bluuebunny/crossref_metadata_2025 huggingface dataset:
Massively parallel anisotropic mesh adaptation
Authors: Digonnet Hugues , Coupez Thierry , Laure Patrice , Silva Luisa
Published: March 2017

Mesh adaptation has proven to be very efficient for simulating transient multiphase computational fluid dynamics applications. In this work, we present a new parallel anisotropic mesh adaptation technique relying on an edge based error estimator. It provides a high level of accuracy while substantially reducing the computational effort. This technique enables a good capture of physical phenomena, boundary layers, interfaces, free surfaces and even multiphase turbulent flows, and has a great potential to simulate a large variety of applications. Current investigations explore the performance of the new algorithm on massively parallel resources. In this paper, we show that the developed adaptive meshing works very well in a parallel environment involving topological mesh modifications and dynamic repartitioning of parallel slots. It is also shown that the proposed methodology provides an additional gain in terms of computational cost due the production of a non-uniform mesh size distribution. Runs performed on national and European supercomputers will show the scalability and pertinence of our developments.
Increasing Teachers’ Use of Behavior-Specific Praise Using a Multitiered System for Professional Development
Authors: Gage Nicholas A. , MacSuga-Gage Ashley S. , Crews Emily
Published: March 2017

Successful instruction is contingent upon effective classroom management. Unfortunately, not all teachers are effective classroom managers and many require in-service professional development (PD) to increase their use of evidence-based classroom management skills. Although PD models have been developed and evaluated, many are resource-intensive. To address this, we developed a multitiered system for PD (MTS-PD) to provide increased levels of support based on need as measured by teacher behavior. We conducted two studies to examine the effect of Tiers 1 and 2 of the MTS-PD model on elementary school teachers’ use of behavior-specific praise (BSP). Study 1 examined the effect of Tier 1, a single 25-min didactic training, and Study 2 examined the effect of Tier 2, which included regular visual performance feedback delivered via email. The results of Study 1 indicated that teachers did not increase their rates of BSP to a priori defined levels of success. Study 2 found that the Tier 2 PD approach increased teachers’ BSP rates, a functional relationship was established, and the rates maintained 3 months after the Tier 2 PD. Study limitations and future directions are discussed.
Socioeconomic status, social capital and self-reported unmet health care needs: A population-based study
Authors: Lindstrӧm Christine , Rosvall Maria , Lindstrӧm Martin
Published: March 2017

Aims: The aim of this study was to investigate the associations between socioeconomic status (SES) and self-reported unmet health care needs, taking economic stress, generalized trust in other people and trust in the health care system into account. Methods: The 2012 public health survey in Scania was conducted using a postal questionnaire and included 28,029 participants aged 18–80 years. The study was cross-sectional. Associations between SES and unmet health care needs were investigated, adjusting for economic stress and trust in logistic regressions. Results: SES was significantly associated with unmet health care needs. The SES categories of unemployed, on long-term sick leave and unskilled manual workers reported particularly high levels of unmet health care needs. SES differences in unmet needs were attenuated when economic stress and the two dimensions of trust and self-rated health were introduced in multiple analyses. The working population gave a lack of time as the reason for unmet health care needs, whereas those on sick leave or unemployed reported a lack of money. Conclusions: SES differences in self-reported unmet health care needs were observed and these associations were attenuated when economic stress during the past year, generalized trust in other people, trust in the health care system and self-rated health were introduced into the multiple models.
Days of sick leave and inpatient care at the time of pregnancy and childbirth in relation to maternal age
Authors: Brehmer Lovisa , Alexanderson Kristina , Schytt Erica
Published: March 2017

Aims: To explore whether older women differ from younger women with respect to sick leave and inpatient care at the time around their first pregnancy and delivery. Methods: This was a descriptive population-based cohort study. The study population included all 236,176 nulliparous women registered as living in Sweden who gave birth to their first singleton infant in 2006–2010. Data from nationwide Swedish registers were used. Maternal age was categorized in five-year intervals. Time was calculated in years with the delivery date as the starting point, from two years before and up to three years after delivery. Descriptive statistics were used to calculate mean values and ANOVA tables were used to obtain the 95% confidence intervals of the means. Restriction was used to reduce potential confounding. Results: Women aged ⩾35 years had a higher annual mean number of sick leave days from two years before to one year after their delivery date compared with younger women. The range for all age categories in the year before the delivery date, including pregnancy, was 15.3–37.4 mean sick leave days. The mean number of inpatient days increased with each age category during the year after the date of delivery in the range 1.4–4.3 days. Conclusions: This first explorative study indicates the need for more knowledge on morbidity among older primiparous women. They had a higher number of days with sick leave and hospitalization in the year before and after their delivery date. This might reflect higher health risks during pregnancy and childbirth among older women; however, social factors and reverse causation might also be influential.
Waiting times for cancer patients in Sweden: A nationwide population-based study
Authors: Robertson Stephanie , Adolfsson Jan , Stattin Pär , Sjövall Annika , Winnersjö Rocio , Hanning Marianne , Sandelin Kerstin
Published: March 2017

