bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal and water vapor transport properties of selected lofty nonwoven products
Authors: Naylor Geoffrey RS , Wilson Cheryl A , Laing Raechel M
Published: July 2016

The mechanism of dry heat flow through lofty nonwoven structures (i.e. thermal resistance) as occurs in quilts has been established. By contrast, there is a scarcity of published information on the water vapor transport properties. This work explores the thermal and water vapor transport properties of a number of different quilt samples with a focus on identifying fiber type effects. Both commercial product and matched laboratory samples were examined. Steady-state thermal resistance and water vapor resistance measurements confirmed that both properties are primarily determined by sample thickness and are largely independent of fiber type. Experiments were also undertaken to observe transient effects. Test samples were initially equilibrated on a ‘dry’ guarded hotplate (35 ± 0.1℃) in a low relative humidity environment (45%). The relative humidity was then rapidly increased to 85%. Compared to polyester, wool samples exhibited a large reduction in the heat flux required to maintain the hotplate temperature. This transient peak lasted for in excess of 1000 seconds. The magnitude of this transient peak in heat flux was proportional to the quantity of wool in the sample and is believed to be associated with the known exothermic nature of water vapor absorption by wool as relative humidity increases. Based on the published values of the heat of water absorption of wool it is estimated that this additional transient heat source is significant relative to a typical human resting metabolic rate and so the effect may be of practical relevance in the bedding environment.
Critical rotating speed of rotor cup in an air suction open-end spinning machine
Authors: Xiao Meina , Dou Hua-Shu , Wu Chuanyu
Published: July 2016

Simulation of three-dimensional turbulent flow in a rotor spinning machine is carried out, and the flow structure and behavior in the rotor cup are analyzed. The governing equations are the steady three-dimensional Navier–Stokes equations and the Spalart–Allmaras turbulence model. The results show that the rotating speed has great influence on the flow behavior in the rotor cup. It is found that there is a critical speed of the rotor cup beyond which the pressure and velocity on the slip surface is not changed anymore regardless of the magnitude of the rotating speed. When the rotating speed is larger than this critical speed, the flow structure becomes unstable with the increasing of the rotating speed. The mechanism of this phenomenon is that the airflow in the rotor groove passes about 180 degrees from two sides along the rotor wall and a pressure balance is achieved. When the rotating speed is larger than the critical speed, the balance will break down. When the rotor speed is low, the flow characteristic in the air-inlet plane is mainly determined by the high-speed airflow at the outlet of the transfer channel. However, when the rotor speed is higher than the critical speed of n = 80,000 r/min, the flow behavior is mainly determined by the rotating rotor. In the meridian plane perpendicular to the air-inlet plane, the flow behavior is mainly determined by the rotor speed. The rotating speed of the rotor has little effect on the flow characteristics in the transfer channel.
Through-thickness permeability of woven fabric under increasing air pressure: Theoretical framework and simulation
Authors: Xiao Xueliang , Long Andrew , Qian Kun , Zeng Xuesen , Hua Tao
Published: July 2016

Many technical applications of woven fabric are subject to increasing high pressure from air transport through the fabric. The through-thickness permeability (TP) of woven materials exhibits a dynamic response to increased air pressure. This paper presents an analytical model for predicting the steady TP of woven fabric. The approach was based on Darcy’s law and the Poiseuille equation, using the flow boundary of an idealized plain-weave unit cell. The unit cell model consists of a gradual converging-diverging (GCD) duct with a rectangular cross-section. Further, the dynamic TP of the GCD duct was established analytically as a function of increasing pressure, which correlates to the separation of air flow from the GCD duct wall. Air flow separation from the duct wall led to a quadratic relationship between the increasing pressure and air flow velocities. This dynamic TP and air flow nonlinearity were simulated numerically in the computational fluid dynamics solver CFX. Five GCD ducts under increasing air pressure were analyzed numerically and analytically. The comparison showed good agreement between the proposed analytical model and the CFD simulation, with a maximum error up to 12%. A sensitivity study showed that an increase in porosity or a decrease in the thickness of weave materials could result in a larger dynamic TP value.
Nonlinear vibration mechanism for fabrication of crimped nanofibers with bubble electrospinning and stuffer box crimping method
Authors: Wang Ping , Liu Peng , Kong Hai-Yan , Zhang Yan , He Ji-Huan
Published: July 2016

This paper aims to produce nanoscale crimped fibers using stuffer box crimping and bubble electrospinning. Nanofibers are originally obtained via a ruptured bubble and then crimped with the stuffer box crimping method. During this spinning process, the governing equations for nonlinear transverse vibration of an axially moving viscoelastic beam with finite deformation are established using the Hamiltonian principle. The crimp frequency is affected by many factors, including spinning conditions and mechanical properties of fibers. The obtained governing equations can be further used for numerical or analytical study of the crimping mechanism.
The moderating effect of trust in management on consequences of job insecurity
Authors: Jiang Lixin , Probst Tahira M
Published: July 2016

