bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between macular vessel density and central visual field sensitivity at different glaucoma stages
Authors: Shin Joong Won , Lee Jiyun , Kwon Junki , Jo Younhye , Jeong Daun , Shon Gilhwan , Kook Michael S
Published: January 2019

Aims

To evaluate the relationship between macular vessel density (mVD) and central visual field sensitivity (cVFS) at different stages of glaucoma and to compare this relationship with that between the thickness of the macular ganglion cell-inner plexiform layer (mGCIPLT) and cVFS.

Methods

The mVD and mGCIPLT were measured by optical coherence tomography angiography in 139 patients with glaucoma. The cVFS was defined as the average of 12 central points on 24-2 visual field (VF) testing. Vasculature–function and structure–function relationships were analysed by comparing mVD and mGCIPLT with cVFS in eyes with early and moderate-to-advanced glaucoma.

Results

Global and regional mVD–cVFS associations were statistically significant in eyes with moderate-to-advanced (all p<0.05), but not early stage (all p>0.05) glaucoma. The global association between average mVD and cVFS was significantly stronger than that between average mGCIPLT and cVFS in eyes with moderate-to-advanced glaucoma (p=0.049). Reduced mVD was independently associated with cVFS loss after adjusting for age and mGCIPLT in eyes with moderate-to-advanced glaucoma.

Conclusions

The macular vasculature–function relationship using mVD was stronger than the structure–function relationship using mGCIPLT in eyes with moderate-to-advanced glaucoma. The mVD may be useful in monitoring cVFS in advanced glaucoma.
Utilisation of the principles of the Armed Forces Covenant in NHS Trusts and Clinical Commissioning Groups across England: a freedom of information investigation
Authors: McGill Gill , Wilson Gemma , Hill Michael , Kiernan Matthew D
Published: January 2019

Objectives

To determine the extent to which National Health Service (NHS) service providers appoint a named Armed Forces veteran lead or champion, and to explore the commissioning of veteran-specific services by Clinical Commissioning Groups.

Design

A convergent mixed method design was used to improve understanding obtained from the information provided by respondents on their practice. The study comprised two parts: phase 1 involved NHS Trusts, and phase 2 involved Clinical Commissioning Groups.

Setting

All NHS Trusts and Clinical Commissioning Groups in England were contacted using a freedom of information request.

Participants

All NHS trusts and Clinical Commissioning Groups across England.

Interventions

Initially, existing national websites were searched to gather information within the public domain. An audit was carried out, using the Freedom of Information Act (FOIA) 2000 to gather further information.

Primary and secondary outcome measures

The FOIA 2000 applies to UK Government departments and public authorities, including NHS Trusts in England, Wales and Northern Ireland.

Results

Responses from the freedom of information requests illustrate inconsistencies in relation to adopting the principles of the Armed Forces Covenant. The inconsistencies extend to the practice of appointing an Armed Forces Veteran Lead or an Armed Forces Veteran Champion. There is also evidence to suggest a lack of commitment to and understanding of policy guidance in relation to Clinical Commissioning Group responsibility for commissioning veteran-specific services.

Conclusions

Findings from this study support the case for making improvements to, and improving the consistency of, commissioning practices for veterans.
Features and trends of thyroid cancer in patients with thyroidectomies in Beijing, China between 1994 and 2015: a retrospective study
Authors: Zhao Ling , Pang Ping , Zang Li , Luo Yukun , Wang Fulin , Yang Guoqing , Du Jin , Wang Xianling , Lyu Zhaohui , Dou Jingtao , Mu Yiming
Published: January 2019

Objectives

This study aims to summarise the features and trends of thyroid carcinoma in the past two decades in China.

Design, setting and participants

Clinical data obtained from 10 798 patients treated by thyroidectomy from 1994 to 2015 at the Department of General Surgery of the People’s Liberation Army General Hospital, Beijing, China were retrospectively analysed.

Outcome measures

Incidence and histopathological features of thyroid cancer were compared and the risk factors for local lymph node metastasis analysed.

Results

Our data indicated a significant increase in the detection of thyroid cancer (from 16.8% to 69.8%, p<0.01). Among the 5235 thyroid cancer cases, papillary thyroid carcinoma (PTC) was the most common histotype, accounting for 95.1% of all malignancies over the 22-year period. Among the 4979 PTCs, micro-PTCs (mPTC) with the largest diameter ≤10 mm has gradually become the dominant form, and its percentage in PTCs has increased from 13.3% in the biennial period of 1994–1995 to 51.2% in 2010–2011. Furthermore, the size of the tumour has decreased significantly from 2.3±1.1 cm in 1994 to 1.2±0.9 cm in the largest diameter (p<0.01), while the average age at diagnosis and female dominance remained unchanged during the period. Logistic regression showed that tumour nodules>1 cm and male gender were the main risk factors for local lymph node metastasis (LNM), whereas patients over 45 years had lower risk.

