bluuebunny/crossref_metadata_2025 huggingface dataset:
Community paramedics treat high acuity conditions in the home: a prospective observational study
Authors: Abrashkin Karen Anna , Poku Asantewaa , Ramjit Alyeah , Washko Jonathan , Zhang Jenny , Guttenberg Michael , Smith Kristofer Lawrence
Published: April 2019

Objectives

As the US population ages and healthcare reimbursement shifts, identifying new patient-centred, cost-effective models to address acute medical needs will become increasingly important. This study examined whether community paramedics can evaluate and treat, under the direction of a credentialed physician, high acuity medical conditions in the home within an advanced illness management (AIM) practice.

Methods

A prospective observational study of an urban/suburban community paramedicine (CP) programme, with responses initiated based on AIM-practice protocols and triaged prior to dispatch using the Advanced Medical Priority Dispatch System (AMPDS). Primary outcome was association between AMPDS acuity levels and emergency department (ED) transport rates. Secondary outcomes were ED presentations at 24 and 48 hours post-visit, and patient/caregiver survey results.

Results

1159 individuals received 2378 CP responses over 4 years. Average age was 86 years; dementia, heart failure and asthma/chronic obstructive pulmonary disease were prevalent. Using AMPDS, most common reasons for dispatch included ‘breathing problems’ (28.2%), ‘sick person’ (26.5%) and ‘falls’ (13.1%). High acuity responses were most prevalent. 17.9% of all responses and 21.0% of high acuity responses resulted in ED transport. Within 48 hours of the visit, only 5.7% of the high acuity responses not initially transported were transported to the ED. Patient/caregiver satisfaction rates were high.

Conclusion

Community paramedics, operating within an AIM programme, can evaluate and treat a range of conditions, including high acuity conditions, in the home that would typically result in ED transport in a conventional 911 system. This model may provide an effective means for avoiding hospital-based care, allowing older adults to age in place.
Spiritual care provided by nursing home physicians: a nationwide survey
Authors: Gijsberts Marie-José H E , van der Steen Jenny T , Hertogh Cees M P M , Deliens Luc
Published: April 2019

Objective

To examine perceptions and experiences regarding providing spiritual care at the end of life of elderly care physicians practising in nursing homes in the Netherlands, and factors associated with spiritual care provision.

Methods

A cross-sectional survey was sent to a representative sample of 642 elderly care physicians requesting information about their last patient who died and the spiritual care they provided. We compared their general perception of spiritual care with spiritual and other items abstracted from the literature and variables associated with the physicians’ provision of spiritual care. Self-reported reasons for providing spiritual care were analysed with qualitative content analysis.

Results

The response rate was 47.2%. Almost half (48.4%) provided spiritual end-of-life care to the last resident they cared for. Half (51.8%) identified all 15 spiritual items, but 95.4% also included psychosocial items in their perception of spirituality and 49.1% included other items. Physicians who included more non-spiritual items reported more often that they provided spiritual care, as did more religious physicians and those with additional training in palliative care. Reasons for providing spiritual care included a request by the resident or the relatives, resident’s religiousness, fear of dying and involvement of a healthcare chaplain.

Conclusion

Most physicians perceived spirituality as a broad concept and this increased self-reported spiritual caregiving. Religious physicians and those trained in palliative care may experience fewer barriers to providing spiritual care. Additional training in reflecting upon the physician’s own perception of spirituality and training in multidisciplinary spiritual caregiving may contribute to the quality of end-of-life care for nursing home residents.
01 Development and validation of a pragmatic prehospital tool to identify stroke MIMIC patients
Authors: McClelland Graham , Flynn Darren , Rodgers Helen , Price Chris
Published: April 2019

Background

Stroke mimics (SM) are non-stroke conditions producing similar symptoms to stroke. Prehospital stroke identification tools prioritise sensitivity over specificity, therefore >25% of prehospital suspected stroke patients are SM. Failure to identify SM Results in inefficient use of ambulances and specialist stroke services. We developed a pragmatic tool for paramedics, using information often available in the prehospital setting, to identify SM amongst suspected stroke patients.

Methods

The initial tool was developed using a systematic literature review to identify SM characteristics, a survey of UK paramedics to explore the acceptability of SM identification and regression analysis of clinical variables documented in ambulance records of suspected stroke patients linked to their primary hospital diagnoses (n=1,650, 40% SM).

The initial tool was refined using two focus groups with paramedics (n=3) and hospital clinicians (n=9) and analysis of an expanded prehospital dataset (n=3,797, 41% SM) to produce the final STEAM tool.

Results

STEAM scores six variables:

1 point for Systolic blood pressure <90 mmHg

1 point for Temperature >38.5°C with heart rate >90 bpm

1 point for seizures or 2 points for seizures with diagnosed Epilepsy

1 point for Age <40 years or 2 points for age <30 years

1 point for headache with diagnosed Migraine

1 point for FAST–ve

A score of ≥2 on STEAM predicted SM diagnosis in the expanded derivation dataset with 5.5% sensitivity, 99.6% specificity and positive predictive value (PPV) of 91.4%. STEAM was validated using an external dataset (n=1,848, 33% SM) of prehospital suspected stroke patients where STEAM was 5.5% sensitive, 99.4% specific with a PPV of 82.5%.

