
Can we improve the prescribing and delivery of oxygen on a respiratory ward in accordance with new British Thoracic Society oxygen guidelines?
Authors: Choudhury Aklak , Young Gregor , Reyad Beshoy , Shah Nirali , Rahman Radhea
Published: October 2018

The British Thoracic Society recommends oxygen delivery to achieve target oxygen saturation range between 94% and 98% for medically unwell adult patients, and 88% to 92% in patients at risk of hypercapnic respiratory failure. Interviews with our medical and nursing staff suggested that oxygen was sometimes being given to patients without a valid order and there was a failure to titrate oxygen to the stated oxygen saturation range. Our aim was to improve appropriate oxygen delivery to 90% of our patients on a 30-bedded respiratory ward within 3 months. We identified several key steps to safe oxygen delivery on our ward. These include the recording of target oxygen saturation range, the prescribing of an oxygen order on drug chart and the correct bedside delivery of oxygen to the patient. To help improve compliance of these key steps, the following plan-do-study-act (PDSA) interventions were undertaken: (1) Educational announcements at board rounds. (2) A communication oxygen poster. (3) Highlighting improvement progress to teams via email. (4) Pharmacist review of inpatient drug chart. (5) Display of target oxygen saturation range at patient bedside. At baseline, only 50% of drug charts had a recorded oxygen order and 60% of drug charts had a set target oxygen saturation range. Following PDSA interventions, both measures improved to 93%. Our main outcome measure of appropriate oxygen delivery to the patient improved from a baseline of 20% to 80% on completion. Our quality improvement programme has shown simple interventions can improve oxygen prescribing and appropriate delivery of oxygen to the patient. The most effective PDSA interventions were sharing our measurements via email and displaying target oxygen saturation ranges by the patient bedside. We aim to provide future oxygen educational sessions at induction to our staff and scale our quality improvement programme to other wards including our acute medical unit.
‘Lock to Live’: development of a firearm storage decision aid to enhance lethal means counselling and prevent suicide
Authors: Betz Marian E , Knoepke Christopher E , Siry Bonnie , Clement Ashley , Azrael Deborah , Ernestus Stephanie , Matlock Daniel D
Published: October 2018

Objectives

We sought to (1) clarify decision needs among suicidal adults with home firearm access; (2) identify accurate, unbiased and acceptable approaches for content and messaging; and (3) develop a tablet-delivered decision aid for firearm storage options.

Methods

Following international standards, we used stakeholder interviews to develop a decision aid for the decision, ‘what option(s) to choose to reduce home access to firearms for an adult at risk of suicide’. Participants were adults with personal or family history of suicidal ideation or behaviours, firearm ownership or employment in a firearm range or store, involvement in suicide prevention field, or work as emergency department or other healthcare provider.

Results

Through 64 interviews, we created the ‘Lock to Live’ decision aid, which includes (1) introduction specifying the decision, (2) clarification of preferences and logistics, (3) table of storage options and (4) summary with specific next steps. The final tool had high user acceptability.

Conclusions

Should the ‘Lock to Live’ decision aid prove useful in a pilot feasibility trial and subsequent testing, it could enhance lethal means counselling and help prevent firearm suicide.
Assessment of vibration exposure and physiological responses of crew members during Infantry Combat Vehicle (ICV) operation: a pilot study
Authors: Malhari Archana A , Bhattacharyya D , Arya K , Chatterjee T , Pal M
Published: October 2018

Background

Operation of infantry combat vehicle (ICV) influences the cardiorespiratory responses as well as the risk of vibration exposure on the crew members which adversely affect their performance and health.

Aim

To assess the effect of stress factors, that is, ICV’s compartmental temperature, relative humidity (RH) and vehicular vibration on the physiological parameters (heart rate (HR), respiratory frequency (RF), estimated core body temperature (ECT)) of the crew members during the ICV operation.

Methods

A 1 hour run trial of the ICV operation was conducted with its crew members at their respective positions. Compartmental temperature and RH were monitored at an interval of every 15 min during the run trial. Physiological parameters were monitored continuously during the run trial. Whole body vibration (WBV) and hand-arm vibration (HAV) of the crew members were also measured during the run trial time.

Results

The findings showed a strong positive correlation (p<0.05) between the increasing compartmental temperature and RH with its run trial time. Significant changes were observed in the physiological parameters (p<0.05) along with the increasing run trial time. Additionally, the physiological parameters showed a strong positive correlation with compartmental temperature and RH, respectively (p<0.05). Also, a significant increase (p<0.05) in the muscle strength was recorded after their exposure to ICV operation. The study also confirmed high level of WBV exposure of the crew members during the ICV operation.

