bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on the subtractive clustering algorithm for mobile ad hoc network based on the Akaike information criterion
Authors: Banteng Liu , Yang Haibo , Chen Qiuxia , Wang Zhangquan
Published: September 2019

Large and dense mobile ad hoc networks often meet scalability problems, the hierarchical structures are needed to achieve performance of network such as cluster control structure. Clustering in mobile ad hoc networks is an organization method dividing the nodes in groups, which are managed by the nodes called cluster-heads. As far as we know, the difficulty of clustering algorithm lies in determining the number and positions of cluster-heads. In this article, the subtractive clustering algorithm based on the Akaike information criterion is proposed. First, Akaike information criterion is introduced to formulate the optimal number of the cluster-heads. Then, subtractive clustering algorithm is used in mobile ad hoc networks to get several feasible clustering schemes. Finally, the candidate schemes are evaluated by the index of minimum of the largest within-cluster distance variance to determine the optimal scheme. The results of simulation show that the performance of the proposed algorithm is superior to widely referenced clustering approach in terms of average cluster-head lifetime.
1,3-Dinitrobenze-Induced Genotoxicity Through Altering Nuclear Integrity of Diploid and Polyploidy Germ Cells
Authors: Peiris L. Dinithi C. , Chathu Prathitha , Perera D. D. B. D. , Moore Harry D.
Published: September 2019

1,3-Dinitrobenzene (mDNB) is a widely used intermediate in commercial products and causes testicular injury. However, genotoxic effects upon low-level exposure are poorly understood. The present study evaluated the effects of very low-chronic doses of mDNB on sperm nuclear integrity. Male hamsters were treated with 1.5 mg/kg/d/4 wks (group A), 1.5 mg/kg/mDNB/d/week/4 weeks (group B), 1.0 mg/kg/mDNB/3 d/wk/4 wks (group C), or polyethylene glycol 600 (control). Nuclear integrity of distal cauda epididymal sperm was determined using the sperm chromatin structure assay and acridine orange staining (AOS). The germ cell nuclear integrity was assessed by the comet assay. Testicular histopathology was conducted to evaluate the sensitive stages. The comet assay revealed denatured nuclear DNA in group A (in diploid and polyploid cells from weeks 2-5); respectively at week 4 and weeks 3 to 4 in groups B and C. According to AOS, only group A animals exhibited denatured sperm DNA (weeks 1 and 3). The effective sperm count declined from weeks 1 to 6. Mean sperm DNA denaturation extent, percentage cells outside the main population, and standard deviation indicated altered sperm nuclear integrity in group A. Same animals exhibited progressive disruption of the Sertoli cells, while groups B and C exhibited damages on germ cells. The results suggest that mDNB affects sperm nuclear integrity at very low chronic doses targeting cell-specific testicular damage.
Risk and sensitivity quantification of fracture failure employing cohesive zone elements
Authors: Lee Young-Joo , Suh Wonho
Published: September 2019

Many structures are subjected to the risk of fatigue failure. For their reliability-based design, it is thus important to calculate the probability of fatigue failure and assess the relative importance of the involved parameters. Although various studies have analyzed the fatigue failure, the stage of fracture failure has been less focused. In particular, the risk analysis of fracture failure needs to be conducted considering its importance in actual structures. This article proposes a new probabilistic framework for the risk and sensitivity analysis of structural fatigue failure employing cohesive zone elements. The proposed framework comprises three steps, namely finite element analysis using cohesive zone elements, response surface construction, and risk and sensitivity analysis of fatigue failure, which require several mathematical techniques and algorithms. The proposed framework is tested by applying it to an illustrative example, and the corresponding analysis results of fracture failure probability with different threshold values of a limit-state function are presented. In addition, the sensitivities of failure risk with respect to the statistical parameters of random variables are presented and their relative importance is discussed.
Process planning and scheduling for loop layout robotic workcell using virtual reality technology
Authors: Yap Hwa Jen , Tan Chee Hau , Phoon Sin Ye , Liew Kan Ern , Chandra Sekaran Sivadas
Published: September 2019

The adoption of virtual reality in manufacturing system simulation had proved its effectiveness in bridging up to the gap between different areas of expertise, especially in product design and manufacturing. Virtual reality had enclosed human–machine interface by enabling the user to be immersed into the virtual environment and experience real-time interaction with the virtual objects. In this article, an implementation of virtual reality in cellular manufacturing system simulation is presented. By utilizing the features of visualization and real-time interaction of virtual reality technology, the manufacturing process of a product had been visualized while the real-time control on the product traveling path based on the user’s input was performed and the corresponding activities that related to the change of traveling path had been predicted in the virtual environment. Through the study, simulation of the manufacturing system in virtual reality showed its potential as a powerful decision support system in process planning and scheduling. Various process planning and schedules can be planned through the virtual environment, while the product traveling distance can be obtained from the developed system.
High expression of IQGAP3 indicates poor prognosis in colorectal cancer patients
Authors: Wu Jian , Chen Zhen , Cao Huihua , Yu Zhan , Feng Jin , Wang Kai , Lu Qicheng , Wu Yugang
Published: September 2019

Background:

The oncogene IQ motif-containing GTPase activating protein 3 (IQGAP3) is ubiquitously overexpressed in several human cancers. This study was designed to explore the expression and role of IQGAP3 in colorectal cancer.

