bluuebunny/crossref_metadata_2025 huggingface dataset:
Robotic precision assembly system for microstructures
Authors: Shao Chao , Ye Xin , Qian Jiahui , Zhang Zhijing , Zhu Dongsheng
Published: November 2019

This article proposes a robotic precision assembly system for the typical parts of microstructures such as non-silicon microelectromechanical system parts. The assembly system contains three parallel assembly units and support system. In each unit, the images of the base part and target part can be obtained simultaneously from the coaxial alignment vision detection module. This article proposes a system calibration method to ensure accuracy of assembly system. Assembly experiments and accuracy validation tests are conducted. The experimental results show that the synthesizing assembly accuracy of the robotic precision assembly system can reach higher than 3 µm and the mean assembly cycle time of each part is less than 20 s, including the time for feeding and unloading parts. The robotic precision assembly system with nondestructive imaging and gripping can save on cost, achieve better quality results in less time, and greatly facilitate the precision assembly reliability and automation of microstructures.
HBO Promotes the Differentiation of Neural Stem Cells via Interactions Between the Wnt3/β-Catenin and BMP2 Signaling Pathways
Authors: Chen Chongfeng , Yang Yujia , Yao Yue
Published: November 2019

Hyperbaric oxygen (HBO) therapy may promote neurological recovery from hypoxic-ischemic encephalopathy (HIE). However, the therapeutic effects of HBO and its associated mechanisms remain unknown. The canonical Wnt/β-catenin signaling pathways and bone morphogenetic protein (BMP) play important roles in mammalian nervous system development. The present study examined whether HBO stimulates the differentiation of neural stem cells (NSCs) and its effect on Wnt3/β-catenin and BMP2 signaling pathways. We showed HBO treatment (2 ATA, 60 min) promoted differentiation of NSCs into neurons and oligodendrocytes in vitro. In addition, rat hypoxic-ischemic brain damage (HIBD) tissue extracts also promoted the differentiation of NSCs into neurons and oligodendrocytes, with the advantage of reducing the number of astrocytes. These effects were most pronounced when these two were combined together. In addition, the expression of Wnt3a, BMP2, and β-catenin nuclear proteins were increased after HBO treatment. However, blockade of Wnt/β-catenin or BMP signaling inhibited NSC differentiation and reduced the expression of Wnt3a, BMP2, and β-catenin nuclear proteins. In conclusion, HBO promotes differentiation of NSCs into neurons and oligodendrocytes and reduced the number of astrocytes in vitro possibly through regulation of Wnt3/β-catenin and BMP2 signaling pathways. HBO may serve as a potential therapeutic strategy for treating HIE.
‘A Completely Open Race’: Anglo–Soviet Competition over German Military Science and Technology, 1944–1949
Authors: Hall Charlie
Published: November 2019

In the period immediately following the Second World War, during which Germany was occupied by the four victorious Allies, fierce competition erupted between them over the spoils of German military science and technology. Among this four-power squabbling, the British and Soviet authorities engaged in a particularly desperate struggle, especially over recruitment of expert German personnel, which they felt might give them the edge in any future conflict. This article explores the policies which arose from this struggle and shows that the first act of the Cold War arms race played out most vividly amongst the ruins of the Third Reich.
Hyponatremia With Intravenous Sulfamethoxazole/Trimethoprim in Children
Authors: Stephens Katy , Miller Jamie L. , Lewis Teresa V. , Neely Stephen , Johnson Peter N.
Published: November 2019

Background: Intravenous (IV) sulfamethoxazole/trimethoprim (SMX/TMP) has been associated with hyponatremia in adults. Objective: The primary objective was to identify the number of patients with a serum sodium <135 mEq/L. Secondary objectives between the hyponatremic versus nonhyponatremic groups included demographic comparisons, median serum sodium concentrations, SMX/TMP cumulative dose, number of diuretics, and other medications causing hyponatremia. Methods: This was a retrospective study of children <18 years receiving IV SMP/TMX. Comparisons were conducted via Mann-Whitney-Wilcoxon and Mantel-Haenszel χ2tests with an a priori P value <0.05. Results: Sixty-one patients received 66 total courses; 20 courses (30.3%) were associated with hyponatremia with a decrease in the median nadir serum sodium concentration of 133 and 138 mEq/L in the hyponatremic and nonhyponatremic groups, respectively ( P<0.001). The median age (interquartile range) was lower in the hyponatremic versus nonhyponatremic group, but this was not statistically significant: 0.6 (0.1-5.5) versus 3.9 (0.3-11.0) years; P=0.077. There was no significant difference in the median cumulative dose (mg/kg) between groups; P=0.104. In addition, there was a significant difference in the number of children in the hyponatremic versus nonhyponatremic groups receiving diuretics (16 [80.0%] vs 23 [50.0%], P=0.023) and other medications that cause hyponatremia (7 [35.0%] vs 5 [10.9%], P=0.034), respectively. Furosemide was noted to be the medication most associated with hyponatremia. Conclusion and Relevance: Approximately one-third administered IV SMX/TMP developed hyponatremia. Concomitant furosemide administration was one of the most common risk factors. Clinicians should be aware of this potential adverse event when initiating IV SMX/TMP in children.
Entanglement of Top-Down and Bottom-Up: Sociotechnical Innovation Pathways of Geothermal Energy in Switzerland
Authors: Ejderyan Olivier , Ruef Franziska , Stauffacher Michael
Published: November 2019

