bluuebunny/crossref_metadata_2025 huggingface dataset:
Differentiation of renal angiomyolipoma without visible fat from renal cell carcinoma by machine learning based on whole-tumor computed tomography texture features
Authors: Cui En-Ming , Lin Fan , Li Qing , Li Rong-Gang , Chen Xiang-Meng , Liu Zhuang-Sheng , Long Wan-Sheng
Published: February 2019

Background

Morphological findings showed poor accuracy in differentiating angiomyolipoma without visible fat (AMLwvf) from renal cell carcinoma (RCC).

Purpose

To determine the performance of a machine learning classifier in differentiating AMLwvf from different subtypes of RCC based on whole-tumor slices of CT images.

Material and Methods

In this retrospective study, 171 pathologically proven renal masses were collected from a single institution. Texture features were extracted from whole-tumor images in three phases including the pre-contrast (PCP), corticomedullary (CMP), and nephrographic (NP) phases. A support vector machine with the recursive feature elimination method based on fivefold cross-validation (SVM-RFECV) with the synthetic minority oversampling technique (SMOTE) was utilized to establish classifiers for differentiating AMLwvf from all subtypes of RCC (all-RCC), clear cell RCC (ccRCC), and non-ccRCC. The performances of the classifiers based on three-phase and single-phase images were compared with each other and morphological interpretations.

Results

A machine learning classifier achieved the best performance in differentiating AMLwvf from all-RCC, ccRCC, and non-ccRCC. The performance of the best machine learning classifier for differentiating AMLwvf from all-RCC (area under the curve [AUC] = 0.96) and ccRCC (AUC = 0.97) was higher than that for differentiating AMLwvf from non-ccRCC (AUC = 0.89); morphological interpretations achieved lower performance for differentiating AMLwvf from all-RCC (AUC = 0.67), ccRCC (AUC = 0.68), and non-ccRCC (AUC = 0.64).

Conclusion

Machine learning can be a useful non-invasive technique for differentiating AMLwvf from all-RCC, ccRCC, and non-ccRCC, and it can be more accurate than morphological interpretation by radiologists.
Dandy–Walker syndrome associated with syringomyelia in an adult: a case report and literature review
Authors: Zhang Nan , Qi Zhenyu , Zhang Xuewen , Zhong Fangping , Yao Hui , Xu Xiang , Liu Jiangang , Huang Yulun
Published: February 2019

Dandy–Walker syndrome associated with syringomyelia is a rare condition, with few reports of adult cases. We describe an adult case of Dandy–Walker syndrome with concomitant syringomyelia. A 33-year-old man presented with a 3-month history of walking instability, numbness in the hands, memory deterioration, and urinary incontinence. A physical examination showed a positive Romberg sign. Brain computed tomography and magnetic resonance imaging showed hydrocephalus, a cyst in the posterior fossa, absence of the cerebellar vermis, hypoplasia of the corpus callosum and cerebella, and syringomyelia. All of these symptoms were consistent with the diagnosis of Dandy–Walker syndrome. Surgery involving arachnoid adhesiolysis and endoscopic third ventriculostomy was performed. At the 6-month follow-up, the symptoms were completely relieved. Magnetic resonance imaging showed that syringomyelia was greatly reduced and the hydrocephalus remained unchanged. Dandy–Walker syndrome with concomitant syringomyelia in adults is exceedingly rare. Early diagnosis and appropriate surgical treatment of this condition should be highlighted. Combined arachnoid adhesiolysis and endoscopic third ventriculostomy may be an effective approach.
Histologic transformation to small-cell lung cancer following gefitinib and radiotherapy in a patient with pulmonary adenocarcinoma
Authors: Fiore Michele , Trecca Pasquale , Perrone Giuseppe , Amato Michelina , Righi Daniela , Trodella Lucio , D’Angelillo Rolando M. , Ramella Sara
Published: February 2019

Introduction:

Targeted therapies against epidermal growth factor receptor (EGFR) have revolutionized the treatment of a subset of lung adenocarcinomas that have EGFR-activating mutations; however, all patients treated with EGFR tyrosine kinase inhibitors (TKIs) ultimately develop resistance. Histologic transformation of EGFR-mutant adenocarcinoma to small cell lung cancer (SCLC) is a resistance mechanism rarely reported in the literature.

Case presentation:

We describe the case of a woman with metastatic lung cancer adenocarcinoma with mutated EGFR with an initial response to gefitinib and radiation therapy, who progressed after 18 months due to the development of a resistance mechanism. The new biopsy performed after progression highlighted histologic transformation to SCLC, while maintaining the original EGFR mutation.

Conclusions:

To better identify patients who progress after TKIs and radiation therapy, it is important to perform tumor rebiopsy and collect data to study mechanisms of acquired EGFR TKI resistance.
A rare testicular tumor: primary carcinoid tumor
Authors: Darré Tchin , Doukouré Brahima , Kouyaté Mohamed , Djiwa Toukilnan , Kwamé Doh , Napo-Koura Gado
Published: February 2019

Background:

Primary carcinoid tumors are rare and constitute 0.23% of all testicular tumors. We report a case of primary carcinoid tumor of testicular localization, with a review of the literature.