Methods:

We first assessed the IQGAP3 expression level in colorectal cancer. The correlation of IQGAP3 expression with the clinicopathological characteristics and prognosis was then assessed. At last, we investigated the function of IQGAP3 in colorectal cancer by knocking down its expression in colorectal cancer cell lines.

Results:

Consistent with the conclusions drawn from The Cancer Genome Atlas database, IQGAP3 was upregulated in colorectal cancer at the tissue level and cellular level. Based on immunohistochemistry results of the tissue microarrays, we demonstrated that higher expression of IQGAP3 was associated with higher tumor node metastasis stage ( P = 0.005), higher incidence of lymph node metastasis ( P = 0.004), and shorter overall survival ( P = 0.022). Knockdown of IQGAP3 in colorectal cancer cell lines remarkably decreased their proliferation and migration abilities.

Conclusion:

Our data provide evidence that IQGAP3 significantly promote malignant progression of colorectal cancer and could serve as a potential therapeutic target.
Stable emergent formations for a swarm of autonomous car-like vehicles
Authors: Vanualailai Jito
Published: September 2019

A biological swarm is an ideal multi-agent system that collectively self-organizes into bounded, if not stable, formations. A mathematical model, developed appropriately from some principle of swarming, should enable one, therefore, to study formation strategies for multiple autonomous robots. In this article, based on the hypothesis that swarming is an interplay between long-range attraction and short-range repulsion between the individuals in the swarm, a planar individual-based or Lagrangian swarm model is constructed using the Direct Method of Lyapunov. While attraction ensures the swarm is cohesive, meaning that the individuals in the swarm remain close to each other at all times, repulsion ensures that the swarm is well-spaced, meaning that no two individuals in the swarm occupy the same space at the same time. Via a novel Lyapunov-like function with attractive and repulsive components, the article establishes the global existence, uniqueness, and boundedness of solutions about the centroid. This paves the way to prove that the swarm model, governed by a system of first-order ordinary differential equations (ODEs), is cohesive and well-spaced. The article goes on to show that the artificial swarm can collectively self-organize into two stable formations: (i) a constant arrangement about the centroid when the system has equilibrium points, and (ii) a highly parallel formation when the system does not have equilibrium points. Computer simulations not only illustrate these but also reveal other emergent patterns such as swirling structures and random-like walks. As an application, we tailor the model accordingly and propose new autonomous steering laws giving rise to pattern-forming for multiple nonholonomic car-like vehicles.
Snap shot: Achieving better care through a one-page personal health profile
Authors: Aston Megan , Sweet Krista , McAfee Erin , Price Sheri , Sheriko Jordan , Monaghan Joelle , Filliter Jillian , Walls Cathy , McGrath Patrick , Vanderlee Emma , Bye Amanda
Published: September 2019

Children with intellectual disabilities (IDs) can have complex health conditions that require intense and ongoing care management by multiple healthcare professionals (HCPs). Families often experience frustrations and challenges sharing necessary information about their children’s unique emotional and communicative needs with HCPs. In turn, these needs are often poorly documented and shared with other HCPs. This contributes to compromised care and frustrations for families and HCPs. We conducted a qualitative study using focus groups to examine how 10 parents and 3 HCPs experienced provision of care for children with ID, as well as their suggestions for developing a one-page personal health profile (PHP) to improve communication. Parents suggested including behavioural descriptors rather than diagnoses. All participants believed a one-page PHP that was child and parent led would be very helpful and would improve communication between HCPs, parents and children leading to effective and supportive care.
Where was I? Taking alternative visual perspectives can make us (briefly) misplace our own
Authors: Samuel Steven , Legg Edward W , Manchester Callum , Lurz Robert , Clayton Nicola S
Published: September 2019

How do we imagine what the world looks like from another visual perspective? The two most common proposals—embodiment and array rotation—imply that we must briefly imagine either movement of the self (embodiment) or movement of the scene (array rotation). What is not clear is what this process might mean for our real, egocentric perspective of the world. We present a novel task in which participants had to locate a target from an alternative perspective but make a manual response consistent with their own. We found that when errors occurred they were usually manual responses that would have been correct from the computed alternative perspective. This was the case both when participants were instructed to find the target from another perspective and when they were asked to imagine the scene itself rotated. We interpret this as direct evidence that perspective-taking leads to the brief adoption of a computed perspective—a new imagined relationship between ourselves and the scene—to the detriment of our own, egocentric point of view.
Stroke epidemiology and stroke policies in China from 1980 to 2017: A systematic review and meta-analysis
Authors: Hu Sophia , Cui Bijun , Mlynash Michael , Zhang Xin , Mehta Kala M , Lansberg Maarten G
Published: September 2019

Background

Stroke is the leading cause of death and years of life lost in China, and this problem is growing because stroke risk factors such as hypertension and hypercholesteremia have been on the rise as China experiences the demographic transition. The Chinese government has created public health initiatives in the form of guidelines, policies and programs to combat this problem, but the dissemination and effectiveness of these policies are not well known.