Using data from 1071 staff and administrative professionals at a large university experiencing repeated rounds of budget cuts, this article examines the attenuating effect of trust in management on the negative consequences of job insecurity. Results show that job insecurity was associated with increased burnout and psychological distress as well as decreased work and supervisor satisfaction and affective commitment. However, trust in management was negatively related to burnout and psychological distress but positively related to work and supervisor satisfaction and affective commitment. More importantly, trust in management was found to consistently buffer the relationships between job insecurity and these job-related outcomes. Implications for successfully managing job insecurity during times of organizational or economic upheaval are discussed.
Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study
Authors: Tavares Alze Pereira dos Santos , Paparelli Carolina , Kishimoto Carolina Sassaki , Cortizo Silvia Avo , Ebina Karen , Braz Mariana Sarkis , Mazutti Sandra Regina Gonçalves , Arruda Marcio José Cristiano , Antunes Bárbara
Published: July 2016

Background:

Gathering clinical evidence data on patients’ palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread.

Aim:

To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients.

Design:

An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly.

Setting/participants:

Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study.

Results:

Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: ‘pain’ and ‘other symptoms’ presented statistical significant differences ( p < 0.05).

Conclusion:

Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.
Communication and support from health-care professionals to families, with dependent children, following the diagnosis of parental life-limiting illness: A systematic review
Authors: Fearnley Rachel , Boland Jason W.
Published: July 2016

Background:

Communication between parents and their children about parental life-limiting illness is stressful. Parents want support from health-care professionals; however, the extent of this support is not known. Awareness of family’s needs would help ensure appropriate support.

Aim:

To find the current literature exploring (1) how parents with a life-limiting illness, who have dependent children, perceive health-care professionals’ communication with them about the illness, diagnosis and treatments, including how social, practical and emotional support is offered to them and (2) how this contributes to the parents’ feelings of supporting their children.

Design:

A systematic literature review and narrative synthesis.

Data sources:

Embase, MEDLINE, PsycINFO, CINAHL and ASSIA ProQuest were searched in November 2015 for studies assessing communication between health-care professionals and parents about how to talk with their children about the parent’s illness.

Results:

There were 1342 records identified, five qualitative studies met the inclusion criteria (55 ill parents, 11 spouses/carers, 26 children and 16 health-care professionals). Parents wanted information from health-care professionals about how to talk to their children about the illness; this was not routinely offered. Children also want to talk with a health-care professional about their parents’ illness. Health-care professionals are concerned that conversations with parents and their children will be too difficult and time-consuming.

Conclusion:

Parents with a life-limiting illness want support from their health-care professionals about how to communicate with their children about the illness. Their children look to health-care professionals for information about their parent’s illness. Health-care professionals, have an important role but appear reluctant to address these concerns because of fears of insufficient time and expertise.
Managing Your Loved One’s Health: Development of a New Care Management Measure for Dementia Family Caregivers
Authors: Sadak Tatiana , Wright Jacob , Borson Soo
Published: July 2016

The National Alzheimer’s Plan calls for improving health care for people living with dementia and supporting their caregivers as capable health care partners. Clinically useful measurement tools are needed to monitor caregivers’ knowledge and skills for managing patients’ often complex health care needs as well as their own self-care. We created and validated a comprehensive, caregiver-centered measure, Managing Your Loved One’s Health (MYLOH), based on a core set of health care management domains endorsed by both providers and caregivers. In this article, we describe its development and preliminary cultural tailoring. MYLOH is a questionnaire containing 29 items, grouped into six domains, which requires <20 min to complete. MYLOH can be used to guide conversations between clinicians and caregivers around health care management of people with dementia, as the basis for targeted health care coaching, and as an outcome measure in comprehensive dementia care management interventions.
Assessing Motivation of Secondary School Students: An Analysis of Promotion and Prevention Orientations as Measured by the Regulatory Focus Questionnaire
Authors: Hodis Flaviu A. , Hodis Georgeta M.
Published: July 2016

Measuring human motivation requires understanding the outcomes individuals value and the strategies they prefer to employ to attain them. Knowledge of promotion and prevention, two pivotal motivation orientations, provide key information regarding these aspects. The Regulatory Focus Questionnaire, which measures these two independent constructs, was validated using data provided by university students and alumni of an elite U.S. university. Thus, little is known whether this instrument provides reliable and valid measures of promotion and prevention in a population of younger respondents from a different culture. To bridge this gap, the study employed data collected from three independent large samples of New Zealand secondary school students and used the jigsaw piecewise technique in combination with confirmatory factor analyses. Findings show that, in this population, items in the Regulatory Focus Questionnaire measure promotion and prevention as theoretically distinct constructs.
A parametric modeling method for the pose-dependent dynamics of bi-rotary milling head
Authors: Du Chao , Zhang Jun , Lu Dun , Zhang Huijie , Zhao Wanhua
Published: July 2016