Case presentation:

A 29-year-old man, without specific ascendants, consulted the urology department for progressive scrotal swelling of 6 months, associated with pain. After surgery, histology showed diffuse tumor proliferation composed of small round monotone cells with hyperchromatic nuclei evoking undifferentiated carcinoma. Immunohistochemistry showed that tumor cells were positive for chromogranin A and negative for placental alkaline phosphatase and α-fetoprotein.

Conclusion:

Primary neuroendocrine carcinoma of the testis is a very rare malignant tumor. Immunohistochemistry contributes to its diagnosis in relation to other metastatic neuroendocrine carcinomas, carcinoid tumor teratomas, seminoma, and Sertoli cells.
Differential diagnosis between bone relapse of breast cancer and lambda light chain multiple myeloma: role of the clinical biochemist
Authors: Mastroianni Antonio , Panella Rossella , Morelli Daniele
Published: February 2019

Purpose:

The integration of expertise between oncologist and clinical biochemist for the monitoring and diagnosis of plasma cell dyscrasia is crucial. In some cases, medical laboratory scientists can provide an original contribution using the appropriate techniques to arrive at a diagnosis.

Methods:

We report a case of 67-year-old woman who was admitted to our hospital for bone pain. Imaging studies showed multiple diffuse bone lytic lesions, and a laboratory screen revealed anemia and altered creatinemia; serum capillary zone electrophoresis confirmed a monoclonal peak in the γ-zone that had been known since 2011, typed as immunoglobulin G kappa by immunosubtraction electrophoresis. The patient had undergone surgery for breast cancer in 2013, and based on her clinical history, the oncologist suspected the presence of bone metastases from the breast cancer and opted for relative therapy. Immunosubtraction, however, showed a very small reduction in lambda free light chains in the beta zone, but it was difficult to establish if was a monoclonal component, and consequently additional tests were performed.

Discussion:

A monoclonal component composed of only lambda free light chains was evidenced. This result in association with multiple diffuse bone lytic lesions observed led us to suspect multiple myeloma and not bone metastases from the breast cancer. Based on these observations, we encouraged the oncologist to conduct an osteomedullary biopsy, allowing us to make a diagnosis of low-grade stage II lambda light chain multiple myeloma.

Conclusion:

In this report, we show how the expertise of the clinical biochemist was instrumental in solving this case.
Crowd-sourcing structure-from- motion data for terrain modelling in a real-world disaster scenario: A proof of concept
Authors: Ratner JJ , Sury JJ , James MR , Mather TA , Pyle DM
Published: February 2019

Structure-from-motion (SfM) photogrammetry techniques are now widely available to generate digital terrain models (DTMs) from optical imagery, providing an alternative to costlier options such as LiDAR or satellite surveys. SfM could be a useful tool in hazard studies because its minimal cost makes it accessible even in developing regions and its speed of use can provide updated data rapidly in hazard-prone regions. Our study is designed to assess whether crowd-sourced SfM data is comparable to an industry standard LiDAR dataset, demonstrating potential real-world use of SfM if employed for disaster risk reduction purposes. Three groups with variable SfM knowledge utilized 16 different camera models, including four camera phones, to collect 1001 total photos in one hour of data collection. Datasets collected by each group were processed using VisualSFM, and the point densities, accuracies and distributions of points in the resultant point clouds (DTM skeletons) were compared. Our results show that the point clouds are resilient to inconsistency in users’ SfM knowledge: crowd-sourced data collected by a moderately informed general public yields topography results comparable in data density and accuracy to those produced with data collected by highly-informed SfM users or experts using LiDAR. This means that in a real-world scenario involving participants with a diverse range of expertise, topography models could be produced from crowd-sourced data quite rapidly and to a very high standard. This could be beneficial to disaster risk reduction as a relatively quick, simple and low-cost method to attain rapidly updated knowledge of terrain attributes, useful for the prediction and mitigation of many natural hazards.
Trends in mental health system transformation: Integrating youth services within the Canadian context
Authors: Halsall Tanya , Manion Ian , Iyer Srividya N. , Mathias Steve , Purcell Rosemary , Henderson Joanna
Published: February 2019

The current mental health services system in Canada is fragmented and transitions between the youth and adult mental health systems have been identified as needing significant improvement. Integrated Youth Services (IYS) are designed to be adaptable and developmentally appropriate as well as to promote seamless transitions, including during emerging adulthood. This article provides an overview of recent developments in Canadian mental health system transformation to promote the integration of services and the holistic promotion of youth well-being. We offer an overview of the current state of knowledge related to best practices in IYS in Canada and highlight areas for future development. We also introduce Frayme, a Canadian-based international knowledge translation platform designed to connect organizations working in the youth services system to accelerate the implementation of IYS.
Modified expandable graphite as an effective flame retardant for LLDPE/EVA composites filled with Mg(OH)2/Al(OH)3
Authors: Liu Nian , Wang Na , Li Lingtong , He Weidi , Guo Jianbing , Chen Xiaolang , Zhang Kun , Wu Hong
Published: February 2019

