bluuebunny/crossref_metadata_2025 huggingface dataset:
Freedom in the wilderness: A study of a Darknet space
Authors: Graham Roderick , Pitman Brian
Published: October 2018

Mass media and journalistic accounts of Darknets have focused disproportionately on their criminogenic aspects. Moreover, research has focused mainly on the Darknet technology Tor. We wish to expand scholars’ knowledge of Darknets by exploring a different Darknet technology, Freenet. Using a combination of content analysis and grounded theory, this research asked three progressively complex questions. First, we asked: What are the types of content and the distribution of content on Freenet? Our findings show that Freenet fosters a singular distribution of content, with a high ratio of blogs (or flogs), child pornography, empty links, and Web 1.0 websites that archive information. We assumed that this content is not discrete points of data but instead produce sociologically interesting phenomena. Therefore, we ask: What are the content patterns on Freenet? Four patterns were identified. Freenet is (1) an archive of deviant data resistant to censorship, (2) a space dominated by content associated with masculinity, (3) a nonmarket space where commercial exchange is nonexistent, and (4) an empty space with many requests not returning information, and many flogs abandoned. We asked a third question: How does the analysis of Freenet inform current understandings of hacker culture? Freenet, we suggest, can be understood as a type of digital ‘wilderness’. It is a singular Darknet space, supporting a distinct set of hacker practices.
Using telehealth to improve access to hepatitis C treatment in the direct-acting antiviral therapy era
Authors: Schulz Thomas R , Kanhutu Kudzai , Sasadeusz Joseph , Watkinson Sally , Biggs Beverley-Ann
Published: October 2018

Introduction

One-third of the Australian population lives outside major cities and this group has worse health outcomes. Telehealth is becoming an accepted way to improve patient access to specialist healthcare. Over 200,000 Australian’s have hepatitis C virus (HCV) and new treatments are very effective and well tolerated. We aim to demonstrate that HCV treatment utilising telehealth support for care delivery has cure rates similar to onsite care in clinical trials. We also report length of consultation and calculate reductions in travel and carbon output.

Methods

Patient demographic, clinical, and treatment outcome data were collected prospectively from hospital software and analysed retrospectively. This was an audit of all patients treated for HCV in one year from a single tertiary hospital that included telehealth in their care delivery.

Results

Sustained virological response was achieved in 51/52 (98%) patients with completed treatment courses, and 51/58 (88%) of those who had a planned telehealth consultation as part of their management. A median of 634 km of patient travel was saved per telehealth consultation.

Discussion

We found that a telehealth-supported outreach programme for patients in regional Australia with HCV produced similar outcomes to clinical trials. There was a considerable saving in time and cost for the patients and significant environmental benefit through the reduction in carbon footprint associated with travel to distant specialist health services. We conclude that telehealth facilitated outreach is a feasible and effective way to access HCV treatment and cure in regional Australia.
Music therapy within an integrated project for families exposed to domestic violence: A qualitative study of professionals’ perspectives
Authors: Annesley Luke
Published: October 2018

This article focuses on a collaborative project that took place from 2012 to 2015 between an NHS Music Therapy Service for children and young people, a Child and Adolescent Mental Health Service and the charity Housing for Women. Music therapy interventions for children and young people took place alongside therapeutic family interventions. The families involved had all experienced exposure to domestic abuse. A qualitative study of professionals’ perceptions of the project took place after the project had ended, using a methodology of Interpretative Phenomenological Analysis. Interviews with non-music therapy professionals were transcribed and analysed, providing data about perceived benefits for children and families, the evolving perspectives of the professionals involved and the degree to which processes in music therapy were communicated and understood.
Determination of optimal parameters of the tuned mass damper to reduce the torsional vibration of the shaft by using the principle of minimum kinetic energy
Authors: Nguyen Duy-Chinh
Published: October 2018

In this paper, an analytical method is presented to determine the optimal parameters of the symmetric tuned mass damper, such as the ratio between natural frequency of tuned mass damper and shaft (tuning ratio) and the ratio of the viscous coefficient of tuned mass damper (damping ratio). The optimal parameters of tuned mass damper are applied to reduce the torsional vibration of the shaft based on consideration of the vibration duration and stability criterion. The dynamic equations of the shaft are provided via Lagrangian equations, and the optimal parameters of tuned mass damper are derived by using the principle of minimum kinetic energy. Analytical and numerical examples are implemented to verify the reliability of the proposed method. The analytical and numerical results indicate that the optimal parameters of tuned mass damper have significant effects in the torsional vibration reduction of the shaft.
Modeling of adhesive layers with temperature-dependent cohesive zone elements for predicting adhesive failure during the drying process of cathodic dip painting
Authors: Günther N , Griese M , Stammen E , Dilger K
Published: October 2018