Bi-rotary milling head is one of the core components of five-axis machining center, and its dynamic characteristics directly affect the machining stability and accuracy. During the sculptured surface machining, the bi-rotary milling head exhibits varying dynamics in various machining postures. To facilitate rapid evaluation of the dynamic behavior of the bi-rotary milling head within the whole workspace, this article presents a method for parametrically establishing dynamic equation at different postures. The rotating and swing shafts are treated as rigid bodies. The varying stiffness of the flexible joints (such as bearings and hirth coupling) affected by gravity and cutting force at different swing angles is analyzed and then a multi-rigid-body dynamic model of the bi-rotary milling head considering the pose-varying joint stiffness is established. The Lagrangian method is employed to deduce the parametric dynamic equation with posture parameters. The static stiffness, natural frequencies and frequency response functions at different postures are simulated using the parametric equation and verified by the impact testing experiments. The theoretical and experimental results show that the dynamics of the bi-rotary milling head vary with the machining postures, and the proposed method can be used for efficient and accurate evaluation of the pose-dependent dynamics at the design stage.
Encounters between cluster theory, policy and practice in Norway: Hubbing, blending and conceptual stretching
Authors: Njøs Rune , Jakobsen Stig-Erik , Wiig Aslesen Heidi , Fløysand Arnt
Published: July 2016

For more than two decades, cluster theory has served as a basis for widespread implementation of regional development policies in several countries. However, there are still persistent struggles in academia towards agreement on clear operational definitions of a cluster. In this article, we argue that this definitional haziness, reflected by difficulties in demarcating the scale and scope of clusters, leads to a stretching of the cluster concept when put into practice. We show how actors, through cluster projects, are utilizing strategies of “hubbing” and/or “blending” to develop their own understandings of both what clusters are and what they might or should be. Through studies of three Norwegian cluster projects, we argue that national cluster policies, through translation of an academically vague concept, facilitate a stretching of the original definition of clusters, giving regional stakeholders leeway to integrate other theoretical rationales instead. We argue that this is not taken into account in current policies.
Comparing econometric and survey-based methodologies in measuring offshoring: The Danish experience
Authors: Refslund Bjarke
Published: July 2016

Offshoring, understood as the geographical relocation of companies’ activities to another country, is a key feature of contemporary globalization and has growing social, political and economic implications. However, the phenomenon remains poorly examined at aggregated macro levels such as the national or regional level. Most macro analyses are based on proxies and trade statistics with limitations. Drawing on unique Danish survey data, this article demonstrates how survey data can provide important insights into the national scale and impacts of offshoring, including changes of employment, which are difficult to measure with other methods.
Trauma informed care: a radical shift or basic good practice?
Authors: Isobel Sophie
Published: July 2016

Objective:

There is significant multidisciplinary work contributing to the implementation of trauma informed care (TIC) into mental health policy and practice in Australia. Within psychiatry, there may be potential confusion about how to navigate the integration of TIC into a speciality built upon treating psychological distress; creating dismissive reactions of a patronising approach and paradoxical radicalism. This paper aims to discuss the need for psychiatry to view TIC as a significant and urgent paradigm shift required to integrate existing knowledge about the prevalence and effects of trauma into a progressive articulation of the relational and interpersonal underpinnings of modern psychiatric practice; and to lead and support its widespread implementation.

Conclusion:

Active consideration of the intent of TIC may aid in reducing misunderstanding and misaligned resistance while allowing services and individuals an important opportunity to reflect on how to deliver mental health treatment that is universally sensitive to the dynamics of trauma in the care environment.
Patient/Family Education for Newly Diagnosed Pediatric Oncology Patients: Consensus Recommendations from a Children’s Oncology Group Expert Panel
Authors: Landier Wendy , Ahern JoAnn , Barakat Lamia P. , Bhatia Smita , Bingen Kristin M. , Bondurant Patricia G. , Cohn Susan L. , Dobrozsi Sarah K. , Haugen Maureen , Herring Ruth Anne , Hooke Mary C. , Martin Melissa , Murphy Kathryn , Newman Amy R. , Rodgers Cheryl C. , Ruccione Kathleen S. , Sullivan Jeneane , Weiss Marianne , Withycombe Janice , Yasui Lise , Hockenberry Marilyn
Published: July 2016