Conclusion

Increase in HR, RF and ECT along with increase in temperature and RH is a predictive indicator of physiological stress. Moreover, high levels of vibration exposure of various operations may bring deleterious effect on soldiers’ health as well as their performance. Proper ergonomic intervention can reduce exposure to vibration, physiological stress and increase comfort which may ultimately ensure an optimum performance of soldiers and successful completion of mission.
Global health diplomacy and humanitarian assistance: understanding the intentional divide between military and non-military actors
Authors: Eagan Sheena M
Published: October 2018

Often known as‘globalhealth diplomacy’, the provision of medical care to accomplish strategic objectives, advance public diplomacy goals and enhance soft power is increasingly emphasised in international affairs and military policies. Despite this emergent trend, there has been little critical analysis and examination of the ethics of military actors engaging in this type of work. This type of mission represents the most common form of military medical deployment within the International Security Assistance Force in Afghanistan and is now explicitly emphasised in many militaries’ defence doctrine. The growth of these programmes has occurred with little analysis, examination or critique. This paper examines the history of global health diplomacy as directly related to humanitarian assistance, focusing on the difference in intention to highlight ethical dilemmas related to military involvement in the humanitarian sphere. The relationship between non-military humanitarian actors and military actors will be a focal point of discussion, as this relationship has been historically complicated and continues to shift. Relevant differences between these two groups of actors, their motivations and work will be highlighted. In order to examine the morally important differences between these groups, analysis will draw on relevant international doctrine and codes that attempt to provide ethical guidance within the humanitarian sphere.
Role of Wnt/β-catenin pathway agonist SKL2001 in Caerulein-induced acute pancreatitis
Authors: Huang Hua-Li , Tang Guo-Du , Liang Zhi-Hai , Qin Meng-Bin , Wang Xian-Mo , Chang Ren-Jie , Qin He-Ping
Published: October 2018

The goal of this study was to clarify the protective role of the Wnt/β-catenin pathway agonist SKL2001 in a rat model of Caerulein-induced acute pancreatitis. AR42J cells and rats were divided into 4 groups: control, Caerulein, SKL2001 + Caerulein, and SKL2001 + control. Cell apoptosis was examined using flow cytometry. Hematoxylin–eosin staining was performed to observe pathological changes in pancreatic and small intestinal tissues. Inflammatory cytokines were detected by enzyme-linked immunosorbent assay (ELISA), while genes related to the Wnt/β-catenin pathway were quantified using quantitative real-time PCR. In vitro results showed that Caerulein promoted cell necrosis, inhibited the Wnt/β-catenin pathway, and increased the level of inflammatory cytokines. However, SKL2001 reduced cell necrosis and inflammatory cytokines and activated the Wnt/β-catenin pathway. Additionally, in vivo results demonstrated the accumulation of fluid (i.e., edema), hemorrhage, inflammation and necrosis of the pancreatic acini occurred 6 h after the final Caerulein induction, with the damage reaching a maximal level 12 h after the final Caerulein induction; meanwhile, the Wnt/β-catenin pathway was evidently inhibited with an enhanced level of inflammatory cytokines. The aforementioned damage was further aggravated 12 h later. Nevertheless, the pancreatic and small intestinal tissue damages were alleviated in Caerulein-induced rats treated with SKL2001. In conclusion, activation of the Wnt/β-catenin pathway could inhibit Caerulein-induced cell apoptosis and inflammatory cytokine release, thus improving pancreatic and intestinal damage in rats with acute pancreatitis.
Identifying key marine habitat sites for seabirds and sea ducks in the Canadian Arctic
Authors: Mallory Mark L. , Gaston Anthony J. , Provencher Jennifer F. , Wong Sarah N.P. , Anderson Christine , Elliott Kyle H. , Gilchrist H. Grant , Janssen Michael , Lazarus Thomas , Patterson Allison , Pirie-Dominix Lisa , Spencer Nora C.
Published: October 2018

The Canadian Arctic hosts millions of marine birds annually, many of which aggregate in large numbers at well-defined sites at predictable times of the year. Marine habitats in this region will be under increasing threats from anthropogenic activities, largely facilitated by climate change and long-term trends of reduced sea ice extent and thickness. In this review, we update previous efforts to delineate the most important habitats for marine birds in Arctic Canada, using the most current population estimates for Canada, as well as recent information from shipboard surveys and telemetry studies. We identify 349 160 km2of key habitat, more than doubling earlier suggestions for key habitat extent. As of 2018, 1% of these habitats fall within the boundaries of legislated protected areas. New marine conservation areas currently being finalized in the Canadian Arctic will only increase the proportion protected to 13%.
Availability and Comparison of Spare Systems with a Repairable Server
Authors: Kuo Ching-Chang , Ke Jau-Chuan
Published: October 2018