The number of electric and hybrid vehicles on the roads has increased significantly in recent years. The high weight of these vehicles requires the use of lightweight construction technologies and materials. In this context, adhesively bonded multi-material structures are increasingly being used. However, the combination of different materials with the production processes established in the automotive industry is a challenge to the manufacturers. Especially the drying process after cataphoretic dip coating can lead to adhesive failure. In order to detect and solve these problems as early as possible, a forecast using the finite element simulation is necessary in the early stage of the project. The objective is to show that a temperature-dependent cohesive zone model can be used to predict damage during the drying process. Therefore, the parameters for such a model were identified on different temperature levels using tubular butt joints, tapered double cantilever beams, and tapered end notched flexure specimens. Finally, the material model was validated on heated lap shear specimens. It could be shown that it is generally possible to predict damage within the adhesive layer using a cohesive zone model. Furthermore, it was shown that the way the stiffnesses are determined has a decisive influence on the calculation accuracy under temperature influence.
In situ spatial strain monitoring of a single-lap joint using inkjet-printed carbon nanotube embedded thin films
Authors: Zhao Yingjun , Schagerl Martin , Gschossmann Sandra , Kralovec Christoph
Published: October 2018

Adhesive bonds are particularly favored by lightweight structures due to their weight efficiency and insulating property regarding contact corrosion. However, it is challenging to interrogate directly over the bonding area due to its sandwiched structure. In this study, an inkjet-printed carbon nanotube (CNT) strain distribution sensing film is embedded at the interface between an adherend and the adhesive in a single-lap joint configuration to monitor the spatial strain distribution over the bonding area. The conductivity distribution reconstructed by an algorithm of electrical impedance tomography (EIT) results in similar trend to the correlated conductivity distribution numerically calculated from a three-dimensional (3D) finite element model. Moreover, the EIT result of a defect-embedded testing specimen shows a different conductivity distribution compared to the healthy specimen, indicating the existence of the debonding region.
IWSHM 2017: Structural health monitoring of the loosening in a multi-bolt structure using linear and modulated nonlinear ultrasound acoustic moments approach
Authors: Fierro Gian Piero Malfense , Meo Michele
Published: October 2018

Applying highly accurate clamp loads in bolted joints during assembly and inspections is essential for estimation of the integrity of a joint and reduction of disastrous failures. Non-destructive post-assembly and in-service inspections of joint integrity are vital and significantly reduce maintenance and associated repair costs. Therefore, a bolt control technology able to provide precise direct measurement of bolt loosening state during assembly and in-service is needed. This work proposes an in situ structural health monitoring approach based on the evaluation of linear and nonlinear modulated acoustic moments for the assessment of the loosened state of bolts in a multi-bolted structure. Linear and nonlinear ultrasound methods’ detection accuracy and robustness can be highly dependent on correct frequency selection. The structural health monitoring method suggested uses material resonance and a frequency sweep methodology coupled with a cross-correlation method which identifies significant frequency pairs or higher harmonics used to determine bolt loosening. The proposed approach was tested and successfully validated on three different bolted structures showing that loosening of the structure can be identified accurately with a limited number of transducers. The solution provides a qualitative solution, which identifies degradation in the torque of a bolted structure; furthermore, the developed structural health monitoring method has the potential to become an automatic tool for monitoring the loosened state of bolts in critical complex structural components.
Community-Based Participatory Research for Health
Authors: Page-Reeves Janet
Published: October 2018

The new edition of Community-Based Participatory Research for Health by Nina Wallerstein and colleagues is an extremely valuable resource for a wide variety of stakeholders interested in collaborative work to promote health equity. This updated collection succinctly delineates the theory, history, principles, and practices of community-based participatory research (CBPR) to help the reader understand CBPR as an approach, a philosophy, and an ethic. This updated edition will serve as a helpful resource for those interested in incorporating CBPR principles and approaches into their work. The chapters are authored by leaders and innovators in CBPR who provide insights, share experiences, and describe case studies that expand our ability to understand and envision the transformative power of CBPR in practice. The book is divided thematically into seven parts plus 13 appendices. Updates to this edition align with critical dialogues about positionality, privilege, and power in a way that encourages healthy self-reflection.
Fabrication and characterization of the composite nanofibers of polyacrylonitrile/fluorescent core-shell silica particles with their potential use for anticounterfeiting purposes in the textile industry
Authors: Momeni Hajarsadat , Youssefi Mostafa
Published: October 2018