Conclusions

During the 22-year period, an increased detection of thyroid cancer, particularly mPTC, was found while the occurrence of LNM decreased. Our results suggest that the current preoperative diagnosis and risk stratification are adequate, supporting the published guidelines for the diagnosis of thyroid cancer.
Impact of a specific training programme on the neuromodulation of pain in female patient with fibromyalgia (DouFiSport): a 24-month, controlled, randomised, double-blind protocol
Authors: Le Fur Bonnabesse Anais , Cabon Mathilde , L’Heveder Gildas , Kermarrec Aurélie , Quinio Bertrand , Woda Alain , Marchand Serge , Dubois Amandine , Giroux-Metges Marie-Agnes , Rannou Fabrice , Misery Laurent , Bodéré Céline
Published: January 2019

Introduction

The main symptom of fibromyalgia (FM) is diffuse pain. There is currently no aetiological treatment for FM. However, all pain associations and best practice guidelines strongly advocate the practice of aerobic physical activity to improve the symptoms of FM subjects. The mechanisms of dysfunctional pain are mostly central and related to stress axis dysfunction (autonomic nervous system and corticotropic axis). Our main objective is to assess the efficacy of a specific training programme on endogenous pain control mechanisms in female patients with FM. Further aims include rebalancing the autonomic neurovegetative system, improving quality of life and sleep quality, and reintegrating patients into society and work.

Methods and analysis

110 female patients with FM diagnosed on American College of Rheumatology 2010 criteria, aged 18–65 years and meeting inclusion conditions will be recruited and randomised into two groups (active and semiactive). The training programme will consist of three 45 min sessions per week of supervised, individualised physical activity over 2 years. Only the intensity of the exercises will differ between the two groups (moderate intensity vs low intensity).

All outcome measures will be conducted at baseline (T0), after 6–9 months of training (T6–9) and after 24 months of training (T24). The primary endpoint will be an improvement of pain modulation (activation of diffuse noxious inhibitory control) evaluated by the stimulation test. The secondary endpoint will be relief of pain, anxiety, depression, stress, sleep disorders, pain impact on life quality, and improved heart rate, blood pressure and salivary cortisol.

Ethics and dissemination

This study is approved by the Committee for the Protection of Persons West VI. The results will be published in specialised scientific journals and will be presented at scientific meetings on pain and/or physical activity.

Trial registration number

NCT02486965; Pre-results.
Spatial barriers and the bypassing of nearby dental clinics for dental services: a secondary data analysis in Korea
Authors: Shin Hosung , Cho Han-A
Published: January 2019

Objective

This study aimed to calculate the distance patients travel to dental clinics, the rate of bypassing nearby dental clinics and the distance covered when bypassing nearby dental clinics, and explored factors associated with patients’ spatial access to dental clinics.

Design

A secondary data analysis.

Setting

Korea Health Panel.

Participants

We included users of dental care services from 2008 to 2011. A total of 2375 patients and 15 978 dental visits were analysed.

Primary outcome measures

Korea Health Panel data (2008–2011) were used to geocode patients’ and healthcare facilities’ addresses. The distance travelled was calculated using road network information. To analyse the panel data, we adopted a generalised estimating equation: geographical measures on the choice of dental care facility were examined based on sex, age, educational level, equivalent income, treatment details and regional classification.

Results

The median distance travelled to a dental clinic was 1.8 km, which is farther for rural (8.4 km) than for urban (1.5 km) patients. The bypass rate was 58.9%. Patients bypassing nearby dental clinics travelled 9.6 times farther for dental care (p<0.001). Unlike bypass distance, travel distance was not associated with equivalent income. People with higher education and those with implants/orthodontic treatment were more likely to bypass nearby dental clinics and travelled 1.27 times and 1.17 times farther (p<0.01), respectively.

Conclusions

Given the spatial barrier to available dental resources, factors associated with spatial access were mostly the same between travel and bypass distance except for equivalent income. The findings of this study suggest that spatial distance acts as a utilisation barrier and demands additional opportunity cost. At the same time, patients’ preferences for services also increase their willingness to bypass nearby dental clinics and travel greater distances.
Impact of a mass media campaign on participation rates in a National Bowel Cancer Screening Program: a field experiment
Authors: Durkin Sarah J , Broun Kate , Spittal Matthew J , Wakefield Melanie A
Published: January 2019

Objectives and design

This field experiment aimed to compare bowel cancer screening participation rates prior to, during and after a mass media campaign promoting screening, and the extent to which a higher intensity campaign in one state led to higher screening rates compared with another state that received lower intensity campaign exposure.