Aims

The aim of this study was to determine trends in stroke incidence, prevalence, and stroke-related mortality in China and to report these trends in the context of stroke initiatives that have been enacted by the Chinese government.

Summary of review

We systematically reviewed articles on stroke rates and stroke initiatives from 1980 to 2017. A meta-regression including 11 studies showed that stroke incidence remained stable at 128.3 per 100,000 per year from 1980 to 2005 and has increased by 21.3 per 100,000 per year since then to 298.7 per 100,000 per year in 2013. A meta-regression including seven studies demonstrated a gradual decline in stroke-related mortality by 6.5 per 100,000 per year since 1980 (a decline from 369.2 in 1980 to 154.7 per 100,000 per year in 2013). Average stroke prevalence was 898.4 per 100,000 over the entire time-period. Limitations included heterogeneity between the studies. We identified 12 stroke initiatives, the first of which was enacted in 2006.

Conclusions

Despite numerous public health initiatives aimed at combating stroke that started in 2006, stroke incidence in China has increased over the last decade, likely as a result of aging and urbanization of the Chinese population.
Combined noninvasive ventilation and mechanical insufflator–exsufflator for acute respiratory failure in patients with neuromuscular disease: effectiveness and outcome predictors
Authors: Chen Tai-Heng , Liang Wen-Chen , Chen I-Chen , Liu Yi-Ching , Hsu Jong-Hau , Jong Yuh-Jyh
Published: September 2019

Background:

To determine the effectiveness of combined noninvasive ventilation (NIV) and mechanical insufflator-exsufflator (MI-E) for acute respiratory failure (ARF) in patients with neuromuscular disease (NMD), and outcome predictors.

Methods:

A prospectively observational study of patients with ARF was conducted in a pediatric intensive care unit (PICU). All received combined NIV/MI-E during PICU stays between 2007 and 2017. Pertinent clinical variables of heart rate (HR), respiratory rate (RR), pH, PaCO2, and PaO2/FiO2 ratio were collected at baseline and at 2 h, 4-8 h, and 12-24 h after initiating use of NIV/MI-E. Treatment success was defined as avoiding intubation.

Results:

A total of 62 ARF episodes in 56 patients with NMD (median age, 13 years) were enrolled. The most frequent underlying NMD was spinal muscular atrophy (32/62, 52%). ARF was primarily due to pneumonia (65%). The treatment success rate was 86%. PICU stay and hospitalization were shorter in the success group (9.4 ± 6.1 vs. 21.9 ± 13.9 days and 16.3 ± 7.8 vs. 33.6 ± 17.9 days, respectively; both p < 0.05). HR, RR, pH, and PaCO2 showed a progressive improvement, particularly after 4 h following successful NIV/MI-E treatment. RR decrease at 4 h, and pH increase and PaCO2 decrease at 4-8 h might predict success of NIV/MI-E treatment. The multivariate analysis identified PaCO2 at 4-8 h of 58.0 mmHg as an outcome predictor of NIV/MI-E treatment.

Conclusions:

Applying combined NIV/MI-E in the acute care setting is an efficient means of averting intubation in NMD patients with ARF. Clinical features within 8 h of the institution may predict treatment outcome. The reviews of this paper are available via the supplemental material section.
Patterns of care in metastatic pancreatic cancer: patient selection in clinical routine
Authors: Scheithauer Werner , Putora Paul Martin , Grünberger Birgit , Eisterer Wolfgang , Wöll Ewald , Prager Gerald , Schaberl-Moser Renate , Greil Richard , Glatzer Markus
Published: September 2019

Background:

The management of patients with metastatic pancreatic cancer (mPC) is challenging, and the optimal treatment strategy is debated among experts. In an attempt to identify treatment decision criteria and to investigate variations in the first-line management of this disease, we performed an analysis of treatment algorithms among experts in the field of pancreatic cancer. The aim of this study was to identify relevant criteria in the complex process of patient selection and decision making for the management of mPC patients.

Methods:

Experts from the ABCSG (Austrian Breast and Colorectal Cancer Study Group) Pancreatic Cancer Club were contacted and agreed to participate in this analysis. Eight experts from seven centers in Austria provided their decision algorithms for the first-line treatment of patients with mPC. Their responses were converted into decision trees based on the objective consensus methodology. The decision trees were used to identify consensus and discrepancies.

Results:

The final treatment algorithms included four decision criteria (performance status, age, comorbidities, and symptomatic disease) and six treatment options: mFOLFIRINOX, gemcitabine + nab-paclitaxel, gemcitabine mono, 5-FU mono, gemcitabine/erlotinib, and best supportive care (BSC).