Composite nanofibers of polyacrylonitrile/fluorescent core–shell silica particles were fabricated. Two different sizes of fluorescent core–shell silica particles were synthesized. The first one consisted of particles with the diameter of about 310 nm (Bigger size fluorescent core-shell silica particles [BFSPs]) and the other one had the diameter of about 166 nm (smaller size fluorescent core-shell silica particles [SFSPs]). The images obtained by scanning and transmission electron microscopy confirmed the synthesis of spherical and nearly uniform particles. However, some clusters of smaller unformed silica particles were observed, especially in SFSPs. The results of Fourier transform infrared spectra spectroscopy confirmed the linkage between silica and fluorescein isothiocyanate. Scanning electron microscopy images of the composite nanofibers showed that the shell had a uniform morphology; however, there were some points having a higher diameter, where the core–shell particles were located. The fluorescence microscopy images of the composite nanofibers also showed the fluorescence property of the composite nanofibers with bright spots on them, where the particles were located. The fluorescence intensity of the composite nanofibers was significantly increased with the enhancement of the pH value in the range of 4.00–8.00. The observed pattern of composite nanofibers under ultraviolet radiation suggested that these composite nanofibers could be applied as anticounterfeiting markers for special clothes as well as pH-sensitive parts in smart clothing.
Efficacy of Combined Regional Inductive Moderate Hyperthermia and Chemotherapy in Patients With Multiple Liver Metastases From Breast Cancer
Authors: Klimanov Mykhailo Yu , Syvak Liubov A. , Orel Valerii E. , Lavryk G. V. , Tarasenko Tetiana Ye , Orel Valerii B. , Rykhalskyi Alex Yu , Stegnii Viadysiav V. , Nesterenko Andrii O.
Published: October 2018

Purpose:

Regional inductive moderate hyperthermia in combination with chemotherapy can improve the therapeutic efficacy in patients with breast cancer with multiple liver metastases.

Methods:

The study included 103 patients with breast cancer with multiple liver metastases: 53 patients (main group) who received a combined chemotherapy (TC drug combination) and regional inductive moderate hyperthermia treatment and 50 patients (control group) who received chemotherapy (TC drug combination) alone. Regional inductive moderate hyperthermia exploited electromagnetic fields with an operating frequency of 27.17 ± 0.16 MHz and output power of 75 W. Treatment results were assessed by computed tomography and ultrasound imaging.

Results:

Partial regression was defined as a 30% decrease in the sum of the maximum diameters of investigated tumors. In the current study, partial regression was described in 8 (15.1%) patients assigned to the main group and 2 (4%) patients in the control ( P < .05). The process stabilization was reported in 32 (60.4%) patients receiving the combined treatment and 19 (38%) in the control ( P < .05). Equally important, tumor progression was observed in 13 (24.5%) patients representing the main group and 29 (58%) in the control. During a 30-minute treatment session, a temperature increase overlaying greater than 90% of the liver projection exposed to electromagnetic irradiation was not exceeding 40°C.

Conclusion:

The combined regional inductive moderate hyperthermia and chemotherapy treatment increased the overall therapeutic efficacy by 33.9% (χ2 = 12.182; P < .01).
Endograft Infection Due to Secondary Aortoenteric Fistula Treated With Custom-Made Bovine In Situ Aortic Bifurcation Graft
Authors: Walter Corinna , Taher Fadi , Rieger Hannes , Assadian Afshin , Falkensammer Jürgen
Published: October 2018

Purpose:

To increase awareness of the clinical presentation, diagnostic workup, and treatment options for endograft infections.

Case Report:

A 75-year-old male patient was admitted with suspected endograft infection 4 years after endovascular aortic aneurysm repair (EVAR). Although preoperative diagnostics showed no definitive signs of endograft infection, eventual surgical exposure of the endograft revealed signs of advanced inflammation, including the unexpected finding of an aortoduodenal fistula.

Conclusion:

A detailed evaluation of patient history and clinical examination, performed as a part of routine follow-ups, may be beneficial in identifying possible severe complications after EVAR early on. Regarding options for aortic reconstruction in case of endograft infection, bovine pericardium deserves consideration as a promising, feasible, and easily available graft material.
Correlation of Adiponectin With Testosterone in Patients With and Without Type 2 Diabetes and Erectile Dysfunction
Authors: Elsaied Moustafa A. , Masallat Doaa , Abdel-Hamid Ibrahim A.
Published: October 2018

The aim of this study was to evaluate the levels of adiponectin in diabetic patients with and without erectile dysfunction (ED). In addition, the correlations of adiponectin with the scores of international index of erectile function (IIEF) and total testosterone levels were explored in diabetic and nondiabetic patients with ED. The study included three groups: Type 2 Diabetic patients (T2DM) with and without ED and a third nondiabetics with ED group, each of 29 patients. Fasting blood glucose (FBG), fasting insulin (FI), homeostasis model assessments of insulin resistance (HOMA-IR index), testosterone and adiponectin levels were evaluated. IIEF was applied to diabetic and nondiabetic patients with ED. The results showed that adiponectin was lower in diabetic patients with ED than in both nondiabetics with ED and diabetics without ED groups (5.23 ± 1.05 vs. 11.38 ± 10.08 and 6.5 ± 2.13; p = .003 and .006 respectively). Testosterone was lower in diabetic patients with ED than in diabetics without ED group (2.52 ± 1.15 vs. 4.1 ± 1.46; p = .024). Testosterone had a direct correlation with adiponectin ( r = .371; p = .001). Both adiponectin and testosterone levels did not correlate with IIEF. In conclusion, the decreased adiponectin and testosterone are associated with ED in T2DM. Testosterone has a direct correlation with circulating adiponectin while both have no correlation with IIEF.
Lifestyle Change Alone Sufficient to Lower Cholesterol in Male Patient With Moderately Elevated Cholesterol: A Case Report
Authors: Janse Van Rensburg Walter J.
Published: October 2018