Intervention

An 8-week television-led mass media campaign was launched in selected regions of Australia in mid-2014 to promote Australia’s National Bowel Cancer Screening Program (NBCSP) that posts out immunochemical faecal occult blood test (iFOBT) kits to the homes of age-eligible people. The campaign used paid 30-second television advertising in the entire state of Queensland but not at all in Western Australia. Other supportive campaign elements had national exposure, including print, 4-minute television advertorials, digital and online advertising.

Outcome measures

Monthly kit return and invite data from NBCSP (January 2012 to December 2014). Return rates were determined as completed kits returned for analysis out of the number of people invited to do the iFOBT test in the current and past 3 months in each state.

Results

Analyses adjusted for seasonality and the influence of other national campaigns. The number of kits returned for analysis increased in Queensland (adjusted rate ratio 20%, 95% CI 1.06% to 1.35%, p<0.01) during the months of the campaign and up to 2 months after broadcast, but only showed a tendency to increase in Western Australia (adjusted rate ratio 11%, 95% CI 0.99% to 1.24%, p=0.087).

Conclusions

The higher intensity 8-week television-led campaign in Queensland increased the rate of kits returned for analysis in Queensland, whereas there were marginal effects for the low intensity campaign elements in Western Australia. The low levels of participation in Australia’s NBCSP could be increased by national mass media campaigns, especially those led by higher intensity paid television advertising.
Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network
Authors: Hoang Uy , Liyanage Harshana , Coyle Rachel , Godden Charles , Jones Simon , Blair Mitch , Rigby Michael , de Lusignan Simon
Published: January 2019

Objectives

Respiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations.

Design

Cross-sectional study.

Setting

We analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England.

Participants

Children 5–12 years.

Interventions

None. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma.

Primary and secondary outcome measures

We describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children.

Results

83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5–11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children.

Conclusion

We showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections.
Electronic patient reported outcomes to support care of patients with traumatic brain injury: PRiORiTy study qualitative protocol
Authors: Retzer Ameeta , Turner Grace M , Slade Anita , Kyte Derek , McMullan Christel , Jones Laura , Belli Antonio , Calvert Melanie
Published: January 2019

Introduction

Traumatic brain injury (TBI) represents a major health and socioeconomic problem internationally. The expansive nature of injuries results in a heterogeneous population. The degree and type of long-term impacts following TBI and improvement following injury are highly variable. The use of electronic Patient Reported Outcomes Measures (ePROMs) could help identify residual impacts of TBI and support patient management and care. The Patient Reported Outcomes Research in Trauma study is a qualitative study exploring the long-term symptoms and impacts that are experienced by those with TBI and the potential utility of an ePROM platform to collect real-time information on patient symptoms and quality of life to inform treatment and identify support needs.

Methods and analysis

Semi-structured telephone and face-to-face interviews will be conducted with approximately 30–40 individuals recruited from five groups: (1) people with TBI; (2) carers and relatives of individuals with TBI; (3) TBI healthcare professionals; (4) researchers and (5) third sector staff members and volunteers working with those with TBI. Data will be analysed using directed thematic analysis employing an iterative coding frame that will be modified as analysis progresses. Intercoder triangulation will be employed to enhance credibility.

Ethics and dissemination

This study was approved by the West Midlands—Black Country Research Ethics Committee (Ref: 18/WM/0033). Findings will be disseminated via conference presentations, peer-reviewed journals, social media (@CPROR_UoB;http://www.birmingham.ac.uk/cpror) and the National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre.
Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study
Authors: Greiver Michelle , Kalia Sumeet , Voruganti Teja , Aliarzadeh Babak , Moineddin Rahim , Hinton William , Dawes Martin , Sullivan Frank , Syed Saddaf , Williams John , de Lusignan Simon
Published: January 2019

Objectives

To study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes.

Design

Retrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017.

Setting

Primary care practices in Canada and the UK.

Participants

Adults aged 18 years or more.

Main outcome measures

Mean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes.

Results

707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP.

Conclusions

Acquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.
Impact of screening on cervical cancer incidence in England: a time trend analysis
Authors: Pesola Francesca , Sasieni Peter
Published: January 2019

Objectives

To better model underlying trends in cervical cancer incidence so as to model past trends, to estimate the impact of cervical screening on cervical cancer rates at different ages and to obtain a counterfactual baseline under a no-screening scenario.

Design

Trend analysis of cancer registry data recorded between 1971 and 2013.

Setting

England.

Participants

132 493 women aged 20–84 with a diagnosis of cervical cancer.

Outcome measure

Cervical cancer incidence data were modelled using a modified age period cohort model able to capture both increased exposure to human papillomavirus (HPV) as well as changes in the age of exposure to HPV in young cohorts. Observed rates were compared with counterfactual baseline rates under a no-screening scenario to estimate the protective effect of screening.