By looking at deep geothermal energy in Switzerland, this article illustrates how innovation pathways in federal countries take entangled forms between top-down and bottom-up. The Swiss federal government presents deep geothermal energy as an important technology to decarbonize electricity production. Setbacks in early projects have slowed these efforts. Despite strong policy incentives from the federal government, no electricity is being produced from geothermal projects in Switzerland in 2019. Based on four case studies, we analyze how some cantons and cities have taken different pathways: Rather than implementing federal objectives, they favor heat production instead of electricity generation. The relative success of these initiatives led federal authorities to modify their approach to promoting geothermal energy. This study shows that federal mechanisms and instruments alone are not enough to make energy infrastructures acceptable locally. To learn from bottom-up experiences and adapt federal policies to local reality, better coordination between the federal and subnational levels is needed.
Career Confidence: Fostering Professional Self-Efficacy Through Student-Run Agencies and Integrative Learning
Authors: Ranta Jeffrey A. , Davis Deborah , Bergstrom Andrea
Published: November 2019

This quantitative study investigates linkages between integrative learning experiences provided by student-run firms and fostering professional self-efficacy or the confidence to do one’s job effectively and efficiently. Based on a survey of 182 students involved in student-run agencies, this research measured students’ professional self-efficacy (confidence) in being able to perform 23 communication tasks. It also measures attribution respondents award to their student-run agency experiences in attaining that confidence. The study suggests changes to pedagogy and provides evidence for the effectiveness of student-run firms in preparing graduates for responsibilities in the professions of advertising, public relations, integrated communication, and strategic communication.
Advancing HIV Vaccine Research With Low-Cost High-Performance Computing Infrastructure: An Alternative Approach for Resource-Limited Settings
Authors: Mabvakure Batsirai M , Rott Raymond , Dobrowsky Leslie , Van Heusden Peter , Morris Lynn , Scheepers Cathrine , Moore Penny L
Published: November 2019

Next-generation sequencing (NGS) technologies have revolutionized biological research by generating genomic data that were once unaffordable by traditional first-generation sequencing technologies. These sequencing methodologies provide an opportunity for in-depth analyses of host and pathogen genomes as they are able to sequence millions of templates at a time. However, these large datasets can only be efficiently explored using bioinformatics analyses requiring huge data storage and computational resources adapted for high-performance processing. High-performance computing allows for efficient handling of large data and tasks that may require multi-threading and prolonged computational times, which is not feasible with ordinary computers. However, high-performance computing resources are costly and therefore not always readily available in low-income settings. We describe the establishment of an affordable high-performance computing bioinformatics cluster consisting of 3 nodes, constructed using ordinary desktop computers and open-source software including Linux Fedora, SLURM Workload Manager, and the Conda package manager. For the analysis of large antibody sequence datasets and for complex viral phylodynamic analyses, the cluster out-performed desktop computers. This has demonstrated that it is possible to construct high-performance computing capacity capable of analyzing large NGS data from relatively low-cost hardware and entirely free (open-source) software, even in resource-limited settings. Such a cluster design has broad utility beyond bioinformatics to other studies that require high-performance computing.
‘It’s So Hard Not to be Funny in This Situation’: Memes and Humor in U.S. Youth Online Political Expression
Authors: Penney Joel
Published: November 2019

In light of the promise of humorous political memes as popular routes to citizen empowerment as well as concerns over their potential dangers, it is necessary to examine how everyday citizens make sense of their role in political expression and how they engage with them—or not—in their everyday social media activities. This focus group study explores these questions by focusing on the digital practices of U.S. young adults. The findings suggest a range of benefits of posting political memes and humor online, including building solidarity with likeminded peers and reinforcing communal identity, as well as advancing accessible and influential political critiques. However, these positive assessments are complicated by concerns over the relationship between political meme humor and threats of trivialization and hyper-polarization, which limit some users from participating in its circulation and lead them to seek alternative modes of online engagement that are perceived as more civically valuable.
Flood-fill-based object segmentation and tracking for intelligent vehicles
Authors: Chu Phuong Minh , Cho Seoungjae , Huang Kaisi , Cho Kyungeun
Published: November 2019

In this article, an application for object segmentation and tracking for intelligent vehicles is presented. The proposed object segmentation and tracking method is implemented by combining three stages in each frame. First, based on our previous research on a fast ground segmentation method, the present approach segments three-dimensional point clouds into ground and non-ground points. The ground segmentation is important for clustering each object in subsequent steps. From the non-ground parts, we continue to segment objects using a flood-fill algorithm in the second stage. Finally, object tracking is implemented to determine the same objects over time in the final stage. This stage is performed based on likelihood probability calculated using features of each object. Experimental results demonstrate that the proposed system shows effective, real-time performance.
How Behavioral Economics and Nudges Could Help Diminish Irrationality in Suicide-Related Decisions
Authors: Bauer Brian W. , Capron Daniel W.
Published: November 2019