Aims: The reported long waiting times for cancer patients have mostly been related to prognostic outcome and less to patient-related experience to outcome. We assessed waiting times for patients with cancer of the breast, prostate, colon or rectum in Sweden. Methods: The median time from referral to start of treatment was assessed using data from clinical cancer registers for patients who received curative treatment during 2011, 2012 and 2013. Results: The median overall waiting time in different counties ranged from 7 to 28 days for breast cancer, from 117 to 280 days for prostate cancer, from 27 to 64 days for colon cancer and from 48 to 80 days for rectal cancer. For the entire nation, the median time from referral to start of treatment remained unchanged from 2011 to 2013 for each cancer diagnosis. Conclusions: Large variations were found in waiting times between different counties in Sweden and between different types of cancer. The long waiting times identified in this study emphasize the need to improve national programmes for more rapid diagnosis and treatment.
The political tendency in environmental and sustainability education
Authors: Håkansson Michael , Östman Leif , Van Poeck Katrien
Published: March 2017

This article presents a categorisation of the different situations in which the political dimension of environmental and sustainability education can be handled and experienced in practice: the ‘political tendency’. Using a methodology inspired by Wittgenstein’s user perspective on language, we empirically identified situations that express the political tendency by looking for language games centred around the question of how to organise social life, recognising that this inevitably requires decision-making about different and competing alternatives. Classifying these situations resulted in a typology (the political tendency) that distinguishes ‘Democratic participation’, ‘Political reflection’, ‘Political deliberation’ (sub-divided into ‘Normative deliberation’, ‘Consensus-oriented deliberation’ and ‘Conflict-oriented deliberation’) and ‘Political moment’. Next, we discuss the developed typology from an educative perspective, showing that the distinguished situations in the political tendency differ as to how they enable the foregrounding and backgrounding of different educational goals: preparation, socialisation and person-formation (i.e. identification and subjectification as perspective shifting and subjectification as dismantling).
The placement journey: Do year one placement modules support Childhood Studies students’ professional development?
Authors: Brown Zeta , Edwards Tracey , Perkins Helen
Published: March 2017

This study investigated changes made to the Childhood Studies placement journey of one post-1992 University in England. The Childhood Studies degree includes ‘practitioner options’ that requires students to complete 200 h placement experience, including 50 h in year one. In 2014, the participant university responded to this expectation by developing a year one placement module. The study sought to investigate whether the placement module supported the development of student’s professional identities in the first year of their studies. The study primarily used questionnaires, with a small amount of interviews and focus groups during 2014–2015. It found three key themes that students associated with their year one placement and their professional development. These were the importance of placement, links made from theory to practice and links from practice to theory. Students did however state disparities in their experiences of placement, especially in the range of responsibilities they were given. Students commented generally on the benefits (to their professional development) of relating theory to their year one practice, but noted frustration that there were minimal opportunities to reflect on practice in module assessments. The study contributes to existing literature by questioning how theory to practice and practice to theory links can be made more explicit in year one programmes.
Formative Research to Understand the Psychographics of 1% Milk Consumption in a Low-Income Audience
Authors: Finnell Karla Jaye , John Robert
Published: March 2017

A clear understanding of the knowledge, perceptions, beliefs, attitudes, and values of those whose behavior we hope to change is an essential task in a social marketing project. This formative research used mixed methods to identify consumer psychographics about high-fat milk among a low-income priority audience. High-fat milk users believe they choose the type of milk that is the healthiest for them and their families but had poor milk nutrition knowledge and an inaccurate appraisal of low-fat milk. Habit and taste preferences reinforced high-fat milk use but 2% milk users, a group that already adapted to reduced-fat milk, were the audience segment most willing to consider low-fat milk use. Low-fat milk use can be promoted by raising awareness that 2% milk is not low fat and addressing knowledge deficiencies while assuring the priority audience that 1% milk has all of the vitamins and minerals of whole or 2% milk but with less fat. The resonance of the promotion can be enhanced by incorporating words that “work” such as vitamins, minerals, healthy, choice, habit, and avoiding the words “switch” and “skim” that were viewed negatively by this low-income audience.
Littering Reduction
Authors: Almosa Yara , Parkinson Joy , Rundle-Thiele Sharyn
Published: March 2017

Littering continues to be a problem worldwide. The purpose of this article is to update earlier systematic reviews on littering and using a scorecard of seven social marketing components, assess the extent of social marketing use in identified littering programs. Following Center for Reviews and Dissemination guidelines, the search included all peer-reviewed studies published between 1995 and 2015 in the English language available through 10 databases. A total of 1,220 articles were initially identified and resulted in a final set of 17 that met the study criteria. The analysis revealed key insights including a lack of social marketing use in litter prevention efforts to date providing an opportunity for future research. Limitations of the current study and opportunities for future research are outlined.
Expression and Influence of Matrix Metalloproteinase–9/Tissue Inhibitor of Metalloproteinase–1 and Vascular Endothelial Growth Factor in Diabetic Foot Ulcers
Authors: Li Gongchi , Zou Xinhua , Zhu Youpeng , Zhang Jing , Zhou Lijun , Wang Dan , Li Binghui , Chen Zhenbing
Published: March 2017