Conclusions:

We identified consensus for the treatment of young and fit patients with mFOLFIRINOX. With higher age and reduced performance status, gemcitabine + nab-paclitaxel was increasingly used. For patients with Eastern Co-operative Oncology Group Performance Status (ECOG PS) 4, BSC was the treatment of choice. Among experts, different decision criteria and treatment options are implemented in clinical routine. Despite multiple options in current recommendations, a consensus for specific recommendations was identified.
Conformational Assignments of Thujopsene and Related Compounds
Authors: Yaoita Yasunori , Machida Koichi
Published: September 2019

Conformational analysis suggests that thujopsene (1) can exist as 2 possible conformations, steroidal and nonsteroidal. The conformation of 1 has been investigated using a NMR spectroscopic method. Analyses of the 1H NMR, ROESY, and long-range 1H-1H COSY spectra indicate that 1 exists in a steroidal conformation. Although the conformations of related compounds 2 and 3 were originally assigned as nonsteroidal, careful reexamination of the published NMR data indicates that both compounds exist in a steroidal conformation.
Factors Associated With DNR Status After Nontraumatic Intracranial Hemorrhage
Authors: Lillemoe Kaitlyn , Lord Aaron , Torres Jose , Ishida Koto , Czeisler Barry , Lewis Ariane
Published: September 2019

Background:

We explored factors associated with admission and discharge code status after nontraumatic intracranial hemorrhage.

Methods:

We extracted data from patients admitted to our institution between January 1, 2013, and March 1, 2016 with nontraumatic intracerebral hemorrhage or subarachnoid hemorrhage who had a discharge modified Rankin Scale (mRS) of 4 to 6. We reviewed data based on admission and discharge code status.

Results:

Of 88 patients who met inclusion criteria, 6 (7%) were do not resuscitate (DNR) on admission (aDNR). Do not resuscitate on admission patients were significantly older than those who were full code on admission ( P = 0.04). There was no significant difference between admission code status and sex, marital status, active cancer, premorbid mRS, admission Glasgow Coma scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, or bleed severity. At discharge, 66 (75%) patients were full code (dFULL), 11 (13%) were DNR (dDNR), and 11 (13%) were comfort care. African American and Hispanic patients were significantly more likely to be dFULL than Asian or white patients ( P = .01) and less likely to be seen by palliative care ( P = .004). Patients with less aggressive code status had higher median APACHE II scores ( P = .008) and were more likely to have active cancer ( P = .06). There was no significant difference between discharge code status and sex, age, marital status, premorbid mRS, discharge GCS, or bleed severity.

Conclusions:

Limitation of code status after nontraumatic intracranial hemorrhage appears to be associated with older age, white race, worse APACHE II score, and active cancer. The role of palliative care after intracranial hemorrhage and the racial disparity in limitation and de-escalation of treatment deserves further exploration.
Dosimetric advantages of proton beam therapy compared to intensity-modulated radiation therapy for retroperitoneal chordoma
Authors: Yu Nathan Y , Vora Sujay A
Published: September 2019

Retroperitoneal chordomas are exceedingly rare and account for less than 5% of all primary bone malignancies. Their etiology remains unknown. We report a rare case of an extravertebral chordoma of the retroperitoneum in a 71-year-old man treated with surgical resection and post-operative spot-scanning proton beam therapy. We describe how to safely treat a retroperitoneal target to a prescription dose over 70 Gy (relative biological effectiveness) with spot-scanning proton beam therapy and also report a dosimetric comparison of spot-scanning proton beam therapy versus intensity-modulated radiation therapy. This case not only highlights a rare diagnosis of an extravertebral retroperitoneal chordoma but it also draws attention to the dosimetric advantages of proton beam therapy and illustrates a promising radiotherapeutic option for retroperitoneal targets.
Recent developments in the treatment of blastic plasmacytoid dendritic cell neoplasm
Authors: Economides Minas P. , Konopleva Marina , Pemmaraju Naveen
Published: September 2019

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a clinically aggressive hematologic malignancy derived from precursors of dendritic cells and involves most frequently the skin, bone marrow and lymph nodes. Diagnosis depends upon identification of specific tumor markers including CD4, CD56 and CD123. Historically, the median survival has been less than 2 years in most reported series. While for many years, conventional chemotherapy followed by stem cell transplantation was the standard of care, recently tagraxofusp, a cytotoxin directed against CD123, received United States Food and Drug Administration approval specifically for patients with BPDCN. In this review, we will discuss the markers used for diagnosis of BPDCN and focus on the new targeted treatments available. Specifically in BPDCN, tagraxofusp was highly effective with a safety profile found to be acceptable overall, with the noted occurrence of capillary leak syndrome. Future directions in therapy approaches for patients with BPDCN will include the development of other CD123-targeted agents, agents targeting beyond CD123 and investigation of rational combination approaches of CD123-directed therapy with other therapies.
Review of multimodal treatment for type 2 diabetes: combining metabolic surgery and pharmacotherapy
Authors: Sudlow Alexis , le Roux Carel W , Pournaras Dimitri J
Published: September 2019