People regularly make decisions that are not aligned with their own self-interests. These irrational decisions often stem from humans having bounded rationality (e.g., limited computational power), which produces reliable cognitive biases that occur outside of people’s awareness and influences the decisions people make. There are many important decisions leading up to a suicide attempt, and it is likely that these same biases exist within suicide-related decisions. This article presents an argument for the likely existence of cognitive biases within suicide-related decision making and how they may influence people to make irrational decisions. In addition, this article provides new evidence for using a behavioral economic intervention—nudges—as a potential way to combat rising suicide rates. We explore how nudges can help increase means safety, disseminate suicide prevention skills/materials, diminish well-known biases (e.g., confirmation bias), and uncover biases that may be occurring when making suicide-related decisions.
Perioperative management of patients with rheumatoid arthritis undergoing orthopaedic surgery
Authors: Agarwal Nikhil , Kamaraj Achi , McDonnell Stephen , Khan Wasim
Published: November 2019

Rheumatoid arthritis is an autoimmune disease which is characterised by systemic inflammation. In the recent decades, the advent of disease modifying anti-rheumatic drugs have reduced the need for orthopaedic procedures. However, there are numerous patients in which pharmacological treatment fails and these patients require surgical intervention. Complications can arise due to the underlying pathology and multitude of medications these patients can be on, specifically increased infection rates due to use of immunosuppressive agents. An understanding into the disease itself, as well as perioperative management, may improve overall patient outcomes and prevent future complications.
Validation of the integrative model of adjustment to chronic conditions: Applicability to adult-onset epilepsy
Authors: Hammond LD , Farrington AP , Kılınç S
Published: November 2019

Adapting to life with adult-onset epilepsy is a challenge and there is a need for better interventions to support people, who have difficulty with psychosocial adjustment to the condition. The integrative model of adjustment to chronic conditions was developed for type 2 diabetes. This study aimed to demonstrate the applicability of the model to adult-onset epilepsy and thus make an original contribution to the development of relevant interventions. Qualitative data from a previous phenomenological study on the experience of adult-onset epilepsy were mapped onto the integrative model of adjustment to chronic conditions using framework analysis. Ten of the original 39 datasets were selected. All 10 datasets were from females diagnosed with epilepsy within 5 years before participation in the original study. The results demonstrated applicability of the integrative model of adjustment to chronic conditions after minor revisions to the model. These findings support further development of the integrative model of adjustment to chronic conditions for use as a clinical intervention for people with adult-onset epilepsy.
A Note on Concavity Conditions of Cobb–Douglas and CES Production Function with at Least Two Inputs
Authors: Kojić Vedran
Published: November 2019

In microeconomics, the strict concavity is a very important property of a production function. In 2010, Avvakumov et al. gave a necessary and sufficient condition for the strict concavity of the Cobb–Douglas and constant elasticity of substitution (CES) production function with at least two inputs. To derive these conditions, the negative definiteness of the Hessian for both production functions was examined using certain recurrences for the principal corner minors. The purpose of this note is to complement the proof of Avvakumov, Kiselev, Orlov & Taras’ev ( 2010 , Computational Mathematics and Modeling, 21(3), 336–378) by showing that the use of recurrences and mathematical induction is not necessary, and that a necessary and sufficient condition for the strict concavity can be obtained by considering a particular square matrix, whose determinant can be calculated directly using the rule for the determinant of a lower or upper triangular matrix.

JEL Classifications: C60, C65, D21, D24
Self-Regulated Learning in Online Graduate Business Communication Courses: A Qualitative Inquiry
Authors: Flynn Catherine , Olson Joel , Reinhardt Michelle
Published: November 2019

This qualitative study reviewed student application of self-regulated learning (SRL) processes in self-paced graduate business communication courses. It was preceded by a quantitative analysis of the same courses. In both studies, researchers sought to understand student experience in a self-paced learning environment, and how this experience demonstrated SRL and increased student performance. Neither study established a clear connection between a self-paced learning environment, SRL, and student performance. However, both studies confirmed the importance of student predisposition for the cyclical phases of preparation, performance, and appraisal and highlighted the critical role of support in readying students for learning strategy changes.
Effects of Acquired Aphasia on the Recognition of Speech Under Energetic and Informational Masking Conditions
Authors: Villard Sarah , Kidd Gerald
Published: November 2019