There is a paucity of data to support evidence-based practices in the provision of patient/family education in the context of a new childhood cancer diagnosis. Since the majority of children with cancer are treated on pediatric oncology clinical trials, lack of effective patient/family education has the potential to negatively affect both patient and clinical trial outcomes. The Children’s Oncology Group Nursing Discipline convened an interprofessional expert panel from within and beyond pediatric oncology to review available and emerging evidence and develop expert consensus recommendations regarding harmonization of patient/family education practices for newly diagnosed pediatric oncology patients across institutions. Five broad principles, with associated recommendations, were identified by the panel, including recognition that (1) in pediatric oncology, patient/family education is family-centered; (2) a diagnosis of childhood cancer is overwhelming and the family needs time to process the diagnosis and develop a plan for managing ongoing life demands before they can successfully learn to care for the child; (3) patient/family education should be an interprofessional endeavor with 3 key areas of focus: (a) diagnosis/treatment, (b) psychosocial coping, and (c) care of the child; (4) patient/family education should occur across the continuum of care; and (5) a supportive environment is necessary to optimize learning. Dissemination and implementation of these recommendations will set the stage for future studies that aim to develop evidence to inform best practices, and ultimately to establish the standard of care for effective patient/family education in pediatric oncology.
The Recursive Nature of Institutional Change
Authors: Clemente Marco , Durand Rodolphe , Roulet Thomas
Published: July 2016

In this essay, we propose a recursive model of institutional change building on the Annales School, one of the 20th century’s most influential streams of historical research. Our model builds upon three concepts from the Annales—mentalities, levels of time, and critical events—to explore how critical events affect different dimensions of institutional logics and exert short- or long-range influences. On these bases, organizations make choices, from decoupling to radical shifts in logics, leading to severe institutional changes that become the matter of history. As much as organizations are influenced by events and the prevalent institutional logics, their choices trigger macro-level changes in a recursive manner. More broadly, we comment on how fruitful is our approach to historicize organization studies.
Systemic effects of low-dose dopamine during administration of cytarabine
Authors: Connelly James , Benani Dina J , Newman Matthew , Burton Bradley , Crow Jessica , Levis Mark
Published: July 2016

Purpose

Low-dose dopamine has been utilized to improve renal blood flow, urine output, and reduce drug-induced nephrotoxicity. The purpose of this study was to assess changes in renal function, cardiovascular adverse events, and neurologic toxicity in patients receiving cytarabine with or without low-dose dopamine.

Methods

A retrospective, single-center, cohort study of patients receiving cytarabine at 667 mg/m2/dose or greater, with or without dopamine at ≤5 mcg/kg/min. Cohorts were based upon initiation or absence of low-dose dopamine; cytarabine only, cytarabine + pre- and day of low-dose dopamine, and cytarabine + post-low-dose dopamine. Renal outcomes (urine output, serum creatinine, and creatinine clearance) were compared with baseline and between cohorts. Safety endpoints (arrhythmias, tachycardia, and neurotoxicity) were compared between cohorts based on low-dose dopamine exposure.

Results

There was no difference in urine output from baseline in all cohorts. Comparing cytarabine only and pre- and day of low-dose dopamine cohorts, there was no difference in urine output. In those receiving low-dose dopamine, there was no difference in serum creatinine and creatinine clearance from baseline. No arrhythmias were documented during the study period, and there was no difference in the incidence of tachycardia between groups (P = 0.66). Neurotoxicity was reported in three patients who were on low-dose dopamine.

Conclusion

Though variation existed in individual patients administered low-dose dopamine, the use of low-dose dopamine did not significantly impact renal function in this small sample at a single institution. In addition, low-dose dopamine did not negatively impact cardiovascular function.
Teenage intimate partner violence: Factors associated with victimization among Norwegian youths
Authors: Hellevik Per , Øverlien Carolina
Published: July 2016

Objective: The aim of the present study was threefold: (1) learn more about factors associated with teenage intimate partner violence (IPV) victimization; (2) explore aspects of digital media use in connection with teenage IPV; (3) and compare the impact IPV victimization has on boys and girls. Method: Survey data from 549 Norwegian students, mean age 15.2 years, who had experience(s) with being in intimate relationship(s), were examined. Experiences with psychological, physical, digital, and sexual violence were analyzed. Results: In total, 42.9% of the participants had experienced some form of IPV: 29.1% had experienced digital violence; 25.9% had experienced psychological violence; 18.8% had experienced sexual violence; and 12.8% had experienced physical violence. Factors significantly associated with teenage IPV victimization were female gender, older partners, domestic violence, bullying victimization, low academic achievements, and sending sexual messages via digital media. Girls reported to be significantly more negatively impacted by the victimization than boys. Conclusions: Some teenagers experience victimization in their intimate relationships, and for many digital media seems to play a central role in this violence. Teenagers who experience victimization outside their relationships or have risky lifestyles have a higher risk of experiencing IPV victimization. A focus on teenage IPV, and especially digital media’s role in this violence, is needed if this public health issue is to be combated.
Nonlinear creep response of oriented polypropylene tapes
Authors: Barkoula Nektaria M , Alcock Ben , van Erp Tim B , Govaert Leon E , Peijs Ton
Published: July 2016