Treating type 2 diabetes mellitus (T2DM) in patients with obesity remains a challenge for physicians, endocrinologists and surgeons, a fact supported by uncontroverted evidence from studies looking at mortality and associated morbidity. Metabolic surgery remains the most effective treatment for obesity and T2DM with evidence demonstrating an improvement or resolution of symptoms of T2DM and a reduction in a mortality and rates of cardiovascular events compared with pharmacotherapy alone. While these results are promising, two important limitations must be recognized and addressed. With regards to long-term remission of T2DM, the metabolic benefits of bariatric surgery appear to fatigue with time and a proportion of patients will not maintain normoglycaemia without pharmacotherapy. Second, there has been noteworthy progress in the development of several classes of medications for the treatment of T2DM which were unavailable when the original studies comparing the effects of bariatric surgery with pharmacotherapy were conducted.

Recognizing the need for further treatment following metabolic surgery for long-term disease control in conjunction with the availability of newer medications offering more effective, nonsurgical treatment presents a critical turning point in treatment treating obesity. While the traditional approach would be to determine the superiority (or non-inferiority) of these agents compared with surgery, clinicians and surgeons must acknowledge the limitations of this attitude towards treatment given evidence from fields such as cancer, where a combinational approach is the gold standard. Recent advances in pharmacotherapy, present not only a novel approach to medical therapy but a renewed impetus to investigate what can be achieved through multimodal care.
Evaluation of methenamine for urinary tract infection prevention in older adults: a review of the evidence
Authors: Chwa Amy , Kavanagh Kevin , Linnebur Sunny Anne , Fixen Danielle R.
Published: September 2019

Urinary tract infections (UTI) commonly occur in older adults and can lead to more severe, life-threatening infections. Physiological factors that change with age are thought to contribute to the increased frequency of UTI recurrence in older adults. Unfortunately, there are limited methods to prevent UTI in older adults, and utilization of antimicrobial agents for prevention can have many negative consequences. Methenamine has been proposed as a useful drug for the prevention of UTI as it works as a urinary antiseptic, safely producing formaldehyde to prevent bacterial growth while avoiding bacterial resistance. The objective of this review is to evaluate the existing literature and discuss the use of methenamine in older adults for prevention of UTI. A PubMed search was conducted to identify studies evaluating the effectiveness of methenamine to prevent UTI in older adults, and 10 publications were selected based on relevant criteria. Based on the literature, methenamine appears to be a safe and effective option to prevent UTI in older adults with recurrent UTI, genitourinary surgical procedures, and potentially long-term catheterization. Studies have not evaluated the safety of methenamine in patients with impaired renal function or CrCl <30 ml/min. When selecting a treatment approach to preventing UTI in older adults with adequate renal function, clinicians may consider methenamine as a viable option.
Pedagogical approaches surrounding the touchscreen: The child and practitioner perspective
Authors: Ludgate Shannon
Published: September 2019

This article reports on the findings of a mixed-methods, interpretive study identifying practitioners’ pedagogical approaches when children aged 3–4 years use touchscreen devices in early years settings in the West Midlands, UK. A multi-site case study approach was adopted involving interviews with 12 practitioners to identify their rationale for using these devices. Coupled with 160 observations of touchscreen practice, this allowed the opportunity to critique intentions with practice, to determine children’s opportunities to play with, and potentially learn from, touchscreen technologies. Capturing child voice was an integral aspect of this study. By providing the opportunity for children to express their views through four focus-group interviews, the study found that there was a distinct difference between children’s and practitioners’ intentions regarding touchscreen play. As a result, practitioners overlooked opportunities to strengthen children’s learning by following their interests. The data were analysed using activity theory as a central theoretical framework. From this analysis, it is argued that pedagogical approaches surrounding touchscreen use in early years settings need to be developed in order to incorporate the child’s voice in decisions which impact on the ways in which they play with these devices.
Value, rent, and nature: The centrality of class
Authors: Greco Elisa , Apostolopoulou Elia
Published: September 2019

Welcoming the renewed interest in value among geographers, we engage with the arguments that Kay and Kenney-Lazar (2017) put forward in their article, ‘Value in Capitalist Natures: An Emerging Framework’. We organize our contribution around three important aspects that can advance current debates and propose an agenda for future research. Firstly, we argue that current debates need to refocus from whether nature contributes to material wealth to whether and how nature relates to the value form under capitalism. Secondly, we highlight the need for a systematically joint analysis of value and rent to understand the role of nature in capitalism. This analysis leads to a focus on class and class struggle and requires interdisciplinary collaborations between nature–society geographers and other scholars working within the value theoretical framework to bridge current struggles over rent and value. Thirdly, contra Kay and Kenney-Lazar, we argue that beyond capitalism we do not need either alternative valuation systems or value but rather a new vocabulary to redefine social needs and social wealth.
Takotsubo syndrome in elderly woman: The diagnosis by transthoracic echocardiography
Authors: Sulistya Inggita Hanung , Hartopo Anggoro Budi , Dinarti Lucia Kris , Setianto Budi Yuli
Published: September 2019