A high matrix metalloproteinase–9/tissue inhibitor of metalloproteinase–1 (MMP9/TIMP1) ratio is associated with poor ulcer healing, yet how the ratio of MMP9/TIMP1 changes in diabetic foot ulcers (DFUs) with infection and how these changes may affect wound healing remain unclear. Therefore, the objective of this investigation was to explore relationships among the MMP9/TIMP1 ratio, infection, and DFUs. After being informed of the details of this study, 32 patients signed consent forms. Skin biopsies were performed for all patients. Wound tissues were obtained from all patients with wounds, and healthy skin samples were collected from patients without wounds during orthopedic surgery. Microbial cultures were obtained using the samples from diabetic patients with wounds. All patients were divided into 4 groups according to colony-forming units (CFUs) per gram of tissue (>1 × 106 or <1 × 106): group A (diabetic wounds with high quantities of bacteria), group B (diabetic wounds with low quantities of bacteria), group C (diabetic patients without wounds), and group D (nondiabetic patients with wounds). In addition, the biopsies were evaluated by both reverse transcription–quantitative polymerase chain reaction and Western blotting to assess the levels of MMP9, TIMP1, and vascular endothelial growth factor (VEGF). The results show that for both mRNA and protein, expression of MMP9 (fold change 1.14 ± 0.12 vs 0.60 ± 0.08 vs 0.39±0.09 vs 0.13 ± 0.06, P < .01) decreased, whereas that of TIMP1 (1.01 ± 0.09 vs 2.86 ± 0.85 vs 4.88 ± 0.83 vs 7.29 ± 1.55, P < .01) and VEGF (1.01 ± 0.22 vs 3.55 ± 0.97 vs 5.72 ± 0.55 vs 6.92 ± 1.55, P < .01) increased from group A to group D. These results suggest that an increase in the MMP9/TIMP1 ratio in infected DFUs may induce a decrease in VEGF expression.
Lymphangiogenesis: fuel, smoke, or extinguisher of inflammation’s fire?
Authors: Abouelkheir Gabriella R , Upchurch Bradley D , Rutkowski Joseph M
Published: March 2017

Lymphangiogenesis is a recognized hallmark of inflammatory processes in tissues and organs as diverse as the skin, heart, bowel, and airways. In clinical and animal models wherein the signaling processes of lymphangiogenesis are manipulated, most studies demonstrate that an expanded lymphatic vasculature is necessary for the resolution of inflammation. The fundamental roles that lymphatics play in fluid clearance and immune cell trafficking from the periphery make these results seemingly obvious as a mechanism of alleviating locally inflamed environments: the lymphatics are simply providing a drain. Depending on the tissue site, lymphangiogenic mechanism, or induction timeframe, however, evidence shows that inflammation-associated lymphangiogenesis (IAL) may worsen the pathology. Recent studies have identified lymphatic endothelial cells themselves to be local regulators of immune cell activity and its consequential phenotypes – a more active role in inflammation regulation than previously thought. Indeed, results focusing on the immunocentric roles of peripheral lymphatic function have revealed that the basic drainage task of lymphatic vessels is a complex balance of locally processed and transported antigens as well as interstitial cytokine and immune cell signaling: an interplay that likely defines the function of IAL. This review will summarize the latest findings on how IAL impacts a series of disease states in various tissues in both preclinical models and clinical studies. This discussion will serve to highlight some emerging areas of lymphatic research in an attempt to answer the question relevant to an array of scientists and clinicians of whether IAL helps to fuel or extinguish inflammation.

Impact statement

Inflammatory progression is present in acute and chronic tissue pathologies throughout the body. Lymphatic vessels play physiological roles relevant to all medical fields as important regulators of fluid balance, immune cell trafficking, and immune identity. Lymphangiogenesis is often concurrent with inflammation and can potentially aide or worsen disease progression. How new lymphatic vessels impact inflammation and by which mechanism is an important consideration in current and future clinical therapies targeting inflammation and/or vasculogenesis. This review identifies, across a range of tissue-specific pathologies, the current understanding of inflammation-associated lymphangiogenesis in the progression or resolution of inflammation.
Endovascular Treatment of Massive Axillary Artery Aneurysm for Palliation
Authors: Epstein David A. , Ibrahim M. Taha , Franz Randall W.
Published: March 2017

Atherosclerotic axillary artery aneurysms are rare. We report a case of a ninety six year old female who presented with a pulsatile left breast mass causing her intractable pain. She was diagnosed with a massive axillary artery aneurysm which was treated with and endovascular aneurysm repair for palliation of her symptoms.
Ulnar Artery Aneurysm in a 6-Month-Old: A Case Report
Authors: Meals Clifton G. , Carey George B. , Higgins James P. , Chang Benjamin
Published: March 2017