Background. Cardiovascular disease is a major cause of deaths. Elevated cholesterol levels to above the normal reference range is a major risk factor for developing cardiovascular disease. Current guidelines recommend the use of cholesterol-lowering drugs to lower cholesterol levels to within the normal reference range. However, the American Heart Association further recommends a change in lifestyle in managing cholesterol levels. Thus, cholesterol-lowering drugs may not be needed if a lifestyle-change alone is sufficient in lowering cholesterol levels to within normal ranges. Unfortunately, limited examples exist in academic literature to illustrate the effectiveness of lifestyle change alone in lowering of cholesterol levels. Case report. We report a case of a 33-year-old man, with moderately elevated cholesterol levels and a family history of cardiovascular disease. Method. The man followed an altered healthy fat diet accompanied with moderate exercise for 6 weeks, without the addition of cholesterol-lowering agents. Results. At the 6-week follow-up, he was able to decrease his total cholesterol by 40.25% and low-density lipid cholesterol by 52.8%, to within normal ranges. The cholesterol levels remained within normal ranges after 6 months. Conclusion. This case illustrates that in some individuals, lifestyle change alone is sufficient to lower moderately elevated cholesterol levels.
Dialectical tensions in the narrative discourse of Donald J. Trump and Pope Francis
Authors: Deye Joseph M , Fairhurst Gail T
Published: October 2018

Reacting to the impact of Pope Francis and President Donald J. Trump on the world stage, New York Times essayist, Austen Ivereigh, asked the question, “Is Pope Francis the Anti-Trump?” He concluded that the answer is not an obvious one. Using qualitative methods, this study explores this question through the dialectical tensions and management strategies present in the narratives evoked in the many speeches and tweets of Pope Francis and President Trump. The dialectical tensions found in this study include: truth–post–truth, popular–elite, and unity–disunity. Their management by these two leaders is very different, with Trump responding in a much more unilateral fashion than Francis. The implications of these findings for the study of post-truth leadership are discussed, especially regarding the role of narrative and social media.
Women in the field: Positioning, troubling, and (em)bodying researcher identities in international and comparative education
Authors: Johnson Ane Turner
Published: October 2018

In this paper, I consider not only issues associated with the positionality of the researcher in international and comparative education fieldwork, but also how the researcher’s gender intercedes and intersects with position. Using heuristic research methods, specifically (self-)dialogue and the collection of research manuscripts, I explored how women researchers describe their experiences conducting international fieldwork and how they position their work as insiders/outsiders. Findings suggest that women struggled less with their insider/outsider stance than they did with a researcher/practitioner stance. Additionally, women spoke of gender as being associated with their bodies, perceptions of their bodies by participants and others, and how this positioned them in the field. Important, challenging questions emerged related to how we train women researchers, the homogeneity of the field of international and comparative education, and using gender norms to gain access to participants.
Identification of serve pacing strategies during five-set tennis matches
Authors: Martin C , Bideau B , Touzard P , Kulpa R
Published: October 2018

This study aims to investigate the prominence of different pacing strategies adopted by male professional tennis players during five-set matches and their relationship with match outcome, ATP ranking and Grand Slam tournament. Fifty five-set matches of the 2014 Grand Slam tournaments were analyzed. First and second serve velocities, percentages of first serve in, and percentages of first and second serve points won were collected for each of the five sets. According to the fluctuations of mean first serve velocity for each of the five sets, players were classified into five types of pacing strategies: ‘variable’, ‘parabolic’, ‘constant’, ‘all-out’ and ‘negative-split’. Professional players mostly used ‘variable’ pacing strategy (45%), followed by ‘parabolic’ (20%), ‘constant’ (18%) and ‘all-out’ (15%) strategies, which are closely distributed. Finally, ‘negative-split’ strategy (2%) is infrequently used. The pacing strategy used by players tends to exert an influence on match outcome ( P = 0.072). There is no significant association between players’ ranking and type of pacing strategy used ( P = 0.384). There is no significant association between Grand Slam tournaments and type of pacing strategy used ( P = 0.875). Serve velocity and serve points won are significantly decreased in losers, while they are increased or kept constant in winners during the fifth set of the match. ‘Negative split’, ‘variable’ and ‘parabolic’ strategies seem to be the most effective for winning five-set match, while ‘all-out’ strategy appears ineffective since when players used it, they lost the match in 73% of cases. Moreover, tennis players should consider physical conditioning programs to avoid decreases in serve velocity and percentage during the fifth set of a tennis match.
A corpus-driven analysis of representations of Syrian asylum seekers in the Turkish press 2011–2016
Authors: Efe İbrahim
Published: October 2018