The creep response of a highly oriented polypropylene tape used for the manufacture of self-reinforced polypropylene or all-polypropylene composites was studied over a range of stresses and temperatures. Similar to oriented polyethylene, the creep compliance is linear viscoelastic at short loading times, whereas pronounced stress dependence is observed at longer loading times. A mathematical model is proposed, where the total deformation of the fibre is regarded as being composed of a stress-linear delayed elastic component and a nonlinear plastic flow contribution. Model predictions are in good agreement with the experimental data.
Place and the uncanny in child protection social work: Exploring findings from an ethnographic study
Authors: Jeyasingham Dharman
Published: July 2016

This article presents findings from an ethnographic study of child protection social workers in Britain, which explored social workers’ experiences of and practices in space and place. It draws on data from interviews with practitioners and observations that were carried out as social workers moved around the places (the town, estates, streets and areas around service users’ homes) where they worked. It focuses on the significance of a particular affective experience, the uncanny, which social workers evoked in many of their accounts of these places. The article introduces recent conceptualisations of space, affect and the uncanny before going on to consider data from the interviews. The following themes are explored: the relationships between the intimate spaces of service users’ homes and the neighbourhoods in which they were located; social workers’ accounts of feeling vulnerable in public and open spaces; social workers’ experiences of feeling unsettled by apparently mundane features of neighbourhood spaces. The article draws on critical engagements with the uncanny to consider its significance for child protection social work practice in Britain and its consequences in terms of social workers’ potential to work in emplaced and locally sensitive ways.
Urban distress and political narrative: Life stories of local leaders in a poor, underprivileged suburb and the reconstruction of urban order
Authors: Dahan Yitzhak
Published: July 2016

This study discusses the relations between life stories, political narratives and attitudes towards social problems taken by local leaders living in a poor, underprivileged suburb. Using the ‘biographical-narrative’ method, it addresses the questions—How do local conditions (in terms of: housing, social class, municipal policy, social networks, NGO settings, local conflicts, organizational narratives, etc.) affect local leaders’ narratives, biographies, attitudes and strategies and, vice versa—How do their narratives affect the urban order? In order to attain these answers, this paper presents two contradicting narratives, taken from two different local activists, both acting on behalf of the weak Arab population in an Israeli suburb at the turn of 21st century. The findings show that these divergent narratives and resultant attitudes were both deeply rooted in each narrator’s life story and close social milieu. Furthermore, such life stories, charged by certain biographical resources, generated and maintained particular strategies that, in turn, affected the reconstruction of their immediate urban socio-political order. Applying the ‘biographical-narrative’ method to the urban political realm has created a unique configuration of social analysis with some policy implications, especially in regard to community social work.
Illness perceptions of leprosy-cured individuals in Surinam with residual disfigurements – “I am cured, but still I am ill”
Authors: van Haaren Mark AC , Reyme Melinda , Lawrence Maggie , Menke Jack , Kaptein Ad A
Published: July 2016

Objective

Leprosy has rarely been the subject of health psychology research despite its substantial impact. Our aim was to explore illness perceptions in patients and their health care providers in Surinam. The Common Sense Model (CSM) was the guiding theoretical model.

Design

Patients with biomedically cured leprosy and their health care providers completed the B-IPQ and took part in semi-structured interviews. The literature on illness perceptions in patients with leprosy was reviewed.

Main outcome measures

Patients’ B-IPQ scores were compared with samples of patients with other (chronic) illnesses, and with health care providers completing the questionnaire as if they were visibly disfigured patients. Quotations from the semi-structured interviews were used to contextualise the illness perceptions.

Results

Patients’ B-IPQ scores reflected the chronic nature of leprosy and were comparable with those with other chronic illnesses. Health care providers perceived leprosy to have a greater negative impact than did the patients. Perceived understanding of causes differed considerably between patients and health care providers.