Background: Pediatric ulnar aneurysms are rare and, unlike their adult counterparts, cannot be explained by repetitive trauma to the palm. A small number of case reports describe diagnostic difficulty with these lesions and different treatments. Methods: We present the case of a 6-month-old with an ulnar artery aneurysm of unknown cause. The diagnosis was supported with magnetic resonance imaging, and the lesion was resected. Results: Because the hand remained well perfused, the ulnar artery was not reconstructed. Conclusions: Although the early result was good, the long-term outcome of this approach is unknown.
The Diagnostic Utility and Clinical Implications of Wrist MRI in the Pediatric Population
Authors: Gornitzky Alex L. , Lin Ines C. , Carrigan Robert B.
Published: March 2017

Background: Unexplained wrist pain is a common presentation in children. To our knowledge, no studies have explored the clinical utility of magnetic resonance imaging (MRI) in the diagnostic workup of pediatric patients. Methods: We retrospectively reviewed 307 consecutive wrist MRIs ordered at a tertiary-care pediatric hospital. Demographic data and the indication for imaging were recorded and grouped into admitting categories. The final impression of each MRI was scored with regard to potential impact on future treatment (0 = normal, 1 = minimal, 2 = moderate, 3 = high). Patients who went on to wrist surgery within 1 year were noted. Results: In our cohort, 27% of all studies were normal, including 34% of those with pain. Although pain was the most common category, MRI was most useful in the delineation of a mass/cyst, evaluating for infection and evaluating arthropathy. Compared with all other categories, patients with pain were 3.6 times more likely to have a normal study and 4.6 times more likely to have a clinical score less than or equal to 1. Given an admitting diagnosis of pain, females were 1.7 times more likely to present for an MRI and 2.4 times more likely to have a normal MRI. The Spearman correlation revealed no linear relationship between age and MRI outcome. In all, 13% of patients went on to have surgery within 1 year of MRI. Conclusions: At our pediatric institution, the majority of wrist MRIs were ordered for wrist pain. Given our data, wrist MRI is not an ideal screening tool in children, particularly in those with wrist pain, and should only be used to exclude or confirm a specific diagnosis.
Extensor Pollicis Brevis Spiral Tenodesis for Combined Metacarpophalangeal Instability and Trapeziometacarpal Arthritis
Authors: Henry Mark
Published: March 2017

Background: In more advanced stages of trapeziometacarpal arthritis, the thumb metacarpal may develop an adduction contracture, leading to secondary hyperextension instability of the metacarpophalangeal joint. Following trapeziometacarpal arthroplasty, uncorrected substantial metacarpophalangeal hyperextension may contribute to ongoing Z-collapse deformity, weakness of pinch and grip, and patient perception of diminished function. Methods: We prospectively analyzed a consecutive case series of 55 trapeziometacarpal arthroplasty patients (mean age, 60 years; 7 males) who received simultaneous extensor pollicis brevis spiral tenodesis for thumb metacarpophalangeal hyperextension of at least 50°. Preoperative/postoperative (mean, 24 weeks) objective measurements and Disabilities of the Arm, Shoulder and Hand (DASH) scores were compared using paired t tests with P < .05. Results: Mean preoperative/postoperative measurements were as follows: metacarpophalangeal hyperextension, 62.0°/−1.7°; metacarpophalangeal flexion, 52.1°/50.1°; interphalangeal arc of motion, 66.4°/65.5°; key pinch, 3.6/5.4 kg; grip strength, 14.1/20.1 kg; DASH score, 56.6/8.4. Differences were statistically significant for metacarpophalangeal hyperextension, key pinch, grip strength, and DASH score. Differences were not significant for metacarpophalangeal flexion or interphalangeal arc of motion. No patient demonstrated paresthesias or hypersensitivity of the digital nerves. All patients achieved stability at the metacarpophalangeal joint. One Kirschner wire was removed earlier than planned after migration and penetration through the skin. Conclusions: Performed in conjunction with trapeziometacarpal arthroplasty, spiral tenodesis effectively stabilizes the metacarpophalangeal joint without compromising metacarpophalangeal flexion, interphalangeal motion, or the digital nerves. Postoperatively, patients demonstrate significant improvements in key pinch, grip strength, and DASH scores.
Three-dimensional fractal model of normal contact damping of dry-friction rough surface
Authors: Pan Wujiu , Li Xiaopeng , Guo Na , Yang Zemin , Sun Zhaoning
Published: March 2017

According to the influence of the normal contact damping of joint surfaces on the dynamic characteristics of high-precision machinery (machine tool, robot, etc.), in this article, a three-dimensional fractal model of normal contact damping of dry-friction rough joint surfaces based on Hertz theory and fractal theory is established. The three-dimensional surface topography is constructed, according to the modified double variable Weierstrass–Mandelbrot function. The fractal model of strain energy [Formula: see text], dissipated energy [Formula: see text], damping loss factor [Formula: see text], and normal contact damping [Formula: see text] are deduced in detail, and the influence of fractal parameters and dynamic friction coefficient [Formula: see text] on them are simulated. The simulation curves show that strain energy [Formula: see text], dissipated energy [Formula: see text], damping loss factor [Formula: see text], and normal damping [Formula: see text] increase with the increase in the fractal roughness G; the influence of fractal dimension D on [Formula: see text] is more changeable, first [Formula: see text] decreases with the increase in D and then increases. [Formula: see text], [Formula: see text], and [Formula: see text] increase with the increase in D and [Formula: see text], respectively; the effect of [Formula: see text] on [Formula: see text] is not obvious, so simple change in [Formula: see text] has no significant change in [Formula: see text]; a comparative analysis of the theoretical calculation of normal damping and experimental results show that their general trend is consistent, and they increase with the increase in total normal contact load P, the relative error is 5%–25%. The theoretical model can provide reference for the design of normal contact damping of the joint surfaces.
Dynamic model and workspace analysis of novel incompletely restrained cable-suspension swing system driven by two cables
Authors: Wang Naige , Cao Guohua , Zhu Zhencai , Wang Lei , Peng Weihong
Published: March 2017