Results

Rates of cervical cancer incidence have been decreasing since the introduction of screening but are projected to increase in the future under the current scenario. Between 1988 and 2013, it was estimated that screening had prevented approximately 65 000 cancers. Moreover, in 2013, the age-standardised rate (ASR) estimated under the no-screening scenario (37.9, 95% CI 37.4 to 38.3) was threefold higher among women aged 20–84 than the observed ASR (12.8, 95% CI 12.3 to 13.3). We estimate that the age of first HPV exposure has decreased by about 1 year every decade since the early 1970s (women born in 1955 onwards).

Conclusions

Our results corroborated the importance of screening in preventing cervical cancer and indicated future rates are dependent on age at HPV exposure. Estimated future rates can be used for healthcare planning while the counterfactual baseline to quantify the impact of HPV vaccination in microsimulations.
Physiotherapy improves symptoms of exercise-induced laryngeal obstruction in young elite athletes: a case series
Authors: Kolnes Liv-Jorunn , Vollsæter Maria , Røksund Ola Drange , Stensrud Trine
Published: January 2019

Objective

A constricted, upper chest breathing pattern and postural dealignments habitually accompany exercise-induced laryngeal obstruction (EILO), but there are few effective treatments for athletes presenting with EILO. This case series was conducted to examine whether physiotherapy based on principles from the Norwegian psychomotor physiotherapy (NPMP) combined with elements of cognitive behavioural therapy can reduce laryngeal distress in athletes with EILO.

Methods

Respiratory distress in four subjects was examined by interview prior to a physiotherapeutic body examination. Inappropriate laryngeal movements during exercise were measured by the continuous laryngoscopy exercise test, lung function was measured by flow-volume curves, and non-specific bronchial hyper-responsiveness was measured by a methacholine provocation test. History of asthma, allergy and respiratory symptoms was recorded in a modified AQUA2008questionnaire. Parasympathetic activity was assessed by pupillometry. All data were gathered before and after 5 months of intervention.

Results

Physiotherapy based on the principles from NPMP improved breathing problems in athletes with EILO. All athletes had less respiratory distress, improved lung function at rest and reduced inappropriate laryngeal movements during maximal exercise.

Conclusion

A diaphragmatic breathing pattern, a more balanced tension in respiratory muscles, and sound cervical alignment and stability may help to reduce adverse stress on the respiratory system and optimise the function of the larynx during high-intensity exercise. Our results suggest that understanding and management of EILO need to extend beyond structures located in the anterior neck and include factors influencing the whole respiratory system.
Prehospital analysis of northern trauma outcome measures: the PHANTOM study
Authors: Smith Christopher A , Hardern Richard D , LeClerc Simon , Howes Richard J
Published: January 2019

Objective

To compare the mortality and morbidity of traumatically injured patients who received additional prehospital care by a doctor and critical care paramedic enhanced care team (ECT), with those solely treated by a paramedic non-ECT.

Methods

A retrospective analysis of Trauma Audit and Research Network (TARN) data and case note review of all severe trauma cases (Injury Severity Score ≥9) in North East England from 1 January 2014 to 1 December 2017 who were treated by the North East Ambulance Service, the Great North Air Ambulance Service or both. TARN methods were used to calculate the number of unexpected survivors or deaths in each group (W score (Ws)). The Glasgow Outcome Scores were contrasted to evaluate morbidity.

Results

The ECT group treated 531 patients: there were 17 unexpected survivors and no unexpected deaths. The non-ECT group treated 1202 patients independently: there were no unexpected survivors and 31 unexpected deaths. The proportion of patients requiring critical care interventions differed between the two groups 49% versus 33% (CI for difference 12% to 20%). In the ECT group, the Ws was 3.22 (95% CI 0.79 to 5.64). In the non-ECT group, the Ws was −2.97 (95% CI −1.22 to −4.71). The difference between the Ws was 6.18 (95% CI 3.19 to 9.17). There was no evidence of worse morbidity in the ECT group.

Conclusion

This is the first UK ECT service to demonstrate a risk-adjusted mortality benefit in trauma patients with no detriment in morbidity: our results demonstrate an additional 3.22 survivors per 100 severe trauma casualties when treated by an ECT. The authors encourage other ECT services to conduct similar research.
Comments on the dilemma in the December issue: Dealing with dogs that bite
Authors: Donald Melissa
Published: January 2019

In the dilemma discussed in the December issue of In Practice, Simon Coghlan described a scenario where you are working as a veterinarian in an animal shelter. The senior vet tells you about a dog that was surrendered to the shelter after it escaped from its yard and, without provocation, attacked a person, causing them a laceration that required stitches. A staff member at the shelter has offered to rehome the aggressive dog, as they live in the country and have a fenced yard. They believe the dog is owed a second chance. However, the senior vet disagrees saying: ‘Such dogs do not deserve to be in the community. They are a menace and should be destroyed’ (IP, December 2018, vol 40, pp 470‐471). Is it morally right for you to kill the dog?
US military medical ethics in the War on Terror
Authors: Annas George J , Crosby S
Published: January 2019