Conclusion

Leprosy continues to be experienced as an illness with major psychological and social consequences such as stigmatisation, even after biomedical cure. Interventions that target patients, health care providers, and society at large may help reduce perceived shame and stigma. The CSM is a helpful theoretical model in studying this population.
The risk to the cutaneous nerve branches in the anterior (Wagner) and snuff-box approaches to the trapezium: a cadaveric study
Authors: Mohamed K. , Yong L. Y. , Davidson D. M.
Published: July 2016

We compared the risk with the subcutaneous nerves with the anterior (Wagner) and snuff-box approaches to the trapezium in cadavers. Branches that crossed tattooed incision markings or lay within 1 cm of the markings were identified on six matched pairs of fresh-frozen cadaveric hands. Their distance from the proximal end of the incision was recorded. For anterior incisions, there were 20 vulnerable branches in total, at a mean distance of 22 mm from the proximal end of the incision. A total of 13 lay in the distal half of the incision. For snuff-box incisions, there were 18 vulnerable branches in total, at a mean distance of 11 mm from the proximal end of the incision, with 17 of them lying in the proximal half of the incision. Neither incision is without risk to nerve braches, but our study suggests a lesser risk of subcutaneous nerve damage with the snuff-box approach and highlights the greater risk in the proximal half of this incision.
Fluctuating locked-in syndrome as a presentation of a bilateral pontine infarction
Authors: García-Esperón Carlos , López-Cancio Elena , Martín-Aguilar Lorena , Millán Mónica , Castaño Carlos , Munuera Josep , Dávalos Antoni
Published: July 2016

The “pontine warning syndrome” is characterized by recurrent episodes of motor hemiparesis, dysarthria and horizontal gaze palsy associated with basilar artery branch infarction. We report a case of a patient who presented with recurrent, self-limited episodes of locked-in syndrome, related to a bilateral pontine infarction. As far as we know, this clinical presentation as a subtype of pontine warning syndrome has never been described. We discuss the case, the differential diagnosis of the neuroimaging and the possible underlying mechanism.
Vitamin D Deficiency Among Professional Basketball Players
Authors: Fishman Matthew P. , Lombardo Stephen J. , Kharrazi F. Daniel
Published: July 2016

Background:

Vitamin D plays an important role in several systems of the human body. Various studies have linked vitamin D deficiency to stress and insufficiency fractures, muscle recovery and function, and athletic performance. The prevalence of vitamin D deficiency in the elite athletic population has not been extensively studied, and very few reports exist among professional athletes.

Hypothesis:

There is a high prevalence of vitamin D deficiency or insufficiency among players attending the National Basketball Association (NBA) Combine.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

This is a retrospective review of data previously collected as part of the routine medical evaluation of players in the NBA Combines from 2009 through 2013. Player parameters evaluated were height, weight, body mass index (BMI), and vitamin D level. Statistical analysis using t tests and analysis of variance was used to detect any correlation between the player parameters and vitamin D level. Vitamin D levels were categorized as deficient (<20 ng/mL), insufficient (20-32 ng/mL), and sufficient (>32 ng/mL).

Results:

After institutional review board approval was submitted to the NBA, the NBA released deidentified data on 279 players who participated in the combines from 2009 through 2013. There were 90 players (32.3%) who were deficient, 131 players (47.0%) who were insufficient, and 58 players (20.8%) who were sufficient. A total of 221 players (79.3%) were either vitamin D deficient or insufficient. Among all players included, the average vitamin D level was 25.6 ± 10.2 ng/mL. Among the players who were deficient, insufficient, and sufficient, the average vitamin D levels were 16.1 ± 2.1 ng/mL, 25.0 ± 3.4 ng/mL, and 41.6 ± 8.6 ng/mL, respectively. Player height and weight were significantly increased in vitamin D–sufficient players compared with players who were not sufficient ( P = .0008 and .009, respectively). Player age and BMI did not significantly differ depending on vitamin D status ( P = .15 and .77, respectively).

Conclusion:

There is a high prevalence of vitamin D deficiency or insufficiency among participants in the NBA Combines. As a result, there should be a high suspicion for this metabolic abnormality among elite basketball players.

Clinical Relevance:

Vitamin D level has been linked to bone health, muscle recovery and function, and athletic performance. Because of the high prevalence of vitamin D deficiency in the NBA Combines, clinicians should maintain a high suspicion for vitamin D abnormalities among elite basketball players.
Combined Biomarker and Computed Tomography Screening Strategies for Lung Cancer
Authors: Kong Chung Yin , Sheehan Deirdre F. , McMahon Pamela M. , Gazelle G. Scott , Pandharipande Pari
Published: July 2016