This article, using methods from corpus linguistics and critical discourse analysis, reports the findings of a research project that aimed to explore the representations of Syrian asylum seekers in the Turkish press from March 2011, when the first Syrians arrived in Turkey, to December 2015, when the project ended. Using a corpus of 2321 texts collected from five Turkish daily newspapers, concordances of the words Syrian, refugee and asylum seeker were examined and grouped along patterns through which discourses on and around Syrian asylum seekers were uncovered. We found differing discourses that framed asylum seekers as ‘our brothers’, ‘victims’, ‘needy people’ and/or ‘threat’, ‘criminals’ and so on. Newspapers maintained one or a combination of these discourses to construct their own reality about the refugee crisis in Turkey. The analysis also reveals that Turkish newspapers use pertinent terms interchangeably, leading to an ambiguity which reflects the political as well as daily usage of the terms.
Risks assessment in Moroccan microfinance sector
Authors: Lamrani Alaoui Youssef , Tkiouat Mohamed
Published: October 2018

Managing risks is very significant for microfinance institutions (MFIs) to guarantee their financial soundness, to achieve their social objectives and then to encourage donors and investors to participate in microfinance industry financing. Risks impacts on MFIs differ considerably which make their prioritizing a highly important task to figure out the candidate risks to be mitigated or tolerated. This article provides a clear picture of the most serious risks affecting the microfinance sector in Morocco. We used an approach that combines the interval-valued intuitionistic fuzzy sets (IVIFSs) and the technique for order of preference by similarity to ideal solution (TOPSIS) method to deal with the lack of sufficient statistical data and the subjectivity of the experts’ judgement in risk rating. A sensitivity analysis was also conducted to show the impact of criteria weights on the decision process and to examine the robustness of the model results.
“It’s Lonely”: Patients’ Experiences of the Physical Environment at a Newly Built Stroke Unit
Authors: Anåker Anna , von Koch Lena , Heylighen Ann , Elf Marie
Published: October 2018

Objective:

The aim of this study was to explore patients’ experiences of the physical environment at a newly built stroke unit.

Background:

For a person who survives a stroke, life can change dramatically. The physical environment is essential for patients’ health and well-being. To reduce infections, a majority of new healthcare facilities mainly have a single-room design. However, in the context of stroke care, knowledge of how patients experience the physical environment, particularly their experience of a single-room design, is scarce.

Method:

This study used a qualitative design. Patients ( n = 16) participated in semistructured individual interviews. Data were collected in December 2015 and February 2017 in Sweden; interviews were transcribed verbatim and analyzed using content analysis.

Results:

Two main themes were identified: (i) incongruence exists between community and privacy and (ii) connectedness with the outside world provides distraction and a sense of normality. In single rooms, social support was absent and a sense of loneliness was expressed. Patients were positively distracted when they looked at nature or activities that went on outside their windows.

Conclusions:

The physical environment is significant for patients with stroke. This study highlights potential areas for architectural improvements in stroke units, primarily around designing communal areas with meeting places and providing opportunities to participate in the world outside the unit. A future challenge is to design stroke units that support both community and privacy. Exploring patients’ experiences could be a starting point when designing new healthcare environments and inform evidence-based design.
A Systematic Review of the Outcome Evaluation Tools for the Foot and Ankle
Authors: Shazadeh Safavi Pejma , Janney Cory , Jupiter Daniel , Kunzler Daniel , Bui Roger , Panchbhavi Vinod K.
Published: October 2018

Background. The goal of this systematic review is to determine the most commonly used outcome measurement tools used by foot and ankle specialists and determine their limitations, such as whether they are validated, have floor/ceiling effects, and so on. Methods. A literature search was conducted to identify primary publications between January 1, 2012 and July 1, 2017 that concern care of the foot and ankle and use any established grading criteria to evaluate patients. Results. In 669 publications, 76 scoring systems were used. The 10 most common were American Orthopaedic Foot and Ankle Score (AOFAS), visual analog scale (VAS), Short Form–36 (SF-36), Foot Function Index (FFI), Foot and Ankle Outcome Score (FAOS), Foot and Ankle Ability Measure (FAAM), SF-12, Short Musculoskeletal Function Assessment (SMFA), Ankle Osteoarthritis Scale (AOS), and Foot and Ankle Disability Index (FADI). AOFAS was used in 393 articles, VAS in 308, and SF-36 in 133 publications. AOFAS, VAS, and SF-36 were used to evaluate 23,352, 20,759, and 13,184 patients respectively. AOFAS and VAS were used simultaneously in 172 publications. Conclusion. While there are many different scoring systems available for foot and ankle specialists to use to assess or demonstrate the effectiveness of treatments, the AOFAS, while it is an unvalidated scoring system, is the most commonly used scoring system in this review. Clinical Relevance. This review presents data about commonly used patient reported outcomes systems in foot and ankle surgery.