Military medical ethics has been challenged by the post-11 September 2001 ‘War on Terror’. Two recurrent questions are whether military physicians are officers first or physicians first, and whether military physicians need a separate code of ethics. In this article, we focus on how the War on Terror has affected the way we have addressed these questions since 2001. Two examples frame this discussion: the use of military physicians to force-feed hunger strikers held in Guantanamo Bay prison camp, and the uncertain fate of the Department of Defense’s report on ‘Ethical Guidelines and Practices for US Military Medical Professionals’.
Republished: MRI SPACE sequence confirmation of occluded MCA M2 dissection stump masquerading as a ruptured MCA aneurysm
Authors: Khattar Nicolas K , White Andrew C , Adams Shawn W , Aljuboori Zaid S , Wilder Michael J , Downs Richard K , James Robert F
Published: January 2019

Intracranial vascular pathologies often have overlapping clinical presentations. Dissected vessel occlusions and bifurcation aneurysms can appear similar on pretherapeutic imaging. The medical management of these two entities is drastically different. The patient is a 51-year-old man who presented with severe, sudden-onset headache. Initial presentation was consistent with a ruptured middle cerebral artery (MCA) aneurysm and surgical clipping was recommended. However, further review of radiographic findings could not definitively differentiate an aneurysmal origin of the symptoms as opposed to intracranial dissection followed by occlusion of the M2 branch of the MCA. MRI sampling perfection with application optimised contrasts using different flip angle evolution (SPACE) was performed and showed thin flow signalling distal to the dissected vessel stump confirming the diagnosis. Accurate diagnosis is a crucial step in directing treatment for intracranial vascular lesions. MRI SPACE is a simple tool in the diagnostic armamentarium to adequately direct treatment and avoid the potential for unnecessary interventions.
Perforated appendicitis in the setting of a massive ventral hernia, morbid obesity, and multiple severe comorbidities: challenges in acute management
Authors: Skelhorne-Gross Graham , Gomez David
Published: January 2019

Case summary

A 57-year-old woman with morbid obesity (body mass index [BMI] of 43), systemic lupus on steroids, type 2 insulin-dependent diabetes, peripheral vascular disease, unprovoked pulmonary embolism on rivaroxaban, and hypertension presented with 3 days of worsening abdominal pain and nausea. She had an extensive surgical history including a cesarean section, multiple laparotomies for small bowel obstructions (one complicated by bowel perforation requiring resection), and a double-barrelled ileostomy, which had been since reversed. As a result, she had a massive incisional hernia (figure 1). On presentation she was afebrile but tachycardic at 110 beats per minute. Physical examination revealed tenderness to deep palpation in the right upper and lower quadrants. CT demonstrated an 11 mm appendix with an appendicolith outside the hernia sac abutting the right kidney, discontinuity of the appendix tip, free fluid, and associated stranding in the subhepatic region (figure 2A). She was admitted to the surgical floor for a trial of conservative management with ancef and flagyl. On day 3, her pain worsened, her white cell count remained stable at 12 x109/L, her temperature was 37.8°C, she was not tachycardic, and a repeat CT showed a 15 mm perforated appendix with increased periappendiceal stranding and an associated small volume of free fluid. There was no phlegmon or organized abscess (figure 2B).

Figure 1

Patient’s abdomen demonstrating midline laparotomy incisional scar, previous ileostomy scar, and massive ventral hernia.

Figure 2

Abdominal CT showing increased stranding centered around the appendix, with discontinuity of the wall of the appendix tip and free fluid within the abdomen and pelvis. (A) Admission CT. White arrow: appendix. (B) CT on postadmit day 3 as patient worsened clinically. Black arrow: fecalith.

What would you do?

Continue non-operative management with broadened intravenous antibiotic coverage and bowel rest.

Laparoscopic ± open appendectomy without concomitant hernia repair.

Laparoscopic ± open appendectomy with abdominal wall reconstruction.
Use of posterior component separation and transversus abdominis release in trauma and emergency general surgery patients: a case report and review of the literature
Authors: Como John J , Gunter Oliver L , Diaz Jose J , Ho Vanessa P , Miller Preston R
Published: January 2019

Posterior component separation with transversus abdominis release and implantation of synthetic mesh in the retromuscular space is a durable type of repair for many large incisional hernias with recurrence rates consistently less than 10%. The purported advantage of biologic prostheses in contaminated fields has recently been challenged, and the concern for placing synthetic mesh in contaminated fields may be overstated. There are almost no data specifically addressing the use of this type of repair for chronic incisional hernias in trauma and emergency general surgery patients, so research is needed on this patient population. In this review, a case of a trauma patient receiving posterior component separation with transversus abdominis release and implantation of synthetic mesh for a chronic incisional hernia resulting from a gunshot wound to the abdomen is presented, the technique is explained, and relevant literature is reviewed.
SAV1, regulated by microRNA-21, suppresses tumor growth in colorectal cancer
Authors: Jiang Jianwu , Chang Wei , Fu Yang , Gao Yongshun , Zhao Chunlin , Zhang Xiefu , Zhang Shuijun
Published: January 2019