Persons with aphasia (PWA) often report difficulty understanding spoken language in noisy environments that require listeners to identify and selectively attend to target speech while ignoring competing background sounds or “maskers.” This study compared the performance of PWA and age-matched healthy controls (HC) on a masked speech identification task and examined the consequences of different types of masking on performance. Twelve PWA and 12 age-matched HC completed a speech identification task comprising three conditions designed to differentiate between the effects of energetic and informational masking on receptive speech processing. The target and masker speech materials were taken from a closed-set matrix-style corpus, and a forced-choice word identification task was used. Target and maskers were spatially separated from one another in order to simulate real-world listening environments and allow listeners to make use of binaural cues for source segregation. Individualized frequency-specific gain was applied to compensate for the effects of hearing loss. Although both groups showed similar susceptibility to the effects of energetic masking, PWA were more susceptible than age-matched HC to the effects of informational masking. Results indicate that this increased susceptibility cannot be attributed to age, hearing loss, or comprehension deficits and is therefore a consequence of acquired cognitive-linguistic impairments associated with aphasia. This finding suggests that aphasia may result in increased difficulty segregating target speech from masker speech, which in turn may have implications for the ability of PWA to comprehend target speech in multitalker environments, such as restaurants, family gatherings, and other everyday situations.
Burden of headache disorders in China, 1990–2017: findings from the Global Burden of Disease Study 2017
Authors: Yao Chengye , Wang Yu , Wang Lijun , Liu Yunning , Liu Jiangmei , Qi Jinlei , Lin Yun , Yin Peng , Zhou Maigeng
Published: November 2019

Background

Headache has emerged as a global public health concern. However, little is known about the burden from headache disorders in China. The aim of this work was to quantify the spatial patterns and temporal trends of burden from headache disorders in China.

Methods

Following the general analytic strategy used in the 2017 Global Burden of Disease study, we analyzed the prevalence and years lived with disability (YLDs) of headache and its main subcategories, including migraine and tension-type headache (TTH), by age, sex, year and 33 province-level administrative units in China from 1990 to 2017.

Results

Almost 112.4 million individuals were estimated to have headache disorders in 1990 in China, which rose to 482.7 million in 2017. The all-age YLDs increased by 36.2% from 1990 to 2017. Migraine caused 5.5 million YLDs, much higher than TTH (1.1 million) in 2017. The age-standardized prevalence and YLDs rate of headache remained stable and high in 2017 compared with 1990, respectively. The proportion of total headache YLDs in all diseases increased from 1990 to 2017 by 5.4%. A female preponderance was observed for YLDs and the YLDs were mainly in people aged 20~54 years.

Conclusions

Headache remains a huge health burden in China from 1990 to 2017, with prevalence and YLDs rates higher in eastern provinces than western provinces. The substantial increase in headache cases and YLDs represents an ongoing challenge in Chinese population. Our results can help shape and inform headache research and public policy throughout China, especially for females and middle-aged people.
Early continuous ultrafiltration in Chinese patients with congestive heart failure (EUC-CHF): study protocol for an open-label registry-based prospective clinical trial
Authors: Yang Ying , Shen Chao , Lu Jiangting , Xu Fen , Tong Jinshan , Jiang Jiangfen , Fu Guosheng
Published: November 2019

Background

Conventional pharmacologic therapies aim to reduce fluid overload in advanced heart failure (HF) represented by intravenous (IV) loop diuretics (LDs) have sometimes not so efficacious and been reported to have side effects such as unpredictable removal of water and sodium and electrolyte disturbance. It is not certain whether early ultrafiltration (UF) is effective than LDs in relieving edema. Given the weakness of evidence for early UF in patients with fluid overload, recommendations of UF in guidelines is considered as second-line therapy only for patients with refractory congestion, who failed to respond to LD-based strategies.

Methods

The early continuous ultrafiltration in Chinese patients with congestive heart failure (EUC-CHF) trial is an open-label, registry-based, prospective study, recruiting patients with severe acute decompensated HF who are hospitalized for HF worsening due to overt fluid overload 24 h from hospital admission. Forty patients will be enrolled to two treatment groups (n = 20 for each group). The primary outcomes are the changes of weight loss and dyspnea severity score after treatment, as well as the occurrence of clinically overt major bleeding.

Discussion

EUC-CHF trial was primarily designed to evaluate the efficacy and safety of early UF in patients with acute decompensated HF to reduce volume overload and improve clinical outcome. The trial aims to determine if early UF in acute HF is superior to IV LDs in clinical parameter improvement without adverse events and prevents rehospitalization up to 30 days. Also the trial is expected to establish a scoring system based on Chinese population to guide early UF treatment in appropriate patients. EUC-CHF is one of the first controlled trials tailored to determine the benefit of UF with 24 h from hospital admission.

Trial registration

www.chictr.org.cn, ChiCTR1800019556. Registered on 18 November 2018.
The association between circulating 25-hydroxyvitamin D and cardiovascular diseases: a meta-analysis of prospective cohort studies
Authors: Gholami Fatemeh , Moradi Ghobad , Zareei Bushra , Rasouli Mohammad Aziz , Nikkhoo Bahram , Roshani Daem , Ghaderi Ebrahim
Published: November 2019

Background

There is a controversy about the association between vitamin D and cardiovascular diseases (CVDs). The effect of serum 25-OH-vitD on the risk of CVDs was evaluated.