Conclusions

STEAM uses common clinical characteristics to identify a small number of SM patients with a high level of certainty. The benefits of reducing SM admissions to specialist stroke services should be weighed against delayed admission for the small number of stroke patients identified as a SM.
PP10 ‘The ones that don’t say’; challenges in managers identifying potentially traumatised ambulance staff
Authors: Miller Joshua ,   Paramedic
Published: April 2019

Background

Stress and psychological illness among emergency services personnel is reported at higher prevalence than the general population, with one UK ambulance service ascribing it to 15% of staff sickness. Research in this field has focused on ambulance crew views, while manager experiences are limited to EMS systems outside the UK. This qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work.

Methods

Face-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained.

Results

All participants claimed to see the identification of potentially traumatised staff as a vital part of their role. They outlined the use of case factors such as visceral elements and child involvement, and staff factors such as home life and resilience. Interviewees talked about their changing roles as managers, peers, parent figures, clinicians, and adjudicators.

Factors found as enabling the identification of potentially traumatised staff included: knowing the staff, formalising handover to other managers, and manager presence – both at incidents and on station. Disabling factors included: atypical cases, hierarchical culture, and isolated remote staff. All participants reported concerns about staff being reluctant to report distress.

Conclusions

Limitations of this study include the small sample size, possible response bias, and respondents conforming to social norms, as their practice was self-reported, rather than observed. Manager presence was highlighted as very important by participants; services should consider this in their structures and policies. Further studies could examine staff reluctance to report psychological distress, as well as staff resilience, which participants saw as beneficial, yet difficult to define or predict.
PP11 The use of prehospital 12-lead electrocardiograms in acute stroke patients
Authors: Munro Scott , Cooke Debbie , Joy Mark , Smith Adam , Poole Kurtis , Perciato Laurence , Holah Janet , Speirs Ottilia , Quinn Tom
Published: April 2019

Background

Emergency medical services (EMS) play a vital role in the recognition, management and transportation of acute stroke patients. UK guidelines recommend clinicians consider performing a prehospital 12-lead electrocardiogram (PHECG) in patients with suspected stroke, but this recommendation is based on expert consensus, rather than robust evidence.

The aim of this study was to investigate the association between PHECG and modified Rankin scale (mRS). Secondary outcomes included in-hospital mortality, EMS and in-hospital time intervals and rates of thrombolysis received.

Methods

A multicentre retrospective cohort study was undertaken.

The data collection period spanned from 29/12/2013–30/01/2017. Participants were identified through secondary analysis of hospital data routinely collected as part of the Sentinel Stroke National Audit Programme (SSNAP) and linked to EMS clinical records (PCRs) via EMS incident number.

Results

PHECG was performed in 558 (48%) of study patients. PHECG was associated with an increase in mRS (aOR 1.30, 95% CI 1.01 to 1.66, p=0.04) and in-hospital mortality (aOR 1.83, 95% CI 1.26–2.67, p=0.002). There was no association between PHECG and administration of thrombolysis (aOR 1.06, 95% CI 0.75–1.52, p=0.73).

Patients who had a PHECG recorded spent longer under the care of EMS (median 49 vs 43 min, p=0.007). No difference in times to receiving brain scan (Median 28 with PHECG vs 29 min no PHECG, p=0.32) or median door-to-needle time (median 46 min vs 48 min, p=0.37) were observed.

Conclusion

This is the first study of its kind to investigate the association between PHECG and functional outcome in stroke patients attended by EMS. Although there are limitations in regard to the retrospective study design, the findings challenge current guideline recommendations regarding PHECG in patients with acute stroke.
PP21 Rapid assessment of membrane osmotic pressure as a guide to resuscitation in the acutely shocked patient
Authors: Prior Frank , Clegg Gareth , McRaild Alan
Published: April 2019

Background

Resuscitation of the shocked patient presents a dilemma for the prehospital resuscitation team. Selection of the appropriate type and quantity of resuscitation fluid is not supported by evidence based consensus and discussions such as the ‘crystalloid colloid debate’ have been prolonged and unhelpful. We are seeking a straightforward way of guiding resuscitation of shocked patients.

The Prior Hypothesis suggests that capillary blood pressure and membrane osmotic pressure (MOP) must be equal and opposite to achieve fluid balance in the microcirculation. Membrane osmotic pressure is critically dependant on the pore size of small vessels – larger pores allowing the egress of large molecules from capillaries and therefore lowering capillary MOP. Our studies suggest that shocked patients fall into two groups: a ‘dry shock’ group with elevated MOP, and a ‘leaky shock’ group with a low MOP. The ability to identify these different groups has implications for treatment– both choice of resuscitation fluid, and the use of other vasoactive pharmacological agents which influence capillary pore size.

Methods

Concurrent blood pressure and MOP were measured in 57 shocked patients on presentation to the Emergency Department. MOPs were measured using a process taking less than 5 min with a standalone osmometer requiring as little as 50 µl of serum.

Results

In the patients tested two distinct patterns of abnormal MOP were distinguishable. 20 patients fell into the ‘leaky’ shock group (MOP 19–24 mmHg), 9 in the ‘dry’ shock group (MOP 27–30 mmHg) with a further 16 having MOP in the normal range (24–27 mmHg).