This study investigated the role and action of the Salvador 1 protein (SAV1, also called WW45) in colorectal cancer (CRC). For this, CRC SW480 and HCT116 cells were infected with lentiviruses of SAV1 overexpression vector (lenti-SAV1) and SAV1 short hairpin RNA (sh-SAV1) to overexpress and silence SAV1 respectively, or transfected with microRNA-21 (miR-21) mimic to overexpress miR-21. Relative mRNA levels of SAV1 and relative miR-21 levels in CRC tissues or cells were detected. The effects of SAV1 and miR-21 on cell proliferation and apoptosis were evaluated using the MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assay and annexin V – fluorescein isothiocyanate (FITC) – propidium iodide (PI) flow cytometry, respectively. Our results revealed that SAV1 was downregulated in CRC tissues compared with the adjacent noncancerous tissues. Furthermore, SAV1 overexpression inhibited proliferation and promoted apoptosis in SW480 and HCT116 cells, whereas knockdown of SAV1 exerted the opposite effect. Additionally, the tumorigenesis of SW480 cells in xenografted mice was significantly inhibited by SAV1 overexpression but promoted by SAV1 knockdown. MiR-21 levels significantly and negatively correlated with SAV1 expression in CRC tissues. More importantly, miR-21 overexpression significantly abolished the SAV1-mediated inhibition of proliferation and stimulation of apoptosis of SW480. In conclusion, SAV1 suppresses tumor growth in CRC and is regulated by miR-21.
Seed banks of subtropical grassland patches within an urban matrix in South Africa: reflecting the past and foretelling the future
Authors: Sershen  , Drury Charmaine C. , Carbutt Clinton , Ramdhani Syd
Published: January 2019

Urban grasslands often exist as fragmented patches with varying threat levels. These patches are generally inappropriately managed due to limited data on their responses to disturbance and seed bank regenerative potential. This study compared seed banks between non-naturally disturbed and undisturbed patches of South African subtropical grasslands in an urban environment. Standing vegetation was characterised via year-round quadrat and monthly transect sampling. The seed banks were sampled after the two main dispersal periods and assessed for species composition and density. The seed bank species (24) represented a subset (9%) of the standing vegetation, with forbs being the most speciose life form and grasses the most abundant. Disturbance had a moderate impact on seed bank density but significantly affected species composition and ordering. Clustering and ordination analyses separated seed banks based on disturbance history. However, seed banks in disturbed patches maintained the general character of the grassland type. Diagnostic, rare and threatened taxa were absent from seed banks, irrespective of disturbance history. Consequently, restoration will possibly require seed enrichment and species reintroduction rather than exploitation of natural seed banks. Identifying disturbance-sensitive species through seed bank surveys can inform grassland conservation and restoration strategies.
Dynamics of viscous dissipative gravitational collapse in f(R, T) gravity with full causal approach
Authors: Ahmed Riaz , Abbas G.
Published: January 2019

We present a study of dissipative gravitational collapse in spherically symmetric gravitating spacetime by applying the Misner–Sharp approach in metric f(R, T) gravity. This work is an extension of the study by Herrera, Di Prisco, Fuenmayor, and Troconis, Int. J. Mod. Phys. D, 18, 129 (2009), that was already done with the general theory of relativity. To this end, we have formulated a set of equations of motion by using f(R, T) = R + λT (where R is the Ricci scalar, T is the trace of stress–energy tensor, and λ is the coupling constant), as well as a stress–energy tensor of viscous and heat conducting fluid. The conservation equations have been also derived for such setup. Both the conservation equations and equation of motion provide the dynamical equations in terms of the theory of gravity. Furthermore, the causal thermodynamic approach introduced by Müller–Israel–Stewart has been used to formulate the transportation equations of heat flux and bulk viscosity. Then, we perform the coupling of dynamical equations and transportation equations. The effects of bulk and shear viscosities have been investigated in detail. Finally, we studied the impact of the matter curvature coupling parameter λ on the dynamics of the gravitating source.
THE EFFECTS OF UNCONVENTIONAL MONETARY POLICY IN JAPAN: NEW EVIDENCE FROM TIME-VARYING PARAMETER VAR ANALYSIS
Authors: OTSUBO KANSHO PIOTR
Published: January 2019