Methods

Major electronic databases including Scopus, Science Direct, and PubMed were searched. All prospective cohort studies on the relationship between vitamin D status and CVDs conducted between April 2000 and September 2017 were included, regardless language. The study participants were evaluated regardless of their age, sex, and ethnicity. The Newcastle-Ottawa Scale was used to assess the quality of the studies. Two investigators independently selected the studies and extracted the data. The designated effects were risk ratio (RR) and hazard ratio (HR). The random effects model was used to combine the results.

Results

A meta-analysis of 25 studies with 10,099 cases of CVDs was performed. In general, a decrease in the level of vitamin D was associated with a higher relative risk of CVDs (incidence-mortality combined) (RR = 1.44, 95% CI: 1.24–1.69). This accounts for 54% of CVDs mortality rate (RR = 1.54, 95% CI: 1.29–1.84(. However, no significant relationship was observed between the vitamin D status and incidence of CVDs (RR = 1.18, 95% CI: 1–1.39). In general, low serum vitamin D level increased the risk of CVD by 44% (RR = 1.44, 95% CI: 1.24–1.69). It also increased the risk of CVD mortality (RR = 1.54, 95% CI: 1.29–1.84) and incidence rates (RR = 1.18, 95% CI: 1–1.39).

Conclusions

The findings showed that vitamin D deficiency increases the CVDs mortality rate. Due to the limited number of studies on patients of the both genders, further research is suggested to separately evaluate the effect of vitamin D status on CVD in men and women.
Screening and computational analysis of colorectal associated non-synonymous polymorphism in CTNNB1 gene in Pakistani population
Authors: Razak Suhail , Bibi Nousheen , Dar Javid Ahmad , Afsar Tayyaba , Almajwal Ali , Parveen Zahida , Jahan Sarwat
Published: November 2019

Background

Colorectal cancer (CRC) is categorized by alteration of vital pathways such as β-catenin(CTNNB1) mutations,WNTsignaling activation,tumor protein 53 (TP53) inactivation,BRAF, Adenomatous polyposis coli (APC) inactivation,KRAS, dysregulation of epithelial to mesenchymal transition (EMT) genes,MYCamplification, etc. In the present study an attempt was made to screenCTNNB1gene in colorectal cancer samples from Pakistani population and investigated the association ofCTNNB1gene mutations in the development of colorectal cancer.

Methods

200 colorectal tumors approximately of male and female patients with sporadic or familial colorectal tumors and normal tissues were included. DNA was extracted and amplified through polymerase chain reaction (PCR) and subjected to exome sequence analysis. Immunohistochemistry was done to study protein expression. Molecular dynamic (MD) simulations of CTNNB1WTand mutant S33F and T41A were performed to evaluate the stability, folding, conformational changes and dynamic behaviors of CTNNB1 protein.

Results

Sequence analysis revealed two activating mutations (S33F and T41A) in exon 3 ofCTNNB1gene involving the transition of C.T and A.G at amino acid position 33 and 41 respectively (p.C33T and p.A41G). Immuno-histochemical staining showed the accumulation of β-catenin protein both in cytoplasm as well as in the nuclei of cancer cells when compared with normal tissue. Further molecular modeling, docking and simulation approaches revealed significant conformational changes in the N-terminus region of normal to mutantCTNNB1gene critical for binding with Glycogen synthase kinase 3-B (GSK3) and transducin containing protein1 (TrCp1).

Conclusion

Present study on Pakistani population revealed an association of two non-synonymous polymorphisms in theCTNNB1gene with colorectal cancer. These genetic variants led to the accumulation of theCTNNB1, a hallmark of tumor development. Also, analysis of structure to function alterations inCTNNB1gene is crucial in understanding downstream biological events.
A logistic regression analysis of risk factors in ME/CFS pathogenesis
Authors: Lacerda Eliana M. , Geraghty Keith , Kingdon Caroline C. , Palla Luigi , Nacul Luis
Published: November 2019

Background

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex disease, whose exact cause remains unclear. A wide range of risk factors has been proposed that helps understanding potential disease pathogenesis. However, there is little consistency for many risk factor associations, thus we undertook an exploratory study of risk factors using data from the UK ME/CFS Biobank participants. We report on risk factor associations in ME/CFS compared with multiple sclerosis participants and healthy controls.

Methods

This was a cross-sectional study of 269 people with ME/CFS, including 214 with mild/moderate and 55 with severe symptoms, 74 people with multiple sclerosis (MS), and 134 healthy controls, who were recruited from primary and secondary health services. Data were collected from participants using a standardised written questionnaire. Data analyses consisted of univariate and multivariable regression analysis (by levels of proximity to disease onset).