Conclusion

Our findings are consistent with the use of a rapid MOP test to categorise acutely presenting patients into ‘dry’ and ‘leaky’ shock depending on capillary pore size. Further work is required to test the utility of near patient MOP testing as a guide to effective therapy during emergency resuscitation.
PP27 Pre-hospital lactate monitoring: a worthy adjunct to systolic blood pressure and shock index in triggering blood product administration in patients with suspected traumatic haemorrhage?
Authors: Griggs JE , Lyon RM , Sherriff M , Leung J , Wareham G
Published: April 2019

Introduction

Pre-hospital identification of patients with suspected occult traumatic haemorrhage is problematic. Physiological parameters and clinical gestalt are inadequate surrogates for ongoing haemorrhage. Lactate monitoring may hold stronger predictive clinical utility to identify patients with suspected traumatic haemorrhage above other physiological parameters.

Methods

A single centre, service evaluation of pre-hospital lactate monitoring. A point of care test was introduced into a Helicopter Emergency Medical Service in the United Kingdom. Clinicians adhered to strict education and governance, supported by standard operating procedure. Systolic blood pressure (SBP) and shock index (SI) was measured in patients that received pre-hospital transfusion therapy. A predetermined ‘cut off’ value of lactate >2.5 mmol was acknowledged. In-hospital follow up established further transfusion therapy.

Results

Wilcoxon rank sum compared pre-lactate (n=22) and post-lactate (n=6) groups. Monte Carlo permutations were used to obtain exact probabilities. No statistically significant differences were found between groups for: SBP, p=0.955; and, SI, p=0.401. Univariate logistic regression identified the odds ratio (OR) and confidence interval (CI) for each continuous variable as: SBP, 0.97 (CI 0.94 to 1.01); SI, 26.91 (CI 1.11 to 652.48) and lactate >2.5 mmol, 2.33 (CI 0.23 to 23.91). Multivariate logistic regression identified OR as: SBP, 0.99 (CI 0.95 to 1.04); SI, 22.98 (CI 0.56 to 946.44); and lactate >2.5 mmol, 3.05 (CI 0.14 to 65.86).

Conclusion

Lactate monitoring has been successfully introduced into an enhanced care service. The Results confirm SBP is not predictive of further transfusion. The OR for SI shows greater predictive power. Limited by a small dataset, the Results are hypothesis-generating only.
First evidence of a paediatric patient with Cornelia de Lange syndrome with acute lymphoblastic leukaemia
Authors: Fazio Grazia , Massa Valentina , Grioni Andrea , Bystry Vojtech , Rigamonti Silvia , Saitta Claudia , Galbiati Marta , Rizzari Carmelo , Consarino Caterina , Biondi Andrea , Selicorni Angelo , Cazzaniga Giovanni
Published: April 2019

Cornelia de Lange syndrome (CdLS) is a rare autosomal-dominant genetic disorder characterised by prenatal and postnatal growth and mental retardation, facial dysmorphism and upper limb abnormalities. Germline mutations of cohesin complex genesSMC1A,SMC3,RAD21or their regulatorsNIPBLandHDAC8have been identified in CdLS as well as somatic mutations in myeloid disorders. We describe the first case of a paediatric patient with CdLS with B-cell precursor Acute Lymphoblastic Leukaemia (ALL). The patient did not show any unusual cytogenetic abnormality, and he was enrolled into the high risk arm of AIEOP-BFM ALL2009 protocol because of slow early response, but 3 years after discontinuation, he experienced an ALL relapse. We identified a heterozygous mutation in exon 46 ofNIPBL, causing frameshift and a premature stop codon (RNA-Targeted Next generation Sequencing Analysis). The analysis of the family indicated a de novo origin of this previously not reported deleterious variant. As for somatic cohesin mutations in acute myeloid leukaemia, also this ALL case was not affected by aneuploidy, thus suggesting a major impact of the non-canonical role ofNIPBLin gene regulation. A potential biological role ofNIPBLin leukaemia has still to be dissected.
First seizure presentations in adults: beyond assessment and treatment
Authors: Foster Emma , Carney Patrick , Liew Danny , Ademi Zanfina , O’Brien Terry , Kwan Patrick
Published: April 2019

Almost 10% of people will experience at least one seizure over a lifetime. Although common, first seizures are serious events and warrant careful assessment and management. First seizures may be provoked by acute or remote symptomatic factors including life-threatening metabolic derangements, drug toxicity or structural brain lesions. An unprovoked first seizure may herald the onset of epilepsy and may be accompanied by medical and psychiatric illnesses. Accidents, injuries and death associated with first seizures are likely under-reported. The cognitive and emotional impact of first seizures is often neglected. Evaluation of a patient presenting with a first seizure requires careful history-taking and early specialist assessment, however optimal management strategies have not been extensively investigated. Further, advances in technology and the role of eHealth interventions such as telemedicine may be of value in the care of patients who have experienced a first seizure. This article reviews the impact and implications of first seizures beyond the scope provided in current guidelines which tend to focus on assessment and management. It examines the effect of first seizures on the well-being of patients; assesses morbidity and premature mortality in first seizures and discusses current and future directions to optimise safety and health of people with first seizures, with a focus on adult patients. Recognition of these issues is essential to provide adequate care for people with first seizures.
Welding fumes and lung cancer: a meta-analysis of case-control and cohort studies
Authors: Honaryar Manoj Kumar , Lunn Ruth M , Luce Danièle , Ahrens Wolfgang , ’t Mannetje Andrea , Hansen Johnni , Bouaoun Liacine , Loomis Dana , Byrnes Graham , Vilahur Nadia , Stayner Leslie , Guha Neela
Published: April 2019

Background

An estimated 110 million workers are exposed to welding fumes worldwide. Welding fumes are classified by the International Agency for Research on Cancer ascarcinogenic to humans(group 1), based onsufficient evidenceof lung cancer from epidemiological studies.