This article analyzes availability characteristics among three various spare system configurations. Each configuration includes various amount of primary and warm standby units, and an unreliable server is responsible for repairing the failed units. The server may fail or break-down when it is repairing. Additionally, it is assumed the server’s time to break-down has exponential distribution. When the primary unit fails, the standby unit replaces it immediately where the replacement is perfect. The repair time of the failed units and the recovery time of the break-down server follow a random variable. Next, a useful model is built based on the three system configurations. We develop the explicit expressions of availability measures among three spare system configurations. The cost/benefit is also compared among three configurations with given to the distribution parameters, and to the cost of the primary and warm standby units.
ENHANCEMENT OF ADHESION STRENGTH AND TRIBOLOGICAL PERFORMANCE OF CVD DIAMOND FILMS ON TUNGSTEN CARBIDE SUBSTRATES WITH HIGH COBALT CONTENT VIA AMORPHOUS SiC INTERLAYERS
Authors: HE YUANPING , CUI YU-XIAO , SUN FANG-HONG
Published: October 2018

In this study, the diamond films are deposited on tungsten carbide substrates with 10[Formula: see text]wt.% Co via hot filament chemical vapor deposition (HFCVD). Amorphous SiC (a-SiC) interlayers with various thicknesses are fabricated between the diamond films and tungsten carbide substrates via precursor pyrolysis to promote the adhesion and friction performance of diamond films. Indentation tests are performed to evaluate the adhesion of the as-fabricated diamond films, which show that the a-SiC interlayers can greatly improve the adhesive strength between diamond films and tungsten carbide substrates with 10[Formula: see text]wt.% Co. Moreover, the thickness of a-SiC interlayer is of great importance for the effectiveness on the film–substrate adhesion enhancement. The optimum thickness of a-SiC interlayer is 1[Formula: see text][Formula: see text]m. Afterwards, ball-on-disc experiments are chosen to check the tribological properties of the as-fabricated a-SiC interlayered diamond film specimen with the optimum interlayer thickness, which exhibits lower friction coefficient than the conventional diamond film with no interlayer.
The Rational Origin of Irrational Instability: Rising American Populism and its Political Ramification in Northeast Asia
Authors: KIM Sunil
Published: October 2018

This study discusses the rise of populism in the United States and its political ramification in the Northeast Asian region, surrounding the recent North Korean nuclear crisis. Rather than simply blaming the irrational behaviours of political leaders, this study argues that their different political preferences originating from their background as well as the demographic nature of their core constituency are the fundamental sources of instability in the region. Unlike the conventional understanding, this study claims that the key problem that has been driving countries in the region towards the nuclear debacle—as well as the sudden volte-face—is US political leader’s very rationality, unbounded by ideological or partisan traditions, rather than his irrational, or oft-regarded as deranged, personality.
Estimation of net apparent erosion in the SW Barents Sea by applying velocity inversion analysis
Authors: Ktenas Dimitrios , Meisingset Ivar , Henriksen Erik , Nielsen Jesper Kresten
Published: October 2018

The SW Barents Sea was subjected to significant uplift and erosion during the Cenozoic, processes that are believed to have had a significant impact on hydrocarbon maturation and migration in the area. The current study uses compaction of shale- and sand-dominated layers to make a map of net apparent erosion throughout the SW Barents Sea. The map shows regional trends consistent with deep-seated isostatic uplift of the crust in combination with glacial erosion as a driving mechanism for the erosion. We find increased erosion towards the north and decreased erosion towards the west, in the western Barents Sea. The trend of highest erosion has an axis stretching in a SE–NW orientation towards Svalbard. This indicates a major change in the crustal uplift pattern in the transition from the Norwegian mainland to the Barents Sea. The velocity inversion method used in this study combined with a two-baseline normal compaction trend model demonstrates a reliable procedure for accurate erosion estimations. It allows erosion estimates from layers with different lithologies to be integrated into a common interpretation and differences to be interpreted geologically: for example, an apparent facies change to a mixed sand–shale lithology, possibly with reservoir quality sands developed, in the Cretaceous on the Bjarmeland Platform.
Multimodel Representation of Complex Nonlinear Systems: A Multifaceted Approach for Real-Time Application
Authors: Hichem Bennasr , Faouzi M’Sahli
Published: October 2018