Results

A history of frequent colds (OR = 8.26, P <= 0.001) and infections (OR = 25.5, P = 0.015) before onset were the strongest factors associated with a higher risk of ME/CFS compared to healthy controls. Being single (OR = 4.41, P <= 0.001), having lower income (OR = 3.71, P <= 0.001), and a family history of anxiety is associated with a higher risk of ME/CFS compared to healthy controls only (OR = 3.77, P < 0.001). History of frequent colds (OR = 6.31, P < 0.001) and infections before disease onset (OR = 5.12, P = 0.005), being single (OR = 3.66, P = 0.003) and having lower income (OR = 3.48, P = 0.001), are associated with a higher risk of ME/CFS than MS. Severe ME/CFS cases were associated with lower age of ME/CFS onset (OR = 0.63, P = 0.022) and a family history of neurological illness (OR = 6.1, P = 0.001).

Conclusions

Notable differences in risk profiles were found between ME/CFS and healthy controls, ME/CFS and MS, and mild-moderate and severe ME/CFS. However, we found some commensurate overlap in risk associations between all cohorts. The most notable difference between ME/CFS and MS in our study is a history of recent infection prior to disease onset. Even recognising that our results are limited by the choice of factors we selected to investigate, our findings are consistent with the increasing body of evidence that has been published about the potential role of infections in the pathogenesis of ME/CFS, including common colds/flu.
Traumatic optic neuropathy-associated progressive thinning of the retinal nerve fiber layer and ganglion cell complex: two case reports
Authors: Lee Won June , Hong Eun Hee , Park Hae Min , Lim Han Woong
Published: November 2019

Background

Traumatic optic neuropathy (TON) is a form of optic nerve injury that occurs secondary to trauma and is etiologically associated with acute axonal loss with severe vision loss. Here, we reported longitudinal changes in the peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell complex (GCC) using wide-field swept source optical coherence tomography (SS-OCT) in two cases of TON and identified the source of the damage.

Case presentation

(Case 1) A 65-year-old man was admitted to the hospital due to an injury in the right eye (OD) and was subsequently diagnosed with indirect TON. He was then treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 day, 2 days, 1 week, 1 month, and 4 months. The wide-field deviation map detected thinning earlier in the macular GCC than in the peripapillary RNFL. (Case 2) A 63-year-old man was admitted to the hospital with a fractured left maxilla-zygomatic complex attributed to blunt-force trauma to the head and loss of vision in his left eye (OS). He was diagnosed with indirect TON and treated with high-doses of intravenous steroids. Wide-field SS-OCT was performed at the baseline and after 1 week, 2 weeks, 2 months 5 months, and 7 months. The wide-field deviation map detected thinning earlier in the peripapillary RNFL than in the macular GCC.

Conclusions

Wide-field SS-OCT facilitated the identification of various sequential progression patterns in patients with TON. Furthermore, the area in which the structural damage was first detected was seen differently in the peripapillary and macular deviation maps for each case. Thus, wide-field imaging, which includes the macular and peripapillary areas, are useful in monitoring TON.
Does internet use affect levels of depression among older adults in China? A propensity score matching approach
Authors: Wang Yean , Zhang Huan , Feng Tong , Wang Hongyang
Published: November 2019

Background

Emerging research on the use of new technology suggests that internet use is generally associated with high levels of efficiency among older adults in the following areas: quality of life, mood, positive psychological well-being, and the individual and societal costs of caring for them. However, there is little empirical evidence specifically concerning the causal effects of older adults’ internet use on their depression level. There is a need for more replication studies to help confirm that the emerging evidence on the impact of internet use is accurate and applicable to different populations and in different situations.

Method

Using national data from the China Family Panel Study in 2016, this study helps to fill the above mentioned research gap. This study followed a two-step analytical strategy to empirically examine the association between internet use and reported depression in older adults. In the first step, we estimated a binary logistic regression model with internet use as the dependent variable and 8 demographic and socioeconomic factors as the confounding variables. In the second step, we performed a propensity score analysis to control for potential bias using the confounding variables confirmed in the first step.

Results

The results show that older adults who reported internet use have lower depression levels than did those who did not use the internet, with adjustments made for gender, age, urban or rural residence, pension status, educational background, physical health, life satisfaction, and intelligence level.

Conclusion

These findings suggest that it is critical to advocate for technology-based policies and programs that promote older adults’ internet use to improve their social well-being, which can also serve as a policy strategy to help alleviate older adults’ depression.
Patterns of brain structural alteration in COPD with different levels of pulmonary function impairment and its association with cognitive deficits
Authors: Yin Minmin , Wang Haibao , Hu Xianwei , Li Xiaoshu , Fei Guanghe , Yu Yongqiang
Published: November 2019

Background

To explore patterns of brain structural alteration in chronic obstructive pulmonary disease (COPD) patients with different levels of lung function impairment and the associations of those patterns with cognitive functional deficits using voxel-based morphometry (VBM) and tract-based spatial statistics (TBSS) analyses based on high-resolution structural MRI and diffusion tensor imaging (DTI).