The flammability, thermal properties, and synergistic effects of modified expandable graphite (MEG) with magnesium hydroxide (MH) and aluminum hydroxide (ATH) on the linear low-density polyethylene/ethylene vinyl acetate (LLDPE/EVA) blends are investigated by Underwriters Laboratories-94 (UL-94) vertical combustion test, limiting oxygen index (LOI), thermogravimetric analysis (TGA), cone calorimeter test (CCT), and scanning electron microscopy (SEM). The results show that the MEG improves the flame-retardant efficiency of LLDPE/EVA blends. The addition of MEG apparently improves the LOI values and the UL-94 rating of LLDPE/EVA composites. The data obtained from the CCT show that the heat release rate (HRR), the total heat release (THR), and the gas production rate of composites with MEG decrease remarkably with increasing the content of MEG. When 10 phr of MEG is added, the char residues of LEMEG10 increase to 38.2% from 2.7% of LLDPE/EVA. The results of SEM and CCT present that MEG can improve the quality of char layers. The rate of char formation is enhanced also due to the existence of MEG, which plays an important role to improve the flame retardancy of the LLDPE/EVA composites.
Adjusted time-varying population attributable hazard in case–control studies
Authors: Zhao Wei , Zheng Jiayin , Chen Ying Qing , Hsu Li
Published: February 2019

Population attributable fraction is a widely used measure for quantifying the disease burden associated with a modifiable exposure of interest at the population level. It has been extended to a time-varying measure, population attributable hazard function, to provide additional information on when and how the exposure's impact varies over time. However, like the classic population attributable fraction, the population attributable hazard is generally biased if confounders are present. In this article, we provide a natural definition of adjusted population attributable hazard to take into account the effects of confounders, and its alternative that is identifiable from case–control studies under the rare disease assumption. We propose a novel estimator, which combines the odds ratio estimator from logistic regression model, and the conditional density function estimator of the exposure and confounding variables distribution given the failure times of cases or the current times of controls from a kernel smoother. We show that the proposed estimators are consistent and asymptotically normal with variance that can be estimated empirically from the data. Simulation studies demonstrate that the proposed estimators perform well in finite sample sizes. Finally, we illustrate the method by an analysis of a case–control study of colorectal cancer. Supplementary materials for this article are available online.
Multivariate permutation tests for two sample testing in presence of nondetects with application to microarray data
Authors: Arboretti Rosa , Bathke Arne C , Carrozzo Eleonora , Pesarin Fortunato , Salmaso Luigi
Published: February 2019

Very often, data collected in medical research are characterized by censored observations and/or data with mass on the value zero. This happens for example when some measurements fall below the detection limits of the specific instrument used. This type of left censored observations is called “nondetects”. Such a situation of an excessive number of zeros in a data set is also referred to as zero-inflated data. In the present work, we aim at comparing different multivariate permutation procedures in two-sample testing for data with nondetects. The effect of censoring is investigated with regard to the different values that may be attributed to nondetected values, both under the null hypothesis and under alternative. We motivate the problem using data from allergy research.
Decision on Institutional Choice in the Healthcare Sector: Micro-empirical Evidences from West Bengal (India)
Authors: Chatterjee Somnath , Laha Arindam
Published: February 2019

An attempt has been made in this article to shed some light on the decisions of patients on their institutional choice in accessing healthcare services within micro empirical framework in the state of West Bengal, India. The determinants of such decisions are also recognized in this article. In conscientious, statistical methods are anticipated to frame the socio-economic and decisional variables, that influence the decision. Principal component analysis and ordered probit analysis have been deployed to scrutinize the same. It is observed that the economic status of the patients, their level of schooling, their income and some other decision variables have a strong influence on their access of healthcare institutions. The study has projected that intra-category and inter-category competition among available alternative service providers needs to be introduced and social entrepreneurship model in state-owned hospitals can be pioneered with due considerations.
Employee Loyalty in Indian Private Hospitals: The Role of Demographic and Employment Factors
Authors: Singh Abhishek , Rangnekar Santosh
Published: February 2019

The present study examines the impact of demographic variables (age, gender, education and marital status) and employment-related factors (number of years worked for current organization, nature of work and total work experience) on perception of reasons for being loyal. Ineson, Benke and László (2013, International Journal of Hospitality Management, 32, 31–39) have given 21 items for measuring the perception of reasons for being loyal. For this study, response has been taken from 100 middle- and lower-level employees of National Accreditation Board for Hospitals and Healthcare Providers (NABH) accredited hospitals in Uttarakhand, India. ANOVA and independent samples t-test are performed to analyse the data. The results of the study exhibit that reasons for employee loyalty do not have significant mean difference with respect to employees’ gender, age and education. However, significant mean difference does exist with respect to employees’ marital status. In addition to this, it is concluded that there is no significant difference in the mean scores of reasons for employee loyalty and employment-related factors with respect to total work experience, but significant mean difference does exist with respect to number of years worked for current organization and nature of work in NABH accredited hospitals in Uttarakhand, India.
Understanding the Impact of Social Apps and Social Network Sites on Consumer’s Online Purchase Intention
Authors: Waheed Abdul , Farrukh Muhammad , Zameer Hashim , Khan Sher Zaman
Published: February 2019