This paper investigates the macroeconomic effects of unconventional monetary policies by estimating a time-varying parameter structural vector auto-regression (TVP-VAR) using Japanese monthly data beginning with the implementation of quantitative easing in 2001. The results of the empirical study can be summarized in four points. First, the impulse responses of output to a positive monetary policy shock rose during the period of quantitative easing (March 2001–July 2006) but declined after the comprehensive monetary easing began (October 2010–July 2015). Second, the impulse responses of inflation to a positive monetary policy shock became stably positive after the introduction of inflation targeting in January 2013. Third, the impulse responses of stock prices to positive monetary policy shocks rose each time an unconventional monetary policy was adopted. Finally, the recovery of the credit transmission channel might be attributed to the level of non-performing loans remaining low. The third result implies that increased stock prices from a monetary policy shock are primarily affected by foreign capital because foreign capital responds more strongly than domestic capital to unconventional monetary policy.
DHIMAN: A novel algorithm for economic

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ispatch problem based on optimization met

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od us

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ng

M

onte Carlo simulation and

A

strophysics co

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cepts
Authors: Dhiman Gaurav , Singh Pritpal , Kaur Harsimran , Maini Ritika
Published: January 2019

This paper presents a new model using optimization approach for efficient prediction of load in real-life environment. Monte Carlo simulation and Schrödinger equations provide the effective number of solutions. This technique is useful in representation of relationships between different models. The proposed algorithm is verified and validated with various state-of-the-art approaches for solving economic load power dispatch problem to demonstrate its efficiency. Experimental results signify that the proposed algorithm is more precise than existing competing models.
Quaternion generalization of super-Poincaré group
Authors: Chauhan Bhupendra C. S. , Joshi Pawan Kumar , Negi O. P. S.
Published: January 2019

Super-Poincaré algebra in [Formula: see text] space–time dimensions has been studied in terms of quaternionic representation of Lorentz group. Starting the connection of quaternion Lorentz group with [Formula: see text] group, the [Formula: see text] spinors for Dirac and Weyl representations of Poincaré group are described consistently to extend the Poincaré algebra to super-Poincaré algebra for [Formula: see text] space–time.
Evidence for complete low-frequency vibration band gaps in a thick elastic steel metamaterial plate
Authors: Li Suobin , Dou Yihua , Chen Tianning , Wan Zhiguo , Huang Jingjing , Li Bing , Zhang Fan
Published: January 2019

Elastic steel metamaterial plates can be used for noise- and vibration-reduction due to unique physical properties related to their vibration band gap. However, obtaining a complete low-frequency vibration band gap in a thick elastic steel metamaterial plate is difficult. In this paper, we simulate a complete low-frequency vibration band gap in a thick elastic steel metamaterial plate. The structure consists of periodic, double-sided, composite stepped resonators, which were deposited on a 2D locally resonant phononic crystal plate. The phononic crystal plate consists of an array of rubber fillers embedded in a thick steel plate. The dispersion relations, power-transmission spectra, and the displacement fields of the eigenmodes are calculated using the finite-element method. The results show that, for the proposed structure, the opening of the first complete vibration band gap is reduced by a factor of 9.5 compared to a conventional thick elastic steel metamaterial plate. This causes attenuation of low-frequency elastic waves. The formation mechanisms for the vibration band gap are also explored numerically. The results indicate that the formation mechanism for the new low-frequency vibration band gap can be attributed to coupling between a local resonance mode of the composite stepped resonators and the Lamb wave mode of the thick steel-plate. The location of the vibration band gap is determined by the resonator mode of the composite stepped resonators. The vibration band gap effects of the composite stepped resonators are also investigated in this paper. We find that the location of the complete vibration band gaps can be modulated with a relatively low frequency using different composite stepped resonators. Such an elastic steel metamaterial plate with a complete low-frequency vibration band gap can be used to reduce both vibration and noise in various commercial and research applications.
The influence of samples on meta-heuristic algorithm for parameter estimation of chaotic system
Authors: Peng Yuexi , Sun Kehui , He Shaobo , Alamodi O. A.
Published: January 2019

Parameter estimation of chaotic system is an important issue in nonlinear science. The meta-heuristic algorithm is one of the effective estimation approaches, and has received increasing attention. However, few people have noticed the influence of the samples on parameter estimation. In fact, when using meta-heuristic algorithm for parameter estimation, the number of samples will affect the efficiency greatly. In this paper, this problem is investigated. The relationship between sample and step size, and the factors that affect the difficulty of parameter estimation are also considered. Experimental results show that it is more efficient to set the samples to a small number, and the number of estimated parameters is the most important factor affecting the difficulty of parameter estimation. Finally, to improve the precision further, a new hybrid chaotic particle swarm optimization algorithm which combines a special inertia weight with chaotic search is proposed. Results demonstrate that the new hybrid algorithm is more effective than the other four meta-heuristic algorithms.
Investigation on growth and electronic characteristics of vertical carbon nanotubes
Authors: Lan Kuibo , Pei Zhihui , Zhang Yibo , Zhang Kailiang , Chen Xuejiao , Qin Guoxuan
Published: January 2019