Objective

To conduct a meta-analysis of case-control and cohort studies on welding or exposure to welding fumes and risk of lung cancer, accounting for confounding by exposure to asbestos and tobacco smoking.

Methods

The literature was searched comprehensively in PubMed, reference lists of relevant publications and additional databases. Overlapping populations were removed. Meta-relative risks (mRRs) were calculated using random effects models. Publication bias was assessed using funnel plot, Eggers’s test and Begg’s test.

Results

Forty-five studies met the inclusion criteria (20 case-control, 25 cohort/nested case-control), which reduced to 37 when overlapping study populations were removed. For ‘ever’ compared with ‘never’ being a welder or exposed to welding fumes, mRRs and 95% CIs were 1.29 (1.20 to 1.39; I2=26.4%; 22 studies) for cohort studies, 1.87 (1.53 to 2.29; I2=44.1%; 15 studies) for case-control studies and 1.17 (1.04 to 1.38; I2=41.2%) for 8 case-control studies that adjusted for smoking and asbestos exposure. The mRRs were 1.32 (95% CI 1.20 to 1.45; I2=6.3%; 15 studies) among ‘shipyard welders’, 1.44 (95% CI 1.07 to 1.95; I2=35.8%; 3 studies) for ‘mild steel welders’ and 1.38 (95% CI 0.89 to 2.13; I2=68.1%; 5 studies) among ‘stainless steel welders’. Increased risks persisted regardless of time period, geographic location, study design, occupational setting, exposure assessment method and histological subtype.

Conclusions

These results support the conclusion that exposure to welding fumes increases the risk of lung cancer, regardless of the type of steel welded, the welding method (arc vs gas welding) and independent of exposure to asbestos or tobacco smoking.
Rapid use of high-sensitive cardiac troponin I for ruling-in and ruling-out of acute myocardial infarction (RACING-MI): study protocol
Authors: Bang Camilla , Hansen Camilla , Lauridsen Kasper Glerup , Frederiksen Christian Alcaraz , Schmidt Morten , Jensen Tage , Hornung Nete , Løfgren Bo
Published: April 2019

Introduction

The European Society of Cardiology has suggested an accelerated algorithm for ruling-in and ruling-out myocardial infarction (MI) with high-sensitive cardiac troponin (hs-cTn) measured at admission (0 hour) and after 1 hour (1 hour) as an alternative to standard measurements at 0 hour and 3 hours. However, the 0 hour/1 hour algorithm has only been tested in a limited amount of patient cohorts and not for all hs-cTn assays. Moreover, it is unknown if MI can be ruled-out faster than 1 hour. In this single-centre, clinical trial, we will investigate whether MI safely can be ruled-in or ruled-out after 30 min and 1 hour.

Methods and analysis

Patients with chest pain suggestive of MI admitted to the emergency department will be subjected to hs-cTn measurements at the following time points: 0 hour, 30 min, 1 hour and 3 hours. Chest pain characteristics will be recorded. In total, 1000 patients with all four blood samples will be included. The diagnostic algorithms will be derived based on the first 500 patients and validated in the subsequent 500 patients. The primary endpoint is the negative predictive value of the 0 hour/30 min and the 0 hour/1 hour algorithms. Secondary endpoints include positive predictive value, sensitivity and specificity. Results will be compared with the standard 0 hour/3 hour algorithm.

Ethics and dissemination

Oral and written informed consent will be obtained from all patients. The trial is approved by The Regional Committee on Health Research Ethics and the Danish Data Protection Agency. Data will be disseminated and submitted to peer-reviewed scientific journals and meetings irrespective of study outcome.

Trial registration number

NCT03634384
Diagnostic and prognostic value of biomarkers in acute myocardial infarction
Authors: Chen Yuqi , Tao Yifei , Zhang Lan , Xu Weiting , Zhou Xiang
Published: April 2019

The incidence of acute myocardial infarction (AMI) has been increasing rapidly in recent years, seriously endangering human health. Cardiac biomarkers play critical roles in the diagnosis and prognosis of AMI. Troponin is a highly sensitive and specific biomarker for AMI diagnosis and can independently predict adverse cardiac events. Other biomarkers such as N-terminal B-type natriuretic peptide and C reactive protein are also valuable predictors of cardiovascular prognosis. Recently, several novel biomarkers have been identified for the diagnosis and risk assessment in patients with AMI. A multibiomarker approach can potentially enhance the diagnostic accuracy and provide more information for the early risk stratification of AMI. In this review, we will summarise the biomarkers discovered in recent years and focus on their diagnostic and prognostic value for patients with AMI.
Window of opportunity in rheumatoid arthritis – definitions and supporting evidence: from old to new perspectives
Authors: Burgers Leonie E , Raza Karim , van der Helm - van Mil Annette H
Published: April 2019