Takotsubo syndrome has increasingly been recognized in the differential diagnosis of patients presenting with acute chest pain. Those affected are typically older women suffering after an emotional or physical stress. Normally it is a transient condition but complications including death have been reported. We reported a case of takotsubo syndrome who was initially diagnosed as acute coronary syndrome. The patient presented with typical angina, ST-T segment changes, and elevated high sensitive–troponin I. Coronary angiography showed normal coronary arteries. Transthoracic echocardiography revealed mild left atrial dilatation and left ventricle concentric hypertrophy, reduced left ventricle ejection fraction with circumferential hypokinetic, apical ballooning, systolic anterior motion, left ventricle outflow tract obstruction, and sigmoid septum hypertrophy. One month later, patient recovered and transthoracic echocardiography revealed improved heart anatomy and function. To differentiate takotsubo syndrome with other conditions, especially acute coronary syndrome, is crucial. Their clinical presentations are similar but the managements are different. The transthoracic echocardiography holds an important role in supporting the diagnosis of takotsubo syndrome.
Use of contrast-enhanced ultrasonography for the detection of a feline insulinoma
Authors: Cervone Mario , Harel Mathieu , Ségard-Weisse Emilie , Krafft Emilie
Published: September 2019

Case summary

A 14-year-old cat was presented with a 2-week history of ataxia, seizure-like episodes, vomiting and weight loss. Serum biochemistry revealed severe hypoglycaemia, associated with low serum fructosamine and high insulin concentrations. On abdominal ultrasound, a focal hypoechoic well-defined mass in the left limb of the pancreas was identified and the presence of an additional smaller nodule was suspected. Contrast-enhanced ultrasonography (CEUS) confirmed the presence of both lesions and revealed a third, even smaller nodule. Partial pancreatectomy was performed. Histopathology and immunohistochemistry confirmed the presence of a multifocal insulinoma. Six months later, the cat presented with tenesmus and obstipation. A colorectal adenocarcinoma was diagnosed with histopathology after partial excision of a colorectal mass. The cat was euthanased a month later owing to recurrent episodes of severe obstipation.

Relevance and novel information

This is the first clinical description of the use of CEUS in the diagnosis of feline insulinoma. Furthermore, the available scientific literature on feline insulinoma was reviewed.
Promoting Staff and Physician Well-Being With a Single-Day Event: Event Satisfaction and Perceived Well-Being Benefits of an Addiction and Mental Health Sports Day
Authors: Vuong Wesley , Ledi Denise , Kelland Jill , Hunter DeAnn , Boffa Ernie , Agyapong Vincent I. O.
Published: September 2019

Background: Addiction and mental health (AMH) professionals often experience high levels of burnout, which can lead to detrimental outcomes for patient care and safety and the AMH professional themselves. Interventions aimed at improving well-being can be useful to tackle the issues surrounding burnout. Specifically, implementing activity-based events (ABEs), which encourages individuals to be more physically active, can be useful in improving physical, mental, and social well-being. Alberta Health Services AMH, Edmonton Zone, implemented a Sports Day event to promote well-being as a way to help offset the risk of burnout. Methods: This was an online anonymous cross-sectional, postsurvey evaluation. The postsurvey was administered to 243 AMH staff and physicians who registered for Sports Day. Findings: The responses from 66 AMH staff and physician attendees indicated that individuals were highly satisfied with the event and felt that Sports Day promoted positive mental and physical well-being, helped to develop a sense of community, and strengthened colleague relationships. Conclusions/Application to Professional Practice: The results build on the literature examining the effects of single-day ABEs and can be implemented by health care organizations to promote staff and physician well-being via increased physical activity. Single-day ABEs, like Sports Day, can promote mental, physical, and social well-being. Organizing a sports day event is a feasible way to help offset the risk of burnout and is generally well received by individuals.
Anhedonia as a Key Clinical Feature in the Maintenance and Treatment of Opioid Use Disorder
Authors: Kiluk Brian D. , Yip Sarah W. , DeVito Elise E. , Carroll Kathleen M. , Sofuoglu Mehmet
Published: September 2019

There is a critical need for research on clinical features that may influence response to treatment for opioid use disorder (OUD). Given its neurobiology and relevance to opioid use, anhedonia may be one such promising clinical feature. We identified and reviewed 11 studies that measured anhedonia in humans with OUD to characterize the current state of evidence and highlight potential implications for treatment. The majority of studies were cross-sectional, indicating higher anhedonia scores in opioid-dependent samples compared with healthy control subjects. Rates of participants with clinically significant anhedonia ranged from 21% to 48%. Anhedonia scores were correlated with opioid craving and use; however, there are significant knowledge gaps regarding its time course and impact on treatment adherence and outcomes. Repeated assessment of anhedonia early in treatment for OUD is recommended because it may be a unique predictor of dropout or nonresponse and a potential target for behavioral and/or pharmacological intervention.
The Critical Need for Help-Seeking Controls in Clinical High-Risk Research
Authors: Millman Zachary B. , Gold James M. , Mittal Vijay A. , Schiffman Jason
Published: September 2019