The incompletely restrained cable-suspension swing system driven by two cables is introduced in this article. Based on wrench of forces theory and Lagrange’s equation of first kind, the static and dynamics models of incompletely restrained cable-suspension swing system driven by two cables are established, respectively. In order to obtain an intuitive understanding of the trajectory analysis, a dynamics model consisting of governing equation and geometric constraint conditions which is a set of the mixed differential-algebraic equation in mathematics is established. A typical feedback controller and an inverse model were set up to estimate the driving function. The effective workspace, which is used to guarantee an efficient swing process, mostly depends on the geometrical shape rather than the volume itself which was calculated by trajectory analysis. In order to estimate system features and ensure a limited range of tension in underconstrained spatial cable system, the probable location of unbalanced loading was evaluated by pointwise evaluation techniques during normal work.
A role for the locus coeruleus in the analgesic efficacy of N-acetylaspartylglutamate peptidase (GCPII) inhibitors ZJ43 and 2-PMPA
Authors: Nonaka Takahiro , Yamada Toshihiko , Ishimura Tatsuhiro , Zuo Daiying , Moffett John R , Neale Joseph H , Yamamoto Tatsuo
Published: March 2017

N-acetylaspartylglutamate (NAAG) is the third most prevalent and widely distributed neurotransmitter in the mammalian nervous system. NAAG activates a group II metabotropic glutamate receptor (mGluR3) and is inactivated by an extracellular enzyme, glutamate carboxypeptidase II (GCPII) in vivo. Inhibitors of this enzyme are analgesic in animal models of inflammatory, neuropathic and bone cancer pain. NAAG and GCPII are present in the locus coeruleus, a center for the descending noradrenergic inhibitory pain system. In the formalin footpad model, systemic treatment with GCPII inhibitors reduces both phases of the inflammatory pain response and increases release of spinal noradrenaline. This analgesic efficacy is blocked by systemic injection of a group II mGluR antagonist, by intrathecal (spinal) injection of an alpha 2 adrenergic receptor antagonist and by microinjection of an α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA) receptor antagonist directly into the contralateral locus coeruleus. Footpad inflammation increases release of glutamate in the contralateral locus coeruleus and systemic treatment with a GCPII inhibitor blocks this increase. Direct injection of GCPII inhibitors into the contralateral or ipsilateral locus coeruleus reduces both phases of the inflammatory pain response in a dose-dependent manner and the contralateral effect also is blocked by intrathecal injection of an alpha 2 adrenergic receptor antagonist. These data support the hypothesis that the analgesic efficacy of systemically administered GCPII inhibitors is mediated, at least in part, by the contralateral locus coeruleus via group II mGluR, AMPA and alpha 2 adrenergic receptors.
Mechanisms of nerve growth factor signaling in bone nociceptors and in an animal model of inflammatory bone pain
Authors: Nencini Sara , Ringuet Mitchell , Kim Dong-Hyun , Chen Yu-Jen , Greenhill Claire , Ivanusic Jason J
Published: March 2017

Sequestration of nerve growth factor has been used successfully in the management of pain in animal models of bone disease and in human osteoarthritis. However, the mechanisms of nerve growth factor-induced bone pain and its role in modulating inflammatory bone pain remain to be determined. In this study, we show that nerve growth factor receptors (TrkA and p75) and some other nerve growth factor-signaling molecules (TRPV1 and Nav1.8, but not Nav1.9) are expressed in substantial proportions of rat bone nociceptors. We demonstrate that nerve growth factor injected directly into rat tibia rapidly activates and sensitizes bone nociceptors and produces acute behavioral responses with a similar time course. The nerve growth factor-induced changes in the activity and sensitivity of bone nociceptors we report are dependent on signaling through the TrkA receptor, but are not affected by mast cell stabilization. We failed to show evidence for longer term changes in expression of TrkA, TRPV1, Nav1.8 or Nav1.9 in the soma of bone nociceptors in a rat model of inflammatory bone pain. Thus, retrograde transport of NGF/TrkA and increased expression of some of the common nerve growth factor signaling molecules do not appear to be important for the maintenance of inflammatory bone pain. The findings are relevant to understand the basis of nerve growth factor sequestration and other therapies directed at nerve growth factor signaling, in managing pain in bone disease.
Smartphone electrographic monitoring for atrial fibrillation in acute ischemic stroke and transient ischemic attack
Authors: Tu Hans T , Chen Ziyuan , Swift Corey , Churilov Leonid , Guo Ruibing , Liu Xinfeng , Jannes Jim , Mok Vincent , Freedman Ben , Davis Stephen M , Yan Bernard
Published: March 2017