Levels of Evidence: Level III: Systematic review.
A Comparative Analysis of Clinical Outcomes in Noninsertional Versus Insertional Tendinopathy Using PROMIS
Authors: Bernstein David N. , Anderson Michael R. , Baumhauer Judith F. , Oh Irvin , Flemister A. Samuel , Ketz John P. , DiGiovanni Benedict F.
Published: October 2018

Background. Achilles tendinopathy is a common clinical disorder. Utilizing the Patient-Reported Outcomes Measurement Information System, we aim to determine clinical response to nonoperative achilles tendinopathy rehabilitative care of insertional achilles tendinopathy compared to non-insertional achilles tendinopathy. Methods. Prospective Patient-Reported Outcomes Measurement Information System Physical Function, Pain Interference, and Depression scores were collected for patients with achilles tendinopathy at presentation and following a standard course of nonoperative care. A distribution-based method was used to determine the minimal clinically important difference. Descriptive statistics were reported and bivariate analysis was used to compare insertional achilles tendinopathy and non-insertional achilles tendinopathy. Receiver operating characteristic curve analysis was used to predict clinical improvement. Results. A total of 102 patients with an average follow-up of 68 days were included. For the non-insertional achilles tendinopathy group: Fifteen (46%), 12 (36%) and 9 (27%) patients reached clinical improvement for Physical Function, Pain Interference and Depression, respectively. For the insertional achilles tendinopathy group: Seventeen (25%), 20 (29%) and 22 (32%) patients reached clinical improvement for Physical Function, Pain Interference and Depression, respectively. Physical Function scores improved more in non-insertional achilles tendinopathy patients (4.0 vs. -0.046; p = 0.035) and more patients clinically improved (45.5% vs. 24.6%; p = 0.034). Patients with non-insertional and insertional achilles tendinopathy clinically improved functionally when initial Physical Function scores were equal to or lower than 40.25 and 38.08, respectively. Conclusions. Nonoperative care in achilles tendinopathy is often successful. The Patient-Reported Outcomes Measurement Information System can be used to evaluate and help determine clinical success.

Levels of Evidence: Level II: Prospective comparative study
Who Drives the Agenda: Media or Parties? A Seven-Country Comparison in the Run-Up to the 2014 European Parliament Elections
Authors: Jansen A. Severin , Eugster Beatrice , Maier Michaela , Adam Silke
Published: October 2018

In this paper, we examine who drives attention to the European Union (EU) in member nations—the media or the parties—and how cross-national variations in these media-party interactions can be explained by focusing on issue salience in campaign communications, party polarization, and media system characteristics. To answer these questions, we rely on a quantitative content analysis of newspaper articles and party press releases in seven countries (Austria, France, Germany, Greece, the Netherlands, Portugal, and the United Kingdom) during the twelve weeks prior to the 2014 European Parliament (EP) election. Our results from a daily-level vector autoregression (VAR) analysis show that parties are the main driver. However, our findings also indicate that single approaches in comparative research, namely, issue salience, party polarization, and media characteristics, cannot fully explain cross-national variations, which stem from combinations of different determinants, such as low (high) EU issue salience interacting with high (low) party polarization.
Multimorbidity, inflammation, and disability: a longitudinal mediational analysis
Authors: Friedman Elliot M. , Mroczek Daniel K. , Christ Sharon L.
Published: October 2018

Background:

Using longitudinal data from the Survey of Mid-Life Development in the United States, this study examined the role of systemic inflammation in mediating the link between multimorbidity and increases in and onset of functional limitations over a 17–19 year follow-up period.

Methods:

Participants completed questionnaire assessments of chronic conditions and functional limitations. Interleukin-6, C-reactive protein, and fibrinogen were assayed in serum. Structural equation models were used to predict increases in and onset of functional limitations associated with baseline multimorbidity status; mediation by inflammation was also determined.

Results:

Multimorbidity ( versus 0–1 conditions) predicted more functional limitations and greater odds of onset of limitations over time. Significant indirect effects showed that inflammation partially mediated the link between multimorbidity and changes in, but not onset of, limitations.

Discussion:

These results show that inflammation, a nonspecific marker of multiple disease conditions, explains in part the degree to which multimorbidity is disabling.
The impact of trisomy 21 on treatment modalities and outcome in adults with congenital heart disease in Switzerland
Authors:   SACHER, Johannes Judith , Greutmann Matthias , Tobler Daniel , Bouchardy Judith , Stambach Dominik , Wustmann Kerstin , Schwitz Fabienne , Schwerzmann Markus
Published: October 2018