Despite rapidly growing knowledge of the clinical high-risk (CHR) state for psychosis, the vast majority of case-control studies have relied on healthy volunteers as a reference point for drawing inferences about the CHR construct. Researchers have long recognized that results generated from this design are limited by significant interpretive concerns, yet little attention has been given to how these concerns affect the growing field of CHR research. We argue that overreliance on healthy control participants in CHR research threatens the validity of inferences concerning group differences, hinders advances in understanding the development of psychosis, and limits clinical progress. We suggest that the combined use of healthy and help-seeking (i.e., psychiatric) controls is a necessary step for the next generation of CHR research. We then evaluate methods for help-seeking control studies, identify the available CHR studies that have used such designs, discuss select findings in this literature, and offer recommendations for research.
Introducing the Leapfrog Design: A Simple Bayesian Adaptive Rolling Trial Design for Accelerated Treatment Development and Optimization
Authors: Blackwell Simon E. , Woud Marcella L. , Margraf Jürgen , Schönbrodt Felix D.
Published: September 2019

The application of basic science research to the development and optimization of psychological treatments holds great potential. However, this process of clinical translation is challenging and time-consuming, and the standard route by which it proceeds is inefficient. Adaptive rolling designs, which originated within cancer treatment research, provide an alternative methodology with potential to accelerate development and optimization of psychological treatments. In such designs, multiple treatment options are tested simultaneously, with sequential Bayesian analyses used to remove poorly performing arms. Further, new treatment arms informed by the latest research findings can be introduced into the existing infrastructure as the trial progresses. These features dramatically reduce the sample sizes needed and offer a means for more rapid and efficient clinical translation. This article outlines the utility of such designs to clinical psychological science, focusing on a new variant termed the leapfrog design, and discusses their potential uses to accelerate clinical translation.
Current Trends in Pediatric Spine Deformity Surgery: Multimodal Pain Management and Rapid Recovery
Authors: Shah Sagar A. , Guidry Richard , Kumar Abhishek , White Tyler , King Andrew , Heffernan Michael J.
Published: September 2019

Study Design:

Narrative review.

Objectives:

The purpose of this article is to perform a review of the literature assessing the efficacy of opioid alternatives, multimodal pain regimens, and rapid recovery in pediatric spine surgery.

Methods:

A literature search utilizing PubMed database was performed. Relevant studies from all the evidence levels have been included. Recommendations to decrease postoperative pain and expedite recovery after posterior spinal fusion in adolescent idiopathic scoliosis patients have been provided based on results of studies with the highest level of evidence.

Results:

Refining perioperative pain management to lessen opioid consumption with multimodal regimens may be useful to decrease recovery time, pain, and complications. Nonsteroidal anti-inflammatory drugs, acetaminophen, gabapentin, neuraxial blockades, and local anesthesia alone offer benefits for postoperative pain management, but their combination in multimodal regimens and rapid recovery pathways may contribute to faster recovery time, improved pain levels, and lower reduction in total opioid consumption.

Conclusion:

A rapid recovery pathway using the multimodal approach for pediatric scoliosis correction may offer superior postoperative pain management and faster recovery than traditional opioid only pain protocols.
Rural Disparities in Hospital Patient Satisfaction: Multilevel Analysis of the Massachusetts AHA, SID, and HCAHPS Data
Authors: Kang Yu (Sunny) , Tzeng Huey-Ming , Zhang Ting
Published: September 2019

Introduction:

Hospital patient satisfaction has been a salient policy concern. We examined rurality’s impact on patient satisfaction measures.

Methodology:

We examined patients (age 50 and up) from 65 rural and urban hospitals in Massachusetts, using the merged data from 2007 American Hospital Association Annual Survey, State Inpatient Database and Survey of Patients’ Hospital Experiences, utilizing Hierarchical binary logistic regression analyses to examine the rural disparities in patient satisfaction measures.

Results:

Relative to the urban location, rurality reduced the likelihood of cleanliness of environment (odds ratio = 0.66, 95% confidence interval: [0.63-0.70]); but increased the likelihood of staff responsiveness and quietness. Compared to Caucasian counterparts, Hispanic patients were less likely to reside in a quiet hospital. Compared to other payments, Medicare or Medicaid coverage each reduced the likelihood of staff responsiveness and cleanliness. Compared to other diagnoses, depressive or psychosis disorders predicted smaller odds in responsiveness and cleanliness. Anxiety diagnosis reduced the likelihood of cleanness and quietness. At the facility level, higher registered nurse full-time equivalent (FTE)s or being a teaching hospital increased the likelihood of all measures.