Rationale

Paroxysmal atrial fibrillation is a common and preventable cause of devastating strokes. However, currently available monitoring methods, including Holter monitoring, cardiac telemetry and event loop recorders, have drawbacks that restrict their application in the general stroke population. AliveCor™ heart monitor, a novel device that embeds miniaturized electrocardiography (ECG) in a smartphone case coupled with an application to record and diagnose the ECG, has recently been shown to provide an accurate and sensitive single lead ECG diagnosis of atrial fibrillation. This device could be used by nurses to record a 30-s ECG instead of manual pulse taking and automatically provide a diagnosis of atrial fibrillation.

Aims

To compare the proportion of patients with paroxysmal atrial fibrillation detected by AliveCor™ ECG monitoring with current standard practice.

Sample size

296 Patients.

Design

Consecutive ischemic stroke and transient ischemic attack patients presenting to participating stroke units without known atrial fibrillation will undergo intermittent AliveCor™ ECG monitoring administered by nursing staff at the same frequency as the vital observations of pulse and blood pressure until discharge, in addition to the standard testing paradigm of each participating stroke unit to detect paroxysmal atrial fibrillation.

Study outcome

Proportion of patients with paroxysmal atrial fibrillation detected by AliveCor™ ECG monitoring compared to 12-lead ECG, 24-h Holter monitoring and cardiac telemetry.

Discussion

Use of AliveCor™ heart monitor as part of routine stroke unit nursing observation has the potential to be an inexpensive non-invasive method to increase paroxysmal atrial fibrillation detection, leading to improvement in stroke secondary prevention.
Concussions in Community-Level Rugby: Risk, Knowledge, and Attitudes
Authors: Martin R. Kyle , Hrubeniuk Travis J. , Witiw Christopher D. , MacDonald Peter , Leiter Jeff
Published: March 2017

Background:

Rugby is a popular collision sport where participants are at risk of sustaining concussions. Most research focuses on elite-level or youth divisions. Comparatively, little is known about adult community rugby. The aim of this research was to estimate the risk of sustaining a concussion during participation in community-level rugby and summarize the collective knowledge and attitudes toward concussions.

Hypothesis:

Concussion symptoms will be reported frequently among community-level rugby players and a substantial proportion will report a willingness to continue participation despite the risk.

Study Design:

Cross-sectional analysis.

Level of Evidence:

Level 3.

Methods:

An anonymous, voluntary survey was administered to all 464 senior rugby players registered in the province of Manitoba in 2015. Two primary domains were assessed: (1) concussion history from the preceding season including occurrence, symptomatology, and impact on daily activities and (2) knowledge and attitudes toward concussion risks and management.

Results:

In total, 284 (61.2%) rugby players responded. Concussive symptoms were reported by 106 (37.3%). Of those, 87% were formally diagnosed with a concussion and 27% missed school and/or work as a result. The danger of playing while symptomatic was recognized by 93.7% of participants, yet 29% indicated they would continue while symptomatic. Furthermore, 39% felt they were letting others down if they stopped playing due to a concussion.

Conclusion:

Concussive symptoms were common among the study cohort and had a notable impact on daily activities. A high proportion of players were willing to continue while experiencing symptoms despite recognizing the danger. The observed discord between knowledge and attitudes implicates a culture of “playing injured.”

Clinical Relevance:

Understanding the risk of injury may affect an individual’s decision to participate in community-level rugby. Moreover, evidence of discord between the knowledge and attitudes of players may direct future research initiatives and league governance.
Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes
Authors: Carlton Joshua A , Maxwell Adam W , Bauer Lindsey B , McElroy Sara M , Layfield Lester J , Ahsan Humera , Agarwal Ajay
Published: March 2017

Background and purpose

In patients with squamous cell carcinoma of the head and neck (HNSCC), extracapsular spread (ECS) of metastases in cervical lymph nodes affects prognosis and therapy. We assessed the accuracy of intravenous contrast-enhanced computed tomography (CT) and the utility of imaging criteria for preoperative detection of ECS in metastatic cervical lymph nodes in patients with HNSCC.

Materials and methods

Preoperative intravenous contrast-enhanced neck CT images of 93 patients with histopathological HNSCC metastatic nodes were retrospectively assessed by two neuroradiologists for ECS status and ECS imaging criteria. Radiological assessments were compared with histopathological assessments of neck dissection specimens, and interobserver agreement of ECS status and ECS imaging criteria were measured.

Results

Sensitivity, specificity, positive predictive value, and accuracy for overall ECS assessment were 57%, 81%, 82% and 67% for observer 1, and 66%, 76%, 80% and 70% for observer 2, respectively. Correlating three or more ECS imaging criteria with histopathological ECS increased specificity and positive predictive value, but decreased sensitivity and accuracy. Interobserver agreement for overall ECS assessment demonstrated a kappa of 0.59. Central necrosis had the highest kappa of 0.74.