The therapeutic window of opportunity in rheumatoid arthritis (RA) is often referred to. However, some have questioned whether such a period, in which the disease is more susceptible to disease-modifying treatment, really exists. Observational studies are most frequently referenced as supporting evidence, but results of such studies are subject to confounding. In addition formal consensus on the definition of the term has never been reached. We first reviewed the literature to establish if there is agreement on the concept of the window of opportunity in terms of its time period and the outcomes influenced. Second, a systemic literature search was performed on the evidence of the benefit of early versus delayed treatment as provided by randomised clinical trials. We observed that the concept of the window of opportunity has changed with respect to timing and outcome since its first description 25 years ago. There is an ‘old definition’ pointing to the first 2 years after diagnosis with increased potential for disease-modifying treatment to prevent severe radiographic damage and disability. Strong evidence supports this concept. A ‘new definition’ presumes a therapeutic window in a pre-RA phase in which the biologic processes could be halted and RA development prevented by very early treatment. This definition is not supported by evidence, although is less well studied in trials. Some suggestions for future research in this area are made.
René Carlson
Authors:   American Veterinary Medical Association
Published: April 2019

A practising small animal veterinarian in her home community, she was also a passionate and enthusiastic leader on international veterinary matters.
Photon added coherent states of the parity deformed oscillator
Authors: Dehghani A. , Mojaveri B. , Faseghandis S. Amiri
Published: April 2019

Using the parity deformed Heisenberg algebra (RDHA), we first establish associated coherent states (RDCSs) for a pseudo-harmonic oscillator (PHO) system that are defined as eigenstates of a deformed annihilation operator. Such states can be expressed as superposition of an even and odd Wigner cat states.[Formula: see text] The RDCSs minimize a corresponding uncertainty relation, and resolve an identity condition through a positive definite measure which is explicitly derived. We introduce a class of single-mode excited coherent states (PARDCS) of the PHO through “m” times application of deformed creation operators to RDCS. For the states thus constructed, we analyze their statistical properties such as squeezing and sub-Poissonian statistics as well as their uncertainty relations.
Discriminative Metric Learning with Deep Forest
Authors: Utkin Lev V. , Ryabinin Mikhail A.
Published: April 2019

A Discriminative Deep Forest (DisDF) as a metric learning algorithm is proposed in the paper. It is based on the Deep Forest or gcForest proposed by Zhou and Feng and can be viewed as a gcForest modification. The case of the fully supervised learning is studied when the class labels of individual training examples are known. The main idea underlying the algorithm is to assign weights to decision trees in random forest in order to reduce distances between objects from the same class and to increase them between objects from different classes. The weights are training parameters. A specific objective function which combines Euclidean and Manhattan distances and simplifies the optimization problem for training the DisDF is proposed. The numerical experiments illustrate the proposed distance metric algorithm.
A NOVEL METHOD FOR STUDYING THE CORROSION RESISTANCE AND MICROSTRUCTURE OF ENAMEL COATING MODIFIED ON HIGH-STRENGTH STEEL IN 3.5 wt.% NaCl SOLUTION
Authors: LI YULIN , WANG JUNJIE , ZHONG QINGDONG
Published: April 2019

A new method was introduced to research the corrosion resistance of enamel coatings which were sintered at different temperatures in this paper. 1 – 4 Scanning electrochemical microscopy (SECM) conjunction with capacitance-potential test and Mott–Schottky analysis technique were used to study the coating failure process and semiconductor conduction behavior of enamel coating in 3.5[Formula: see text]wt.% NaCl solution. The high strength steel (SAPH440) was selected as the metal substrate. The coatings which were sintered at different temperatures on the high strength steel were analyzed and their corrosion behaviors and microstructures were also measured by potentiodynamic polarization curves, Mott–Schottky analysis technique and scanning electrochemical microscopy. 5 – 10 In this paper, five kinds of enamel coatings were prepared on high strength steel. The SECM results show that the Faraday current of the microprobe tip gradually decreases with the soaking time increasing, which indicates that the coatings become failure slowly with the invasion of water and aggressive ions. At the same time, the tip current was homogeneous during the immersion process, which reflected that the surface of the sample remained stable, no obvious bulges appeared. Capacitance–potential test and Mott–Schottky analysis 7 , 8 show that the external ions and water molecules gradually penetrate into the coating; coating showed characteristics of [Formula: see text]-type semiconductor as time increases, the capacitance increases gradually, the space charge layer thickness decreases, slope of Mott–Schottky curve decreased gradually which indicates that the failure of coating in the process of soaking slowly with the charge carrier density increases.
DEVELOPMENTS, MECHANICAL PROPERTY MEASUREMENTS AND STRENGTH EVALUATIONS OF THE WRIST BRACES FOR THE WRIST FRACTURE PATIENTS
Authors: CHEN CHUNG-DE , CHEN CHING-HSIANG , LIN CHENG-LI , LIN CHIEN-KUNG , WANG CHI-TSANG , LIN RUEY-MO , FANG JING-JING
Published: April 2019

In this paper, the wrist braces for the wrist fracture patients are developed. Geometry of the patient’s wrist surface anatomy was digitalized and recorded by an optical 3D scanner. An expert software was developed to generate the brace model, on which several holes are distributed to increase the air permeability. Finally, the brace is fabricated by commercial FDM 3D printer. For ensuring the strength of the wrist brace, the tensile test and impact test were conducted to measure the elastic modulus, yielding strength and fracture strength. A finite element model was established to investigate the stresses and deformations when the wrist brace is subjected to a static load. The mechanical properties measured in the tensile tests are as input parameters in the model. The static analysis showed that, for four considered movements of the wrist, the maximum von-Mises stress is less than the yielding strength. An impact analysis was also conducted to simulate brace impacted by a moving rigid ball with a mass of 0.3768[Formula: see text]kg. The results showed that the deformation at the impact point remains in the elastic range when the impact speed is 3[Formula: see text]m/s. The finite element calculations give us rules to design the number of holes and the thickness of the brace.
Minimal Penner dilatations on nonorientable surfaces
Authors: Liechti Livio , Strenner Balázs
Published: April 2019