Conclusion:

Relative to the urban counterparts, rural patients experienced lower likelihood of staff responsiveness after adjusting for other factors. Compared to Caucasian patients, Hispanic patients were less likely to reside in quiet hospital environment. Research is needed to further explore the basis of these disparities. Mental health diagnoses in depressive and psychosis disorders also called upon further studies in special care needs.
Monitoring Commercial Ibuprofen Potency Changes Over 1 Year When Stored in a Household Setting
Authors: Archibald Timothy , Brown Stacy
Published: September 2019

Background: Most over-the-counter medications are labeled for storage in a dry, room temperature environment. Despite this, many households store medications in the bathroom, where temperature and humidity extremes may be experienced. Objective: In this project, we sought to investigate the effect that long-term storage in a household bathroom had on potency of over-the-counter ibuprofen (IBU) products as well as on the emergence of a known toxic degradation product, 4-isobutylacetophenone (4-IBP). Methods: A liquid chromatography-tandem mass spectrometry method was developed for the quantitative determination of IBU and 4-IBP in aqueous samples. Three brands each of IBU tablets (200 mg) and suspensions (100 mg/5 mL) were assayed for IBU concentration at the initiation of the study and once monthly thereafter. The samples were stored in a household bathroom, with continuous temperature and humidity monitoring. Each sample was assayed in triplicate and percent recovery was calculated against freshly prepared standards of IBU using bulk powder. Results: Tablets maintained >90% average strength through 3 months, with statistically significant deviation from initial concentration (2-way analysis of variance, P = .05) detected after 6 to 7 months. Suspensions maintained >90% average strength through 5 months, with statistically significant changes from initial concentration emerging after 7 months. After 12 months, the average strength was 73% and 83% for tablets and suspensions, respectively. 4-IBP was not detected in any of the samples during the duration of the study. Conclusions: These data indicate that, while 4-IBP was not detected following 12-month bathroom storage of commercial IBU products, significant changes in potency should negatively affect efficacy.
A New Flexible Multibody Dynamics Analysis Methodology of Deployable Structures with Scissor-Like Elements
Authors: Peng Qi’an , Wang Sanmin , Zhi Changjian , Li Bo
Published: September 2019

There are vast constraint equations in conventional dynamics analysis of deployable structures, which lead to differential-algebraic equations (DAEs) solved hard. To reduce the difficulty of solving and the amount of equations, a new flexible multibody dynamics analysis methodology of deployable structures with scissor-like elements (SLEs) is presented. Firstly, a precise model of a flexible bar of SLE is established by the higher order shear deformable beam element based on the absolute nodal coordinate formulation (ANCF), and the master/slave freedom method is used to obtain the dynamics equations of SLEs without constraint equations. Secondly, according to features of deployable structures, the specification matrix method (SMM) is proposed to eliminate the constraint equations among SLEs in the frame of ANCF. With this method, the inner and the boundary nodal coordinates of element characteristic matrices can be separated simply and efficiently, especially on condition that there are vast nodal coordinates. So the element characteristic matrices can be added end to end circularly. Thus, the dynamic model of deployable structure reduces dimension and can be assembled without any constraint equation. Next, a new iteration procedure for the generalized-α algorithm is presented to solve the ordinary differential equations (ODEs) of deployable structure. Finally, the proposed methodology is used to analyze the flexible multi-body dynamics of a planar linear array deployable structure based on three scissor-like elements. The simulation results show that flexibility has a significant influence on the deployment motion of the deployable structure. The proposed methodology indeed reduce the difficulty of solving and the amount of equations by eliminating redundant degrees of freedom and the constraint equations in scissor-like elements and among scissor-like elements.
An exclusion experiment to study the influence of habitat structure provided by Mussismilia corals (Cnidaria; Anthozoa) on the predation of associated crustaceans
Authors: Nogueira Marcos M. , Neves Elizabeth , Johnsson Rodrigo
Published: September 2019

Predation is an interaction between species that influences community organisation by the direct consumption of prey, influencing prey numbers, behaviours and traits. The intensity of predation is greatly influenced by the environment, and the physical structure of habitats may influence predation intensity by providing refuge for prey or reducing the foraging efficiency of predators. In this context, the aim of the present study is to verify the influence of predation on the richness and density patterns of crustaceans inhabiting different species of Mussismilia corals, which provide various habitat structures for the associated fauna. We conducted an exclusion experiment to include total, partial and no cage treatments. The richness and density of crustaceans differed among coral species and cage treatments, except between partial cage and no cage treatment. Mussismilia harttii showed higher richness and density in uncaged and partial cage treatments compared with M. braziliensis, which in turn showed higher values than M. hispida. These findings indicate the importance of predation in the structure of crustacean assemblage associated with Mussismilia species and that differences in the richness and abundance of associated fauna result from the different habitat structures provided by each species of Mussismilia.