Presenting an important potential in the representation of nonlinear systems, the multimodel approach remains an attractive axis for research. One of the important problems in the multimodel structure concerns the validity calculation which is a fundamental point especially when the process is corrupted with noise and/or its parameters are of high variations. A new approach based on the use of both two type of validity is proposed. A developed specification of the need of each one is explained by an optimization procedure. The conduct of this approach requires, first, the classification of the numerical data into a set of clusters. The frequency-sensitive competitive learning (FSCL) algorithm is used to select the number of models and the fuzzy k-means algorithm identify the operating clusters. From the satisfactory results in terms of precision and robustness obtained on theoretical examples, we are incited to confirm our contribution to real process reactor. The results obtained are compared to the classical approaches showing its ability to represent adequately the nonlinear process with a superior precision and accuracy and from this the classic strategy of multimodel representation is oriented towards a multifaceted approach.
Accuracy of Periapical Radiography and CBCT in Endodontic Evaluation
Authors: Lo Giudice R. , Nicita F. , Puleio F. , Alibrandi A. , Cervino G. , Lizio A. S. , Pantaleo G.
Published: October 2018

Introduction. A radiological evaluation is essential in endodontics, for diagnostic purposes, planning and execution of the treatment, and evaluation of the success of therapy. The periapical radiography is nowadays the main radiographic investigations used but presents some limits as 3D anatomic alteration, geometric compression, and possible anatomical structures overlapping that can obscure the area of interest. CBCT (cone beam computed tomography) in endodontics allows a detailed assessment of the teeth and surrounding alveolar anatomy for endodontic diagnosis, treatment planning, and follow-up. Objective. The purpose of this study was to evaluate the accuracy of CBCT in comparison with conventional intraoral radiographs used in endodontic procedures. Materials and Methods. Statistical analysis was performed on 101 patients with previous endodontic treatments with the relative radiographic documentation (preoperative, postoperative, and follow-up intraoral X-ray) that had underwent at CBCT screening for surgical reasons. The CBCT scans were evaluated independently by two operators and compared with the corresponding periapical images. Results. Our analysis shows that the two radiological investigations statistically agree in 100% of cases in the group of patients without any endodontic sign. In the group of patients with an endodontic pathology, detected with CBCT, endodontic under extended treatments (30.6%), MB2 canals in nontreated maxillary molars (20.7%), second canals in nontreated mandibular incisors (9%), root fractures (2.7%), and root resorption (2.7%) were not always visible in intraoral X-ray. Otherwise, positivity in the intraoral X-ray was always confirmed in CBCT. A radiolucent area was detected in CBCT exam in 46%, while the intraoral X-ray exam was positive only in 18%. Conclusions. Our study shows that some important radiological signs acquired using CBCT are not always visible in periapical X-ray. Furthermore, CBCT is considered as a II level exam and could be used to solve diagnostic questions, essential to a proper management of the endodontic problems.
Understanding Friction and Wear Behaviours of Smooth Resilient Surfaces: Application for Pedestrian Fall Safety Improvements
Authors: Kim In-Ju
Published: October 2018

The recent literature identified that certain types of smooth floors and flooring materials showed good slip‐resistance performance under moderately contaminated situations such as water wet and soapsuds‐covered conditions. However, topographic structures of such flat floor/walkway surfaces are significantly changed by wear and tear developments with continuous ambulation. A number of reasons seem to be involved in flooring wear developments, but such changes may result in substantial losses of slip resistance (or traction) functions. Even though the importance of this issue is wide, it is scarce to find any systematic investigations on tribophysical characteristics of smooth floors (<10 µm in Ra roughness) and their wear impacts on traction performance. Moreover, it is difficult to find studies on wear progress of floors and its impacts on pedestrian fall safety assessments. This study focuses on exploring wear activities of smooth resilient floors and disclosing wear consequences on traction properties. To measure slip‐resistance features and investigate wear advances of smooth resilient floors, dynamic friction tests were carried out amongst purposely arranged 4 flat specimens (polymethyl methacrylate: PMMA) and 3 shoes. Wear formations and progressions of the PMMA surfaces were methodically evaluated by observing surface profiles during the tests. The test outcomes evidently presented that initial surface features of the PMMA specimens were significantly modified by primary‐, secondary‐, and shared‐wear mechanisms and significantly influenced traction performance. This study may have design applications for the safety enhancements of smooth floors/footpaths to preclude pedestrian fall incidents.
Trends in Extreme Climate Events over Three Agroecological Zones of Southern Ethiopia
Authors: Esayas Befikadu , Simane Belay , Teferi Ermias , Ongoma Victor , Tefera Nigussie
Published: October 2018