This study explores the relationships of social apps (SA) and social network sites (SNSs) on online purchase intention with moderating effect of gender (GD) and education (ED). Data were gathered using the random distribution of the questionnaires among 2,000 ( n = 2000) online shoppers in Pakistan. Structural equation modeling (SEM) was applied using Smart-PLS. The current study revealed the positive associations of SAs (e.g., Twitter, WhatsApp, WeChat, Facebook Messenger, Snapchat and Instagram) and SNSs (e.g., LinkedIn, Facebook, Tumblr, YouTube, Twitter, Weibo and Pinterest). The findings further affirmed the insignificant impact of GD and ED where such factors were treated as the moderators. This study attempts to explore insights on how strategic management, policymakers and practitioners can utilize such thriving digital platforms in order to reach the customers and attaining their utmost attention. Despite, several theoretical and managerial implications are suggested along with future research opportunities for academicians and professionals across the nations.
Intrathecal Morphine Administration Does Not Affect Survival After Liver Resection for Hepatocellular Carcinoma
Authors: Smith Natalie K. , Demaria Samuel , Katz Daniel , Tabrizian Parissa , Schwartz Myron , Miller Joanna C. , Hill Bryan , Cardieri Brielle , Kim Sang J. , Zerillo Jeron
Published: February 2019

Introduction. Opioids may influence tumor recurrence and cancer-free survival in hepatocellular carcinoma (HCC). The relationship between intrathecal morphine administration, tumor recurrence, and patient survival after hepatectomy for HCC is unknown. Patients and Methods. This single-center, retrospective study included 1837 liver resections between July 2002 and December 2012; 410 cases were incorporated in the final univariate and multivariate analysis. Confirmatory propensity matching yielded 65 matched pairs (intrathecal morphine vs none). Primary outcomes were recurrence of HCC and survival. Secondary outcomes included characterization of factors associated with recurrence and survival. Results. Groups were similar except for increased coronary artery disease in the no intrathecal morphine group. All patients received volatile anesthesia. Compared with no intrathecal morphine (N = 307), intrathecal morphine (N = 103) was associated with decreased intraoperative intravenous morphine administration (median difference = 12.5 mg; 95% confidence interval [CI] = 5-20 mg). There was no difference in blood loss, transfusion, 3- or 5-year survival, or recurrence in the univariate analysis. Multivariate analysis identified covariates that significantly correlated with 5-year survival: intrathecal morphine (hazard ratio [HR] = 0.527, 95% CI = 0.296-0.939), lesion diameter (HR = 1.099, 95% CI = 1.060-1.141), vascular invasion (HR = 1.658, 95% CI = 1.178-2.334), and satellite lesions (HR = 2.238, 95% CI = 1.447-3.463). Survival analysis on the propensity-matched pairs did not demonstrate a difference in 5-year recurrence or survival. Discussion and Conclusion. Multivariate analysis revealed a significant association between intrathecal morphine and 5-year survival. This association did not persist after propensity matching. The association between intrathecal morphine and HCC recurrence and survival remains unclear and prospective work is necessary to determine whether an association exists.
Common feline problem behaviors: Aggression in multi-cat households
Authors: Ramos Daniela
Published: February 2019

Practical relevance:

Being able to understand and intervene in cases of cat–cat aggression in multi-cat households is important for all veterinarians and behavior counsellors dealing with feline behavior cases.

Clincal challenges:

Feline conflicts are common, perhaps not helped by many owners’ assumption that this is the norm. Interventions can be complex in multi-cat households with large numbers of cats as there are more interactions to evaluate and monitor, and care needs to be taken not to negatively affect the other cats. There may be limitations due to the environment or the people involved and so behavior guidelines should always be tailored to the individual situation.

Aims:

This article reviews the main forms of aggression in multi-cat households and the appropriate behavioral interventions, considering both the typical scenarios and emotions/motivations most likely involved. It details essential environmental management for multi-cat homes, as well as an approach to friendly cat introductions.

Audience:

This article is aimed at veterinarians dealing with feline behavior cases as well as behavior counsellors, as both professionals are likely to experience cases of aggression in multi-cat households.

Evidence base:

The author draws on the published literature where available and, where there is a lack of research, on hypotheses derived from her own clinical behavior experience.
Clostridium difficile colitis in patients undergoing surgery for hip fractures: an analysis of 17,474 patients
Authors: Malik Azeem Tariq , Quatman Carmen E , Phieffer Laura S , Ly Thuan V , Khan Safdar N
Published: February 2019

Background:

We compiled evidence from a large national surgical database to identify the incidence, risk factors and postoperative impact of Clostridium difficile infection (CDI) in patients undergoing hip fracture repair.

Methods:

We identified 17,474 patients who underwent hip fracture repairs in 2015 using the ACS-NSQIP database. Interventions studied were open reduction/Internal fixation, total hip arthroplasty or hemiarthroplasty being performed for traumatic hip fractures. Outcomes studied were incidence, preoperative and postoperative risk factors for occurrence of CDI were studied using descriptive and statistical analysis.