Trisomy 21 (T21) is associated in 40–45% of cases with heart defects, most commonly shunt lesions. These defects, if not repaired, can lead to irreversible shunt‐induced pulmonary hypertension (i.e. Eisenmenger syndrome [ES]). In ES patients, intracardiac repair is no longer possible, but selective pulmonary vasodilators may increase exercise capacity and improve prognosis. This study aimed to estimate the prevalence of cardiac defects and ES in adult T21 patients and to assess the impact of T21 on treatment modalities and outcome in ES patients. A questionnaire was sent to 6906 Swiss physicians inviting them to indicate the number of adults with T21 under their care (survey report). We also analyzed all adults with ES (with and without T21) included in the Swiss Adult Congenital HEart disease Registry (SACHER) and studied the impact of T21 on the use of selective pulmonary vasodilators and survival. In the survey, 348 physicians cared for 695 adult T21 patients. Overall, 24% of T21 survey patients were known to have a cardiac defect, one in four with a defect had developed ES and 13% of those with ES were on specific pulmonary vasodilators. In SACHER, ES was present in 2% of adults with congenital heart disease and selective pulmonary vasodilators were used in 68% of ES patients with T21. In SACHER, survival during follow‐up was worse with higher nt‐proBNP levels (hazard ratio [HR] = 1.15 per 1000 units, 95% confidence interval [CI] = 1.02–1.29) and lower left ventricular ejection fraction (HR = 1.07 per percent decrease, 95% CI = 1.01–1.13). Age at inclusion and T21 did not affect survival. The prevalence of cardiac defects in adults with T21 in Switzerland is half the prevalence in children. T21 is over‐represented among adults with ES. Raised awareness of the therapeutic options for T21 patients with ES is warranted.
Membranous nephropathy followed by anti-glomerular basement disease: A case report and review of clinical presentation and treatment
Authors: Speer Claudius , Gaida Matthias Martin , Waldherr Rüdiger , Nusshag Christian , Kälble Florian , Zeier Martin
Published: October 2018

Membranous nephropathy is a common cause of nephrotic syndrome in adults and can be primary or secondary through autoimmune disease, medication, infection, or malignancy. Rapidly progressive glomerulonephritis with crescent formation is rare in patients with membranous nephropathy. Thus, in cases with rapid decline in renal function, after excluding complications such as malignant hypertension, acute hypersensitivity interstitial nephritis, and bilateral renal vein thrombosis, the simultaneous occurrence of a superimposed glomerulonephritis should be considered. We report a 55-year-old man suffering from a biopsy-confirmed primary membranous nephropathy, who developed rapidly progressive glomerulonephritis with anti-glomerular basement membrane antibodies after being affected with membranous nephropathy for 8 years. The kidney biopsy revealed a concurrence of membranous nephropathy and anti-glomerular basement membrane disease. Clinical presentation and treatment of membranous nephropathy followed by anti-glomerular basement membrane disease are discussed based on our observation with promising follow-up.
Performance measures for endoscopic retrograde cholangiopancreatography and endoscopic ultrasound: A European Society of Gastrointestinal Endoscopy (ESGE) Quality Improvement Initiative
Authors: Domagk Dirk , Oppong Kofi W , Aabakken Lars , Czakó Laszlo , Gyökeres Tibor , Manes Gianpiero , Meier Peter , Poley Jan-Werner , Ponchon Thierry , Tringali Andrea , Bellisario Cristina , Minozzi Silvia , Senore Carlo , Bennett Cathy , Bretthauer Michael , Hassan Cesare , Kaminski Michal F , Dinis-Ribeiro Mario , Rees Colin J , Spada Cristiano , Valori Roland , Bisschops Raf , Rutter Matthew D
Published: October 2018

The European Society of Gastrointestinal Endoscopy (ESGE) and United European Gastroenterology present a short list of key performance measures for endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). We recommend that endoscopy services across Europe adopt the following seven key and one minor performance measures for EUS and ERCP, for measurement and evaluation in daily practice at centre and endoscopist level: 1 Adequate antibiotic prophylaxis before ERCP (key performance measure, at least 90%); 2 antibiotic prophylaxis before EUS‐guided puncture of cystic lesions (key performance measure, at least 95%); 3 bile duct cannulation rate (key performance measure, at least 90%); 4 tissue sampling during EUS (key performance measure, at least 85%); 5 appropriate stent placement in patients with biliary obstruction below the hilum (key performance measure, at least 95%); 6 bile duct stone extraction (key performance measure, at least 90%); 7 post‐ERCP pancreatitis (key performance measure, less than 10%); and 8 adequate documentation of EUS landmarks (minor performance measure, at least 90%).

This present list of quality performance measures for ERCP and EUS recommended by the ESGE should not be considered to be exhaustive; it might be extended in future to address further clinical and scientific issues.
Perceived Significance of Engagement in Research Prioritization Among Chronic Kidney Disease Patients, Caregivers, and Health Care Professionals: A Qualitative Study
Authors: Elliott Meghan J. , Goodarzi Zahra , Sale Joanna E. M. , Wilhelm Linda A. , Laupacis Andreas , Hemmelgarn Brenda R. , Straus Sharon E.
Published: October 2018

Background:

Patients and other stakeholders are increasingly engaging as partners in research, although how they perceive such experiences, particularly over the long term, is not well understood.

Objective:

To characterize how participants from a nondialysis chronic kidney disease (CKD) research priority-setting project conducted 2 years previously perceived the significance of their involvement.

Design:

Qualitative descriptive study with semi-structured, individual interviews.

Setting:

Participants resided across Canada.