Background: Lung cancer screening with computed tomography (CT) of individuals who meet certain age and smoking history criteria is the current standard-of-care. Methods: Using a published simulation model, we compared outcomes associated with seven biomarker + CT screening strategies to CT screening alone using Centers for Medicare & Medicaid Services eligibility criteria. We assumed that the biomarker had conditionally independent performance; was used for first-line screening in some, or all, individuals screened; and could be extended to Centers for Medicare & Medicaid Services–ineligible smokers. Strategies differed by inclusion criteria (e.g., pack-years) and proportion of individuals for whom CT remained the first-line test. Each model run simulated a combined cohort of one million men and one million women born in 1950. Primary outcomes were cancer-specific mortality reduction and screening costs; biomarker costs were measured relative to CT. Efficiency frontiers identified optimal health and economic tradeoffs. Sensitivity analysis evaluated the stability of results. Results: Standard-of-care screening yielded an 8.3% cancer-specific mortality reduction in the simulated US population (screened + unscreened individuals). For a biomarker test with 75% sensitivity and 95% specificity, mortality reductions across biomarker + CT strategies ranged from 7.0% to 23.9%. If the biomarker’s cost was >0.86× that of CT, standard-of-care screening remained on the efficiency frontier, indicating that health and economic tradeoffs were equally (or more) efficient relative to all biomarker + CT strategies. Biomarker + CT strategy costs were principally driven by biomarker specificity; mortality reduction was driven by sensitivity. Conclusion: Combined biomarker + CT strategies have the potential to improve future lung cancer screening effectiveness in the United States and achieve economic efficiency that is greater than the current standard-of-care.
Blood Pressure Control in Hypertensive Patients in Federally Qualified Health Centers
Authors: Olomu Adesuwa , Khan Nazia Naz S. , Todem David , Huang Qinhua , Bottu Shireesha , Qadri Syeda , Holmes-Rovner Margaret
Published: July 2016

Background: Hypertension (HTN) in people with diabetes doubles the risk of cardiovascular disease. Prior patient activation studies largely show improved communication but little impact on behavior or health outcomes. We sought to 1) assess the impact of Office-Based Guidelines Applied to Practice (Office-GAP) Program on blood pressure (BP) control; 2) determine the rate and predictors of BP control in patients with HTN and/or diabetes mellitus (DM) in federally qualified health centers. Methods: Sample: Patients with coronary heart disease (CHD) and/or DM with history of HTN; analyzed patients with DM and HTN compared to HTN without DM. Intervention: Office-GAP included physician training, patient activation, and an Office-GAP decision checklist. Two-site intervention/control design; data collection at baseline and after 3, 6, and 12 months. Logistic regression with propensity scoring assessed impact on BP control over time. Results: Of 243 patients, HTN was present in 75% at baseline; 32% had BP controlled. Consistent trend showed Office-GAP slightly improved the rate of BP control across time, while the control arm showed a nonsignificant decrease in the rate of BP control across time, compared to baseline. BP improved at 6 months at the intervention site compared to control site (odds ratio = 2.92; 95% confidence interval = 1.11–7.69). Conclusion: BP control was better at the intervention site compared to the control site at 6 months. Office-GAP shows promise to implement guidelines-based patient-centered care that improves BP.
Developing and Evaluating a Clinic-Based Decision Aid Delivery System
Authors: Lewis Carmen L. , Dalton Alexandra F. , Drake Lauren , Brenner Alison T. , Colford Cristin M. , DeLeon Chris , McDonald Shaun , Morris Carolyn B. , Waters Matthew , Werner Lisa , Chung Arlene
Published: July 2016

Background: Despite evidence of their benefits, decision aids (DAs) have not been widely adopted in clinical practice. Quality improvement methods could help embed DA delivery into primary care workflows and facilitate DA delivery and uptake, defined as reading or watching DA materials. Objectives: 1) Work with clinic staff and providers to develop and test multiple processes for DA delivery; 2) implement a systems approach to measuring delivery and uptake; 3) compare uptake and patient satisfaction across delivery models. Methods: We employed a microsystems approach to implement three DA delivery models into primary care processes and workflows: within existing disease management programs, by physician request, and by mail. We developed a database and tracking tools linked to our electronic health record and designed clinic-based processes to measure uptake and satisfaction. Results: A total of 1144 DAs were delivered. Depending on delivery method, 51% to 73% of patients returned to the clinic within 6 months. Nurses asked 67% to 75% of this group follow-up questions, and 65% to 79% recalled receiving the DA. Among them, uptake was 23% to 27%. Satisfaction among patients who recalled receiving the DA was high. Eighty-two to 93% of patients reported that they liked receiving this patient education information, and 82% to 91% reported that receiving patient education information like this is useful to them. Conclusion: Our results demonstrate the realities of clinical practice. One fourth to one third of patients did not return for a follow-up visit. Although nurses were able to assess uptake in the course of their usual duties, the results did not achieve the standards typically expected of clinical research. Despite these limitations, uptake, though modest, was similar across delivery methods, suggesting that there are multiple strategies for implementing DAs in clinical practice.
Lymphovenous hemostasis and the role of platelets in regulating lymphatic flow and lymphatic vessel maturation
Authors: Welsh John D. , Kahn Mark L. , Sweet Daniel T.
Published: July 2016