Results:

A total of 92 patients (0.53%) developed CDI within 30 days of the operation. Following adjustment using multi-variate logistic regression, preoperative and hospital-associated factors associated with development of CDI were smoking (OR 1.75 [95% CI 1.03–2.99]), hypertension (OR 1.70 [95% CI 1.01–2.85]), hyponatraemia (OR 1.65 [95% CI 1.04–2.63]), prior systemic inflammatory response syndrome (SIRS) (OR 2.18 [95% CI 1.32-3.59]) and a length of stay >7 days (OR 1.98 [95% CI 1.11–3.53]. Postoperative factors associated with occurrence of CDI were occurrence of a deep surgical site infection (SSI) (OR 5.89 [95% CI 1.31–26.6]), a stay in the hospital >30 days (OR 6.56 [95% CI 2.56–16.9]) and unplanned reoperations (OR 2.78 [95% CI 1.29–5.99]).

Conclusion:

As we move toward an era of bundled-payment models, identification of risk factors associated with the occurrence of postoperative complications, such as CDI, will help curb excess healthcare utilisation and costs associated with the management of this complication.
10-year results of ReCap hip resurfacing arthroplasty: a non-designer case series
Authors: Kiran Manish , Santhapuri Sunil , Moeen Sara , Merchant Irfan , Arvinte Dan , Sood Manoj
Published: February 2019

Introduction:

We present the 10-year results of the ReCap Magnum HRA system in a consecutive single surgeon’s series from a non-designer centre.

Patients and methods:

Hip resurfacing arthroplasty (HRA) was performed in active males under 65 years and in pre-menopausal females with adequate bone density proven by a DEXA scan. Clinical follow-up; annual Oxford hip scoring, UCLA scoring and whole blood metal ion level measurement. Kaplan-Meier method was used to determine survivorship with revision as the end point. Radiographs were analysed for; acetabular inclination, notching, neck thinning and change in implant position. 72 HRAs were performed in 66 patients with a mean age of 45.7 years. The mean follow-up was 10.63 ± 0.54 years (range 10–11.75 years).

Results:

The survivorship of the cohort at minimum 10 years was 97.22% (95% confidence interval 94.14–99.01). There was a significant improvement in the Oxford Hip Score from 15.77 ± 4.33 to 45.67 ± 4.43 ( p < 0.001) and the UCLA score from 3.14 ± 0.74 to 7.07 ± 1.16 ( p < 0.001). Mean whole blood cobalt and chromium levels were 28.83 ± 8.42 nmol/l and 39.93 ± 9.64 nmol/l respectively. There were 2 revisions, due to avascular necrosis and implant failure. In our series the implant has performed well with <1% failure per year. We did not note any difference between the genders, since all the females in our series had been screened for osteopenia using a DEXA scan. All our patients returned to an active lifestyle which was maintained at final follow-up.

Conclusion:

Strict selection criteria and a well-designed implant result in good long-term functional and radiological results with hip resurfacing.
An Overview of International Staff Time Measurement Validation Studies of the RUG-III Case-mix System
Authors: Turcotte Luke A , Poss Jeff , Fries Brant , Hirdes John P
Published: February 2019

The RUG-III case-mix system is a method of grouping patients in long-term and post-acute care settings. RUG-III groups patients by relative per diem resource consumption and may be used as the basis for prospective payment systems to ensure that facility reimbursement is commensurate with patient acuity. Since RUG-III’s development in 1994, more than a dozen international staff time measurement studies have been published to evaluate the utility of the case-mix system in a variety of diverse health care environments around the world. This overview of the literature summarizes the results of these RUG-III validation studies and compares the performance of the algorithm across countries, patient populations, and health care environments. Limitations of the RUG-III validation literature are discussed for the benefit of health system administrators who are considering implementing RUG-III and next-generation resource utilization group case-mix systems.
Resource Intensity for Children and Youth: The Development of an Algorithm to Identify High Service Users in Children’s Mental Health
Authors: Stewart Shannon L , Poss Jeff W , Thornley Elizabeth , Hirdes John P
Published: February 2019

Children’s mental health care plays a vital role in many social, health care, and education systems, but there is evidence that appropriate targeting strategies are needed to allocate limited mental health care resources effectively. The aim of this study was to develop and validate a methodology for identifying children who require access to more intense facility-based or community resources. Ontario data based on the interRAI Child and Youth Mental Health instruments were analysed to identify predictors of service complexity in children’s mental health. The Resource Intensity for Children and Youth (RIChY) algorithm was a good predictor of service complexity in the derivation sample. The algorithm was validated with additional data from 61 agencies. The RIChY algorithm provides a psychometrically sound decision-support tool that may be used to inform the choices related to allocation of children’s mental health resources and prioritisation of clients needing community- and facility-based resources.
Acute Symptomatic Sinus Bradycardia in High-Dose Methylprednisolone Therapy in a Woman With Inflammatory Myelitis: A Case Report and Review of the Literature
Authors: Sodero Alessandro , Squitieri Martina , Mazzeo Salvatore , Pasca Matteo , Matà Sabrina , Pieri Francesco , Bessi Valentina , Sorbi Sandro
Published: February 2019