Methods

A total of 115 right-handed participants (26 severe, 29 moderate, and 29 mild COPD patients and a comparison group of 31 individuals without COPD) completed tests of cognitive (Montreal Cognitive Assessment [MoCA]) and pulmonary function (forced expiratory volume in 1 s [FEV1]) and underwent MRI scanning. VBM and TBSS analyses were used to identify changes in grey matter density (GMD) and white matter (WM) integrity in COPD patients. In addition, correlation analyses between these imaging parameter changes and cognitive and pulmonary functional impairments were performed.

Results

There was no significant difference in brain structure between the comparison groups and the mild COPD patients. Patients with moderate COPD had atrophy of the left middle frontal gyrus and right opercular part/triangular part of the inferior frontal gyrus, and WM changes were present mainly in the superior and posterior corona radiata, corpus callosum and cingulum. Patients with severe COPD exhibited the most extensive changes in GMD and WM. Some grey matter (GM) and WM changes were correlated with MoCA scores and FEV1.

Conclusions

These findings suggest that patients with COPD exhibit progressive structural impairments in both the GM and the WM, along with impaired levels of lung function, highlighting the importance of early clinical interventions.
Evaluation of tibial tunnel placement in single case posterior cruciate ligament reconstruction: reducing the graft peak stress may increase posterior tibial translation
Authors: Wang Zhiqiang , Xiong Yan , Li Qi , Chen Gang , Zhang Zhong , Tang Xin , Li Jian
Published: November 2019

Background

The killer turn has been documented as the primary drawback of posterior cruciate ligament (PCL) reconstruction. Fanelli advocated placing the tibial tunnel outlet in the inferior lateral part of the PCL fovea to reduce the killer turn. This study aimed to confirm the validity of Fanelli’s viewpoint regarding PCL reconstruction technique and to assess the specific Fanelli tunnel area on the inferior lateral part of the PCL fovea.

Methods

The geometrical data of the model were obtained by nuclear magnetic resonance (MRI) and computerized tomography (CT), with images taken from a healthy Chinese volunteer. The three-dimensional finite element model of the knee joint was established using Mimics, Geomagic Studio, 3-matic, and Ansys software. The finite analysis was performed after the material behavior, contact and boundary conditions, and loading were defined. The drawer tests were simulated with a posterior tibial load of 134 N at 0°, 30°, 60°, and 90° knee flexion. The PCL peak stress and tibial translation were recorded and compared among the 30 distinct tibial tunnel loci over a range of angles from 0° to 90°.

Results

In the area (Fanelli area, 5–20 mm inferior and 5–10 mm lateral to the PCL anatomical insertion), the lowest PCL peak stress in all sites with different flexion angles was lower than that of the PCL anatomical insertion site. The lowest PCL peak stress with different knee flexion angles was observed in the following location: 10 mm inferior and 5 mm lateral to the PCL anatomical insertion. In the Fanelli area, the tibial translations of three sites were lower and those of other sites were higher than that of the PCL anatomical insertion site.

Conclusions

PCL reconstruction in the Fanelli area, especially 10 mm inferior and 5 mm lateral to the PCL anatomical insertion, could reduce the peak stress of the graft and may reduce the killer turn. However, whether the posterior stability of the knee is affected needs to be further studied.
The mid-long term results of reconstructional cage and morselized allografts combined application for the Paprosky type III acetabular bone defects in revision hip arthroplasty
Authors: Xiao Qiang , Wang Haoyang , Zhou Kai , Wang Duan , Ling Tingxian , Pei Fuxing , Zhou Zongke
Published: November 2019

Background

Severe acetabular bone defects is a complex problem in revision hip arthroplasty, cage is one of the reconstruction options. The purpose of this study is to report the mid-long term clinical and radiographic results of Paprosky type III acetabular bone defects revised with reconstructional cage and morselized allogeneic cancellous bone graft without impaction.

Methods

We retrospectively analyzed 28 patients who underwent revision hip arthroplasty with reconstructional cage and allogeneic cancellous bone graft between January 2007 and January 2016. There were 13 Paprosky type IIIA bone defect patients and 15 Paprosky type IIIB bone defect patients and 4 patients of the 15 were also with pelvic discontinuity. Clinical assessment included Harris Hip Score (HHS) and Short Form-12 (SF-12). Radiographic assessment included center of rotation, cage migration, and bone graft incorporation.

Results

All patients were followed up with a mean follow-up of 79.5 months (range 38–141), HHS improved from 31.4 (13–43) points preoperatively to 84.6 (55–94) points at last follow-up and SF-12 also improved significantly. There was 1 re-revision for the cage loosening and screw breakage at 61 months after surgery, and 2 patients had nonprogressive radiolucency in zone III and the junction of zone II and zone III at the bone implant interface.