The study aims to assess trends in extremes of surface temperature and precipitation through the application of the World Meteorological Organization’s (WMO) Expert Team on Climate Change Detection and Indices (ETCCDI) on datasets representing three agroecological zones in Southern Ethiopia. The indices are applied to daily temperature and precipitation data. Nonparametric Sen’s slope estimator and Mann–Kendall’s trend tests are used to detect the magnitude and statistical significance of changes in extreme climate, respectively. All agroecological zones (AEZs) have experienced both positive and negative trends of change in temperature extremes. Over three decades, warmest days, warmest nights, and coldest nights have shown significantly increasing trends except in the midland AEZ where warmest days decreased by 0.017°C/year (p<0.05). Temperature extreme’s magnitude of change is higher in the highland AEZ and lower in the midland AEZ. The trend in the daily temperature range shows statistically significant decrease across AEZs (p<0.05). A decreasing trend in the cold spell duration indicator was observed in all AEZs, and the magnitude of change is 0.667 days/year in lowland (p<0.001), 2.259 days/year in midland, and 1 day/year in highland (p<0.05). On the contrary, the number of very wet days revealed a positive trend both in the midland and highland AEZs (p<0.05). Overall, it is observed that warm extremes are increasing while cold extremes are decreasing, suggesting considerable changes in the AEZs.
Study on Composing Dense Formations in a Dynamic Environment of Multirotor UAVs by Distributed Control
Authors: Zhou Shudao , Shen Ao , Wang Min , Peng Shuling , Liu Zhanhua
Published: October 2018

In order to make multirotor unmanned aerial vehicles (UAV) compose a desired dense formation and improve the practicality of UAV formation, a distributed algorithm based on fuzzy logic was proposed. The airflow created by multirotor UAVs was analyzed according to the structure of the multirotor UAV and the characteristic equation of the fluid. This paper presented a dynamic model for the process of formation of and path search algorithm based on this model. The membership function in this model combines the factors of position, flow field, and movement. Integrating the dynamic model and its desired position in formations, each UAV evaluates the surrounding points and then selects the direction for step motion. Through simulation, this algorithm was improved by a by-step formation approach, and the effectiveness of this method in dense formation of multirotor UAVs was proved.
Frequency of Trypanosoma cruzi Infection in Synanthropic and Wild Rodents Captured in a Rural Community in Southeast of Mexico
Authors: Hernández-Cortazar Ivonne , Cecilia Amaya Guardia Karla , Torres-Castro Marco , Acosta-Viana Karla , Guzmán-Marín Eugenia , Israel Chan-Pérez José , Ortega-Pacheco Antonio , Rodríguez-Vivas Roger I. , Medina-Pinto Rodrigo , Jiménez-Coello Matilde
Published: October 2018

The protozoan parasite Trypanosoma cruzi is the causative agent of the Chagas disease, which is endemic in southeastern Mexico and is transmitted by the vector Triatoma dimidiata (triatomide). T. cruzi infect a great variety of domestic and wild mammals; rodents are considered one of the most important reservoirs of the parasite in the transmission cycles of T. cruzi. The objective of this study was to determine the frequency of T. cruzi infection and to determine the parasitic load in synanthropic and wild rodents from the rural community of southern Mexico. A total of 41 blood samples and 68 heart tissue samples were collected from various species of synanthropic (n= 48 in 2 species) and wild rodents (n= 35 in 5 species). DNA was extracted from samples to detect the presence of T. cruzi through quantitative PCR (qPCR). T. cruzi DNA was detected in the 9.75% of the blood samples of the synanthropic species (4/41) (14.28%) for Rattus rattus samples and 25% for Ototylomys phyllotis samples, with an average of parasitic load of 4.80 ± 1.17 parasites/μL. In the case of heart tissue samples, 10.29% were positive for T. cruzi (7/68) (8.7% for Rattus rattus, 40% for Peromyscus yucatanicus, and 42.8% for Ototylomys phyllotis) with an average parasite load of 3.15 ± 1.98 eq-parasites/mg. The active and chronic infection of T. cruzi in synanthropic or wild rodents of the rural community of southern Mexico evidences the natural infection in these reservoirs which contribute to maintaining the agent in the wild and domestic environments and can represent a risk of infection for the human population when the vector is present.