Participants:

Eligible participants included stakeholders (ie, patients with nondialysis CKD, caregivers, health care professionals, and policy makers) who had taken part in a prior CKD research priority-setting project.

Measurements:

We explored stakeholder experiences and perspectives on engagement in CKD research prioritization.

Methods:

We purposively sampled across stakeholder roles and engagement types (ie, involvement in the priority-setting workshop, wiki online tool, and/or steering committee). All interviews were conducted by a single investigator by telephone or face-to-face, and audio-recordings were transcribed verbatim. The data were inductively coded and analyzed by 2 investigators using a thematic analysis approach.

Results:

We conducted 23 interviews across stakeholder roles and engagement types. Participants appreciated the integration of distinct stakeholder communities of patients, researchers, and health care professionals that occurred through engagement in research priority setting. Their opportunity to interact with patients and others directly impacted by CKD outside of the clinical setting contributed to an enhanced understanding of the CKD lived experience and value of patient-oriented research. This interaction helped participants refine and refocus their commitment to patient-centered CKD care and research, characterized by enhanced knowledge and confidence (patients/caregivers), adaptations to existing clinical practices and policies (health care providers/policy makers), and subsequent research engagement.

Limitations:

The views of participants may not reflect those of individuals in other research or health care settings.

Conclusions:

Stakeholder engagement in nondialysis CKD research prioritization encouraged the integration of stakeholder communities, an appreciation of the CKD experience, and a refocusing of participants’ commitment to research and care. Findings highlight considerations for future health research engaging stakeholders, particularly those living with CKD, as research partners.
Azygos Vein to the Rescue of Warden Anastomosis in High Pulmonary Venous Drainage
Authors: Amboli Siddharth , Ashtaputre Yatindra U. , Kamath Anuradha , Hiremath Channabasavaraj S. , Manohar Krishna
Published: October 2018

Partial anomalous pulmonary venous return is a congenital anomaly in which some of the pulmonary veins drain into the right atrium or one of its venous tributaries. Although excellent long-term results have been described for the classic two-patch technique repair in older patients, The Warden procedure has an important role in smaller and younger patients and those patients in whom the superior vena cava (SVC) may be small and the right-sided pulmonary veins may connect high, at or above the azygos vein. In addition to prevention of early and late sinus node dysfunction, the Warden procedure helps to avoid systemic or pulmonary venous obstruction if care is taken to ensure a tension-free Warden anastomosis. Patch extension or interposition of prosthetic grafts with no growth potential have been used in instances of high partial anomalous pulmonary venous connection (PAPVC) to SVC. We report three cases of high PAPVC to SVC using an innovative technique of incorporating the azygos vein into the Warden anastomosis for a tension-free suture line.
Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies
Authors: Houck Darby A. , Kraeutler Matthew J. , McCarty Eric C. , Bravman Jonathan T.
Published: October 2018

Background:

Fixed- and adjustable-loop femoral cortical suspension devices are commonly used for femoral graft fixation during anterior cruciate ligament reconstruction (ACLR).

Purpose:

To compare the biomechanical results of fixed- versus adjustable-loop femoral cortical suspension devices in studies simulating ACLR with an isolated device and/or specimen setup using porcine femora and bovine flexor tendons.

Study Design:

Systematic review.

Methods:

Two independent reviewers searched PubMed, Embase, and the Cochrane Library databases to find studies comparing the biomechanical strength of fixed- and adjustable-loop cortical suspension devices for ACLR with isolated device and/or specimen setups using porcine femora and bovine flexor tendons. Studies that compared both devices with similar biomechanical methods were included. Data extracted included displacement during cyclic loading, ultimate load to failure, and mode of failure of the different cortical suspension devices for ACLR.

Results:

Six studies were identified that met the inclusion criteria, including a total of 76 fixed-loop devices and 120 adjustable-loop devices. Load to failure was significantly different ( P < .0001), with the strongest fixation device being the ToggleLoc with ZipLoop adjustable-loop device (1443.9 ± 512.3 N), compared with the Endobutton CL fixed-loop device (1312.9 ± 258.1 N; P = .04) and the TightRope RT adjustable-loop device (863.8 ± 64.7 N; P = .01). Cyclic displacement was significantly different, with Endobutton CL (3.7 ± 3.9 mm) showing the least displacement, followed by ToggleLoc with ZipLoop (4.9 ± 2.3 mm) and TightRope RT (7.7 ± 11.1 mm) ( P < .0001). Mode of failure was statistically different between the 3 groups ( P = .01), with suture failure accounting for 83.8% of TightRope RT devices, 69.4% of ToggleLoc with ZipLoop devices, and 60.3% of Endobutton CL devices.

Conclusion:

Current biomechanical data suggest that the ToggleLoc with ZipLoop device is the strongest fixation device at “time zero” in terms of ultimate load to mechanical failure. However, the Endobutton CL device demonstrated the least cyclic displacement, which may be a more clinically applicable measure of device superiority.