Conclusion

CT has moderate specificity for ECS assessment in HNSCC metastatic cervical nodes. Identifying three or more ECS imaging criteria raises specificity and positive predictive value, therefore preoperative identification of multiple criteria may be clinically useful. Interobserver agreement is moderate for overall ECS assessment, substantial for central necrosis. Other ECS CT criteria had moderate agreement at best and therefore should not be used individually as criteria for detecting ECS by CT.
On the Factors Causing Processing Difficulty of Multiple-Scene Displays
Authors: Stainer Matthew J , Scott–Brown Kenneth C , Tatler Benjamin W
Published: March 2017

Multiplex viewing of static or dynamic scenes is an increasing feature of screen media. Most existing multiplex experiments have examined detection across increasing scene numbers, but currently no systematic evaluation of the factors that might produce difficulty in processing multiplexes exists. Across five experiments we provide such an evaluation. Experiment 1 characterises difficulty in change detection when the number of scenes is increased. Experiment 2 reveals that the increased difficulty across multiple-scene displays is caused by the total amount of visual information accounts for differences in change detection times, regardless of whether this information is presented across multiple scenes, or contained in one scene. Experiment 3 shows that whether quadrants of a display were drawn from the same, or different scenes did not affect change detection performance. Experiment 4 demonstrates that knowing which scene the change will occur in means participants can perform at monoplex level. Finally, Experiment 5 finds that changes of central interest in multiplexed scenes are detected far easier than marginal interest changes to such an extent that a centrally interesting object removal in nine screens is detected more rapidly than a marginally interesting object removal in four screens. Processing multiple-screen displays therefore seems dependent on the amount of information, and the importance of that information to the task, rather than simply the number of scenes in the display. We discuss the theoretical and applied implications of these findings.
Factors affecting the concussion knowledge of athletes, parents, coaches, and medical professionals
Authors: Cusimano Michael D , Zhang Stanley , Topolovec-Vranic Jane , Hutchison Michael G , Jing Rowan
Published: March 2017

Objectives:

To determine the predictors of knowledge and awareness of concussion symptoms and outcomes through a survey of athletes, parents of players and coaches in sports settings in Canada.

Methods:

A cross-sectional survey of athletic communities in Canada was conducted. Respondents’ concussion knowledge score consists of responses to questions about the symptoms, diagnosis, and treatment of a concussion and the timing of return-to-sport post-concussion. The percentage of correct responses was defined as the “identification rate.” The extent to which participant factors affected the scores was examined by univariate and multivariate analyses.

Results:

Respondents were able to identify a mean of 80.6% of symptoms. Cognitive symptoms were most commonly known, and mental health symptoms associated with concussion were least known, and health professionals, coaches, and those with a personal history of concussion had the highest levels of overall knowledge. Language, age, educational level, annual household income, and traumatic brain injury history were good predictors of better concussion knowledge.

Conclusion:

Those designing and implementing interventions aimed at concussion management and prevention should ensure that younger, lower income, lower educational, non-English-speaking persons, and those without experience of traumatic brain injury or concussion be specifically accounted for in the design and implementation of interventions to prevent and treat concussion and mild traumatic brain injury.
A pilot study of clinical results of Odyliresin (Iresine celosia) in symptomatic benign prostatic hyperplasia
Authors: Porru D , Franco C Di , Bobbi V , Tinelli C , Rovereto B
Published: March 2017

Aim:

The aim of this pilot clinical trial was to determine if Odyliresin ( Iresine celosia), a cytochrome-flavoprotein with a powerful anti-oxidant action on cells, has a therapeutic effect on benign prostatic hyperplasia-related lower urinary tract symptoms, reducing symptoms and prostate volume, improving the patient’s quality of life and eventually limiting the number of patients who require surgery or endoscopy after medical treatment.

Methods:

Thirty patients with benign prostatic hyperplasia-related lower urinary tract symptoms were recruited and followed up. Primary outcomes were assessed using International Prostate Symptom Score symptom questionnaires, quality of life score, examination, prostate-specific antigen, transrectal ultrasound, uroflowmetry with post-void residual volume. Once recruited, patients were assigned for treatment: alpha-antagonist (alfuzosin 10 mg)+Odyliresin ( Iresine celosia) 2 ml, 20 drops once daily.

Results:

The results for quantitative variables were expressed as mean values and standard deviation as they were all normally distributed (Shapiro–Wilk test). The study included 30 patients with an average age of 68 years (range 56–80 years). The statistical analysis of data reports significant improvement of mean values of maximum urinary flow rate (+1.2, p=0.050), average flow rate (+0.47, p>0.002), International Prostate Symptom Score (–4.8, p=0.000), quality of life (–1.4, p=0.000), total prostatic volume (–1.7, p=0.000), prostatic adenoma (–6.9, p=0.000) and post-void residual volume (–17.8, p>0.004) between baseline and 12 months after treatment. No patient had acute urinary retention during treatment or need for benign prostatic hyperplasia-related surgery at the end of the 12-month treatment.