High dose corticosteroid therapy is widely used as attack therapy of inflammatory central nervous system disorders and can induce several adverse reactions. Bradycardia is an infrequent event after corticosteroids administration and is often asymptomatic. We report a case of a woman admitted to the neurological department of our hospital for paraesthesias of the lower limbs. She received adiagnosis of inflammatory myelitis and high dose corticosteroid therapy was prescribed. During the therapy she complained of chest tightness, dyspnoea, weakness and malaise. An electrocardiogram revealed sinus bradycardia. A significant increase in body weight, probably due to plasma volume expansion, was detected. Bradycardia and high blood pressure spontaneously resolved in few days. We provide a collection and a statistical analysis of literature data about steroid induced bradycardia. We found that higher total doses are associated with lower pulse rate and symptomatic bradycardia. Bradycardia is more frequent in older patients and those with underlying cardiac disease or with autonomic disturbance. However clinicians must be aware about the occurrence of symptomatic bradycardia in all patients who undergo high dose corticosteroid therapy, not only in those at risk, to early detect and treat this potentially dangerous condition.
Satisfaction and Awareness of Systemic Psoriasis Treatments: A National Survey Comparing Biologic and Nonbiologic Users
Authors: Ighani Arvin , Yu Ashley M. , Sandhu Vijay K. , Barankin Benjamin , Manolson Morris F.
Published: February 2019

Background:

There is ongoing development of new therapies for psoriasis, including biologic and systemic agents such as interleukin-17, interleukin-23, and phosphodiesterase-4 inhibitors. The development of these agents has changed the landscape of psoriasis treatment options.

Objective:

The objective of this study was to characterize the impact of newer biologic and systemic agents approved by June 2016 on patient outcomes. We sought to evaluate and compare biologic users and nonbiologic systemic users with respect to their treatment awareness and satisfaction.

Methods:

We conducted a national Canadian survey from July to September 2016 on adult patients with moderate-to-severe psoriasis using biologic agents or nonbiologic systemic agents as their current primary treatment modality. Patients were asked to evaluate their overall satisfaction with their treatment agent and their awareness of other treatment options. Responses from biologic and nonbiologic systemic users were compared.

Results:

Overall, 343 participants were included (biologic users: n = 218; nonbiologic users: n = 125). Treatment satisfaction: Biologic users had a higher overall satisfaction score than nonbiologic users ( P < .001). Among nonbiologic agents, apremilast (62%) was associated with the highest satisfaction proportion. Among biologic agents, ustekinumab (77%) and adalimumab (72%) were associated with the highest proportions of satisfaction. With respect to treatment awareness, 30% of nonbiologic patients did not have enough information to form an opinion about biologics.

Conclusions:

This study demonstrates the greater treatment satisfaction of biologic users compared with nonbiologic users for moderate-to-severe psoriasis. Given that nearly one-third of nonbiologic users did not have enough information to form an opinion about biologic agents, physicians may consider counselling these patients on the use of biologic agents for psoriasis management.
An experimental study on the optimization of the production and efficiency of tunable Helmholtz absorbers for the modal control of small rooms
Authors: Thomazelli Rodolfo , Bertoli Stelamaris
Published: February 2019

Helmholtz absorbers are a common solution for controlling the low-frequency modes found in small rooms. These devices only perform in a narrow spectrum range with the tuning depending on each room’s geometrical configurations. Consequently, their development still operates on a case-by-case basis. A possible alternative to optimize the production of these acoustic solutions is the development of a tunable Helmholtz absorber capable of changing its geometrical configurations according to each room’s acoustic needs. The present work shares the results of tests performed on varied samples of different configurations of absorbers. The samples were chosen aiming the control of the three first modes of each direction in rooms with volume ranging from 20 to 60 m3. The research revealed that the use of a single tunable absorber has the potential to produce sound absorption coefficients higher than 0.8 in almost the entirety of the frequency spectrum considered.
Clinical relevance of cortical network dynamics in early primary progressive MS
Authors: Tur Carmen , Kanber Baris , Eshaghi Arman , Altmann Dan R , Khaleeli Zhaleh , Prados Ferran , Ourselin Sebastian , Thompson Alan J , Gandini Wheeler-Kingshott Claudia AM , Toosy Ahmed T , Ciccarelli Olga
Published: February 2019

Background:

Structural cortical networks (SCNs) reflect the covariance between the cortical thickness of different brain regions, which may share common functions and a common developmental evolution. SCNs appear abnormal in neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases, but have never been assessed in primary progressive multiple sclerosis (PPMS).

Objective:

The aim of this study was to test whether SCNs are abnormal in early PPMS and change over 5 years, and correlate with disability worsening.

Methods:

A total of 29 PPMS patients and 13 healthy controls underwent clinical and brain magnetic resonance imaging (MRI) assessments for 5 years. Baseline and 5-year follow-up cortical thickness values were obtained and used to build correlation matrices, considered as weighted graphs to obtain network metrics. Bootstrap-based statistics assessed SCN differences between patients and controls and between patients with fast and slow progression.