Conclusion

The reconstructional cage combining with morselized allografts without impaction achieves a good result with a high complete allograft incorporation rate in Paprosky type III acetabular bone defects.
Training the next generation of Africa’s doctors: why medical schools should embrace the team-based learning pedagogy
Authors: Odongo Charles Okot , Talbert-Slagle Kristina
Published: November 2019

Background

As far back as 1995, the Cape Town Declaration on training Africa’s future doctor recognized the need for medical schools to adopt active-learning strategies in order to nurture holistic development of the doctor. However, medical education in Africa remains largely stuck with traditional pedagogies that emphasize the ‘hard skills’ such as knowledge and clinical acumen while doing little to develop ‘soft skills’ such as effective communication, teamwork, critical thinking or life-long learning skills.

Body of abstract

By reviewing literature on Africa’s epidemiologic and demographic transitions, we establish the need for increasing the output of well-trained doctors in order to match the continent’s complex current and future healthcare needs. Challenges that bedevil African medical education such as outdated curricula, limited educational infrastructure and chronic resource constraints are presented and discussed. Furthermore, increased student enrollments, a trend observed at many schools, coupled with chronic faculty shortages have inadvertently presented specific barriers against the success of small-group active-learning strategies such as Problem-Based and Case-Based Learning. We argue that Team-Based Learning (TBL) offers a robust alternative for delivering holistic medical education in the current setting. TBL is instructor-driven and embodies key attributes that foster development of both ‘hard’ and ‘soft’ skills. We elaborate on advantages that TBL is likely to bring to the African medical education landscape, including increased learner enthusiasm and creativity, accountability, peer mentorship, deep learning and better knowledge retention. As with all new pedagogical methods, challenges anticipated during initial implementation of TBL are discussed followed by the limited pilot experiences with TBL in Africa.

Conclusion

For its ability to enable a student-centered, active learning experience delivered at minimum cost, we encourage individual instructors and African medical schools at large, to adopt TBL as a complementary strategy towards realizing the goal of training Africa’s fit-for-purpose doctor.
Smart pumps improve medication safety but increase alert burden in neonatal care
Authors: Melton Kristin R. , Timmons Kristen , Walsh Kathleen E. , Meinzen-Derr Jareen K. , Kirkendall Eric
Published: November 2019

Background

Smart pumps have been widely adopted but there is limited evidence to understand and support their use in pediatric populations. Our objective was to assess whether smart pumps are effective at reducing medication errors in the neonatal population and determine whether they are a source of alert burden and alert fatigue in an intensive care environment.

Methods

Using smart pump records, over 370,000 infusion starts for continuously infused medications used in neonates and infants hospitalized in a level IV NICU from 2014 to 2016 were evaluated. Attempts to exceed preset soft and hard maximum limits, percent variance from those limits, and pump alert frequency, patterns and salience were evaluated.

Results

Smart pumps prevented 160 attempts to exceed the hard maximum limit for doses that were as high as 7–29 times the maximum dose and resulted in the reprogramming or cancellation of 2093 infusions after soft maximum alerts. While the overall alert burden from smart pumps for continuous infusions was not high, alerts clustered around specific patients and medications, and a small portion (17%) of infusions generated the majority of alerts. Soft maximum alerts were often overridden (79%), consistent with low alert salience.

Conclusions

Smart pumps have the ability to improve neonatal medication safety when compliance with dose error reducing software is high. Numerous attempts to administer high doses were intercepted by dosing alerts. Clustered alerts may generate a high alert burden and limit safety benefit by desensitizing providers to alerts. Future efforts should address ways to improve alert salience.
Workload and influencing factors in non-emergency medical transfers: a multiple linear regression analysis of a cross-sectional questionnaire study
Authors: Keunecke Johann Georg , Gall Christine , Birkholz Torsten , Moritz Andreas , Eiche Christian , Prottengeier Johannes
Published: November 2019

Background

Human workload is a key factor for system performance, but data on emergency medical services (EMS) are scarce. We investigated paramedics’ workload and the influencing factors for non-emergency medical transfers. These missions make up a major part of EMS activities in Germany and are growing steadily in number.

Methods

Paramedics rated missions retrospectively through an online questionnaire. We used the NASA-Task Load Index (TLX) to quantify workload and asked about a variety of medical and procedural aspects for each mission. Teamwork was assessed by the Weller teamwork measurement tool (TMT). With a multiple linear regression model, we identified a set of factors leading to relevant increases or decreases in workload.

Results

A total of 194 non-emergency missions were analysed. Global workload was rated low (Mean = 27/100). In summary, 42.8% of missions were rated with a TLX under 20/100. TLX subscales revealed low task demands but a very positive self-perception of performance (Mean = 15/100). Teamwork gained high ratings (Mean TMT = 5.8/7), and good teamwork led to decreases in workload. Aggression events originating from patients and bystanders occurred frequently (n = 25, 12.9%) and increased workload significantly. Other factors affecting workload were the patient’s body weight and the transfer of patients with transmittable pathogens.

Conclusion

The workload during non-emergency medical transfers was low to very low, but performance perception was very positive, and no indicators of task underload were found. We identified several factors that led to workload increases. Future measures should attempt to better train paramedics for aggression incidents, to explore the usefulness of further technical aids in the transfer of obese patients and to reconsider standard operating procedures for missions with transmittable pathogens.