Carbon nanotubes (CNTs) as interconnects in integrated circuits (ICs) which are vertically aligned in growth with high tube density and long tube length are required. In this paper, we present a method to improve the height of CNTs. High-resolution transmission electron microscopic (TEM) images confirm CNTs top growth mode. By cutting and modifying the top of CNTs, the influences of different radii of apertures on interconnect resistance were studied. According to the analysis, we proposed a novel growth mechanism to improve growth height of CNTs interconnection structure and the top contact resistances of pre-cutting and post-cutting CNTs interconnection structure were forecasted. The result demonstrates that the electronic performances of the post-cutting CNTs interconnection structure with platinum (Pt)-protected layer are better than the ones of pre-cutting CNTs interconnection structure. The resistivity of the post-cutting CNTs interconnection structure with Pt-protected layer is [Formula: see text], which is much less than that of post-cutting CNTs interconnect structure [Formula: see text]. In what follows, the resistance of the contacted area of pre-cutting CNTs interconnection structure is 31 [Formula: see text], which is much less than that of post-cutting CNTs interconnection structure 439 [Formula: see text]. This constitutes a significant step to realize longer CNTs interconnects with complementary metal oxide semiconductor (CMOS) contact modules.
Primary pyroelectric transition temperatures of binary nitrides (AlN, GaN and InN)
Authors: Swain Muralidhar , Sahoo Sushant K. , Sahoo Bijay K.
Published: January 2019

The primary pyroelectric transition temperature of wurtzite nitrides (AlN, GaN and InN) has been explored theoretically from their thermal properties. The spontaneous and piezoelectric polarization modifies the thermal conductivity of nitrides. The thermal conductivity [Formula: see text] as a function of temperature including and excluding the polarization mechanism predicts a transition temperature [Formula: see text] between primary and secondary pyroelectric effects. Below [Formula: see text], thermal conductivity including polarization field [Formula: see text] is lesser than thermal conductivity excluding polarization field [Formula: see text]. This is due to negative thermal expansion in binary nitrides below [Formula: see text]; however, above [Formula: see text], [Formula: see text]. [Formula: see text] is significantly contributed by piezoelectric polarization above [Formula: see text] due to thermal expansion which is the reason for the secondary pyroelectric effect. The transition temperature [Formula: see text] for AlN, GaN and InN has been predicted as 100 K, 70 K and 60 K, respectively, which fit well with the prior literature studies. This report proposes that thermal properties’ study can reveal the role of acoustic phonons in pyroelectricity.
The fundamentals of harnessing the magneto-optics of quantum wires for designing optical amplifiers: Formalism
Authors: Kushwaha Manvir S.
Published: January 2019

Quantum wires occupy a unique status among the semiconducting nanostructures with reduced dimensionality, no other system seems to have engaged researchers with as many appealing features to pursue. This paper aims at a core issue related with the magnetoplasmon excitations in the quantum wires characterized by the confining harmonic potential and subjected to a longitudinal electric field and a perpendicular magnetic field in the symmetric gauge. Despite the substantive complexity, we obtain the exact analytical expressions for the eigenfunction and eigenenergy, using the scheme of ladder operators, which fundamentally characterize the quantal system. Crucial to this inquiry is an intersubband collective excitation that evolves into a magnetoroton — above a threshold value of magnetic field — which observes a negative group velocity between the maxon and the roton. The evidence of negative group velocity implies anomalous dispersion in a gain medium with the population inversion that forms the basis for the lasing action of lasers. Thus, the technological pathway that unfolds is the route to devices exploiting the magnetoroton features for designing the novel optical amplifiers at nanoscale and hence paving the way to a new generation of lasers.
Design of Knowledge Map Construction Based on Convolutional Neural Network
Authors: Li Xiulai , Chen Mingrui , Xie Gengquan , Jiang Yirui
Published: January 2019

With the advent of the Web era, data has exploded, with tens of thousands of textual data being generated every day. Traditional text sentiment analysis methods are mainly based on lexicon and machine learning-based methods. These methods show certain limitations as the data size increases. Here, we propose a new knowledge map design method based on convolutional neural network. For the academic literature data crawled from HowNet and Baidu Academic Website with the theme of computer, the corresponding ontology database, the fusion application of multiple data sources, and the mapping of different ontology libraries through data fusion are constructed for data sources in different fields. The global ontology library then uses the entity alignment and entity link methods for knowledge acquisition and fusion. Finally, the convolutional neural network is used for training and testing. The experimental results show that the subject search task can not only obtain the book through the convolution network, the effective academic literature in the question bank can also be used to obtain the relevance of the keyword in the search results, which verifies the effectiveness of the method.