Results:

At baseline, patients showed features of lower connectivity ( p = 0.02) and efficiency ( p < 0.001) than controls. Over 5 years, patients, especially those with fastest clinical progression, showed significant changes suggesting an increase in network connectivity ( p < 0.001) and efficiency ( p < 0.02), not observed in controls.

Conclusion:

SCNs are abnormal in early PPMS. Longitudinal SCN changes demonstrated a switch from low- to high-efficiency networks especially among fast progressors, indicating their clinical relevance.
The Nexus Among Economic Growth, Inflation and Unemployment in Bhutan
Authors: Tenzin Ugyen
Published: February 2019

In order to understand the dynamics of unemployment in Bhutan at a macro-level, this study has explored the association among economic growth, inflation and unemployment from 1998 to 2016. The autoregressive distributed lag (ARDL) model was applied to estimate the impact of economic growth and inflation on unemployment. The results of this empirical analysis suggest that economic growth had no impact on the reduction of unemployment rate in Bhutan both in the short and in the long run. In fact, as the economic growth increased, so did the unemployment rate. However, inflation had a negative association with unemployment rate in the short run and a positive association in the long run. In other words, an increase in the employment rate led to an increase in the inflation in the short run. Likewise, if inflation is not monitored or controlled, the uncertainty of inflation can lead to lower investment and lower economic growth, thereby causing unemployment to rise in the long run. This study, therefore, recommends policymakers to take into account the employment elasticity with respect to economic output and focus on sectors, which have more absorptive capacity in engaging the young labour market entrants.

JEL: B22, C22, E24, E31
Walking as transgenerational methodology
Authors: Murray Lesley , Järviluoma Helmi
Published: February 2019

The embodied practice of walking is said to make the city a cinematic experience that carves a path through to be read in multiple ways by future mobile bodies. De Certeau’s (1984) undifferentiated practitioner has been critiqued, with, in particular, alternative gendered accounts of the mobile body (Grosz, 1998; Collie, 2013). This research note seeks to add to such accounts through exploring the walking body that is differentiated according to generation and then through suggesting a transgenerational walking methodology. The article articulates a methodological approach developed as part of a European Research Council funded project on transgenerational cultural transformations of the sensory between 1950 and 2020. Through a series of transgenerational sensory walks – a younger person (sometimes a child) and an older person – the project examines changes in and multisensory engagements with local environments in three national contexts: Turku (Finland), Brighton (UK), and Ljubljana (Slovenia). This paper introduces the project and considers the role of generation in determining mobile space, and hence determines a rationale for a transgenerational methodological approach intersecting several disciplines. We ask the following questions: how are the bodies of different generations written in mobile space? and how does ethnographic sensory walking with different generations offer particular understandings of mobile space?
Real world application of angular scan pulse-echo ultrasonic propagation imager for damage tolerance evaluation of full-scale composite fuselage
Authors: Lee WJ , Seo BH , Hong SC , Won MS , Lee JR
Published: February 2019

Composite structures are assertively used for new airframe designs and manufacturing in military aircrafts because of superior strength-to-weight ratios and fatigue resistance. Because the composites have different fatigue failure characteristics compared with metals, it is necessary to develop different approaches for the composite fatigue design and testing. In this study, we propose an in situ damage evaluation technology with high spatial resolution during full-scale fatigue testing of composite aircraft structures. For real composite structure development considering composite fatigue characteristics, full-scale fatigue and damage tolerance tests of the composite fuselage structure were conducted to evaluate the structural characteristics. In the meantime, the laser ultrasonic nondestructive inspection method, called an angular scan pulse-echo ultrasonic propagation imager, which is fully noncontact, real-time, and portable to position it in between the complex test rigs, is used to observe in situ damage growth of the composite. Finally, the verification procedure assisted by the angular scan pulse-echo ultrasonic propagation imager assures no growth of the initial impact damages after lifetime operation and proves the damage tolerance capability of the developed composite fuselage structure.
An Extremely Rare Complication: Abdominal Aortic Aneurysm Rupture Caused by Migration of a Zenith Main Body Years After Repair of the Suprarenal Stent Separation
Authors: Ueda Tatsuo , Tajima Hiroyuki , Murata Satoru , Iwata Kotomi , Saitou Hidemasa , Miki Izumi , Yasui Daisuke , Sugihara Fumie , Onozawa Shiro , Morota Tetsuro , Kumita Shin-ichiro
Published: February 2019

Purpose: To report an unusual case of an abdominal aortic aneurysm (AAA) rupture caused by migration of a Zenith stent-graft main body years after its separation from the suprarenal stent. Case Report: A 72-year-old man underwent endovascular aneurysm repair with a Zenith stent-graft for an infrarenal AAA in year 2000. At that time, a femorofemoral bypass was performed because the left external iliac and common femoral arteries were dissected during treatment. In 2013, follow-up computed tomography (CT) showed disconnection of the uncovered proximal stent, which led to a type Ia endoleak. An additional Zenith main body and Large Palmaz XL balloon-expandable stent were deployed; the endoleak disappeared. In 2016, the patient had abdominal pain, and emergency CT showed AAA rupture caused by migration of the first main body deployed in 2000 under the distal edge of the contralateral (left) leg of the additional main body from 2013, which led to a type IIIa endoleak between the 2 main bodies. A converter and iliac legs were deployed to successfully seal the type IIIa endoleak. The patient remains well 18 months after the second repair; CT scans document stable stent-grafts and no endoleak. Conclusion: Physicians should be aware of the potential risk for AAA rupture caused by late main body migration after treatment for suprarenal stent separation from a Zenith stent-graft.
Real-Time Quantitative Measurements of Foot Perfusion in Patients With Critical Limb Ischemia
Authors: Mironov O. , Zener R. , Eisenberg N. , Tan K.T. , Roche-Nagle Graham
Published: February 2019