For any nonorientable closed surface, we determine the minimal dilatation among pseudo-Anosov mapping classes arising from Penner’s construction. We deduce that the sequence of minimal Penner dilatations has exactly two accumulation points, in contrast to the case of orientable surfaces where there is only one accumulation point. One of our key techniques is representing pseudo-Anosov dilatations as roots of Alexander polynomials of fibered links and comparing dilatations using the skein relation for Alexander polynomials.
Data-driven Anomaly Detection with Timing Features for Embedded Systems
Authors: Lu Sixing , Lysecky Roman
Published: April 2019

Malware is a serious threat to network-connected embedded systems, as evidenced by the continued and rapid growth of such devices, commonly referred to as the Internet of Things. Their ubiquitous use in critical applications require robust protection to ensure user safety and privacy. That protection must be applied to all system aspects, extending beyond protecting the network and external interfaces. Anomaly detection is one of the last lines of defence against malware, in which data-driven approaches that require the least domain knowledge are popular. However, embedded systems, particularly edge devices, face several challenges in applying data-driven anomaly detection, including unpredictability of malware, limited tolerance to long data collection windows, and limited computing/energy resources. In this article, we utilize subcomponent timing information of software execution, including intrinsic software execution, instruction cache misses, and data cache misses as features, to detect anomalies based on ranges, multi-dimensional Euclidean distance, and classification at runtime. Detection methods based on lumped timing range are also evaluated and compared. We design several hardware detectors implementing these data-driven detection methods, which non-intrusively measuring lumped/subcomponent timing of all system/function calls of the embedded application. We evaluate the area, power, and detection latency of the presented detector designs. Experimental results demonstrate that the subcomponent timing model provides sufficient features to achieve high detection accuracy with low false-positive rates using a one-class support vector machine, considering sophisticated mimicry malware.
Beyond Worst-case (In)approximability of Nonsubmodular Influence Maximization
Authors: Schoenebeck Grant , Tao Biaoshuai
Published: April 2019

We consider the problem of maximizing the spread of influence in a social network by choosing a fixed number of initial seeds, formally referred to as the
influence maximization problem
. It admits a (1−1/e)-factor approximation algorithm if the influence function is
submodular
. Otherwise, in the worst case, the problem is NP-hard to approximate to within a factor of
N
1−ε
. This article studies whether this worst-case hardness result can be circumvented by making assumptions about either the underlying network topology or the cascade model. All our assumptions are motivated by many real-life social network cascades.

First, we present strong inapproximability results for a very restricted class of networks called the
(stochastic) hierarchical blockmodel
, a special case of the well-studied
(stochastic) blockmodel
in which relationships between blocks admit a tree structure. We also provide a dynamic-programming-based polynomial time algorithm, which optimally computes a directed variant of the influence maximization problem on hierarchical blockmodel networks. Our algorithm indicates that the inapproximability result is due to the bidirectionality of influence between agent-blocks.

Second, we present strong inapproximability results for a class of influence functions that are “almost” submodular, called
2-quasi-submodular
. Our inapproximability results hold even for any 2-quasi-submodular
f
fixed in advance. This result also indicates that the “threshold” between submodularity and nonsubmodularity is sharp, regarding the approximability of influence maximization.
Delineating the age-related attenuation of vascular function: Evidence supporting the efficacy of the single passive leg movement as a screening tool
Authors: Hydren Jay R. , Broxterman Ryan M. , Trinity Joel D. , Gifford Jayson R. , Kwon Oh Sung , Kithas Andrew C. , Richardson Russell S.
Published: April 2019

Continuous passive leg movement (PLM) is a promising clinical assessment of the age-related decline in peripheral vascular function. To further refine PLM, this study evaluated the efficacy of a single PLM (sPLM), a simplified variant of the more established continuous movement approach, to delineate between healthy young and old men based on vascular function. Twelve young (26 ± 5 yr) and 12 old (70 ± 7 yr) subjects underwent sPLM (a single passive flexion and extension of the knee joint through 90°), with leg blood flow (LBF, common femoral artery with Doppler ultrasound), blood pressure (finger photoplethysmography), and leg vascular conductance (LVC) assessed. A receiver operator characteristic curve analysis was used to determine an age-specific cut score, and a factor analysis was performed to assess covariance. Baseline LBF and LVC were not different between groups ( P = 0.6). The high level of covariance and similar predictive value for all PLM-induced LBF and LVC responses indicates LBF, alone, can act as a surrogate variable in this paradigm. The peak sPLM-induced increase in LBF from baseline was attenuated in the old (Young: 717 ± 227, Old: 260 ± 97 ml/min, P < 0.001; cut score: 372 ml/min), as was the total LBF response (Young: 155 ± 67, Old: 26 ± 17 ml, P < 0.001; cut score: 58 ml). sPLM, a simplified version of PLM, exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction, as evidenced by an age-related attenuation in the peripheral hyperemic response and a clearly delineated age-specific cut score.