Conclusions:

All patients with benign prostatic hyperplasia-related lower urinary tract symptoms received both alphalitic and Odyliresin treatment. Clinical parameters and uroflowmetry parameters significantly improved, adenoma volume and post-void residual volume were significantly reduced at 12 months. This is the first clinical experience with Iresine celosia, a phytotherapeutic agent with no scientifically proven clinical efficacy so far in benign prostatic hyperplasia.
Toward a Conceptual Understanding of Formula One Motorsport and Local Cosmopolitanism Discourse in Urban Placemarketing Strategies
Authors: Lowes Mark
Published: March 2017

Guided by a conceptual approach, this article delves into the image-saturated world of Formula One (F1) motorsport to argue that the interrelations among sport mega events, urban identity, and placemarketing work to create spectacular entertainment events that embody a distinctly promotional performance of local cosmopolitanism. F1 events are staged promotional performances of local cosmopolitanism intended for a global audience and feature prominently in urban placemarketing strategies. Hosting such sport mega events is a constitutive feature of placemarketing strategies designed and implemented by host cities to join the ranks of “world-class” cosmopolitan cities. F1 motorsport is a representation of a particular conception of urban cosmopolitanism, one that embodies a fusion of sports entertainment, symbolic capital, and image into a single placemarketing product. The article concludes that the bombardment of visual signs advertising elite global mega brands constructs a specific identity for host cities anchored in a broad discourse of cosmopolitanism. This deployment of visual indicators is designed to link the image of F1 cities with the desired lifestyle markers that are constitutive features of the aesthetic of contemporary urban cosmopolitanism.
Internal fixation of S1-S3 iliosacral screws and pubic screw as the best configuration for unstable pelvic fracture with unilateral vertical sacral fracture (AO type C1.3)
Authors: Dilogo Ismail Hadisoebroto , Satria Oryza , Fiolin Jessica
Published: March 2017

Background:

Although internal fixation is the definitive treatment in unstable pelvic fractures with disruption of the anterior arch and a vertical fracture of the sacrum (AO type C1.3), there have been no agreement of the best technique of internal fixation yet. We aimed to derive comparable objective data on stiffness and load to failure in this type of fracture fixations.

Methods:

Synbone was modified into AO type C1.3 fracture model, while treatments were divided into six internal fixation treatment groups using tension band plate (TBP), symphysis pubis plate (SP) with iliosacral screw at S1 and S2 (IS S1-S2), pubic screw (PS) with iliosacral TBP, PS and IS S1-S2, SP and IS S1-S3, PS and S1-S3 and finally PS and IS S1-S3. Sensor was applied to detect the shifting and rotation of fracture fragments. Mechanical strength test conducted with the application of axial force on the sacrum vertebra (S1).

Results:

The highest translational stiffness was observed in the group IS S1-S3 + PS (830.36 N/mm, p = 0.031) and there was no difference on the rigidity of the rotation between the groups posterior fixation using IS S1-S2 and IS S1-S3 ( p = 0.51). Meanwhile the highest load to failure was found in group IS S1-S3 + PS (1522.20 N). PS provided advantages compared to the use of plate.

Conclusions:

Group of PS and S1-S3 IS is the configuration of internal fixation with best translational and rotational stiffness and the largest load to failure compared to other techniques in AO type C1.3 fracture.
Perforin and CD107a testing is superior to NK cell function testing for screening patients for genetic HLH
Authors: Rubin Tamar S. , Zhang Kejian , Gifford Carrie , Lane Adam , Choo Sharon , Bleesing Jack J. , Marsh Rebecca A.
Published: March 2017

Key Points

NK cell function testing is less sensitive and no more specific for discriminating genetic HLH compared to perforin and CD107a expression. Perforin and CD107a testing could augment NK-cell cytotoxicity testing for use in HLH diagnostic criteria.
Prospective study of insomnia and incident asthma in adults: the HUNT study
Authors: Brumpton Ben , Mai Xiao-Mei , Langhammer Arnulf , Laugsand Lars Erik , Janszky Imre , Strand Linn Beate
Published: March 2017

Insomnia is highly prevalent among asthmatics; however, few studies have investigated insomnia symptoms and asthma development. We aimed to investigate the association between insomnia and the risk of incident asthma in a population-based cohort.

Among 17 927 participants free from asthma at baseline we calculated odds ratios and 95% confidence intervals for the risk of incident asthma among those with insomnia compared to those without. Participants reported sleep initiation problems, sleep maintenance problems and nonrestorative sleep. Chronic insomnia was defined as those reporting one or more insomnia symptom at baseline and 10 years earlier. Incident asthma was defined by questions on asthma at baseline and follow-up (average 11 years).

The prevalence of sleep initiation problems, sleep maintenance problems and nonrestorative sleep were 1%, 1% and 5%, respectively. The multi-adjusted odds ratios were 1.18 (95% CI 0.97–1.44), 1.30 (95% CI 1.03–1.64) and 1.70 (95% CI 1.37–2.11) for people with one, two and three insomnia symptoms, respectively, compared with people without symptoms (p<0.01 for trend). The risk of developing asthma in those with chronic insomnia was three times higher (adjusted OR 3.16, 95% CI 1.37–6.40) than those without.

Insomnia symptoms were associated with increased risk of incident asthma in this study.