Introduction:

Current methods of evaluating adequacy of endovascular procedures are imperfect and do not always predict which patients will do well. The purpose of this study was to evaluate the role of real-time quantitative measurements of perfusion among patients with critical limb ischemia.

Materials and Methods:

Thirty-four patients with critical limb ischemia undergoing endovascular treatment were recruited. Perfusion Images of the foot were obtained pre and post successful angioplasty using an SPY Elite System (Novadaq Technologies, Ontario, Canada). Patients were followed for 6 months. Subsequently a logistic regression was performed to determine whether intraprocedural perfusion parameters predicted the odds of wound healing.

Results:

Twenty-nine patients had successful angioplasty. Median age was 69.5% ± 8.3; 75% were men and 64% were diabetic. Rutherford stages were (4%-39%, 5%-57%, 6%-4%), and the average target limb ankle–brachial index (ABI) was 0.58 (SD 2.24). There was no significant correlation between the ABI and perfusion parameters. Inflow perfusion rate correlated significantly with Rutherford stage (Spearman rho 0.398, P = .036). After successful angioplasty 39% had a decrease in inflow rate and 57% had a decreased total inflow. In all, 25 patients completed 6 months of follow-up. Resolution of rest pain and/or healing of the ischemic wound occurred in 10 (40%) patients at 1 month, 4 (16%) at 3 months, and 2 (8%) at 6 months. One patient underwent a major amputation at 2 months. Eight (32%) patients never healed or had persistent rest pain. None of the real-time perfusion variables were significant predictors of wound healing.

Conclusion:

Many patients experience a paradoxical decrease in perfusion following successful angioplasty suggesting perfusion may not correlate with angiographic outcome, possibly due to microemboli, microvascular disease, or vasospasm. Real-time perfusion imaging following intra-arterial infusion of indocyanine green does not predict the odds of wound healing.
Experimental investigations on the thermal performance of a domestic condensing heat recovery air-conditioner
Authors: Qiu Fuqiang , Li Baoguo , Xu Taoping
Published: February 2019

An experiment was carried out on a domestic condensing heat recovery air-conditioner. The working principle was introduced in this article. And thermal performance and theoretical analysis of the dynamic behavior of the system were conducted followed by experimental investigation. The results illustrated that the operating parameters of various modes were satisfactory. In the summer and winter seasons, the space cooling performance ( COPsc) and space heating performance ( COPsh) values were 2.85 and 3.37, respectively. In the condensing heat recovery for water heating mode, the average COPwh was found to be 2.58, and the COPsc was observed to be 2.84 with an overall coefficient of performance ( COPcw) of up to 5.42; the mean heat recovery rate was about 95%. In water heating only mode, the heat capacity was declining with an average COPwh value of 3.94.
Color identification for quadcopter flight control and object inspection
Authors: Lee Yi-Sheng , Juang Jih-Gau
Published: February 2019

This study focuses on quadcopter flight control and image application. The proposed quadcopter can be applied to inspect rust or damage areas of ship hull. Real-time image identification with proper devices is also proposed. Proportional–integral–derivative control and fuzzy control are used in flight control design. Due to hardware limitation of the quadcopter, complicate control theory is avoid in controller design. A simple fuzzy control is used in this study. In sensor fusion, air pressure altimeter, Global Positioning System (GPS), ultrasonic sensor, and optical flow sensor are utilized to maintain altitude holding in outdoor and indoor environments. In color identification, Pixy (CMUcam5) camera is used to perform image processing and image tracking. Signals from different sensors are processed in the Arduino board. In flight simulation, pitch and roll angle commands are constructed in a rule table. Flight control can be performed by feedback tracking error, and software simulations for proportional–integral–derivative and fuzzy control are given.
Dynamic p+q maximal hub location problem for freight transportation planning with rational markets
Authors: Alizadeh Roghayyeh , Nishi Tatsushi
Published: February 2019

In this article, a dynamic maximal hub location covering problem for a freight transportation system is studied, in which the model has the possibility of having expansion scenarios for future according to the forecasts of increasing demands. Two expansion scenarios are to add up the number of hubs in the network and to add up more carriers. As the markets are involved in the pricing procedure, the model is a bi-level problem which needs more effort to deal with, for which in this work two reformulations based on Karush–Kuhn–Tucker conditions and duality theory are utilized to reformulate the bi-level problem to a single-level one. To solve the model efficiently, a decomposition method is applied and numerical examples are solved to verify the accuracy of the proposed model.