NEW & NOTEWORTHY Single passive leg movement (sPLM) exhibits the prerequisite qualities of a valid screening test for peripheral vascular dysfunction. sPLM displayed an age-related reduction in the peripheral hemodynamic response for amplitude, duration, initial rate of change, and total change with clearly delineated age-specific cut scores. sPLM has a strong candidate variable that is a simple single numeric value, for which to appraise peripheral vascular function, the 45-s hyperemic response (leg blood flow area under the curve: 45 s).
Jejunoileal GIST: A Rare Case of Transient Intussusception and Gastrointestinal Bleeding
Authors: Santos Sara Catarino , Leite Cláudia , Pinho Helena , Casimiro Carlos
Published: April 2019

Gastrointestinal stromal tumors (GIST) comprised 0,2% of all GI tumors. They are typically asymptomatic, but can manifest with nonspecific GI symptoms, GI bleeding, or intussusception. The authors report a case of a 55-year-old female patient with hematochezia and a palpable mass on the left lower quadrant. Ultrasound revealed possible intussusception. However, CT scan did not show any signs of lesions or intussusception. On reevaluation, the mass was no longer palpable. The patient had recurrent episodes of hematochezia with need of transfusional support. CT enterography revealed a 20-24 mm jejunoileal lesion. A laparotomy was undertaken with small bowel resection containing the lesion. Histological examination confirmed GIST. GIST presentation as transient intussusception and intermittent GI bleeding is rare. This case report emphasizes the rarity of jejunoileal GIST, its clinical details, diagnostic study, and treatment.
Omni-Channel Product Distribution Network Design by Using the Improved Particle Swarm Optimization Algorithm
Authors: Zhang Si , Zhu Heying , Li Xia , Wang Yan
Published: April 2019

Distribution network under Omni-Channel integration contains many levels. There are one or more dealers at each level which forms a many-to-many distribution network. Consumers purchase a wide variety of products and their demands are uncertain, which constitutes a complex demand network and increases the complexity of the supply chain network. This paper focuses on the integrated optimization of supply chain distribution network and demand network and constructs the joint randomization planning model of location and routing. The goal is to minimize the total costs of the supply chain network under uncertain customer demands. Based on the traditional particle swarm optimization (PSO), this study introduces the collaborative idea to reduce the coding dimension, improves the boundary processing strategy, and adopts the mutation operator to expand the search space. A case study of distribution under Omni-Channel integration in a large enterprise was done. The validity of the model and the effectiveness of the proposed method were verified by numerical experiments.
Central Precocious Puberty as a Complication of Therapy with Adrenocorticotropin (ACTH) and an Aromatase Inhibitor for Refractory Nephrotic Syndrome
Authors: Agrawal Sungeeta , Gensure Robert , Milner Lawrence , Nicoletta Julie , Sadeghi-Nejad Abdollah
Published: April 2019

Glucocorticoids are typically prescribed for the treatment of idiopathic nephrotic syndrome of childhood. In selected patients with refractory focal segmental glomuerulosclerosis (FSGS), adrenocorticotropin (ACTH) can be used to induce remission and decrease the progression of the disease. We report a 6 8/12-year-old girl with recurrent proteinuria, resistant to standard immunotherapy. She underwent related renal transplant but again developed proteinuria and was started on ACTH. She subsequently developed peripheral precocious puberty (PPP), presumably from peripheral aromatization of adrenal androgens. She was started on an aromatase inhibitor, and her ACTH dose was slowly decreased. She then developed central precocious puberty (CPP). We hypothesize that treatment of her peripheral precocious puberty with an aromatase inhibitor may have triggered central precocious puberty.
Design, Modeling, and Experiments of the Vortex‐Induced Vibration Piezoelectric Energy Harvester with Bionic Attachments
Authors: Jin Zunlong , Li Guoping , Wang Junlei , Zhang Zhien
Published: April 2019

Since the energy demand increases, the sources of fluid energy such as wind energy and marine energy have attracted widespread attention, especially vortex‐induced vibrations excited by wind energy. It is well known that the lock‐in effect in vortex‐induced vibration can be applied to the piezoelectric energy harvester. Although numerous researches have been conducted on piezoelectric energy harvesting devices in recent years, a common problem of low bandwidth and harvesting efficiency still exists. In order to increase the response amplitude and decrease the threshold wind speed of vortex‐induced vibration, a bionic attachment structure is proposed based on the experimental method. In the present work, twelve models are designed according to the size of pits and hemispheric protrusions which are added to the surface of a flexible smooth cylinder. Compared with the smooth cylinder which is taken as a carrier, the harvester with the bionic structure shows stronger energy capture performance on the whole. As the threshold speed decelerates from 1.8m/s to 1 m/s, the bandwidth, on the contrary, increases from 39.3% to 51.4%. Particularly, for the 10 mm pits structure with 5 columns, its peak voltage can reach 47 V, and its peak power can reach 1.21 mW with a resistance of 800 kΩ, 0.57 mW higher than that of the smooth cylinder. Comparatively speaking, the hemispherical projections structure figures with a much more different energy capturing characteristic. Starting from the column, the measured voltage of the hemispherical bionic harvester is much smaller than that of the smooth cylinder, with a peak voltage less than 15 V and a reducing bandwidth. However, compared with the smooth cylinder, hemispheric projections with 3 columns have a better energy capture effect with a measured voltage of 35V, a resistance of 800kΩ, and a wind speed of 3.097 m/s. Besides, its output power also enhances from 0.48 to 0.56 mW.
Blockade of Cyclophilin D Attenuates Oxidative Stress-Induced Cell Death in Human Dental Pulp Cells
Authors: Huang Shengbin , Zheng Bingbing , Jin Xing , Yu Qihao , Zhang Xiaorong , Sun Xiaoyu , Chen Yuting , Ren Xuerui , Wismeijer Daniel , Ma Jianfeng , Zhang Chengfei , Wu Gang , Pan Yihuai
Published: April 2019