Aside from the established role for platelets in regulating hemostasis and thrombosis, recent research has revealed a discrete role for platelets in the separation of the blood and lymphatic vascular systems. Platelets are activated by interaction with lymphatic endothelial cells at the lymphovenous junction, the site in the body where the lymphatic system drains into the blood vascular system, resulting in a platelet plug that, with the lymphovenous valve, prevents blood from entering the lymphatic circulation. This process, known as “lymphovenous hemostasis,” is mediated by activation of platelet CLEC-2 receptors by the transmembrane ligand podoplanin expressed by lymphatic endothelial cells. Lymphovenous hemostasis is required for normal lymph flow, and mice deficient in lymphovenous hemostasis exhibit lymphedema and sometimes chylothorax phenotypes indicative of lymphatic insufficiency. Unexpectedly, the loss of lymph flow in these mice causes defects in maturation of collecting lymphatic vessels and lymphatic valve formation, uncovering an important role for fluid flow in driving endothelial cell signaling during development of collecting lymphatics. This article summarizes the current understanding of lymphovenous hemostasis and its effect on lymphatic vessel maturation and synthesizes the outstanding questions in the field, with relationship to human disease.
LEON-BIS: multiple alignment evaluation of sequence neighbours using a Bayesian inference system
Authors: Vanhoutreve Renaud , Kress Arnaud , Legrand Baptiste , Gass Hélène , Poch Olivier , Thompson Julie D.
Published: July 2016

Background

A standard procedure in many areas of bioinformatics is to use a multiple sequence alignment (MSA) as the basis for various types of homology-based inference. Applications include 3D structure modelling, protein functional annotation, prediction of molecular interactions, etc. These applications, however sophisticated, are generally highly sensitive to the alignment used, and neglecting non-homologous or uncertain regions in the alignment can lead to significant bias in the subsequent inferences.

Results

Here, we present a new method, LEON-BIS, which uses a robust Bayesian framework to estimate the homologous relations between sequences in a protein multiple alignment. Sequences are clustered into sub-families and relations are predicted at different levels, including ‘core blocks’, ‘regions’ and full-length proteins. The accuracy and reliability of the predictions are demonstrated in large-scale comparisons using well annotated alignment databases, where the homologous sequence segments are detected with very high sensitivity and specificity.

Conclusions

LEON-BIS uses robust Bayesian statistics to distinguish the portions of multiple sequence alignments that are conserved either across the whole family or within subfamilies. LEON-BIS should thus be useful for automatic, high-throughput genome annotations, 2D/3D structure predictions, protein-protein interaction predictions etc.
Heat and moisture exchanger use reduces in-hospital complications following total laryngectomy: A case–control study
Authors: Foreman A. , De Santis R. J. , Sultanov F. , Enepekides D. J. , Higgins K. M.
Published: July 2016

Background

Total laryngectomy (TL) is an appropriate oncologic operation for many patients with laryngeal cancer delivering excellent oncologic outcomes, however it remains beset with significant functional consequences. Following TL, the upper and lower airways are permanently disconnected, which causes unfiltered, cold air with reduced humidity to enter the tracheobronchial tree, resulting in mucus overproduction and an increase in the viscosity of the mucus. In response to this, Heat and moisture exchangers were developed to compensate for the lost functions of the upper respiratory tract and their effect on the patients’ respiratory performance in addition to their quality of life.

Methods

The case records of 48 patients undergoing total laryngectomy were reviewed and data concerning demographics, surgical details, post-operative care requirements and adverse events was retrieved. Post hoc analysis of the case patients was undertaken to identify any benefit of using a heat and moisture exchanger (HME) system with particular reference to post-operative respiratory outcomes.

Results

There was no significant difference between case and control subjects based on demographics, extent of surgery or need for flap repair. 16 patients had used a HME and 32 patients had used external humidification (EH). Of those experiencing mucous plugging, only 3/24 (12.5 %) had used a HME system, in contrast to 21/24 (87.5 %) who used EH (Chi square = 9.375, p = 0.002). The odds ratio of having an adverse event if not using HME was 8.27 (CI = 1.94 – 35.71). Use of HME also significantly reduced the number of days requiring physiotherapy (1.75 days vs. 3.20 days, p = 0.034).

Conclusion

Use of an HME system can reduce in-hospital complications, in particular episodes of mucus plugging, and post-operative care requirements. Furthermore, there is a cost benefit to using HME systems that warrants more widespread introduction of these devices in head and neck surgery centers.