Pathological stimuli, such as bacterial activity, dental bleaching, and nonpolymerized resin monomers, can cause death of dental pulp cells (DPCs) through oxidative stress- (OS-) induced mitochondrial dysfunction. However, the crucial molecular mechanisms that mediate such a phenomenon remain largely unknown. OS is characterized by the overproduction of reactive oxygen species (ROS), e.g., H2O2, O2−, and ⋅OH. Mitochondria are a major source of ROS and the principal attack target of ROS. Cyclophilin D (CypD), as the only crucial protein for mitochondrial permeability transition pore (mPTP) induction, facilitates the opening of mPTP and causes mitochondrial dysfunction, leading to cell death. In the present study, we hypothesized that CypD-mediated mitochondrial molecular pathways were closely involved in the process of OS-induced death of human DPCs (HDPCs). We tested the phenotypic and molecular changes of HDPCs in a well-established OS model—H2O2 treatment. We showed that H2O2 dramatically reduced the viability and increased the death of HDPCs in a time- and dose-dependent manner by performing MTT, flow cytometry, and TUNEL assays and quantifying the expression changes of Bax and Bcl-2 proteins. H2O2 also induced mitochondrial dysfunction, as reflected by the increased mitochondrial ROS, reduced ATP production, and activation of mPTP (decreased mitochondrial membrane potential and enhanced intracellular Ca2+ level). An antioxidant (N-acetyl-L-cysteine) effectively preserved mitochondrial function and significantly attenuated H2O2-induced cytotoxicity and death. Moreover, H2O2 treatment markedly upregulated the CypD protein level in HDPCs. Notably, genetic or pharmacological blockade of CypD significantly attenuated H2O2-induced mitochondrial dysfunction and cell death. These findings provided novel insights into the role of a CypD-dependent mitochondrial pathway in the H2O2-induced death in HDPCs, indicating that CypD may be a potential therapeutic target to prevent OS-mediated injury in dental pulp.
Periprosthetic Fracture of Greater Trochanter in Total Hip Replacement Stemming from Pin Site Placement in Navigation-Assisted Surgery
Authors: Brozovich Ava , Lionberger David R.
Published: April 2019

Surgeons are looking to use computer computer-assisted surgery (CAS) in total hip arthroplasty (THA) in order to quantify leg length measurement, angular cup placement, and enhance stability to provide enhanced accuracy in implant placement. As a result, CAS in THA is gaining popularity. This technology employs the use of pins and provides the surgeon with real-time feedback on positioning intraoperatively. Previous total knee arthroplasty (TKA) literature has reported pin-associated complications such as infections, neuropraxia, and suture abscess. To our knowledge, there have been reports of tibial stress fracture after CAS TKA, but this is the first report of a pin causing fracture of the greater trochanter leading to dislocation in THA. Further studies may be warranted to optimize pin placement for trackers to prevent fractures of the greater trochanter.
Humeral Avulsion of the Lateral Collateral Ligament of the Elbow Concomitant with the Medial Epicondyle Fracture of a Child with General Joint Laxity
Authors: Morimoto Toru , Izumi Masashi , Ueba Hiroaki , Ikeuchi Masahiko
Published: April 2019

Medial epicondyle fracture is a common elbow injury for children, and it was reported that 30-50% of this fracture was associated with elbow dislocation. However, dysfunction of the lateral collateral ligament (LCL) complex accompanied with the medial epicondyle fracture has rarely been reported. In this report, a 13-year-old girl who had a humeral avulsion of the LCL concomitant with a displaced medial epicondyle fracture was presented. Since her general joint laxity had been recognized from past medical history and the humeral avulsion of the LCL was clearly confirmed by ultrasonography, simultaneous surgical repair for the LCL avulsion and medial epicondyle fracture was conducted and satisfactory outcome was achieved. Although general joint laxity does not tend to receive attention in trauma as much as chronic conditions, it should be borne in mind to prevent overlooking important soft tissue damage coexisting with apparent fractures.
Quorum Sensing: A Prospective Therapeutic Target for Bacterial Diseases
Authors: Jiang Qian , Chen Jiashun , Yang Chengbo , Yin Yulong , Yao Kang
Published: April 2019

Bacterial quorum sensing (QS) is a cell-to-cell communication in which specific signals are activated to coordinate pathogenic behaviors and help bacteria acclimatize to the disadvantages. The QS signals in the bacteria mainly consist of acyl-homoserine lactone, autoinducing peptide, and autoinducer-2. QS signaling activation and biofilm formation lead to the antimicrobial resistance of the pathogens, thus increasing the therapy difficulty of bacterial diseases. Anti-QS agents can abolish the QS signaling and prevent the biofilm formation, therefore reducing bacterial virulence without causing drug-resistant to the pathogens, suggesting that anti-QS agents are potential alternatives for antibiotics. This review focuses on the anti-QS agents and their mediated signals in the pathogens and conveys the potential of QS targeted therapy for bacterial diseases.